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Sample records for care management redesign

  1. Active Redesign of a Medicaid Care Management Strategy for Greater Return on Investment: Predicting Impactability.

    Science.gov (United States)

    DuBard, C Annette; Jackson, Carlos T

    2018-04-01

    Care management of high-cost/high-needs patients is an increasingly common strategy to reduce health care costs. A variety of targeting methodologies have emerged to identify patients with high historical or predicted health care utilization, but the more pertinent question for program planners is how to identify those who are most likely to benefit from care management intervention. This paper describes the evolution of complex care management targeting strategies in Community Care of North Carolina's (CCNC) work with the statewide non-dual Medicaid population, culminating in the development of an "Impactability Score" that uses administrative data to predict achievable savings. It describes CCNC's pragmatic approach for estimating intervention effects in a historical cohort of 23,455 individuals, using a control population of 14,839 to determine expected spending at an individual level, against which actual spending could be compared. The actual-to-expected spending difference was then used as the dependent variable in a multivariate model to determine the predictive contribution of a multitude of demographic, clinical, and utilization characteristics. The coefficients from this model yielded the information required to build predictive models for prospective use. Model variables related to medication adherence and historical utilization unexplained by disease burden proved to be more important predictors of impactability than any given diagnosis or event, disease profile, or overall costs of care. Comparison of this approach to alternative targeting strategies (emergency department super-utilizers, inpatient super-utilizers, or patients with highest Hierarchical Condition Category risk scores) suggests a 2- to 3-fold higher return on investment using impactability-based targeting.

  2. Optimizing enactment of nursing roles: redesigning care processes and structures

    Directory of Open Access Journals (Sweden)

    Jackson K

    2014-02-01

    Full Text Available Karen Jackson,1 Deborah E White,2 Jeanne Besner,1 Jill M Norris21Health Systems and Workforce Research Unit, Alberta Health Services, Calgary, Alberta, Canada; 2Faculty of Nursing, University of Calgary, Calgary, Alberta, CanadaBackground: Effective and efficient use of nursing human resources is critical. The Nursing Role Effectiveness Model conceptualizes nursing practice in terms of key clinical role accountabilities and has the potential to inform redesign efforts. The aims of this study were to develop, implement, and evaluate a job redesign intended to optimize the enactment of registered nurse (RN clinical role accountabilities.Methods: A job redesign was developed and implemented in a single medical patient care unit, the redesign unit. A mixed-methods design was used to evaluate the job redesign; a second medical patient care unit served as a control unit. Data from administrative databases, observations, interviews, and demographic surveys were collected pre-redesign (November 2005 and post-redesign (October 2007.Results: Several existing unit structures and processes (eg, model of care delivery influenced RNs' ability to optimally enact their role accountabilities. Redesign efforts were hampered by contextual issues, including organizational alignment, leadership, and timing. Overall, optimized enactment of RN role accountabilities and improvements to patient outcomes did not occur, yet this was predictable, given that the redesign was not successful. Although the results were disappointing, much was learned about job redesign.Conclusion: Potential exists to improve the utilization of nursing providers by situating nurses' work in a clinical role accountability framework and attending to a clear organizational vision and well-articulated strategic plan that is championed by leaders at all levels of the organization. Health care leaders require a clear understanding of nurses' role accountabilities, support in managing change, and

  3. Redesigning ambulatory care business processes supporting clinical care delivery.

    Science.gov (United States)

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

    1997-04-01

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

  4. 78 FR 27968 - Federal Management Regulation; Redesignations of Federal Buildings

    Science.gov (United States)

    2013-05-13

    ... Management Regulation; Redesignations of Federal Buildings AGENCY: Public Buildings Service (PBS), General... designation and redesignation of six Federal buildings. DATES: Expiration Date: This bulletin announcement expires July 30, 2013. The building designations and redesignations remains in effect until canceled or...

  5. Case management redesign in an urban facility.

    Science.gov (United States)

    Almaden, Stefany; Freshman, Brenda; Quaye, Beverly

    2011-01-01

    To explore strategies for improving patient throughput and to redesign case management processes to facilitate level of care transitions and safe discharges. Large Urban Medical Center in South Los Angeles County, with 384 licensed beds that services poor, underserved communities. Both qualitative and quantitative methods were applied. Combined theoretical frameworks were used for needs assessment, intervention strategies, and change management. Observations, interviews, surveys, and database extraction methods were used. The sample consisted of case management staff members and several other staff from nursing, social work, and emergency department staff. Postintervention measures indicated improvement in reimbursements for services, reduction in length of stay, increased productivity, improved patients' access to care, and avoiding unnecessary readmission or emergency department visits. Effective change management strategies must consider multiple factors that influence daily operations and service delivery. Creating accountability by using performance measures associated with patient transitions is highlighted by the case study results. The authors developed a process model to assist in identifying and tracking outcome measures related to patient throughput, front-end assessments, and effective patient care transitions. This model can be used in future research to further investigate best case management practices.

  6. Partnered research in healthcare delivery redesign for high-need, high-cost patients: development and feasibility of an Intensive Management Patient-Aligned Care Team (ImPACT).

    Science.gov (United States)

    Zulman, Donna M; Ezeji-Okoye, Stephen C; Shaw, Jonathan G; Hummel, Debra L; Holloway, Katie S; Smither, Sasha F; Breland, Jessica Y; Chardos, John F; Kirsh, Susan; Kahn, James S; Asch, Steven M

    2014-12-01

    We employed a partnered research healthcare delivery redesign process to improve care for high-need, high-cost (HNHC) patients within the Veterans Affairs (VA) healthcare system. Health services researchers partnered with VA national and Palo Alto facility leadership and clinicians to: 1) analyze characteristics and utilization patterns of HNHC patients, 2) synthesize evidence about intensive management programs for HNHC patients, 3) conduct needs-assessment interviews with HNHC patients (n = 17) across medical, access, social, and mental health domains, 4) survey providers (n = 8) about care challenges for HNHC patients, and 5) design, implement, and evaluate a pilot Intensive Management Patient-Aligned Care Team (ImPACT) for a random sample of 150 patients. HNHC patients accounted for over half (52 %) of VA facility patient costs. Most (94 %) had three or more chronic conditions, and 60 % had a mental health diagnosis. Formative data analyses and qualitative assessments revealed a need for intensive case management, care coordination, transitions navigation, and social support and services. The ImPACT multidisciplinary team developed care processes to meet these needs, including direct access to team members (including after-hours), chronic disease management protocols, case management, and rapid interventions in response to health changes or acute service use. Two-thirds of invited patients (n = 101) enrolled in ImPACT, 87 % of whom remained actively engaged at 9 months. ImPACT is now serving as a model for a national VA intensive management demonstration project. Partnered research that incorporated population data analysis, evidence synthesis, and stakeholder needs assessments led to the successful redesign and implementation of services for HNHC patients. The rigorous design process and evaluation facilitated dissemination of the intervention within the VA healthcare system. Employing partnered research to redesign care for high-need, high

  7. Acceptance of lean redesigns in primary care: A contextual analysis.

    Science.gov (United States)

    Hung, Dorothy; Gray, Caroline; Martinez, Meghan; Schmittdiel, Julie; Harrison, Michael I

    Lean is a leading change strategy used in health care to achieve short-term efficiency and quality improvement while promising longer-term system transformation. Most research examines Lean intervention to address isolated problems, rather than to achieve broader systemic changes to care delivery. Moreover, no studies examine contextual influences on system-wide Lean implementation efforts in primary care. The aim of this study was to identify contextual factors most critical to implementing and scaling Lean redesigns across all primary care clinics in a large, ambulatory care delivery system. Over 100 interviews and focus groups were conducted with frontline physicians, clinical staff, and operational leaders. Data analysis was guided by a modified Consolidated Framework for Implementation Research (CFIR), a popular implementation science framework. On the basis of expert recommendations, the modified framework targets factors influencing the implementation of process redesigns. This modified framework, the CFIR-PR, informed our identification of contextual factors that most impacted Lean acceptance among frontline physicians and staff. Several domains identified by the CFIR-PR were critical to acceptance of Lean redesigns. Regarding the implementation process acceptance was influenced by time and intensity of exposure to changes, "top-down" versus "bottom-up" implementation styles, and degrees of employee engagement in developing new workflows. Important factors in the inner setting were the clinic's culture and style of leadership, along with availability of information about Lean's effectiveness. Last, implementation efforts were impacted by individual and team characteristics regarding changed work roles and related issues of professional identity, authority, and autonomy. This study underscores the need for change leaders to consider the contextual factors that surround efforts to implement Lean in primary care. As Lean redesigns are scaled across a system

  8. Innovation in ambulatory care: a collaborative approach to redesigning the health care workplace.

    Science.gov (United States)

    Johnson, Paula A; Bookman, Ann; Bailyn, Lotte; Harrington, Mona; Orton, Piper

    2011-02-01

    To improve the quality of patient care and work satisfaction of the physicians and staff at an ambulatory practice that had recently started an innovative model of clinical care for women. The authors used an inclusive process, collaborative interactive action research, to engage all physicians and staff members in assessing and redesigning their work environment. Based on key barriers to working effectively and integrating work and family identified in that process, a pilot project with new work practices and structures was developed, implemented, and evaluated. The work redesign process established cross-occupational care teams in specific clinical areas. Members of the teams built skills in assessing clinical operations in their practice areas, developed new levels of collaboration, and constructed new models of distributed leadership. The majority of participants reported an improvement in how their area functioned. Integrating work and family/personal life-particularly practices around flexible work arrangements-became an issue for team discussion and solutions, not a matter of individual accommodation by managers. By engaging the workforce, collaborative interactive action research can help achieve lasting change in the health care workplace and increase physicians' and staff members' work satisfaction. This "dual agenda" may be best achieved through a collaborative process where cross-occupational teams are responsible for workflow and outcomes and where the needs of patients and providers are integrated.

  9. 77 FR 40358 - Federal Management Regulation; FMR Bulletin PBS-2012-03; Redesignations of Federal Buildings...

    Science.gov (United States)

    2012-07-09

    ... Management Regulation; FMR Bulletin PBS-2012-03; Redesignations of Federal Buildings: Correction AGENCY: Public Buildings Service (PBS), General Services Administration (GSA). ACTION: Notice of a bulletin..., 2012, a bulletin announcing the designation and redesignation of three Federal buildings. Inadvertently...

  10. Redesigning nursing work in long-term care environments.

    Science.gov (United States)

    Hall, L M; O'Brien-Pallas, L

    2000-01-01

    The authors present a highly statistically oriented argument for examining work attitudes and activities among three groups of caregivers [RNs, RPNs, and HCAs] working in long-term care. The investigators used both work sampling, written surveys, and interviews with a sample of 46 caregivers in a large university-affiliated LTC facility in Toronto, Canada. While RNs stated their strong affinity for direct patient care activities, they perform the lowest percentage of direct care, chiefly due to their accountability for planning and coordinating the care provided by others. The HCAs who provided the bulk of direct patient care "valued it the least," apparently finding little gratification with this aspect of their role. This study suggests that there is a need to examine and clarify work roles and perceptions for all caregivers as part of any work redesign process. A higher level of RN involvement in direct patient care activities, along with "attention to enhancing the importance" of these activities for staff employed in the HCA role, could be beneficial.

  11. 77 FR 35393 - Federal Management Regulation; FMR Bulletin PBS-2012-03; Redesignations of Federal Buildings

    Science.gov (United States)

    2012-06-13

    ... Management Regulation; FMR Bulletin PBS-2012-03; Redesignations of Federal Buildings AGENCY: Public Buildings... bulletin announces the designation and redesignation of three Federal buildings. Expiration Date: This bulletin announcement expires October 31, 2012. The building designation and redesignations remains in...

  12. 76 FR 54772 - Federal Management Regulation; FMR Bulletin PBS-2011-B2; Redesignations of Federal Buildings

    Science.gov (United States)

    2011-09-02

    ... Management Regulation; FMR Bulletin PBS-2011-B2; Redesignations of Federal Buildings AGENCY: Public Buildings... announces the designation and redesignation of two Federal buildings. Expiration Date: This bulletin announcement expires January 31, 2012. The building designation and redesignation remains in effect until...

  13. 75 FR 69080 - Federal Management Regulation; FMR Bulletin PBS-2010-B5; Redesignations of Federal Buildings

    Science.gov (United States)

    2010-11-10

    ... Management Regulation; FMR Bulletin PBS-2010-B5; Redesignations of Federal Buildings AGENCY: Public Buildings... announces the designation and redesignation of two Federal buildings. DATES: Expiration Date: This bulletin announcement expires April 30, 2011. The building designation and redesignation remains in effect until...

  14. 76 FR 6792 - Federal Management Regulation; FMR Bulletin PBS-2011-B1; Redesignations of Federal Buildings

    Science.gov (United States)

    2011-02-08

    ... Management Regulation; FMR Bulletin PBS-2011-B1; Redesignations of Federal Buildings AGENCY: Public Buildings... announces the redesignations of three Federal buildings. DATES: Expiration Date: This bulletin announcement expires June 30, 2011. The building redesignations remain in effect until canceled or superseded by...

  15. 75 FR 44264 - Federal Management Regulation; FMR Bulletin PBS-2010-B4; Redesignation of Federal Building

    Science.gov (United States)

    2010-07-28

    ... Management Regulation; FMR Bulletin PBS-2010-B4; Redesignation of Federal Building AGENCY: Public Buildings... announces the redesignation of a Federal building. DATES: Expiration Date: This bulletin expires December 31, 2010. However, the building redesignation announced by this bulletin will remain in effect until...

  16. Redesigning Health Care Practices to Address Childhood Poverty.

    Science.gov (United States)

    Fierman, Arthur H; Beck, Andrew F; Chung, Esther K; Tschudy, Megan M; Coker, Tumaini R; Mistry, Kamila B; Siegel, Benjamin; Chamberlain, Lisa J; Conroy, Kathleen; Federico, Steven G; Flanagan, Patricia J; Garg, Arvin; Gitterman, Benjamin A; Grace, Aimee M; Gross, Rachel S; Hole, Michael K; Klass, Perri; Kraft, Colleen; Kuo, Alice; Lewis, Gena; Lobach, Katherine S; Long, Dayna; Ma, Christine T; Messito, Mary; Navsaria, Dipesh; Northrip, Kimberley R; Osman, Cynthia; Sadof, Matthew D; Schickedanz, Adam B; Cox, Joanne

    2016-04-01

    Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty. Copyright © 2016 Academic Pediatric Association. All rights reserved.

  17. Lean thinking across a hospital: redesigning care at the Flinders Medical Centre.

    Science.gov (United States)

    Ben-Tovim, David I; Bassham, Jane E; Bolch, Denise; Martin, Margaret A; Dougherty, Melissa; Szwarcbord, Michael

    2007-02-01

    Lean thinking is a method for organising complex production processes so as to encourage flow and reduce waste. While the principles of lean thinking were developed in the manufacturing sector, there is increasing interest in its application in health care. This case history documents the introduction and development of Redesigning Care, a lean thinking-based program to redesign care processes across a teaching general hospital. Redesigning Care has produced substantial benefits over the first two-and-a-half years of its implementation, making care both safer and more accessible. Redesigning Care has not been aimed at changing the specifics of clinical practice. Rather, it has been concerned with improving the flow of patients through clinical and other systems. Concepts that emerged in the manufacturing sector have been readily translatable into health care. Lean thinking may play an important role in the reform of health care in Australia and elsewhere.

  18. Across the divide: "Primary care departments working together to redesign care to achieve the Triple Aim".

    Science.gov (United States)

    Koslov, Steven; Trowbridge, Elizabeth; Kamnetz, Sandra; Kraft, Sally; Grossman, Jeffrey; Pandhi, Nancy

    2016-09-01

    Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim. As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care. This article describes the process of aligning these three primary care departments: defining panel size, developing a common primary care job description, redesigning the primary care compensation plan, redesigning the care model, and developing standardized staffing. Prior to the initiative, the rate of patient satisfaction was 85%, anticoagulation measurement 65%, pneumococcal vaccination 85%, breast cancer screening 79%, and colorectal cancer screening 69%. These rates all improved to 87%, 75%, 88%, 80%, and 80% respectively. Themes around key challenges to departmental integration are identified: (1) implementing effective communication strategies; (2) addressing specialty differences in primary care delivery; (3) working within resource limitations; and (4) developing long-term sustainability. Primary care in this large academic health center was transformed through developing a united primary care leadership team that bridged individual departments to create and adopt a common vision and solutions to shared problems. Our collaboration has achieved improvements across patient satisfaction, clinical safety metrics, and publicly-reported preventive care outcomes. The description of this experience may be useful for other academic health centers or other non-integrated delivery systems undertaking primary care practice transformation. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Redesigning Care Delivery with Patient Support Personnel: Learning from Accountable Care Organizations

    Science.gov (United States)

    Gorbenko, Ksenia O.; Fraze, Taressa; Lewis, Valerie A.

    2017-01-01

    INTRODUCTION Accountable care organizations (ACOs) are a value-based payment model in the United States rooted in holding groups of healthcare providers financially accountable for the quality and total cost of care of their attributed population. To succeed in reaching their quality and efficiency goals, ACOs implement a variety of care delivery changes, including workforce redesign. Patient support personnel (PSP)—non-physician staff such as care coordinators, community health workers, and others—are critical to restructuring care delivery. Little is known about how ACOs are redesigning their patient support personnel in terms of responsibilities, location, and evaluation. METHODS We conducted semi-structured one-hour interviews with 25 executives at 16 distinct ACOs. The interviews were recorded, transcribed, and coded for themes, using a qualitative coding and analysis process. RESULTS ACOs deployed PSP to perform four clusters of responsibilities: care provision, care coordination, logistical help with transportation, and social and emotional support. ACOs deployed these personnel strategically across settings (primary care, inpatient services, emergency department, home care and community) depending on their population needs. Most ACOs used personnel with the same level of training across settings. Few ACOs planned to conduct a comprehensive evaluation of their PSP to optimize their value. DISCUSSION ACO strategies in workforce redesign indicate a shift from a physician-centered to a team-based approach. Employing personnel with varying levels of clinical training to perform different tasks can help further optimize care delivery. More robust evaluation of the deployment of PSP and their performance is needed to demonstrate cost-saving benefits of workforce redesign. PMID:28217305

  20. [Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA].

    Science.gov (United States)

    Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I

    2010-01-01

    To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

  1. Innovative use of technologies and methods to redesign care: the problem of care transitions.

    Science.gov (United States)

    Richman, Mark; Sklaroff, Laura Myerchin; Hoang, Khathy; Wasson, Elijah; Gross-Schulman, Sandra

    2014-01-01

    Organizations are redesigning models of care in today's rapidly changing health care environment. Using proven innovation techniques maximizes likelihood of effective change. Our safety-net hospital aims to reduce high emergency department visit, admission, and readmission rates, key components to health care cost control. Twenty-five clinical stakeholders participated in mixed-methods innovation exercises to understand stakeholders, frame problems, and explore solutions. We identified existing barriers and means to improve post-emergency department/post-inpatient discharge care coordination/communication among patient-centered medical home care team members, including patients. Physicians and staff preferred automated e-mail notifications, including patient identifiers, medical home/primary care provider information, and relevant clinical documentation, to improve communication efficiency/efficacy.

  2. Effective Strategies to Spread Redesigning Care Processes Among Healthcare Teams.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; O'Connor, Patricia; Lavigne, Geneviève L; Briand, Anaïck; Biron, Alain; Baillargeon, Sophie; MacGibbon, Brenda; Ringer, Justin; Cyr, Guylaine

    2015-07-01

    The purpose of this study was to describe how spread strategies facilitate the successful implementation of the Transforming Care at the Bedside (TCAB) program and their impact on healthcare workers and patients in a major Canadian healthcare organization. This study used a qualitative and descriptive design with focus groups and individual interviews held in May 2014. Participants included managers and healthcare providers from eight TCAB units in a university health center in Quebec, Canada. The sample was composed of 43 individuals. The data were analyzed using NVivo according to the method proposed by Miles and Huberman. The first two themes that emerged from the analysis are related to context (organizational transition requiring many changes) and spread strategies for the TCAB program (senior management support, release time and facilitation, rotation of team members, learning from previous TCAB teams, and engaging patients). The last theme that emerged from the analysis is the impact on healthcare professionals (providing front-line staff and managers with the training they need to make changes, team leadership, and increasing receptivity to hearing patients' and families' needs and requests). This study describes the perspectives of managers and team members to provide a better understanding of how spread strategies can facilitate the successful implementation of the TCAB program in a Canadian healthcare organization. Spread strategies facilitate the implementation of changes to improve the quality and safety of care provided to patients. © 2015 Sigma Theta Tau International.

  3. Feasibility study for the redesign of MDOT's pavement management systems software.

    Science.gov (United States)

    2011-04-01

    In August of 2006 the Mississippi Department of Transportation (MDOT) initiated State Study No. 191, entitled Feasibility : Study for the Redesign of MDOTs Pavement Management System (PMS) Software. At the initiation of this study, the : Dep...

  4. Experiences of primary care physicians and staff following lean workflow redesign.

    Science.gov (United States)

    Hung, Dorothy Y; Harrison, Michael I; Truong, Quan; Du, Xue

    2018-04-10

    In response to growing pressures on primary care, leaders have introduced a wide range of workforce and practice innovations, including team redesigns that delegate some physician tasks to nonphysicians. One important question is how such innovations affect care team members, particularly in view of growing dissatisfaction and burnout among healthcare professionals. We examine the work experiences of primary care physicians and staff after implementing Lean-based workflow redesigns. This included co-locating physician and medical assistant dyads, delegating significant responsibilities to nonphysician staff, and mandating greater coordination and communication among all care team members. The redesigns were implemented and scaled in three phases across 46 primary care departments in a large ambulatory care delivery system. We fielded 1164 baseline and 1333 follow-up surveys to physicians and other nonphysician staff (average 73% response rate) to assess workforce engagement (e.g., job satisfaction, motivation), perceptions of the work environment, and job-related burnout. We conducted multivariate regressions to detect changes in experiences after the redesign, adjusting for respondent characteristics and clustering of within-clinic responses. We found that both physicians and nonphysician staff reported higher levels of engagement and teamwork after implementing redesigns. However, they also experienced higher levels of burnout and perceptions of the workplace as stressful. Trends were the same for both occupational groups, but the increased reports of stress were greater among physicians. Additionally, members of all clinics, except for the pilot site that developed the new workflows, reported higher burnout, while perceptions of workplace stress increased in all clinics after the redesign. Our findings partially align with expectations of work redesign as a route to improving physician and staff experiences in delivering care. Although teamwork and engagement

  5. Review series: Examples of chronic care model: the home-based chronic care model: redesigning home health for high quality care delivery.

    Science.gov (United States)

    Suter, Paula; Hennessey, Beth; Florez, Donna; Newton Suter, W

    2011-01-01

    Individuals with chronic obstructive pulmonary disease (COPD) face significant challenges due to frequent distressing dyspnea and deficits related to activities of daily living. Individuals with COPD are often hospitalized frequently for disease exacerbations, negatively impacting quality of life and healthcare expenditure burden. The home-based chronic care model (HBCCM) was designed to address the needs of patients with chronic diseases. This model facilitates the re-design of chronic care delivery within the home health sector by ensuring patient-centered evidence-based care. This HBCCM foundation is Dr. Edward Wagner s chronic care model and has four additional areas of focus: high touch delivery, theory-based self management, specialist oversight and the use of technology. This article will describe this model in detail and outline how model use for patients with COPD can bring value to stakeholders across the health care continuum.

  6. Managing care.

    Science.gov (United States)

    Sandifer, Q D

    1997-09-01

    The terms 'managed care' and 'disease management' are gaining common usage in the health service but their meaning is not widely understood. Managed care is a generic term describing any health care system that integrates the financing and delivery of medical care. Its growth in the United States has been driven by pressure to control costs, and there is circumstantial evidence that costs are slowing as a result of better management of resources. However, it is not clear how much of this is due to managed care, the selection of more favourable enrollees to health plans or other factors. Research evidence is limited, and that available is constrained by the rapidly changing nature of managed care. In the United States a bewildering variety of managed care arrangements have emerged, although several common characteristics can be identified: limited choice of physician providers; controlled access to secondary care; selective contracting; financial incentives; quality management; and utilization management. All are present in the National Health Service (NHS), which exemplifies a nationalized managed care system. Disease management is an extension of managed care that takes a global approach to patient care by attempting to co-ordinate resources across the entire health care delivery system throughout the life cycle of the disease. This is poorly developed in the NHS, so that the attention of commercial organizations has been attracted. However, concern has been expressed about the implications of commercial involvement: the fragmentation of general medical services; effect of for-profit status; and use of patient-based data. Recent policy developments could allow disease management to develop within the NHS.

  7. Information Technology Management: Course Re-Design Using an Assessment Driven Approach

    Science.gov (United States)

    Schwieger, Dana; Surendran, Ken

    2013-01-01

    One of the core courses in the IS2010 Model Curriculum Guideline is "IS Strategy, Management and Acquisition" ("ISMA"). The authors redesigned their pre-IS2010 model Information Technology Management (ITM) course to meet the skills development stated in the ISMA course. Since the IT discipline is changing rapidly, the technical…

  8. Inpatient Dialysis Unit Project Development: Redesigning Acute Hemodialysis Care.

    Science.gov (United States)

    Day, Jennifer

    2017-01-01

    Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency. The results of the project were a newly constructed tandem hemodialysis room and an operational plan with clearly defined key performance indicators, process improvement initiatives, and financial goals. This article provides an overview of essential components of a business plan to guide the establishment of an inpatient hemodialysis unit. Copyright© by the American Nephrology Nurses Association.

  9. Redesigning models of patient care delivery and organisation: building collegial generosity in response to workplace challenges.

    Science.gov (United States)

    Chiarella, E Mary

    2007-04-01

    This case study describes the New South Wales Nursing and Midwifery Office (NaMO) Models of Care Project, a project designed to identify, encourage and disseminate innovations in nursing care organisation and delivery. The project is a 4-year action research project, using a range of interactive engagements including workshops, seminars, questionnaires and websites to achieve the goals. This case study briefly describes the main stimuli for review and redesign of models of care identified through analysis of the clinicians' presentations, and explores the range of responses to the workplace challenges.

  10. Redesigning care for chronic conditions: improving hospital-based ambulatory care for people with osteoarthritis of the hip and knee.

    Science.gov (United States)

    Brand, C A; Amatya, B; Gordon, B; Tosti, T; Gorelik, A

    2010-06-01

    Osteoarthritis of the hip and knee is a highly prevalent chronic condition in Australia that commonly affects older people who have other comorbidities. We report the pilot implementation of a new chronic disease management osteoarthritis service, which was multidisciplinary, evidence-based, supported patient self-management and care coordination. A musculoskeletal coordinator role was pivotal to service redesign and osteoarthritis pathway implementation. Impact evaluation included: service utilization, patient and general practitioner service experience, a 'before and after' audit of clinician adherence to recommendations, and 3- and 6-month patient health outcomes (pain, physical function, patient and physician global health (Visual Analogue Scale), disability (Multi-Attribute Prioritisation Tool), Partners in Health Scale and body mass index). A total of 123 patients, median age of 66 years, were assessed. Documentation of osteoarthritis assessment and management improved for all parameters. At 3 months there were improvements in self-reported pain (P preferences for therapy. The cost implications for implementation were low. The osteoarthritis service model is feasible to implement, is well received by patients and staff, and provides a template for translation into other settings.

  11. Service-Learning and Integrated Course Redesign: Principles of Management and the Campus Kitchen Metaproject

    Science.gov (United States)

    Flannery, Brenda L.; Pragman, Claudia H.

    2010-01-01

    This article describes the process of redesigning a Principles of Management course to integrate a service-learning metaproject. The metaproject was Campus Kitchen, a food recovery and delivery program operated on a handful of university campuses across the United States. We used L. Dee Fink's integrated course design approach as well as systems…

  12. Chronic disease management: time for consultant physicians to take more leadership in system redesign.

    Science.gov (United States)

    Brand, C; Scott, I; Greenberg, P; Sargious, P

    2007-09-01

    There is a need for system redesign to meet the needs of individuals with chronic disease. New models of chronic disease care include team-based paradigms that focus on continuous and patient-centred care. In such models the roles of providers and patients must change. In this article we focus on new roles for consultant physicians, as well as barriers and incentives to these roles.

  13. A Case Report: Cornerstone Health Care Reduced the Total Cost of Care Through Population Segmentation and Care Model Redesign.

    Science.gov (United States)

    Green, Dale E; Hamory, Bruce H; Terrell, Grace E; O'Connell, Jasmine

    2017-08-01

    Over the course of a single year, Cornerstone Health Care, a multispecialty group practice in North Carolina, redesigned the underlying care models for 5 of its highest-risk populations-late-stage congestive heart failure, oncology, Medicare-Medicaid dual eligibles, those with 5 or more chronic conditions, and the most complex patients with multiple late-stage chronic conditions. At the 1-year mark, the results of the program were analyzed. Overall costs for the patients studied were reduced by 12.7% compared to the year before enrollment. All fully implemented programs delivered between 10% and 16% cost savings. The key area for savings factor was hospitalization, which was reduced by 30% across all programs. The greatest area of cost increase was "other," a category that consisted in large part of hospice services. Full implementation was key; 2 primary care sites that reverted to more traditional models failed to show the same pattern of savings.

  14. Redesigning the regulatory framework for ambulatory care services in New York.

    Science.gov (United States)

    Chokshi, Dave A; Rugge, John; Shah, Nirav R

    2014-12-01

    Policy Points: The landscape of ambulatory care services in the United States is rapidly changing on account of payment reform, primary care transformation, and the rise of convenient care options such as retail clinics. New York State has undertaken a redesign of regulatory policy for ambulatory care rooted in the Triple Aim (better health, higher-quality care, lower costs)-with a particular emphasis on continuity of care for patients. Key tenets of the regulatory approach include defining and tracking the taxonomy of ambulatory care services as well as ensuring that convenient care options do not erode continuity of care for patients. While hospitals remain important centers of gravity in the health system, services are increasingly being delivered through ambulatory care. This shift to ambulatory care is giving rise to new delivery structures, such as retail clinics and urgent care centers, as well as reinventing existing ambulatory care capacity, as seen with the patient-centered medical home model and the movement toward team-based care. To protect the public's interests, oversight of ambulatory care services must keep pace with these rapid changes. With this purpose, in January 2013 the New York Public Health and Health Planning Council undertook a redesign of the regulatory framework for the state's ambulatory care services. This article describes the principles undergirding the framework as well as the regulatory recommendations themselves. We explored and analyzed the regulation of ambulatory care services in New York in accordance with the available gray and peer-reviewed literature and legislative documents. The deliberations of the Public Health and Health Planning Council informed our review. The vision of high-performing ambulatory care should be rooted in the Triple Aim (better health, higher-quality care, lower costs), with a particular emphasis on continuity of care for patients. There is a pressing need to better define the taxonomy of ambulatory

  15. Telehealth-based model of care redesign to facilitate local fitting and management of patients with a spinal fracture requiring a thoracic lumbar sacral orthosis in rural hospitals in New South Wales.

    Science.gov (United States)

    Gallagher, Ryan; Giles, Michelle; Morison, Jane; Henderson, Judith

    2018-03-23

    To develop and implement a telehealth-based model of care for spinal fractures requiring management with thoracic lumbar sacral orthoses that eliminates the need for transfer to a metropolitan tertiary referral hospital. Pre-post design observational study evaluating model of care implementation. Rural referral hospitals in a large NSW region covering metropolitan, rural and remote hospitals. Patients presenting with a thoracic or lumbar spine fracture requiring thoracic lumbar sacral orthoses management and rural clinicians caring for them. Number of patients managed in rural hospitals without transfer to a metropolitan tertiary referral hospital; length of stay and related cost efficiencies; clinicians' perceived skills, knowledge and confidence levels. Model of care was implemented with clinical and system governance processes; and educational workshops across eight rural hospitals. A total of 81 patients managed in rural hospitals under this model between July 2013 and June 2016 without transfer were included in this study. Mean length of stay reduced from nine to four days. Hospital transfers were eliminated from the patient journey, totalling 24 324 km. Workshops were attended by 71 clinicians from nine rural hospitals and survey findings indicated a significant increase in staff knowledge, skill and confidence post education. Cost efficiencies were gained by eliminating 162 inter-hospital transfers and 405 patient bed days. This model has streamlined patient journeys and reduced transfers and travel, enabling rural clinicians to provide specialised services in local communities and facilitating timely evidence-based care in local communities without any adverse events. © 2018 National Rural Health Alliance Ltd.

  16. Regional process redesign of lung cancer care: a learning health system pilot project.

    Science.gov (United States)

    Fung-Kee-Fung, M; Maziak, D E; Pantarotto, J R; Smylie, J; Taylor, L; Timlin, T; Cacciotti, T; Villeneuve, P J; Dennie, C; Bornais, C; Madore, S; Aquino, J; Wheatley-Price, P; Ozer, R S; Stewart, D J

    2018-02-01

    The Ottawa Hospital (toh) defined delay to timely lung cancer care as a system design problem. Recognizing the patient need for an integrated journey and the need for dynamic alignment of providers, toh used a learning health system (lhs) vision to redesign regional diagnostic processes. A lhs is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions. To operationalize a lhs, we developed the Ottawa Health Transformation Model (ohtm) as a consensus approach that addresses process barriers, resistance to change, and conflicting priorities. A regional Community of Practice (cop) was established to engage stakeholders, and a dedicated transformation team supported process improvements and implementation. The project operationalized the lung cancer diagnostic pathway and optimized patient flow from referral to initiation of treatment. Twelve major processes in referral, review, diagnostics, assessment, triage, and consult were redesigned. The Ottawa Hospital now provides a diagnosis to 80% of referrals within the provincial target of 28 days. The median patient journey from referral to initial treatment decreased by 48% from 92 to 47 days. The initiative optimized regional integration from referral to initial treatment. Use of a lhs lens enabled the creation of a system that is standardized to best practice and open to ongoing innovation. Continued transformation initiatives across the continuum of care are needed to incorporate best practice and optimize delivery systems for regional populations.

  17. An operations-partnered evaluation of care redesign for high-risk patients in the Veterans Health Administration (VHA): Study protocol for the PACT Intensive Management (PIM) randomized quality improvement evaluation.

    Science.gov (United States)

    Chang, Evelyn T; Zulman, Donna M; Asch, Steven M; Stockdale, Susan E; Yoon, Jean; Ong, Michael K; Lee, Martin; Simon, Alissa; Atkins, David; Schectman, Gordon; Kirsh, Susan R; Rubenstein, Lisa V

    2018-06-01

    Patient-centered medical homes have made great strides providing comprehensive care for patients with chronic conditions, but may not provide sufficient support for patients at highest risk for acute care use. To address this, the Veterans Health Administration (VHA) initiated a five-site demonstration project to evaluate the effectiveness of augmenting the VA's Patient Aligned Care Team (PACT) medical home with PACT Intensive Management (PIM) teams for Veterans at highest risk for hospitalization. Researchers partnered with VHA leadership to design a mixed-methods prospective multi-site evaluation that met leadership's desire for a rigorous evaluation conducted as quality improvement rather than research. We conducted a randomized QI evaluation and assigned high-risk patients to participate in PIM and compared them with high-risk Veterans receiving usual care through PACT. The summative evaluation examines whether PIM: 1) decreases VHA emergency department and hospital use; 2) increases satisfaction with VHA care; 3) decreases provider burnout; and 4) generates positive returns on investment. The formative evaluation aims to support improved care for high-risk patients at demonstration sites and to inform future initiatives for high-risk patients. The evaluation was reviewed by representatives from the VHA Office of Research and Development and the Office of Research Oversight and met criteria for quality improvement. VHA aims to function as a learning organization by rapidly implementing and rigorously testing QI innovations prior to final program or policy development. We observed challenges and opportunities in designing an evaluation consistent with QI standards and operations priorities, while also maintaining scientific rigor. This trial was retrospectively registered at ClinicalTrials.gov on April 3, 2017: NCT03100526. Protocol v1, FY14-17. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Advancing Care Within an Adult Mental Health Day Hospital: Program Re-Design and Evaluation.

    Science.gov (United States)

    Taube-Schiff, Marlene; Mehak, Adrienne; Marangos, Sandy; Kalim, Anastasia; Ungar, Thomas

    2017-11-13

    Day hospital mental health programs provide alternate care to individuals of high acuity that do not require an inpatient psychiatric stay. Ensuring provision of best practice within these programs is essential for patient stabilization and recovery. However, there is scant literature to review when creating such a program. This paper provides an overview of the steps an acute care hospital took when designing and implementing new programming within a day hospital program. Qualitative data was collected following initial program rollout. This data helped to inform the ongoing modification of groups offered, group scheduling and content, as well as ensuring patient satisfaction and adequate skill delivery during the rollout period and beyond. The goal of this paper is to inform health service delivery for other programs when attempting to build or re-design a day hospital program.

  19. A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety.

    Science.gov (United States)

    Xie, Anping; Carayon, Pascale

    2015-01-01

    Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.

  20. The chronic care model versus disease management programs: a transaction cost analysis approach.

    Science.gov (United States)

    Leeman, Jennifer; Mark, Barbara

    2006-01-01

    The present article applies transaction cost analysis as a framework for better understanding health plans' decisions to improve chronic illness management by using disease management programs versus redesigning care within physician practices.

  1. Health care clinicians' engagement in organizational redesign of care processes: The importance of work and organizational conditions.

    Science.gov (United States)

    Dellve, L; Strömgren, M; Williamsson, A; Holden, R J; Eriksson, A

    2018-04-01

    The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production. The results show that kinds of engagement are interlinked and contribute to clinical engagement behaviour in quality of care and patient safety. Increased work resources have importance for engagements in organizational improvements, especially in top-down implementations. An extended work engagement model during organizational improvements in health care was supported. The model contributes to knowledge about how and when clinicians are mobilized to engage in organizational changes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Redesigned geriatric emergency care may have helped reduce admissions of older adults to intensive care units.

    Science.gov (United States)

    Grudzen, Corita; Richardson, Lynne D; Baumlin, Kevin M; Winkel, Gary; Davila, Carine; Ng, Kristen; Hwang, Ula

    2015-05-01

    Charged with transforming geriatric emergency care by applying palliative care principles, a process improvement team at New York City's Mount Sinai Medical Center developed the GEDI WISE (Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements) model. The model introduced workforce enhancements for emergency department (ED) and adjunct staff, including role redefinition, retraining, and education in palliative care principles. Existing ED triage nurses screened patients ages sixty-five and older to identify those at high risk of ED revisit and hospital readmission. Once fully trained, these nurses screened all but 6 percent of ED visitors meeting the screening criteria. Newly hired ED nurse practitioners identified high-risk patients suitable for and desiring palliative and hospice care, then expedited referrals. Between January 2011 and May 2013 the percentage of geriatric ED admissions to the intensive care unit fell significantly, from 2.3 percent to 0.9 percent, generating an estimated savings of more than $3 million to Medicare. The decline in these admissions cannot be confidently attributed to the GEDI WISE program because other geriatric care innovations were implemented during the study period. GEDI WISE programs are now running at Mount Sinai and two partner sites, and their potential to affect the quality and value of geriatric emergency care continues to be examined. Project HOPE—The People-to-People Health Foundation, Inc.

  3. Flipping the Classroom Applications to Curriculum Redesign for an Introduction to Management Course: Impact on Grades

    Science.gov (United States)

    Albert, Michael; Beatty, Brian J.

    2014-01-01

    The authors discuss the application of the flipped classroom model to the redesign of an introduction to management course at a highly diverse, urban, Association to Advance Collegiate Schools of Business-accredited U.S. university. The author assessed the impact of a flipped classroom versus a lecture class on grades. Compared to the prior…

  4. Well-Child Care Redesign: A Mixed Methods Analysis of Parent Experiences in the PARENT Trial.

    Science.gov (United States)

    Mimila, Naomi A; Chung, Paul J; Elliott, Marc N; Bethell, Christina D; Chacon, Sandra; Biely, Christopher; Contreras, Sandra; Chavis, Toni; Bruno, Yovana; Moss, Tanesha; Coker, Tumaini R

    Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), is a well-child care (WCC) model that has demonstrated effectiveness in improving the receipt of comprehensive WCC services and reducing emergency department utilization for children aged 0 to 3 in low-income communities. PARENT relies on a health educator ("parent coach") to provide WCC services; it utilizes a Web-based previsit prioritization/screening tool (Well-Visit Planner) and an automated text message reminder/education service. We sought to assess intervention feasibility and acceptability among PARENT trial intervention participants. Intervention parents completed a survey after a 12-month study period; a 26% random sample of them were invited to participate in a qualitative interview. Interviews were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis; survey responses were analyzed using bivariate methods. A total of 115 intervention participants completed the 12-month survey; 30 completed a qualitative interview. Nearly all intervention participants reported meeting with the coach, found her helpful, and would recommend continuing coach-led well visits (97-99%). Parents built trusting relationships with the coach and viewed her as a distinct and important part of their WCC team. They reported that PARENT well visits more efficiently used in-clinic time and were comprehensive and family centered. Most used the Well-Visit Planner (87%), and found it easy to use (94%); a minority completed it at home before the visit (18%). Sixty-two percent reported using the text message service; most reported it as a helpful source of new information and a reinforcement of information discussed during visits. A parent coach-led intervention for WCC for young children is a model of WCC delivery that is both acceptable and feasible to parents in a low-income urban population. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All

  5. Effect of a redesigned fracture management pathway and 'virtual' fracture clinic on ED performance.

    Science.gov (United States)

    Vardy, J; Jenkins, P J; Clark, K; Chekroud, M; Begbie, K; Anthony, I; Rymaszewski, L A; Ireland, A J

    2014-06-13

    Collaboration between the orthopaedic and emergency medicine (ED) services has resulted in standardised treatment pathways, leaflet supported discharge and a virtual fracture clinic review. Patients with minor, stable fractures are discharged with no further follow-up arranged. We aimed to examine the time taken to assess and treat these patients in the ED along with the rate of unplanned reattendance. A retrospective study was undertaken that covered 1 year before the change and 1 year after. Prospectively collected administrative data from the electronic patient record system were analysed and compared before and after the change. An ED and orthopaedic unit, serving a population of 300 000, in a publicly funded health system. 2840 patients treated with referral to a traditional fracture clinic and 3374 patients managed according to the newly redesigned protocol. Time for assessment and treatment of patients with orthopaedic injuries not requiring immediate operative management, and 7-day unplanned reattendance. Where plaster backslabs were replaced with removable splints, the consultation time was reduced. There was no change in treatment time for other injuries treated by the new discharge protocol. There was no increase in unplanned ED attendance, related to the injury, within 7 days (p=0.149). There was a decrease in patients reattending the ED due to a missed fracture clinic appointment. This process did not require any new time resources from the ED staff. This process brought significant benefits to the ED as treatment pathways were agreed. The pathway reduced unnecessary reattendance of patients at face-to-face fracture clinics for a review of stable, self-limiting injuries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Health care operations management

    NARCIS (Netherlands)

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

    2012-01-01

    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully

  7. Case-based reasoning as a technique for knowledge management in business process redesign

    NARCIS (Netherlands)

    Limam Mansar, S.; Reijers, H.A.; Marir, F.

    2003-01-01

    Business Process Redesign (BPR) helps rethinking a process in order to enhance its performance. Practitioners have been developing methodologies to support BPR implementation. However, most methodologies lack actual guidance on deriving a process design threatening the success of BPR. In this paper,

  8. Palliative care - managing pain

    Science.gov (United States)

    ... page, please enable JavaScript. Palliative care is a holistic approach to care that focuses on treating pain ... stressful for you and your family. But with treatment, pain can be managed. How Pain is Measured ...

  9. Health care engineering management.

    Science.gov (United States)

    Jarzembski, W B

    1980-01-01

    Today, health care engineering management is merely a concept of dreamers, with most engineering decisions in health care being made by nonengineers. It is the purpose of this paper to present a rationale for an integrated hospital engineering group, and to acquaint the clinical engineer with some of the salient features of management concepts. Included are general management concepts, organization, personnel management, and hospital engineering systems.

  10. Redesign workshop

    DEFF Research Database (Denmark)

    Bornoe, Nis; Billestrup, Jane; Andersen, Jesper

    2014-01-01

    . The leading question was: “Can software developers contribute actively to alternative redesign suggestions?” Under the guidance of usability specialists, we found that the developers were able to constructively reconsider the existing design based on a top down approach. In this paper we report a hands...

  11. A conceptual model: Redesigning how we provide palliative care for patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Philip, Jennifer; Crawford, Gregory; Brand, Caroline; Gold, Michelle; Miller, Belinda; Hudson, Peter; Smallwood, Natasha; Lau, Rosalind; Sundararajan, Vijaya

    2017-05-31

    Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns. Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers. Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia. A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver; (2) equitable, enabling access to components of palliative care for a group with significant needs; (3) accessible; and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care; (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as "usual" care by patients and clinicians alike; (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care; and (d) transition to usual palliative care services is facilitated as the patient nears death. Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with

  12. Redesigning Orientation in an Intensive Care Unit Using 2 Theoretical Models.

    Science.gov (United States)

    Kozub, Elizabeth; Hibanada-Laserna, Maribel; Harget, Gwen; Ecoff, Laurie

    2015-01-01

    To accommodate a higher demand for critical care nurses, an orientation program in a surgical intensive care unit was revised and streamlined. Two theoretical models served as a foundation for the revision and resulted in clear clinical benchmarks for orientation progress evaluation. The purpose of the project was to integrate theoretical frameworks into practice to improve the unit orientation program. Performance improvement methods served as a framework for the revision, and outcomes were measured before and after implementation. The revised orientation program increased 1- and 2-year nurse retention and decreased turnover. Critical care knowledge increased after orientation for both the preintervention and postintervention groups. Incorporating a theoretical basis for orientation has been shown to be successful in increasing the number of nurses completing orientation and improving retention, turnover rates, and knowledge gained.

