WorldWideScience

Sample records for care program 2004-2008

  1. Pacific Northwest National Laboratory Institutional Plan FY 2004-2008

    Energy Technology Data Exchange (ETDEWEB)

    Quadrel, Marilyn J.

    2004-04-15

    This Institutional Plan for FY 2004-2008 is the principal annual planning document submitted to the Department of Energy's Office of Science by Pacific Northwest National Laboratory in Richland, Washington. This plan describes the Laboratory's mission, roles, and technical capabilities in support of Department of Energy priorities, missions, and plans. It also describes the Laboratory strategic plan, key planning assumptions, major research initiatives, and program strategy for fundamental science, energy resources, environmental quality, and national security.

  2. Research production among students from the Facultad Nacional de Salud Publica, Universidad de Antioquia, during the period 2004-2008

    Directory of Open Access Journals (Sweden)

    Camilo Noreña H

    2011-05-01

    Full Text Available Objective: to describe the research production of undergraduate students from the National Faculty of Public Health (Facultad Nacional de Salud Pública, FNSP, Universidad deAntioquia, during the period 2004-2008. Methods: descriptive study document review. The Study population was limited to graduation projects according to their different modalities (research projects, development project and monographs of the three undergraduate programs at the FNSP and research papers published in the Revista Facultad Nacional de SaludPública during the period 2004-2008. The analysis unit was restricted to graduation projects that could be located at the FNSP library and research papers including undergraduatestudents as authors. Descriptive statistics were used for the analysis of the data collected. Results: a total amount of 279 graduation projects were reviewed, from wich 119 (42.7% were research projects. In the undergraduate program of Management of Health Information Systems, research projects were the most frequent type of graduation project (79.1%. This proportion was smaller in the health administration programs both in its emphasis in health services (36.2% and in its emphasis on environment and sanitation (19.7%. A total amount of 126 research papers were reviewd finding 22 (17.5% with undergraduate students of the FNSP as coauthors. The proportion of research projects published in the Revista FNSP was 11.8%. Conclusions: during the period2004-2008, two out of five graduation projects in the FNSPwere research projects. During the period studied important differences according to the undergraduate programs were observed. The proportion of research projects published in the Revista FNSP is still very small.

  3. Income and Employment in the United States, 2004-2008 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays 2004-2008 per capita personal income, annual number of full-time and part-time jobs, average wage per job in dollars, population, and per...

  4. Assuring Seafood Safety: Contaminants and Residues in Irish Seafood 2004-2008

    OpenAIRE

    McGovern, Evin; McHugh, Brendan; O’Hea, Linda; Joyce, Eileen; Tlustos, Christina; Glynn, Denise

    2011-01-01

    This report provides an overview on the occurrence of environmental contaminants, such as metals and persistent organic pollutants (POPs), and veterinary residues in Irish seafood. Compliance of seafood (shellfish, crustaceans, wild and farmed finfish) with relevant EC Regulatory Limits for contaminants is examined and an overview of conformance of the aquaculture sector with the requirements of the EC Residues Directive (Dir 96/23/EC) is presented for 2004 - 2008. The contribution of seafood...

  5. Temporal changes in stress preceding the 2004-2008 eruption of Mount St. Helens, Washington

    Science.gov (United States)

    Lehto, H.L.; Roman, D.C.; Moran, S.C.

    2010-01-01

    The 2004-2008 eruption of Mount St. Helens (MSH), Washington, was preceded by a swarm of shallow volcano-tectonic earthquakes (VTs) that began on September 23, 2004. We calculated locations and fault-plane solutions (FPS) for shallow VTs recorded during a background period (January 1999 to July 2004) and during the early vent-clearing phase (September 23 to 29, 2004) of the 2004-2008 eruption. FPS show normal and strike-slip faulting during the background period and on September 23; strike-slip and reverse faulting on September 24; and a mixture of strike-slip, reverse, and normal faulting on September 25-29. The orientation of ??1 beneath MSH, as estimated from stress tensor inversions, was found to be sub-horizontal for all periods and oriented NE-SW during the background period, NW-SE on September 24, and NE-SW on September 25-29. We suggest that the ephemeral ~90?? change in ??1 orientation was due to intrusion and inflation of a NE-SW-oriented dike in the shallow crust prior to the eruption onset. ?? 2010 Elsevier B.V.

  6. Rozw\\'oj bibliotek cyfrowych i repozytori\\'ow elektronicznych na Dolnym Slasku w latach 2004-2008 / Development of Digital Libraries and Electronic Repositories in Lower Silesia in Years 2004-2008

    CERN Document Server

    Moskwa, Krzysztof

    2010-01-01

    In following elaboration were presented digital libraries and electronic repositories operating in Lower Silesia region (of Poland) in years 2004-2008. General description of character and size of their collections was presented, as well as standards and methods of digital collections management and juridical aspects of this management. Potential of usage of digital collections in regional scientific researches was described. ----- W referacie przedstawiono biblioteki cyfrowe i repozytoria elektroniczne funkcjonujace na Dolnym Slasku w latach 2004-2008. Scharakteryzowano og\\'olnie ich zawarto\\'s\\'c i wielko\\'s\\'c, zaprezentowano standardy i systemy zarzadzania kolekcjami cyfrowymi oraz om\\'owiono uwarunkowania prawne towarzyszace zarzadzaniu zasobami cyfrowymi. Wskazano mo\\.zliwo\\'sci wykorzystania kolekcji cyfrowych w badaniach naukowych realizowanych w regionie.

  7. The Nordic maintenance care program

    DEFF Research Database (Denmark)

    Malmqvist, Stefan; Leboeuf-Yde, Charlotte

    2009-01-01

    of maintenance care. Previous studies have identified chiropractors' choices of case management strategies in response to different case scenarios. However, the rationale for these management strategies is not known. In other words, when presented with both the case, and different management strategies......Maintenance care is a well known concept among chiropractors, although there is little knowledge about its exact definition, its indications and usefulness. As an initial step in a research program on this phenomenon, it was necessary to identify chiropractors' rationale for their use......, there was consensus on how to match these, but if only the management strategies were provided, would chiropractors be able to define the cases to fit these strategies? The objective with this study was to investigate if there is a common pattern in Finnish chiropractors' case management of patients with low back...

  8. Rethinking collegiality: restratification in English general medical practice 2004-2008.

    Science.gov (United States)

    McDonald, Ruth; Checkland, Kath; Harrison, Stephen; Coleman, Anna

    2009-04-01

    For Freidson [(1985). The reorganisation of the medical profession. Medical Care Review, 42(1), 11-35], collegiality, or ostensible equal status amongst members of the medical profession, serves a dual purpose. It socialises members into an attitude of loyalty to colleagues and presents an image to those outside the profession that all its members are competent and trustworthy. However, Freidson saw the use of formal standards developed by one (knowledge) elite within medicine and enforced by another (administrative) elite as threatening collegiality and professional unity. Drawing on two studies in English primary medical care this paper reports the emergence of new strata or elites, with groups of doctors involved in surveillance of others and action to improve compliance in deficient individuals and organizations. Early indications are that these developments have not led to the consequences which Freidson predicted. The increasing acceptance of the legitimacy of professional scrutiny and accountability that we identify suggests that new norms are emerging in English primary medical care, the possibility of which Freidson's analysis fails to take account.

  9. 中国2004-2008年恶性肿瘤城乡死亡率分析%Malignancy mortality in urban and rural China,2004-2008

    Institute of Scientific and Technical Information of China (English)

    王明月; 杨光; 王刚; 白云

    2013-01-01

    目的 分析恶性肿瘤死因及恶性肿瘤城乡死亡率的分布特征,为肿瘤预防与控制提供参考依据.方法 对2004-2008年中国疾病监测系统所获得的恶性肿瘤统计资料进行分析.结果 2004-2008年全国疾病监测系统中恶性肿瘤总死亡率分别为135.71/10万、136.04/10万、118.00/10万、131.83/10万、134.00/10万;恶性肿瘤死因排序前5位的肿瘤分别是肺癌、肝癌、胃癌、食管癌、肠和肛门癌;胃癌、食管癌总死亡率整体呈下降趋势;肠和肛门癌总死亡率变化不明显;肝癌死亡率2004-2006年呈下降趋势,2006年以后开始上升;肺癌死亡率整体呈上升趋势;各年肺癌、肠和肛门癌死亡率均为城市高于农村(P <0.0001);除2006年肝癌死亡率城乡差异无统计学意义(P>0.05),其他年份均为农村高于城市(P <0.0001).结论 城市应以肺癌、肠和肛门癌预防与控制为主;农村应以肝癌、胃癌、食管癌预防与控制为主.%Objective To analyze the distribution pattern of malignancy mortality in urban and rural areas of China,and to provide scientific basis for cancer prevention and control.Methods Data on malignancies was collected from national disease surveillance system of China Center for Disease Control and Prevention in 2004-2008.Results The total mortality of malignant tumor from 2004 to 2008 was 135.71/100 000,136.04/100 000,118.00/100 000,131.83/100 000,and 134.00/100 000.The top five causes of cancer death were lung,liver,stomach,esophageal cancer,and intestinal and anal cancer.Gastric,esophageal,and colorectal cancer mortality showed a downward trend.From 2004 to 2006,liver cancer mortality presented a downward trend,but increased after 2006;lung cancer mortality showed upward trend.The mortality of lung,intestinal,and anal cancer were higher in urban than in rural areas (P < 0.000 1).The overall mortality of liver,stomach,and esophageal cancer were higher in rural than in urban areas

  10. The socioeconomic impacts of the 2004-2008 drought in the Ebro river basin (Spain): A comprehensive and critical assessment

    Science.gov (United States)

    Hernández-Mora, N.; Garrido, A.; Gil, M.

    2012-04-01

    Water scarcity and drought are particularly relevant phenomena in Spain, a country with a Mediterranean climate and intense pressure on existing water resources. Spain's drought management policies have evolved significantly over time, and today Spain is at the forefront of drought management and mitigation planning in Europe. However, drought management policies are not informed by comprehensive or accurate estimations of the socioeconomic impacts of drought, nor by the efficiency or efficacy of drought management and mitigation measures. Previous studies attempting to estimate on the impacts of drought are based on direct economic users of water, primarily irrigated agriculture and hydropower. Existing analyses do not take into consideration the impacts on other economic sectors, such as recreational uses, which have a growing importance from a socioeconomic perspective. Additionally, the intangible or non-market impacts (on social welfare and wellbeing and on the environment) are not considered or measured, although they can be significant. This paper presents the mid-point results of the PREEMPT project (Policy relevant assessment of the socioeconomic effects of droughts and floods, ECHO - grant agreement # 070401/2010/579119/SUB/C4), an effort to provide a comprehensive assessment of the socioeconomic impacts of the 2004-2008 drought in the Ebro river basin. The study gathers existing information on direct and indirect economic impacts of drought on different sectors, completing existing gaps and comparing the results of studies that use different methodologies. It also estimates the welfare losses resulting from domestic water use restrictions and environmental degradation as a result of the drought using a value transfer approach from results derived from value choice experiments developed for other Spanish and international river basins. Results indicate that there is a clear need to improve our knowledge of the direct and indirect impacts of drought and to

  11. EL URBANISMO DE RENOVACIÓN DE GRANDES CONJUNTOS DE VIVIENDA SOCIAL EN FRANCIA, 2004-2008

    Directory of Open Access Journals (Sweden)

    María Castrillo Romón

    2010-05-01

    Full Text Available RESUMEN Los "grands ensembles" (grandes conjuntos de vivienda social construidos en Francia entre mediados de las décadas de 1950 y 1970 han sido objeto preferente del Programa Nacional de la Renovación Urbana (PNRU inicialmente previsto por el gobierno francés para 2004-2008. La finalización de este periodo permite acometer la evaluación de sus resultados y, en concreto, como propone este artículo, analizar los rasgos distintivos del urbanismo de esas operaciones de renovación urbana en torno a dos ejes (argumentos justificativos y aspectos operativos, principalmente de carácter proyectivo y a partir de una doble confrontación: (i con el urbanismo funcionalista característico de esos grandes conjuntos; y (ii con el urbanismo de renovación urbana masiva precedente. El análisis se nutre de textos institucionales y del estudio comparado de ocho proyectos de renovación urbana de "grands ensembles" de la región Ile-de-France. Se concluye la especificidad del urbanismo de las operaciones financiadas por el PNRU (morfología híbrida, residencial y la identificación de diversas filiaciones y rupturas con el urbanismo funcionalista (zonificación, interpretación de la renovación y reestructuración parcelaria, entre otros.SUMMARY The "grands ensembles" (large social housing estates constructed in France in the middle of the 1950s and 1970s have been the special focus of the National Urban Renovation Programme (PNRU planned initially by the French government for 2004-2008. The finalization of this period allows an analysis of its results to be made. In particular, as this article proposes, an analysis of the distinguishing characteristics of the planning of those urban renovation operations around two axes. These are the justificatory arguments and the operative aspects, mainly of a planning character, and from two comparisons: (i with functionalist planning characteristics of those large estates; and, (ii with the planning of previous

  12. Antimicrobial Susceptibility of Bloodstream Isolates of Staphylococcus aureus: Global Results from the Tigecycline Evaluation and Surveillance Trial, 2004-2008

    Directory of Open Access Journals (Sweden)

    Daniel Amsterdam

    2010-01-01

    Full Text Available Problem statement: The Tigecycline Evaluation and Surveillance Trial (TEST commenced in 2004 to monitor the activity of tigecycline, a new glycylcycline and numerous comparators against major hospital-and community-associated pathogens. In this report we examine the efficacy of tigecycline and comparators against isolates of Staphylococcus aureus collected from blood. Approach: Almost 4000 blood-derived isolates of Staphylococcus aureus were collected from participating centers globally between 2004-2008. Results: All isolates were susceptible to tigecycline (MIC90 0.25 mg L-1 and linezolid (MIC90 4 mg L-1; 99.9% of isolates were susceptible to vancomycin (MIC90 1 mg L-1. Tigecycline and linezolid activity were unaffected by resistance to methicillin, ICU vs non-ICU isolate collection or the age of patients from which the isolates were collected. Although 95.3% of MSSA were levofloxacin susceptible, only 14.4% of MRSA isolates were susceptible to levofloxacin in this study. Conclusion: Tigecycline is shown here to be active against S. aureus isolates collected from blood and is unaffected by methicillin resistance. However, tigecycline is not as yet approved for the treatment of bacteremic infections.

  13. Shared Heritage: An Intergenerational Child Care Program.

    Science.gov (United States)

    Hawkeye Area Community Action Program, Cedar Rapids, IA.

    This report describes ways in which older persons may become involved in the field of home child care. It is intended to provide (1) detailed information on an intergenerational child care (IGCC) program; (2) general information relating to intergenerational contacts and home child care; and (3) "how-to" information for agencies planning…

  14. Gestión y financiamiento de las investigaciones por el Instituto Nacional de Salud, Perú 2004-2008 Management and funding of the research by the peruvian National Institute of Health, 2004-2008

    Directory of Open Access Journals (Sweden)

    Gladys Garro

    2010-09-01

    Full Text Available Se analizó los resultados de los proyectos de investigación que han sido aprobados y financiados por el Instituto Nacional de Salud durante el periodo 2004-2008. De 182 investigaciones aprobadas y presupuestadas, se ejecutaron 150 (82%; 86% (129/150 culminaron en informe final y solo 14% (18/129 se publicaron en revistas indizadas, el promedio de tiempo de publicación de un artículo fue de 2,7 años. De las investigaciones presentadas, 68 (45%, fueron a través del fondo concursable, 60 (40% institucionales, 14 (9% de direcciones regionales de salud y 8 (5% colaborativas. El presupuesto ejecutado fue de $5 032 906,62. En promedio, se asignó a cada investigación $ 33 552,71 y el costo por cada publicación fue de $ 279 605,92; la distribución del presupuesto según objeto o tema de estudio fue 61% para enfermedades transmisibles, 12% para no transmisibles y 27% para desarrollo tecnológico. La promoción, desarrollo y financiamiento de la investigación en el Instituto Nacional de Salud durante este periodo, ha tenido una tendencia descendente, influenciada por la política institucional. Para revertir esta situación no solo a nivel institucional sino nacional, es necesario que el Estado defina su política nacional de investigación, respetando las prioridades nacionales y regionales de investigación en salud.The results of the research projects that have been approved and funded by the Instituto Nacional de Salud (Peru during the period 2004-2008 were analyzed. Out of 182 approved and funded research projects, 150 (82% were actually performed, 86% (129/150 ended in the final report and only 14% (18/129 were published in indexed journals, the mean time for publication of an article was of 2,7 years. Out of the presented research projects, 68 (45% were through a competitive fund, 60 (40% were institutional, 14 (9% coming from regional (provincial health directions and 8 (5% collaborative. The executed budget was of $ 5’032,906.62. The

  15. Research plan, technological development and demonstration for radioactive waste management 2004-2008; Plan de investigacion, desarrollo tecnologico y demostracion para la gestion de residuos radiactivos 2004-2008

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-07-01

    Since ENRESA establisment the Company has been Deveeloping solutions through its R D Programme as key factor of knowledge, scientific and technological developmenty providing solutions to those aspects related where there is not available conventional and industrial capabilities. Main works have been developed concerning to HLW, LILW, Radiological Protection, Dismantling Closure. Facilities supporting, Old Uranium Mill Tailing Environmental Restoration, and improvements of aspects related to safety, are the pillars supporting the different ENRESA's R D Plans. Nawadays ENRESA is finishing its current R D Plan 1999-2003. The results obtained under this framework will be the basis to build next Plan 2004-2008 as the ENRESA's Fifth R D Plan, according to General Radioactive Waste Plan and in parallel to th co-operation opportunities offered through the international and National Framework of R D (Spanish Natinal Programme of R D, EU Sixth R D Framework, NEA/OCDE, IAEA/OIEA, and main bilateral agreements between main national agencies, etc.). In this sense, ENRESA takes advantage in order to offer an open summit, next 1 to 4 December 2003, in Tarragona City, where the main sicientific and technological results reached so far in this field will be showed to the Spanish society. The present document is a compilation of th eposter summaries that are displayed under the framework of this meeting. Likewise, this meeting is a key action to transmit to the society in a clear and transparent way the effort that ENRESA is making according to the environmental sustaianable criteria in order to Build the Future. (Author)

  16. El gradiente socioeconómico de la mortalidad por tuberculosis en México (2004-2008

    Directory of Open Access Journals (Sweden)

    José Alejandro Meza-Palmeros

    2013-01-01

    Full Text Available Objetivo: Analizar la relación entre mortalidad por tuberculosis (TB y diversos indicadores de rezago social (pobreza alimentaria, ocupación, porcentaje de población hablante de una lengua indígena en México, durante el período 2004-2008. Metodología: Se conformó una base de datos con las defunciones registradas en el país por TB de 2004 a 2008 que incluyó: municipio, localidad de residencia y ocupación –tanto por sector económico (primario, secundario, terciario, como condición de empleado/desempleado- de los fallecidos; información relacionada con el grado de rezago social por localidad (porcentaje de población hablante de lengua indígena y por municipio (porcentaje de población en situación de pobreza alimentaria. Posteriormente se estimaron las tasas de mortalidad por TB según las variables mencionadas anteriormente. El análisis estadístico se realizó utilizando pruebas de chi cuadrada y regresión lineal. Resultados: Se encontró que la mortalidad por TB obedece a un gradiente socioeconómico que se expresa en una relación estadísticamente significativa entre la mortalidad por TB y los indicadores analizados (grado de rezago social, porcentaje de población indígena por localidad, sector económico de ocupación y, condición de empleado/desempleado. Conclusiones: La mortalidad por TB en México parece concentrarse en la población socialmente vulnerable, por lo que es necesario que en la estrategia de prevención y control de la TB se consideren en mayor medida, los determinantes sociales de la enfermedad.

  17. Emergence Corporate Financial Distressin Emerging Market: Empirical Evidence from Indonesia Stock Exchange(IDX 2004-2008

    Directory of Open Access Journals (Sweden)

    Koes Pranowo

    2011-11-01

    Full Text Available Normal 0 false false false MicrosoftInternetExplorer4 st1\\:*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Financial recovery is the most difficult in financial management. Therefore, this is important to study how a company in financially-distress can survive to rise up to a healthy financial condition (emergence financial distress. The research consists of 200 non financial companies which are listed on Indonesia Stock Exchange (IDX for the period of 2004-2008. This study focuses on management of working capital. How a company fulfill its current liabilities, and its sources in current assets which shall be cashed at the short term period. By using Multinomial logit, we analyzed the probability a financially-distress company rise up to emergence financial distress or stay of the status of financial distress and what are financial indicators affect to a company in the status of Non Financial Distress tend to Financial Distress. Thus, the important thing is to determine financial ratios which can be an indicator to determine of emergence financial distress. We find a positive relationship between Profit, efficiency and emergence financial distress and a negative relationship between leverage and emergence financial distress.   Keywords: Emergence Financial Distress, Indonesia Stock Exchange (IDX, Multinomial Logit JEL Classification Codes: G 3

  18. El gradiente socioeconómico de la mortalidad por tuberculosis en México (2004-2008

    Directory of Open Access Journals (Sweden)

    José Alejandro Meza-Palmeros

    2013-01-01

    Full Text Available Objetivo: Analizar la relación entre mortalidad por tuberculosis (TB y diversos indicadores de rezago social (pobreza alimentaria, ocupación, porcentaje de población hablante de una lengua indígena en México, durante el período 2004-2008. Metodología utilizada: Se conformó una base de datos con las defunciones registradas en el país por TB de 2004 a 2008 que incluyó: municipio, localidad de residencia y ocupación –tanto por sector económico (primario, secundario, terciario, como condición de empleado/desempleado- de los fallecidos; información relacionada con el grado de rezago social por localidad (porcentaje de población hablante de lengua indígena y por municipio (porcentaje de población en situación de pobreza alimentaria. Posteriormente se estimaron las tasas de mortalidad por TB según las variables mencionadas anteriormente. El análisis estadístico se realizó utilizando pruebas de chi cuadrada y regresión lineal. Resultados: Se encontró que la mortalidad por TB obedece a un gradiente socioeconómico que se expresa en una relación estadísticamente significativa entre la mortalidad por TB y los indicadores analizados (grado de rezago social, porcentaje de población indígena por localidad, sector económico de ocupación y, condición de empleado/desempleado. Conclusiones: La mortalidad por TB en México parece concentrarse en la población socialmente vulnerable, por lo que es necesario que en la estrategia de prevención y control de la TB se consideren en mayor medida, los determinantes sociales de la enfermedad.

  19. The Nordic maintenance care program

    DEFF Research Database (Denmark)

    Myburgh, Corrie; Brandborg-Olsen, Dorthe; Albert, Hanne;

    2013-01-01

    To describe and interpret Danish Chiropractors' perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics.......To describe and interpret Danish Chiropractors' perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics....

  20. Long-Term Care Ombudsman Program

    Science.gov (United States)

    ... Strategic Plan Federal Initiatives Career Opportunities Contact Us Administration on Aging (AoA) Long-Term Care Ombudsman Program ( ... Prevention HIV/AIDS Nutrition Services Oral Health Elder Justice & Adult Protective Services Elder Justice Coordinating Council Prevention ...

  1. 潍坊社区2004-2008年肿瘤发病及生存调查%Investigation of the cancer incidence and survival in Weifang Community from 2004-2008

    Institute of Scientific and Technical Information of China (English)

    汪镛

    2014-01-01

    目的:分析潍坊社区2004-2008年肿瘤流行病学特征。方法:从上海市肿瘤病例报告系统及上海市浦东新区人口全死因数据库获取资料,分析5年肿瘤患者发病及死亡信息。结果:5年内肿瘤共发病2079例;女性乳腺癌发病始终居首位,男性为肺癌,其次为大肠癌(结、直肠癌)、胃癌。肿瘤发病人群集中趋势5年内变化不大,40岁以上人群发病率明显增高,尤以80岁以上年龄段。5年内肿瘤患者死亡数排名前五位男性为肺癌、胃癌、肝癌、胰腺癌、结肠癌;女性为肺癌、胃癌、结肠癌、肝癌、乳腺癌。其中,肝癌女性一年内及5年内病死率均明显高于男性(P=0.004)。结论:肿瘤发病正呈现发病率增高、肿瘤发病谱改变、首次发病年轻化等状况,且多原发肿瘤病例增多。%Objective: To analyze the cancer epidemiological characteristics of a community from 2004 to 2008. Methods: The information about the incidence and death of the cancers in the five years were collected from the Shanghai cancer case reporting system and the all-cause mortality database of Pudong New District. Results: In the five years, 2079 cases were reported. The female breast cancer was always in the ifrst place, so was the lung cancer for the man. Colorectal cancer (colon and rectal cancers) and stomach cancer followed as the second and third. The change of the trend concentrated in the cancer incidence of the population was not great. The incidence was prominent in the population over 40 years old, and especially in the group of 80 years and above. The rank of the cancer deaths in the top ifve of the male in the ifve years was the lung cancer, gastric cancer, liver cancer, pancreatic cancer, and colon cancer, and that of the female was the lung cancer, gastric cancer, colon cancer, liver cancer, and breast cancer. The mortality of the liver cancer of the female was obviously higher than that of the

  2. Program management of telemental health care services.

    Science.gov (United States)

    Darkins, A

    2001-01-01

    Telemedicine is a new adjunct to the delivery of health care services that has been applied to a range of health care specialties, including mental health. When prospective telemedicine programs are planned, telemedicine is often envisaged as simply a question of introducing new technology. The development of a robust, sustainable telemental health program involves clinical, technical, and managerial considerations. The major barriers to making this happen are usually how practitioners and patients adapt successfully to the technology and not in the physical installation of telecommunications bandwidth and the associated hardware necessary for teleconsultation. This article outlines the requirements for establishing a viable telemental health service, one that is based on clinical need, practitioner acceptance, technical reliability, and revenue generation. It concludes that the major challenge associated with the implementation of telemental health does not lie in having the idea or in taking the idea to the project stage needed for proof of concept. The major challenge to the widespread adoption of telemental health is paying sufficient attention to the myriad of details needed to integrate models of remote health care delivery into the wider health care system.

  3. Better Kid Care Program Improves the Quality of Child Care: Results from an Interview Study

    Science.gov (United States)

    Ostergren, Carol S.; Riley, David A.; Wehmeier, Jenny M.

    2011-01-01

    More high quality child care is needed in the United States. This article evaluates the Better Kid Care (BKC) program produced by Pennsylvania State University Extension. Child care staff in Wisconsin were interviewed about changes they had made in their early childhood programs following participation in the BKC program. Findings show that 2…

  4. Supporting Nutrition in Early Care and Education Settings: The Child and Adult Care Food Program (CACFP)

    Science.gov (United States)

    Stephens, Samuel A.

    2016-01-01

    Child care centers, Head Start programs, and family child care providers serving young children--as well as after school programs and homeless shelters that reach older children, adults, and families--are supported in providing healthy meals and snacks by reimbursements through the Child and Adult Care Food Program (CACFP). Administered by the…

  5. Astroclimate at San Pedro M\\'artir I: 2004-2008 Seeing Statistics from the TMT Site Testing Data

    CERN Document Server

    Sánchez, L J; Echevarría, J; Ruelas-Mayorga, A; García, A M; Avila, R; Carrasco, E; Carramiñana, A; Nigoche-Netro, A

    2012-01-01

    We present comprehensive seeing statistics for the San Pedro M\\'artir site derived from the Thirty Meter Telescope site selection data. The observations were obtained between 2004 and 2008 with a Differential Image Motion Monitor (DIMM) and a Multi Aperture Scintillation Sensor (MASS) combined instrument (MASS--DIMM). The parameters that are statistically analised here are: whole atmosphere seeing -measured by the DIMM-; free atmosphere seeing --measured by the MASS--; and ground-layer seeing (GL) --difference between the total and free-atmosphere seeing--. We made a careful data coverage study along with statistical distributions of simultaneous MASS--DIMM seeing measurements, in order to investigate the nightly, monthly, seasonal, annual and global behaviour, as well as possible hourly seeing trends. Although this campaign covers five years, the sampling is uneven, being 2006 and 2007 the best sampled years in terms of seasonal coverage. The overall results yield a median seeing of 0.78 (DIMM), 0.37 (MASS) ...

  6. Epidemiological Analysis for Rubella in Shenzhen From 2004 to 2008%2004-2008年深圳市风疹流行病学分析

    Institute of Scientific and Technical Information of China (English)

    邱劲军; 李丽廉; 舒彬

    2009-01-01

    目的 分析深圳市福田区2004-2008年风疹的流行病学特点,为风疹疫情的防控提供科学依据.方法 利用来自国家疾病报告管理信息系统的疫情资料,对风疹监测资料进行描述性流行病学分析.结果 2004-2008年深圳市福田区共报告风疹病例84例,发病率1.47/10万,风疹发病有明显的季节性,3、11月为发病高峰,发病以0~5岁、20~25岁年龄组较为集中,全区各街道都有病例报告,在学生、散居儿童和商业服务人员发病率较高.结论 实施风疹疫苗接种是控制风疹流行最有效的措施,应加强对漏种儿童和育龄妇女的补种工作,以提高风疹疫苗接种率,防止风疹的暴发流行和先天性风疹综合症的发生.%Objective According to rubella case's morbidity situation from 2004 to 2008 in Futian district of Shenzhen, study the epidemiology characteristic of rubella and provide the scientific basis for the prevention and control. Method The "National Management Information System for Disease Reporting" software was employed to gather epidemic data, and epidemiological analysis was made for rubella. Results There were 84 cases reported in Futian district of Shenzhen from 2004 to 2008, the incidence of rubella was 1.47/10 mil-lion. There were clear seasonal changes, a morbidity peak was in March and in November, and the 0 -5, 20 -25 year-old age group was most concentrated in. The region of the street have reported cases generally. The student, scattered children and commercial service personnel was in a higher rate of incidence. Conclu-sion The main effective measures to control the outbreak of rubella lie in rubella vaccination. We should strengthen to the vaccination of the child and the reproductive woman who had forgotten to vaccination, raise the coverage of rubella vaccination, prevent the rubella to explode and the congenital rubella syndrome occur-rence.

  7. Vouchers for Day Care of Children: Evaluating a Program Model.

    Science.gov (United States)

    Parker, Michael D.

    1989-01-01

    Examined effects of a pilot voucher program on the price, supply, and quality of day care. Findings offered no conclusive evidence concerning expected benefits. Discusses vouchers' potential for easing the day care crisis. (RJC)

  8. Budget of organic carbon in the North-Western Mediterranean open sea over the period 2004-2008 using 3-D coupled physical-biogeochemical modeling

    Science.gov (United States)

    Ulses, C.; Auger, P.-A.; Soetaert, K.; Marsaleix, P.; Diaz, F.; Coppola, L.; Herrmann, M. J.; Kessouri, F.; Estournel, C.

    2016-09-01

    A 3-D hydrodynamic-biogeochemical coupled model has been used to estimate a budget of organic carbon and its interannual variability over the 5 year period 2004-2008 in the North-Western Mediterranean Open Sea (NWMOS). The comparison of its results with in situ and satellite observations reveals that the timing and the magnitude of the convection and bloom processes during the study period, marked by contrasted atmospheric conditions, are reasonably well reproduced by the model. Model outputs show that the amount of nutrients annually injected into the surface layer is clearly linked to the intensity of the events of winter convection. During cold winters, primary production is reduced by intense mixing events but then spectacularly increases when the water column restratifies. In contrast, during mild winters, the primary production progressively and continuously increases, sustained by moderate new production followed by regenerated production. Overall, interannual variability in the annual primary production is low. The export in subsurface and at middepth is however affected by the intensity of the convection process, with annual values twice as high during cold winters than during mild winters. Finally, the estimation of a global budget of organic carbon reveals that the NWMOS acts as a sink for the shallower areas and as a source for the Algerian and Balearic subbasins.

  9. The impact of recent Central and Eastern European migration on the Scottish health service: A study of newspaper coverage 2004-2008.

    Science.gov (United States)

    Catto, Alastair; Gorman, Dermot; Higgins, Martin

    2010-09-01

    This paper examines newspaper coverage of the impact on NHS Scotland of recent Central and Eastern European immigration. It follows rising public interest in the impacts of 'record' and 'unexpected' levels of migration after the 2004 and 2007 European Union (EU) enlargements. We reviewed reporting in six Scottish newspapers during 2004-2008 to track underlying themes within their coverage of EU migration. The framework of Social Representations Theory (SRT) was used to analyse how migration's impact was conceptualised and explained. This research shows that portrayal of migrants posing a threat to the NHS (e.g. European staff with inadequate qualifications), has increased in frequency but changed in nature over the past 4 years. Meanwhile, reports have also portrayed themes of reassurance (e.g. NHS management control) to allay societies' fears. The overall pattern is of representations of threat in the Scottish press being closely followed by those of reassurances. The most important reassurances relate to Scottish socioeconomic conditions, which raises questions might be seen in other UK newspapers as well as what will happen in Scotland if A8 migration decreases.

  10. Certificate Program in Self-Care for Pharmacy Practice.

    Science.gov (United States)

    Blank, Jerome W.; Popovich, Nicholas G.

    The Purdue University School of Pharmacy and Pharmacal Sciences initiated a Certificate Program in Self-Care for Pharmacy Practice. The program aimed to enable pharmacists to develop their practice to better serve the self-care needs of customers. In a pilot group 26 participating pharmacists took a sequence of home study modules and workshops…

  11. Wellness Programs: Preventive Medicine to Reduce Health Care Costs.

    Science.gov (United States)

    Martini, Gilbert R., Jr.

    1991-01-01

    A wellness program is a formalized approach to preventive health care that can positively affect employee lifestyle and reduce future health-care costs. Describes programs for health education, smoking cessation, early detection, employee assistance, and fitness, citing industry success figures. (eight references) (MLF)

  12. Epidemiological analysis of measles in Jiaozuo from 2004 to 2008%焦作市2004-2008年麻疹流行病学分析

    Institute of Scientific and Technical Information of China (English)

    王军

    2010-01-01

    目的 了解焦作市近年麻疹流行病学特点和疫情发生特点,为今后制定科学合理的预防控制麻疹策略和措施提供依据.方法 对2004-2008年麻疹疫情资料进行描述流行病学分析.结果 焦作市近年来麻疹发病一直控制在较低水平,发病形式主要为散发和局部小范围暴发.各县市区报告麻疹发病相差悬殊.发病高峰在3-6月份(占73.91%).在667例确诊病例中,<15岁人群占89.05%,发病为小年龄组模式,<1岁人群占25.48%.麻疹病例以散居儿童为多,占46.35%,其次为学龄和幼托儿童,占42.10%.在确诊病例中,有免疫史者仅占33.13%,无免疫史者占44.38%,免疫史不详者占22.49%.麻疹血清样本采集率为58.89%.结论 加强麻疹监测,提高麻疹疫苗常规免疫接种率和接种质量,消除暴发仍是今后全市控制麻疹的工作重点和主要任务.而做好儿童入托、入学查漏补种工作,提高麻疹疫苗复种率,减少免疫空白和易感人群的积累是建立全市牢固免疫屏障的关键.%Objective To understand epidemiological characteristics of measles in Jiaozuo, Henan Province and provide a scientific basis for strategies and measures of prevention and control of measles in the future. Methods Descriptive epidemiological method was used to analyze the data of measles during 2004-2008. Results Measles was controlled at low attack rates and occurred sporadically and in a manner of smallrange outbreaks. The attack rates varied with different regions. The peak incidences were discovered from March to June(73.91%). Among 667 confirmed cases, 89.05% were observed in < 15 year group, with 25.48% in < 1 year group. The measles cases were mainly seen in scattered children(46.35%), followed by school-age and nursery children(42.10%). There were 33.13%, 44.38%, and 22.49% of the cases with immunized history, non-immunized history, and unclear immunized history, respectively. The serum collecting rate was 58

  13. Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

    Science.gov (United States)

    Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

    2012-09-01

    In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

  14. Prepregnancy contraceptive use among teens with unintended pregnancies resulting in live births - Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2008.

    Science.gov (United States)

    2012-01-20

    Approximately 400,000 teens aged 15-19 years give birth every year in the United States (1), and the teen birth rate remains the highest in the developed world. Teen childbearing is a public health concern because teen mothers are more likely to experience negative social outcomes, including school dropout. In addition, infants of teen mothers are more likely to be low birth weight and have lower academic achievement, and daughters of teen mothers are more likely to become teen mothers themselves. To learn why teens wishing to avoid pregnancy become pregnant, CDC analyzed data from the 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS). This report describes estimated rates of self-reported prepregnancy contraceptive use among white, black, and Hispanic teen females aged 15-19 years with unintended pregnancies resulting in live births. Approximately one half (50.1%) of these teens were not using any method of birth control when they got pregnant, and of these, nearly one third (31.4%) believed they could not get pregnant at the time; 21.0% used a highly effective contraceptive method (although less than 1% used one of the most effective methods, such as an intrauterine device [IUD]); 24.2% used the moderately effective method of condoms; and 5.1% used the least effective methods, such as rhythm and withdrawal. To decrease teen birth rates, efforts are needed to reduce or delay the onset of sexual activity, provide factual information about the conditions under which pregnancy can occur, increase teens' motivation and negotiation skills for pregnancy prevention, improve access to contraceptives, and encourage use of more effective contraceptive methods.

  15. Peak discharge evaluation of five exceptional winter flash floods of 2004-2008 in Central-East Sardinian karst areas and their geomorphological effectiveness (Italy)

    Science.gov (United States)

    Cossu, Q. A.; de Waele, J.; Bodini, A.; Sanna, L.; Cabras, S.

    2009-04-01

    In five subsequent winters (2004-2008) extreme meteorological events have occurred in karst areas of Central East Sardinia, leading to flash floods in several watersheds. Codula Ilune and Flumineddu experienced the most severe flash flood in December 2004, Codula Fuili in December 2006 and Codula Sisine in December 2008. The scars of these flash floods are still well visible in the river bed morphology, caused by the huge quantities of water that have passed the river reaches during these extreme floods. Since no gauges are present in none of these watersheds, the only possible way of estimating the peak flow is a combination of geomorphological and hydraulic observations. Three different methods for the estimation of peak flow velocity have been applied in several river reaches of 4 karstic watersheds (Codula Ilune, Codula Fuili and Codula Sisine in the Gulf of Orosei and Riu Flumineddu in Supramonte), using the Manning's equation, the similar Jarrett's formula and the Costa's method (1983) that make use of the mean diameter of the biggest by the flood water transported boulders. These estimates allow to quantify the peak flow of the floods in different river reaches, and also to have an idea of where and how much water penetrates into the karst aquifer, thus feeding the underground karst river network. Based on measurements from raingauges close to the study area, a statistical analysis of the rainfalls that have caused these flash floods has been also carried out. Total volume of water has been estimated for these four watersheds in the 5 events.

  16. La gestión de los espacios y recursos costeros en España: Política e instituciones de una legislatura (2004-2008

    Directory of Open Access Journals (Sweden)

    Barragán Muñoz, Juan Manuel

    2010-07-01

    Full Text Available This article studies the government of Spain’s coastal management during one legislature (2004-2008 as an analysis of a specific public policy; it assesses progress in the management model through ten key issues related to the Ministry of the Environment’s Directorate General of Coasts. The results allow us to offer several affirmations: firstly, a notable lack of integration in Spain’s coastal management still remains; secondly, interesting initiatives for changing the traditional coastal management model have arisen; thirdly, these initiatives have had very little impact on management for a number of different reasons (the absence of a policy based on a broad perspective, very slow-paced application, impediments in the relationship between the government system and the scope of management and lastly, the management model will need to overcome serious stumbling blocks as long as progress is not achieved in several of the key issues studied (policy, coordination, institutions, strategy, administrators and participation, etc..

    El artículo estudia la gestión costera del gobierno de España a lo largo de una legislatura (2004-2008. Este ejercicio se interpreta como análisis de una política pública específica. Los avances constatados en el modelo de gestión se evalúan a través de diez temas clave relacionados con la Dirección General de Costas del Ministerio de Medio Ambiente. Los resultados permiten varias afirmaciones: 1 La situación de la gestión costera en España todavía dista mucho de ser integrada. 2 Surgen interesantes iniciativas de cambio en el modelo tradicional de gestión costera. 3 Estas iniciativas han tenido bajo impacto en la gestión real por diferentes causas (ausencia de política de amplia perspectiva, aplicación muy lenta, dificultades de relación entre el sistema de gobierno y el ámbito de gestión. 4 El modelo de gestión tendrá grandes obstáculos para mejorar mientras no se progrese en varios

  17. 2004-2008年浙江省15岁以上摩托车驾驶员道路交通伤害监测结果分析%Analysis on road traffic inkury surveillance on motorcycle drivers aged 15 years and above in Zhejiang Province, 2004-2008

    Institute of Scientific and Technical Information of China (English)

    赵鸣; 俞敏; 张新卫; 肖媛媛; 钟节鸣; 丛黎明

    2012-01-01

    Objective To analysis the road traffic injury among motorcycle drivers in Zhejiang Province, and provide scientific evidence for future intervention. Methods The data from Zhejiang provincial hospital-based injury surveillance system were analyzed during 2004 - 2008. Results 7053 cases of injury were reported from 2004 to 2008, with a male to female ratio of 3.58:1. 59. 59% of patients were 25 to 44 years old. The severity of injury among injured motorcycle drivers was in the moderate level (43.46% ). The helmet fitting and wearing rate of injured motorcycle drivers were 40.61% and 33.43%. The self-reported proportion of alcohol use was 4.08%. The soft tissue injury was the main injury kind (71.93% ), and head was the main injured position of body (41. 25% ). Conclusion The road traffic injury among motorcycle drivers has its characteristics and feature. Driving with helmet and no-drinking should be paid more attention among motorcycle drivers.%[目的]分析浙江省摩托车驾驶员道路交通伤害情况,为今后开展相关干预提供依据.[方法]利用浙江省医院伤害监测数据进行分析.[结果]2004-2008年共监测15岁以上摩托车驾驶员道路交通伤害病例7053例,男女性别比为3.58∶1;25~44岁年龄组占59.59%.伤害严重程度以中度为主,占43.46%.安全头盔配置率和使用率分别为40.61%和33.43%、伤害病例中,自报饮酒率为4.08%.伤害性质以软组织伤为主(71.93%),伤害部位以头部为主(41.25%).[结论]摩托车驾驶员道路交通伤害的发生有其特性与规律,应针对安全头盔使用和酒后驾驶开展干预.

  18. 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.

  19. 75 FR 79323 - Health Care for Homeless Veterans Program

    Science.gov (United States)

    2010-12-20

    ... information technology, e.g., permitting electronic submission of responses. The proposed amendments to title... counseling. (2) Professional counseling, including counseling on self care skills, adaptive coping skills and, as appropriate, vocational rehabilitation counseling, in collaboration with VA programs and...

  20. 45 CFR 1306.35 - Family child care program option.

    Science.gov (United States)

    2010-10-01

    ... condition that poses a threat to children's health. Family child care providers must ensure that pets are... 45 Public Welfare 4 2010-10-01 2010-10-01 false Family child care program option. 1306.35 Section... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES,...

  1. Psychotropic Medication Management in a Residential Group Care Program

    Science.gov (United States)

    Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.

    2010-01-01

    This article presents a psychotropic medication management approach that is used within a residential care program. The approach is used to assess medications at youths' times of entry and to facilitate decision making during care. Data from a typical case study have indicated that by making medication management decisions slowly, systematically,…

  2. Collaboration and Subsidized Early Care and Education Programs in Illinois

    Science.gov (United States)

    Spielberger, Julie; Zanoni, Wladimir; Barisik, Elizabeth

    2013-01-01

    As a result of policy changes following welfare reform in 1996 and the costs associated with providing high-quality early care and education for children of low-income working families, agency collaboration in the state of Illinois has become an increasingly salient feature of subsidized early care and education programs (SECE). The authors…

  3. An innovative night service program in home care.

    Science.gov (United States)

    Tennant, J; Narayan, M C

    1997-05-01

    Comprehensive night service by a home care agency has resulted in increased customer satisfaction and referrals to the agency. The description of this innovative night nurse program includes the job requirements and duties of a visiting night nurse and the tools the nurse uses to accomplish the task of nighttime care delivery. The use of self-directed work groups and mentorship to manage the demands of night service are discussed. Continuity of care, nurse safety, professional development, and program cost also are addressed.

  4. The value of data collection within a palliative care program.

    Science.gov (United States)

    Kamal, Arif H; Currow, David C; Ritchie, Christine; Bull, Janet; Wheeler, Jane L; Abernethy, Amy P

    2011-08-01

    Collecting reliable and valid data is an increasing expectation within palliative care. Data remain the crux for demonstrating value and quality of care, which are the critical steps to program sustainability. Parallel goals of conducting research and performing quality assessment and improvement can also ensure program growth, financial health, and viability in an increasingly competitive environment. Mounting expectations by patients, hospitals, and payers and inevitable pay-for-performance paradigms have transitioned data collection procedures from novel projects to expected standard operation within usual palliative care delivery. We present types of data to collect, published guides for data collection, and how data can inform quality, value, and research within a palliative care organization. Our experiences with the Quality Data Collection Tool (QDACT) in the Carolinas Palliative Care Consortium to collect data on quality have led to valuable lessons learned in creating a data collection system. Suggested steps in forming data-sharing collaborations and building data collection procedures are shared.

  5. A Care Coordination Program for Substance-Exposed Newborns

    Science.gov (United States)

    Twomey, Jean E.; Caldwell, Donna; Soave, Rosemary; Fontaine, Lynne Andreozzi; Lester, Barry M.

    2011-01-01

    The Vulnerable Infants Program of Rhode Island (VIP-RI) was established as a care coordination program to promote permanency for substance-exposed newborns in the child welfare system. Goals of VIP-RI were to optimize parents' opportunities for reunification and increase the efficacy of social service systems involved with families affected by…

  6. Military Child Care Programs: Progress Made, More Needed.

    Science.gov (United States)

    1982-06-01

    program areas such as nutri- tion, health, child growth and development, educational guidance, and remedial techniques. None of the existing service...activities weakens their programs. The child care staff should know about such things as nutri- tion, health, child growth and development

  7. Confronting trade-offs in health care: Harvard Pilgrim Health Care's organizational ethics program.

    Science.gov (United States)

    Sabin, James E; Cochran, David

    2007-01-01

    Patients, providers, and policy leaders need a new moral compass to guide them in the turbulent U.S. health care system. Task forces have proposed excellent ethical codes, but these have been seen as too abstract to provide guidance at the front lines. Harvard Pilgrim Health Care's ten-year experience with an organizational ethics program suggests ways in which health care organizations can strengthen transparency, consumer focus, and overall ethical performance and contribute to the national health policy dialogue.

  8. Public dental health care program for persons with disability

    DEFF Research Database (Denmark)

    Christensen, Lisa Bøge; Hede, Børge; Petersen, Poul Erik

    2005-01-01

    ) payment of service, (4) providers of oral health care, (5) special training of staff, 6) dental services delivered, (7) ethical issues, and (8) patient rights. Less than one-third of persons estimated by the health authorities were enrolled in the program. On average, 0.4% of the municipal population...... attended the program, ranging from 0.03% to 1.53%. In large municipalities, and where internal providers delivered oral health care, relatively more persons were enrolled in the program (p ...The objectives of the study were (1) to describe the organization and content of the Danish public oral health care program for persons with disability, and (2) to analyse possible variations in relation to the goals and requirements set by the health authorities. Data were collected by means...

  9. Quality of Care in Family Planning Program in China

    Institute of Scientific and Technical Information of China (English)

    Zhen-ming XIE; Hong-yan LIU

    2006-01-01

    Objective To sum up the theory of quality care according to the experience of F.P. program in China.Methods The author summarized the QOC theory and draw on its experiences and strength in family planning program in China.Results The theory facilitated the earnest program of the population and family planning program during the tenth five-year plan period, benefited the realization of the innovation of system and mechanism in population and family planning work, and the creation of a nice population environment for the healthy social and economic development in China.Conclusion The development of QOC has displayed a conspicuous theory in China's family planning program.

  10. Selecting, adapting, and sustaining programs in health care systems

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-04-01

    Full Text Available Leah L Zullig,1,2 Hayden B Bosworth1–4 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University Medical Center, Durham, NC, USA; 3School of Nursing, 4Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA Abstract: Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities. Keywords: program sustainability, diffusion of innovation, information dissemination, health services research, intervention studies 

  11. The Patient Care Connect Program: Transforming Health Care Through Lay Navigation.

    Science.gov (United States)

    Rocque, Gabrielle B; Partridge, Edward E; Pisu, Maria; Martin, Michelle Y; Demark-Wahnefried, Wendy; Acemgil, Aras; Kenzik, Kelly; Kvale, Elizabeth A; Meneses, Karen; Li, Xuelin; Li, Yufeng; Halilova, Karina I; Jackson, Bradford E; Chambless, Carol; Lisovicz, Nedra; Fouad, Mona; Taylor, Richard A

    2016-06-01

    The Patient Care Connect Program (PCCP) is a lay patient navigation program, implemented by the University of Alabama at Birmingham Health System Cancer Community Network. The PCCP's goal is to provide better health and health care, as well as to lower overall expenditures. The program focuses on enhancing the health of patients, with emphasis on patient empowerment and promoting proactive participation in health care. Navigator training emphasizes palliative care principles and includes development of skills to facilitate advance care planning conversations. Lay navigators are integrated into the health care team, with the support of a nurse supervisor, physician medical director, and administrative champion. The intervention focuses on patients with high needs to reach those with the greatest potential for benefit from supportive services. Navigator activities are guided by frequent distress assessments, which help to identify patient concerns across multiple domains, triage patients to appropriate resources, and ultimately overcome barriers to health care. In this article, we describe the PCCP's development, infrastructure, selection and training of lay navigators, and program operations.

  12. Time-series analysis on the acute mortality affected by air pollution, in the city of Guangzhou, 2004-2008%广州市2004-2008年大气污染对城区居民每日死亡率影响的时间序列分析

    Institute of Scientific and Technical Information of China (English)

    黄晓亮; 戴灵真; 卢萍; 尚羽; 李怡; 陶晔彬; 黄薇

    2012-01-01

    目的 评价2004-2008年广州市大气污染短期暴露与居民死亡风险的相关性.方法 采用时间序列方法,对主要大气污染物可吸入颗粒物(PM10)、二氧化氮(NO2)和二氧化硫(SO2)与每日死亡率相关性进行Poisson回归分析.结果 模型分析结果表明,通过控制年龄、性别、时间、星期几效应和气象因素,发现PM10、NO2和SO2这3种大气污染物暴露与超额死亡风险存在正相关关系.广州市3种大气污染物在过去48 h的暴露浓度每上升10 μg/m3所对应的总死亡的超额风险分别为0.94%(0.79~ 1.09)、1.55%(1.31 ~ 1.78)和1.09%(0.91 ~ 1.27).研究结果表明,大气污染物暴露与心血管系统疾病或呼吸系统疾病死亡的关联显著,对老年人和女性的影响更为显著.结论 广州市主要大气污染短期暴露与居民的超额死亡风险显著相关.%Objective To study the associations between daily mortality and the status of exposure to air pollution.Methods A time-series analysis was conducted to assess the relations between acute mortality and exposure to respiratory particulate matter (PM10),sulfur-dioxide (SO2) and nitrogen dioxide (NO2) in urban residents of Guangzhou (2004-2008),using Poisson regression.Results Through controling the factors as temperature,relative humidity,age,gender and time,significant increases were observed in all-cause mortality of 0.94% (0.79-1.09) for PM10,1.55%(1.31-1.78) for NO2,and 1.09% (0.91-1.27) for SO2,per 10 μg/m3,when increase of the lagging 2-day average concentrations of air pollution was seen,in Guangzhou.Stronger effects of exposure to air pollution were found on cardiovascular and respiratory mortality,as well as in elderly( ≥65 years) and female population.Conclusion Our results suggested that exposure to ambient pollution was significantly associated with the increase of excess risks,on total and cardio-respiratory mortality in the residents of Guangzhou.

  13. Quality of Care Provided by a Comprehensive Dementia Care Comanagement Program.

    Science.gov (United States)

    Jennings, Lee A; Tan, Zaldy; Wenger, Neil S; Cook, Erin A; Han, Weijuan; McCreath, Heather E; Serrano, Katherine S; Roth, Carol P; Reuben, David B

    2016-08-01

    Multiple studies have shown that quality of care for dementia in primary care is poor, with physician adherence to dementia quality indicators (QIs) ranging from 18% to 42%. In response, the University of California at Los Angeles (UCLA) Health System created the UCLA Alzheimer's and Dementia Care (ADC) Program, a quality improvement program that uses a comanagement model with nurse practitioner dementia care managers (DCM) working with primary care physicians and community-based organizations to provide comprehensive dementia care. The objective was to measure the quality of dementia care that nurse practitioner DCMs provide using the Assessing Care of Vulnerable Elders (ACOVE-3) and Physician Consortium for Performance Improvement QIs. Participants included 797 community-dwelling adults with dementia referred to the UCLA ADC program over a 2-year period. UCLA is an urban academic medical center with primarily fee-for-service reimbursement. The percentage of recommended care received for 17 dementia QIs was measured. The primary outcome was aggregate quality of care for the UCLA ADC cohort, calculated as the total number of recommended care processes received divided by the total number of eligible quality indicators. Secondary outcomes included aggregate quality of care in three domains of dementia care: assessment and screening (7 QIs), treatment (6 QIs), and counseling (4 QIs). QIs were abstracted from DCM notes over a 3-month period from date of initial assessment. Individuals were eligible for 9,895 QIs, of which 92% were passed. Overall pass rates of DCMs were similar (90-96%). All counseling and assessment QIs had pass rates greater than 80%, with most exceeding 90%. Wider variation in adherence was found among QIs addressing treatments for dementia, which patient-specific criteria triggered, ranging from 27% for discontinuation of medications associated with mental status changes to 86% for discussion about acetylcholinesterase inhibitors. Comprehensive

  14. 75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

    Science.gov (United States)

    2010-06-08

    ... HUMAN SERVICES Administration on Aging Funding Opportunity: Affordable Care Act Medicare Beneficiary...: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act... Protection and Affordable Care Act of 2010 (Affordable Care Act). Catalog of Federal Domestic......

  15. 78 FR 79619 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization...

    Science.gov (United States)

    2013-12-31

    ...-9957-CN; 9964-CN] RIN 0938-AR82; RIN 0938-AR74 Patient Protection and Affordable Care Act; Program... Affordable Care Act; Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards... and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization Programs, and...

