Bartlett, J G
Approximately one-half of all patients with HIV infection who are under care have Medicaid as the third party payor. Unlike Medicare, Medicaid is a state-specific program that has huge variations in reimbursement strategies. Multiple studies have shown that care for persons with AIDS is about $20,000/year, but reimbursement through various state Medicaid programs varies about $100/m/m to $2800/m/m despite the fact that expectations for care are identical. Hopkins has a major commitment to persons with HIV infection with a program that now includes 30 faculty members and a support staff of 170. With the introduction of mandatory managed care for Medicaid recipients in July, 1997, we were confronted with the issue of substantial downsizing with abandonment of over half of our patients, or learning the transition to managed care. This has been a steep learning curve involving negotiations with the state Medicaid office, reorganization of our clinic, careful scrutiny of our database regarding resource utilization and cost, education of providers, and longitudinal collection of new information and integration of the rapid changes in the field. In the process of this transition, we learned that there are precious few resources to provide guidance and that there is a perceived need for assistance by HIV providers throughout the country. Consequently, we have now established the "HIV Managed Care Network" with substantial funding from diverse sources to support education, data collection, and public policy review. It is premature to evaluate performance since most of these activities have just begun, but we expect that this Network will serve as a demonstration model for methods to deal with chronic diseases under managed care. PMID:10881336
California Childcare Health Program, 2011
This "Integrated Pest Management Toolkit for Early Care and Education Programs" presents practical information about using integrated pest management (IPM) to prevent and manage pest problems in early care and education programs. This curriculum will help people in early care and education programs learn how to keep pests out of early care and…
Qiu, Xiao Ling
Business education has been booming in China due to the increasing demand of business graduates since China's economic reform. Chinese health care professionals are eager for business education to improve their competencies. The purpose of the study was to investigate the determinants of a successful health care management program for Chinese…
Algozzine, T; Pannone, R; Kozma, C M
Medical directors of managed care organizations (MCOs) were surveyed about their views on disease management programs in their facilities. A survey was mailed to 600 MCO medical directors. The survey consisted of 14 Likert-type items related to disease management programs, 4 demographic items, and 1 item related to satisfaction. Seventy-nine usable surveys were received, for a net response rate of 14%. There were 48 medical directors (61%) with disease management programs at their MCO; 25 (52%) were working independently. A majority (71%) of programs were targeted at asthma. Seventy percent of the 48 medical directors were completely to somewhat satisfied and 13% dissatisfied to some extent with their disease management programs. Satisfaction was significantly related to the MCO's partnerships for these programs. A majority of medical directors agreed or strongly agreed that disease management programs could improve outcomes and decrease health care costs at their MCO, that an independent consultant could help analyze their MCO's prescription and medical data, and that they would be willing to accept grants or funds from pharmaceutical companies to initiate and support an independent disease management program at their MCO. MCO medical directors who responded to a national survey indicated that their organization could benefit from disease management programs, that internal resources might be insufficient to manage these programs, and that their MCO might be willing to contract with external organizations for support. PMID:9606454
... improve Program management and integrity in the Child and Adult Care Food Program (CACFP), at 67 FR 43447 (June 27, 2002) and at 69 FR 53501 (September 1, 2004). Section 243 of Public Law 106-224, the... rule was issued in proposed form on September 12, 2000 (65 FR 55101). In response to State and...
McCarty, Dennis; Frank, Richard G.; Denmead, Gabrielle C.
Coverage for methadone services in state Medicaid plans may facilitate access to the most effective therapy for heroin dependence. State Medicaid plans were reviewed to assess coverage for methadone services, methadone benefits in managed care, and limitations on methadone treatment. Medicaid does not cover methadone maintenance medication in 25 states (59 percent). Only 12 states (24percent) include methadone services in Medicaid managed care plans. Moreover, two of the 12 states limit cover...
Bowerman, S; Bellman, M; Saltsman, P; Garvey, D; Pimstone, K; Skootsky, S; Wang, H J; Elashoff, R; Heber, D
Most primary care physicians do not treat obesity, citing lack of time, resources, insurance reimbursement, and knowledge of effective interventions as significant barriers. To address this need, a 10-minute intervention delivered by the primary care physician was coupled with individual dietary counseling sessions delivered by a registered dietitian via telephone with an automated calling system (House-Calls, Mobile, AL). Patients were seen for follow-up by their physician at weeks 4, 12, 24, 36 and 52. A total of 252 patients (202 women and 50 men) were referred by 18 primary care physicians to the program. The comorbid conditions reported for all patients at baseline included low back pain, 29% (n = 72); hypertension, 45% (n = 113); hypercholesterolemia, 41% (n = 104); type 2 diabetes, 10% (n = 26); and sleep apnea, 5% (n = 12). When offered a choice of meal plans based on foods or meal replacements, two-thirds of patients (n = 166) chose to use meal replacements (Ultra Slim-Fast; Slim-Fast Foods Co., West Palm Beach, FL) at least once daily. Baseline weights of subjects averaged 200 +/- 46 lb for women (n = 202) and 237 +/- 45 lb for men (n = 50). Patients completing 6 months in the program lost an average of 19.0 +/- 4.0 lb for women (n = 94) and 15.5 +/- 8.2 lb for men (n = 26). Physicians reported a high degree of satisfaction with the program, suggesting that a brief, effective physician-directed program with nutritionist support by telephone can be implemented in a busy primary care office. PMID:11707560
Administration for Children, Youth, and Families (DHHS), Washington, DC.
Intended for managers of child care programs, this brochure lists the basic components of a clearly defined personnel policy. The guide is based on the personnel practices and experiences of more than 1,200 Head Start programs serving over 442,000 children nationwide. Emphasis is given to staff recruitment, screening, and the selection process.…
Lewin, Gill; Concanen, Karyn; Youens, David
The Home Independence Program (HIP), an Australian restorative home care/reablement service for older adults, has been shown to be effective in reducing functional dependency and increasing functional mobility, confidence in everyday activities, and quality of life. These gains were found to translate into a reduced need for ongoing care services and reduced health and aged care costs over time. Despite these positive outcomes, few Australian home care agencies have adopted the service model - a key reason being that few Australian providers employ health professionals, who act as care managers under the HIP service model. A call for proposals from Health Workforce Australia for projects to expand the scope of practice of health/aged care staff then provided the opportunity to develop, implement, and evaluate a service delivery model, in which nonprofessionals replaced the health professionals as Care Managers in the HIP service. Seventy older people who received the HIP Coordinator (HIPC) service participated in the outcomes evaluation. On a range of personal outcome measures, the group showed statistically significant improvement at 3 and 12 months compared to baseline. On each outcome, the improvement observed was larger than that observed in a previous trial in which the service was delivered by health professionals. However, differences in the timing of data collection between the two studies mean that a direct comparison cannot be made. Clients in both studies showed a similarly reduced need for ongoing home care services at both follow-up points. The outcomes achieved by HIPC, with non-health professionals as Care Managers, were positive and can be considered to compare favorably with the outcomes achieved in HIP when health professionals take the Care Manager role. These findings will be of interest to managers of home care services and to policy makers interested in reducing the long-term care needs of older community dwelling individuals. PMID:27382264
Wells, Aaron R.; Hamar, Brent; Bradley, Chastity; Gandy, William M.; Harrison, Patricia L.; Sidney, James A.; Coberley, Carter R.; Rula, Elizabeth Y.; Pope, James E
Evaluation of chronic care management (CCM) programs is necessary to determine the behavioral, clinical, and financial value of the programs. Financial outcomes of members who are exposed to interventions (treatment group) typically are compared to those not exposed (comparison group) in a quasi-experimental study design. However, because member assignment is not randomized, outcomes reported from these designs may be biased or inefficient if study groups are not comparable or balanced prior ...
Ali Akbar Vaezi
Full Text Available Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU.Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P<0.05. Conclusion: Creating necessary modifications in nursing environments through the management development program by head nurses may improve nurses' clinical competency.
Nuovo, Jim; Balsbaugh, Thomas; Barton, Sue; Davidson, Ellen; Fox-Garcia, Jane; Gandolfo, Angela; Levich, Bridget; Seibles, Joann
Improving the quality of care for patients with chronic illness has become a high priority. Implementing training programs in disease management (DM) so the next generation of physicians can manage chronic illness more effectively is challenging. Residency training programs have no specific mandate to implement DM training. Additional barriers at the training facility include: 1) lack of a population-based perspective for service delivery; 2) weak support for self-management of illness; 3) incomplete implementation due to physician resistance or inertia; and 4) few incentives to change practices and behaviors. In order to overcome these barriers, training programs must take the initiative to implement DM training that addresses each of these issues. We report the implementation of a chronic illness management curriculum based on the Improving Chronic Illness Care (ICIC) Model. Features of this process included both patient care and learner objectives. These were: development of a multidisciplinary diabetes DM team; development of a patient registry; development of diabetes teaching clinics in the family practice center (nutrition, general management classes, and one-on-one teaching); development of a group visit model; and training the residents in the elements of the ICIC Model, ie, the community, the health system, self-management support, delivery system design, decision support, and clinical information systems. Barriers to implementing these curricular changes were: the development of a patient registry; buy-in from faculty, residents, clinic leadership, staff, and patients for the chronic care model; the ability to bill for services and maintain clinical productivity; and support from the health system key stakeholders for sustainability. Unique features of each training site will dictate differences in emphasis and structure; however, the core principles of the ICIC Model in enhancing self-management may be generalized to all sites. PMID:15671788
Marín, Rigoberto; Martínez, Pablo; Cornejo, Juan P.; Díaz, Berta; Peralta, José; Tala, Álvaro; Rojas, Graciela
Background: In Chile, there are inconsistencies in the management of depression in primary care settings, and the National Depression Program, currently in effect, was implemented without a standardized training program. The objective of this study is to evaluate the acceptability of a training program on the management of depression for primary care health teams. Methods: The study was a randomized controlled trial, and two primary centers from the Metropolitan Region of Santiago were randomly selected to carry out the intervention training program. Pre-post surveys were applied, to evaluate expectations and satisfaction with the intervention, respectively. Descriptive and content analysis was carried out. Result: The sample consisted of 41 health professionals, 56.1% of who reported that their expectations for the intervention were met. All of the training activities were evaluated with scores higher than 6.4 (on a 1–7 scale). The trainers, the methodology, and the learning environment were considered strengths and facilitators of the program, while the limited duration of the training, the logistical problems faced during part of the program, and the lack of educational material were viewed as weaknesses. Conclusion: The intervention was well accepted by primary health care teams. However, the clinical impact in patients still has to be evaluated.
Jeon, Yun-Hee; Simpson, Judy M; Chenoweth, Lynn; Cunich, Michelle; Kendig, Hal
Background A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australi...
Full Text Available Abstract This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The series of six articles has been contributed by Management Sciences for Health (MSH and will be published article-by-article over the next few weeks. The third article presents a successful application in Mozambique of a leadership development program created by Management Sciences for Health (MSH. Through this program, managers from 40 countries have learned to work in teams to identify their priority challenges and act to implement effective responses. From 2003 to 2004, 11 health units in Nampula Province, participated in a leadership and management development program called the Challenges Program. This was following an assessment which found that the quality of health services was poor, and senior officials determined that the underlying cause was the lack of human resource capacity in leadership and management in a rapidly decentralizing health care system. The program was funded by the US Agency for International Development (USAID and implemented in partnership between the Mozambican Ministry of Health (MOH Provincial Directorate in Nampula and Management Sciences for Health (MSH. The Challenges Program used simple management and leadership tools to assist the health units and their communities to address health service challenges. An evaluation of the program in 2005 showed that 10 of 11 health centers improved health services over the year of the program. The Challenges Program used several strategies that contributed to successful outcomes. It integrated leadership strengthening into the day-to-day challenges that staff were facing in the health units. The second success factor in the Challenges Program was the creation of participatory teams. After the program, people no longer waited passively to be trained but instead proactively requested training in needed areas. MOH workers
Hamar, Brent; Wells, Aaron; Gandy, William; Haaf, Andreas; Coberley, Carter; Pope, James E.; Rula, Elizabeth Y.
Hospital admissions are the source of significant health care expenses, although a large proportion of these admissions can be avoided through proper management of chronic disease. In the present study, we evaluate the impact of a proactive chronic care management program for members of a German insurance society who suffer from chronic disease. Specifically, we tested the impact of nurse-delivered care calls on hospital admission rates. Study participants were insured individuals with corona...
Andrulis, Dennis; Hopkins, Sarah
Although an increasing proportion of the US population receives health services through managed care, pregnant women and mothers eligible for Medicaid who are involved with alcohol or other drugs are often excluded from these programs due in large part to lack of information on costs, service needs, and service use. To develop such information policy, service settings, and managed-care plans, the project conducted a national survey using a provider group with experience in caring for this pop...
Louis-Philippe Boulet; Eileen Dorval; Manon Labrecque; Michel Turgeon; Terrence Montague; Thivierge, Robert L
BACKGROUND AND OBJECTIVES: Asthma care in Canada and around the world persistently falls short of optimal treatment. To optimize care, a systematic approach to identifying such shortfalls or ‘care gaps’, in which all stakeholders of the health care system (including patients) are involved, was proposed.METHODS: Several projects of a multipartner, multidisciplinary disease management program, developed to optimize asthma care in Quebec, was conducted in a period of eight years. First, two popu...
Keith Killu; Victor Coba; Michael Mendez; Subhash Reddy; Tanja Adrzejewski; Yung Huang; Jessica Ede; Mathilda Horst
Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respec...
Cabassa, Leopoldo J; Gomes, Arminda P; Lewis-Fernández, Roberto
Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice. PMID:25542194
Jessica D. Shaw
Full Text Available Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF. Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF. Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients. Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors. Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care.
Vetter-Smith, Molly; Massey, Vera; Rellergert, Linda; Wissmann, Mary
Taking Care of You: Body, Mind, Spirit is a multi-session group program developed by University of Missouri Extension that provides a unique and practical approach to helping adults better managing their stress and bounce back from life's challenges while improving lifestyle behaviors. The program combines mindfulness and a variety of other…
Carter, M W; Hans, E.W.; Kolisch, R.
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.
Abstract This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The series of six articles has been contributed by Management Sciences for Health (MSH) and will be published article-by-article over the next few weeks. The third article presents a successful application in Mozambique of a leadership development program created by Management Sciences for Health (MSH). Through this program, managers from 4...
Full Text Available Abstract Background The expectations of patients for managing pain induced by exercise and mobilization (PIEM have seldom been investigated. We identified the views of patients and care providers regarding pain management induced by exercise and mobilization during physical therapy programs. Methods We performed a qualitative study based on semi-structured interviews with a stratified sample of 12 patients (7 women and 14 care providers (6 women: 4 general practitioners [GPs], 1 rheumatologist, 1 physical medicine physician, 1 geriatrician, 2 orthopedic surgeons, and 5 physical therapists. Results Patients and care providers have differing views on PIEM in the overall management of the state of disease. Patients' descriptions of PIEM were polymorphic, and they experienced it as decreased health-related quality of life. The impact of PIEM was complex, and patient views were sometimes ambivalent, ranging from denial of symptoms to discontinuation of therapy. Care providers agreed that PIEM is generally not integrated in management strategies. Care providers more often emphasized the positive and less often the negative dimensions of PIEM than did patients. However, the consequences of PIEM cited included worsened patient clinical condition, fears about physical therapy, rejection of the physical therapist and refusal of care. PIEM follow-up is not optimal and is characterized by poor transmission of information. Patients expected education on how better to prevent stress and anxiety generated by pain, education on mobilization, and adaptations of physical therapy programs according to pain intensity. Conclusion PIEM management could be optimized by alerting care providers to the situation, improving communication among care providers, and providing education to patients and care providers.
U.S. Department of Health & Human Services — This report is composed annually and profiles enrollment statistics on Medicaid managed care programs on a plan-specific level. This report also provides...
State and federal agencies increasingly rely on site stewardship programs to protect archaeological resources, and site stewardship programs rely on volunteers to do this work. Given the importance of volunteers to site stewardship programs, especially in the wake of budget cuts and “sequesters,” this paper asks: how do managers and volunteers define site stewardship program priorities and how do differences in their opinions impact program success? In this paper, I briefly review the literat...
End of life - pain management; Hospice - pain management ... or if you have side effects from your pain treatments. ... Bookbinder M, McHugh ME. Symptom management in palliative care and ... Medicine . 1st ed. Philadelphia, PA: Elsevier Saunders; 2008:chap ...
Petinaux, Bruno; Ferguson, Brandy; Walker, Milena; Lee, Yeo-Jin; Little, Gary; Parenti, David; Simon, Gary
To address the organizational complexities associated with a highly virulent infectious disease (HVID) hazard, such as Ebola Virus Disease (EVD), an acute care facility should institute an emergency management program rooted in the fundamentals of mitigation, preparedness, response, and recovery. This program must address all known facets of the care of a patient with HVID, from unannounced arrival to discharge. The implementation of such a program not only serves to mitigate the risks from an unrecognized exposure but also serves to prepare the organization and its staff to provide for a safe response, and ensure a full recovery. Much of this program is based on education, training, and infection control measures along with resourcing for appropriate personal protective equipment which is instrumental in ensuring an organized and safe response of the acute care facility in the service to the community. This emergency management program approach can serve as a model in the care of not only current HVIDs such as EVD but also future presentations in our healthcare setting. PMID:26963227
Full Text Available Recent research indicates a definite positive impact on treatment outcomes when an integrative approach that focuses on symptom control and quality of life is provided along with the standard therapeutic regimens. However implementation or practice of this approach is not seen widely due to the culture of medical training and practice. This article presents the initial development of a program for incorporating integrative care principles into an ongoing comprehensive cancer care program at a tertiary centre. The key purpose of the program being to develop, facilitate, and establish comprehensive and holistic processes including palliative care principles, that would positively enhance the quantity and quality of life of the person with disease, as well as create an environment that reflects and sustains this approach. The vision, objectives, goals, strategies, activities and results within the 7 months of implementation are documented. The new learnings gained during the process have also been noted in the hope that the model described may be used to conceptualize similar care giving facilities in other centres.
Timothy M. Dall, MS
Full Text Available IntroductionThe Disease Management Association of America identifies diabetes as one of the chronic conditions with the greatest potential for management. TRICARE Management Activity, which administers health care benefits for US military service personnel, retirees, and their dependents, created a disease management program for beneficiaries with diabetes. The objective of this study was to determine whether participation intensity and prior indication of uncontrolled diabetes were associated with health care use and costs for participants enrolled in TRICARE’s diabetes management program.MethodsThis ongoing, opt-out study used a quasi-experimental approach to assess program impact for beneficiaries (n = 37,370 aged 18 to 64 living in the United States. Inclusion criteria were any diabetes-related emergency department visits or hospitalizations, more than 10 diabetes-related ambulatory visits, or more than twenty 30-day prescriptions for diabetes drugs in the previous year. Beginning in June 2007, all participants received educational mailings. Participants who agreed to receive a baseline telephone assessment and telephone counseling once per month in addition to educational mailings were considered active, and those who did not complete at least the baseline telephone assessment were considered passive. We categorized the diabetes status of each participant as “uncontrolled” or “controlled” on the basis of medical claims containing diagnosis codes for uncontrolled diabetes in the year preceding program eligibility. We compared observed outcomes to outcomes predicted in the absence of diabetes management. Prediction equations were based on regression analysis of medical claims for a historical control group (n = 23,818 that in October 2004 met the eligibility criteria for TRICARE’s program implemented June 2007. We conducted regression analysis comparing historical control group patient outcomes after October 2004 with these
Full Text Available Abstract Background This study analyzed the likelihood of less-urgent emergency department (ED visits among type 2 diabetic patients receiving care under a diabetes disease management (DM program offered by the Louisiana State University Health Care Services Division (LSU HCSD. Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI, gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further
Gill Lewin,1 Karyn Concanen,2 David Youens3 1School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia; 2Silver Chain Group, Osborne Park, WA, Australia; 3Faculty of Health Science, Curtin University, Perth, WA, Australia Abstract: The Home Independence Program (HIP), an Australian restorative home care/reablement service for older adults, has been shown to be effective in reducing functional dependency and increasing functional mobility, confidence in everyday ...
Kissel, R C; Whitman, T L; Reid, D H
Although considerable attention has been given to the development of institutional staff training and management programs, the generalized effects of such programs on staff and resident behavior have seldom been examined. This study evaluated a program for teaching institutional staff behavioral training and self-management skills during self-care teaching sessions with severely and profoundly retarded residents. Following baseline observations in three self-care situations (toothbrushing, ha...
Full Text Available Problem statement: Since improving the quality of high education is the final purpose of educational evaluation and an internal evaluation can make it possible to judge the quality of high education and achieve the goal of educational systems, in this study an internal evaluation in health care management department of Allied Medical Sciences Faculty of Tehran University of Medical Sciences, which is responsible for training health care management Students, was conducted. Approach: The study was a descriptive and cross-sectional one which was done in an applied manner in health care management department in 2006. The participants in the study included the manager of the department, the members of evaluation committee (3 people, Faculty board members (5 people, all the students, graduate students (20 people and four experts. Nine questions were the tool used in the study. The questions were approved, considering reliability and validity, by means of the internal evaluation software of ministry of health, treatment and medical education. Regarding final approvement, 85- percent Cronoch,s alpha was obtained. To score the questions in the questionnaire, the researchers used likert choice scale (from completely undesirable to completely desirable. At the end, the data were analyzed using descriptive statistics and SPSS software. Results: Findings indicated that the faculty board members had the highest utility (70% and the research factor the lowest (36.6%. Conclusion: Considering the factors evaluated, the utility of the department under study was rather high. The SWOT analysis shows that the department can obtain higher scores in later evaluations.
Malmqvist, Stefan; Leboeuf-Yde, Charlotte
Maintenance care is a well known concept among chiropractors, although there is little knowledge about its exact definition, its indications and usefulness. As an initial step in a research program on this phenomenon, it was necessary to identify chiropractors' rationale for their use of...... maintenance care. Previous studies have identified chiropractors' choices of case management strategies in response to different case scenarios. However, the rationale for these management strategies is not known. In other words, when presented with both the case, and different management strategies, there...... was consensus on how to match these, but if only the management strategies were provided, would chiropractors be able to define the cases to fit these strategies? The objective with this study was to investigate if there is a common pattern in Finnish chiropractors' case management of patients with...
Davis, Kyle A; Miyares, Marta A; Price-Goodnow, Venessa S
A pharmacist-managed deep vein thrombosis (DVT) treatment program was put into operation at Jackson Memorial Hospital in Miami, Florida to provide appropriate transition of care to the outpatient setting for patients diagnosed with DVT. A postgraduate year 1 pharmacy practice resident partnered with a clinical pharmacist to establish and implement the DVT pilot program in the emergency department (ED). Once contacted, the pharmacy resident or the clinical pharmacist communicated with the ED physician and made recommendations regarding appropriate anticoagulation. The pharmacist met with the patient to obtain informed consent and provide counseling regarding the anticoagulants. A timely outpatient appointment at the pharmacy-managed warfarin clinic was arranged for the patient and contact information was exchanged between the patient and the pharmacist. On average, patients enrolled in the DVT program from the ED were released 18.29 hours (±7.06) following the time of arrival. Following release from the hospital, 91% of patients attended their outpatient follow-up appointment at the warfarin clinic. Since the initiation of the DVT program, 1 patient experienced a recurrent DVT and major bleed during their treatment course. Due to successful implementation of this pharmacist-managed DVT program in the ED, the services were subsequently extended to inpatients with DVT. PMID:23172896
Child care and early education subsidies are an important part of government efforts to increase economic independence and improve development of children in low-income families in the United States. This chapter describes the main subsidy programs in the U.S., discusses economic issues that arise in designing such programs and evaluating their effects, and surveys evidence on the effects of the programs. An important theme of the chapter is the tradeoff between the policy goals of increasing...
Health care waste management (HCWM) is a process to help ensure proper hospital hygiene and safety of health care workers and communities. It includes planning and procurement, construction, staff training and behavior, proper use of tools, machines and pharmaceuticals, proper disposal methods inside and outside the hospital, and evaluation. Its many dimensions require a broader focus than ...
Williams, C M; Petrelli, J; Murphy, M
This article discusses how the development of a longitudinal geriatric assessment form facilitated a case management program in identifying high-risk frail elders within a military family practice clinic. A careful review of geriatric assessment tools was performed. From this review, a model geriatric assessment form was developed. A "SWOT" (strengths, weaknesses, opportunities, and threats) analysis of the family medicine department was completed to determine if the environment was ready for case management. Analysis of the SWOT data revealed that the environment was favorable for a population-based approach to case management. Results of this initial study are encouraging. The new longitudinal geriatric assessment form has assisted family practice residents in organizing problems and data while seeing elderly patients. As a direct result, higher-risk frail elders have been identified for closer evaluation and follow-up. Future goals are to measure outcomes-based data and to refine the geriatric assessment process. PMID:11143424
Rojas, Graciela; Martínez, Pablo; Vöhringer, Paul A.; Martínez, Vania; Castro-Lara, Ariel; Fritsch, Rosemarie
Background Depression is a common and disabling condition. Since 2001, Chile has had a national program for depression in primary care and universal access to treatment for depressed people over the age of 15. There are National Guidelines to treat depression but no training program exists. The aim of the present study protocol is to measure the effectiveness of a comprehensive technology-assisted training and supervision program to enhance depression management in primary care. Methods and d...
Dubler, N N
Managed care has not only intensified existing conflicts between patient and provider, it has, by its very nature, changed the shape and scope of the healthcare enterprise and introduced an entirely new set of disputes. The decision-making dynamics have been altered, and the cast of players has expanded. Traditionally, the therapeutic interaction took place between the physician and the patient although it occasionally included the patient's family. Whatever obligations existed, such as fidelity, confidentiality, and standard of care, they bound only those parties. Now, as the managed care organization has interposed itself between the patient and the physician, the dyad has become a triad. The power balance has shifted, and a new set of rights and responsibilities now flows between and among the players, each of whom has interests that may or may not coincide. This article argues that, because of its cost containment origins and orientation, managed care increases the likelihood that misunderstandings, disagreements and disputes will develop into full-blown conflicts. If managed care is to succeed financially and operate with integrity, it must develop techniques for managing the increasing conflicts that arise inevitably between and among the organizations, physicians, and patients. It is clear that the voice of the patient needs to be strengthened within the new complex decision-making, review, and appeal procedures. Mediation is the most appropriate method of dispute resolution for the managed care setting because it balances the disparities in power endemic to the bureaucratization of medicine and refocuses the interests of the various parties. Using bioethics consultation as a model for dispute mediation provides a set of principles and guideline tasks that can be applied effectively to managed care. PMID:9514387
As part of a research project on managerial work based on a new model of the roles, the head nurse of a hospital unit was observed during a working day. Her work is described, with reference especially to the roles of leading, linking, controlling, and doing. Conclusions are drawn about the advantages of a craft style of management as opposed to the more traditional "boss" or professional styles. The author also discusses what those in general management can learn from those in nursing management, which seems best practiced out in the open, on one's feet, as a kind of blended care. PMID:8089715
Campbell, Jonathan D
Uncontrolled asthma is an enormous burden in terms of the propensity to reach asthma control in the future, direct and indirect costs, and health-related quality of life. The complex pathophysiology, treatment, and triggers of asthma warrant a unified, yet targeted, approach to care. No single factor is fully responsible for poor control. Complicating the problem of asthma control is adherence to long-term controller medications. The National Asthma Education and Prevention Program (NAEPP) established several key points for asthma control, and developed classifications for asthma control and recommended actions for treatment. All parties involved in the management of asthma, including physicians, pharmacists, nurses, patients, family members, and insurance companies, need to be aware of the NAEPP guidelines. To determine if the goals of asthma therapy are being met, assessment of asthma outcomes is necessary. Unfortunately, some measures may get overlooked, and patient-reported outcomes (as assessed by the validated control instruments) are not often collected during routine examinations. The Healthcare Effectiveness Data and Information Set measure for asthma may be used to quantify asthma care, but there is evidence that it does not fully capture the goals of asthma management. Most well-designed, education-based interventions are considered good value for money, but it can be difficult to put into practice such policy interventions. An optimal managed care plan will adhere to known evidence-based guidelines, can measure outcomes, is targeted to the patient's risk and impairment, and can adapt to changes in our understanding of asthma and its treatment. PMID:21761959
Cabassa, Leopoldo J.; Gomes, Arminda P.; Lewis-Fernández, Roberto
Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders’ recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from ...
Center for Law and Social Policy, Inc. (CLASP), 2012
The Illinois Child Care Collaboration Program promotes collaboration between child care and other early care and education providers, including Early Head Start (EHS), by creating policies to ease blending of funds to extend the day or year of existing services. While no funding is provided through the initiative, participating programs may take…
Phillips, J N
Current proposals for health care reform emphasize managed care in an effort to achieve universal coverage and access to health care for all Americans. One of the many strategies to achieve this goal is to create a new health care workforce by supporting the recruitment and education of health professionals from population groups underrepresented in health care. To help insure that the managed care industry will be adequately prepared to face the challenges of reform, the Group Health Foundation of the Group Health Association of America, Inc., has crafted an innovative Minority Training Program--a management training program in the field of managed care. The program involves resident fellows who will train in select health maintenance organizations (HMOs) in the Washington, DC/Baltimore metropolitan area. To augment training, the fellows will simultaneously participate in a comprehensive didactic program especially designed to prepare each fellow for a first or middle-management position in an HMO or a similar managed care organization. Following successful completion of the first years in Washington, DC, the program will be broadened to other geographical areas. PMID:7918893
Pecchia, Leandro; Schiraldi, Fernando; Verde, Sossio; Mirante, Enrico; Bath, Peter A; Bracale, Marcello
This paper aimed to assess the early effectiveness of a disease management program (DMP), called “Dimissione Protetta Difficile” (Di.Pro.Di) conducted by personnel from the intensive care unit (ICU) of Public Hospital S. Paolo, Naples, Italy. Di.Pro.Di significantly reduces the number and risk of rehospitalizations and total hospital length of stay.
Lalonde, Lyne; Choinière, Manon; Martin, Elisabeth; Lévesque, Lise; Hudon, Eveline; Bélanger, Danielle; Perreault, Sylvie; Lacasse, Anaïs; Laliberté, Marie-Claude
Purpose There is evidence that the management of chronic non-cancer pain (CNCP) in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care. Methods Using the Chronic Care Model as a conceptual framework, physicians (n=6), pharmacists (n=6), nurses (n=6), physiotherapists (n=6), psychologists (n=6), pain specialists (n=6), patients (n=3), family members (n=3), decision makers and managers (n=4), and pain researchers (n=7) took part in seven focus groups and five nominal groups. Results Challenges identified in focus group discussions were related to five dimensions: knowledge gap, “work in silos”, lack of awareness that CNCP represents an important clinical problem, difficulties in access to health professionals and services, and patient empowerment needs. Based on the nominal group discussions, the following priority interventions were identified: interdisciplinary continuing education, interdisciplinary treatment approach, regional expert leadership, creation and definition of care paths, and patient education programs. Conclusion Barriers to optimal management of CNCP in primary care are numerous. Improving its management cannot be envisioned without considering multifaceted interventions targeting several dimensions of the Chronic Care Model and focusing on both clinicians and patients. PMID:25995648
Platt, Richard; Caldwell, Blake
Managed-care organizations have a unique opportunity, still largely unrealized, to collaborate with health-care providers and epidemiologists to prevent health care-associated infections. Several attributes make these organizations logical collaborators for infection control programs: they have responsibility for defined populations of enrollees and for their overall health, including preventive care; they possess unique data resources about their members and their care; and they are able to ...
Full Text Available Abstract Background Chiropractic treatment for low back pain (LBP can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care. Method The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team. Results Replies were received from 59 (60% of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care. Conclusion To a reasonable extent, Swedish chiropractors participating in this
MacDougall, Conan; Polk, Ron E.
Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based o...
Full Text Available Objective. To assess the blood pressure control and cardiovascular risk factors (CVRFs in a population of hypertensive patients with access to care under a government-financed program, the Cardiovascular Health Program (CHP. Design. A cross-sectional and multicenter study. Setting. 52 primary care centers, metropolitan area of Santiago, Chile. Participants. 1,194 patients were selected by a systematic random sampling from a universe of 316,654 hypertensive patients. Key Measurements. Demographic information, blood pressure (BP measurements, and CVRF were extracted from medical records of patients followed for a 12-month period. Results. 59.7% of patients reached target BP <140/90 mmHg. More women were captured in the sampling (2.1 : 1, achieving better BP control than men. Diabetic patients (26.4% had worse BP control than nondiabetics. Antihypertensive medications were used in 91.5%, with multidrug therapy more frequent in patients with higher BP and more difficult control. Conclusions. The success in improving the BP control to values <140/90 mmHg from 45.3% to 59.7% underscores the contribution of this program in the Chilean primary care cardiovascular preventive strategies. However, fewer hypertensive men than women were captured by this program, and it is of concern the underperforming of BP control observed in diabetics.
Christel van Dijk
Full Text Available Background: Disease management programs (DMP aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs.Research design and methods: Healthcare utilization for diabetes patients was analyzed using 2008 self-reported data (N=316 and data from electronic medical records (EMR (N=9023, and divided whether or not care was described in the Dutch type 2 diabetes multidisciplinary healthcare standard.Results: On average 4.3 different disciplines of healthcare providers were involved in the care for diabetes patients. 96% contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthcare standard. Only a limited part of total healthcare utilization of diabetes patients was included in the healthcare standard and therefore theoretically included in DMPs.Conclusion: Organizing the care for diabetics in a DMP might harm the coordination and quality of all healthcare for diabetics. DMPs should be integrated in the overall organization of care.
Boots, Lizzy M. M.; De Vugt, Marjolein E; Kempen, Gertrudis I. J. M.; Verhey, Frans R. J.
Background The benefits of e-health support for dementia caregivers are becoming increasingly recognized. Reaching early-stage dementia caregivers could prevent high levels of burden and psychological problems in them in the later stages of dementia. An iterative step-wise approach was employed to develop the blended care self-management program “Partner in Balance” for early-stage dementia caregivers. The design of a study evaluating the process characteristics and effects is presented. Meth...
Background This project investigated the impact of a DM self-management education program provided through a telemedicine link at nine rural health clinics in Northern California. Methods Two hundred thirty nine patients were provided with a single 2-hour class on DM delivered through a live televideo connection. Patients provided pre-intervention information on: demographics and overall health, self-care behaviors, and knowledge about DM. All participants completed a post-education survey on...
As the health care revolution progresses, so must the management styles of today's leaders. The authors must ask ourselves if we are managing tomorrow's work force or the work force of the past. Participatory management may better meet the needs of today's work force. This paper identifies the reasons participatory management is a more effective management style, the methods used to implement a participatory management program, its benefits (such as higher productivity and more efficient, effective implementation and acceptance of change), and the difficulties experienced
... Alternative health care : products and services such as acupuncture, homeopathy, nutrition therapy, and massage, that can complement ... with a specific diagnosis, such as cancer or diabetes. The goals of disease management are to improve ...