  13. Policy redesign for solving the financial bottleneck in demand side management (DSM) in China

    International Nuclear Information System (INIS)

    Yu, Yongzhen

    2010-01-01

    DSM is one of the best and most practical policy tools for China to balance environmental protection and economic growth. However, the bottleneck lies in the lack of long-term, stable, sufficient and gradually increasing funds to flow into DSM projects. The author redesigns the practical 'system benefit charge (SBC)' policy, which will provide long-term and stable funding for DSM, the policy to facilitate the financial support from banking sector and capital market, and investigates the possibility of DSM funding from CDM projects. SBC is the best way to boost long-term stable and sufficient funding for DSM at present in China. The current low inflation rate and natural resource price are favored to expedite the implementation of SBC and DSM developments. With regard to the uneven development, China needs to design relative policies to offset the impact in different areas, such as tax reduction and fiscal subsides. It is time for China to develop a definite and clear target and timetable to implement DSM, which will give the public and enterprises a definite and clear expectation for the future. The government should publicize a clear and integrated DSM development plan and relative policy outline in the near, medium, and long term. (author)

  14. The Role of the IT Department in Organizational Redesign.

    Science.gov (United States)

    Petersen, Lone Stub

    2015-01-01

    Focus within eHealth research is often on development and implementation. However, the role of information systems maintenance and management is often neglected. In order for the IT department to accommodate the needs of the hospitals and continuous change of organization and practice there is a need for developing an understanding of the complex relationship between the IT department and clinical practice. In this paper the concept of redesign is used to deepen our understanding of IT related organizational change in healthcare organizations. In the paper I argue that the IT department is a central partner, steward and power in organizational change and learning in hospitals as the IT department serve both as a barrier and a catalyst of change and flexibility in the organization through management of information systems maintenance and redesign. Therefore it is important to consider and secure appropriate forms for stewarding redesign and learning in cooperation between the health care organizations and the IT department.

  15. Embedding care management in the medical home: a case study.

    Science.gov (United States)

    Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D

    2014-04-01

    Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.

  16. Finance leadership imperatives in clinical redesign.

    Science.gov (United States)

    Harris, John; Holm, Craig E; Inniger, Meredith C

    2015-03-01

    As physicians embrace their roles in managing healthcare costs and quality, finance leaders should seize the opportunity to engage physicians in clinical care redesign to ensure both high-quality performance and efficient resource use. Finance leaders should strike a balance between risk and reward to achieve a portfolio of clinical initiatives that is organizationally sustainable and responsive to current external drivers of payment changes. Because these initiatives should be driven by physicians, the new skill set of finance leaders should include an emphasis on relationship building to achieve consensus and drive change across an organization.

  17. Rehabilitation centers in change: participatory methods for managing redesign and renovation.

    Science.gov (United States)

    Lahtinen, Marjaana; Nenonen, Suvi; Rasila, Heidi; Lehtelä, Jouni; Ruohomäki, Virpi; Reijula, Kari

    2014-01-01

    The aim of this article is to describe a set of participatory methods that we have either developed or modified for developing future work and service environments to better suit renewable rehabilitation processes. We discuss the methods in a larger framework of change process model and participatory design. Rehabilitation organizations are currently in transition; customer groups, financing, services, and the processes of rehabilitation centers are changing. The pressure for change challenges the centers to develop both their processes and facilities. There is a need for methods that support change management. Four participatory methods were developed: future workshop, change survey, multi-method assessment tool, and participatory design generator cards. They were tested and evaluated in three rehabilitation centers at the different phases of their change process. The developed methods were considered useful in creating a mutual understanding of the change goals between different stakeholders, providing a good picture of the work community's attitudes toward the change, forming an integrated overview of the built and perceived environment, inspiring new solutions, and supporting the management in steering the change process. The change process model described in this article serves as a practical framework that combined the viewpoints of organizational and facility development. However, participatory design continues to face challenges concerning communication between different stakeholders, and further development of the methods and processes is still needed. Intervention studies could provide data on the success factors that enhance the transformations in the rehabilitation sector. Design process, methodology, organizational transformation, planning, renovation.

  18. Improving the quality of care of patients with rheumatic disease using patient-centric electronic redesign software.

    Science.gov (United States)

    Newman, Eric D; Lerch, Virginia; Billet, Jon; Berger, Andrea; Kirchner, H Lester

    2015-04-01

    Electronic health records (EHRs) are not optimized for chronic disease management. To improve the quality of care for patients with rheumatic disease, we developed electronic data capture, aggregation, display, and documentation software. The software integrated and reassembled information from the patient (via a touchscreen questionnaire), nurse, physician, and EHR into a series of actionable views. Core functions included trends over time, rheumatology-related demographics, and documentation for patient and provider. Quality measures collected included patient-reported outcomes, disease activity, and function. The software was tested and implemented in 3 rheumatology departments, and integrated into routine care delivery. Post-implementation evaluation measured adoption, efficiency, productivity, and patient perception. Over 2 years, 6,725 patients completed 19,786 touchscreen questionnaires. The software was adopted for use by 86% of patients and rheumatologists. Chart review and documentation time trended downward, and productivity increased by 26%. Patient satisfaction, activation, and adherence remained unchanged, although pre-implementation values were high. A strong correlation was seen between use of the software and disease control (weighted Pearson's correlation coefficient 0.5927, P = 0.0095), and a relative increase in patients with low disease activity of 3% per quarter was noted. We describe innovative software that aggregates, stores, and displays information vital to improving the quality of care for patients with chronic rheumatic disease. The software was well-adopted by patients and providers. Post-implementation, significant improvements in quality of care, efficiency of care, and productivity were demonstrated. Copyright © 2015 by the American College of Rheumatology.

  19. Redesigning Schools to Reach Every Student with Excellent Teachers: Change Management--Key Theories to Consider when Extending Reach

    Science.gov (United States)

    Barrett, Sharon Kebschull

    2012-01-01

    As schools, their teachers, and outside facilitators redesign jobs and incorporate technology to extend the reach of excellent teachers to more students and develop an Opportunity Culture for all, choosing the right school models is just one part of the task. The human experience--and experience in education--says that even perfect design will not…

  20. Operations management in health care.

    Science.gov (United States)

    Henderson, M D

    1995-01-01

    Health care operations encompass the totality of those health care functions that allow those who practice health care delivery to do so. As the health care industry undergoes dramatic reform, so will the jobs of those who manage health care delivery systems. Although health care operations managers play one of the most vital and substantial roles in the new delivery system, the criteria for their success (or failure) are being defined now. Yet, the new and vital role of the operations manager has been stunted in its development, which is primarily because of old and outdated antipathy between hospital administrators and physicians. This article defines the skills and characteristics of today's health care operations managers.

  1. Professional management for eye care

    Directory of Open Access Journals (Sweden)

    AK Sivakumar

    2006-09-01

    Full Text Available IntroductionThe global initiative VISION 2020: The Right to Sight, estimates that only 25 per cent of existing infrastructure is used for eye care, while the target utilisation is set at 90 per cent. This requires a complete reorganisation. Many providers have the potential to significantly enhance their service by adopting professional management practice and new technologies in clinical services. This article addresses this opportunity from a professional management perspective.The responsibilities of a hospital administrator could be broadly classified as managing patient care, functional areas, support services, and developmental work. Eye care providers need to focus on four key areas. Strategic management to enhance the efficiency of their organisations requires: human resources management; quality management; marketing; and financial sustainability.

  2. Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery.

    Science.gov (United States)

    Trosman, Julia R; Carlos, Ruth C; Simon, Melissa A; Madden, Debra L; Gradishar, William J; Benson, Al B; Rapkin, Bruce D; Weiss, Elisa S; Gareen, Ilana F; Wagner, Lynne I; Khan, Seema A; Bunce, Mikele M; Small, Art; Weldon, Christine B

    2016-11-01

    Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. We examined challenges faced by a patient with early-stage breast cancer that resulted from difficulties in understanding and managing task interdependence across clinical domains involved in this patient's care. We used team science supported by the project management discipline to discuss how various task interdependence aspects can be recognized, deliberately designed, and systematically managed to prevent care breakdowns. This case highlights how effective task interdependence management facilitated by project management methods could markedly improve the course of a patient's care. This work informs efforts of cancer centers and practices to redesign cancer care delivery through innovative, practical, and patient-centered approaches to management of task interdependence in cancer care. Future patient-reported outcomes research will help to determine optimal ways to engage patients, including those who are medically underserved, in managing task interdependence in their own care.

  3. Moral challenges in managed care

    Directory of Open Access Journals (Sweden)

    Leandri Hattingh

    2015-11-01

    Full Text Available Managed health care in South Africa is faced with complex moral challenges, where different stakeholders appeal to different ethics principles to guide decision making. The traditional bio-medical ethics principles of beneficence, non-maleficence and respect for autonomy are typically emphasised in clinical practice, while third party funders appeal to the principle of justice to guide the allocation of limited, pooled resources. Health care professionals working in managed care are particularly exposed to these conflicts, vis-à-vis incongruence between the ethics guidelines from their professional bodies and the legislation pertaining to managed care. Common understanding of the claims and responsibilities of each of the stakeholders may promote a more coherent, sustainable health care system. 

  4. Medicaid Managed Care Enrollment Report

    Data.gov (United States)

    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...

  5. Managing obesity in primary care.

    Science.gov (United States)

    Goldie, Christine; Brown, Jenny

    Obesity is a complex problem and often difficult to tackle in primary care. A year-long pilot of a practice nurse-led scheme that used a holistic approach towards self-care in obesity management was set up to reduce the cardiovascular risk of patients who were obese and improve their quality of life. This person-centred approach may offer an important tool in the management of these patients in the GP surgery.

  6. Glossary of Managed Care Definitions

    Science.gov (United States)

    ... or treatment provided to a plan member. Coverage : decision making process that identifies what services or products are ... themselves and pay a monthly premium for it. Mental health care : medical ... abuse. Mixed model or network HMO : a managed care plan that ...

  7. Process design and redesign

    NARCIS (Netherlands)

    Reijers, H.A.; Dumas, M.; Aalst, van der W.M.P.; Hofstede, ter A.H.M.

    2005-01-01

    This chapter aims to provide concrete guidance in redesigning business processes. Two alternative methods are described, both of them suitable to boost business performance. The first one is based on a collection of best practices, as applied in various redesign projects. These best practices all

  8. Evaluating treatment process redesign by applying the EFQM Excellence Model.

    Science.gov (United States)

    Nabitz, Udo; Schramade, Mark; Schippers, Gerard

    2006-10-01

    To evaluate a treatment process redesign programme implementing evidence-based treatment as part of a total quality management in a Dutch addiction treatment centre. Quality management was monitored over a period of more than 10 years in an addiction treatment centre with 550 professionals. Changes are evaluated, comparing the scores on the nine criteria of the European Foundation for Quality Management (EFQM) Excellence Model before and after a major redesign of treatment processes and ISO certification. In the course of 10 years, most intake, care, and cure processes were reorganized, the support processes were restructured and ISO certified, 29 evidence-based treatment protocols were developed and implemented, and patient follow-up measuring was established to make clinical outcomes transparent. Comparing the situation before and after the changes shows that the client satisfaction scores are stable, that the evaluation by personnel and society is inconsistent, and that clinical, production, and financial outcomes are positive. The overall EFQM assessment by external assessors in 2004 shows much higher scores on the nine criteria than the assessment in 1994. Evidence-based treatment can successfully be implemented in addiction treatment centres through treatment process redesign as part of a total quality management strategy, but not all results are positive.

  9. A SUSTAINABLE HEALTH CARE SYSTEM REQUIRES MANAGEMENT TRANSFORMATION

    Directory of Open Access Journals (Sweden)

    Kanellopoulos Dimitros

    2011-12-01

    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

  10. Respiratory care management information systems.

    Science.gov (United States)

    Ford, Richard M

    2004-04-01

    Hospital-wide computerized information systems evolved from the need to capture patient information and perform billing and other financial functions. These systems, however, have fallen short of meeting the needs of respiratory care departments regarding work load assessment, productivity management, and the level of outcome reporting required to support programs such as patient-driven protocols. The respiratory care management information systems (RCMIS) of today offer many advantages over paper-based systems and hospital-wide computer systems. RCMIS are designed to facilitate functions specific to respiratory care, including assessing work demand, assigning and tracking resources, charting, billing, and reporting results. RCMIS incorporate mobile, point-of-care charting and are highly configurable to meet the specific needs of individual respiratory care departments. Important and substantial benefits can be realized with an RCMIS and mobile, wireless charting devices. The initial and ongoing costs of an RCMIS are justified by increased charge capture and reduced costs, by way of improved productivity and efficiency. It is not unusual to recover the total cost of an RCMIS within the first year of its operation. In addition, such systems can facilitate and monitor patient-care protocols and help to efficiently manage the vast amounts of information encountered during the practitioner's workday. Respiratory care departments that invest in RCMIS have an advantage in the provision of quality care and in reducing expenses. A centralized respiratory therapy department with an RCMIS is the most efficient and cost-effective way to monitor work demand and manage the hospital-wide allocation of respiratory care services.

  11. Managed care: mastering the moving parts.

    Science.gov (United States)

    Boyd, Dawn; Finman, Larry

    2010-05-01

    A hospital's success with managed care depends on how thoroughly the hospital understands its interrelated aspects, including: Managed care strategy Contract negotiations. Contract language. Key performance indicators. Modeling. Contract termination provisions. Movement from wholesale to retail health care.

  12. Reengineering health care materials management.

    Science.gov (United States)

    Connor, L R

    1998-01-01

    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.

  13. Collaborative care management effectively promotes self-management: patient evaluation of care management for depression in primary care.

    Science.gov (United States)

    DeJesus, Ramona S; Howell, Lisa; Williams, Mark; Hathaway, Julie; Vickers, Kristin S

    2014-03-01

    Chronic disease management in the primary care setting increasingly involves self-management support from a nurse care manager. Prior research had shown patient acceptance and willingness to work with care managers. This survey study evaluated patient-perceived satisfaction with care management and patient opinions on the effectiveness of care management in promoting self-management. Qualitative and quantitative survey responses were collected from 125 patients (79% female; average age 46; 94% Caucasian) enrolled in care management for depression. Qualitative responses were coded with methods of content analysis by 2 independent analysts. Patients were satisfied with depression care management. Patients felt that care management improved their treatment above and beyond other aspects of their depression treatment (mean score, 6.7 [SD, 2]; 10 = Very much), increased their understanding of depression self-management (mean score, 7.2 [SD, 2]; 10 = Very much), and increased the frequency of self-management goal setting (mean score, 6.9 [SD, 3]; 10 = Very much). Predominant qualitative themes emphasized that patients value emotional, motivational, and relational aspects of the care manager relationship. Patients viewed care managers as caring and supportive, helpful in creating accountability for patients and knowledgeable in the area of depression care. Care managers empower patients to take on an active role in depression self-management. Some logistical challenges associated with a telephonic intervention are described. Care manager training should include communication and motivation strategies, specifically self-management education, as these strategies are valued by patients. Barriers to care management, such as scheduling telephone calls, should be addressed in future care management implementation and study.

  14. Disease Management, Case Management, Care Management, and Care Coordination: A Framework and a Brief Manual for Care Programs and Staff.

    Science.gov (United States)

    Ahmed, Osman I

    2016-01-01

    With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.

  15. Optimizing diabetes management: managed care strategies.

    Science.gov (United States)

    Tzeel, E Albert

    2013-06-01

    Both the prevalence of type 2 diabetes mellitus (DM) and its associated costs have been rising over time and are projected to continue to escalate. Therefore, type 2 DM (T2DM) management costs represent a potentially untenable strain on the healthcare system unless substantial, systemic changes are made. Managed care organizations (MCOs) are uniquely positioned to attempt to make the changes necessary to reduce the burdens associated with T2DM by developing policies that align with evidence-based DM management guidelines and other resources. For example, MCOs can encourage members to implement healthy lifestyle choices, which have been shown to reduce DM-associated mortality and delay comorbidities. In addition, MCOs are exploring the strengths and weaknesses of several different benefit plan designs. Value-based insurance designs, sometimes referred to as value-based benefit designs, use both direct and indirect data to invest in incentives that change behaviors through health information technologies, communications, and services to improve health, productivity, quality, and financial trends. Provider incentive programs, sometimes referred to as "pay for performance," represent a payment/delivery paradigm that places emphasis on rewarding value instead of volume to align financial incentives and quality of care. Accountable care organizations emphasize an alignment between reimbursement and implementation of best practices through the use of disease management and/ or clinical pathways and health information technologies. Consumer-directed health plans, or high-deductible health plans, combine lower premiums with high annual deductibles to encourage members to seek better value for health expenditures. Studies conducted to date on these different designs have produced mixed results.

  16. The impact of managed care in dentistry.

    Science.gov (United States)

    Clouse, H R

    1999-01-01

    Managed care plans attempt to control health care expenditures aggressively. These plans directly influence access to medical care and the type, level, and frequency of care rendered. As a result, hospital stays are reduced, focus shifts from inpatient to outpatient care, and patients are responsible for a larger share of health care costs. Dentistry is not immune from the impact of managed care. The attractiveness of the dental market has drawn many managed care organizations, insurers, and entrepreneurs to encourage dentists to participate in a wide variety of managed care programs. However, the delivery of dental care differs markedly in many respects from that of medical care. Therefore, many of the cost saving aspects of managed care that have been so successful in medicine may not result in similar cost savings in dentistry.

  17. Managed consumerism in health care.

    Science.gov (United States)

    Robinson, James C

    2005-01-01

    The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations.

  18. Results from a national survey on chronic care management by health plans.

    Science.gov (United States)

    Mattke, Soeren; Higgins, Aparna; Brook, Robert

    2015-05-01

    The growing burden of chronic disease necessitates innovative approaches to help patients and to ensure the sustainability of our healthcare system. Health plans have introduced chronic care management models, but systematic data on the type and prevalence of different approaches are lacking. Our goal was to conduct a systematic examination of chronic care management programs offered by health plans in the commercial market (ie, in products sold to employers and individuals. We undertook a national survey of a representative sample of health plans (70 plans, 36% response rate) and 6 case studies on health plans' programs to improve chronic care in the commercial market. The data underwent descriptive and bivariate analyses. All plans, regardless of size, location, and ownership, offer chronic care management programs, which identify eligible members from claims data and match them to interventions based on overall risk and specific care gaps. Plans then report information on care gaps to providers and offer self-management support to their members. While internal evaluations suggest that the interventions improve care and reduce cost, plans report difficulties in engaging members and providers. To overcome those obstacles, plans are integrating their programs into provider work flow, collaborating with providers on care redesign and leveraging patient support technologies. Our study shows that chronic care management programs have become a standard component of the overall approach used by health plans to manage the health of their members.

  19. How will computerization revolutionize managed care?

    Science.gov (United States)

    Trabin, T

    1994-01-01

    Computerization of behavioral health care information systems is revolutionizing how payors, managed care companies, and providers exchange information. In this article, an imaginary scenario is depicted of how patient data will be accessed and communicated to facilitate care management of behavioral health care services in the near future.

  20. Managed care innovation and new product development.

    Science.gov (United States)

    Clark, C S; Schuster, T B

    1994-01-01

    This article explores recent innovative activity by managed care payor plans nationwide with particular emphasis on emerging, new relationships between the plans and their purchasers, enrollees, provider panels, and competitors. Because they already practice what advocates of health care reform are now preaching, many managed care plans are leading the charge to transform our health care delivery and financing systems.

  1. Controlling Curriculum Redesign with a Process Improvement Model

    Science.gov (United States)

    Drinka, Dennis; Yen, Minnie Yi-Miin

    2008-01-01

    A portion of the curriculum for a Management Information Systems degree was redesigned to enhance the experiential learning of students by focusing it on a three-semester community-based system development project. The entire curriculum was then redesigned to have a project-centric focus with each course in the curriculum contributing to the…

  2. Care management in nursing within emergency care units

    Directory of Open Access Journals (Sweden)

    Roberta Juliane Tono de Oliveira

    2015-12-01

    Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  3. Care management in nursing within emergency care units.

    Science.gov (United States)

    Tono de Oliveira, Roberta Juliane; Vieira Hermida, Patrícia Madalena; da Silva Copelli, Fernanda Hannah; Guedes Dos Santos, José Luís; Lorenzini Erdmann, Alacoque; Regina de Andrade, Selma

    2015-12-01

    Understand the conditions involved in the management of nursing care in emergency care units. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  4. Managed care and ethical conflicts: anything new?

    OpenAIRE

    Meyers, C

    1999-01-01

    Does managed care represent the death knell for the ethical provision of medical care? Much of the current literature suggests as much. In this essay I argue that the types of ethical conflicts brought on by managed care are, in fact, similar to those long faced by physicians and by other professionals. Managed care presents new, but not fundamentally different, factors to be considered in medical decision making. I also suggest ways of better understanding and resolving these conflicts, in p...

  5. Care management in nursing within emergency care units

    OpenAIRE

    Roberta Juliane Tono de Oliveira; Patrícia Madalena Vieira Hermida; Fernanda Hannah da Silva Copelli; José Luís Guedes dos Santos; Alacoque Lorenzini Erdmann; Selma Regina de Andrade

    2015-01-01

    Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency se...

  6. An overview of Medicaid managed care litigation.

    Science.gov (United States)

    Rosenbaum, S; Teitelbaum, J; Kirby, C; Priebe, L; Klement, T

    1998-11-01

    Since the enactment of Medicaid in 1965, states have had the option of offering beneficiaries enrollment in managed care arrangements. With the advent of mandatory managed care reaching millions of beneficiaries (including a growing proportion of disabled recipients), the amount and scope of litigation involving Medicaid managed care plans can be expected to grow. A review of the current litigation regarding Medicaid managed care reveals two basic types of lawsuits: (1) those that challenge the practices of managed care companies under various federal and state laws that safeguard consumer rights, protect health care quality, and prohibit discrimination; and (2) suits that assert claims arising directly under the Medicaid statute and implementing regulations, as well as claims related to Constitutional safeguards that undergird the program. Lawsuits asserting claims arising under Medicaid tend to raise two basic questions: (1) the extent to which enrollment in a Medicaid managed care plan alters existing Medicaid beneficiary rights and state agency duties under federal or state Medicaid law; and (2) the extent to which managed care companies, as agents of the state, act under "color of law" (i.e., undertaking to perform official duties or acting with the imprimatur of state authority). Additionally, states might see an increase in litigation brought by prospective and current contractors who assert that they have been wrongfully denied contracts or improperly penalized for poor performance. These assertions may involve claims that are grounded in federal and state law, the Medicaid statute, and the Constitution. Moreover, in light of the consumer protection elements of the managed care reforms contained in the Balanced Budget Act, future managed care litigation may focus on the manner in which companies carry out states' obligations toward managed care enrollees. Resolution of Medicaid managed care cases involves the application of general principles of

  7. Information Needs of Nurse Care Managers

    Science.gov (United States)

    Dorr, David A.; Tran, Hanh; Gorman, Paul; Wilcox, Adam B.

    2006-01-01

    Unmet information needs of physicians and patients are common, but those of nurse care managers – defined as collaborative care planners for with chronic conditions – are less well understood. We taped and transcribed daily activities and conducted semi-structured interviews of 7 care managers, and analyzed questions elicited through this work through a variety of frameworks. PMID:17238532

  8. Managing Cancer Care - Finding Health Care Services

    Science.gov (United States)

    ... my condition? Has it been rated by state, consumer, or other groups for its quality of care? ... be both rewarding and demanding. It can change relationships and require families to cope with all aspects ...

  9. A case study on the training issues related to leaders of self-managing teams in a redesign plant

    OpenAIRE

    Gunawardena, Asela

    1993-01-01

    Self-managing teams (SMTs) are receiving increasing attention from organizations striving for continuous improvement and searching for innovative ways to get their employees involved and empowered. More and more organizations are realizing the significant impact these teams have on quality, productivity, the social circles, worker esteem, and profitability. Consultants and researchers have also paid significant attention to the concept of SMTs, focusing on many aspects o...

  10. Tailoring Self-Management in Chronic Care

    NARCIS (Netherlands)

    Touwen, ID

    2016-01-01

    Self-management is nowadays seen as an important element in chronic care and therefore, self-management is increasingly embedded in chronic care guidelines; however, implementation in clinical practice is a slow and difficult process. Evidence, from research on self-management interventions, shows

  11. Information technology-enabled team-based, patient-centered care: The example of depression screening and management in cancer care.

    Science.gov (United States)

    Randhawa, Gurvaneet S; Ahern, David K; Hesse, Bradford W

    2017-03-01

    The existing healthcare delivery systems across the world need to be redesigned to ensure high-quality care is delivered to all patients. This redesign needs to ensure care is knowledge-based, patient-centered and systems-minded. The rapid advances in the capabilities of information and communication technology and its recent rapid adoption in healthcare delivery have ensured this technology will play a vital role in the redesign of the healthcare delivery system. This commentary highlights promising new developments in health information technology (IT) that can support patient engagement and self-management as well as team-based, patient-centered care. Collaborative care is an effective approach to screen and treat depression in cancer patients and it is a good example of the benefits of team-based and patient-centered care. However, this approach was developed prior to the widespread adoption and use of health IT. We provide examples to illustrate how health IT can improve prevention and treatment of depression in cancer patients. We found several knowledge gaps that limit our ability to realize the full potential of health IT in the context of cancer and comorbid depression care. These gaps need to be filled to improve patient engagement; enhance the reach and effectiveness of collaborative care and web-based programs to prevent and treat depression in cancer patients. We also identify knowledge gaps in health IT design and implementation. Filling these gaps will help shape policies that enable clinical teams to deliver high-quality cancer care globally.

  12. Money's (Not) On My Mind: A Qualitative Study Of How Staff And Managers Understand Health Care's Triple Aim

    DEFF Research Database (Denmark)

    Storkholm, Marie Højriis

    as a dilemma between quality and cost, managers saw it as a paradox that invited improvement efforts. To create alignment between external efficiency requirements and staff understandings of the need for change, managers choose an action strategy that resonated with the professional ethos of staff. Limitations...... in redesigning clinical care. This case illustrates how managers can be guided by mental models in order to create alignment between change efforts and the organizations overall purpose. Originality/value This study makes an empirical contribution to thus far conceptual papers on how mental models guide change...

  13. Characteristics of effective health care managers.

    Science.gov (United States)

    Johnson, Sherryl W

    2005-01-01

    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.

  14. Managing the physics of the economics of integrated health care.

    Science.gov (United States)

    Zismer, Daniel K; Werner, Mark J

    2012-01-01

    The physics metaphor, as applied to the economics (and financial performance) of the integrated health system, seems appropriate when considered together with the nine principles of management framework provided. The nature of the integrated design enhances leaders' management potential as they consider organizational operations and strategy in the markets ahead. One question begged by this argument for the integrated design is the durability, efficiency and ultimate long-term survivability of the more "traditional" community health care delivery models, which, by design, are fragmented, internally competitive and less capital efficient. They also cannot exploit the leverage of teams, optimal access management or the pursuit of revenues made available in many forms. For those who wish to move from the traditional to the more integrated community health system designs (especially those who have not yet started the journey), the path requires: * Sufficient balance sheet capacity to fund the integration process-especially as the model requires physician practice acquisitions and electronic health record implementations * A well-prepared board13, 14 * A functional, durable and sustainable physician services enterprise design * A redesigned organizational and governance structure * Favorable internal financial incentives alignment design * Effective accountable physician leadership * Awareness that the system is not solely a funding strategy for acquired physicians, rather a fully -.. committed clinical and business model, one in which patient-centered integrated care is the core service (and not acute care hospital-based services) A willingness to create and exploit the implied and inherent potential of an integrated design and unified brand Last, it's important to remember that an integrated health system is a tool that creates a "new potential" (a physics metaphor reference, one last time). The design doesn't operate itself. Application of the management principles

  15. Redesign of a health science centre: reflections on co-leadership.

    Science.gov (United States)

    MacTavish, M; Norton, P

    1995-01-01

    Since 1988, the Sunnybrook Health Science Centre has been proactive in re-designing its system toward decentralized management, the purpose being to further enhance patient care. This process has involved numerous changes, among which were the establishment of three large clinical units. These clinical units are not defined following the historic medical model, but group patients with similar service and care needs. Subsequently, each of the clinical units defined Patient Service Units (PSUs). The hospital has chosen a co-leadership model for the lead management at each of the unit levels. This paper describes the model for clinical units.

  16. Multi-Stakeholder Collaboration in the Redesign of Family-Centered Rounds Process

    Science.gov (United States)

    Xie, Anping; Carayon, Pascale; Cartmill, Randi; Li, Yaqiong; Cox, Elizabeth D.; Plotkin, Julie A.; Kelly, Michelle M.

    2014-01-01

    A human factors approach to healthcare system redesign emphasizes the involvement of multiple healthcare stakeholders (e.g., patients and families, healthcare providers) in the redesign process. This study explores the experience of multiple stakeholders with collaboration in a healthcare system redesign project. Interviews were conducted with ten stakeholder representatives who participated in the redesign of the family-centered rounds process in a pediatric hospital. Qualitative interview data were analyzed using a phenomenological approach. A model of collaborative healthcare system redesign was developed, which defined four phases (i.e., setup of the redesign team, preparation for meetings, collaboration in meetings, follow-up after meetings) and two outcomes (i.e., team outcomes, redesign outcomes) of the collaborative process. Challenges to multi-stakeholder collaboration in healthcare system redesign, such as need to represent all relevant stakeholders, scheduling of meetings and managing different perspectives, were identified. PMID:25124394

  17. A strategic planning methodology for aircraft redesign

    Science.gov (United States)

    Romli, Fairuz Izzuddin

    Due to a progressive market shift to a customer-driven environment, the influence of engineering changes on the product's market success is becoming more prominent. This situation affects many long lead-time product industries including aircraft manufacturing. Derivative development has been the key strategy for many aircraft manufacturers to survive the competitive market and this trend is expected to continue in the future. Within this environment of design adaptation and variation, the main market advantages are often gained by the fastest aircraft manufacturers to develop and produce their range of market offerings without any costly mistakes. This realization creates an emphasis on the efficiency of the redesign process, particularly on the handling of engineering changes. However, most activities involved in the redesign process are supported either inefficiently or not at all by the current design methods and tools, primarily because they have been mostly developed to improve original product development. In view of this, the main goal of this research is to propose an aircraft redesign methodology that will act as a decision-making aid for aircraft designers in the change implementation planning of derivative developments. The proposed method, known as Strategic Planning of Engineering Changes (SPEC), combines the key elements of the product redesign planning and change management processes. Its application is aimed at reducing the redesign risks of derivative aircraft development, improving the detection of possible change effects propagation, increasing the efficiency of the change implementation planning and also reducing the costs and the time delays due to the redesign process. To address these challenges, four research areas have been identified: baseline assessment, change propagation prediction, change impact analysis and change implementation planning. Based on the established requirements for the redesign planning process, several methods and

  18. Pro-ACT II: integrating utilization management, discharge planning, and nursing case management into the outcomes manager role.

    Science.gov (United States)

    Brett, J L; Bueno, M; Royal, N; Kendall-Sengin, K

    1997-02-01

    Building on redesign efforts that created case management, clinical care technicians, support service hosts, and pharmacy technician roles, this redesign focused on integrating case management, utilization management, and discharge planning functions into a new outcomes manager role. The authors describe the process of developing and implementing the new role and outline specific actions that eliminated redundancy and inefficiency. Results of the evaluation of the project are reviewed, including full-time equivalent and salary savings and employee and physician satisfaction improvements.

  19. Chronic care model for the management of depression: synthesis of barriers to, and facilitators of, success.

    Science.gov (United States)

    Holm, Anne Lise; Severinsson, Elisabeth

    2012-12-01

    Depression is a socially- and physically-disabling condition. The Chronic Care Model (CCM) was developed to promote better management of long-term conditions, such as depression, in primary care settings. The aim of the study was to identify barriers to, and facilitators of, success when implementing the CCM for the management of depression in primary care. A systematic search was conducted in electronic databases from January 2005 to December 2011. Thirteen articles met the inclusion criteria and were reviewed by means of a thematic analysis. The barriers were categorized under two themes: lack of organizational, administrative, and professional ability to change and implement the components of the CCM; and lack of clarity pertaining to the responsibility inherent in the role of care manager (often a nurse) when it comes to promoting the patient's self-management ability. In terms of the facilitators of success, two themes emerged: leadership support and vision, and redesigning the delivery system. When shaping an environment for organizational change, leadership and professionals must work towards a common goal and vision. Such processes require a care manager with a clear role and responsibilities in order for the health-care system to meet the needs of the person with depression. © 2012 The Authors. International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

  20. Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines.

    Science.gov (United States)

    Hung, Dorothy; Martinez, Meghan; Yakir, Maayan; Gray, Caroline

    2015-01-01

    Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers. This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care. Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts. Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery.

  1. Strategic management of health care information systems: nurse managers' perceptions.

    Science.gov (United States)

    Lammintakanen, Johanna; Kivinen, Tuula; Saranto, Kaija; Kinnunen, Juha

    2009-01-01

    The aim of this study is to describe nurse managers' perceptions of the strategic management of information systems in health care. Lack of strategic thinking is a typical feature in health care and this may also concern information systems. The data for this study was collected by eight focus group interviews including altogether 48 nurse managers from primary and specialised health care. Five main categories described the strategic management of information systems in health care; IT as an emphasis of strategy; lack of strategic management of information systems; the importance of management; problems in privacy protection; and costs of IT. Although IT was emphasised in the strategies of many health care organisations, a typical feature was a lack of strategic management of information systems. This was seen both as an underutilisation of IT opportunities in health care organisations and as increased workload from nurse managers' perspective. Furthermore, the nurse managers reported that implementation of IT strengthened their managerial roles but also required stronger management. In conclusion, strategic management of information systems needs to be strengthened in health care and nurse managers should be more involved in this process.

  2. [Quality management in intensive care medicine].

    Science.gov (United States)

    Martin, J; Braun, J-P

    2013-09-01

    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 extern 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.

  3. Physician-patient communication in managed care.

    OpenAIRE

    Gordon, G H; Baker, L; Levinson, W

    1995-01-01

    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 ...

  4. Intensive Care Nursing And Time Management

    OpenAIRE

    ÖZCANLI, Derya; İLGÜN, Seda

    2008-01-01

    Time is not like other resources, because it can not be bought, sold, stolen, borrowed, stored, saved, multiplied or changed. All it can be done is spent. Time management means the effective use of resources, including time, in such a way that indi- viduals are effective in achieving important personal goals. With the increasing emphasis on efficiency in health care, how a nurse manages her time is an important consideration. Since intensive care nurs- ing is focused on the care and tr...

  5. Application of Computer Simulation Modeling to Medication Administration Process Redesign

    OpenAIRE

    Huynh, Nathan; Snyder, Rita; Vidal, Jose M.; Tavakoli, Abbas S.; Cai, Bo

    2012-01-01

    The medication administration process (MAP) is one of the most high-risk processes in health care. MAP workflow redesign can precipitate both unanticipated and unintended consequences that can lead to new medication safety risks and workflow inefficiencies. Thus, it is necessary to have a tool to evaluate the impact of redesign approaches in advance of their clinical implementation. This paper discusses the development of an agent-based MAP computer simulation model that can be used to assess...

  6. Motivation Enhancement Through Work Redesign.

    Science.gov (United States)

    Oldham, Greg R., Kulik, Carol T.

    1983-01-01

    The possibility of redesigning the work experiences of faculty members in an effort to enhance their motivation, productivity, and personal and work satisfactions is examined. One approach to work redesign, job characteristics theory, is described. Several strategies are discussed. (Author/MLW)

  7. Intensive Care Management of Patients with Cirrhosis.

    Science.gov (United States)

    Olson, Jody C

    2018-06-01

    Cirrhosis is a major worldwide health problem which results in a high level of morbidity and mortality. Patients with cirrhosis who require intensive care support have high mortality rates of near 50%. The goal of this review is to address the management of common complications of cirrhosis in the ICU. Recent epidemiological studies have shown an increase in hospitalizations due to advanced liver disease with an associated increase in intensive care utilization. Given an increasing burden on the healthcare system, it is imperative that we strive to improve our management cirrhotic patients in the intensive care unit. Large studies evaluating the management of patients in the intensive care setting are lacking. To date, most recommendations are based on extrapolation of data from studies in cirrhosis outside of the ICU or by applying general critical care principles which may or may not be appropriate for the critically ill cirrhotic patient. Future research is required to answer important management questions.

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

    Science.gov (United States)

    Bauer, M; Bach, A

    1998-06-01

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

  9. Evaluating managed care's special telecommunications needs.

    Science.gov (United States)

    Harrison, P; Schenk, D

    1993-11-01

    Right now, managed care is a vast cosmic soup. But whether its ultimate form is the result of a bureaucratic big bang or a series of small industry explosions, one thing seems clear: telecommunications is the framework upon which managed care will be built. Managed care's primary players--purchasers, providers and payors--have already discovered the unifying power of telecommunications within their respective worlds. However, as the three worlds collide, an entirely new set of special telecommunications needs arises. And most of these needs can be distilled into three basic requirements: bigger networks, faster networks and smarter networks.

  10. Managed care aspects of managing multiple sclerosis.

    Science.gov (United States)

    Owens, Gary M

    2013-11-01

    Multiple sclerosis (MS) is a chronic disease of the central nervous system usually diagnosed in the second or third decade of life; MS is more common among women than men by a ratio of 3 to 1. With its relatively early age of onset and symptoms that impair patients' quality of life, MS requires lifelong, dynamic treatment, and places a substantial economic burden on individuals, healthcare systems, and society. The costs associated with providing benefits for MS therapy are growing rapidly and the increasing complexity of the MS market is impacting disease management for payers. Employers are also increasingly aware of the costs associated with MS and are asking health plans to advise on the most appropriate and cost-effective ways to manage both pharmacologic and non-pharmacologic therapies for MS. Health plans, by necessity, must therefore balance appropriate access to treatments for MS with the need to manage rising treatment costs. To meet this goal, payers require population-based solutions, guidelines, and treatment algorithms for the management of MS that can be used in clinical and formulary management decision making in the context of an evolving therapeutic landscape. Further, comparative studies are necessary for payers to determine which agents may work best on a population basis. Due to the current lack of appropriate clinical guidance and insufficient head-to-head data on disease-modifying drugs, strategies for health plans and clinical management have been designed using the best available evidence. Undoubtedly, management of this class will continue to evolve with the launch of newer agents.

  11. [The role of management in health care].

    Science.gov (United States)

    Güntert, Bernhard J

    2007-01-01

    The situation in the health care sector is affected by a shortage of public funds on the one hand and, on the other hand, by rapid developments in medicine and nursing with an enormous expansion of both diagnostic and therapeutic possibilities. This and the aging population are generating a steadily increasing demand for health care services. The result is an increased cost consciousness in society calling for more professional management in health care organizations. However, the traditional administration of health care organizations, which is closely aligned with health professionals and production processes, was not able to cope with these dynamics or did so only unsatisfactorily. An improved management would surely lead to an optimization of health care delivery processes and a more effective use of resources. The question, however, is whether the effectiveness of the total system can be improved and whether patients' and society's needs can actually be met by classical management approaches.

  12. Home Care Nursing Improves Cancer Symptom Management

    Science.gov (United States)

    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.

  13. Medicare Managed Care plan Performance, A Comparison...

    Data.gov (United States)

    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...

  14. Participatory management in today's health care setting

    International Nuclear Information System (INIS)

    Burnham, B.A.

    1987-01-01

    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

  15. Participative management in health care services

    Directory of Open Access Journals (Sweden)

    M. Muller

    1995-03-01

    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.

  16. Primary care quality management in Slovenia.

    NARCIS (Netherlands)

    Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Bulc, M.

    2008-01-01

    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

  17. Attachment Theory and Neuroscience for Care Managers.

    Science.gov (United States)

    Blakely, Thomas J; Dziadosz, Gregory M

    2016-09-01

    This article describes a model for care managers that is based on attachment theory supplemented by knowledge from neuroscience. Together, attachment theory and basic knowledge from neuroscience provide for both an organizing conceptual framework and a scientific, measureable approach to assessment and planning interventions in a care plan.

  18. Achieving a competitive advantage in managed care.

    Science.gov (United States)

    Stahl, D A

    1998-02-01

    When building a competitive advantage to thrive in the managed care arena, subacute care providers are urged to be revolutionary rather than reactionary, proactive rather than passive, optimistic rather than pessimistic and growth-oriented rather than cost-reduction oriented. Weaknesses must be addressed aggressively. To achieve a competitive edge, assess the facility's strengths, understand the marketplace and comprehend key payment methods.

  19. ILRS Website Redesign

    Science.gov (United States)

    Noll, C.; Lee, L.; Torrence, M.

    2011-01-01

    The International Laser Ranging Service (ILRS) website, http://ilrs.gsfc.nasa.gov, is the central source of information for all aspects of the service. The website provides information on the organization and operation of ILRS and descriptions of ILRS components, data, and products. Furthermore, the website and provides an entry point to the archive of these data and products available through the data centers. Links are provided to extensive information on the ILRS network stations including performance assessments and data quality evaluations. Descriptions of supported satellite missions (current, future, and past) are provided to aid in station acquisition and data analysis. The current format for the ILRS website has been in use since the early years of the service. Starting in 2010, the ILRS Central Bureau began efforts to redesign the look and feel for the website. The update will allow for a review of the contents, ensuring information is current and useful. This poster will detail the proposed design including specific examples of key sections and webpages.

  20. Fibromyalgia: management strategies for primary care providers.

    Science.gov (United States)

    Arnold, L M; Gebke, K B; Choy, E H S

    2016-02-01

    Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management. We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements. The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes. The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training. Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting. © 2016 John Wiley & Sons Ltd.

  1. Managing diversity in the health care workplace.

    Science.gov (United States)

    Davidhizar, R; Dowd, S; Newman Giger, J

    1999-03-01

    Cultural diversity is increasing in the United States as increasing numbers of minorities enter the United States from abroad, and cultural diversity is especially prevalent in the health care workplace. In fact, the health care professions are particularly interested in the presence of minorities among caregivers because this often enhances the cultural competence of care delivery. Nevertheless, subtle discrimination can still be found, and managers must be alert that such behavior is not tolerated. Use of the Giger-Davidhizar Cultural Assessment Model can provide managers with information needed to respond to diversity among staff appropriately.

  2. Simulation modeling for the health care manager.

    Science.gov (United States)

    Kennedy, Michael H

    2009-01-01

    This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

  3. Approaches to long-term conditions management and care for older people: similarities or differences?

    Science.gov (United States)

    Tullett, Michael; Neno, Rebecca

    2008-03-01

    In the past few years, there has been an increased emphasis both on the care for older people and the management of long-term conditions within the United Kingdom. Currently, the Department of Health and the Scottish Executive identify and manage these two areas as separate entities. The aim of this article is to examine the current approaches to both of these areas of care and identify commonalities and articulate differences. The population across the world and particularly within the United Kingdom is ageing at an unprecedented rate. The numbers suffering long-term illness conditions has also risen sharply in recent years. As such, nurses need to be engaged at a strategic level in the design of robust and appropriate services for this increasing population group. A comprehensive literature review on long-term conditions and the care of older people was undertaken in an attempt to identify commonalities and differences in strategic and organizational approaches. A policy analysis was conducted to support the paper and establish links that may inform local service development. Proposing service development based on identified needs rather than organizational boundaries after the establishment of clear links between health and social care for those with long-term conditions and the ageing population. Nurse Managers need to be aware of the similarities and differences in political and theoretical approaches to the care for older people and the management of long-term conditions. By adopting this view, creativity in the service redesign and service provision can be fostered and nurtured as well as achieving a renewed focus on partnership working across organizational boundaries. With the current renewed political focus on health and social care, there is an opportunity in the UK to redefine the structure of care. This paper proposes similarities between caring for older people and for those with long-term conditions, and it is proposed these encapsulate the wider

  4. Child and Youth Care Approaches to Management

    Science.gov (United States)

    Gharabaghi, Kiaras

    2008-01-01

    This article explores the themes and issues related to child and youth care approaches to management. The profession is significantly underrepresented at the management level. To some extent, this reflects the challenges of being recognized in the broader human services sector as a profession, but perhaps more so, it reflects an underdevelopment…

  5. Website Redesign: A Case Study.

    Science.gov (United States)

    Wu, Jin; Brown, Janis F

    2016-01-01

    A library website redesign is a complicated and at times arduous task, requiring many different steps including determining user needs, analyzing past user behavior, examining other websites, defining design preferences, testing, marketing, and launching the site. Many different types of expertise are required over the entire process. Lessons learned from the Norris Medical Library's experience with the redesign effort may be useful to others undertaking a similar project.

  6. Critical care management of acute ischemic stroke.

    Science.gov (United States)

    Coplin, William M

    2012-06-01

    Acute ischemic stroke (AIS) can have profound and devastating effects on the CNS and several other organs. Approximately 15% to 20% of patients with AIS are admitted to an intensive care unit and cared for by a multidisciplinary team. This article discusses the critical care management of patients with AIS. Patients with AIS require attention to airway, pulmonary status, blood pressure, glucose, temperature, cardiac function, and, sometimes, life-threatening cerebral edema. The lack of disease-specific data has led to numerous management approaches and limited guidance on choosing among them. Existing guidelines emphasize risk factors, prevention, natural history, and prevention of bleeding but provide little discussion of the complex critical care issues involved in caring for patients with AIS.

  7. Quality management in Irish health care.

    Science.gov (United States)

    Ennis, K; Harrington, D

    1999-01-01

    This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.