  16. Responses of Canada's health care management education programs to health care reform initiatives.

    Science.gov (United States)

    Angus, D E; Lay, C M

    2000-01-01

    Canada's provincial health care systems have been experiencing significant changes, mostly through horizontal integration achieved by merging hospitals, and, in a few cases, through vertical integration of public health, long term care, home care and hospital services. The government motivation for forcing these changes seems to have been primarily financial. In a few cases, the integration seems to have resulted in a stable and successful outcome, but, in most others, there has been destabilization, and in some, there has been chaos. The question posed in this research was how the five accredited Canadian graduate programs in health care management were responding to these changes. Two of the programs have recently made major changes in structure and/or delivery processes, following careful examination of their perceived environments. One has rationalized by subdividing courses. Another is repatriating courses from the business school in order to achieve more health-related content. Four of the five programs have added a number of courses in the last few years, or plan to do so in the next year or two, either because of accreditation criteria or student or faculty interest. The program directors viewed the educational requirements for clinicians and non-clinicians as being identical. In spite of the major structural changes, and the resulting destabilization of the health care organizations (and even governments), none of the programs emphasized the changes as factors in their plans for program changes. They expressed some concern about the possibility of fads as opposed to significant changes. It may be that these changes are dealt with in the content of individual courses. This aspect was not examined by the survey nor by interviews with the directors. Each of the programs has emphasized its own niche, with no consensus about changes required.

  17. Establishing an education program for chronic wound care in China.

    Science.gov (United States)

    Yu, Ying; Fu, Xiaobing

    2012-12-01

    Chronic wounds in China are an important issue. However, wound care knowledge and the skill of health care professionals varies among hospitals and cities. The Chinese Tissue Repair Society (CTRS) has developed a 3-year training program in wound care in China that is sponsored by the World Diabetes Foundation and the Coloplast Access to Healthcare foundation. The project focuses on training physicians and nurses in wound care for patients with diabetic mellitus and other chronic skin wounds. In the past 2 years, 1618 health care professionals, including 915 physicians and 703 nurses, have been trained. Participants are from more than 200 hospitals in 21 provinces. About 1200 patients per month, on average, have benefited from this project. In total, 13 hospitals have become training bases to continue the education program. The aim of the program is to help Chinese medical professionals efficiently manage chronic wounds, thereby shortening the wound healing time, reducing the amputation rate and treatment costs, and improving quality of life.

  18. Retracted: Using bald eagles to track spatial (1999-2008) and temporal (1987-1992, 1999-2003, and 2004-2008) trends of contaminants in Michigan's aquatic ecosystems.

    Science.gov (United States)

    Wierda, Michael R; Leith, Katherine F; Grubb, Teryl G; Sikarskie, James G; Best, David A; Bowerman, William

    2016-08-01

    Retraction: 'Using bald eagles to track spatial (1999-2008) and temporal (1987-1992, 1999-2003, and 2004-2008) trends of contaminants in Michigan's aquatic ecosystems' by Michael R. Wierda, Katherine F. Leith, Teryl G. Grubb, James G. Sikarskie, David A. Best, and William Bowerman The above article from Environmental Toxicology and Chemistry, published online on 10 February 2015 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor in Chief, G.A. Burton, Jr., SETAC and Wiley Periodicals, Inc. The retraction has been agreed since the authors determined that some of the plasma samples run at Clemson University had failed quality assurance/quality control and were retested. The concentrations have since been corrected and validated. Reference Wierda MR, Leith KF, Grubb TG, Sikarskie JG, Best DA, Bowerman W. 2015. Using bald eagles to track spatial (1999-2008) and temporal (1987-1992, 1999-2003, and 2004-2008) trends of contaminants in Michigan's aquatic ecosystems. Environ ToxicolChem doi:10.1002/etc.2859.

  19. Can object technology meet health care's programming needs?

    Science.gov (United States)

    McCormack, J

    1997-02-01

    Although object technology is just starting to make inroads in programming for health care applications, some observers predict it will drive information systems into the next century and beyond. Objects technology could play a major role in quicker development of the computer-based patient record and in easing the creation of links between systems.

  20. 78 FR 29441 - Child Care and Development Fund (CCDF) Program

    Science.gov (United States)

    2013-05-20

    ... systems for child care quality improvement. This proposed rule is driven by the same priorities and vision... into better alignment with the current knowledge in the field, result in a more comprehensive vision of... administration of the program. These proposed changes represent minimum, common-sense standards for the...

  1. Type and subtype distribution of influenza virus and genetic evolution of hemagglutinin in Shanghai area in duration of 2004-2008%上海地区2004-2008年流行性感冒病毒亚型分布及血凝素基因进化研究

    Institute of Scientific and Technical Information of China (English)

    杨吉星; 居丽雯; 蒋露芳; 施强; 姜庆五; 张宇艳; 周艳冰; 申惠国; 谈逸云

    2009-01-01

    Objective To analyze the type and subtype distribution of influenza virus and the genetic evolution of hemngglutinin (HA) in Shanghai area during 2004 to 2008. Methods All 962 throat swabs were collected from influenza-like patients in 5 influenza sentry hospitals and influenza outbreaks. Influenza viruses were isolated in MDCK cell lines, and then viral types and subtypes were identified. The HA of influenza Aisolates selected by outbreak or sporadic patients in different areas and epidemic seasons were sequenced and analyzed by phyiogenetic trees. Results A/H3N2, accounting for 54.9% (162/295),was the dominate subtype in recent years, but less popular in the end of 2005 to the middle of 2006 with 0% (0/16)and 23.5% (8/34)of positive specimen,respectively. There were more A/ H1N1 isolates in 2005-2006 with 21.4% (12/56),43.8% (7/16)and 76.5% (26/34)of positive specimen, respectivly, but declined obviously in 2007-2008 accounting for only 0% (0/44)and 5.0% (7/ 139). Influenza B virus was more popular in 2004 to 2005 with 42.9% (24/56)and 56. 2% (9/16), respectively,and not isolated from 2006 to 2007,then increased in 2008 accounting for 34. 5% (48/139). Phylogenetic tree of HA showed that A/H1N1 isolates in the same year clustered from 2005 to 2008, and most A/H3N2 isolated were homologous in the same year during 2004-2008 while some were inserted to the clusters of near years and more distinguished sequences appeared. A/H1N1 and A/H3N2 isolates were all similar to the vaccine strains recommended by WHO. Conclusion The distribution of influenza type and subtype kept on changing each year, but A/H3N2 dominated in most years. A/H1N1 and A/H3N2 in the same year clustered ,but some A/H3N2 of near years were and evolved faster with more distinguished strains appeared in same interval Generally, HA of influenza A isolates in Shanghai during 2004 to 2008 were similar to the WHO reference strains.%目的 了解上海地区近几年的流行性感冒(简称流感)病毒型

  2. [DEVELOPMENTAL CARE IN THE NEONATAL INTENSIVE CARE UNIT ACCORDING TO NEWBORN INDIVIDUALIZED DEVELOPMENTAL CARE AND ASSESSMENT PROGRAM (NIDCAP)].

    Science.gov (United States)

    Silberstein, Dalia; Litmanovitz, Ita

    2016-01-01

    During hospitalization in the neonatal intensive care unit (NICU), the brain of the preterm infant undergoes a particularly vulnerable and sensitive period of development. Brain development might be negatively influenced by direct injury as well as by complications of prematurity. Over the past few years, stress has come to be increasingly recognized as a potential risk factor. The NICU environment contains numerous stress factors due to maternal deprivation and over-stimulation, such as light, sound and pain, which conflict with the brain's developmental requirements. Developmental care is a caregiving approach that addresses the early developmental needs of the preterm infant as an integral component of quality neonatal care. NIDCAP (Newborn Individualized Developmental Care and Assessment Program) is a comprehensive program that aims to reduce environmental stress, to support the infant's neuro-behavioral maturation and organization, and to promote early parent-infant relationships. The implementation of developmental care based on NIDCAP principles is a gradual, in-depth systems change process, which affects all aspects of care in the NICU. This review describes the theoretical basis of the NIDCAP approach, summarizes the scientific evidence and addresses some of the implications of the transition from a traditional to a developmental care NICU.

  3. American Organization of Nurse Executives Care Innovation and Transformation program: improving care and practice environments.

    Science.gov (United States)

    Oberlies, Amanda Stefancyk

    2014-09-01

    The American Organization of Nurse Executives conducted an evaluation of the hospitals participating in the Care Innovation and Transformation (CIT) program. A total of 24 hospitals participated in the 2-year CIT program from 2012 to 2013. Reported outcomes include increased patient satisfaction, decreased falls, and reductions in nurse turnover and overtime. Nurses reported statistically significant improvements in 4 domains of the principles and elements of a healthful practice environment developed by the Nursing Organizations Alliance.

  4. 76 FR 67801 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

    Science.gov (United States)

    2011-11-02

    ... Participating in ACOs c. Antitrust Policy Statement d. Coordinating the Shared Savings Program Application With...) Identification of Primary Care Services Rendered in FQHCs and RHCs (2) Identification of the Type of Practitioner... Insurance Program CMP Civil Monetary Penalties CMS Centers for Medicare & Medicaid Services CNM...

  5. Tennessee Star-Quality Child Care Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Tennessee's Star-Quality Child Care Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

  6. Evaluation of patients with stroke monitored by home care programs

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

    2013-10-01

    Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.

  7. Evaluation of patients with stroke monitored by home care programs

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

    Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.

  8. Prematurity and programming: contribution of neonatal Intensive Care Unit interventions.

    Science.gov (United States)

    Kalhan, S C; Wilson-Costello, D

    2013-04-01

    Contemporary clinical practice for the care of the prematurely born babies has markedly improved their rates of survival so that most of these babies are expected to grow up to live a healthy functional life. Since the clinical follow-up is of short duration (years), only limited data are available to relate non-communicable diseases in adult life to events and interventions in the neonatal period. The major events that could have a programming effect include: (1) intrauterine growth restriction; (2) interruption of pregnancy with change in redox and reactive oxygen species (ROS) injury; (3) nutritional and pharmacological protocols for clinical care; and (4) nutritional care in the first 2 years resulting in accelerated weight gain. The available data are discussed in the context of perturbations in one carbon (methyl transfer) metabolism and its possible programming effects. Although direct evidence for genomic methylation is not available, clinical and experimental data on impact of redox and ROS, of low protein intake, excess methionine load and vitamin A, on methyl transfers are reviewed. The consequences of antenatal and postnatal administration of glucocorticoids are presented. Analysis of the correlates of insulin sensitivity at older age, suggests that premature birth is the major contributor, and is compounded by gain in weight during infancy. We speculate that premature interruption of pregnancy and neonatal interventions by affecting one carbon metabolism may cause programming effects on the immature baby. These can be additive to the effects of intrauterine environment (growth restriction) and are compounded by accelerated growth in early infancy.

  9. Kansas Primary Care Weighs In: A Pilot Randomized Trial of a Chronic Care Model Program for Obesity in 3 Rural Kansas Primary Care Practices

    Science.gov (United States)

    Ely, Andrea C.; Banitt, Angela; Befort, Christie; Hou, Qing; Rhode, Paula C.; Grund, Chrysanne; Greiner, Allen; Jeffries, Shawn; Ellerbeck, Edward

    2008-01-01

    Context: Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care. Purpose: To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary…

  10. 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…

  11. Identifying wound prevalence using the Mobile Wound Care program.

    Science.gov (United States)

    Walker, Judi; Cullen, Marianne; Chambers, Helen; Mitchell, Eleanor; Steers, Nicole; Khalil, Hanan

    2014-06-01

    Measuring the prevalence of wounds within health care systems is a challenging and complex undertaking. This is often compounded by the clinicians' training, the availability of the required data to collect, incomplete documentation and lack of reporting of this type of data across the various health care settings. To date, there is little published data on wound prevalence across regions or states. This study aims to identify the number and types of wounds treated in the Gippsland area using the Mobile Wound Care (MWC™) program. The MWC program has enabled clinicians in Gippsland to collect data on wounds managed by district nurses from four health services. The main outcomes measured were patient characteristics, wound characteristics and treatment characteristics of wounds in Gippsland. These data create several clinical and research opportunities. The identification of predominant wound aetiologies in Gippsland provides a basis on which to determine a regional wound prospective and the impact of the regional epidemiology. Training that incorporates best practice guidelines can be tailored to the most prevalent wound types. Clinical pathways that encompass the Australian and New Zealand clinical practice guidelines for the management of venous leg ulcers can be introduced and the clinical and economical outcomes can be quantitatively measured. The MWC allows healing times (days) to be benchmarked both regionally and against established literature, for example, venous leg ulcers.

  12. 76 FR 43254 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2011-07-20

    ..., 2010, at 75 FR 41793. Child and Adult Care Food Program (CACFP) [Per meal rates in whole or fractions... 48 FR 29114, June 24, 1983.) This notice has been determined to be not significant and was reviewed... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day...

  13. 75 FR 41793 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2010-07-19

    ..., 2009, at 74 FR 34295. Child and Adult Care Food Program (CACFP) Lunch and Centers Breakfast supper \\1... related notice published at 48 FR 29114, June 24, 1983.) This notice has been determined to be not... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day...

  14. Implementation and evaluation of Stanford Health Care direct-care teledermatology program

    Directory of Open Access Journals (Sweden)

    Akhilesh S Pathipati

    2016-07-01

    Full Text Available Introduction: Teledermatology has proven to be an effective means of providing dermatologic care. The existing research has primarily evaluated its usefulness in a consultative model. Few academic centers have evaluated a patient-initiated model, and direct-to-consumer services remain the subject of controversy. Stanford Health Care recently launched a direct-care, patient-initiated teledermatology pilot program. This article evaluates the viability and patient satisfaction with this service. Materials and Methods: During the pilot period, patients were able to seek remote dermatologic care using an eVisit tool in their MyHealth account. Patients initiated the consultation, answered questions regarding their complaint, and uploaded a picture if relevant. A Stanford dermatologist reviewed each eVisit and responded with an assessment and plan. The dermatologist noted whether they were able to make a diagnosis and their level of confidence in it. After the study, 10 patients participated in a focus group to provide feedback on the service. Results: In all, 38 patients sought care during the pilot period. A dermatologist was able to make a diagnosis in 36 of 38 (95% cases, with an average confidence level of 7.9 of 10. The average time to consultation was 0.8 days. Patients indicated high levels of satisfaction with the service although they had suggestions for improvement. Discussion: Patients provided clinically useful images and information in a direct-care teledermatology model. Such services allow dermatology providers to increase access while maintaining high-quality care in an academic medical center. Further research is needed on standalone services that cannot integrate encounters with the patient’s existing medical record.

  15. History of the Animal Care Program at Johnson Space Center

    Science.gov (United States)

    Khan-Mayberry, Noreen; Bassett, Stephanie

    2010-01-01

    NASA has a rich history of scientific research that has been conducted throughout our numerous manned spaceflight programs. This scientific research has included animal test subjects participating in various spaceflight missions, including most recently, Space Shuttle mission STS-131. The Animal Care Program at Johnson Space Center (JSC) in Houston, Texas is multi-faceted and unique in scope compared to other centers within the agency. The animal care program at JSC has evolved from strictly research to include a Longhorn facility and the Houston Zoo's Attwater Prairie Chicken refuge, which is used to help repopulate this endangered species. JSC is home to more than 300 species of animals including home of hundreds of white-tailed deer that roam freely throughout the center which pose unique issues in regards to population control and safety of NASA workers, visitors and tourists. We will give a broad overview of our day to day operations, animal research, community outreach and protection of animals at NASA Johnson Space Center.

  16. Space maintenance in a child dental care program.

    Science.gov (United States)

    Hill, C J; Sorenson, H W; Mink, J R

    1975-04-01

    Five types of space maintainers were placed in 196 children participating in an extensive dental care program during a four-year study. Children with space maintainers were examined at six-month intervals. During the study, some sort of difficulty was encountered with 43% of the appliances inserted. The most common problem encountered was lost or missing appliances. Sixteen appliances had broken arch wires or loop wires; only ten broken bands were noted. Anther problem was distortion of arch wires. Suggestions are made for possible modifications in the space maintainers to reduce the incidence of problems.

  17. 上海市宝山区2004~2008年麻疹流行病学分析%Epidemiological analysis on measles in Baoshan District of Shanghai during 2004-2008

    Institute of Scientific and Technical Information of China (English)

    李晓军; 杨佳平; 徐慧清; 吴铭; 朱奇; 陈永君

    2012-01-01

    OBJECTIVE To analyze the incidence of measles in Baoshan District during 2004-2008, to guide control strategy and provide the basis to achieve measles elimination goals. METHODS Used data from disease surveillance and reporting system to analyze epidemiological characteristics of measles cases in Baoshan district during 2004-2008. RESULTS There were 621 patients reported as suspected cases of measles, and 443 as diagnosed cases during 2004-2008. The highest incidence was 13.01 per 100 thousand, the lowest incidence was 2.06 per 100 thousand, higher than the previous years significantly. Cases were mainly young adults of 15-35 years age. Onset time was relatively concentrated in 13rd-24th week. A total of 12 cases of epidemic outbreaks were focal outbreaks. After measles vaccination, the antibody positive rate was 96.46%. Monitoring of measles antibody levels in healthy population, the positive rate was 88.92%. CONCLUSION Measles crowd gradually shift to the large age groups. The floating population become the main cases. To achieve the objective of eliminating measles, children (especially foreign migrant children) should be strengthened measles vaccination coverage and timely rates, adult measles vaccine coverage should be improved.%目的 分析宝山区2004~2008年麻疹发病情况,为麻疹消除策略和措施的制定提供依据.方法 利用疾病监测信息报告系统的数据,对2004~2008年宝山区麻疹病例进行流行病学分析.结果 宝山区2004~2008年共报告麻疹疑似病例621例,确诊443例,年发病率最高13.01/10万,最低2.06/10万,明显高于往年.病例以15~35岁人群为主,时间相对集中于13~24周,发生暴发疫情共12起,呈局灶性暴发.麻疹疫苗免疫后,抗体阳性率为96.46%.健康人群麻疹抗体水平监测,阳性率为88.92%.结论 麻疹发病人群逐渐向大年龄人群转移,病例以外来流动人口为主,要达到消除麻疹目标,应加强儿童(特别是外来流动儿

  18. End-of-life care in a children's hospice program.

    Science.gov (United States)

    Steele, Rose; Davies, Betty; Collins, John B; Cook, Karen

    2005-01-01

    A project was completed in 1999 to evaluate the Canuck Place children's hospice program. This article reports only on the end-of-life care component. Results are provided from mail-out surveys with families who required end-of-life care and are supplemented by qualitative data which were collected from interviews with individuals prior to the survey. Eighteen families completed face-to-face interviews and another 70 families completed the mail-out questionnaire developed from the initial interviews. A total of 39 parents responded to the survey section about end-of-life care services. Results indicated that parents were reasonably comfortable discussing death with staff; they generally felt well prepared for their child's death because of the staff; the death of another child had a significant effect on families; parents' wishes at the time of their child's death were very supported by staff; and families were well supported by staff at the time of a child's death. Implications for practice and suggestions for future research are discussed.

  19. What do practitioners think? A qualitative study of a shared care mental health and nutrition primary care program

    Directory of Open Access Journals (Sweden)

    Jann Paquette-Warren

    2006-10-01

    Full Text Available Objective: To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. Design: Qualitative method of focus groups. Setting/Participants: The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. Method: Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. Main findings: Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. Conclusion: Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting.

  20. ESTADO DEL ARTE SOBRE LOS TRABAJOS PRÁCTICOS EN LA ENSEÑANZA DE LA BIOLOGÍA ABORDADOS EN PUBLICACIONES (2004-2008: RESULTADOS RELACIONADOS CON LAS FINALIDADES

    Directory of Open Access Journals (Sweden)

    Mónica Alexandra Correa

    2014-05-01

    Full Text Available Presentamos la investigación ESTADO DEL ARTE SOBRE LOS TRABAJOS PRÁCTICOS EN LA ENSEÑANZA DE LA BIOLOGÍA (2004-2008: UN APORTE A LA FORMACIÓN DOCENTE, cuyo objetivo se centró en caracterizar los Trabajos Prácticos en la Enseñanza de la Biología a partir de 216 publicaciones de 16 revistas especializadas realizadas durante  el periodo (2004-2008 y realizar un análisis de los aportes a la formación docente derivados de esto. La metodología que orientó la caracterización corresponde a un enfoque cualitativo interpretativo-hermenéutico, la investigación documental, y la  modalidad de estado del arte. Para la sistematización de la información se empleó como instrumento el RAE, cuyo diseño se basó en los criterios que se han acogido para la caracterización de la Didáctica de las Ciencias como campo de conocimiento y los de un sistema de categorías para el análisis de Trabajos Prácticos en la enseñanza de la Biología: Problema, Composición de equipo de trabajo, Sección de la revista, Autores, Temáticas Biológicas, Tipo de trabajo, Población objeto de estudio, Metodología, Naturaleza del TP (Tipo de TP, imagen de Práctica, relación T-P, clase de TP, Finalidades, Metodología del TP, Evaluación, Relación con aspectos epistemológicos y Aspectos relacionados con la formación docente. Para efectos de esta ponencia mostramos exclusivamente los resultados relacionados con  las finalidades de los trabajos prácticos, quienes mayoritariamente propenden por finalidades que abarcan simultáneamente aspectos tanto Conceptuales y Procedimentales y aquellas que abordan exclusivamente elementos Conceptuales

  1. Goals and Characteristics of Long-Term Care Programs: An Analytic Model.

    Science.gov (United States)

    Braun, Kathryn L.; Rose, Charles L.

    1989-01-01

    Used medico-social analytic model to compare five long-term care programs: Skilled Nursing Facility-Intermediate Care Facility (SNF-ICF) homes, ICF homes, foster homes, day hospitals, and home care. Identified similarities and differences among programs. Preliminary findings suggest that model is useful in the evaluation and design of long-term…

  2. Risk Factors Associated with Children Lost to Care in a State Early Childhood Intervention Program

    Science.gov (United States)

    Giannoni, Peggy P.; Kass, Philip H.

    2010-01-01

    A retrospective cohort study was conducted to identify risk factors associated with children lost to care, and their families, compared to those not lost to care within the California Early Start Program. The cohort included data on 8987 children enrolled in the Early Start Program in 1998. This cohort consisted of 2443 children lost to care, 6363…

  3. Orientation of Medical Residents to the Psychosocial Aspects of Primary Care: Influence of Training Program.

    Science.gov (United States)

    Eisenthal, Sherman; And Others

    1994-01-01

    A survey of 63 general medical residents found most accepted the psychosocial role of the primary care physician, found it most appropriate in ambulatory care settings, felt ambivalent about their ability to perform it, and assigned it secondary priority in patient care. More attention by training programs to ambulatory care and psychosocial…

  4. 76 FR 33306 - Medicare Program; Pioneer Accountable Care Organization Model, Request for Applications; Correction

    Science.gov (United States)

    2011-06-08

    ... Care Organization Model: Request for Applications.'' FOR FURTHER INFORMATION CONTACT: Maria Alexander... http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco... HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Program; Pioneer Accountable...

  5. The role of programmed and emergent mechanisms of coordination: How standardized care pathways contribute to coordinate care tasks in hospitals

    DEFF Research Database (Denmark)

    Prætorius, Thim

    Hospitals face substantial coordination challenges. To meet this hospitals more and more use standardized work processes such as care pathways. By drawing on recent coordination theory that increasingly emphasizes the role of lateral and emergent interactions alongside traditional, programmed...... mechanisms of coordination, this paper finds that standardized work processes such as care pathways should be considered as a bundle of coordination mechanisms—plans and rules, objects, routines, roles and proximity—rather than a mechanism of its own. The bundle builds the accountability, predictability...... and common understanding needed to coordinate standardized care tasks. The analysis lends theoretical insights to the traditional view that see standardized work processes as programmed processes. For health care workers who design, implement and use care pathways to solve care tasks, the analysis calls...

  6. A remote care platform for the social support program CASSAUDEC

    Directory of Open Access Journals (Sweden)

    Andrés Felipe Ardila Rodríguez

    2016-06-01

    Full Text Available The training strategies developed for the social support program bring deficits in accessibility to the chronic ill patients (EC and the CASSA-UDEC’s caretaker (CASSA-UDEC: Centre for Social Health Care at Universidad de Cundinamarca they do not have time to commute, hindering their legal relationship established by the contract. For this reason, a remote care platform (PTD was developed to support users at CASSA-UDEC improving aspects related to coverage, cost, quality, access and appropriation of information from caregivers and chronic ill patients. The design was based on gerontological constructs identifying features such as modularity, object size, usability, ergonomics, and some others, providing a friendly platform for the user with dynamic, modular and high usability content. The Platform provides a space for interaction and aid, which works as a dynamic entity in the job done by CASSA-UDEC giving support in the development of activities, expanding its coverage, access; all thanks to the benefits offered in a virtual mode.

  7. Preventive Adolescent Health Care in Family Practice: A Program Summary

    Directory of Open Access Journals (Sweden)

    Barry Knishkowy

    2006-01-01

    Full Text Available The AMA Guidelines for Adolescent Preventive Services (GAPS has been the cornerstone of preventive care for teenagers since its publication in 1994. Despite this, there has been little documentation of their implementation in the family medicine literature. This article gives an overview of a family practice–based adolescent preventive health program based on GAPS recommendations, and reports on compliance, feasibility and health issues. A Community-Oriented Primary Care (COPC program targeted all adolescent patients aged 12—18 years in two Israeli family practices. 321 teenagers were invited to participate. Every 7th and 10th grader was invited for a preventive health visit with the family physician and nurse. The visits included a medical evaluation, screening and counseling regarding health issues recommended by GAPS, and counseling regarding personal health concerns. Parents were also invited to meet with the staff. 184 (57% of the adolescents invited for health visits attended. The overall visit time was 47 minutes, including 12 minutes for a questionnaire and 35 minutes with providers. Common biomedical problems included overweight, acne and dysmenorrhea. Health risk behaviors and psychosocial problems included cigarette or alcohol use, dieting, infrequent/never seat belt use, and feeling depressed. 78% wanted to discuss at least one personal health issue. 27% were invited for follow-up visits. Only 3% of the parents came for visits. A community-oriented approach facilitates bringing adolescents for preventive health visits. Many previously undetected health issues, particularly psychosocial and behavioral, are revealed during these visits. A concerns checklist aids in addressing personal health concerns.

  8. EuCARD and CARE - development of accelerator technology in Poland

    CERN Document Server

    Romaniuk, Ryszard

    2009-01-01

    EuCARD (2009-1013) and CARE (2004-2008) are examples of big European R&D projects for building integrated accelerator infrastructures in Europe. Several research teams from a number of European countries are participating in this consolidated effort. Here we summarize the tasks done by some teams from Poland on a more general background.

  9. Strategic plan 2004-2008 : Summary

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-10-01

    This document presents Hydro-Quebec's business objectives. It was designed to consolidate the progress made toward three main goals: maintaining the quality of customer service; creating value for the shareholder and Quebec society at large; and, increasing electricity generating capability in Quebec. Efforts will focus on five major areas: quality of customer service; employee motivation and expertise; value creation for the shareholder and Quebec society; sustainable development; and, organizational efficiency. Specific business objectives have been developed for each Hydro-Quebec business unit, such as Hydro-Quebec Production, Hydro-Quebec TransEnergie, Hydro-Quebec Distribution, Hydro-Quebec CapiTech, and Hydro-Quebec IndusTech. A brief financial outlook was provided. 2 figs.

  10. 76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2011-07-26

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations...

  11. Patient Outcomes of an International Telepediatric Cardiac Critical Care Program

    Science.gov (United States)

    Otero, Andrea Victoria; Welchering, Nils; Bermon, Anderson; Castillo, Victor; Duran, Álvaro; Castro, Javier; Muñoz, Ricardo

    2015-01-01

    Abstract Background: An optimal model for telemedicine use in the international care setting has not been established. Our objective was to describe variables associated with patient outcome during the implementation of an international pediatric cardiac critical care (PCCC) telemedicine program. Materials and Methods: A retrospective review was performed of clinical records and a telemedicine database of patients admitted to the cardiac intensive care unit (CICU) at the Fundacion Cardiovascular de Colombia, Bucaramanga, Colombia, during the initial 10 months of our program, compared with patients admitted during a previous period. Information collected included demographic data, cardiac diagnosis and associated factors, Risk Adjustment for Congenital Heart Surgery (RACHS)-1 classification, and perioperative events. Primary outcome was composed of CICU and hospital mortality. Secondary outcomes were CICU and hospital length of stay (LOS). Results: Of the 553 patients who were included, teleconsultation was done for 71 (12.4%), with a total of 156 encounters, including 19 for patients on extracorporeal membrane oxygenation. Three hundred twenty-one recommendations were given, and 42 real-time interventions were documented. RACHS-1 distribution was similar between study periods (p=0.427). Teleconsulted patients were significantly younger (44 versus 24 months; p=0.03) and had higher surgical complexity than nonteleconsulted patients (p=0.01). RACHS-1 adjusted hospital survival was similar between study periods. CICU and hospital LOS intervals were significantly shorter in the telemedicine period (10 versus 17 days [p=0.02] and 22 versus 28 days [p<0.001]). In surgical cases, preoperative CICU LOS was significantly shorter (3 versus 6 days; p<0.001). Variables associated with hospital mortality were higher RACHS-1 categories, lower weight, bypass time longer than 150 min, and use of circulatory arrest, as well as the presence of sepsis or necrotizing enterocolitis

  12. Medicaid program; eligibility changes under the Affordable Care Act of 2010. Final rule, Interim final rule.

    Science.gov (United States)

    2012-03-23

    This final rule implements several provisions of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). The Affordable Care Act expands access to health insurance coverage through improvements to the Medicaid and Children's Health Insurance (CHIP) programs, the establishment of Affordable Insurance Exchanges ("Exchanges"), and the assurance of coordination between Medicaid, CHIP, and Exchanges. This final rule codifies policy and procedural changes to the Medicaid and CHIP programs related to eligibility, enrollment, renewals, public availability of program information and coordination across insurance affordability programs.

  13. Fetal programming of adult disease: implications for prenatal care.

    Science.gov (United States)

    Lau, Christopher; Rogers, John M; Desai, Mina; Ross, Michael G

    2011-04-01

    The obesity epidemic, including a marked increase in the prevalence of obesity among pregnant women, represents a critical public health problem in the United States and throughout the world. Over the past two decades, it has been increasingly recognized that the risk of adult health disorders, particularly metabolic syndrome, can be markedly influenced by prenatal and infant environmental exposures (ie, developmental programming). Low birth weight, together with infant catch-up growth, is associated with a significant risk of adult obesity and cardiovascular disease, as well as adverse effects on pulmonary, renal, and cerebral function. Conversely, exposure to maternal obesity or high birth weight also represents an increased risk for childhood and adult obesity. In addition, fetal exposure to select chemicals (eg, phytoestrogens) or environmental pollutants (eg, tobacco smoke) may affect the predisposition to adult disease. Animal models have confirmed human epidemiologic findings and provided insight into putative programming mechanisms, including altered organ development, cellular signaling responses, and epigenetic modifications (ie, control of gene expression without modification of DNA sequence). Prenatal care is transitioning to incorporate goals of optimizing maternal, fetal, and neonatal health to prevent or reduce adult-onset diseases. Guidelines regarding optimal pregnancy nutrition and weight gain, management of low- and high-fetal-weight pregnancies, use of maternal glucocorticoids, and newborn feeding strategies, among others, have yet to fully integrate long-term consequences on adult health.

  14. Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability. Final rule.

    Science.gov (United States)

    2016-05-01

    This final rule modernizes the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems. The final rule aligns, where feasible, many of the rules governing Medicaid managed care with those of other major sources of coverage, including coverage through Qualified Health Plans and Medicare Advantage plans; implements statutory provisions; strengthens actuarial soundness payment provisions to promote the accountability of Medicaid managed care program rates; and promotes the quality of care and strengthens efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. It also ensures appropriate beneficiary protections and enhances policies related to program integrity. This final rule also implements provisions of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and addresses third party liability for trauma codes.

  15. Intervening at the Setting Level to Prevent Behavioral Incidents in Residential Child Care: Efficacy of the CARE Program Model.

    Science.gov (United States)

    Izzo, Charles V; Smith, Elliott G; Holden, Martha J; Norton, Catherine I; Nunno, Michael A; Sellers, Deborah E

    2016-07-01

    The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening "upstream" at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions.

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

    Science.gov (United States)

    Cramm, Jane Murray; Nieboer, Anna Petra

    2014-01-01

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

  17. Child Care and Development Fund (CCDF) Program. Final rule.

    Science.gov (United States)

    2016-09-30

    This final rule makes regulatory changes to the Child Care and Development Fund (CCDF) based on the Child Care and Development Block Grant Act of 2014. These changes strengthen requirements to protect the health and safety of children in child care; help parents make informed consumer choices and access information to support child development; provide equal access to stable, high-quality child care for low-income children; and enhance the quality of child care and the early childhood workforce.

  18. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  19. Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders

    Directory of Open Access Journals (Sweden)

    Seekles Wike

    2009-06-01

    Full Text Available Abstract Background Mood and anxiety disorders are highly prevalent and have a large impact on the lives of the affected individuals. Therefore, optimal treatment of these disorders is highly important. In this study we will examine the effectiveness of a stepped care program for primary care patients with mood and anxiety disorders. A stepped care program is characterized by different treatment steps that are arranged in order of increasing intensity. Methods This study is a randomised controlled trial with two conditions: stepped care and care as usual, whereby the latter forms the control group. The stepped care program consists of four evidence based interventions: (1 Watchful waiting, (2 Guided self-help, (3 Problem Solving Treatment and (4 Medication and/or specialized mental health care. The study population consists of primary care attendees aged 18–65 years. Screeners are sent to all patients of the participating general practitioners. Individuals with a Diagnostic and Statistical Manual of mental disorders (DSM diagnosis of major depression, dysthymia, panic disorder (with or without agoraphobia, generalized anxiety disorder, or social phobia are included as well as individuals with minor depression and anxiety disorders. Primary focus is the reduction of depressive and anxiety symptoms. Both conditions are monitored at 8, 16 and 24 weeks. Discussion This study evaluates the effectiveness of a stepped care program for patients with depressive and anxiety disorder. If effective, a stepped care program can form a worthwhile alternative for care as usual. Strengths and limitations of this study are discussed. Trial Registration Current Controlled Trails: ISRCTN17831610.

  20. Pediatric Oncology Clinic Care Model: Achieving Better Continuity of Care for Patients in a Medium-sized Program.

    Science.gov (United States)

    Johnston, Donna L; Halton, Jacqueline; Bassal, Mylène; Klaassen, Robert J; Mandel, Karen; Ramphal, Raveena; Simpson, Ewurabena; Peckan, Li

    2016-10-25

    Providing the best care in both the inpatient and outpatient settings to pediatric oncology patients is all programs goal. Using continuous improvement methodologies, we changed from a solely team-based physician care model to a hybrid model. All patients were assigned a dedicated oncologist. There would then be 2 types of weeks of outpatient clinical service. A "Doc of the Day" week where each oncologist would have a specific day in clinic when their assigned patients would be scheduled, and then a "Doc of the Week" week where one physician would cover clinic for the week. Patient satisfaction surveys done before and 14 months after changing the model of care showed that patients were very satisfied with the care they received in both models. A questionnaire to staff 14 months after changing showed that the biggest effect was increased continuity of care, followed by more efficient clinic workflow and increased consistency of care. Staff felt it provided better planning and delivery of care. A hybrid model of care with a primary physician for each patient and assigned clinic days, alternating with weeks of single physician coverage is a feasible model of care for a medium-sized pediatric oncology program.

  1. The INTERACT Quality Improvement Program: An Overview for Medical Directors and Primary Care Clinicians in Long-Term Care

    Science.gov (United States)

    Ouslander, Joseph G.; Bonner, Alice; Herndon, Laurie; Shutes, Jill

    2014-01-01

    INTERACT is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and ACOs, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust QAPI program which is being rolled out by the federal government over the next year. PMID:24513226

  2. Vender/Voucher Systems: A Parent Selected Child Care Subsidy Program That Works.

    Science.gov (United States)

    Freis, Ruth; Miller, Miriam

    The vendor/voucher, or purchase of service, system for child care delivery is discussed as a logical model for communities which are looking for a method of developing a new system or have outgrown their current program. Discussion initially focuses on the increasing need for child care, cost/benefit aspects of child care, the regulation of child…

  3. 42 CFR 1001.201 - Conviction relating to program or health care fraud.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Conviction relating to program or health care fraud... Permissive Exclusions § 1001.201 Conviction relating to program or health care fraud. (a) Circumstance for... misdemeanor relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other...

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  5. 76 FR 50540 - Pilot Program of Enhanced Contract Care Authority for Veterans in Highly Rural Areas

    Science.gov (United States)

    2011-08-15

    ... AFFAIRS Pilot Program of Enhanced Contract Care Authority for Veterans in Highly Rural Areas AGENCY... implementing Sec. 403 of Public Law (Pub. L.) 110-387, ``Veterans' Mental Health and Other Care Improvements Act of 2008,'' which requires VA to establish a pilot program to contract with non-VA health...

  6. Developing Memory Clinics in Primary Care: An Evidence-Based Interprofessional Program of Continuing Professional Development

    Science.gov (United States)

    Lee, Linda; Weston, W. Wayne; Hillier, Loretta M.

    2013-01-01

    Introduction: Primary care is challenged to meet the needs of patients with dementia. A training program was developed to increase capacity for dementia care through the development of Family Health Team (FHT)-based interprofessional memory clinics. The interprofessional training program consisted of a 2-day workshop, 1-day observership, and 2-day…

  7. Nutrition Standards for Child Care Programs: Meeting Children's Nutrition and Education Needs. Nutrition, Health and Safety.

    Science.gov (United States)

    Briley, Margaret E.; Grey, Cynthia R.

    2000-01-01

    Presents information on standards for American child care and early education programs participating in the Child and Adult Care Food Program. Topics discussed include meal plans, nutritional requirements, food preparation and food service, cultural diversity, food safety and sanitation, nutrition education, and emotional climate at mealtimes. (KB)

  8. Reliability of an interactive computer program for advance care planning.

    Science.gov (United States)

    Schubart, Jane R; Levi, Benjamin H; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

    2012-06-01

    Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83-0.95, and 0.86-0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time.

  9. Healthcare organization-education partnerships and career ladder programs for health care workers.

    Science.gov (United States)

    Dill, Janette S; Chuang, Emmeline; Morgan, Jennifer C

    2014-12-01

    Increasing concerns about quality of care and workforce shortages have motivated health care organizations and educational institutions to partner to create career ladders for frontline health care workers. Career ladders reward workers for gains in skills and knowledge and may reduce the costs associated with turnover, improve patient care, and/or address projected shortages of certain nursing and allied health professions. This study examines partnerships between health care and educational organizations in the United States during the design and implementation of career ladder training programs for low-skill workers in health care settings, referred to as frontline health care workers. Mixed methods data from 291 frontline health care workers and 347 key informants (e.g., administrators, instructors, managers) collected between 2007 and 2010 were analyzed using both regression and fuzzy-set qualitative comparative analysis (QCA). Results suggest that different combinations of partner characteristics, including having an education leader, employer leader, frontline management support, partnership history, community need, and educational policies, were necessary for high worker career self-efficacy and program satisfaction. Whether a worker received a wage increase, however, was primarily dependent on leadership within the health care organization, including having an employer leader and employer implementation policies. Findings suggest that strong partnerships between health care and educational organizations can contribute to the successful implementation of career ladder programs, but workers' ability to earn monetary rewards for program participation depends on the strength of leadership support within the health care organization.

  10. An Online Educational Program Improves Pediatric Oncology Nurses' Knowledge, Attitudes, and Spiritual Care Competence.

    Science.gov (United States)

    Petersen, Cheryl L; Callahan, Margaret Faut; McCarthy, Donna O; Hughes, Ronda G; White-Traut, Rosemary; Bansal, Naveen K

    This study evaluated the potential impact of an online spiritual care educational program on pediatric nurses' attitudes toward and knowledge of spiritual care and their competence to provide spiritual care to children with cancer at the end of life. It was hypothesized that the intervention would increase nurses' positive attitudes toward and knowledge of spiritual care and increase nurses' level of perceived spiritual care competence. A positive correlation was expected between change in nurses' perceived attitudes toward and knowledge of spiritual care and change in nurses' perceived spiritual care competence. A prospective, longitudinal design was employed, and analyses included one-way repeated-measures analysis of variance, linear regression, and partial correlation. Statistically significant differences were found in nurses' attitudes toward and knowledge of spiritual care and nurses' perceived spiritual care competence. There was a positive relationship between change scores in nurses' attitudes toward and knowledge of spiritual care and nurses' spiritual care competence. Online spiritual care educational programs may exert a lasting impact on nurses' attitudes toward and knowledge of spiritual care and their competence to provide spiritual care to children with cancer at the end of life. Additional studies are required to evaluate the direct effects of educational interventions patient outcomes.

  11. How effective are programs at managing transition from hospital to home? A case study of the Australian transition care program

    Directory of Open Access Journals (Sweden)

    Gray Leonard C

    2012-03-01

    Full Text Available Abstract Background An increasing demand for acute care services due in part to rising proportions of older people and increasing rates of chronic diseases has led to new models of post-acute care for older people that offer coordinated discharge, ongoing support and often a focus on functional restoration. Overall, review of the literature suggests there is considerable uncertainty around the effectiveness and resource implications of the various model configurations and delivery approaches. In this paper, we review the current evidence on the efficacy of such programs, using the Australian Transition Care Program as a case study. Discussion The Australian Transition Care Program was established at the interface of the acute and aged care sectors with particular emphasis on transitions between acute and community care. The program is intended to enable a significant proportion of care recipients to return home, rather than prematurely enter residential aged care, optimize their functional capacity, and reduce inappropriate extended lengths of hospital stay for older people. Broadly, the model is configured and targeted in accordance with programs reported in the international literature to be effective. Early evaluations suggest good acceptance of the program by hospitals, patients and staff. Ultimately, however, the program's place in the array of post-acute services should be determined by its demonstrated efficacy relative to other services which cater for similar patient groups. Summary Currently there is a lack of robust evaluation to provide convincing evidence of efficacy, either from a patient outcome or cost reduction perspective. As the program expands and matures, there will be opportunity to scrutinise the systematic effects, with lessons for both Australian and international policy makers and clinical leaders.

  12. Fast-track rehabilitation program vs conventional care after colorectal resection: A randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    Gang Wang; Zhi-Wei Jiang; Jing Xu; Jian-Feng Gong; Yang Bao; Li-Fei Xie; Jie-Shou Li

    2011-01-01

    AIM: To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS: One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge, while 104 consecutive patients underwent conventional care after resection of colorectal cancer. Their gastrointestinal functions, postoperative complications and hospital stay time were recorded.RESULTS: The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care (2.1 d vs 3.2 d, P < 0.01). The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (13.2% vs 26.9%, P < 0.05). Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (6.6% vs 15.4%, P < 0.05). The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care (5 d vs 7 d, P <0.01). No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care (3.8% vs 8.7%).CONCLUSION: The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.

  13. Practicing Self-Care for Nurses: A Nursing Program Initiative.

    Science.gov (United States)

    Blum, Cynthia A

    2014-09-01

    Self-care is imperative to personal health, sustenance to continue to care for others, and professional growth. This article briefly reviews stressors common to students and nurses and the importance of practicing self-care to combat stress and promote health in practice. Florida Atlantic University offers a course for all levels of undergraduate nursing students called Caring for Self. The course, supported by principles of Adult Learning Theory, focuses on guiding the nurse to practice and model self-care. The author describes the evolution of this self-care initiative by discussing the needs assessment, course description and strategies, examples of course activities, and an exemplar of student impact. The conclusion offers discussion of challenges and lessons noted by faculty and students.

  14. Telemedicine: an enhanced emergency care program for older adults

    Directory of Open Access Journals (Sweden)

    Takahashi PY

    2014-07-01

    Full Text Available Paul Y Takahashi,1 Anupam Chandra,1 Frederick North,1 Jennifer L Pecina,2 Benjavan Upatising,3 Gregory J Hanson11Mayo Clinic Division of Primary Care Internal Medicine, 2Mayo Clinic Department of Family Medicine, Rochester, MN, USA; 3Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USAAbstract: Recent changes and consolidations in health care systems have resulted in an increase in new health care delivery models. Telemedicine holds great promise as one of these models. There is a great potential for new patient evaluation and treatment models in emergency care (EC, especially when patients are miles away from a medical team. Evaluations can be performed in a patient's home, a nursing care facility, and in hospitals that focus on advanced subspecialty care. Due to rapid developments in this area, current care models are constantly being evaluated and modified. This review article outlines current telemedicine models for EC and summarizes their potential benefits to patients and the health care system. The review examines the role that the telephone, a fundamental tool of telemedicine, plays in these new models. The review also examines evidence of improved health care outcomes by highlighting the role of telemedicine in reducing hospitalizations. The patient is the primary focus; as a result, this review also examined patient experiences and satisfaction levels regarding telemedicine health care teams. The authors support these technological advances and their potential for information transfer. Health care providers need to continue developing these models by making use of increasing amounts of information. One of the main implementation barriers of these new models in the US and other countries is the issue of payment and reimbursement. Despite this, advancements in EC telemedicine continue.Keywords: telemedicine, emergency care, geriatric, patient evaluation models

  15. A Review of Advance Care Planning Programs in Long-Term Care Homes: Are They Dementia Friendly?

    Directory of Open Access Journals (Sweden)

    Abigail Wickson-Griffiths

    2014-01-01

    Full Text Available Background. Persons living with dementia in the long-term care home (LTCH setting have a number of unique needs, including those related to planning for their futures. It is therefore important to understand the advance care planning (ACP programs that have been developed and their impact in order for LTCH settings to select a program that best suits residents’ needs. Methods. Four electronic databases were searched from 1990 to 2013, for studies that evaluated the impact of advance care planning programs implemented in the LTCH setting. Studies were critically reviewed according to rigour, impact, and the consideration of the values of residents with dementia and their family members according to the Dementia Policy Lens Toolkit. Results and Conclusion. Six ACP programs were included in the review, five of which could be considered more “dementia friendly.” The programs indicated a variety of positive impacts in the planning and provision of end-of-life care for residents and their family members, most notably, increased ACP discussion and documentation. In moving forward, it will be important to evaluate the incorporation of residents with dementia’s values when designing or implementing ACP interventions in the LTCH settings.

  16. Implementing a care coordination program for children with special healthcare needs: partnering with families and providers.

    Science.gov (United States)

    Taylor, April; Lizzi, Michele; Marx, Alison; Chilkatowsky, Maryann; Trachtenberg, Symme W; Ogle, Sue

    2013-01-01

    Care coordination has been a key theme in national forums on healthcare quality, design, and improvement. This article describes the characteristics of a care coordination program aimed at supporting families in building care coordination competencies and providers in the coordination of care across multiple specialties. The program included implementation of a Care Coordination Counselor (CC Counselor) and several supporting tools-Care Binders, Complex Scheduling, Community Resources for Families Database, and a Care Coordination Network. Patients were referred by a healthcare provider to receive services from the CC Counselor or to receive a Care Binder organizational tool. To assess the impact of the counselor role, we compared patient experience survey results from patients receiving CC Counselor services to those receiving only the Care Binder. Our analysis found that patients supported by the CC Counselor reported greater agreement with accessing care coordination resources and identifying a key point person for coordination. Seventy-five percent of CC Counselor patients have graduated from the program. Our findings suggest that implementation of a CC Counselor role and supporting tools offers an integrative way to connect patients, families, and providers with services and resources to support coordinated, continuous care.

  17. 76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative

    Science.gov (United States)

    2011-10-03

    ... improvement, and meaningful use of health information technology can achieve the three-part aim of better care... Center's approach to supporting comprehensive primary care. Learning systems will support participating... savings will not be a part of the payment methodology for Medicaid fee-for-service. III. Collection...

  18. Identifying potentially cost effective chronic care programs for people with COPD

    Directory of Open Access Journals (Sweden)

    L M G Steuten

    2008-12-01

    Full Text Available L M G Steuten1, K M M Lemmens2, A P Nieboer2, H JM Vrijhoef31Maastricht University Medical Centre, School for Care and Public Health Research, Department of Health, Organisation, Policy and Economics, Maastricht, The Netherlands; 2Erasmus University Medical Centre, Institute of Health Policy and Management, Rotterdam, The Netherlands; 3Maastricht University Medical Centre, School for Care and Public Health Research, Department of Integrated Care, Maastricht, The NetherlandsObjective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified.Methods: Systematic search of Medline and Cochrane databases for evaluations of multi-component disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized.Results: Twenty articles describing 17 unique COPD programs were included. There is little evidence for significant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specific knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing ≥3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money.Conclusion: Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate significant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specific programs illustrated in this paper can, in the absence of ‘perfect data’, support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision

  19. 2004-2008年北京市女性乳腺癌发病及死亡变化趋势%The incidence and mortality trends of female breast cancer in Beijing, China: between 2004 and 2008

    Institute of Scientific and Technical Information of China (English)

    杨雷; 孙婷婷; 王宁

    2012-01-01

    .43/100 000( 1910/3 445 812) and 10.65/100 000( 367/3 445 812)to 70.70/100 000(2628/3 717 436)and 15.01/100 000(558/3 717 436).And in rural areas,those rates separately rose from 30.60/100 000 ( 691/2 257 953 ) and 5.54/100 000 ( 125/2 257 953 ) in 2004 to 44.78/100 000( 1046/2 336 040)and 7.49/100 000 (175/2 336 040)in 2008.After adjusting by world population constitution,the difference showed no statistical significance in mortality trend of female breast cancer in rural areas of Beijing ( P > 0.05 ).In year 2004,the female breast cancer incidence rate ratio of urban to rural areas in Beijing fluctuated between 1.34 and 4.47,with the average ratio value at 1.81.In year 2008,the ratio value fluctuated between 1.15 and 2.37,with the average ratio value at 1.57.During 2004 and 2008,the peak age group of the female breast cancer incidence in urban areas was in 60-64 years old group,with the rate of 126.92/100 000 (998/786 300 ) whereas the mortality rate was increasing within aging.In rural areas the peak age groups of the incidence and mortality were separately in 50-54 and 80-84 years old groups,with the rate of 80.63/100 000 (793/983 516) and 29.17/100 000 (40/137 132) respectively.Conclusion The incidence and mortality of breast cancer in urban areas in Beijing,as well as the incidence of breast cancer in rural areas in Beijing showed increasing trend annually.The gap in breast cancer incidence between rural and urban areas in Beijing was narrowing,while the incidence rate among different aging groups and the peak mortality rate showed significant difference between urban and rural areas in Beijing.%目的 分析2004-2008年北京城区和农村地区女性乳腺癌发病及死亡趋势.方法 提取北京市肿瘤登记处2004-2008年女性乳腺癌发病与死亡数据,发病共计15 527例,死亡共计3219例,覆盖人口29 351 258人年;其中城区女性乳腺癌发病11 065例,死亡2378例,覆盖人口17 877 128人年;农村地区发病4462例,死亡841

  20. 2004-2008年宁波市狂犬病流行因素分析%Analysis of rabies epidemic factors from 2004 to 2008 in Ningbo city

    Institute of Scientific and Technical Information of China (English)

    易波; 方挺; 周爱明

    2009-01-01

    目的 分析宁波市2004-2008年狂犬病流行因素,探讨有效防制措施.方法 通过对宁波市发生的所有狂犬病病例的流行病学个案调查和全市犬密度及犬免疫状况调查;收集全市110家狂犬病门诊(暴露人群监测点)的数据进行分析.结果 2004-2008年全市共报告狂犬病病例52例,年平均发病率0.16/10万,病死率为100%;全市8个县(市、区)均有病例报告,以慈溪市发病最多(28例),占全市病例总数的53.85%;发病年龄最大80岁,最小3岁,儿童及青壮年发病较多;病例职业分布以农民(46.15%)为主,伤人动物全部为犬;伤口暴露部位以上肢(67.31%)为主,伤口暴露以Ⅲ度(76.92%)暴露为主,未进行伤口处理35例(67.31%),未接种疫苗42例(80.77%),10例接种疫苗者均未完成全程免疫.门诊暴露监测点显示暴露人群以农民为主;各月均有暴露者,以7-8月最多;最大年龄84岁,最小158 d;暴露部位以上下肢为主(68.22%),暴露咬伤程度以Ⅲ度为主(83.05%);犬密度为42.39只/100户,犬的免疫率为9.62%.结论 犬密度高,免疫率低,群众防病意识差,暴露后未进行规范的预防治疗,是宁波市人间狂犬病流行的主要因素.%Objective To analyze epidemic factors of rabies from 2004 to 2008 in Ningbo and to explore the effective control measures. Methods It was investigated for epidemic situation of rabies patients and the density and vaccination of the dogs in villages. There were 110 rabies outpatient clinics selected as sentinel site. Results There were 52 cases of human rabies reported from 2004 to 2008. The average annual incidence rate was 0.16/0.1 million. Fatality rate was 100%. The rabies case distributed at eight counties. Cixi county ranked the first, accounted for 53.85% of all cases. Patients aged from 3 to 80 years and the proportion of farmers was the highest with the value of 46.15%. The main wound exposed section was the upper limbs (67.31%). The Ⅲ degree exposure topped

  1. The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs.

    Science.gov (United States)

    Griffin, Brenda; Bushby, Philip A; McCobb, Emily; White, Sara C; Rigdon-Brestle, Y Karla; Appel, Leslie D; Makolinski, Kathleen V; Wilford, Christine L; Bohling, Mark W; Eddlestone, Susan M; Farrell, Kelly A; Ferguson, Nancy; Harrison, Kelly; Howe, Lisa M; Isaza, Natalie M; Levy, Julie K; Looney, Andrea; Moyer, Michael R; Robertson, Sheilah Ann; Tyson, Kathy

    2016-07-15

    As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs.

  2. A risk-adjusted approach to comparing the return on investment in health care programs.

    Science.gov (United States)

    Sendi, Pedram; Al, Maiwenn J; Zimmermann, Heinz

    2004-09-01

    The league table approach to rank ordering health care programs according to the incremental cost-effectiveness ratio is a common method to guide policy makers in setting priorities for resource allocation. In the presence of uncertainty, however, ranking programs is complicated by the degree of variability associated with each program. Confidence intervals for cost-effectiveness ratios may be overlapping. Moreover, confidence intervals may include negative ratios and the interpretation of negative cost-effectiveness ratios is ambiguous. We suggest to rank mutually exclusive health care programs according to their rate of return which is defined as the net monetary benefit over the costs of the program. However, how does a program with a higher expected return but higher uncertainty compare to a program with a lower expected return but lower risk? In the present paper we propose a risk-adjusted measure to compare the return on investment in health care programs. Financing a health care program is treated as an investment in a risky asset. The risky asset is combined with a risk-free asset in order to construct a combined portfolio. The weights attributed to the risk-free and risky assets are chosen in such a manner that all programs under consideration exhibit the same degree of uncertainty. We can then compare the performance of the individual programs by constructing a risk-adjusted league table of expected returns.