Going into the next millennium do we see nuclear energy? Yes we will see an expanding nuclear sector in the modem community. he modem community that cares for people, health and environment needs nuclear. Energy saves lives. Electricity is efficient use of energy. Energy will be the key to a sustainable society, energy is life. Nuclear energy protects the environment. Nuclear is an integral part of the modern community caring for people, health and environment. The dynamics of the public opinion-forming process and its effects on the nuclear industry are a challenge of the global nuclear industry. Current communications strategy and its consequences are on of the key issues. The nuclear industry must be perceived in certain ways in order to move towards achieving the vision and avoiding the harassment scenario. Each perception goal does not bear the same function within the communications process. As the nuclear industry is oe of the keys to a sustainable society, it must achieve legitimacy in its capacity as an interesting agenda-setter for tackling problems and as an expert. We have to build our communication activities on an open and honest attitude and we have to establish trust and confidence. The nuclear industry must also prove its ability and performance. If this could be achieved there will be an option for the future
Although construction is one of the largest industries in the United States, it lags behind other industries in its implementation of modern management techniques such as those contained in the Standard for Program Management (the Standard) by the Project Management Institute (PMI(R)). Construction Program Management details the successful use of the PMI(R) approach for the construction of capital programs. It demonstrates, through case studies, how implementation of PMI's set of tools and techniques can improve the chances of program success. Exploring tactical and strategic management method
The French plutonium management program is summarized in this paper. The program considers nuclear generation as a major component of national electric power supply and includes the reprocessing of the spent fuel. (author)
The Program Management System (PMS), as detailed in this manual, consists of all the plans, policies, procedure, systems, and processes that, taken together, serve as a mechanism for managing the various subprograms and program elements in a cohesive, cost-effective manner. The PMS is consistent with the requirements of the Nuclear Waste Policy Act of 1982 and the ''Mission Plan for the Civilian Radioactive Waste Management Program'' (DOE/RW-0005). It is based on, but goes beyond, the Department of Energy (DOE) management policies and procedures applicable to all DOE programs by adapting these directives to the specific needs of the Civilian Radioactive Waste Management program. This PMS Manual describes the hierarchy of plans required to develop and maintain the cost, schedule, and technical baselines at the various organizational levels of the Civilian Radioactive Waste Management Program. It also establishes the management policies and procedures used in the implementation of the Program. These include requirements for internal reports, data, and other information; systems engineering management; regulatory compliance; safety; quality assurance; and institutional affairs. Although expanded versions of many of these plans, policies, and procedures are found in separate documents, they are an integral part of this manual. The PMS provides the basis for the effective management that is needed to ensure that the Civilian Radioactive Waste Management Program fulfills the mandate of the Nuclear Waste Policy Act of 1982. 5 figs., 2 tabs
Full Text Available Aim: Anticoagulants (AC and anti-platelet (AP agents are widely administered to patients with hematological malignancies (HM. However, HM patients may be at high risk of bleeding and hemorrhagic complications, because of different form of coagulopathies and several degrees of thrombocytopenia. Materials and Methods: A prospective evaluation of the use of anticoagulant and anti-thrombotic agents as well as of bleeding and thrombotic complications in a consecutive cohort of patients, which were followed during the first semester of 2010 by our home care service, was performed. In this regard, three pharmacological class of agents, such as oral anticoagulants (warfarin and acenocumarine, low molecular weight heparin (LMWH and anti-platelet (AP drugs were considered. Results: Out of 129 patients, 26 (20% were treated with AC/AP drugs. Warfarin, acenocumarine, LMWH as well as AP were used in 7, 11 and 12 patients, respectively. Adverse events (bleeding were observed in 3 patients (11.5%, 2 cases being on warfarin (replaced by LMWH and 1 being AP (suspension without replacement; out of the 3 patients with bleeding, none presented thrombocytopenia. Conclusions: Despite the frequent findings of hemostatic disorders in a population of frail patients managed in a home care setting, our experience demonstrated that the use of AC/AP drugs has been very rarely responsible for significant complications.
Griswold, Carol H.; Nasso, Jacqueline T.; Swider, Susan; Ellison, Brenda R.; Griswold, Daniel L.; Brooks, Marilyn
School absenteeism and poor compliance with prenatal appointments are concerns for pregnant teens. The Prenatal Care at School (PAS) program is a new model of prenatal care involving local health care providers and school personnel to reduce the need for students to leave school for prenatal care. The program combines prenatal care and education…
Malone Robert M
Full Text Available Abstract Background Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. Methods Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI, the Center for Epidemiological Studies-Depression Scale scale (CESD and the Pain Disability Index (PDI. Patients were monitored for substance misuse. Results Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73% completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003. The mean PDI score improved to 39.3 (p Conclusions A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up.
Smith, Wally R.; Cotter, J. James; Louis F Rossiter
Rising Medicaid health expenditures have hastened the development of State managed care programs. Methods to monitor and improve health care under Medicaid are changing. Under fee-for-service (FFS), the primary concern was to avoid overutilization. Under managed care, it is to avoid underutilization. Quality enhancement thus moves from addressing inefficiency to addressing insufficiency of care. This article presents a case study of Virginia's redesign of Quality Assessment and Improvement (Q...
Connor, L R
Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management. PMID:9785300
Resolving conflict throughout organizations requires a programmatic infrastructure and a committed management team. Leaders must recognize the need to approach conflict by building a format for learning, creating and managing an effective conflict management program. Careful attention to the elements of design and the stages of development can make all the difference in building a sustainable and useful conflict management approach. PMID:15600105
Full Text Available Peter Joseph Jongen,1,2 Ludovicus G Sinnige,3 Björn M van Geel,4 Freek Verheul,5 Wim I Verhagen,6 Ruud A van der Kruijk,7 Reinoud Haverkamp,8 Hans M Schrijver,9 Jacoba C Baart,10 Leo H Visser,11 Edo P Arnoldus,12 Herman Jacobus Gilhuis,13 Paul Pop,14 Monique Booy,15 Marco Heerings,16 Anton Kool,17 Esther van Noort17 1Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, 2MS4 Research Institute, Nijmegen, 3Multiple Sclerosis Centre Leeuwarden, Medical Centre Leeuwarden, Leeuwarden, 4Department of Neurology, Medical Centre Alkmaar, Alkmaar, 5Department of Neurology, Groene Hart Hospital, Gouda, 6Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, 7Department of Neurology, Slingeland Hospital, Doetinchem, 8Department of Neurology, Zuwe Hofpoort Hospital, Woerden, 9Multiple Sclerosis Centre, Westfries Gasthuis, Hoorn, 10Department of Neurology, Ziekenhuisgroep Twente, Almelo-Hengelo, 11Multiple Sclerosis Centre Midden Brabant, St Elisabeth Hospital, Tilburg, 12Multiple Sclerosis Centre Midden Brabant, Tweesteden Hospital, 13Department of Neurology, Reinier de Graaf Gasthuis, Delft, 14Department of Neurology, Viecuri Medical Centre, Venlo-Venray, 15Multiple Sclerosis Centre, Amphia Hospital, Breda, 16MH Advies en organisatiebureau, Assen, 17Curavista bv, Geertruidenberg, the Netherlands Background: MSmonitor is an interactive web-based program for self-management and integrated, multidisciplinary care in multiple sclerosis.Methods: To assess the utilization and valuation by persons with multiple sclerosis, we held an online survey among those who had used the program for at least 1 year. We evaluated the utilization and meaningfulness of the program’s elements, perceived use of data by neurologists and nurses, and appreciation of care, self-management, and satisfaction.Results: Fifty-five persons completed the questionnaire (estimated response rate 40%. The
Shogo Kato; Satoko Tsuru; Yoshinori Iizuka
The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans a...
Capitman, John A.
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...
Kodner, Dennis L
The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries-primarily older persons-with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO). The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a "whole systems" approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program includes the staffing structure
Dennis L Kodner
Full Text Available The Massachusetts General Care Management Program (Mass General CMP or CMP was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each. It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO. The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program
, difficulties in access to health professionals and services, and patient empowerment needs. Based on the nominal group discussions, the following priority interventions were identified: interdisciplinary continuing education, interdisciplinary treatment approach, regional expert leadership, creation and definition of care paths, and patient education programs. Conclusion: Barriers to optimal management of CNCP in primary care are numerous. Improving its management cannot be envisioned without considering multifaceted interventions targeting several dimensions of the Chronic Care Model and focusing on both clinicians and patients. Keywords: chronic pain, community-based participatory research, health service accessibility, patient-centered care, primary health care
Stewart, Della W
With the economic and market changes currently taking place, organizations cannot survive or prosper without quality employees. Key to employee loyalty, performance, and retention is the relationship between the leader, manager, and employee. Leaders are visionaries who make sure that the right things are done for the organization. Managers are in a position to make sure that things are done right within the organization. There are traits and qualities that good leaders and managers must possess to ensure organizational success. Displaying these characteristics will ensure that employees are taken care of, which will benefit both the employees and the organization. PMID:22282003
Kodner, Dennis L.
The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusett...
Ashbaugh, John; Smith, Gary
This article discusses implications of the movement toward managed health care models for long-term health care services for people with disabilities, especially people with developmental disabilities. It notes possible advantages of managed care but raises issues concerning consumer choice, management and financial capacity of managed care…
One of the hottest topics in transportation planning today is California's Congestion Management Program (CMP). California's program has been suggested as a model to the rest of the United States for addressing transportation problems and for conforming to the federal Clean Air Act. This article introduces California's Congestion Management Program, describes some problems related to California's CMP legislation, outlines the major CMP elements, and briefly explains the issue of the environmental impact of CMPs. This information might assist others in developing their own CMP programs
Creech, Constance J; Kornblau, Barbara; Strugar-Fritsch, Donna
This paper presents the background and multiyear outcome data for a limited benefit safety-net care program in Michigan. It is a possible solution for policymakers and hospital/clinic administrators to consider when evaluating plans to provide primary care for the 30 million uninsured Americans who will be affected by the Affordable Care Act. PMID:22643481
Ferguson, Fred S.; And Others
In 1980, the State University of New York at Stony Brook began a program, integrated into the program of children's dentistry, to train students in care for the developmentally disabled. Management of developmentally disabled patients is provided over three years, and represents an extension of pediatric behavior management. (MSE)
Gawadiak, Yuri; Wong, Alan; Maluf, David; Bell, David; Gurram, Mohana; Tran, Khai Peter; Hsu, Jennifer; Yagi, Kenji; Patel, Hemil
The Program Management Tool (PMT) is a comprehensive, Web-enabled business intelligence software tool for assisting program and project managers within NASA enterprises in gathering, comprehending, and disseminating information on the progress of their programs and projects. The PMT provides planning and management support for implementing NASA programmatic and project management processes and requirements. It provides an online environment for program and line management to develop, communicate, and manage their programs, projects, and tasks in a comprehensive tool suite. The information managed by use of the PMT can include monthly reports as well as data on goals, deliverables, milestones, business processes, personnel, task plans, monthly reports, and budgetary allocations. The PMT provides an intuitive and enhanced Web interface to automate the tedious process of gathering and sharing monthly progress reports, task plans, financial data, and other information on project resources based on technical, schedule, budget, and management criteria and merits. The PMT is consistent with the latest Web standards and software practices, including the use of Extensible Markup Language (XML) for exchanging data and the WebDAV (Web Distributed Authoring and Versioning) protocol for collaborative management of documents. The PMT provides graphical displays of resource allocations in the form of bar and pie charts using Microsoft Excel Visual Basic for Application (VBA) libraries. The PMT has an extensible architecture that enables integration of PMT with other strategic-information software systems, including, for example, the Erasmus reporting system, now part of the NASA Integrated Enterprise Management Program (IEMP) tool suite, at NASA Marshall Space Flight Center (MSFC). The PMT data architecture provides automated and extensive software interfaces and reports to various strategic information systems to eliminate duplicative human entries and minimize data integrity
Ramona S DeJesus
Full Text Available Ramona S DeJesus1, Kristin S Vickers2, Robert J Stroebel1, Stephen S Cha31Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Psychiatry and Psychology, Mayo Clinic, MN, USA; 3Department of Biostatistics, Mayo Clinic, Rochester, MN, USAPurpose: The collaborative care model, using care managers, has been shown to be effective in achieving sustained treatment outcomes in chronic disease management. Little effort has been made to find out patient preferences for chronic disease care, hence, we conducted a study aimed at identifying these.Methods: A 20-item questionnaire, asking for patients’ and providers’ preferences and perceptions, was mailed out to 1000 randomly selected patients in Olmsted County, Minnesota, identified through a diabetes registry to have type 2 diabetes mellitus, a prototypical prevalent chronic disease. Surveys were also sent to 42 primary care providers.Results: There were 254 (25.4% patient responders and 28 (66% provider responders. The majority of patients (>70% and providers (89% expressed willingness to have various aspects of diabetes care managed by a care manager. Although 75% of providers would be comfortable expanding the care manager role to other chronic diseases, only 39.5% of patient responders would be willing to see a care manager for other chronic problems. Longer length of time from initial diagnosis of diabetes was associated with decreased patient likelihood to work with a care manager.Conclusion: Despite study limitations, such as the lack of validated measures to assess perceptions related to care management, our results suggest that patients and providers are willing to collaborate with a care manager and that both groups have similar role expectations of a care manager.Keywords: care manager, collaborative care, patient preference, diabetes care
Full Text Available Peter Joseph Jongen,1,2 Ludovicus G Sinnige,3 Björn M van Geel,4 Freek Verheul,5 Wim l Verhagen,6 Ruud A van der Kruijk,7 Reinoud Haverkamp,8 Hans M Schrijver,9 J Coby Baart,10 Leo H Visser,11 Edo P Arnoldus,12 H Jacobus Gilhuis,13 Paul Pop,14 Monique Booy,15 Wim Lemmens,16 Rogier Donders,16 Anton Kool,17 Esther van Noort17 1Department of Community and Occupational Medicine, University Medical Center Groningen, University Groningen, Groningen, 2MS4 Research Institute, Nijmegen, 3Multiple Sclerosis Centre Leeuwarden, Medical Centre Leeuwarden, Leeuwarden, 4Department of Neurology, Medical Centre Alkmaar, Alkmaar, 5Department of Neurology, Groene Hart Hospital, Gouda, 6Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, 7Department of Neurology, Slingeland Hospital, Doetinchem, 8Department of Neurology, Zuwe Hofpoort Hospital, Woerden, 9Multiple Sclerosis Centre, Westfries Gasthuis, Hoorn, 10Department of Neurology, Ziekenhuisgroep Twente, Almelo-Hengelo, 11Multiple Sclerosis Centre Midden Brabant, St Elisabeth Hospital, 12Multiple Sclerosis Centre Midden Brabant, Tweesteden Hospital, Tilburg, 13Department of Neurology, Reinier de Graaf Gasthuis, Delft, 14Department of Neurology, Viecuri Medical Centre, Venlo-Venray, 15Multiple Sclerosis Centre, Amphia Hospital, Breda, 16Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, 17Curavista bv, Geertruidenberg, the Netherlands Background: There is a growing need to offer persons with multiple sclerosis (PwMS possibilities for self-management and to integrate multidisciplinary health data. In 2009–2014 we developed a patient-reported outcome based, interactive, web-based program (MSmonitor for (self-monitoring, self-management and integrated, multidisciplinary care in MS.Methods: The notions underlying the MSmonitor concept and the program’s elements are described. We analyze MSmonitor’s role in the self-management of fatigue by retrospective
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MacDougall, Conan; Polk, Ron E
Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources. PMID:16223951
According to section 35.32, ''Quality Management Program,'' of 10 CFR Part 35, ''Medical Use of Byproduct Material,'' applicants or licensees, as applicable, are required to establish a quality management (QM) program. This regulatory guide provides guidance to licensees and applicants for developing policies and procedures for the QM program. This guide does not restrict or limit the licensee from using other guidance that may be equally useful in developing a QM program, e.g., information available from the Joint Commission on Accreditation of Healthcare Organizations or the American College of Radiology. Any information collection activities mentioned in this regulatory guide are contained as requirements in 10 CFR Part 35, which provides the regulatory basis for this guide. This information collection requirements in 10 CFR Part 35 have been cleared under OMB Clearance No. 3150-0010
Anne E. Hall
I estimate the welfare, both gross and net, provided by the Medicare managed care program in 1999 through 2002. First, I estimate a model of demand for the benefits offered by managed care plans to Medicare beneficiaries. I then use the demand estimates to form estimates of welfare provided by the program. Medicare beneficiaries derived $14.9 billion of gross welfare per year from the Medicare HMO program. Depending on the amount of selection in the program, the Medicare managed care program ...
Kilbourne, Amy M.; Goodrich, David E.; O’Donnell, Allison N.; Miller, Christopher J.
There is growing realization that persons with bipolar disorder may exclusively be seen in primary (general medical) care settings, notably because of limited access to mental health care and stigma in seeking mental health treatment. At least two clinical practice guidelines for bipolar disorder recommend collaborative chronic care models (CCMs) to help integrate mental health care to better manage this illness. CCMs, which include provider guideline support, self-management support, care ma...
Effects of the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) on biomedical outcomes, observed cardiovascular events and cardiovascular risks in primary care: a longitudinal comparative study
Jiao, Fang Fang; Fung, Colman Siu Cheung; Wong, Carlos King Ho; Wan, Yuk Fai; Dai, Daisy; Kwok, Ruby; Lam, Cindy Lo Kuen
Background To assess whether the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) led to improvements in biomedical outcomes, observed cardiovascular events and predicted cardiovascular risks after 12-month intervention in the primary care setting. Methods A random sample of 1,248 people with diabetes enrolled to RAMP-DM for at least 12 months was selected and 1,248 people with diabetes under the usual primary care were matched by age, sex...
As the prime contractor to the Department of Energy Idaho Operations Office (DOE-ID), Lockheed Martin Idaho Technologies Company (LMITCO) provides comprehensive waste management services to all contractors at the Idaho National Engineering and Environmental Laboratory (INEEL) through the Waste Management (WM) Program. This Program Management Plan (PMP) provides an overview of the Waste Management Program objectives, organization and management practices, and scope of work. This document will be reviewed at least annually and updated as needed to address revisions to the Waste Management's objectives, organization and management practices, and scope of work. Waste Management Program is managed by LMITCO Waste Operations Directorate. The Waste Management Program manages transuranic, low-level, mixed low-level, hazardous, special-case, and industrial wastes generated at or transported to the INEEL
Pace, T.G. [U.S. Environmental Protection Agency, NC (United States); Markin, S. [Ministry of Environmental Protection and Natural Resources, Moscow (Sweden); Kosenkova, S.V. [Volgograd Environmental Services Administration, Volgograd (Russian Federation)
The Russia Air Management Program is in the second year of a four-year cooperative program between the Russian Ministry of Environmental Protection and Natural Resources (MEPNR) and the U.S. Environmental Protection Agency (EPA) to improve national institutions, policies, and practices for air quality management in Russia. This program is part of the Environmental Policy and Technology project being conducted by the U.S. Agency for International Development. The Russia Air Management Program will pilot the application of potential air program improvements in the important industrial City of Volgograd which will enable the development, practical demonstration and evaluation of alternative approaches for improving AQM policies and practices in Russia. Volgograd has a progressive and environmentally enlightened local government, a diverse industrial base and a relatively healthy economy. It is located south of Moscow on the Volga River and was proposed by the Ministry of Environmental Protection and Natural Resources. It was selected after a site visit and a series of discussions with the Ministry, Volgograd officials, the World Bank and the EPA. Following the pilot, RAMP will work to facilitate implementation of selected parts of the pilot in other areas of Russia using training, technology transfer, and public awareness. (author)
Hobson, Kristin A.; Burkhardt, Jason T.
Background: A music education program with a goal of enhancing cognitive development of preschool-aged children enrolled in local preschools is evaluated by The Evaluation Center at Western Michigan University. The budget for the evaluation was small, and therefore presented several challenges to the evaluation team. Purpose: Through a case study…
Ramona S DeJesus1, Kristin S Vickers2, Robert J Stroebel1, Stephen S Cha31Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Psychiatry and Psychology, Mayo Clinic, MN, USA; 3Department of Biostatistics, Mayo Clinic, Rochester, MN, USAPurpose: The collaborative care model, using care managers, has been shown to be effective in achieving sustained treatment outcomes in chronic disease management. Little effort has been made to find out patient preferenc...
Song, In Han; Kim, Sang-A; Park, Woong-Sub
The objective of this study was to examine the effects of a hypertension management program provided by a primary health care post located in a distant rural area in South Korea on the level of knowledge of hypertension. The panel data consisted of a total of 319 people or the entire population aged above 40 years of five villages located in…
van Os, TWDP; Ormel, J; van den Brink, RHS; Jenner, JA; Van der Meer, K; Tiemens, BG; van der Doorn, W; Smit, A; van den Brink, W
The purpose of this pretest-posttest study was to evaluate effects of a training program designed to improve primary care physicians' (PCPs) ability to recognize mental health problems (MHP) and Co diagnose and manage depression according to clinical guidelines. The primary care settings were in the
Brady, Teresa J; Murphy, Louise; O’Colmain, Benita J.; Beauchesne, Danielle; Daniels, Brandy; Greenberg, Michael; House, Marnie; Chervin, Doryn
Introduction The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions; it has been implemented worldwide. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies conducted in English-speaking countries to determine the program’s effects on health behaviors, physical and psychological healt...
Stevenson, Paul B; Messinger, Stephen F; Welter, Terri
In response to poor payment performance by health plans, providers are realizing that managed care contracts require systematic, ongoing management rather than a periodic focus. An effective managed care cycle that encompasses strategy development, implementation of the strategy through contracting and operations, and monitoring of contract performance can accomplish this needed oversight. Each phase requires specialized management tools, skills, and staff. Because of the importance of managed care to the provider's financial viability, a wide range of persons should be involved in the managed care cycle, including the board of directors, business office staff, senior management, and finance staff. As providers embrace a more structured approach to managed care, they will increase their chances of receiving accurate contracted payments. PMID:11899723
Riner, R. Myles
Full Text Available Some researchers and consulting groups have promoted managed care as a way to provide cost-effective quality care to Medicaid patients, based on assertions that are often poorly substantiated. Unfortunately, politicians and policy makers in California and other states have adopted the presumption of the cost-effectiveness of Medicaid Managed Care as a rationale for expanding the use of managed care programs to include a larger share of more Medicaid eligible enrollees, and expand coverage and services to the currently uninsured. This paper challenges the assertion that Medi-Cal Managed Care is cost effective, by demonstrating that the unique and idiosyncratic manner in which Medi-Cal managed care has been implemented in California (and other states creates perverse incentives leading to cost-shifting and selective enrollment and dis-enrollment of costly beneficiaries. This places an unfair burden on fee-for-service Medi-Cal providers, who are expected to provide more services for less reimbursement. Administrators of Medicaid Managed Care programs need to consider risk adjusted rates for beneficiaries enrolled in plans in order to align incentives with program objectives. [WestJEM. 2009;10:124-129.
Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Baymirova, L.
The Uzbek government has a central role in primary care quality management. On paper, many quality management structures and procedures exist. Now, primary care practice should follow, as NIVEL research – done on the initiative of the World Health Organisation (WHO) – has shown. The results have been published in a WHO report. With donor support, quality improvement in primary care is a national priority. Many laws, decrees and orders deal with the improvement of (primary) health care service...
Kulshreshtha, Archana; Zacharia, Anish J; Jarouliya, Urmila; Bhadauriya, Pratiksha; Prasad, G B K S; Bisen, P S
Spirulina is a photosynthetic, filamentous, spiral-shaped and multicellular edible microbe. It is the nature's richest and most complete source of nutrition. Spirulina has a unique blend of nutrients that no single source can offer. The alga contains a wide spectrum of prophylactic and therapeutic nutrients that include B-complex vitamins, minerals, proteins, gamma-linolenic acid and the super anti-oxidants such as beta-carotene, vitamin E, trace elements and a number of unexplored bioactive compounds. Because of its apparent ability to stimulate whole human physiology, Spirulina exhibits therapeutic functions such as antioxidant, anti-bacterial, antiviral, anticancer, anti-inflammatory, anti-allergic and anti-diabetic and plethora of beneficial functions. Spirulina consumption appears to promote the growth of intestinal micro flora as well. The review discusses the potential of Spirulina in health care management. PMID:18855693
Chakinala, Murali M; Duncan, Maribeth; Wirth, Joel
Pulmonary hypertension remains a challenging condition to diagnose and manage. Decentralized care for pulmonary arterial hypertension (PAH) has led to shortcomings in the diagnosis and management of PAH. The Pulmonary Hypertension Association-sponsored Pulmonary Hypertension Care Center program is designed to recognize specialty centers capable of providing multidisciplinary and comprehensive care of PAH. Ideally, Pulmonary Hypertension Care Centers will comanage PAH patients with community-based practitioners and address the growing needs of this emerging population of long-term PAH patients. PMID:27443143
Johnson, Sherryl W
This article provides an overview of traditional and contemporary management theories. Concerns, characteristics, and skills of effective managers are also presented. Further, a self-assessment (survey) of 7 highly effective health care managers in a South Georgia community was conducted to determine their ratings on 6 management indices. The assessment or Scale of Transformational Leadership uses a Likert-type scale to allow for the evaluation of managers. The scale contains 6 management elements for assessment: attention, meaning, trust, self, vision, and feeling. Individual ratings and group summary skills rating are presented. Findings revealed the order of managerial importance of the elements as follows (from highest to lowest): Management of Trust, Management of Attention, Management of Self, Management of Feeling, Management of Meaning, and Management of Risk. As a second tier, the final ratings are corroborated by health care management interns. PMID:15923923
Full Text Available Maria Crema, Chiara Verbano Department of Management and Engineering, University of Padova, Vicenza, Italy Abstract: This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance. Keywords: health care, lean management, clinical risk management, quality, health care processes
Hernández Josep M
Full Text Available Abstract Background Most depressed patients are attended at primary care. However, there are significant shortcomings in the diagnosis, management and outcomes of these patients. The aim of this study is to determine whether the implementation of a structured programme for managing depression will provide better health outcomes than usual management. Methods/Design Design: A cluster-randomized controlled trial involving two groups, one of which is the control group consisting of patients who are treated for depression in the usual way and the other is the intervention group consisting of patients on a structured programme for treating depression. Setting: 20 primary care centres in the province of Tarragona (Spain Sample: 400 patients over 18 years of age who have experienced an episode of major depression (DSM-IV and who need to initiate antidepressant treatment Intervention: A multi-component programme with clinical, educational and organisational procedures that includes training for the health care provider and evidence-based clinical guidelines. It also includes primary care nurses working as care-managers who provide educational and emotional support for the patients and who are responsible for active and systematic clinical monitoring. The programme aims to improve the primary care/specialized level interface. Measurements: The patients will be monitored by telephone interviews. The interviewer will not know which group the patient belongs to (blind trial. These interviews will be given at 0, 3, 6 and 12 months. Main variables: Severity of the depressive symptoms, response rate and remission rate. Analysis: Outcomes will be analyzed on an intent-to-treat basis and the unit of analysis will be the individual patient. This analysis will take into account the effect of study design on potential lack of independence between observations within the same cluster. Discussion The effectiveness of caring for depression in primary care can be
Myburgh, Corrie; Brandborg-Olsen, Dorthe; Albert, Hanne;
To describe and interpret Danish Chiropractors' perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics.......To describe and interpret Danish Chiropractors' perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics....
Bauer, M; Bach, A
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
Hiranandani, Vanmala Sunder
Medicaid, America's largest government-funded health insurance program, plays a pivotal role in providing health services to eight million adults with disabilities. Since the mid-1990s, many Medicaid programs have aggressively introduced managed care, which reconfigures service delivery using bus...
Ayşe Ebru Sakallıoğlu Abalı
Full Text Available Burn injury is still a leading cause of morbidity and mortality in children. This article aimed to review the current principles of management from initial assessment to early management and intensive care for pediatric burn patients. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 62-9
Development and testing of the Dementia Symptom Management at Home (DSM-H) program: An interprofessional home health care intervention to improve the quality of life for persons with dementia and their caregivers.
Brody, Abraham A; Guan, Carrie; Cortes, Tara; Galvin, James E
Home health care agencies are increasingly taking care of sicker, older patients with greater comorbidities. However, they are unequipped to appropriately manage these older adults, particular persons living with dementia (PLWD). We therefore developed the Dementia Symptom Management at Home (DSM-H) Program, a bundled interprofessional intervention, to improve the care confidence of providers, and quality of care delivered to PLWD and their caregivers. We implemented the DSM-H with 83 registered nurses, physical therapists, and occupational therapists. Overall, there was significant improvement in pain knowledge (5.9%) and confidence (26.5%), depression knowledge (14.8%) and confidence (36.1%), and neuropsychiatric symptom general knowledge (16.8%), intervention knowledge (20.9%), attitudes (3.4%) and confidence (27.1%) at a statistical significance of (P < .0001). We also found significant differences between disciplines. Overall, this disseminable program proved to be implementable and improve clinician's knowledge and confidence in caring for PLWD, with the potential to improve quality of care and quality of life, and decrease costs. PMID:26922312
Gordon, G H; Baker, L; Levinson, W
The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent ...
Tan, ZS; Jennings, L; Reuben, D
Alzheimer's disease and other dementias are chronic, incurable diseases that require coordinated care that addresses the medical, behavioral, and social aspects of the disease. With funding from the Center for Medicare and Medicaid Innovation, we launched a dementia care program in which a nurse practitioner acting as a dementia care manager worked with primary care physicians to develop and implement a dementia care plan that offers training and support to caregivers, manages care transition...
Martin, J; Braun, J-P
Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to external quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system. PMID:24493011
The program CARE calculates the annual environmental exposure of complex nuclear installations. In the calculation, the real weather conditions and the measured release rates of the nuclides are taken into account. According to their location in the plant, the contributions of the time integrated pollutant concentrations of the individual emitters are superimposed at predefinable receiving points. In the conception of the model for calculating the resultant dose care was taken to ensure that the program is capable of treating both individual emissions and quasi-continuous emissions. The program CARE can therefore be used in the event of accidents. (orig.)
Oklahoma State Dept. of Education, Oklahoma City.
This handbook details requirements for family day care homes in Oklahoma for providing child nutrition through the Child and Adult Care Food Program. The handbook includes contact information for state consultants. The basic responsibilities for sponsors of family day care home child nutrition programs are outlined, and the sponsoring organization…
... Strategic Plan Federal Initiatives Career Opportunities Contact Us Administration on Aging (AoA) Long-Term Care Ombudsman Program ( ... Section Q Fact Sheet Back to top Funding History Older Americans Act Title VII Chapter 2 (Ombudsman ...
Crema, Maria; Verbano, Chiara
This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance. PMID:24255600
Mitcho, K; Yanko, J R
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
Cannon, Jeremy W; Chung, Kevin K; King, David R
Care of critically injured patients has evolved over the 50 years since Shoemaker established one of the first trauma units at Cook County Hospital in 1962. Modern trauma intensive care units offer a high nurse-to-patient ratio, physicians and midlevel providers who manage the patients, and technologically advanced monitors and therapeutic devices designed to optimize the care of patients. This article describes advances that have transformed trauma critical care, including bedside ultrasonography, novel patient monitoring techniques, extracorporeal support, and negative pressure dressings. It also discusses how to evaluate the safety and efficacy of future advances in trauma critical care. PMID:22850154
Zwijsen, S.A.; Smalbrugge, M.; Eefsting, J.A.; Gerritsen, D.L.; Hertogh, C.M.P.M.; Pot, A.M.
BACKGROUND: The Grip on Challenging Behavior care program for managing challenging behavior was implemented in the dementia special care units of 17 Dutch nursing homes. A process evaluation of the implementation of the care program was performed to determine the quality of the implementation and th
This document summarizes safety management programs used within the scope of the project Hanford Management Contract (PHMC). The document had been developed to meet the format and content requirements of DOE-STD-3009-94, CH-2
Faced with increasing managed care penetration and declining net revenue in recent years, healthcare providers increasingly are emphasizing revenue management. To streamline processes and reduce costs in this area, many healthcare providers have implemented or are considering automated contract management systems. When selecting such a system, healthcare financial managers should make certain that the system can interface with both patient-accounting and decision-support systems of the organization. This integration enhances a healthcare provider's financial viability by providing integrated revenue-management capabilities to analyze projected performance of proposed managed care contracts and actual performance of existing contracts. PMID:11963597
An environmental assessment of the current healthcare market in the United States shows four stages of evolution: (1) the unstructured stage, (2) the loose framework, (3) consolidation, and (4) managed competition. Recognition of these stages should help in the development of strategies for the future. After determining the existing stage of the health-care market in a particular geographic area, clinical endocrinologists can compose a vision statement, develop goals and objectives, and formulate strategies to achieve the established goals. For example, one strategy is to join a managed-care plan. Some practical business advice about assuming risk (responsibility) for various health-care services is provided, and the concept of disease-specific capitation is discussed. Health-care reform is likely to proceed regardless of what the federal government does. In the managed-care environment, the most successful physician participants will be those who are thoroughly informed. PMID:15251504
Shmueli, Amir; Stam, Piet; Wasem, Jürgen; Trottmann, Maria
Managed care emerged in the American health system in the 1980s as a way to manage suppliers' induced demand and to contain insurers' costs. While in Israel the health insurers have always been managed care organizations, owning health care facilities, employing medical personnel or contracting selectively with independent providers, European insurers have been much more passive, submitting themselves to collective agreements between insurers' and providers' associations, accompanied by extensive government regulation of prices, quantities, and budgets. With the 1990s reforms, and the introduction of risk-adjusted "managed competition", a growing pressure to allow the European insurers to manage their own care - including selective contracting with providers - has emerged, with varying speed of the introduction of policy changes across the individual countries. This paper compares experiences with managed care in Israel, The Netherlands, Germany and Switzerland since the 1990s. After a brief description of the health insurance markets in the four countries, we focus comparatively on the emergence of managed care in the markets for ambulatory care and inpatient market care. We conclude with an evaluation of the current situation and a discussion of selected health policy issues. PMID:25776034
Full Text Available For the past years defense programs have faced delays in delivering defense capabilities and budget overruns. Stakeholders are looking for ways to improve program management and the decision making process given the very fluid and uncertain economic and political environment. Consequently, they have increasingly resorted to risk management as the main management tool for achieving defense programs objectives and for delivering the defense capabilities strongly needed for the soldiers on the ground on time and within limited defense budgets. Following a risk management based decision-making approach the stakeholders are expected not only to protect program objectives against a wide range of risks but, at the same time, to take advantage of the opportunities to increase the likelihood of program success. The prerequisite for making risk management the main tool for achieving defense programs objectives is the design and implementation of a strong risk management framework as a foundation providing an efficient and effective application of the best risk management practices. The aim of this paper is to examine the risk management framework for defense programs based on the ISO 31000:2009 standard, best risk management practices and the defense programs’ needs and particularities. For the purposes of this article, the term of defense programs refers to joint defense programs.
Slobogean, Gerard; Sprague, Sheila; Furey, Andrew; Pollak, Andrew
The dire challenges faced in Haiti, both preearthquake and postearthquake, highlight the need for developing surgical infrastructure to care for traumatic musculoskeletal injuries. The proposed Orthopaedic Trauma Care Specialist (OTCS) residency program aims to close the critical human resource gap that limits the appropriate care of musculoskeletal trauma in Haiti. The OTCS program is a proposal for a 2-year residency program that will focus primarily on the management of orthopaedic trauma. The proposed program will be a comprehensive approach for implementing affordable and sustainable strategies to improve orthopaedic trauma care. Its curriculum will be tailored to the injuries seen in Haiti, and the treatments that can be delivered within their health care system. Its long-term sustainability will be based on a "train-the-trainers" approach for developing local faculty to continue the program. This proposal outlines the OTCS framework specifically for Haiti; however, this concept is likely applicable to other low- and middle-income environments in a similar need for improved trauma and fracture care. PMID:26356211
Zarabozo, Carlos; Taylor, Charles(8 Cherryl House, Seymour Gardens, Sutton Coldfield, West Midlands, B74 4ST, U.K.); Hicks, Jarret
This article captures some key trends in Medicare managed care. The figures which accompany this article explore, among other issues: enrollment; numbers of participating plans; demographic characteristics such as geographic location, age, and income; and premium and benefit comparisons.
Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.
Evidence suggests that the share of Medicare managed care enrollees in a region affects the costs of treating traditional fee-for-service (FFS) Medicare beneficiaries; however, little is known about the mechanisms through which these 'spillover effects' operate. This paper examines the relationship between Medicare managed care penetration and treatment intensity for FFS enrollees hospitalized with a primary diagnosis of AMI. I find that increased Medicare managed care penetration is associated with a reduction in both the costs and the treatment intensity of FFS AMI patients. Specifically, as Medicare managed care penetration increases, FFS AMI patients are less likely to receive surgical reperfusion and mechanical ventilation and to experience an overall reduction in the number of inpatient procedures. Copyright © 2015 John Wiley & Sons, Ltd. PMID:25960418
U.S. Department of Health & Human Services — The study evaluates the performance of Medicare managed care, Medicare Advantage, Plans in comparison to Medicare fee-for-service Plans in three states with...
Jongen, Peter Joseph; Sinnige, Ludovicus G.; van Geel, Bjoern M.; Verheul, Freek; Verhagen, Wim I.; van der Kruijk, Ruud A.; Haverkamp, Reinoud; Schrijver, Hans M.; Baart, J. Coby; Visser, Leo H.; Arnoldus, Edo P.; Gilhuis, H. Jacobus; Pop, Paul; Booy, Monique; Lemmens, Wim; Donders, Rogier; Kool, Anton; van Noort, Esther
Background: There is a growing need to offer persons with multiple sclerosis (PwMS) possibilities for self-management and to integrate multidisciplinary health data. In 2009-2014 we developed a patient-reported outcome based, interactive, web-based program (MSmonitor) for (self-) monitoring, self-ma
Jongen, P.J.; Sinnige, L.G.; Geel, B.M. van; Verheul, F.; Verhagen, W.I.; Kruijk, R.A. van der; Haverkamp, R.; Schrijver, H.M.; Baart, J.C.; Visser, L.H.; Arnoldus, E.P.J.; Gilhuis, H.J.; Pop, P.; Booy, M.; Lemmens, W.; Donders, R.; Kool, A.; Noort, E.
BACKGROUND: There is a growing need to offer persons with multiple sclerosis (PwMS) possibilities for self-management and to integrate multidisciplinary health data. In 2009-2014 we developed a patient-reported outcome based, interactive, web-based program (MSmonitor) for (self-)monitoring, self-man
Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Bulc, M.
Of all GPs in Slovenia 86% are not interested in activities to systematically improve care. A clear national quality policy, further education for care managers and financial incentives for GPs could change the picture, as NIVEL research – done on the initiative of the World Health Organisation (WHO
Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L
To understand better the financial management practices and strategies of modern health care organizations, we conducted interviews with chief financial officers (CFOs) of several leading health care systems. In this introduction, we present an overview of the project and summary responses on corporate financial structures and strategic challenges facing CFOs. PMID:10845383
This document summarizes safety management programs used within the scope of the ''Project Hanford Management Contract''. The document has been developed to meet the format and content requirements of DOE-STD-3009-94, ''Preparation Guide for US. Department of Energy Nonreactor Nuclear Facility Documented Safety Analyses''. This document provides summary descriptions of Fluor Hanford safety management programs, which Fluor Hanford nuclear facilities may reference and incorporate into their safety basis when producing facility- or activity-specific documented safety analyses (DSA). Facility- or activity-specific DSAs will identify any variances to the safety management programs described in this document and any specific attributes of these safety management programs that are important for controlling potentially hazardous conditions. In addition, facility- or activity-specific DSAs may identify unique additions to the safety management programs that are needed to control potentially hazardous conditions
GARVIN, L. J.; JENSEN, M. A.
This document summarizes safety management programs used within the scope of the ''Project Hanford Management Contract''. The document has been developed to meet the format and content requirements of DOE-STD-3009-94, ''Preparation Guide for US. Department of Energy Nonreactor Nuclear Facility Documented Safety Analyses''. This document provides summary descriptions of Fluor Hanford safety management programs, which Fluor Hanford nuclear facilities may reference and incorporate into their safety basis when producing facility- or activity-specific documented safety analyses (DSA). Facility- or activity-specific DSAs will identify any variances to the safety management programs described in this document and any specific attributes of these safety management programs that are important for controlling potentially hazardous conditions. In addition, facility- or activity-specific DSAs may identify unique additions to the safety management programs that are needed to control potentially hazardous conditions.
Full Text Available The need and demand for the highest-quality management of all health care delivery activities requires a participative management approach. The purpose with this article is to explore the process of participative management, to generate and describe a model for such management, focusing mainly on the process of participative management, and to formulate guidelines for operationalisation of the procedure. An exploratory, descriptive and theory-generating research design is pursued. After a brief literature review, inductive reasoning is mainly employed to identify and define central concepts, followed by the formulation of a few applicable statements and guidelines. Participative management is viewed as a process of that constitutes the elements of dynamic interactive decision-making and problem-solving, shared governance, empowerment, organisational transformation, and dynamic communication within the health care organisation. The scientific method of assessment, planning, implementation and evaluation is utilised throughout the process of participative management.
In China, national regulations and standards for health care waste management were implemented in 2003. To investigate the current status of health care waste management at different levels of health care facilities (HCF) after the implementation of these regulations, one tertiary hospital, one secondary hospital, and four primary health care centers from Binzhou District were visited and 145 medical staff members and 24 cleaning personnel were interviewed. Generated medical waste totaled 1.22, 0.77, and 1.17 kg/bed/day in tertiary, secondary, and primary HCF, respectively. The amount of medical waste generated in primary health care centers was much higher than that in secondary hospitals, which may be attributed to general waste being mixed with medical waste. This study found that the level of the HCF, responsibility for medical waste management in departments and wards, educational background and training experience can be factors that determine medical staff members' knowledge of health care waste management policy. Regular training programs and sufficient provision of protective measures are urgently needed to improve occupational safety for cleaning personnel. Financing and administrative monitoring by local authorities is needed to improve handling practices and the implementation of off-site centralized disposal in primary health care centers.
Jéssica Nascimento SILVA
Full Text Available Oral health can not be separated from general health and directly influences the quality of life and self-esteem of the individual. Preventive programs accompanying children from birth are fundamental to the development of a healthy dentition without caries or other sequelae due to para- functional habits. Moreover, it is very important that the manager understands the user’s view in relation to the health service, so that it feels safe and welcomed. This study aimed to examine the program of maternal and child dental care Dental Polyclinic line in the Fire Brigade of the Federal District (PODON - CBMDF. Thus, we evaluated the perception of those responsible for children 0-2 years attending the first phase of the program in the period 2011-2013 and oral health conditions thereof. This research was exploratory, using a quantitative approach, the applied nature, where there was a field study, occurring in 2 steps: a questionnaire to managers and analysis of medical records of patients. Microsoft Excel 2007 software was used for statistical analysis. After tabulation and interpretation thereof, a report was made, and the same was delivered to program management. The questionnaire to parents identified that they are very satisfied with the actions and services of the program and the institution. The analysis of the records showed that of the 75 children studied, 67 (89 % had oral disease during follow-up. Thus, the program appears to be effective in preventing early childhood caries in early childhood.
... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Amending program manager's management... Ownership Operations Program Management § 91.1017 Amending program manager's management specifications. (a... specifications; or (2) The program manager applies for the amendment of any management specifications, and...
Pleacher, M D; Dexter, W W
Objective To assess current concussion management practices of primary care providers. Methods An 11 item questionnaire was mailed to primary care providers in the state of Maine, with serial mailings to non‐respondents. Results Over 50% of the questionnaires were completed, with nearly 70% of primary care providers indicating that they routinely use published guidelines as a tool in managing patients with concussion. Nearly two thirds of providers were aware that neuropsychological tests could be used, but only 16% had access to such tests within a week of injury. Conclusions Primary care providers are using published concussion management guidelines with high frequency, but many are unable to access neuropsychological testing when it is required. PMID:16371479
Kash, Bita A; Deshmukh, A A
The purpose of this study was to develop a marketing plan for the Physical and Occupational Therapy (PT/OT) department at a Critical Access Hospital (CAH). We took the approach of understanding and analyzing the rural community and health care environment, problems faced by the PT/OT department, and developing a strategic marketing plan to resolve those problems. We used hospital admissions data, public and physician surveys, a SWOT analysis, and tools to evaluate alternative strategies. Lack of awareness and negative perception were key issues. Recommended strategies included building relationships with physicians, partnering with the school district, and enhancing the wellness program. PMID:23924224
Layman, Elizabeth J
Health care supervisors and managers are often asked to redesign jobs in their departments. Frequently, little information accompanies the directive. This article lists sources of change in work and defines key terms. Also reviewed are factors that supervisors and managers can weigh in their redesigns. The article suggests actions aligned to common problems in the work environment. Finally, guidelines for a practical, step-by-step approach are provided. For health care supervisors and managers, the key to a successful job redesign is to achieve the unique balance of factors that matches the situation. PMID:17464222
Hipple-Walters, Bethany; Adams, Samantha; Nieboer, Anna; Bal, Roland
textabstractBackground: Disease management programs, especially those based on the Chronic Care Model (CCM),are increasingly common in the Netherlands. While disease management programs have beenwell-researched quantitatively and economically, less qualitative research has been done. Theoverall aim of the study is to explore how disease management programs are implementedwithin primary care settings in the Netherlands; this paper focuses on the early developmentand implementation stages of fi...
Walters Bethany; Adams Samantha A; Nieboer Anna P; Bal Roland
Abstract Background Disease management programs, especially those based on the Chronic Care Model (CCM), are increasingly common in the Netherlands. While disease management programs have been well-researched quantitatively and economically, less qualitative research has been done. The overall aim of the study is to explore how disease management programs are implemented within primary care settings in the Netherlands; this paper focuses on the early development and implementation stages of f...
PAQUETTE,D.E.; BENNETT,D.B.; DORSCH,W.R.; GOODE,G.A.; LEE,R.J.; KLAUS,K.; HOWE,R.F.; GEIGER,K.
THE DEPARTMENT OF ENERGY ORDER 5400.1, GENERAL ENVIRONMENTAL PROTECTION PROGRAM, REQUIRES THE DEVELOPMENT AND IMPLEMENTATION OF A GROUNDWATER PROTECTION PROGRAM. THE BNL GROUNDWATER PROTECTION MANAGEMENT PROGRAM DESCRIPTION PROVIDES AN OVERVIEW OF HOW THE LABORATORY ENSURES THAT PLANS FOR GROUNDWATER PROTECTION, MONITORING, AND RESTORATION ARE FULLY DEFINED, INTEGRATED, AND MANAGED IN A COST EFFECTIVE MANNER THAT IS CONSISTENT WITH FEDERAL, STATE, AND LOCAL REGULATIONS.
McSherry, J; Weiss, R.
PROBLEM ADDRESSED: Management of benign prostatic hyperplasia (BPH) is changing from a surgical approach to a medical approach, and the role of primary care physicians is expanding. OBJECTIVE OF PROGRAM: To introduce a patient-centred approach to managing BPH in primary care through a continuing medical education (CME) program. MAIN COMPONENTS OF PROGRAM: A practice-based, small group, peer-led CME program focused on application of the International Prostate Symptom Score and Quality of Life ...
This report is a resource document of the methods and procedures used currently in the Data Management Program of the Marshall Islands Dose Assessment and Radioecology Project. Since 1973, over 60,000 environmental samples have been collected. Our program includes relational database design, programming and maintenance; sample and information management; sample tracking; quality control; and data entry, evaluation and reduction. The usefulness of scientific databases involves careful planning in order to fulfill the requirements of any large research program. Compilation of scientific results requires consolidation of information from several databases, and incorporation of new information as it is generated. The success in combining and organizing all radionuclide analysis, sample information and statistical results into a readily accessible form, is critical to our project
Stoker, A.C.; Conrado, C.L.
This report is a resource document of the methods and procedures used currently in the Data Management Program of the Marshall Islands Dose Assessment and Radioecology Project. Since 1973, over 60,000 environmental samples have been collected. Our program includes relational database design, programming and maintenance; sample and information management; sample tracking; quality control; and data entry, evaluation and reduction. The usefulness of scientific databases involves careful planning in order to fulfill the requirements of any large research program. Compilation of scientific results requires consolidation of information from several databases, and incorporation of new information as it is generated. The success in combining and organizing all radionuclide analysis, sample information and statistical results into a readily accessible form, is critical to our project.
Shivers, C. Herbert
Program Managers (PM) can protect program resources and improve chances of success by anticipating, understanding and managing risks. Understanding the range of potential risks helps one to avoid or manage the risks. A PM must choose which risks to accept to reduce fire fighting, must meet the expectations of stakeholders consistently, and avoid falling into costly "black holes" that may open. A good risk management process provides the PM more confidence to seize opportunities save money, meet schedule, even improve relationships with people important to the program. Evidence of managing risk and sound internal controls can mean better support from superiors for the program by building a trust and reputation from being on top of issues. Risk managers have an obligation to provide the PM with the best information possible to allow the benefits to be realized (Small Business Consortium, 2004). The Institute for Chartered Accountants in England and Wales sees very important benefits for companies in providing better information about what they do to assess and manage key business risks. Such information will: a) provide practical forward-looking information; b) reduce the cost of capital; c) encourage better risk management; and d) improve accountability for stewardship, investor protection and the usefulness of financial reporting. We are particularly convinced that enhanced risk reporting will help listed companies obtain capital at the lowest possible cost (The Institute of Chartered Accountants in England &Wales, June 2002). Risk managers can take a significant role in quantifying the success of their department and communicating those figures to executive (program) management levels while pushing for a broader risk management role. Overall, risk managers must show that risk management work matters in the most crucial place-the bottom line- as they prove risk management can be a profit center (Sullivan, 2004).
Department of Veterans Affairs — The Primary Care Management Module (PCMM) was developed to assist VA facilities in implementing Primary Care. PCMM supports both Primary Care and non-Primary Care...
Thijs, JC; Arents, NLA; van Zwet, AA; Kleibeuker, JH
Background: Dyspepsia is common in western society. Prompt endoscopy is imperative in all patients with sinister symptoms or if symptoms first appear after the age of 50-55 years, but the optimal management of younger patients with uncomplicated dyspepsia is still open to debate. Methods: The litera
Jaan Sidorov; Franz Joseph Fisher; Sabrina Girolami; Otto Wolke
Objective: To describe the cost savings achieved in a health maintenance organization (HMO)-sponsored primary care-based case management and disease management programs. Methods: The HMO-sponsored programs recruited patients in the primary care setting and relied on clinical guidelines and HMO-employed patient education nurses and case management nurses. Total per member per month (PMPM) charges for medical services and changes in selected clinical outcomes before and after entry into HMO-spo...
Holm Larsen, Michael; Kühn Pedersen, Mogens
The paper addresses the electronic commerce application field of Health Care Administration. Models for knowledge distribution is a rare commodity in the Health Care Administration. Distributed Knowledge Management (DKM) is a concept that originated as an abstraction of a business model prepared for the mechanical and agricultural industry but holds promises for a more general use. The contribution of this paper is to suggest a new business model based on DKM and show ...
This program summary book is a compendium of project summaries submitted by principal investigators in the Environmental Management Science Program and Environmental Management/Energy Research Pilot Collaborative Research Program (Wolf-Broido Program). These summaries provide information about the most recent project activities and accomplishments. All projects will be represented at the workshop poster sessions, so you will have an opportunity to meet with the researchers. The projects will be presented in the same order at the poster session as they are presented in this summary book. Detailed questions about an individual project may be directed to the investigators involved.
Major burn injury is one of the most serious and often life-threatening forms of trauma. Burn patients not only suffer from the physical, psychological, social and spiritual impacts of their injury but also experience considerable changes in health-related quality of life. This paper presents a review of the literature on the implications of previous research and clinical care guidelines related to major burn injuries in order to help clinical practice nurses use evidence-based care guidelines to respond to initial injury assessments, better manage the complex systemic response to these injuries, and provide specialist wound care, emotional support, and rehabilitation services. PMID:26242439
This paper describes the NASA Risk Management Program established by the Headquarters Office of Safety and Mission Quality (MSQ). Current agency policy is outlined, risk management assistance to the field is described, and examples are given of independent risk assessments conducted by SMQ. The motivation for and the structure of the program is placed in the historical context of pre- and post-Challenger environments.
Myths impede the effective management of health care, for example that the system is failing (indeed, that is a system), and can be fixed by detached social engineering and heroic leadership, or treating it more like a business. This field needs to reframe its management, as distributed beyond the "top"; its strategy as venturing, not planning; its organizing as collaboration beyond control, and especially itself, as a system beyond its parts. PMID:23342753
... From the Federal Register Online via the Government Publishing Office OFFICE OF PERSONNEL MANAGEMENT Notice of Federal Long Term Care Insurance Program Open Season AGENCY: Office of Personnel Management. ACTION: Notice of Federal Long Term Care Insurance Open Season. SUMMARY: The Office of...
Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M
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
As a part of Periodic Safety Review Program (PSR) NEK will review and perform some activities related to Equipment Qualification (EQ) and Aging Management Program (AMP). (EQ) and AMP are safety factors, which need to be assessed during PSR. The goal of PSR and AMP is to determine aging effects and give the conclusion whether the plant has been managed to control aging related degradations and that safety margins are maintained. The parallel goal is also to establish AMP for future plant operation and provide basis for possible Life Extension Program. NEK will develop NEK Aging and Life Cycle Management Program, similar by format and content to one determined by License Renewal program. The bases are in 10CFR54, and NEI 95-10 Industry Guidelines for 10 CFR 54 implementation. The process of establishment the AMP is to be done in two steps. The first step is dealing with SSC's (Systems Structures and Components) scoping and screening and identification of TLAA's (Time Limited Aging Analyses). That means, that a database of all SSC's and TLAA's will be created and then evaluated within AMP program. Based on the scope in first phase an evaluation will be performed in step two. NEK will maintain AMP program as a living program that may be also used for Life Extension and Life Cycle Management. This paper will present and describe AMP, scoping and screening process and the results achieved through the first phase of the project.(author)
... person with pain become part of the treatment team and take an active role in regaining control of his or her life ... program is ongoing and the responsibility of all team members Monitoring of ... and performance is provided to you, caregivers, significant others, and ...
The ERDA commercial waste program is summarized. It consists of three parts: terminal storage, processing, and preparation of the Generic Environmental Impact Statement. Emplacement in geologic formations is the best disposal method for high-level waste; migration would be essentially zero, as it was in the Oklo event. Solidification processes are needed. Relations with the states, etc. are touched upon
In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10105044
The management of depression in the primary care setting should ideally take a biological, psychological, and sociological approach. Antidepressants are the most commonly used biological agents in the treatment of depression. Psychological therapies and psychosocial interventions improve the outcome of treatment when combined with pharmacotherapy. Clinical depression is treatable and thus efforts should be made to alleviate the suffering of patients with depression.
Myers, D. D.
An overview of the Shuttle Program organization and management concepts suggests the necessity of careful measurements of contractor schedules, cost and technical performance, and program modification control to keep both the development and operating cost of the Program at the lowest possible level. Maximum use of the contractors' own management systems and the utilization of new technologies, procedures and materials during space operations are also envisaged as contributors to the reduction of costs per flight to acceptable limits.
This paper discusses an annual study of the costs for the radioactive waste disposal program administered by the Office of Civilian Radioactive Waste management (OCRWM). This annual study, referred to as the Total System Life Cycle Cost (TSLCC) analysis, established the long-term financial plan for the OCRWM program and reflects as closely as possible the most current plans and policies of the program. This paper presents a summary of how the program cost projections contained in the five TSLCC analyses performed and the estimating methods used to make these cost projections have changed over time
This Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Infectious disease in cancer patients; Immunological aspects of supportive care of cancer patients; Nutritional evaluation and support of cancer patients; Pain management of cancer patients
Alkon, Abbey; Kalmar, Evie; Leonard, Victoria; Flint, Mary Louise; Kuo, Devina; Davidson, Nita; Bradman, Asa
Young children and early care and education (ECE) staff are exposed to pesticides used to manage pests in ECE facilities in the United States and elsewhere. The objective of this pilot study was to encourage child care programs to reduce pesticide use and child exposures by developing and evaluating an Integrated Pest Management (IPM) Toolkit for…
The aspects of plant ageing management (AM) gained increasing attention over the last ten years. Numerous technical studies have been performed to study the impact of ageing mechanisms on the safe and reliable operation of nuclear power plants. National research activities have been initiated or are in progress to provide the technical basis for decision making processes. The long-term operation of nuclear power plants is influenced by economic considerations, the socio-economic environment including public acceptance, developments in research and the regulatory framework, the availability of technical infrastructure to maintain and service the systems, structures and components as well as qualified personnel. Besides national activities there are a number of international activities in particular under the umbrella of the IAEA, the OECD and the EU. The paper discusses the process, procedure and database developed for Slovenian Nuclear Safety Administration (SNSA) surveillance of ageing process of Nuclear power Plant Krsko.(author)
Nuclear Power Plant (NPP) Operators are challenged with securing reliable supply channels for safety related equipment due to equipment obsolescence. Many Original Equipment Manufacturers (OEMs) have terminated production of spare parts and product life-cycle support. The average component life cycles are much shorter than the NPP design life, which means that replacement components and parts for the original NPP systems are not available for the complete design life of the NPPs. The lack or scarcity of replacement parts adversely affects plant reliability and ultimately the profitability of the affected NPPs. This problem is further compounded when NPPs pursue license renewal and approval for plant-life extension. A reliable and predictable supply of replacement co components is necessary for NPPs to remain economically competitive and meet regulatory requirements and guidelines. Electrical and I and C components, in particular, have short product life cycles and obsolescence issues must be managed pro actively and not reactively in order to mitigate the risk to the NPP to ensure reliable and economic NPP operation. (Author)
This report examines current issues relating to day care and challenges many of the policy assumptions that underlie a major public program of subsidized day care for children. A historical perspective of day care is presented and various types of day care are described. The costs and benefits of day care are examined and the relation of day care…
Physicians are becoming more involved in performance management as hospitals restructure to increase effectiveness. Although physicians are not hospital employees, they are subject to performance appraisals because the hospitals are accountable to patients and the community for the quality of hospital services. The performance of a health care professional may be appraised by the appropriate departmental manager, by other professionals in a team or program or by peers, based on prior agreemen...
Alexander J Clark
Full Text Available OBJECTIVE: Individuals with chronic pain referred to specialist chronic pain management programs frequently wait months to years for assessment and care. In the authors' pain management program, approximately 600 patients are on the waiting list. An innovative recommendation program to encourage and educate referring physicians to continue active care of pain during this waiting period was developed.
Marek, Karen Dorman; Stetzer, Frank; Adams, Scott J.; Bub, Linda Denison; Schlidt, Andrea; Colorafi, Karen Jiggins
Objectives To determine whether a home-based care coordination program focused on medication self-management would affect the cost of care to the Medicare program and whether the addition of technology, a medication-dispensing machine, would further reduce cost. Design Randomized, controlled, three-arm longitudinal study. Setting Participant homes in a large Midwestern urban area. Participants Older adults identified as having difficulty managing their medications at discharge from Medicare H...
Full Text Available Abstract Background While it is recommended that records are kept between primary care providers (PCPs and specialists during patient transitions from hospital to community care, this communication is not currently standardized. We aimed to assess the transmission of cardiac rehabilitation (CR program intake transition records to PCPs and to explore PCPs' needs in communication with CR programs and for intake transition record content. Method 144 PCPs of consenting enrollees from 8 regional and urban Ontario CR programs participated in this cross-sectional study. Intake transition records were tracked from the CR program to the PCP's office. Sixty-six PCPs participated in structured telephone interviews. Results Sixty-eight (47.6% PCPs received a CR intake transition record. Fifty-eight (87.9% PCPs desired intake transition records, with most wanting it transmitted via fax (n = 52, 78.8%. On a 5-point Likert scale, PCPs strongly agreed that the CR transition record met their needs for providing patient care (4.32 ± 0.61, with 48 (76.2% reporting that it improved their management of patients' cardiac risk. PCPs rated the following elements as most important to include in an intake transition record: clinical status (4.67 ± 0.64, exercise test results (4.61 ± 0.52, and the proposed patient care plan (4.59 ± 0.71. Conclusions Less than half of intake transition records are reaching PCPs, revealing a large gap in continuity of patient care. PCP responses should be used to develop an evidence-based intake transition record, and procedures should be implemented to ensure high-quality transitional care.
... Chairmen's ] Reports and Meeting Management. Closing Plenary (Other Business, Document Production and PMC... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is...
... Meeting Management. Other Business. Schedule for Committee Deliverables and Next Meeting Date. Adjourn... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is...
..., Agency Committee Management Office, Business Operations Group, AJP-92, NextGen & Operations Planning... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is...
Spagnulo, Marcello; Balduccini, Mauro; Nasini, Federico
Beginning with the basic elements that differentiate space programs from other management challenges, Space Program Management explains through theory and example of real programs from around the world, the philosophical and technical tools needed to successfully manage large, technically complex space programs both in the government and commercial environment. Chapters address both systems and configuration management, the management of risk, estimation, measurement and control of both funding and the program schedule, and the structure of the aerospace industry worldwide.
Tubbs, J. Eric; Heard, Michael S.; Epps, Adrian
School principals need to be well prepared to manage school facilities assigned to their care. Educational leadership programs can make best use of the Educational Leadership Constituent Council (ELCC) Standards to develop a course of study to address school facility management issues. Every standard has its facility implications that lead to…
... From the Federal Register Online via the Government Publishing Office OFFICE OF PERSONNEL MANAGEMENT Notice of Federal Long-Term Care Insurance Program Open Season; Correction AGENCY: U.S. Office of Personnel Management. ACTION: Notice; correction. SUMMARY: The Office of Personnel Management is...
Brynildson, Mark E.
The annual program report provides detailed information about all aspects of the SNL/CA Hazardous Materials Management Program for a given calendar year. It functions as supporting documentation to the SNL/CA Environmental Management System Program Manual. The 2005 program report describes the activities undertaken during the past year, and activities planned in future years to implement the Hazardous Materials Management Program, one of six programs that supports environmental management at SNL/CA.
Gold, Marsha; Felt, Suzanne
The massive shift to managed care in many State Medicaid programs heightens the importance of identifying effective approaches to promote and oversee quality in plans serving Medicaid enrollees. This article reviews operational issues and lessons from the ongoing evaluation of a three-State demonstration of the Health Care Financing Administration's (HCFA) Quality Assurance Reform Initiative (QARI) for Medicaid managed care. The QARI experience to date shows the potential utility of the syste...
Roets-Merken, Lieve M.; Graff, Maud J. I.; Zuidema, Sytse U.; Hermsen, Pieter G. J. M.; Teerenstra, Steven; Kempen, Gertrudis I. J. M.; Vernooij-Dassen, Myrra J. F. J.
Background: Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study
Roets-Merken, L.M.; Graff, M.J.L.; Zuidema, S.U.; Hermsen, P.G.; Teerenstra, S.; Kempen, G.I.J.M.; Vernooij-Dassen, M.J.F.J.
BACKGROUND: Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study
The wildly varying utilization and quality control practices that make up "managed care" make it difficult to generalize new rules and requirements. Information that can aid counselor trainees in understanding the demands of managed health care is presented. The text explores the following questions: (1) "What do managed care companies want?" and…
B. Hipple-Walters (Bethany); S.A. Adams (Samantha); A.P. Nieboer (Anna); R.A. Bal (Roland)
textabstractBackground: Disease management programs, especially those based on the Chronic Care Model (CCM),are increasingly common in the Netherlands. While disease management programs have beenwell-researched quantitatively and economically, less qualitative research has been done. Theoverall aim
Schmittdiel, Julie A.; Shortell, Stephen M.; Rundall, Thomas G; Bodenheimer, Thomas; SELBY, Joe V.
PURPOSE It has been suggested that the best way to improve chronic illness care is through a redesign of primary care emphasizing comprehensive, coordinated care as espoused by the Chronic Care Model (CCM). This study examined the relationship between primary care orientation and the implementation of the CCM in physician organizations.
Bruce, Martha L; Raue, Patrick J.; Sheeran, Thomas; Reilly, Catherine; Pomerantz, Judith C.; Meyers, Barnett S.; Weinberger, Mark I.; Zukowski, Diane
High levels of depressive symptoms are common and contribute to poorer clinical outcomes even in geriatric patients who are already taking antidepressant medication. The Depression CARE for PATients at Home (Depression CAREPATH) intervention was designed to meet the needs of medical and surgical patients who suffer from depression. The intervention’s clinical protocols are designed to guide clinicians in managing depression as part of routine home care.
Full Text Available The main purpose of this paper is to give A view of the hospital waste management and environmental problem in india. The objective of this study is to analyze the health care waste management system, including practices and compliances. Most countries of the world, especially the developing countries, are facing the grim situation arising out of environmental pollution due to pathological waste arising from increasing populations and the consequent rapid growth in the number of hospital units. In india, there are about 6 lakhs hospital beds, over 23,000 primary health centers, more than 15,000 small and private hospitals. In india, the biomedical waste (management and handling rules 1998 make it mandatory for hospitals, clinics, and other medical and veterinary institutes to dispose of bio medical wastes strictly according to the rules.
Adel M. Bassily-Marcus
Full Text Available Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases.
Dill, Janette S; Chuang, Emmeline; Morgan, Jennifer C
Increasing concerns about quality of care and workforce shortages have motivated health care organizations and educational institutions to partner to create career ladders for frontline health care workers. Career ladders reward workers for gains in skills and knowledge and may reduce the costs associated with turnover, improve patient care, and/or address projected shortages of certain nursing and allied health professions. This study examines partnerships between health care and educational organizations in the United States during the design and implementation of career ladder training programs for low-skill workers in health care settings, referred to as frontline health care workers. Mixed methods data from 291 frontline health care workers and 347 key informants (e.g., administrators, instructors, managers) collected between 2007 and 2010 were analyzed using both regression and fuzzy-set qualitative comparative analysis (QCA). Results suggest that different combinations of partner characteristics, including having an education leader, employer leader, frontline management support, partnership history, community need, and educational policies, were necessary for high worker career self-efficacy and program satisfaction. Whether a worker received a wage increase, however, was primarily dependent on leadership within the health care organization, including having an employer leader and employer implementation policies. Findings suggest that strong partnerships between health care and educational organizations can contribute to the successful implementation of career ladder programs, but workers' ability to earn monetary rewards for program participation depends on the strength of leadership support within the health care organization. PMID:25441318
Bruera, E; Neumann, C M; Gagnon, B.; Brenneis, C; Kneisler, P; Selmser, P; J Hanson
The Edmonton Regional Palliative Care Program was established in July 1995 to measure the access of patients with terminal cancer to palliative care services, decrease the number of cancer-related deaths in acute care facilities and increase the participation of family physicians in the care of terminally ill patients. In this retrospective study the authors compared the pattern of care and site of deaths before establishment of the program (1992/93) and during its second year of operation (1...
Dillon Carla; Twells Laurie; Bishop Lisa; Young Stephanie; Hawboldt John; O'Shea Patrick
Abstract Background The beneficial outcomes of oral anticoagulation therapy are dependent upon achieving and maintaining an optimal INR therapeutic range. There is growing evidence that better outcomes are achieved when anticoagulation is managed by a pharmacist with expertise in anticoagulation management rather than usual care by family physicians. This study compared a pharmacist managed anticoagulation program (PC) to usual physician care (UC) in a family medicine clinic. Methods A retros...
Harachi, Tracy; Anthony, Emily; Bleisner, Siri
Seattle's Comprehensive Child Care Program (CCCP) (Washington) is made up of a child care subsidy to offset child care costs for working and student families with low incomes, and quality assurance and technical assistance for 150 child care providers, including on-site evaluations, public health consulting, continuing education for providers, and…
L M G Steuten
Full Text Available L M G Steuten1, K M M Lemmens2, A P Nieboer2, H JM Vrijhoef31Maastricht University Medical Centre, School for Care and Public Health Research, Department of Health, Organisation, Policy and Economics, Maastricht, The Netherlands; 2Erasmus University Medical Centre, Institute of Health Policy and Management, Rotterdam, The Netherlands; 3Maastricht University Medical Centre, School for Care and Public Health Research, Department of Integrated Care, Maastricht, The NetherlandsObjective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified.Methods: Systematic search of Medline and Cochrane databases for evaluations of multi-component disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized.Results: Twenty articles describing 17 unique COPD programs were included. There is little evidence for significant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specific knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing ≥3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money.Conclusion: Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate significant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specific programs illustrated in this paper can, in the absence of ‘perfect data’, support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision
... National Oceanic Atmospheric Administration Alaska Coastal Management Program Withdrawal From the National Coastal Management Program Under the Coastal Zone Management Act (CZMA) AGENCY: Office of Ocean and Coastal Resource Management (OCRM), National Ocean Service (NOS), National Oceanic...
In 2005, two physicians, former NASA astronauts, created LifeWings Partners LLC in Memphis, Tennessee and began using Crew Resource Management (CRM) techniques developed at Ames Research Center in the 1970s to help improve safety and efficiency at hospitals. According to the company, when hospitals follow LifeWings? training, they can see major improvements in a number of areas, including efficiency, employee satisfaction, operating room turnaround, patient advocacy, and overall patient outcomes. LifeWings has brought its CRM training to over 90 health care organizations and annual sales have remained close to $3 million since 2007.
Rodwin, Marc A
The conventional wisdom is that managed care's brief life is over and we are now in a post-managed care era. In fact, managed care has a long history and continues to thrive. Writers also often assume that managed care is a fixed thing. They overlook that managed care has evolved and neglect to examine the role that it plays in the health system. Furthermore, private actors and the state have used managed care tools to promote diverse goals. These include the following: increasing access to medical care; restricting physician entrepreneurialism; challenging professional control over the medical economy; curbing medical spending; managing medical practice and markets; furthering the growth of medical markets and private insurance; promoting for-profit medical facilities and insurers; earning bounties for reducing medical expenditures: and reducing governmental responsibility for, and oversight of, medical care. Struggles over these competing goals spurred the metamorphosis of managed care. This article explores how managed care transformed physicians' conflicts of interests and responses to them. It also examines how managed care altered the opportunities for patients/medical consumers to use exit and voice to spur change. PMID:20579232
Hedley-Williams, Andrea J.; Sladen, Douglas P.; Tharpe, Anne Marie
This article provides an overview of current cochlear implant technology, programming strategies, troubleshooting, and care techniques. It considers: device components, initial stimulation, speech coding strategies, use and care, troubleshooting, and the classroom environment. (Contains references.) (DB)
Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A.
Background Care management in primary care can be effective in helping patients with chronic disease improve their health status. Primary care practices, however, are often challenged with its implementation. Incorporating care management involves more than a simple physical process redesign to existing clinical care routines. It involves changes to who is working with patients, and consequently such things as who is making decisions, who is sharing patient information, and how. Studying the ...