  8. Do competition and managed care improve quality?

    Science.gov (United States)

    Sari, Nazmi

    2002-10-01

    In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. This paper provides new insights about the quality consequences of this dynamic in US hospital markets. I empirically investigate the impact of managed care and hospital competition on quality using in-hospital complications as quality measures. I use random and fixed effects, and instrumental variable fixed effect models using hospital panel data from up to 16 states in the 1992-1997 period. The paper has two important findings: First, higher managed care penetration increases the quality, when inappropriate utilization, wound infections and adverse/iatrogenic complications are used as quality indicators. For other complication categories, coefficient estimates are statistically insignificant. These findings do not support the straightforward view that increases in managed care penetration are associated with decreases in quality. Second, both higher hospital market share and market concentration are associated with lower quality of care. Hospital mergers have undesirable quality consequences. Appropriate antitrust policies towards mergers should consider not only price and cost but also quality impacts. Copyright 2002 John Wiley & Sons, Ltd.

  9. Management or care: different outcomes.

    Science.gov (United States)

    Cohain, Judy Slome

    2007-01-01

    Recently a popular magazine published a birth story of a long, medically managed, first labor of a low-risk woman, which ended in a cesarean. (1) The doctor/writer was convinced that the labor could not be safely managed other than how he described it and that no safe alternative existed to a cesarean delivery. This is another example of the media trend of promoting medical birth stories and not midwifery-supported birth stories. The article below provides two versions of the same woman's labor to show how a woman's choice of birth attendant and labor support can influence the course of labor and the likelihood of cesarean surgery. judyslome@hotmail.com.

  10. Advisory Committee on the Redesign of the Space Station

    Science.gov (United States)

    1993-06-01

    The Space Station Program was initiated in 1984 to provide for permanent human presence in an orbiting laboratory. This program evolved into Space Station Freedom, later identified as a component to facilitate a return of astronauts to the Moon, followed by the exploration of Mars. In March 1993 the Clinton Administration directed NASA to undertake an intense effort to redesign the space station at a substantial cost savings relative to Space Station Freedom. The Advisory Committee on the Redesign of the Space Station was established in March 1993 to provide independent assessment of the advantages and disadvantages of the redesign options. The results of the Committee's work is described. Discussion describes the mission that the Administration has articulated for the Space Station Program and the scientific and technical characteristics that a redesigned station must possess to fulfill those objectives. A description of recommended management, operations, and acquisition strategies for the redesigned program is provided. The Committee's assessment of the redesign options against five criteria are presented. The five criteria are technical capabilities, research capabilities, schedule, cost, and risk. A discussion of general mission risk is included.

  11. Participative management in health care services.

    Science.gov (United States)

    Muller, M

    1995-03-01

    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 operationalization 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. A continuum of interactive decision-making and problem-solving is described, the different role-players involved, as well as the levels of interactive decision-making and problem-solving. The most appropriate decision-making strategy should be employed in pro-active and reactive decision-making. Applicable principles and assumptions in each element of participative management is described. It is recommended that this proposed model for participative management be refined by means of a literature control, interactive dialogue with experts and a model case description or participative management, to ensure the trustworthiness of this research.

  12. Implementation of a diabetes self-management education program in primary care for adults using shared medical appointments.

    Science.gov (United States)

    Sanchez, Iris

    2011-01-01

    The purpose of this study was to implement diabetes self-management education in primary care using the Chronic Care Model and shared medical appointments (SMA) to provide evidence-based interventions to improve process and measure outcomes. A quality improvement project using the Plan-Do-Check-Act cycle was implemented in a primary care setting in South Texas to provide diabetes self-management education for adults. Biological measures were evaluated in 70 patients at initiation of the project and thereafter based on current practice guidelines. The results of the project were consistent with the literature regarding the benefits, sustainability, and viability of SMA. As compared with that in studies presented in the literature, the patient population who participated in SMA had similar outcomes regarding improvement in A1C, self-management skills, and satisfaction. SMA are an innovative system redesign concept with the potential to provide comprehensive and coordinated care for patients with multiple and chronic health conditions while still being an efficient, effective, financially viable, and sustainable program. As the incidence and prevalence of diabetes increase, innovative models of care can meet the growing demand for access and utilization of diabetes self-management education programs. Programs focusing on chronic conditions to improve outcomes can be replicated by health care providers in primary care settings. SMA can increase revenue and productivity, improve disease management, and increase provider and patient satisfaction.

  13. Physician fees and managed care plans.

    Science.gov (United States)

    Zwanziger, Jack

    2002-01-01

    One of the objectives of managed care organizations (MCOs) has been to reduce the rate of growth of health care expenditures, including that of physician fees. Yet, due to a lack of data, no one has been able to determine whether MCOs have been successful in encouraging the growth of price competition in the market for physician services in order to slow the growth in physician fees. This study uses a unique, national-level data set to determine what factors influenced the physician fees that MCOs negotiated during the 1990-92 period. The most influential characteristics were physician supply and managed care penetration, which suggest that the introduction of competition into the health care market was an effective force in reducing physician fees.

  14. Multiple sclerosis care: an integrated disease-management model.

    Science.gov (United States)

    Burks, J

    1998-04-01

    A disease-management model must be integrated, comprehensive, individual patient focused and outcome driven. In addition to high quality care, the successful model must reduce variations in care and costs. MS specialists need to be intimately involved in the long-term care of MS patients, while not neglecting primary care issues. A nurse care manager is the "glue" between the managed care company, health care providers and the patient/family. Disease management focuses on education and prevention, and can be cost effective as well as patient specific. To implement a successful program, managed care companies and health care providers must work together.

  15. Managing complaints in health and social care.

    Science.gov (United States)

    Holmes-Bonney, Kathy

    2010-04-01

    An important aspect of allowing patients to take control of their health care is the introduction of new procedures for dealing with complaints. This article examines the concepts that underpin the new Department of Health regulations on complaints management and what they will mean for health and social care professionals. It also explains why these regulations focus on restorative justice rather than blame when adverse events occur.

  16. Understanding performance management in primary care.

    Science.gov (United States)

    Rogan, Lisa; Boaden, Ruth

    2017-02-13

    Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management. Findings There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation. Originality/value The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

  17. Evaluating treatment process redesign by applying the EFQM Excellence Model

    NARCIS (Netherlands)

    Nabitz, Udo; Schramade, Mark; Schippers, Gerard

    2006-01-01

    OBJECTIVE: To evaluate a treatment process redesign programme implementing evidence-based treatment as part of a total quality management in a Dutch addiction treatment centre. METHOD: Quality management was monitored over a period of more than 10 years in an addiction treatment centre with 550

  18. VHA Support Service Center Primary Care Management Module (PCMM)

    Data.gov (United States)

    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...

  19. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

    Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model.Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation.Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes.Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve

  20. Redesigning the Way We Listen

    DEFF Research Database (Denmark)

    Søndergaard, Morten

    2014-01-01

    This paper is based on a research project-in-progress investigating curatorial practice as methodology for creating responsive interfaces to sound art practices. Sound art is a transdisciplinary practice. As such, it creates new domains that may be used for redesign-purposes. Not only do experien......This paper is based on a research project-in-progress investigating curatorial practice as methodology for creating responsive interfaces to sound art practices. Sound art is a transdisciplinary practice. As such, it creates new domains that may be used for redesign-purposes. Not only do...... experiences of sound alter; the way we listen to sound is transforming as well. Thus, the paper analyses and discusses two responsive sound interfaces and claim that curating as a transdisciplinary practice may frame what is termed in the paper as a domain-game redesigning the way the audience listens...

  1. Developing an evaluation framework for clinical redesign programs: lessons learnt.

    Science.gov (United States)

    Samaranayake, Premaratne; Dadich, Ann; Fitzgerald, Anneke; Zeitz, Kathryn

    2016-09-19

    Purpose The purpose of this paper is to present lessons learnt through the development of an evaluation framework for a clinical redesign programme - the aim of which was to improve the patient journey through improved discharge practices within an Australian public hospital. Design/methodology/approach The development of the evaluation framework involved three stages - namely, the analysis of secondary data relating to the discharge planning pathway; the analysis of primary data including field-notes and interview transcripts on hospital processes; and the triangulation of these data sets to devise the framework. The evaluation framework ensured that resource use, process management, patient satisfaction, and staff well-being and productivity were each connected with measures, targets, and the aim of clinical redesign programme. Findings The application of business process management and a balanced scorecard enabled a different way of framing the evaluation, ensuring measurable outcomes were connected to inputs and outputs. Lessons learnt include: first, the importance of mixed-methods research to devise the framework and evaluate the redesigned processes; second, the need for appropriate tools and resources to adequately capture change across the different domains of the redesign programme; and third, the value of developing and applying an evaluative framework progressively. Research limitations/implications The evaluation framework is limited by its retrospective application to a clinical process redesign programme. Originality/value This research supports benchmarking with national and international practices in relation to best practice healthcare redesign processes. Additionally, it provides a theoretical contribution on evaluating health services improvement and redesign initiatives.

  2. Benchmarking and performance management in health care

    OpenAIRE

    Buttigieg, Sandra; ; EHMA Annual Conference : Public Health Care : Who Pays, Who Provides?

    2012-01-01

    Current economic conditions challenge health care providers globally. Healthcare organizations need to deliver optimal financial, operational, and clinical performance to sustain quality of service delivery. Benchmarking is one of the most potent and under-utilized management tools available and an analytic tool to understand organizational performance. Additionally, it is required for financial survival and organizational excellence.

  3. Implementing comprehensive health care management for sickle ...

    African Journals Online (AJOL)

    2015-05-28

    May 28, 2015 ... adopted as the strategy for the management of SCD and this has resulted in the ... Therefore, there is a need to adapt this form of care for the low-resource settings in ..... Omilola B. Patterns and trends of child and maternal ...

  4. Health care management modelling: a process perspective

    NARCIS (Netherlands)

    Vissers, J.M.H.

    1998-01-01

    Modelling-based health care management ought to become just as popular as evidence based medicine. Making managerial decisions based on evidence by modelling efforts is certainly a step forward. Examples can be given of many successful applications in different areas of decision making: disease

  5. Knowledge management: organizing nursing care knowledge.

    Science.gov (United States)

    Anderson, Jane A; Willson, Pamela

    2009-01-01

    Almost everything we do in nursing is based on our knowledge. In 1984, Benner (From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984) described nursing knowledge as the culmination of practical experience and evidence from research, which over time becomes the "know-how" of clinical experience. This "know-how" knowledge asset is dynamic and initially develops in the novice critical care nurse, expands within competent and proficient nurses, and is actualized in the expert intensive care nurse. Collectively, practical "know-how" and investigational (evidence-based) knowledge culminate into the "knowledge of caring" that defines the profession of nursing. The purpose of this article is to examine the concept of knowledge management as a framework for identifying, organizing, analyzing, and translating nursing knowledge into daily practice. Knowledge management is described in a model case and implemented in a nursing research project.

  6. Redesign of a Life Span Development Course Using Fink's Taxonomy

    Science.gov (United States)

    Fallahi, Carolyn R.

    2008-01-01

    This study compared a traditional lecture-based life span development course to the same course redesigned using Fink's (2003) taxonomy of significant learning. The goals, activities, and feedback within the course corresponded to Fink's 6 taxa (knowledge, application, integration, human dimension, caring, learning how to learn). Undergraduates in…

  7. Outsourcing of Corporate Information Services: Implications for Redesigning Corporate Library Services.

    Science.gov (United States)

    Agada, John

    1996-01-01

    Examines the trend in outsourcing information services and suggests it threatens the survival of corporate libraries. Topics include changes in the competitive corporate environment; characteristics of outsourceable services; managing change; redesigning the corporate librarian's role; and implications for redesigning corporate information…

  8. Application of Computer Simulation Modeling to Medication Administration Process Redesign

    Directory of Open Access Journals (Sweden)

    Nathan Huynh

    2012-01-01

    Full Text Available The medication administration process (MAP is one of the most high-risk processes in health care. MAP workflow redesign can precipitate both unanticipated and unintended consequences that can lead to new medication safety risks and workflow inefficiencies. Thus, it is necessary to have a tool to evaluate the impact of redesign approaches in advance of their clinical implementation. This paper discusses the development of an agent-based MAP computer simulation model that can be used to assess the impact of MAP workflow redesign on MAP performance. The agent-based approach is adopted in order to capture Registered Nurse medication administration performance. The process of designing, developing, validating, and testing such a model is explained. Work is underway to collect MAP data in a hospital setting to provide more complex MAP observations to extend development of the model to better represent the complexity of MAP.

  9. 10 CFR 501.67 - Petition redesignations.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Petition redesignations. 501.67 Section 501.67 Energy... Certifications § 501.67 Petition redesignations. OFE, with the petitioner's approval, will redesignate an exemption petition if the petitioner qualifies for an exemption other than the one originally requested...

  10. Designing the role of the embedded care manager.

    Science.gov (United States)

    Hines, Patricia; Mercury, Marge

    2013-01-01

    : The role of the professional case manager is changing rapidly. Health reform has called upon the industry to ensure that care is delivered in an efficient, effective, and high-quality and low cost manner. As a means to achieve this objective, health plans and health systems are moving the care manager out of a centralized location within their organizations to "embedding" them into physician offices. This move enables the care manager to work alongside the primary care physicians and their high-risk patients. This article discusses the framework for designing and implementing an embedded care manager role into a physician practice. Key elements of the program are discussed. IMPLICATIONS FOR CARE MANAGEMENT:: Historically care management has played a foundational role in improving the quality of care for individuals and populations via the efficient and effective use of resources. Now with the goals of health care reform, a successful transition from a volume-based to value-based reimbursement system requires primary care physicians to welcome care managers into their practices to improve patient care, quality, and costs through care coordination across health care settings and populations. : As patient-centered medical homes and integrated delivery systems formulate their plans for population health management, their efforts have included embedding a care manager in the primary practice setting. Having care managers embedded at the physician offices increases their ability to collaborate with the physician and their staff in the implementation and monitoring care plans for their patients. : Implementing an embedded care manager into an existing physician's practice requires the following:Although the embedded care manager is a highly evolving role, physician groups are beginning to realize the benefits from their care management collaborations. Examples cited include improved outreach and coordination, patient adherence to care plans, and improved quality of life.

  11. Better team management--better team care?

    Science.gov (United States)

    Shelley, P; Powney, B

    1994-01-01

    Team building should not be a 'bolt-on' extra, it should be a well planned, integrated part of developing teams and assisting their leaders. When asked to facilitate team building by a group of NHS managers we developed a framework which enabled individual members of staff to become more effective in the way they communicated with each other, their teams and in turn within the organization. Facing the challenge posed by complex organizational changes, staff were able to use 3 training days to increase and develop their awareness of the principles of teamwork, better team management, and how a process of leadership and team building could help yield better patient care.

  12. Transitional care management in the outpatient setting.

    Science.gov (United States)

    Baldonado, Analiza; Hawk, Ofelia; Ormiston, Thomas; Nelson, Danielle

    2017-01-01

    Patients who are high risk high cost (HRHC), those with severe or multiple medical issues, and the chronically ill elderly are major drivers of rising health care costs.1 The HRHC patients with complex health conditions and functional limitations may likely go to emergency rooms and hospitals, need more supportive services, and use long-term care facilities.2 As a result, these patient populations are vulnerable to fragmented care and "falling through the cracks".2 A large county health and hospital system in California, USA introduced evidence-based interventions in accordance with the Triple AIM3 focused on patient-centered health care, prevention, health maintenance, and safe transitions across the care continuum. The pilot program embedded a Transitional Care Manager (TCM) within an outpatient Family Medicine clinic to proactively assist HRHC patients with outreach assistance, problem-solving and facilitating smooth transitions of care. This initiative is supported by a collaborative team that included physicians, nurses, specialists, health educator, and pharmacist. The initial 50 patients showed a decrease in Emergency Department (ED) encounters (pre-vs post intervention: 33 vs 17) and hospital admissions (pre-vs post intervention: 32 vs 11), improved patient outcomes, and cost saving. As an example, one patient had 1 ED visit and 5 hospital admission with total charges of $217,355.75 in the 6 months' pre-intervention with no recurrence of ED or hospital admissions in the 6 months of TCM enrollment. The preliminary findings showed improvement of patient-centered outcomes, quality of care, and resource utilization however more data is required.

  13. DEPRESSION IN PRIMARY CARE. PART 2: MANAGEMENT

    Directory of Open Access Journals (Sweden)

    XV Pereira

    2007-01-01

    Full Text Available The management of depression in the primary care setting should ideally take a biological, psychological, and sociologicalapproach. Antidepressants are the most commonly used biological agents in the treatment of depression. Psychologicaltherapies 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.

  14. On Engineering Support for Business Process Modelling and Redesign

    NARCIS (Netherlands)

    Doumeingts, G.; Franken, H.M.; de Weger, M.K.; Browne, J.; Quartel, Dick; Ferreira Pires, Luis

    1997-01-01

    Currently, there is an enormous (research) interest in business process redesign (BPR). Several management-oriented approaches have been proposed showing how to make BPR work. However, detailed descriptions of empirical experience are few. Consistent engineering methodologies to aid and guide a

  15. Using Social Network Analysis to Examine the Effect of Care Management Structure on Chronic Disease Management Communication Within Primary Care.

    Science.gov (United States)

    Holtrop, Jodi Summers; Ruland, Sandra; Diaz, Stephanie; Morrato, Elaine H; Jones, Eric

    2018-05-01

    Care management and care managers are becoming increasingly prevalent in primary care medical practice as a means of improving population health and reducing unnecessary care. Care managers are often involved in chronic disease management and associated transitional care. In this study, we examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. We sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? Individual written surveys were given to all practice members in the participating practices. Survey questions assessed demographics as well as practice culture, quality improvement, care management activities, and communication regarding chronic disease care. Using social network analysis and other statistical methods, we analyzed the communication dynamics related to chronic disease care for each practice. The structure of chronic disease communication varies greatly from practice to practice. Care managers who were embedded in the practice or co-located were more likely to be in the core of the communication network than were off-site care managers. These care managers also had higher in-degree centrality, indicating that they acted as a hub for communication with team members in many other roles. Social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. Structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.

  16. Management of dizziness in primary care.

    Science.gov (United States)

    Sloane, P D; Dallara, J; Roach, C; Bailey, K E; Mitchell, M; McNutt, R

    1994-01-01

    We sought to determine the types of dizziness problems that are commonly seen in primary care practices, and to bring to light clinical and demographic factors that predict management decisions. We undertook a prospective cohort study with a 6-month follow-up using data gathered in nine primary care practices in two North Carolina counties. Subjects were 144 dizziness patients examined by primary care physicians. Data collected included demographic characteristics, a standardized dizziness history, physician estimation of symptom severity and diagnostic certainty, and physician "worry" about arrhythmia, transient ischemic attack, and brain tumor. Physicians reported their management decisions and diagnosis (or differential diagnosis) by responding to a questionnaire after completing the patient encounter. A 6-month follow-up chart review and physician interview were completed on 140 patients (97.2 percent); information obtained included changes in diagnosis and patient mortality. The most common diagnoses were labyrinthitis, otitis media, benign positional vertigo, unspecified presyncope, sinusitis, and transient ischemic attack. The initial diagnosis changed during the 6-month follow-up period in 34 (24.3 percent) of patients. The overall course of these patients was benign, however, with only one death occurring during the 6-month follow-up period. Patients' dizziness tended to be managed using a combination of strategies, including office laboratory testing (33.6 percent), advanced testing (11.4 percent), referral to a specialist (9.3 percent), medication (61.3 percent), observation (71.8 percent), reassurance (41.6 percent), and behavioral recommendations (15.0 percent). Office laboratory testing was associated with younger patient age, a suspected metabolic or endocrine disorder, and physician worry about a cardiac arrhythmia; advanced laboratory testing was associated with suspected cardiovascular or neurologic disorders. Medication tended to be prescribed

  17. Fundamentals of pain management in wound care.

    Science.gov (United States)

    Coulling, Sarah

    Under-treated pain can result in a number of potentially serious sequelae (Australian and New Zealand College of Anaesthetists, 2006), including delayed mobilization and recovery, cardiac complications, thromboses, pulmonary complications, delayed healing, psychosocial problems and chronic pain syndromes. This article considers pain management in the context of painful wounds. An international comparative survey on wound pain (European Wound Management Association, 2002) found that practitioners in the wound care community tend to focus on healing processes rather than the patient's total pain experience involving an accurate pain assessment and selection of an appropriate pain management strategy. Procedural pain with dressing removal and cleansing caused the greatest concerns. An overview of simple, evidence-based drug and non-drug techniques is offered as potential strategies to help minimize the experience of pain.

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

    Science.gov (United States)

    Mowll, C A

    1998-01-01

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

  19. The evolving role and care management approaches of safety-net Medicaid managed care plans.

    Science.gov (United States)

    Gusmano, Michael K; Sparer, Michael S; Brown, Lawrence D; Rowe, Catherine; Gray, Bradford

    2002-12-01

    This article provides new empirical data about the viability and the care management activities of Medicaid managed-care plans sponsored by provider organizations that serve Medicaid and other low-income populations. Using survey and case study methods, we studied these "safety-net" health plans in 1998 and 2000. Although the number of safety-net plans declined over this period, the surviving plans were larger and enjoying greater financial success than the plans we surveyed in 1998. We also found that, based on a partnership with providers, safety-net plans are moving toward more sophisticated efforts to manage the care of their enrollees. Our study suggests that, with supportive state policies, safety-net plans are capable of remaining viable. Contracting with safety-net plans may not be an efficient mechanism for enabling Medicaid recipients to "enter the mainstream of American health care," but it may provide states with an effective way to manage and coordinate the care of Medicaid recipients, while helping to maintain the health care safety-net for the uninsured.

  20. Pulmonary Hypertension in Pregnancy: Critical Care Management

    Directory of Open Access Journals (Sweden)

    Adel M. Bassily-Marcus

    2012-01-01

    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.

  1. Meeting the challenge of managed care - Part II: Designing a radiation oncology department and setting up a clinical practice program

    International Nuclear Information System (INIS)

    Halman, Marc A.; Szerlag, Chester

    1997-01-01

    Objective: Identify the business practices necessary to develop a successful radiation oncology department in the current health care environment. Course content will be of interest to new practitioners establishing first time programs or joining existing groups as well as experienced radiation oncologists who are challenged with redesigning programs to be competitive. Course Content: During this session, the following topics will be discussed: 1) Space planning and equipment selection 2) Personnel; creating efficiencies while promoting productivity 3) Professional and Technical Billing; establishing proper fee structures and coding procedures 4) Utilizing benchmarking as a tool to improve operations 5) Information technology in radiation oncology 6) Current and Future Trends: a) Oncology networks b) Reimbursement: managed care and capitation c) Downsizing d) Relative Value Units

  2. Management of postmenopausal osteoporosis for primary care.

    Science.gov (United States)

    Miller, P; Lukert, B; Broy, S; Civitelli, R; Fleischmann, R; Gagel, R; Khosla, S; Lucas, M; Maricic, M; Pacifici, R; Recker, R; Sarran, H S; Short, B; Short, M J

    1998-01-01

    The shift in health care delivery from a subspecialty to primary care system has transferred the responsibility of preventing osteoporotic fractures from specialists in metabolic bone disease to the web of physicians--family practitioners, general internists, pediatricians, and gynecologists--who provide the bulk of primary care. The challenge for this group of physicians is to decrease the rising prevalence of osteoporotic hip and vertebral fractures while operating within the cost parameters. It is the goal of this brief summary to provide primary practitioners with focused guidelines for the management of postmenopausal osteoporosis based on new and exciting developments. Prevention and treatment will change rapidly over the next decade and these advances will require changes in these recommendations. We identified patients at risk for osteoporosis and provided indications for bone mass measurement, criteria for diagnosis of osteoporosis, therapeutic interventions, and biochemical markers of the disease. Prevention and treatment are discussed, including hormone replacement therapy and use of calcitonin, sodium fluoride, bisphosphonates, and serum estrogen receptor modulators. Postmenopausal osteoporosis should no longer be an accepted process of aging. It is both preventable and treatable. Primary care physicians must proactively prevent and treat osteoporosis in their daily practice, and combination therapies are suggested.

  3. Managing change in health care organizations.

    Science.gov (United States)

    Margulies, N

    1977-08-01

    The forces for change seem more potent today than ever before; increased technological advancement and rapid "societal upheavals" create a more critical need for change and a more significant need for skills to manage and channel change toward meaningful ends. The area of health care delivery is probably one of the fields most impinged upon and most affected by these turbulent times. Organizational development is presented herein as an approach to assist people in health care organizations with the problems of adaptation and change. A specific change strategy, action research, is discussed and a concrete case example is presented to illustrate the ways in which the action research model can be applied. Advantages and pitfalls are discussed in the concluding section.

  4. A managed clinical network for cardiac services: set-up, operation and impact on patient care

    Directory of Open Access Journals (Sweden)

    Karen E. Hamilton

    2005-09-01

    Full Text Available Purpose: To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. Methods: This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Results: Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and ‘bed down’. Its primary “modus operand” was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were

  5. A managed clinical network for cardiac services: set-up, operation and impact on patient care.

    Science.gov (United States)

    Stc Hamilton, Karen E; Sullivan, Frank M; Donnan, Peter T; Taylor, Rex; Ikenwilo, Divine; Scott, Anthony; Baker, Chris; Wyke, Sally

    2005-01-01

    To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and 'bed down'. Its primary "modus operand" was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not statistically significant. There was no difference

  6. Crew Management Processes Revitalize Patient Care

    Science.gov (United States)

    2009-01-01

    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.

  7. The evolving role and care management approaches of safety-net medicaid managed care plans

    OpenAIRE

    Gusmano, Michael K.; Sparer, Michael S.; Brown, Lawrence D.; Rowe, Catherine; Gray, Bradford

    2002-01-01

    This article provides new empirical data about the viability and the care management activities of Medicaid managed-care plans sponsored by provider organizations that serve Medicaid and other low-income populations. Using survey and case study methods we studied these “safety-net” health plans in 1998 and 2000. Although the number of safety-net plans declined over this period, the surviving plans were larger and enjoying greater financial success than the plans we surveyed in 1998. We also f...

  8. The importance of management information systems in a managed care environment.

    Science.gov (United States)

    Porro, M R; Brill, K R

    1995-06-01

    Keys to successful information systems for home care providers are planning and control. With managed care's emphasis on data, agencies need to have information systems that can handle the demands managed care puts on agencies today--planning before hurrying to install a system will ensure control as the managed care contracts add up.

  9. Management of neonatal jaundice in primary care

    Directory of Open Access Journals (Sweden)

    Angeline Wan Seng Lian

    2016-02-01

    Full Text Available The Clinical Practice Guidelines on Management of Neonatal Jaundice 2003 was updated by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2014. A systematic review of 13 clinical questions was conducted using evidence retrieved mainly from Medline and Cochrane databases. Critical appraisal was done using the Critical Appraisal Skills Programme checklist. Recommendations were formulated based on the accepted 103 evidences and tailored to local setting as stated below. Neonatal jaundice (NNJ is a common condition seen in primary care. Multiple risk factors contribute to severe NNJ, which if untreated can lead to adverse neurological outcomes. Visual assessment, transcutaneous bilirubinometer (TcB and total serum bilirubin (TSB are the methods used for the detection of NNJ. Phototherapy remains the mainstay of the treatment. Babies with severe NNJ should be followed-up to detect and manage sequelae. Strategies to prevent severe NNJ include health education, identification of risk factors, proper assessment and early referral.

  10. Managed Care for Children: Effect on Access to Care and Utilization of Health Services.

    Science.gov (United States)

    Szilagyi, Peter G.

    1998-01-01

    Reviews what is known about the effect of managed care on access to health services, as well as utilization of hospital care, emergency department visits, primary care services, and specialty pediatric services. The effect of managed care appears dependent on several factors and, thus, is likely to vary according to the population served. (SLD)

  11. The role of managed care organizations in obesity management.

    Science.gov (United States)

    Schaecher, Kenneth L

    2016-06-01

    In the United States, obesity is characterized as this century's greatest healthcare threat. The American Medical Association and several other large organizations now classify obesity as a disease. Several federal initiatives are in the planning stages, have been approved, or are being implemented to address the disease. Obesity poses challenges for all healthcare stakeholders. Diet and exercise often are insufficient to create the magnitude of change patients and their attending healthcare providers need. Managed care organizations (MCOs) have 3 tools that can help their members: health and wellness programs focusing on lifestyle changes, prescription weight-loss drugs, and bariatric surgical interventions. MCOs are addressing changes with national requirements and are responding to the availability of new weight-loss drugs to help their members achieve better health. A number of factors either deter or stimulate the progress of weight loss therapy. Understanding how MCOs are key to managing obesity at the local level is important for healthcare providers. It can help MCOs and individual healthcare providers develop and coordinate strategies to educate stakeholders and better manage overall care.

  12. Redesigning Acquisition Processes: A New Methodology Based on the Flow of Knowledge and Information

    National Research Council Canada - National Science Library

    Kock, Ned F; Murphy, Frederic

    2001-01-01

    Current business process redesign practices, in the defense sector as well as in business in general, are based on several assumptions inherited from Taylor s scientific management method, including...

  13. Public health emergencies and the public health/managed care challenge.

    Science.gov (United States)

    Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra

    2002-01-01

    The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

  14. Evaluation of home care management of umbilical cord stumps by ...

    African Journals Online (AJOL)

    Background: Umbilical cord care is an integral part of neonatal care in all communities and cultures and appropriate cord care reduces the risk of infection in the newborn infant. Objective: The present study assessed the home care management of the umbilical stump by the mothers at Ilesa, Southwestern Nigeria. Subjects ...

  15. Managing chronic conditions in a South African primary care context ...

    African Journals Online (AJOL)

    Managing chronic conditions in a South African primary care context: ... is an approach to motivating behaviour change in general health care settings. ... They had mixed experiences with skills for agenda setting and reducing resistance.

  16. Implications of the development of managed health care in the ...

    African Journals Online (AJOL)

    care or the public heatth care sector, and that it may potentially promote ... The MHC approach controls costs through measures such as .... (managers, computer systems, accountants). If it does not, .... Health EconomICS 1994: 3: 351-357.

  17. Using Technology, Clinical Workflow Redesign, and Team Solutions to Achieve the Patient Centered Medical Home

    Science.gov (United States)

    2011-01-01

    Redesign, and Team Solutions to Achieve the Patient Centered Medical Home LTC Nicole Kerkenbush, MHA, MN Army Medical Department, Office of the...TITLE AND SUBTITLE Using Technology, Clinical Workflow Redesign, and Team Solutions to Achieve the Patient Centered Medical Home 5a. CONTRACT...Describe how these tools are being used to implement the Patient Centered Medical Home care model 2 2011 MHS Conference MEDCOM AHLTA Provider Satisfaction

  18. Conflicts between managed care organizations and emergency departments in California.

    OpenAIRE

    Johnson, L A; Derlet, R W

    1996-01-01

    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...

  19. 20 strategies for marketing your managed care plan.

    Science.gov (United States)

    Firshein, J

    1996-01-01

    In today's fiercely competitive managed care marketplace, healthcare executives must find a way to set their plans apart from the competition and build a sufficient customer base. At the same time, they must confront a growing anti-managed care backlash among a wary and confused public. Healthcare executive magazine talked with managed care experts to gather their views on key strategies to help executives meet both of these challenges. Here's what they suggest.

  20. Health information technology: transforming chronic disease management and care transitions.

    Science.gov (United States)

    Rao, Shaline; Brammer, Craig; McKethan, Aaron; Buntin, Melinda B

    2012-06-01

    Adoption of health information technology (HIT) is a key effort in improving care delivery, reducing costs of health care, and improving the quality of health care. Evidence from electronic health record (EHR) use suggests that HIT will play a significant role in transforming primary care practices and chronic disease management. This article shows that EHRs and HIT can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Influencing Organizational Commitment through Office Redesign

    Science.gov (United States)

    Morrow, Paula C.; McElroy, James C.; Scheibe, Kevin P.

    2012-01-01

    Prior research on the effects of office redesign on work-related outcomes has been largely a theoretical and yielded mixed and conflicting findings. Expanding on individual reactions to office design changes as specified by social interference theory, we propose that office redesign affects organizational commitment and this relationship is…

  2. Assessment, authorization and access to medicaid managed mental health care.

    Science.gov (United States)

    Masland, Mary C; Snowden, Lonnie R; Wallace, Neal T

    2007-11-01

    Examined were effects on access of managed care assessment and authorization processes in California's 57 county mental health plans. Primary data on managed care implementation were collected from surveys of county plan administrators; secondary data were from Medicaid claims and enrollment files. Using multivariate fixed effects regression, we found that following implementation of managed care, greater access occurred in county plans where assessments and treatment were performed by the same clinician, and where service authorizations were made more rapidly. Lower access occurred in county plans where treating clinicians authorized services themselves. Results confirm the significant effects of managed care processes on outcomes and highlight the importance of system capacity.

  3. The match between institutional elderly care management research and management challenges - a systematic literature review.

    Science.gov (United States)

    Kokkonen, Kaija; Rissanen, Sari; Hujala, Anneli

    2012-11-08

    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. 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. 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. 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.

  4. Management challenges faced by managers of New Zealand long-term care facilities.

    Science.gov (United States)

    Madas, E; North, N

    2000-01-01

    This article reports on a postal survey of 78 long-term care managers in one region of New Zealand, of whom 45 (58%) responded. Most long-term care managers (73.2%) were middle-aged females holding nursing but not management qualifications. Most long-term care facilities (69%) tended to be stand-alone facilities providing a single type of care (rest home or continuing care hospital). The most prominent issues facing managers were considered to be inadequate funding to match the growing costs of providing long-term care and occupancy levels. Managers believed that political/regulatory, economic and social factors influenced these issues. Despite a turbulent health care environment and the challenges facing managers, long-term care managers reported they were coping well and valued networking.

  5. Managed care: employers' influence on the health care system.

    Science.gov (United States)

    Corder, K T; Phoon, J; Barter, M

    1996-01-01

    Health care reform is a complex issue involving many key sectors including providers, consumers, insurers, employers, and the government. System changes must involve all sectors for reform to be effective. Each sector has a responsibility to understand not only its own role in the health care system, but the roles of others as well. The role of business employers is often not apparent to health care providers, especially nurses. Understanding the influence employers have on the health care system is vital if providers want to be proactive change agents ensuring quality care.

  6. Health Care Autonomy in Children with Chronic Conditions: Implications for Self Care and Family Management

    Science.gov (United States)

    Beacham, Barbara L.; Deatrick, Janet A.

    2013-01-01

    Synopsis Health care autonomy typically occurs during late adolescence but health care providers and families often expect children with chronic health conditions to master self-care earlier. Few studies have examined the development of health care autonomy as it pertains to self-care and family management. This review will link the three concepts and discuss implications for families and health care providers. Case studies are provided as exemplars to highlight areas where intervention and research is needed. PMID:23659815

  7. NETWORKS OF HEALTH CARE: A CHALLENGE TO SUS MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Camila Dubow

    2013-09-01

    Full Text Available The article proposes a critical reflection, based on national law, scholarly, scientific, on the current development of Networks of Health Care, as a strategy for strengthening the Single Health System (SUS. Are weighted inefficiency of traditional ways of organizing care and management, the challenge of Network Health Care for comprehensive care and management mechanisms used in this process. The work provides subsidies for the care practices and health management are reflected, pointing strategies that result in disruptions of paradigms through a refocusing of attention in existing models. For networks of health care can be consolidated, is fundamental to political sensitivity of health managers with a commitment to build a new model of care, through the struggle to consolidate the SUS and the realization of the principles of universality, comprehensiveness and equity.

  8. Care management actions in the Family Health Strategy

    Directory of Open Access Journals (Sweden)

    Marcelo Costa Fernandes

    2015-11-01

    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.

  9. The match between institutional elderly care management research and management challenges - a systematic literature review

    Science.gov (United States)

    2012-01-01

    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. PMID:23137416

  10. The match between institutional elderly care management research and management challenges - a systematic literature review

    Directory of Open Access Journals (Sweden)

    Kokkonen Kaija

    2012-11-01

    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.

  11. Using patient acuity data to manage patient care outcomes and patient care costs.

    Science.gov (United States)

    Van Slyck, A; Johnson, K R

    2001-01-01

    This article describes actual reported uses for patient acuity data that go beyond historical uses in determining staffing allocations. These expanded uses include managing patient care outcomes and health care costs. The article offers the patient care executive examples of how objective, valid, and reliable data are used to drive approaches to effectively influence decision making in an increasingly competitive health care environment.

  12. Quality management in home care: models for today's practice.

    Science.gov (United States)

    Verhey, M P

    1996-01-01

    In less than a decade, home care providers have been a part of two major transitions in health care delivery. First, because of the advent of managed care and a shift from inpatient to community-based services, home care service delivery systems have experienced tremendous growth. Second, the principles and practices of total quality management and continuous quality improvement have permeated the organization, administration, and practice of home health care. Based on the work of Deming, Juran, and Crosby, the basic tenets of the new quality management philosophy involve a focus on the following five key areas: (1) systems and processes rather than individual performance; (2) involvement, collaboration, and empowerment; (3) internal and external "customers"; (4) data and measurement; and (5) standards, guidelines, and outcomes of care. Home care providers are among those in the forefront who are developing and implementing programs that integrate these foci into the delivery of quality home care services. This article provides a summary of current home care programs that address these five key areas of quality management philosophy and provide models for innovative quality management practice in home care. For further information about each program, readers are referred to the original reports in the home care and quality management journal literature, as cited herein.

  13. Care for children with special health care needs in a managed care system: a patient satisfaction survey.

    Science.gov (United States)

    Flynn, J M; Bravo, C J; Reyes, O

    2001-09-01

    In 1994 the government of Puerto Rico adopted a capitated managed health care system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special health care needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special health care needs in capitated managed health care programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special health care needs under a capitated managed health care system.

  14. The costs of caring: medical costs of Alzheimer's disease and the managed care environment.

    Science.gov (United States)

    Murman, D L

    2001-01-01

    This review summarizes the medical costs associated with Alzheimer's disease (AD) and related dementias, as well as the payers responsible for these medical costs in the US health care system. It is clear from this review that AD and related dementias are associated with substantial medical costs. The payers responsible for a majority of these costs are families of patients with AD and the US government through the Medicare and Medicaid programs. In an attempt to control expenditures, Medicare and Medicaid have turned to managed care principles and managed care organizations. The increase in "managed" dementia care gives rise to several potential problems for patients with AD, along with many opportunities for systematic improvement in the quality of dementia care. Evidence-based disease management programs provide the greatest opportunities for improving managed dementia care but will require the development of dementia-specific quality of care measures to evaluate and continually improve them.

  15. Participatory redesign of work organisation in hospital nursing: A study of the implementation process.

    Science.gov (United States)

    Stab, Nicole; Hacker, Winfried

    2018-05-01

    The main goal of the study was to apply and analyse a moderated participatory small-group procedure with registered nurses, which aims at the development and implementation of measures to improve work organisation in hospital wards and nursing units. Participation in job redesign is an essential prerequisite of the successful implementation of improvement measures in nursing. The study was carried out in a public hospital of maximum care in Germany. We selected 25 wards with the most critical reported exhaustion and general health and applied a series of moderated small-group sessions in which the registered nurses jointly identified deficits in their work organisation, developed improvement measures, and then implemented and assessed them. Registered nurses of 22 wards actively took part in the small-group procedure. All nursing units jointly identified organisational deficits, developed possible improvement measures, and implemented them. The nursing teams then evaluated the implemented measures which were already assessable at the end of our research period; nearly all (99.0%) showed improvements, while 69.4% actually attained the desired goals. Participatory small-group activities may be successfully applied in hospital nursing in order to improve work organisation. Participatory assessment and redesign of nurses' work organisation should be integrated into regular team meetings. The nursing management should actively support the implementation process. © 2018 John Wiley & Sons Ltd.

  16. Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital.

    Science.gov (United States)

    Gayed, Benjamin; Black, Stephen; Daggy, Joanne; Munshi, Imtiaz A

    2013-11-01

    In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.1 days during fiscal year 2008. The Joint Replacement Program system redesign project was initiated following the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model to increase efficiency, decrease length of stay, and reduce non-VA care costs. To determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital. Perioperative processes for patients undergoing total joint replacement were redesigned following the VA-TAMMCS model--the VA's official, branded method of Lean Six Sigma process improvement. A multidisciplinary team including the orthopedic surgeons, frontline staff, and executive management identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a 1-year baseline period and a 20-month sustainment period. The primary endpoint was length of stay; a secondary analysis considered non-VA care cost reductions. Length of stay decreased 36% overall, decreasing from 5.3 days during the preproject period to 3.4 days during the 20-month sustainment period (P Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center.

  17. A Survey of Managed Care Education at Optometry Schools.

    Science.gov (United States)

    Soroka, Mort; Reis, Lesley

    2003-01-01

    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)

  18. Use of Care Paths to Improve Patient Management

    Science.gov (United States)

    Campbell, Suzann K.

    2013-01-01

    The purpose of this special issue of Physical & Occupational Therapy in Pediatrics is to present an evidence-based system to guide the physical therapy management of patients in the Neonatal Intensive Care Unit (NICU). Two systematic guides to patient management will be presented. The first is a care path intended primarily for use by physical…

  19. Primary care referral management: a marketing strategy for hospitals.

    Science.gov (United States)

    Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J

    1990-06-01

    With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.

  20. Preparing Students for Practice in a Managed Care Environment

    Science.gov (United States)

    Claiborne, Nancy; Fortune, Anne

    2005-01-01

    Managed care has profound effects on health and mental health service delivery in the United States. This article describes the knowledge that students need for effective social work practice within a managed care environment and evaluates a course to deliver the content. (Contains 3 tables.)

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

    Science.gov (United States)

    Kazmirski, G

    1998-11-01

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

  2. COPD self-management supportive care: chaos and complexity theory.

    Science.gov (United States)

    Cornforth, Amber

    This paper uses the emergent theories of chaos and complexity to explore the self-management supportive care of chronic obstructive pulmonary disease (COPD) patients within the evolving primary care setting. It discusses the concept of self-management support, the complexity of the primary care context and consultations, smoking cessation, and the impact of acute exacerbations and action planning. The author hopes that this paper will enable the acquisition of new insight and better understanding in this clinical area, as well as support meaningful learning and facilitate more thoughtful, effective and high quality patient-centred care within the context of primary care.

  3. Managing Home Health Care (For Parents)

    Science.gov (United States)

    ... this topic for: Parents Kids Teens Palliative Care Electronic Health Records When Your Child's in the Pediatric Intensive Care ... Us Contact Us Partners Editorial Policy Permissions Guidelines Privacy Policy & Terms of Use Notice of Nondiscrimination Visit ...

  4. Academic medicine meets managed care: a high-impact collision.

    Science.gov (United States)

    Carey, R M; Engelhard, C L

    1996-08-01

    The managed care revolution is sweeping the country as a result of intense marketing on the part of managed care organizations and the widespread belief that price-sensitive managed care systems will control health costs. Although few believe that managed care alone can adequately stem the growth of nation health care spending, competition based on price has emerged as a powerful force in the health care sector. Academic health center (AHCs) stand to suffer with this new managed care regime because their special missions of teaching, research, and highly specialized clinical care make them more expensive than nonacademic hospitals and place them at a noncompetitive disadvantage. The traditional focus of the acute care hospital with individual departmentally designed programs will be narrow. Major changes will be required on the part of AHCs if they are to survive and preserve patient volume, maintain the integrity of medical education, advance scientific research, and provide highly specialized care. AHCs will have to make unprecedented adjustments in virtually every phase of their operations, particularly in the areas of clinical decision making and speedy patient-related information flow. A premium will be placed on multidisciplinary, inclusive medical services that can assume total health care risks for large populations. New ways of educating students in ambulatory settings with an emphasis on outcomes and population-based health will be needed along with the traditional responsibility of pursuing new approaches to the diagnosis, treatment, and prevention of disease. The extent to which managed care will ultimately alter the traditional role of AHCs in the American health care system is unclear, but successful adaptation in the short term will require them to respond broadly, flexibly, and in a timely fashion to the anticipated health care scene.

  5. Health care managers' views on and approaches to implementing models for improving care processes.

    Science.gov (United States)

    Andreasson, Jörgen; Eriksson, Andrea; Dellve, Lotta

    2016-03-01

    To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes. In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome. In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory. 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work. Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management. © 2015 John Wiley & Sons Ltd.

  6. Managing high-risk patients: the Mass General care management programme

    Directory of Open Access Journals (Sweden)

    Dennis L Kodner

    2015-09-01

    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

  7. Data Management for Evaluating Complications of Health Care

    OpenAIRE

    Streed, Stephen A.; Massanari, R. Michael

    1988-01-01

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

  8. Managed care and its impact on American urology.

    Science.gov (United States)

    Holtgrewe, H L

    1998-05-01

    America's health care is undergoing a revolution. A previous private, fee-for-service, delivery system chiefly centered around hospital specialty care is rapidly being replaced by a commercialized system of managed care, controlled by businessmen whose prime motive is profit. Increasing emphasis of these managed care organizations is upon primary physicians who function as gatekeepers. While this new commercialized method of health care has been attended with reductions in the previous omnipresent health care inflation our country has experienced for the past several decades, its impact on quality of care and patient choice of physician remain a great concern. Especially vulnerable in this new system are our nation's academic centers, which, burdened with responsibility for education and research, are at a disadvantage in the competitive cost-based bidding for managed care contracts. Urology work force issues and the number of urologists in our nation remain another concern for urologists as they compete for access to patients in this new highly competitive environment. In a 1995 survey of a cohort of urologists in seven states, the respondents reported 35.8% of gross income came from managed care contracts, 86% reported the need for preservice approval for many diagnostic and therapeutic undertakings, 87% reported an inability to refer complex cases outside the Managed Care Organization (MCO) network, and 23% reported they were required to retain patients for treatment who they would have otherwise referred to a more qualified urologist. The majority of American urologists are reporting dropping gross revenues and increasing overhead in their dealings with managed care contracts. The advent of managed care is being attended with dropping gross revenues, increasing overhead costs and interference with the practice patterns of American urologists.