  3. Successfully integrating aged care services: A review of the evidence and tools emerging from a long-term care program

    Directory of Open Access Journals (Sweden)

    Michael J. Stewart

    2013-02-01

    Full Text Available Background: Providing efficient and effective aged care services is one of the greatest public policy concerns currently facing governments. Increasing the integration of care services has the potential to provide many benefits including increased access, promoting greater efficiency, and improving care outcomes. There is little research, however, investigating how integrated aged care can be successfully achieved. The PRISMA (Program of Research to Integrate Services for the Maintenance of Autonomy project, from Quebec, Canada, is one of the most systematic and sustained bodies of research investigating the translation and outcomes of an integrated care policy into practice.  The PRISMA research program has run since 1988, yet there has been no independent systematic review of this work to draw out the lessons learnt. Methods: Narrative review of all literature emanating from the PRISMA project between 1988 and 2012. Researchers accessed an online list of all published papers from the program website. The reference lists of papers were hand searched to identify additional literature. Finally, Medline, Pubmed, EMBASE and Google Scholar indexing databases were searched using key terms and author names. Results were extracted into specially designed spread sheets for analysis. Results: 45 journal articles and two books authored or co-authored by the PRISMA team were identified. Research was primarily concerned with: the design, development and validation of screening and assessment tools; and results generated from their application. Both quasi-experimental and cross sectional analytic designs were used extensively. Contextually appropriate expert opinion was obtained using variations on the Delphi Method. Literature analysis revealed the structures, processes and outcomes which underpinned the implementation. PRISMA provides evidence that integrating care for older persons is beneficial to individuals through reducing incidence of functional

  4. Successfully integrating aged care services: A review of the evidence and tools emerging from a long-term care program

    Directory of Open Access Journals (Sweden)

    Michael J. Stewart

    2013-02-01

    Full Text Available Background: Providing efficient and effective aged care services is one of the greatest public policy concerns currently facing governments. Increasing the integration of care services has the potential to provide many benefits including increased access, promoting greater efficiency, and improving care outcomes. There is little research, however, investigating how integrated aged care can be successfully achieved. The PRISMA (Program of Research to Integrate Services for the Maintenance of Autonomy project, from Quebec, Canada, is one of the most systematic and sustained bodies of research investigating the translation and outcomes of an integrated care policy into practice.  The PRISMA research program has run since 1988, yet there has been no independent systematic review of this work to draw out the lessons learnt.Methods: Narrative review of all literature emanating from the PRISMA project between 1988 and 2012. Researchers accessed an online list of all published papers from the program website. The reference lists of papers were hand searched to identify additional literature. Finally, Medline, Pubmed, EMBASE and Google Scholar indexing databases were searched using key terms and author names. Results were extracted into specially designed spread sheets for analysis.Results: 45 journal articles and two books authored or co-authored by the PRISMA team were identified. Research was primarily concerned with: the design, development and validation of screening and assessment tools; and results generated from their application. Both quasi-experimental and cross sectional analytic designs were used extensively. Contextually appropriate expert opinion was obtained using variations on the Delphi Method. Literature analysis revealed the structures, processes and outcomes which underpinned the implementation. PRISMA provides evidence that integrating care for older persons is beneficial to individuals through reducing incidence of functional

  5. 78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2013-07-26

    ... June 30, 2013, on July 24, 2012, in the Federal Register at 77 FR 43229. Adjusted Payments The... related notice published at 48 FR 29114, June 24, 1983.) This notice has been determined to be not... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day...

  6. [Family Health Program and children palliative care: listening the relatives of technology dependent children].

    Science.gov (United States)

    Rabello, Cláudia Azevedo Ferreira Guimarães; Rodrigues, Paulo Henrique de Almeida

    2010-03-01

    This study discusses the creation of a new children palliative care program based on the Family Health Program, considering the level of care at home and yielding to family requests. The study focused on eighteen members of nine families of technology dependent children (TDC) who were hospital patients at Instituto Fernandes Figueira (IFF): four who are being assisted by its palliative care program Programa de Assistência Domiciliar Interdisciplinar (PADI); three who were inpatients waiting for inclusion in the Program, and finally two inpatients already included in PADI. PADI was chosen because it is the only child palliative care program in Brazil. The results are positive in regards to the connection established between the families and the health care team, the reception of the children, the explanation to the family concerning the disease, and the functional dynamics between the PADI and IFF. As negative points, difficulties arose as a result of the implementation of the program, from its continuity to the worsening or illness of the entire family. In conclusion, although the PADI is the IFF's way of discharging patients, the domiciliary cares taken by the Family Health Program, well articulated with the healthcare system, would be ideal for being the adequate assistance for such.

  7. Monitoring of health care personnel employee and occupational health immunization program practices in the United States.

    Science.gov (United States)

    Carrico, Ruth M; Sorrells, Nikka; Westhusing, Kelly; Wiemken, Timothy

    2014-01-01

    Recent studies have identified concerns with various elements of health care personnel immunization programs, including the handling and management of the vaccine. The purpose of this study was to assess monitoring processes that support evaluation of the care of vaccines in health care settings. An 11-question survey instrument was developed for use in scripted telephone surveys. State health departments in all 50 states in the United States and the District of Columbia were the target audience for the surveys. Data from a total of 47 states were obtained and analyzed. No states reported an existing monitoring process for evaluation of health care personnel immunization programs in their states. Our assessment indicates that vaccine evaluation processes for health care facilities are rare to nonexistent in the United States. Identifying existing practice gaps and resultant opportunities for improvements may be an important safety initiative that protects patients and health care personnel.

  8. 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.

  9. Ceramic material life prediction: A program to translate ANSYS results to CARES/LIFE reliability analysis

    Science.gov (United States)

    Vonhermann, Pieter; Pintz, Adam

    1994-01-01

    This manual describes the use of the ANSCARES program to prepare a neutral file of FEM stress results taken from ANSYS Release 5.0, in the format needed by CARES/LIFE ceramics reliability program. It is intended for use by experienced users of ANSYS and CARES. Knowledge of compiling and linking FORTRAN programs is also required. Maximum use is made of existing routines (from other CARES interface programs and ANSYS routines) to extract the finite element results and prepare the neutral file for input to the reliability analysis. FORTRAN and machine language routines as described are used to read the ANSYS results file. Sub-element stresses are computed and written to a neutral file using FORTRAN subroutines which are nearly identical to those used in the NASCARES (MSC/NASTRAN to CARES) interface.

  10. Effects of the Program of All-Inclusive Care for the Elderly on Hospital Use

    Science.gov (United States)

    Meret-Hanke, Louise A.

    2011-01-01

    Purpose of the Study: This study evaluates the effects of the Program of All-Inclusive Care for the Elderly (PACE) on hospital use. PACE's capitated financing creates incentives to reduce the use of costly services. Furthermore, its emphasis on preventative care and regular monitoring by provides a mechanism for reducing unnecessary hospital use…

  11. Partnership and empowerment program: a model for patient-centered, comprehensive, and cost-effective care.

    Science.gov (United States)

    Brown, Corinne; Bornstein, Elizabeth; Wilcox, Catina

    2012-02-01

    The Partnership and Empowerment Program model offers a comprehensive, patient-centered, and cost-effective template for coordinating care for underinsured and uninsured patients with cancer. Attention to effective coordination, including use of internal and external resources, may result in decreased costs of care and improved patient compliance and health outcomes.

  12. Implementation of a Tailored Kiosk-Based Injury Prevention Program in Pediatric Primary Care

    OpenAIRE

    2013-01-01

    This study identified behavioral and organizational barriers and facilitators related to the implementation of a clinic-based pediatric injury prevention program. Safe N′ Sound (SNS), an evidence-based tailored injury prevention program designed for pediatric primary care, was implemented in five pediatric clinics in North Carolina. Office managers participated in structured interviews; health care providers participated in focus groups. Waiting room observations were conducted in participati...

  13. Strengthening preventive care programs: a permanent challenge for healthcare systems; lessons from PREVENIMSS México

    OpenAIRE

    Cantón Sonia; Acosta Benjamín; Reyes Hortensia; Levy Santiago; Pérez-Cuevas Ricardo; Gutiérrez Gonzalo; Muñoz Onofre

    2010-01-01

    Abstract Background In 2001, the Instituto Mexicano del Seguro Social (IMSS) carried out a major reorganization to provide comprehensive preventive care to reinforce primary care services through the PREVENIMSS program. This program divides the population into programmatic age groups that receive specific preventive services: children (0-9 years), adolescents (10-19 years), men (20-59 years), women (20-59 years) and older adults (> = 60 years). The objective of this paper is to describe the i...

  14. Transitional care programs: who is left behind? A systematic review

    Directory of Open Access Journals (Sweden)

    Emily Piraino

    2012-08-01

    Full Text Available OBJECTIVE: Older adults are at risk of rehospitalization if their care transitions from hospital-to-home are not properly managed. The objective of this review was to determine if older patient populations recruited for randomized controlled trials of transitional care interventions represented those at greatest risk of rehospitalization following discharge.  Relevant risk factors examined were cognitive impairment, depression, polypharmacy, comorbidity, length of stay, advanced non-malignant diseases, and available social support.DESIGN: Systematic Review.SETTING: Hospital to home.PARTICIPANTS: Older hospitalized adults.MEASUREMENTS: For inclusion, articles were required to focus on hospital-to-home transitions with a self-care component, have components occurring both before and after discharge, and a randomized controlled trial design. Articles were excluded if participants had a mean age under 55 years, or if interventions focused on developmental disabilities, youth, addictions, or case management, or were solely primary-care based.RESULTS:  Following title, abstract, and full review by two authors, 17 articles met inclusion criteria.  Risk factors for rehospitalization were often listed either as exclusion criteria or were not reported at baseline by the studies. One study included patients with all identified risk factors for rehospitalization.CONCLUSIONS: These data suggest that published studies of transitional care interventions do not often include older adults at highest risk of rehospitalization, raising concerns about the generalizability of their results. Studies are needed that evaluate interventions that explicitly address the needs and characteristics of these patients.

  15. Transitional care programs: who is left behind? A systematic review

    Directory of Open Access Journals (Sweden)

    Emily Piraino

    2012-08-01

    Full Text Available OBJECTIVE: Older adults are at risk of rehospitalization if their care transitions from hospital-to-home are not properly managed. The objective of this review was to determine if older patient populations recruited for randomized controlled trials of transitional care interventions represented those at greatest risk of rehospitalization following discharge.  Relevant risk factors examined were cognitive impairment, depression, polypharmacy, comorbidity, length of stay, advanced non-malignant diseases, and available social support. DESIGN: Systematic Review. SETTING: Hospital to home. PARTICIPANTS: Older hospitalized adults. MEASUREMENTS: For inclusion, articles were required to focus on hospital-to-home transitions with a self-care component, have components occurring both before and after discharge, and a randomized controlled trial design. Articles were excluded if participants had a mean age under 55 years, or if interventions focused on developmental disabilities, youth, addictions, or case management, or were solely primary-care based. RESULTS:  Following title, abstract, and full review by two authors, 17 articles met inclusion criteria.  Risk factors for rehospitalization were often listed either as exclusion criteria or were not reported at baseline by the studies. One study included patients with all identified risk factors for rehospitalization. CONCLUSIONS: These data suggest that published studies of transitional care interventions do not often include older adults at highest risk of rehospitalization, raising concerns about the generalizability of their results. Studies are needed that evaluate interventions that explicitly address the needs and characteristics of these patients.

  16. CARES/LIFE Ceramics Analysis and Reliability Evaluation of Structures Life Prediction Program

    Science.gov (United States)

    Nemeth, Noel N.; Powers, Lynn M.; Janosik, Lesley A.; Gyekenyesi, John P.

    2003-01-01

    This manual describes the Ceramics Analysis and Reliability Evaluation of Structures Life Prediction (CARES/LIFE) computer program. The program calculates the time-dependent reliability of monolithic ceramic components subjected to thermomechanical and/or proof test loading. CARES/LIFE is an extension of the CARES (Ceramic Analysis and Reliability Evaluation of Structures) computer program. The program uses results from MSC/NASTRAN, ABAQUS, and ANSYS finite element analysis programs to evaluate component reliability due to inherent surface and/or volume type flaws. CARES/LIFE accounts for the phenomenon of subcritical crack growth (SCG) by utilizing the power law, Paris law, or Walker law. The two-parameter Weibull cumulative distribution function is used to characterize the variation in component strength. The effects of multiaxial stresses are modeled by using either the principle of independent action (PIA), the Weibull normal stress averaging method (NSA), or the Batdorf theory. Inert strength and fatigue parameters are estimated from rupture strength data of naturally flawed specimens loaded in static, dynamic, or cyclic fatigue. The probabilistic time-dependent theories used in CARES/LIFE, along with the input and output for CARES/LIFE, are described. Example problems to demonstrate various features of the program are also included.

  17. Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation

    OpenAIRE

    Manca, Donna Patricia; Aubrey-Bassler, Kris; Kandola, Kami; Aguilar, Carolina; Campbell-Scherer, Denise; Sopcak, Nicolette; O’Brien, Mary Ann; Meaney, Christopher; Faria, Vee; Baxter, Julia; Moineddin, Rahim; Salvalaggio, Ginetta; Green, Lee; Cave, Andrew; Grunfeld, Eva

    2014-01-01

    Background The objectives of this paper are to describe the planned implementation and evaluation of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER 2) program which originated from the BETTER trial. The pragmatic trial, informed by the Chronic Care Model, demonstrated the effectiveness of an approach to Chronic Disease Prevention and Screening (CDPS) involving the use of a new role, the prevention practitioner. The desired goals of t...

  18. Evaluation of Quality in Social Care: Aplus Program

    Science.gov (United States)

    Dutrenit, Jean-Marc

    2005-01-01

    France is not advanced regarding evaluation in social work, despite a law established in January 2002 making evaluation a legal obligation every 5 years. This article presents a software program to help social services evaluate on both individual and group levels. Automatic dashboard results of the program with special emphasis on the main…

  19. 76 FR 34541 - Child and Adult Care Food Program Improving Management and Program Integrity

    Science.gov (United States)

    2011-06-13

    ... memorandums are available on the FNS Web site at http://www.fns.usda.gov/cnd/Care/Regs-Policy/Policy/Memoranda....gov/cnd/care/Management/79-2.pdf . Finally, after publishing each of the interim rules, the...

  20. The Association of Shelter Veterinarians veterinary medical care guidelines for spay-neuter programs.

    Science.gov (United States)

    Looney, Andrea L; Bohling, Mark W; Bushby, Philip A; Howe, Lisa M; Griffin, Brenda; Levy, Julie K; Eddlestone, Susan M; Weedon, James R; Appel, Leslie D; Rigdon-Brestle, Y Karla; Ferguson, Nancy J; Sweeney, David J; Tyson, Kathy A; Voors, Adriana H; White, Sara C; Wilford, Christine L; Farrell, Kelly A; Jefferson, Ellen P; Moyer, Michael R; Newbury, Sandra P; Saxton, Melissa A; Scarlett, Janet M

    2008-07-01

    As efforts to reduce the overpopulation and euthanasia of unwanted and unowned dogs and cats have increased, greater attention has been focused on spay-neuter programs throughout the United States. Because of the wide range of geographic and demographic needs, a wide variety of programs have been developed to increase delivery of spay-neuter services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, feral cat programs, and services provided through private practitioners. In an effort to ensure a consistent level of care, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. The guidelines consist of recommendations for preoperative care (eg, patient transport and housing, patient selection, client communication, record keeping, and medical considerations), anesthetic management (eg, equipment, monitoring, perioperative considerations, anesthetic protocols, and emergency preparedness), surgical care (eg, operating-area environment; surgical-pack preparation; patient preparation; surgeon preparation; surgical procedures for pediatric, juvenile, and adult patients; and identification of neutered animals), and postoperative care (eg, analgesia, recovery, and release). These guidelines are based on current principles of anesthesiology, critical care medicine, microbiology, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs.

  1. The History of the Animal Care Program at NASA Johnson Space Center

    Science.gov (United States)

    Khan-Mayberry, Noreen; Bassett, Stephanie

    2010-01-01

    This slide presentation reviews the work of the Animal Care Program (ACP). Animals have been used early in space exploration to ascertain if it were possible to launch a manned spacecraft. The program is currently involved in many studies that assist in enhancing the scientific knowledge of the effect of space travel. The responsibilities of the ACP are: (1) Organize and supervise animal care operations & activities (research, testing & demonstration). (2) Maintain full accreditation by the International Association for the Assessment and Accreditation of Laboratory Animal Care (AAALAC) (3) Ensure protocol compliance with IACUC recommendations (4) Training astronauts for in-flight animal experiments (5) Maintain accurate & timely records for all animal research testing approved by JSC IACUC (6) Organize IACUC meetings and assist IACUC members (7) Coordinate IACUC review of the Institutional Program for Humane Care and Use of Animals (every 6 mos)

  2. Results of a multidisciplinary program for patients with fibromyalgia implemented in the primary care

    NARCIS (Netherlands)

    van Wilgen, C.P.; Bloten, H.; Oeseburg, B.

    2007-01-01

    Purpose. Fibromyalgia is a syndrome of unknown origin with a high prevalence. Multimodal approaches seem to be the treatment of choice in fibromyalgia. A multidisciplinary program was developed and implemented for patients with fibromyalgia in the primary care setting. The program included education

  3. Determinants of impact of a practice accreditation program in primary care: a qualitative study

    NARCIS (Netherlands)

    Nouwens, E.; Lieshout, J. van; Wensing, M.

    2015-01-01

    BACKGROUND: Practice accreditation is a widely used method to assess and improve the quality of healthcare services. In the Netherlands, a practice accreditation program was implemented in primary medical care. We aimed to identify determinants of impact of a practice accreditation program, building

  4. Teaching the Spiritual Dimension of Nursing Care: A Survey of U.S. Baccalaureate Nursing Programs.

    Science.gov (United States)

    Lemmer, Corinne

    2002-01-01

    Responses from 132 baccalaureate nursing programs indicated that the majority include spiritual dimensions in program philosophy and curriculum, but few had definitions of spirituality and nursing care. Content typically addressed patients' spiritual needs, dying, and holism. Respondents were uncertain about faculty preparation to teach about…

  5. 7 CFR 250.61 - Child and Adult Care Food Program (CACFP).

    Science.gov (United States)

    2010-01-01

    ... Section 250.61 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS AND POLICIES-FOOD DISTRIBUTION DONATION OF FOODS... National School Lunch Program (NSLP) and Other Child Nutrition Programs § 250.61 Child and Adult Care...

  6. Educators' Curriculum Guide. Quality Assurance and Animal Care: Youth Education Program.

    Science.gov (United States)

    Busboom, Jan R.; Newman, Jerry A.; Shulaw, William P.; Jeffreys, J. Bradford

    This curriculum guide contains a six-unit, two-level program combining animal science and veterinary care for youth club leaders and members in grades three through twelve. The Facilitator and Educator/Leader Introductions describe the program, the goals, and the students who will participate. The six lesson plans contain what the lesson is about,…

  7. A new "loyalty rewards" program in health care customer relationships.

    Science.gov (United States)

    Macstravic, Scott

    2006-01-01

    "Loyalty rewards" in sponsored DM and HRM programs can apply to both providers and consumers. Physicians and hospitals can be paid to "loyally" adhere to payers' guidelines for managing diseases and risks. Many payer and their outsourced vendor programs include significant efforts to create collaborations between payer and provider, rather than relying on unilateral efforts. And growing numbers are rewarding providers for their efforts and results achieved.

  8. Effect of the California tobacco control program on personal health care expenditures.

    Directory of Open Access Journals (Sweden)

    James M Lightwood

    2008-08-01

    Full Text Available BACKGROUND: Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California's large-scale tobacco control program on aggregate personal health care expenditures in the state. METHODS AND FINDINGS: Cointegrating regressions were used to predict (1 the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2 the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started and 2004, the California program was associated with $86 billion (2004 US dollars (95% confidence interval [CI] $28 billion to $151 billion lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%-12.1% of total health care expenditures in 2004. CONCLUSIONS: A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures.

  9. A Model for Community-Based Pediatric Oral Heath: Implementation of an Infant Oral Care Program

    Directory of Open Access Journals (Sweden)

    Francisco J. Ramos-Gomez

    2014-01-01

    Full Text Available The Affordable Care Act (ACA mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0–5 and their caregivers. In collaboration with the Venice Family Clinic's Simms/Mann Health and Wellness Center, UCLA Pediatrics, Women, Infants, and Children (WIC, and Early Head Start and Head Start programs, the IOCP increases family-centered care access and promotes early utilization of dental services in nontraditional, primary care settings. Emphasizing disease prevention, management, and care that is sensitive to cultural, language, and oral health literacy challenges, IOCP patients achieve better oral health maintenance “in health” not in “disease modality”. IOCP uses interprofessional education to promote pediatric oral health across multiple disciplines and highlights the necessity for the “age-one visit”. This innovative clinical model facilitates early intervention and disease management. It sets a new standard of minimally invasive dental care that is widely available and prevention focused, with high retention rates due to strong collaborations with the community-based organizations serving these vulnerable, high-risk children.

  10. Outcomes assessment of a pharmacist-directed seamless care program in an ambulatory oncology clinic.

    Science.gov (United States)

    Edwards, Scott J; Abbott, Rick; Edwards, Jonathan; LeBlanc, Michael; Dranitsaris, George; Donnan, Jennifer; Laing, Kara; Whelan, Maria A; MacKinnon, Neil J

    2014-02-01

    The primary goal of seamless care is improved patient outcomes and improved standards of care for patients with cancer. The pharmacy service of the Newfoundland Cancer Treatment and Research Foundation conducted a randomized control study that measured clinical and humanistic outcomes of a pharmacist-directed seamless care program in an ambulatory oncology clinic. This article focuses on the intervention group, particularly the identification of drug-related problems (DRPs) and utilization of health care services as well the satisfaction of 3 types of health professionals with the services provided by the pharmacist-directed seamless care program. Overall, the seamless care pharmacist (SCP) identified an average of 3.7 DRPs per intervention patient; the most common DRP reported was a patient not receiving or taking a drug therapy for which there is an indication. The SCP identified more DRPs in patients receiving adjuvant treatment compared to those receiving palliative treatment. On average, family physicians, oncology nurses, and hospital pharmacists were satisfied with the SCP intervention indicating that they agreed the information collected and distributed by the SCP was useful to them. Pharmacist-directed seamless care services in an ambulatory oncology clinic have a significant impact on clinical outcomes and processes of patient care. The presence of a SCP can help identify and resolve DRPs experienced by patients in an outpatient oncology clinic, ensuring that patients are receiving the highest standard of care.

  11. A Program for Clinical Care in Physical Trauma.

    Science.gov (United States)

    2014-09-26

    concentrations of biochemical substrates and associated increased gluconeogene- sis and skeletal muscle nitrogen release. There is also a failure to...have been inserted in the hepatic, portal, and mesenteric veins, and in the renal vein. In one study, catheters were carefully placed in the lower aorta...the sheep and dog . American Journal of Physiology 216:946-952, 1969. 3. Katz, M.L., Bergman, E.W.: A method for simultaneous cannulation of the major

  12. Practicing End-of-Life Conversations: Physician Communication Training Program in Palliative Care.

    Science.gov (United States)

    Rucker, Bronwyn; Browning, David M

    2015-01-01

    A Physician Communication Training Program (PCTP) utilizing scripts based on actual family conferences with patients, families, and the health care team was developed at one medical center in the Northeast. The program was designed, adapted, and directed by a palliative care social worker. The primary goal of the program is to help residents and attending physicians build better communication skills in establishing goals of care and in end-of-life planning. The scripts focus on improving physicians' basic skills in conducting family meetings, discussing advance directives, prognosis, brain death, and withdrawal of life support. Excerpts from the scripts utilized in the program are included. Feedback from participants has been positive, with all respondents indicating improvement in their capacity to take part in these challenging conversations.

  13. The patient perspective: arthritis care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians

    Directory of Open Access Journals (Sweden)

    Warmington K

    2015-08-01

    Full Text Available Kelly Warmington,1 Carol A Kennedy,2 Katie Lundon,3 Leslie J Soever,4 Sydney C Brooks,5 Laura A Passalent,6 Rachel Shupak,7 Rayfel Schneider,8 1Learning Institute, Hospital for Sick Children, 2Musculoskeletal Health and Outcomes Research, St Michael’s Hospital, 3Continuing Professional Development, Faculty of Medicine, University of Toronto, 4University Health Network, 5Ontario Division, Arthritis Society, 6Toronto Western Hospital, 7Division of Rheumatology, St Michael's Hospital, 8Division of Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Objective: To assess patient satisfaction with the arthritis care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC program. Materials and methods: This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient–Doctor Interaction Scale, modified to capture patient–practitioner interactions. Participants completed selected items from the Group Health Association of America's Consumer Satisfaction Survey, and items capturing quality of care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP services with previously received arthritis care. Results: A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%, female (72%, and living in urban areas (79%. The mean age of participants was 54 years (range 3–92 years, and 51% were not working. Patients with inflammatory (51% and noninflammatory conditions (31% were represented. Mean (standard deviation Patient–Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60 to 4.63 (0.48 (1 to 5 [greater satisfaction]. Overall satisfaction with the quality of care was high (4.39 [0.77], as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]. Ninety-eight percent of

  14. Development of an interprofessional program for cardiovascular prevention in primary care: A participatory research approach

    Directory of Open Access Journals (Sweden)

    Lyne Lalonde

    2014-02-01

    Full Text Available Background: The chronic care model provides a framework for improving the management of chronic diseases. Participatory research could be useful in developing a chronic care model–based program of interventions, but no one has as yet offered a description of precisely how to apply the approach. Objectives: An innovative, structured, multi-step participatory process was applied to select and develop (1 chronic care model–based interventions program to improve cardiovascular disease prevention that can be adapted to a particular regional context and (2 a set of indicators to monitor its implementation. Methods: Primary care clinicians (n = 16, administrative staff (n = 2, patients and family members (n = 4, decision makers (n = 5, researchers, and a research coordinator (n = 7 took part in the process. Additional primary care actors (n = 26 validated the program. Results: The program targets multimorbid patients at high or moderate risk of cardiovascular disease with uncontrolled hypertension, dyslipidemia or diabetes. It comprises interprofessional follow-up coordinated by case-management nurses, in which motivated patients are referred in a timely fashion to appropriate clinical and community resources. The program is supported by clinical tools and includes training in motivational interviewing. A set of 89 process and clinical indicators were defined. Conclusion: Through a participatory process, a contextualized interventions program to optimize cardiovascular disease prevention and a set of quality indicators to monitor its implementation were developed. Similar approach might be used to develop other health programs in primary care if program developers are open to building on community strengths and priorities.

  15. 75 FR 44971 - Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children

    Science.gov (United States)

    2010-07-30

    ... [CMS-2480-NC] Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care... recommendations for legislative changes to improve the quality of care provided to children under Medicaid and the... quality of care provided to children under Medicaid and the Children's Health Insurance Program....

  16. El sistema metrocable línea K y su impacto en la calidad de vida de la población de la Comuna Uno en la ciudad de Medellín entre los años 2004-2008. Análisis de percepción

    OpenAIRE

    Anzoategui Zapata, Juan Camilo; Vásquez Roldan, Julián Santiago

    2012-01-01

    International audience; La calidad de vida medida a través del sistema de transporte de una región se convierte en una variable significativa en el desarrollo de las personas, que como conjunto reflejan el desarrollo de una localidad. La motivación de esta investigación se enfoca en la importancia del sistema de transporte Metro Cable Linea K y los impactos generados en la comuna uno de la ciudad de Medellín durante el periodo (2004-2008), comuna caracterizada por la alta vulnerabilidad econó...

  17. Incorporating human rights into reproductive health care provider education programs in Nicaragua and El Salvador.

    Science.gov (United States)

    Reyes, H Luz McNaughton; Zuniga, Karen Padilla; Billings, Deborah L; Blandon, Marta Maria

    2013-07-01

    Health care providers play a central role in the promotion and protection of human rights in patient care. Consequently, the World Medical Association, among others, has called on medical and nursing schools to incorporate human rights education into their training programs. This report describes the efforts of one Central American nongovernmental organization to include human rights - related content into reproductive health care provider training programs in Nicaragua and El Salvador. Baseline findings suggest that health care providers are not being adequately prepared to fulfill their duty to protect and promote human rights in patient care. Medical and nursing school administrators, faculty, and students recognize the need to strengthen training in this area and are enthusiastic about incorporating human rights content into their education programs. Evaluation findings suggest that exposure to educational materials and methodologies that emphasize the relationship between human rights and reproductive health may lead to changes in health care provider attitudes and behaviors that help promote and safeguard human rights in patient care.

  18. Developing a Comprehensive Animal Care Occupational Health and Safety Program at a Land-Grant Institution.

    Science.gov (United States)

    Goodly, Lyndon J; Jarrell, Vickie L; Miller, Monica A; Banks, Maureen C; Anderson, Thomas J; Branson, Katherine A; Woodward, Robert T; Peper, Randall L; Myers, Sara J

    2016-01-01

    The Public Health Service Policy on the Humane Care and Use of Laboratory Animals and sound ethical practices require institutions to provide safe working environments for personnel working with animals; this mandate is achieved in part by establishing an effective animal care Occupational Health and Safety Program (OHSP). Land-grant institutions often face unique organizational challenges in fulfilling this requirement. For example, responsibilities for providing health and safety programs often have historically been dispersed among many different divisions scattered around the campus. Here we describe how our institutional management personnel overcame organizational structure and cultural obstacles during the formation of a comprehensive campus-wide animal care OHSP. Steps toward establishing the animal care OHSP included assigning overall responsibility, identifying all stakeholders, creating a leadership group, and hiring a fulltime Animal Care OHSP Specialist. A web-based portal was developed, implemented, and refined over the past 7 y and reflected the unique organizational structures of the university and the needs of our research community. Through this web-based portal, hazards are identified, risks are assessed, and training is provided. The animal care OHSP now provides easy mandatory enrollment, supports timely feedback regarding hazards, and affords enrollees the opportunity to participate in voluntary medical surveillance. The future direction and development of the animal care OHSP will be based on the research trends of campus, identification of emerging health and safety hazards, and ongoing evaluation and refinement of the program.

  19. The VA Maryland Health Care System's telemental health program.

    Science.gov (United States)

    Koch, Edward F

    2012-05-01

    The VA Maryland Health Care System introduced videoconferencing technology to provide psychiatry, evidenced-based psychotherapy, case management, and patient education at rural clinics where it was difficult to recruit providers. Telemental health services enable rural clinics to offer additional services, such as case management and patient education. Services have been expanded to urban outpatient clinics where a limited number of mental health clinic hours are available. This technology expands the availability of mental health providers and services, allowing patients to receive services from providers located at distant medical centers.

  20. 76 FR 52575 - Health Care for Homeless Veterans Program

    Science.gov (United States)

    2011-08-23

    ... affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the... facilities have been ascertained to VA's satisfaction, and then only to applicants determined by VA to meet... policies and procedures of the program. There will be at a minimum, an employee on duty on the premises,...

  1. 78 FR 36449 - State Long-Term Care Ombudsman Program

    Science.gov (United States)

    2013-06-18

    ... to the satisfaction of the resident, working with the resident to assure his or her well-being. In... life at the local, state and national levels. Begun in 1972 as a demonstration program, Ombudsman... and rights as well as to provide the resident with the option to consent to disclosure of...

  2. Back care instructions in physical therapy: a trend analysis of individualized back care programs.

    NARCIS (Netherlands)

    Kerssens, J.J.; Sluijs, E.M.; Verhaak, P.F.M.; Knibbe, H.J.J.; Hermans, I.M.J.

    1999-01-01

    Background and Purpose: The treatment of people with low back pain often includes giving a variety of instructions about back care. The objective of our study was to explore the content and sequence of these instructions. Subjects: Our database contained information on 1,151 therapy sessions for 132

  3. Secondary prevention after minor stroke and TIA - usual care and development of a support program.

    Directory of Open Access Journals (Sweden)

    Stefanie Leistner

    Full Text Available BACKGROUND: Effective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program. METHODS: Two consecutive cohorts of patients with acute minor stroke or TIA undergoing usual outpatient care versus a secondary prevention program were compared. Risk factor control and medication adherence were assessed in 6-month follow-ups (6M-FU. Usual care consisted of detailed information concerning vascular risk factor targets given at discharge and regular outpatient care by primary care physicians. The stepwise modeled support program additionally employed up to four outpatient appointments. A combination of educational and behavioral strategies was employed. RESULTS: 168 patients in the observational cohort who stated their openness to participate in a prevention program (mean age 64.7 y, admission blood pressure (BP: 155/84 mmHg and 173 patients participating in the support program (mean age 67.6 y, BP: 161/84 mmHg were assessed at 6 months. Proportions of patients with BP according to guidelines were 50% in usual-care and 77% in the support program (p<0.01. LDL<100 mg/dl was measured in 62 versus 71% (p = 0.12. Proportions of patients who stopped smoking were 50 versus 79% (p<0.01. 72 versus 89% of patients with atrial fibrillation were on oral anticoagulation (p = 0.09. CONCLUSIONS: Risk factor control remains unsatisfactory in usual care. Targets of secondary prevention were met more often within the supported cohort. Effects on (cerebro-vascular recurrence rates are going to be assessed in a multicenter randomized trial.

  4. The German National Program on Psoriasis Health Care 2005-2015: results and experiences.

    Science.gov (United States)

    Augustin, M; Eissing, L; Langenbruch, A; Enk, A; Luger, T; Maaßen, D; Mrowietz, U; Reich, K; Reusch, M; Strömer, K; Thaçi, D; von Kiedrowski, R; Radtke, M A

    2016-08-01

    In 2005, the first national psoriasis survey in Germany revealed large deficits in health care particularly in patients with moderate to severe disease. The consecutive goal was to improve health care for psoriasis countrywide. For this, a large-scale national program was initiated starting with a comprehensive analysis of structures and processes of care for psoriasis. Patient burden, economic impact and barriers to care were systematically analyzed. In order to optimize routine care, a S3 guideline, a set of outcomes measures and treatment goals, were developed. Implementation was enforced by the German Psoriasis Networks (PsoNet) connecting the most dedicated dermatologists. The annual National Conference on Health Care in Psoriasis established in 2009 consented National Health Care Goals in Psoriasis 2010-2015 and defined a set of quality indicators, which are monitored on a regular basis. Currently 28 regional networks including more than 800 dermatologists are active. Between 2005 and 2014 7 out of 8 quality indicators have markedly improved, and regional disparities were resolved. e.g., mean PASI (Psoriasis Area Severity Index) dropped from 11.4 to 8.1 and DLQI (Dermatology Life Quality Index) from 8.6 to 5.9. A decade of experience indicates that a coordinated nationwide psoriasis program based on goal orientation can contribute to better quality of care and optimized outcomes.

  5. Bereavement photography for children: program development and health care professionals' response.

    Science.gov (United States)

    Michelson, Kelly Nicole; Blehart, Kathleen; Hochberg, Todd; James, Kristin

    2013-07-01

    Reports of in-hospital bereavement photography focus largely on stillborns and neonates. Empiric data regarding the implementation of bereavement photography in pediatrics beyond the neonatal period and the impact of such programs on healthcare professionals (HCPs) is lacking. The authors describe the implementation of a pediatric intensive care unit (PICU) bereavement photography program and use questionnaire data from HCPs to describe HCPs' reflections on the program and to identify program barriers. From July 2007 through April 2070, families of 59 (36%) of the 164 patients who died in the PICU participated in our bereavement photography program. Forty questionnaires from 29 HCPs caring for 39 participating patients/families indicated that families seemed grateful for the service (n = 34; 85%) and that the program helped HCPs feel better about their role (n = 30; 70%). Many HCPs disagreed that the program consumed too much of his/her time (n = 34; 85%) and that the photographer made his/her job difficult (n = 37; 92.5%). Qualitative analysis of responses to open-ended questions revealed 4 categories: the program's general value; positive aspects of the program; negative aspects of the program; and suggestions for improvements. Implementing bereavement photography in the PICU is feasible though some barriers exist. HCPs may benefit from such programs.

  6. Prevalence of health promotion programs in primary health care units in Brazil

    Science.gov (United States)

    Ramos, Luiz Roberto; Malta, Deborah Carvalho; Gomes, Grace Angélica de Oliveira; Bracco, Mário M; Florindo, Alex Antonio; Mielke, Gregore Iven; Parra, Diana C; Lobelo, Felipe; Simoes, Eduardo J; Hallal, Pedro Curi

    2014-01-01

    OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil. PMID:25372175

  7. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

    Science.gov (United States)

    Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

    2014-07-01

    Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  8. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    Directory of Open Access Journals (Sweden)

    Daniel Alyeshmerni

    2014-07-01

    Full Text Available Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA, and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  9. Application of a Comprehensive Unit-based Safety Program in critical care: the royal exchange.

    Science.gov (United States)

    Smith, Lauren E; Flanders, Sonya A

    2014-12-01

    This article discusses the history of the Comprehensive Unit-based Safety Program (CUSP) and how it is used to foster a culture of safety. CUSP involves interdisciplinary teamwork and empowers nurses at all levels to pioneer changes and develop leadership skills. A case study is presented to show how CUSP was used effectively in critical care to create a standardized handover of patients from the operating room to the intensive care unit.

  10. The primary care clinic as a setting for continuing medical education: program description.

    Science.gov (United States)

    Pérez-Cuevas, R; Reyes, H; Guiscafré, H; Juárez-Díaz, N; Oviedo, M; Flores, S; Muñoz, O

    2000-11-14

    The Mexican Institute of Social Security (IMSS) is Mexico's Largest state-financed health care system, providing care to 50 million people. This system comprises 1450 family medicine clinics staffed by 14,000 family physicians, as well as 240 secondary care hospitals and 10 tertiary care medical centres. We developed a program of continuing medical education (CME) for IMSS family physicians. The program had 4 stages, which were completed over a 7-month period: development of clinical guidelines, training of clinical instructors, an educational intervention (consisting of interactive workshops, individual tutorials and peer group sessions), and evaluation of both physicians' performance and patients' health status. The pilot study was conducted in an IMSS family medicine clinic providing care to 45,000 people; 20 family physicians and 4 clinical instructors participated. The 2 main reasons for visits to IMSS family medicine clinics are acute respiratory infections and type 2 diabetes mellitus. Therefore, patients being treated at the clinic for either of these illnesses were included in the study. The sources of data were interviews with physicians and patients, clinical records and written prescriptions. A 1-group pretest-posttest design was used to compare physicians' performance in treating the 2 illnesses of interest. We found that the daily activities of the clinic could be reorganized to accommodate the CME program and that usual provision of health care services was maintained. Physicians accepted and participated actively in the program, and their performance improved over the course of the study. We conclude that this CME strategy is feasible, is acceptable to family physicians and may improve the quality of health care provided at IMSS primary care facilities. The effectiveness and sustainability of the strategy should be measured through an evaluative study.

  11. Interprofessional education in practice: Evaluation of a work integrated aged care program.

    Science.gov (United States)

    Lawlis, Tanya; Wicks, Alison; Jamieson, Maggie; Haughey, Amy; Grealish, Laurie

    2016-03-01

    Health professional clinical education is commonly conducted in single discipline modes, thus limiting student collaboration skills. Aged care residential facilities, due to the chronic and complex health care needs of residents, provide an ideal placement to provide a collaborative experience. Interprofessional education is widely acknowledged as the pedagogical framework through which to facilitate collaboration. The aim of the evaluation was to assess student attitudes towards collaboration after active involvement in an interprofessional education program. Students studying nursing, occupational therapy, and aged care were invited to complete a version of the Readiness for Interprofessional Learning Scale before and after participating in a three-week pilot interprofessional program. A positive change in student attitudes towards other health professionals and the importance of working in interprofessional teams was reported with significant differences between two statements indicated: Learning with health-care students before qualifications would improve relationships after qualifications; and I learned a lot from the students from the other disciplines. The innovative pilot project was found to enhance student learning in interprofessional teams and the aged care environment. Further development of this and similar interprofessional programs is required to develop sustainable student projects that have health benefits for residents in aged care residential facilities.

  12. Commentary: Recommendations and remaining questions for health care leadership training programs.

    Science.gov (United States)

    Stoller, James K

    2013-01-01

    Effective leadership is critical for optimizing cost, access, and quality in health care. Creating a pipeline of effective health care leaders requires developing leadership competencies that differ from the usual criteria of clinical and scientific excellence by which physicians have traditionally been promoted to leadership positions. Specific competencies that differentiate effective leaders from average leaders, especially emotional intelligence and its component abilities, are essential for effective leadership.Adopting a long-standing practice from successful corporations, some health care institutions, medical societies, and business schools now offer leadership programs that address these differentiating leadership competencies. The author draws on experience with such programs through the Cleveland Clinic Academy to provide recommendations for health care leadership training and to identify unanswered questions about such programs.The author recommends that such training should be broadly available to all health care leadership communities (i.e., nurses, administrators, and physicians). A progressive curriculum, starting with foundational concepts and extending to coaching and feedback opportunities through experiential learning, recognizes the challenge of becoming an effective leader and the long time line needed to do so. Linking leadership courses to continuing medical education and to graduate credit opportunities is appealing to participants. Other recommendations focus on the importance of current leaders' involvement in nominating emerging leaders for participation, embedding leadership development discussions in faculty's professional reviews, and blending discussion of frameworks and theory with practical, experiential lessons. The author identifies questions about the benefits of formal health care leadership training that remain to be answered.

  13. [The list of drugs in the Popular Pharmacy Program and the Brazilian National Pharmaceutical Care Policy].

    Science.gov (United States)

    Yamauti, Sueli Miyuki; Barberato-Filho, Silvio; Lopes, Luciane Cruz

    2015-08-01

    This study aimed to analyze the list of drugs in the Popular Pharmacy Program in Brazil (PFPB) in relation to the country's pharmaceutical care policy. The list of drugs in the PFPB was compared to the Brazilian and international reference lists of essential medicines, the components of pharmaceutical care in Brazilian Unified National Health System (SUS), and drug production by the country's government pharmaceutical laboratories. The PFPB list includes 119 drugs, of which 19.3% and 47.1% were not selected on the Brazilian and international reference lists, respectively; 16.8% are not used in primary care, and 40.3% are not produced by the country's government laboratories. A revision of the PFPB list based on the essential medicines concept (World Health Organization), alignment of pharmaceutical care policies, and production by government laboratories are essential to improve quality of health care, management, training of prescribers, and information for the population.

  14. Effect of a Comprehensive Health Care Program by Korean Medicine Doctors on Medical Care Utilization for Common Infectious Diseases in Child-Care Centers

    Directory of Open Access Journals (Sweden)

    Minjung Park

    2014-01-01

    Full Text Available As the role of traditional medicine in community health improvement increases, a comprehensive health care program for infectious diseases management in child-care centers by Korean medicine doctors was developed. The purpose of this study is to evaluate the effects of the program intervention on infection-related medical care utilization among children. The study used a quasi-experimental design with nonequivalent control group, comparing pre- and post-intervention data of the same children. The program implemented interventions in terms of management, education, and medical examination for the teachers, parents, and children in 12-week period. The frequency of utilization, cost, and prescription days of drugs and antibiotics due to infectious diseases prior to the intervention were compared with those during the 3-month intervention, using health insurance claim data. A panel analysis was also conducted to support the findings. A significant reduction (12% in infection-related visit days of hospitals was observed with the intervention (incident rate ratio = 0.88, P=0.01. And medical cost, drug prescription days, and antibiotics prescription days were decreased, although not statistically significant. A further cost-effectiveness analysis in terms of social perspectives, considering the opportunity costs for guardians to take children to medical institutions, would be needed.

  15. Rural Health and Spiritual Care Development: A Review of Programs across Rural Victoria, Australia.

    Science.gov (United States)

    Carey, Lindsay B; Hennequin, Christine; Krikheli, Lillian; O'Brien, Annette; Sanchez, Erin; Marsden, Candace R

    2016-06-01

    Given declining populations in rural areas and diminishing traditional religious support, this research explores whether spiritual care education programs would be beneficial for and appreciated by those working in rural health and/or community organizations. An overview of literature identified three dominant rural health issues affecting the provision of spiritual care in rural areas, namely the disparity between rural and urban areas in terms of resources, the lack of access to services, plus the need for education and training within rural areas. Spiritual Health Victoria Incorporated (Victoria, Australia) sought to address these issues with the implementation of a variety of spiritual education programs within rural areas. Results of an evaluation of these programs are presented specifying participant demographics, reasons why participants attended, their evaluation of the program and any recommendations for future programs. In overall terms, the results indicated that at least 90% of participants favorably rated their attended program as either 'very good' or 'good' and indicated that the main reason for their attendance was to develop their own education and/or practice of spiritual care within their rural context for the benefit of local constituents. Several recommendations are made for future programs.

  16. Impact of a home-based social welfare program on care for palliative patients in the Basque Country (SAIATU Program

    Directory of Open Access Journals (Sweden)

    Molina Emilio Herrera

    2013-01-01

    Full Text Available Abstract Background SAIATU is a program of specially trained in-home social assistance and companionship which, since February 2011, has provided support to end-of-life patients, enabling the delivery of better clinical care by healthcare professionals in Osakidetza (Basque Health Service, in Guipúzcoa (Autonomous Community of the Basque Country. In January 2012, a retrospective observational study was carried out, with the aim of describing the characteristics of the service and determining if the new social service and the associated socio-health co-ordination had produced any effect on the use of healthcare resources by end-of-life patients. The results of a comparison of a cohort of cases and controls demonstrated evidence that the program could reduce the use of hospital resources and promote the continuation of living at home, increasing the home-based activity of primary care professionals. The objective of this study is to analyse whether a program of social intervention in palliative care (SAIATU results in a reduction in the consumption of healthcare resources and cost by end-of-life patients and promotes a shift towards a more community-based model of care. Method/design Comparative prospective cohort study, with randomised selection of patients, which will systematically measure patient characteristics and their consumption of resources in the last 30 days of life, with and without the intervention of a social support team trained to provide in-home end-of-life care. For a sample of approximately 150 patients, data regarding the consumption of public healthcare resources, SAIATU activity, home hospitalisation teams, and palliative care will be recorded. Such data will also include information dealing with the socio-demographic and clinical characteristics of the patients and attending carers, as well as particular characteristics of patient outcomes (Karnofsky Index, and of the outcomes of palliative care received (Palliative

  17. Advancing geriatric education: development of an interprofessional program for health care faculty.

    Science.gov (United States)

    Ford, Channing R; Brown, Cynthia J; Sawyer, Patricia; Rothrock, Angela G; Ritchie, Christine S

    2015-01-01

    To improve the health care of older adults, a faculty development program was created to enhance geriatric knowledge. The University of Alabama at Birmingham (UAB) Geriatric Education Center leadership instituted a one-year, 36-hour curriculum focusing on older adults with complex health care needs. Content areas were chosen from the Institute of Medicine Transforming Health Care Quality report and a local needs assessment. Potential preceptors were identified and participant recruitment efforts began by contacting UAB department chairs of health care disciplines. This article describes the development of the program and its implementation over three cohorts of faculty scholars (n = 41) representing 13 disciplines, from nine institutions of higher learning. Formative and summative evaluation showed program success in terms of positive faculty reports of the program, information gained, and expressed intent by each scholar to apply learned content to teaching and/or clinical practice. This article describes the initial framework and strategies guiding the development of a thriving interprofessional geriatric education program.

  18. Patient quality of life in the Mayo Clinic Care Transitions program: a survey study

    Directory of Open Access Journals (Sweden)

    Faucher J

    2016-08-01

    Full Text Available Joshua Faucher,1 Jordan Rosedahl,2 Dawn Finnie,3 Amy Glasgow,3 Paul Takahashi4 1Mayo Medical School, Mayo Clinic College of Medicine, 2Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, 3Center for the Science of Health Care Delivery, 4Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA Background: Transitional care programs are common interventions aimed at reducing medical complications and associated readmissions for patients recently discharged from the hospital. While organizations strive to reduce readmissions, another important related metric is patient quality of life (QoL. Aims: To compare the relationship between QoL in patients enrolled in the Mayo Clinic Care Transitions (MCCT program versus usual care, and to determine if QoL changed in MCCT participants between baseline and 1-year follow-up. Methods: A baseline survey was mailed to MCCT enrollees in March 2013. Those who completed a baseline survey were sent a follow-up survey 1 year later. A cross-sectional survey of usual care participants was mailed in November 2013. We included in our analysis 199 participants (83 in the MCCT and 116 in usual care aged over 60 years with multiple comorbidities and receiving primary care. Primary outcomes were self-rated QoL; secondary outcomes included self-reported general, physical, and mental health. Intra- and intergroup comparisons of patients were evaluated using Pearson’s chi-squared analysis. Results: MCCT participants had more comorbidities and higher elder risk assessment scores than those receiving usual care. At baseline, 74% of MCCT participants reported responses of good-to-excellent QoL compared to 64% after 1 year (P=0.16. Between MCCT and usual care, there was no significant difference in self-reported QoL (P=0.21. Between baseline and follow-up in MCCT patients, and compared to usual care, there were no significant

  19. Evaluation of an Urban Phase of the Specialized Care Program for Diabetes in Iran: Providers′ Perspectives

    Directory of Open Access Journals (Sweden)

    Hamid Ravaghi

    2014-01-01

    Full Text Available Background: To develop and implement more effective programs of health care delivery to prevent and control diabetes, Iran has developed and implemented the urban phase of the specialized care program for diabetic′s patients. Deeply understanding the views and experiences of various stakeholders in this program can assist policy makers to identify the program′s strengths and weaknesses and enable them to develop action plans. Hence, the present study aimed to evaluate the planning and establishing of this program from the perspective of providers. Methods: A qualitative study was applied using documents review and face-to-face semi-structured interviews with the program leads and relevant executive managers of the local medical universities. Thematic analysis was used to analyze the data. Results: Three main themes and nine subthemes were explored, including program planning (the content and the strengths, weaknesses, and corrective measures, implementation (executive mechanisms at the university level, establishment of referral system, collaboration between deputies of health and treatment, information dissemination mechanisms, satisfaction measurement and strengths, weaknesses and corrective measures, and result (implementation results. Conclusions: The urban phase of the specialized care program for diabetic′s patients has been a good base to improve continuity of care, which emphasizes on controlling and prevention of occurrence or progression of chronic complications of diabetes. This model can also be used for better management of other chronic disease. However, there are still issues that should be considered and improved such as allocation of guaranteed resources, more trained health professionals, and more evidence based guidelines and protocols, better collaboration among medical universities′ deputies, clearer payment system for program evaluation and better information management system.

  20. The process of implementing a rural VA wound care program for diabetic foot ulcer patients.

    Science.gov (United States)

    Reiber, Gayle E; Raugi, Gregory J; Rowberg, Donald

    2007-10-01

    Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going.

  1. Cincinnati Beacon Community Program highlights challenges and opportunities on the path to care transformation.

    Science.gov (United States)

    Fairbrother, Gerry; Trudnak, Tara; Christopher, Ronda; Mansour, Mona; Mandel, Keith

    2014-05-01

    The Cincinnati, Ohio, metropolitan area was one of seventeen US communities to participate in the federal Beacon Community Cooperative Agreement Program to demonstrate how health information technology (IT) could be used to improve health care. Given $13.7 million to spend in thirty-one months, the Cincinnati project involved hundreds of physicians, eighty-seven primary care practices, eighteen major hospital partners, and seven federally qualified health centers and community health centers. The thrust of the program was to build a shared health IT infrastructure to support quality improvement through data exchange, registries, and alerts that notified primary care practices when a patient visited an emergency department or was admitted to a hospital. A special focus of this program was on applying these tools to adult patients with diabetes and pediatric patients with asthma. Despite some setbacks and delays, the basic technology infrastructure was built, the alert system was implemented, nineteen practices focusing on diabetes improvement were recognized as patient-centered medical homes, and many participants agreed that the program had helped transform care. However, the experience also demonstrated that the ability to transfer data was limited in electronic health record systems; that considerable effort was required to adapt technology to support quality improvement; and that the ambitious agenda required more time for planning, training, and implementation than originally thought.

  2. Essential health care package for children--the 'Fit for School' program in the Philippines.

    NARCIS (Netherlands)

    Monse, B.; Naliponguit, E.; Belizario, V.; Benzian, H.; Palenstein Helderman, W.H. van

    2010-01-01

    High prevalence of poverty diseases such as diarrhoea, respiratory tract infection, parasitic infections and dental caries among children in the developing world calls for a return to primary health care principles with a focus on prevention. The 'Fit for School' program in the Philippines is based

  3. Professional Development in Law, Health Care, and Aging: A Model Fellowship Program.

    Science.gov (United States)

    Kapp, Marshall B.

    2000-01-01

    Argues there is a growing need for a core of professionals with the education and sensitivities necessary to integrate the fields of law, health care, and gerontology. Paper describes a professional development fellowship program which attempts to address this need by having recently graduated attorneys assess, on a firsthand level, provisions of…

  4. 75 FR 70165 - Medicare Program; Request for Information Regarding Accountable Care Organizations and the...

    Science.gov (United States)

    2010-11-17

    ... systems will test new reimbursement methods intended to ] create incentives for health care providers to... (CMMI) within CMS, which is authorized to test innovative payment and service delivery models to reduce... innovative payment and delivery system models that complement the Shared Savings Program in the CMMI. In...

  5. Training of Unskilled Child Care Providers: An In-House Program to Overcome Management's Financial Constraints.

    Science.gov (United States)

    Adams, Brian

    An in-house staff development program was designed and implemented for unskilled child caregivers employed at Tiny Tots Educare Academies, Inc., a privately owned and operated child care center located in Ellenton, Florida. Employees had little knowledge of child development and other topics related to early childhood education and, therefore,…

  6. MENTAL-HEALTH INTERVENTION PROGRAMS IN PRIMARY CARE - THEIR SCIENTIFIC BASIS

    NARCIS (Netherlands)

    VANDENBRINK, W; LEENSTRA, A; ORMEL, J; VANDEWILLIGE, G

    1991-01-01

    This study examines the scientific basis for mental health intervention programs in primary care. The validity of five underlying assumptions is evaluated, using the results of a naturalistic study covering a representative sample of 25 Dutch family practices and data from the literature. Our findin

  7. The Care-Integrated Concentration Meditation Program for Patients With Weaning Difficulty: A Pilot Study.

    Science.gov (United States)

    Thinhuatoey, Benjamard; Songwathana, Praneed; Petpichetchian, Wongchan

    2016-01-01

    Because of the multifaceted process of weaning patients with prolonged mechanical ventilation, enhancing weaning success remains a challenge. The Care-Integrated Concentration Meditation Program was developed on the basis of Buddhist philosophy and implemented to determine its procedural feasibility. A qualitative case study with 3 participants was conducted, and the process and initial outcomes were evaluated.

  8. Long-Term Outcomes for the Promoting CARE Suicide Prevention Program

    Science.gov (United States)

    Hooven, Carole; Herting, Jerald R.; Snedker, Karen A.