Many public power systems have initiated home energy audit programs in response to the requests of their consumers. The manual provides smaller public power systems with the information and specific skills needed to design and develop a program of residential energy audits. The program is based on the following precepts: locally owned public systems are the best, and in many cases the only agencies available to organize and coordinate energy conservation programs in many smaller communities; consumers' rights to energy conservation information and assistance should not hinge on the size of the utility that serves them; in the short run, public power systems of all sizes should offer residential energy conservation assistance to their consumers, because such assistance is desirable, necessary, and in the public interest; and in the long run, such programs will complement national energy goals and will produce economic benefits for both consumers and the public power system. A detailed description of home audit program planning, organization, and management are given. (MCW)
This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with better outcomes in diabetes care. Quality management was measured with newly developed questionnaires about organisation of care, multidisciplinary teamwork, patient centeredness, performance results, q...
Harris, Diane; Hillier, Loretta M; Keat, Nancy
This paper describes an education program designed to improve palliative care practice through the development of workplace hospice palliative care resources (PCRs), and its impact on knowledge transfer and longer-term changes to clinical practice. Evaluation methods included pre- and post-program questionnaires, and a survey of learners' (n=301) perceptions of program learning strategies. Interviews (n=21) were conducted with a purposeful sample of PCRs and representatives from their work sites. Ratings of the sessions indicated that they were relevant to learners' clinical practice. At follow up, the majority of learners (83%) continued to serve as PCRs. Many positive effects were identified, including enhanced pain and symptom management, staff education, and development of care policies and guidelines. Management support, particularly the prioritization of palliative care and staff development, were factors facilitating sustained implementation. These findings highlight the importance of multimodal learning strategies and supportive work environments in the development of PCRs to enhance palliative care practice. PMID:18251444
Erdmann, Y; Wilson, R
This article summarizes recent developments in the United Kingdom, the Netherlands, Switzerland, and the new Baltic states that reflect the influence of US managed care concepts and practices. We emphasize (a) developments in restructuring traditional health insurance mechanisms by shifting premium and out-of-pocket burdens to consumers so as to constrain demand and costs and (b) reliance on prospective hospital budgets and case management by primary physicians. Social insurance mechanisms and universal coverage remain national tasks as well as basic components of the social structure of most European countries. Full open-market competition between traditional sick funds and private insurance companies and the introduction of for-profit MCOs beholden to their shareholders appears unlikely on other than an experimental basis. Increased competition between providers may well result from the new right of insurers and payers to contract with medical care providers of their choice. It remains to be shown how far these experiments, which differ substantially between the countries examined, will succeed in their objectives and become permanent features of their national systems. PMID:11274522
This Management Control Plan has been prepared to define the Energy Systems approach to managing its participation in the US DOE's Environmental Restoration (ER) Program in a manner consistent with DOE/ORO 931: Management Plan for the DOE Field Office, Oak Ridge, Decontamination and Decommissioning Program; and the Energy Systems Environmental Restoration Contract Management Plan (CMP). This plan discusses the systems, procedures, methodology, and controls to be used by the program management team to attain these objectives
... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Program management. 1214.1706 Section 1214... Participants § 1214.1706 Program management. The Associate Administrator for Space Flight is responsible for program management under the direction of the Committee chairperson....
... 10 Energy 4 2010-01-01 2010-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility...
... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Program management. 402.13 Section 402.13... WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Application, Evaluation, and Management Procedures § 402.13 Program management. (a) After the conclusion of negotiations, the USGS will transmit a grant...
... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal...
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Program management. 638.800 Section 638.800... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Administrative Provisions § 638.800 Program management. (a) The Job Corps Director shall establish and use internal program management procedures...
Thornton, P.T.; Spence, K.
As government funding grows scarce, competition between the national laboratories is increasing dramatically. In this era of tougher competition, there is no for resistance to change. There must instead be a uniform commitment to improving the overall quality of our products (research and technology) and an increased focus on our customers` needs. There has been an ongoing effort to bring the principles of total quality management (TQM) to all Energy Systems employees to help them better prepare for future changes while responding to the pressures on federal budgets. The need exists for instituting a vigorous program of education and training to an understanding of the techniques needed to improve and initiate a change in organizational culture. The TQM facilitator is responsible for educating the work force on the benefits of self-managed work teams, designing a program of instruction for implementation, and thus getting TQM off the ground at the worker and first-line supervisory levels so that the benefits can flow back up. This program plan presents a conceptual model for TQM in the form of a hot air balloon. In this model, there are numerous factors which can individually and collectively impede the progress of TQM within the division and the Laboratory. When these factors are addressed and corrected, the benefits of TQM become more visible. As this occurs, it is hoped that workers and management alike will grasp the ``total quality`` concept as an acceptable agent for change and continual improvement. TQM can then rise to the occasion and take its rightful place as an integral and valid step in the Laboratory`s formula for survival.
Johnson, L. A.; Derlet, R W
To control costs, managed care organizations have begun to restrict the use of hospital emergency departments by their enrollees. They are doing this by educating enrollees, providing better access to 24-hour urgent care, denying preauthorizations for care for some patients who do present to emergency departments, and retrospectively denying payment for certain patients who use emergency services. Changing traditional use of emergency departments has resulted in conflicts between managed care...
Wallace, Cara L
This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care. PMID:27332743
Gans, Gary (Technical Monitor)
As basic policy, NASA believes that colleges and universities should be encouraged to participate in the nation's space and aeronautics program to the maximum extent practicable. Indeed, universities are considered as partners with government and industry in the nation's aerospace program. NASA's objective is to have them bring their scientific, engineering, and social research competence to bear on aerospace problems and on the broader social, economic, and international implications of NASA's technical and scientific programs. It is expected that, in so doing, universities will strengthen both their research and their educational capabilities to contribute more effectively to the national well being. This annual report is one means of documenting the NASA-university relationship, frequently denoted, collectively, as NASA's University Program. This report is consistent with agency accounting records, as the data is obtained from NASA's Financial and Contractual Status (FACS) System, operated by the Financial Management Division and the Procurement Office. However, in accordance with interagency agreements, the orientation differs from that required for financial or procurement purposes. Any apparent discrepancies between this report and other NASA procurement or financial reports stem from the selection criteria for the data.
Griffin, Brenda; Bushby, Philip A; McCobb, Emily; White, Sara C; Rigdon-Brestle, Y Karla; Appel, Leslie D; Makolinski, Kathleen V; Wilford, Christine L; Bohling, Mark W; Eddlestone, Susan M; Farrell, Kelly A; Ferguson, Nancy; Harrison, Kelly; Howe, Lisa M; Isaza, Natalie M; Levy, Julie K; Looney, Andrea; Moyer, Michael R; Robertson, Sheilah Ann; Tyson, Kathy
As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs. PMID:27379593
Chung, Young-Soon; Kim, Yongsuk; Lee, Chang Hee
Objectives The aim of this study was to assess the effectiveness of the Smart Care service for the diabetes management. Methods Fifty-six patients with diabetes mellitus were recruited in Daegu, Korea. All participants completed a diabetes management education course (diet, exercise, and complications) for their self-care and received access to a care management website through a netbook and smartphone. The website accepts uploads of glucose level, body weight, HbA1c, low-density lipoprotein ...
Full Text Available Over the last decade, the approach to clinical management of blood glucose concentration (BGC in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high BGC variability, optimal BGC target range and BGC monitoring devices for patients in the intensive care unit (ICU will be discussed. Hypoglycemia has an increased risk of death, even after the occurrence of a single episode of mild hypoglycemia (BGC < 80 mg/dL, and it is also associated with an increase in the ICU length of stay, the major determinant of ICU costs. Hyperglycemia (with a threshold value of 180 mg/dL is associated with an increased risk of death, longer length of stay and higher infective morbidity in ICU patients. In ICU patients, insulin infusion aimed at maintaining BGC within a 140-180 mg/dL target range (NICE-SUGAR protocol is considered to be the state-of-the-art. Recent evidence suggests that a lower BGC target range (129-145 mg/dL is safe and associated with lower mortality. In trauma patients without traumatic brain injury, tight BGC (target < 110 mg/dL might be associated with lower mortality. Safe BGC targeting and estimation of optimal insulin dose titration should include an adequate nutrition protocol, the length of insulin infusion and the change in insulin sensitivity over time. Continuous glucose monitoring devices that provide accurate measurement can contribute to minimizing the risk of hypoglycemia and improve insulin titration. In conclusion, in ICU patients, safe and effective glycemia management is based on accurate glycemia monitoring and achievement of the optimal BGC target range by using insulin titration, along with an adequate nutritional protocol.
Kruis, A L; Chavannes, N H
Chronic obstructive pulmonary disease (COPD) represents a major and progressive cause of morbidity and mortality worldwide, resulting in an important financial and health burden in coming decades. Pulmonary rehabilitation (PR) has been proven to be the most effective treatment in all patients in whom respiratory symptoms are associated with diminished functional capacity or reduced quality of life. Nevertheless, despite wide recommendation and proven efficacy, the use of PR is limited in daily practice. Reasons for these include low accessibility and availability, high costs, and lack of motivation to continue a healthy life style after treatment. By contrast, it has been demonstrated that primary care patients can be reactivated by formulating personal targets and designing individualized treatment plans in collaboration with their general practitioner or practice nurse. Based on these personal plans and targets, specific education must be provided and development of self management skills should be actively encouraged. Ideally, elements of pulmonary rehabilitation are tailored into a comprehensive primary care integrated disease management program. In that way, the benefits of PR can be extended to a substantially larger part of the COPD population, to reach even those with milder stages of disease. Favorable long-term effects on exercise tolerance and quality of life in a number of studies have been demonstrated in recent years, but broad introduction in the primary care setting still needs further justification in the form of a proper cost effectiveness analysis. PMID:21214043
Smith, Grant; Bernacki, Rachelle; Block, Susan D
By 2021, health care spending is projected to grow to 19.6% of the GDP, likely crowding out spending in other areas. The 2010 Affordable Care Act (ACA) attempts to curb health care spending by incentivizing high-value care through the creation of Accountable Care Organizations (ACOs), which assume financial risk for patient outcomes. With this financial risk, health systems creating ACOs will be motivated to pursue innovative care models that maximize the value of care. Palliative care, as an emerging field with a growing evidence base, is positioned to improve value in ACOs by increasing high-quality care and decreasing costs for the sickest patients. ACO leaders may find palliative care input valuable in optimizing high-quality patient-centered care in the accountable care environment; however, palliative care clinicians will need to adopt new models that extrapolate their direct patient care skills to population management strategies. We propose that palliative care specialists take on responsibilities for working with ACO leaders to broaden their mission for systemwide palliative care for appropriate patients by prospectively identifying patients with a high risk of death, high symptom burden, and/or significant psychosocial dysfunction, and developing targeted, "triggered" interventions to enhance patient-centered, goal-consistent, coordinated care. Developing these new population management competencies is a critical role for palliative care teams in the ACO environment. PMID:25723619
The Environmental Restoration Information Resources Management (ER IRM) Program Plan defines program requirements, organizational structures and responsibilities, and work breakdown structure and to establish an approved baseline against which overall progress of the program as well as the effectiveness of its management will be measured. This plan will guide ER IRM Program execution and define the program`s essential elements. This plan will be routinely updated to incorporate key decisions and programmatic changes and will serve as the project baseline document. Environmental Restoration Waste Management Program intersite procedures and work instructions will be developed to facilitate the implementation of this plan.
Marcelo Costa Fernandes
Full Text Available Objective: to identify, from nurses’ speeches, the actions that enable care management in the Family Health Strategy.Methods: descriptive study with a qualitative approach conducted with 32 nurses of primary care. It was used a semistructuredinterview as the data collection technique. The methodological process of the collective subject discourse wasused to organize the data Results: from the nurses’ speeches one identified the categories: complementary relationshipbetween care and management; meeting with community health agents, a care management strategy in nurses’ work;health education activities such as a care management action and a health information system as an essential tool forcare Conclusion: it was possible to observe that nurses understood the importance of coordination and complementaritybetween the activities of the working process of care and management.
Faeda, Marília Silveira; Perroca, Márcia Galan
ABSTRACT Objectives: analyze agreement between nursing prescriptions recorded in medical files and patients' care needs; investigate the correlation between the nurses' professional background and agreement of prescriptions. Method: descriptive study with quantitative and documentary approach conducted in the medical clinic, surgical, and specialized units of a university hospital in the interior of São Paulo, Brazil. The new validated version of a Patient Classification Instrument was used and 380 nursing prescriptions written at the times of hospital admission and discharge were assessed. Results: 75% of the nursing prescriptions items were compatible with the patients' care needs. Only low correlation between nursing prescription agreement and professional background was found. Conclusion: the nursing prescriptions did not fully meet the care needs of patients. The care context and work process should be analyzed to enable more effective prescriptions, while strategies to assess the care needs of patients are recommended. PMID:27508902
Frederick C. Lee
The cancer disease management field took root in the early 1990s. Health plans in the US seeking to aggressively manage cancer reached out to entrepreneurial start-ups that had infused the general principles of managed care into cancer programs. More than two dozen health plans had adopted some form of cancer disease management by the end of the century. However, employers, witnessing the managed care backlash and experiencing difficulty recruiting an adequate pool of skilled labor during flu...
This document outlines the operational and research and development (R and D) activities of the Office of Nuclear Waste Management (ETW) under the Assistant Secretary for Energy Technology, DOE. The national energy policy as it applies to waste management and spent fuel storage is presented first. The program strategy, structure, budget, management approach, and public participation programs are then identified. The next section describes program activities and outlines their status. Finally, the applicability of departmental policies to ETW programs is summarized, including field and regional activities, commercialization plans, the environmental and socioeconomic implications of waste management activities, and international programs
McKay, Niccie L; Meng, Xiaoxian
This study examines the effect of managed care on hospitals' provision of uncompensated care, using a new measure of managed care that is hospital-specific, rather than measured for the area as a whole, and which includes payment by preferred provider organizations (PPOs) as well as by health maintenance organizations (HMOs). Based on data for Florida hospitals in the period 1998-2002, the results indicate that a higher percentage of private managed care patient-days was associated with a decrease in uncompensated care as a percentage of total operating expenses, holding net profit margin and other factors constant. The results suggest that spillover effects on uncompensated care should be taken into account when considering increases in managed care payment. PMID:17583265
Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.;
Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients...... with type 2 diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by insurance data analysis. Intervention: We compared protocol-based care management including structured assessment, action...
Full Text Available Abstract Background Disease management programs, especially those based on the Chronic Care Model (CCM, are increasingly common in the Netherlands. While disease management programs have been well-researched quantitatively and economically, less qualitative research has been done. The overall aim of the study is to explore how disease management programs are implemented within primary care settings in the Netherlands; this paper focuses on the early development and implementation stages of five disease management programs in the primary care setting, based on interviews with project leadership teams. Methods Eleven semi-structured interviews were conducted at the five selected sites with sixteen professionals interviewed; all project directors and managers were interviewed. The interviews focused on each project’s chosen chronic illness (diabetes, eating disorders, COPD, multi-morbidity, CVRM and project plan, barriers to development and implementation, the project leaders’ action and reactions, as well as their roles and responsibilities, and disease management strategies. Analysis was inductive and interpretive, based on the content of the interviews. After analysis, the results of this research on disease management programs and the Chronic Care Model are viewed from a traveling technology framework. Results This analysis uncovered four themes that can be mapped to disease management and the Chronic Care Model: (1 changing the health care system, (2 patient-centered care, (3 technological systems and barriers, and (4 integrating projects into the larger system. Project leaders discussed the paths, both direct and indirect, for transforming the health care system to one that addresses chronic illness. Patient-centered care was highlighted as needed and a paradigm shift for many. Challenges with technological systems were pervasive. Project leaders managed the expenses of a traveling technology, including the social, financial, and
The Environmental Restoration Information Resources Management (ER IRM) Program Plan defines program requirements, organizational structures and responsibilities, and work breakdown structure and to establish an approved baseline against which overall progress of the program as well as the effectiveness of its management will be measured. This plan will guide ER IRM Program execution and define the program's essential elements. This plan will be routinely updated to incorporate key decisions and programmatic changes and will serve as the project baseline document. Environmental Restoration Waste Management Program intersite procedures and work instructions will be developed to facilitate the implementation of this plan
Floyd, Latosha; Phillips, Deborah A
The U.S. military has come to realize that providing reliable, high-quality child care for service members' children is a key component of combat readiness. As a result, the Department of Defense (DoD) has invested heavily in child care. The DoD now runs what is by far the nation's largest employer-sponsored child-care system, a sprawling network with nearly 23,000 workers that directly serves or subsidizes care for 200,000 children every day. Child-care options available to civilians typically pale in comparison, and the military's system, embedded in a broader web of family support services, is widely considered to be a model for the nation. The military's child-care success rests on four pillars, write Major Latosha Floyd and Deborah A. Phillips. The first is certification by the military itself, including unannounced inspections to check on safety, sanitation, and general compliance with DoD rules. The second is accreditation by nationally recognized agencies, such as the National Association for the Education of Young Children. The third is a hiring policy that sets educational and other requirements for child-care workers, and the fourth is a pay scale that not only sets wages high enough to discourage the rapid turnover common in civilian child care but also rewards workers for completing additional training. Floyd and Phillips sound a few cautionary notes. For one, demand for military child care continues to outstrip the supply In particular, as National Guard and Reserve members have been activated during the wars in Iraq and Afghanistan, the DoD has sometimes struggled to provide child care for their children. And force reductions and budget cuts are likely to force the military to make difficult choices as it seeks to streamline its child-care services in the years ahead. PMID:25518693
Full Text Available Abstract Background Elderly care practice and its management together with policy and research play a crucial role in responding to increasing challenges in institutional care for elderly people. Successful dialogue between these is necessary. The purpose of this systematic literature review is to compare how institutional elderly care management research meets the care challenges currently emphasized in international long-term care policy documents. Methods This paper was based on a systematic literature review. After screening 1971 abstracts using inclusion/exclusion criteria, 58 refereed articles published between 2000 and 2010 remained for analysis. The articles were analyzed using theory-based content analysis by comparing the results to the framework based on analysis of international long-term care management policy documents. Results The current challenges of long-term care management identified from policy documents were Integrated Care Management, Productivity Management, Quality Management, Workforce Management and ICT Management. The research on institutional elderly care management responded somewhat to the challenges mentioned in policy documents. However, some of the challenges were studied broadly and some were paid only minor attention. Further, only few studies focused on the core items of challenges addressed in policy documents. Conclusions Institutional care management research needs to focus more on challenges in integrated care, productivity, ICT and division of labor. Managers, researchers and policy-makers should assume more active collaborative roles in processes of research, policymaking and policy implementation. In addition managers’ and policymakers’ scientific literacy needs to be enhanced.
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
Rekhter, Natalia; Togunov, Igor A.
Introduction: For more than 70 years, health care management in the Soviet Union reflected a centralized directive style familiar to the Soviet political system. Market-oriented reform in post-Soviet Russia is pushing practicing physicians and physician-executives to acquire new information and skills regarding health care management. To assist…
Soroka, Mort; Reis, Lesley
Studied the courses and topics offered at schools of optometry and the total hours devoted to managed care. Responses from the 17 schools of optometry reveal significant variations in curricular coverage of managed care, although a core set of materials was found to exist that could be the basis for more standard curriculum. (SLD)
Brown, H Shelton; Pagán, José A
Managed care penetration has been partly responsible for slowing down increases in health care costs in recent years. This study uses a 1992-1996 Health Care Utilization Project sample of hospitals to analyze the relationship between managed care penetration in local insurance markets and hospital scale efficiency. After controlling for hospital and market area variables, we find that managed care insurance, particularly the preferred provider type, is associated with increases in hospital scale efficiency in tertiary cases. The results presented here are consistent with the view that managed care can lead to reductions in health cost inflation by controlling the diffusion of technology via improvements in the scale efficiency of hospitals. PMID:17111213
Izzo, Charles V; Smith, Elliott G; Holden, Martha J; Norton, Catherine I; Nunno, Michael A; Sellers, Deborah E
The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening "upstream" at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions. PMID:27138932
Peterson, Kristina; Rogers, Bonnie M E; Brosseau, Lisa M; Payne, Julianne; Cooney, Jennifer; Joe, Lauren; Novak, Debra
This article compares hospital managers' (HM), unit managers' (UM), and health care workers' (HCW) perceptions of respiratory protection safety climate in acute care hospitals. The article is based on survey responses from 215 HMs, 245 UMs, and 1,105 HCWs employed by 98 acute care hospitals in six states. Ten survey questions assessed five of the key dimensions of safety climate commonly identified in the literature: managerial commitment to safety, management feedback on safety procedures, coworkers' safety norms, worker involvement, and worker safety training. Clinically and statistically significant differences were found across the three respondent types. HCWs had less positive perceptions of management commitment, worker involvement, and safety training aspects of safety climate than HMs and UMs. UMs had more positive perceptions of management's supervision of HCWs' respiratory protection practices. Implications for practice improvements indicate the need for frontline HCWs' inclusion in efforts to reduce safety climate barriers and better support effective respiratory protection programs and daily health protection practices. PMID:27056750
McConnell, K. John; Lindrooth, Richard C; Wholey, Douglas R; Maddox, Thomas M.; Bloom, Nicholas
Importance:- To improve the quality of health care, many researchers have suggested that health care institutions adopt management approaches that have been successful in the manufacturing and technology sectors. However, relatively little information exists about how these practices are disseminated in hospitals and whether they are associated with better performance. Objectives:- To describe the variation in management practices among a large sample of hospital cardiac care units; asses...
Rich, Miriam Sommers
An agricultural research program managed at Virginia Tech has won an international award for its work with pest-management practices that show economic benefits with minimal impact on health and the environment.
Kokkonen Kaija; Rissanen Sari; Hujala Anneli
Abstract Background Elderly care practice and its management together with policy and research play a crucial role in responding to increasing challenges in institutional care for elderly people. Successful dialogue between these is necessary. The purpose of this systematic literature review is to compare how institutional elderly care management research meets the care challenges currently emphasized in international long-term care policy documents. Methods This paper was based on a systemat...
Streed, Stephen A.; Massanari, R. Michael
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....
Wound care is an important step in promoting wound healing, but it may cause wound care pain. This article aims to explore factors influencing wound care pain and the effectiveness of various interventions to alleviate it. Five major factors that influence wound care pain include inappropriate dressing change techniques, inflammation response, emotion, cognition, and social-cultural factors. Nurses should apply appropriate dressings and dressing change techniques to relieve wound care pain. Music therapy and aromatherapy can alleviate wound pain after dressing change. But distraction techniques should be used in conjunction with consideration of the needs of the individual subject. PMID:17554674
Green, Cynthia P.
Program management has received insufficient attention among family planning leaders, possibly because of medical or demographic background of many leaders, a focus on other program priorities (such as sheer survival), the pressure to expand programs rapidly, and limited donor interest in the subject. As programs grow in complexity, the problems resulting from weak management systems become more obvious, and organizations are compelled to introduce rational systems. The more successful family...
Weech-Maldonado, R; Morales, L. S.; Spritzer, K; Elliott, M.; Hays, R D
OBJECTIVE: This study examines whether parents' reports and ratings of pediatric health care vary by race/ethnicity and language in Medicaid managed care. DATA SOURCES: The data analyzed are from the National Consumer Assessment of Health Plans (CAHPS) Benchmarking Database 1.0 and consist of 9,540 children enrolled in Medicaid managed care plans in Arkansas, Kansas, Minnesota, Oklahoma, Vermont, and Washington state from 1997 to 1998. DATA COLLECTION: The data were collected by telephone and...
Roby, Dylan H.; Kominski, Gerald F.; Nadereh Pourat
Disease management has gained popularity as a way to improve health status and control of chronic illness through the use of risk stratification, targeted nurse outreach, telephonic nurse advice, and evidence-based guidelines in managing illness. Disease management programs have been successfully implemented by commercial insurers and managed care plans, as well as in Medicare and state Medicaid programs. Although evidence regarding cost savings is inconsistent, it appears that disease manage...
Joanna Kobza; Magdalena Syrkiewicz-Świtała
Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011) have be...
Berenson, Robert A; Horvath, Jane
This paper examines the ability of the current Medicare program--both traditional fee-for-service and risk-based contracting--to address the needs of beneficiaries with chronic conditions, who represent almost 80 percent of program enrollment. Grounded in indemnity insurance principles, including concerns about "moral hazard," the traditional Medicare program faces difficulty evolving to support of a chronic care model of health care practice. Although capitation may be the most desirable platform to support provision of care to beneficiaries with chronic conditions, the current structural limitations and problems faced in the Medicare+Choice program limit capitation's use at this time. PMID:14527234
Physicians are increasingly expected to assume responsibility for the management of human and financial resources in health care, particularly in hospitals. Juggling their new management responsibilities with clinical care, teaching and research can lead to conflicting roles. However, their presence in management is crucial to shaping the future health care system. They bring to management positions important skills and values such as observation, problem-solving, analysis and ethical judgeme...
Maeng, Daniel D; Snyder, Susan R; Baumgart, Charles; Minnich, Amy L; Tomcavage, Janet F; Graf, Thomas R
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
Eng Benjamin; Schaaf David; McAdam-Marx Carrie; Holtorf Anke-Peggy; Oderda Gary
Abstract Background Maintaining quality of care while managing limited healthcare resources is an ongoing challenge in healthcare. The objective of this study was to evaluate how the impact of drug management programs is reported in the literature and to identify potentially existing quality standards. Methods This analysis relates to the published research on the impact of drug management on economic, clinical, or humanistic outcomes in managed care, indemnity insurance, VA, or Medicaid in t...
Holtorf, Anke-Peggy; McAdam-Marx, Carrie; Schaaf, David; Eng, Benjamin; Oderda, Gary
Background Maintaining quality of care while managing limited healthcare resources is an ongoing challenge in healthcare. The objective of this study was to evaluate how the impact of drug management programs is reported in the literature and to identify potentially existing quality standards. Methods This analysis relates to the published research on the impact of drug management on economic, clinical, or humanistic outcomes in managed care, indemnity insurance, VA, or Medicaid in the USA pu...
The impact of a disease management program (COACH on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study: a randomised controlled trial
Selvaraj Francis Jude
Full Text Available Abstract Background To evaluate the efficacy of Counselling and Advisory Care for Health (COACH programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm and primary care physicians assisted by nurse educators (PCP-NE arm. Methods This was a multi-centre, open label, randomised trial of a disease management programme (COACH among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE and 148 to care provided by primary care physicians (PCP alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio, Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36. Results Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS mean change from baseline LDL-C were −30.09% and −27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288, with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had
Mirhashemi, R; Janicek, M F; Schoell, W M
Radical pelvic surgery in gynecologic oncology patients poses a challenge to the surgeon and the ancillary team in charge of the peri-operative care. The high frequency of medical problems observed in this patient population, in conjunction with the stresses of radical surgery, necessitates careful monitoring of patients' medical status. A comprehensive team approach in the perioperative period is critical to patient care. Early intervention and anticipation of potential problems for the patient at risk in the postoperative period minimizes morbidity and mortality. This article will review the essentials of critical care as it relates to patients undergoing radical pelvic operations. PMID:10225307
Busch, Alisa B; Huskamp, Haiden A; McWilliams, J Michael
People with mental illness use more health care and have worse outcomes than those without such illnesses. In response to incentives to reduce spending, accountable care organizations (ACOs) may therefore attempt to improve their management of mental illness. We examined changes in mental health spending, utilization, and quality measures associated with ACO contracts in the Medicare Shared Savings Program and Pioneer model for beneficiaries with mental illness, using Medicare claims for the period 2008-13 and difference-in-differences comparisons with local non-ACO providers. Pioneer contracts were associated with lower spending on mental health admissions in the first year of the contract, an effect that was attenuated in the second year. Otherwise, ACO contracts were associated with no changes in mental health spending or readmissions, outpatient follow-up after mental health admissions, rates of depression diagnosis, or mental health status. These results suggest that ACOs have not yet focused on mental illness or have been largely unsuccessful in early efforts to improve their management of it. PMID:27385241
textabstractDisease management has emerged as a new strategy to enhance quality of care for patients suffering from chronic conditions, and to control health care costs. So far, however, the effects of this strategy remain unclear. The purpose of this thesis was to determine the core elements of disease management and to understand how they operate and interact in order to effectively evaluate disease-management programmes, particularly for patients with chronic obstructive pulmonary disease....
Petri, Cynthia J.; Winnail, Scott D.; Geiger, Brian F.; Artz, Lynn M.; Mason, J. W.
Children, parents, and child caregivers are vulnerable to several infectious diseases as a result of contact with child care centers. This pilot program, implemented in a rural county in a southeastern state, was designed to enhance knowledge and skills related to improved hygiene practices in a child care setting. The target audience for the…
Shaughnessy, Mary Angela
This publication addresses issues concerning the application of the law to extended-day Catholic schools. The first chapter provides an overview of extended care. In the second chapter, sources of the law that are applied to extended care programs are described. Canon law affects Catholic schools. Catholic schools are also subject to four types of…
Blackwell, Jacqueline; Leeper, Sarah H.
In order to determine the effect of day care center sponsorship on children's development, the authors examined the ways in which programs, objects and materials, and teacher/child interactions affected the preoperational behavior of 4-year-old black children in publicly and privately supported day care centers. A total of 120 4-year-olds (30 from…
This presentation will discuss one approach to performing a management evaluation of waste disposal programs by: describing how the Department of Energy environment, safety and health (ES and H) oversight activities evolved into a management evaluation program based on three guiding principles showing how these three guiding principles provide a programmatic approach to determine the effectiveness of environment (including waste management), safety and health programs; exploring a process that can be used to conduct a management evaluation of your waste disposal programs using these guiding principles; and describing how these guiding principles are used in performing Safety Management Evaluations at Department of Energy sites. These guiding principles: focusing on line management responsibilities, identification of requirements, and skills and knowledge of the work force; provide a management verses compliance approach to evaluating safety programs (including environmental programs). The Department of Energy approach, which addressed these three guiding principles for conducting Safety Management Evaluations, can serve as a frame work for other federal agencies, public organizations and private companies. Also, although this presentation will focus primarily on waste disposal programs, the approach works equally well in evaluating other environment, safety and health programs
Collins, Sandra K
The decisions and actions of health care managers are oftentimes heavily scrutinized by the public. Given the current economic climate, managers may feel intense pressure to produce higher results with fewer resources. This could inadvertently test their moral fortitude and their social consciousness. A study was conducted to determine what corporate social responsibility orientation and viewpoint future health care managers may hold. The results of the study indicate that future health care managers may hold patient care in high regard as opposed to profit maximization. However, the results of the study also show that future managers within the industry may continue to need rules, laws, regulations, and legal sanctions to guide their actions and behavior. PMID:21045586
Bellini, Lisa M; Asch, David A.
Expanding primary care and ambulatory experiences in internal medicine training programs is limited by insufficient resources devoted to their development and implementation, heavy inpatient service demands and loyalty to the traditional inpatient based training model. Overcoming these barriers is a challenge likely to create new approaches to ambulatory education. The Pilot Education and Ambulatory Care (PACE) program at the Sepulveda VA is one such initiative that represents a multidiscipli...
Healthcare financing and insurance is changing everywhere. We want to understand the impact that financial pressures can have for the uninsured in advanced economies. To do so we focus on analyzing the effect of the introduction in the US of managed care and the big rise in financial pressures that it implied. Traditionally, in the US safety net hospitals have financed their provision of unfunded care through a complex system of cross-subsidies. Our hypothesis is that financial pressures undermine the ability of a hospital to cross-subsidize and challenges their survival. We focus on the impact of price pressures and cost-controlling mechanisms imposed by managed care. We find that financial pressures imposed by managed care disproportionately affect the closure of safety net hospitals. Moreover, amongst those hospitals that remain open, in areas where managed care penetration increases the most, they react by closing the health services most commonly used by the uninsured. PMID:23389814
Bovier Patrick A; Agoritsas Thomas; Deom Marie; Perneger Thomas V
Abstract Background How doctors perceive managed care tools and incentives is not well known. We assessed doctors' opinions about the expected impact of eight managed care tools on quality of care, control of health care costs, professional autonomy and relations with patients. Methods Mail survey of doctors (N = 1546) in Geneva, Switzerland. Respondents were asked to rate the impact of 8 managed care tools on 4 aspects of care on a 5-level scale (1 very negative, 2 rather negative, 3 neutral...
Gennissen, Lokke; Stammen, Lorette; Bueno-de-Mesquita, Jolien; Wieringa, Sietse; Busari, Jamiu
Purpose It is assumed that the use of valid and reliable assessment methods can facilitate the development of medical residents' management and leadership competencies. To justify this assertion, the perceptions of an expert panel of health care leaders were explored on assessment methods used for evaluating care management (CM) development in Dutch residency programs. This paper aims to investigate how assessors and trainees value these methods and examine for any inherent benefits or shortcomings when they are applied in practice. Design/methodology/approach A Delphi survey was conducted among members of the platform for medical leadership in The Netherlands. This panel of experts was made up of clinical educators, practitioners and residents interested in CM education. Findings Of the respondents, 40 (55.6 per cent) and 31 (43 per cent) participated in the first and second rounds of the Delphi survey, respectively. The respondents agreed that assessment methods currently being used to measure residents' CM competencies were weak, though feasible for use in many residency programs. Multi-source feedback (MSF, 92.1 per cent), portfolio/e-portfolio (86.8 per cent) and knowledge testing (76.3 per cent) were identified as the most commonly known assessment methods with familiarity rates exceeding 75 per cent. Practical implications The findings suggested that an "assessment framework" comprising MSF, portfolios, individual process improvement projects or self-reflections and observations in clinical practice should be used to measure CM competencies in residents. Originality/value This study reaffirms the need for objective methods to assess CM skills in post-graduate medical education, as there was not a single assessment method that stood out as the best instrument. PMID:27397747
McElroy, F D
Pratylenchus and Xiphinema species have been associated with decline and mortality of brambles (Rubus species) in the Pacific Northwest of the United States. These nematodes cause direct feeding damage and (or) transmit viruses that result in poor fruit quality and plant decline. A nematode management program has been developed by the author to minimize chemical use and nematode-induced damage while optimizing fruit production. Nematode management is an integral part of a total plant health care program in which foliar and soil pests, plant stresses, and fertility are managed. PMID:19283023
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
Full Text Available Abstract Background Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care. Methods A Systematic review of Medline, EMBASE, CINAHL (all 1990–2006, Cochrane Library (Issue 1 2006, and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1 a multi-disciplinary primary care team or 2 through shared care by primary and secondary providers. Results One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided. Conclusion While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact
Bennett, Alice L; Munkholm, Pia; Andrews, Jane M
Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians is...... affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician's IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD...... are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and...
Peyser, N; Wong, A
Managed care today is being shaped by the emergence of a savvier, better informed health care consumer. Facing a strikingly similar consumer movement over the past two decades, the banking industry experienced a market transformation that holds important lessons for managed care. Nontraditional entrants in the financial services industry, offering focused "monoline" products and services closely analogous to "carve-out" providers in health care, targeted rising consumer demands and stronger preferences. Banks in time answered these formidable new competitive forces with innovative consolidation and globalization strategies. The most successful initiatives in healthcare, as in banking, will focus on satisfying the consumer's hunger for information, improved levels of service, and enhanced outcomes. Managed care plans may play a lead role in accelerating the impact of consumerism by bridging the disconnect between patients and their purchasing decisions. PMID:11010386
New health care law emphasizes quality, safety, and efficiency. Pay-for-performance emphasis requires attention of quality managers. Many quality provisions will not kick in for several years. PMID:20491197
U.S. Department of Health & Human Services — The Medicaid managed care penetration rates and expansion enrollment by state charts are composed annually by the Data and System Group (DSG) of the Centers for...