  9. Telephone Care Management of Fall Risk:: A Feasibility Study.

    Science.gov (United States)

    Phelan, Elizabeth A; Pence, Maureen; Williams, Barbara; MacCornack, Frederick A

    2017-03-01

    Care management has been found to be more effective than usual care for some chronic conditions, but few studies have tested care management for prevention of elder falls. This study aimed to assess the feasibility and preliminary efficacy of telephone care management of older adults presenting for medical attention due to a fall. The setting was an independent practice association in western Washington serving 1,300 Medicare Advantage-insured patients. Patients aged ≥65 years treated for a fall in an emergency department or their primary care provider's office were contacted via telephone by a care manager within 48 hours of their fall-related visit and invited to participate in a telephone-administered interview to identify modifiable fall risk factors and receive recommendations and follow-up to address identified risk factors. Data from care manager records, patient medical records, and healthcare claims for the first 6 months (November 2009-April 2010) of program implementation were analyzed in 2011. The feasibility of screening and management of fall risk factors over the telephone and the effect on medically attended falls were assessed. Twenty-two patients eligible for fall care management were reached and administered the protocol. Administration took 15-20 minutes and integrated easily with the care manager's other responsibilities. Follow-through on recommendations varied, from 45% for those for whom exercise participation was recommended to 100% for other recommendations. No medically attended falls occurred over 6 months of follow-up. Telephone care management of fall risk appears feasible and may reduce falls requiring medical attention. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  10. The mapping competences of the nurse Case/Care Manager in the context of Intensive Care.

    Science.gov (United States)

    Alfieri, Emanuela; Ferrini, Anna Chiara; Gianfrancesco, Francesca; Lise, Gianluca; Messana, Giovanni; Tirelli, Lorenzo; Lorenzo, Ana; Sarli, Leopoldo

    2017-03-15

    Since the recent introduction of the Case/Care Manager's professional figure, it is quite difficult to identify properly his/her own particular features, which could be mainly be found revising mainly in American studies. Therefore, the present study intended to identify the Case/Care Manager's skills and professional profile in an Intensive Care Unit experience, taking into consideration the staff's activities, perception and expectations towards the Case/Care Manager. In particular, it has been compared the experience of an Intensive Care Units where the Case/Care Manager's profile is operational to a different Unit where a Case/Care Manager is not yet in force. a Levati's model was used to map the Case/Care Manager's skills, involving each unit whole working staff, executives and caregivers through semi-structured interviews. It has been taken into consideration the Anaesthesia Unit and Emergency Unit of Cesena's healthcare organisation (AUSL of Romagna) and a Cardiology Intensive Care Unit of Piacenza's healthcare organisation, where the Case/Care Manager's profile has not been experimented yet. Firstly, it a data collection in each healthcare organization has been organised. Subsequently, semi-structured interviews to doctors, unit nurses, caregivers, nurses' coordinators and medical staff have been used to compare each healthcare system. The interviewees' described their expectations in relation to the Case/Care Manager working in a critical area. Then, every data collected during interviews has been organised to map a Case/Care Manager's essential professional profile to work in a critical area together with medical staff. Piacenza's O.U. critical area experience reported a major demand for patients' and patient's families' assistance. On the other hand, the very same aspects seem to have been better achieved in Cesena's O.U., where a Case/Care Manager's recent introduction has actually helped to overcome the void in organising systems. a Case/Care Manager

  11. Using business process redesign to reduce wait times at a university hospital in the Netherlands

    NARCIS (Netherlands)

    Elkhuizen, Sylvia G.; Burger, Matthe P. M.; Jonkers, Rene E.; Limburg, Martien; Klazinga, Niek; Bakker, Piet J. M.

    2007-01-01

    BACKGROUND: Business process redesign (BPR) has been applied to implement more customer-focused and cost-effective care. In 2002, two pilot projects to improve patient care processes for two specific patient groups were conducted at the Academic Medical Center, a 1,000-bed university hospital in

  12. Towards redesigning indigenous mung bean foods

    NARCIS (Netherlands)

    Dahiya, P.K.

    2013-01-01

    Redesigning traditional foods requires consideration of the various factors affecting the nutrient intake from such foods. Amongst these factors are adequate consumption, proper nutrient bioavailability and consumer satisfaction. These factors are related to traditional food quality at various

  13. Care managers' views on death and caring for older cancer patients in Japan.

    Science.gov (United States)

    Matsui, Miho; Kanai, Emi; Kitagawa, Akiko; Hattori, Keiko

    2013-12-01

    Care managers (CMs) have an important role in coordinating care for cancer patients who are in the end-of-life stage; however, little is known about their views of death and their experiences while caring for older cancer patients. This study was conducted to examine CMs' views of death and caring for older cancer patients in a home care setting in Japan. Convenience sampling was undertaken, and 35 offices from 43 approached services agreed to participate. The final valid sample included responses from 136 CMs (90.7%). Most CMs, including nurses, care workers, home helpers, and social workers in home care settings, experienced difficulty in managing the care of cancer patients in the end-of-life stage. Respondents reported a wide array of experiences with end-of-life care, care management, and seminar attendance, and their ages and Frommelt Attitude Toward Care of the Dying (FATCOD) scores were associated factors. Moreover, multiple regression analysis indicated that better attitudes toward caring for the dying were positively associated with seminar attendance. These results suggest that CMs need education about palliative and end-of-life care in order to promote good home care for cancer patients.

  14. Diabetes quality management in care groups and outpatient clinics

    NARCIS (Netherlands)

    Campmans-Kuijpers, M.J.E.

    2015-01-01

    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

  15. Customer service: the key to remaining competitive in managed care.

    Science.gov (United States)

    Howard, J E

    2000-01-01

    The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Employers and managed care organizations are demanding better service and higher quality care, while providers are trying to tackle reimbursement cutbacks, streamlining of services, and serving a diverse population. Providers have begun to realize that to overcome these obstacles and meet the needs of their health plans and consumers, they must focus on the demands of their customers. Health care organizations have found they can meet the demands of both the consumer and the managed care industry through initiating and maintaining a customer service program. This essay explains the importance of customer service and its link to success in the managed care environment.

  16. Managed Care Approaches to Children's Services within Public Systems of Care.

    Science.gov (United States)

    Pumariega, Andres; Fallon, Theodore, Jr.

    This report presents two discussions of conceptual and infrastructure issues that state mental health systems serving children with emotional disturbances must consider to make an effective transition towards a managed care organization of services under Medicaid. The first discussion, "Clinical Experiences in Managed Care Implementation for…

  17. Corporate social responsibility and the future health care manager.

    Science.gov (United States)

    Collins, Sandra K

    2010-01-01

    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.

  18. Managed care, consumerism, preventive medicine: does a causal connection exist?

    Science.gov (United States)

    Rizzo, John A; Xie, Yang

    2006-07-01

    Managed care plans, and HMOs in particular, have long touted that their emphasis is on preventive care, to avoid expensive illness later in life. However, few articles in the contemporary literature adequately address this claim. The available evidence seems to support that HMOs do, in fact, provide greater access to preventive services, but the limitations of this research are substantial. This article discusses the scientific evidence on the relationships between managed care arrangements and the implications for preventive care in the current era, emphasizing consumer choices and less-restrictive plan structures.

  19. Toward population management in an integrated care model.

    Science.gov (United States)

    Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

    2013-01-01

    Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative. © 2013 S. Karger AG, Basel.

  20. Redesign and modernization of radioactive waste administration systems in Ukraine

    Energy Technology Data Exchange (ETDEWEB)

    Nieder-Westermann, Gerald H.; Walther, Thorsten; Krone, Juergen [DBE Technology GmbH, Peine (Germany)

    2016-06-15

    The European Commission (EC) has undertaken a series of projects to render assistance to Ukraine in modernizing and redesigning the Ukrainian approach to the administration, management and ultimately disposal of all forms of radioactive waste, including waste associated with the Chornobyl accident as well as waste generated as part of the Ukrainian energy infrastructure and from industrial and medical applications. One of the most recently completed projects focused on modernizing Ukraine's management and administrative systems responsible for the disposal of radioactive waste.

  1. Redesign and modernization of radioactive waste administration systems in Ukraine

    International Nuclear Information System (INIS)

    Nieder-Westermann, Gerald H.; Walther, Thorsten; Krone, Juergen

    2016-01-01

    The European Commission (EC) has undertaken a series of projects to render assistance to Ukraine in modernizing and redesigning the Ukrainian approach to the administration, management and ultimately disposal of all forms of radioactive waste, including waste associated with the Chornobyl accident as well as waste generated as part of the Ukrainian energy infrastructure and from industrial and medical applications. One of the most recently completed projects focused on modernizing Ukraine's management and administrative systems responsible for the disposal of radioactive waste.

  2. Design and application of a theory-based case/care management model for home care: advanced practice for nurses as care managers.

    Science.gov (United States)

    Sears, Nancy A

    2002-01-01

    Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.

  3. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

    2016-01-01

    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......, and monitoring delivered by medical assistants with usual care. Measurements: All-cause hospitalizations at 12 months (primary outcome) and quality of life scores (Short Form 12 Health Questionnaire [SF-12] and the Euroqol instrument [EQ-5D]). Results: Included patients had, on average, four co-occurring chronic...

  4. Hospital's redesigned Web site patient-friendly, comprehensive. Site one-of-a-kind in Twin Cities market area.

    Science.gov (United States)

    Rees, T

    2001-01-01

    North Memorial Medical Center, Robbinsdale, Minn., has opened a brightly redesigned Web site. It is patient-friendly and features a different approach to provide healthcare information called "care areas," which are organized by condition, such as heart care, cancer care and childbirth. This approach led to the the site being named North Memorial Online Care Center.

  5. Nurse care manager contribution to quality of care in a dual-eligible special needs plan.

    Science.gov (United States)

    Roth, Carol P; Ganz, David A; Nickles, Lorraine; Martin, David; Beckman, Robin; Wenger, Neil S

    2012-07-01

    We evaluated the quality of care provided to older patients with complex needs in a dual-eligible, community-based Medicare Special Needs Plan that used a nurse care manager model. Care provided by physicians was substantially supplemented by nurse care managers, as measured by Assessing Care of Vulnerable Elders quality indicators. We describe selected nurse care manager activities for six geriatric conditions (falls, dementia, depression, nutrition, urinary incontinence, and end-of-life care) during provision of patient care coordination and management for patients in the highest decile of clinical complexity. We identify areas of high nurse performance (i.e., falls screening, functional assessment, behavioral interventions for dementia problems, advance care planning) and areas of potential missed opportunities (i.e., follow up for new memory problems, targeted dementia counseling, nutrition, and behavioral approaches to urinary incontinence). Increasing the collaborative interaction between nurses providing care in this model and physicians has the potential to enhance nurses' contributions to primary care for vulnerable older adults.

  6. Organizing and managing care in a changing health system.

    Science.gov (United States)

    Kohn, L T

    2000-04-01

    To examine ways in which the management and organization of medical care is changing in response to the shifting incentives created by managed care. Site visits conducted in 12 randomly selected communities in 1996/ 1997. Approximately 35-60 interviews were conducted per site with key informants in healthcare and community organizations; about half were with providers. A standardized interview protocol was implemented across all sites, enabling cross-site comparisons. Multiple respondents were interviewed on each issue. A great deal of experimentation and apparent duplication exist in efforts to develop programs to influence physician practice patterns. Responsibility for managing care is being contested by health plans, medical groups and hospitals, as each seeks to accrue the savings that can result from the more efficient delivery of care. To manage the financial and clinical risk, providers are aggressively consolidating and reorganizing. Most significant was the rapid formation of intermediary organizations, such as independent practice arrangements (IPAs), physician-hospital organizations (PHOs), or management services organizations (MSOs), for contracting with managed care organizations. Managed care appears to have only a modest effect on how healthcare organizations deliver medical care, despite the profound effect that managed care has on how providers are organized. Rather than improving the efficiency of healthcare organizations, provider efforts to build large systems and become indispensable to health plans are exacerbating problems of excess capacity. It is not clear if new organizational arrangements will help providers manage the changing incentives they face, or if their intent is to blunt the effects of the incentives by forming larger organizations to improve their bargaining power and resist change.

  7. Risk Management for Point-of-Care Testing

    OpenAIRE

    James, H. Nichols

    2014-01-01

    Point-of-care testing (POCT) is growing in popularity, and with this growth comes an increased chance of errors. Risk management is a way to reduce errors. Originally developed for the manufacturing industry, risk management principles have application for improving the quality of test results in the clinical laboratory. The Clinical and Laboratory Standards Institute (CLSI), EP23-A Laboratory Quality Control based on Risk Management guideline, introduces risk management to the clinical labor...

  8. Patients-people-place: developing a framework for researching organizational culture during health service redesign and change.

    Science.gov (United States)

    Gale, Nicola K; Shapiro, Jonathan; McLeod, Hugh S T; Redwood, Sabi; Hewison, Alistair

    2014-08-20

    Organizational culture is considered by policy-makers, clinicians, health service managers and researchers to be a crucial mediator in the success of implementing health service redesign. It is a challenge to find a method to capture cultural issues that is both theoretically robust and meaningful to those working in the organizations concerned. As part of a comparative study of service redesign in three acute hospital organizations in England, UK, a framework for collecting data reflective of culture was developed that was informed by previous work in the field and social and cultural theory. As part of a larger mixed method comparative case study of hospital service redesign, informed by realist evaluation, the authors developed a framework for researching organisational culture during health service redesign and change. This article documents the development of the model, which involved an iterative process of data analysis, critical interdisciplinary discussion in the research team, and feedback from staff in the partner organisations. Data from semi-structured interviews with 77 key informants are used to illustrate the model. In workshops with NHS partners to share and debate the early findings of the study, organizational culture was identified as a key concept to explore because it was perceived to underpin the whole redesign process. The Patients-People-Place framework for studying culture focuses on three thematic areas ('domains') and three levels of culture in which the data could be organised. The framework can be used to help explain the relationship between observable behaviours and cultural artefacts, the values and habits of social actors and the basic assumptions underpinning an organization's culture in each domain. This paper makes a methodological contribution to the study of culture in health care organizations. It offers guidance and a practical approach to investigating the inherently complex phenomenon of culture in hospital organizations

  9. Health care autonomy in children with chronic conditions: implications for self-care and family management.

    Science.gov (United States)

    Beacham, Barbara L; Deatrick, Janet A

    2013-06-01

    Health care autonomy typically occurs during late adolescence but health care providers and families often expect children with chronic health conditions to master self-care earlier. Few studies have examined the development of health care autonomy as it pertains to self-care and family management. This review links the 3 concepts and discusses the implications for families and health care providers. Case studies are provided as exemplars to highlight areas where intervention and research is needed. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Becoming nursing manager in the nested and complex border of caring and management dimensions

    Directory of Open Access Journals (Sweden)

    Gabriela Marcellino de Melo Lanzoni

    2015-06-01

    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.

  11. The European initiative for quality management in lung cancer care

    DEFF Research Database (Denmark)

    Blum, Torsten G; Rich, Anna; Baldwin, David

    2014-01-01

    . 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 wide...... countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe....

  12. Service Line Management: A New Paradigm in Health Care System

    Directory of Open Access Journals (Sweden)

    Rafat Rezapour Nasrabad

    2016-12-01

    Full Text Available Health care organizations are required to implement modern management practices and approaches due to the importance of improving quality and increasing efficiency of health care services. Service line management of healthcare services is one of the new approaches that managers of health sectors are interested in. The “service line” approach will organize the management of inpatient and outpatient in clinical services focusing on patient diagnostic clusters. Services specific in each patient diagnostic cluster will be offered by a multidisciplinary team including nurses, physicians, and so no. Accordingly, the present study aims to evaluate the features, process and benefits of service line management approach in the provision of health services. In this descriptive study, internal and external scientific database have been reviewed and the necessary data have been extracted from the latest research projects and related scientific documents. The results showed that the new management approach is based on a paradigm shift from traditional health care system management to healthcare service line management with a focus on managers’ competencies. Four specific manager’s competencies in this new management model are: conceptual, collaborative, interpersonal, and leadership competencies. Theses competencies should be developed in health system managers so as to lead to organizational excellency and improvement of health service quality. The health sector managers should strengthen these four key competencies and act on them. Then they will become effective leaders and managers in the health system.

  13. Business ethics: implications for managed care contracts.

    Science.gov (United States)

    Stahl, D A

    1997-01-01

    Business ethics is a specialized study that emphasizes how moral standards apply to organizations, policies, procedures and behavior. Moral standards must be considered to understand the implications of business ethics in subacute care.

  14. Intensive care management of severe tetanus at the university of ...

    African Journals Online (AJOL)

    Intensive care management of severe tetanus at the university of Benin teaching ... Journal Home > Vol 14, No 1 (2015) > ... Open Access DOWNLOAD FULL TEXT ... protocol in the centre, in line with evidence-based medical principles.

  15. Pain management in primary care – current perspectives | Meyer ...

    African Journals Online (AJOL)

    According to a 1998 World Health Organization Survey of 26 000 primary care ... in pain medicine and continue to follow the biomedical approach, which ... The modern paradigm of pain management has moved from this biomedical to the ...

  16. The evolution of physician-directed managed care.

    Science.gov (United States)

    Unland, J J

    1995-01-01

    The health care industry is evolving. In the near term, POs will become the state of the art in physician-directed managed care. Eventually, POs will merge into fully integrated group practices. From there, regional POs and group practices will develop their own insurance products. But because these organizations will be dominated by physicians who wish to practice medicine, rather than sell insurance, money will be made by appropriately managing risk and providing high-quality care. In time, physicians will take control and "manage" managed care, as they are the only ones--not administrators, executives, or other business people--who are in a position to fundamentally revise the way medicine is practiced.

  17. Medicaid Managed Care Penetration Rates and Expansion Enr...

    Data.gov (United States)

    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...

  18. Responding to financial pressures. The effect of managed care on hospitals' provision of charity care.

    Science.gov (United States)

    Mas, Núria

    2013-06-01

    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.

  19. Disabling health care? Medicaid managed care and people with disabilities in America

    DEFF Research Database (Denmark)

    Hiranandani, Vanmala Sunder

    2011-01-01

    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...... business principles. Most states have insufficient experience in developing managed care plans for Medicaid beneficiaries with disabilities. Middle-aged adults with physical disabilities present their own constellation of health care issues that is not readily appreciated in health and social services....... The purpose of the study was to understand their experiences in accessing physical health care services and to ascertain the effects of managed care on their health and well-being. This study found beneficiaries encounter numerous barriers in accessing preventative, treatment, and acute care services. Overall...

  20. Indonesian heath care and the economic crisis: is managed care the needed reform?

    Science.gov (United States)

    Hotchkiss, D R; Jacobalis, S

    1999-03-01

    The ramifications of the current economic crisis are being felt throughout Asia, but problems are particularly acute in Indonesia; in the midst of high inflation and unemployment the government is considering expanding managed care reform. In this paper, we discuss the impact of the recent economic crisis on the health sector in Indonesia, and analyze the potential for implementing effective reform following the managed care model. The health sector is discussed, highlighting pre-existing problems in the health care supply environment. The determinants of the economic crisis are summarized, and the broad impacts of the crisis to date on the health sector are assessed. Next the prospects for success of current managed-care reform proposals are examined in some detail: viability of expanded managed care reform measures are assessed in light of the continuing crisis and its likely impacts on the consumers and suppliers of health care. Analysis of the potential impact of the continuing crisis focuses on key participants in health care reform: households, the government, and private health care providers. In conclusion the potential viability of managed care appears poor, given the current economic, political, and institutional conditions and likely future impacts, and suggest some alternative reform measures.

  1. Human resource management in patient-centered pharmaceutical care.

    Science.gov (United States)

    White, S J

    1994-04-01

    Patient-centered care may have the pharmacists and technicians reporting either directly or in a matrix to other than pharmacy administration. The pharmacy administrative people will need to be both effective leaders and managers utilizing excellent human resource management skills. Significant creativity and innovation will be needed for transition from departmental-based services to patient care team services. Changes in the traditional methods of recruiting, interviewing, hiring, training, developing, inspiring, evaluating, and disciplining are required in this new environment.

  2. A survey of managed care strategies for pregnant smokers

    OpenAIRE

    Barker, D.; Robinson, L.; Rosenthal, A.

    2000-01-01

    OBJECTIVE—The purpose of this study was to measure the content and comprehensiveness of pregnancy specific smoking cessation strategies within managed care organisations (MCOs) responding affirmatively to the national 1997-98 Addressing Tobacco in Managed Care (ATMC) survey.
DESIGN—This cross sectional follow up study consisted of a fax survey sent to medical directors and a 37 question telephone survey of program overseers about the smoking cessation strategy.
SUBJECTS—147 MCOs identifying a...

  3. Managed Care, Distance Traveled, and Hospital Market Definition

    OpenAIRE

    Frech, Ted E

    1998-01-01

    Most scholars and antitrust cases have defined hospital service markets as primarily local. But, two recent decisions have greatly expanded geographic markets, incorporating hospitals as far as 100 miles apart. Managed care plans, now important in most markets, were believed to shift patients to distant hospitals to capture lower prices. We examine distance traveled and its connection to managed care penetration. In contrast to earlier literature, we examine both direct and indirect effects. ...

  4. Nurse management skills required at an emergency care unit

    OpenAIRE

    Montezeli, Juliana Helena; Peres, Aida Maris; Bernardino, Elizabeth

    2013-01-01

    Objective: To identify the management skills needed for this professional at an emergency care unit. Method: An exploratory descriptive qualitative study conducted with eight nurses in which semi-structured interviews with nonparticipating systematic observation were conducted; the data was processed by content analysis. Results: The categories which emerged from the content analysis served as a list of management skills necessary to their work at the emergency care unit: leadership, decision...

  5. Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care.

    Science.gov (United States)

    Holtrop, Jodi Summers; Luo, Zhehui; Piatt, Gretchen; Green, Lee A; Chen, Qiaoling; Piette, John

    2017-10-01

    To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight. Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%). These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.

  6. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers

    Science.gov (United States)

    Roberts, James R.; McCurdy, Leyla Erk

    2005-01-01

    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…

  7. Kangaroo Mother Care Management of a 750 Ggrammes Baby: A ...

    African Journals Online (AJOL)

    This paper presents the successful management of 750 grammes low birth weight baby using kangaroo mother care in the hospital and at home. The baby had suffered a variety of morbidities associated with prematurity in the early neonatal period. Key words: Kangaroo mother care, low birth weight babies ...

  8. Medicine management in municipal home care : delegating, administrating and receiving

    OpenAIRE

    Gransjön Craftman, Åsa

    2015-01-01

    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...

  9. Manager traits and quality-of-care performance in hospitals.

    Science.gov (United States)

    Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke

    2015-07-06

    This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.

  10. Care management: agreement between nursing prescriptions and patients' care needs.

    Science.gov (United States)

    Faeda, Marília Silveira; Perroca, Márcia Galan

    2016-08-08

    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. 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. 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. 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. analisar a concordância entre prescrições de enfermagem, registradas nos prontuários, e as necessidades de cuidados dos pacientes; investigar a correlação entre o perfil profissional dos enfermeiros e a concordância das prescrições. estudo descritivo com abordagem quantitativa e documental, realizado em unidades de clínica médica, cirúrgica e especializada de um hospital de ensino, no interior do Estado de São Paulo. Foi aplicada a nova versão validada do Instrumento de Classificação de Pacientes e, posteriormente, investigadas 380 prescrições de enfermagem no momento da admissão e alta hospitalar. foi identificado que 75% dos itens das prescrições de enfermagem estavam compatíveis com as necessidades cuidativas dos pacientes. Encontrou-se baixa correlação entre a concordância da prescrição de enfermagem e o perfil profissional. as prescrições de enfermagem não estão sendo realizadas, em sua totalidade, em consonância com as necessidades dos pacientes. Para

  11. Health care waste management practice in a hospital.

    Science.gov (United States)

    Paudel, R; Pradhan, B

    2010-10-01

    Health-care waste is a by-product of health care. Its poor management exposes health-care workers, waste handlers and the community to infections, toxic effects and injuries including damage of the environment. It also creates opportunities for the collection of disposable medical equipment, its re-sale and potential re-use without sterilization, which causes an important burden of disease worldwide. The purpose of this study was to find out health care waste management practice in hospital. A cross-sectional study was conducted in Narayani Sub-Regional Hospital, Birgunj from May to October 2006 using both qualitative and quantitative methods. Study population was four different departments of the hospital (Medical/Paediatric, Surgical/Ortho, Gynae/Obstetric and Emergency), Medical Superintendent, In-charges of four different departments and all sweepers. Data was collected using interview, group discussion, observation and measurement by weight and volume. Total health-care waste generated was 128.4 kg per day while 0.8 kg per patient per day. The composition of health care waste was found to be 96.8 kg (75.4%) general waste, 24.1 kg (8.8%) hazardous waste and 7.5 kg (5.8%) sharps per day by weight. Health staffs and sweepers were not practicing the waste segregation. Occupational health and safety was not given due attention. Majority of the sweepers were unaware of waste management and need of safety measures to protect their own health. Health care waste management practice in the hospital was unsatisfactory because of the lack of waste management plan and carelessness of patients, visitors and staffs. Therefore the hospital should develop the waste management plan and strictly follow the National Health Care Waste Management Guideline.

  12. Which kind of knowledge is suitable for redesigning hospital logistic processes?

    NARCIS (Netherlands)

    Maruster, L; Jorna, RJ; Miksch, S; Hunter, J; Keravnou, E

    2005-01-01

    A knowledge management perspective is rarely used to model a process. Using the cognitive perspective on knowledge management in which we start our analysis with events and knowledge (bottom-up) instead of with processes and units (top-down), we propose a new approach for redesigning hospital

  13. Supporting the full BPM life-cycle using process mining and intelligent redesign

    NARCIS (Netherlands)

    Netjes, M.; Reijers, H.A.; Aalst, van der W.M.P.; Siau, K.

    2007-01-01

    Abstract. Business Process Management (BPM) systems provide a broad range of facilities to enact and manage operational business processes. Ideally, these systems should provide support for the complete BPM life-cycle: (re)design, configuration, execution, control, and diagnosis by the FileNet P8

  14. Development of a Patient Charting System to Teach Family Practice Residents Disease Management and Preventive Care

    National Research Council Canada - National Science Library

    Dickerman, Joel

    1997-01-01

    .... Designing notes which 'prompt' residents to gather patient information vital to optimal care can teach residents the concepts of longitudinal care, particularly chronic disease management and preventive care...

  15. Managing social awkwardness when caring for morbidly obese patients in intensive care: A focused ethnography.

    Science.gov (United States)

    Hales, Caz; de Vries, Kay; Coombs, Maureen

    2016-06-01

    Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges in the intensive care setting. These are resultant from specific physiological responses to critical illness in this population and the nature of the interventional therapies used in the intensive care environment. An additional challenge arises for this population when considering the social stigma that is attached to being obese. Intensive care staff therefore not only attend to the physical and care needs of the critically ill morbidly obese patient but also navigate, both personally and professionally, the social terrain of stigma when providing care. To explore the culture and influences on doctors and nurses within the intensive care setting when caring for critically ill morbidly obese patients. A focused ethnographic approach was adopted to elicit the 'situated' experiences of caring for critically ill morbidly obese patients from the perspectives of intensive care staff. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. Analysis was conducted using constant comparison technique to compare incidents applicable to each theme. An 18 bedded tertiary intensive care unit in New Zealand. Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40kg/m(2). Interactions between intensive care staff and morbidly obese patients were challenging due to the social stigma surrounding obesity. Social awkwardness and managing socially awkward moments were evident when caring for morbidly obese patients. Intensive care staff used strategies of face-work and mutual pretence to alleviate feelings of discomfort when engaged in aspects of care and caring. This was a strategy used to prevent embarrassment and distress for both the patients and staff. This study has brought new understandings

  16. Application of participatory ergonomics to the redesign of the family-centred rounds process.

    Science.gov (United States)

    Xie, Anping; Carayon, Pascale; Cox, Elizabeth D; Cartmill, Randi; Li, Yaqiong; Wetterneck, Tosha B; Kelly, Michelle M

    2015-01-01

    Participatory ergonomics (PE) can promote the application of human factors and ergonomics (HFE) principles to healthcare system redesign. This study applied a PE approach to redesigning the family-centred rounds (FCR) process to improve family engagement. Various FCR stakeholders (e.g. patients and families, physicians, nurses, hospital management) were involved in different stages of the PE process. HFE principles were integrated in both the content (e.g. shared mental model, usability, workload consideration, systems approach) and process (e.g. top management commitment, stakeholder participation, communication and feedback, learning and training, project management) of FCR redesign. We describe activities of the PE process (e.g. formation and meetings of the redesign team, data collection activities, intervention development, intervention implementation) and present data on PE process evaluation. To demonstrate the value of PE-based FCR redesign, future research should document its impact on FCR process measures (e.g. family engagement, round efficiency) and patient outcome measures (e.g. patient satisfaction).

  17. Application of participatory ergonomics to the redesign of the family-centered rounds process

    Science.gov (United States)

    Xie, Anping; Carayon, Pascale; Cox, Elizabeth D.; Cartmill, Randi; Li, Yaqiong; Wetterneck, Tosha B.; Kelly, Michelle M.

    2015-01-01

    Participatory ergonomics (PE) can promote the application of human factors and ergonomics (HFE) principles to healthcare system redesign. This study applied a PE approach to redesigning the family-centered rounds (FCR) process to improve family engagement. Various FCR stakeholders (e.g., patients and families, physicians, nurses, hospital management) were involved in different stages of the PE process. HFE principles were integrated in both the content (e.g., shared mental model, usability, workload consideration, systems approach) and process (e.g., top management commitment, stakeholder participation, communication and feedback, learning and training, project management) of FCR redesign. We describe activities of the PE process (e.g., formation and meetings of the redesign team, data collection activities, intervention development, intervention implementation) and present data on PE process evaluation. To demonstrate the value of PE-based FCR redesign, future research should document its impact on FCR process measures (e.g., family engagement, round efficiency) and patient outcome measures (e.g., patient satisfaction). PMID:25777042

  18. Emotion management in children′s palliative care nursing

    Directory of Open Access Journals (Sweden)

    Eryl Zac Maunder

    2008-01-01

    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.

  19. Care for the case manager: balancing your wheel of life.

    Science.gov (United States)

    Crowell, D M

    1998-01-01

    The case manager's role in our complex health care system is demanding and draining without some self-reflective attention. The Wheel of Life is a key tool for individuals to assess how well they are leading a fully balanced life. The eight aspects of a balanced life--values, self-care, work, relationships, leisure, relaxation, exercise, and centering--are explained and discussed. A self-reflective activity is presented that encourages readers to assess their current life balance. This focused clarification of personal and professional life will facilitate a more fully balanced life with rewards for case managers as individuals, and for their family, clients, and the health care organization.

  20. Pediatric wound care and management in the emergency department [digest].

    Science.gov (United States)

    Sanders, Jennifer E; Pade, Kathryn H

    2017-10-23

    Traumatic wounds and lacerations are common pediatric presenting complaints to emergency departments. Although there is a large body of literature on wound care, many emergency clinicians base management of wounds on theories and techniques that have been passed down over time. Therefore, controversial, conflicting, and unfounded recommendations are prevalent. This issue reviews evidence-based recommendations for wound care and management, including wound cleansing and irrigation, anxiolysis/sedation techniques, closure methods, and post-repair wound care. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  1. Intensive Care Management of Myasthenia Gravis After Thymectomy ...

    African Journals Online (AJOL)

    Aim:To evaluate the management of post thymectomy myasthenia gravis (MG) patient in our centre; to highlight those aspects of patient care that could improve outcome and to serve as a bench mark for developing a standardized protocol for management. Method: A retrospective study of 5 cases of post thymectomy MG ...

  2. Audit Trail Management System in Community Health Care Information Network.

    Science.gov (United States)

    Nakamura, Naoki; Nakayama, Masaharu; Nakaya, Jun; Tominaga, Teiji; Suganuma, Takuo; Shiratori, Norio

    2015-01-01

    After the Great East Japan Earthquake we constructed a community health care information network system. Focusing on the authentication server and portal server capable of SAML&ID-WSF, we proposed an audit trail management system to look over audit events in a comprehensive manner. Through implementation and experimentation, we verified the effectiveness of our proposed audit trail management system.

  3. Primary care management of food allergy and food intolerance.

    Science.gov (United States)

    Garzon, Dawn Lee; Kempker, Tara; Piel, Pamela

    2011-12-16

    The incidence of food allergies is steadily increasing. Due to potentially life-threatening complications, it is important that primary care providers recognize and appropriately manage these disorders. This article includes a discussion of the current evidence-based guidelines for the diagnosis, screening, and management of food allergies.

  4. Consumer Protection in Managed Care: A Third-Generation Approach.

    Science.gov (United States)

    Rother, John

    1996-01-01

    Discusses three generations of consumer protection issues related to managed care: (1) individual treatment decisions--individuals wanting treatment their plan does not cover or deems unnecessary; (2) insurance practices and risk selection--impact of health management organizations on the rest of the health insurance system; and (3) health plan…

  5. Systems for the management of respiratory disease in primary care - an international series: Australia.

    Science.gov (United States)

    Glasgow, Nicholas

    2008-03-01

    Australia has a complex health system with policy and funding responsibilities divided across federal and state/territory boundaries and service provision split between public and private providers. General practice is largely funded through the federal government. Other primary health care services are provided by state/territory public entities and private allied health practitioners. Indigenous health services are specifically funded by the federal government through a series of Aboriginal Community Controlled Organisations. NATIONAL POLICY AND MODELS: The dominant primary health care model is federally-funded private "small business" general practices. Medicare reimbursement items have incrementally changed over the last decade to include increasing support for chronic disease care with both generic and disease specific items as incentives. Asthma has received a large amount of national policy attention. Other respiratory diseases have not had similar policy emphasis. Australia has a high prevalence of asthma. Respiratory-related encounters in general practice, including acute and chronic respiratory illness and influenza immunisations, account for 20.6% of general practice activity. Lung cancer is a rare disease in general practice. Tuberculosis is uncommon and most often found in people born outside of Australia. Aboriginal and Torres Strait Islanders have higher rates of asthma, smoking and tuberculosis. Access to care is positively influenced by substantial public funding underpinning both the private and public sectors through Medicare. Access to general practice care is negatively influenced by workforce shortages, the ongoing demands of acute care, and the incremental way in which system redesign is occurring in general practice. Most general practice operates from privately-owned rooms. The Australian Government requires general practice facilities to be accredited against certain standards in order for the practice to receive income from a number of

  6. Managing the overflow of intensive care patients

    NARCIS (Netherlands)

    van Rijsbergen, M.; Boucherie, Richardus J.; van Houdenhoven, M.; Litvak, Nelli

    2005-01-01

    Many hospitals in the Netherlands are confronted with capacity problems at their Intensive Care Units (ICUs) resulting in cancelling operations, overloading the staff with extra patients, or rejecting emergency patients. In practice, the last option is a common choice because juridically, as well as

  7. Nurses improve migraine management in primary care

    NARCIS (Netherlands)

    Veenstra, Petra; Kollen, Boudewijn J.; de Jong, Gosse; Baarveld, Frans; van den Berg, J. S. Peter

    Introduction Migraine is a common disorder with a high burden. Adequate treatment results in improvement of quality of life. Migraine patients are mainly treated by general practitioners (GPs), but there is still room for improvement. This study investigated whether primary care nurses could improve

  8. Managing stress in a palliative care team.

    Science.gov (United States)

    Gupta, Vineeta; Woodman, Clare

    2010-12-01

    This article describes a strategy to reduce the high levels of stress experienced by community nurses in a children's palliative care team. The development, use and effectiveness of a problem-solving team intervention are illustrated by direct quotations from the nurses themselves.

  9. Investigation of health care waste management in Binzhou District, China

    International Nuclear Information System (INIS)

    Ruoyan, Gai; Xu Lingzhong; Li Huijuan; Zhou Chengchao; He Jiangjiang; Yoshihisa, Shirayama; Tang Wei; Chushi, Kuroiwa

    2010-01-01

    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.

  10. Optimizing cardiothoracic surgery information for a managed care environment.

    Science.gov (United States)

    Denton, T A; Matloff, J M

    1995-11-01

    The rapid change occurring in American healthcare is a direct response to rising costs. Managed care is the fastest growing model that attempts to control escalating costs through limitations in patient choice, the active use of guidelines, and placing providers at risk. Managed care is an information intensive system, and those providers who use information effectively will be at an advantage in the competitive healthcare marketplace. There are five classes of information that providers must collect to be competitive in a managed care environment: patient satisfaction, medical outcomes, continuous quality improvement, quality of the decision, and financial data. Each of these should be actively used in marketing, assuring the quality of patient care, and maintaining financial stability. Although changes in our healthcare system are occurring rapidly, we need to respond to the marketplace to maintain our viability, but as physicians, we have the singular obligation to maintain the supremacy of the individual patient and the physician-patient relationship.

  11. Guidelines for Management Information Systems in Canadian Health Care Facilities

    Science.gov (United States)

    Thompson, Larry E.

    1987-01-01

    The MIS Guidelines are a comprehensive set of standards for health care facilities for the recording of staffing, financial, workload, patient care and other management information. The Guidelines enable health care facilities to develop management information systems which identify resources, costs and products to more effectively forecast and control costs and utilize resources to their maximum potential as well as provide improved comparability of operations. The MIS Guidelines were produced by the Management Information Systems (MIS) Project, a cooperative effort of the federal and provincial governments, provincial hospital/health associations, under the authority of the Canadian Federal/Provincial Advisory Committee on Institutional and Medical Services. The Guidelines are currently being implemented on a “test” basis in ten health care facilities across Canada and portions integrated in government reporting as finalized.

  12. [Access to prenatal care and quality of care in the Family Health Strategy: infrastructure, care, and management].

    Science.gov (United States)

    Guimarães, Wilderi Sidney Gonçalves; Parente, Rosana Cristina Pereira; Guimarães, Thayanne Louzada Ferreira; Garnelo, Luiza

    2018-05-10

    This study focuses on access to prenatal care and quality of care in the Family Health Strategy in Brazil as a whole and in the North region, through evaluation of infrastructure characteristics in the health units, management, and supply of care provided by the teams, from the perspective of regional and state inequalities. A cross-sectional evaluative and normative study was performed, drawing on the external evaluation component of the second round of the Program for Improvement of Access and Quality of Primary Care, in 2013-2014. The results revealed the inadequacy of the primary healthcare network's infrastructure for prenatal care, low adequacy of clinical actions for quality of care, and the teams' low management capacity to guarantee access and quality of care. In the distribution according to geopolitical regions, the findings pertaining to the units' infrastructure indicate a direct relationship between the infrastructure's adequacy and social contexts with higher municipal human development indices and income. For the clinical actions in patient care, the teams in all the regions scored low on adequacy, with slightly better results in the North and South regions of the country. There were important differences between the states of the North, and the states with higher mean income and human development scored higher on adequacy. The results indicate important organizational difficulties in both access and quality of care provided by the health teams, in addition to visible insufficiency in management activities aimed to improve access and quality of prenatal care.

  13. The Expanding Role of Managed Care in the Medicaid Program

    Science.gov (United States)

    Caswell, Kyle J.; Long, Sharon K.

    2015-01-01

    States increasingly use managed care for Medicaid enrollees, yet evidence of its impact on health care outcomes is mixed. This research studies county-level Medicaid managed care (MMC) penetration and health care outcomes among nonelderly disabled and nondisabled enrollees. Results for nondisabled adults show that increased penetration is associated with increased probability of an emergency department visit, difficulty seeing a specialist, and unmet need for prescription drugs, and is not associated with reduced expenditures. We find no association between penetration and health care outcomes for disabled adults. This suggests that the primary gains from MMC may be administrative simplicity and budget predictability for states rather than reduced expenditures or improved access for individuals. PMID:25882616

  14. Government Health Care Contract Incentives: Making Managed Health Care Work in Federal Government Procurements

    National Research Council Canada - National Science Library

    Teskey, Mark S

    1999-01-01

    Contracting for managed health care systems is a complex undertaking. The current TRICARE contracts captured all the important parts of the system and ensured detailed compliance with the many system requirements...

  15. Nutrition services in managed care: new paradigms for dietitians.

    Science.gov (United States)

    Laramee, S H

    1996-04-01

    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.

  16. A guide to wound managment in palliative care.

    Science.gov (United States)

    Naylor, Wayne A

    2005-11-01

    Wound management in palliative patients is often a very challenging area of care. There are many unique issues that can combine to produce complicated wound management scenarios, including the types of wounds and wound symptoms most commonly affecting palliative care patients, as well as the presence of concurrent disease and associated treatment. Problems exist with the availability of suitable dressings and balancing life expectancy with the goals of wound care. A significant, and possibly under-recognized, issue is the emotional and social distress experienced by these patients, which can be directly attributed to their wound. These problems must all be recognized and addressed in order to manage wounds effectively in this patient population. This article aims to explore these issues and offer advice on the management of wound-related symptoms, with the ultimate goal of improving patients' quality of life.

  17. Using matrix organization to manage health care delivery organizations.

    Science.gov (United States)

    Allcorn, S

    1990-01-01

    Matrix organization can provide health care organization managers enhanced information processing, faster response times, and more flexibility to cope with greater organization complexity and rapidly changing operating environments. A review of the literature informed by work experience reveals that the use of matrix organization creates hard-to-manage ambiguity and balances of power in addition to providing positive benefits for health care organization managers. Solutions to matrix operating problems generally rely on the use of superior information and decision support systems and extensive staff training to develop attitudes and behavior consistent with the more collegial matrix organization culture. Further improvement in understanding the suitability of matrix organization for managing health care delivery organizations will involve appreciating the impact of partial implementation of matrix organization, temporary versus permanent uses of matrix organization, and the impact of the ambiguity created by dual lines of authority upon the exercise of power and authority.

  18. Referral determinants in Swiss primary care with a special focus on managed care.

    Directory of Open Access Journals (Sweden)

    Ryan Tandjung

    Full Text Available Studies have shown large variation of referral probabilities in different countries, and many influencing factors have been described. This variation is most likely explained by different healthcare systems, particularly to which extent primary care physicians (PCPs act as gatekeepers. In Switzerland no mandatory gatekeeping system exists, however insurance companies offer voluntary managed care plans with reduced insurance premiums. We aimed at investigating the role of managed care plans as a potential referral determinant in a non-gatekeeping healthcare system. We conducted a cross-sectional study with 90 PCPs collecting data on consultations and referrals in 2012/2013. During each consultation up to six reasons for encounters (RFE were documented. For each RFE PCPs indicated whether a referral was initiated. Determinants for referrals were analyzed by hierarchical logistic regression, taking the potential cluster effect of the PCP into account. To further investigate the independent association of the managed care plan with the referral probability, a hierarchical multivariate logistic regression model was applied, taking into account all available data potentially affecting the referring decision. PCPs collected data on 24'774 patients with 42'890 RFE, of which 2427 led to a referral. 37.5% of patients were insured in managed health care plans. Univariate analysis showed significant higher referral rates of patients with managed care plans (10.7% vs. 8.5%. The difference in referral probability remained significant after controlling for other confounders in the hierarchical multivariate regression model (OR 1.355. Patients in managed care plans were more likely to be referred than patients without such a model. These data contradict the argument that patients in managed care plans have limited healthcare access, but underline the central role of PCPs as coordinator of care.

  19. Will your academic department survive managed care?

    Science.gov (United States)

    Feinstein, L; Temmerman, J

    1996-12-01

    The current form of academic department is likely to vanish from many institutions. Changes occurring in health care are part of the evolution other industries have experienced, following the product life cycle. Physicians are becoming "deprofessionalized" and as such are beginning to resemble technical workers seen in other industries. The rearrangements in health care are bringing together organizations with different missions, priorities, culture and even language. An academic department may not be considered as an asset to the larger organization or network, representing but one option for product differentiation in the market place. There are strategies for maintaining the viability of the academic component of an organization that necessitate congruence with the overall strategy for the greater organization.

  20. Health care units and human resources management trends.

    Science.gov (United States)

    André, Adriana Maria; Ciampone, Maria Helena Trench; Santelle, Odete

    2013-02-01

    To identify factors producing new trends in basic health care unit management and changes in management models. This was a prospective study with ten health care unit managers and ten specialists in the field of Health in São Paulo, Southeastern Brazil, in 2010. The Delphi methodology was adopted. There were four stages of data collection, three quantitative and the fourth qualitative. The first three rounds dealt with changing trends in management models, manager profiles and required competencies, and the Mann-Whitney test was used in the analysis. The fourth round took the form of a panel of those involved, using thematic analysis. The main factors which are driving change in basic health care units were identified, as were changes in management models. There was consensus that this process is influenced by the difficulties in managing teams and by politics. The managers were found to be up-to-date with trends in the wider context, with the arrival of social health organizations, but they are not yet anticipating these within the institutions. Not only the content, but the professional development aspect of training courses in this area should be reviewed. Selection and recruitment, training and assessment of these professionals should be guided by these competencies aligned to the health service mission, vision, values and management models.

  1. An Application of Business Process Management to Health Care Facilities.

    Science.gov (United States)

    Hassan, Mohsen M D

    The purpose of this article is to help health care facility managers and personnel identify significant elements of their facilities to address, and steps and actions to follow, when applying business process management to them. The ABPMP (Association of Business Process Management Professionals) life-cycle model of business process management is adopted, and steps from Lean, business process reengineering, and Six Sigma, and actions from operations management are presented to implement it. Managers of health care facilities can find in business process management a more comprehensive approach to improving their facilities than Lean, Six Sigma, business process reengineering, and ad hoc approaches that does not conflict with them because many of their elements can be included under its umbrella. Furthermore, the suggested application of business process management can guide and relieve them from selecting among these approaches, as well as provide them with specific steps and actions that they can follow. This article fills a gap in the literature by presenting a much needed comprehensive application of business process management to health care facilities that has specific steps and actions for implementation.