    2010-01-01

    Objectives: To provide a long-term look at suicide risk from adolescence to young adulthood for former participants in Promoting CARE, an indicated suicide prevention program. Methods: Five hundred ninety-three suicide-vulnerable high school youth were involved in a long-term follow-up study. Latent class growth models identify patterns of change…

  9. The CareWell-primary care program: design of a cluster controlled trial and process evaluation of a complex intervention targeting community-dwelling frail elderly

    Directory of Open Access Journals (Sweden)

    Ruikes Franca GH

    2012-12-01

    Full Text Available Abstract Background With increasing age and longevity, the rising number of frail elders with complex and numerous health-related needs demands a coordinated health care delivery system integrating cure, care and welfare. Studies on the effectiveness of such comprehensive chronic care models targeting frail elders show inconclusive results. The CareWell-primary care program is a complex intervention targeting community-dwelling frail elderly people, that aims to prevent functional decline, improve quality of life, and reduce or postpone hospital and nursing home admissions of community dwelling frail elderly. Methods/design The CareWell-primary care study includes a (cost- effectiveness study and a comprehensive process evaluation. In a one-year pragmatic, cluster controlled trial, six general practices are non-randomly recruited to adopt the CareWell-primary care program and six control practices will deliver ‘care as usual’. Each practice includes a random sample of fifty frail elders aged 70 years or above in the cost-effectiveness study. A sample of patients and informal caregivers and all health care professionals participating in the CareWell-primary care program are included in the process evaluation. In the cost-effectiveness study, the primary outcome is the level of functional abilities as measured with the Katz-15 index. Hierarchical mixed-effects regression models / multilevel modeling approach will be used, since the study participants are nested within the general practices. Furthermore, incremental cost-effectiveness ratios will be calculated as costs per QALY gained and as costs weighed against functional abilities. In the process evaluation, mixed methods will be used to provide insight in the implementation degree of the program, patients’ and professionals’ approval of the program, and the barriers and facilitators to implementation. Discussion The CareWell-primary care study will provide new insights into the (cost

  10. Implementing a Mobility Program to Minimize Post-Intensive Care Syndrome.

    Science.gov (United States)

    Hopkins, Ramona O; Mitchell, Lorie; Thomsen, George E; Schafer, Michele; Link, Maggie; Brown, Samuel M

    2016-01-01

    Immobility in the intensive care unit (ICU) is associated with neuromuscular weakness, post-intensive care syndrome, functional limitations, and high costs. Early mobility-based rehabilitation in the ICU is feasible and safe. Mobility-based rehabilitation varied widely across 5 ICUs in 1 health care system, suggesting a need for continuous training and evaluation to maintain a strong mobility-based rehabilitation program. Early mobility-based rehabilitation shortens ICU and hospital stays, reduces delirium, and increases muscle strength and the ability to ambulate. Long-term effects include increased ability for self-care, faster return to independent functioning, improved physical function, and reduced hospital readmission and death. Factors that influence early mobility-based rehabilitation include having an interdisciplinary team; strong unit leadership; access to physical, occupational, and respiratory therapists; a culture focused on patient safety and quality improvement; a champion of early mobility; and a focus on measuring performance and outcomes.

  11. Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study.

    Science.gov (United States)

    Allen, Suzanne M; Ballweg, Ruth A; Cosgrove, Ellen M; Engle, Kellie A; Robinson, Lawrence R; Rosenblatt, Roger A; Skillman, Susan M; Wenrich, Marjorie D

    2013-12-01

    The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

  12. House Calls: California Program For Homebound Patients Reduces Monthly Spending, Delivers Meaningful Care.

    Science.gov (United States)

    Melnick, Glenn A; Green, Lois; Rich, Jeremy

    2016-01-01

    In 2009 HealthCare Partners Affiliates Medical Group, based in Southern California, launched House Calls, an in-home program that provides, coordinates, and manages care primarily for recently discharged high-risk, frail, and psychosocially compromised patients. Its purpose is to reduce preventable emergency department visits and hospital readmissions. We present data over time from this well-established program to provide an example for other new programs that are being established across the United States to serve this population with complex needs. The findings show that the initial House Calls structure, staffing patterns, and processes differed across the geographic areas that it served, and that they also evolved over time in different ways. In the same time period, all areas experienced a reduction in operating costs per patient and showed substantial reductions in monthly per patient health care spending and hospital utilization after enrollment in the House Calls program, compared to the period before enrollment. Despite more than five years of experience, the program structure continues to evolve and adjust staffing and other features to accommodate the dynamic nature of this complex patient population.

  13. The formation, elements of success, and challenges in managing a critical care program: Part I.

    Science.gov (United States)

    St Andre, Arthur

    2015-04-01

    Leaders of critical care programs have significant responsibility to develop and maintain a system of intensive care. At inception, those clinician resources necessary to provide and be available for the expected range of patient illness and injury and throughput are determined. Simultaneously, non-ICU clinical responsibilities and other expectations, such as education of trainees and participation in hospital operations, must be understood. To meet these responsibilities, physicians must be recruited, mentored, and retained. The physician leader may have similar responsibilities for nonphysician practitioners. In concert with other critical care leaders, the service adopts a model of care and assembles an ICU team of physicians, nurses, nonphysician providers, respiratory therapists, and others to provide clinical services. Besides clinician resources, leaders must assure that services such as radiology, pharmacy, the laboratory, and information services are positioned to support the complexities of ICU care. Metrics are developed to report success in meeting process and outcomes goals. Leaders evolve the system of care by reassessing and modifying practice patterns to continually improve safety, efficacy, and efficiency. Major emphasis is placed on the importance of continuity, consistency, and communication by expecting practitioners to adopt similar practices and patterns. Services anticipate and adapt to evolving expectations and resource availability. Effective services will result when skilled practitioners support one another and ascribe to a service philosophy of care.

  14. Sri Lanka's Health Unit Program: A Model of "Selective" Primary Health Care

    Directory of Open Access Journals (Sweden)

    Soma Hewa

    2011-12-01

    Full Text Available This paper argues that the health unit program developed in Sri Lanka in the early twentieth century was an earlier model of selective primary health care promoted by the Rockefeller Foundation in the 1980s in opposition to comprehensive primary health care advocated by the Alma-Ata Declaration of the World Health Organization. A key strategy of the health unit program was to identify the most common and serious infectious diseases in each health unit area and control them through improved sanitation, health education, immunization and treatment with the help of local communities. The health unit program was later introduced to other countries in South and Southeast Asia as part of the Rockefeller Foundation's global campaign to promote public health.

  15. The Home Independence Program with non-health professionals as care managers: an evaluation

    Directory of Open Access Journals (Sweden)

    Lewin G

    2016-06-01

    Full Text Available Gill Lewin,1 Karyn Concanen,2 David Youens3 1School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia; 2Silver Chain Group, Osborne Park, WA, Australia; 3Faculty of Health Science, Curtin University, Perth, WA, Australia Abstract: The Home Independence Program (HIP, an Australian restorative home care/reablement service for older adults, has been shown to be effective in reducing functional dependency and increasing functional mobility, confidence in everyday activities, and quality of life. These gains were found to translate into a reduced need for ongoing care services and reduced health and aged care costs over time. Despite these positive outcomes, few Australian home care agencies have adopted the service model – a key reason being that few Australian providers employ health professionals, who act as care managers under the HIP service model. A call for proposals from Health Workforce Australia for projects to expand the scope of practice of health/aged care staff then provided the opportunity to develop, implement, and evaluate a service delivery model, in which nonprofessionals replaced the health professionals as Care Managers in the HIP service. Seventy older people who received the HIP Coordinator (HIPC service participated in the outcomes evaluation. On a range of personal outcome measures, the group showed statistically significant improvement at 3 and 12 months compared to baseline. On each outcome, the improvement observed was larger than that observed in a previous trial in which the service was delivered by health professionals. However, differences in the timing of data collection between the two studies mean that a direct comparison cannot be made. Clients in both studies showed a similarly reduced need for ongoing home care services at both follow-up points. The outcomes achieved by HIPC, with non-health professionals as Care Managers, were positive and can be considered to compare favorably

  16. Children and Residential Experiences: A Comprehensive Strategy for Implementing a Research-Informed Program Model for Residential Care

    Science.gov (United States)

    Holden, Martha J.; Izzo, Charles; Nunno, Michael; Smith, Elliott G.; Endres, Thomas; Holden, Jack C.; Kuhn, Frank

    2010-01-01

    This paper describes an effort to bridge research and practice in residential care through implementing a program model titled Children and Residential Experiences (CARE). The strategy involves consulting at all levels of the organization to guide personnel to incorporate CARE evidence-based principles into daily practice, and fostering an…

  17. 75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

    Science.gov (United States)

    2010-11-03

    ... provide a forum for community-based organizations, hospitals, Quality Improvement Organizations... materials will be posted on the CMS Care Transitions Web site prior to the meeting. FOR FURTHER INFORMATION CONTACT: Juliana Tiongson, Social Science Research Analyst, Centers for Medicare & Medicaid Services,...

  18. Mental Health In-Service Program for Employed Long-Term Care Personnel. Final Report for May and June 1975.

    Science.gov (United States)

    Souhrada, Julie

    Since June 1973, Iowa Lakes Community College (Iowa) has been conducting an in-service training program for employees of local nursing homes. The program was designed to upgrade the participants' knowledge of the mental health aspects of care for the aged and to improve their abilities to provide physical health care. The specific objectives of…

  19. 78 FR 25591 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Science.gov (United States)

    2013-05-02

    ... MANAGEMENT 45 CFR Part 800 RIN 3206-AM47 Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges; Correction AGENCY: U.S. Office of... Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

  20. 78 FR 75581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Science.gov (United States)

    2013-12-12

    ... MANAGEMENT Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges; Announcement AGENCY: Office of Personnel Management (OPM). ACTION: Notice of... Affordable Care Act; Establishment of the Multi-State Plan Program for the Affordable Insurance...

  1. 78 FR 6851 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

    Science.gov (United States)

    2013-01-31

    ... AFFAIRS Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program....'' SUPPLEMENTARY INFORMATION: Title: Patient Satisfaction Survey Michael E. DeBakey Home Care Program, VA Form 10.... Abstract: VA Form 10-0476 will be used to gather feedback from patients regarding their satisfaction...

  2. 75 FR 62635 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

    Science.gov (United States)

    2010-10-12

    ... AFFAIRS Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program... needed to determine patients' satisfaction with services provided by or through the Michael E. DeBakey.... Title: Patient Satisfaction Survey Michael E. DeBakey Home Care Program, VA Form 10-0476. OMB...

  3. 77 FR 69550 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

    Science.gov (United States)

    2012-11-19

    ... AFFAIRS Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program.... This notice solicits comments on information needed to determine patients' satisfaction with services... information technology. Title: Patient Satisfaction Survey Michael E. DeBakey Home Care Program, VA Form...

  4. Comparing responses to horticultural-based and traditional activities in dementia care programs.

    Science.gov (United States)

    Jarrott, Shannon E; Gigliotti, Christina M

    2010-12-01

    Engaging persons with dementia in meaningful activities supports well-being; however, care staff are challenged to implement age- and ability-appropriate activities in a group setting. We compared a randomly assigned treatment group, who received horticultural therapy-based (HT-based) programming to a comparison group, who engaged in traditional activities (TA) programming, on engagement and affect. Horticultural therapy-based programming was implemented twice weekly at 4 treatment sites for 6 weeks, while regular TA were observed at comparison sites. Results revealed no differences between groups on affective domains. Levels of adaptive behavior differed between the groups, with the treatment group demonstrating higher levels of active, passive, and other engagement and the comparison group demonstrating higher levels of self-engagement. Our results highlight the value of HT-based programs and the importance of simultaneously capturing participants' affective and behavioral responses. Theoretical and practical considerations about the facilitation of and context in which the programming occurs are discussed.

  5. The effect of a "surveillance nurse" telephone support intervention in a home care program.

    Science.gov (United States)

    Kelly, Ronald; Godin, Lori

    2015-01-01

    This study is an evaluation of a unique "surveillance nurse" telephone support intervention for community-dwelling elderly individuals in a home care program. A combined propensity-based covariate-matching procedure was used to pair each individual who received the intervention ("treatment" condition, nT = 930) to a similar individual who did not receive the intervention ("control" condition, nC1 = 930) from among a large pool of potential control individuals (nC0 = 4656). The intervention consisted of regularly scheduled telephone calls from a surveillance nurse to proactively assess the individual's well-being, care plan status, use of and need for services (home support, adult day program, physiotherapy, etc.) and home environment (e.g., informal caregiver support). Treatment and control conditions were compared with respect to four service utilization outcomes: (1) rate of survival in the community before institutionalization in an assisted living or nursing home facility or death, (2) rate of emergency room registrations, (3) rate of acute care hospitalizations, and (4) rate of days in hospital, during home care enrollment. Results indicated a beneficial effect of the surveillance nurse intervention on reducing rate of service utilization by increasing the duration of the home care episode.

  6. Reliability Analysis of Brittle Material Structures - Including MEMS(?) - With the CARES/Life Program

    Science.gov (United States)

    Nemeth, Noel N.

    2002-01-01

    Brittle materials are being used, or considered, for a wide variety of high tech applications that operate in harsh environments, including static and rotating turbine parts. thermal protection systems, dental prosthetics, fuel cells, oxygen transport membranes, radomes, and MEMS. Designing components to sustain repeated load without fracturing while using the minimum amount of material requires the use of a probabilistic design methodology. The CARES/Life code provides a general-purpose analysis tool that predicts the probability of failure of a ceramic component as a function of its time in service. For this presentation an interview of the CARES/Life program will be provided. Emphasis will be placed on describing the latest enhancements to the code for reliability analysis with time varying loads and temperatures (fully transient reliability analysis). Also, early efforts in investigating the validity of using Weibull statistics, the basis of the CARES/Life program, to characterize the strength of MEMS structures will be described as as well as the version of CARES/Life for MEMS (CARES/MEMS) being prepared which incorporates single crystal and edge flaw reliability analysis capability. It is hoped this talk will open a dialog for potential collaboration in the area of MEMS testing and life prediction.

  7. Incorporating person centred care principles into an ongoing comprehensive cancer management program: An experiential account

    Directory of Open Access Journals (Sweden)

    Vallath Nandini

    2011-01-01

    Full Text Available Recent research indicates a definite positive impact on treatment outcomes when an integrative approach that focuses on symptom control and quality of life is provided along with the standard therapeutic regimens. However implementation or practice of this approach is not seen widely due to the culture of medical training and practice. This article presents the initial development of a program for incorporating integrative care principles into an ongoing comprehensive cancer care program at a tertiary centre. The key purpose of the program being to develop, facilitate, and establish comprehensive and holistic processes including palliative care principles, that would positively enhance the quantity and quality of life of the person with disease, as well as create an environment that reflects and sustains this approach. The vision, objectives, goals, strategies, activities and results within the 7 months of implementation are documented. The new learnings gained during the process have also been noted in the hope that the model described may be used to conceptualize similar care giving facilities in other centres.

  8. Establishment of a renal supportive care program: Experience from a rural community hospital in Taiwan.

    Science.gov (United States)

    Chao, Chia-Ter; Tsai, Hung-Bin; Shih, Chih-Yuan; Hsu, Su-Hsuan; Hung, Yu-Chien; Lai, Chun-Fu; Ueng, Ruey-Hsiuang; Chan, Ding-Cheng; Hwang, Juey-Jen; Huang, Sheng-Jean

    2016-07-01

    Renal supportive care (RSC) denotes a care program dedicated for patients with acute, chronic renal failure, and end-stage renal disease (ESRD), aiming to offer maximal symptom relief and optimize patients' quality of life. The uncertainty of prognosis for patients with chronic kidney disease and ESRD, the sociocultural issues inherent to the Taiwanese society, and the void of structured and practical RSC pathway, contributes to the underrecognition and poor utilization of RSC. Taiwanese patients rarely receive information regarding RSC as part of a standardized care and are not commonly offered this option. In National Taiwan University Hospital Jinshan branch, we started a RSC subprogram, supported by the community-based palliative/hospice care main program. We focused on understanding the need and providing the choice of RSC to suitable candidates. A three-step and four-phase protocol was designed and implemented to identify appropriate patients and to enhance the applicability of the RSC. We harnessed family visit and home-based family meeting as a vehicle to understand the patients' preferences, to discover what ESRD patients and their family value most, and to introduce the option of RSC. In the current review, we described our pilot experience of establishing a RSC program in Taiwan, and discuss its potential advantage.

  9. Evidence for the long term cost effectiveness of home care reablement programs

    Directory of Open Access Journals (Sweden)

    Lewin GF

    2013-10-01

    Full Text Available Gill F Lewin,1,2 Helman S Alfonso,3 Janine J Alan41Faculty of Health Sciences, Curtin University, Perth, WA, Australia; 2Research Department, Silver Chain Group, Perth, WA, Australia; 3School of Population Health, University of Western Australia, Perth, WA, Australia; 4Faculty of Health Sciences, Curtin University, Perth, WA, AustraliaBackground: The objectives of this study were to determine whether older individuals who participated in a reablement (restorative program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years.Materials and methods: Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time.Results: Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years.Conclusion: The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age.Keywords: restorative, older adults, community dwelling, service costs

  10. Patient quality of life in the Mayo Clinic Care Transitions program: a survey study

    Science.gov (United States)

    Faucher, Joshua; Rosedahl, Jordan; Finnie, Dawn; Glasgow, Amy; Takahashi, Paul

    2016-01-01

    Background Transitional care programs are common interventions aimed at reducing medical complications and associated readmissions for patients recently discharged from the hospital. While organizations strive to reduce readmissions, another important related metric is patient quality of life (QoL). Aims To compare the relationship between QoL in patients enrolled in the Mayo Clinic Care Transitions (MCCT) program versus usual care, and to determine if QoL changed in MCCT participants between baseline and 1-year follow-up. Methods A baseline survey was mailed to MCCT enrollees in March 2013. Those who completed a baseline survey were sent a follow-up survey 1 year later. A cross-sectional survey of usual care participants was mailed in November 2013. We included in our analysis 199 participants (83 in the MCCT and 116 in usual care) aged over 60 years with multiple comorbidities and receiving primary care. Primary outcomes were self-rated QoL; secondary outcomes included self-reported general, physical, and mental health. Intra- and intergroup comparisons of patients were evaluated using Pearson’s chi-squared analysis. Results MCCT participants had more comorbidities and higher elder risk assessment scores than those receiving usual care. At baseline, 74% of MCCT participants reported responses of good-to-excellent QoL compared to 64% after 1 year (P=0.16). Between MCCT and usual care, there was no significant difference in self-reported QoL (P=0.21). Between baseline and follow-up in MCCT patients, and compared to usual care, there were no significant differences in self-reported general, physical, or mental health. Conclusion We detected no difference over time in QoL between MCCT patients and those receiving usual care, and a nonsignificant QoL decline in MCCT participants after 1 year. Progression of chronic disease may overwhelm any QoL improvement attributable to the MCCT intervention. The MCCT interventions may blunt expected declines in QoL, producing

  11. Patient-Centered Cancer Care Programs in Italy: Benchmarking Global Patient Education Initiatives.

    Science.gov (United States)

    Truccolo, Ivana; Cipolat Mis, Chiara; Cervo, Silvia; Dal Maso, Luigino; Bongiovanni, Marilena; Bearz, Alessandra; Sartor, Ivana; Baldo, Paolo; Ferrarin, Emanuela; Fratino, Lucia; Mascarin, Maurizio; Roncadin, Mario; Annunziata, Maria Antonietta; Muzzatti, Barbara; De Paoli, Paolo

    2016-06-01

    In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of their own health conditions in particular. The National Cancer Institute in the USA and the Organization of European Cancer Institutes encourage comprehensive cancer centers in providing educational programs conceived to overcome these gaps. The goal of this paper is to identify and describe the key elements necessary to develop a global patient education program and provide recommendations for strategies with practical examples for implementation in the daily activities of cancer institutes. A multidisciplinary committee was established for patient education, including patient representatives as equal partners, to define, implement, verify, and evaluate the fundamental steps for establishing a comprehensive education program. Six essential topics were identified for the program: appropriate communication of cancer epidemiology, clinical trial information, new therapeutic technologies, support in the use of medicines, psycho-oncological interventions, age-personalized approaches, and training programs for healthcare providers. Integration of these topics along with patient feedback is the key to a successful model for educational programs. An integrated educational program can transform a comprehensive cancer center to an institution that provides research and care for and with patients.

  12. The effects of salf-care program on blood pressure of patients with diabetes

    Directory of Open Access Journals (Sweden)

    Shahbodaghi Z

    2014-11-01

    Full Text Available Background and Objective: Hypertension is a preventable health risk. Thus, it is necessary to pay attention to hypertention in order to decrease macrovascular and microvascular complications of diabetes mellitus. This study examines the effect of the self-care program on the blood pressure of patients with diabetes. Materials and Method: This study was a randomized clinical trial performed on 134 patients with type 2 diabetes in the Diabetes Center in Sirajn, Iran, in 2011. The participants were assigned randomly into 2 groups of intervention and control (n = 67 using a random number table. The study tools consisted of a demographic information questionnaire and sphygmomanometer. The blood pressure of participants in both groups was measured before the intervention and every month during the intervention (for 3 months. The self-care program was conducted according to regulatory protocols in 6 sessions of 90 minutes for 6 weeks in the intervention group. Data were analyzed using SPSS software version 15, and descriptive statistics (mean, relative frequency and repeated measure ANOVA, chi-squared test. Results: No difference was observed between mean systolic blood pressure of the two study groups after the intervention at different times of measurement. However, mean diastolic blood pressure of the two groups showed a significant difference (P = 0.001. Conclusion: The results showed that implementation of the self-care program can reduce diastolic blood pressure in type 2 diabetic patients. Therefore, the use of this program is recommended in diabetic patients in order to control diabetes complications.

  13. Factors associated with multiple transitions in care during the end of life following enrollment in a comprehensive palliative care program

    Directory of Open Access Journals (Sweden)

    Critchley Patrick

    2006-05-01

    Full Text Available Abstract Background Patients often experience changes or transitions in where and by whom they are cared for at the end of life. These cause stress for both patients and families. Although not all transitions during the end of life can be avoided, advance identification of those who could potentially experience numerous transitions may allow providers and caregivers to anticipate the problem and consider strategies to minimize their occurrence. This study examines the relationship between patient characteristics and the total number of transitions experienced by the patient from the date of admission to a palliative care program (PCP to death and during final weeks of life. Methods Subjects included all adults registered with the PCP in Halifax, Nova Scotia, Canada between 1998 and 2002 and who had died during that period. Data was extracted from the regional PCP database and linked to census information. Transitions were defined as either: 1 a change in location of where the patient was cared for; or 2 a change in which service (specialist groupings, primary care, etc provided care. Descriptive statistics were calculated plus rate ratios for the association between patient characteristics and total number of transitions. Results In total, 3972 patients made 5903 transitions during the study period. Although 28% experienced no transitions, over 40% experienced one and 6.3% five or more. At least one transition was made by 47% during the last four weeks of life. Adjusted results suggest women, the elderly and more recent death are associated with experiencing fewer transitions. Multiple transitions were associated with a hospital death and a cancer diagnosis. During the last month of life, age was no longer associated with the total number of transitions, cancer patients were found to experience a similar number or fewer transitions than patients with a non-cancer diagnosis and pain and symptom control become a significant factor associated with

  14. Guidelines for a Comprehensive Care Program to Ostomized Patients and Families: a Nursing proposal

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    Paula Alvarenga de Figueiredo

    2016-01-01

    Full Text Available Objectives: describe care needs and demands that mark the discursive practices of ostomized clients and family members and discuss guidelines for a comprehensive care program to ostomized clients and their families, organized by macrosociological categories. Method: Creative and Sensitive, involving 17 ostomized subjects and family members at a municipal outpatient clinic. The ethical aspects were complied with. A characterization form was used, as well as Creativity and Sensitivity Dynamics: "speaking map", "body-knowledge" and "calendar". Critical Discourse Analysis was applied. Results: the health needs and care demands of the ostomized patients and their family members, in their multiple dimensions, were constituted in the home and community, outpatient and social context, implying new orientations for nursing care. The unveiling of the data brought elements that constituted guidelines, in a macrosociological approach, to achieve the expanded integrality of nursing care. Conclusion: the ostomized clients are unique in their genre/peculiar from Latin sui generis, calling for strategies that respond to and distinguish their specificities. Elaborating a Public Health Policy that improves and reorganizes the care demands, taking into account these individual biopsychosocial and spiritual aspects, is a possible and irrevocable target in the attempt to achieve better conditions of health and wellbeing.

  15. The Business Case for Palliative Care: Translating Research Into Program Development in the U.S.

    Science.gov (United States)

    Cassel, J Brian; Kerr, Kathleen M; Kalman, Noah S; Smith, Thomas J

    2015-12-01

    Specialist palliative care (PC) often embraces a "less is more" philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A special business case is needed in which the financial benefits for organizations such as hospitals and payers are aligned with the demonstrable clinical benefits for patients. Based on published studies and our work with PC programs over the past 15 years, we identified 10 principles that together form a business model for specialist PC. These principles are relatively well established for inpatient PC but are only now emerging for community-based PC. Three developments that are key for the latter are the increasing penalties from payers for overutilization of hospital stays, the variety of alternative payment models such as accountable care organizations, which foster a population health management perspective, and payer-provider partnerships that allow for greater access to and funding of community-based PC.

  16. 76 FR 19527 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

    Science.gov (United States)

    2011-04-07

    ... Plans and Integration of Community Resources 11. ACO Marketing Guidelines 12. Program Integrity... Agency for Healthcare Research and Quality BCBSMA Blue Cross Blue Shield of Massachusetts BIPA Benefits... to determine an appropriate method to assign Medicare FFS beneficiaries to an ACO participating...

  17. Is there a model for demonstrating a beneficial financial impact of initiating a palliative care program by an existing hospice program?

    Science.gov (United States)

    Passik, Steven D; Ruggles, Carol; Brown, Gretchen; Snapp, Janet; Swinford, Susan; Gutgsell, Terrence; Kirsh, Kenneth L

    2004-12-01

    The value of integrating palliative with curative modes of care earlier in the course of disease for people with life threatening illnesses is well recognized. Whereas the now outdated model of waiting for people to be actively dying before initiating palliative care has been clearly discredited on clinical grounds, how a better integration of modes of care can be achieved, financed and sustained is an ongoing challenge for the health care system in general as well as for specific institutions. When the initiative comes from a hospital or academic medical center, which may, for example, begin a palliative care consultation service, financial benefits have been well documented. These palliative care services survive mainly by tracking cost savings that can be realized in a number of ways around a medical center. We tried to pilot 3 simple models of potential cost savings afforded to hospice by initiating a palliative care program. We found that simple models cannot capture this benefit (if it in fact exists). By adding palliative care, hospice, while no doubt improving and streamlining care, is also taking on more complex patients (higher drug costs, shorter length of stay, more outpatient, emergency room and physician visits). Indeed, the hospice was absorbing the losses associated with having the palliative care program. We suggest that an avenue for future exploration is whether partnering between hospitals and hospice programs can defray some of the costs incurred by the palliative care program (that might otherwise be passed on to hospice) in anticipation of cost savings. We end with a series of questions: Are there financial benefits? Can they be modeled and quantified? Is this a dilemma for hospice programs wanting to improve the quality of care but who are not able on their own to finance it?

  18. Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain

    Directory of Open Access Journals (Sweden)

    Keenum Michael

    2006-08-01

    Full Text Available Abstract Background Previous clinical trials have assessed the percentage of participants who utilized further health care after a period of conservative care for low back pain, however no chiropractic clinical trial has determined the total amount of care during this time and any differences based on assigned treatment group. The objective of this clinical trial follow-up was to assess if there was a difference in the total number of office visits for low back pain over one year after a four week clinical trial of either a form of physical therapy (Exercise Program or a form of chiropractic care (Flexion Distraction for chronic low back pain. Methods In this randomized clinical trial follow up study, 195 participants were followed for one year after a four-week period of either a form of chiropractic care (FD or a form of physical therapy (EP. Weekly structured telephone interview questions regarded visitation of various health care practitioners and the practice of self-care for low back pain. Results Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p Conclusion During a one-year follow-up, participants previously randomized to physical therapy attended significantly more health care visits than those participants who received chiropractic care.

  19. The effect of nursing management development program on clinical competency in coronary care unit

    Directory of Open Access Journals (Sweden)

    Ali Akbar Vaezi

    2011-03-01

    Full Text Available Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU.Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P<0.05. Conclusion: Creating necessary modifications in nursing environments through the management development program by head nurses may improve nurses' clinical competency.

  20. Using a computer simulation program to assess the decision-making process in child health care.

    Science.gov (United States)

    Lauri, S

    1992-01-01

    The purpose of this paper was to describe the development and testing of a computer simulation program designed to assess the decision-making process in the public health nurses' work in child health care. The work was based primarily on theories of problem-solving and decision making; on knowledge of child development, health care, and education; and on the soft systems methodology. An authoring program and two simulations were designed and produced at the University of Turku by a team of two nurse researchers, a computer specialist, and three public health nurses. The simulations presented two typical situations encountered by the public health nurses' work in child health care. A total of 61 public health nurses from 11 health centers in the southwestern part of Finland completed the simulations. The public health nurses responded positively to the simulations and the program worked very well. The results revealed some inconsistencies in the decision-making process of the public health nurses with respect to the needs of the child and the family. The public health nurses' decisions were more closely related to the developmental stage of the child than to the unique needs of each family. The simulation is acting to test the public health nurses' ability to make decisions "here and now" but not about caring it forward. These shortcomings can be corrected by asking them to explain their decisions and thoughts after each stage and by tape recording their answers. The findings gave many answers to the question of how the computer simulation program can be developed.

  1. Medical Education About the Care of Addicted Incarcerated Persons: A National Survey of Residency Programs.

    Science.gov (United States)

    Kraus, Mark L.; Isaacson, J. Harry; Kahn, Ruth; Mundt, Marlon P.; Manwell, Linda Baier

    2001-06-01

    In June 1998, there were 1.8 million inmates in correctional facilities for adults; 1.2 million in state and federal prisons and 600,000 in municipal/county jails (668 persons per 100,000 U.S. population). Rates of TB, AIDS, mental illness, and substance abuse are 2-13 times higher in persons living in jails and prisons. This study was designed to assess the level of training offered to residents in seven medical specialties in the care of addicted incarcerated persons. The study design involved two stages. The first entailed a mailed survey to 1,831 residency directors in family medicine, internal medicine, osteopathic medicine, pediatrics, obstetrics and gynecology, psychiatry, and emergency medicine. The second stage was a telephone interview, about substance use disorders, of faculty listed by the residency directors as teaching residents. The mailed survey was completed by 1,205 residency directors (66%). The 769 faculty from those identified programs, who participated in the telephone interview, reported that only 14% of their residency programs offered lectures or conferences on the care of incarcerated persons, yet 44% of the programs had residents caring for incarcerated persons with substance abuse problems, in a clinical setting. Only 22% offered clinical experiences for residents in a correctional facility.We recognize that our survey of correctional health and substance abuse training is limited, but as such, a greater number of respondents to our survey do not teach residents addiction medicine topics pertaining to prevention, evaluation, intervention, and management of the addicted criminal offender/patient in a correctional setting or give adequate clinical exposure to this special population. The data suggests a need to develop and implement educational programs on medical care for this high-risk and expanding population.

  2. Technology-Based Innovations in Child Maltreatment Prevention Programs: Examples from SafeCare®

    Directory of Open Access Journals (Sweden)

    Melissa Cowart-Osborne

    2014-08-01

    Full Text Available Each year, hundreds of thousands of children in the U.S. are victims of child maltreatment. Experts recommend behavioral, skill-based parent training programs as a strategy for the prevention of child abuse and neglect. These programs can be enhanced using innovative technology strategies. This paper presents a brief history of the use of technology in SafeCare®, a home visiting program shown to prevent child neglect and physical abuse, and highlights current work that takes a technology-based hybrid approach to SafeCare delivery. With this unique approach, the provider brings a tablet computer to each session, and the parent interacts with the software to receive psychoeducation and modeling of target skills. The provider and parent then work together to practice the targeted skills until mastery is achieved. Initial findings from ongoing research of both of these strategies indicate that they show potential for improving engagement and use of positive parenting skills for parents and ease of implementation for providers. Future directions for technology enhancements in SafeCare are also presented.

  3. Joint Task Force on Undergraduate Physics Programs: Implications for physics programs and why you should care

    Science.gov (United States)

    Hodapp, Theodore

    2016-03-01

    The content of undergraduate physics programs has not changed appreciably in 50 years, however, the jobs our students take have changed dramatically. Preparing students for careers they are likely to encounter requires physics programs to rethink and in some cases retool to provide an education that will not only educate an individual in the habits of mind and keen sense of how to solve complex technical problems, but also what related skills they will need to be effective in those careers. Do you teach your student how to read or create a budget? How about dealing with a low-performing member of an R&D team? This talk will explore driving forces behind this report, potential implications for physics departments, and practical steps faculty members can take to continue to consider improvements in experiences for our students. This work is supported in part by the National Science Foundation (NSF-1540570).

  4. Financial Incentives, Workplace Wellness Program Participation, and Utilization of Health Care Services and Spending.

    Science.gov (United States)

    Fronstin, Paul; Roebuck, M Christopher

    2015-08-01

    This paper analyzes data from a large employer that enhanced financial incentives to encourage participation in its workplace wellness programs. It examines, first, the effect of financial incentives on wellness program participation, and second, it estimates the impact of wellness program participation on utilization of health care services and spending. The Patient Protection and Affordable Care Act of 2010 (PPACA) allows employers to provide financial incentives of as much as 30 percent of the total cost of coverage when tied to participation in a wellness program. Participation in health risk assessments (HRAs) increased by 50 percentage points among members of unions that bargained in the incentive, and increased 22 percentage points among non-union employees. Participation in the biometric screening program increased 55 percentage points when financial incentives were provided. Biometric screenings led to an average increase of 0.31 annual prescription drug fills, with related spending higher by $56 per member per year. Otherwise, no significant effects of participation in HRAs or biometric screenings on utilization of health care services and spending were found. The largest increase in medication utilization as a result of biometric screening was for statins, which are widely used to treat high cholesterol. This therapeutic class accounted for one-sixth of the overall increase in prescription drug utilization. Second were antidepressants, followed by ACE inhibitors (for hypertension), and thyroid hormones (for hypothyroidism). Biometric screening also led to significantly higher utilization of biologic response modifiers and immunosuppressants. These specialty medications are used to treat autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, and are relatively expensive compared with non-specialty medications. The added spending associated with the combined increase in fills of 0.02 was $27 per member per year--about one-half of the

  5. The Program of All-Inclusive Care for the Elderly (PACE): an innovative long-term care model in the United States.

    Science.gov (United States)

    Mui, A C

    2001-01-01

    This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.

  6. Upaya Peningkatan Status Gizi Balita Malnutrisi Akut Berat Melalui Program Home Care

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    Fitri Haryanti

    2014-12-01

    Full Text Available Malnutrisi pada balita masih merupakan permasalahan di Indonesia termasuk di Daerah Istimewa Yogyakarta. Berdasarkan indikator berat badan menurut tinggi badan, 2,6% balita mengalami malnutrisi akut berat. Pada beberapa dekade terakhir, telah terjadi pergeseran paradigma dalam penanganan balita malnutrisi, yang sebelumnya berbasis pendekatan fasilitas kesehatan bergeser menjadi pendekatan berbasis komunitas. Tujuan penelitian ini adalah untuk menganalisis pengaruh program home care terhadap peningkatan status gizi balita malnutrisi pada anak usia 6-60 bulan. Penelitian menggunakan desain kuasi eksperimen dengan pretest dan posttest control group melalui tiga tahap pendampingan yaitu intensif, mandiri, dan penguatan dengan pendekatan asuhan keperawatan. Sampel adalah 56 balita malnutrisi akut di dua wilayah, yaitu 33 balita di Kota Yogyakarta (eksperimen dan 23 balita di Kabupaten Sleman (kontrol dengan teknik pengambilan sampel yaitu purposive sampling. Intervensi home care diberikan selama tiga 3 bulan (Januari sampai Maret 2013. Hasil penelitian menunjukkan setelah program home care, terjadi peningkatan yang signifikan pada status gizi balita (p < 0,05. Pada akhir intervensi, terjadi penurunan kejadian malnutrisi akut berat dari 100% menjadi 56,7% (p < 0,05. Improving Nutritional Status of Children with Severe Acute Malnutrition Through Home Care Program Children undernutrition is still an issue in Indonesia, including in the Special Region of Yogyakarta. Based on weight for height indicator, 2.6% children experience severe acute malnutrition. In the last few decades, there has been a paradigm shift in the management of acute malnutrition from a facility- based to community-centered approach. The purpose of this study was to analyze the effect of home care intervention on the improvement of nutritional status of severe acute malnutrition children aged 6-60 months. This study was designed with quasi-experimental and pretest-posttest control

  7. Impact of a diabetic foot care education program on lower limb amputation rate

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    Abdullah M Al-Wahbi

    2010-10-01

    Full Text Available Abdullah M Al-WahbiDepartment of Surgery, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyahd, Kingdom of Saudi ArabiaBackground: Diabetic foot complications are a leading cause of lower extremity amputation. With the increasing incidence of diabetes mellitus in the Arab world, specifically in the Kingdom of Saudi Arabia, the rate of amputation will rise significantly. A diabetic foot care program was implemented at King Abdulaziz Medical City in Riyadh, Saudi Arabia, in 2002. The program was directed at health care staff and patients to increase their awareness about diabetic foot care and prevention of complications. The purpose of this study was to perform a primary evaluation of the program’s impact on the rate of lower extremity amputation due to diabetic foot complications.Method: This pilot study was the first analysis of the diabetic foot care program and examined two groups of participants for comparison, ie, a “before” group having had diabetic foot ulcers managed between 1983, when the hospital was first established, and 2002 when the program began and an “after group” having had foot ulcers managed between 2002 and 2004, in the program’s initial phase. A total of 41 charts were randomly chosen retrospectively. A data sheet containing age, gender, medical data, and the presentation, management, and outcome of diabetic foot cases was used for the analysis.Results: The before group contained 20 patients (17 males and the after group contained 21 patients (16 males. There was no difference between the two groups with regard to age and comorbidities. The rate of amputation was 70% in the before group and 61.9% in the after group. There was a decrease in the percentage of toe amputation in the after group and an increase in the percentage of below-knee amputation in the before group. However, these changes were not significant.Conclusion: The program, although evaluated at an early

  8. Qualitative research on point-of-care testing strategies and programs for HIV.

    Science.gov (United States)

    Engel, Nora; Pant Pai, Nitika

    2015-01-01

    Point-of-care (POC) testing in communities, home settings and primary healthcare centers plays an important role in cutting delays in HIV diagnosis and in the uptake of voluntary testing and counseling. Qualitative research methods have important potential to overcome the current challenges in expanding HIV POC testing programs and strategies, by examining the diagnostic processes, complex inter-relationships and patterns involved in making POC diagnostics work in real-world settings. This article reviews existing qualitative studies on POC testing strategies and programs for HIV. Qualitative research on POC diagnostics around the uptake of POC tests, the actual diagnostic and testing processes involved, the influence of POC tests on clinical decision-making, communication of decisions and decisions exercised by patients are limited. Equally limited are studies that explore adaptation of POC programs to various socio-cultural contexts. More qualitative research is needed to inform test developers, funders and policymakers.

  9. The specialized role of the RN in the Program of All-inclusive Care for the Elderly (PACE) interdisciplinary care team.

    Science.gov (United States)

    Madden, Karen A; Waldo, Mary; Cleeter, Deborah

    2014-01-01

    There is an increasing volume of literature supporting the Program of All-inclusive Care for the Elderly (PACE) as an innovative model of health care delivery for frail seniors. Registered Nurses (RN) hold an essential position among the PACE interdisciplinary teams (IDT) which serve as the foundational practice approach to patient care. There are currently 97 PACE programs in 31 states. Federal and respective state laws provide comprehensive specifications for IDT composition, minimum qualification of team members and services provided. The role of the RN is not fully defined beyond the requirement of periodic assessments. The intent of this study was to explore and describe the role of the nurse in PACE and to compare nursing care delivery models. Focused interviews and survey results show great variation in nursing roles as well as some common themes among nursing leaders for the vision of PACE nurses.

  10. Multidisciplinary program for stress-related disease in primary health care

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    Eva Ekvall Hansson

    2009-05-01

    Full Text Available Eva Ekvall Hansson1, Eva Håkansson2, Annelie Raushed2, Anders Håkansson1 1Lund University, Department of Clinical Sciences in Malmö/General Practice, Malmö, Sweden; 2Primary Health Care Malmö, SwedenObjective: To describe a multidisciplinary program, given by an occupational therapist and a physiotherapist, for patients with stress-related disease in primary health care and to measure the effect of this program in terms of self-perceived health, degree of burnout, physical activity, symptoms, recreational activities, and psychological and physical well-being.Method: Retrospective study.Results: At measures after three months, the thirteen patients included in this study had improved in self-estimated health, measured with EuroQol-5D Visual Analogue Scale (p = 0.000, and in degree of burnout, measured with the Shirom–Melamed Burnout Questionnaire (p = 0.001. There was also a decrease in presence of headache, in physical activity and in satisfaction with leisure time, although not statistically significant. After six months, the improvements remained for all measures except physical activity. The patients were also satisfied with the program to a high degree, measured with Client Satisfaction Questionnaire (median 3.7.Conclusion: This descriptive study shows that a stress-management program, provided by a team including an occupational therapist and a physiotherapist in primary health care, is both feasible and effective in terms of self-estimated health, degree of burnout, and patient satisfaction. Keywords: stress-related health, burnout, occupational therapy, physiotherapy

  11. Reimagining care for adolescent and young adult cancer programs: Moving with the times.

    Science.gov (United States)

    Gupta, Abha A; Papadakos, Janet K; Jones, Jennifer M; Amin, Leila; Chang, Eugene K; Korenblum, Chana; Santa Mina, Daniel; McCabe, Lianne; Mitchell, Laura; Giuliani, Meredith E

    2016-04-01

    Literature regarding the development of adolescent and young adult (AYA) cancer programs has been dominantly informed by pediatric centers and practitioners. However, the majority of young adults are seen and treated at adult cancer centers, in which cancer volumes afford the development of innovative supportive care services. Although the supportive care services in adult cancer centers are helpful to AYAs, some of the most prominent and distinct issues faced by AYAs are not adequately addressed through these services alone. This article describes how the AYA Program at Princess Margaret Cancer Centre has collaborated with existing supportive care services in addition to supplying its own unique services to meet the comprehensive needs of AYAs in the domains of: symptom management (sexuality and fatigue), behavior modification (return to work and exercise), and health services (advanced cancer and survivorship). These collaborations are augmented by patient education interventions and timely referrals. The objective of this article was to assist other centers in expanding existing services to address the needs of AYA patients with cancer.

  12. Clinical metric and medication persistency effects: evidence from a Medicaid care management program.

    Science.gov (United States)

    Berg, Gregory D; Leary, Fredric; Medina, Wendie; Donnelly, Shawn; Warnick, Kathleen

    2015-02-01

    The objective was to estimate clinical metric and medication persistency impacts of a care management program. The data sources were Medicaid administrative claims for a sample population of 32,334 noninstitutionalized Medicaid-only aged, blind, or disabled patients with diagnosed conditions of asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, or heart failure between 2005 and 2009. Multivariate regression analysis was used to test the hypothesis that exposure to a care management intervention increased the likelihood of having the appropriate medication or procedures performed, as well as increased medication persistency. Statistically significant clinical metric improvements occurred in each of the 5 conditions studied. Increased medication persistency was found for beta-blocker medication for members with coronary artery disease, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and diuretic medications for members with heart failure, bronchodilator and corticosteroid medications for members with chronic obstructive pulmonary disease, and aspirin/antiplatelet medications for members with diabetes. This study demonstrates that a care management program increases the likelihood of having an appropriate medication dispensed and/or an appropriate clinical test performed, as well as increased likelihood of medication persistency, in people with chronic conditions.

  13. Structural process and implementation programs of pharmaceutical care in different countries.

    Science.gov (United States)

    Martín-Calero, M J; Machuca, M; Murillo, M D; Cansino, J; Gastelurrutia, M A; Faus, M J

    2004-01-01

    Pharmaceutical care started in the nineties in the United States and has rapidly extended in many other countries. Although there are different trends, such as clinical pharmacy services, cognitive services, medication management, medication review, they all share the same philosophy and objectives, namely "the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life". To attain these objectives, a pharmaceutical care process has to be followed point-by-point in order to detect possible medication-related problems. Furthermore, pharmacists have to work together with patients, and ultimately with physicians to establish a care plan. This methodology requires basic skills of documentation and communication and therefore, it is important to establish implementation programs aimed at community-, hospital-, and consultant pharmacists, and to consider PC as a basic element of University teaching programs and postgraduate studies. Moreover, there are still barriers that hinder the provision of this service and have to be overcome. In this article, we have revised the implementation process and the existing projects in many countries and we conclude that despite the enormous amount of work, there is still much to be done from sides of Administration and pharmacists themselves.

  14. Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: a systematic literature review.

    NARCIS (Netherlands)

    Hopman, P.; Bruijn, S.R. de; Forjaz, M.J.; Rodriguez-Blazquez, C.; Tonnara, G.; Lemmens, L.C.; Onder, G.; Baan, C.A.; Rijken, M.

    2016-01-01

    Objective: To describe comprehensive care programs targeting multimorbid and/or frail patients and to estimate their effectiveness regarding improvement of patient and caregiver related outcomes, healthcare utilization and costs. Methods: Systematic search in six electronic databases for scientific

  15. Healthy Parenting Skills Program toward First-Time Father’s Skills on Caring for Newborn Baby

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    Uswatun Khasanah

    2014-01-01

    Full Text Available Purpose: This study is to examine the effects of skills training program named healthy parenting program on first time father skills. The skills are baby bath and umbilical cord care, baby blanket, burping and handling the baby, baby lullaby and replace baby clothes.Method: This is a quasi experiment study. Sampling technique is purposive sampling with 30 first time father with 0-28 days new born baby. Sample equally assigned into experimental and control groups. Subject in experimental group received healthy parenting skills program, while control group was given routine care only. The instrument is observation guideline. Wilcoxon and Man Whitney Test are used to analyze data.Result: Father’ skills in experimental group after receiving the program are statistically increased from before the program (bathing and umbilical cord care, baby blanket, baby burping, baby handling, baby lullaby, replace baby clothes.Conclusion: Father’ skills in experimental group after receiving the program are statistically increased over control group (bathing and umbilical cord care, baby blanket skill, baby burping, baby handling, baby lullaby, replace baby clothes. Suggestions are the educational efforts by health-care professionals could beneficially be directed toward fathers throughout prenatal and postpartum periods. Health center in Indonesia should initiate class program directed to father in part of program in reducing neonates and post partum mothers health problems.

  16. What would it take? Stakeholders' views and preferences for implementing a health care manager program in community mental health clinics under health care reform.

    Science.gov (United States)

    Cabassa, Leopoldo J; Gomes, Arminda P; Lewis-Fernández, Roberto

    2015-02-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice.

  17. [Social representation related to care in the family health program in Natal-Brazil].

    Science.gov (United States)

    Rodrigues, Maísa Paulino; de Lima, Kenio Costa; Roncalli, Angelo Giuseppe

    2008-01-01

    This study examines the core and outlying representational elements of healthcare constructed by Family Healthcare Program teams in Natal, Brazil, using the theory of social representations and the central core theory. The sample consisted of ninety healthcare practitioners working with this Program, with data collected through free word association, a questionnaire and focus groups. The core representation consists of attention/love and comfort, disclosing different understandings and showing that accumulated knowledge is supported by a view that is close to care-giving. However, traditional values and trivial connotations are maintained, hindering the implementation of more effective interventions in by this Program. The core composition indicated that any capacity-building efforts that try to modify attitudes - and thus the daily practice of these practitioners - must assign high priority to discussions on redefining these elements of attention/love and comfort. They must consider the set of mental, emotional, and practical elaborations as well as explanations arising from daily life that are introduced into the constitution of the social representations under examination, influencing choices and shaping the strategies used by practitioners to provide care.

  18. Continuity of Care Evaluation: The View of Patients and Professionals about Urban Family Physician Program

    Science.gov (United States)

    Jahromi, Vahid Kohpeima; Mehrolhassani, Mohammad Hossein; Dehnavieh, Reza; Anari, Hosein Saberi

    2017-01-01

    Background: A responsibility of the family physician (FP) and one of the four aspects of the delivery of primary care services is continuity of care (COC). This study aimed to determine the COC of health care in urban health centers. Methods: Between September 2015 and March 2016, we conducted a cross-sectional study using Primary Care Evaluation Tool questionnaires with multistage stratified cluster sample of FPs (n = 141) and patients (n = 710) in two provinces in Iran, Fars and Mazandaran. The questionnaires contained essential dimensions of COC: Informational, interpersonal, and longitudinal COC. Results: Almost all FPs had a computer. The FPs hadn’t kept their patients’ medical records routinely. The software had some problems, so the FPs couldn’t produce lists of patients based on their health risk and they couldn’t monitor their population. Almost 88% of FPs have written referral letters for all referred patients but 57% of them got medical feedback from specialists. About 80% of patients’ consultation times were up to 10 min. 29% of FPs knew the past problems and illnesses of the patients. From 40% to 50% of the patients stated that their FPs asked them for their desire about prescribed medicine and gave clear explanation about their illnesses. On average, patients visited their doctor 5.5 times during the previous year. Generally, patients and FPs in Mazandaran could summarize their experiences better than Fars in most topics of COC. Conclusions: It seems that after 3 years of using urban FP program in two pilot provinces, there were still some problems in COC. Strengthen software program, introducing incentives for FPs, and promoting patients’ responsibility can be used by policy-makers when they seek to enhance COC. PMID:28299031

  19. Is it easy to take care of coordinating a "Children's Program of Hearing Loss"?

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    José Ignacio BENITO-OREJAS

    2016-03-01

    Full Text Available Introduction and objective: Hearing loss is the most prevalent sensory deficiency at birth. Even though, coordinating a program for early detection and care may seem simple tasks, they are not so when it takes responsibility for the negative impact that a delay in the identification or treatment, can cause in the linguistic and educational development of the child. With this review, we provide an overview of the commitment involved in the practice of this task. Method: We analyze functions assigned to the supervisor of a "Children's Program of Hearing Loss", which are set in the program of the Community of Castilla y León, that are a reflection of other communities and countries, because they belong to an international consensus backed by different regulatory organisms, which in Spain corresponds to the Commission for the Early Detection of Hearing Loss (CODEPEH. Results: The coordinator of a "Children's Program of Hearing Loss" should monitor the early identification of the new born with hearing impairment, ensure early diagnosis and treatment, ask for specific tests and assess the success of the intervention. This process focuses on the family as a key driver of the project. The institutional and administrative support should be at the service of this activity. Conclusions: Take over a "Children's Program of Hearing Loss" implies a global conception, which consists of establishing a preventive control of hearing health of the child, that increases the complexity of their development.

  20. Program development: role of the clinical nurse specialist in implementing a fast-track postanesthesia care unit.

    Science.gov (United States)

    Harrington, Linda

    2005-01-01

    Advanced practice nurses are involved in many aspects of program development as part of their roles. This can involve such things as developing programs for staff and family education, organizing system-wide quality assurance programs, or implementing new care programs. One unique aspect of the advanced practice nurse's role is the ability to serve as a change agent and implement new models of care. Although all advanced practice nurses can be involved in program development, the role of the Clinical Nurse Specialist lends itself to devoting dedicated services for implementing programmatic change in the clinical setting. This article describes the role of the Clinical Nurse Specialist in implementing an evidence-based, fast-track postanesthesia care unit.

  1. Program evaluation of Sea Mar’s Chronic Care Program for Latino and Caucasian patients with type 2 diabetes: providers and staff perspectives

    Directory of Open Access Journals (Sweden)

    Bond GE

    2012-09-01

    Full Text Available Gail E Bond,1 Laurie Rechholtz,1 Christina Bosa,1 Celine Impert,1,2 Sara Barker21College of Nursing, Seattle University, Seattle WA, USA; 2Sea Mar Community Health Center, Seattle, WA, USAProblem statement: Unprecedented consumption of health care resources in the USA coupled with increasing rates of chronic disease has fueled pursuit of improved models of health care delivery. The Chronic Care Model provides an organizational framework for chronic care management and practice improvement. Sea Mar, a community health care organization in Washington state, implemented the Chronic Care Model, but has not evaluated the outcomes related to provider and staff satisfaction. The specific aim of this project was to evaluate the effectiveness of the Chronic Care Model with the addition of the Chronic Care Coordinator role.Approach: A descriptive method was used, which incorporated quantitative, and qualitative data from providers and clinic staff collected through a Web-based survey consisting of Likert-type questions sent via an electronic link.Results: This evaluation identified the strengths of and barriers to the chronic care model with a focus on provider and staff satisfaction regarding patient care since the addition of the Chronic Care Coordinator role. We found a high appreciation (94% and acceptance of the role; 80% agreed that the Chronic Care Coordinator was well-integrated into clinic operations. Major strengths of the program included more patient education, better follow-up, and improved team communications. Barriers to success included limited provider access, confusion regarding role expectations of the Chronic Care Coordinator, inconsistent communications, and Chronic Care Coordinator turnover.Conclusions/recommendations: Our findings help to validate the importance of community health organizations such as Sea Mar, the utility of the chronic care model, and the potential value for specific roles such as the Chronic Care Coordinator to

  2. Advanced general dentistry program directors' attitudes on physician involvement in pediatric oral health care.

    Science.gov (United States)

    Raybould, Ted P; Wrightson, A Stevens; Massey, Christi Sporl; Smith, Tim A; Skelton, Judith

    2009-01-01

    Childhood oral disease is a significant health problem, particularly for vulnerable populations. Since a major focus of General Dentistry Program directors is the management of vulnerable populations, we wanted to assess their attitudes regarding the inclusion of physicians in the prevention, assessment, and treatment of childhood oral disease. A survey was mailed to all General Practice Residency and Advanced Education in General Dentistry program directors (accessed through the ADA website) to gather data. Spearman's rho was used to determine correlation among variables due to nonnormal distributions. Overall, Advanced General Dentistry directors were supportive of physicians' involvement in basic aspects of oral health care for children, with the exception of applying fluoride varnish. The large majority of directors agreed with physicians' assessing children's oral health and counseling patients on the prevention of dental problems. Directors who treated larger numbers of children from vulnerable populations tended to strongly support physician assistance with early assessment and preventive counseling.

  3. Service quality assessment of workers compensation health care delivery programs in New York using SERVQUAL.

    Science.gov (United States)

    Arunasalam, Mark; Paulson, Albert; Wallace, William

    2003-01-01

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

  4. States' Experiences with Loan Repayment Programs for Health Care Professionals in a Time of State Budget Cuts and NHSC Expansion

    Science.gov (United States)

    Pathman, Donald E.; Morgan, Jennifer Craft; Konrad, Thomas R.; Goldberg, Lynda

    2012-01-01

    Purpose: The landscape of education loan repayment programs for health care professionals has been turbulent in recent years, with doubling of the funding for the National Health Service Corps (NHSC) and cuts in funding for some states' programs. We sought to understand how this turbulence is being felt within the state offices involved in…

  5. AIDS Drug Assistance Programs: managers confront uncertainty and need to adapt as the Affordable Care Act kicks in.

    Science.gov (United States)

    Martin, Erika G; Meehan, Terence; Schackman, Bruce R

    2013-06-01

    With the Affordable Care Act set to expand insurance coverage to millions more Americans next year, existing discretionary health programs that receive federal support might find themselves competing for funds as the health reform law is fully implemented. To assess the implications the Affordable Care Act might have for discretionary health programs, we focused on state AIDS Drug Assistance Programs, which provide free medications to low-income HIV patients. We conducted semistructured interviews with program managers from twenty-two states. Many of the managers predicted that their programs will change focus to provide "wrap-around services," such as helping newly insured clients finance out-of-pocket expenses, including copayments, deductibles, and premiums. Although program managers acknowledged that they must adapt to a changing environment, many said that they were overwhelmed by the complexity of the Affordable Care Act, and some expressed fear that state AIDS Drug Assistance Programs would be eliminated entirely. To remain viable, such programs must identify and justify the need for services in the context of the Affordable Care Act and receive sufficient political support and funding.