Giuseppe Marcon; Lorenzo Dorigo
This work aims to introduce care management from the moral viewpoint of stakeholder theory. It considers stakeholder theory a useful methodology for managerial descriptions, narratives and theorising of business ethics, and the feminist thought, especially the moral grounding of care, a valuable normative core to earn productive remarks and insights into stakeholder research in modern capitalism. Care leads researchers to meaningful conceptualizations of the firm as a relational entity, both ...
Enthoven, Alain C
A market made up of health care financing and delivery plans and individual consumers, without a carefully drawn set of rules to mitigate market failures, and without mediation by collective action on the demand side, cannot produce efficiency and equity. The concept of competition that can achieve these goals, at least to a satisfactory approximation, is managed competition, with intelligent active agents on the demand side, called sponsors, that contract with the competing health care plans...
Gransjön Craftman, Åsa
The general aim of this thesis was to investigate how delegation of medication is handled in municipal home care. Specific aims were to 1) explore the prevalence of medication use in older adults over time; 2) describe district nurses’ experiences of the delegation of medication management to municipal home care personnel; 3) explore and describe how home care assistants experience receiving the actual delegation of the responsibility of medication administration; and 4) to describe how older...
This plan briefly describes the Lawrence Livermore National Laboratory (LLNL) institutional structure and how Nevada Experiments and Operations Program (N Program's) organization fits within this structure, roles and responsibilities, and management processes that govern N Program activities. This plan also serves as the Integrated Safety Management (ISM) Implementation Plan for N Program work. This plan applies to all work performed by and for LLNL that falls under the oversight of DOE/NV except LLNL activities in support of the Yucca Mountain Project Office (YMPO)
Miller, T R
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
Roberts, James R.; McCurdy, Leyla Erk
These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…
Dogba, Maman Joyce; Rauch, Frank; Wong, Trudy; Ruck, Joanne; Glorieux, Francis H; Bedos, Christophe
Background Achieving a successful transition from pediatric to adult care for young adults with special needs, especially rare genetic diseases such as osteogenesis imperfecta (OI), is a prominent issue in healthcare research. This transition represents a challenge for patients with OI, their families, clinicians and healthcare managers because of the complex nature of the process and the lack of evaluation of existing transition programs. We evaluated a transition program for adolescents and...
Twomey, Jean E.; Caldwell, Donna; Soave, Rosemary; Fontaine, Lynne Andreozzi; Lester, Barry M.
The Vulnerable Infants Program of Rhode Island (VIP-RI) was established as a care coordination program to promote permanency for substance-exposed newborns in the child welfare system. Goals of VIP-RI were to optimize parents' opportunities for reunification and increase the efficacy of social service systems involved with families affected by…
Frølich, Anne; Bellows, Jim; Nielsen, Bo Friis;
Of fifteen diabetes care management practices, our data indicate that high performance is most associated with provider alerts and more weakly associated with action plans and with guideline distribution and training. Lack of convergence in the literature on effective care management practices...... suggests that factors contributing to high performance may be highly context-dependent or that the factors involved may be too numerous or their implementation too nuanced to be reliably identified in observational studies....
Fairfield, G.; Hunter, D.J.; Mechanic, D.; Rosleff, F.
The rhetoric and realities of managed care are easily confused. The rapid growth of managed care in the United States has had many implications for patients, doctors, employers, state and federal programmes, the health insurance industry, major medical institutions, medical research, and vulnerable patient populations. It has restricted patients' choice of doctors and limited access to specialists, reduced the professional autonomy and earnings of doctors, shifted power from the non-profit to...
... Transitions Program (CCTP) Meeting AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice... about the upcoming Community-based Care Transitions Program. The meeting is open to the public, but... will be posted on the CMS Care Transitions Web site at...
This Management Plan was prepared to describe the manner in which Oak Ridge National Laboratory will provide technical management of the Nuclear Standards Program. The organizational structure that has been established within ORNL for this function is the Nuclear Standards Management Center, which includes the Nuclear Standards Office (NSO) already in existence at ORNL. This plan is intended to support the policies and practices for the development and application of technical standards in ETN projects, programs, and technology developments as set forth in a standards policy memorandum from the DOE Program Director for Nuclear Energy.
This Management Plan was prepared to describe the manner in which Oak Ridge National Laboratory will provide technical management of the Nuclear Standards Program. The organizational structure that has been established within ORNL for this function is the Nuclear Standards Management Center, which includes the Nuclear Standards Office (NSO) already in existence at ORNL. This plan is intended to support the policies and practices for the development and application of technical standards in ETN projects, programs, and technology developments as set forth in a standards policy memorandum from the DOE Program Director for Nuclear Energy
Hawthorne, Margaret; LaNoue, Marianna; Brenner, Jeffrey
Abstract In the movement to improve the health of patients with multiple chronic conditions and vulnerabilities, while reducing the need for hospitalizations, care management programs have garnered wide attention and support. The qualitative data presented in this paper sheds new light on key components of successful chronic care management programs. By going beyond a task- and temporal-based framework, this analysis identifies and defines the importance of “authentic healing relationships” in driving individual and systemic change. Drawing on the voices of 30 former clients of the Camden Coalition of Healthcare Providers, the investigators use qualitative methods to identify and elaborate the core elements of the authentic healing relationship—security, genuineness, and continuity—a relationship that is linked to patient motivation and active health management. Although not readily found in the traditional health care delivery system, these authentic healing relationships present significant implications for addressing the persistent health-related needs of patients with frequent hospitalizations. (Population Health Management 2016;19:248–256) PMID:26565379
Borges, Maria Cristina Leite Araujo; Silva, Lucilane Maria Sales da
Objective: The objective was to understand the perception of the nursing team on the (dis)connections between management actions and care performed by nurses in a surgical intensive care unit. Method: Exploratory research with qualitative approach carried out in a surgical intensive care unit of a hospital in the public net of Fortaleza-CE, Brazil. Data was collected between March and July 2011, through semi-structured interviews and systematic observations, with 20 nursing ...
Wong, Ken; Boulanger, Luke; Smalarz, Amy; Wu, Ning; Fraser, Kimberly; Wogen, Jenifer
Background Fragmentation within health care systems may negatively impact the quality of chronic disease patient care. We sought to evaluate the relationship between care management processes (CMP), integration of services, and blood pressure (BP) control among diabetic patients. Methods Retrospective chart reviews were performed for a random sample of adult diabetic hypertensive patients (n = 2,162) from 28 physician organizations in the United States (US). A modified version of the Physicia...
Riaz Talha; Riaz Haris; Hussain Syed A; Kherani Danish
Abstract Application of SMS in reminders of medical appointments and delivering medical tests is not new, however its focus on clinical interventions has just begun. Usage of tailored SMS reminders to increase adherence in treatment programs among sick individuals has allowed an interventional role in self-care management of Diabetes Mellitus (DM).
..., 2010, at 75 FR 41793. Child and Adult Care Food Program (CACFP) [Per meal rates in whole or fractions... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care... Day Care Homes for the Period July 1, 2011 Through June 30, 2012 AGENCY: Food and Nutrition...
..., 2009, at 74 FR 34295. Child and Adult Care Food Program (CACFP) Lunch and Centers Breakfast supper \\1... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care... Day Care Homes for the Period July 1, 2010 Through June 30, 2011 AGENCY: Food and Nutrition...
Full Text Available Abstract Background Complex care management is seen as an approach to face the challenges of an ageing society with increasing numbers of patients with complex care needs. The Medical Research Council in the United Kingdom has proposed a framework for the development and evaluation of complex interventions that will be used to develop and evaluate a primary care-based complex care management program for chronically ill patients at high risk for future hospitalization in Germany. Methods and design We present a multi-method procedure to develop a complex care management program to implement interventions aimed at reducing potentially avoidable hospitalizations for primary care patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, or chronic heart failure and a high likelihood of hospitalization. The procedure will start with reflection about underlying precipitating factors of hospitalizations and how they may be targeted by the planned intervention (pre-clinical phase. An intervention model will then be developed (phase I based on theory, literature, and exploratory studies (phase II. Exploratory studies are planned that entail the recruitment of 200 patients from 10 general practices. Eligible patients will be identified using two ways of 'case finding': software based predictive modelling and physicians' proposal of patients based on clinical experience. The resulting subpopulations will be compared regarding healthcare utilization, care needs and resources using insurance claims data, a patient survey, and chart review. Qualitative studies with healthcare professionals and patients will be undertaken to identify potential barriers and enablers for optimal performance of the complex care management program. Discussion This multi-method procedure will support the development of a primary care-based care management program enabling the implementation of interventions that will potentially reduce avoidable
Tapp, Jane; Kropp, Denise
It is difficult to assess the effectiveness of the delivery of pain management care because pain management is a complex process. This article describes a quality assurance study that was conducted on a surgical unit at a community teaching hospital, which is a member of a 1200 licensed inpatient beds multihospital system, to determine the effectiveness of pain management at the unit level. For the study, a Chart Audit Analysis Tool was developed and used to review second postoperative day charts of patients who had undergone a major abdominal surgery. The Chart Audit Analysis Tool quantifies by weighted indicators 2 outcomes measures, nurses' care delivery and pharmacologic management. The Chart Audit Analysis Tool, along with the results of a test of the nurses' knowledge and attitudes about pain management, provides nurse managers a quick and easy method to identify strengths and weaknesses of pain management at the unit level. PMID:15839297
Eryl Zac Maunder
Full Text Available This article explores the emotional labor involved for nurses providing palliative care for children/young people living with life-limiting illnesses/conditions, and their families. It highlights the challenges nurses face in managing their emotion when caring for children/young people and their families, and explores strategies to enable nurses to cope with this aspect of their role without compromising their personal wellbeing. It suggests that emotional labor within nursing goes largely unrecorded, and remains undervalued by managers and health care services.
Gabriela Marcellino de Melo Lanzoni
Full Text Available The study aimed to understand the experience of managing medical-surgical inpatient units in a general hospital, highlighting the meaning of being a nursing manager, with the intention to qualify and instrument nurses for caring management practice in this scenario. This is a Grounded Theory research, conducted from August 2010 to August 2012, through interviews with 19 participants from the nursing team, distributed in 3 sampling groups. From the analysis emerged the phenomenon “Becoming a nursing manager in the nested and complex border of caring and management dimension”. To exercise caring management, nurses use management instruments as essential tools, they become capable theoretically and enhances, based on his experience, professional skills and personal characteristics. We conclude that competency mobilization beyond the clinical aspect is needed; allowing the use of management instruments to make caring viable and to improve relational and interactive processes.
Zhen-ming XIE; Hong-yan LIU
Objective To sum up the theory of quality care according to the experience of F.P. program in China.Methods The author summarized the QOC theory and draw on its experiences and strength in family planning program in China.Results The theory facilitated the earnest program of the population and family planning program during the tenth five-year plan period, benefited the realization of the innovation of system and mechanism in population and family planning work, and the creation of a nice population environment for the healthy social and economic development in China.Conclusion The development of QOC has displayed a conspicuous theory in China's family planning program.
Davidovitch, Nitza; Yavich, Roman
The Ariel University has a unique interdisciplinary program in healthcare management that targets experienced healthcare professionals who wish to earn an academic degree. Only one academic study has been held so far on the integration of graduates of an academic university-level school in healthcare management in the field. In the current study,…
Full Text Available Leah L Zullig,1,2 Hayden B Bosworth1–4 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University Medical Center, Durham, NC, USA; 3School of Nursing, 4Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA Abstract: Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities. Keywords: program sustainability, diffusion of innovation, information dissemination, health services research, intervention studies
Rachel Root, PharmD, MS
Full Text Available Purpose: The purpose of this project was to design and pilot a pharmacist-led process to address medication management across the continuum of care within a large integrated health-system.Summary: A care transitions pilot took place within a health-system which included a 150-bed community hospital. The pilot process expanded the pharmacist’s medication management responsibilities to include providing discharge medication reconciliation, a patient-friendly discharge medication list, discharge medication education, and medication therapy management (MTM follow-up.Adult patients with a predicted diagnosis-related group (DRG of congestive heart failure or chronic obstructive pulmonary disease admitted to the medical-surgical and intensive care units who utilized a primary care provider within the health-system were included in the pilot. Forty patients met the inclusion criteria and thirty-four (85% received an intervention from an inpatient or MTM pharmacist. Within this group of patients, 88 drug therapy problems (2.6 per patient were identified and 75% of the drug therapy recommendations made by the pharmacist were accepted by the care provider. The 30-day all-cause readmission rates for the intervention and comparison groups were 30.5% and 35.9%, respectively. The number of patients receiving follow-up care varied with 10 (25% receiving MTM follow-up, 26 (65% completing a primary care visit after their first hospital discharge, and 23 (58% receiving a home care visit.Conclusion: Implementation of a pharmacist-led medication management pilot across the continuum of care resulted in an improvement in the quality of care transitions within the health-system through increased identification and resolution of drug therapy problems and MTM follow-up. The lessons learned from the implementation of this pilot will be used to further refine pharmacy care transitions programs across the health-system.
Laramee, S H
Managed care systems are transforming the health care system in the United States. Dietitians will need to review practice opportunities in new and different settings, and develop additional skills to make a successful transition to the transformed health care environment. The shift in health care financing from a fee-for-service model to a capitated system will have the most dramatic impact on the profession. Not all the answers are available, but the focus for the future is clear--customer satisfaction, outcomes research, and cost-effective nutrition services. PMID:8598432
Clarke, Charlotte; Mantle, Ruth
Risk management for people with dementia has traditionally focused on preventing physical harm. However, research has demonstrated that focusing on the physical safety of people with dementia may result in their social and psychological wellbeing being overlooked - the very aspects that are necessary to achieve person-centred care. This article discusses the main challenges for practitioners caring for people with dementia in various settings, and encourages a care approach which enables appropriate risk taking as a way of promoting person-centred care. PMID:26959471
Piraino, Emily; Heckman, George A; Glenny, Christine; Stolee, Paul
OBJECTIVE: Older adults are at risk of rehospitalization if their care transitions from hospital-to-home are not properly managed. The objective of this review was to determine if older patient populations recruited for randomized controlled trials of transitional care interventions represented those at greatest risk of rehospitalization following discharge. Relevant risk factors examined were cognitive impairment, depression, polypharmacy, comorbidity, length of stay, advanced non-malignant...
Blum, Torsten G; Rich, Anna; Baldwin, David;
Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe....... The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a...... feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed...
... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care... Day Care Homes for the Period July 1, 2013 Through June 30, 2014 AGENCY: Food and Nutrition Service...-risk afterschool care centers, and adult day care centers; the food service payment rates for meals...
Alavi, Afsaneh; Kirsner, Robert S
Hidradenitis suppurativa (HS) is a chronic, recurrent, debilitating disease predominantly involving apocrine gland-bearing skin. The folliculoinfundibular dysfunction and an aberrant cutaneous immune response to commensal bacteria are recognized as potential contributors. Topical antibiotics, such as clindamycin, and keratolytic agents have been used in the management of early stages of HS. Proper wound care is a key part of management, particularly in patients with advanced HS. The evidence for the optimal topical therapy or optimal local wound care is limited. As such, a multidisciplinary approach is necessary to address all aspects of HS, including topical therapy, systemic therapy, and proper wound care. The focus of this paper is to review the evidence for the topical management and local wound care strategies in patients with HS. PMID:26470618
The University of Helsinki has devised a powerful in-service training course for managers of health centres. By working together at the University and their own centres on setting objectives, analysing data and solving problems, the participants greatly enhance their management and teamwork skills. PMID:7945761
Yamauti, Sueli Miyuki; Barberato-Filho, Silvio; Lopes, Luciane Cruz
This study aimed to analyze the list of drugs in the Popular Pharmacy Program in Brazil (PFPB) in relation to the country's pharmaceutical care policy. The list of drugs in the PFPB was compared to the Brazilian and international reference lists of essential medicines, the components of pharmaceutical care in Brazilian Unified National Health System (SUS), and drug production by the country's government pharmaceutical laboratories. The PFPB list includes 119 drugs, of which 19.3% and 47.1% were not selected on the Brazilian and international reference lists, respectively; 16.8% are not used in primary care, and 40.3% are not produced by the country's government laboratories. A revision of the PFPB list based on the essential medicines concept (World Health Organization), alignment of pharmaceutical care policies, and production by government laboratories are essential to improve quality of health care, management, training of prescribers, and information for the population. PMID:26375644
Goodly, Lyndon J; Jarrell, Vickie L; Miller, Monica A; Banks, Maureen C; Anderson, Thomas J; Branson, Katherine A; Woodward, Robert T; Peper, Randall L; Myers, Sara J
The Public Health Service Policy on the Humane Care and Use of Laboratory Animals and sound ethical practices require institutions to provide safe working environments for personnel working with animals; this mandate is achieved in part by establishing an effective animal care Occupational Health and Safety Program (OHSP). Land-grant institutions often face unique organizational challenges in fulfilling this requirement. For example, responsibilities for providing health and safety programs often have historically been dispersed among many different divisions scattered around the campus. Here we describe how our institutional management personnel overcame organizational structure and cultural obstacles during the formation of a comprehensive campus-wide animal care OHSP. Steps toward establishing the animal care OHSP included assigning overall responsibility, identifying all stakeholders, creating a leadership group, and hiring a fulltime Animal Care OHSP Specialist. A web-based portal was developed, implemented, and refined over the past 7 y and reflected the unique organizational structures of the university and the needs of our research community. Through this web-based portal, hazards are identified, risks are assessed, and training is provided. The animal care OHSP now provides easy mandatory enrollment, supports timely feedback regarding hazards, and affords enrollees the opportunity to participate in voluntary medical surveillance. The future direction and development of the animal care OHSP will be based on the research trends of campus, identification of emerging health and safety hazards, and ongoing evaluation and refinement of the program. PMID:26817980
Dawn Hunt, Sharon
As the increasing burden on healthcare costs continues to rise, posing clinical and financial challenges for all healthcare providers attempting to provide optimal, evidence-based wound care, the situation appears to be reaching the tipping point with regard to reduced resources, increasing patient groups with complex wounds and financial restraints. It is clearly time for action and new ways of working that include empowering patients and carers to take appropriate ownership within their personal wound-care journey. This observational evaluation explores 10 community-based patients presenting with postoperative acute surgical wounds; it examines and evaluates the patients' experience with regard to self-care satisfaction, Leukomed Control product satisfaction and actual traditional/personal costs incurred up to a 4-week period. The evaluation highlights not only an overall positive improvement within patient satisfaction and experience, alongside optimised wound progression and related cost savings, but also offers a valuable insight into the promotion and success of patients taking ownership of their wound-care journey. PMID:27523771
Lambert Barraquier, Arièle
Compassionate care can appear ambiguous when subject to critical examination. The spotlight falls on the responsibility and activity of management with regard to policy guidance and the management of activities in the medical-social field. Discussion around this subject enables an assessment of current standards and ethical progress to be carried out. PMID:27157562
Schellevis, F.G.; Rusovich, V.; Egorov, K.N.; Podpalov, V.P.; Boerma, W.G.W.
Both in Belarus and in the Netherlands, guidelines on the management of hypertension in primary care have been developed, including recommendations about detection, treatment and follow-up. These guidelines are meant to harmonize actual practice management of hypertension of improve the quality of c
Full Text Available Background: To develop and implement more effective programs of health care delivery to prevent and control diabetes, Iran has developed and implemented the urban phase of the specialized care program for diabetic′s patients. Deeply understanding the views and experiences of various stakeholders in this program can assist policy makers to identify the program′s strengths and weaknesses and enable them to develop action plans. Hence, the present study aimed to evaluate the planning and establishing of this program from the perspective of providers. Methods: A qualitative study was applied using documents review and face-to-face semi-structured interviews with the program leads and relevant executive managers of the local medical universities. Thematic analysis was used to analyze the data. Results: Three main themes and nine subthemes were explored, including program planning (the content and the strengths, weaknesses, and corrective measures, implementation (executive mechanisms at the university level, establishment of referral system, collaboration between deputies of health and treatment, information dissemination mechanisms, satisfaction measurement and strengths, weaknesses and corrective measures, and result (implementation results. Conclusions: The urban phase of the specialized care program for diabetic′s patients has been a good base to improve continuity of care, which emphasizes on controlling and prevention of occurrence or progression of chronic complications of diabetes. This model can also be used for better management of other chronic disease. However, there are still issues that should be considered and improved such as allocation of guaranteed resources, more trained health professionals, and more evidence based guidelines and protocols, better collaboration among medical universities′ deputies, clearer payment system for program evaluation and better information management system.
Brando, Sabrina I. C. A.
The aim of this paper is to illustrate how the training of marine mammals has facilitated improved marine mammal husbandry practices. The marine mammal community has seen many changes, refinements and improvements in animal care programs since the first marine mammals were brought in captivity in the early 19th century. Cross disciplinary fields such as veterinarian science, psychology, physiology and conservation biology have advanced the knowledge and care of the different species of cetace...
Mei, Jing; Li, Jing; Yu, Yiqin; Li, Xiang; Liu, Haifeng; Xie, Guotong
The computerization of care pathways (CPs) has drawn considerable attention, for improving quality of health care and reducing costs. A well-known big challenge of implementing CPs is their flexibility and ad hoc variations in execution of clinical tasks. We observe that case management suits well to address this problem, and this paper proposes a CMMN-based CP model, where CMMN (Case Management Model and Notation) is becoming an industry standard. Via an experimental experience on modelling CHF (congestive heart failure) ambulatory CP, we illustrate that the usage of case management paves the way to popularize CPs, particularly for its quick deployment and execution in industrial products. PMID:25160134
The Department of Energy Office of Environmental Management (EM), in partnership with the Office of Energy Research (ER), designed, developed, and implemented the Environmental Management Science Program as a basic research effort to fund the scientific and engineering understanding required to solve the most challenging technical problems facing the government's largest, most complex environmental cleanup program. The intent of the Environmental Management Science Program is to: (1) Provide scientific knowledge that will revolutionize technologies and cleanup approaches to significantly reduce future costs, schedules, and risks. (2) Bridge the gap between broad fundamental research that has wide-ranging applications such as that performed in the Department's Office of Energy Research and needs-driven applied technology development that is conducted in Environmental Management's Office of Science and Technology. (3) Focus the nation's science infrastructure on critical Department of Energy environmental problems. In an effort to share information regarding basic research efforts being funded by the Environmental Management Science Program and the Environmental Management/Energy Research Pilot Collaborative Research Program (Wolf-Broido Program), this CD includes summaries for each project. These project summaries, available in portable document format (PDF), were prepared in the spring of 1998 by the principal investigators and provide information about their most recent project activities and accomplishments.
This project is being implemented as a way for local villagers to obtain rights of use and benefits from forests. This is done in one either as a Joint Forest Management or a Community Based Forest Management program. PES-1 (Payments for Environmental Services Associate Award)
The purpose of this NASA Software Management Guidebook is twofold. First, this document defines the core products and activities required of NASA software projects. It defines life-cycle models and activity-related methods but acknowledges that no single life-cycle model is appropriate for all NASA software projects. It also acknowledges that the appropriate method for accomplishing a required activity depends on characteristics of the software project. Second, this guidebook provides specific guidance to software project managers and team leaders in selecting appropriate life cycles and methods to develop a tailored plan for a software engineering project.
Hoban, Francis T. (Editor)
This volume is the sixth in an ongoing series on aerospace project management at NASA. Articles in this volume cover evolution of NASA cost estimating; SAM 2; National Space Science Program: strategies to maximize science return; and human needs, motivation, and results of the NASA culture surveys. A section on resources for NASA managers rounds out the publication.
... planning and management activities. Grant administrative requirements for these funds appear in 40 CFR... 40 CFR part 35, subpart J. A State may also use part of the 205(g) funds to administer approved... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Program management. 130.11 Section...
Georgia Univ., Athens. Div. of Vocational Education.
This program guide presents the standard fashion production and management curriculum for technical institutes in Georgia. It is designed to relate primarily to the development of those skills needed to become a qualified alterationist, clothing design assistant, home textiles assistant, fashion management assistant, or tailoring assistant. A…
This article describes the University of Northern British Columbia's (UNBC's) Outdoor Recreation and Tourism Management (ORTM) Program, which focuses squarely on the management of outdoor recreation as it relates to conservation (i.e., in and around parks and protected areas), tourism that is both based in and concerned with the natural/cultural…
The Lewis Research Center's cryogenic fluid management program flight concept definition is presented in viewgraph form. Diagrams are given of the cryogenic fluid management subpallet and its configuration with the Delta launch vehicle. Information is given in outline form on feasibility studies, requirements definition, and flight experiments design.
Mechanic, D; Schlesinger, M
Social trust in health care organizations and interpersonal trust in physicians may be mutually supportive, but they also diverge in important ways. The success of medical care depends most importantly on patients' trust that their physicians are competent, take appropriate responsibility and control, and give their patients' welfare the highest priority. Utilization review and structural arrangements in managed care potentially challenge trust in physicians by restricting choice, contradicting medical decisions and control, and restricting open communication with patients. Gatekeeping and incentives to limit care also raise serious trust issues. We argue that managed care plans rather than physicians should be required to disclose financial arrangements, that limits be placed on incentives that put physicians at financial risk, and that professional norms and public policies should encourage clear separation of interests of physicians from health plan organization and finance. PMID:8637148
Eric A. Coleman
Full Text Available Objective: To investigate the association between care co-ordination and use of the Emergency Department (ED in older managed care enrollees. Design: Nested case-control with 103 cases (used the ED and 194 controls (did not use the ED. Patients and methods: Older patients with multiple chronic illnesses enrolled in a care management programme of a large group-model health maintenance organisation with more than 50,000 members over the age of 64. Better care co-ordination was defined as timely follow-up after a change in treatment; fewer decision-makers involved with the care plan; and a higher patient-perceived rating of overall care co-ordination. Logistic regression was used to assess the relationship between ED use (the outcome variable and measures of care co-ordination (the predictor variables. Results: Self-reported care co-ordination was not significantly different between cases and controls for any of the four classifications of inappropriate ED use. Similarly, no differences were found in the number of different physicians or medication prescribers involved in the patients' care. Four-week follow-up after potentially high-risk events for subsequent ED use, including changes in chronic disease medications, missed encounters, and same day encounters, did not differ between subjects with inappropriate ED use and controls. Conclusion: Existing measures of care co-ordination were not associated with inappropriate ED use in this study of older adults with complex care needs. The absence of an association may, in part, be attributable to the paucity of validated measures to assess care co-ordination, as well as the methodological complexity inherent in studying this topic. Future research should focus on the development of new measures and on approaches that better isolate the role of care co-ordination from other potential variables that influence utilisation.
This viewgraph presentation reviews Computer-Aided Corrosion Program Management at John F. Kennedy Space Center. The contents include: 1) Corrosion at the Kennedy Space Center (KSC); 2) Requirements and Objectives; 3) Program Description, Background and History; 4) Approach and Implementation; 5) Challenges; 6) Lessons Learned; 7) Successes and Benefits; and 8) Summary and Conclusions.
Marks, M; Gupta-Wright, A.; Doherty, JF; Singer, M; Walker, D.
The number of people travelling to malaria-endemic countries continues to increase, and malaria remains the commonest cause of serious imported infection in non-endemic areas. Severe malaria, mostly caused by Plasmodium falciparum, often requires intensive care unit (ICU) admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. The mortality from imported malaria remains significant. This article reviews the man...
High availability of data in healthcare is essential, since the introduction of e-Health project patient key information should be available to all health institutions. These data are condition to fast and efficient patient care in any healthcare institution. Awareness of the importance of high data availability and reliability is fast developing in Slovenia. With aging population and increasing number of treatments with modern technologies, amount of each patient data is rapidly increasing. ...
This paper discusses subjective hazards in wilderness activities and suggests means of assessing and managing related risks. Wilderness educators conveniently group hazards into objective and subjective ones. Objective hazards such as rockfall, moving water, and weather, while not necessarily predictable, are visible and understandable. Subjective…
Neitch, Shirley M; Meadows, Charles; Patton-Tackett, Eva; Yingling, Kevin W
Every day, patients with dementia, their families, and their physicians face the enormous challenges of this pervasive life-changing condition. Seeking help, often grasping at straws, victims, and their care providers are confronted with misinformation and myths when they search the internet or other sources. When Persons with Dementia (PWD) and their caregivers believe and/or act on false information, proper treatment may be delayed, and ultimately damage can be done. In this paper, we review commonly misunderstood issues encountered in caring for PWD. Our goal is to equip Primary Care Practitioners (PCPs) with accurate information to share with patients and families, to improve the outcomes of PWD to the greatest extent possible. While there are innumerable myths about dementia and its causes and treatments, we are going to focus on the most common false claims or misunderstandings which we hear in our Internal Medicine practice at Marshall Health. We offer suggestions for busy practitioners approaching some of the more common issues with patients and families in a clinic setting. PMID:27025116
As managed care becomes more and more dominant in U.S. health care, it is coming into conflict with medical education. There are historical reasons for this: medical education traditionally excluded physicians who chose to work in health plans, and for profit managed care has tended to avoid subsidizing medical education. In order to improve the climate, three changes are necessary: medical education must understand the tense history of discord between the two; distinctions must be made between responsible and irresponsible managed care plans; and medical educators should not assume they own the moral high ground. Arrogance, a gross oversupply of physicians and especially specialists, scandals and fraud, an often callous attitude toward the poor, and other sins can be laid at medical education's door. The worse threat for both sides is that the public and payers could simply abandon both, leading to underfunding for health professions education, a society that does not trust its health care system, and the loss of superb teaching organizations. To prevent this, managed care and medical education should work together to solve several difficult problems: how to shrink the medical education infrastructure; how to report honestly the uses to which medical education funds are put; and how to identify and end irresponsible behavior on the part of health plans and medical education entities alike. If the two sides can exercise leadership in these areas, they will be able to protect and enhance the singular place of honor that medical education holds in this society. PMID:9159575
Proceedings Paper (for Acquisition Research Program) Recent reform measures in acquisition processes support the acquisition community''s long-established goal of providing warfighters with the highest quality and most cost-effective weapons systems. Since the role of the Program Manager remains pivotal to overall program success or failure, efforts to reform the acquisition community must supplement and expand traditional expectations of PMs, focusing on four key concepts: ensuring leader...
Vernooij-Dassen Myrra JFJ; Adang Eddy M; Leontjevas Ruslan; Teerenstra Steven; Smalbrugge Martin; Gerritsen Debby L; Derksen Els; Koopmans Raymond TCM
Abstract Background The aim of this study is evaluating the (cost-) effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the management of depression, including standardized use of measurement instruments and diagnostical methods, and protocolized psychosocial, psychological and pharmacological treatment. Methods/De...
Given current economic and regulatory challenges, utilities are facing the need to manage inventories more efficiently, lower spare parts costs, and reduce the downtime associated with equipment failure. Two programs helping utilities achieve these goals are the Joint Procurement Corporation (JPC) for multicompany purchase of common equipment and services and the pooled inventory management (PIM) program for joint purchase and storage of nuclear generating unit spare parts. Both of these are cooperative programs that decrease the probability of extended plant outages and reduce duplication of effort and/or inventory among participating utilities
White, K R; Thompson, J M; Patel, U B
The hospital marketing function has been widely adopted as a way to learn about markets, attract sufficient resources, develop appropriate services, and communicate the availability of such goods to those who may be able to purchase such services. The structure, tasks, and effectiveness of the marketing function have been the subject of increased inquiry by researchers and practitioners alike. A specific understanding of hospital marketing in a growing managed care environment and the relationship between marketing and managed care processes in hospitals is a growing concern. Using Kotler and Clarke's framework for assessing marketing orientation, we examined the marketing orientation of hospitals in a single state at two points in time--1993 and 1999. Study findings show that the overall marketing orientation score decreased from 1993 to 1999 for the respondent hospitals. The five elements of the Kotler and Clarke definition of marketing orientation remained relatively stable, with slightly lower scores related to customer philosophy. In addition, we evaluated the degree to which selected managed care activities are carried out as part of its marketing function. A significant (p managed care processes coordinated with the formal marketing function was evident from 1993 to 1999. With increasing numbers of managed care plan enrollees, hospitals are likely focusing on organizational buyers as important customers. In order to appeal to organizational buyers, hospital executives may be focusing more on clinical quality and cost efficiency in the production of services, which will improve a hospital's position with organizational buyers. PMID:11570344
... AGENCY Best Management Practices for Unused Pharmaceuticals at Health Care Facilities AGENCY... guidance document entitled, Best Management Practices for Unused Pharmaceuticals at Health Care Facilities... been studying unused pharmaceutical disposal practices at health care facilities, prompted by...
Simoni, Jane M.; Katz, David A.; Golden, Matthew R.
Abstract Improving patient retention in HIV care and use of antiretroviral therapy (ART) are key steps to improving the HIV care continuum in the US. However, contemporary quantitative data on barriers to care and treatment from population-based samples of persons poorly engaged in care are sparse. We analyzed the prevalence of barriers to clinic visits, ART initiation, and ART continuation reported by 247 participants in a public health HIV care relinkage program in King County, WA. We identified participants using HIV surveillance data (N=188) and referrals from HIV/STD clinics and partner services (N=59). Participants most commonly reported insurance (50%), practical (26–34%), and financial (30%) barriers to care, despite residing in a state with essentially universal access to HIV care. Perceived lack of need for medical care was uncommon (<20%), but many participants (58%) endorsed a perceived lack of need for medication as a reason for not initiating ART. Depression and substance abuse were both highly prevalent (69% and 54%, respectively), and methamphetamine was the most commonly abused substance. Barriers to HIV care and treatment may be amenable to intervention by health department outreach in coordination with existing HIV medical and support services. PMID:25826007
This program management plan (PMP) describes the FY 1995 project plans for the Pretreatment Program of the Tank Focus Area. The Tank Focus Area is one of five areas of environmental concerns originally identified by the Deputy Assistant Secretary for Technology Development (EM-50). Projects in the Tank Focus Area relate to the remediation of liquid waste stored in underground storage tanks at various US Department of Energy sites. The Pretreatment Program is an organizational unit performing work within the Tank Focus Area. The function of the Pretreatment Program is to develop, test, evaluate, and demonstrate new technologies, with emphasis on separations. The 11 Pretreatment Program projects for FY 1995 are (1) Cesium Extraction Testing, (2) Comprehensive Supernate Treatment, (3) Hot Cell Studies, (4) Cesium Removal Demonstration, (5) Out-of-Tank Evaporator Demonstration, (6) Crossflow Filtration, (7) Technical Interchange with CEA, (8) TRUEX Applications, (9) NAC/NAG Process Studies (conducted at Oak Ridge National Laboratory), (10) NAC/NAG Process and Waste Form Studies (conducted at Florida International University), and (11) Program Management. Section 2 of this PMP contains a separate subsection for each FY 1995 project. A brief description of the project, a schedule of major milestones, and a breakdown of costs are provided for each project. The PMP also contains sections that describe the project controls that are in place. Quality assurance, document control, the project management system, and the management organization are described in these sections
Morrison, M.I. [Midwest Technical Inc., Oak Ridge, Tennessee (United States); McGinnis, C.P.; Wilkenson, W.T.; Hunt, R.D. [Oak Ridge National Lab., TN (United States)
This program management plan (PMP) describes the FY 1995 project plans for the Pretreatment Program of the Tank Focus Area. The Tank Focus Area is one of five areas of environmental concerns originally identified by the Deputy Assistant Secretary for Technology Development (EM-50). Projects in the Tank Focus Area relate to the remediation of liquid waste stored in underground storage tanks at various US Department of Energy sites. The Pretreatment Program is an organizational unit performing work within the Tank Focus Area. The function of the Pretreatment Program is to develop, test, evaluate, and demonstrate new technologies, with emphasis on separations. The 11 Pretreatment Program projects for FY 1995 are (1) Cesium Extraction Testing, (2) Comprehensive Supernate Treatment, (3) Hot Cell Studies, (4) Cesium Removal Demonstration, (5) Out-of-Tank Evaporator Demonstration, (6) Crossflow Filtration, (7) Technical Interchange with CEA, (8) TRUEX Applications, (9) NAC/NAG Process Studies (conducted at Oak Ridge National Laboratory), (10) NAC/NAG Process and Waste Form Studies (conducted at Florida International University), and (11) Program Management. Section 2 of this PMP contains a separate subsection for each FY 1995 project. A brief description of the project, a schedule of major milestones, and a breakdown of costs are provided for each project. The PMP also contains sections that describe the project controls that are in place. Quality assurance, document control, the project management system, and the management organization are described in these sections.