  2. Dementia Care: Confronting Myths in Clinical Management.

    Science.gov (United States)

    Neitch, Shirley M; Meadows, Charles; Patton-Tackett, Eva; Yingling, Kevin W

    2016-01-01

    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.

  3. Nursing management and organizational ethics in the intensive care unit.

    Science.gov (United States)

    Wlody, Ginger Schafer

    2007-02-01

    This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.

  4. Nonprice competition and quality of care in managed care: the New York SCHIP market.

    Science.gov (United States)

    Liu, Hangsheng; Phelps, Charles E

    2008-06-01

    To examine the effect of nonprice competition among managed care plans on the quality of care in the New York SCHIP market. U.S. Census 2000; 2002 New York State Managed Care Plan Performance Report; and 2001 New York State Managed Care Annual Enrollment Report. Each market is defined as a county, and competition is measured as the number of plans in a market. Quality of care is measured in percentages using three Consumer Assessment of Health Plans Survey and three Health Plan Employer Data and Information Set scores. Two-stage least squares is applied to address the endogeneity between competition and the quality of care, using population as an instrument. We find a negative association between competition and quality of care. An additional managed care plan is significantly associated with a decrease of 0.40-2.31 percentage points in four out of six quality measures. After adjusting for production cost, a positive correlation is observed between price and quality measures across different pricing regions. It seems likely that pricing policy is a constraint on quality production, although it may not be interpreted as a causal relationship and further study is needed.

  5. Strategies to address management challenges in larger intensive care units.

    Science.gov (United States)

    Matlakala, M C; Bezuidenhout, M C; Botha, A D H

    2015-10-01

    To illustrate the need for and suggest strategies that will enhance sustainable management of a large intensive care unit (ICU). The challenges faced by intensive care nursing in South Africa are well documented. However, there appear to be no strategies available to assist nurses to manage large ICUs or for ICU managers to deal with problems as they arise. Data sources to illustrate the need for strategies were challenges described by ICU managers in the management of large ICUs. A purposive sample of managers was included in individual interviews during compilation of evidence regarding the challenges experienced in the management of large ICUs. The challenges were presented at the Critical Care Society of Southern Africa Congress held on 28 August to 2 September 2012 in Sun City North-West province, South Africa. Five strategies are suggested for the challenges identified: divide the units into sections; develop a highly skilled and effective nursing workforce to ensure delivery of quality nursing care; create a culture to retain an effective ICU nursing team; manage assets; and determine the needs of ICU nurses. ICUs need measures to drive the desired strategies into actions to continuously improve the management of the unit. Future research should be aimed at investigating the effectiveness of the strategies identified. This research highlights issues relating to large ICUs and the strategies will assist ICU managers to deal with problems related to large unit sizes, shortage of trained ICU nurses, use of agency nurses, shortage of equipment and supplies and stressors in the ICU. The article will make a contribution to the body of nursing literature on management of ICUs. © 2014 John Wiley & Sons Ltd.

  6. Care management at Ikata Power Station

    International Nuclear Information System (INIS)

    Sakai, Koji

    1982-01-01

    For operating nuclear power stations safely and economically, it is necessary to control nuclear fuel itself and reactor cores. Nuclear fuel must be controlled consistently in view of quantitative balance and operational method over the whole nuclear fuel cycle of uranium ore, fabrication, burning in reactors and reprocessing, based on the plan of using fuel in electric power companies. The control of the burning in reactors is called core management, and it is important because the users of fuel execute it. For dealing with such core management works, Shikoku Electric Power Co., Inc., has developed the computer code system for grasping the state of fuel exchange and the burning condition in reactors and used it since 1972. The outline of the core management in Ikata Power Station is reported in this paper centering around computing works. The core management works are divided into those at the time of regular inspection and those in operation. In the regular inspection, fuel inspection, fuel exchange and reactor physics test are performed. In operation, the burning condition of fuel is grasped. The technical computations corresponding to these works are explained, and the examples of computations are shown. (Kako, I.)

  7. Association Between Health Plan Exit From Medicaid Managed Care and Quality of Care, 2006-2014.

    Science.gov (United States)

    Ndumele, Chima D; Schpero, William L; Schlesinger, Mark J; Trivedi, Amal N

    2017-06-27

    State Medicaid programs have increasingly contracted with insurers to provide medical care services for enrollees (Medicaid managed care plans). Insurers that provide these plans can exit Medicaid programs each year, with unclear effects on quality of care and health care experiences. To determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. Retrospective cohort of all comprehensive Medicaid managed care plans (N = 390) during the interval 2006-2014. Plan exit, defined as the withdrawal of a managed care plan from a state's Medicaid program. Eight measures from the Healthcare Effectiveness Data and Information Set were used to construct 3 composite indicators of quality (preventive care, chronic disease care management, and maternity care). Four measures from the Consumer Assessment of Healthcare Providers and Systems were combined into a composite indicator of patient experience, reflecting the proportion of beneficiaries rating experiences as 8 or above on a 0-to-10-point scale. Outcome data were available for 248 plans (68% of plans operating prior to 2014, representing 78% of beneficiaries). Of the 366 comprehensive Medicaid managed care plans operating prior to 2014, 106 exited Medicaid. These exiting plans enrolled 4 848 310 Medicaid beneficiaries, with a mean of 606 039 beneficiaries affected by plan exits annually. Six states had a mean of greater than 10% of Medicaid managed care recipients enrolled in plans that exited, whereas 10 states experienced no plan exits. Plans that exited from a state's Medicaid market performed significantly worse prior to exiting than those that remained in terms of preventive care (57.5% vs 60.4%; difference, 2.9% [95% CI, 0.3% to 5.5%]), maternity care (69.7% vs 73.6%; difference, 3.8% [95% CI, 1.7% to 6.0%]), and patient experience (73.5% vs 74.8%; difference, 1.3% [95% CI, 0.6% to 1

  8. Medicare managed care. How physicians can make it better.

    Science.gov (United States)

    Roggin, G M

    1997-12-01

    The federal government is attempting to control anticipated, increased Medicare health care costs by providing the senior population with incentives to encourage their movement into managed care programs. For-profit corporate HMOs that currently dominate the managed care arena are coming under increased competitive pressure at a time when their perception of profiteering is undergoing increased public scrutiny. If physicians are to take advantage of this window of opportunity and successfully enter the Medicare managed care marketplace, they must identify the major deficiencies existing in the current model, and fashion a new product that divests itself of the profit orientation of current corporate HMOs. A nonprofit version of a highly integrated, multispecialty provider service organization (PSO) provides an appropriate model to effectively compete with the corporate HMO. The ideal physician-controlled managed care model must: develop a responsive policy board structure; create practice guidelines that decrease variation in physician practice; achieve an appropriate balance between primary and specialty medical care; and adopt a quality-assurance program that effectively addresses both process and outcome data.

  9. Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention

    Directory of Open Access Journals (Sweden)

    Natalie A. DiPietro

    2014-01-01

    Full Text Available As medication therapy management (MTM continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.   Type: Idea Paper

  10. Using management information systems to enhance health care quality assurance.

    Science.gov (United States)

    Rosser, L H; Kleiner, B H

    1995-01-01

    Examines how computers and quality assurance are being used to improve the quality of health care delivery. Traditional quality assurance methods have been limited in their ability to effectively manage the high volume of data generated by the health care process. Computers on the other hand are able to handle large volumes of data as well as monitor patient care activities in both the acute care and ambulatory care settings. Discusses the use of computers to collect and analyse patient data so that changes and problems can be identified. In addition, computer models for reminding physicians to order appropriate preventive health measures for their patients are presented. Concludes that the use of computers to augment quality improvement is essential if the quality of patient care and health promotion are to be improved.

  11. Impact of managed care on cancer trial enrollment.

    Science.gov (United States)

    Gross, C P; Krumholz, H M

    2005-06-01

    To determine the relationship between managed care market activity and cancer trial enrollment. Trial participant data were obtained from the National Cancer Institute. Participants in cooperative group trials of breast, colorectal, lung, or prostate cancer during the years 1996 through 2001 were assigned to counties based on their zip code of residence. Linear regression was used to determine the relationship between county enrollment rate and two measures of county managed care activity (penetration and index of competition [IOC]), adjusting for other county characteristics. In bivariate analysis, there was a strong inverse correlation between trial enrollment rate and IOC (r = -0.23; P penetration, proportion uninsured, and other county characteristics. Counties in the lowest quartile of managed care penetration tended to have lower enrollment rates than the remaining counties (r = -0.05; P = .048), while counties in the second, third, and fourth quartiles of penetration all had similar enrollment rates to one another. Cancer trial enrollment rates were suboptimal across all counties, and counties with higher levels of managed care competition had significantly lower enrollment rates. The relationship between managed care penetration and trial enrollment was less consistent. Future efforts to enhance trial participation should address the potential negative influence of market factors.

  12. Price elasticity and pharmaceutical selection: the influence of managed care.

    Science.gov (United States)

    Domino, Marisa Elena; Salkever, David S

    2003-07-01

    State Medicaid programs are turning increasingly to managed care to control expenditures, although the types of managed care programs in use have changed dramatically. Little is known about the influence of the shifting Medicaid managed care arena on treatment decisions. This paper investigates factors affecting the selection of treatments for depression by providers participating in either of two Medicaid managed care programs. Of particular interest is the influence of medication price on the choice of treatment, since one vehicle through which managed care organizations can reduce total expenditures is by increasing the price sensitivity of participating providers. We take a new approach by phrasing the problem as a discrete choice, using a nested multinomial logit model for the analyses. Contrary to earlier literature, we find some evidence that physicians in both programs do take price into consideration when selecting among treatment options. HMO providers in particular demonstrate increased price sensitivity in the two most commonly prescribed categories of antidepressants. Copyright 2002 John Wiley & Sons, Ltd.

  13. Spiritual beliefs and barriers among managed care practitioners.

    Science.gov (United States)

    McCauley, Jeanne; Jenckes, Mollie W; Tarpley, Margaret J; Koenig, Harold G; Yanek, Lisa R; Becker, Diane M

    2005-01-01

    Ninety percent of American adults believe in God and 82% pray weekly. A majority wants their physicians to address spirituality during their health care visit. However, clinicians incorporate spiritual discussion in less than 20% of visits. Our objectives were to measure clinician beliefs and identify perceived barriers to integrating spirituality into patient care in a statewide, primary care, managed care group. Practitioners completed a 30-item survey including demographics and religious involvement (DUREL), spirituality in patient care (SPC), and barriers (BAR). We analyzed data using frequencies, means, standard deviations, and ANOVA. Clinicians had a range of religious denominations (67% Christian, 14% Jewish, 11% Muslim, Hindu or Buddhist, 8% agnostic), were 57% female and 24% had training in spirituality. Sixty-six percent reported experiencing the divine. Ninety-five percent felt that a patient's spiritual outlook was important to handling health difficulties and 68% percent agreed that addressing spirituality was part of the physician's role. Ninety-five percent of our managed care group noted 'lack of time' as an important barrier, 'lack of training' was indicated by 69%, and 21% cited 'fear of response from administration'. Managed care practitioners in a time constrained setting were spiritual themselves and believed this to be important to patients. Respondents indicated barriers of time and training to implementing these beliefs. Comparing responses from our group to those in other published surveys on clinician spirituality, we find similar concerns. Clinician education may overcome these barriers and improve ability to more fully meet their patients' expressed needs regarding spirituality and beliefs.

  14. Managing mechanistic and organic structure in health care organizations.

    Science.gov (United States)

    Olden, Peter C

    2012-01-01

    Managers at all levels in a health care organization must organize work to achieve the organization's mission and goals. This requires managers to decide the organization structure, which involves dividing the work among jobs and departments and then coordinating them all toward the common purpose. Organization structure, which is reflected in an organization chart, may range on a continuum from very mechanistic to very organic. Managers must decide how mechanistic versus how organic to make the entire organization and each of its departments. To do this, managers should carefully consider 5 factors for the organization and for each individual department: external environment, goals, work production, size, and culture. Some factors may push toward more mechanistic structure, whereas others may push in the opposite direction toward more organic structure. Practical advice can help managers at all levels design appropriate structure for their departments and organization.

  15. Time based management in health care system: The chosen aspects

    Directory of Open Access Journals (Sweden)

    Joanna Kobza

    2014-08-01

    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

  16. [Time based management in health care system: the chosen aspects].

    Science.gov (United States)

    Kobza, Joanna; Syrkiewicz-Świtała, Magdalena

    2014-01-01

    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.

  17. Documentation of pain care processes does not accurately reflect pain management delivered in primary care.

    Science.gov (United States)

    Krebs, Erin E; Bair, Matthew J; Carey, Timothy S; Weinberger, Morris

    2010-03-01

    Researchers and quality improvement advocates sometimes use review of chart-documented pain care processes to assess the quality of pain management. Studies have found that primary care providers frequently fail to document pain assessment and management. To assess documentation of pain care processes in an academic primary care clinic and evaluate the validity of this documentation as a measure of pain care delivered. Prospective observational study. 237 adult patients at a university-affiliated internal medicine clinic who reported any pain in the last week. Immediately after a visit, we asked patients to report the pain treatment they received. Patients completed the Brief Pain Inventory (BPI) to assess pain severity at baseline and 1 month later. We extracted documentation of pain care processes from the medical record and used kappa statistics to assess agreement between documentation and patient report of pain treatment. Using multivariable linear regression, we modeled whether documented or patient-reported pain care predicted change in pain at 1 month. Participants' mean age was 53.7 years, 66% were female, and 74% had chronic pain. Physicians documented pain assessment for 83% of visits. Patients reported receiving pain treatment more often (67%) than was documented by physicians (54%). Agreement between documentation and patient report was moderate for receiving a new pain medication (k = 0.50) and slight for receiving pain management advice (k = 0.13). In multivariable models, documentation of new pain treatment was not associated with change in pain (p = 0.134). In contrast, patient-reported receipt of new pain treatment predicted pain improvement (p = 0.005). Chart documentation underestimated pain care delivered, compared with patient report. Documented pain care processes had no relationship with pain outcomes at 1 month, but patient report of receiving care predicted clinically significant improvement. Chart review measures may not accurately

  18. Health care managers learning by listening to subordinates' dialogue training.

    Science.gov (United States)

    Grill, C; Ahlborg, G; Wikström, E

    2014-01-01

    Middle managers in health care today are expected to continuously and efficiently decide and act in administration, finance, care quality, and work environment, and strategic communication has become paramount. Since dialogical communication is considered to promote a healthy work environment, the purpose of this paper is to investigate the ways in which health care managers experienced observing subordinates' dialogue training. A qualitative study using semi-structured interviews and documents from eight middle managers in a dialogue programme intervention conducted by dialogue trainers. Focus was on fostering and assisting workplace dialogue. Conventional qualitative content analysis was used. Managers' experiences were both enriching and demanding, and consisted of becoming aware of communication, meaning perceiving interaction between subordinates as well as own silent interaction with subordinates and trainer; Discovering communicative actions for leadership, by gaining self-knowledge and recognizing relational leadership models from trainers--such as acting democratically and pedagogically--and converting theory into practice, signifying practising dialogue-promoting conversation behaviour with subordinates, peers, and superiors. Only eight managers participated in the intervention, but data afforded a basis for further research. Findings stressed the importance of listening, and of support from superiors, for well-functioning leadership communication at work. Studies focusing on health care managers' communication and dialogue are few. This study contributes to knowledge about these activities in managerial leadership.

  19. Grid Computing BOINC Redesign Mindmap with incentive system (gamification)

    OpenAIRE

    Kitchen, Kris

    2016-01-01

    Grid Computing BOINC Redesign Mindmap with incentive system (gamification) this is a PDF viewable of https://figshare.com/articles/Grid_Computing_BOINC_Redesign_Mindmap_with_incentive_system_gamification_/1265350

  20. Functioning of primary health care in opinion of managers of primary health care units.

    Science.gov (United States)

    Bojar, I; Wdowiak, L; Kwiatosz-Muc, M

    2006-01-01

    The aim of the research is to get to know opinions of primary health care managers concerning working of primary health care and concerning quality of medical services offered by family doctors out-patient clinics. The research among managers of primary health care units took place in all out-patient clinics in Lublin province. Research instrument was survey questionnaire of authors own construction. Results were statistically analyzed. From 460 surveys sent, 108 questionnaires were accepted to analysis. Majority of managers of out-patient clinics of primary health care is satisfied with the way and the quality of work of employed staff. In opinion of 71.3% of managers access to family doctor services is very good. Availability of primary health care services is better estimated by managers of not public units. The occupied local provide comfortable work for the staff in opinion of 78.5% of surveyed managers of out-patient clinics. Managers estimate the level of their services as very good (37.96%) and good (37.96%) comparing to other such a subjects present in the market. Internal program of improving quality is run in 22% of out-patient clinics, which were investigated. Managers of primary health care units assess the quality of their services as good and very good. They estimate positively the comfort and politeness in serving patients as well as technical status of equipment and the lodging. They assess availability of their services as very good. Large group of managers of family doctors practices recognizes neighborhood practices as a competitors.

  1. The impact of managed care and current governmental policies on an urban academic health care center.

    Science.gov (United States)

    Rodriguez, J L; Peterson, D J; Muehlstedt, S G; Zera, R T; West, M A; Bubrick, M P

    2001-10-01

    Managed care and governmental policies have restructured hospital reimbursement. We examined reimbursement trends in trauma care to assess the impact of this market driven change on an urban academic health center. Patients injured between January 1997 and December 1999 were analyzed for Injury Severity Score (ISS), length of hospital stay, hospital cost, payer, and reimbursement. Between 1997 and 1999, the volume of patients with an ISS less than 9 increased and length of stay decreased. In addition, overall cost, payment, and profit margin increased. Commercially insured patients accounted for this margin increase, because the margins of managed care and government insured patients experienced double-digit decreases. Patients with ISS of 9 or greater also experienced a volume increase and a reduction in length of stay; however, costs within this group increased greater than payments, thereby reducing profit margin. Whereas commercially insured patients maintained their margin, managed care and government insured patients did not (double- and triple-digit decreases). Managed care and current governmental policies have a negative impact on urban academic health center reimbursement. Commercial insurers subsidize not only the uninsured but also the government insured and managed care patients as well. National awareness of this issue and policy action are paramount to urban academic health centers and may also benefit commercial insurers.

  2. Managing health care organizations in an age of rapid change.

    Science.gov (United States)

    Benjamin, S; al-Alaiwat, S

    1998-03-01

    Health care managers find their work increasingly difficult, due in part to rapid environmental change that plagues organizational life. Management practices and attitudes that may have been appropriate in previous eras are ineffective today. A study was conducted among managers in the Ministry of Health, State of Bahrain, seeking information about current trends in the macro or external environment that affect the Ministry of Health, as well as internal environmental pressures that may be similar or different. This article provides a clear picture of the context in which managers perform their work and offers recommendations for coping with change in dynamic, complex organizations.

  3. Primary care clinicians' recognition and management of depression: a model of depression care in real-world primary care practice.

    Science.gov (United States)

    Baik, Seong-Yi; Crabtree, Benjamin F; Gonzales, Junius J

    2013-11-01

    Depression is prevalent in primary care (PC) practices and poses a considerable public health burden in the United States. Despite nearly four decades of efforts to improve depression care quality in PC practices, a gap remains between desired treatment outcomes and the reality of how depression care is delivered. This article presents a real-world PC practice model of depression care, elucidating the processes and their influencing conditions. Grounded theory methodology was used for the data collection and analysis to develop a depression care model. Data were collected from 70 individual interviews (60 to 70 min each), three focus group interviews (n = 24, 2 h each), two surveys per clinician, and investigators' field notes on practice environments. Interviews were audiotaped and transcribed for analysis. Surveys and field notes complemented interview data. Seventy primary care clinicians from 52 PC offices in the Midwest: 28 general internists, 28 family physicians, and 14 nurse practitioners. A depression care model was developed that illustrates how real-world conditions infuse complexity into each step of the depression care process. Depression care in PC settings is mediated through clinicians' interactions with patients, practice, and the local community. A clinician's interactional familiarity ("familiarity capital") was a powerful facilitator for depression care. For the recognition of depression, three previously reported processes and three conditions were confirmed. For the management of depression, 13 processes and 11 conditions were identified. Empowering the patient was a parallel process to the management of depression. The clinician's ability to develop and utilize interactional relationships and resources needed to recognize and treat a person with depression is key to depression care in primary care settings. The interactional context of depression care makes empowering the patient central to depression care delivery.

  4. Physician directed networks: the new generation of managed care.

    Science.gov (United States)

    Bennett, T; O'Sullivan, D

    1996-07-01

    The external pressure to reduce cost while maintaining quality and services is moving the whole industry into a rapid mode of integration. Hospitals, vendors, MCOs, and now, physicians, are faced with the difficult decisions concerning how their operations will be integrated into the larger health care delivery system. These pressures have forced physicians to consolidate, build leverage, and create efficiencies to become more productive; thereby better positioning themselves to respond to the challenges and the opportunities that lie before them. This initial phase of consolidation has given many physicians the momentum to begin to wrestle back the control of health care and the courage to design the next generation of managed care: Physician Directed Managed Care. What will be the next phase? Perhaps, the next step will be fully-integrated specialty and multi-specialty groups leading to alternate delivery sites. "Everyone thinks of changing the world, but no one thinks of changing himself." - Leo Tolstoy

  5. Improving Obesity Prevention and Management in Primary Care in Canada.

    Science.gov (United States)

    Campbell-Scherer, Denise; Sharma, Arya Mitra

    2016-09-01

    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.

  6. Depression Care Management: Can Employers Purchase Improved Outcomes?

    Directory of Open Access Journals (Sweden)

    Kathryn Rost

    2011-01-01

    Full Text Available Fourteen vendors are currently selling depression care management products to US employers after randomized trials demonstrate improved work outcomes. The research team interviewed 10 (71.4% of these vendors to compare their products to four key components of interventions demonstrated to improve work outcomes. Five of 10 depression products incorporate all four key components, three of which are sold by health maintenance organizations (HMOs; however, HMOs did not deliver these components at the recommended intensity and/or duration. Only one product delivered by a disease management company delivered all four components of care at the recommended intensity and duration. This “voltage drop,” which we anticipate will increase with product implementation, suggests that every delivery system should carefully evaluate the design of its depression product before implementation for its capacity to deliver evidence-based care, repeating these evaluations as new evidence emerges.

  7. Development of a chronic care ostomy self-management program.

    Science.gov (United States)

    Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C; Wendel, Christopher S; Krouse, Robert

    2013-03-01

    Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long-term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self-Management Program, which was informed by (1) evidence on published quality-of-life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self-Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies.

  8. Development of a Chronic Care Ostomy Self Management Program

    Science.gov (United States)

    Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C.; Wendel, Christopher S.; Krouse, Robert

    2012-01-01

    Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self Management Program, which was informed by (1) evidence on published quality of life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies. PMID:23104143

  9. Anaesthetic and Intensive Care Management of Traumatic Cervical Spine Injury

    Directory of Open Access Journals (Sweden)

    G S Umamaheswara Rao

    2008-01-01

    Full Text Available Trauma to the cervical spine may have devastating consequences. Timely interventions are essential to prevent avoidable neurological deterioration. In the initial stabilization of patients with acute cervical spine injuries, physiological disturbances, especially those involving cardiac and respiratory function require careful attention. Early surgery, which facilitates rapid mobi-lization of the patient, is fraught with important management considerations in the intraopoerative period and the subsequent critical care. Airway management poses a crucial challenge at this stage. Those patients who survive the injury with quadriplegia or quadriparesis may present themselves for incidental surgical procedures. Chronic systemic manifestations in these patients require attention in providing anaesthesia and postoperative care at this stage. The current review provides an insight into the physiological disturbances and the management issues in both acute and chronic phases of traumatic cervical spine injury.

  10. Course Redesign: An Evidence-Based Approach

    Science.gov (United States)

    Nomme, Kathy; Birol, Gülnur

    2014-01-01

    A first year non-majors biology course, with an enrollment of around 440 students, has been redesigned from a course of traditional content and teaching style to one that emphasizes biological concepts in current global issues and incorporates active learning strategies. We were informed by the education literature incorporating many aspects of…

  11. Mandated Preparation Program Redesign: Kentucky Case

    Science.gov (United States)

    Browne-Ferrigno, Tricia

    2013-01-01

    This case study presents a chronicle of events spanning a decade in Kentucky that led to state policy changes for principal preparation and details the response to those mandated changes by professors at the University of Kentucky. Professors' collaborative efforts resulted in a new teacher leadership program and redesigned principal certification…

  12. High School Redesign Gets Presidential Lift

    Science.gov (United States)

    Adams, Caralee J.

    2013-01-01

    President Barack Obama applauded high school redesign efforts in his State of the Union address and encouraged districts to look to successful models for inspiration. Last week, he followed up with a request in his fiscal 2014 budget proposal for a new, $300 million competitive-grant program. Recognition is widespread that high schools need to…

  13. RSA Monitoring Redesign Initiative Informational Booklet #1

    Science.gov (United States)

    US Department of Education, 2005

    2005-01-01

    This informational booklet contains background materials regarding the Rehabilitation Services Administration (RSA) initiative to redesign its monitoring system. The booklet is intended to expand the knowledge and understanding of those individuals selected to participate in the RSA-sponsored monitoring conference that was held August 24 and 25,…

  14. RSA Monitoring Redesign Initiative Informational Booklet #2

    Science.gov (United States)

    US Department of Education, 2005

    2005-01-01

    The U.S. Department of Education's Rehabilitation Services Administration (RSA) is undertaking a major initiative to substantially redesign its program monitoring and improvement system. The overriding goal is to improve vocational rehabilitation (VR) services and employment outcomes for individuals with disabilities through the development of a…

  15. Curriculum Redesign in Veterinary Medicine: Part I.

    Science.gov (United States)

    Chaney, Kristin P; Macik, Maria L; Turner, Jacqueline S; Korich, Jodi A; Rogers, Kenita S; Fowler, Debra; Scallan, Elizabeth M; Keefe, Lisa M

    Curricular review is considered a necessary component for growth and enhancement of academic programs and requires time, energy, creativity, and persistence from both faculty and administration. At Texas A&M College of Veterinary Medicine & Biomedical Sciences (TAMU), the faculty and administration partnered with the university's Center for Teaching Excellence to create a faculty-driven, data-enhanced curricular redesign process. The 8-step process begins with the formation of a dedicated faculty curriculum design team to drive the redesign process and to support the college curriculum committee. The next steps include defining graduate outcomes and mapping the current curriculum to identify gaps and redundancies across the curriculum. Data are collected from internal and external stakeholders including veterinary students, faculty, alumni, and employers of graduates. Data collected through curriculum mapping and stakeholder engagement substantiate the curriculum redesign. The guidelines, supporting documents, and 8-step process developed at TAMU are provided to assist other veterinary schools in successful curricular redesign. This is the first of a two-part report that provides the background, context, and description of the process for charting the course for curricular change. The process involves defining expected learning outcomes for new graduates, conducting a curriculum mapping exercise, and collecting stakeholder data for curricular evaluation (steps 1-4). The second part of the report describes the development of rubrics that were applied to the graduate learning outcomes (steps 5-8) and engagement of faculty during the implementation phases of data-driven curriculum change.

  16. Re-Designing Business Card Advertisements.

    Science.gov (United States)

    Schaub, Laura

    2001-01-01

    Discusses ways to turn information from a business card into an advertisement to be placed in a student publication. Addresses visual interest, typography, and other design issues. Includes several sample advertisements and a classroom activity involving redesigning a business card into an advertisement. (RS)

  17. A Flipped Classroom Redesign in General Chemistry

    Science.gov (United States)

    Reid, Scott A.

    2016-01-01

    The flipped classroom continues to attract significant attention in higher education. Building upon our recent parallel controlled study of the flipped classroom in a second-term general chemistry course ("J. Chem. Educ.," 2016, 93, 13-23), here we report on a redesign of the flipped course aimed at scaling up total enrollment while…

  18. Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

    Science.gov (United States)

    Monroe, C Douglas; Chin, Karen Y

    2013-05-01

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

  19. [The hospital perspective: disease management and integrated health care].

    Science.gov (United States)

    Schrappe, Matthias

    2003-06-01

    Disease Management is a transsectoral, population-based form of health care, which addresses groups of patients with particular clinical entities and risk factors. It refers both to an evidence-based knowledge base and corresponding guidelines, evaluates outcome as a continuous quality improvement process and usually includes active participation of patients. In Germany, the implementation of disease management is associated with financial transactions for risk adjustment between health care assurances [para. 137 f, Book V of Social Code (SGB V)] and represents the second kind of transsectoral care, besides a program designed as integrated health care according to para. 140 a ff f of Book V of Social Code. While in the USA and other countries disease management programs are made available by several institutions involved in health care, in Germany these programs are offered by health care insurers. Assessment of disease management from the hospital perspective will have to consider three questions: How large is the risk to compensate inadequate quality in outpatient care? Are there synergies in internal organisational development? Can the risk of inadequate funding of the global "integrated" budget be tolerated? Transsectoral quality assurance by valid performance indicators and implementation of a quality improvement process are essential. Internal organisational changes can be supported, particularly in the case of DRG introduction. The economic risk and financial output depends on the kind of disease being focussed by the disease management program. In assessing the underlying scientific evidence of their cost effectiveness, societal costs will have to be precisely differentiated from hospital-associated costs.

  20. Redesigning journal club in residency.

    Science.gov (United States)

    Al Achkar, Morhaf

    2016-01-01

    The gap between production and implementation of knowledge is the main reason for the suboptimal quality of health care. To eliminate this gap and improve the quality of patient care, journal club (JC) in graduate medical education provides an opportunity for learning the skills of evidence-based medicine. JC, however, continues to face many challenges mainly due to poorly defined goals, inadequate preparation, and lack of interest. This article presents an innovative model to prepare and present JC based on three pillars: dialogical learning through group discussion, mentored residents as peer teachers, and including JC as part of a structured curriculum to learn evidence-based medicine. This engaging model has the potential to transform JC from a moribund session that is daunting for residents into a lively discussion to redefine clinical practice using the most current evidence.

  1. Parity for mental health and substance abuse care under managed care.

    Science.gov (United States)

    Frank, Richard G.; McGuire, Thomas G.

    1998-12-01

    BACKGROUND: Parity in insurance coverage for mental health and substance abuse has been a key goal of mental health and substance abuse care advocates in the United States during most of the past 20 years. The push for parity began during the era of indemnity insurance and fee for service payment when benefit design was the main rationing device in health care. The central economic argument for enacting legislation aimed at regulating the insurance benefit was to address market failure stemming from adverse selection. The case against parity was based on inefficiency related to moral hazard. Empirical analyses provided evidence that ambulatory mental health services were considerably more responsive to the terms of insurance than were ambulatory medical services. AIMS: Our goal in this research is to reexamine the economics of parity in the light of recent changes in the delivery of health care in the United States. Specifically managed care has fundamentally altered the way in which health services are rationed. Benefit design is now only one mechanism among many that are used to allocate health care resources and control costs. We examine the implication of these changes for policies aimed at achieving parity in insurance coverage. METHOD: We develop a theoretical approach to characterizing rationing under managed care. We then analyze the traditional efficiency concerns in insurance, adverse selection and moral hazard in the context of policy aimed at regulating health and mental health benefits under private insurance. RESULTS: We show that since managed care controls costs and utilization in new ways parity in benefit design no longer implies equal access to and quality of mental health and substance abuse care. Because costs are controlled by management under managed care and not primarily by out of pocket prices paid by consumers, demand response recedes as an efficiency argument against parity. At the same time parity in benefit design may accomplish less

  2. Myasthenic crisis patients who require intensive care unit management.

    Science.gov (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto

    2012-09-01

    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care. Copyright © 2012 Wiley Periodicals, Inc.

  3. Marketing a managed care plan: achieving product differentiation.

    Science.gov (United States)

    Romeo, N C

    1996-01-01

    The health care marketplace is changing dramatically, even without federal reform measures. This is a volatile, yet promising, time to market a managed care plan. Before marketing the product, it is critical that the competition is thoroughly evaluated and consumer and employer needs are researched. The final product should be distinguishable from the competition and address market needs. Promotion can then begin, utilizing a proactive public relations and advertising campaign in addition to traditional methods of marketing.

  4. Managing organizational change: strategies for the female health care supervisor.

    Science.gov (United States)

    Davies, G

    1990-07-01

    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)

  5. Antidepressant Medication Management among Older Patients Receiving Home Health Care

    Science.gov (United States)

    Bao, Yuhua; Shao, Huibo; Bruce, Martha L.; Press, Matthew J.

    2014-01-01

    Objective Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay. Methods Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients 65 or older who received HHC in 2006–7 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (vs. discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy. Results About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10–20 percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change. Conclusions Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions. PMID:25158915

  6. A dementia care management intervention: which components improve quality?

    Science.gov (United States)

    Chodosh, Joshua; Pearson, Marjorie L; Connor, Karen I; Vassar, Stefanie D; Kaisey, Marwa; Lee, Martin L; Vickrey, Barbara G

    2012-02-01

    To analyze whether types of providers and frequency of encounters are associated with higher quality of care within a coordinated dementia care management (CM) program for patients and caregivers. Secondary analysis of intervention-arm data from a dementia CM cluster-randomized trial, where intervention participants interacted with healthcare organization care managers (HOCMs), community agency care managers (CACMs), and/ or healthcare organization primary care providers (HOPCPs) over 18 months. Encounters of 238 patient/caregivers (dyads) with HOCMs, CACMs, and HOPCPs were abstracted from care management electronic records. The quality domains of assessment, treatment, education/support, and safety were measured from medical record abstractions and caregiver surveys. Mean percentages of met quality indicators associated with exposures to each provider type and frequency were analyzed using multivariable regression, adjusting for participant characteristics and baseline quality. As anticipated, for all 4 domains, the mean percentage of met dementia quality indicators was 15.5 to 47.2 percentage points higher for dyads with HOCM--only exposure than for dyads with none (all P < .008); not anticipated were higher mean percentages with increasing combinations of provider-type exposure-up to 73.7 percentage points higher for safety (95% confidence interval 65.2%-82.1%) with exposure to all 3 provider types compared with no exposure. While greater frequency of HOCM-dyad encounters was associated with higher quality (P < .04), this was not so for other provider types. HOCMs' interactions with dyads was essential for dementia care quality improvement. Additional coordinated interactions with primary care and community agency staff yielded even higher quality.

  7. A quality improvement management model for renal care.

    Science.gov (United States)

    Vlchek, D L; Day, L M

    1991-04-01

    The purpose of this article is to explore the potential for applying the theory and tools of quality improvement (total quality management) in the renal care setting. We believe that the coupling of the statistical techniques used in the Deming method of quality improvement, with modern approaches to outcome and process analysis, will provide the renal care community with powerful tools, not only for improved quality (i.e., reduced morbidity and mortality), but also for technology evaluation and resource allocation.

  8. Strength in unity: the power of redesign to align the hospital team.

    Science.gov (United States)

    Bell, Anthony; Cochrane, Alastair; Courtice, Sally; Flanigan, Kathy; Mathur, Mandeep; Wilckens, Daniel

    2014-06-01

    The aim of Queen Elizabeth II Jubilee Hospital (QEII) redesign project (QEII United) was to enhance timely access to an inpatient bed and maximise opportunities to value add during the inpatient episode of care. A tripartite relationship between the hospital team, system manager and external consultants. The team, QEII United, was formed to 'diagnose, solve and implement' change under the unifying metaphorical banner of a football team. A marketing strategy and communication plan targeted the key 'players' and outlined the 'game plan'. Baseline data were collected, analysed and reported in keeping with key aims. Strategies for systems improvement implementation were attached to key performance indicators (KPIs). Thematic KPIs were developed to embed internal process change to reflect the contributions made towards the National Emergency Access Target (NEAT) at each stage of the patient journey. As such, access block of under 20%, morning discharge rates of 50% before midday, reduced length of stay for selected elective orthopaedic and general medical diagnostic related groupings (DRGs; i.e. relative stay index ≤1) and hospital in the home (HITH) utilisation rates 1.5% of all admissions were all met. Key to sustainability was the transfer of clinical redesign skills to hospital staff and the fostering of emergent ground up leadership. QEII United's success has been underpinned by the development of themed solution areas developed by the hospital staff themselves. Robust baseline data analysis used in combination with nationally available benchmarking data provided a quantitative starting point for the work. The collaborative elements of the program re-energised the hospital team, who were kept informed by targeted communications, to establish quick wins and build trust and momentum for the more challenging areas.

  9. [Organization of health services and tuberculosis care management].

    Science.gov (United States)

    Barrêto, Anne Jaquelyne Roque; de Sá, Lenilde Duarte; Nogueira, Jordana de Almeida; Palha, Pedro Fredemir; Pinheiro, Patrícia Geórgia de Oliveira Diniz; de Farias, Nilma Maria Porto; Rodrigues, Débora Cezar de Souza; Villa, Tereza Cristina Scatena

    2012-07-01

    The scope of this study was to analyze the discourse of managers regarding the relationship between the organization of the health services and tuberculosis care management in a city in the metropolitan region of João Pessoa, State of Pernambuco. Using qualitative research in the analytical field of the French line of Discourse Analysis, 16 health workers who worked as members of the management teams took part in the study. The transcribed testimonials were organized using Atlas.ti version 6.0 software. After detailed reading of the empirical material, an attempt was made to identify the paraphrasic, polyssemic and metaphoric processes in the discourses, which enabled identification of the following discourse formation: Organization of the health services and the relation with TB care management: theory and practice. In the discourse of the managers the fragmentation of the actions of control of tuberculosis, the lack of articulation between the services and sectors, the compliance of the specific activities for TB, as well as the lack of strategic planning for management of care of the disease are clearly revealed. In this respect, for the organization of the health services to be effective, it is necessary that tuberculosis be considered a priority and acknowledged as a social problem in the management agenda.

  10. The work and challenges of care managers in the implementation of collaborative care: A qualitative study.

    Science.gov (United States)

    Overbeck, G; Kousgaard, M B; Davidsen, A S

    2018-04-01

    WHAT IS KNOWN ON THE SUBJECT?: In collaborative care models between psychiatry and general practice, mental health nurses are used as care managers who carry out the treatment of patients with anxiety or depression in general practice and establish a collaborating relationship with the general practitioner. Although the care manager is the key person in the collaborative care model, there is little knowledge about this role and the challenges involved in it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study shows that before the CMs could start treating patients in a routine collaborative relationship with GPs, they needed to carry out an extensive amount of implementation work. This included solving practical problems of location and logistics, engaging GPs in the intervention, and tailoring collaboration to meet the GP's particular preferences. Implementing the role requires high commitment and an enterprising approach on the part of the care managers. The very experienced mental health nurses of this study had these skills. However, the same expertise cannot be presumed in a disseminated model. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When introducing new collaborative care interventions, the care manager role should be well defined and be well prepared, especially as regards the arrival of the care manager in general practice, and supported during implementation by a coordinated leadership established in collaboration between hospital psychiatry and representatives from general practice. Introduction In collaborative care models for anxiety and depression, the care manager (CM), often a mental health nurse, has a key role. However, the work and challenges related to this role remain poorly investigated. Aim To explore CMs' experiences of their work and the challenges they face when implementing their role in a collaborative care intervention in the Capital Region of Denmark. Methods Interviews with eight CMs, a group interview with five CMs and a recording

  11. Economic and clinical impact of multiple myeloma to managed care.

    Science.gov (United States)

    Cook, Richard

    2008-09-01

    Because of the development of novel agents such as immunomodulators, proteasome inhibitors, and bisphosphonates, the standards of care for the multiple myeloma (MM) patient have changed. The costs associated with current and emerging therapies, as well as supportive care, are significant and pose a tremendous financial burden to both patients and managed care. To review the economic impact of MM and to weigh the advantages and disadvantages of current treatments in bringing value for prolonged life versus the cost of treatment. This chapter will also discuss the need for thorough data review and pharmacoeconomic analyses to determine the most cost-effective therapies. Although MM accounts for only a small percentage of all cancer types, the costs associated with treating and managing it are among the highest. Recent developments in diagnosing, treating, and managing myeloma have led to novel treatment strategies. Immunomodulators, proteasome inhibitors, and bisphosphonates are improving response rates and preserving quality of life. However, these agents are not replacing older treatment modalities, but being used in addition to them. Intensive chemotherapy, stem cell transplantation, and supportive care are all important components in achieving treatment goals. Costs associated with stem cell transplants and complications of the disease add to the economic burden of myeloma. Additional costs for routine diagnostics to measure the progression of the disease or response to treatment need to be considered. Complications (e.g., lytic bone disease, infection, anemia, and renal failure) also add to morbidity and mortality, thus increasing the burden to the patient and the health care system as a whole. Financial and time constraints of caregivers must also be considered, as well as the added administrative burdens to health care providers. New standards of care in the treatment and management of myeloma are likely to lead to significant increases in costs. Although

  12. How the United States exports managed care to developing countries.

    Science.gov (United States)

    Waitzkin, H; Iriart, C

    2001-01-01

    As their expansion slows in the United States, managed care organizations will continue to enter new markets abroad. Investors view the opening of managed care in Latin America as a lucrative business opportunity. As public-sector services and social security funds are cut back, privatized, and reorganized under managed care, with the support of international lending agencies such as the World Bank, the effects of these reforms on access to preventive and curative services will hold great importance throughout the developing world. Many groups in Latin America are working on alternative projects that defend health as a public good, and similar movements have begun in Africa and Asia. Increasingly, this organizing is being recognized not only as part of a class struggle but also as part of a struggle against economic imperialism--which has now taken on the new appearance of rescuing less developed countries from rising health care costs and inefficient bureaucracies through the imposition of neoliberal managed-care solutions exported from the United States.

  13. Managed care, vertical integration strategies and hospital performance.

    Science.gov (United States)

    Wang, B B; Wan, T T; Clement, J; Begun, J

    2001-09-01

    The purpose of this study is to examine the association of managed care with hospital vertical integration strategies, as well as to observe the relationships of different types of vertical integration with hospital efficiency and financial performance. The sample consists of 363 California short-term acute care hospitals in 1994. Linear structure equation modeling is used to test six hypotheses derived from the strategic adaptation model. Several organizational and market factors are controlled statistically. Results suggest that managed care is a driving force for hospital vertical integration. In terms of performance, hospitals that are integrated with physician groups and provide outpatient services (backward integration) have better operating margins, returns on assets, and net cash flows (p < 0.01). These hospitals are not, however, likely to show greater productivity. Forward integration with a long-term-care facility, on the other hand, is positively and significantly related to hospital productivity (p < 0.001). Forward integration is negatively related to financial performance (p < 0.05), however, opposite to the direction hypothesized. Health executives should be responsive to the growth of managed care in their local market and should probably consider providing more backward integrated services rather than forward integrated services in order to improve the hospital's financial performance in today's competitive health care market.

  14. Implementing a Redesign Strategy: Lessons from Educational Change.

    Science.gov (United States)

    Basom, Richard E., Jr.; Crandall, David P.

    The effective implementation of school redesign, based on a social systems approach, is discussed in this paper. A basic assumption is that the interdependence of system elements has implications for a complex change process. Seven barriers to redesign and five critical issues for successful redesign strategy are presented. Seven linear steps for…

  15. Redesigning an intensive insulin service for patients with type 1 diabetes: a patient consultation exercise

    Directory of Open Access Journals (Sweden)

    Ozcan S

    2013-06-01

    Full Text Available Seyda Ozcan,1–3 Helen Rogers,3 Pratik Choudhary,3 Stephanie A Amiel,3 Alison Cox,3 Angus Forbes2,3 1Department of Medical Nursing, Florence Nightingale Nursing Faculty, Istanbul University, Istanbul, Turkey; 2Department of Primary and Intermediate Care, Florence Nightingale School of Nursing and Midwifery, King’s College London, London, United Kingdom; 3Department of Diabetes, King's College Hospital NHS Foundation Trust, London, United Kingdom Context: Providing effective support for patients in using insulin effectively is essential for good diabetes care. For that support to be effective it must reflect and attend to the needs of patients. Purpose: To explore the perspectives of adult type 1 diabetes patients on their current diabetes care in order to generate ideas for creating a new patient centered intensive insulin clinic. Methods: A multi-method approach was used, comprising: an observational exercise of current clinical care; three focus groups (n = 17; and a survey of service users (n = 419 to test the ideas generated from the observational exercise and focus groups (rating 1 to 5 in terms of importance. The ideas generated by the multi-method approach were organized thematically and mapped onto the Chronic Care Model (CCM. Results: The themes and preferences for service redesign in relation to CCM components were: health care organization, there was an interest in having enhanced systems for sharing clinical information; self-management support, patients would like more flexible and easy to access resources and more help with diabetes technology and psychosocial support; delivery system design and clinical information systems, the need for greater integration of care and better use of clinic time; productive relationships, participants would like more continuity; access to health professionals, patient involvement and care planning. The findings from the patient survey indicate high preferences for most of the areas for service

  16. Using systems science for population health management in primary care.

    Science.gov (United States)

    Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

    2014-10-01

    Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of Systems science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings. © The Author(s) 2014.