  6. The barriers to govern long-term care innovations:: The paradoxical role of subsidies in a transition program

    NARCIS (Netherlands)

    Cramer, Hendrik; Dewulf, Geert; Voordijk, Hans

    2014-01-01

    This study deals with the governance of a transition program (2007–2011) that tried to radically change a fragmented, supply-driven long-term care system into an integrated, demand-driven system to deal with an aging population. The transition program was subsidized by the healthcare ministry and en

  7. A taxonomy for community-based care programs focused on HIV/AIDS prevention, treatment, and care in resource-poor settings.

    Science.gov (United States)

    Rachlis, Beth; Sodhi, Sumeet; Burciul, Barry; Orbinski, James; Cheng, Amy H Y; Cole, Donald

    2013-04-16

    Community-based care (CBC) can increase access to key services for people affected by HIV/AIDS through the mobilization of community interests and resources and their integration with formal health structures. Yet, the lack of a systematic framework for analysis of CBC focused on HIV/AIDS impedes our ability to understand and study CBC programs. We sought to develop taxonomy of CBC programs focused on HIV/AIDS in resource-limited settings in an effort to understand their key characteristics, uncover any gaps in programming, and highlight the potential roles they play. Our review aimed to systematically identify key CBC programs focused on HIV/AIDS in resource-limited settings. We used both bibliographic database searches (Medline, CINAHL, and EMBASE) for peer-reviewed literature and internet-based searches for gray literature. Our search terms were 'HIV' or 'AIDS' and 'community-based care' or 'CBC'. Two co-authors developed a descriptive taxonomy through an iterative, inductive process using the retrieved program information. We identified 21 CBC programs useful for developing taxonomy. Extensive variation was observed within each of the nine categories identified: region, vision, characteristics of target populations, program scope, program operations, funding models, human resources, sustainability, and monitoring and evaluation strategies. While additional research may still be needed to identify the conditions that lead to overall program success, our findings can help to inform our understanding of the various aspects of CBC programs and inform potential logic models for CBC programming in the context of HIV/AIDS in resource-limited settings. Importantly, the findings of the present study can be used to develop sustainable HIV/AIDS-service delivery programs in regions with health resource shortages.

  8. Communication in palliative care: philosophy, teaching approaches, and evaluation of an educational program for nurses.

    Science.gov (United States)

    Rønsen, Astrid; Hanssen, Ingrid

    2009-10-01

    In this article is presented a post-graduate program in palliative care nursing focusing communication. The teaching plan was inspired by action learning, and the students' discovery processes necessitated a variety of teaching methods. The program was based on a holistic view of the human being and of inter-human communication. Neuro-motoric stimulation exercises were used to improve the students' focus of attention, sensory reception, and awareness of their corporeal and intellectual selves. Stimulation of relational skills, the discussion of ethical and difficult questions, and narratives helped students discover relationships between theoretical knowledge and palliative practice, and were used to explain and illustrate topics, and as backgrounds for discussions. During the program the students examined, challenged, and continuously reflected upon their explicit and unconscious praxis theories and their communicative habits. Although very different from educational programs they previously had experienced, this teaching/learning plan and the outcome thereof was positively evaluated. At the end of the year the students found themselves to be more knowledgeable, discerning and self-confident nurses. Even so, some found that they needed more time to digest what they had learned and for new knowledge and philosophies to become internalised.

  9. Patient, informal caregiver and care provider acceptance of a hospital in the home program in Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Zhang Wei

    2007-08-01

    Full Text Available Abstract Background Hospital in the home programs have been implemented in several countries and have been shown to be safe substitutions (alternatives to in-patient hospitalization. These programs may offer a solution to the increasing demands made on tertiary care facilities and to surge capacity. We investigated the acceptance of this type of care provision with nurse practitioners as the designated principal home care providers in a family medicine program in a large Canadian urban setting. Methods Patients requiring hospitalization to the family medicine service ward, for any diagnosis, who met selection criteria, were invited to enter the hospital in the home program as an alternative to admission. Participants in the hospital in the home program, their caregivers, and the physicians responsible for their care were surveyed about their perceptions of the program. Nurse practitioners, who provided care, were surveyed and interviewed. Results Ten percent (104 of admissions to the ward were screened, and 37 patients participated in 44 home hospital admissions. Twenty nine patient, 17 caregiver and 38 provider surveys were completed. Most patients (88%–100% and caregivers (92%–100% reported high satisfaction levels with various aspects of health service delivery. However, a significant proportion in both groups stated that they would select to be treated in-hospital should the need arise again. This was usually due to fears about the safety of the program. Physicians (98%–100% and nurse practitioners also rated the program highly. The program had virtually no negative impact on the physician workload. However nurse practitioners felt that the program did not utilize their full expertise. Conclusion Provision of hospital level care in the home is well received by patients, their caregivers and health care providers. As a new program, investment in patient education about program safety may be necessary to ensure its long term success. A

  10. Advanced nursing apprenticeship program: a strategy for retention of experienced critical care nurses.

    Science.gov (United States)

    Coleman, B

    1990-05-01

    Most hospitals are frantically planning recruitment strategies to attract new nurses for intensive care units. The direct cost associated with orientation of one of these nurses is estimated at greater than $2000, plus 6 months' to 1 year's salary per nurse. An interim strategy of using registered nurses to fill a full-time position for 1 year can cost upwards of $75,000 a year. Germane to the acclimatization of these nurses to the intensive care unit is the nurturing role of experienced nurses during the orientation and in assuring continuity of high-quality patient care. By virtue of their position, experienced nurses also model leadership behavior, and they are exposed to many day-to-day stresses that may leave them frustrated and feeling a lack of accomplishment. These factors, coupled with the scarcity of educational opportunities designed specifically for experienced nurses and a perceived absence of challenges, can lead to burnout. In this article I will describe an innovation in practice that uses the clinical nurse specialist role to stimulate and challenge experienced nurses. The program taught, supported, and nurtured unit-based change initiated by experienced nurses.

  11. The impact on families of respite care in a children's hospice program.

    Science.gov (United States)

    Davies, Betty; Steele, Rose; Collins, John B; Cook, Karen; Smith, Stephany

    2004-01-01

    With increasing trends towards home care of children with even the most complex conditions and care requirements, respite becomes critical in improving the quality of life for terminally ill children and their families. This article reports on the respite component of an evaluation project that examined the effect of the Canuck Place children's hospice program on the families it served during its first 30 months of operation. Canuck Place, located in Vancouver, British Columbia, Canada, is the first free-standing children's hospice in North America. Findings are derived from mail-out surveys to 144 families, face-to-face interviews with 18 families, and separate questionnaires specifically directed to parents who had used Canuck Place respite services. Sixty-five parents responded to the respite questions. They cited a wide range of benefits to the ill child, the child's siblings, and to the parents themselves; they also offered a few cautions. Our discussion focuses on three "lessons learned" from this unique investigation of respite within pediatric hospice care.

  12. [Partnership between Psychosocial Care Center and Family Health Program: the challenge of a new knowledge construction].

    Science.gov (United States)

    Delfini, Patrícia Santos de Souza; Sato, Miki Takao; Antoneli, Patrícia de Paulo; Guimarães, Paulo Octávio da Silva

    2009-10-01

    The objective of the article is to report an experience of partnership between a Psychosocial Care Center and three teams of the Family Health Program in the central region of São Paulo city. theoretical concepts like territory, subject, subjectivity/collective, receptiveness, bond, co-responsibility as well as the psychiatric and sanitary reform principles are the base and guide of this work. The partnership aims the promotion of mental health care based on articulated actions from different services. This way, the PSF's and mental health's workers are responsible for the demands of a territory. The strategies used in this partnership were meetings with both teams with training, case discussion about the families assisted, support to workers' difficulties and elaboration of therapeutical projects, and joint domiciliary visits. Some difficulties had been found during the research: great demand for health services and lack of institutional guidelines to guarantee the effectiveness of the partnership. The look directed to the family and the social context presents positive results compared to the look directed only to the illness. The partnership enriches the practice and a larger network of care in the territory becomes possible. It is necessary to bring up new proposals and innovative enterprises.

  13. Effect of the essentials of critical care orientation (ECCO) program on the development of nurses' critical thinking skills.

    Science.gov (United States)

    Kaddoura, Mahmoud A

    2010-09-01

    It is essential for nurses to develop critical thinking skills to ensure their ability to provide safe and effective care to patients with complex and variable needs in ever-changing clinical environments. To date, very few studies have been conducted to examine how nursing orientation programs develop the critical thinking skills of novice critical care nurses. Strikingly, no research studies could be found about the American Association of Critical Care Nurses Essentials of Critical Care Orientation (ECCO) program and specifically its effect on the development of nurses' critical thinking skills. This study explored the perceptions of new graduate nurses regarding factors that helped to develop their critical thinking skills throughout their 6-month orientation program in the intensive care unit. A convenient non-probability sample of eight new graduates was selected from a hospital that used the ECCO program. Data were collected with demographic questionnaires and semi-structured interviews. An exploratory qualitative research method with content analysis was used to analyze the data. The study findings showed that new graduate nurses perceived that they developed critical thinking skills that improved throughout the orientation period, although there were some challenges in the ECCO program. This study provides data that could influence the development and implementation of future nursing orientation programs.

  14. Creation of minimum standard tool for palliative care in India and self-evaluation of palliative care programs using it

    Directory of Open Access Journals (Sweden)

    M R Rajagopal

    2014-01-01

    Full Text Available Background: It is important to ensure that minimum standards for palliative care based on available resources are clearly defined and achieved. Aims: (1 Creation of minimum National Standards for Palliative Care for India. (2 Development of a tool for self-evaluation of palliative care organizations. (3 Evaluation of the tool in India. In 2006, Pallium India assembled a working group at the national level to develop minimum standards. The standards were to be evaluated by palliative care services in the country. Materials and Methods: The working group prepared a "standards" document, which had two parts - the first composed of eight "essential" components and the second, 22 "desirable" components. The working group sent the document to 86 hospice and palliative care providers nationwide, requesting them to self-evaluate their palliative care services based on the standards document, on a modified Likert scale. Results: Forty-nine (57% palliative care organizations responded, and their self-evaluation of services based on the standards tool was analyzed. The majority of the palliative care providers met most of the standards identified as essential by the working group. A variable percentage of organizations had satisfied the desirable components of the standards. Conclusions: We demonstrated that the "standards tool" could be applied effectively in practice for self-evaluation of quality of palliative care services.

  15. Innovating in health care management education: development of an accelerated MBA and MPH degree program at Yale.

    Science.gov (United States)

    Pettigrew, Melinda M; Forman, Howard P; Pistell, Anne F; Nembhard, Ingrid M

    2015-03-01

    Increasingly, there is recognition of the need for individuals with expertise in both management and public health to help health care organizations deliver high-quality and cost-effective care. The Yale School of Public Health and Yale School of Management began offering an accelerated Master of Business Administration (MBA) and Master of Public Health (MPH) joint degree program in the summer of 2014. This new program enables students to earn MBA and MPH degrees simultaneously from 2 fully accredited schools in 22 months. Students will graduate with the knowledge and skills needed to become innovative leaders of health care organizations. We discuss the rationale for the program, the developmental process, the curriculum, benefits of the program, and potential challenges.

  16. Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Burton E

    2013-12-01

    Full Text Available Elissa Burton,1,2 Gill Lewin,1,2 Lindy Clemson,3 Duncan Boldy41Faculty of Health Sciences, Curtin University, Perth, WA, Australia; 2Research Department, Silver Chain, Perth, WA, Australia; 3Health and Work Research Unit, The University of Sydney, Sydney, NSW, Australia; 4School of Nursing and Midwifery, Curtin University, Perth, WA, AustraliaBackground: Restorative home care services are short-term and aimed at maximizing a person’s ability to live independently. They are multidimensional and often include an exercise program to improve strength, mobility, and balance. The aim of this study was to determine whether a lifestyle exercise program would be undertaken more often and result in greater functional gains than the current structured exercise program delivered as part of a restorative home care service for older adults.Methods: A pragmatic randomized controlled trial was conducted in an organization with an established restorative home care service. Individuals who were to have an exercise program as part of their service were randomized to receive either a lifestyle and functional exercise program called LiFE (as this was a new program, the intervention or the structured exercise program currently being used in the service (control. Exercise data collected by the individuals throughout and pre and post intervention testing was used to measure balance, strength, mobility, falls efficacy, vitality, function, and disability.Results: There was no difference between the groups in the amounts of exercise undertaken during the 8-week intervention period. Outcome measurement indicated that the LiFE program was as effective, and on 40% of the measures, more effective, than the structured exercise program.Conclusion: Organizations delivering restorative home care services that include an exercise component should consider whether LiFE rather than the exercise program they are currently using could help their clients achieve better outcomes

  17. Strengthening preventive care programs: a permanent challenge for healthcare systems; lessons from PREVENIMSS México

    Directory of Open Access Journals (Sweden)

    Cantón Sonia

    2010-07-01

    Full Text Available Abstract Background In 2001, the Instituto Mexicano del Seguro Social (IMSS carried out a major reorganization to provide comprehensive preventive care to reinforce primary care services through the PREVENIMSS program. This program divides the population into programmatic age groups that receive specific preventive services: children (0-9 years, adolescents (10-19 years, men (20-59 years, women (20-59 years and older adults (> = 60 years. The objective of this paper is to describe the improvement of the PREVENIMSS program in terms of the increase of coverage of preventive actions and the identification of unmet needs of unsolved and emergent health problems. Methods From 2003 to 2006, four nation-wide cross-sectional probabilistic population based surveys were conducted using a four stage sampling design. Thirty thousand households were visited in each survey. The number of IMSS members interviewed ranged from 79,797 respondents in 2003 to 117,036 respondents in 2006. Results The four surveys showed a substantial increase in coverage indicators for each age group: children, completed schemes of vaccination (> 90%, iron supplementation (17.8% to 65.5%, newborn screening for metabolic disorders (60.3% to 81.6%. Adolescents, measles - rubella vaccine (52.4% to 71.4%, hepatitis vaccine (9.3% to 46.2%, use of condoms (17.9% to 59.9%. Women, measles-rubella vaccine (28.5% to 59-2%, cervical cancer screening (66.7% to 75%, breast cancer screening (> 2.1%. Men, type 2 diabetes screening (38.6% to 57.8% hypertension screening (48-4% to 64.0%. Older adults, pneumococcal vaccine (13.2% to 24.9%, influenza vaccine (12.6% to 52.9 Regarding the unmet needs, the prevalence of anemia in children was 30% and a growing prevalence of overweight and obesity, type 2 diabetes, and hypertension was found in men, women and older adults. Conclusion PREVENIMSS showed an important increase in the coverage of preventive services and stressed the magnitude of the old and

  18. Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: "the Belgian experience"

    Directory of Open Access Journals (Sweden)

    Van Royen Paul

    2009-08-01

    Full Text Available Abstract Background Most research publications on Chronic Care Model (CCM implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Belgian healthcare setting, a setting where the organisational framework for chronic care is mainly hospital-centered. Methods Process evaluation of an action research project (2003–2007 guided by the CCM in a well-defined geographical area with 76,826 inhabitants and an estimated number of 2,300 type 2 diabetes patients. In consultation with the region a program for type 2 diabetes patients was developed. The degree of implementation of the CCM in the region was assessed using the Assessment of Chronic Illness Care survey (ACIC. A multimethod approach was used to evaluate the implementation process. The resulting data were triangulated in order to identify the main facilitators and barriers encountered during the implementation process. Results The overall ACIC score improved from 1.45 (limited support at the start of the study to 5.5 (basic support at the end of the study. The establishment of a local steering group and the appointment of a program manager were crucial steps in strengthening primary care. The willingness of a group of well-trained and motivated care providers to invest in quality improvement was an important facilitator. Important barriers were the complexity of the intervention, the lack of quality data, inadequate information technology support, the lack of commitment procedures and the uncertainty about sustainable funding. Conclusion Guided by the CCM, this study highlights the opportunities and the bottlenecks for adapting chronic care

  19. Act In case of Depression: the evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol

    NARCIS (Netherlands)

    Gerritsen, D.L.; Smalbrugge, M.; Teerenstra, S.; Leontjevas, R.; Adang, E.M.M.; Vernooij-Dassen, M.J.F.J.; Derksen, E.; Koopmans, R.T.C.M.

    2011-01-01

    BACKGROUND: The aim of this study is evaluating the (cost-) effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the man

  20. The effect of exercise intervention on frail elderly in need of care: half-day program in a senior day-care service facility specializing in functional training

    Science.gov (United States)

    Sakamoto, Ryota; Miura, Yasushi

    2016-01-01

    [Purpose] This study investigated the long-term effect of a half-day exercise intervention program on health-related quality of life, life function, and physical function in frail elderly in need of care. The program was conducted at a senior day-care facility specializing in functional training. [Subjects and Methods] Subjects included 41 elderly in need of care who had visited the service facility for at least 1 year. Physical function and life function were evaluated at baseline, 6 months, and 12 months. Quality of life was evaluated with the Short Form-36 at baseline and 12 months. [Results] Improvements in balance, walking speed and endurance, complex performance abilities, self-efficacy during the activities, and the level and sphere of activity were observed at 6 months and maintained up to 12 months. Moreover, improvements in agility, activities of daily living, life function, and quality of life were also observed at 12 months. Improvements in muscle strength, walking ability, self-efficacy over an action, and activities of daily living were related to the improvement in quality of life. [Conclusion] The use of individualized exercise programs developed by physiotherapists led to improvements in activities of daily living and quality of life among elderly in need of care. PMID:27512243

  1. CARACTERIZACIÓN DEL SUICIDIO EN ARMENIACOLOMBIA, 2004 - 2008

    Directory of Open Access Journals (Sweden)

    Oscar Medina Pérez

    2010-04-01

    Full Text Available La investigación describe las tendencias de mortalidad por suicidio y sus principales características en la ciudad de Armenia-Colombia, en el periodo 2004–2008. Las cifras de suicidio han sido suministradas por el Instituto Nacional de Medicina Legal y Ciencias Forenses y las proyecciones poblacionales se han obtenido del Departamento Administrativo Nacional de Estadística (DANE. Los resultados indican una tasa municipal de 8,2 para los cinco años, cifra 64% superior al resto del país. En total se reportaron 116 suicidios en el período estudiado; en la distribución por sexo y grupos etáreos, las tasas más altas se encontraron en hombres entre los 70-79 años, con 31,5 casos/100.000 hab.; en población femenina esta cifra correspondió al rango de los 10-19 años, con una tasa de 8,6. En general, las tasas son altas al compararse con otros lugares de Colombia. Se identifica la urgencia de profundizar en este problema de salud pública a nivel local, estrechamente relacionado con factores sociales

  2. Sissejuhatus : [kogumikule "Bologna protsess Eestis 2004-2008"] / Heli Aru

    Index Scriptorium Estoniae

    Aru, Heli

    Bologna deklaratsiooni rakendamisest tulenenud muudatustest kõrgharidussüsteemis ja Bologna protsessi juhtimisest,mida seni on juhitud iga kahe aasta tagant toimuval ministrite kohtumisel, mis annab hinnangu senitehtule ning kiidab heaks tegevussuunad järgnevateks aastateks

  3. Earth Observing-1 Advanced Land Imager (ALI): 2004-2008

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Global Land Survey (GLS) datasets are a collection of orthorectified, cloud-minimized Landsat-type satellite images, providing near complete coverage of the...

  4. The Influence of Skill Development Training Program for Spiritual Care of Elderly Individual on Elderly Care Technician Students' Perception of Spiritual Support.

    Science.gov (United States)

    Bulduk, Serap; Usta, Esra; Dinçer, Yeliz

    2017-06-01

    Spiritual care means helping an individual protect, maintain and gain all the dimensions of his/her existence. Elderly care technicians face numerous cases or crisis situations in which elderly individuals from different backgrounds question the meaning and value of life. Elderly care technicians must acknowledge that the spirituality is an important element in the way an elderly individual receives healthcare and they must be equipped for this matter. This study was conducted in order to examine the influence of "Skill Development Training Program for Spiritual Care of Elderly Individual," which was carried out with students from elderly care program, on the perception of spirituality support in a pretest-posttest quasi-experimental study design with control group. As the data collection form, "Spiritual Support Perception" (SSP) scale was used. The mean scores of the intervention group after the training and after one month are 50.39 ± 5.34 and 51.13 ± 4.98, respectively, and those of the control group are 43.16 ± 4.83 and 42.72 ± 4.48. A statistically significant difference was found between the mean scores of the intervention group from the pretest and the posttests immediately after the training and one month after the training (f = 94.247, p = 0.001). In the control group, however, there was no significant change in the SSP mean scores (f = 0.269, p = 0.77). As a result, this study pointed out the necessity of such training programs for healthcare professionals to make a distinction between their professional duties and their own personalities in order to offer spiritual care to the elderly individual.

  5. Hospice Care

    Science.gov (United States)

    Hospice care is end-of-life care. A team of health care professionals and volunteers provides it. ... can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's ...

  6. [Feasibility Study of a One-Day Educational Program to Train Advance Care Planning Facilitators(ACPFs)in Regional Areas].

    Science.gov (United States)

    Nishikawa, Mitsunori; Miura, Hisayuki; Oya, Sanae; Kato, Tomonari; Nagae, Hiroyuki; Osada, Yoshiyuki; Watanabe, Tetsuya; Matsuoka, Sachiko; Otsuka, Yasuro; Yamaguchi, Mie; Watanabe, Kazuko; Kito, Katsutoshi; Ooi, Hatsue; Suzuki, Naoko

    2016-12-01

    Promoting advance care planning in regional areas is important. Education For Implementing End-of-Life Discussion(EFIELD) is a two-day educational program for Advance Care Planning Facilitators(ACPFs)developed by the National Center for Geriatrics and Gerontology. Unfortunately, some trainers experience difficulties implementing the content of the program, and some trainees feel the program is too long for implementation in many regional areas. The purpose of the research is to clarify the feasibility of ACPFs education using a one-day program in regional areas. The methods involved documenting the process of a one-day program from implementation to evaluation from May of 2015 to March of 2016 and then evaluating the effectiveness of the program 3 months after the implementation using meeting minutes from 7 local hospitals. The results indicated a need for 5 steps from program implementation to evaluation as well as 5 categories for final evaluation. The most important finding is that E-FIELD challenged trainers to shorten and simplify their expressions in order to teach the content more efficiently. The second finding is that Group for Promoting Advance Care Planning & End Of Life Discussion in Chita(GACPEL) activities encouraged ACPimplementation within each hospital. The limitations of this research are related to small regional areas. In conclusion, a one-day regional ACPFs educational program is feasible.

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

    Science.gov (United States)

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

    2014-12-01

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

  8. Impact of an educational program on nursing students’ caring and self-perception in intensive clinical training in Jordan

    Directory of Open Access Journals (Sweden)

    Khouri RI

    2011-06-01

    Full Text Available Rawda KhouriAl Hussein Bin Talal University, Princess Aisha Bint Al Hussein College Of Nursing, Ma’an, JordanBackground: Framing and development of clinical skills in nursing students during their clinical practice is critical because this can shape their future caring skills. Professional caring empowers patients and contributes to their well-being and health. Education may enhance the capacity of nurses to be effective caring practitioners. Their study program encourages caring behavior in nursing students, consequently affecting their professional self-perception.Methods: The present study investigated the effect of an educational program on caring behavior and professional self-perception in nursing students using a controlled pre/post test study design. The study sample consisted of 50 nursing students undertaking their final year in 2010–2011. Subjects were randomly assigned to either an experimental or a control group. The study was conducted in two critical care units affiliated to the Ma’an and Queen Rania hospitals in the south of Jordan. The instruments utilized were the Caring Dimensions Inventory, Nursing Students Attitude Observational Checklist, and Professional Self-Concept of Nurses Instrument.Results: The study findings favor the effect of the educational program because there was increased knowledge and understanding of caring theory and related concepts, a more holistic approach to care, enhanced caring practices, and improved self-perception in the study group compared with the control group during different periods of assessment. The study group showed significantly better caring perception in psychological, technical, and professional terms than the control group during different periods of assessment. There was a significant positive trend of overall professional self-perception for the study group compared with the control group.Conclusion: Nursing curricula should incorporate concepts and principles that guide

  9. The Nordic Maintenance Care Program – An interview study on the use of maintenance care in a selected group of Danish chiropractors

    Directory of Open Access Journals (Sweden)

    Leboeuf-Yde Charlotte

    2009-06-01

    Full Text Available Abstract Background Although maintenance care appears to be relatively commonly used among chiropractors, the indications for its use are incompletely understood. A questionnaire survey was recently carried out among Swedish chiropractors in order to identify their choice of various management strategies, including maintenance care. That study revealed a common pattern of choice of strategies. However, it would be necessary to verify these findings in another study population and to obtain some additional information best collected through an interview. Objectives The main aim of the present study was to attempt to reproduce the findings in the Swedish study and to obtain more information on the use of maintenance care. Method A group of 11 chiropractors were selected because they used maintenance care. They were interviewed using the questionnaire from the previous Swedish survey. The questionnaire consisted of a simple description of a hypothetical patient with low back pain and nine possible ways in which the case could develop ("scenarios". They could choose between six different management strategies for each scenario. In addition, the chiropractors were encouraged to provide their own definition of maintenance care in an open-ended question. Interviews were taped, transcribed and analyzed. For the open-ended question, statements were identified relating to six pre hoc defined topics on the inclusion criteria/rationale for maintenance care, the frequency of treatments, and the duration of the maintenance care program. Results The open-ended question revealed that in patients with low back pain, maintenance care appears to be offered to prevent new events. The rationale was to obtain optimal spinal function. There appears to be no common convention on the frequency of treatments and duration of the treatment program was not mentioned by any of the interviewees. Conclusion The results from the questionnaire in the Danish survey showed that

  10. Program synergies and social relations: implications of integrating HIV testing and counselling into maternal health care on care seeking

    OpenAIRE

    An, Selena J; George, Asha S; LeFevre, Amnesty; Mpembeni, Rose; Mosha, Idda; Mohan, Diwakar; Yang, Ann; Chebet, Joy; Winch, Peter; Abdullah H. Baqui; Kilewo, Charles

    2015-01-01

    Background Women and children in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. Integration of HIV with maternal and child services aims to reduce the impact of HIV/AIDS. To assess the potential gains and risks of such integration, this paper considers pregnant women’s and providers’ perceptions about the effects of integrated HIV testing and counselling on care seeking by pregnant women during antenatal care in Tanzania. Methods From a larger evaluation of an integrated mater...

  11. [Aspects of the nursing appointments with hypertensive patients cared for in the Family Health Program].

    Science.gov (United States)

    Felipe, Gilvan Ferreira; de Abreu, Rita Neuma Dantas Cavalcante; Moreira, Thereza Maria Magalhães

    2008-12-01

    The objective was to observe the aspects of nursing appointments undergone by hypertensive patients. This is a descriptive study, developed in three healthcare centers in the city of Fortaleza. The subjects were 13 nurses, and data collection comprised the observation of three of each nurse's appointments, followed by an interview with this professional. It was observed that, during the anamnesis, the previous treatment, the ingestion of hypertensive substances and the existence of associated risk factors were identified. Inspections of the patient's appearance, blood pressure and weight were also evident. The identified categories were: aspects of the nurse's role in basic healthtcare; treatment of hypertension and day-to-day difficulties of people with this disease. We conclude that many aspects are not being approached during the nursing appointments, which can result in a low-quality healthcare service provided for people cared for the hypertension program in these basic healthcare centers.

  12. Bio-Intelligence: A Research Program Facilitating the Development of New Paradigms for Tomorrow's Patient Care

    Science.gov (United States)

    Phan, Sieu; Famili, Fazel; Liu, Ziying; Peña-Castillo, Lourdes

    The advancement of omics technologies in concert with the enabling information technology development has accelerated biological research to a new realm in a blazing speed and sophistication. The limited single gene assay to the high throughput microarray assay and the laborious manual count of base-pairs to the robotic assisted machinery in genome sequencing are two examples to name. Yet even more sophisticated, the recent development in literature mining and artificial intelligence has allowed researchers to construct complex gene networks unraveling many formidable biological puzzles. To harness these emerging technologies to their full potential to medical applications, the Bio-intelligence program at the Institute for Information Technology, National Research Council Canada, aims to develop and exploit artificial intelligence and bioinformatics technologies to facilitate the development of intelligent decision support tools and systems to improve patient care - for early detection, accurate diagnosis/prognosis of disease, and better personalized therapeutic management.

  13. Teachers' experiences of English-language-taught degree programs within health care sector of Finnish polytechnics.

    Science.gov (United States)

    Pitkajarvi, Marianne; Eriksson, Elina; Kekki, Pertti

    2011-08-01

    The purpose of this study was to research teachers' experiences of the English-Language-Taught Degree Programs in the health care sector of Finnish polytechnics. More specifically, the focus was on teachers' experiences of teaching methods and clinical practice. The data were collected from eighteen teachers in six polytechnics through focus group interviews. Content analysis was used to analyse the data. The results suggested that despite the positive interaction between students and teachers, choosing appropriate teaching methods provided a challenge for teachers, due to cultural diversity of students as well as to the use of a foreign language in tuition. Due to students' language-related difficulties, clinical practice was found to be the biggest challenge in the educational process. Staffs' attitudes were perceived to be significant for students' clinical experience. Further research using stronger designs is needed.

  14. [Preliminary results of a therapeutic program for childhood obesity in primary health care].

    Science.gov (United States)

    Temboury Molina, M C; Sacristán Martín, A; San Frutos Fernández, M A; Rodríguez Alfaro, F; Llorente González, R

    1993-05-01

    The high prevalence of childhood obesity in our society, its adverse consequences in the psychosocial development of the child, together with its risk of persistence into adulthood, prompted us to carry out this treatment program in our Primary Care Unit. It is based fundamentally on four aspects: diet, physical exercise, psychological and family support. Thirty children, between 4 and 14 years of age, were controlled for 11 months. These children's personal and family characteristics, their habits and psychological aspects were described. An average reduction of the IMC of 2.50 was obtained. The best results were obtained in children with two or more siblings, with a good adherence to the diet and with adequate family support. Sex, obesity of other family members, initial age, previous habits, etc., were not found to be influential. The importance of prevention and family collaboration is emphasized.

  15. Development of a community participation program for diabetes mellitus prevention in a primary care unit, Thailand.

    Science.gov (United States)

    Oba, Nongnut; McCaffrey, Ruth; Choonhapran, Paungphen; Chutug, Pensri; Rueangram, Sujin

    2011-09-01

    The purpose of this study was to create and test a prevention model for diabetes mellitus in a primary care unit in Thailand. This study used a three-stage approach: a situational analysis was conducted by a focus group discussion, a model was developed in a brainstorming session with stakeholders, and the model was tested by community participation. Qualitative and quantitative methods were used to collect and analyze the data. The focus group discussion found that co-operation between health volunteers and primary care unit personnel in relation to diabetes screening, as well as defining the role of nurse practitioners who provide diabetic treatment, was important. The proactive model that was used for preventing diabetes mellitus was a health promotion program. It was trialed with 160 persons with prediabetes for 3 months. After the intervention, the mean score for exercise activity among the persons with prediabetes was significantly higher, while the mean score of the Body Mass Index, waist circumference, and systolic blood pressure were significantly lower than before the intervention. This meant that community participation provided proactive services to Thai persons with prediabetes.

  16. Quality management in nuclear medicine for better patient care: the IAEA program.

    Science.gov (United States)

    Dondi, Maurizio; Kashyap, Ravi; Pascual, Thomas; Paez, Diana; Nunez-Miller, Rodolfo

    2013-05-01

    The International Atomic Energy Agency promotes the practice of nuclear medicine among its Member States with a focus on quality and safety. It considers quality culture as a part of the educational process and as a tool to reduce heterogeneity in the practice of nuclear medicine, and in turn, patient care. Sensitization about quality is incorporated in all its delivery mechanisms. The Agency has developed a structured peer-review process called quality management (QM) audits in nuclear medicine practices to help nuclear medicine facilities improve their quality through this voluntary comprehensive audit process. The process is multidisciplinary, covering all aspects of nuclear medicine practice with a focus on the patient. It complements other QM and accreditation approaches developed by professional societies or accreditation agencies. The Agency is committed to propagate its utility and assist in the implementation process. Similar auditing programs for practice in diagnostic radiology and radiotherapy, called QUADRIL and QUATRO, respectively, are also in place. Necessary amendments in the auditing process and content are incorporated based on technological and practice changes with time. The reader will become familiar with the approach of the Agency on QM in nuclear medicine and its implementation process to improve patient care.

  17. A taxonomy for community-based care programs focused on HIV/AIDS prevention, treatment, and care in resource-poor settings

    Directory of Open Access Journals (Sweden)

    Beth Rachlis

    2013-04-01

    Full Text Available Community-based care (CBC can increase access to key services for people affected by HIV/AIDS through the mobilization of community interests and resources and their integration with formal health structures. Yet, the lack of a systematic framework for analysis of CBC focused on HIV/AIDS impedes our ability to understand and study CBC programs. We sought to develop taxonomy of CBC programs focused on HIV/AIDS in resource-limited settings in an effort to understand their key characteristics, uncover any gaps in programming, and highlight the potential roles they play. Our review aimed to systematically identify key CBC programs focused on HIV/AIDS in resource-limited settings. We used both bibliographic database searches (Medline, CINAHL, and EMBASE for peer-reviewed literature and internet-based searches for gray literature. Our search terms were ‘HIV’ or ‘AIDS’ and ‘community-based care’ or ‘CBC’. Two co-authors developed a descriptive taxonomy through an iterative, inductive process using the retrieved program information. We identified 21 CBC programs useful for developing taxonomy. Extensive variation was observed within each of the nine categories identified: region, vision, characteristics of target populations, program scope, program operations, funding models, human resources, sustainability, and monitoring and evaluation strategies. While additional research may still be needed to identify the conditions that lead to overall program success, our findings can help to inform our understanding of the various aspects of CBC programs and inform potential logic models for CBC programming in the context of HIV/AIDS in resource-limited settings. Importantly, the findings of the present study can be used to develop sustainable HIV/AIDS-service delivery programs in regions with health resource shortages.

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

    Science.gov (United States)

    Essary, Alison C; Wade, Nathaniel L

    2016-01-01

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

  19. Use of Interferon-Gamma Release Assays in a Health Care Worker Screening Program: Experience from a Tertiary Care Centre in the United States

    OpenAIRE

    2012-01-01

    BACKGROUND: Interferon-gamma release assays including the QuantiFERON-TB Gold In-Tube test (QFT-GIT [Cellestis Ltd, Australia]) may be used in place of the tuberculin skin test (TST) in surveillance programs for Mycobacterium tuberculosis infection control. However, data on performance and practicality of the QFT-GIT in such programs for health care workers (HCWs) are limited.OBJECTIVES: To assess the performance, practicality and reversion rate of the QFT-GIT among HCWs at a tertiary health ...

  20. Infection Control Link Nurse Program: An interdisciplinary approach n targeting health care-acquired infection

    Science.gov (United States)

    Sopirala, Madhuri M.; Yahle-Dunbar, Lisa; Smyer, Justin; Wellington, Linda; Dickman, Jeanne; Zikri, Nancy; Martin, Jennifer; Kulich, Pat; Taylor, David; Mekhjian, Hagop; Nash, Mary; Mansfield, Jerry; Pancholi, Preeti; Howard, Mary; Chase, Linda; Brown, Susan; Kipp, Kristopher; Lefeld, Kristen; Myers, Amber; Pan, Xueliang; Mangino, Julie E.

    2014-01-01

    Background We describe a successful interdisciplinary liaison program that effectively reduced health care-acquired (HCA), methicillin-resistant Staphylococcus aureus (MRSA) in a university hospital setting. Methods Baseline was from January 2006 to March 2008, and intervention period was April 2008 to September 2009. Staff nurses were trained to be liaisons (link nurses) to infection prevention (IP) personnel with clearly defined goals assigned and with ongoing monthly education. HCA-MRSA incidence per 1,000 patient-days (PD) was compared between baseline and intervention period along with total and non-HCA-MRSA, HCA and non-HCA-MRSA bacteremia, and hand soap/sanitizer usage. Hand hygiene compliance was assessed. Results A reduction in MRSA rates was as follows in intervention period compared with baseline: HCA-MRSA decreased by 28% from 0.92 to 0.67 cases per 1,000 PD (incidence rate ratio, 0.72; 95% confidence interval: 0.62–0.83, P Hand soap/sanitizer usage and compliance with hand hygiene also increased significantly during IP. Conclusion Link nurse program effectively reduced HCA-MRSA. Goal-defined metrics with ongoing reeducation for the nurses by IP personnel helped drive these results. PMID:24548456

  1. The Nordic Maintenance Care Program - Time intervals between treatments of patients with low back pain: how close and who decides?

    OpenAIRE

    Leboeuf-Yde Charlotte; Bjørnstad Charlotte; Sandnes Kjerstin F; Hestbaek Lise

    2010-01-01

    Abstract Background The management of chiropractic patients with acute and chronic/persistent conditions probably differs. However, little is known on this subject. There is, for example, a dearth of information on maintenance care (MC). Thus it is not known if patients on MC are coerced to partake in a program of frequent treatments over a long period of time, or if they are actively involved in designing their own individualized treatment program. Objectives It was the purpose of this study...

  2. ANALYSIS ON EPIDEMIOLOGICAL CHARACTERISTICS OF CASES OF MEASLES VACCINE IMMUNITY FAILURE IN GUANGDONG PROVINCE DURING 2004-2008%广东省2004~2008年麻疹疫苗免疫失败病例流行病学特征分析

    Institute of Scientific and Technical Information of China (English)

    疏俊; 吴承刚; 彭志强; 谭秋

    2011-01-01

    [Objective] To analyse the epidemiological characterisUcs of cases of measles vaccine immunity failure and the relevant factors in Guangdong Province during 2004-2008. [ Methods] Descriptive epidemiological study was applied to analyse the data from reporting system of infectious diseases and measles monitoring system during 2004-2008. [ Results] A total of 8 197 cases of measles vaccine immunity failure were reported in Guangdong Province during 2004-2008. The cases were reported in every city in Guangdong Province. More cases of measles vaccine immunity failure were reported in Shenzhen,Guangzhou, Zhongshan and Dongguan city. However, the proportion of measles cases was different in different regions. There were more cases from April to July each year There weren 't differences in the month of distribution and the toral cases (Z = -0.17, P = 0.87). The sex ratio for men and women of measles vaccine immunity failure cases was 1∶ 0.75 (4 694/3 503). The rate of the floating measles vaccine immunity failure cases in the total immunity failure cases was 55.80% (4 574/8 197). The age distribution in measles vaccine immunity failure cases and the total cases was the significantly different (Z = -2.88, P =O.OO). The age distribution in measles vaccine immunity failure eases in different regions and years were the significantly different (retSion: x2= 707.78, P= 0.00, year: x2 = 35.21, P = 0.00). [Conclusion] Measles vacine unmunity failure cases are found with a certain percentage in measles cases. It is worth of paying aUention to the fact that the floating populalion and the younger-age cases.%[目的]分析广东省2004~2008年麻疹疫苗免疫失败病例流行病学特征,探析相关影响因素.[方法]通过传染病报告系统和麻疹监测系统收集有关数据,并进行描述性流行病学分析.[结果]2004~2008年间广东省共有8197例麻疹疫苗免疫失败病例报告,全省各市均有病例报告,免疫失败个案以深圳、广州

  3. Use of a Comprehensive HIV Care Cascade for Evaluating HIV Program Performance: Findings From 4 Sub-Saharan African Countries

    Science.gov (United States)

    McNairy, Margaret L.; Lamb, Matthew R.; Abrams, Elaine J.; Elul, Batya; Sahabo, Ruben; Hawken, Mark P.; Mussa, Antonio; Zwede, Ayele; Justman, Jessica; El-Sadr, Wafaa M.

    2016-01-01

    Background The traditional HIV treatment cascade has been noted to have limitations. A proposed comprehensive HIV care cascade that uses cohort methodology offers additional information as it accounts for all patients. Using data from 4 countries, we compare patient outcomes using both approaches. Methods Data from 390,603 HIV-infected adults (>15 years) enrolled at 217 facilities in Kenya, Mozambique, Rwanda, and Tanzania from 2005 to 2011 were included. Outcomes of all patients at 3, 6, and 12 months after enrollment were categorized as optimal, suboptimal, or poor. Optimal outcomes included retention in care, antiretroviral therapy (ART) initiation, and documented transfer. Suboptimal outcomes included retention in care without ART initiation among eligible patients or those without eligibility data. Poor outcomes included loss to follow-up and death. Results The comprehensive HIV care cascade demonstrated that at 3, 6 and 12 months, 58%, 51%, and 49% of patients had optimal outcomes; 22%, 12%, and 7% had suboptimal outcomes, and 20%, 37% and 44% had poor outcomes. Of all patients enrolled in care, 56% were retained in care at 12 months after enrollment. In comparison, the traditional HIV treatment cascade found 89% of patients enrolled in HIV care were assessed for ART eligibility, of whom 48% were determined to be ART-eligible with 70% initiating ART, and 78% of those initiated on ART retained at 12 months. Conclusions The comprehensive HIV care cascade follows outcomes of all patients, including pre-ART patients, who enroll in HIV care over time and uses quality of care parameters for categorizing outcomes. The comprehensive HIV care cascade provides complementary information to that of the traditional HIV treatment cascade and is a valuable tool for monitoring HIV program performance. PMID:26375466

  4. Management of pain induced by exercise and mobilization during physical therapy programs: views of patients and care providers

    Directory of Open Access Journals (Sweden)

    Rannou François

    2011-07-01

    Full Text Available Abstract Background The expectations of patients for managing pain induced by exercise and mobilization (PIEM have seldom been investigated. We identified the views of patients and care providers regarding pain management induced by exercise and mobilization during physical therapy programs. Methods We performed a qualitative study based on semi-structured interviews with a stratified sample of 12 patients (7 women and 14 care providers (6 women: 4 general practitioners [GPs], 1 rheumatologist, 1 physical medicine physician, 1 geriatrician, 2 orthopedic surgeons, and 5 physical therapists. Results Patients and care providers have differing views on PIEM in the overall management of the state of disease. Patients' descriptions of PIEM were polymorphic, and they experienced it as decreased health-related quality of life. The impact of PIEM was complex, and patient views were sometimes ambivalent, ranging from denial of symptoms to discontinuation of therapy. Care providers agreed that PIEM is generally not integrated in management strategies. Care providers more often emphasized the positive and less often the negative dimensions of PIEM than did patients. However, the consequences of PIEM cited included worsened patient clinical condition, fears about physical therapy, rejection of the physical therapist and refusal of care. PIEM follow-up is not optimal and is characterized by poor transmission of information. Patients expected education on how better to prevent stress and anxiety generated by pain, education on mobilization, and adaptations of physical therapy programs according to pain intensity. Conclusion PIEM management could be optimized by alerting care providers to the situation, improving communication among care providers, and providing education to patients and care providers.

  5. Effect of Self–Care Educational Program to Improving Quality of Life among Elderly Referred to Health Centers in Zanjan

    Directory of Open Access Journals (Sweden)

    Fatemeh Salimi

    2015-09-01

    Full Text Available Background and Objectives: Since elderlies are susceptible to various impairments due to different physical and mental problems, they need more attention and abiding and efficient self-care program for their health promotion. The present study investigated the effect of self-care training program on quality of life of elderlies. Materials and Methods: This pre- and post-quasi-experimental study was carried out on 160 elderly clients selected from eight health care centers in Zanjan, Iran. The elderlies were selected by randomized sampling and assigned to two groups of experimental (n = 80 and control (n = 80 groups. The experimental group participated in the self-care training program for six sessions of one hour. The study instruments were questionnaires regarding demographic information and short-form health survey (SF-36. Data analysis was performed using SPSS-22 software by independent t-test, Mann-Whitney and chi-squared. Results: The finding showed a significant difference in mean scores of quality of life between the experimental and control groups after the intervention (P < 0.001. Conclusions: Self-care education to elderlies about the practices of proper nutrition, exercise, rest and medication can prevent several problems and help them to improve their quality of lives.

  6. The role of disease management in pay-for-performance programs for improving the care of chronically ill patients.

    Science.gov (United States)

    Beich, Jeff; Scanlon, Dennis P; Ulbrecht, Jan; Ford, Eric W; Ibrahim, Ibrahim A

    2006-02-01

    To date, pay-for-performance programs targeting the care of persons with chronic conditions have primarily been directed at physicians and provide an alternative to health plan-sponsored chronic disease management (DM) programs. Both approaches require similar infrastructure, and each has its own advantages and disadvantages for program implementation. Pay-for-performance programs use incentives based on patient outcomes; however, an alternative system might incorporate measures of structure and process. Using a conceptual framework, the authors explore the variation in 50 diabetes DM programs using data from the 2002 National Business Coalition on Health's eValue8 Request for Information (RFI). The authors raise issues relevant to the assignment of accountability for patient outcomes to either health plans or physicians. They analyze the association between RFI scores measuring structures and processes, and HEDIS diabetes intermediate outcome measures. Finally, the strengths and weaknesses of using the RFI scores as an alternative metric for pay-for-performance programs are discussed.

  7. The Effect of a Designed Respiratory Care Program on the Incidence of Ventilator-Associated Pneumonia: A Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mohammad Abbasinia

    2016-01-01

    Full Text Available Introduction: Ventilator-associated pneumonia is a common complication of mechanical ventilation. This study aimed to evaluate the effect of designed respiratory care program on incidence of ventilator-associated pneumonia (VAP in the mechanically ventilated patient. Methods: In this clinical trial, 64 patients were selected among those who had undergone mechanical ventilation in the ICU of Al‑Zahra Hospital, Isfahan, Iran, using convenience sampling method. The subjects were randomly allocated to intervention and control groups. In the intervention group an upper respiratory care program and in the control group, routine cares were done. Modified Clinical Pulmonary Infection Questionnaire was completed before and on the third, fourth and fifth day of study. Data were analyzed by Chi-square and independent t-test through SPSS Ver.13. Results: The results of this study showed that until the third day of study, the incidence of VAP was similar in the both groups. However, on the fifth day of study, the incidence of VAP in the intervention group was significantly lower than control group. Conclusion: The results of this study showed that an upper respiratory care program reduced the incidence of VAP. Therefore, nurses are recommended to perform this program for prevention of VAP.

  8. Approving job profiles for curriculum profiles in health care programs : a study on process and product quality

    NARCIS (Netherlands)

    Mulder, Martin; Engels, Otto

    1992-01-01

    A study evaluated the approach used for validation of job profiles for curriculum development in three health care programs in the Netherlands: dietetics, podotherapy, and activity therapy. It also evaluated the quality of these job profiles and the relation between process and product quality. The

  9. 78 FR 70958 - 30-Day Notice of Proposed Information Collection: Recordkeeping for HUD's Continuum of Care Program

    Science.gov (United States)

    2013-11-27

    ... law is the HEARTH Act. As amended by the HEARTH Act, Subpart C of the McKinney-Vento Homeless... Homeless Assistance Act (42 U.S.C.11371 et seq.). The HEARTH Act was designed to improve administrative... HEARTH Act. This rule establishes the regulatory framework for the Continuum of Care Program and...

  10. Evaluation of the Color Me Healthy Program in Influencing Nutrition and Physical Activity in Mississippi Preschool Child Care Facilities

    Science.gov (United States)

    Huye, Holly F.; Bankston, Sarah; Speed, Donna; Molaison, Elaine F.

    2014-01-01

    Purpose/Objectives: The purpose of this research was to determine the level of implementation and perceived value in creating knowledge and behavior change from the Color Me Healthy (CMH) training program in child care centers, family day carehomes, or Head Start facilities throughout Mississippi. Methods: A two-phase survey was used to initially…

  11. Effectiveness of Parent and Therapist Collaboration Program (PTCP) for Teaching Self-Care and Domestic Skills to Individuals with Autism

    Science.gov (United States)

    Cavkaytar, Atilla; Pollard, Elena

    2009-01-01

    The purpose of this study was to develop and determine the effectiveness of a Parent and Therapist Collaboration Program for teaching self care and domestic skills to individuals with autism with varying educational needs, age, and severity of disability. Three individuals with autism, one habilitation provider, and three parents participated in…

  12. 76 FR 624 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

    Science.gov (United States)

    2011-01-05

    ... AFFAIRS Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program.... 2900-New (VA Form 10-0476).'' SUPPLEMENTARY INFORMATION: Title: Patient Satisfaction Survey Michael E... Review: New collection. Abstract: VA Form 10-0476 will be used to gather feedback from patients...

  13. Does a competitive voucher program for adolescents improve the quality of reproductive health care? A simulated patient study in Nicaragua.

    NARCIS (Netherlands)

    Meuwissen, L.E.; Gorter, A.C.; Kester, A.D.M.; Knottnerus, J.A.

    2006-01-01

    Background: Little is known about how sexual and reproductive (SRH) health can be made accessible and appropriate to adolescents. This study evaluates the impact and sustainability of a competitive voucher program on the quality of SRH care for poor and underserved female adolescents and the usefuln

  14. Understanding why women adopt and sustain home water treatment: insights from the Malawi antenatal care program.

    Science.gov (United States)

    Wood, Siri; Foster, Jennifer; Kols, Adrienne

    2012-08-01

    In many settings in Africa, social marketing has proven more successful in generating brand recognition for chlorine water treatment products than in promoting their use. To promote household use of one such product in Malawi, WaterGuard, the Ministry of Health (MOH) and Population Services International (PSI) distributed free hygiene kits that included WaterGuard to pregnant women attending antenatal clinics in 2007. Follow-up surveys documented a sustained increase in WaterGuard use three years after the initial intervention. In 2010, PATH (www.path.org) conducted qualitative research on the factors motivating women to adopt, sustain, or discontinue use. To provide context, interviews were also conducted with their friends, relatives, and husbands. Interviews revealed that sustained use of WaterGuard does not necessarily imply consistent use. Most respondents reported switching back and forth between WaterGuard and stock chlorine distributed for free by the government, and many treated water seasonally rather than year-round. Qualitative findings suggest that two program strategies strongly influenced women's decisions to adopt, purchase, and continue using WaterGuard. First, positive, ongoing contacts with health care workers, especially during home visits, raised awareness of the need to treat water, encouraged trial use, and supported continuing use. Second, an extended free trial of the product overcame initial cost barriers and allowed women and their families to experience the health benefits of WaterGuard, appreciate its value and relevance to their lives, and get used to its taste. Social support-from like-minded relatives, friends, neighbors, health care workers, husbands, and children-was also a critical factor that promoted consistent, ongoing use of WaterGuard. The findings confirm the importance of interpersonal communication in prompting adoption of household water treatment and suggest that consumers assess the perceived value of a product, not

  15. Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components

    Science.gov (United States)

    Huber, Douglas; Curtis, Carolyn; Irani, Laili; Pappa, Sara; Arrington, Lauren

    2016-01-01

    ABSTRACT Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration. Misoprostol was safely introduced in several PAC programs through mid-level providers, extending services to secondary hospitals and primary health centers. In multiple studies, postabortion family planning uptake before discharge increased by 30–70 percentage points within 1–3 years of strengthening postabortion family planning services; in some cases, increases up to 60 percentage points in 4 months were achieved. Immediate postabortion contraceptive acceptance increased on average from 32% before the interventions to 69% post-intervention. Several studies found that women receiving immediate postabortion intrauterine devices and implants had fewer unintended pregnancies and repeat abortions than those who were offered delayed insertions. Postabortion family planning is endorsed by the professional organizations of obstetricians/gynecologists, midwives, and nurses as a standard of practice; major donors agree, and governments should be encouraged to provide universal access to postabortion family planning. Important program recommendations include offering all postabortion women

  16. Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components.

    Science.gov (United States)

    Huber, Douglas; Curtis, Carolyn; Irani, Laili; Pappa, Sara; Arrington, Lauren

    2016-09-28

    Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration. Misoprostol was safely introduced in several PAC programs through mid-level providers, extending services to secondary hospitals and primary health centers. In multiple studies, postabortion family planning uptake before discharge increased by 30-70 percentage points within 1-3 years of strengthening postabortion family planning services; in some cases, increases up to 60 percentage points in 4 months were achieved. Immediate postabortion contraceptive acceptance increased on average from 32% before the interventions to 69% post-intervention. Several studies found that women receiving immediate postabortion intrauterine devices and implants had fewer unintended pregnancies and repeat abortions than those who were offered delayed insertions. Postabortion family planning is endorsed by the professional organizations of obstetricians/gynecologists, midwives, and nurses as a standard of practice; major donors agree, and governments should be encouraged to provide universal access to postabortion family planning. Important program recommendations include offering all postabortion women family planning

  17. Act In case of Depression: The evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol

    Directory of Open Access Journals (Sweden)

    Vernooij-Dassen Myrra JFJ

    2011-05-01

    Full Text Available Abstract Background The aim of this study is evaluating the (cost- effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the management of depression, including standardized use of measurement instruments and diagnostical methods, and protocolized psychosocial, psychological and pharmacological treatment. Methods/Design In a 19-month longitudinal controlled study using a stepped wedge design, 14 somatic and 14 dementia special care units will implement the care program. All residents who give informed consent on the participating units will be included. Primary outcomes are the frequency of depression on the units and quality of life of residents on the units. The effect of the care program will be estimated using multilevel regression analysis. Secondary outcomes include accuracy of depression-detection in usual care, prevalence of depression-diagnosis in the intervention group, and response to treatment of depressed residents. An economic evaluation from a health care perspective will also be carried out. Discussion The care program is expected to be effective in reducing the frequency of depression and in increasing the quality of life of residents. The study will further provide insight in the cost-effectiveness of the care program. Trial registration Netherlands Trial Register (NTR: NTR1477

  18. Prevalence of nosocomial infections in acute care hospitals in Catalonia (VINCat Program).

    Science.gov (United States)

    Olona, Montserrat; Limón, Enric; Barcenilla, Fernando; Grau, Santiago; Gudiol, Francesc

    2012-06-01

    The first objective of the Catalonian Nosocomial Infection Surveillance Program (VINCat) is to monitor the prevalence (%) of patients with nosocomial infections (NI), patients undergoing urinary catheterization with closed circuit drainage (%) and patients undergoing antibiotic treatment (%). We present the results for the period 2008-2010. Comprehensive and point annual prevalence surveys were conducted that included conventionally hospitalized patients in acute care hospitals belonging to the VINCat Program. The number of participating hospitals was 46 (2008), 48 (2009) and 61 (2010), most belonging to the Network of Public Use Hospitals of Servei Català de la Salut. The results are presented globally and by hospital size (500 beds). The prevalence of patients with active NI acquired during the current or the previous hospitalization (global NI/P%) was 7.6 (2008), 6.2 (2009) and 6.3 (2010). The prevalence of patients with active NI acquired during the current (actual NI/P%) was 6.2 (2008), 4.7 (2009) and 4.6 (2010).The results by hospital size shows that the variation occurred mainly in <200 beds hospitals. The proportion of closed circuit urinary catheterization use was 90.2%. The use of antibiotics varied between 34.6% and 37.6%, with no differences due to hospital size. The global prevalence of NI provides information on the burden of NI at the institutional and regional level. Between 17.3% and 26.9% of patients with NI at the time of the study had acquired it in a previous hospitalization at the same institution.