Full Text Available Time-based management (TBM is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms. Over the past two decades a systematic review of Polish literature (since 1990 and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011 have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary
Siegrist, R B; Blish, C S
Advantages and pharmacy applications of computerized hospital management-control and planning systems are described. Hospitals must define their product lines; patient cases, not tests or procedures, are the end product. Management involves operational control, management control, and strategic planning. Operational control deals with day-to-day management on the task level. Management control involves ensuring that managers use resources effectively and efficiently to accomplish the organization's objectives. Management control includes both control of unit costs of intermediate products, which are procedures and services used to treat patients and are managed by hospital department heads, and control of intermediate product use per case (managed by the clinician). Information from the operation and management levels feeds into the strategic plan; conversely, the management level controls the plan and the operational level carries it out. In the system developed at New England Medical Center, Boston, Massachusetts, the intermediate product-management system enables managers to identify intermediate products, develop standard costs, simulate changes in departmental costs, and perform variance analysis. The end-product management system creates a patient-level data-base, identifies end products (patient-care groupings), develops standard resource protocols, models alternative assumptions, performs variance analysis, and provides concurrent reporting. Examples are given of pharmacy managers' use of such systems to answer questions in the areas of product costing, product pricing, variance analysis, productivity monitoring, flexible budgeting, modeling and planning, and comparative analysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3284338
sell in Mexico, as part of a Pharmacy Benefit Management & Manage Care program implemented in our country. Each drug was classified according to its active ingredient under one of the following categories: 1 essentials, 2 excluded, and 3 not essentials - not excluded. The decision in each case was based on pure scientific grounds and using an Evidence-Based Medicine analysis. Results. The proposed formulary contains a total of 1106 active ingredients -either unique or in combination-, from which 429 (38.8% were classified as essentials. About one-out-of-ten drugs (8.7% currently in use within the private medical practice in Mexico, some of them highly prescribed, were regarded by the committee as excluded due to concerns about their efficacy and/or or safety. Conclusions. On this report a detailed description of the process followed to conform the committee, its objectives an its performing criteria is presented, as well as the bases under which the final list of drugs of the formulary were set.
Campbell-Scherer, Denise; Sharma, Arya Mitra
Obesity is a major risk factor for chronic diseases with significant morbidity, mortality and health care cost. There is concern due to the dramatic increase in overweight and obesity in Canada in the last 20 years. The causes of obesity are multifactorial, with underestimation by patients and healthcare providers of the long-term nature of the condition, and its complexity. Solutions related to prevention and management will require multifaceted strategies involving education, health policy, public health and health systems across the care continuum. We believe that to support such strategies we need to have a strong primary care workforce equipped with appropriate knowledge, skills and attitudes to support persons at risk for, or with, obesity. To achieve this end, significant skills building is required to improve primary care obesity prevention and management efforts. This review will first examine the current state, and then will outline how we can improve. PMID:27342445
Hammer, Theodore F.; Rosenberg, Linda
NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.
Armstead, Rodney C.; Elstein, Paul; Gorman, John
As the Nation's largest managed-care purchaser, the Health Care Financing Administration (HCFA) is working to develop a uniform data and performance-measurement system for all enrollees in managed-care plans. This effort will ultimately hold managed-care plans accountable for continuous improvement in the quality of care they provide and will provide information to consumers and purchasers to make responsible managed-care choices. The effort entails overhauling peer review organization (PRO) ...
Bensenhaver, Jessica; Winchester, David P
Evidence has shown that multidisciplinary specialist team evaluation and management for cancer results in better patient outcomes. For breast cancer, breast centers are where this evaluation and management occurs. The National Accreditation Program for Breast Centers has helped standardize multidisciplinary breast cancer care by defining services and standards required of accredited breast centers. PMID:24882354
Lum, LCS; Ng, CJ; Khoo, EM
Dengue is a common cause of illness seen in primary care in the tropical and subtropical countries. An understanding of the course of disease progression, risk factors, recognition of the warning signs and look out for clinical problems during the different phases of the disease will enable primary care physicians to manage dengue fever in an appropriate and timely manner to reduce morbidity and mortality.
Upshur Ross E; Ceresne Lance
Abstract Background Atrial fibrillation is a common serious cardiac arrhythmia. Knowing the prevalence of atrial fibrillation and documentation of medical management are important in the provision of primary care. This study sought to determine the prevalence of atrial fibrillation in a primary care population and to identify and quantify the treatments being used for stroke prevention in this group of patients. Methods A prevalence study through chart audit was conducted in the family medici...
Murthy, N R; Okunade, A A
We applied a battery of cointegration tests comprising those of Johansen and Juselius , Phillips and Hansen , and Engle and Granger , to model aggregate health care expenditure using 1960-96 US data. The existence of a stable long-run economic relationship or cointegration is confirmed, in the United States, between aggregate health care expenditure and real GDP, population age distribution, managed care enrollment, number of practicing physicians, and government deficits. The evidence of cointegration among these variables, chosen on the theoretical basis of prior studies, implies that while they are individually non-stationary in levels, together they are highly correlated and move, in the long run to form an economic equilibrium relationship of US aggregate health care expenditure. More specifically, and for the first time in this line of inquiry, (i) managed care enrollment is found to be negatively associated with the level of health care spending, (ii) supply disinduced demand effects of physicians tend to moderate health expenditure, and (iii) government deficit financing is positively related to health care spending. The observed sign and magnitude of the income coefficient are consistent with health care being a luxury good. PMID:11105414
This study provides evidence of a successful implementation of a not-for-profit operational model within a public setting. The federal government placed a receiver in charge of improving health care within the California Department of Corrections and Rehabilitation. To achieve the receivership's goals, a chronic care model from the not-for-profit sector was selected and implemented to improve the delivery of health care to inmates. The data suggest that operational programs developed outsi...
DOE facilities are required to develop a documented energy management program encompassing owned and leased facilities and vehicles and equipment. The program includes an Energy Management Plan consistent with the requirements of the DOE ten-year In-House Energy Management Plan, an ECP specifying actions associated with the sudden disruption in the supply of critical fuels, an Energy Management Committee comprised of WIPP employees, and reporting criteria for quarterly energy consumption reporting to DOE Headquarters. The In-House Energy Management Program will include an implementation plan, a budget, and an interaction and coordination plan. The goal of this program is to sensitize the WIPP employees to the energy consequences of their actions and to motivate them to use energy more efficiently. To achieve this goal, the program is designed to both improve energy conservation at the WIPP through the direct efforts of every employee, and to encourage employees to take the lead in conserving energy at home, on the road, and in the community
Meijboom, Bert R; Bakx, Saskia J W G C; Westert, Gert P
In health care, multidisciplinary collaboration is both indispensable and complicated. We discuss organizational problems that occur in situations where multiple health care providers are required to cooperate for patients with complex needs. Four problem categories, labelled as communication, patient safety, waiting times and integration are distinguished. Then we develop a supply chain perspective on these problems in the sense of discussing remedies according to supply chain management (SCM) literature. This perspective implies a business focus on inter-organizational conditions and requirements necessary for delivering health care and cure across organizational borders. We conclude by presenting some strategic and policy recommendations. PMID:21069770
The Canadian Nuclear Fuel Waste Management Program involves research into the storage and transportation of used nuclear fuel, immobilization of fuel waste, and deep geological disposal of the immobilized waste. The program is now in the fourth year of a ten-year generic research and development phase. The objective of this phase of the program is to assess the safety and environmental aspects of the deep underground disposal of immobilized fuel waste in plutonic rock. The objectives of the research for each component of the program and the progress made to the end of 1983 are described in this report
Kessler, D M
Through strategic clinical diversification, political activism, and bold expansion, Wills Eye Hospital, a teaching specialty surgical hospital, survives ravages of sudden onslaughts of managed care payment reductions while maintaining autonomy. Slack inpatient resources were re-utilized to create unique programs attractive to regional managed care organizations. Advocacy and lobbying for short-term favorable treatment from Medicare bought the Hospital valuable time and positioning. Building out a regional network of ambulatory surgical centers assures the growth and access to market required for Wills to maintain its autonomy in a managed care contracting environment. PMID:11372488
Melvin, Thomas J; Tankersley, Zach J; Qazi, Zain N; Jasko, John J; Odono, Russell; Shuler, Franklin D
Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus. Successful management of plantar fasciitis is typically achieved with the conservative therapy approaches discussed. PMID:26665894
Carr, Dana Deravin
In this new era of patient safety, the case manager, as an advocate and facilitator of care, has a pivotal role on the front line of healthcare delivery. Effective communication and collaboration between disciplines is key to the promotion of patient safety, and ultimately the avoidance of life-threatening medical errors. Across the healthcare continuum and within hospitals in particular, patients are routinely transferred from one service to another, from one level of care to another, or from one provider to another. As patients are stabilized and transitioned through the hospital system, there are multiple hand-offs of care or care transitions that can often expose the patient to fragmented service and increase the risk of communication breakdown. Ineffective hand-offs can result in a disruption of continuity between one level of care and the next. In a culture that places a strong emphasis on patient safety, case managers can facilitate opportunities that ease care transitions whereby a change in venue is no longer perceived as a disruption in the flow of care but rather is viewed as a coordinated changeover where cautious and comprehensive communication sets the tone for the continued delivery of safe and effective healthcare. PMID:17413671
Luis Rafael Moscote-Salazar
Full Text Available Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.
Cowan, Andrew J; Altemeier, William A; Johnston, Christine; Gernsheimer, Terry; Becker, Pamela S
Patients with acute myeloid leukemia (AML) who are newly diagnosed or relapsed and those who are receiving cytotoxic chemotherapy are predisposed to conditions such as sepsis due to bacterial and fungal infections, coagulopathies, hemorrhage, metabolic abnormalities, and respiratory and renal failure. These conditions are common reasons for patients with AML to be managed in the intensive care unit (ICU). For patients with AML in the ICU, providers need to be aware of common problems and how to manage them. Understanding the pathophysiology of complications and the recent advances in risk stratification as well as newer therapy for AML are relevant to the critical care provider. PMID:24756309
... program use by fractional ownership program manager. 91.1411 Section 91.1411 Aeronautics and Space FEDERAL... airworthiness maintenance program use by fractional ownership program manager. Fractional ownership program... through 91.1443. Any program manager who elects to maintain the program aircraft using a...
Myrtle, Robert C; Chen, Duan-Rung; Liu, Caroline; Fahey, Daniel
The health-care field is undergoing rapid and significant transformation. This transformation has led to the breakdown of traditional career paths for managers in the patient care segment of the industry. To our knowledge, there has not been a systematic examination of how these changes have impacted on the career commitment of managers in this segment of the industry. Building on previous research, we examine the effects of employment-related conditions and career experiences on the career commitment of these managers while controlling for the influence of individual characteristics. Specifically we assess the relationship between employment-related conditions, such as job security, position tenure, industry segment, management level and the extent to which their current position meets their career expectations, and their career experiences, including moving from a non-health-care management position, moving from a different health-care sector, their career stage, career patterns and their satisfaction with their career progression. We found that measures associated with the different employment-related experiences had a more significant influence on career commitment than those measures associated with different career experiences. PMID:18957403
Henry Mintzberg, a professor of management at McGill University in Canada and at INSEAD in France, takes aim at the hype surrounding management fads and gurus and dares to suggest that the emperor has no clothes. In order to rile all who care about management and get them thinking creatively, he presents ten contrarian observations on such topics as the meanness of leanness, the folly of CEOs who fancy themselves strategists, the disempowering that so-called empowerment creates, the myopia of purely financial measures, and the inadequacy of M.B.A. programs. Mintzberg maintains, for example, that it is time to delayer the delayerers. He argues that delayering has created more problems than it has solved be cause it is, in essence, a process by which people who barely know what's going on get rid of those who do--a process ensuring that the real database of the organization, the key to what was its future, lines up at the unemployment office. Too many managers, he says, dream of becoming the next turnaround doctor. They fail to understand that great organizations, once created, don't need great leaders: if a company can't function on its own, a hero won't help. A leader who draws out the knowledge embedded in all parts of an organization is a leader who can help a company function alone--without heroes. Such leaders often practice what Mintzberg calls the craft style of management (as opposed to the professional style or the boss style). It is about inspiring, not empowering. It is based on mutual respect rooted in common experience and offers hope for improving what is now wrong with management. PMID:10158474
Full Text Available OBJECTIVE: Older adults are at risk of rehospitalization if their care transitions from hospital-to-home are not properly managed. The objective of this review was to determine if older patient populations recruited for randomized controlled trials of transitional care interventions represented those at greatest risk of rehospitalization following discharge. Relevant risk factors examined were cognitive impairment, depression, polypharmacy, comorbidity, length of stay, advanced non-malignant diseases, and available social support. DESIGN: Systematic Review. SETTING: Hospital to home. PARTICIPANTS: Older hospitalized adults. MEASUREMENTS: For inclusion, articles were required to focus on hospital-to-home transitions with a self-care component, have components occurring both before and after discharge, and a randomized controlled trial design. Articles were excluded if participants had a mean age under 55 years, or if interventions focused on developmental disabilities, youth, addictions, or case management, or were solely primary-care based. RESULTS: Following title, abstract, and full review by two authors, 17 articles met inclusion criteria. Risk factors for rehospitalization were often listed either as exclusion criteria or were not reported at baseline by the studies. One study included patients with all identified risk factors for rehospitalization. CONCLUSIONS: These data suggest that published studies of transitional care interventions do not often include older adults at highest risk of rehospitalization, raising concerns about the generalizability of their results. Studies are needed that evaluate interventions that explicitly address the needs and characteristics of these patients.
Full Text Available OBJECTIVE: Older adults are at risk of rehospitalization if their care transitions from hospital-to-home are not properly managed. The objective of this review was to determine if older patient populations recruited for randomized controlled trials of transitional care interventions represented those at greatest risk of rehospitalization following discharge. Relevant risk factors examined were cognitive impairment, depression, polypharmacy, comorbidity, length of stay, advanced non-malignant diseases, and available social support.DESIGN: Systematic Review.SETTING: Hospital to home.PARTICIPANTS: Older hospitalized adults.MEASUREMENTS: For inclusion, articles were required to focus on hospital-to-home transitions with a self-care component, have components occurring both before and after discharge, and a randomized controlled trial design. Articles were excluded if participants had a mean age under 55 years, or if interventions focused on developmental disabilities, youth, addictions, or case management, or were solely primary-care based.RESULTS: Following title, abstract, and full review by two authors, 17 articles met inclusion criteria. Risk factors for rehospitalization were often listed either as exclusion criteria or were not reported at baseline by the studies. One study included patients with all identified risk factors for rehospitalization.CONCLUSIONS: These data suggest that published studies of transitional care interventions do not often include older adults at highest risk of rehospitalization, raising concerns about the generalizability of their results. Studies are needed that evaluate interventions that explicitly address the needs and characteristics of these patients.
Conant, G; Kleiner, B H
It has been said that managing change is a synonym for managing people through change. No other industry has experienced more change in the past ten years than the health-care industry. In order to regulate all this change, managers in health-care organizations must identify new ways to deal with the changes. The issues are as old as time: job satisfaction, cultural conflict, and compensation. This paper addresses each of these key issues with the following examples. A new nursing paradigm that was implemented at a hospital has significantly increased job satisfaction. This paper also takes a look at ways to manage cultural conflict in a diversified workforce. Finally, the results of a team approach to compensation are studied. PMID:10346306
Goodman, Gerald R
The uniform and visible commitment to safety management is a cultural and structural change that health care organizations have not typically attempted. Committee structures are just one example of how culture drives structure in managing health care safety. The question is: "Are we interested in making nonpatient safety programs as well understood and as culturally significant as patient safety programs?" Models exist to institutionalize safety management in health care. We need only look to the JCAHO or OSHA and other high-hazard industry models for examples of safety management. Change requires a focus on safety, not occupational safety or patient safety, but just safety. In health care, safety would be a key characteristic of organizational culture. The organizational expectation is then that all employees will work safely and practice safety. Employees will apply safe practices when handling chemicals, in lifting, and when giving medications. Only when safety imbues the work and decisions of each employee in this way will the highest level of safety be attained. PMID:15000050
Smith, H L; Discenza, R
Conservation of energy resources through total energy management programs is receiving considerable attention in the health services sector. Although the total energy management concept has been favorably implemented in hospitals, the record is not entirely clear for other health care institutions. Thirty-one Arizona and 37 Minnesota long-term care facilities were surveyed to examine the attitudes, knowledge and practice of energy management in the nursing home context. Specific questions were directed toward average monthly energy costs, energy consumption, energy conservation methods implemented, energy conservation methods planned for future implementation, and administrator attitudes on the energy management problem. The results of this study indicate that energy is not perceived to be a major problem in long-term care facilities. Administrators generally lack basic knowledge about energy consumption and energy-related characteristics of their facilities. Few long-range plans and programs have been established to address energy problems. These results suggest the need for new energy policies in the health care system, particularly for institutions other than hospitals. PMID:10253193
Rotheram-Borus, Mary Jane; Ingram, Barbara L.; Swendeman, Dallas; Lee, Adabel
Seventy-five percent of spiraling healthcare costs can be attributed to chronic diseases, making prevention and management of chronic conditions one of our highest healthcare priorities, especially as we organize for patient-centered medical homes. Collaborative patient self-management in primary care has been repeatedly demonstrated to be efficacious in reducing both symptoms and increasing quality of life, yet there is no consensus on what, how, when, and by whom self-mana...
Zaenglein, Andrea L; Pathy, Arun L; Schlosser, Bethanee J; Alikhan, Ali; Baldwin, Hilary E; Berson, Diane S; Bowe, Whitney P; Graber, Emmy M; Harper, Julie C; Kang, Sewon; Keri, Jonette E; Leyden, James J; Reynolds, Rachel V; Silverberg, Nanette B; Stein Gold, Linda F; Tollefson, Megha M; Weiss, Jonathan S; Dolan, Nancy C; Sagan, Andrew A; Stern, Mackenzie; Boyer, Kevin M; Bhushan, Reva
Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence. PMID:26897386
Deyi Mou; Xiaoxin Wang
The mathematical model for airline network seat inventory control problem is usually investigated to maximize the total revenue under some constraints such as capacities and demands. This paper presents a chance-constrained programming model based on the uncertainty theory for network revenue management, in which the fares and the demands are both uncertain variables rather than random variables. The uncertain programming model can be transformed into a deterministic form by taking expected v...
This paper presents the issues involved in implementing the programming language ICL and some of the details of the implementation, with special emphasis on aspects of the data management system. While the structures and algorithms presented here apply to all implementations of ICL, they are particularly relevant to the VAX implementation. This report is not intended to serve as an introduction to programming in ICL nor as a comprehensive guide to its implementation.
The waste produced in the course of health-care activities, from contaminated needles to radioactive isotopes, carries a greater potential for causing infection and injury than any other type of waste, and inadequate or inappropriate management is likely to have serious public health consequences and deleterious effects on the environment. This handbook - the result of extensive international consultation and collaboration - provides comprehensive guidance on safe, efficient, and environmentally sound methods for the handling and disposal of health-care wastes. The various categories of waste are clearly defined and the particular hazards that each poses are described. Considerable prominence is given to the careful planning that is essential for the success of waste management; workable means of minimizing waste production are outlined and the role of reuse and recycling of waste is discussed. Most of the text, however, is devoted to the collection, segregation, storage, transport, and disposal of wastes. Details of containers for each category of waste, labelling of waste packages, and storage conditions are provided, and the various technologies for treatment of waste and disposal of final residues are discussed at length. Advice is given on occupational safety for all personnel involved with waste handling, and a separate chapter is devoted to the closely related topic of hospital hygiene and infection control. The handbook pays particular attention to basic processes and technologies that are not only safe but also affordable, sustainable, and culturally appropriate. For health-care settings in which resources are severely limited there is a separate chapter on minimal programmes; this summarizes all the simplest and least costly techniques that can be employed for the safe management of health-care wastes. The guide is aimed at public health managers and policy-makers, hospital managers, environmental health professionals, and all administrators with an
Larson, David B.; Chan, Frandics P.; Newman, Beverley; Fleischmann, Dominik [Stanford University School of Medicine, Department of Radiology, Stanford, CA (United States); Molvin, Lior Z. [Stanford Hospital and Clinics, Stanford, CA (United States); Wang, Jia [Stanford University, Environmental Health and Safety, Stanford, CA (United States)
Modern CT is a powerful yet increasingly complex technology that continues to rapidly evolve; optimal clinical implementation as well as appropriate quality management and improvement in CT are challenging but attainable. This article outlines the organizational structure on which a CT quality management and improvement program can be built, followed by a discussion of common as well as pediatric-specific challenges. Organizational elements of a CT quality management and improvement program include the formulation of clear objectives; definition of the roles and responsibilities of key personnel; implementation of a technologist training, coaching and feedback program; and use of an efficient and accurate monitoring system. Key personnel and roles include a radiologist as the CT director, a qualified CT medical physicist, as well as technologists with specific responsibilities and adequate time dedicated to operation management, CT protocol management and CT technologist education. Common challenges in managing a clinical CT operation are related to the complexity of newly introduced technology, of training and communication and of performance monitoring. Challenges specific to pediatric patients include the importance of including patient size in protocol and dose considerations, a lower tolerance for error in these patients, and a smaller sample size from which to learn and improve. (orig.)
Modern CT is a powerful yet increasingly complex technology that continues to rapidly evolve; optimal clinical implementation as well as appropriate quality management and improvement in CT are challenging but attainable. This article outlines the organizational structure on which a CT quality management and improvement program can be built, followed by a discussion of common as well as pediatric-specific challenges. Organizational elements of a CT quality management and improvement program include the formulation of clear objectives; definition of the roles and responsibilities of key personnel; implementation of a technologist training, coaching and feedback program; and use of an efficient and accurate monitoring system. Key personnel and roles include a radiologist as the CT director, a qualified CT medical physicist, as well as technologists with specific responsibilities and adequate time dedicated to operation management, CT protocol management and CT technologist education. Common challenges in managing a clinical CT operation are related to the complexity of newly introduced technology, of training and communication and of performance monitoring. Challenges specific to pediatric patients include the importance of including patient size in protocol and dose considerations, a lower tolerance for error in these patients, and a smaller sample size from which to learn and improve. (orig.)
Gavin, John N; Goodman, George; Goroff, David B
The owners of a health insurance/managed care business may want to sell that business for a variety of reasons. Health care provider systems may want to exit that business due to operating losses, difficulty in complying with regulations, the inherent conflict in operating that business as part of a provider system, or the desire to focus on being a health care provider. Health insurers/HMOs may want to sell all or a portion of their business due to operating losses, difficulty in servicing a particular market, or a desire to focus on other markets. No matter what reason prompts a seller to undertake a sale, a sale of health insurance/managed care business can be a complicated transaction involving a multitude of issues. This article will focus first on the ways in which such a sale may be structured. The article will then discuss some transactional issues that may arise in the negotiations for the sale of a health insurance/managed care business. The article will then focus on some particular legal issues that arise in each sale-e.g., antitrust, HIPAA, regulatory approvals, and charitable issues. Finally, this article will provide an overview of tax structuring considerations. PMID:18972991
Rajesh K Chudasama
Full Text Available Background: Bio medical waste collection and proper disposal has become a significant concern for both the medical and general community. Objective: To know the awareness and practice of biomedical waste management (BMW among health care personnel working at a tertiary care centre. Methods: The study was conducted from January 2013 to June 2013. It was a descriptive observational hospital based cross sectional study. Study participants included the resident and intern doctors, nursing staff, laboratory technicians, sanitary staff (ward boys, aaya and sweepers working in the P D U Government Medical College and Civil Hospital, Rajkot who are dealing with BMW. The study was conducted by using pretested, semi-structured pro forma. Results: Total 282 health care personnel participated, including 123 resident and intern doctors, 92 nursing personnel, 13 laboratory technicians and 54 sanitary staff. Only 44.3% study participants received training for bio medical waste management. Except for doctors (98.4%, awareness regarding identification and use of color coded bags as per BMW act, was very poor among health care personnel. Record keeping for injuries related to biomedical waste was very poor for all health care personnel. Significant number of paramedics maintained record of BMW at work place, practiced disinfection and segregation of BMW at work place, used personal protective measures while handling BMW. Significant number of resident and intern doctors practiced correct method for collecting sharps and needles than paramedical staff. Conclusion: Intensive training program at regular time interval and a system of monitoring and surveillance about practice of day to day BMW management should be evolved.
... management systems. (a) All Native American grantees shall establish management information systems to... effectively manage its program and to provide information necessary to design program activities and delivery... whereby the information collected and assessments conducted shall be considered in subsequent...
... National Oceanic and Atmospheric Administration Coastal Zone Management Program: Illinois AGENCY: Office of Ocean and Coastal Resource Management (OCRM), National Oceanic and Atmospheric Administration (NOAA), U... Federal Approval of the Illinois Coastal Management Program (ICMP). SUMMARY: NOAA's OCRM announces...
... operation and management of transportation facilities and services in the corridor. 4. Membership of the... Federal Highway Administration Multistate Corridor Operations and Management Program AGENCY: Federal... Management Program authorized by the Safe, Accountable, Flexible, Efficient Transportation Equity Act:...
Iversen, Hans Petter
How do approaches to management affect knowledge and patient care? In this paper, the establishment and dismantling of an organisational unit for research and development (R&D) in a mental health department of a Norwegian health enterprise are analysed. The characteristics of two adverse treatment ideologies and their coherence with approaches to…
Based on a global survey of leaders, this article examines the challenges facing health care managers today and uncovers best practices to develop and select leaders, especially those on the frontline. Highlights include hiring processes that identify motivated, potential leaders who have the knowledge, experience, competencies, and attributes to get the job done. PMID:17314629
Discusses the concept of Total Quality Management (TQM), developed by W. Edward Deming and Joseph Juran in 1940s, and its applications for child care centers. Discusses how TQM focuses on customer satisfaction, measuring performance, benchmarking, employee empowerment, and continuous training. Includes a list of suggested readings on TQM. (MDM)
Kalra, Sanjay; Gupta, Yashdeep
This communication describes simple targets and interventions, aimed at cardiovascular risk reduction in diabetes mellitus, which are feasible at primary care level. It summarizes therapeutic goals and strategies for management of high blood pressure, dyslipidaemia, and anti-platelet therapy. PMID:26228345
Rao, Vijaya L; Micic, Dejan; Kim, Karen E
Gastrointestinal disorders often present to the primary care setting where initial preventive, diagnostic, and treatment strategies are implemented. This article reviews the presentation and diagnosis of common gastrointestinal disorders, including colorectal cancer, irritable bowel syndrome, peptic ulcer disease, gallbladder disorders, inflammatory bowel disease, gastroesophageal reflux, and Barrett's esophagus. We focus on the evaluation and management of these diseases in women. PMID:27212096
This book tackles the concerns of stressed teachers. Whether from nurturance suffering (stress related to caring for students) or from the piles of paperwork yet to be tackled, this text helps the reader sort through the causes of stress, the emotional, physical and social reactions to stress and how one can begin to plan a stress management plan.…
Suzanne Felt-Lisk; Tricia Higgins
Population health management programsâ€”programs targeted to a defined population that use a variety of individual, organizational, and societal interventions to improve health outcomesâ€”are increasingly being looked on by large employers as a promising practice for improving health and outcomes and "bending" the health care cost curve. Given the national focus on the Center for Medicare & Medicaid Services' administrator Donald Berwick's "triple aim" of improving population health and care ...
LaPointe Rudow, Dianne; Cabello, Charlotte C; Rivellini, Denise
Publications on living donor liver transplant have focused on the medical aspects of donor selection, postoperative management, surgical procedures, and outcomes, but little attention has been given to the nursing implications for care of live liver donors during their inpatient stay. Donor advocates from various disciplines are involved during the initial education and evaluation, but most care after surgery is delivered by an inpatient medical team and bedside nursing staff who are not as familiar with the donor and concepts related to donor advocacy. In an effort to improve the overall donor experience and provide safe, high-quality care to patients undergoing elective partial hepatectomy, our academic medical center began a quality improvement project focused on improving the inpatient stay. Inpatient nursing standards and policies and procedures were developed to ensure that consistent care is delivered. However, the infrequency of living donor liver transplantation makes it nearly impossible to have all transplant program staff on a nursing unit be "experts" on donor care. Therefore, our center determined that, similar to the Independent Donor Advocacy Team, a transplant program needs live donor champions on the nursing unit to mirror the goals of the team. To that end, we developed the concept of the Designated Donor Nurse to care for and advocate for live liver donors during the inpatient stay and also to serve as a resource to their colleagues. PMID:21265291
Finello, Karen Moran; Terteryan, Araksi; Riewerts, Robert J
Responsibilities for primary care clinicians are rapidly expanding ascomplexities in families' lives create increased disparities in health and developmental outcomes for young children. Despite the demands on primary care clinicians to promote health in the context of complex family and community factors, most primary care clinicians are operating in an environment of limited training and a shortage of resources for supporting families. Partnerships with evidence-based home visiting programs for very young children and their families can provide a resource that will help to reduce the impact of adverse early childhood experiences and facilitate health equity. Home visiting programs in the United States are typically voluntary and designed to be preventative in nature, although families are usually offered services based on significant risk criteria since the costs associated with universal approaches have been considered prohibitive. Programs may be funded within the health (physical orbehavioral/mental health), child welfare, early education, or early intervention systems or by private foundation dollars focused primarily on oneof the above systems (e.g., health), with a wide range of outcomes targeted by the programs and funders. Services may be primarily focused on the child, the parent, or parent-child interactions. Services include the development of targeted and individualized intervention strategies, better coaching of parents, and improved modeling of interactions that may assist struggling families. This paper provides a broad overview ofthe history of home visiting, theoretical bases of home visiting programs, key components of evidence-based models, outcomes typically targeted, research on effectiveness, cost information, challenges and benefits of home visiting, and funding/sustainability concerns. Significance for primary care clinicians isdescribed specifically and information relevant for clinicians is emphasized throughout the paper. PMID:26872870
Child Trends, 2010
This paper presents a profile of Tennessee's Star-Quality Child Care Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…
... Terrorism Risk Insurance Program; Litigation Management Submissions AGENCY: Departmental Offices. ACTION..., the Terrorism Risk Insurance Program Office is seeking comments regarding Litigation Management..., preferably an original and two copies) to: Terrorism Risk Insurance Program, Public Comment Record,...
Ung, Brian L; Mullins, C Daniel
The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability. PMID:25217142
Zwijsen, S.A.; Smalbrugge, M.; Eefsting, J.A.; Twisk, J.W.R.; Gerritsen, D.L.; Pot, A.M.; Hertogh, C.M.P.M.
OBJECTIVES: The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes. It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription
The emergency management of nuclear hazards relies on a comprehensive medical care system that includes accident prevention administration, environmental monitoring, a health physics organization, and a medical institution. In this paper, the care organization involved in the criticality accident at Tokai-mura is described, and the problems that need to be examined are pointed out. In that incident, even the expert was initially utterly confused and was unable to take appropriate measures. The author concluded that the members of the care organization were all untrained for dealing with nuclear hazards and radiation accidents. The education and training of personnel at the job site are important, and they are even more so for the leaders. Revisions of the regional disaster prevention plans and care manual are needed. (K.H.)
Covaleski, M A
This article considers the role of accounting information embedded in the income statement of health care providers in their increasingly difficult economic environment. This turbulent economic environment has resulted from the dramatic shift in power from the seller to the buyer of health care services, with a consequential shift of risks that will mandate that health care providers obtain access to better cost and utilization information. This article looks at the 2 critical components of the income statement--the revenue function and the cost structure-in terms of their importance in the management of enhanced economic performance in both the fee-for-service and the prepaid provision of health care services. PMID:11239384
Schuckman, P V
Niche markets such as Medicare, Medicaid and behavioral healthcare are looking to managed care to control costs and increase the quality of care provided. Now workers' compensation officials are looking to managed care with the same goals in mind. As managed care organizations begin marketing to these special populations, the information glut is growing. Information technology can aid managed care officials in the collection, organization and dissemination of the data. PMID:10177514
Eley, Christine L.; Harris, Katherine E.; Hudak, Barbara; Hulvey, Lynne E.; Launder, Susan K.
Background: Organizations that value their employees and appreciate their contributions strive to create a supportive work environment. Leaders can demonstrate care and support for staff by offering a stress-management program. However, program implementation can be challenging. Leadership endorsement, funding, program development, and assimilation within the organizational culture are important elements. Demonstrating value is critical to success, and even the most effective programs may not...