  17. Colorectal cancer: complexities and challenges in managed care.

    Science.gov (United States)

    Minkoff, Neil B

    2007-08-01

    Managed care weighs advances and associated costs to determine whether the combination of longer life at sometimes significantly increased cost represents value. The price of treatment is only 1 factor. To review treatment decision processes for oncologic agents in managed care environments. Price can be exceptionally high for individuals. But if the population size is low, the per-member-per-month (PMPM) impact can be almost negligible, unlike treatments that have moderate costs but are used ubiquitously. Cancer therapies have, for the most part, escaped managed care's notice. For 2007, the national Cancer Institute projects that antineoplastic agents will consume almost a quarter of the overall drug spend. The Medicare population is a unique concern with regard to cancer. Traditionally, Medicare reimbursement of chemotherapeutic agents was based on average wholesale price (AWP) discounting, not the oncologist's purchasing cost. This allowed oncologists to use reimbursement for infusions to support their medical practices. The proposed plan of the Center for Medicare & Medicaid Services (CMS) to use average sales price (ASP) plus 6% to reimburse for drugs used in the office setting leads to significant problems. Pharmacy and therapeutics committees will also face challenges: fewer data are available for some agents because they have become available through the U.S. Food and drug administration's Fast Track, Priority review, or accelerated approval processes. Oncology disease management programs must reach out to patients and not necessarily deal with oncology issues directly, but address tangential issues that impact care, especially depression and pain management.

  18. Guideline for primary care management of headache in adults

    Science.gov (United States)

    Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

    2015-01-01

    Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

  19. The new caring: financial asset management and older people.

    Science.gov (United States)

    Tilse, Cheryl; Wilson, Jill; Setterlund, Deborah; Rosenman, Linda

    2007-10-01

    Increasing longevity and the growing proportion of the aged in the population in most countries have served to focus on the question of how governments and older people can finance living, health, and care options in retirement. Prudent management of income and assets is an increasingly complex and important aspect of aging as assets and expectations of self-financing increase. Although many informal caregivers act as asset managers and/or substitute decision-makers for older people, little attention has been paid to this increasingly important aspect of care. This paper summaries key findings of a broad research program exploring family involvement in the management of older people's assets and the practices that constitute good practice as well as financial mismanagement and abuse. It identifies multi-level and multi-strategy responses needed to address the issues raised by the research and outlines an innovative community demonstration project aimed at improving financial management practices in relation to older people's assets.

  20. Managing actinic keratosis in primary care.

    Science.gov (United States)

    Salmon, Nicola; Tidman, Michael J

    2016-10-01

    Actinic, or solar, keratosis is caused by chronic ultraviolet-induced damage to the epidermis. In the UK, 15-23% of individuals have actinic keratosis lesions. Risk factors include: advanced age; male gender; cumulative sun exposure or phototherapy; Fitzpatrick skin phototypes I-II; long-term immuno-suppression and genetic syndromes e.g. xeroderma pigmentosum and albinism. Actinic keratoses are regarded by some authorities as premalignant lesions that may transform into invasive squamous cell carcinoma (SCC) and by others as in situ SCC that may progress to an invasive stage. The risk of malignant change appears low; up to 0.5% per lesion per year. Up to 20-30% of lesions may spontaneously regress but in the absence of any reliable prognostic clinical indicators regarding malignant potential active treatment is considered appropriate. Actinic keratosis lesions may present as discrete hyperkeratotic papules, cutaneous horns, or more subtle flat lesions on sun-exposed areas of skin. The single most helpful diagnostic sign is an irregularly roughened surface texture: a sandpaper-like feel almost always indicates actinic damage. Dermatoscopy can be helpful in excluding signs of basal cell carcinoma when actinic keratosis is non-keratotic. It is always important to consider the possibility of SCC. The principal indication for referral to secondary care is the possibility of cutaneous malignancy. However, widespread and severe actinic damage in patients who are immunosuppressed is also a reason for referral.

  1. Transcultural nursing and a care management partnership project.

    Science.gov (United States)

    Lazure, G; Vissandjée, B; Pepin, J; Kérouac, S

    1997-09-01

    This paper aims to illustrate how Leininger's Theory of Culture Care Diversity and Universality has influenced the research process of a study that emerged from a care management partnership between Canadian nursing teachers and Tunisian nurses. The purpose of the study was to investigate the meanings of care as viewed by university hospital-based Tunisian nurses. The qualitative analysis of data gathered through observation-participation and interviews highlights recurrent patterns and reveals three major professional care themes. For Tunisian nurses care means to secure the patient's cooperation towards the medical regimen within established rules in the hospital; to contribute to curing the patient by using current technology as well as by maintaining their technical skills and improving their medical knowledge; to take charge of the patient to assist the physician in treating disease. This study showed that Tunisian nurses emphasize curing rather than widely shared community values such as interdependence, intercommunication, understanding, presence and responsibility for others. Discussion of the study's findings draws upon the perspective provided by Freire's Oppressed Group Theory. In order to promote cultural congruence within the Care Management Partnership Project in Tunisia, the three predicted modes of care within Leininger's theory guide the decisions and actions for future nursing research and partnership activities.

  2. Assessment and management of suicide risk in primary care.

    Science.gov (United States)

    Saini, Pooja; While, David; Chantler, Khatidja; Windfuhr, Kirsten; Kapur, Navneet

    2014-01-01

    Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Data collection from clinical proformas, case records, and semistructured face-to-face interviews with general practitioners. Primary and secondary care data were available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall κ = .127, p = .10). Depression, care setting (after discharge), suicidal ideation at last contact, and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices, and 33% of staff received training in suicide risk assessments. Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care.

  3. Active Social Media Management: The Case of Health Care

    OpenAIRE

    Miller, Amalia R.; Tucker, Catherine Elizabeth

    2012-01-01

    Given the demand for authentic personal interactions over social media, it is unclear how much firms should actively manage their social media presence. We study this question empirically in a health care setting. We show that active social media management drives more user-generated content. However, we find that this is due to an incremental increase in user postings from an organization's employees rather than from its clients. This result holds when we explore exogenous variation in socia...

  4. Petroleum and Health Care: Evaluating and Managing Health Care's Vulnerability to Petroleum Supply Shifts

    Science.gov (United States)

    Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica

    2011-01-01

    Petroleum is used widely in health care—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services. PMID:21778473

  5. Improving quality in Medicaid: the use of care management processes for chronic illness and preventive care.

    Science.gov (United States)

    Rittenhouse, Diane R; Robinson, James C

    2006-01-01

    Care management processes (CMPs), tools to improve the efficiency and quality of primary care delivery, are particularly important for low-income patients facing substantial barriers to care. To measure the adoption of CMPs by medical groups, Independent Practice Associations, community clinics, and hospital-based clinics in California's Medicaid program and the factors associated with CMP adoption. Telephone survey of every provider organization with at least 6 primary care physicians and at least 1 Medi-Cal HMO contract, Spring 2003. One hundred twenty-three organizations participated, accounting for 64% of provider organizations serving Medicaid managed care in California. We surveyed 30 measures of CMP use for asthma and diabetes, and for child and adolescent preventive services. The mean number of CMPs used by each organization was 4.5 for asthma and 4.9 for diabetes (of a possible 8). The mean number of CMPs for preventive services was 4.0 for children and 3.5 for adolescents (of a possible 7). Organizations with more extensive involvement in Medi-Cal managed care used more CMPs for chronic illness and preventive service. Community clinics and hospital-based clinics used more CMPs for asthma and diabetes than did Independent Practice Associations (IPAs), and profitable organizations used more CMPs for child and adolescent preventive services than did entities facing severe financial constraints. The use of CMPs by Medicaid HMOs and the presence of external (financial and nonfinancial) incentives for clinical performance were strongly associated with use of care management by provider organizations. Physician and provider organizations heavily involved in California's Medicaid program are extensively engaged in preventive and chronic care management programs.

  6. Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

    Science.gov (United States)

    Penney, Christine; Henry, Effie

    2008-01-01

    The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also

  7. Documentation of Contraception and Pregnancy Intention In Medicaid Managed Care

    Directory of Open Access Journals (Sweden)

    Heike Thiel de Bocanegra

    2018-01-01

    Full Text Available Context: Clinical guidelines recommend the documentation of pregnancy intention and family planning needs during primary care visits. Prior to the 2014 Medicaid expansion and release of these guidelines, the documentation practices of Medicaid managed care providers are unknown. Methods: We performed a chart review of 1054 Medicaid managed care visits of women aged 13 to 49 to explore client, provider, and visit characteristics associated with documentation of immediate or future plans for having children and contraceptive method use. Five managed care plans used Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes to identify providers with at least 15 women who had received family planning or well-woman care in 2013. We conducted multilevel logistic regression analyses with documentation of contraceptive method and pregnancy intention as outcome variables and clinic site as the level 2 random effect. Results: Only 12% of charts had documentation of pregnancy intention and 59% documented contraceptive use. Compared to women with a family planning visit reason, women with an annual, reproductive health, or primary care reason for their visit were significantly less likely to have contraception documented (odds ratio [OR] = 11.0; 95% confidence interval [CI] = 6.8-17.7. Age was also a significant predictor with women aged 30 to 49 (OR = 0.6; 95% CI = 0.4-0.9, and women aged 13 to 19 (OR = 0.2; 95% CI = 0.1-0.6 being less likely to have a note about pregnancy intention in their chart. Pregnancy intention was more likely to be documented in multispecialty clinics (OR = 15.5; 95% CI = 2.7-89.2. Conclusions: Interventions to improve routine medical record documentation of contraception and pregnancy intention regardless of patient age and visit characteristics are needed to facilitate the provision of family planning in managed care visits and, ultimately, achieving better maternal infant health outcomes

  8. Redesigning journal club in residency

    Directory of Open Access Journals (Sweden)

    Al Achkar M

    2016-05-01

    Full Text Available Morhaf Al Achkar Department of Family Medicine, Indiana University, Indianapolis, IN, USA Abstract: The gap between production and implementation of knowledge is the main reason for the suboptimal quality of health care. To eliminate this gap and improve the quality of patient care, journal club (JC in graduate medical education provides an opportunity for learning the skills of evidence-based medicine. JC, however, continues to face many challenges mainly due to poorly defined goals, inadequate preparation, and lack of interest. This article presents an innovative model to prepare and present JC based on three pillars: dialogical learning through group discussion, mentored residents as peer teachers, and including JC as part of a structured curriculum to learn evidence-based medicine. This engaging model has the potential to transform JC from a moribund session that is daunting for residents into a lively discussion to redefine clinical practice using the most current evidence. Keywords: journal club, residents, peer teaching, evidence-based medicine, dialogical learning

  9. System redesign of the immunization supply chain: Experiences from Benin and Mozambique.

    Science.gov (United States)

    Prosser, Wendy; Jaillard, Philippe; Assy, Emmanuelle; Brown, Shawn T; Matsinhe, Graça; Dekoun, Mawutondji; Lee, Bruce Y

    2017-04-19

    Evidence suggests that immunization supply chains are becoming outdated and unable to deliver needed vaccines due to growing populations and new vaccine introductions. Redesigning a supply chain could result in meeting current demands. The Ministries of Health in Benin in Mozambique recognized known barriers to the immunization supply chain and undertook a system redesign to address those barriers. Changes were made to introduce an informed push system while consolidating storage points, introducing transport loops, and increasing human resource capacity for distribution. Evaluations were completed in each country. Evaluation in each country indicated improved performance of the supply chain. The Effective Vaccine Management (EVM) assessment in Benin documented notable improvements in the distribution criteria of the tool, increasing from 40% to 100% at the district level. In Mozambique, results showed reduced stockouts at health facility level from 79% at baseline to less than 1% at endline. Coverage rates of DTP3 also increased from 68.9% to 92.8%. Benin and Mozambique are undertaking system redesign in order to respond to constraints identified in the vaccine supply chain. Results and learnings show improvements in supply chain performance and make a strong case for system redesign. These countries demonstrate the feasibility of system redesign for other countries considering how to address outdated supply chains. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  10. Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.

    Science.gov (United States)

    Povar, Gail J; Blumen, Helen; Daniel, John; Daub, Suzanne; Evans, Lois; Holm, Richard P; Levkovich, Natalie; McCarter, Alice O; Sabin, James; Snyder, Lois; Sulmasy, Daniel; Vaughan, Peter; Wellikson, Laurence D; Campbell, Amy

    2004-07-20

    Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.

  11. Safe management of waste from health-care activities

    International Nuclear Information System (INIS)

    Pruess, A.; Giroult, E.; Rushbrook, P.

    1999-01-01

    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

  12. Connecting the dots: interprofessional health education and delivery system redesign at the Veterans Health Administration.

    Science.gov (United States)

    Gilman, Stuart C; Chokshi, Dave A; Bowen, Judith L; Rugen, Kathryn Wirtz; Cox, Malcolm

    2014-08-01

    Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care.

  13. RN Diabetes Virtual Case Management: A New Model for Providing Chronic Care Management.

    Science.gov (United States)

    Brown, Nancy N; Carrara, Barbara E; Watts, Sharon A; Lucatorto, Michelle A

    2016-01-01

    The U.S. chronic disease health care system has substantial gaps in delivery of services. New models of care change traditional delivery of care and explore new settings for care. This article describes a new model of diabetes chronic care delivery: nurse-delivered care that includes protocol-based insulin titration and patient education delivered solely in a virtual environment. In phase 1, the clinical outcome of time to achievement of glycated hemoglobin (A(1C)) goals (P managed insulin titration protocol with individualized A(1C) goals had a significant (P Safety was demonstrated by the absence of hypoglycemia related to RN protocol adjustment. There were no admissions or emergency room (ER) visits for hypoglycemia. This study demonstrates safety and efficacy of RN virtual chronic disease management for an older population of patients with long-standing diabetes.

  14. Managed care and clinical decision-making in child and adolescent behavioral health: provider perceptions.

    Science.gov (United States)

    Yanos, Philip T; Garcia, Christine I; Hansell, Stephen; Rosato, Mark G; Minsky, Shula

    2003-03-01

    This study investigated how managed care affects clinical decision-making in a behavioral health care system. Providers serving children and adolescents under both managed and unmanaged care (n = 28) were interviewed about their awareness of differences between the benefit arrangements, how benefits affect clinical decision-making, outcomes and quality of care; and satisfaction with care. Quantitative and qualitative findings indicated that providers saw both advantages and disadvantages to managed care. Although most providers recognized the advantages of managed care in increasing efficiency, many were concerned that administrative pressures associated with managed care compromise service quality.

  15. The Power of Structural and Symbolic Redesign: Creating a Collaborative Learning Community in Higher Education.

    Science.gov (United States)

    Geltner, Beverley B.

    This paper describes efforts to redesign a graduate program of educational administration and leadership at Oakland University in Rochester, Michigan, shaped by contributions of researchers in contemporary management and leadership theory, feminist pedagogy, action research, and educational reform. A culture of collaboration, inclusion, and…

  16. Improving Health Care Management in Primary Care for Homeless People: A Literature Review

    Science.gov (United States)

    Abcaya, Julien; Ștefan, Diana-Elena; Calvet-Montredon, Céline; Gentile, Stéphanie

    2018-01-01

    Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. Methods: We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Results: Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions: Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. PMID:29439403

  17. Empowerment, patient centred care and self-management.

    Science.gov (United States)

    Pulvirenti, Mariastella; McMillan, John; Lawn, Sharon

    2014-06-01

    Patient or person centred care is widely accepted as the philosophy and practice that underpins quality care. An examination of the Australian National Chronic Disease Strategy and literature in the field highlights assumptions about the self-manager as patient and a focus on clinical settings. This paper considers patient or person centred care in the light of empowerment as it is understood in the health promotion charters first established in Alma Ata in 1977. We argue that patient or person centred care can be reconfigured within a social justice and rights framework and that doing so supports the creation of conditions for well-being in the broader context, one that impacts strongly on individuals. These arguments have broader implications for the practice of patient centred care as it occurs between patient and health professional and for creating shared responsibility for management of the self. It also has implications for those who manage their health outside of the health sector. © 2011 John Wiley & Sons Ltd.

  18. The transfer of a health insurance/managed care business.

    Science.gov (United States)

    Gavin, John N; Goodman, George; Goroff, David B

    2007-01-01

    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.

  19. The role of managed care in work-related injuries.

    Science.gov (United States)

    Shor, M J; Miller, J C

    1996-10-01

    Many opportunities exist today for orthopedic surgeons in the treatment and management of work-related injuries. Physicians wishing to enter or participate in this market must realize that the role of the physician in the treatment of the injured worker has expanded from one of being solely the care giver to being a patient manager, a problem solver, and a communicator. A number of years ago, many orthopedic surgeons missed out on managed care contracting for health maintenance organizations because they thought they could survive without it. They soon learned the challenges of sitting on the sidelines. Whether we like it or not, managed care for work-related injuries is here and its likelihood for going away is about zero. If your state has not yet adopted utilization management standards or managed care for workers' compensation-enabling legislation, when you wake up tomorrow they may have done so. Because of its relative embryonic development, there are exceptional opportunities for practitioners to take active roles in shaping the models that will serve employees and employers in the year 2000. Physicians who are interested in the treatment of injured workers have a unique opportunity right now to develop relationships in the managed workers' compensation arena. Payment and patient referrals for workers' compensation may turn out to be more attractive financially than many of the contracts currently in place with health maintenance organizations and other general health plans. Physicians willing to partner with employers and other players in the workers' compensation arena currently face some challenging, rewarding, and exciting opportunities. In the immortal words of Hippocrates, "Healing is a matter of time, but it is sometimes a matter of opportunity."3 It is unclear whether Hippocrates ever imagined our current level of science, practice, and organization, but it is clear the opportunities to be an active participant in the changes occurring in workers

  20. Effective healthcare process redesign through an interdisciplinary team approach.

    Science.gov (United States)

    Snyder, Rita; Huynh, Nathan; Cai, Bo; Vidal, José; Bennett, Kevin

    2013-01-01

    Healthcare process redesign is a complex and often high risk undertaking. Typically, there is a limited understanding of the baseline process and often inadequate tools by which to assess it. This can be confounded by narrow redesign team expertise that can result in unanticipated and/or unintended redesign consequences. Interdisciplinary research teams of healthcare, biostatistics, engineering and computer science experts provide broad support for a more effective and safer approach to healthcare process redesign. We describe an interdisciplinary research team focused on medication administration process (MAP)redesign and its achievements and challenges.

  1. Management of Tracheostomy: A Survey of Dutch Intensive Care Units

    NARCIS (Netherlands)

    Veelo, Denise P.; Schultz, Marcus J.; Phoa, Kai Y. N.; Dongelmans, Dave A.; Binnekade, Jan M.; Spronk, Peter E.

    2008-01-01

    OBJECTIVE: To determine tracheostomy-management practices in Dutch intensive care units (ICUs) and post-ICU step-down facilities. METHODS: We surveyed the physician medical directors of all Dutch nonpediatric ICUs that have : 5 beds suitable for mechanical ventilation. The survey asked for

  2. The knowledge and practice of self-care management among ...

    African Journals Online (AJOL)

    Background: Self-care management in diabetic patients is crucial to control and ... Rwanda Journal Series F: Medicine and Health Sciences Vol. 2 No. 1, 2015 .... the shoes, and 63% (n=51) checked their feet every day as a matter of principle.

  3. Telephone versus usual care in management of acute whiplash ...

    African Journals Online (AJOL)

    Whiplash associated disorder (WAD) is a common and costly condition, and recommended management includes advice to “act as usual” and exercise. Providing this treatment through a telephonic intervention may help to improve access to care, and reduce costs. This pilot study assessed: (1) the effectiveness of a ...

  4. Care-managers' professional choices: ethical dilemmas and conflicting expectations.

    Science.gov (United States)

    Tønnessen, Siri; Ursin, Gøril; Brinchmann, Berit Støre

    2017-09-07

    Care-managers are responsible for the public administration of individual healthcare decisions and decide on the volume and content of community healthcare services given to a population. The purpose of this study was to investigate the conflicting expectations and ethical dilemmas these professionals encounter in their daily work with patients and to discuss the clinical implications of this. The study had a qualitative design. The data consisted of verbatim transcripts from 12 ethical reflection group meetings held in 2012 at a purchaser unit in a Norwegian city. The participants consist of healthcare professionals such as nurses, occupational therapists, physiotherapists and social workers. The analyses and interpretation were conducted according to a hermeneutic methodology. This study is part of a larger research project. Two main themes emerged through the analyses: 1. Professional autonomy and loyalty, and related subthemes: loyalty to whom/what, overruling of decisions, trust and obligation to report. 2. Boundaries of involvement and subthemes: private or professional, care-manager or provider and accessibility. Underlying values and a model illustrating the dimensions of professional responsibility in the care-manager role are suggested. The study implies that when allocating services, healthcare professionals need to find a balance between responsibility and accountability in their role as care-managers.

  5. Federated management of information for TeleCARE

    NARCIS (Netherlands)

    Afsarmanesh, H.; Guevara-Masis, V.; Hertzberger, L.O.; Camarinha-Matos, L.M.

    2004-01-01

    Distributed information management plays a fundamental role within the base infrastructure supporting the elderly care domain. Specificities of this domain include the autonomy and independence of its involved actors, the critical data that is handled about individuals, and the variety of

  6. Clothing for Elderly Persons: Management and Caring Strategies ...

    African Journals Online (AJOL)

    This paper examines the clothing requirements of the elderly across the globe and the management and caring strategies in supporting them. There is however, no specific requirement for the elderly in terms of what they wear or how they dress over and above the requirements of early adult life in many nations of the world.

  7. Hospital marketing orientation and managed care processes: are they coordinated?

    Science.gov (United States)

    White, K R; Thompson, J M; Patel, U B

    2001-01-01

    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 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.

  8. Primary health care management challenges for childhood atopic ...

    African Journals Online (AJOL)

    Kaarina Frieda Meintjes

    primary health care (PHC) management of their children's atopic eczema in a Gauteng district. A qualitative, explorative, descriptive, contextual embedded single case study design ... direct observation until saturation occurred; analysed according to Tesch's ..... needed, it was provided by the researcher as part of the pro-.

  9. TQ What?: Applying Total Quality Management to Child Care.

    Science.gov (United States)

    Hewes, Dorothy

    1994-01-01

    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)

  10. A retrospective review of intensive care management of ...

    African Journals Online (AJOL)

    Background: Organophosphate (OP) compounds are used as insecticides. Given the widespread availability and use of these chemicals, OP poisoning is quite common following either accidental or intentional exposures. Immediate intensive care management can save lives in these patients. We aimed to investigate ...

  11. Evolving an empowering approach to continuous quality improvement in home care.

    Science.gov (United States)

    McWilliam, C L; Desai, K L; Sweetland, D

    1995-01-01

    Theory suggests that in an "empowering" organization all individuals assume genuine decision-making roles and control over their work. Unfortunately, many organizations actually stifle empowerment through creating new bureaucratic barriers as they implement structures to deploy quality management principles. The Oxford County Home Care Program describes how it redesigned its organizational structure to facilitate empowerment.

  12. The Exnovation of Chronic Care Management Processes by Physician Organizations.

    Science.gov (United States)

    Rodriguez, Hector P; Henke, Rachel Mosher; Bibi, Salma; Ramsay, Patricia P; Shortell, Stephen M

    2016-09-01

    Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care. Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population-level increases in practice use of CMPs over time. Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Over one-third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one-third of exnovators, while nurse

  13. The Exnovation of Chronic Care Management Processes by Physician Organizations

    Science.gov (United States)

    HENKE, RACHEL MOSHER; BIBI, SALMA; RAMSAY, PATRICIA P.; SHORTELL, STEPHEN M.

    2016-01-01

    Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care.Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population‐level increases in practice use of CMPs over time.Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Context Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Methods Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Findings Over one‐third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one

  14. [Interest of psychiatric guidelines in managing agitation in intensive care].

    Science.gov (United States)

    Lazignac, Coralie; Ricou, Bara; Dan, Liviu; Virgillito, Salvatore; Adam, Eric; Seyedi, Majid; Cicotti, Andrei; Azi, Amine; Damsa, Cristian

    2007-02-14

    This paper discusses the importance of psychiatric guidelines and the position of the psychiatrist in the management of agitation in the intensive care unit. The use of psychiatric validated scales to assess agitation seems to ameliorate the quality of care in psychiatry, but also in intensive care. Psychiatric experts' recommendations for managing agitation are given, which is useful to create an open discussion with the intensivists. The use of sedative medication to protect the patient, staff and to prevent an escalation of violence remains a personal choice for each practitioner, depending on individual patient needs and context. In the treatment of agitated patients, an equilibrium needs to be found between the subjective dimension and the available data from evidence based medicine.

  15. Managing information technology human resources in health care.

    Science.gov (United States)

    Mahesh, Sathiadev; Crow, Stephen M

    2012-01-01

    The health care sector has seen a major increase in the use of information technology (IT). The increasing permeation of IT into the enterprise has resulted in many non-IT employees acquiring IT-related skills and becoming an essential part of the IT-enabled enterprise. Health care IT employees work in a continually changing environment dealing with new specializations that are often unfamiliar to other personnel. The widespread use of outsourcing and offshoring in IT has introduced a third layer of complexity in the traditional hierarchy and its approach to managing human resources. This article studies 3 major issues in managing these human resources in an IT-enabled health care enterprise and recommends solutions to the problem.

  16. Fifteen minute consultation: Practical pain management in paediatric palliative care.

    Science.gov (United States)

    Harrop, Emily Jane; Brombley, Karen; Boyce, Katherine

    2017-10-01

    Pain and distress in the paediatric palliative care population can be very difficult to manage. Clinical scenarios range from the acute management of cancer-related pain at the end of life to the ongoing long-term support of children with complex multimodal pain related to progressive neurological conditions. Understanding the child's underlying condition, possible causes of pain and their preferred mode of communication are important to the delivery of holistic care. Modification of environmental factors, basic care consideration and non-pharmacological measures have a large role to play, alongside conventional analgesics. Medication may also need to be delivered by novel routes such as transdermal patches, continuous subcutaneous infusion of multiple drugs or transmucosal breakthrough analgesic doses. Two cases are used to illustrate approaches to these clinical problems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Redesign lifts prep output 288%

    Energy Technology Data Exchange (ETDEWEB)

    Hamric, J

    1987-02-01

    This paper outlines the application of engineering creativity and how it brought output at an Ohio coal preparation plant up from 12,500 tpd to nearly four times that figure, 48,610 tpd. By streamlining the conveyor systems, removing surplus belt length and repositioning subplants the whole operation was able to run far more efficiently with a greater output. Various other alterations including the raw material supply and management and operating practices were also undertaken to provide a test for the achievements possible with such reorganization. The new developments have been in the following fields: fine coal cleaning, heavy media cyclones, feeders, bins, filter presses, dewatering equipment and settling tanks. Output is now limited only by the reduced demand by the Gavin power station nearby.

  18. Effective managed care marketing strategies for evolving markets.

    Science.gov (United States)

    Conlon, M K

    1997-11-01

    In a world of increased competition and changing consumer expectations, one of the keys to a fiscally sound health plan is having a dynamic marketing strategy that takes into account the shifting attitudes of consumers as managed care markets mature. The primary goal of any health plan marketing strategy should be the acquisition and retention of members. Providing cost-efficient and convenient service for enrollees, offering low or no deductibles, having convenient office locations, and minimizing paper-work are important elements of such a marketing strategy. Factors such as brand awareness and the perceived image of a health plan also are important considerations in acquiring and retaining market share. The relative importance of these consumer satisfaction criteria change as a managed care market evolves and matures. Financial and marketing managers, thus, should ascertain their market's stage of development and respond with appropriate marketing strategies.

  19. Intensive Care Unit Nurses' Beliefs About Delirium Assessment and Management.

    Science.gov (United States)

    Oosterhouse, Kimberly J; Vincent, Catherine; Foreman, Marquis D; Gruss, Valerie A; Corte, Colleen; Berger, Barbara

    2016-10-01

    Delirium, the most frequent complication of hospitalized older adults, particularly in intensive care units (ICUs), can result in increased mortality rates and length of stay. Nurses are neither consistently identifying nor managing delirium in these patients. The purpose of this study was to explore ICU nurses' identification of delirium, actions they would take for patients with signs or symptoms of delirium, and beliefs about delirium assessment and management. In this cross-sectional study using qualitative descriptive methods guided by the theory of planned behavior, 30 ICU nurses' responses to patient vignettes depicting different delirium subtypes were explored. Descriptive and content analyses revealed that nurses did not consistently identify delirium; their actions varied in different vignettes. Nurses believed that they needed adequate staffing, balanced workload, interprofessional collaboration, and established policy and protocols to identify and manage delirium successfully. Research is needed to determine if implementing these changes increases recognition and decreases consequences of delirium. ©2016 American Association of Critical-Care Nurses.

  20. [Local planning: the speech of basic health care center manager].

    Science.gov (United States)

    Cubas, Márcia Regina

    2005-01-01

    As planning is understood as a management tool, this article offers an argument through the speech framework of Basic Health Care Center Managers in the city of Curitiba-PR, by means of the Collective Subject Speech Methodology on local planning aspects. Its purpose is to bring local managers to a reflection concerning their styles, practices and experiences, as well as to collaborate with central level leading teams towards building their planning processes in an upward, participatory, communicative and strategic way. Considerations of the speeches built from central ideas are presented: planning methodology; inter-sectoriality; territorial basis; team and community participation; training, autonomy and particular profile of local managers; the manager's agenda; and institutional culture.

  1. [Relationship of the effectiveness of care management services and burdens of primary family caregivers].

    Science.gov (United States)

    Lee, Chia-Ling; Liu, Li-Fan; Chen, Shuh-Sin; Lin, Hsiu-Chun

    2014-02-01

    In Taiwan, long-term care management centers hold primary responsibility for administering long-term care services, assisting with long-term care placements, and sharing the care burden with family caregivers in need. Research into the effectiveness of current care management services and the effectiveness of these services in reducing care burdens remains limited. This study investigates the relationship among care management center service effectiveness, care management personnel, and burdens in relation to the provision of care services from the prospective of caregivers. A purposive sampling method and structured questionnaire survey were used to conduct telephone interviews with 154 home caregivers who had been transferred from care management centers to homecare service centers. Participants expressed overall satisfaction with care management centers and with the services provided by these centers. Satisfaction toward the care managers' professional competence was associated with lower physical burden for caregivers. Participants' psychological and social burdens were associated with overall satisfaction with the care management centers and their satisfaction with the services provided by care managers. The implementation of care management services has improved satisfaction. However, center services remain inadequate to reduce the psychological and social burdens of caregivers. Greater focus on these two aspects will be critical to the successful implementation of the proposed intensive care management model and multiple services intervention in order to meet the complex care needs of home service recipients and their primary caregivers.

  2. Exposure management systems in emergencies as comprehensive medical care

    International Nuclear Information System (INIS)

    Shinohara, Teruhiko

    2000-01-01

    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.)

  3. Control in chronic condition self-care management

    DEFF Research Database (Denmark)

    Lawn, Sharon; Delany, Toni; Sweet, Linda

    2014-01-01

    of their communication style and the power of their role must improve for client chronic condition self-care management to be achieved. Training on the impacts of control in worker communication and systems where they work must be provided if unbeneficial forms of client dependency are to be overcome and true self......Aim: To examine health worker-client interactions during care planning to understand processes that foster client empowerment and disempowerment. Background: It is unclear how health worker-client exchanges and information sharing through chronic condition care planning currently operate in primary...... health care. Moreover, it is unclear how control in these exchanges either enhances collaborative decision-making, partnership and client empowerment, or works to create client disempowerment and dependency on workers and health services. Design: Critical discourse analysis of qualitative data from...

  4. Income statement management in a turbulent health care environment.

    Science.gov (United States)

    Covaleski, M A

    2001-03-01

    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. Copyright 2001 by W.B. Saunders Company

  5. Influence of novel oral anticoagulants on anticoagulation care management.

    Science.gov (United States)

    Janzic, Andrej; Kos, Mitja

    2017-09-01

    Anticoagulation treatment was recently improved by the introduction of novel oral anticoagulants (NOACs). Using a combination of qualitative and quantitative methods, this study explores the effects of the introduction of NOACs on anticoagulation care in Slovenia. Face-to-face interviews with key stakeholders revealed evolvement and challenges of anticoagulation care from different perspectives. Obtained information was further explored through the analysis of nationwide data of drug prescriptions and realization of health care services. Simplified management of anticoagulation treatment with NOACs and their high penetration expanded the capacity of anticoagulation clinics, and consequentially the treated population increased by more than 50 % in the last 5 years. The main challenge concerned the expenditures for medicines, which increased approximately 10 times in just a few years. At the same time, the anticoagulation clinics and their core organisation were not affected, which is not expected to change, since they are vital in delivering high-quality care.

  6. Including product features in process redesign

    DEFF Research Database (Denmark)

    Hvam, Lars; Hauksdóttir, Dagný; Mortensen, Niels Henrik

    2017-01-01

    do not take into account how the product features are applied throughout the process, which makes it difficult to obtain a comprehensive understanding of the activities in the processes and to generate significant improvements. The suggested approach models the product family using the so......This article suggests a visual modelling method for integrating models of product features with business process models for redesigning the business processes involving specifications of customer-tailored products and services. The current methods for redesigning these types of business processes......-called product variant master and the business process modelling notation for modelling the process flow. The product model is combined with the process map by identifying features used in each step of the process flow. Additionally, based on the information absorbed from the integrated model, the value stream...

  7. Accounting for future redesign to balance performance and development costs

    International Nuclear Information System (INIS)

    Villanueva, D.; Haftka, R.T.; Sankar, B.V.

    2014-01-01

    Most components undergo tests after they are designed and are redesigned if necessary. Tests help designers find unsafe and overly conservative designs, and redesign can restore safety or increase performance. In general, the expected changes to the performance and reliability of the design after the test and redesign are not considered. In this paper, we explore how modeling a future test and redesign provides a company an opportunity to balance development costs versus performance by simultaneously designing the design and the post-test redesign rules during the initial design stage. Due to regulations and tradition, safety margin and safety factor based design is a common practice in industry as opposed to probabilistic design. In this paper, we show that it is possible to continue to use safety margin based design, and employ probability solely to select safety margins and redesign criteria. In this study, we find the optimum safety margins and redesign criterion for an integrated thermal protection system. These are optimized in order to find a minimum mass design with minimal redesign costs. We observed that the optimum safety margin and redesign criterion call for an initially conservative design and use the redesign process to trim excess weight rather than restore safety. This would fit well with regulatory constraints, since regulations usually impose minimum safety margins. - Highlights: • Modeling future tests and redesign allows balancing performance and development cost. • We optimize safety margins and redesign criteria for desired balance. • We design with safety margins, with probabilistic optimization to decide the margins. • Redesign also allowed the trade-off of conservativeness and performance. • In our case it paid to be conservative initially but redesign for more

  8. Five Key Leadership Actions Needed to Redesign Family Medicine Residencies.

    Science.gov (United States)

    Kozakowski, Stanley M; Eiff, M Patrice; Green, Larry A; Pugno, Perry A; Waller, Elaine; Jones, Samuel M; Fetter, Gerald; Carney, Patricia A

    2015-06-01

    New skills are needed to properly prepare the next generation of physicians and health professionals to practice in medical homes. Transforming residency training to address these new skills requires strong leadership. We sought to increase the understanding of leadership skills useful in residency programs that plan to undertake meaningful change. The Preparing the Personal Physician for Practice (P4) project (2007-2014) was a comparative case study of 14 family medicine residencies that engaged in innovative training redesign, including altering the scope, content, sequence, length, and location of training to align resident education with requirements of the patient-centered medical home. In 2012, each P4 residency team submitted a final summary report of innovations implemented, overall insights, and dissemination activities during the study. Six investigators conducted independent narrative analyses of these reports. A consensus meeting held in September 2012 was used to identify key leadership actions associated with successful educational redesign. Five leadership actions were associated with successful implementation of innovations and residency transformation: (1) manage change; (2) develop financial acumen; (3) adapt best evidence educational strategies to the local environment; (4) create and sustain a vision that engages stakeholders; and (5) demonstrate courage and resilience. Residency programs are expected to change to better prepare their graduates for a changing delivery system. Insights about effective leadership skills can provide guidance for faculty to develop the skills needed to face practical realities while guiding transformation.

  9. Managing Organized Insecurity: The Consequences for Care Workers of Deregulated Working Conditions in Elderly Care

    Directory of Open Access Journals (Sweden)

    Lene Ede

    2015-06-01

    Full Text Available Part-time work is more than twice as common among women than men in Sweden. New ways of organizing working hours to allow for more full-time jobs have been introduced for care workers in elderly care, which means unscheduled working hours based on the needs of the workplace. The aim of the study is to analyze how the organization of the unscheduled working hours affect employees’ daily lives and their possibility to provide care. The Classic Grounded Theory method was used in a secondary analysis of interviews with employees and managers in Swedish municipal elderly care. The implementation of unscheduled working hours plunged employees into a situation of managing organized insecurity. This main concern for the care workers involved a cyclic process of first having to be available for work because of economic and social obligations to the employer and the co-workers, despite sacrifices in the private sphere. Then, they had to be adaptable in relation to unknown clients and co-workers and to the employer, which means reduced possibilities to provide good care. Full-time jobs were thus created through requiring permanent staff to be flexible, which in effect meant eroded working conditions with high demands on employee adaptability. Solving the part-time problem in elderly care by introducing unscheduled working hours may in effect be counter-productive.

  10. A comprehensive approach to quality management of intensive care services.

    Science.gov (United States)

    Hariharan, Seetharaman; Dey, Prasanta Kumar

    2010-01-01

    The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance. The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated. Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state-of-the-art equipment, well maintained facilities, IT-based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis. The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit. The paper focuses on a uniform model that can be applied to most intensive care units.

  11. Development of an allergy management support system in primary care

    Directory of Open Access Journals (Sweden)

    Flokstra - de Blok BMJ

    2017-03-01

    Full Text Available Bertine MJ Flokstra - de Blok,1,2 Thys van der Molen,1,2 Wianda A Christoffers,3 Janwillem WH Kocks,1,2 Richard L Oei,4 Joanne NG Oude Elberink,2,4 Emmy M Roerdink,5 Marie Louise Schuttelaar,3 Jantina L van der Velde,1,2 Thecla M Brakel,1,6 Anthony EJ Dubois2,5 1Department of General Practice, 2GRIAC Research Institute, 3Department of Dermatology, 4Department of Allergology, 5Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen, 6Teaching Unit, Department of Social Psychology, University of Groningen, Groningen, The Netherlands Background: Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS for primary care. Methods: Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard and AMSS diagnostic categories. Results: The two-page patient-completed AMSS questionnaire consists of 12 (mainly multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other

  12. Strategies for Aligning Physicians to System Redesign Goals at Eight Safety-Net Systems.

    Science.gov (United States)

    Zallman, Leah; Bearse, Adriana; Neal, Natasha; VanDeusen Lukas, Carol; Hacker, Karen

    2014-12-01

    Facing recent economic and regulatory pressures, safety-net systems (SNSs) are redesigning their organizations to improve care delivery, remain financially viable, and maintain competitive positions. Aligning physicians with redesign goals is a priority, particularly as many SNSs shift toward patient-centered, population health-focused models. No previous work has examined efforts to align physicians to safety net redesign efforts. This qualitative study, conducted at eight SNSs, examined challenges faced in a changing health care environment, as well as strategies and resources to address them. Strategies clustered in two categories: physician role definition and organizational infrastructure. Physician role definition strategies were (1) changing payment and employment arrangements, (2) changing clinical roles, (3) increasing physician involvement in quality improvement, and (4) strengthening physician leadership in clinical and quality roles. Organizational infrastructure strategies were (1) ensuring medical center leadership support and integration, (2) utilizing data to drive physician behavior, and (3) addressing competing allegiances with academia. All sites reported multifaceted approaches but differed in specific strategies employed, facilitators noted, and challenges encountered. The findings highlight the need to implement multiple strategies to align physicians in redesign efforts. They suggest that all health systems, whether SNSs or not, can capitalize on qualities of physicians and existing infrastructural and leadership elements to achieve physician alignment. However, they must contend with and address challenges of competing allegiance (for example, academic, physician organization, hospital), as well as resistance to changing clinical roles and payment structures.

  13. Using business process redesign to reduce wait times at a university hospital in the Netherlands.

    Science.gov (United States)

    Elkhuizen, Sylvia G; Burger, Matthe P M; Jonkers, Rene E; Limburg, Martien; Klazinga, Niek; Bakker, Piet J M

    2007-06-01

    Business process redesign (BPR) has been applied to implement more customer-focused and cost-effective care. In 2002, two pilot projects to improve patient care processes for two specific patient groups were conducted at the Academic Medical Center, a 1,000-bed university hospital in Amsterdam. The BPR consisted of process analysis, identification of bottlenecks and goals for redesign, selection of interventions, and evaluation of effects. After identifying and selecting interventions with the greatest expected benefits, changes were implemented and effects were evaluated. For gynecologic oncology patients, access time (from telephone call to first visit) was reduced from 14 days to changes in communication and planning were sufficient to eliminate bottlenecks in the gynecologic oncology project, the dyspnea project required a radical redesign of processes. Experience since these projects suggests that process redesign may have only marginal impact when the greatest bottleneck occurs, as was the case for the two BPR projects, at the point of access to central diagnostic facilities.

  14. Contingency Management of Health Care Organizations: It Depends.

    Science.gov (United States)

    Olden, Peter C

    Managers in health care organizations (HCOs) must perform many processes and activities, such as planning goals, designing organization structure, leading people, motivating employees, making decisions, and resolving conflict. How they do all this strongly affects the performance and outcomes of their organizations and themselves. Some managers develop a usual way of performing their jobs and achieve some success with a preferred method of leading or a favorite approach to motivating. However, their success will be limited if they always rely on a standard "1-size-fits-all" approach. This is because contingency factors influence the effectiveness of a given approach to managing. The "best" approach depends on contingency factors, including the situation and the people involved. Managers should choose an approach to fit with the changing contingency factors. This article explains why and how managers should develop a contingency approach to managing HCOs. The development of contingency theory is briefly described. Practical application of contingency management is explained for leading, motivating, decision making, and resolving conflict. By using a contingency approach, managers can be more effective when managing their HCOs.

  15. The role of primary care in adult weight management: qualitative interviews with key stakeholders in weight management services

    OpenAIRE

    Blane, David N.; Macdonald, Sara; Morrison, David; O’Donnell, Catherine A.

    2017-01-01

    Background Primary care has a key role to play in the prevention and management of obesity, but there remain barriers to engagement in weight management by primary care practitioners. The aim of this study was to explore the views of key stakeholders in adult weight management services on the role of primary care in adult weight management. Methods Qualitative study involving semi-structured interviews with nine senior dietitians involved in NHS weight management from seven Scottish health bo...

  16. Formative evaluation of practice changes for managing depression within a Shared Care model in primary care.

    Science.gov (United States)

    Beaulac, Julie; Edwards, Jeanette; Steele, Angus

    2017-01-01

    Aim To investigate the implementation and initial impact of the Physician Integrated Network (PIN) mental health indicators, which are specific to screening and managing follow-up for depression, in three primary care practices with Shared Mental Health Care in Manitoba. Manitoba Health undertook a primary care renewal initiative in 2006 called the PIN, which included the development of mental health indicators specific to screening and managing follow-up for depression. These indicators were implemented in three PIN group practice sites in Manitoba, which are also part of Shared Mental Health Care. The design was a non-experimental longitudinal design. A formative evaluation investigated the implementation and initial impact of the mental health indicators using mixed methods (document review, survey, and interview). Quantitative data was explored using descriptive and comparative statistics and a content and theme analysis of the qualitative interviews was conducted. Survey responses were received from 32 out of 36 physicians from the three sites. Interviews were conducted with 15 providers. Findings This evaluation illustrated providers' perceived attitudes, knowledge, skills, and behaviours related to recognizing and treating depression and expanded our understanding of primary care processes related to managing depression related to the implementation of a new initiative. Depression is viewed as an important problem in primary care practice that is time consuming to diagnose, manage and treat and requires further investigation. Implementation of the PIN mental health indicators was variable across sites and providers. There was an increase in use of the indicators across time and a general sentiment that benefits of screening outweigh the costs; however, the benefit of screening for depression remains unclear. Consistent with current guidelines, a question the findings of this evaluation suggests is whether there are more effective ways of having an impact on

  17. Innovation in health service management: Adoption of project management offices to support major health care transformation.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; Aubry, Monique; Cyr, Guylaine; Richer, Marie-Claire; Fortin-Verreault, Jean-François; Fortin, Claude; Marchionni, Caroline

    2017-11-01

    To explore the characteristics that influence project management offices acceptance and adoption in healthcare sector. The creation of project management offices has been suggested as a promising avenue to promote successful organisational change and facilitate evidence-based practice. However, little is known about the characteristics that promote their initial adoption and acceptance in health care sector. This knowledge is important in the context where many organisations are considering implementing project management offices with nurse managers as leaders. A descriptive multiple case study design was used. The unit of analysis was the project management offices. The study was conducted in three university-affiliated teaching hospitals in 2013-14 (Canada). Individual interviews (n = 34) were conducted with senior managers. Results reveal that project management offices dedicated to project and change management constitute an innovation and an added value that addresses tangible needs in the field. Project management offices are an innovation highly compatible with health care managers and their approach has parallels to the process of clinical problem solving and reasoning well-known to adopters. This knowledge is important in a context where many nurses hold various roles in project management offices, such as Director, project manager, clinical expert and knowledge broker. © 2017 John Wiley & Sons Ltd.