  19. The Early Results of a New Health Care Program Implementation in HBV Screening: an Iranian Experience.

    Science.gov (United States)

    Sharifian, Afsaneh; Naderi, Nostratollah; Sanati, Azar; Mohebi, Seyed Reza; Azimzadeh, Pedram; Golmohamadi, Ali; Nori, Simin; Khanyaghma, Mahsa; Sheikhesmaeili, Farshad; Zali, Mohamad Reza

    2015-10-01

    BACKGROUND According to the reports of World Health Organization (WHO) and Centers for Disease Control and Prevention, the prevalence of chronic hepatitis B infection in Iran has decreased from 2-7% in 2001 to 1.3-0.8% in children aged 2-14 years. In 2010 the Institute of Medicine recommended more comprehensive screening by primary care physicians (PCPs) for evaluation, vaccination, and management of infected patients for further decrease in the prevalence of chronic HBV infection. Thus, with contribution of the Health Department, we developed a practical flowchart for PCPs to start active screening of hepatitis B virus (HBV) in all visited patients and refer the positive cases for further evaluation and management to Taleghani Hospital. METHODS With collaboration of Health Department of Shahid Beheshti University of Medical Sciences), physicians of health centers were asked to screen all their patients for HBsAg. Positive cases were referred to Taleghani Hospital. They were first registered and educated about their disease, life style, and prevention methods. Their first degree families were screened for HBV infection too and were referred for vaccination if needed. According to the results of lab tests, appropriate management was done by a hepatologist. RESULTS Since implementation of this program, we have encountered a significant rise in patient detection (even in high risk groups). Many of them were not aware of their disease and most of those who were aware of their disease were not managed appropriately. Family screening and vaccination were inadequate and need more emphasis. CONCLUSION Although health system is active about screening of HBV infection in high risk populations, it is not perfect. It seems that health system needs to upgrade the screening and management programs of HBV infection.

  20. Effectivity of Foot Care Education Program in Improving Knowledge, Self-Efficacy and Foot Care Behavior of Diabetes Mellitus Patients in Banjarbaru, Indonesia

    Directory of Open Access Journals (Sweden)

    Mahdalena Mahdalena

    2016-11-01

    Masalah kaki diabetik di Indonesia masih merupakan masalah besar dan masih memerlukan perhatian yang optimal. Edukasi perawatan kaki adalah salah satu upaya yang harus dilakukan dalam mencegah masalah kaki untuk pasien diabetes melitus. Penelitian ini bertujuan untuk menganalisis efektivitas program pendidikan perawatan kaki dalam meningkatkan pengetahuan, efikasi diri, dan perilaku perawatan kaki pasien diabetes di wilayah Banjarbaru. Jenis penelitian yang digunakan adalah quasi experimental dengan prepost test, dilakukan di puskesmas wilayah Banjarbaru tahun 2013. Kelompok intervensi diberikan program pendidikan perawatan kaki. Sampel berjumlah 48 pasien (32 orang kelompok intervensi dan 16 orang kelompok kontrol menggunakan teknik purposive sampling. Variabel yang diukur adalah pengetahuan, efikasi diri, dan perilaku perawatan kaki pasien diabetes melitus. Perlakuan yang diberikan pada responden berupa pendidikan kesehatan tentang perawatan kaki sebanyak dua kali. Setiap variabel diukur dua kali sebelum dan setelah intervensi. Uji pengetahuan diukur menggunakan Diabetic Foot Care Knowledge Questionnaire, efikasi diri diukur menggunakan Foot Care Confident Scale Self-Efficacy, dan perilaku perawatan kaki dinilai menggunakan Behavior Foot Care Questionnaire. Analisis data menggunakan Manova. Hasil penelitian menunjukkan perbedaan yang signifikan pada tingkat pengetahuan (nilai p = 0,001, efikasi diri (nilai p = 0,000 dan perilaku perawatan kaki (nilai p = 0,000 sebelum dan setelah intervensi.

  1. Empowering the dementia care workforce to manage behavioral symptoms of dementia: Development and training outcomes from the VOICE Dementia Care Program.

    Science.gov (United States)

    Karlin, Bradley E; Young, David; Dash, Kim

    2016-07-25

    Nonpharmacological approaches for managing behavioral symptoms of dementia remain widely underutilized, due in part to near-universal training needs reported by dementia caregivers in recent research. This article examines the development, core components, and initial outcomes of an evidence-informed, competency-based training program in the prevention and management of behavioral symptoms of dementia among care managers and nurses within an aging services system. The Vital Outcomes Inspired by Caregiver Engagement (VOICE) Dementia Care Training Program was developed based on identification of state-of-the-art approaches to managing behaviors through expert review of the literature and structured needs assessment. Results reveal robust improvements in knowledge, attitudes, and self-efficacy among training participants, with largest effect sizes (d = 1.8) on domains of knowledge and self-efficacy to manage behaviors. Findings support the feasibility and effectiveness of training in improving the abilities and confidence of aging services providers in dementia care and, specifically, in the nonpharmacological management of dementia-related behaviors.

  2. The VA Point-of-Care Precision Oncology Program: Balancing Access with Rapid Learning in Molecular Cancer Medicine.

    Science.gov (United States)

    Fiore, Louis D; Brophy, Mary T; Turek, Sara; Kudesia, Valmeek; Ramnath, Nithya; Shannon, Colleen; Ferguson, Ryan; Pyarajan, Saiju; Fiore, Melissa A; Hornberger, John; Lavori, Philip

    2016-01-01

    The Department of Veterans Affairs (VA) recognized the need to balance patient-centered care with responsible creation of generalizable knowledge on the effectiveness of molecular medicine tools. Embracing the principles of the rapid learning health-care system, a new clinical program called the Precision Oncology Program (POP) was created in New England. The POP integrates generalized knowledge about molecular medicine in cancer with a database of observations from previously treated veterans. The program assures access to modern genomic oncology practice in the veterans affairs (VA), removes disparities of access across the VA network of clinical centers, disseminates the products of learning that are generalizable to non-VA settings, and systematically presents opportunities for patients to participate in clinical trials of targeted therapeutics.

  3. The development, implementation, utilization and outcomes of a comprehensive dental program for older adults residing in long-term care facilities.

    Science.gov (United States)

    Wyatt, Chris C L; So, Frankie H C; Williams, P Michele; Mithani, Akber; Zed, Christopher M; Yen, Edwin H K

    2006-06-01

    This paper documents the experience of the University of British Columbia's Geriatric Dentistry Program (GDP) with emphasis on the dental treatment needs of patients during its first year of operation. The GDP provided access to dental care for residents of longterm care facilities, education for hospital staff concerning daily mouth care, education of dental students and an opportunity for research. The first year of clinical activity saw a small, yet significant, improvement in oral health for residents using the dental services. We hope that the outcomes of this new dental program for long-term care facilities will encourage dentists to provide care for this vulnerable population.

  4. Food Assistance: Efforts To Control Fraud and Abuse in the Child and Adult Care Food Program Should Be Strengthened. United States General Accounting Office Report to Congressional Committees.

    Science.gov (United States)

    Robertson, Robert E.

    The Child and Adult Care Food Program provides over $1.5 billion in benefits annually to children and adults in day care. In order to address the longstanding problems of fraud and abuse present in the program, state agencies have been charged with the responsibility for implementing Food and Nutrition Service's (FNS) regulations to prevent and…

  5. Prescription of kampo drugs in the Japanese health care insurance program.

    Science.gov (United States)

    Katayama, Kotoe; Yoshino, Tetsuhiro; Munakata, Kaori; Yamaguchi, Rui; Imoto, Seiya; Miyano, Satoru; Watanabe, Kenji

    2013-01-01

    Kampo medicine or traditional Japanese medicine has been used under Japan's National Health Insurance scheme for 46 years. Recent research has shown that more than 80% of physicians use Kampo in daily practice. However, the use of Kampo from the patient perspective has received scant attention. To assess the current use of Kampo drugs in the National Health Insurance Program, we analysed a total of 67,113,579 health care claim records, which had been collected by Japan's Ministry of Health, Labour and Welfare in 2009. We found that Kampo drugs were prescribed for 1.34% of all patients. Among these, 92.2% simultaneously received biomedical drugs. Shakuyakukanzoto was the most frequently prescribed Kampo drug. The usage of frequently prescribed Kampo drugs differed between the youth and the elderly, males and females, and inpatients and outpatients. Kampo medicine has been employed in a wide variety of conditions, but the prescription rate was highest for disorders associated with pregnancy, childbirth, and the puerperium (4.08%). Although the adoption of Kampo medicine by physicians is large in a variety of diseases, the prescription rate of Kampo drugs is very limited.

  6. Prescription of Kampo Drugs in the Japanese Health Care Insurance Program

    Directory of Open Access Journals (Sweden)

    Kotoe Katayama

    2013-01-01

    Full Text Available Kampo medicine or traditional Japanese medicine has been used under Japan’s National Health Insurance scheme for 46 years. Recent research has shown that more than 80% of physicians use Kampo in daily practice. However, the use of Kampo from the patient perspective has received scant attention. To assess the current use of Kampo drugs in the National Health Insurance Program, we analysed a total of 67,113,579 health care claim records, which had been collected by Japan’s Ministry of Health, Labour and Welfare in 2009. We found that Kampo drugs were prescribed for 1.34% of all patients. Among these, 92.2% simultaneously received biomedical drugs. Shakuyakukanzoto was the most frequently prescribed Kampo drug. The usage of frequently prescribed Kampo drugs differed between the youth and the elderly, males and females, and inpatients and outpatients. Kampo medicine has been employed in a wide variety of conditions, but the prescription rate was highest for disorders associated with pregnancy, childbirth, and the puerperium (4.08%. Although the adoption of Kampo medicine by physicians is large in a variety of diseases, the prescription rate of Kampo drugs is very limited.

  7. 75 FR 68799 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

    Science.gov (United States)

    2010-11-09

    ... Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for CY 2011 AGENCY: Centers... inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services... (c) $141.50 for the 21st through 100th day of extended care services in a skilled nursing facility...

  8. 76 FR 29249 - Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications

    Science.gov (United States)

    2011-05-20

    ... participate in the Pioneer Accountable Care Organization Model for a period beginning in 2011 and ending...://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco . Application Submission... Accountable Care Organization Model or the application process. SUPPLEMENTARY INFORMATION: I. Background...

  9. 78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

    Science.gov (United States)

    2013-02-06

    ... Disease Care Model Announcement AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION... the testing of the Comprehensive End- Stage Renal Disease (ESRD) Care Model, a new initiative from the... (CHIP) beneficiaries. We are interested in identifying models designed to improve care for...

  10. 76 FR 34712 - Medicare Program; Pioneer Accountable Care Organization Model; Extension of the Submission...

    Science.gov (United States)

    2011-06-14

    ...: This notice extends the deadlines for the submission of the Pioneer Accountable Care Organization Model...-coordinated-care-models/pioneer-aco . Application Submission Deadline: Applications must be postmarked on or before August 19, 2011. The Pioneer Accountable Care Organization Model ] Application is available...

  11. 78 FR 29139 - Medicare Program; Bundled Payments for Care Improvement Model 1 Open Period

    Science.gov (United States)

    2013-05-17

    ... participation in Model 1 of the Bundled Payments for Care Improvement initiative. DATES: Model 1 of the Bundled Payments for Care Improvement Deadline: Interested organizations must submit a Model 1 Open Period... regarding Model 1 of the Bundled Payments for Care Improvement initiative. For additional information...

  12. Evaluation of health care service diversification options in health care institutions and programs by portfolio analysis: a marketing approach.

    Science.gov (United States)

    Walker, L R; Rosko, M D

    1988-03-01

    Originally conceived as a technique to assess how well current activities contribute to the attainment of organizational goals, portfolio analysis also can be used as a marketing research tool for considering the relative merits of various diversification options under consideration by institutional decision makers. The authors describe the features of portfolio analysis and its use as a tool in the evaluation of health care diversification options. A case study of a hospital that has employed the method in its corporate planning and marketing efforts illustrates the use of this analysis technique.

  13. Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland

    Directory of Open Access Journals (Sweden)

    Miriam Rabkin

    2012-01-01

    Full Text Available The scale-up of HIV services in sub-Saharan Africa has catalyzed the development of highly effective chronic care systems. The strategies, systems, and tools developed to support life-long HIV care and treatment are locally owned contextually appropriate resources, many of which could be adapted to support continuity care for noncommunicable chronic diseases (NCD, such as diabetes mellitus (DM. We conducted two proof-of-concept studies to further the understanding of the status of NCD programs and the feasibility and effectiveness of adapting HIV program-related tools and systems for patients with DM. In Swaziland, a rapid assessment illustrated gaps in the approaches used to support DM services at 15 health facilities, despite the existence of chronic care systems at HIV clinics in the same hospitals, health centers, and clinics. In Ethiopia, a pilot study found similar gaps in DM services at baseline and illustrated the potential to rapidly improve the quality of care and treatment for DM by adapting HIV-specific policies, systems, and tools.

  14. A Study in Child Care (Case Study from Volume II-A): "A Rolls-Royce of Day Care." Day Care Programs Reprint Series.

    Science.gov (United States)

    O'Farrell, Brigid

    The Amalgamated Day Care Center is an independent trust established through a collective bargaining agreement between the Amalgamated Clothing Workers of America, AFL-CIO, and the employers of the garment industry. The free center, open from 6:00 a.m. to 6:00 p.m., is located near the Chicago garment industries to minimize transportation problems…

  15. Development of a hospital reiki training program: training volunteers to provide reiki to patients, families, and staff in the acute care setting.

    Science.gov (United States)

    Hahn, Julie; Reilly, Patricia M; Buchanan, Teresa M

    2014-01-01

    Creating a healing and healthy environment for patients, families, and staff is an ongoing challenge. As part of our hospital's Integrative Care Program, a Reiki Volunteer Program has helped to foster a caring and healing environment, providing a means for patients, family, and staff to reduce pain and anxiety and improve their ability to relax and be present. Because direct care providers manage multiple and competing needs at any given time, they may not be available to provide Reiki when it is needed. This program demonstrates that a volunteer-based program can successfully support nurses in meeting patient, family, and staff demand for Reiki services.

  16. Ready for Discharge? A Survey of Discharge Transition-of-Care Education and Evaluation in Emergency Medicine Residency Programs.

    Science.gov (United States)

    Gallahue, Fiona E; Betz, Amy E; Druck, Jeffrey; Jones, Jonathan S; Burns, Boyd; Hern, Gene

    2015-11-01

    This study aimed to assess current education and practices of emergency medicine (EM) residents as perceived by EM program directors to determine if there are deficits in resident discharge handoff training. This survey study was guided by the Kern model for medical curriculum development. A six-member Council of EM Residency Directors (CORD) Transitions of Care task force of EM physicians performed these steps and constructed a survey. The survey was distributed to program residency directors via the CORD listserve and/or direct contact. There were 119 responses to the survey, which were collected using an online survey tool. Over 71% of the 167 American College of Graduate Medical Education (ACGME) accredited EM residency programs were represented. Of those responding, 42.9% of programs reported formal training regarding discharges during initial orientation and 5.9% reported structured curriculum outside of orientation. A majority (73.9%) of programs reported that EM residents were not routinely evaluated on their discharge proficiency. Despite the ACGME requirements requiring formal handoff curriculum and evaluation, many programs do not provide formal curriculum on the discharge transition of care or evaluate EM residents on their discharge proficiency.

  17. The effects of a long-term care walking program on balance, falls and well-being

    Directory of Open Access Journals (Sweden)

    Dal Bello-Haas Vanina PM

    2012-12-01

    Full Text Available Abstract Background The effects of a regular and graduated walking program as a stand-alone intervention for individuals in long-term care are unclear. Exercise and fall prevention programs typically studied in long-term care settings tend to involve more than one exercise mode, such as a combination of balance, aerobic, strengthening, and flexibility exercises; and, measures do not always include mental health symptoms and behaviors, although these may be of even greater significance than physical outcomes. Methods/design We are randomly assigning residents of long-term care facilities into one of three intervention groups: (1 Usual Care Group - individuals receive care as usual within their long-term care unit; (2 Interpersonal Interaction Group - individuals receive a comparable amount of one-on-one stationary interpersonal interaction time with study personnel administering the walking program; and, (3 Walking Program Group – individuals participate in a supervised, progressive walking program five days per week, for up to half an hour per day. Assessments completed at baseline, 2 and 4 months during intervention, and 2 and 4 months post-intervention include: gait parameters using the GAITRite® computerized system, grip strength, the Berg Balance Scale, the Senior Fitness Test, the Older Adult Resource Services Physical Activities of Daily Living, the Geriatric Depression Scale Short Form, the Cornell Scale for Depression in Dementia, the Revised Memory and Behavior Problems Checklist, the Short Portable Mental Status Questionnaire, the Coloured Analogue Scale, pain assessment scales, and the number and nature of falls. Sophisticated data analytic procedures taking into account both the longitudinal nature of the data and the potential for missing data points due to attrition, will be employed. Discussion Residents in long-term care have a very high number of comorbidities including physical, mental health, and cognitive. The presence of

  18. A Comparative Study on the Effects of Self-Care Program Education Run by Health Volunteers and Health Care Staff on the Elderly\\'s Quality of Life

    Directory of Open Access Journals (Sweden)

    Fazlollah Ghofranipour

    2016-06-01

    Full Text Available Introduction: The diseases and problems due to ageing can affect the quality of life (QoL in the elderly. The aim of this study was to compare the effects of self-care program education run by health volunteers and healthcare staff on the QoL in the elderly. Methods: In this experimental, field trial study, 150 elderly people living in Mashhad were enrolled by multistage sampling in 2014. The participants were randomly assigned to three groups of 50 individuals in each; group A was educated by healthcare staff at healthcare centers, group B by health volunteers at the elderly's homes, and group C was control. The intervention groups (A and B attended two independent self-care education programs for one month. The data were gathered by the SF-36 questionnaire administered before and one month after the completion of the program. Data analysis was done by descriptive statistics [mean (standard deviation] and analytical statistics (independent samples t-test and Kruskal-Wallis H-test. Results: QoL score of the groups A, B, and C was derived 45.44±23.87, 45.36±23.81, and 45.38±23.83 before the intervention and 48.79±22.09, 63.15±19.03, and 46.08±22.67 after the intervention, respectively. The QoL score of the group B was significantly higher than the other two groups (P<0.05 after the intervention. Besides that, after the intervention, the mean scores of QoL and physical function, role-physical, role-emotional, social function, bodily pain, and general health increased significantly more markedly in the group B compared with the other two groups. Conclusion: Self-care education by the health volunteers was much more effective than that by healthcare staff. In addition, implementing the self-care education program contributed to improving QoL and therefore life satisfaction in the elderly.

  19. An innovative telemedicine knowledge translation program to improve quality of care in intensive care units: protocol for a cluster randomized pragmatic trial

    Directory of Open Access Journals (Sweden)

    Pinto Ruxandra

    2009-02-01

    Full Text Available Abstract Background There are challenges to timely adoption of, and ongoing adherence to, evidence-based practices known to improve patient care in the intensive care unit (ICU. Quality improvement initiatives using a collaborative network approach may increase the use of such practices. Our objective is to evaluate the effectiveness of a novel knowledge translation program for increasing the proportion of patients who appropriately receive the following six evidence-based care practices: venous thromboembolism prophylaxis; ventilator-associated pneumonia prevention; spontaneous breathing trials; catheter-related bloodstream infection prevention; decubitus ulcer prevention; and early enteral nutrition. Methods and design We will conduct a pragmatic cluster randomized active control trial in 15 community ICUs and one academic ICU in Ontario, Canada. The intervention is a multifaceted videoconferenced educational and problem-solving forum to organize knowledge translation strategies, including comparative audit and feedback, educational sessions from content experts, and dissemination of algorithms. Fifteen individual ICUs (clusters will be randomized to receive quality improvement interventions targeting one of the best practices during each of six study phases. Each phase lasts four months during the first study year and three months during the second. At the end of each study phase, ICUs are assigned to an intervention for a best practice not yet received according to a random schedule. The primary analysis will use patient-level process-of-care data to measure the intervention's effect on rates of adoption and adherence of each best practice in the targeted ICU clusters versus controls. Discussion This study design evaluates a new system for knowledge translation and quality improvement across six common ICU problems. All participating ICUs receive quality improvement initiatives during every study phase, improving buy-in. This study design

  20. Analysis of an electronic consultation program at an academic medical centre: Primary care provider questions, specialist responses, and primary care provider actions.

    Science.gov (United States)

    Wrenn, Katherine; Catschegn, Sereina; Cruz, Marisa; Gleason, Nathaniel; Gonzales, Ralph

    2017-02-01

    Introduction Electronic consultations (eConsults) increase access to specialty care, but little is known about the types of questions primary care providers (PCPs) ask through eConsults, and how they respond to specialist recommendations. Methods This is a retrospective descriptive analysis of the first 200 eConsults completed in the UCSF eConsult program. Participating PCPs were from eight adult primary care sites at the University of California, San Francisco (UCSF), USA. Medicine subspecialties participating were Cardiology, Endocrinology, Gastroenterology/hepatology, Hematology, Infectious diseases, Nephrology, Pulmonary medicine, Rheumatology, and Sleep medicine. We categorized eConsult questions into "diagnosis," "treatment," and/or "monitoring." We performed medical record reviews to determine the percentage of specialist recommendations PCPs implemented, and the proportion of patients with a specialist visit in the same specialty as the eConsult, emergency department visit, or hospital admission during the subsequent six months. Results PCP questions related to diagnosis in 71% of cases, treatment in 46%, and monitoring in 21%. Specialist responses related to diagnosis in 76% of cases, treatment in 64%, and monitoring in 40%. PCPs ordered 79% of all recommended laboratory tests, 86% of recommended imaging tests and procedures, 65% of recommended new medications, and 73% of recommended medication changes. In the six months after the eConsult, 14% of patients had a specialist visit within the UCSF system in the same specialty as the eConsult. Discussion eConsults provide guidance to PCPs across the spectrum of patient care. PCPs implement specialists' recommendations in the large majority of cases, and few patients subsequently require in-person specialty care related to the reason for the eConsult.

  1. Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

    Directory of Open Access Journals (Sweden)

    Myers Leann

    2009-12-01

    Full Text Available Abstract Background This study analyzed the likelihood of less-urgent emergency department (ED visits among type 2 diabetic patients receiving care under a diabetes disease management (DM program offered by the Louisiana State University Health Care Services Division (LSU HCSD. Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI, gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further

  2. Analisis Cakupan Antenatal Care K4 Program Kesehatan Ibu dan Anak di Wilayah Kerja Dinas Kesehatan Kabupaten Padang Pariaman

    Directory of Open Access Journals (Sweden)

    Elmispendriya Gusna

    2016-01-01

    Full Text Available AbstrakPencapaian target K4 (kunjungan ibu hamil ke tenaga kesehatan yang dilakukan paling sedikit 4 kali selama hamil akan terlaksana jika adanya motivasi bidan di desa ditambah pembinaan dari bidan koordinator yang secara rutin dilakukan dalam bentuk supervisi. Tujuan penelitian ini adalah menganalisis cakupan antenatal care K4 program kesehatan ibu dan anak di wilayah kerja dinas kesehatan kabupaten Padang Pariaman. Penelitian ini menggunakan metode penelitian gabungan antara kuantitatif dan kualitatif. Subjek penelitian untuk penelitian kuantitatif  adalah 49 orang bidan desa, sedangkan informan untuk kualitatif adalah kepala bidang kesehatan keluarga dan Kasie kesehatan ibu dan anak dinas kesehatan kabupaten Padang Pariaman, kepala puskesmas, petugas pemegang program KIA dan bidan pengelola KIA di puskesmas Sungai Limau. Hasil penelitian ini mendapatkan lebih dari separoh (53,1% bidan desa memiliki motivasi rendah, sedangkan lebih dari separoh (67,3% bidan koordinator sudah melakukan supervisi  ke bidan desa dan pada umumnya (91,8% responden memiliki cakupan K4 yang rendah. Tidak terdapat hubungan antara motivasi bidan desa dan supervisi bidan koordinator dengan cakupan antenatal care K4 (p < 0.05. Cakupan antenatal care K4 di Kabupaten Padang Pariaman belum berhasil karena kurangnya peran aktif bidan desa di tengah masyarakat, monitoring dan evaluasi dari dinas kesehatan dan pimpinan puskesmas serta supervisi bidan koordinator belum optimal, serta sumber daya manusia yang belum memaksimalkan perannya dalam melaksanakan tugas ditambah masih kurangnya  kelengkapan sarana dan prasarana. Perlu optimalisasi peran dan fungsi bidan di desa dan optimalisasi kemitraan dengan berbagai pihak dalam komunitas.Kata kunci: cakupan antenatal care K4, motivasi, supervisi AbstractThe achievement of K4 (four time antenatal care target will be success with support from motivation of village midwives and routine supervision of coordinator midwives. The

  3. A Study on How to Implement an Effective Marketing and Education Program for Coordinated Care

    Science.gov (United States)

    1992-11-01

    could play. Philip Kotler and Roberta N. Clarke (1987) recognize that the role marketing plays in health care organizations varies greatly. It is...accepted by professional marketers is provided by Kotler and Clarke (1987): Marketing is the analysis, planning, implementation, and control of carefully...Gaithersburg, MD: Aspen. Kotler , P. & Clarke, R. N. (1987). Marketina for health care organizations. Englewood Cliffs, NJ: Prentice-Hall. Leebov, W. (1988

  4. The World Health Organization program for emergency surgical, obstetric, and anesthetic care: from Mongolia to the future.

    Science.gov (United States)

    Abdullah, Fizan; Troedsson, Hans; Cherian, Meena

    2011-05-01

    This special article provides an introduction to the World Health Organization (WHO) Emergency and Essential Surgical Care (EESC) program. The program was launched by the WHO in December of 2005 to address the lack of adequate surgical capacity as a global public health issue. The overall objective is to reduce death and disability from trauma, burns, pregnancy-related complications, domestic violence, disasters, and other surgically treatable conditions. The program and materials have spread to over 35 countries and focus on providing (1) basic education and training materials; (2) enhancement of surgical infrastructure at the governmental and health facility level; and (3) resources for monitoring and evaluating surgical, obstetrical, and anesthetic capacity. Additionally, a global forum for program members was established that collaborates with ministries of health, WHO country offices, nongovernmental organizations, and academia. The results of the third biennial meeting of global EESC members in Mongolia are outlined as well as future challenges.

  5. Pilot program to improve self-management of patients with heart failure by redesigning care coordination.

    Science.gov (United States)

    Shaw, Jessica D; O'Neal, Daniel J; Siddharthan, Kris; Neugaard, Britta I

    2014-01-01

    Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF). Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF. Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support) to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients. Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors. Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care.

  6. The effect of a community-based, primary health care exercise program on inflammatory biomarkers and hormone levels.

    Science.gov (United States)

    Papini, Camila Bosquiero; Nakamura, Priscila M; Zorzetto, Lucas P; Thompson, Janice L; Phillips, Anna C; Kokubun, Eduardo

    2014-01-01

    The aim of this study was to analyze the impact of a community-based exercise program in primary care on inflammatory biomarkers and hormone levels. The 1-year quasiexperimental study involved 13 women (mean age = 56.8 ± 11.4 years) and it was developed in two basic health care units in Rio Claro City, Brazil. The physical exercise intervention was comprised of two, 60-minute sessions/week. The inflammatory biomarkers were measured at baseline, 6 months, and 1 year. Repeated measures ANOVA analyses indicated that the intervention was effective in reducing CRP and TNFα after 1 year compared to baseline and 6 months (P exercise program can result in a decrease or maintenance of inflammatory biomarkers after 1 year, and thus has the potential to be a viable public health approach for chronic disease prevention.

  7. An impact assessment of the Child Growth, Development and Care Program in the Caribbean Region of Colombia.

    Science.gov (United States)

    Padilla, Alcides de J; Trujillo, Juan C

    2015-10-01

    This article aims to assess the impact of the Child Growth, Development and Care Program in the Caribbean region of Colombia by analyzing variables such as maternal childcare practices and indicators of the nutritional status and health of children under the age of five. To this end, the authors used the quasi-experimental technique Propensity Score Matching. Positive impacts included a decrease in acute diarrheal disease, and an increase in immunization and seeking treatment for acute respiratory infection or fever symptoms. However, the program had little influence on chronic and acute malnutrition in the region.

  8. An impact assessment of the Child Growth, Development and Care Program in the Caribbean Region of Colombia

    Directory of Open Access Journals (Sweden)

    Alcides de J. Padilla

    2015-10-01

    Full Text Available Abstract This article aims to assess the impact of the Child Growth, Development and Care Program in the Caribbean region of Colombia by analyzing variables such as maternal childcare practices and indicators of the nutritional status and health of children under the age of five. To this end, the authors used the quasi-experimental technique Propensity Score Matching. Positive impacts included a decrease in acute diarrheal disease, and an increase in immunization and seeking treatment for acute respiratory infection or fever symptoms. However, the program had little influence on chronic and acute malnutrition in the region.

  9. Medical Care Provided Under California's Workers' Compensation Program: Effects of the Reforms and Additional Opportunities to Improve the Quality and Efficiency of Care.

    Science.gov (United States)

    Wynn, Barbara O; Timbie, Justin W; Sorbero, Melony E

    2011-01-01

    Since 2004, significant changes have been made to the California workers' compensation (WC) system. The Commission on Health and Safety and Workers' Compensation (CHSWC) asked the RAND Corporation to examine the impact that these changes have on the medical care provided to injured workers. This study synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system. To improve incentives for efficiently providing medically appropriate care, California should revise its fee schedule allowances for services provided by hospitals to inpatients, freestanding ambulatory surgery centers, and physicians, create nonmonetary incentives for providing medically appropriate care in the medical provider network (MPN) context through more-selective contracting with providers and reducing medical review requirements for high-performing physicians; reduce incentives for inappropriate prescribing practices by curtailing in-office physician dispensing; and implement pharmacy benefit network regulations. To increase accountability for performance, California should revise the MPN certification process to place accountability for meeting MPN standards on the entity contracting with the physician network; strengthen Division of Workers' Compensation (DWC) authorities to provide intermediate sanctions for failure to comply with MPN requirements; and modify the Labor Code to remove payers and MPNs from the definition of individually identifiable data so that performance on key measures can be publicly available. To facilitate monitoring and oversight, California should provide DWC with more flexibility to add needed data elements to medical data reporting and provide penalties for a claim administrator failing to comply with the data-reporting requirements; require that medical cost

  10. Integrating a Suicide Prevention Program into the Primary Health Care Network: A Field Trial Study in Iran

    Directory of Open Access Journals (Sweden)

    Seyed Kazem Malakouti

    2015-01-01

    Full Text Available Objective. To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion. Methodology. This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases. Results. We identified a higher prevalence of depressive disorders in the intervention site versus the control site (χ2=14.8, P<0.001. We also found a reduction in the rate of suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites. Conclusion. Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas.

  11. Evaluation of the MoleMateTM training program for assessment of suspicious pigmented lesions in primary care

    Directory of Open Access Journals (Sweden)

    Annabel Wood

    2008-05-01

    Conclusion The MoleMateTM training program is a potentially effective and acceptable informatics tool to teach practitioners to recognise the features of SPLs identified by the MoleMateTM system. It will be used as part of the intervention in a randomised controlled trial to compare the diagnostic accuracy and appropriate referral rates of practitioners using the MoleMateTM system with best practice in primary care.

  12. 78 FR 42778 - Medicare Program; Comprehensive ESRD Care Initiative; Extension of the Submission Deadlines for...

    Science.gov (United States)

    2013-07-17

    ... beneficiaries with ESRD regarding the functional status, quality of life, and overall well-being, as well as... improve care for beneficiaries with end-stage renal disease (ESRD). To promote seamless and integrated... quality of care for this population, while lowering total per-capita expenditures under the...

  13. 78 FR 48688 - Medicare Program; Comprehensive ESRD Care Initiative; Extension of the Submission Deadlines for...

    Science.gov (United States)

    2013-08-09

    ... outcomes for beneficiaries with ESRD regarding the functional status, quality of life, and overall well... models designed to improve care for beneficiaries with end-stage renal disease (ESRD). To promote... coordination and quality of care for this population, while lowering total per-capita expenditures under...

  14. Adolescents' Perceptions of Teachers' Caring and Achievement Press Related to Sex, Track, Program, and Achievement.

    Science.gov (United States)

    Bender, David S.

    A group of 3,000 7th through 12th graders were surveyed to investigate their perceptions of how much teachers cared about them and the degree to which they felt teachers urged them to achieve. Of the adolescents surveyed, 39% felt that teachers never or rarely seem to care about them. This is a crucial dimension, since teacher warmth has been…

  15. Implementing a pediatric asthma program: enabling self-care management through education.

    Science.gov (United States)

    Navaie-Waliser, Maryam; Mersman, Cynthia; Lincoln, Priscilla

    2004-09-01

    This article provides an overview of asthma prevalence among children, presents a summary of asthma triggers based on past research, outlines the essential components of a pediatric asthma home care model implemented by a large urban home health agency, and details the types of clinical documentation needed for care plan development and monitoring of asthma in the home.

  16. Learning Self-Care Skills. Functional Programming for People with Autism: A Series.

    Science.gov (United States)

    DePalma, Valerie; Wheeler, Marci

    Many individuals with autism need systematic, intensive teaching in self-care skills due to deficits in language and attention skills, interfering behaviors, and/or sensory impairments. Teaching self-care skills should occur naturally during daily routines, in all environments. Assessments are done to determine current abilities, strengths, and…

  17. Changes in Emotional-Social Intelligence, Caring, Leadership and Moral Judgment during Health Science Education Programs

    Science.gov (United States)

    Larin, Helene; Benson, Gerry; Wessel, Jean; Martin, Lynn; Ploeg, Jenny

    2014-01-01

    In addition to having academic knowledge and clinical skills, health professionals need to be caring, ethical practitioners able to understand the emotional concerns of their patients and to effect change. The purpose of this study was to determine whether emotional-social intelligence, caring, leadership and moral judgment of health science…

  18. Child and Adult Care Food Program: Meal Pattern Revisions Related to the Healthy, Hunger-Free Kids Act of 2010. Final rule.

    Science.gov (United States)

    2016-04-25

    This final rule updates the meal pattern requirements for the Child and Adult Care Food Program to better align them with the Dietary Guidelines for Americans, as required by the Healthy, Hunger-Free Kids Act of 2010. This rule requires centers and day care homes participating in the Child and Adult Care Food Program to serve more whole grains and a greater variety of vegetables and fruit, and reduces the amount of added sugars and solid fats in meals. In addition, this final rule supports mothers who breastfeed and improves consistency with the Special Supplemental Nutrition Program for Women, Infants, and Children and with other Child Nutrition Programs. Several of the changes are extended to the National School Lunch Program, School Breakfast Program, and Special Milk Program. These changes are based on the Dietary Guidelines for Americans, science-based recommendations made by the National Academy of Medicine (formerly the Institute of Medicine of the National Academies), cost and practical considerations, and stakeholder's input. This is the first major revision of the Child and Adult Care Food Program meal patterns since the Program's inception in 1968. These improvements to the meals served in the Child and Adult Care Food Program are expected to safeguard the health of young children by ensuring healthy eating habits are developed early, and improve the wellness of adult participants.

  19. Improving the care of people with traumatic brain injury through the Neurotrauma Evidence Translation (NET program: protocol for a program of research

    Directory of Open Access Journals (Sweden)

    Green Sally E

    2012-08-01

    Full Text Available Abstract The Neurotrauma Evidence Translation (NET program was funded in 2009 to increase the uptake of research evidence in the clinical care of patients who have sustained traumatic brain injury. This paper reports the rationale and plan for this five-year knowledge translation research program. The overarching aims of the program are threefold: to improve outcomes for people with traumatic brain injury; to create a network of neurotrauma clinicians and researchers with expertise in knowledge translation and evidence-based practice; and to contribute knowledge to the field of knowledge translation research. The program comprises a series of interlinked projects spanning varying clinical environments and disciplines relevant to neurotrauma, anchored within four themes representing core knowledge translation activities: reviewing research evidence; understanding practice; developing and testing interventions for practice change; and building capacity for knowledge translation in neurotrauma. The program uses a range of different methods and study designs, including: an evidence fellowship program; conduct of and training in systematic reviews; mixed method study designs to describe and understand factors that influence current practices (e.g., semi-structured interviews and surveys; theory-based methods to develop targeted interventions aiming to change practice; a cluster randomised trial to test the effectiveness of a targeted theory-informed intervention; stakeholder involvement activities; and knowledge translation events such as consensus conferences.

  20. Improving the care of people with traumatic brain injury through the Neurotrauma Evidence Translation (NET) program: protocol for a program of research.

    Science.gov (United States)

    Green, Sally E; Bosch, Marije; McKenzie, Joanne E; O'Connor, Denise A; Tavender, Emma J; Bragge, Peter; Chau, Marisa; Pitt, Veronica; Rosenfeld, Jeffrey V; Gruen, Russell L

    2012-01-01

    The Neurotrauma Evidence Translation (NET) program was funded in 2009 to increase the uptake of research evidence in the clinical care of patients who have sustained traumatic brain injury. This paper reports the rationale and plan for this five-year knowledge translation research program. The overarching aims of the program are threefold: to improve outcomes for people with traumatic brain injury; to create a network of neurotrauma clinicians and researchers with expertise in knowledge translation and evidence-based practice; and to contribute knowledge to the field of knowledge translation research. The program comprises a series of interlinked projects spanning varying clinical environments and disciplines relevant to neurotrauma, anchored within four themes representing core knowledge translation activities: reviewing research evidence; understanding practice; developing and testing interventions for practice change; and building capacity for knowledge translation in neurotrauma. The program uses a range of different methods and study designs, including: an evidence fellowship program; conduct of and training in systematic reviews; mixed method study designs to describe and understand factors that influence current practices (e.g., semi-structured interviews and surveys); theory-based methods to develop targeted interventions aiming to change practice; a cluster randomised trial to test the effectiveness of a targeted theory-informed intervention; stakeholder involvement activities; and knowledge translation events such as consensus conferences.

  1. The Effects of a Family Support Program Including Respite Care on Parenting Stress and Family Quality of Life Perceived by Primary Caregivers of Children with Disabilities in Korea

    Science.gov (United States)

    Sung, Minjung; Park, Jiyeon

    2012-01-01

    In this study, a family support program was carried out for primary caregivers of children with disabilities. The program included respite care, recreation programs, counseling, and social support coordination based on individual needs of each family. In order to verify the intervention effects, parenting stress and family quality of life were…

  2. Improving HIV/STD Prevention in the Care of Persons Living with HIV Through a National Training Program

    Science.gov (United States)

    Burnside, Helen; Hsu, Katherine; Smock, Laura; Coury-Doniger, Patricia; Hall, Christopher; Marrazzo, Jeanne; Nagendra, Gowri; Rietmeijer, Cornelis; Rompalo, Ann; Thrun, Mark

    2014-01-01

    Abstract Persons living with HIV (PLWH) are living longer, remaining sexually active, and may continue risky sexual behaviors. As such, it is crucial for providers to ask all HIV-positive patients about behaviors related to HIV transmission and STD acquisition. The “Ask, Screen, Intervene” (ASI) curriculum was developed to increase provider knowledge, skills, and motivation to incorporate risk assessment and prevention services into the care of PLWH. The ASI curriculum was delivered to 2558 HIV-care providers at 137 sites between September 30, 2007 and December 31, 2010. Immediately post-training, participants self-reported significant gains in perceived confidence to demonstrate ASI knowledge and skills (p<0.001) and 89% agreed they would update practices as a result of the training. Three to six months post-training, 320 participants who served PLWH or supervised HIV-care providers self-reported more frequently performing ASI skills (p<0.001), and 71% self-reported greater perceived confidence than before training to perform those skills (p<0.001). Limitations include self-reported measures and a 30% response rate to the 3–6 month follow-up survey. Our findings suggest that a well-coordinated training program can reach a national audience of HIV-care providers, significantly increase self-reported capacity to incorporate HIV/STD prevention into the care of PLWH, and increase implementation of national recommendations. PMID:24428796

  3. Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

    Directory of Open Access Journals (Sweden)

    Severina Alice da Costa Uchôa

    2016-01-01

    Full Text Available Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%. Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000, availability (p=0.0000, coordination of care (p=0.0000, integration (p=0.0000 and supply (p=0.0000, verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil.

  4. Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

    Science.gov (United States)

    Uchôa, Severina Alice da Costa; Arcêncio, Ricardo Alexandre; Fronteira, Inês Santos Estevinho; Coêlho, Ardigleusa Alves; Martiniano, Claudia Santos; Brandão, Isabel Cristina Araújo; Yamamura, Mellina; Maroto, Renata Melo

    2016-01-01

    Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%). Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000), availability (p=0.0000), coordination of care (p=0.0000), integration (p=0.0000) and supply (p=0.0000), verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil. PMID:26959332

  5. Self-Care Program With Multimedia Software Support Effect on Quality of Life in Patients With Diabetes Type II

    Directory of Open Access Journals (Sweden)

    Sheikh Abumasoudi

    2015-04-01

    Full Text Available Background Different studies have shown that health level, performance statutes and quality of life in chronic patients are less than the expected level especially in patients with diabetes. Objectives The aim of this study was to investigate the effects of a self-care program with a multimedia software support on quality of life in patients with diabetes type II. Patients and Methods This study was a randomized controlled clinical trial in which 60 patients who had been referred to the diabetes clinic of Arak city were randomly divided to experimental (n = 30 and control (n = 30 groups. Diabetes Quality of Life Brief Clinical Inventory was used for determining the quality of life. Data were collected before and two months after the intervention for both groups. An educational program with equal content was conducted for both the experimental group (self-care program with multimedia software support in two sessions and control group (lecture and presentation with PowerPoint in one session. Data analysis was made by the SPSS 16 software. Results There were no significant differences between the two groups in mean scores of quality of life before the intervention (P = 0.97 while after the intervention, the difference between the two groups was significant (P = 0.029. Applying the self-care program with software support improved quality of life of the experimental group after the intervention (P < 0.0001 while there was no significant difference in mean score of quality of life in the control group after eight weeks (P = 0.051. Conclusions According to the results of this study, the examined method is a simple, cheap, effective and attractive intervention program for patients with diabetes.

  6. Retention of antiretroviral naïve patients registered in HIV care in a program clinic in Pune, India

    Directory of Open Access Journals (Sweden)

    Manisha V Ghate

    2014-01-01

    Full Text Available Background: Retention in HIV care ensures delivery of services like secondary prevention, timely initiation of treatment, support, and care on a regular basis. The data on retention in pre antiretroviral therapy (ART care in India is scanty. Materials and Methods: Antiretroviral naοve HIV-infected adult patients registered between January 2011 and March 2012 in HIV care (pre-ART were included in the study. The follow-up procedures were done as per the national guidelines. Patients who did not report to the clinic for 1 year were considered as pre-ART lost to follow-up (pre-ART LFU. They were contacted either telephonically or by home visits. Logistic regression analysis was done to find out factors associated with pre-ART loss to follow-up. Results: A total of 689 antiretroviral naοve adult patients were registered in the HIV care. Fourteen (2% patients died and 76 (11% were LFU till March 2013. The multivariate analysis showed that baseline CD4 count >350 cells/mm 3 (P < 0.01 and illiteracy (P = 0.044 were significantly associated with LFU. Of the total pre-ART LFUs, 35 (46.1% informed that they would visit the clinic at their convenient time. NGOs that referred 16 female sex workers (FSWs who were LFU (21.1% informed that they would make efforts to refer them to the clinic. Conclusion: Higher CD4 count and illiteracy were significantly associated with lower retention in pre-ART care. Developing effective "retention package" for patients and strengthening linkage strategies between key sub-population such as FSWs and ART programming will help to plug the leaky cascade in HIV care.

  7. Challenging stereotypes and changing attitudes: Improving quality of care for people with hepatitis C through Positive Speakers programs.

    Science.gov (United States)

    Brener, Loren; Wilson, Hannah; Rose, Grenville; Mackenzie, Althea; de Wit, John

    2013-01-01

    Positive Speakers programs consist of people who are trained to speak publicly about their illness. The focus of these programs, especially with stigmatised illnesses such as hepatitis C (HCV), is to inform others of the speakers' experiences, thereby humanising the illness and reducing ignorance associated with the disease. This qualitative research aimed to understand the perceived impact of Positive Speakers programs on changing audience members' attitudes towards people with HCV. Interviews were conducted with nine Positive Speakers and 16 of their audience members to assess the way in which these sessions were perceived by both speakers and the audience to challenge stereotypes and stigma associated with HCV and promote positive attitude change amongst the audience. Data were analysed using Intergroup Contact Theory to frame the analysis with a focus on whether the program met the optimal conditions to promote attitude change. Findings suggest that there are a number of vital components to this Positive Speakers program which ensures that the program meets the requirements for successful and equitable intergroup contact. This Positive Speakers program thereby helps to deconstruct stereotypes about people with HCV, while simultaneously increasing positive attitudes among audience members with the ultimate aim of improving quality of health care and treatment for people with HCV.

  8. Perceived benefits and barriers and self-efficacy affecting the attendance of health education programs among uninsured primary care patients.

    Science.gov (United States)

    Kamimura, Akiko; Nourian, Maziar M; Jess, Allison; Chernenko, Alla; Assasnik, Nushean; Ashby, Jeanie

    2016-12-01

    Lifestyle interventions have shown to be effective in improving health status, health behaviors, and self-efficacy. However, recruiting participants to health education programs and ensuring the continuity of health education for underserved populations is often challenging. The goals of this study are: to describe the attendance of health education programs; to identify stages of change to a healthy lifestyle; to determine cues to action; and to specify factors affecting perceived benefits and barriers to healthy food choices and physical activity among uninsured primary care patients. Uninsured primary care patients utilizing a free clinic (N=621) completed a self-administered survey from September to December of 2015. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of cues to action in attending health education programs. While self-efficacy increases perceived benefits and decreases perceived barriers for physical activity, it increases both perceived benefits and perceived barriers for healthy food choices. The participants who had attended health education programs did not believe that there were benefits for healthy food choices and physical activity. This study adds to the body of literature on health education for underserved populations.

  9. Children's tooth decay in a public health program to encourage low-income pregnant women to utilize dental care

    Directory of Open Access Journals (Sweden)

    Shirtcliff R Mike

    2010-02-01

    Full Text Available Abstract Background A community-based public health program to provide a dental home for women covered by the Oregon Health Plan (Medicaid in Klamath County, Oregon USA was instituted with the long-term goal to promote preventive oral care for both mothers and their new infants provided by dental managed care companies. Methods As part of the evaluation of the program, children in Klamath and comparable non-program counties were examined in their 2nd year of life to begin to determine if benefits accrued to the offspring of the mothers in Klamath County. Results Eighty-five and 58.9% of the children were caries free in the Klamath and comparison county samples, respectively (RR = 1.48, 95% CI 1.13, 1.93. The mean (SD number of teeth with any decay was .75 (2.5 in the test population and 1.6 (2.5 in the comparison population (t = 2.08, p = .04. Conclusions The assessment showed that children of mothers in the Klamath County program were about one and a half times more likely to be caries free than children in the comparison counties. Additional controlled studies are being undertaken.

  10. An intervention program to reduce the number of hospitalizations of elderly patients in a primary care clinic

    Directory of Open Access Journals (Sweden)

    Asher Maya

    2008-02-01

    Full Text Available Abstract Background The elderly population consumes a large share of medical resources in the western world. A significant portion of the expense is related to hospitalizations. Objectives To evaluate an intervention program designed to reduce the number of hospitalization of elderly patients by a more optimal allocation of resources in primary care. Methods A multidimensional intervention program was conducted that included the re-engineering of existing work processes with a focus on the management of patient problems, improving communication with outside agencies, and the establishment of a system to monitor quality of healthcare parameters. Data on the number of hospitalizations and their cost were compared before and after implementation of the intervention program. Results As a result of the intervention the mean expenditure per elderly patient was reduced by 22.5%. The adjusted number of hospitalizations/1,000 declined from 15.1 to 10.7 (29.3%. The number of adjusted hospitalization days dropped from 132 to 82 (37.9% and the mean hospitalization stay declined from 8.2 to 6.7 days (17.9%. The adjusted hospitalization cost ($/1,000 patients dropped from $32,574 to $18,624 (42.8%. The overall clinic expense, for all age groups, dropped by 9.9%. Conclusion Implementation of the intervention program in a single primary care clinic led to a reduction in hospitalizations for the elderly patient population and to a more optimal allocation of healthcare resources.

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

    Directory of Open Access Journals (Sweden)

    Fennell Mary L

    2009-09-01

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

  12. Does a competitive voucher program for adolescents improve the quality of reproductive health care? A simulated patient study in Nicaragua

    Directory of Open Access Journals (Sweden)

    Gorter Anna C

    2006-08-01

    Full Text Available Abstract Background Little is known about how sexual and reproductive (SRH health can be made accessible and appropriate to adolescents. This study evaluates the impact and sustainability of a competitive voucher program on the quality of SRH care for poor and underserved female adolescents and the usefulness of the simulated patient (SP method for such evaluation. Methods 28,711 vouchers were distributed to adolescents in disadvantaged areas of Managua that gave free-of-charge access to SRH care in 4 public, 10 non-governmental and 5 private clinics. Providers received training and guidelines, treatment protocols, and financial incentives for each adolescent attended. All clinics were visited by female adolescent SPs requesting contraception. SPs were sent one week before, during (with voucher and one month after the intervention. After each consultation they were interviewed with a standardized questionnaire. Twenty-one criteria were scored and grouped into four categories. Clinics' scores were compared using non-parametric statistical methods (paired design: before-during and before-after. Also the influence of doctors' characteristics was tested using non-parametric statistical methods. Results Some aspects of service quality improved during the voucher program. Before the program started 8 of the 16 SPs returned 'empty handed', although all were eligible contraceptive users. During the program 16/17 left with a contraceptive method (p = 0.01. Furthermore, more SPs were involved in the contraceptive method choice (13/17 vs.5/16, p = 0.02. Shared decision-making on contraceptive method as well as condom promotion had significantly increased after the program ended. Female doctors had best scores before- during and after the intervention. The improvements were more pronounced among male doctors and doctors older than 40, though these improvements did not sustain after the program ended. Conclusion This study illustrates provider

  13. 77 FR 27671 - Medicaid Program; Payments for Services Furnished by Certain Primary Care Physicians and Charges...

    Science.gov (United States)

    2012-05-11

    ... Vaccine Administration Under the Vaccines for Children Program AGENCY: Centers for Medicare & Medicaid... administration of pediatric vaccines to federally vaccine-eligible children under the Pediatric Immunization Distribution Program, more commonly known as the Vaccines for Children (VFC) program. DATES: To be...

  14. Columbia University's Competency and Evidence-based Acute Care Nurse Practitioner Program.

    Science.gov (United States)

    Curran, Christine R.; Roberts, W. Dan

    2002-01-01

    Columbia University's acute care nurse practitioner curriculum incorporates evaluation strategies and standards to assess clinical competence and foster evidence-based practice. The curriculum consists of four core courses, supporting sciences, and specialty courses. (Contains 17 references.) (SK)

  15. 45 CFR 1356.21 - Foster care maintenance payments program implementation requirements.

    Science.gov (United States)

    2010-10-01

    ... serious bodily injury to the child or another child of the parent; or, (iii) The parental rights of the... care of such foster parent, preadoptive parent, or relative caregiver. Notice of and an opportunity...

  16. Participation in Older Adult Physical Activity Programs and Risk for Falls Requiring Medical Care, Washington State, 2005–2011

    Science.gov (United States)

    Rosenberg, Dori E.; Phelan, Elizabeth A.; Fitzpatrick, Annette L.

    2015-01-01

    Introduction Physical activity is known to prevent falls; however, use of widely available exercise programs for older adults, including EnhanceFitness and Silver Sneakers, has not been examined in relation to effects on falls among program participants. We aimed to determine whether participation in EnhanceFitness or Silver Sneakers is associated with a reduced risk of falls resulting in medical care. Methods A retrospective cohort study examined a demographically representative sample from a Washington State integrated health system. Health plan members aged 65 or older, including 2,095 EnhanceFitness users, 13,576 Silver Sneakers users, and 55,127 nonusers from 2005 through 2011, were classified as consistent users (used a program ≥2 times in all years they were enrolled in the health plan during the study period); intermittent users (used a program ≥2 times in 1 or more years enrolled but not all years), or nonusers of EnhanceFitness or Silver Sneakers. The main outcome was measured as time-to-first-fall requiring inpatient or out-of-hospital medical treatment based on the International Classification of Diseases, 9th Revision, Clinical Modification, Sixth Edition and E-codes. Results In fully adjusted Cox proportional hazards models, consistent (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.63–0.88) and intermittent (HR, 0.87; 95% CI, 0.8–0.94) EnhanceFitness participation were both associated with a reduced risk of falls resulting in medical care. Intermittent Silver Sneakers participation showed a reduced risk (HR, 0.93; 95% CI, 0.90–0.97). Conclusion Participation in widely available community-based exercise programs geared toward older adults (but not specific to fall prevention) reduced the risk of medical falls. Structured programs that include balance and strength exercise, as EnhanceFitness does, may be effective in reducing fall risk. PMID:26068411

  17. Implications of Risk Evaluation and Mitigation Strategy (REMS) programs for managed care pharmacy.

    Science.gov (United States)

    Gandhi, Gaurang; Chon, Ashley; Johnson, Nik; Kidder, Phyllis A; Lee, Peter; Leung, Kevin; Ma, Ingrid; Ness, Stacey; Sampsel, Elizabeth; Schlaifer, Marissa; Seifert, Randall; Sternaman, Debora B

    2012-04-01

    In the last 2 decades, health care management has been challenged by more aggressive therapy, the increased number of specialty medications, and more stringent guidelines to monitor adverse events or health risk. To promote patient safety, various communication requirements are mandated to increase the risk awareness of patients and physicians. These include black-box warnings, "Dear Health Care Provider" letters, U.S. Food and Drug Administration (FDA) Talk Papers, MedGuides, and Risk Minimization Action Plans (RiskMAPs).