Davis, Elizabeth E.; Krafft, Caroline; Tout, Kathryn
The Minnesota Child Care Assistance Program (CCAP) provides subsidies to help low-income families pay for child care while parents are working, looking for work, or attending school. The program can help make quality child care affordable and is intended both to support employment for low-income families and to support the development and…
Bickett, Allison; Tapp, Hazel
Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care. PMID:27390262
Venketasubramanian, N; Chan, B P L; Lim, E; Hafizah, Noor; Goh, K T; Lew, Y J; Loo, L; Yin, A; Widjaja, L; Loke, W C; Kuick, G; Lee, N L; Ong, B S; Koh, S F; Heng, B H; Cheah, J
Disease management is an approach to patient care that coordinates medical resources for the patient across the entire healthcare delivery system throughout the lifetime of the patient with the disease. Stroke is suitable for disease management as it is a well-known disease with a high prevalence, high cost, variable practice pattern, poor clinical outcome, and managed by a non-integrated healthcare system. It has measurable and actionable outcomes, with available local expertise and support of the Ministry of Health. Developing the programme requires a multidisciplinary team, baseline data on target populations and healthcare services, identification of core components, collaboration with key stakeholders, development of evidence-based clinical practice guidelines and carepaths, institution of care coordinators, use of information technology and continuous quality improvement to produce an effective plan. Core components include public education, risk factor screening and management, primary care and specialist clinics, acute stroke units, inpatient and outpatient rehabilitation facilities, and supportive community services including medical, nursing, therapy, home help and support groups for patients and carers. The family physician plays a key role. Coordination of services is best done by a network of hospital and community-based care managers, and is enhanced by a coordinating call centre. Continuous quality improvement is required, with audit of processes and outcomes, facilitated by a disease registry. Pitfalls include inappropriate exclusion of deserving patients, misuse, loss of physician and patient independence, over-estimation of benefits, and care fragmentation. Collaboration and cooperative among all parties will help ensure a successful and sustainable programme. PMID:12161880
Loubeau, P R; Jantzen, R
Marketing is a central activity of modern organizations. To survive and succeed, organizations must know their markets, attract sufficient resources, convert these resources into appropriate services, and communicate them to various consuming publics. In the hospital industry, a marketing orientation is currently recognized as a necessary management function in a highly competitive and resource-constrained environment. Further, the literature supports a marketing orientation as superior to other orientation types, namely production, product and sales. In this article, the results of the first national cross-sectional study of the marketing orientation of U.S. hospitals in a managed care environment are reported. Several key lessons for hospital executives have emerged. First, to varying degrees, U.S. hospitals have adopted a marketing orientation. Second, hospitals that are larger, or that have developed strong affiliations with other providers that involve some level of financial interdependence, have the greatest marketing orientation. Third, as managed care organizations have increased their presence in a state, hospitals have become less marketing oriented. Finally, contrary to prior findings, for-profit institutions are not intrinsically more marketing oriented than their not-for-profit counterparts. This finding is surprising because of the traditional role of marketing in non-health for-profit enterprises and management's greater emphasis on profitability. An area of concern for hospital executives arises from the finding that as managed care pressure increases, hospital marketing orientation decreases. Although a marketing orientation is posited to lead to greater customer satisfaction and improved business results, a managed care environment seems to force hospitals to focus more on cost control than on customer satisfaction. Hospital executives are cautioned that cost-cutting, the primary focus in intense managed care environments, may lead to short
Brynildson, Mark E.
The annual program report provides detailed information about all aspects of the Sandia National Laboratories, California (SNL/CA) Hazardous Materials Management Program. It functions as supporting documentation to the SNL/CA Environmental Management System Program Manual. This program annual report describes the activities undertaken during the calender past year, and activities planned in future years to implement the Hazardous Materials Management Program, one of six programs that supports environmental management at SNL/CA.
Brynildson, Mark E.
The annual program report provides detailed information about all aspects of the Sandia National Laboratories, California (SNL/CA) Waste Management Program. It functions as supporting documentation to the SNL/CA Environmental Management System Program Manual. This annual program report describes the activities undertaken during the past year, and activities planned in future years to implement the Waste Management (WM) Program, one of six programs that supports environmental management at SNL/CA.
Heckman, R.A.; Minichino, C.
This document consists of abstracts of all reports published by the Nuclear Regulatory Commission (NRC) Waste Management Program at Lawrence Livermore Laboratory (LLL). It will be updated at regular intervals. Reports are arranged in numerical order, within each category. Unless otherwise specified, authors are LLL scientists and engineers.
This report is the sixth in the series of annual reports on the research and development program for the safe management and disposal of Canada's nuclear fuel waste. The report summarizes progress in 1984 for the following activities: storage and transportation of used fuel, immobilization of nuclear fuel waste, geotechnical research, environmental research, and environmental and safety assessment. 186 refs
This document consists of abstracts of all reports published by the Nuclear Regulatory Commission (NRC) Waste Management Program at Lawrence Livermore Laboratory (LLL). It will be updated at regular intervals. Reports are arranged in numerical order, within each category. Unless otherwise specified, authors are LLL scientists and engineers
... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Tribal Management Grant Program Announcement Type: New and Competing Continuation. Funding Announcement Number: HHS-2013-IHS-TMD-0001. Catalog of Federal...
Ana Railka de Souza Oliveira
Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.
... program manager. 91.1003 Section 91.1003 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT... RULES Fractional Ownership Operations § 91.1003 Management contract between owner and program manager. Each owner must have a contract with the program manager that— (a) Requires the program manager...
Laura Johanson da Silva
Full Text Available OBJECTIVE: construct an explanatory theoretical model about nurses' adherence to the Kangaroo Care Method at the Neonatal Intensive Care Unit, based on the meanings and interactions for care management.METHOD: qualitative research, based on the reference framework of the Grounded Theory. Eight nurses were interviewed at a Neonatal Intensive Care Unit in the city of Rio de Janeiro. The comparative analysis of the data comprised the phases of open, axial and selective coding. A theoretical conditional-causal model was constructed.RESULTS: four main categories emerged that composed the analytic paradigm: Giving one's best to the Kangaroo Method; Working with the complexity of the Kangaroo Method; Finding (demotivation to apply the Kangaroo Method; and Facing the challenges for the adherence to and application of the Kangaroo Method.CONCLUSIONS: the central phenomenon revealed that each nurse and team professional has a role of multiplying values and practices that may or may not be constructive, potentially influencing the (discontinuity of the Kangaroo Method at the Neonatal Intensive Care Unit. The findings can be used to outline management strategies that go beyond the courses and training and guarantee the strengthening of the care model.
Full Text Available ... Overview of Medicare Quality Programs Phases of Surgical Care Physician Quality Reporting ... Practice Management Practice Management Practice Management CPT Coding Bulletin Articles ...
Full Text Available ... Overview of Medicare Quality Programs Phases of Surgical Care Physician Quality Reporting System ... Practice Management Practice Management Practice Management CPT Coding Bulletin Articles ...
Lombardi, D N
Fifteen years ago, Bill Gates was a college dropout working for a four-member, fledgling company in New Mexico. Today, he is the richest man in America and the head of perhaps the most powerful company in recent corporate history. Ten years ago, managed health care was merely a concept discussed in academic and industry observer circles. Now it is a norm in almost every health-care organization nationally. Five years ago, health-care professionals in every discipline believed the maxim that, ¿as long as people get sick, health-care professionals will have jobs.¿ In 1995, health-care executives have alternately referred to the widescale process of laying off employees as reengineering, rightsizing, downsizing, or RIF (reduction in force). With this massive amount of change, both societally and professionally, health-care managers have been contending with the change management process. Although a breadth of concepts borrowed from other industries and a plethora of conceptual practicums have entered the health-care educational realm, a straightforward, immediately useful approach to managing change is probably more beneficial, as the need to manage change quickly and effectively becomes the paramount criterion for health-care management success in the second half of this decade of change. In this article we will explore the four areas where mistakes are made most frequently by leaders in the change process, and we will provide specific strategies to not only avoid these mistakes but moreover reduce resistance to change, activate positive action, and ultimately improve performance through optimum staff contribution. The four critical areas we will explore are the reasons for resistance to change, the management of the proactive phase of change, creating staff interdependence, and key leadership roles for change management. PMID:10154378
Full Text Available Ad A Kaptein, Maarten J Fischer, Margreet Scharloo Medical Psychology Section, Leiden University Medical Centre (LUMC, Leiden, the Netherlands Abstract: In this narrative review, we put self-management in the context of a 50-year history of research about how patients with COPD respond to their illness. We review a definition of self-management, and emphasize that self-management should be combined with disease management and the chronic care model in order to be effective. Reviewing the empirical status of self-management in COPD, we conclude that self-management is part and parcel of modern, patient-oriented biopsychosocial care. In pulmonary rehabilitation programs, self-management is instrumental in improving patients’ functional status and quality of life. We conclude by emphasizing how studying the way persons with COPD make sense of their illness helps in refining self-management, and thereby patient-reported outcomes in COPD. Keywords: chronic obstructive pulmonary disease, self-management, psychology, quality of life, biopsychosocial model, medical humanities
Thompson, Lindsay A; Meinert, Elizabeth; Baker, Kimberly; Knapp, Caprice
Pain is common as a presenting complaint to outpatient and emergency departments for children, yet pain management represents one of the children's largest unmet needs. A child may present with acute pain for an intermittent issue or may have acute or chronic pain in the setting of chronic illness. The mainstay of treatment for pain uses a stepwise approach for pain management, such as set up by the World Health Organization. For children with life-limiting illnesses, the Institute of Medicine guidelines recommends referral upon diagnosis for palliative care, meaning that the child receives comprehensive services that include pain control in coordination with curative therapies; yet barriers remain. From the provider perspective, pain can be better addressed through a careful assessment of one's own knowledge, skills, and attitudes. The key components of pain management in children are multimodal, regardless of the cause of the pain. PMID:23329083
U.S. Department of Energy (DOE) Order 5400.1 requires the establishment of a ground water protection management program to ensure compliance with DOE requirements and applicable federal, state, and local laws and regulations. The Uranium Mill Tailings Remedial Action (UMTRA) Project Office was prepared this Ground Water Protection Management Program Plan (ground water protection plan) whose scope and detail reflect the program's significance and address the seven activities required in DOE Order 5400.1, Chapter III, for special program planning. This ground water protection plan highlights the methods designed to preserve, protect, and monitor ground water resources at UMTRA Project processing and disposal sites. The plan includes an overview of the remedial action status at the 24 designated processing sites and identifies technical guidance documents and site-specific documents for the UMTRA Project ground water protection management program. In addition, the plan addresses the general information required to develop a water resources protection strategy at the permanent disposal sites. Finally, the plan describes ongoing activities that are in various stages of development at UMTRA Project sites
Hiranandani, Vanmala Sunder
. Although the lived realities of accessing managed care services that surfaced in this study can be viewed as reasonably representative of the experiences of disabled Medicaid beneficiaries given the cross-disability nature of the sample, the study does not claim generalizability across the country. States...
Health care waste is considered a major public health hazard. The objective of this study was to assess health care waste management (HCWM) practices currently employed at health care centers (HCCs) in the West Bank - Palestinian Territory. Survey data on solid health care waste (SHCW) were analyzed for generated quantities, collection, separation, treatment, transportation, and final disposal. Estimated 4720.7 m3 (288.1 tons) of SHCW are generated monthly by the HCCs in the West Bank. This study concluded that: (i) current HCWM practices do not meet HCWM standards recommended by the World Health Organization (WHO) or adapted by developed countries, and (ii) immediate attention should be directed towards improvement of HCWM facilities and development of effective legislation. To improve the HCWM in the West Bank, a national policy should be implemented, comprising a comprehensive plan of action and providing environmentally sound and reliable technological measures.
Schubart, Jane R.; Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J.
Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demon...
"Loyalty rewards" in sponsored DM and HRM programs can apply to both providers and consumers. Physicians and hospitals can be paid to "loyally" adhere to payers' guidelines for managing diseases and risks. Many payer and their outsourced vendor programs include significant efforts to create collaborations between payer and provider, rather than relying on unilateral efforts. And growing numbers are rewarding providers for their efforts and results achieved. PMID:17590970
van Vugt, Michael; de Wit, Maartje; Hendriks, Steven H.; Roelofsen, Yvonne; Bilo, Henk J. G.; Snoek, Frank J.
Background: Self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs have the potential of supporting type 2 diabetes patients with managing their diabetes and reducing the workload for the care provider, where the addition of online coachin
Managing health systems in small island countries carry with it challenges that are common with other small communities around the world but also articulates for unique challenges that are intrinsically that of small island countries. Sustainability of economies and the small population in small island countries in the Pacific dictates how health care services align and organize to meet the needs of their population. This paper is an attempt to outline possible strategies that could be implemented in view of the ever decreasing meager resources. It will outline a step approach toward realignment and reengineering a viable health care system that is hopefully both cost effective and outcome oriented. PMID:18181405
Kelly, Andrew S
In 2014, Medicare Advantage (MA) enrollment surpassed 30 percent of eligible beneficiaries. Twenty-five years earlier, enrollment hovered at just 3 percent. The expansion of private Medicare plans presents a puzzling instance of policy change within Medicare-a program long held to be a quintessential case of policy stasis. This article investigates the policy features that made Medicare susceptible to this dramatic policy shift, as well as the processes by which the initial policy change remade the politics of Medicare and solidified the MA program. The first enrollment surge occurred in the absence of a proximate legislative or administrative change. Instead, increased spending and expanded benefits were the result of the interaction of new market dynamics with an existing legislative framework-demonstrating an expansionary form of policy drift. The 1982 Tax Equity and Fiscal Responsibility Act created a policy space that gave the new and lightly controlled managed care industry considerable operational discretion. As the interests of the government's private partners changed in response to new market dynamics, a change occurred in the output and performance of the Medicare managed care program. As enrollment and spending increased, Medicare's politics were remade by the political empowerment of the managed care industry and the creation of a new subconstituency of beneficiaries. PMID:26921379
Mokgadi C. Matlakala
Full Text Available Background: Nurses in intensive care units (ICUs are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives.Objectives: The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs.Method: A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding.Results: Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU.Conclusion: Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.
Full Text Available Gail E Bond,1 Laurie Rechholtz,1 Christina Bosa,1 Celine Impert,1,2 Sara Barker21College of Nursing, Seattle University, Seattle WA, USA; 2Sea Mar Community Health Center, Seattle, WA, USAProblem statement: Unprecedented consumption of health care resources in the USA coupled with increasing rates of chronic disease has fueled pursuit of improved models of health care delivery. The Chronic Care Model provides an organizational framework for chronic care management and practice improvement. Sea Mar, a community health care organization in Washington state, implemented the Chronic Care Model, but has not evaluated the outcomes related to provider and staff satisfaction. The specific aim of this project was to evaluate the effectiveness of the Chronic Care Model with the addition of the Chronic Care Coordinator role.Approach: A descriptive method was used, which incorporated quantitative, and qualitative data from providers and clinic staff collected through a Web-based survey consisting of Likert-type questions sent via an electronic link.Results: This evaluation identified the strengths of and barriers to the chronic care model with a focus on provider and staff satisfaction regarding patient care since the addition of the Chronic Care Coordinator role. We found a high appreciation (94% and acceptance of the role; 80% agreed that the Chronic Care Coordinator was well-integrated into clinic operations. Major strengths of the program included more patient education, better follow-up, and improved team communications. Barriers to success included limited provider access, confusion regarding role expectations of the Chronic Care Coordinator, inconsistent communications, and Chronic Care Coordinator turnover.Conclusions/recommendations: Our findings help to validate the importance of community health organizations such as Sea Mar, the utility of the chronic care model, and the potential value for specific roles such as the Chronic Care Coordinator to
Full Text Available In order to be the health care system sustainable , management transformations must be based on very precise diagnostic analysis that includes complete and current information. It is necessary to implement an information system that collects information in real time, that watches the parameters that significantly influence the sustainability of the system. Such an information system should point out a radiography(a scan of the system at some time under following aspects:: 1. An overview of system; 2 An overview of the economic situation; 3 A technical presentation ;4. A legal overview; 5. A social overview ; 6. A management overview .Based on these Xrays of the health system, it outlines a series of conclusions and recommendations together with a SWOT analysis that highlights the potential internal (strengths and weaknesses and external potential (opportunities and threats. Based on this analysis and recommendations, the management is going to redesign the system in order to be adapted to the changing environmental requirements. Management transformation is recommended to be by following steps. :1. The development of a new management system that would make a positive change in the health care system 2. Implementation of the new management system 3. Assessment of the changes
Full Text Available Temperature management in neurocritical care is important and has gained due importance in recent years. Targeted temperature management (TTM includes deliberate reduction of core body temperature to a range of 32–34°C in comatose survivors of cardiac arrest after return of spontaneous circulation and also therapeutic hypothermia (33–35°C in normothermic patients or controlled normothermia (cooling patients to 37°C in hyperthermic patients. This review focuses on the practical aspects of cooling and temperature management in neurocritical care. An electronic search of Google Scholar, MEDLINE (OVID, EMBASE and the Cochrane library was performed. The physiological changes, potential side effects along with significant research and clinical applications in the field of temperature management are main highlights. Currently, the research evidence is available for TTM in adults following cardiac arrest, neonatal hypoxic ischaemic encephalopathy and raised intracranial pressure. Controlled normothermia in neurocritical care population is rapidly gaining popularity. However, data on disease specific therapeutic markers, therapeutic depth and duration and prognostication of this modality are limited. Overall in experienced hands, the technique is safe to execute without the major morbidity and a potential to improve the outcome. Though over the years, clinical applications are unable to consistently demonstrate its benefits, but TTM in neurological insult has become an established and promising concept.
Darkins, Adam; Ryan, Patricia; Kobb, Rita; Foster, Linda; Edmonson, Ellen; Wakefield, Bonnie; Lancaster, Anne E
Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Demographic changes in the veteran population necessitate VHA increase its noninstitutional care (NIC) services 100% above its 2007 level to provide care for 110,000 NIC patients by 2011. By 2011, CCHT will meet 50% of VHA's anticipated NIC provision. CCHT involves the systematic implementation of health informatics, home telehealth, and disease management technologies. It helps patients live independently at home. Between 2003 and 2007, the census figure (point prevalence) for VHA CCHT patients increased from 2,000 to 31,570 (1,500% growth). CCHT is now a routine NIC service provided by VHA to support veteran patients with chronic conditions as they age. CCHT patients are predominantly male (95%) and aged 65 years or older. Strict criteria determine patient eligibility for enrollment into the program and VHA internally assesses how well its CCHT programs meet standardized clinical, technology, and managerial requirements. VHA has trained 5,000 staff to provide CCHT. Routine analysis of data obtained for quality and performance purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrolment into the program. The cost of CCHT is $1,600 per patient per annum, substantially less than other NIC programs and nursing home care. VHA's experience is that an enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings. PMID:19119835
Shirtcliff R Mike; Sutherland Marilynn; Milgrom Peter; Ludwig Sharity; Smolen Darlene
Abstract Background A community-based public health program to provide a dental home for women covered by the Oregon Health Plan (Medicaid) in Klamath County, Oregon USA was instituted with the long-term goal to promote preventive oral care for both mothers and their new infants provided by dental managed care companies. Methods As part of the evaluation of the program, children in Klamath and comparable non-program counties were examined in their 2nd year of life to begin to determine if ben...
Smidth, Margrethe; Christensen, Morten Bondo; Olesen, Frede; Vedsted, Peter
Background Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstru...
Cassel, J. Brian; Kerr, Kathleen M.; Kalman, Noah S.; Smith, Thomas J.
Specialist palliative care (PC) often embraces a “less is more” philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A special business case is needed in which the financial benefits for organizations such as hospitals and payers are aligned with the demonstrable clinical benefits for patients. Based on published studies and our work with PC programs over the past 15 years, we identified 10 principles that together form a business model for specialist PC. These principles are relatively well established for inpatient PC but are only now emerging for community-based PC. Three developments that are key for the latter are the increasing penalties from payers for overutilization of hospital stays, the variety of alternative payment models such as accountable care organizations, which foster a population health management perspective, and payer-provider partnerships that allow for greater access to and funding of community-based PC. PMID:26297853
Cassel, J Brian; Kerr, Kathleen M; Kalman, Noah S; Smith, Thomas J
Specialist palliative care (PC) often embraces a "less is more" philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A special business case is needed in which the financial benefits for organizations such as hospitals and payers are aligned with the demonstrable clinical benefits for patients. Based on published studies and our work with PC programs over the past 15 years, we identified 10 principles that together form a business model for specialist PC. These principles are relatively well established for inpatient PC but are only now emerging for community-based PC. Three developments that are key for the latter are the increasing penalties from payers for overutilization of hospital stays, the variety of alternative payment models such as accountable care organizations, which foster a population health management perspective, and payer-provider partnerships that allow for greater access to and funding of community-based PC. PMID:26297853
The Brazilian Nuclear Energy Commission planned prepared and established a Research Waste Management Program, started in 1996, in order to map, to analyze and to solve the common problems in the research field. The specific study done included a large number of academic institutions. The procedures, results and operational methodology used by the Team linked to the Program, in one of the research institutions studied where corrective actions were implemented to avoid unnecessary dose to the public, will be discussed in this article. (author)
Muhammad Saiful Ridhwan
Full Text Available The importance of managing medical information has become very critical in the healthcare delivery system. Medical information nowadays are optimized towards serving different areas such as; diagnosing of diseases, planning and administration, treatment and monitoring of patient outcomes, services and costs. This article provides a review into various Health and Social Care systems which encompasses the Knowledge Management value. For analysis, more than 30 systems that are related to Health and Social Care were gathered via Internet research, only 20 of these systems were finally selected based on recent system development and popularity of the system.Keywords: Health Care, Knowledge, Knowledge Management, Social Care, systemdoi:10.12695/ajtm.2013.6.2.4 How to cite this article:Ridhwan, M.S., and Oyefolahan, I.O. (2013. Knowledge Management System in Health & Social Care: Review on 20 Practiced Knowledge Management. The Asian Journal of Technology Management 6 (2: 92-101. Print ISSN: 1978-6956; Online ISSN: 2089-791X. doi:10.12695/ajtm.2013.6.2.4
Abdullah M Al-Wahbi
Full Text Available Abdullah M Al-WahbiDepartment of Surgery, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyahd, Kingdom of Saudi ArabiaBackground: Diabetic foot complications are a leading cause of lower extremity amputation. With the increasing incidence of diabetes mellitus in the Arab world, specifically in the Kingdom of Saudi Arabia, the rate of amputation will rise significantly. A diabetic foot care program was implemented at King Abdulaziz Medical City in Riyadh, Saudi Arabia, in 2002. The program was directed at health care staff and patients to increase their awareness about diabetic foot care and prevention of complications. The purpose of this study was to perform a primary evaluation of the program’s impact on the rate of lower extremity amputation due to diabetic foot complications.Method: This pilot study was the first analysis of the diabetic foot care program and examined two groups of participants for comparison, ie, a “before” group having had diabetic foot ulcers managed between 1983, when the hospital was first established, and 2002 when the program began and an “after group” having had foot ulcers managed between 2002 and 2004, in the program’s initial phase. A total of 41 charts were randomly chosen retrospectively. A data sheet containing age, gender, medical data, and the presentation, management, and outcome of diabetic foot cases was used for the analysis.Results: The before group contained 20 patients (17 males and the after group contained 21 patients (16 males. There was no difference between the two groups with regard to age and comorbidities. The rate of amputation was 70% in the before group and 61.9% in the after group. There was a decrease in the percentage of toe amputation in the after group and an increase in the percentage of below-knee amputation in the before group. However, these changes were not significant.Conclusion: The program, although evaluated at an early
Lichtenthal, Wendy G; Kissane, David W
We review the literature on family conflict in palliative care. The prevalence and common sources of conflict are discussed, including historical issues of tension, differing coping styles, the division of labour, and the presence of acute or chronic mental illness within the family. Assessment and intervention strategies used in Family Focused Grief Therapy (FFGT), a family-centred preventive intervention that begins during palliative care and continues during bereavement, are presented, with special consideration given to research on treatment decision-making, cultural issues, special-needs populations, and the management of crises within the family. We conclude with a discussion of challenges that frequently impede conflict resolution and with suggestions for addressing these difficulties in the palliative care setting. PMID:24027358
... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012 Correction In notice document...
Full Text Available We report a case of "can ventilate but can′t intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don′t struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.
Griffith, J R
Today's successful community hospitals should and will evolve into integrated health care organizations (IHCOs) that will share several common characteristics. IHCOs will have a community--not a membership--orientation, and this will be a distinguishing characteristic and a source of market appeal. The transition to IHCO will be a slow one, and to prosper, the IHCO will have to accommodate both price-oriented markets and traditional ones. Successful IHCOs will expand technical skills and capabilities to control costs and quality. New strategic competencies will have to be developed, and to do this, emerging IHCOs will improve the ability of managers to support decisions and sell them both to the buyers and the public at large. Excellent patient care will rest upon better trained, advised, and informed management teams. Making the change to an IHCO will take time and money, but organizations that make steady progress are likely to succeed. PMID:10156172
Taylor, R S; Newton, B
The Financial Accounting Standards Board (FASB) has forced U.S. companies to look squarely at their current retiree health obligations and their future commitments. Accounting Statement No. 106 (FAS 106) requires employers to accrue liabilities for retiree health benefits during employees' active service, rather than record the costs as benefits are paid. Employers are scrambling to find ways to reduce the statement's effect on corporate balance sheets. While managed health care has been increasingly employed to control benefit costs in active employee health plans, it has not been as popular in retiree plans. This article reviews important demographic and health trends in the retiree population and summarizes employers' early responses to FAS 106. It explores why managed health care has thus far played a limited role in reducing employers' postretirement medical liability, and offers insight into how that role could be increased in the future. PMID:10116958
Ellis Alan R
Full Text Available Abstract Background In most states, mental illness costs are an increasing share of Medicaid expenditures. Specialized depression care managers (CM have consistently demonstrated improvements in patient outcomes relative to usual primary care (UC, but are costly and may not be fully utilized in smaller practices. A generalist care manager (GCM could manage multiple chronic conditions and be more accepted and cost-effective than the specialist depression CM. We designed a pilot program to demonstrate the feasibility of training/deploying GCMs into primary care settings. Methods We randomized depressed adult Medicaid patients in 2 primary care practices in Western North Carolina to a GCM intervention or to UC. GCMs, already providing services in diabetes and asthma in both study arms, were further trained to provide depression services including self-management, decision support, use of information systems, and care management. The following data were analyzed: baseline, 3- and 6-month Patient Health Questionnaire (PHQ9 scores; baseline and 6-month Short Form (SF 12 scores; Medicaid claims data; questionnaire on patients' perceptions of treatment; GCM case notes; physician and office staff time study; and physician and office staff focus group discussions. Results Forty-five patients were enrolled, the majority with preexisting depression. Both groups improved; the GCM group did not demonstrate better clinical and functional outcomes than the UC group. Patients in the GCM group were more likely to have prescriptions of correct dosing by chart data. GCMs most often addressed comorbid conditions (36%, then social issues (27% and appointment reminders (14%. GCMs recorded an average of 46 interactions per patient in the GCM arm. Focus group data demonstrated that physicians valued using GCMs. A time study documented that staff required no more time interacting with GCMs, whereas physicians spent an average of 4 minutes more per week. Conclusion GCMs
Westinghouse has incorporated radiation management into the design of its NSSS plants. This paper describes the Westinghouse program for incorporating As Low As Reasonably Achievable (ALARA) radiation exposure into the design process. A description is given of the method of collecting data from operating Westinghouse plants. The analysis of this data and its use in the total NSSS plant exposure estimate is presented. Application of a detailed exposure review to the development of an improved mechanical component is described. A particular exposure review for a refueling task is discussed. One high exposure task is detailed and specific design improvements are identified. The disadvantages of the existing design are expressed and design improvements are suggested. The matrix management of the team that develops the improved design is described and the resulting product is presented. The specific example is used to illustrate the operation of the Westinghouse ALARA program
Sandhu, B K; Duquette, A; Kérouac, S; Rouillier, L
Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management. PMID:1291932
After the Law of the Republic of Lithuania was passed on Radioactive Waste (RW) Management on 20 May 1999, much more attention has been given to the disposal of this kind of waste in our country and especially to the Ignalina NPP, the facility that produces most of it. The Ministry of Economy set up the Radioactive Waste Management Agency (RATA) on 20 July 2001. Its task is to take care of the final disposal of RW in the Republic of Lithuania. Structure, description of the activities and plans for future of RATA is presented
Full Text Available Introduction In the United States, tobacco use is the leading preventable cause of death and disease. The health and cost consequences of tobacco dependence have made treatment and prevention of tobacco use a key priority among multiple stakeholders, including health plans, insurers, providers, employers, and policymakers. In 2002, the third survey of tobacco control practices and policies in health plans was conducted by Americas Health Insurance Plans technical assistance office as part of the Addressing Tobacco in Managed Care (ATMC program. Methods The ATMC survey was conducted in the spring of 2002 via mail, e-mail, and fax. A 19-item survey instrument was developed and pilot-tested. Of the 19 items, 12 were the same as in previous years, four were modified to collect more detailed data on areas of key interest, and three were added to gain information about strategies to promote smoking cessation. The sample for the survey was drawn from the 687 plans listed in the national directory of member and nonmember health plans in America's Health Insurance Plans. Results Of the 246 plans in the sample, 152 plans (62% representing more than 43.5 million health maintenance organization members completed the survey. Results show that health plans are using evidence-based programs and clinical guidelines to address tobacco use. Compared to ATMC survey data collected in 1997 and 2000, the 2002 ATMC survey results indicate that more health plans are providing full coverage for first-line pharmacotherapies and telephone counseling for smoking cessation. Plans have also shown improvement in their ability to identify at least some members who smoke. Similarly, a greater percentage of plans are employing strategies to address smoking cessation during the postpartum period to prevent smoking relapse and during pediatric visits to reduce or eliminate childrens exposure to environmental tobacco smoke. Conclusion The results of the 2002 ATMC survey
This report, the fifth of a series of annual reports, reviews the progress that has been made in the research and development program for the safe management and disposal of Canada's nuclear fuel waste. The report summarizes activities over the past year in the following areas: public interaction; used fuel storage and transportation; immobilization of used fuel and fuel recycle waste; geoscience research related to deep underground disposal; environmental research; and environmental and safety assessment
Since 1954, defense-generated transuranic (TRU) waste has been received at the Radioactive Waste Management Complex (RWMC) at the Idaho National Engineering Laboratory (INEL). Prior to 1970, approximately 2.2 million cubic feet of transuranic waste were buried in shallow-land trenches and pits at the RWMC. Since 1970, an additional 2.1 million cubic feet of waste have been retrievably stored in aboveground engineered confinement. A major objective of the Department of Energy (DOE) Nuclear Waste Management Program is the proper management of defense-generated transuranic waste. Strategies have been developed for managing INEL stored and buried transuranic waste. These strategies have been incorporated in the Defense Waste Management Plan and are currently being implemented with logistical coordination of transportation systems and schedules for the Waste Isolation Pilot Plant (WIPP). The Stored Waste Examination Pilot Plant (SWEPP) is providing nondestructive examination and assay of retrievably stored, contact-handled TRU waste. Construction of the Process Experimental Pilot Plant (PREPP) was recently completed, and PREPP is currently undergoing system checkout. The PRFPP will provide processing capabilities for contact-handled waste not meeting WIPP-Waste Acceptance Criteria (WAC). In addition, ongoing studies and technology development efforts for managing the TRU waste such as remote-handled and buried TRU waste, are being conducted
Since 1954, defense-generated transuranic (TRU) waste has been received at the Radioactive Waste Management Complex (RWMC) at the Idaho National Engineering Laboratory (INEL). Prior to 1970, approximately 2.2 million cubic feet of transuranic waste were buried in shallow-land trenches and pits at the RWMC. Since 1970, an additional 2.1 million cubic feet of waste have been retrievably stored in aboveground engineered confinement. A major objective of the Department of Energy (DOE) Nuclear Waste Management Program is the proper management of defense-generated transuranic waste. Strategies have been developed for managing INEL stored and buried transuranic waste. These strategies have been incorporated in the Defense Waste Management Plan and are currently being implemented with logistical coordination of transportation systems and schedules for the Waste Isolation Pilot Plant (WIPP). The Stored Waste Examination Pilot Plant (SWEPP) is providing nondestructive examination and assay of retrievably stored, contact-handled TRU waste. Construction of the Process Experimental Pilot Plant (PREPP) was recently completed, and PREPP is currently undergoing system checkout. The PREPP will provide processing capabilities for contact-handled waste not meeting WIPP-Waste Acceptance Criteria (WAC). In addition, ongoing studies and technology development efforts for managing the TRU waste such as remote-handled and buried TRU waste, are being conducted
De Maeseneer Jan; Vanden Bussche Piet; Feyen Luc; Bastiaens Hilde; Vandekerckhove Marie; Sunaert Patricia; De Sutter An; Willems Sara
Abstract Background Self-management support is seen as a cornerstone of good diabetes care and many countries are currently engaged in initiatives to integrate self-management support in primary care. Concerning the organisation of these programs, evidence is growing that engagement of health care professionals, in particular of GPs, is critical for successful application. This paper reports on a study exploring why a substantial number of GPs was (initially) reluctant to refer patients to a ...
McSherry, J.; Weiss, R.
PROBLEM ADDRESSED: Management of benign prostatic hyperplasia (BPH) is changing from a surgical approach to a medical approach, and the role of primary care physicians is expanding. OBJECTIVE OF PROGRAM: To introduce a patient-centred approach to managing BPH in primary care through a continuing medical education (CME) program. MAIN COMPONENTS OF PROGRAM: A practice-based, small group, peer-led CME program focused on application of the International Prostate Symptom Score and Quality of Life Assessment in four case studies on prostatism, including BPH. At 86 workshops held across Canada, 658 physicians participated in discussions with case materials that included videos and a handbook. A before-after practice behaviour questionnaire was administered at each workshop to evaluate "intent to change." CONCLUSIONS: Participating physicians showed willingness to learn new skills for patient-centred management of BPH. These results suggest that peer-led, small group CME can successfully encourage use of new practice guidelines in primary are and teach physicians practical steps for developing therapeutic alliances with their patients. PMID:10690495
The Environmental Management Science Program (EMSP) is a collaborative partnership between the DOE Office of Environmental Management (EM), Office of Science (DOE-SC), and the Idaho Operations Office (DOE-ID) to sponsor basic environmental and waste management related research. Results are expected to lead to reduction of the costs, schedule, and risks associated with cleaning up the nation's nuclear complex. The EMSP research portfolio addresses the most challenging technical problems of the EM program related to high level waste, spent nuclear fuel, mixed waste, nuclear materials, remedial action, decontamination and decommissioning, and health, ecology, or risk. The EMSP was established in response to a mandate from Congress in the fiscal year 1996 Energy and Water Development Appropriations Act. Congress directed the Department to ''provide sufficient attention and resources to longer-term basic science research which needs to be done to ultimately reduce cleanup costs, develop a program that takes advantage of laboratory and university expertise, and seek new and innovative cleanup methods to replace current conventional approaches which are often costly and ineffective''. This mandate followed similar recommendations from the Galvin Commission to the Secretary of Energy Advisory Board. The EMSP also responds to needs identified by National Academy of Sciences experts, regulators, citizen advisory groups, and other stakeholders.
Full Text Available Abstract Background The prevalence of both chronic diseases and multi-morbidity increases with longer life spans. As Australia's population ages, the aged care sector is under increasing pressure to ensure that quality aged care is available. Key to responding to this pressure is leadership and management capability within the aged care workforce. A systematic literature review was conducted to inform the policy development necessary for the enhancement of clinical and managerial leadership skills of middle managers within residential aged care. Methods Using scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts, 4,484 papers were found. After a seven-tiered culling process, we conducted a detailed review (narrative synthesis of 153 papers relevant to leadership and management development in aged care, incorporating expert and key stakeholder consultations. Results • Positive staff experiences of a manager's leadership are critical to ensure job satisfaction and workforce retention, the provision of quality care and the well-being of care recipients, and potentially a reduction of associated costs. • The essential attributes of good leadership for aged care middle management are a hands-on accessibility and professional expertise in nurturing respect, recognition and team building, along with effective communication and flexibility. However, successful leadership and management outcomes depend on coherent and good organisational leadership (structural and psychological empowerment. • There is inadequate preparation for middle management leadership roles in the aged care sector and a lack of clear guidelines and key performance indicators to assess leadership and management skills. • Theory development in aged care leadership and management research is limited. A few effective generic clinical leadership programs targeting both clinical and managerial leaders exist. However
Full Text Available Abstract Background The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1 improvement in the rational utilization of health-care services and 2 benefits reflected in improved health status and quality of life for patients. Methods/Design A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients and the other the control group (n = 32,114 patients. The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. Discussion The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of
Khan-Mayberry, Noreen; Bassett, Stephanie
NASA has a rich history of scientific research that has been conducted throughout our numerous manned spaceflight programs. This scientific research has included animal test subjects participating in various spaceflight missions, including most recently, Space Shuttle mission STS-131. The Animal Care Program at Johnson Space Center (JSC) in Houston, Texas is multi-faceted and unique in scope compared to other centers within the agency. The animal care program at JSC has evolved from strictly research to include a Longhorn facility and the Houston Zoo's Attwater Prairie Chicken refuge, which is used to help repopulate this endangered species. JSC is home to more than 300 species of animals including home of hundreds of white-tailed deer that roam freely throughout the center which pose unique issues in regards to population control and safety of NASA workers, visitors and tourists. We will give a broad overview of our day to day operations, animal research, community outreach and protection of animals at NASA Johnson Space Center.