  18. Knowledge Management System in Health & Social Care: Review on 20 Practiced Knowledge Management

    Directory of Open Access Journals (Sweden)

    Muhammad Saiful Ridhwan

    2014-02-01

    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

  19. ESRD in the geriatric population: the crisis of managed care and the opportunity of disease management.

    Science.gov (United States)

    Steinman, Theodore I

    2002-01-01

    The geriatric population with end-stage renal disease (ESRD) is placed at risk with regards to the quality and extent of medical coverage because of the rapidly changing financial environment. Managed care organizations (MCOs) are generally for-profit companies that must focus on the bottom line. While the verbal commitment to quality care is voiced, the financial pressures on MCOs have led to a decrease in coverage of many services and outright denial for some necessary treatments. While denying services, the MCOs have also reduced payments to providers for services rendered. The coverage crisis is compounded by health maintenance organizations (HMOs) quitting Medicare because the reimbursement from the Health Care Financing Administration (HCFA) is less than their costs. Because of the above issues which can potentially impact on the quality of care delivered to the ESRD geriatric population, a new approach to disease management has created the opportunity to improve total patient care to a level not yet achieved in the United States. Disease management encompasses integrated care across all disciplines. Every component of care can be tracked by a dedicated information system. Improvement in outcomes has far exceeded the U.S. Renal Data System (USRDS) benchmark performance measurements with a disease management model approach. The key to success is the health service coordinator (HSC), a senior nurse with many years of ESRD experience. This individual coordinates care across all disciplines and expedites necessary referrals. With rapid attention to patient needs there has been a significant reduction in hospital admissions, hospital length of stay, and emergency room visits. Patient care will steadily improve as the disease management system matures as a consequence of understanding the patients total physical and psychosocial needs.

  20. Using project management methodology to plan and track inpatient care.

    Science.gov (United States)

    Kaufman, Darren S

    2005-08-01

    Effective care of each patient throughout a hospital admission involves executing a specific set of tasks to produce a favorable outcome within an appropriate time frame. The ProjectRounds methodology, which can be implemented using widely available software, incorporates the principles of project management in planning and control hospital inpatient care. It consists of four stages--clinical assessment, planning, scheduling, and tracking. OVERVIEW OF PROJECTROUNDS AND EXAMPLE: As an example, a 68-year-old-man is admitted with pneumonia. In clinical assessment, the admitting physician uses an assessment tool that prompts her to list all the patient's clinical issues, define the conditions that need to be met to discharge the patient, highlight special problems, and list any consultations, diagnostic tests, and procedures that are planned. In planning, the work breakdown structure--a tabulation of all the tasks in the "project" (the admission)--is created. In scheduling, a project schedule is generated, and in tracking, the clinical team evaluates and monitors the project's course. During interdisciplinary clinical rounds, the progress of the patient's hospital care can be tracked and quantified by employing the percent complete method. Tracking can be used as a "dashboard," providing a concise summary of the care that needs to be and has been rendered to the patient. Applying the tenets of project management can optimize the process of providing health care to hospital inpatients.

  1. Diabetes management in an Australian primary care population.

    Science.gov (United States)

    Krass, I; Hebing, R; Mitchell, B; Hughes, J; Peterson, G; Song, Y J C; Stewart, K; Armour, C L

    2011-12-01

    Worldwide studies have shown that significant proportions of patients with type 2 diabetes (T2DM) do not meet targets for glycaemic control, blood pressure (BP) and lipids, putting them at higher risk of developing complications. However, little is known about medicines management in Australian primary care populations with T2DM. The aim of this study was to (i) describe the management of a large group of patients in primary care, (ii) identify areas for improvement in management and (iii) determine any relationship between adherence and glycaemic, BP and lipid control. This was a retrospective, epidemiological study of primary care patients with T2DM diabetes, with HbA(1c) of >7%, recruited in 90 Australian community pharmacies. Data collected included demographic details, diabetes history, current medication regimen, height, weight, BP, physical activity and smoking status. Of the 430 patients, 98% used antidiabetics, 80% antihypertensives, 73% lipid lowering drugs and 38% aspirin. BP and all lipid targets were met by only 21% and 14% of the treated patients and 21% and 12% of the untreated patients respectively. Medication adherence was related to better glycaemic control (P = 0.04). An evidence-base prescribing practice gap was seen in this Australian primary care population of T2DM patients. Patients were undertreated with antihypertensive and lipid lowering medication, and several subgroups with co-morbidities were not receiving the recommended pharmacotherapy. Interventions are required to redress the current evidence-base prescribing practice gap in disease management in primary care. © 2011 Blackwell Publishing Ltd.

  2. Chronic disease management: improving care for people with osteoarthritis.

    Science.gov (United States)

    Brand, Caroline A; Ackerman, Ilana N; Tropea, Joanne

    2014-02-01

    Chronic disease management (CDM) service models are being developed for many conditions; however, there is limited evidence to support their effectiveness in osteoarthritis (OA). A systematic review was undertaken to examine effectiveness, cost effectiveness and barriers to the use of osteoarthritis-chronic disease management (OA-CDM) service models. Thirteen eligible studies (eight randomised controlled trial (RCTs)) were identified. The majority focussed on delivery system design (n = 9) and/or providing self-management support (SMS) (n = 8). Overall, reported model effectiveness varied, and where positive impacts on process or health outcomes were observed, they were of small to moderate effect. There was no information about cost effectiveness. There is some evidence to support the use of collaborative care/multidisciplinary case management models in primary and community care and evidence-based pathways/standardisation of care in hospital settings. Multiple barriers were identified. Future research should focus on identifying the effective components of multi-faceted interventions and evaluating cost-effectiveness to support clinical and policy decision-making. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement.

    Science.gov (United States)

    Rao-Gupta, Suma; Kruger, David; Leak, Lonna D; Tieman, Lisa A; Manworren, Renee C B

    2017-12-15

    Most children experience pain in hospitals; and their parents report dissatisfaction with how well pain was managed. Engaging patients and families in the development and evaluation of pain treatment plans may improve perceptions of pain management and hospital experiences. The aim of this performance improvement project was to engage patients and families to address hospitalized pediatric patients' pain using interactive patient care technology. The goal was to stimulate conversations about pain management expectations and perceptions of treatment plan effectiveness among patients, parents, and health care teams. Plan-Do-Study-Act was used to design, develop, test, and pilot new workflows to integrate the interactive patient care technology system with the automated medication dispensing system and document actions from both systems into the electronic health record. The pediatric surgical unit and hematology/oncology unit of a free-standing, university-affiliated, urban children's hospital were selected to pilot this performance improvement project because of the high prevalence of pain from surgeries and hematologic and oncologic diseases, treatments, and invasive procedures. Documentation of pain assessments, nonpharmacologic interventions, and evaluation of treatment effectiveness increased. The proportion of positive family satisfaction responses for pain management significantly increased from fiscal year 2014 to fiscal year 2016 (p = .006). By leveraging interactive patient care technologies, patients and families were engaged to take an active role in pain treatment plans and evaluation of treatment outcomes. Improved active communication and partnership with patients and families can effectively change organizational culture to be more sensitive to patients' pain and patients' and families' hospital experiences. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  4. Adapting to managed care by becoming a learning organization.

    Science.gov (United States)

    O'Sullivan, M J

    1999-03-01

    In the tumultuous and chaotic environment of managed health care, hospital-based mental health providers need to change in fundamental ways. The traditional view of mental health organizations is a professional-bureaucratic one where actions and outcomes of planning are thought to be highly predictable. The author proposes an alternative paradigm for viewing mental health provider organizations, one based on learning theory, which accepts that the future is unknowable because of its complexity and the probabilistic nature of the world. Within this perspective, mental health care providers need to become "learning organizations" to successfully adapt to the new and evolving conditions.

  5. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Hannah Masoud

    2016-01-01

    Full Text Available Accurate diagnosis of Takotsubo Cardiomyopathy has substantial prognostic implications in an intensive care unit, given its increased mortality risk and association with life-threatening complications. This report seeks to discuss diagnostic modalities that can be useful in accurately differentiating Takotsubo Cardiomyopathy from Acute Coronary Syndrome, and also briefly discuss prevention and management of this cardiomyopathy in an intensive care unit. For critically ill Takotsubo patients, intensive clinicians can consider establishment of diagnosis by specific electrocardiograph changes, distinctive marked release of cardiac enzymes, characteristic echocardiograph findings, as well as invasive coronary angiography or noninvasive cardiac magnetic imaging.

  6. Youth Psychotherapy Change Trajectories and Outcomes in Usual Care: Community Mental Health versus Managed Care Settings

    Science.gov (United States)

    Warren, Jared S.; Nelson, Philip L.; Mondragon, Sasha A.; Baldwin, Scott A.; Burlingame, Gary M.

    2010-01-01

    Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome…

  7. Key strategies and criteria to redesigning the nuclear fuel cycle

    International Nuclear Information System (INIS)

    Iakimets, V.N.

    1999-01-01

    Design of the nuclear fuel cycle (NFC) impacts future development of the nuclear industry on the one hand and the scale of the technological and environmental risk for future generations on the other hand. Adequate protection for humans and the biosphere will depend upon careful and unbiased design of the NFC. This paper addresses the two following problems: 1. What are the key strategies in restructuring nuclear power production itself in terms of choosing the safest possible variant of the NFC and identifying reasonable approaches to redesigning decision-making procedures for design, siting and operation, and decommissioning of new facilities, which have to be based on a strong legally approved citizen involvement. 2. What criteria should be used to evaluate any strategic or mid-term decisions related to the NFC, how can these be made operational, and what procedures may we apply to evaluate alternatives and select the most preferable one mutually acceptable to both citizens and nuclear specialists?

  8. The development of an acute care case manager orientation.

    Science.gov (United States)

    Strzelecki, S; Brobst, R

    1997-01-01

    The authors describe the development of an inpatient acute care case manager orientation in a community hospital. Benner's application of the Dreyfus model of skill acquisition provides the basis for the orientation program. The candidates for the case manager position were expert clinicians. Because of the role change it was projected that they would function as advanced beginners. It was also predicted that, as the case managers progressed within the role, the educational process would need to be adapted to facilitate progression of skills to the proficient level. Feedback from participants reinforced that the model supported the case manager in the role transition. In addition, the model provided a predictive framework for ongoing educational activities.

  9. Challenges encountered by critical care unit managers in the large intensive care units.

    Science.gov (United States)

    Matlakala, Mokgadi C; Bezuidenhout, Martie C; Botha, Annali D H

    2014-04-04

    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. The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs. 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. 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. 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.

  10. Challenges encountered by critical care unit managers in the large intensive care units

    Directory of Open Access Journals (Sweden)

    Mokgadi C. Matlakala

    2014-04-01

    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.

  11. Guidelines of care for the management of acne vulgaris.

    Science.gov (United States)

    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

    2016-05-01

    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. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  12. Health Care Leadership: Managing Knowledge Bases as Stakeholders.

    Science.gov (United States)

    Rotarius, Timothy

    Communities are composed of many organizations. These organizations naturally form clusters based on common patterns of knowledge, skills, and abilities of the individual organizations. Each of these spontaneous clusters represents a distinct knowledge base. The health care knowledge base is shown to be the natural leader of any community. Using the Central Florida region's 5 knowledge bases as an example, each knowledge base is categorized as a distinct type of stakeholder, and then a specific stakeholder management strategy is discussed to facilitate managing both the cooperative potential and the threatening potential of each "knowledge base" stakeholder.

  13. [Training of health-care employees in crisis resource management].

    Science.gov (United States)

    Spanager, Lene; Østergaard, Doris; Lippert, Anne; Nielsen, Kurt; Dieckmann, Peter

    2013-03-25

    Studies show that human errors contribute to up to 70% of mistakes and mishaps in health care. Crisis resource management, CRM, is a conceptual framework for analysing and training individual and team skills in order to prevent and manage errors. Different CRM training methods, e.g. simulation, are in use and the literature emphasises the need of training the full team or organisation for maximal effect. CRM training has an effect on skill improvement, but few studies have shown an effect on patient outcome. However, these studies show great variability of quality.

  14. Tools for primary care management of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bennett, Alice L; Munkholm, Pia; Andrews, Jane M

    2015-01-01

    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 ...... supportive literature. The purpose of this review is to investigate what non-specialist tools, action plans or guidelines for IBD are published in readily searchable medical literature and compare these to those which exist for other chronic conditions....... 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 associated...

  15. Solid health care waste management status at health care centers in the West Bank - Palestinian Territory

    International Nuclear Information System (INIS)

    Al-Khatib, Issam A.; Sato, Chikashi

    2009-01-01

    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 m 3 (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.

  16. Peer-led, transformative learning approaches increase classroom engagement in care self-management classes during inpatient rehabilitation of individuals with spinal cord injury.

    Science.gov (United States)

    Gassaway, Julie; Jones, Michael L; Sweatman, W Mark; Young, Tamara

    2017-10-16

    Evaluate effects of revised education classes on classroom engagement during inpatient rehabilitation for individuals with spinal cord injury/disease (SCI/D). Multiple-baseline, quasi-experimental design with video recorded engagement observations during conventional and revised education classes; visual and statistical analysis of difference in positive engagement responses observed in classes using each approach. 81 patients (72% male, 73% white, mean age 36 SD 15.6) admitted for SCI/D inpatient rehabilitation in a non-profit rehabilitation hospital, who attended one or more of 33 care self-management education classes that were video recorded. All study activities were approved by the host facility institutional review board. Conventional nurse-led self-management classes were replaced with revised peer-led classes incorporating approaches to promote transformative learning. Revised classes were introduced across three subject areas in a step-wise fashion over 15 weeks. Positive engagement responses (asking questions, participating in discussion, gesturing, raising hand, or otherwise noting approval) were documented from video recordings of 14 conventional and 19 revised education classes. Significantly higher average (per patient per class) positive engagement responses were observed in the revised compared to conventional classes (p=0.008). Redesigning SCI inpatient rehabilitation care self-management classes to promote transformative learning increased patient engagement. Additional research is needed to examine longer term outcomes and replicability in other settings.

  17. In Connecticut: improving patient medication management in primary care.

    Science.gov (United States)

    Smith, Marie; Giuliano, Margherita R; Starkowski, Michael P

    2011-04-01

    Medications are a cornerstone of the management of most chronic conditions. However, medication discrepancies and medication-related problems-some of which can cause serious harm-are common. Pharmacists have the expertise to identify, resolve, monitor, and prevent these problems. We present findings from a Centers for Medicare and Medicaid Services demonstration project in Connecticut, in which nine pharmacists worked closely with eighty-eight Medicaid patients from July 2009 through May 2010. The pharmacists identified 917 drug therapy problems and resolved nearly 80 [corrected] percent of them after four encounters. The result was an estimated annual saving of $1,123 per patient on medication claims and $472 per patient on medical, hospital, and emergency department expenses-more than enough to pay for the contracted pharmacist services. We recommend that the Center for Medicare and Medicaid Innovation support the evaluation of pharmacist-provided medication management services in primary care medical homes, accountable care organizations, and community health and care transition teams, as well as research to explore how to enhance team-based care.

  18. Pharmaceutical management in ProCare Health Limited.

    Science.gov (United States)

    Malcolm, L; Barry, M; MacLean, I

    2001-06-22

    To review pharmaceutical budget holding and management in ProCare Health Limited by; describing budget holding strategies implemented in 1995/6, identifying prescribing savings achieved, analysing variation in prescribing behaviour and comparing the findings with experience elsewhere. With 340 members, ProCare is one of the largest and most progressive of New Zealand's independent practitioner associations (IPAs). Data were obtained for the three years 1994 to 1996 to determine pharmaceutical expenditure against budget and against national trends, by member and general medical services (GMS) consultations. ProCare has established a classical, quality focussed pharmaceutical management strategy. Savings against the agreed budget was 9.5% comparing 1996 with 1995 but 5.7% compared, with national trends. Wide variation in per capita and per consultation costs was not reduced and was entirely explained by prescribing volumes not drug prices. The most important finding is that general practitioners (GPs), working collaboratively, can establish a strategy of clinical and corporate governance which may be exerting a wide ranging influence over clinical behaviour. Although there may be doubts about the actual levels of saving these appeared to be well in excess of the financial investment in the strategy. Greater savings appear possible with a focus on addressing the large and apparently inappropriate per capita prescribing volume variation between practices. Understanding and successfully addressing this variation will be one of the key issues facing the implementation of the government's primary health care strategy.

  19. Enhancing systems to improve the management of acute, unscheduled care.

    Science.gov (United States)

    Braithwaite, Sabina A; Pines, Jesse M; Asplin, Brent R; Epstein, Stephen K

    2011-06-01

    For acutely ill patients, health care services are available in many different settings, including hospital-based emergency departments (EDs), retail clinics, federally qualified health centers, and outpatient clinics. Certain conditions are the sole domain of particular settings: stabilization of critically ill patients can typically only be provided in EDs. By contrast, many conditions that do not require hospital resources, such as advanced radiography, admission, and same-day consultation can often be managed in clinic settings. Because clinics are generally not open nights, and often not on weekends or holidays, the ED remains the only option for face-to-face medical care during these times. For patients who can be managed in either setting, there are many open research questions about which is the best setting, because these venues differ in terms of access, costs of care, and potentially, quality. Consideration of these patients must be risk-adjusted, as patients may self-select a venue for care based upon perceived acuity. We present a research agenda for acute, unscheduled care in the United States developed in conjunction with an Agency for Healthcare Research and Quality-funded conference hosted by the American College of Emergency Physicians in October 2009, titled "Improving the Quality and Efficiency of Emergency Care Across the Continuum: A Systems Approach." Given the possible increase in ED utilization over the next several years as more people become insured, understanding differences in cost, quality, and access for conditions that may be treated in EDs or clinic settings will be vital in guiding national health policy. © 2011 by the Society for Academic Emergency Medicine.

  20. A Training Intervention to Improve Information Management in Primary Care

    Science.gov (United States)

    Schifferdecker, Karen E.; Reed, Virginia A.; Homa, Karen

    2010-01-01

    Background and Objectives Training programs designed to improve information management have been implemented but not adequately tested. Three critical components for information management were tested in a randomized control study: (1) knowledge of valid, synthesized summary information, (2) skills to use Web-based resources that provide access to these summaries, and (3) use of Web-based resources in clinical practice. Methods Twenty-four primary care practices were provided with computers and high-speed Internet access and then matched, with half randomly assigned to receive training and half to receive training at a later date. Training was designed to address knowledge, skills, and use of Web-based information. Outcomes were assessed by comparing baseline and follow-up questionnaires that focused on five conceptual domains related to Web-based resource use for patient care decisions and patient education. Results Compared to the delayed training group, the initial training group increased their knowledge and skill of Web-based resources and use for patient care decisions. Some measures of communication with patients about using Web-based resources and of incorporating use of Web-based resources into daily practice increased from baseline to follow-up for all participants. Conclusions Our findings suggest that training and providing computers and Internet connections have measurable effects on information management behaviors. PMID:18773781

  1. The effect of normative social forces on managed care organizations: implications for strategic management.

    Science.gov (United States)

    Kirby, E G; Sebastian, J G

    1998-01-01

    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

  2. The impact of care management information technology model on quality of care after Coronary Artery Bypass Surgery: "Bridging the Divides".

    Science.gov (United States)

    Weintraub, William S; Elliott, Daniel; Fanari, Zaher; Ostertag-Stretch, Jennifer; Muther, Ann; Lynahan, Margaret; Kerzner, Roger; Salam, Tabassum; Scherrer, Herbert; Anderson, Sharon; Russo, Carla A; Kolm, Paul; Steinberg, Terri H

    Reducing readmissions and improving metrics of care are a national priority. Supplementing traditional care with care management may improve outcomes. The Bridges program was an initial evaluation of a care management platform (CareLinkHub), supported by information technology (IT) developed to improve the quality and transition of care from hospital to home after Coronary Artery Bypass Surgery (CABG) and reduce readmissions. CareLink is comprised of care managers, patient navigators, pharmacists and physicians. Information to guide care management is guided by a middleware layer to gather information, PLR (ColdLight Solutions, LLC) and presented to CareLink staff on a care management platform, Aerial™ (Medecision). In addition there is an analytic engine to help evaluate and guide care, Neuron™ (Coldlight Solutions, LLC). The "Bridges" program enrolled a total of 716 CABG patients with 850 admissions from April 2013 through March 2015. The data of the program was compared with those of 1111 CABG patients with 1203 admissions in the 3years prior to the program. No impact was seen with respect to readmissions, Blood Pressure or LDL control. There was no significant improvement in patients' reported outcomes using either the CTM-3 or any of the SAQ-7 scores. Patient follow-up with physicians within 1week of discharge improved during the Bridges years. The CareLink hub platform was successfully implemented. Little or no impact on outcome metrics was seen in the short follow-up time. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Implementing Business Process Redesign: early lessons from the Australian experience

    Directory of Open Access Journals (Sweden)

    Marianne Broadbent

    1995-05-01

    Full Text Available Business Process Redesign (BPR is a change management approach aimed at achieving quantum improvements in business performance. Industry interest levels in BPR are high as a direct result of current difficulties in the global economic climate and tight business conditions. Integral to BPR is the availability of new stable technologies which both stimulate and enable process changes. This paper highlights the experiences of a number of Australian firms which have implemented BPR. A ten step framework for BPR is presented together with a series of caveats. BPR is a difficult, messy and often non-linear activity which challenges many of the ways organisations operate. Information Technology plays a pivotal role in BPR as both an enabler and disenabler for change. Lessons emerging from early Australian experiences with BPR focus on the role of executive sponsorship, consultants, measurements, education and training, technology and people involved in the change process.

  4. Managed care and the quality of substance abuse treatment.

    Science.gov (United States)

    Shepard, Donald S; Daley, Marilyn; Ritter, Grant A; Hodgkin, Dominic; Beinecke, Richard H

    2002-12-01

    In the US, the spiraling costs of substance abuse and mental health treatment caused many state Medicaid agencies to adopt managed behavioral health care (MBHC) plans during the 1990s. Although research suggests that these plans have successfully reduced public sector spending, their impact on the quality of substance abuse treatment has not been established. The Massachusetts Medicaid program started a risk-sharing contract with MHMA, a private, for-profit specialty managed behavioral health care (MBHC) carve-out vendor on July 1, 1992. This paper evaluates the carve-out s impact on spending per inpatient episode and three proxy measures of quality: (i) access to inpatient treatment (ii) 30-day re-admissions and (iii) continuity of care. Medicaid claims for inpatient treatment were collapsed into episodes. Clients were tracked across the five-year period and an interrupted time series design was used to compare the three quality outcomes and spending in the year prior to (FY1992) and the four years during MHMA (FY1993-FY1996). Logistic and linear regression models were used to control for race, disability status, age, gender and primary diagnosis. Despite a 99% reduction in the use of hospital-based settings, access to 24-hour services overall increased by 38%, largely due to an expansion in the use of freestanding detoxification and acute residential services. Continuity improved by 73%. Nevertheless, rates of 7-day (58%) and 30-day (24%) readmission increased significantly, even after controlling for increases in disability status. Per episode spending decreased by 76% ($2,773), characterized by a dramatic spending reduction in FY1993 that was maintained but not augmented in subsequent years. The carve-out had mixed effects on the quality of substance abuse treatment. While one of the three measures (readmission rates) deteriorated, two improved (access and continuity). Rapid re-admissions were strongly associated with shorter lengths of stay, suggesting that

  5. Bowel management systems in critical care: a service evaluation.

    Science.gov (United States)

    Ritzema, Jennifer

    2017-01-25

    Aim Many patients who are critically ill develop faecal incontinence associated with diarrhoea, and require a bowel management system (BMS) to prevent skin excoriation. Following guidelines produced by the National Institute for Health and Care Excellence, early rehabilitation has resulted in a reduction in the number of days that patients receive mechanical ventilation. However, patients with a BMS are potentially mechanically ventilated for longer because they are cared for in bed. The aim of this evaluation was to investigate whether patients with a BMS are mechanically ventilated for longer than those without a BMS. Method This was a retrospective service evaluation, in which a database search was conducted to identify patients admitted to the critical care department in one healthcare organisation during 2013. The search was narrowed to identify patients admitted to the critical care department who had received advanced respiratory support (mechanical ventilation), to compare the mean number of mechanically ventilated days between patients with and without a BMS (n = 122). Data were analysed using the Mann-Whitney U test. Results There was a significant difference in the number of mechanically ventilated days (Pcritically ill patients with a BMS are placed in a sitting position for short periods of time. Further research should explore alternative bowel care options for patients who are critically ill.

  6. Managing managed care: habitus, hysteresis and the end(s) of psychotherapy.

    Science.gov (United States)

    Kirschner, S R; Lachicotte, W S

    2001-12-01

    In this paper we examine how clinicians at a community mental health center are responding to the beginnings of changes in the health care delivery system, changes that are designated under the rubric of "managed care." We describe how clinicians' attitudes about good mental health care are embodied in what sociologist Pierre Bourdieu calls their habitus, i.e., their professional habits and sense of good practice. Viewed in this light, their moral outrage and sense of threat, as well as their strategic attempts to resist or subvert the dictates of managed care agencies, become a function of what Bourdieu terms the hysteresis effect. The paper is based on ethnographic fieldwork conducted by a team of researchers at the mental health and substance abuse service of a hospital-affiliated, storefront clinic which serves residents of several neighborhoods in a large northeastern city. Data consist primarily of observations of meetings and interviews with staff members. We describe four aspects of the clinicians' professional habitus: a focus on cases as narratives of character and relationship, an imperative of authenticity, a distinctive orientation towards time, and an ethic of ambiguity. We then chronicle practices that have emerged in response to the limits on care imposed by managed care protocols, which are experienced by clinicians as violating the integrity of their work. These are discussed in relation to the concept of hysteresis.

  7. Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

    Directory of Open Access Journals (Sweden)

    Morris J

    2014-06-01

    Full Text Available Joanne Morris,1 Karen Grimmer,2 Lisa Gilmore,1 Chandima Perera,3 Gordon Waddington,4 Greg Kyle,4 Bryan Ashman,5 Karen Murphy61The Physiotherapy Department, The Canberra Hospital, ACT Health, Canberra, ACT, Australia; 2International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia; 3Department of Rheumatology, The Canberra Hospital, Canberra, ACT, Australia; 4The Faculty of Health, University of Canberra, Canberra, ACT, Australia; 5Department of Surgical Services, The Canberra Hospital, Canberra, ACT, Australia; 6Office of Allied Health Advisor, ACT Health, Canberra, ACT, AustraliaAbstract: Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable

  8. Anaesthetic and critical care management of thoracic injuries.

    Science.gov (United States)

    Round, J A; Mellor, A J

    2010-09-01

    Thoracic wounding has been a relatively common presentation of military wounds throughout modern conflict. When civilian casualties are included the incidence has remained constant at around 10%, although the frequency and severity of wounds to combatants has been altered by modern body armour. Whilst thoracic injury has a high initial mortality on the battlefield, those surviving to reach hospital frequently have injuries that only require simple management. In addition to penetrating ballistic injury, blunt chest trauma frequently occurs on operations as a result of road traffic collisions or tertiary blast injury. The physiological impact of thoracic wounds, however, is often great and survivors often require intensive care management and, where available, complex strategies to ensure oxygenation and carbon dioxide removal. This review examines the incidence and patterns of thoracic trauma and looks at therapeutic options for managing these complex cases.

  9. Managing corporate governance risks in a nonprofit health care organization.

    Science.gov (United States)

    Troyer, Glenn T; Brashear, Andrea D; Green, Kelly J

    2005-01-01

    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.

  10. When bad things happen: adverse event reporting and disclosure as patient safety and risk management tools in the neonatal intensive care unit.

    Science.gov (United States)

    Donn, Steven M; McDonnell, William M

    2012-01-01

    The Institute of Medicine has recommended a change in culture from "name and blame" to patient safety. This will require system redesign to identify and address errors, establish performance standards, and set safety expectations. This approach, however, is at odds with the present medical malpractice (tort) system. The current system is outcomes-based, meaning that health care providers and institutions are often sued despite providing appropriate care. Nevertheless, the focus should remain to provide the safest patient care. Effective peer review may be hindered by the present tort system. Reporting of medical errors is a key piece of peer review and education, and both anonymous reporting and confidential reporting of errors have potential disadvantages. Diagnostic and treatment errors continue to be the leading sources of allegations of malpractice in pediatrics, and the neonatal intensive care unit is uniquely vulnerable. Most errors result from systems failures rather than human error. Risk management can be an effective process to identify, evaluate, and address problems that may injure patients, lead to malpractice claims, and result in financial losses. Risk management identifies risk or potential risk, calculates the probability of an adverse event arising from a risk, estimates the impact of the adverse event, and attempts to control the risk. Implementation of a successful risk management program requires a positive attitude, sufficient knowledge base, and a commitment to improvement. Transparency in the disclosure of medical errors and a strategy of prospective risk management in dealing with medical errors may result in a substantial reduction in medical malpractice lawsuits, lower litigation costs, and a more safety-conscious environment. Thieme Medical Publishers, Inc.

  11. Effect of Medicaid Managed Care on racial disparities in health care access.

    Science.gov (United States)

    Cook, Benjamin Lê

    2007-02-01

    To evaluate the impact of Medicaid Managed Care (MMC) on racial disparities in access to care consistent with the Institute of Medicine (IOM) definition of racial disparity, which excludes differences stemming from health status but includes socioeconomic status (SES)-mediated differences. Secondary data from the Adult Samples of the 1997-2001 National Health Interview Survey, metropolitan statistical area (MSA)-level Medicaid Health Maintenance Organization (MHMO) market share from the 1997 to 2001 InterStudy MSA Trend Dataset, and MSA characteristics from the 1997 to 2001 Area Resource File. I estimate multivariate regression models to compare racial disparities in doctor visits, emergency room (ER) use, and having a usual source of care between enrollees in MMC and Medicaid Fee-for-Service (FFS) plans. To contend with potential selection bias, I use a difference-in-difference analytical strategy and assess the impact of greater MHMO market share at the MSA level on Medicaid enrollees' access measures. To implement the IOM definition of racial disparity, I adjust for health status but not SES factors using a novel method to transform the distribution of health status for minority populations to approximate the white health status distribution. MMC enrollment is associated with lowered disparities in having any doctor visit in the last year for blacks, and in having any usual source of care for both blacks and Hispanics. Increasing Medicaid HMO market share lowered disparities in having any doctor visits in the last year for both blacks and Hispanics. Although disparities in most other measures were not much affected, black-white ER use disparities exist among MMC enrollees and in areas of high MHMO market share. MMC programs' reduction of some disparities suggests that recent shifts in Medicaid policy toward managed care plans have benefited minority enrollees. Future research should investigate whether black-white disparities in ER use within MMC groups

  12. Enhancing policy innovation by redesigning representative democracy

    DEFF Research Database (Denmark)

    Sørensen, Eva

    2016-01-01

    Policy innovation is a key aspect of public innovation, which has been largely overlooked. Political leadership, competition and collaboration are key drivers of policy innovation. It is a barrier in traditional models of representative democracy that they provide weak conditions for collaboration....... Two Danish case studies indicate that collaboration between politicians and relevant and affected stakeholders can promote policy innovation, but also that a redesign of representative democracy is needed in order to establish a productive combination of political leadership, competition...... and collaboration in political life....

  13. Redesigning Health Information Systems in Developing Countries

    DEFF Research Database (Denmark)

    Mengiste, Shegaw Anagaw; Kimaro, Honest; Aanestad, Margunn

    2008-01-01

    or no end user involvement results in a centralised HIS with an extensive, somewhat inappropriate, but also inflexible set of standards. Consequently, the HIS is not very useful for the wished-for decentralisation of health services, and there is an urgent need to redesign the existing HIS in order to make...... degree of control over a decentralised HIS, including budgets and the use of resources, should be delegated to the district administration. In order to achieve the aim of a locally relevant, well-working HIS, it is necessary that appropriate authority, capacity and decentralised allocation of resources...

  14. Redesigning Manufacturing Footprint from Dynamic Perspective

    DEFF Research Database (Denmark)

    Yang, Cheng; Farooq, Sami; Johansen, John

    2009-01-01

    footprint to address the constantly emerging new challenges by giving a holistic approach from dynamic perspective. Three Danish companies are presented. The way they developed their international manufacturing networks is analysed historically, and their redesigning of manufacturing footprint is expressed...... as how to re-assign portfolios of products and processes between specific plants within the same manufacturing network at one point in time. The strategic factors that have impact on such decisions are discussed and classified into two groups. Last, a holistic framework and a process model is presented...

  15. Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model.

    Science.gov (United States)

    Delon, Sandra; Mackinnon, Blair

    2009-01-01

    Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.

  16. RESOURCE MANAGEMENT AMONG INTENSIVE CARE NURSES: AN ETHNOGRAPHIC STUDY.

    Science.gov (United States)

    Heydari, Abbas; Najar, Ali Vafaee; Bakhshi, Mahmoud

    2015-12-01

    Nurses are the main users of supplies and equipment applied in the Intensive Care Units (ICUs) which are high-priced and costly. Therefore, understanding ICU nurses' experiences about resource management contributes to the better control of the costs. This study aimed to investigate the culture of nurses' working environment regarding the resource management in the ICUs in Iran. In this study, a focused ethnographic method was used. Twenty-eight informants among ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations as a participant observer was used for data gathering. Data analysis was performed using the methods described by Miles and Huberman (1994). Two main themes describing the culture of ICU nurses regarding resource management included (a) consumption monitoring and auditing, and (b) prudent use. The results revealed that the efforts for resource management are conducted in the conditions of scarcity and uncertainty in supply. ICU nurses had a sense of futurism in the supply and use of resources in the unit and do the planning through taking the rules and guidelines as well as the available resources and their values into account. Improper storage of some supplies and equipment was a reaction to this uncertain condition among nurses. To manage the resources effectively, improvement of supply chain management in hospital seems essential. It is also necessary to hold educational classes in order to enhance the nurses' awareness on effective supply chain and storage of the items in the unit stock.

  17. Integrated Pest Management: A Curriculum for Early Care and Education Programs

    Science.gov (United States)

    California Childcare Health Program, 2011

    2011-01-01

    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…

  18. 76 FR 34541 - Child and Adult Care Food Program Improving Management and Program Integrity

    Science.gov (United States)

    2011-06-13

    ... 7 CFR Parts 210, 215, 220 et al. Child and Adult Care Food Program Improving Management and Program..., 220, 225, and 226 RIN 0584-AC24 Child and Adult Care Food Program Improving Management and Program... management and integrity in the Child and Adult Care Food Program (CACFP), at 67 FR 43447 (June 27, 2002) and...

  19. A survey of managed care strategies for pregnant smokers.

    Science.gov (United States)

    Barker, D C; Robinson, L A; Rosenthal, A C

    2000-01-01

    The purpose of this study was to measure the content and comprehensiveness of pregnancy specific smoking cessation strategies within managed care organisations (MCOs) responding affirmatively to the national 1997-98 Addressing Tobacco in Managed Care (ATMC) survey. This cross sectional follow up study consisted of a fax survey sent to medical directors and a 37 question telephone survey of program overseers about the smoking cessation strategy. 147 MCOs identifying a pregnancy specific smoking cessation strategy on the 1997-98 ATMC survey served as the initial sample; 88 MCOs of 128 eligible plans completed both components, with a response rate of 69%. Pregnancy specific smoking cessation strategies varied. 40% of respondents used the Agency for Health Care Policy and Research guidelines for clinical smoking cessation to design their strategy. Strategies included self help materials, quit classes, telephone support and brief counselling by providers, linkages to quality improvement efforts, and use of patient databases for outreach. Only 42% offered a postpartum relapse prevention element. Lack of patient interest, competing clinic priorities, and the lack of a smoker identification system were the most problematic barriers to implementing strategies, common to at least a quarter of respondents. A majority ranked best practice manuals and web site linkages as the most useful form of technical assistance, followed by peer-to-peer counselling, regional workshops, newsletters, on-site assistance, and national conferences. The survey provides the first profile of prenatal tobacco treatment strategies in managed care. While design limitations prevent generalisation of these results to all MCOs, such information can help guide technical assistance to plans interested in reducing smoking among pregnant women.

  20. Development of redesign method of production system based on QFD

    Science.gov (United States)

    Kondoh, Shinsuke; Umeda, Yasusi; Togawa, Hisashi

    In order to catch up with rapidly changing market environment, rapid and flexible redesign of production system is quite important. For effective and rapid redesign of production system, a redesign support system is eagerly needed. To this end, this paper proposes a redesign method of production system based on Quality Function Deployment (QFD). This method represents a designer's intention in the form of QFD, collects experts' knowledge as “Production Method (PM) modules,” and formulates redesign guidelines as seven redesign operations so as to support a designer to find out improvement ideas in a systematical manner. This paper also illustrates a redesign support tool of a production system we have developed based on this method, and demonstrates its feasibility with a practical example of a production system of a contact probe. A result from this example shows that comparable cost reduction to those of veteran designers can be achieved by a novice designer. From this result, we conclude our redesign method is effective and feasible for supporting redesign of a production system.

  1. Best practices in business process redesign: an overview and qualitative evaluation of successful redesign heuristics

    NARCIS (Netherlands)

    Reijers, H.A.; Limam Mansar, S.

    2005-01-01

    To implement business process redesign several best practices can be distinguished. This paper gives an overview of heuristic rules that can support practitioners to develop a business process design that is a radical improvement of a current design. The emphasis is on the mechanics of the process,

  2. Procedure Redesign Methods : E3-Control: a redesign methodology for control procedures

    NARCIS (Netherlands)

    Liu, J.; Hofman, W.J.; Tan, Y.H.

    2011-01-01

    This chapter highlights the core research methodology, e3-control, that is applied throughout the ITAIDE project for the purpose of control procedure redesign. We present the key concept of the e3-control methodology and its technical guidelines. Based on the output of this chapter, domain experts

  3. Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: a controlled before and after study

    NARCIS (Netherlands)

    Janssen, M.; Wensing, M.; Gaag, R.J. van der; Cornelissen, I.; Deurzen, P.A. van; Buitelaar, J.K.

    2014-01-01

    BackgroundImplementation of clinical guidelines for diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents is a challenge in practice due to insufficient availability of mental health specialists and lack of effective cooperation with primary care

  4. Physicians in health care management: 2. Managing performance: who, what, how and when?

    OpenAIRE

    Lemieux-Charles, L

    1994-01-01

    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...

  5. The challenge of managing laboratory information in a managed care environment.

    Science.gov (United States)

    Friedman, B A

    1996-04-01

    This article considers some of the major changes that are occurring in pathology and pathology informatics in response to the shift to managed care in the United States. To better understand the relationship between information management in clinical laboratories and managed care, a typology of integrated delivery systems is presented. Following this is a discussion of the evolutionary trajectory for the computer networks that serve these large consolidated healthcare delivery organizations. The most complex of these computer networks is a community health information network. Participation in the planning and deployment of community health information networks will be important for pathologists because information management within pathology will be inexorably integrated into the larger effort by integrated delivery systems to share clinical, financial, and administrative data on a regional basis. Finally, four laboratory information management challenges under managed care are discussed, accompanied by possible approaches to each of them. The challenges presented are (1) organizational integration of departmental information systems such as the laboratory information system; (2) weakening of the best-of-breed approach to laboratory information system selection; (3) the shift away from the centralized laboratory paradigm; and (4) the development of rule-based systems to monitor and control laboratory utilization.

  6. Emergency planning and management in health care: priority research topics.

    Science.gov (United States)

    Boyd, Alan; Chambers, Naomi; French, Simon; Shaw, Duncan; King, Russell; Whitehead, Alison

    2014-06-01

    Many major incidents have significant impacts on people's health, placing additional demands on health-care organisations. The main aim of this paper is to suggest a prioritised agenda for organisational and management research on emergency planning and management relevant to U.K. health care, based on a scoping study. A secondary aim is to enhance knowledge and understanding of health-care emergency planning among the wider research community, by highlighting key issues and perspectives on the subject and presenting a conceptual model. The study findings have much in common with those of previous U.S.-focused scoping reviews, and with a recent U.K.-based review, confirming the relative paucity of U.K.-based research. No individual research topic scored highly on all of the key measures identified, with communities and organisations appearing to differ about which topics are the most important. Four broad research priorities are suggested: the affected public; inter- and intra-organisational collaboration; preparing responders and their organisations; and prioritisation and decision making.

  7. Forging community partnerships to improve health care: the experience of four Medicaid managed care organizations.

    Science.gov (United States)

    Silow-Carroll, Sharon; Rodin, Diana

    2013-04-01

    Some managed care organizations (MCOs) serving Medicaid beneficiaries are actively engaging in community partnerships to meet the needs of vulnerable members and nonmembers. We found that the history, leadership, and other internal factors of four such MCOs primarily drive that focus. However, external factors such as state Medicaid policies and competition or collaboration among MCOs also play a role. The specific strat­egies of these MCOs vary but share common goals: (1) improve care coordination, access, and delivery; (2) strengthen the community and safety-net infrastructure; and (3) prevent illness and reduce disparities. The MCOs use data to identify gaps in care, seek community input in designing interventions, and commit resources to engage community organiza­tions. State Medicaid programs can promote such work by establishing goals, priorities, and guidelines; providing data analysis and technical assistance to evaluate local needs and community engagement efforts; and convening stakeholders to collaborate and share best practices.

  8. Factors associated with advance care planning discussions by area agency on aging care managers.

    Science.gov (United States)

    Hazelett, Susan; Baughman, Kristin R; Palmisano, Barbara R; Sanders, Margaret; Ludwick, Ruth E

    2013-12-01

    Initiating advance care planning (ACP) discussions in the home may prevent avoidable hospitalizations by elucidating goals of care. Area agencies on aging care managers (AAACMs) work in the home with high-risk consumers. To determine which AAACM characteristics contribute to an increased frequency of ACP discussions. Cross-sectional investigator-generated surveys administered to AAACMs at 3 AAAs in Ohio. Of 289 AAACMs, 182 (63%) responded. The more experience and comfort AAACMs felt with ACP discussions, the more likely they were to initiate ACP discussions. It may be necessary to build interactive educational experiences where, for example, AAACMs are asked to fill out their own advance directives and/or facilitate others in ACP discussions to improve experience and comfort with ACP discussions.

  9. MANAGEMENT OF INNOVATION IN HEALTH CARE AT THE REGIONAL LEVEL

    Directory of Open Access Journals (Sweden)

    Ye. G. Totskaya

    2014-01-01

    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

  10. Development of consensus guidance to facilitate service redesign around pharmacist prescribing in UK hospital practice.

    Science.gov (United States)

    Tonna, Antonella; McCaig, Dorothy; Diack, Lesley; West, Bernice; Stewart, Derek

    2014-10-01

    The last decade has seen a drive towards non-medical prescribing in the United Kingdom (UK). However, there is a dearth of any published literature on applying the principles of service redesign to support pharmacist prescribing in any sphere of practice. To develop consensus guidance to facilitate service redesign around pharmacist prescribing. UK hospital practice. The Delphi technique was used to measure consensus of a panel of expert opinion holders in Scotland. Individuals with key strategic and operational roles in implementing initiatives of pharmacy practice and medicines management were recruited as experts. An electronic questionnaire consisting of 30 statements related to pharmacist prescribing service redesign was developed. These were presented as five-point Likert scales with illustrative quotes. Consensus, defined as 70 % of panel members agreeing (ranked strongly agree/agree) with each statement. Responses were obtained from 35/40 (87.5 %) experts in round one and 29 (72.5 %) in round two. Consensus in round one was achieved for 27/30 of statements relating to aspects of generic 'service development' (e.g. succession planning, multidisciplinary working, quality evaluation, practice development and outcome measures) and 'pharmacist prescribing role development' (e.g. education and future orientation of service). Issues of disagreement were around targeting of pharmacist prescribing to clinical specialities and financial remuneration for prescribing in the hospital setting. Consensus guidance has been developed to facilitate service redesign around hospital pharmacist prescribing.

  11. Looking at CER from the managed care organization perspective.

    Science.gov (United States)

    Cannon, H Eric

    2012-05-01

    The amount of available comparative effectiveness research (CER) is increasing, giving managed care organizations (MCOs) more information to use in decision making. However, MCOs may not be prepared to integrate this new and voluminous data into their current practices and policies. To describe ways that health care reform will affect MCO populations in the future, to examine examples of how MCOs have utilized CER data in the past, and to identify questions that MCOs will have to address as they integrate CER into future decision making. Unquestionably, health care reform will change the U.S. market. Millions more insured individuals will be making purchasing decisions. In addition, health care reform will mean more CER data will be available, affecting the decisions MCOs must make. In the past, MCOs may not have used CER as effectively as they could in making formulary and other policy decisions. However, there are examples that show how CER can be integrated effectively, such as Intermountain Healthcare's use of CER to create treatment guidelines, which have been shown to lower costs and improve delivery of care. In the future, MCOs will need to assess their own abilities to utilize CER, including their infrastructure of expertise, hardware, software, and protocols and processes. MCOs will also need to understand how pertinent CER is to their own needs, how it may affect benefit design, and how it will affect their customers' needs. Health care reform, and the resultant growth of CER, will have significant impact on MCOs, who will need to invest in better infrastructure and new understandings of a transforming market, changing customer bases, and evolving data.

  12. ProvenCare-Psoriasis: A disease management model to optimize care.

    Science.gov (United States)

    Gionfriddo, Michael R; Pulk, Rebecca A; Sahni, Dev R; Vijayanagar, Sonal G; Chronowski, Joseph J; Jones, Laney K; Evans, Michael A; Feldman, Steven R; Pride, Howard

    2018-03-15

    There are a variety of evidence-based treatments available for psoriasis. The transition of this evidence into practice is challenging. In this article, we describe the design of our disease management approach for Psoriasis (ProvenCare®) and present preliminary evidence of the effect of its implementation. In designing our approach, we identified three barriers to optimal care: 1) lack of a standardized and discrete disease activity measure within the electronic health record, 2) lack of a system-wide, standardized approach to care, and 3) non-uniform financial access to appropriate non-pharmacologic treatments. We implemented several solutions, which collectively form our approach. We standardized the documentation of clinical data such as body surface area (BSA), created a disease management algorithm for psoriasis, and aligned incentives to facilitate the implementation of the algorithm. This approach provides more coordinated, cost effective care for psoriasis, while being acceptable to key stakeholders. Future work will examine the effect of the implementation of our approach on important clinical and patient outcomes.