  18. Effect of self-care educational program based on Orem’s Theory on hope in patients with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Dahmardeh H

    2015-08-01

    Full Text Available Background and Objective: Multiple sclerosis (MS as one of the major causes of disability in the world, can create a sense of hopelessness in patient. Thus the application of self-care methods is very important for these patients. The current study was conducted to determine the effect of self-care educational program based on Orem’s Theory on hope in patients with Multiple sclerosis. Materials and Method: In this clinical trial study, 88 patients with multiple sclerosis who were registered in MS Association of Zahedan, were selected through convenience sampling and then randomly allocated into two intervention and control groups of 44 people in 2014-2015. Then, nine educational sessions were designed and conducted according to patients’ needs based on Orem’s Theory. The rate of implementing the program by patients was measured through a self-report checklist. The hope of patients was measured by Snyder Hope Scale before and 3 months after the intervention. Data were analyzed by SPSS 16 using independent T-test, paired t-test and Chi-square. Results: The mean of total hope score, aspects of pathway thinking and agency thinking didn’t show significant difference between two groups before and after the intervention, but the mean of change score of total hope and aspects of pathway thinking and agency thinking in intervention group was increased significantly after the educational program in compare with control group (p<0.001. Conclusion: According to the results, implementation of Orem’s self-care program can increase the hope in patients with MS. Given the limitations of the present study, further studies is recommended.

  19. Eye Care Quality and Accessibility Improvement in the Community (EQUALITY: impact of an eye health education program on patient knowledge about glaucoma and attitudes about eye care

    Directory of Open Access Journals (Sweden)

    Rhodes LA

    2016-05-01

    Full Text Available Lindsay A Rhodes,1 Carrie E Huisingh,1 Gerald McGwin Jr,1,2 Stephen T Mennemeyer,3 Mary Bregantini,4 Nita Patel,4 Jinan Saaddine,5 John E Crews,5 Christopher A Girkin,1 Cynthia Owsley11Department of Ophthalmology, School of Medicine, 2Department of Epidemiology, 3Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 4Prevent Blindness, Chicago, IL, USA; 5Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USAPurpose: To assess the impact of the education program of the Eye Care Quality and Accessibility Improvement in the Community (EQUALITY telemedicine program on at-risk patients’ knowledge about glaucoma and attitudes about eye care as well as to assess patient satisfaction with EQUALITY.Patients and methods: New or existing patients presenting for a comprehensive eye exam (CEE at one of two retail-based primary eye clinics were enrolled based on ≥1 of the following at-risk criteria for glaucoma: African Americans ≥40 years of age, Whites ≥50 years of age, diabetes, family history of glaucoma, and/or preexisting diagnosis of glaucoma. A total of 651 patients were enrolled. A questionnaire was administered prior to the patients’ CEE and prior to the patients receiving any of the evidence-based eye health education program; a follow-up questionnaire was administered 2–4 weeks later by phone. Baseline and follow-up patient responses regarding knowledge about glaucoma and attitudes about eye care were compared using McNemar’s test. Logistic regression models were used to assess the association of patient-level characteristics with improvement in knowledge and attitudes. Overall patient satisfaction was summarized.Results: At follow-up, all patient responses in the knowledge and attitude domains significantly improved from baseline (P≤0.01 for all questions. Those who were unemployed (odds

  20. The Defense and Veterans Brain Injury Center Care Coordination Program: Assessment of Program Structure, Activities, and Implementation

    Science.gov (United States)

    2013-01-01

    RCCs who provided invaluable input about the program. We also thank our colleagues Deborah Scharf, Rajeev Ramchand, Lisa Mer- edith, Mike Fisher , and...Vandana Sundaram, Dena M. Bravata, Robyn Lewis, Nancy Lin, Sally A. Kraft, Moira McKinnon, Helen Paguntalan, and Douglas K. Owens, Closing the Quality

  1. The Effects of the Transforming Care at the Bedside Program on Perceived Team Effectiveness and Patient Outcomes.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; O'Connor, Patricia; Biron, Alain; Lavigne, Geneviéve L; Fréchette, Julie; Briand, Anaïck

    The objective of the study was to document the impact of Transforming Care at the Bedside (TCAB) program on health care team's effectiveness, patient safety, and patient experience. A pretest and posttest (team effectiveness) and a time-series study design (patient experience and safety) were used. The intervention (the TCAB program) was implemented in 8 units in a multihospital academic health science center in Montreal, Quebec, Canada. The impact of TCAB interventions was measured using the Team Effectiveness (TCAB teams, n = 50), and Clostridium difficile-associated diarrhea and vancomycin-resistant Enterobacter rates (patient safety) and Hospital Consumer Assessment of Healthcare Providers and Systems (patient experience; n = 551 patients). The intervention was composed of 4 learning modules, each lasting 12 to 15 weeks of workshops held at the start of each module, combined with hands-on learning 1 day per week. Transforming Care at the Bedside teams also selected 1 key safety indicator to improve throughout the initiative. Pretest and posttest differences indicate improvement on the 5 team effectiveness subscales. Improvement in vancomycin-resistant Enterococcus rate was also detected. No significant improvement was detected for patient experience. These findings call to attention the need to support ongoing quality improvement competency development among frontline teams.

  2. Evaluation of a Specialized Yoga Program for Persons Admitted to a Complex Continuing Care Hospital: A Pilot Study

    Science.gov (United States)

    Kuluski, Kerry; Bechsgaard, Gitte; Ridgway, Jennifer; Katz, Joel

    2016-01-01

    Introduction. The purpose of this study was to evaluate a specialized yoga intervention for inpatients in a rehabilitation and complex continuing care hospital. Design. Single-cohort repeated measures design. Methods. Participants (N = 10) admitted to a rehabilitation and complex continuing care hospital were recruited to participate in a 50–60 min Hatha Yoga class (modified for wheelchair users/seated position) once a week for eight weeks, with assigned homework practice. Questionnaires on pain (pain, pain interference, and pain catastrophizing), psychological variables (depression, anxiety, and experiences with injustice), mindfulness, self-compassion, and spiritual well-being were collected at three intervals: pre-, mid-, and post-intervention. Results. Repeated measures ANOVAs revealed a significant main effect of time indicating improvements over the course of the yoga program on the (1) anxiety subscale of the Hospital Anxiety and Depression Scale, F(2,18) = 4.74, p Yoga program improves pain-related factors and psychological experiences in individuals admitted to a rehabilitation and complex continuing care hospital. PMID:28115969

  3. Evaluation of a Specialized Yoga Program for Persons Admitted to a Complex Continuing Care Hospital: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Kathryn Curtis

    2016-01-01

    Full Text Available Introduction. The purpose of this study was to evaluate a specialized yoga intervention for inpatients in a rehabilitation and complex continuing care hospital. Design. Single-cohort repeated measures design. Methods. Participants (N=10 admitted to a rehabilitation and complex continuing care hospital were recruited to participate in a 50–60 min Hatha Yoga class (modified for wheelchair users/seated position once a week for eight weeks, with assigned homework practice. Questionnaires on pain (pain, pain interference, and pain catastrophizing, psychological variables (depression, anxiety, and experiences with injustice, mindfulness, self-compassion, and spiritual well-being were collected at three intervals: pre-, mid-, and post-intervention. Results. Repeated measures ANOVAs revealed a significant main effect of time indicating improvements over the course of the yoga program on the (1 anxiety subscale of the Hospital Anxiety and Depression Scale, F(2,18 = 4.74, p<.05, and ηp2 = .35, (2 Self-Compassion Scale-Short Form, F(2,18 = 3.71, p<.05, and ηp2 = .29, and (3 Magnification subscale of the Pain Catastrophizing Scale, F(2,18 = 3. 66, p<.05, and ηp2 = .29. Discussion. The results suggest that an 8-week Hatha Yoga program improves pain-related factors and psychological experiences in individuals admitted to a rehabilitation and complex continuing care hospital.

  4. Internação domiciliar: o perfil dos pacientes assistidos pelo Programa HU em Casa Home care: profile of patients attended by a home care program

    Directory of Open Access Journals (Sweden)

    Daniella Reis Barbosa Martelli

    2011-01-01

    Full Text Available Internação domiciliar é uma modalidade de atendimento à saúde que está se transformando em uma alternativa importante para minimizar alguns dos principais problemas inerentes aos sistemas de saúde vigentes, especialmente os da rede pública. O objetivo do estudo foi descrever o perfil sociodemográfico e clínico da população assistida pelo Programa de Internação Domiciliar (PID HU em Casa do Hospital Universitário Clemente de Faria da Universidade Estadual de Montes Claros. O estudo foi descritivo e retrospectivo por meio da análise de prontuários, realizada de maio de 2005 a maio de 2008. Foram analisados 137 pacientes, sendo 75 do gênero feminino (54,7% e 62 do masculino (45,3%. O grupo de 61 a 80 anos foi mais prevalente (37,2% e 73% dos pacientes residiam em bairros periféricos do município de Montes Claros-MG. Dos agravos mais comuns na primeira internação, a pneumonia foi prevalente, 22 casos (16,1%. A maioria dos pacientes foi encaminhada ao PID pela clinica médica (84,7%, com intervalo de maior prevalência de duas a três internações (42,4%. Do total de pacientes, 120 (87,6% permaneceram internados por 16 a 30 dias e 51,8% não necessitaram passar novamente pelo PID para uma segunda internação. Com relação à resolutividade clínica, 130 (94,9% tiveram alta clínica, no PID, na primeira internação. O PID mostrou-se ser um programa de alta resolutividade, atendendo mais ao público idoso feminino, de baixa renda e com períodos de internação relativamente curtos.The home care is a modality of health care which is becoming an important alternative to minimize some of mainly relevant problems of world health, especially the public health network. This paper aimed to describe the socio-demographic and clinical population assisted by the Home Care Program HU em Casa, of the University Hospital Clemente de Faria, Universidade Estadual de Montes Claros. It is a descriptive and retrospective study analyzing

  5. [Health counseling in primary care doctors' offices: a new wind! The Health Coaching Program of the Swiss College of Primary Care Medicine].

    Science.gov (United States)

    Neuner-Jehle, Stefan; Grüninger, Ueli; Schmid, Margareta

    2014-05-14

    The Health Coaching Program facilitates health behavior counseling in all areas of primary medical care: prevention, therapy and rehabilitation, i.e. wherever the patient is the decisive agent of change. Health Coaching gives the patient the main role. The physician becomes his coach. Health Coaching offers skills training and simple algorithms with a colour-coded visual tool to assist patient and physician through the 4 steps of developing awareness, building motivation, preparing a personal health project and implementing it. Health Coaching was tested successfully by 20 family doctors during 12 months: of 1045 patients invited 91% enrolled; 37% completed all four steps; one half achieved a positive behavior change. Acceptance and feasibility were high in physicians and patients. Nationwide dissemination is now in preparation.

  6. Review of the President’s Fiscal Year 2009 Budget Request for the Defense Health Program’s Private Sector Care Budget Activity Group

    Science.gov (United States)

    2008-05-28

    2009 budget request for the Defense Health Program’s Private Sector Care BAG. To do this, we reviewed (1) DOD’s justification for the request for the... Private Sector Care BAG, including the underlying estimates and the extent to which DOD considered historical information; and (2) changes between this...develop the budget requests for the Private Sector Care BAG in fiscal years 2008 and 2009. We also interviewed officials and analyzed documents from

  7. Mobile health in China: a review of research and programs in medical care, health education, and public health.

    Science.gov (United States)

    Corpman, David W

    2013-01-01

    There are nearly 1 billion mobile phone subscribers in China. Health care providers, telecommunications companies, technology firms, and Chinese governmental organizations use existing mobile technology and social networks to improve patient-provider communication, promote health education and awareness, add efficiency to administrative practices, and enhance public health campaigns. This review of mobile health in China summarizes existing clinical research and public health text messaging campaigns while highlighting potential future areas of research and program implementation. Databases and search engines served as the primary means of gathering relevant resources. Included material largely consists of scientific articles and official reports that met predefined inclusion criteria. This review includes 10 reports of controlled studies that assessed the use of mobile technology in health care settings and 17 official reports of public health awareness campaigns that used text messaging. All source material was published between 2006 and 2011. The controlled studies suggested that mobile technology interventions significantly improved an array of health care outcomes. However, additional efforts are needed to refine mobile health research and better understand the applicability of mobile technology in China's health care settings. A vast potential exists for the expansion of mobile health in China, especially as costs decrease and increasingly sophisticated technology becomes more widespread.

  8. [THE OPINION OF MEDICAL PERSONNEL ABOUT EFFECTIVENESS OF IMPLEMENTATION OF THE PROGRAM OF HEALTH CARE MODERNIZATION AT THE LEVEL OF MULTIFIELD HOSPITAL].

    Science.gov (United States)

    Badma-Gariaev, M S

    2015-01-01

    The article presents results of analysis of opinion of physicians of Moscow large multifield hospital concerning issues of effectiveness of implementation of the Program of health care modernization and development of its material technical equipment. The issues of increasing of quality of medical care were also touched upon.

  9. Challenges to Providing End-of-Life Care to Low-Income Elders with Advanced Chronic Disease: Lessons Learned from a Model Program

    Science.gov (United States)

    Kramer, Betty J.; Auer, Casey

    2005-01-01

    Purpose: This study explored the challenges in providing end-of-life care to low-income elders with multiple comorbid chronic conditions in a fully "integrated" managed care program, and it highlighted essential recommendations. Design and Methods: A case-study design was used that involved an extensive analysis of qualitative data from five focus…

  10. Make a Move: A Comprehensive Effect Evaluation of a Sexual Harassment Prevention Program in Dutch Residential Youth Care.

    Science.gov (United States)

    van Lieshout, Sanne; Mevissen, Fraukje E F; van Breukelen, Gerard; Jonker, Marianne; Ruiter, Robert A C

    2016-06-27

    Sexual harassment-unwanted sexual comments, advances, or behaviors-and sexual violence are still prevalent worldwide, leading to a variety of physical, cognitive, and emotional problems among those being harassed. In particular, youth in care are at risk of becoming perpetrators (and victims) of sexual harassment. However, in general, there are very few interventions targeting this at-risk group, and no such programs exist in the Netherlands. To this end, a group intervention program-Make a Move-targeting determinants of sexual harassment was developed. This program was implemented and evaluated among boys (N = 177) in Dutch residential youth care (20 institutions). A pre-test, post-test, and 6-month follow-up design including an intervention and a waiting list control group with randomized assignment of institutions (cluster randomized trial) was used to measure the effects of the intervention on determinants of sexual harassment. Multilevel (mixed) regression analysis with Bonferroni correction for multiple testing (α = .005) showed no significant effects of Make a Move on determinants of sexual harassment (ps > .03, Cohen's ds < .44). Results are discussed in light of a three-way explanatory model focusing on intervention content, evaluation, and implementation as potential explanations for not finding any measurable intervention effects.

  11. The Program for the Prevention of Childhood Asthma: a specialized care program for children with wheezing or asthma in Brazil

    Science.gov (United States)

    Urrutia-Pereira, Marilyn; Avila, Jennifer; Solé, Dirceu

    2016-01-01

    Objective : To present the Programa Infantil de Prevenção de Asma (PIPA, Program for the Prevention of Childhood Asthma) and the characteristics of the patients followed in this program. Methods : Implemented in the city of Uruguaiana, Brazil, PIPA has as its target population children and adolescents ( 3 years of age, respectively. Physician-diagnosed asthma was reported in 26.5% and 82.2%, respectively. In the sample as a whole, the prevalence of passive smoking was high (> 36%), occurring during pregnancy in > 15%; > 40% of the patients had been born by cesarean section; and 30% had a mother who had had < 8 years of schooling. Conclusions : A prevention program for children with asthma is an effective strategy for controlling the disease. Knowledge of local epidemiological and environmental characteristics is essential to reducing the prevalence of the severe forms of asthma, to improving the use of health resources, and to preventing pulmonary changes that could lead to COPD in adulthood. PMID:26982040

  12. [Career planning for explanation of clinical test results and program of inspections: developing medical technologists for team medical care].

    Science.gov (United States)

    Uchida, Misuko

    2013-04-01

    Current medical care is subdivided according to medical advances, and sophistication and new techniques are necessary. In this setting, doctors and nurses have been explaining to and consulting patients about their medical examinations; however, in recent years, medical technologists have performed these duties at the start of the team's medical care. Therefore, we think it is possible for patients to receive clear and convincing explanations. Most patients cannot understand their examination data, which are written using numbers and charts, etc. Recently, the Nagano Medical Technologist Society has been developing technologists who could explain examination results to patients. This development training included hospitality and communication. The certificate of completion will be issued in March when the program starts.

  13. Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy.

    Directory of Open Access Journals (Sweden)

    Joilda Silva Nery

    2014-11-01

    Full Text Available Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP and primary health care (Family Health Program-FHP programs on new case detection rate of leprosy.We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004-2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI  =0.74-0.83 and significantly increased in municipalities with FHP coverage in the medium (72-95% (Risk Ratio 1.05; 95% CI  =1.02-1.09 and higher coverage tertiles (>95% (Risk Ratio 1.12; 95% CI  =1.08-1.17.At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.

  14. Clinical confidence following an interprofessional educational program on eating disorders for health care professionals: a qualitative analysis

    Directory of Open Access Journals (Sweden)

    Pettersen G

    2012-08-01

    Full Text Available Gunn Pettersen,1 Jan H Rosenvinge,1 Kari-Brith Thune-Larsen,2 Rolf Wynn1,31Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; 2Oslo University Hospital, Oslo, Norway; 3Division of Addictions and Specialized Services, University Hospital of North Norway, Tromsø, NorwayAbstract: There are an increasing number of educational programs to improve clinical competence and skills to treat mental disorders. For complex disorders there is also a focus on improving the quality of interprofessional work. This paper reports on interprofessional outputs of an educational program on eating disorders. A total of 207 professionals who completed the program were requested to describe up to 12 possible scenarios depicted as realistic prospects for their future work within this field. Analyzing the scenarios resulted in three categories of describing the participants' preferences: (1 interprofessional interventions and treatment; (2 the further development of competence; and (3 organization of the health care system. The findings showed that the participants were considering working across new lines in their current workplaces or crossing borders to new frontiers in the execution of competence. Our findings may be summarized into the concept of "clinical confidence." This concept has so far been understood as some kind of personal trait, disposition, or attitude. The present findings add nuances to this concept in terms of state-dependent encouragement, engagement, and a potential to act and to cross professional borders in order to better treat complex mental disorders.Keywords: interprofessional educational programs, interprofessional work, clinical confidence, eating disorders program, health care professional

  15. A Primary Care-Based Early Childhood Nutrition Intervention: Evaluation of a Pilot Program Serving Low-Income Hispanic Women.

    Science.gov (United States)

    Watt, Toni Terling; Appel, Louis; Lopez, Veronica; Flores, Bianca; Lawhon, Brittany

    2015-12-01

    Nutrition in early childhood can significantly impact physical and mental health outcomes for children. However, research on broadly defined pre/postnatal nutrition interventions is sparse. The present study is a process and outcome evaluation of a primary care-based nutrition intervention targeting low-income Hispanic women. Pregnant women enrolled in the program were in their first trimester and received services through their 6-month well child check. The program provided vouchers for fruits and vegetables from the local farmers' market, nutrition classes, cooking classes, and lactation counseling. We conducted a prospective study of program participants (n = 32) and a comparable group of women for whom the program was not available (n = 29). Panel survey data measured maternal diet, exercise, stress, depression, social support, infant feeding practices, and demographics. Outcome measures obtained from medical records included pregnancy weight gain, infant weight at 6 and 12 months, and infant development at 9 months. Findings reveal that the program was not associated with infant weights. However, despite similar profiles at baseline, women in the intervention group were more likely than women in the comparison group to have significant improvements in diet, exercise, and depression (p ≤ .05). In addition, participants were more likely to breastfeed (p = .07) and their infants were more likely to pass the ages and stages developmental screen (p = .06) than women in the comparison group. The study was limited by a lack of random assignment and small samples. However, the breadth and size of the effects suggest pre/postnatal nutrition interventions integrated into primary care warrant additional investigation.

  16. The facilitators’ point of view regarding the primary health care planning as a continuing education program

    Directory of Open Access Journals (Sweden)

    Kênia Lara Silva

    2012-09-01

    Full Text Available This is a qualitative study that aims at analyzing the Primary Health Care Strategic Planning in a continuing education process, as well as the professional’s formation to work as facilitators in it. Data was obtained through interviews with 11 nurses that had acted as the plan’s facilitators in a municipality within Belo Horizonte. The results indicate that the experience as facilitators allowed them to reflect on the work process and this practice contributed to the incorporation of new tools to the primary health care system. The participants reported the difficulties faced when conducting the experience and the gap in the professionals’ formation to act in the PHC and to put into practice the processes of continuing education on a day to day basis. In conclusion, the Planning represents an important continuing education strategy and it is significance to transform processes and practices in the primary health care service.

  17. Determinants of retention in care in an antiretroviral therapy (ART program in urban Cameroon, 2003-2005

    Directory of Open Access Journals (Sweden)

    Anne Cecile Zoung-Kanyi

    2008-07-01

    Full Text Available Background:Retention in long-term antiretroviral therapy (ART program remains a major challenge for effective management of HIV infected people in sub-Saharan Africa. Highly Active Antiretroviral Therapy (ART discontinuation raises concerns about drug resistance and could negate much of the benefit sought by ART programs. Methods:Based on existing patient records, we assessed determinants of retention in HIV care among HIV patients enrolled in an urban ART at two urban hospitals in Cameroon. Extended Cox regression procedures were used to identify significant predictors of retention in HIV care. Results:Of 455 patients, 314 (69% were women, median (IQR age and baseline CD4 cell count were respectively 36 years (30 – 43 and 110 cells/µL (39 – 177. Forty patients (9% had active tuberculosis (TB at enrollment. After a median (IQR follow-up of 18 months (10–18, 346 (75% were still in care, 8 (2% were known dead, and 101 (22% were lost to follow-up (LFU. Severe immunosuppression (CD4 cell count ≤ 50 cells/µL at baseline (aHR 2.3; 95% CI 1.4 - 3.7 and active tuberculosis upon enrollment (aHR 1.8; 95% CI 1.0 - 3.6 were independent predictors of cohort losses to follow-up within the first 6 months after HAART initiation. Conclusion:These data suggest that three-quarter of HIV patients initiated on HAART remained in care and on HAART by 18 months; however, those with compromised immunologic status at treatment initiation, and those co-infected with TB were at increased risk for being lost to follow-up within the first 6 months on treatment.

  18. Ensuring quality: a key consideration in scaling-up HIV-related point-of-care testing programs

    Science.gov (United States)

    Fonjungo, Peter N.; Osmanov, Saladin; Kuritsky, Joel; Ndihokubwayo, Jean Bosco; Bachanas, Pam; Peeling, Rosanna W.; Timperi, Ralph; Fine, Glenn; Stevens, Wendy; Habiyambere, Vincent; Nkengasong, John N.

    2016-01-01

    Objective: The objective of the WHO/US President's Emergency Plan for AIDS Relief consultation was to discuss innovative strategies, offer guidance, and develop a comprehensive policy framework for implementing quality-assured HIV-related point-of-care testing (POCT). Methods: The consultation was attended by representatives from international agencies (WHO, UNICEF, UNITAID, Clinton Health Access Initiative), United States Agency for International Development, Centers for Disease Control and Prevention/President's Emergency Plan for AIDS Relief Cooperative Agreement Partners, and experts from more than 25 countries, including policy makers, clinicians, laboratory experts, and program implementers. Main outcomes: There was strong consensus among all participants that ensuring access to quality of POCT represents one of the key challenges for the success of HIV prevention, treatment, and care programs. The following four strategies were recommended: implement a newly proposed concept of a sustainable quality assurance cycle that includes careful planning; definition of goals and targets; timely implementation; continuous monitoring; improvements and adjustments, where necessary; and a detailed evaluation; the importance of supporting a cadre of workers [e.g. volunteer quality corps (Q-Corps)] with the role to ensure that the quality assurance cycle is followed and sustained; implementation of the new strategy should be seen as a step-wise process, supported by development of appropriate policies and tools; and joint partnership under the leadership of the ministries of health to ensure sustainability of implementing novel approaches. Conclusion: The outcomes of this consultation have been well received by program implementers in the field. The recommendations also laid the groundwork for developing key policy and quality documents for the implementation of HIV-related POCT. PMID:26807969

  19. The Role of Nonphysician Consultants as Health-Care Educators in Postgraduate Programs of Anesthesiology.

    Science.gov (United States)

    Rosenberg, Henry; Polonsky, Binnie

    1990-01-01

    Advantages of using non-physician consultants in postgraduate anesthesiology training programs are presented, including using their expertise in teaching, training, curriculum design, evaluation, program planning, and interpersonal communications. Successful use of a nonphysician consultant by the Department of Anesthesiology at Hahnemann…

  20. 77 FR 74381 - Medicaid Program; Payments for Services Furnished by Certain Primary Care Physicians and Charges...

    Science.gov (United States)

    2012-12-14

    ... Vaccine Administration Under the Vaccines for Children Program; Correction AGENCY: Centers for Medicare... Vaccine Administration under the Vaccines for Children Program.'' DATES: Effective Date: The provisions of... vaccines. SUPPLEMENTARY INFORMATION: I. Background In FR Doc. 2012-26507 of November 6, 2012 (77 FR...

  1. Valued Youth Partnerships: Programs in Caring. Cross-Age Tutoring Dropout Prevention Strategies.

    Science.gov (United States)

    Intercultural Development Research Association, San Antonio, TX.

    This booklet provides information about the Valued Youth Partnership (VYP) program for dropout prevention. Begun in 1984 with the support of the Coca-Cola Company and the collaboration of the Intercultural Development Research Association, the VYP program is being implemented in the Edgewood and South San Antonio school districts in San Antonio,…

  2. Child Care in Denmark: Part I. Policies and Daytime Programs in Their Social Context.

    Science.gov (United States)

    Dubin-Snyder, Constance G.

    This study offers a description of the daytime programs and facilities serving the preschool population in Denmark, with emphasis on the types of programs offered, their administrative organization, minimum standards, scope and cost, and supply and demand. The greatest detail is given to the "bornehave" and "bornehaveklasse"…

  3. 78 FR 38594 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Science.gov (United States)

    2013-06-27

    ... requirements that an institution will have to meet in order to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or as a nursing facility (NF) in the Medicaid program. These... sections 1819(b)(2) and 1919(b)(2) of the Act, a skilled nursing facility (SNF) or nursing facility...

  4. An integrated care program to prevent work disability due to chronic low back pain: a process evaluation within a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van Mechelen Willem

    2009-11-01

    Full Text Available Abstract Background In the past decade, a considerable amount of research has been carried out to evaluate the effectiveness of innovative low back pain (LBP interventions. Although some interventions proved to be effective, they are not always applied in daily practice. To successfully implement an innovative program it is important to identify barriers and facilitators in order to change practice routine. Because usual care is not directly aimed at return to work (RTW, we evaluated an integrated care program, combining a patient-directed and a workplace-directed intervention provided by a multidisciplinary team, including a clinical occupational physician to reduce occupational disability in chronic LBP patients. The aims of this study were to describe the feasibility of the implementation of the integrated care program, to assess the satisfaction and expectations of the involved stakeholders and to describe the needs for improvement of the program. Methods Eligible for this study were patients who had been on sick leave due to chronic LBP. Data were collected from the patients, their supervisors and the involved health care professionals, by means of questionnaires and structured charts, during 3-month follow-up. Implementation, satisfaction and expectations were investigated. Results Of the 40 patients who were eligible to participate in the integrated care program, 37 patients, their supervisors and the health care professionals actually participated in the intervention. Adherence to the integrated care program was in accordance with the protocol, and the patients, their supervisors and the health care professionals were (very satisfied with the program. The role of the clinical occupational physician was of additional value in the RTW process. Time-investment was the only barrier for implementation reported by the multidisciplinary team. Conclusion The implementation of this program will not be influenced by any flaws in its application

  5. Facilitating the Collection and Dissemination of Information to Parents of Children in a Child Care Program.

    Science.gov (United States)

    de Armas, Maria P.

    To improve conditions at a nonprofit day care center serving low-income, mainly non-English-speaking families, this practicum addressed the need of recently immigrated parents to increase their knowledge of child development and available community resources. A total of 52 Hispanic parents were given materials at an information distribution area…

  6. Evaluation of communication training programs in nursing care : a review of the literature

    NARCIS (Netherlands)

    Kruijver, IPM; Kerkstra, A; Francke, AL; Bensing, JM; van de Wiel, HBM

    2000-01-01

    An important aspect of nursing care is communication with patients. Nurses' major communication tasks are not only to inform the patient about his/her disease and treatment, but also to create a therapeutically effective relationship by assessing patients' concerns, showing understanding, empathy, a

  7. 78 FR 37031 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, Premium...

    Science.gov (United States)

    2013-06-19

    ... received before the close of the comment period. 3. By express or overnight mail. You may send written... through the Exchange is in the interests of qualified individuals and qualified employers in the State or... inaccurate rate setting from 2014 through 2016. Section 1343 of the Affordable Care Act establishes...

  8. 78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-05-10

    ... Episode of Care for Acute Myocardial Infarction (AMI) Measure 7. Electronic Clinical Quality Measures 8... Osteopathic Association APR DRG All Patient Refined Diagnosis Related Group System APRN Advanced practice... percentage DRA Deficit Reduction Act of 2005, Public Law 109-171 DRG Diagnosis-related group...

  9. 78 FR 50495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-08-19

    ... Episode-of-Care for Acute Myocardial Infarction (AMI) Measure 7. Electronic Clinical Quality Measures 8... All Patient Refined Diagnosis Related Group System APRN Advanced practice registered nurse ARRA... Deficit Reduction Act of 2005, Public Law 109-171 DRG Diagnosis-related group DSH Disproportionate...

  10. Designing & Evaluating General Individual Preconception Care : - The Ready for a Baby program -

    NARCIS (Netherlands)

    S. Temel (Sevilay)

    2016-01-01

    markdownabstractPreconception Care (PCC) entails risk assessment, health promotion, counselling, and intervention. The Dutch Health Council categorized PCC into general PCC targeted at couples planning a pregnancy within the general population, and specialist PCC for couples with a known or predefin

  11. Evaluation of communication training programs in nursing care: a review of the literature

    NARCIS (Netherlands)

    Kruijver, I.P.M.; Kerkstra, A.; Francke, A.L.; Bensing, J.; Wiel, H.B.M. van de

    2000-01-01

    An important aspect of nursing care is communication with patients. Nurses’ major communication tasks are not only to inform the patient about his / her disease and treatment, but also to create a therapeutically effective relationship by assessing patients’ concerns, showing understanding, empathy,

  12. A New Standard of Care: Despite Opportunity, Gerontology Programs Face Obstacles

    Science.gov (United States)

    Fernandez, Kim

    2008-01-01

    Across the United States, there is a need for professionals who have expertise caring for aging men and women. Doctors and nurses are among the most sought after. But it is not just clinicians who are needed; a variety of professionals, from housing specialists to social workers and service administrators, also are in high demand. Many of the…

  13. 75 FR 50041 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2010-08-16

    ... New Technology Add-On Payments a. Auto Laser Interstitial Thermal Therapy (AutoLITT TM ) System b... Neutrality Adjustment for the Rural and Imputed Floors 3. Floor for Area Wage Index for Hospitals in Frontier... Affordable Care Act returning the rural floor budget neutrality to a uniform national adjustment.) Table...

  14. Staff opinions regarding the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

    NARCIS (Netherlands)

    Pal, S.M. van der; Maguire, C.M.; Cessie, S.L.; Veen, S.; Wit, J.M.; Walther, F.J.; Bruil, J.

    2007-01-01

    This study explored the opinions of (para)medical and nursing staff in two Dutch Neonatal Intensive Care Units (NICU's). A questionnaire was used that measured: a) the perceived impact of NIDCAP on several NICU conditions, b) attitudes, subjective norm, perceived behavioral control, knowledge and ab

  15. Overlaps and disconnects in reproductive health care: global policies, national programs, and the micropolitics of reproduction in northern Senegal.

    Science.gov (United States)

    Foley, Ellen E

    2007-01-01

    The International Conference on Population and Development (ICPD) held in Cairo in 1994 called for a global commitment to increasing women's agency and reproductive options by promoting a reproductive health agenda. Voluntary contraceptive use and the quality of reproductive health care have become the predominant emphases in family planning initiatives. Yet, many programs worldwide demonstrate a continued commitment to fertility reduction and slowing population growth. This article explores three arenas of contemporary discourse about reproductive health and family planning. Using Senegal as a case study, it highlights the significant overlaps and disconnects among global reproductive health policy, national priorities and programs, and the biopolitics of gender, marriage, and fertility that shape Senegalese women's reproductive behavior. The article points to the slow decline in national fertility rates to explore how family planning initiatives fail to address reproduction in the context of women's socio-economic challenges and cultural and religious fertility ideals.

  16. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    OpenAIRE

    Daniel Alyeshmerni; Froehlich, James B; Jack Lewin; Kim A Eagle

    2014-01-01

    Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how h...

  17. Expenditures for the care of HIV-infected patients in rural areas in China's antiretroviral therapy programs

    Directory of Open Access Journals (Sweden)

    Duan Song

    2011-01-01

    Full Text Available Abstract Background The Chinese government has provided health services to those infected by the human immunodeficiency virus (HIV under the acquired immunodeficiency syndrome (AIDS care policy since 2003. Detailed research on the actual expenditures and costs for providing care to patients with AIDS is needed for future financial planning of AIDS health care services and possible reform of HIV/AIDS-related policy. The purpose of the current study was to determine the actual expenditures and factors influencing costs for untreated AIDS patients in a rural area of China after initiating highly active antiretroviral therapy (HAART under the national Free Care Program (China CARES. Methods A retrospective cohort study was conducted in Yunnan and Shanxi Provinces, where HAART and all medical care are provided free to HIV-positive patients. Health expenditures and costs in the first treatment year were collected from medical records and prescriptions at local hospitals between January and June 2007. Multivariate linear regression was used to determine the factors associated with the actual expenditures in the first antiretroviral (ARV treatment year. Results Five ARV regimens are commonly used in China CARES: zidovudine (AZT + lamivudine (3TC + nevirapine (NVP, stavudine (D4T + 3TC + efavirenz (EFV, D4T + 3TC + NVP, didanosine (DDI + 3TC + NVP and combivir + EFV. The mean annual expenditure per person for ARV medications was US$2,242 (US$1 = 7 Chinese Yuan (CNY among 276 participants. The total costs for treating all adverse drug events (ADEs and opportunistic infections (OIs were US$29,703 and US$23,031, respectively. The expenses for treatment of peripheral neuritis and cytomegalovirus (CMV infections were the highest among those patients with ADEs and OIs, respectively. On the basis of multivariate linear regression, CD4 cell counts (100-199 cells/μL versus P = 0.02; and ≥200 cells/μL versus P P P = 0.04 and OIs (P = 0.02 were significantly

  18. Assessing Health Status Differences Between Veterans Affairs Home-Based Primary Care and State Medicaid Waiver Program Clients

    Science.gov (United States)

    Wharton, Tracy C.; Nnodim, Joseph; Hogikyan, Robert; Mody, Lona; James, Mary; Montagnini, Marcos; Fries, Brant E.

    2013-01-01

    Objectives Comprehensive health care for older adults is complex, involving multiple comorbidities and functional impairments of varying degrees and numbers. In response to this complexity and associated barriers to care, home-based care models have become prevalent. The home-based primary care (HBPC) model, based at a Michigan Department of Veterans Affairs Medical Center, and the Michigan Waiver Program (MWP) that includes home-based care are 2 of these. Although both models are formatted to address barriers to effective and efficient health care, there are differences in disease prevalence and functional performance between groups. The objective of this study was to explore the differences between the 2 groups, to shed some light on potential trends that could suggest areas for resource allocation by service providers. Design Using a retrospective analysis of data collected using the interRAI-home care, we examined a cross-sectional representation of clients enrolled in HBPC and MWP in 2008. Participants The HBPC sample had 89 participants. The MWP database contained 9324 participants from across the State of Michigan and were weighted to be comparable to the HBPC population in sex and age, and to simulate the HBPC sample size. Results Veterans were more independent in basic activities of daily living performance, but there was no difference in the rate of reported falls between the 2 groups. Veterans had more pain and a higher prevalence of coronary artery disease (z = 7.0; P <.001), Chronic obstructive pulmonary disease (z = 3.9; P < .001), and cancer (z = 8.5; P < .001). There was no statistically significant difference between the 2 groups in terms of the prevalence of geriatric syndromes. Scores on subscales of the interRAI-home care indicated a lower risk of serious health decline and adverse outcomes for MWP compared with HBPC clients (1.4 ± 1.1 vs 0.9 ± 0.1; z = 2.5; P = .012). Veterans receiving home-based care through the Veterans Affairs Medical

  19. Effectiveness of the introduction of a Chronic Care Model-based program for type 2 diabetes in Belgium

    Directory of Open Access Journals (Sweden)

    De Maeseneer Jan

    2010-07-01

    Full Text Available Abstract Background During a four-year action research project (2003-2007, a program targeting all type 2 diabetes patients was implemented in a well-defined geographical region in Belgium. The implementation of the program resulted in an increase of the overall Assessment of Chronic Illness Care (ACIC score from 1.45 in 2003 to 5.5 in 2007. The aim of the follow-up study in 2008 was to assess the effect of the implementation of Chronic Care Model (CCM elements on the quality of diabetes care in a country where the efforts to adapt primary care to a more chronic care oriented system are still at a starting point. Methods A quasi-experimental study design involving a control region with comparable geographical and socio-economic characteristics and health care facilities was used to evaluate the effect of the intervention in the region. In collaboration with the InterMutualistic Agency (IMA and the laboratories from both regions a research database was set up. Study cohorts in both regions were defined by using administrative data from the Sickness Funds and selected from the research database. A set of nine quality indicators was defined based on current scientific evidence. Data were analysed by an institution experienced in longitudinal data analysis. Results In total 4,174 type 2 diabetes patients were selected from the research database; 2,425 patients (52.9% women with a mean age of 67.5 from the intervention region and 1,749 patients (55.7% women with a mean age of 67.4 from the control region. At the end of the intervention period, improvements were observed in five of the nine defined quality indicators in the intervention region, three of which (HbA1c assessment, statin therapy, cholesterol target improved significantly more than in the control region. Mean HbA1c improved significantly in the intervention region (7.55 to 7.06%, but this evolution did not differ significantly (p = 0.4207 from the one in the control region (7.44 to 6

  20. Leading from the Middle: Replication of a Re-Engagement Program for Veterans with Mental Disorders Lost to Follow-Up Care

    Directory of Open Access Journals (Sweden)

    David E. Goodrich

    2012-01-01

    Full Text Available Objectives. Persons with mental disorders experience functional impairments and premature mortality. Limited continuity of care may contribute to disparities in this group. We describe the replication of an evidence-based outreach program (Re-Engage to reconnect Veterans with mental disorders into care who have dropped out of services. Methods. Using the Enhanced Replicating Effective Programs framework, population-based registries were used to identify Veterans lost-to-care, and providers used this information to determine Veteran disposition and need for care. Providers recorded Veteran preferences, health status, and care utilization, and formative process data was collected to document implementation efforts. Results. Among Veterans who dropped out of care (n=126, the mean age was 49 years, 10% were women, and 29% were African-American. Providers determined that 39% of Veterans identified for re-engagement were deceased, hospitalized, or ineligible for care. Of the remaining 68 Veterans, outreach efforts resulted in contact with 20, with 7 returning to care. Providers averaged 14.2 hours over 4 months conducting re-engagement services and reported that gaining facility leadership support and having service agreements for referrals were essential for program implementation. Conclusions. Population-level, panel management strategies to re-engage Veterans with mental disorders are potentially feasible if practices are identified to facilitate national rollout.

  1. A social pedagogy approach to residential care: balancing education and placement in the development of an innovative child welfare residential program in Ontario, Canada.

    Science.gov (United States)

    Gharabaghi, Kiaras; Groskleg, Ron

    2010-01-01

    This paper chronicles the exploration and development of a residential program of the child welfare authority of Renfrew County in Ontario, Canada. Recognizing that virtually its entire population of youth in care was failing to achieve positive outcomes in education, Renfrew County Family and Children Services embarked on a program development process that included many unique elements within the Ontario child welfare context. This process introduced the theoretical framework of social pedagogy to the provision of residential care, and it replaced the idea of psychotherapy as the primary agent of change for youth with the concept of living and learning. The result is a template for the Ottawa River Academy, a living and learning program for youth in care that exemplifies the possibilities embedded in creative thought, attention to research and evidence, and a preparedness to transcend traditional assumptions with respect to service designs and business models for residential care in child welfare.

  2. 78 FR 65045 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization...

    Science.gov (United States)

    2013-10-30

    ... accounting principles GAAS Generally accepted auditing standards GAGAS Generally accepted governmental... ] representatives, health insurance issuers, trade groups, consumer advocates, employers, and other interested... States to coordinate oversight efforts across those program areas and reduce the burden on...

  3. Electronic Health Record Vendors Reported by Health Care Providers Participating in Federal EHR Incentive Programs

    Data.gov (United States)

    U.S. Department of Health & Human Services — This public use file combines registration data compiled from two federal programs that are on-going since February 2009 – the Centers for Medicare & Medicaid...

  4. The interactive web-based program MSmonitor for self-management and multidisciplinary care in multiple sclerosis : utilization and valuation by patients

    NARCIS (Netherlands)

    Jongen, Peter Joseph; Sinnige, Ludovicus G.; van Geel, Bjoern M.; Verheul, Freek; Verhagen, Wim I.; van der Kruijk, Ruud A.; Haverkamp, Reinoud; Schrijver, Hans M.; Baart, Jacoba C.; Visser, Leo H.; Arnoldus, Edo P.; Gilhuis, Herman Jacobus; Pop, Paul; Booy, Monique; Heerings, Marco; Kool, Anton; van Noort, Esther

    2016-01-01

    Background: MSmonitor is an interactive web-based program for self-management and integrated, multidisciplinary care in multiple sclerosis. Methods: To assess the utilization and valuation by persons with multiple sclerosis, we held an online survey among those who had used the program for at least

  5. Childbirth care after the implementation of the Carioca Stork Program: the perspective of nursing

    OpenAIRE

    Ana Elisa Fernandes Lima; Leila Justino da Silva; Marianne de Lira Maia; Adriana Lenho de Figueiredo Pereira; Marcele Zveiter; Tânia Maria de Almeida Silva

    2016-01-01

    Objective: to describe the actions recommended by the Carioca Stork Program for assistance to pregnant women and identifywhether the implementation of this program had repercussions on the assistance from the perspective of the nursingteam. Methods: descriptive study with a qualitative approach, conducted in a public maternity hospital. Semi-structuredinterviews were conducted with four obstetric nurses and seven nursing auxiliaries who work at the obstetric center of thismaternity hospital. ...

  6. Patient-Centered Cancer Care Programs in Italy: Benchmarking Global Patient Education Initiatives

    OpenAIRE

    Truccolo, Ivana; Cipolat Mis, Chiara; Cervo, Silvia; Dal Maso, Luigino; Bongiovanni, Marilena; Bearz, Alessandra; Sartor, Ivana; Baldo, Paolo; Ferrarin, Emanuela; Fratino, Lucia; Mascarin, Maurizio; Roncadin, Mario; Annunziata, Maria Antonietta; Muzzatti, Barbara; Paoli, Paolo

    2015-01-01

    In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of th...

  7. Effects of palliative care training program on knowledge, attitudes, beliefs and experiences among student physiotherapists: A preliminary quasi-experimental study

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available Background: Physiotherapists play an inherent role in the multidisciplinary palliative care team. Existing knowledge, attitudes, beliefs and experiences influence their team participation in palliative care. Aims: The objective of this study was to assess the changes in knowledge, attitudes, beliefs and experiences among student physiotherapists who attended a palliative care training program. Settings and Design: Preliminary quasi-experimental study design, conducted at an academic institution. Materials and Methods: Fifty-two student physiotherapists of either gender (12 male, 40 female of age (20.51±1.78 years who attended a palliative care training program which comprised lectures and case examples of six-hours duration participated in this study. The study was performed after getting institutional approval and obtaining participants′ written informed consent. The lecture content comprised WHO definition of palliative care, spiritual aspects of life, death and healing, principles, levels and models of palliative care, and role of physiotherapists in a palliative care team. The physical therapy in palliative care-knowledge, attitudes, beliefs and experiences scale (PTiPC-KABE Scale- modified from palliative care attitudes scale were used for assessing the participants before and after the program. Statistical Analysis: Paired t-test and Wilcoxon signed rank test at 95% confidence interval using SPSS 11.5 for Windows. Results: Statistically significant differences (P<0.05 were noted for all four subscales- knowledge (7.84±4.61 points, attitudes (9.46±8.06 points, beliefs (4.88±3.29 points and experiences (15.8±11.28 points out of a total score of 104 points. Conclusions: The focus-group training program produced a significant positive change about palliative care in knowledge, attitudes, beliefs and experiences among student physiotherapists.

  8. Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

    Science.gov (United States)

    Khan, Raymond M.; Aljuaid, Maha; Aqeel, Hanan; Aboudeif, Mohammed M.; Elatwey, Shaimaa; Shehab, Rajeh; Mandourah, Yasser; Maghrabi, Khalid; Hawa, Hassan; Khalid, Imran; Qushmaq, Ismael; Latif, Asad; Chang, Bickey; Berenholtz, Sean M.; Tayar, Sultan; Al-Harbi, Khloud; Yousef, Amin; Amr, Anas A.; Arabi, Yaseen M.

    2017-01-01

    Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia. PMID:28197216

  9. Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Raymond M Khan

    2017-01-01

    Full Text Available Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs. Earlier initiatives used the concept of ventilator care bundles (sets of interventions, with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization. The approach of the Comprehensive Unit-based Safety Program (CUSP was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs (a total of 271 beds in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.

  10. The role of siblings in goal achievement in residential child care programs

    Directory of Open Access Journals (Sweden)

    Eduardo Martín

    2015-04-01

    Full Text Available Within the child welfare system, when groups of siblings are placed in residential care it is recommendedto keep them together. The goal of this work is to verify whether keeping groups of siblings together inresidential care is beneficial. The sample was made up of 167 children and adolescents who lived insupervised homes; 105 (62.9% were with siblings and 62 (37.1% were alone. We analyzed the evolution oftheir scores on the monthly goal observation scale of the SERAR (Del Valle and Bravo, 2007. The resultsindicate that, in general, children who are with their siblings obtain more benefits than children who arealone, especially in the dimensions of the residential setting. Nevertheless, when stays are too long, socialinteraction within the residence worsens in the groups of siblings. These results are discussed with regardto prior research and its practical implications.

  11. Impact of a pharmaceutical care program on clinical evolution and antiretroviral treatment adherence: a 5-year study

    Directory of Open Access Journals (Sweden)

    Hernández Arroyo MJ

    2013-08-01

    Full Text Available María Jesús Hernández Arroyo,1 Salvador Enrique Cabrera Figueroa,2 Rosa Sepúlveda Correa,3 María de la Paz Valverde Merino,1 Alicia Iglesias Gómez,4 Alfonso Domínguez-Gil Hurlé5 On behalf of the Tormes Team 1Pharmacy Service, University Hospital of Salamanca, Salamanca, Spain; 2Pharmacy Institute, University Austral of Chile, Valdivia, Chile; 3Department of Statistics, University of Salamanca, Salamanca, Spain; 4Infectious Disease Service, University Hospital of Salamanca, Salamanca, Spain; 5Department of Pharmacy and Pharmaceutical Technology, University of Salamanca, Salamanca, Spain Background: Antiretroviral treatments (ART form the basis of adequate clinical control in human immunodeficiency virus-infected patients, and adherence plays a primary role in the grade and duration of the antiviral response. The objectives of this study are: (1 to determine the impact of the implementation of a pharmaceutical care program on improvement of ART adherence and on the immunovirological response of the patients; and (2 to detect possible correlations between different adherence evaluation measurements. Methods: A 60-month long retrospective study was conducted. Adherence measures used were: therapeutic drug monitoring, a simplified medication adherence questionnaire, and antiretroviral dispensation records (DR. The number of interviews and interventions related to adherence made for each patient in yearly periods was related to the changes in the adherence variable (measured with DR in these same yearly periods. The dates when the laboratory tests were drawn were grouped according to proximity with the study assessment periods (February–May, 2005–2010. Results: A total of 528 patients were included in the study. A significant relationship was observed between the simplified medication adherence questionnaire and DR over the 60-month study period (P < 0.01. Improvement was observed in the mean adherence level (P < 0.001, and there was a

  12. The Effect of a Community-Based, Primary Health Care Exercise Program on Inflammatory Biomarkers and Hormone Levels

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    Camila Bosquiero Papini

    2014-01-01

    Full Text Available The aim of this study was to analyze the impact of a community-based exercise program in primary care on inflammatory biomarkers and hormone levels. The 1-year quasiexperimental study involved 13 women (mean age = 56.8 ± 11.4 years and it was developed in two basic health care units in Rio Claro City, Brazil. The physical exercise intervention was comprised of two, 60-minute sessions/week. The inflammatory biomarkers were measured at baseline, 6 months, and 1 year. Repeated measures ANOVA analyses indicated that the intervention was effective in reducing CRP and TNFα after 1 year compared to baseline and 6 months (P<0.05. There were no changes in IL10, IL6, and insulin after 1 year. However, leptin significantly increased at 1 year (P=0.016. The major finding of this study is that a community-based exercise program can result in a decrease or maintenance of inflammatory biomarkers after 1 year, and thus has the potential to be a viable public health approach for chronic disease prevention.

  13. An Analysis of the Allocation of Funds for the Direct Health Care Provider Program (DHCPP)

    Science.gov (United States)

    1989-05-26

    RENEWAL 15 __ OPTOMET 16 __ PREVMED 25 -REQ_$ 17 __ PA $ (000) 18 __ ENLISTED 26 --- REQ_$/WY $ (000) 27 _%_WORK 28 _AMEPFUND $ (000) 29 __ FY88 Other...Nutrition Care Provider NUTRI .5329 .0154 Optometry Provider OPTOMET .3439 .0544 Preventive Med. Provider PREVMED .33/2 .0024 z Physician Assistant Prov...RAD) + .6419 (PHYSMED) + .4350 (FAMPRAC) + .3190 (SOCIAL) + .4789 (PHARM) + .5329 (NUTRI) + .3439 ( OPTOMET ) + .3372 (PREVMED) + .3758 (PA) + .3331

  14. Innovation in diabetes care: improving consumption of healthy food through a "chef coaching" program: a case report.

    Science.gov (United States)

    Polak, Rani; Dill, Diana; Abrahamson, Martin J; Pojednic, Rachele M; Phillips, Edward M

    2014-11-01

    Nutrition therapy as part of lifestyle care is recommended for people with type 2 diabetes. However, most people with diabetes do not follow this guideline. Changing eating habits involves obtaining knowledge and building practical skills such as shopping, meal preparation, and food storage. Just as fitness coaches use their specific knowledge base in fitness to enhance the effectiveness of their coaching, credentialed chefs trained as health coaches might combine their culinary expertise with coaching in order to improve clients' food choices and lifestyles. This report documents the case of a 55-year-old white male physician, single and living alone, who was recently diagnosed with type 2 diabetes and reported chronic stress, sedentary behavior, and unhealthy eating habits. He participated in a chef coaching program of 8 weekly one-on-one 30-minute coaching sessions via Skype delivered by a chef trained as a health coach. During the first five meetings, the patient's goals were primarily culinary; however, with his success in accomplishing these goals, the patient progressed and expanded his goals to include other lifestyle domains, specifically exercise and work-life balance. At the end of the program, the patient had improved both his nutritional and exercise habits, his confidence in further self-care improvement, and his health parameters such as HgA1c (8.8% to 6.7%; normal culinary skills and implement them so that they eat better and, further, has the potential to help them improve their overall self-care. We intend to further develop chef coaching and assess its potential as we learn from its implementation.

  15. Changes in Chinese Discharged Chronic Mental Patients Attending a Psychiatric Rehabilitation Program with Holistic Care Elements: A Quasi-Experimental Study

    OpenAIRE

    Luk, Andrew L.; Shek, Daniel T L

    2006-01-01

    This study attempted to examine the changes and related factors in discharged chronic mental patients attending a psychiatric rehabilitation program in Hong Kong adopting a self-help group (SHG) approach with holistic care emphases on the physical, psychological, social, and spiritual functioning of the program participants. A quasi-experimental design involving an experimental group (109 participants attending the program) and a control group (154 patients from a psychiatric outpatient clini...

  16. Program Planning for 6-12 Year-Olds in Day Care Centers: The Record of a Pilot Institute on Planning and Developing Creative Programs for School-Agers' Growth Through Play.

    Science.gov (United States)

    Eckstein, Esther

    This pamphlet offers guidelines for directors and teachers interested in providing good after-school day care programs for children 6-12 years of age. The typical school-age child served by after-school programs in New York City is described in the introduction, and the importance of creative play is emphasized. Topics include: (1) the role of the…

  17. Cost-Effectiveness and Quality of Care of a Comprehensive ART Program in Malawi.

    Science.gov (United States)

    Orlando, Stefano; Diamond, Samantha; Palombi, Leonardo; Sundaram, Maaya; Shear Zimmer, Lauren; Marazzi, Maria Cristina; Mancinelli, Sandro; Liotta, Giuseppe

    2016-05-01

    The aim of this study is to assess the cost-effectiveness of a holistic, comprehensive human immunodeficiency virus (HIV) treatment Program in Malawi.Comprehensive cost data for the year 2010 have been collected at 30 facilities from the public network of health centers providing antiretroviral treatment (ART) throughout the country; two of these facilities were operated by the Disease Relief through Excellent and Advanced Means (DREAM) program.The outcomes analysis was carried out over five years comparing two cohorts of patients on treatment: 1) 2387 patients who started ART in the two DREAM centers during 2008, 2) patients who started ART in Malawi in the same year under the Ministry of Health program.Assuming the 2010 cost as constant over the five years the cost-effective analysis was undertaken from a health sector and national perspective; a sensitivity analysis included two hypothesis of ART impact on patients' income.The total cost per patient per year (PPPY) was $314.5 for the DREAM protocol and $188.8 for the other Malawi ART sites, with 737 disability adjusted life years (DALY) saved among the DREAM program patients compared with the others. The Incremental Cost-Effectiveness Ratio was $1640 per DALY saved; it ranged between $896-1268 for national and health sector perspective respectively. The cost per DALY saved remained under $2154 that is the AFR-E-WHO regional gross domestic product per capita threshold for a program to be considered very cost-effective.HIV/acquired immune deficiency syndrome comprehensive treatment program that joins ART with laboratory monitoring, treatment adherence reinforcing and Malnutrition control can be very cost-effective in the sub-Saharan African setting.