Smith, Alan D.
The literature on the use of strategic management principles by health care organizations is reviewed. After considering basic concepts of strategic management and managerial problems in nonprofit organizations, strategic planning and management of health care organizations are covered. Attention is directed to the health care environment,…
the Integrated Management System. CM ensures that during the entire operational life of the plant the following requirements are met: · The basic design requirements of the plant are established, documented and maintained; · The physical structures, systems and components (SSCs) of the plant are in conformity with the design requirements; · The physical and functional characteristics of the plant are correctly incorporated in the operational and maintenance documentation, as well as in the documents for testing and training; · The changes in the design documentation are incorporated in the physical configuration and · the operative documentation; · The changes in the design are minimized by management process for review according to approved criteria. The purpose of this report is to try to clarify the place of configuration management program within the Integrated Management System of Kozloduy NPP and to present the computerized information system for organization of the operational activities (IS OOA) as a tool for effective management of the facility. (authors)
Lambert, B L; Salmon, J W; Stubbings, J; Gilomen-Study, G; Valuck, R J; Kezlarian, K
This multi-site, cross-sectional, observational study sought to identify attitudinal and social normative factors associated with the prescribing of oral antibiotics to ambulatory patients in a managed care setting. Participants were 25 physicians specializing in internal medicine, family practice or pediatrics from five ambulatory care clinics within a large, fully integrated health care system in a major midwestern U.S. city. The main outcome measure was number of prescriptions per physician written in the fourth quarter of 1994 for each of seven selected antibiotics. Correlational and multiple regression analyses revealed that behavioral intentions were significantly associated (P antibiotic prescribing behavior. Prescribing behavior may have been a function of patient-specific rather than general beliefs about antibiotics. Methodological limitations related to the sample size and the sparseness of the utilization data may also have prevented a significant effect of intentions on behavior from being detected. Alternatively, in managed care settings, it is hypothesized that prescribing behavior may have been influenced more by non-psychological factors, such as management systems, formularies and therapeutic substitution programs, than they were by internal, psychological factors such as attitudes, subjective norms and intentions. Managed care is altering the role of the physician as an autonomous decision-maker. In response, models of prescribing must either incorporate variables such as perceived behavioral control to aid in the prediction of non-volitional behavior, model the decision-making of non-physician managers, or forego psychological models in favor of structural or system-level models of drug utilization. PMID:9447627
Vernooij-Dassen Myrra JFJ
Full Text Available Abstract Background The aim of this study is evaluating the (cost- effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the management of depression, including standardized use of measurement instruments and diagnostical methods, and protocolized psychosocial, psychological and pharmacological treatment. Methods/Design In a 19-month longitudinal controlled study using a stepped wedge design, 14 somatic and 14 dementia special care units will implement the care program. All residents who give informed consent on the participating units will be included. Primary outcomes are the frequency of depression on the units and quality of life of residents on the units. The effect of the care program will be estimated using multilevel regression analysis. Secondary outcomes include accuracy of depression-detection in usual care, prevalence of depression-diagnosis in the intervention group, and response to treatment of depressed residents. An economic evaluation from a health care perspective will also be carried out. Discussion The care program is expected to be effective in reducing the frequency of depression and in increasing the quality of life of residents. The study will further provide insight in the cost-effectiveness of the care program. Trial registration Netherlands Trial Register (NTR: NTR1477
The National Ignition Facility (NIF) has the mission of supporting Stockpile Stewardship and Basic Science research in high-energy-density plasmas. To execute those missions, the facility must provide diagnostic instrumentation capable of observing and resolving in time events and radiation emissions characteristic of the plasmas of interest. The diagnostic instrumentation must conform to high standards of operability and reliability within the NIF environment. These exacting standards, together with the facility mission of supporting a diverse user base, has led to the need for a central organization charged with delivering diagnostic capability to the NIF. The National NIF Diagnostics Program (NNDP) has been set up under the aegis of the NIF Director to provide that organization authority and accountability to the wide user community for NIF. The funds necessary to perform the work of developing diagnostics for NIF will be allocated from the National NIF Diagnostics Program to the participating laboratories and organizations. The participating laboratories and organizations will design, build, and commission the diagnostics for NIF. Restricted availability of funding has had an adverse impact, unforeseen at the time of the original decision to projectize NIF Core Diagnostics Systems and Cryogenic Target Handing Systems, on the planning and initiation of these efforts. The purpose of this document is to provide an interim project management plan describing the organizational structure and management processes currently in place for NIF Core Diagnostics Systems. Preparation of a Program Execution Plan for NIF Core Diagnostics Systems has been initiated and a current draft is provided as Attachment 1 to this document. The National NIF Diagnostics Program Interim Management Plan provides a summary of primary design criteria and functional requirements, current organizational structure, tracking and reporting procedures, and current planning estimates of project scope
The National Ignition Facility (NIF) has the mission of supporting Stockpile Stewardship and Basic Science research in high-energy-density plasmas. To execute those missions, the facility must provide diagnostic instrumentation capable of observing and resolving in time events and radiation emissions characteristic of the plasmas of interest. The diagnostic instrumentation must conform to high standards of operability and reliability within the NIF environment. These exacting standards, together with the facility mission of supporting a diverse user base, has led to the need for a central organization charged with delivering diagnostic capability to the NIF. The National NIF Diagnostics Program (NNDP) has been set up under the aegis of the NIF Director to provide that organization authority and accountability to the wide user community for NIF. The funds necessary to perform the work of developing diagnostics for NIF will be allocated from the National NIF Diagnostics Program to the participating laboratories and organizations. The participating laboratories and organizations will design, build, and commission the diagnostics for NIF. Restricted availability of funding has had an adverse impact, unforeseen at the time of the original decision to projectize NIF Core Diagnostics Systems and Cryogenic Target Handing Systems, on the planning and initiation of these efforts. The purpose of this document is to provide an interim project management plan describing the organizational structure and management processes currently in place for NIF Core Diagnostics Systems. Preparation of a Program Execution Plan for NIF Core Diagnostics Systems has been initiated and a current draft is provided as Attachment 1 to this document. The National NIF Diagnostics Program Interim Management Plan provides a summary of primary design criteria and functional requirements, current organizational structure, tracking and reporting procedures, and current planning estimates of project scope
Kirby, E G; Sebastian, J G
Drawing on institutional theory, this study examines how adherence to a number of "institutional" and "technical" environmental forces can influence the business success of managed care organizations (MCOs). The standards studied include: (1) institutional forces: socially accepted procedures for delivering care (access to quality care, availability of information, and delivery of care in a personal manner); and (2) technical forces: industry standards for cost control and efficient use of financial and medical resources. The most significant finding is that successful MCOs must conform to both institutional and technical forces to be successful. MCOs that conform to either one or the other type of standard were no more successful than those that conformed to neither. These findings have several important implications for MCO strategy. First, to be successful, MCO executives must understand the external environment in which they operate. They must anticipate and respond to shifts in that environment. Second, this understanding of the external environment must place equal emphasis on societal demands (e.g., for accessible care and information) and on technical demands (e.g., for cost-efficient care). These findings may well reflect that once managed care penetration reaches relatively high levels, marketshare can no longer be gained through cost-efficiency alone; rather, enrollee satisfaction based on societal demands becomes a key factor in maintaining and gaining marketshare. Institutional theory provides' some strategies for accomplishing these goals. Cost-containment strategies include implementing policies for cutting costs in areas that do not affect the quality of care, such as using generic drugs and reducing administrative excesses and redundancies. At the same time, MCOs must implement strategies aimed at improving conformity to prevailing societal perceptions of appropriate care, including providing patients more freedom to choose their physicians and
Leontjevas, R.; Gerritsen, D.L.; Koopmans, R.T.C.M.; Smalbrugge, M.; Vernooij-Dassen, M.J.F.J.
BACKGROUND: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): "Act in case of Depression" (AiD). OBJECTIVE: Before effect analyses, to evaluate AiD proc
Toktobaev, Nurjan; Emmanuel, Jorge; Djumalieva, Gulmira; Kravtsov, Alexei; Schüth, Tobias
A novel low-cost health care waste management system was implemented in all rural hospitals in Kyrgyzstan. The components of the Kyrgyz model include mechanical needle removers, segregation using autoclavable containers, safe transport and storage, autoclave treatment, documentation, recycling of sterilized plastic and metal parts, cement pits for anatomical waste, composting of garden wastes, training, equipment maintenance, and management by safety and quality committees. The gravity-displacement autoclaves were fitted with filters to remove pathogens from the air exhaust. Operating parameters for the autoclaves were determined by thermal and biological tests. A hospital survey showed an average 33% annual cost savings compared to previous costs for waste management. All general hospitals with >25 beds except in the capital Bishkek use the new system, corresponding to 67.3% of all hospital beds. The investment amounted to US$0.61 per capita covered. Acceptance of the new system by the staff, cost savings, revenues from recycled materials, documented improvements in occupational safety, capacity building, and institutionalization enhance the sustainability of the Kyrgyz health care waste management system. PMID:25649402
Troyer, Glenn T; Brashear, Andrea D; Green, Kelly J
Triggered by corporate scandals, there is increased oversight by governmental bodies and in part by the Sarbanes-Oxley Act of 2002. Corporations are developing corporate governance compliance initiatives to respond to the scrutiny of regulators, legislators, the general public and constituency groups such as investors. Due to state attorney general initiatives, new legislation and heightened oversight from the Internal Revenue Service, nonprofit entities are starting to share the media spotlight with their for-profit counterparts. These developments are changing nonprofit health care organizations as well as the traditional role of the risk manager. No longer is the risk manager focused solely on patients' welfare and safe passage through a complex delivery system. The risk manager must be aware of corporate practices within the organization that could allow the personal objectives of a few individuals to override the greater good of the community in which the nonprofit organization serves. PMID:20200865
Full Text Available Abstract Background The beneficial outcomes of oral anticoagulation therapy are dependent upon achieving and maintaining an optimal INR therapeutic range. There is growing evidence that better outcomes are achieved when anticoagulation is managed by a pharmacist with expertise in anticoagulation management rather than usual care by family physicians. This study compared a pharmacist managed anticoagulation program (PC to usual physician care (UC in a family medicine clinic. Methods A retrospective cohort study was carried out in a family medicine clinic which included a clinical pharmacist. In 2006, the pharmacist assumed anticoagulation management. For a 17-month period, the PC group (n = 112 of patients on warfarin were compared to the UC patients (n = 81 for a similar period prior to 2006. The primary outcome was the percentage of time patients' INR was in the therapeutic range (TTR. Secondary outcomes were the percentage of time in therapeutic range within ± 0.3 units of the recommended range (expanded TTR and percentage of time the INR was >5.0 or Results The baseline characteristics were similar between the groups. Fifty-five percent of the PC group was male with a mean age of 67 years; 51% of the UC group was male with a mean age of 71 years. The most common indications for warfarin in both groups were atrial fibrillation, mechanical heart valves and deep vein thrombosis. The TTR was 73% for PC and 65% for UC (p 5 were 0.3% for PC patients and 0.1% for UC (p Conclusion The pharmacist-managed anticoagulation program within a family practice clinic compared to usual care by the physicians achieved significantly better INR control as measured by the percentage of time patients' INR values were kept in both the therapeutic and expanded range. Based on the results of this study, a collaborative family practice clinic using pharmacists and physicians may be an effective model for anticoagulation management with these results verified in future
The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. However, health care expenditure is a great cause for concern and many nations around the world struggle to contain rising health care costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug...
Gans, Gary (Technical Monitor)
As basic policy, NASA believes that colleges and universities should be encouraged to participate in the nation's space and aeronautics program to the maximum extent practicable. Indeed, universities are considered as partners with government and industry in the nation's aerospace program. NASA's objective is to have them bring their scientific, engineering, and social research competence to bear on aerospace problems and on the broader social, economic, and international implications of NASA's technical and scientific programs. It is expected that, in so doing, universities will strengthen both their research and their educational capabilities to contribute more effectively to the national well being. This annual report is one means of documenting the NASA-university relationship, frequently denoted, collectively, as NASA's University Program. This report is consistent with agency accounting records, as the data is obtained from NASA's Financial and Contractual Status (FACS) System, operated by the Financial Management Division and the Procurement Office. However, in accordance with interagency agreements, the orientation differs from that required for financial or procurement purposes. Any apparent discrepancies between this report and other NASA procurement or financial reports stem from the selection criteria for the data. This report was prepared by the Office of Education/N.
Full Text Available Obesity and being overweight could be real chronic conditions above all if there are other complications such as type 2 diabetes, cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer and various psychosocial and psychopathological disorders,. Due to the multifactorial etiology of obesity, evidence-based interventions to improve weight loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. There are significant limitations in this multidisciplinary chronic care management of obesity, most notably those regarding costs and long-term adherence and efficacy. Programs including eHealth platforms and new technologies could overcome limitations connected to the traditional in-patient chronic care management of obesity, thus providing promising opportunities in enhancing weight reduction and reducing complications in terms of long-term efficacy and effectiveness across clinical, organizational, and economic perspectives.
As basic policy, NASA believes that colleges and universities should be encouraged to participate in the nation's space and aeronautics program to the maximum extent practicable. Indeed, universities are considered as partners with government and industry in the nation's aerospace program. NASA:s objective is to have them bring their scientific, engineering, and social research competence to bear on aerospace problems and on the broader social, economic, and international implications of NASA's technical and scientific programs. It is expected that, in so doing, universities will strengthen both their research and their educational capabilities to contribute more effectively to the national well-being. NASA field codes and certain Headquarters program offices provide funds for those activities in universities which contribute to the mission needs of that particular NASA element. Although NASA has no predetermined amount of money to devote to university activities, the effort funded each year is substantial. This annual report is one means of documenting the NASA-university relationship, frequently denoted, collectively, as NASA's University Program. This report is consistent with agency accounting records, as the data is obtained from NASA:s Financial and Contractual Status (FACS) System, operated by the Financial Management Division and the Procurement Office. However, in accordance with interagency agreements, the orientation differs from that required for financial or procurement purposes. Any apparent discrepancies between this report and other NASA procurement or financial reports stem from the selection criteria for the data.* This report was prepared by the Education Division/FE, Office of Human Resources and Education, using a management information system which was modernized during FY 1993.
Johnson, Tammie M; Richards, Jennifer; Churilla, James R
Objective. Previous studies have shown that receiving diabetes self-management education (DSME) is associated with increased care utilization. However, the relationship between DSME duration and care utilization patterns remains largely unexamined. Our purpose is to characterize DSME duration and examine the relationship between DSME duration and clinical- and self-care utilization patterns. Methods. The study sample included 1,446 adults who were ≥18 years of age, had diabetes, and had participated in the 2008 Florida Behavioral Risk Factor Surveillance System survey. Clinical- and self-care outcomes were derived using responses to the survey's diabetes module and were based on minimum standards of care established by the American Diabetes Association. The outcomes examined included self-monitoring of blood glucose at least once per day; receiving at least one eye exam, one foot exam, A1C tests, and an influenza vaccination in the past year; and ever receiving a pneumococcal vaccination. DSME duration was categorized as no DSME, >0 to 10 hours. Results. After adjusting for sociodemographic variables, compared to those who did not receive DSME, those who had 4-10 or 10+ hours of DSME were more likely to receive two A1C tests (odds ratio [95% CI] 2.69 [1.30-5.58] and 2.63 [1.10-6.31], respectively) and have a pneumococcal vaccination (1.98 [1.03-3.80] and 1.92 [1.01-3.64], respectively). Those receiving 10+ hours of DSME were 2.2 times (95% CI 1.18-4.09) as likely to have an influenza vaccination. Conclusion. These data reveal a positive relationship between DSME duration and utilization of some diabetes clinical care services. PMID:26300613
... 49 Transportation 4 2010-10-01 2010-10-01 false Adoption of bridge management programs. 237.31 Section 237.31 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD... Adoption of bridge management programs. Each track owner shall adopt a bridge safety management program...
Review of Emergency Management: Concepts and Strategies for Effective Programs By Lucien G. Canton, CEM. By taking a different perspective on local government emergency management programs, this book presents the vision for a very different model--one that includes an independent emergency manager leading an enterprise-wide program focused on strategies that promote disaster resilient communities.
... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false State water management planning program. 740.4 Section 740.4 Conservation of Power and Water Resources WATER RESOURCES COUNCIL STATE WATER MANAGEMENT PLANNING PROGRAM § 740.4 State water management planning program. (a) A State shall submit a description of its...
Roblin, D. W.; Richardson, D K; Thomas, E; Fitzgerald, F; Veintimilla, R.; Hulac, P.; Bemis, G.; Leon, L.
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)...
Full Text Available Objective: To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. Design: Qualitative method of focus groups. Setting/Participants: The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. Method: Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. Main findings: Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. Conclusion: Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting.
Koutkias, Vassilis G; Chouvarda, Ioanna; Triantafyllidis, Andreas; Malousi, Andigoni; Giaglis, Georgios D; Maglaveras, Nicos
The ongoing efforts toward continuity of care and the recent advances in information and communication technologies have led to a number of successful personal health systems for the management of chronic care. These systems are mostly focused on monitoring efficiently the patient's medical status at home. This paper aims at extending home care services delivery by introducing a novel framework for monitoring the patient's condition and safety with respect to the medication treatment administered. For this purpose, considering a body area network (BAN) with advanced sensors and a mobile base unit as the central communication hub from the one side, and the clinical environment from the other side, an architecture was developed, offering monitoring patterns definition for the detection of possible adverse drug events and the assessment of medication response, supported by mechanisms enabling bidirectional communication between the BAN and the clinical site. Particular emphasis was given on communication and information flow aspects that have been addressed by defining/adopting appropriate formal information structures as well as the service-oriented architecture paradigm. The proposed framework is illustrated via an application scenario concerning hypertension management. PMID:20007042
Knapp, K K
The demand for pharmacists in the changing health care market is discussed. The Pharmacy Manpower Project (PMP) evolved out of concerns raised in the late 1980s, when the demand for pharmacists exceeded the supply. PMP collects, analyzes, and disseminates data on pharmacy work force variables. PMP's Subcommittee to Study Demand Issues was formed after the publication in 1995 of the Pew Health Professions Commission report projecting dramatic surpluses of pharmacists. In 1996-97, the PMP subcommittee held a series of sessions to discuss the future demand for pharmacists and their services. The panel identified a wide range of work force projections, but it concluded that medication management problems in the context of increasing prescription numbers and the emergence of data-driven health care support a scenario of a steadily increasing demand for pharmacists and pharmaceutical services. The data did not show that higher penetration by managed care is associated with smaller pharmacy staffs or job loss in institutions. There is little reason to expect the dramatic downsizing of the pharmacy work force predicted by the third report of the Pew Commission. However, retaining pharmacy roles that are useful to the system and satisfying to pharmacists will require a continuation of current proactive measures by the profession. PMID:10683127
O'Konski, Gerry, Ed.
This manual provides detailed information on how local non-profit organizations can sponsor licensed family day care homes for participation in the federally funded Child Care Food Program. This program subsidizes the provision of nutritious meals to children who are not in school. The introductory section of the manual answers basic questions…
... National Oceanic and Atmospheric Administration Coastal Zone Management Program: Illinois AGENCY: Office of Ocean and Coastal Resource Management (OCRM), National Oceanic and Atmospheric Administration (NOAA...: NOAA's Office of Ocean and Coastal Resource Management (OCRM) announces availability of the...
... National Oceanic And Atmospheric Administration Coastal Zone Management Program: Illinois AGENCY: Office of Ocean and Coastal Resource Management (OCRM), National Oceanic and Atmospheric Administration (NOAA... Impact Statement (DEIS) prepared by NOAA's Office of Ocean and Coastal Resource Management. The...
Full Text Available The aim of this study was to evaluate health-care waste in the 18 districts of metropolitan municipality of the third biggest city in Turkey. This cross-sectional study was carried out with 825 health institutions established in the 18 districts of Izmir metropolitan municipality, in 2007. The total amount of health-care waste collected was 4841 tons and 621 kilograms per patient's bed in 2007. Most of the medical wastes were collected from Konak, Karsiyaka and Bornova districts and were 2308, 272 and 1020 tons, respectively. Regarding to overpopulation, the number of health institutions in these districts are more than the number of health institutions in the other administrative districts. There was a statistically significant, positive correlation between the amount of health-care waste collected and population of the 18 districts (r = 0.79, p < 0.001, and number of beds/patients (r = 0.83, p < 0.001. To provide a safe health-care waste management metropolitan municipality must provide hazardous waste separation in health institutions, establish sterilization units for infectious waste, and provide the last storage of medical waste in completely different, safe and special areas apart from the municipal waste storage areas.
Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L
Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective. PMID:27453745
Full Text Available Targeted temperature management (TTM in today′s modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21 st century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI, meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios.
Jukema, Jan S; Harps-Timmerman, Annelies; Stoopendaal, Annemiek; Smits, Carolien H M
Change management is an important area of training in undergraduate nursing education. Successful change management in healthcare aimed at improving practices requires facilitation skills that support teams in attaining the desired change. Developing facilitation skills in nursing students requires formal educational support. A Dutch Regional Care Improvement Program based on a nationwide format of change management in healthcare was designed to act as a Powerful Learning Environment for nursing students developing competencies in facilitating change. This article has two aims: to provide comprehensive insight into the program components and to describe students' learning experiences in developing their facilitation skills. This Dutch Regional Care Improvement Program considers three aspects of a Powerful Learning Environment: self-regulated learning; problem-based learning; and complex, realistic and challenging learning tasks. These three aspects were operationalised in five distinct areas of facilitation: increasing awareness of the need for change; leadership and project management; relationship building and communication; importance of the local context; and ongoing monitoring and evaluation. Over a period of 18 months, 42 nursing students, supported by trained lecturer-coaches, took part in nine improvement teams in our Regional Care Improvement Program, executing activities in all five areas of facilitation. Based on the students' experiences, we propose refinements to various components of this program, aimed at strengthenin the learning environment. There is a need for further detailed empirical research to study the impact this kind of learning environment has on students developing facilitation competencies in healthcare improvement. PMID:26004744
Hahn, Julie; Reilly, Patricia M; Buchanan, Teresa M
Creating a healing and healthy environment for patients, families, and staff is an ongoing challenge. As part of our hospital's Integrative Care Program, a Reiki Volunteer Program has helped to foster a caring and healing environment, providing a means for patients, family, and staff to reduce pain and anxiety and improve their ability to relax and be present. Because direct care providers manage multiple and competing needs at any given time, they may not be available to provide Reiki when it is needed. This program demonstrates that a volunteer-based program can successfully support nurses in meeting patient, family, and staff demand for Reiki services. PMID:24310710
Hospital and other health care facilities (HCFs) are known to generate lot of waste for which its management is a matter of considerable public health and environmental concern. The study was undertaken to describe the current practices, gaps and quantify the load of health care solid waste. Out of one hundred and fifty health care facilities (HCFs) in Punjab, the largest province of Pakistan, a sample of fifteen (HCFs) was taken from a few selected Districts, to include six large hospitals and nine without indoor facilities. Only 40% of studied institutions had some program to dispose-off the waste. Even these programs were deficient in many areas and could hardly be considered as scientific. One third of institutional personnel interviewed had proper awareness or existence of a training program. Only one institution had some concept of taking safety steps from infectious materials. The process of solid waste collection, storing, transporting and final disposal was highly inefficient in almost all the institutions. No regulatory body or system of waste was in place in any of the hospitals. There was no allocated budget in 27% of the hospitals for covering the cost of waste disposal. An average of 0.3 kg/bed/day of solid unsafe waste demands a systematic program of its disposal, failing which serious environmental hazards would develop for within and surroundings communities. (author)
Conway, Jane; Dilworth, Sophie; Hullick, Carolyn; Hewitt, Jacqueline; Turner, Catherine; Higgins, Isabel
This case study describes a multi-organisation aged care emergency (ACE) service. The service was designed to enable point-of-care assessment and management for older people in residential aged care facilities (RACFs). Design of the ACE service involved consultation and engagement of multiple key stakeholders. The ACE service was implemented in a large geographical region of a single Medicare Local (ML) in New South Wales, Australia. The service was developed over several phases. A case control pilot evaluation of one emergency department (ED) and four RACFs revealed a 16% reduction in presentations to the ED as well as reductions in admission to the hospital following ED presentation. Following initial pilot work, the ACE service transitioned across another five EDs and 85 RACFs in the local health district. The service has now been implemented in a further 10 sites (six metropolitan and four rural EDs) across New South Wales. Ongoing evaluation of the implementation continues to show positive outcomes. The ACE service offers a model shown to reduce ED presentations and admissions from RACFs, and provide quality care with a focus on the needs of the older person. PMID:25981903
Ye. G. Totskaya
Full Text Available The paper reviews topical issues of organization and management of innovative activity in the regional health care system.Objective. Development and scientific substantiation of a conceptual model of managing innovation in the regional health care system, introduction of institutional mechanisms for its implementation, and evaluation of their efficacy in using diagnosis and treatment technologies. Objectives of the study included reviewing the organization status and problems hampering the development, identification of prospects, and justification for appropriate changes in innovation in healthcare system and medical science at the regional level.Material and methods. To conduct a comprehensive assessment of the status and meet challenges of innovation promotion, a methodology for social-hygienic research was worked out including bibliographic and analytical methods, situational analysis, sociological and economic methods, expert assessment, methods for quality management system audit in accordance with ISO 19011:2002, IDEFO function modeling (RD IDEF0-2000, and organizational modeling. The study was based on the analysis of foreign and domestic literature, statistics, methods for managerial modeling, as well as management experience (including innovative methodological approaches gained by Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan which meets the requirements for a platform for research and innovative product reproduction, including research, clinical, organizational, and managerial aspects. Other facilities were considered in conjunction with the leading innovative platform.Results. The paper presents a scientifically based model of innovative medical environment with its elements as subjects, each with a set of functions. Conceptual model for management includes structuring (resource, processes, and quality management; application of international standards and strategic management mechanisms
Full Text Available The mathematical model for airline network seat inventory control problem is usually investigated to maximize the total revenue under some constraints such as capacities and demands. This paper presents a chance-constrained programming model based on the uncertainty theory for network revenue management, in which the fares and the demands are both uncertain variables rather than random variables. The uncertain programming model can be transformed into a deterministic form by taking expected value on objective function and confidence level on the constraint functions. Based on the strategy of nested booking limits, a solution method of booking control is developed to solve the problem. Finally, this paper gives a numerical example to show that the method is practical and efficient.
This plan describes the program management principles and functions to be implemented in the Mixed Waste Focus Area (MWFA). The mission of the MWFA is to provide acceptable technologies that enable implementation of mixed waste treatment systems developed in partnership with end-users, stakeholders, tribal governments and regulators. The MWFA will develop, demonstrate and deliver implementable technologies for treatment of mixed waste within the DOE Complex. Treatment refers to all post waste-generation activities including sampling and analysis, characterization, storage, processing, packaging, transportation and disposal
Asklund, U.; Bendix, Lars Gotfred; Ekman, T.
Extreme programming (XP) is a software development method that prescribes the use of 12 different practices. Four of these practices (collective code ownership, continuous integration, small releases and refactoring) can indeed be given good support by the use of simple configuration management (CM......) techniques. We report on our experience in providing many groups of novice developers with CM education, processes and tools to support the four CM-related XP practices in their projects. True to the spirit of XP both education and processes are very lightweight and we found that it was sufficient to focus...
This plan describes the program management principles and functions to be implemented in the Mixed Waste Focus Area (MWFA). The mission of the MWFA is to provide acceptable technologies that enable implementation of mixed waste treatment systems developed in partnership with end-users, stakeholders, tribal governments and regulators. The MWFA will develop, demonstrate and deliver implementable technologies for treatment of mixed waste within the DOE Complex. Treatment refers to all post waste-generation activities including sampling and analysis, characterization, storage, processing, packaging, transportation and disposal.
Aschenbrener, C A; Siders, C T
Physician executives face low to mid-level intensity conflicts, day-to-day issues and problems associated with pressures and changes in the health care environment. Such conflicts can be sorted on the basis of relationship, duration, and intensity. The authors apply the five major modes of conflict management--competition, avoidance, compromise, accommodation, and collaboration--to specific scenarios taken from their work in health care and suggest guidelines for managing conflicts with peers, supervisees, and authority figures. Thorough preparation and a portfolio of skills build flexibility through the conflict management process. In part 1 of this article series, the authors presented the conflict management checklist, a diagnostic tool for assessing conflict in organizations. PMID:10558283
Giannoni, Peggy P.; Kass, Philip H.
A retrospective cohort study was conducted to identify risk factors associated with children lost to care, and their families, compared to those not lost to care within the California Early Start Program. The cohort included data on 8987 children enrolled in the Early Start Program in 1998. This cohort consisted of 2443 children lost to care, 6363…
... the Medicare Community-Based Care Transitions Program AGENCY: Centers for Medicare & Medicaid Services... to participate in the Medicare Community-based Care Transitions Program, which was authorized by... Tiongson, (410) 786-0342 or by e-mail at CareTransitions@cms.hhs.gov . ADDRESSES: Proposals should...
Essary, Alison C; Wade, Nathaniel L
According to the most recent statistics from the National Center for Education Statistics, disparities in enrollment in undergraduate and graduate education are significant and not improving commensurate with the national population. Similarly, only 12% of graduating medical students and 13% of graduating physician assistant students are from underrepresented racial and ethnic groups. Established in 2012 to promote health care transformation at the organization and system levels, the School for the Science of Health Care Delivery is aligned with the university and college missions to create innovative, interdisciplinary curricula that meet the needs of our diverse patient and community populations. Three-year enrollment trends in the program exceed most national benchmarks, particularly among students who identify as Hispanic and American Indian/Alaska Native. The Science of Health Care Delivery program provides students a seamless learning experience that prepares them to be solutions-oriented leaders proficient in the business of health care, change management, innovation, and data-driven decision making. Defined as the study and design of systems, processes, leadership and management used to optimize health care delivery and health for all, the Science of Health Care Delivery will prepare the next generation of creative, diverse, pioneering leaders in health care. PMID:27262477
Muhammad Saiful Ridhwan; Ishaq Oyebisi Oyefolahan
The importance of managing medical information has become very critical in the healthcare delivery system. Medical information nowadays are optimized towards serving different areas such as; diagnosing of diseases, planning and administration, treatment and monitoring of patient outcomes, services and costs. This article provides a review into various Health and Social Care systems which encompasses the Knowledge Management value. For analysis, more than 30 systems that are related to Health ...
Powers, Jennifer G; Higham, Catherine; Broussard, Karen; Phillips, Tania J
In the United States, chronic ulcers--including decubitus, vascular, inflammatory, and rheumatologic subtypes--affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measures include disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies to promote healing. In this article, we discuss recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers. PMID:26979353
Blum, J D
This article deals with the application of economic measures to the appointment, reappointment, and delineation of medical staff privileges, the so-called practice of economic credentialing. The concept of economic credentialing is first explored in the hospital context with a focus on legal and political issues. The second part of the article examines how economic credentialing will evolve in new managed care practice settings. Emphasis is placed on how the law and legislation will be utilized by organized medicine to protect physician interests in the process of selective contracting. Specific discussion focuses on the American Medical Association's Patient Protection Act and the implications of "any willing provider" provisions. PMID:8528826
... Care initiative (CPC), a multipayer model designed to improve primary care. DATES: Letter of Intent... strengthen free-standing primary care capacity by testing a model of comprehensive, accountable primary care... through the implementation of the Comprehensive Primary Care (CPC) initiative: To collaborate with...
Antonio Giulio de Belvis
Full Text Available
In the most developed countries, it is necessary to bring about significant changes to health care delivery through the strengthening of prevention, rehabilitation and the integration of the social and healthcare dimensions.
This means moving the policy focus from “treating” to “taking care” of the sick in a broader and more integrated way, one which is more closely linked to the World Health Organization’s definition of health as physical, psychological and social well-being. This change involves the delivery of care for the elderly. Developed countries are confronting this issue by using different community-based programs to integrate acute and long-term care services for frail elderly individuals with complex health needs.
The objective of this health policy article is to give an overview of the most recent initiatives on long-term care management for the elderly including normative, funding and organizational issues in the USA, as their public health system largely differs from those of the Western European countries.
Particular attention is given to the PACE (Program of All Inclusive Care for the Elderly, which applies a comprehensive approach to managing the care of the frail elderly population and would represent a new framework in geriatric care. By incorporating a central core care team to manage the needs of each elderly individual, this approach recognizes the contributing factors that non-traditional health related functions play in the overall health of the individual.
Although there is a little knowledge of this program, as it covers a very small percentage of the eligible individuals, and it may be difficult to extrapolate to other sectors of the population, PACE offers many lessons that could be applied to more effective integration of care for individuals and lead to better health outcomes.
The modern industrial manger faces the challenge of safely and efficiently operating increasingly complex, sophisticated, and expensive plants in an atmosphere of reduced resources and increased competition, and frequently with heightened political and public oversight. These political and public concerns have become especially significant where the Federal Government regulates and/or funds programs that have a significant potential for adverse public safety or environmental impacts. Under these circumstances, a major accident or environmental insult could translate into major programmatic delay, redirection, or even plant closing. After-the-fact (reactive) resolution of safety and/or environment problems is both costly and time-consuming process. Therefore, it is prudent for managers at all levels to initiate aggressive proactive efforts to identify and control the risks (hazards) associated with their programs. Unfortunately, risk is not a concept with a single, universally accepted definition. It is most often represented as the product of the probability of occurrence of undesired events and the resultant consequences of those events. The consequences of concern may include: loss of human health, reduction in life expectancy, or loss of life; material or financial losses; environmental damage; or even societal disturbances. This paper discusses risk management and systems safety interest in which has intensified over the post decade principally because of public perceptions of the risks associated with nuclear power and the disposal of hazardous chemical wastes
Van de Putte, M; Appels, S; Boone, T; Collienne, S; Daems, T; De Lepeleire, J; Foulon, V
Medication management in home care is an error prone process. In a small pilot project in Flanders, community pharmacists collaborated with physicians and home care nurses through a shared electronic care plan, to optimize the medication management of their home care patients. The pilot project shows that GPs and nurses are positive about the possible contribution of the pharmacist in medication management of home care patients. A larger follow up study is necessary to further identify possible roles of pharmacists in home care and to show related health benefits. PMID:23697093
Gosling, J; Case, P; Tulloch, J; Chandramohan, D.; Wegbreit, J; Newby, G; Gueye, CS; Koita, K; Gosling, R.
Effective program management is essential for successful elimination of malaria. In this perspective article, evidence surrounding malaria program management is reviewed by management science and malaria experts through a literature search of published and unpublished gray documents and key informant interviews. Program management in a malaria elimination setting differs from that in a malaria control setting in a number of ways, although knowledge and understanding of these distinctions are ...