  13. Management of pharmaceutical services in the Brazilian primary health care.

    Science.gov (United States)

    Gerlack, Letícia Farias; Karnikowski, Margô Gomes de Oliveira; Areda, Camila Alves; Galato, Dayani; Oliveira, Aline Gomes de; Álvares, Juliana; Leite, Silvana Nair; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

    2017-11-13

    To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

  14. Care Management Processes Used Less Often For Depression Than For Other Chronic Conditions In US Primary Care Practices.

    Science.gov (United States)

    Bishop, Tara F; Ramsay, Patricia P; Casalino, Lawrence P; Bao, Yuhua; Pincus, Harold A; Shortell, Stephen M

    2016-03-01

    Primary care physicians play an important role in the diagnosis and management of depression. Yet little is known about their use of care management processes for depression. Using national survey data for the period 2006-13, we assessed the use of five care management processes for depression and other chronic illnesses among primary care practices in the United States. We found significantly less use for depression than for asthma, congestive heart failure, or diabetes in 2012-13. On average, practices used fewer than one care management process for depression, and this level of use has not changed since 2006-07, regardless of practice size. In contrast, use of diabetes care management processes has increased significantly among larger practices. These findings may indicate that US primary care practices are not well equipped to manage depression as a chronic illness, despite the high proportion of depression care they provide. Policies that incentivize depression care management, including additional quality metrics, should be considered. Project HOPE—The People-to-People Health Foundation, Inc.

  15. The management of health care service quality. A physician perspective.

    Science.gov (United States)

    Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L

    2016-01-01

    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.

  16. Assessment, care and management of patients with red eye.

    Science.gov (United States)

    Watkinson, Susan; Seewoodhary, Ramesh

    2017-12-06

    Red eye is a common ocular presentation in primary care, and there are several challenges that healthcare practitioners may encounter when caring for such patients. The main ocular conditions that can give rise to red eye are: primary acute angle closure glaucoma, acute iritis, dry eye, blepharitis and conjunctivitis. Red eye can be classified as sight-threatening or non-sight-threatening. Many patients presenting with painless red eye and normal vision usually recover well. However, when red eye is associated with pain, photophobia, watering and blurred vision, it is potentially sight-threatening and must be addressed urgently. Therefore, it is vital for healthcare practitioners to be able to undertake a careful assessment of the patient and make an accurate diagnosis early. This article provides an overview of the common causes of red eye encountered in general practice or an eye clinic. It discusses the nurse's role in the care and management of patients with red eye, with reference to patient assessment, the skills required to make an accurate diagnosis, treatment and health promotion. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  17. Management of health-care waste in Izmir, Turkey

    Directory of Open Access Journals (Sweden)

    Ahmet Soysal

    2010-01-01

    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.

  18. Managed care. What is its impact on nursing education and practice?

    Science.gov (United States)

    Malloy, C

    1997-08-01

    Market forces present the nursing profession with an urgency to prepare gerontological nurses to assume significant roles in the managed care industry. An understanding of the current managed care environment underscores the need for training. Nurses require a "managed care" skill-set encompassing a firm grasp of the organization, financing, delivery, and policy implications of managed care as well as advanced practice clinical skills and a sound business orientation. The importance of the consumer as a significant player in managed care is highlighted.

  19. [Quality assurance and quality management in intensive care].

    Science.gov (United States)

    Notz, K; Dubb, R; Kaltwasser, A; Hermes, C; Pfeffer, S

    2015-11-01

    Treatment success in hospitals, particularly in intensive care units, is directly tied to quality of structure, process, and outcomes. Technological and medical advancements lead to ever more complex treatment situations with highly specialized tasks in intensive care nursing. Quality criteria that can be used to describe and correctly measure those highly complex multiprofessional situations have only been recently developed and put into practice.In this article, it will be shown how quality in multiprofessional teams can be definded and assessed in daily clinical practice. Core aspects are the choice of a nursing theory, quality assurance measures, and quality management. One possible option of quality assurance is the use of standard operating procedures (SOPs). Quality can ultimately only be achieved if professional groups think beyond their boundaries, minimize errors, and establish and live out instructions and SOPs.

  20. Front/back office considerations in the operational access to long-term care for older people : Findings of a multiple case study

    NARCIS (Netherlands)

    Schipper, E.C.C.; Meijboom, B.R.; Luijkx, K.G.; Schols, J.M.G.A.

    2013-01-01

    Background Organizations that provide long-term care in the Netherlands are reconsidering the operational access to their services. Principles of operations management, such as front/back office configurations, might improve the redesign of operational access. Once a client gains entrance to the

  1. [Munchausen syndrome: need for centralized administrative health-care management].

    Science.gov (United States)

    Altmark, D; Sigal, M; Gelkopf, M

    1991-03-01

    The clinical picture of Munchausen syndrome is that of feigned or self-induced illness with the aim of being hospitalized and/or receiving unnecessary medical interventions, peregrination from 1 hospital to another, and disruptive behavior when hospitalized. These patients are a danger to themselves and heavily burden inpatient facilities that care for them. We present a case that illustrates the problems of diagnosing and managing such patients. We stress the need for adequate centralization and distribution of the relevant information concerning these patients.

  2. GUIDELINES OF CARE FOR THE MANAGEMENT OF ATOPIC DERMATITIS

    Science.gov (United States)

    Eichenfield, Lawrence F.; Tom, Wynnis L.; Chamlin, Sarah L.; Feldman, Steven R.; Hanifin, Jon M.; Simpson, Eric L.; Berger, Timothy G.; Bergman, James N.; Cohen, David E.; Cooper, Kevin D.; Cordoro, Kelly M.; Davis, Dawn M.; Krol, Alfons; Margolis, David J.; Paller, Amy S.; Schwarzenberger, Kathryn; Silverman, Robert A.; Williams, Hywel C.; Elmets, Craig A.; Block, Julie; Harrod, Christopher G.; Begolka, Wendy Smith; Sidbury, Robert

    2014-01-01

    Atopic dermatitis (AD) is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2–3% of adults. This guideline addresses important clinical questions that arise in AD management and care, providing updated and expanded recommendations based on the available evidence. In this first of four sections, methods for diagnosis and monitoring of disease, outcomes measures for assessment and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed. PMID:24290431

  3. A computer science approach to managing security in health care.

    Science.gov (United States)

    Asirelli, P; Braccini, G; Caramella, D; Coco, A; Fabbrini, F

    2002-09-01

    The security of electronic medical information is very important for health care organisations, which have to ensure confidentiality, integrity and availability of the information provided. This paper will briefly outline the legal measures adopted by the European Community, Italy and the United States to regulate the use and disclosure of medical records. It will then go on to highlight how information technology can help to address these issues with special reference to the management of organisation policies. To this end, we will present a modelling example for the security policy of a radiological department.

  4. Managed care and the delivery of primary care to the elderly and the chronically ill.

    Science.gov (United States)

    Wholey, D R; Burns, L R; Lavizzo-Mourey, R

    1998-06-01

    To analyze primary care staffing in HMOs and to review the literature on primary care organization and performance in managed care organizations, with an emphasis on the delivery of primary care to the elderly and chronically ill. Analysis of primary care staffing: InterStudy HMO census data on primary care (n = 1,956) and specialist (n = 1,777) physician staffing levels from 1991 through 1995. Primary care organization and performance for the chronically ill and elderly were analyzed using a review of published research. For the staffing-level models, the number of primary care and specialist physicians per 100,000 enrollees was regressed on HMO characteristics (HMO type [group, staff, network, mixed], HMO enrollment, federal qualification, profit status, national affiliation) and community characteristics (per capita income, population density, service area size, HMO competition). For the review of organization and performance, literature published was summarized in a tabular format. The analysis of physician staffing shows that group and staff HMOs have fewer primary care and specialist physicians per 100,000 enrollees than do network and mixed HMOs, which have fewer than IPAs. Larger HMOs use fewer physicians per 100,000 enrollees than smaller HMOs. Federally qualified HMOs have fewer primary care and specialist physicians per 100,000 enrollees. For-profit, nationally affiliated, and Blue Cross HMOs have more primary care and specialist physicians than do local HMOs. HMOs in areas with high per capita income have more PCPs per 100,000 and a greater proportion of PCPs in the panel. HMO penetration decreases the use of specialists, but the number of HMOs increases the use of primary care and specialist physicians in highly competitive markets. Under very competitive conditions, HMOs appear to compete by increasing access to both PCPs and specialists, with a greater emphasis on access to specialists. The review of research on HMO performance suggests that access

  5. Review article: Critical Care Airway Management eLearning modules.

    Science.gov (United States)

    Doshi, Deepak; McCarthy, Sally; Mowatt, Elizabeth; Cahill, Angela; Peirce, Bronwyn; Hawking, Geoff; Osborne, Ruth; Hibble, Belinda; Ebbs, Katharine

    2017-11-16

    The Australasian College for Emergency Medicine (ACEM) has recently launched the Critical Care Airway Management eLearning modules to support emergency medicine trainees in developing their airway management skills in the ED. A team of emergency physicians and trainees worked collaboratively to develop the eLearning resources ensuring extensive stakeholder consultation. A comprehensive resource manual was written to provide learners with knowledge that underpins the modules. ACEM provided project coordination as well as administrative and technical team support to the production. Although specifically developed with early ACEM trainees in mind, it is envisaged the resources will be useful for all emergency clinicians. The project was funded by the Australian Commonwealth Department of Health. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  6. The impact of care management information technology model on quality of care after percutaneous coronary intervention: "Bridging the Divides".

    Science.gov (United States)

    Weintraub, William S; Fanari, Zaher; Elliott, Daniel; Ostertag-Stretch, Jennifer; Muther, Ann; Lynahan, Margaret; Kerzner, Roger; Salam, Tabassum; Scherrer, Herbert; Anderson, Sharon; Russo, Carla A; Kolm, Paul; Steinberg, Terri H

    2017-07-03

    Reducing readmissions and improving metrics of care are a national priority. Supplementing traditional care with care management may improve outcomes. The Bridges program was an initial evaluation of a care management platform (CareLinkHub), supported by information technology (IT) developed to improve the quality and transition of care from hospital to home after percutaneous coronary intervention (PCI) and reduce readmissions. CareLink is comprised of care managers, patient navigators, pharmacists and physicians. Information to guide care management is guided by a middleware layer to gather information, PLR (ColdLight Solutions, LLC) and presented to CareLink staff on a care management platform, Aerial™ (Medecision). An additional analytic engine [Neuron™ (ColdLight Solutions, LLC)] helps, evaluates and guide care. The "Bridges" program enrolled a total of 2054 PCI patients with 2835 admission from April, 1st 2013 through March 1st, 2015. The data of the program was compared with those of 3691 PCI patients with 4414 admissions in the 3years prior to the program. No impact was seen with respect to inpatient and observation readmission, or emergency department visits. Similarly no change was noticed in LDL control. There was minimal improvement in BP control and only in the CTM-3 and SAQ-7 physical limitation scores in the patients' reported outcomes. Patient follow-up with physicians within 1week of discharge improved during the Bridges years. The CareLink hub platform was successfully implemented. Little or no impact on outcome metrics was seen in the short follow-up time. The Bridges program suggests that population health management must be a long-term goal, improving preventive care in the community. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Social Determinants of Health in Managed Care Payment Formulas.

    Science.gov (United States)

    Ash, Arlene S; Mick, Eric O; Ellis, Randall P; Kiefe, Catarina I; Allison, Jeroan J; Clark, Melissa A

    2017-10-01

    Managed care payment formulas commonly allocate more money for medically complex populations, but ignore most social determinants of health (SDH). To add SDH variables to a diagnosis-based payment formula that allocates funds to managed care plans and accountable care organizations. Using data from MassHealth, the Massachusetts Medicaid and Children's Health Insurance Program, we estimated regression models predicting Medicaid spending using a diagnosis-based and SDH-expanded model, and compared the accuracy of their cost predictions overall and for vulnerable populations. MassHealth members enrolled for at least 6 months in 2013 in fee-for-service (FFS) programs (n = 357 660) or managed care organizations (MCOs) (n = 524 607). We built cost prediction models from a fee-for-service program. Predictors in the diagnosis-based model are age, sex, and diagnoses from claims. The SDH model adds predictors describing housing instability, behavioral health issues, disability, and neighborhood-level stressors. Overall model explanatory power and overpayments and underpayments for subgroups of interest for all Medicaid-reimbursable expenditures excepting long-term support services (mean annual cost = $5590 per member). We studied 357 660 people who were FFS participants and 524 607 enrolled in MCOs with a combined 806 889 person-years of experience. The FFS program experience included more men (49.6% vs 43.6%), older patients (mean age of 26.1 years vs 21.6 years), and sicker patients (mean morbidity score of 1.16 vs 0.89) than MCOs. Overall, the SDH model performed well, but only slightly better than the diagnosis-based model, explaining most of the spending variation in the managed care population (validated R2 = 62.4) and reducing underpayments for several vulnerable populations. For example, raw costs for the quintile of people living in the most stressed neighborhoods were 9.6% ($537 per member per year) higher than average. Since greater

  8. [Community health in primary health care teams: a management objective].

    Science.gov (United States)

    Nebot Adell, Carme; Pasarin Rua, Maribel; Canela Soler, Jaume; Sala Alvarez, Clara; Escosa Farga, Alex

    2016-12-01

    To describe the process of development of community health in a territory where the Primary Health Care board decided to include it in its roadmap as a strategic line. Evaluative research using qualitative techniques, including SWOT analysis on community health. Two-steps study. Primary care teams (PCT) of the Catalan Health Institute in Barcelona city. The 24 PCT belonging to the Muntanya-Dreta Primary Care Service in Barcelona city, with 904 professionals serving 557,430 inhabitants. Application of qualitative methodology using SWOT analysis in two steps (two-step study). Step 1: Setting up a core group consisting of local PCT professionals; collecting the community projects across the territory; SWOT analysis. Step 2: From the needs identified in the previous phase, a plan was developed, including a set of training activities in community health: basic, advanced, and a workshop to exchange experiences from the PCTs. A total of 80 team professionals received specific training in the 4 workshops held, one of them an advanced level. Two workshops were held to exchange experiences with 165 representatives from the local teams, and 22 PCTs presenting their practices. In 2013, 6 out of 24 PCTs have had a community diagnosis performed. Community health has achieved a good level of development in some areas, but this is not the general situation in the health care system. Its progression depends on the management support they have, the local community dynamics, and the scope of the Primary Health Care. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  9. Do the Math: Course Redesign's Impact on Learning and Scheduling

    Science.gov (United States)

    Squires, John; Faulkner, Jerry; Hite, Carl

    2009-01-01

    The math department at Cleveland State Community College embarked upon course redesign in 2008. As a result of this project, student engagement, learning, and success rates have increased dramatically. By including both developmental and college level math courses in the redesign, the department has been able to implement innovative scheduling and…

  10. Evaluation of the Redesign of an Undergraduate Cell Biology Course

    Science.gov (United States)

    McEwen, Laura April; Harris, dik; Schmid, Richard F.; Vogel, Jackie; Western, Tamara; Harrison, Paul

    2009-01-01

    This article offers a case study of the evaluation of a redesigned and redeveloped laboratory-based cell biology course. The course was a compulsory element of the biology program, but the laboratory had become outdated and was inadequately equipped. With the support of a faculty-based teaching improvement project, the teaching team redesigned the…

  11. 76 FR 16233 - Interpretive Rule Regarding Electronic Contributor Redesignations

    Science.gov (United States)

    2011-03-23

    ... audit, the Commission recently determined that a specific redesignation practice provided the same degree of assurance of the contributor's identity and the contributor's intent to redesignate the... that this process provided assurance of contributor identity and intent equivalent to a written...

  12. Payment and economic evaluation of integrated care

    Directory of Open Access Journals (Sweden)

    Apostolos Tsiachristas

    2015-04-01

    Full Text Available Chronic diseases have an increasingly negative impact on (1 population health by increasing morbidity and mortality, (2 society by increasing health inequalities and burden to informal caregivers, and (3 economy by requiring enormous financial resources and jeopardising macro-economic development (e.g. consumption, capital accumulation, labour productivity and labour supply. Integrated care is the most promising concept in redesigning care to tackle the increasing threat of chronic diseases. Several European countries have experimented with models for integrating care, most frequently in the form of disease management programmes. These models were often supported by payment schemes to provide financial incentives to health care providers for implementing integrated care. This thesis aimed to investigate these payment schemes and assess their impact, explore the variability in costs of disease management programmes, and determine the costs and effects of disease management programmes.

  13. Effect of care management program structure on implementation: a normalization process theory analysis.

    Science.gov (United States)

    Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A

    2016-08-15

    Care management in primary care can be effective in helping patients with chronic disease improve their health status, however, primary care practices are often challenged with implementation. Further, there are different ways to structure care management that may make implementation more or less successful. Normalization process theory (NPT) provides a means of understanding how a new complex intervention can become routine (normalized) in practice. In this study, we used NPT to understand how care management structure affected how well care management became routine in practice. Data collection involved semi-structured interviews and observations conducted at 25 practices in five physician organizations in Michigan, USA. Practices were selected to reflect variation in physician organizations, type of care management program, and degree of normalization. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with NPT as a guiding framework. Seventy interviews and 25 observations were completed. Two key structures for care management organization emerged: practice-based care management where the care managers were embedded in the practice as part of the practice team; and centralized care management where the care managers worked independently of the practice work flow and was located outside the practice. There were differences in normalization of care management across practices. Practice-based care management was generally better normalized as compared to centralized care management. Differences in normalization were well explained by the NPT, and in particular the collective action construct. When care managers had multiple and flexible opportunities for communication (interactional workability), had the requisite knowledge, skills, and personal characteristics (skill set workability), and the organizational support and resources (contextual integration), a trusting professional relationship

  14. Home-based Self-care: Understanding and Designing Pervasive Technology to Support Care Management Work at Home

    DEFF Research Database (Denmark)

    Verdezoto, Nervo

    the self-care management work at home. People need to know which care activities to perform, when to perform them, how to proceed and why these are important. While at home, an active lifestyle and comorbidity not only challenge self-care activities but also the use of self-care technologies in non...... that fit into people’s everyday life. Through a design research approach applying user-centered design methods and prototyping, the main focus of this dissertation is on exploring and providing a holistic understanding of the self-care work practices in non-clinical settings. Several home-based care...... practices are investigated to (a) further understand the self-care management work in nonclinical settings, and (b) inform future design of pervasive healthcare technology that accounts for people’s perspectives on self-care and everyday life. First, we explore two selfcare practices of medication...

  15. Modern Management and Diagnosis of Hypertension in the United Kingdom: Home Care and Self-care.

    Science.gov (United States)

    Sheppard, James P; Schwartz, Claire L; Tucker, Katherine L; McManus, Richard J

    2016-01-01

    The effective diagnosis and management of hypertension is one of the most important parts of cardiovascular prevention internationally and this is no different in the United Kingdom. Approximately 14% of the UK population currently receive treatment for hypertension. Recent UK guidelines from the National Institute of Health and Care Excellence have placed greater emphasis on the utilization of out-of-office measurement of blood pressure to more accurately diagnose hypertension. The aim of the present study was to provide a state-of-the-art review of the evidence for screening, diagnosing, and managing hypertension, as implemented in the United Kingdom, with an emphasis on the role of self-monitored and ambulatory blood pressure monitoring in routine clinical care. Consideration was given to the use of ambulatory and home monitoring to confirm a diagnosis of hypertension and the use of self-monitoring and self-management to monitor and guide treatment. The evidence for the use of self-monitoring in patients with hypertension was examined, both in isolation, and in combination with lifestyle and treatment interventions. There is a place for self-monitored blood pressure in specific underresearched populations such as the elderly, specialist conditions, ethnic groups, and during pregnancy and this is discussed here. The evidence supporting the use of out-of-office monitoring in all aspects of routine clinical care has increased substantially in recent years and is reflected in increased utilization by patients and clinicians alike. Several areas require further research but it is clear that out-of-office monitoring is here to stay and is fast becoming an important part of hypertension management in the United Kingdom. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  16. Physician anger: Leggo dem managed care blues--leadership beyond the era of managed cost.

    Science.gov (United States)

    Kirz, H L

    1999-01-01

    While managed care has caused great disruption, it has also provided physician executives with a natural leadership raison d'être. Managed care, with all its pros and cons, is largely a response to certain unrelenting trends. The core functions of leaders comprise the stewardship of organizations and colleagues in response to these trends. Four trends are explored: (1) The demise of open-ended funding of American health care; (2) continued competition for health care resources; (3) thriving pluralism; and (4) patients continually adjusting to assure themselves of appropriate health care access, quality, and service. In the 21st century, the industry will need a new brand of leader, one capable of balancing the needs of the professionals with the business and accountability requirements of a permanently competitive and resource-constrained service industry. The keys to successful leadership in the future include: (1) Clear service differentiation and a compelling vision to match it; (2) recruiting and retaining top clinical talent, including the required return to physician self-direction and governance; (3) successful partnerships with others outside your organization; and (4) a steady focus on performance in all its dimensions.

  17. [Economic impact of AFId management with modern management system in Intensive Care patients: comparison between ICUs].

    Science.gov (United States)

    Fuoco, Giovanni; Di Giulio, Paola

    2016-01-01

    . Economic impact of AFId management with modern management systems in Intensive Care patients: comparison between ICUs. Acute fecal incontinence associated with diarrhea (AFId) affects up to 40% of intensive care unit (ICU) patients and may be responsible for pressure ulcers (PU). The FMS (Fecal Management System) though improving the management of these patients is not often provided due to its cost. To measure the costs of the use of FMS compared to routine care in three intensive care units (ICU) of Piedmont (Italy). All patients admitted from January to June 2016, > 18 years with at least three AFId episodes in the previous 24 hours were included. The costs for hygiene, medications and nursing time spent were calculated on 10 patients without FMS, accounting for the mean number of diarrhea attacks (3.04 per day), and mean days of FMS use. The FMS generated savings compared to routine care in nursing time, equipments for hygiene and pressure sores medications in patients with sacral sores. Savings depended on length of use (LoU) of the device: ICU with 10 patients (7 with PUs), mean LoU FMS 11.9 days, savings 1.210 euros; ICU with 10 patients (2 with PUs), mean LoU FMS 17.3 days, savings 5.317 euros; ICU with 45 patients (11 with PUs) mean LoU FMS 9.3 days, cost increase 1.057 euros. The cost of FMS is quickly amortised in patients with PUs. No FMS patients developed a new PUs. The FMS gives rise to savings when used in patients with PUs or for more than 10 days. The savings related to the prevention of PUs should be also added.

  18. Fathers and Asthma Care: Paternal Involvement, Beliefs, and Management Skills.

    Science.gov (United States)

    Friedman, Deborah; Masek, Bruce; Barreto, Esteban; Baer, Lee; Lapey, Allen; Budge, Eduardo; McQuaid, Elizabeth L

    2015-09-01

    To compare asthma care roles of maternal and paternal caregivers, and examine associations between caregiver involvement and the outcomes of adherence, morbidity, and parental quality of life (QoL). Mothers and fathers in 63 families of children, ages 5-9 years, with persistent asthma completed semistructured interviews and questionnaires. Adherence was measured via electronic monitoring. Paired t tests compared parental asthma care roles, and analysis of covariance, controlling for socioeconomic status, evaluated associations of asthma outcomes with caregiver involvement scores. Mothers had higher scores on measures of involvement, beliefs in medication necessity, and on four subscales of the Family Asthma Management System Scale interview (Asthma Knowledge, Relationship with Provider, Symptom Assessment, and Response to Symptoms). Maternal QoL was lowest when both maternal and paternal involvement was high. Paternal involvement was associated with increased morbidity. There is room for enhancement of fathers' asthma care roles. Higher levels of paternal involvement may be driven by family need. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Staff Experience of Pain Management: An Improvement in Palliative Care

    Directory of Open Access Journals (Sweden)

    Anna Unné

    2013-09-01

    Full Text Available Palliative care involves helping patients to achieve best possible quality of life by alleviating symptoms and suffering. The aim of the study was to describe and analyze staff member’s experience of working with evidence-based guidelines for pain management in palliative care. The study comprised a total of eight group interviews and 93 narratives from 22 staff members, all of who worked in palliative care. Data was analyzed using manifest qualitative content analysis and deductive perspectives according to SOC (sense of coherence. Three categories, “Awareness of Pain Management”, “Participation in Pain Management”, and “Safety at Pain Management”, were identified. The result showed an increased awareness of the value of a deeper understanding of policy documents and local guidelines. A key factor in improvement work was that team members were given the opportunity to repeat and continuously reflect on their performed work together within the team in dialog form. Teamwork may contribute to a better knowledge and understanding of how to develop high quality in healthcare by learning from each other in everyday work and by using evidence-based practices. Consistency in the working group could improve healthcare by using the espoused theory and theory-in-use for develop procedures and guidelines at work.

  20. Managing chronic myeloid leukemia: a coordinated team care perspective.

    Science.gov (United States)

    Holloway, Stacie; Lord, Katharine; Bethelmie-Bryan, Beverly; Shepard, Marian W; Neely, Jessica; McLemore, Morgan; Reddy, Satyanarayan K; Montero, Aldemar; Jonas, William S; Gladney, Sara Pierson; Khanwani, Shyam L; Reddy, Silpa C; Lahiry, Anup K; Heffner, Leonard T; Winton, Elliott; Arellano, Martha; Khoury, Hanna Jean

    2012-04-01

    Treatment of chronic myeloid leukemia (CML) has seen dramatic progress in recent years with the development of tyrosine kinase inhibitors (TKIs). To take maximum advantage of therapy with TKIs, compliance and good understanding of monitoring response to therapy are essential. We established a team that included a hematologist, a physician assistant (PA), and a nurse who work closely with a social worker, a pharmacist, and a research coordinator to assist patients throughout their journey with CML. The patient and the referring community oncologist were incorporated into this team. This coordinated team care approach takes advantage of each member's specific skills to provide patients with education about CML, encourage patients' strong involvement in tracking/monitoring results/response to therapy, and support patients with issues that arise throughout the long course of the disease. A low rate of noncompliance with clinic visits (3%) was an indirect measure of the impact of this approach. The inclusion of the referring oncologist in the team extended the tracking of monitoring results to the community practice. We conclude that a coordinated team care approach is feasible in the management of patients with CML. This approach provided patients with education and a good understanding of response to therapy and improved relations with the health care team. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Redesign of a Low Energy Probe Head

    CERN Document Server

    Rao, Yi-Nong; Ries, Thomas

    2005-01-01

    The present situation of the low energy probe LE2 in TRIUMF cyclotron is that the thickness of the finger 5 is uniform over a radial length of 3.25 inch and its weight which amounts to ~447 g is affecting its re-circulating ball mechanism and causing it to fall below the median plane over its range of movement. We therefore re-design it in order to reduce its weight. First, we made simulations and determined the optimum thickness of the probe head vs its radial length. These simulation results are found to be in good agreement with experimental measurements made. Finally, we calculated the temperature rise caused by the beam power dumped on the probe, and figured out the maximum current of beam that can be dumped on the finger.

  2. Safety in the redesigning of production lines

    DEFF Research Database (Denmark)

    Dyhrberg, Mette Bang; Broberg, Ole; Jacobsen, Peter

    2006-01-01

    This paper is a case study report on how safety considerations were handled in the process of redesigning a production line. The design process was characterized as a specification and negotiation process between engineers from the company and the supplier organization. The new production line...... became safer, but not as a result of any intentional plan to integrate safety aspects into the design process. Instead, the supplier’s design of a new piece of equipment had a higher built-in safety level. The engineering team in the company was aware of the importance of safety aspects neither...... in the specification material nor in their face-to-face meetings with the supplier. Safety aspects were not part of their work practice. On this basis, it was suggested that formal guidelines or procedures for integrating safety in the design of production lines would have no effect. Instead, the researchers set up...

  3. Medicare managed care plan performance: a comparison across hospitalization types.

    Science.gov (United States)

    Basu, Jayasree; Mobley, Lee Rivers

    2012-01-01

    The study evaluates the performance of Medicare managed care (Medicare Advantage [MA]) Plans in comparison to Medicare fee-for-service (FFS) Plans in three states with historically high Medicare managed care penetration (New York, California, Florida), in terms of lowering the risks of preventable or ambulatory care sensitive conditions (ACSC) hospital admissions and providing increased referrals for admissions for specialty procedures. Using 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Healthcare Research and Quality, ACSC admissions are compared with 'marker' admissions and 'referral-sensitive' admissions, using a multinomial logistic regression approach. The year 2004 represents a strategic time to test the impact of MA on preventable hospitalizations, because the HMOs dominated the market composition in that time period. MA enrollees in California experienced 22% lower relative risk (RRR= 0.78, p<0.01), those in Florida experienced 16% lower relative risk (RRR= 0.84, p<0.01), while those in New York experienced 9% lower relative risk (RRR=0.91, p<0.01) of preventable (versus marker) admissions compared to their FFS counterparts. MA enrollees in New York experienced 37% higher relative risk (RRR=1.37, p<0.01) and those in Florida had 41% higher relative risk (RRR=1.41, p<0.01)-while MA enrollees in California had 13% lower relative risk (RRR=0.87, p<0.01)-of referral-sensitive (versus marker) admissions compared to their FFS counterparts. While MA plans were associated with reductions in preventable hospitalizations in all three states, the effects on referral-sensitive admissions varied, with California experiencing lower relative risk of referral-sensitive admissions for MA plan enrollees. The lower relative risk of preventable admissions for MA plan enrollees in New York and Florida became more pronounced after accounting for selection bias.

  4. Managing the primary care practice on the Web

    Science.gov (United States)

    Van Grevenhof P; Rahman; Cabanela; Naessens; Lassig

    2000-01-01

    Physicians and administrators have little hope of responding appropriately to the challenges of the health care market without data to support decision making. Desired Mayo Clinic s Primary Care Practice was to have the ability to access and integrate data from many platforms in many formats from the Enterprise and bring this information to the desktop in a robust interactive display. The solution was delivery of the data to the Web through an interface using Java with access to Online Analytical Processing (OLAP) tools for summarization, graphical display and reporting. Communicating major trends, assisting in planning and management, visually displaying alerts in summary data and individual patients that are all possible through an easy-to-use Web application. To really understand what the summarized data represents, the physicians must be able to drill down, download and explore their own detail data. A pilot project was developed to test the capabilities of the development environment, the acceptance Web tools, the ability to deliver timely information and the methodology of using a multi-dimensional database to define the data. The Family Medicine practice at four separate locations was chosen for the demonstration project. Two practices in Rochester, MN and practices in two smaller towns, totaling 50 physicians and administrative personnel, were the first clients using the system. A cross-functional team examined a variety of development issues such as data sources, data definitions, levels of security, data analysis types, and style of display. Demonstrations of the prototype met with an overwhelming positive response from administrators and department leaders. The Physician Patient Management solution collects, analyzes, and communicates the information needed to meet today s health care challenges.

  5. Redesign of the Human Metabolic Simulator

    Science.gov (United States)

    Duffield, Bruce; Jeng, Frank; Lange, Kevin

    2004-01-01

    The National Aeronautics and Space Administration (NASA) is currently building a Human Metabolic Simulator (HMS) at the Johnson Space Center as part of the Advanced Life Support Air Revitalization Technology Evaluation Facility (ARTEF). The purpose of ARTEF is to evaluate Environmental Control and Life Support System Technologies for Advanced Missions. The HMS is needed to reproduce the primary metabolic effects of human respiration on an enclosed atmosphere when humans cannot be present and the impact of human presence on the system is required. A HMS was designed, built and successfully operated in 2000 but larger crew size requirements and the expense of upgrade of the current system necessitate redesign. This paper addresses the redesign. Several concepts were considered, ranging from chemical oxidation of a hydrocarbon like ethanol or ethyl acetate to carbon dioxide and water, oxidation of an iron-containing compound, or by using a fuel cell. For reasons of cost, simplicity, safety and other factors, the concept chosen includes: a molecular sieve packaged as an industrial oxygen concentrator to remove oxygen from the atmosphere, with direct carbon dioxide, water and heat injection. The water injection is done via heating water to steam with a heat exchanger and thermal effects are handled by directly adding heat to the air stream with a second heat exchanger. Both heat exchangers are supplied by a hot oil loop. The amount of oxygen removal, carbon dioxide addition, water addition and heat addition were calculated using metabolic profiles for respiration and heat, calculated using a series of empirical equations developed for International Space Station (ISS). Sketches of the Human Metabolic Simulator and the hot oil bath loop used to supply heat to the heat exchangers are included

  6. Assessment of quality of care in acute postoperative pain management

    Directory of Open Access Journals (Sweden)

    Milutinović Dragana

    2009-01-01

    Full Text Available Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA, discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (χ, multiple correlation coefficient (R were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5 and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57% evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001. The analysis of patients evaluation (MANOVA p

  7. Management training of physician executives, their leadership style, and care management performance: an empirical study.

    Science.gov (United States)

    Xirasagar, Sudha; Samuels, Michael E; Curtin, Thomas F

    2006-02-01

    To examine associations between management training of physician executives and their leadership styles, as well as effectiveness in achieving disease management goals. Cross-sectional national survey. Executive directors of community health centers (269 respondents; response rate = 40.9%) were surveyed regarding their perceptions of the medical director's leadership, and for quantitative information on the center's achievement of clinical (mostly disease management) goals. The dependent variables were the medical director's scores (as perceived by the executive director) on transformational, transactional, and laissez-faire leadership, effectiveness, satisfaction with the leader, and subordinate extra effort, using an adapted Multifactor Leadership Questionnaire (43 items; 5-point Likert scale). The independent variable was the medical director's management training status. Compared with medical directors with or =30 days of in-service training, had 0.32, 0.35, 0.30, 0.36, and 0.37 higher scores on transformational leadership, transactional leadership, rated effectiveness, satisfaction, and subordinate extra effort, respectively, and 0.31 lower score on laissez-faire leadership (all P management degrees but with > or =30 days of in-service training had 0.34, 0.36, 0.50, and 0.47 higher scores on transformational leadership, transactional leadership, rated effectiveness, and satisfaction with the leader (all P management goals. Training may enable physician executives to develop leadership styles that are effective in influencing clinical providers' adoption of disease management guidelines under managed care.

  8. Managing Bias in Palliative Care: Professional Hazards in Goals of Care Discussions at the End of Life.

    Science.gov (United States)

    Callaghan, Katharine A; Fanning, Joseph B

    2018-02-01

    In the setting of end-of-life care, biases can interfere with patient articulation of goals and hinder provision of patient-centered care. No studies have addressed clinician bias or bias management specific to goals of care discussions at the end of life. To identify and determine the prevalence of palliative care clinician biases and bias management strategies in end-of-life goals of care discussions. A semistructured interview guide with relevant domains was developed to facilitate data collection. Participants were asked directly to identify biases and bias management strategies applicable to this setting. Two researchers developed a codebook to identify themes using a 25% transcript sample through an iterative process based on grounded theory. Inter-rater reliability was evaluated using Cohen κ. It was 0.83, indicating near perfect agreement between coders. The data approach saturation. A purposive sampling of 20 palliative care clinicians in Middle Tennessee participated in interviews. The 20 clinicians interviewed identified 16 biases and 11 bias management strategies. The most frequently mentioned bias was a bias against aggressive treatment (n = 9), described as a clinician's assumption that most interventions at the end of life are not beneficial. The most frequently mentioned bias management strategy was self-recognition of bias (n = 17), described as acknowledging that bias is present. This is the first study identifying palliative care clinicians' biases and bias management strategies in end-of-life goals of care discussions.

  9. Caring behaviour perceptions from nurses of their first-line nurse managers.

    Science.gov (United States)

    Peng, Xiao; Liu, Yilan; Zeng, Qingsong

    2015-12-01

    Nursing is acknowledged as being the art and science of caring. According to the theory of nursing as caring, all persons are caring but not every behaviour of a person is caring. Caring behaviours in the relationship between first-line nurse managers and Registered Nurses have been studied to a lesser extent than those that exist between patients and nurses. Caring behaviour of first-line nurse managers from the perspective of Registered Nurses is as of yet unknown. Identifying caring behaviours may be useful as a reference for first-line nurse managers caring for nurses in a way that nurses prefer. To explore first-line nurse managers' caring behaviours from the perspective of Registered Nurses in mainland China. Qualitative study, using descriptive phenomenological approach. Fifteen Registered Nurses recruited by purposive sampling method took part in in-depth interviews. Data were analysed according to Colaizzi's technique. Three themes of first-line nurse managers' caring behaviours emerged: promoting professional growth, exhibiting democratic leadership and supporting work-life balance. A better understanding of the first-line nurse managers' caring behaviours is recognised. The three kinds of behaviours have significant meaning to nurse managers. Future research is needed to describe what first-line nurse managers can do to promote nurses' professional growth, increase the influence of democratic leadership, as well as support their work-life balance. © 2015 Nordic College of Caring Science.

  10. Patient-centeredness and quality management in Dutch diabetes care organizations after a 1-year intervention

    NARCIS (Netherlands)

    Campmans-Kuijpers, Marjo J E; Lemmens, Lidwien C.; Baan, Caroline A.; Rutten, Guy E H M

    2016-01-01

    Background: More focus on patient-centeredness in care for patients with type 2 diabetes requests increasing attention to diabetes quality management processes on patient-centeredness by managers in primary care groups and outpatient clinics. Although patient-centered care is ultimately determined

  11. Making it local: Beacon Communities use health information technology to optimize care management.

    Science.gov (United States)

    Allen, Amy; Des Jardins, Terrisca R; Heider, Arvela; Kanger, Chatrian R; Lobach, David F; McWilliams, Lee; Polello, Jennifer M; Rein, Alison L; Schachter, Abigail A; Singh, Ranjit; Sorondo, Barbara; Tulikangas, Megan C; Turske, Scott A

    2014-06-01

    Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks--including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation--the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability.

  12. Impact of chronic kidney disease management in primary care.

    Science.gov (United States)

    Meran, S; Don, K; Shah, N; Donovan, K; Riley, S; Phillips, A O

    2011-01-01

    The introduction of eGFR reporting and publication of national CKD guidelines has led to major challenges in primary and secondary care, leading to an increase in the number of referrals to nephrology clinics. We have shown that introduction of a renal patient care pathway reduces nephrology referrals and enables managed discharges of CKD patients to primary care. The aim of this article is to examine the outcome of patients discharged to primary care to find out if there is an associated risk with increased discharge supported by the patient pathway. The study was carried out within a single NHS Trust covering a population of 560,000. All patients discharged from the trust's renal outpatient clinic between June 2007 and July 2008 were identified. Patient notes and the local laboratory database systems were used to determine the source and timing of tests. A total of 31 new referrals and 57 regular follow-ups were discharged during this period. The median age of discharge was 67.5 years. Most subjects (60%) had CKD stage 3 at the time of discharge. A total of 23% of discharges were categorized as CKD stages 1, 2 or normal and 17% of patients had CKD stage 4. Overall, 93% had stable eGFRs prior to discharge, 77.5% of patients had blood pressure within threshold (140/90 according to UK CKD guidelines) and 97.7% of patients had haemoglobins >10 g/dl. Post-discharge 83% of patients had eGFRs recorded by their general practitioner and 92.6% of these were measured within appropriate time frames as per CKD guidelines. The majority of patients (82%) had either improved or stable eGFR post-discharge and only three patients had a significant decline in their eGFR. These data indicate that selected CKD patients can be appropriately discharged from secondary care and adequately monitored in primary care. Furthermore, we have shown that this was a safe practice for patients.

  13. Informal care givers’ experiences with support in primary palliative care when a case manager is involved: a descriptive study in the Netherlands.

    NARCIS (Netherlands)

    Plas, A.G.M. van der; Francke, A.L.; Deliens, L.; Jansen, W.J.J.; Vissers, K.C.; Onwuteaka-Philipsen, B.D.

    2017-01-01

    Introduction: Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal care givers. The case manager provides support in addition to the care provided by the home care nurse and

  14. Evaluation and management of overactive bladder: strategies for optimizing care

    Directory of Open Access Journals (Sweden)

    Willis-Gray MG

    2016-07-01

    Full Text Available Marcella G Willis-Gray, Alexis A Dieter, Elizabeth J Geller Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Abstract: Overactive bladder (OAB is a common condition affecting millions of men and women worldwide. It is an embarrassing condition with far-reaching consequences. Although many treatment options exist, no single treatment has been proven to be most effective. Often a combination of therapy is required to successfully manage OAB symptoms. In this review, we provide an overview of OAB, including risk factors for development of OAB; keys to diagnosis; therapeutic options including conservative and medical management, as well as treatments for refractory OAB; when to consider referral to a specialist; and resources for clinicians and patients. The aim of this review is to inform clinicians regarding OAB management in order to improve patient counseling and care. Keywords: overactive bladder, urge incontinence, urinary incontinence, bladder training, lifestyle modifications

  15. Crises in clinical care: an approach to management.

    Science.gov (United States)

    Runciman, W B; Merry, A F

    2005-06-01

    A "crisis" in health care is "the point in the course of a disease at which a decisive change occurs, leading either to recovery or to death". The daunting challenges faced by clinicians when confronted with a crisis are illustrated by a tragic case in which a teenage boy died after a minor surgical procedure. Crises are challenging for reasons which include: presentation with non-specific signs or symptoms, interaction of complex factors, progressive evolution, new situations, "revenge effects", inadequate assistance, and time constraints. In crises, clinicians often experience anxiety- and overload-induced performance degradation, tend to use "frequency gambling", run out of "rules" and have to work from first principles, and are prone to "confirmation bias". The effective management of crises requires formal training, usually simulator-based, and ideally in the inter-professional groups who will need to function as a team. "COVER ABCD-A SWIFT CHECK" is a pre-compiled algorithm which can be applied quickly and effectively to facilitate a systematic and effective response to the wide range of potentially lethal problems which may occur suddenly in anaesthesia. A set of 25 articles describing additional pre-compiled responses collated into a manual for the management of any crisis under anaesthesia has been published electronically as companion papers to this article. This approach to crisis management should be applied to other areas of clinical medicine as well as anaesthesia.

  16. [Outsourcing in long-term care: a risk management approach].

    Science.gov (United States)

    Guimarães, Cristina Machado; Carvalho, José Crespo de

    2012-05-01

    This article seeks to investigate outsourcing decisions in supply chain management of healthcare organizations, namely the motives and constraints behind the decision, the selection criteria for activities to be outsourced to third parties, the type of possible agreements, and the impact of this decision on the organization per se. A case study of the start-up phase of a Long-term Care unit with an innovative approach and high levels of customization was conducted to understand the outsourcing process in a start-up context (not in the standard context of organizational change) and a risk evaluation matrix was created for outsourcing activities in order to define and implement a performance monitoring process. This study seeks to understand how to evaluate and assess the risks of an outsourcing strategy and proposes a monitoring model using risk management tools. It was shown that the risk management approach can be a solution for monitoring outsourcing in the organizational start-up phase. Conclusions concerning dissatisfaction with the results of outsourcing strategies adopted are also presented.

  17. Advancements in the critical care management of status epilepticus.

    Science.gov (United States)

    Bauerschmidt, Andrew; Martin, Andrew; Claassen, Jan

    2017-04-01

    Status epilepticus has a high morbidity and mortality. There are little definitive data to guide management; however, new recent data continue to improve understanding of management options of status epilepticus. This review examines recent advancements regarding the critical care management of status epilepticus. Recent studies support the initial treatment of status epilepticus with early and aggressive benzodiazepine dosing. There remains a lack of prospective randomized controlled trials comparing different treatment regimens. Recent data support further study of intravenous lacosamide as an urgent-control therapy, and ketamine and clobazam for refractory status epilepticus. Recent data support the use of continuous EEG to help guide treatment for all patients with refractory status epilepticus and to better understand epileptic activity that falls on the ictal-interictal continuum. Recent data also improve our understanding of the relationship between periodic epileptic activity and brain injury. Many treatments are available for status epilepticus and there are much new data guiding the use of specific agents. However, there continues to be a lack of prospective data supporting specific regimens, particularly in cases of refractory status epilepticus.

  18. Diabetes management patterns in a palliative care unit in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Sami Ayed Alshammary

    2016-01-01

    Conclusion: Diabetes management varied among PCU patients. There is a real need for evidence-based guidelines for diabetes management among patients at the end of life. These guidelines should be tailored to patients' individual preferences in goals of care. Advance care planning should include discussion about patient preferences for management of diabetes at the end of life.

  19. Talent management best practices: how exemplary health care organizations create value in a down economy.

    Science.gov (United States)

    Groves, Kevin S

    2011-01-01

    : Difficult economic conditions and powerful workforce trends pose significant challenges to managing talent in health care organizations. Although robust research evidence supports the many benefits of maintaining a strong commitment to talent management practices despite these challenges, many organizations compound the problem by resorting to workforce reductions and limiting or eliminating investments in talent management. : This study examines how nationwide health care systems address these challenges through best practice talent management systems. Addressing important gaps in talent management theory and practice, this study develops a best practice model of talent management that is grounded in the contextual challenges facing health care practitioners. : Utilizing a qualitative case study that examined 15 nationwide health care systems, data were collected through semistructured interviews with 30 executives and document analysis of talent management program materials submitted by each organization. : Exemplary health care organizations employ a multiphased talent management system composed of six sequential phases and associated success factors that drive effective implementation. Based on these findings, a model of talent management best practices in health care organizations is presented. : Health care practitioners may utilize the best practice model to assess and enhance their respective talent management systems by establishing the business case for talent management, defining, identifying, and developing high-potential leaders, carefully communicating high-potential designations, and evaluating talent management outcomes.

  20. Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction.

    Science.gov (United States)

    Warner, Courtney J; Horvath, Alexander J; Powell, Richard J; Columbo, Jesse A; Walsh, Teri R; Goodney, Philip P; Walsh, Daniel B; Stone, David H

    2015-08-01

    Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care systems. Copyright © 2015 Society for