  18. Enhancing early child care quality and learning for toddlers at risk: the responsive early childhood program.

    Science.gov (United States)

    Landry, Susan H; Zucker, Tricia A; Taylor, Heather B; Swank, Paul R; Williams, Jeffrey M; Assel, Michael; Crawford, April; Huang, Weihua; Clancy-Menchetti, Jeanine; Lonigan, Christopher J; Phillips, Beth M; Eisenberg, Nancy; Spinrad, Tracy L; de Villiers, Jill; de Villiers, Peter; Barnes, Marcia; Starkey, Prentice; Klein, Alice

    2014-02-01

    Despite reports of positive effects of high-quality child care, few experimental studies have examined the process of improving low-quality center-based care for toddler-age children. In this article, we report intervention effects on child care teachers' behaviors and children's social, emotional, behavioral, early literacy, language, and math outcomes as well as the teacher-child relationship. The intervention targeted the use of a set of responsive teacher practices, derived from attachment and sociocultural theories, and a comprehensive curriculum. Sixty-five childcare classrooms serving low-income 2- and 3-year-old children were randomized into 3 conditions: business-as-usual control, Responsive Early Childhood Curriculum (RECC), and RECC plus explicit social-emotional classroom activities (RECC+). Classroom observations showed greater gains for RECC and RECC+ teachers' responsive practices including helping children manage their behavior, establishing a predictable schedule, and use of cognitively stimulating activities (e.g., shared book reading) compared with controls; however, teacher behaviors did not differ for focal areas such as sensitivity and positive discipline supports. Child assessments demonstrated that children in the interventions outperformed controls in areas of social and emotional development, although children's performance in control and intervention groups was similar for cognitive skills (language, literacy, and math). Results support the positive impact of responsive teachers and environments providing appropriate support for toddlers' social and emotional development. Possible explanations for the absence of systematic differences in children's cognitive skills are considered, including implications for practice and future research targeting low-income toddlers.

  19. Program Evaluation of Health Care Management: Is it adjusted for Students Needs?

    Directory of Open Access Journals (Sweden)

    Fereshteh Farzianpour

    2011-01-01

    Full Text Available Problem statement: Since improving the quality of high education is the final purpose of educational evaluation and an internal evaluation can make it possible to judge the quality of high education and achieve the goal of educational systems, in this study an internal evaluation in health care management department of Allied Medical Sciences Faculty of Tehran University of Medical Sciences, which is responsible for training health care management Students, was conducted. Approach: The study was a descriptive and cross-sectional one which was done in an applied manner in health care management department in 2006. The participants in the study included the manager of the department, the members of evaluation committee (3 people, Faculty board members (5 people, all the students, graduate students (20 people and four experts. Nine questions were the tool used in the study. The questions were approved, considering reliability and validity, by means of the internal evaluation software of ministry of health, treatment and medical education. Regarding final approvement, 85- percent Cronoch,s alpha was obtained. To score the questions in the questionnaire, the researchers used likert choice scale (from completely undesirable to completely desirable. At the end, the data were analyzed using descriptive statistics and SPSS software. Results: Findings indicated that the faculty board members had the highest utility (70% and the research factor the lowest (36.6%. Conclusion: Considering the factors evaluated, the utility of the department under study was rather high. The SWOT analysis shows that the department can obtain higher scores in later evaluations.

  20. Early experience with digital advance care planning and directives, a novel consumer-driven program.

    Science.gov (United States)

    Fine, Robert L; Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-07-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digital ACP/AD tool, to achieve proportional representation of all 50 states by population size and then reviewed their responses. The 900 participants had an average age of 50.8 years (SD = 16.6); 84% of the men and 91% of the women were in self-reported good health when signing their ADs. Among the respondents, 94% wanted their physicians to consult a supportive and palliative care team if they were seriously ill; nearly 85% preferred cessation of life-sustaining treatments during their final days; 76% preferred to spend their final days at home or in a hospice; and 70% would accept attempted cardiopulmonary resuscitation in limited circumstances. Most respondents wanted an autopsy under certain conditions, and 62% wished to donate their organs. In conclusion, analysis of early experience with this ACP/AD platform demonstrates that individuals of different ages and conditions can engage in an interrogatory process about values, develop ADs that are more nuanced than traditional paper-based ADs in reflecting those values, and easily make changes to their ADs. Online ADs have the potential to remove barriers to ACP/AD and thus further improve patient-centered end-of-life care.

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

    Science.gov (United States)

    Lobis, S; Fry, D; Paxton, A

    2005-02-01

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

  2. Evaluation of Communication Training Programs in Nursing Care: A Review of the Literature.

    Science.gov (United States)

    Kruijver, Irma P. M.; Kerkstra, Ada; Francke, Anneke L.; Bensing, Jozien M.; van de Wiel, Harry B. M.

    2000-01-01

    Reviews 14 studies that focus on the evaluation of the effects of communication training programs for nurses. Results show limited or no effects on nurses' skills, on nurses' behavioral changes in practice, and on patient outcomes. The majority of the studies had a weak design. Experimental research designs should be pursued in future studies.…

  3. PRESENTATION OF A PHYSIOTHERAPY PROGRAM IN THE SCHOLARS CORPORAL CARE: EXPERIENCE REPORT

    Directory of Open Access Journals (Sweden)

    Patrícia Turra

    2012-12-01

    Full Text Available Is increasing the importance given to the full development of children by projects and actions that aim promoting health, considering the people in their family, social and community background in a multidisciplinary way. In this context, this article’s proposal consists in the presentation of a program for scholar health, by means of experience report, developed in a philanthropic institution and some primary education public schools, by the Physiotherapy college of. The program which was elaborated in the perspective of teaching, research and extention. This program has as goal to evaluate, identify, and follow scholar children’s growth and corporal development, by means of specific evaluation to investigate the sociodemographic profile, pain incidence, stature, weight,corporal flexibility, plantar impression register, evaluation by computerized photometry of corporal posture and motor development. Despite of the program been in its inicial phase it is expected consolidate the physiotherapy actuation in the places where it develops, as well as enlarge the insertion of the physiotherapist in the context of a multidisciplinary team.

  4. Continuing Care in High Schools: A Descriptive Study of Recovery High School Programs

    Science.gov (United States)

    Finch, Andrew J.; Moberg, D. Paul; Krupp, Amanda Lawton

    2014-01-01

    Data from 17 recovery high schools suggest programs are dynamic and vary in enrollment, fiscal stability, governance, staffing, and organizational structure. Schools struggle with enrollment, funding, lack of primary treatment accessibility, academic rigor, and institutional support. Still, for adolescents having received treatment for substance…

  5. "Taking Care of Business": A Study of Administrators at ACEJMC-Accredited Journalism Programs.

    Science.gov (United States)

    Applegate, Edd; Oneal, Dennis; Blake, Ken

    2001-01-01

    Provides demographic, professional, and educational information about directors, assistant directors, chairs, and heads of journalism programs accredited by the Accrediting Council on Education in Journalism and Mass Communications (ACEJMC), in an effort to provide a complete profile of these individuals. Casts some light on the individuals who…

  6. 78 FR 61197 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-10-03

    ... Purchasing (VBP) Program Adjustment Factors for FY 2014. Due to a technical error in including high cost... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND... payments for FY 2014 with the application of section 1886(r)(1) of the Act; (3) calculation of Factor 1;...

  7. 78 FR 54069 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility...

    Science.gov (United States)

    2013-08-30

    ... assisters in assisting consumers with obtaining Exchange coverage; provides for the handling consumer cases... Related to the Risk Corridors Program C. Part 155--Exchange Establishment Standards and Other Related... believe it is important that all issuers offering coverage within a State, both through the Exchanges...

  8. Caring for All Students: Empathic Design as a Driver for Innovative School Library Services and Programs

    Science.gov (United States)

    Perrault, Anne Marie; Levesque, Aimee M.

    2012-01-01

    To understand and share the feelings of students one must see the world through their lens. Empathic design includes aspects of empathy and offers a means for a practical application of the concept by encouraging organizations to put themselves into the shoes or situation of their users so as to better understand users' needs. Program evaluation…

  9. Evaluation of a structured smoking cessation program for primary care medicine

    NARCIS (Netherlands)

    Jaehne, A.; Ruether, T.; Deest, H.; Gehrig, H.; de Zeeuw, J.; Alberti, A.; Mulzer, K.

    2014-01-01

    Background: Despite the fact that 9 of 10 general practitioners in Germany believe that smoking cessation is an important topic structured programs are only rarely offered to patients. Beside a lack of time and missing reimbursement, physician's limited treatment skills are frequent reasons for this

  10. 75 FR 57039 - Medicare Program; Workshop Regarding Accountable Care Organizations, and Implications Regarding...

    Science.gov (United States)

    2010-09-17

    ..., global payments and/or capitated rates) on market power assessments; (3) ways to assess whether formation... for ACOs with both the antitrust laws and the fraud and abuse laws. The FTC and the HHS Agencies are... Act must present no risk of program or patient abuse. C. Content and Timeframe for Submission...

  11. Fetal programming and environmental exposures: Implications for prenatal care and preterm birth

    Science.gov (United States)

    Fetal programming is an enormously complex process that relies on numerous environmental inputs from uterine tissue, the placenta, the maternal blood supply, and other sources. Recent evidence has made clear that the process is not based entirely on genetics, but rather on a deli...

  12. Yoga as a Preventive Health Care Program for White and Black Elders: An Exploratory Study.

    Science.gov (United States)

    Haber, David

    1983-01-01

    Evaluated a 10-week yoga program with 61 White and 45 low-income Black elders and a control group. Results showed White elders attended class regularly, practiced daily, improved psychological well-being, and lowered their blood pressure level. Black elders attended regularly but did not practice or improve well-being. (JAC)

  13. New CPSC Standards Require Replacing All Cribs in Child Care Programs

    Science.gov (United States)

    Karolak, Eric

    2011-01-01

    Consumer Product Safety Commission (CPSC) is charged with protecting the public from unreasonable risks of injury or death from some 15,000 products, including cribs, toys, and a host of other products used in early childhood and school-age programs. Smart early childhood professionals act on those recalls promptly, working in partnership with the…

  14. Home-Based Care Program Reduces Disability And Promotes Aging In Place.

    Science.gov (United States)

    Szanton, Sarah L; Leff, Bruce; Wolff, Jennifer L; Roberts, Laken; Gitlin, Laura N

    2016-09-01

    The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program, funded by the Center for Medicare and Medicaid Innovation, aims to reduce the impact of disability among low-income older adults by addressing individual capacities and the home environment. The program, described in this innovation profile, uses an interprofessional team (an occupational therapist, a registered nurse, and a handyman) to help participants achieve goals they set. For example, it provides assistive devices and makes home repairs and modifications that enable participants to navigate their homes more easily and safely. In the period 2012-15, a demonstration project enrolled 281 adults ages sixty-five and older who were dually eligible for Medicare and Medicaid and who had difficulty performing activities of daily living (ADLs). After completing the five-month program, 75 percent of participants had improved their performance of ADLs. Participants had difficulty with an average of 3.9 out of 8.0 ADLs at baseline, compared to 2.0 after five months. Symptoms of depression and the ability to perform instrumental ADLs such as shopping and managing medications also improved. Health systems are testing CAPABLE on a larger scale. The program has the potential to improve older adults' ability to age in place.

  15. Opinions of Primary Care Family Physicians About Family Medicine Speciality Training Program

    Directory of Open Access Journals (Sweden)

    Hamit Sirri Keten

    2014-04-01

    Material and Method: A total of 170 family physicians working in Kahramanmaras were included in the study. After obtaining informed consent a questionnaire comprising questions regarding socio-demographic properties, conveying contracted family physicians as family medicine specialists and organization of the training program was applied to participants. Results: Among physicians participating in the study 130 (76.5% were male and 40 (23.5% were female, with a mean age of 40.7±7.1 (min = 26 years, max = 64 years. The mean duration of professional experience of physicians was 15.3±7.0 (min = 2 years, max = 40 years years. Of all, 91 (53.5% participants had already read the decree on family medicine specialist training program for contracted family physicians. A hundred and fifteen (67.6% family physicians supported that Family Medicine Specialty program should be taken part-time without interrupting routine medical tasks. Only 51 (30.0% participants stated the requirement of an entrance examination (TUS for family medicine specialty training. Conclusion: Family medicine specialty training program towards family physicians should be considered in the light of scientific criteria. In family medicine, an area exhibited a holistic approach to the patient; specialty training should be through residency training instead of an education program. For this purpose, family medicine departments in medical faculties should play an active role in this process. Additionally further rotations in needed branches should be implemented with a revision of area should be performed. In medicine practical training is of high importance and distant or part-time education is not appropriate, and specialist training shall be planned in accordance with the medical specialty training regulations. [Cukurova Med J 2014; 39(2.000: 298-304

  16. Canadian federalism and the Canadian health care program: a comparison of Ontario and Quebec.

    Science.gov (United States)

    Palley, H A

    1987-01-01

    The Quebec and Ontario health insurance and health service delivery systems, developed within the parameters of federal regulations and national financial subsidies, provide generally universal and comprehensive basic hospital and medical benefits and increasingly provide for the delivery of long-term care services. Within a framework of cooperative federalism, the health care systems of Ontario and Quebec have developed uniquely. In terms of vital statistics, the health of Ontario and Quebec residents generally is comparable. In viewing expenditures, Quebec has a more clearly articulated plan for providing accessible services to low-income persons and for integrating health and social services, although it has faced some difficulties in seeking to achieve the latter goal. Its plans for decentralized services are counter-balanced by a strong provincial role in health policy decision-making. Quebec's political culture also allows the province to play a stronger role in hospital planning and in the regulation of physician income than one finds in Ontario. These political dynamics allow Quebec an advantage in control of costs. In Ontario, in spite of some recent setbacks, physician interests and hospital sector interests play a more active role in health system bargaining and are usually able to influence remuneration and resource allocation decisions more than physician interests and hospital sector interests in Quebec.

  17. The person-trade-off approach to valuing health care programs.

    Science.gov (United States)

    Nord, E

    1995-01-01

    The person-trade-off technique is a way of estimating the social values of different health care interventions. Basically it consists in asking people how many outcomes of one kind they consider equivalent in social value to X outcomes of another kind. The paper outlines a number of the author's previous studies using the technique. The studies suggest that while the technique is theoretically appealing for resource-allocation purposes, it is in practice quite demanding. It needs to be applied in fairly large groups of subjects to keep random measurement error at an acceptable level. Possible framing effects include the effects of argument presentation and the choice of start points in numerical exercises. To control for these effects, it seems important to take subjects through a multistep procedure, in which they are induced to carefully consider the various arguments that might be relevant in each exercise and to reconsider initial responses in the light of their implications. The investigator must also think through which decision context he or she wishes to study and make his or her choice of context very clear when reporting the results. In spite of these problems, the person-trade-off technique deserves greater attention in the field of cost-utility analysis.

  18. The NADI program and the JOICFP integrated project: partners in delivering primary health care.

    Science.gov (United States)

    Arshat, H; Othman, R; Kuan Lin Chee; Abdullah, M

    1985-10-01

    The NADI program (pulse in Malay) was initially launched as a pilot project in 1980 in Kuala Lumpur, Malaysia. It utilized an integrated approach involving both the government and the private sectors. By sharing resources and expertise, and by working together, the government and the people can achieve national development faster and with better results. The agencies work through a multi-level supportive structure, at the head of which is the steering committee. The NADI teams at the field level are the focal points of services from the various agencies. Members of NADI teams also work with urban poor families as well as health groups, parents-teachers associations, and other similar groups. The policy and planning functions are carried out by the steering committee, the 5 area action committees and the community action committees, while the implementation function is carried out by the area program managers and NADI teams. The chairman of each area action committee is the head of the branch office of city hall. Using intestinal parasite control as the entry point, the NADI Integrated Family Development Program has greatly helped in expanding inter-agency cooperation and exchange of experiences by a coordinated, effective and efficient resource-mobilization. The program was later expanded to other parts of the country including the industrial and estate sectors. Services provided by NADI include: comprehensive health services to promote maternal and child health; adequate water supply, proper waste disposal, construction of latrines and providing electricity; and initiating community and family development such as community education, preschool education, vocational training, family counseling and building special facilities for recreational and educational purposes.

  19. Description and analysis of pulmonary rehabilitation care programs current state in four cities of Colombia

    OpenAIRE

    Duran-Palomino, Diana; Wilches-Luna, Esther-Cecilia; Martinez-Santa, Jaime

    2010-01-01

    Purpose: there are many studies reporting the benefits of pulmonary rehabilitation, but few of them exhibit the behavior and activities of these services. This article presents the characteristics of services, parts management and training level of team members, in addition to the variables or instruments used to measure the effectiveness and impact in these programs. Method: it was made a cross sectional convenience sample which included seven pulmonary rehabilitation services in four Colomb...

  20. Towards Excellence in Asthma Management: Final report of an eight-year program aimed at reducing care gaps in asthma management in Quebec

    Science.gov (United States)

    Boulet, Louis-Philippe; Dorval, Eileen; Labrecque, Manon; Turgeon, Michel; Montague, Terrence; Thivierge, Robert L

    2008-01-01

    BACKGROUND AND OBJECTIVES: Asthma care in Canada and around the world persistently falls short of optimal treatment. To optimize care, a systematic approach to identifying such shortfalls or ‘care gaps’, in which all stakeholders of the health care system (including patients) are involved, was proposed. METHODS: Several projects of a multipartner, multidisciplinary disease management program, developed to optimize asthma care in Quebec, was conducted in a period of eight years. First, two population maps were produced to identify regional variations in asthma-related morbidity and to prioritize interventions for improving treatment. Second, current care was evaluated in a physician-patient cohort, confirming the many care gaps in asthma management. Third, two series of peer-reviewed outcome studies, targeting high-risk populations and specific asthma care gaps, were conducted. Finally, a process to integrate the best interventions into the health care system and an agenda for further research on optimal asthma management were proposed. RESULTS: Key observations from these studies included the identification of specific patterns of noncompliance in using inhaled corticosteroids, the failure of increased access to spirometry in asthma education centres to increase the number of education referrals, the transient improvement in educational abilities of nurses involved with an asthma hotline telephone service, and the beneficial effects of practice tools aimed at facilitating the assessment of asthma control and treatment needs by general practitioners. CONCLUSIONS: Disease management programs such as Towards Excellence in Asthma Management can provide valuable information on optimal strategies for improving treatment of asthma and other chronic diseases by identifying care gaps, improving guidelines implementation and optimizing care. PMID:18818784

  1. Reduction of cardiovascular risk in patients with metabolic syndrome in a community health center after a pharmaceutical care program of pharmacotherapy follow-up

    OpenAIRE

    Camila Pedro Plaster; Danilo Travassos Melo; Veraci Boldt; Karla Oliveira dos Santos Cassaro; Fernanda Campos Rosetti Lessa; Giovanna Assis Pererira Boëchat; Nazaré Souza Bissoli; Tadeu Uggere de Andrade

    2012-01-01

    The objective of this study was to determine the impact of a pharmaceutical care (PC) program in a sample of public outpatients with metabolic syndrome (MS) who were being treated in Brazil's health system; the patients were randomized into PC or standard care. The pharmacotherapy follow-up (PF) was performed in a total of 120 patients with type 2 diabetes for 6 months. Adherence to treatment (measured with the Morisky test), negative outcomes associated with medication (NOM) and anthropometr...

  2. Cost-Utility Analysis of Three U.S. HIV Linkage and Re-engagement in Care Programs from Positive Charge.

    Science.gov (United States)

    Jain, Kriti M; Zulliger, Rose; Maulsby, Cathy; Kim, Jeeyon Janet; Charles, Vignetta; Riordan, Maura; Holtgrave, David

    2016-05-01

    Linking and retaining people living with HIV in ongoing, HIV medical care is vital for ending the U.S. HIV epidemic. Yet, 41-44 % of HIV+ individuals are out of care. In response, AIDS United initiated Positive Charge, a series of five HIV linkage and re-engagement projects around the U.S. This paper investigates whether three Positive Charge programs were cost effective and calculates a return on investment for each program. It uses standard methods of cost utility analysis and WHO-CHOICE thresholds. All three projects were found to be cost effective, and two were highly cost effective. Cost utility ratios ranged from $4439 to $137,271. These results suggest that HIV linkage to care programs are a productive and efficient use of public health funds.

  3. Nurse practitioners’ attitudes to nutritional challenges dealing with the patients’ nutritional needs and ability to care for themselves in a fast track program

    DEFF Research Database (Denmark)

    Graarup, Jytte; Pedersen, Preben Ulrich; Bjerrum, Merete

    2014-01-01

    Background: Nutrition plays an important role to the success of fast track programs, but under nutrition are still reported. Nutritional care seems to be a low priority among nurses even though it is well-known that insufficient nutrition has severe consequences for the patients. The aim...... is to report to what extent a training program has made Nutritional Nurse Practitioners aware of the nutritional care for short-term hospitalized patients, and how they deal with patients’ nutritional needs and ability to provide self-care in the context of a fast track program. Methods: Deductive content...... analysis was used to analyse data from four focus group interviews. Sixteen Nutritional Nurse Practitioners from either medical or surgery wards participated. The Nutritional Nurse Practitioners were interviewed twice. The interviews were recorded and verbally transcribed. Results: In the Nutritional Nurse...

  4. The PAMINO-project: evaluating a primary care-based educational program to improve the quality of life of palliative patients

    Directory of Open Access Journals (Sweden)

    Engeser Peter

    2007-05-01

    Full Text Available Abstract Background The care of palliative patients challenges the health care system in both quantity and quality. Especially the role of primary care givers needs to be strengthened to provide them with the knowledge and the confidence of applying an appropriate end-of-life care to palliative patients. To improve health care services for palliative patients in primary care, interested physicians in and around Heidelberg, Germany, are enabled to participate in the community-based program 'Palliative Medical Initiative North Baden (PAMINO' to improve their knowledge in dealing with palliative patients. The impact of this program on patients' health and quality of life remains to be evaluated. Methods/Design The evaluation of PAMINO is a non-randomized, controlled study. Out of the group of primary care physicians who took part in the PAMINO program, a sample of 45 physicians and their palliative patients will be compared to a sample of palliative patients of 45 physicians who did not take part in the program. Every four weeks for 6 months or until death, patients, physicians, and the patients' family caregivers in both groups answer questions to therapy strategies, quality of life (QLQ-C15-PAL, POS, pain (VAS, and burden for family caregivers (BSFC. The inclusion of physicians and patients in the study starts in March 2007. Discussion Although participating physicians value the increase in knowledge they receive from PAMINO, the effects on patients remain unclear. If the evaluation reveals a clear benefit for patients' quality of life, a larger-scale implementation of the program is considered. Trial registration: The study was registered at ‘current controlled trials (CCT’, registration number: ISRCTN78021852.

  5. Affordable Care Act Qualified Health Plan Enrollment for AIDS Drug Assistance Program Clients: Virginia's Experience and Best Practices.

    Science.gov (United States)

    McManus, Kathleen A; Rodney, Robert C; Rhodes, Anne; Bailey, Steven; Dillingham, Rebecca

    2016-09-01

    With the implementation of the Affordable Care Act (ACA) in 2014, many safety net resources, including state AIDS Drug Assistance Programs (ADAPs), incorporated ACA Qualified Health Plans (QHPs) into their healthcare delivery model. This article highlights the benefits of the ACA for persons living with HIV. It also describes the range of strategies employed by state ADAPs to enroll patients in QHPs. The Virginia ADAP ACA implementation experience is described to illustrate one ADAP's shift to purchasing QHPs in addition to providing direct medications. Virginia ADAP is in a Medicaid nonexpansion state and funds the full costs of the QHP premiums, deductibles, and medication copayments. Virginia's experience is applicable to other Medicaid nonexpansion states and to state ADAPs in Medicaid expansion states, who are looking for options for their Medicaid ineligible clients. This article provides practical details of Virginia ADAP's ACA implementation as well as insights and best practices at both the state and clinic level.

  6. Current Challenges to the United States’ AIDS Drug Assistance Program and Possible Implications of the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Kathleen A. McManus

    2013-01-01

    Full Text Available AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are the “payer of last resort” for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS. ADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased their contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living longer; the antiretroviral therapy (ART guidelines have been changed to recommend initiation of treatment for all; the United States is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding, ADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not sustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation of the Affordable Care Act (ACA. Lessons learned from the challenges associated with providing sustainable access to ART for vulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after the implementation of the ACA.

  7. Impact of a dental care program on the quality of life of children with and without caries.

    Science.gov (United States)

    Paula, Janice Simpson de; Sarracini, Karin Luciana Migliato; Ambrosano, Gláucia Maria Bovi; Pereira, Antônio Carlos; Meneghim, Marcelo de Castro; Mialhe, Fábio Luiz

    2016-12-22

    The aim of the present study was to evaluate the long-term effects of the caries treatment provided by a dental care program on changes in schoolchildren's OHRQoL. A one-year follow-up was conducted with a sample of 372 children aged 8 to 10 years which were clinically examined and divided into two matched groups according to their caries experience: dental treatment group (DTG) and group without caries (GWC). Both groups were assessed three times (at baseline, at 4 weeks, and at 1 year) using the Child Perceptions Questionnaire (CPQ8-10). The normality test was performed for the statistical analyses; the Friedman test was used for the dependent variables (longitudinal assessment repeated three times for the same group); and the Mann-Whitney test was used for the independent variables (test and control groups in each time period). There was improvement in all domains and in overall CPQ8-10 (p 0.05) were observed at baseline for overall CPQ8-10 and for the emotional well-being domain in the GWC. The comparison between groups demonstrated that OHRQoL was persistently better for the GWC (p dental caries treatment has a long-term positive impact on schoolchildren's OHRQoL, highlighting the importance of health policies that promote access to dental care for this population.

  8. A Statewide Medicaid Enhanced Prenatal and Postnatal Care Program and Infant Injuries.

    Science.gov (United States)

    Meghea, Cristian I; You, Zhiying; Roman, Lee Anne

    2015-10-01

    To compare infant injuries in the first year of life between Maternal Infant Health Program (MIHP) participants and matched comparison groups. The population was the cohort of Medicaid-insured singleton infants born in 2011 in Michigan who had continuous Medicaid insurance and survived the first year after birth (N = 51,078). Propensity score matching was used to compare participants in MIHP to matched comparison groups from among the nonparticipants. Injury episodes were defined based on Medicaid claims in the first year of life. Matched comparisons were performed using McNemar, Bowker, and Wilcoxon signed rank tests to assess the effects of program participation on infant injuries. Infants of MIHP participants were more likely to have injury episodes (11.7 vs. 10.4 %, p < 0.01) and a higher rate of episodes (126.9/1,000 infants vs. 109.6/1,000) compared to matched nonparticipants. Infants of MIHP participants were more likely to have superficial injuries (4.9 vs. 3.9 %, p < 0.01) and a higher rate of episodes related to superficial injuries (49.7/1,000 vs. 39.6/1,000), which mainly accounted for the difference in injury visits between groups. Similar results were found among those enrolled and risk-screened in the program by the 2nd pregnancy trimester and who received a dosage of at least three additional MIHP contacts when compared to matched nonparticipants. MIHP participants did not experience reductions in infant injuries in the first year of life compared to matched nonparticipants. Possible explanations may include increased health-seeking behavior of the mothers participating in MIHP or improved recognition of infant injuries that warrant medical attention.

  9. Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations--Revised Benchmark Rebasing Methodology, Facilitating Transition to Performance-Based Risk, and Administrative Finality of Financial Calculations. Final rule.

    Science.gov (United States)

    2016-06-10

    Under the Medicare Shared Savings Program (Shared Savings Program), providers of services and suppliers that participate in an Accountable Care Organization (ACO) continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. This final rule addresses changes to the Shared Savings Program, including: Modifications to the program's benchmarking methodology, when resetting (rebasing) the ACO's benchmark for a second or subsequent agreement period, to encourage ACOs' continued investment in care coordination and quality improvement; an alternative participation option to encourage ACOs to enter performance-based risk arrangements earlier in their participation under the program; and policies for reopening of payment determinations to make corrections after financial calculations have been performed and ACO shared savings and shared losses for a performance year have been determined.

  10. Provider Network Development under the Department of Defense Coordinated Care Program: A Methodology for Primary Care Network Development and Its Implementation in the San Antonio Service Area

    Science.gov (United States)

    1993-04-01

    Administration Academy of Health Sciences , U.S. Army (HSHA-MH) Fort Sam Houston, TX 78234-6100’ N1 11. SUPPLEMENTARY NOTES 12a. DISTRIBUTION/ AVAILABILITY...Dallas/Ft Worth areas. San Antonio’s largest employers include several health care related organizations: University of Texas Health Science Center... physicall Conducted by Primary Care Manager for for ages 2-6. ages over 24 months. (For well baby $15 copayment per care up to 24 months of age, see

  11. Micropolitics of the work in the Brazilian Family Health Program: do caretakers also need care?

    Directory of Open Access Journals (Sweden)

    Francisco Senna de Oliveira Neto

    2011-12-01

    Full Text Available The space of work micropolitics in the Brazilian Family Health Strategy is a scenario where the protagonism of workers and users of health services takes place. The objective of this article was to recognize and study the diverse, creative, and dynamic potential of how the activities in the Brazilian Family Health Strategy are organized and, mainly, to see the other face of the health care technology: the health of the health workers. This is a qualiquantitative exploratory study, developed by the application of instruments for the evaluation of life quality and occupational history, supported by the observation and evaluation of the daily work in a Brazilian Family Health Strategy unit in the town of Jerônimo Monteiro, state of Espírito Santo, in Brazil. The results show that, when targeting his/her own health, the health worker is more concerned about health problems and disorders already installed, neglecting the preventive aspects. Signs of organic and psychic suffering were considered as caused by work overload and by precariousness of links and work conditions. The study also showed that reflections on occupational health in the Brazilian Family Health Strategy also need to be carried out and that health prevention and promotion need to be explored by health workers. It is also important to review the path of the Brazilian Family Health Strategy under the perspective of health workers, aiming at the construction of a humanized work environment. 

  12. Application of smart phone in "Better Border Healthcare Program": A module for mother and child care

    Directory of Open Access Journals (Sweden)

    Sawang Surasak

    2010-11-01

    Full Text Available Abstract Background To assess the application of cell phone integrating into the healthcare system to improve antenatal care (ANC and expanded programme on immunization (EPI services for the under-served population in border area. Methods A module combining web-based and mobile technology was developed to generate ANC/EPI visit schedule dates in which the healthcare personnel can cross-check, identify and update the mother's ANC and child's EPI status at the healthcare facility or at the household location when performing home visit; with additional feature of sending appointment reminder directly to the scheduled mother in the community. Results The module improved ANC/EPI coverage in the study area along the country border including for both Thai and non-Thai mothers and children who were either permanent resident or migrants; numbers of ANC and EPI visit on-time as per schedule significantly increased; there was less delay of antenatal visits and immunizations. Conclusions The module integrated and functioned successfully as part of the healthcare system; it is proved for its feasibility and the extent to which community healthcare personnel in the low resource setting could efficiently utilize it to perform their duties.

  13. Effect of Self-Efficacy Enhancing Education Program on Family Caregivers’ Competencies in Caring for Patients with mild Traumatic Brain Injury in Yogyakarta, Indonesia

    Directory of Open Access Journals (Sweden)

    Erfin Firmawati

    2015-03-01

    Full Text Available Purpose: This study was conducted to examine the effect of a self-efficacy enhancing education program on family caregivers’ competencies regarding perceived confidence and performance in caring for patients with mild TBI in Yogyakarta, Indonesia. Methods: The quasi-experimental study, two groups pre-test and post-test design was conducted. Fifty family caregivers and patients with mild TBI who met the inclusion criteria were recruited. The first 25 control group received the routine care were, while another 25 subjects in the experimental group received a self-efficacy enhancing education program developed by the researchers. The program was constructed using Bandura’s four sources of self-efficacy. The family caregivers’ perceived confidence and performance were measured by using the Perceived Confidence Questionnaire (PCQ and the Performance Questionnaire (PQ. The data were analyzed using paired t-test, independent t-test, Wilcoxon Signed Rank test, and Mann-Whitney U test. Results: The findings showed that the family caregivers who participated in the program had a higher in perceived confidence (t = 8.30, p < .05 and performance (U = .00, p < .05 in caring for patients with mild TBI upon the completion of the program. Conclusion: This study suggests the program may have contributed in improving the family caregivers’ competencies regarding perceived confidence and also influencing their performance in caring for patients with mild TBI. Therefore, this program is recommended for nurses to extend this knowledge for nursing practices and improve family caregivers’ competencies in caring for patients with mild TBI before and after discharge.

  14. Treatment outcomes in a decentralized antiretroviral therapy program: a comparison of two levels of care in north central Nigeria.

    Science.gov (United States)

    Okonkwo, Prosper; Sagay, Atiene S; Agaba, Patricia A; Yohanna, Stephen; Agbaji, Oche O; Imade, Godwin E; Banigbe, Bolanle; Adeola, Juliet; Oyebode, Tinuade A; Idoko, John A; Kanki, Phyllis J

    2014-01-01

    Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24 weeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001) and 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care.

  15. Infection surveillance and control programs in the Department of Veterans Affairs nursing home care units: a preliminary assessment.

    Science.gov (United States)

    Tsan, Linda; Hojlo, Christa; Kearns, Martha A; Davis, Chester; Langberg, Robert; Claggett, Maurice; Coughlin, Nancy; Miller, Michael; Gaynes, Robert; Gibert, Cynthia; Montgomery, Ona; Richards, Chesley; Danko, Linda; Roselle, Gary

    2006-03-01

    A survey was conducted to assess the capacity and current practices of the infection surveillance and control programs at the Department of Veterans Affairs' 130 nursing home care units (VA NHCUs) covering a total of 15,006 beds in 2003. All 130 VA NHCUs responded to the survey, although not all NHCUs answered every question. The majority of the VA NHCUs provided specialized services that might pose increased risks of infection. For every 8 to 10 VA NHCU beds, there was 1 regular-pressure or negative-pressure infection control room available. Each VA NHCU had an active ongoing infection surveillance and control program managed by highly educated infection control personnel (ICP), of which 96% had a minimum of a bachelor degree. A median of 12 hours per week of these ICP efforts was devoted to the infection surveillance and control activities. The most frequently used surveillance methods were targeted surveillance for specific infections and for specific organisms. Most VA NHCUs conducted surveillance for antibiotic-resistant organisms. However, VA NHCUs did not use a uniform set of definitions for nosocomial infections for their infection surveillance and control purposes. We conclude that VA NHCUs have a considerable infrastructure and capacity for infection surveillance and control. This information can be used to develop a nationwide VA NHCU nosocomial infection surveillance system.

  16. Improving Perinatal Mental Health Care for Women Veterans: Description of a Quality Improvement Program.

    Science.gov (United States)

    Katon, Jodie G; Lewis, Lacey; Hercinovic, Selma; McNab, Amanda; Fortney, John; Rose, Susan M

    2017-02-06

    Purpose We describe results from a quality improvement project undertaken to address perinatal mental healthcare for women veterans. Description This quality improvement project was conducted in a single VA healthcare system between 2012 and 2015 and included screening for depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) three times during the perinatal period, a dedicated maternity care coordinator (MCC), an on-site clinical social worker, and an on-site obstetrician/gynecologist (Ob/gyn). Information on prior mental health diagnosis was collected by the MCC or Ob/gyn. The prevalence of perinatal depressive symptoms and receipt of mental healthcare among those with such symptoms are reported by presence of a pre-pregnancy mental health diagnosis. Assessment Of the 199 women who used VA maternity benefits between 2012 and 2015, 56% (n = 111) had at least one pre-pregnancy mental health diagnosis. Compared to those without a pre-pregnancy mental health diagnosis, those with such a diagnosis were more likely to be screened for perinatal depressive symptoms at least once (61.5% vs. 46.8%, p = 0.04). Prevalence of depressive symptoms was 46.7% among those with a pre-pregnancy mental health diagnosis and 19.2% among those without. Among those with a pre-pregnancy mental health diagnosis and depressive symptoms (n = 35), 88% received outpatient mental healthcare and 77% met with the clinical social worker. Among those without a pre-pregnancy mental health diagnosis and depressive symptoms (n = 8), none received outpatient mental healthcare, but 77.8% met with the clinical social worker. Conclusion Improving perinatal mental healthcare for women veterans requires a multidisciplinary approach, including on-site integrated mental healthcare.

  17. The way forward of Primary Care and Family Health Program in Brazil

    Directory of Open Access Journals (Sweden)

    Gustavo Diniz Ferreira Gusso

    2011-09-01

    Primary Care Assessment Tool10, ou seja, acesso, coordenação, integralidade, longitudinalidade, orientação familiar e comunitária, além de competência cultural. Não se pode exigir resultados sem estrutura e processo. Neste sentido,os principais indicadores seriam: infraestrutura da Unidade de Saúde; grau de afiliação da população (serviço considerado referência; equipes trabalhando com uma população inferior a 3.000 habitantes; profissionais que participam de um processo de educação permanente; profissionais com formação para atuar na APS, hierarquizando as diferentes modalidades com maior valorização, no caso do médico, da residência em MFC ou título de especialista em MFC; tempo dos profissionais na mesma equipe; rol de procedimentos disponibilizados pela equipe; tempo de demora para agendamento de uma consulta com o médico da equipe; e acesso a consultas do mesmo dia (acolhimento e demanda espontânea. Quanto à carga horária, se, por um lado, precisa flexibilização, nenhuma ação vai ajudar se não houver a definitiva regulação da formação, em especial na medicina, com residência para todos em médio prazo e 40% das vagas para MFC, como ocorre em praticamente todos os países que têm um sistema público de saúde universal e equânime11. A simples redução da carga horária representará a desassistência imediata de milhões de pessoas. Mais uma vez, a palavra de ordem não é flexibilização, mas sim reforma ampla com regulação. É fundamental dizer o que pode e o que não pode. Quem for se dedicar a 20 ou 30 horas, não poderia trabalhar o restante no sistema privado, mas sim cuidar da sua vida pessoal, trabalhar na gestão, pesquisa ou ensino da APS ou realizar plantões na rede do Sistema Único de Saúde (SUS. Outro item que merece destaque é a desejável escolha dos pacientes pela sua equipe. Embora a PNAB vigente não diga que é proibida tal flexibilização para usar o jargão neoliberal adotado de forma n

  18. Care priorities- Registered Nurses' clinical daily work in municipal elderly care settings.

    Science.gov (United States)

    Norell, Margaretha; Ziegert, Kristina; Kihlgren, Annica

    2013-06-01

    Common in Swedish elderly home care is that Registered Nurses work independently, and lead the care team without being a part of it. People involved in the care of the patient can be social services, physician, Registered Nurse (RN), nurses in inpatient care and family. In according to current model for nursing documentation RNs interventions is described as participation, information/education, support, environment, general care, training, observation/surveillance, special care drug administration and coordination. Time pressure is perceived as high, but the nurses have the opportunity to influence their daily work situation and make priorities. The purpose of this study was to investigate how RNs prioritise interventions in municipal elderly care settings. A quantitative descriptive method was used for the study. Data were collected during the months of April and October 2004 - 2008, using a web-based form. The nurses filled in patient's type of housing, performed interventions, and if the interventions were delegated. Interventions were described as keywords and were attributed a certain amount of time, calculated in previous time studies. The inclusion criteria were: all patients 80 years of age and older, in a municipality in south-western Sweden, who received some form of health care from a RN, or performed by non-certified staff by delegation. Results indicate that differences in priority could be observed, depending on the patient's gender, or whether the patient was living in independent or sheltered housing. Drug administration was prioritised for female patients, while coordination became a priority for patients living in ordinary housing. Support received the highest priority, regardless if the patient lived in ordinary or sheltered housing. However, it is not entirely clear what support signifies in municipal health care settings, and this issue would therefore require further investigation.

  19. Medicare Program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system changes and FY2011 rates; provider agreements and supplier approvals; and hospital conditions of participation for rehabilitation and respiratory care services; Medicaid program: accreditation for providers of inpatient psychiatric services. Final rules and interim final rule with comment period.

    Science.gov (United States)

    2010-08-16

    : We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain provisions of the Affordable Care Act and other legislation. In addition, we describe the changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital-related costs. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and setting forth the changes to the payment rates, factors, and other payment rate policies under the LTCH PPS. In addition, we are finalizing the provisions of the August 27, 2009 interim final rule that implemented statutory provisions relating to payments to LTCHs and LTCH satellite facilities and increases in beds in existing LTCHs and LTCH satellite facilities under the LTCH PPS. We are making changes affecting the: Medicare conditions of participation for hospitals relating to the types of practitioners who may provide rehabilitation services and respiratory care services; and determination of the effective date of provider agreements and supplier approvals under Medicare. We are also setting forth provisions that offer psychiatric hospitals and hospitals with inpatient psychiatric programs increased flexibility in obtaining accreditation to participate in the Medicaid program. Psychiatric hospitals and hospitals with inpatient psychiatric programs will have the choice of undergoing a State survey or of obtaining accreditation from a national accrediting organization whose hospital accreditation

  20. The residency program in social medicine of Montefiore Medical Center: 37 years of mission-driven, interdisciplinary training in primary care, population health, and social medicine.

    Science.gov (United States)

    Strelnick, A H; Swiderski, Debbie; Fornari, Alice; Gorski, Victoria; Korin, Eliana; Ozuah, Philip; Townsend, Janet M; Selwyn, Peter A

    2008-04-01

    Founded in 1970 to train physicians to practice in community health centers and underserved areas, the Residency Program in Social Medicine (RPSM) of Montefiore Medical Center, Bronx, New York, has graduated 562 board-eligible family physicians, general internists, and pediatricians whose careers fulfill this mission. The RPSM was a model for federal funding for primary care residency programs and has received Title VII grants during most of its history. The RPSM has tailored its mission and structured its curriculum to promote a community and population orientation and to provide the requisite knowledge and skills for integrating social medicine into clinical practice. Six unique hallmarks of RPSM training are (1) mission-oriented resident recruitment/selection and self-management, (2) interdisciplinary collaborative training among primary care professionals, (3) community-health-center-based and community-oriented primary care education, (4) biopsychosocial and ecological family systems curriculum, (5) the social medicine core curriculum and projects, and (6) grant support through Title VII. These hallmark curricular, training, and funding elements, in which population health is deeply embedded, have been carefully evaluated, regularly revised, and empirically validated since the program's inception. Practice outcomes for RPSM graduates as leaders in and advocates for population health and the care of underserved communities are described and discussed in this case study.

  1. Partnership for fragility bone fracture care provision and prevention program (P4Bones: study protocol for a secondary fracture prevention pragmatic controlled trial

    Directory of Open Access Journals (Sweden)

    Gaboury Isabelle

    2013-01-01

    Full Text Available Abstract Background Fractures associated with bone fragility in older adults signal the potential for secondary fracture. Fragility fractures often precipitate further decline in health and loss of mobility, with high associated costs for patients, families, society and the healthcare system. Promptly initiating a coordinated, comprehensive pharmacological bone health and falls prevention program post-fracture may improve osteoporosis treatment compliance; and reduce rates of falls and secondary fractures, and associated morbidity, mortality and costs. Methods/design This pragmatic, controlled trial at 11 hospital sites in eight regions in Quebec, Canada, will recruit community-dwelling patients over age 50 who have sustained a fragility fracture to an intervention coordinated program or to standard care, according to the site. Site study coordinators will identify and recruit 1,596 participants for each study arm. Coordinators at intervention sites will facilitate continuity of care for bone health, and arrange fall prevention programs including physical exercise. The intervention teams include medical bone specialists, primary care physicians, pharmacists, nurses, rehabilitation clinicians, and community program organizers. The primary outcome of this study is the incidence of secondary fragility fractures within an 18-month follow-up period. Secondary outcomes include initiation and compliance with bone health medication; time to first fall and number of clinically significant falls; fall-related hospitalization and mortality; physical activity; quality of life; fragility fracture-related costs; admission to a long term care facility; participants’ perceptions of care integration, expectations and satisfaction with the program; and participants’ compliance with the fall prevention program. Finally, professionals at intervention sites will participate in focus groups to identify barriers and facilitating factors for the integrated

  2. Cost-effectiveness of non-invasive assessment in the Dutch breast cancer screening program versus usual care: A randomized controlled trial

    NARCIS (Netherlands)

    Timmers, J.M.H.; Damen, J.A.A.G.; Pijnappel, R.M.; Verbeek, A.L.M.; Heeten, GJ. den; Adang, E.M.M.; Broeders, M.J.M.

    2014-01-01

    OBJECTIVE: Increased recall rates in the Dutch breast cancer screening program call for a new assessment strategy aiming to reduce unnecessary costs and anxiety. Diagnostic work-up (usual care) includes multidisciplinary hospital assessment and is similar for all recalled women, regardless of the ra

  3. Barriers and facilitators to evidence based care of type 2 diabetes patients : experiences of general practitioners participating to a quality improvement program

    NARCIS (Netherlands)

    Goderis, G.; Borgermans, L.D.A.; Mathieu, C.; Broeke, C. Van Den; Hannes, K.; Heyrman, J.; Grol, R.P.T.M.

    2009-01-01

    ABSTRACT: OBJECTIVE: To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs) who participated in an 18-month quality improvement program (QIP). This QIP was implemented to promote compliance with international guidelines. METHODS: Twenty

  4. 2 CFR 376.147 - Does an exclusion from participation in Federal health care programs under Title XI of the Social...

    Science.gov (United States)

    2010-01-01

    ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Does an exclusion from participation in Federal health care programs under Title XI of the Social Security Act affect a person's eligibility to... NONPROCUREMENT DEBARMENT AND SUSPENSION General § 376.147 Does an exclusion from participation in Federal...

  5. A Study of a University-Based Men-Only Prevention Program (Men Care): Effect on Attitudes and Behaviors Related to Sexual Violence

    Science.gov (United States)

    Liu, En-Hsien

    2010-01-01

    This study assesses the correlations of participation in a prevention program, Men Creating Attitudes for Rape-free Environments (Men CARE), and participants' attitudes and behavior toward sexual violence. The t-tests were used to determine the association, either by the intervention or the cohort, on attitudes and behaviors between the groups,…

  6. The Day Nursery Association of Cleveland, Cleveland, Ohio: A Long History of Care for Children, Involvement of Parents, and Service to the Community. Model Programs--Childhood Education.

    Science.gov (United States)

    American Institutes for Research in the Behavioral Sciences, Palo Alto, CA.

    The multi-faceted program of the Day Nursery Association of Cleveland is described in this booklet. Specific topics included are: a therapeutic nursery school, day nurseries for low-income neighborhoods, neighborhood day care homes and group centers, summer camp, and consultation services. Sources of more detailed information are provided for this…

  7. Early Childhood Care and Education and Other Family Policies and Programs in South-East Asia. Early Childhood and Family Policy Series.

    Science.gov (United States)

    Kamerman, Sheila B.

    This report describes early childhood care and education (ECCE) and other family support policies and programs in seven southeast Asian countries: Thailand, Malaysia, Philippines, Indonesia, Vietnam, Laos, and Cambodia. The report draws primarily on background country reports prepared by officials in these countries to focus on the context in…

  8. The Nordic maintenance care program--time intervals between treatments of patients with low back pain: how close and who decides?

    DEFF Research Database (Denmark)

    Sandnes, Kjerstin F; Bjørnstad, Charlotte; Leboeuf-Yde, Charlotte;

    2010-01-01

    The management of chiropractic patients with acute and chronic/persistent conditions probably differs. However, little is known on this subject. There is, for example, a dearth of information on maintenance care (MC). Thus it is not known if patients on MC are coerced to partake in a program...

  9. Effects on health care use and associated cost of a home visiting program for older people with poor health status: a randomized clinical trial in the Netherlands.

    NARCIS (Netherlands)

    Bouman, A.; Rossum, E. van; Evers, S.; Ambergen, T.; Kempen, G.; Knipschild, P.

    2008-01-01

    BACKGROUND: Home visiting programs have been developed to improve the functional abilities of older people and subsequently to reduce the use of institutional care services. The results of trials have been inconsistent and their cost-effectiveness uncertain. Home visits for a high-risk population ra

  10. Effect of an educational program in primary care: the case of lipid control in cardio-cerebrovascular prevention.

    Science.gov (United States)

    Arcoraci, V; Santoni, L; Ferrara, R; Furneri, G; Cannata, A; Sultana, J; Moretti, S; Di Luccio, A; Tari, D U; Pagliaro, C; Corrao, S; Tari, M

    2014-01-01

    Lowering blood cholesterol levels reduces the risk of coronary heart disease. However, the effect of interventions depends on the patients' adherence to treatment. Primary care plays an important role in the detection, treatment and monitoring of disease, therefore different educational programs (EP) have been implemented to improve disease management in general practice. The present study is aimed to assess whether a general practitioner auditing and feedback EP may improve dyslipidaemia management in a primary care setting and to evaluate patients' adherence to prescribed lipid-lowering treatment. The quality of cardiovascular and cerebrovascular disease prevention before and after the implementation of an EP offered to 25 general practitioners (GPs), was evaluated. Clinical and prescription data on patients receiving at least one lipid-lowering treatment was collected. To evaluate the quality of the healthcare service provided, clinical and biochemical outcomes, and drug-utilization, process indicators were set up. Adherence was evaluated before and after the EP as the "Medication Possession Ratio" (MPR). A correlation analysis was carried out to estimate the effect of the MPR in achieving pre-defined clinical end-points. Prescription data for lipid-lowering drugs was collected in a sample of 839 patients. While no differences in the achievement of blood lipid targets were observed, a slight but significant improvement of the MPR was registered after the EP (MPR >0.8=64.2% vs 60.6%, p=0.0426). Moreover, high levels of statin adherence were associated with the achievement of total blood cholesterol target (OR=3.3 for MPR >0.8 vs MPR goal (OR=3.3 for MPR >0.8 vs MPR <0.5, 95% CI:1.5-7.2). The EP partially improved the defined clinical targets; probably, a more patient-based approach could be more appropriate to achieve the defined target. Further studies are needed to identify how healthcare services can be improved.

  11. Medicare and Medicaid programs; physicians' referrals to health care entities with which they have financial relationships. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

    Science.gov (United States)

    2001-01-04

    This final rule with 90-day comment period (Phase I of this rulemaking) incorporates into regulations the provisions in paragraphs (a), (b), and (h) of section 1877 of the Social Security Act (the Act). Under section 1877, if a physician or a member of a physician's immediate family has a financial relationship with a health care entity, the physician may not make referrals to that entity for the furnishing of designated health services (DHS) under the Medicare program, unless an exception applies. The following services are DHS: clinical laboratory services; physical therapy services; occupational therapy services; radiology services, including magnetic resonance imaging, computerized axial tomography scans, and ultrasound services; radiation therapy services and supplies; durable medical equipment and supplies; parenteral and enteral nutrients, equipment, and supplies; prosthetics, orthotics, and prosthetic devices and supplies; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services. In addition, section 1877 of the Act provides that an entity may not present or cause to be presented a Medicare claim or bill to any individual, third party payer, or other entity for DHS furnished under a prohibited referral, nor may we make payment for a designated health service furnished under a prohibited referral. Paragraph (a) of section 1877 of the Act includes the general prohibition. Paragraph (b) of the Act includes exceptions that pertain to both ownership and compensation relationships, including an in-office ancillary services exception. Paragraph (h) includes definitions that are used throughout section 1877 of the Act, including the group practice definition and the definitions for each of the DHS. We intend to publish a second final rule with comment period (Phase II of this rulemaking) shortly addressing, to the extent necessary, the remaining sections of the Act. Phase II of this rulemaking will address comments

  12. Understanding palliative care.

    Science.gov (United States)

    Martin, Caren McHenry

    2006-09-01

    While most pharmacists and other health care practitioners are familiar with the programs and philosophy of hospice, they may lack a clear understanding of palliative care. Because myths and misconceptions about palliative care abound, a review of the definitions and components of palliative care can enhance the practice of all practitioners who care for patients with chronic diseases.

  13. The Nordic Maintenance Care Program - Time intervals between treatments of patients with low back pain: how close and who decides?

    Directory of Open Access Journals (Sweden)

    Leboeuf-Yde Charlotte

    2010-03-01

    Full Text Available Abstract Background The management of chiropractic patients with acute and chronic/persistent conditions probably differs. However, little is known on this subject. There is, for example, a dearth of information on maintenance care (MC. Thus it is not known if patients on MC are coerced to partake in a program of frequent treatments over a long period of time, or if they are actively involved in designing their own individualized treatment program. Objectives It was the purpose of this study to investigate how chiropractic patients with low back pain were scheduled for treatment, with special emphasis on MC. The specific research questions were: 1. How many patients are on maintenance care? 2 Are there specific patterns of intervals between treatments for patients and, if so, do they differ between MC patients and non-MC patients? 3. Who decides on the next treatment, the patient, the chiropractor or both, and are there any differences between MC patients and non-MC patients? Methods Chiropractic students, who during their summer holidays were observers in chiropractic clinics in Norway and Denmark, recorded whether patients were classified by the treating chiropractor as a MC-patient or not, dates for last and subsequent visits, and made a judgement on whether the patient or the chiropractor decided on the next appointment. Results Observers in the study were 16 out of 30 available students. They collected data on 868 patients from 15 Danish and 13 Norwegian chiropractors. Twenty-two percent and 26%, respectively, were classified as MC patients. Non-MC patients were most frequently seen within 1 week. For MC patients, the previous visit was most often 2-4 weeks prior to the actual visit, and the next appointment between 1 and 3 months. This indicates a gradual increase in intervals. The decision of the next visit was mainly made by the chiropractor, also for MC patients. However, the study samples of chiropractors appear not to be

  14. A neurobehavioral intervention incorporated into a state early intervention program is associated with higher perceived quality of care among parents of high-risk newborns.

    Science.gov (United States)

    McManus, Beth M; Nugent, J Kevin

    2014-07-01

    The purpose of this study is to compare two models of early intervention (EI) service delivery-a neurobehavioral intervention and usual care-on parents' perceived quality of EI service delivery. Families of newborns referred to EI were randomly assigned to a neurobehavioral intervention or usual care group and followed until the infant was 12 weeks corrected gestational age. The intervention group (n = 25) received a weekly neurobehavioral intervention. The usual care group (n = 13) received standard weekly home visits. Mothers completed the Home Visiting Index (HVI) measuring the quality of EI service delivery. Mixed linear regression was used to examine group differences in quality scores. The intervention group reported higher quality of care related to facilitating optimal parent-infant social interaction (mean difference = 2.17, 95% CI: 0.41, 3.92).A neurobehavioral model of service delivery can be successfully integrated into EI programming and appears to be associated with higher parent-reported perceived quality.

  15. Programas de continuidad de cuidados: el ejemplo del distrito de Chamartín de Madrid Continuity of care programs: the example of Madrid Chamartin district

    Directory of Open Access Journals (Sweden)

    Ana González Rodríguez

    2011-12-01

    Full Text Available Se presenta el programa de continuidad de cuidados del Centro de Salud Mental de Chamartín en Madrid, para ilustrar con una experiencia fuera del ámbito anglosajón donde surgen estos programas, la teoría expuesta en la primera parte acerca del surgimiento, desarrollo y filosofía de los programas de continuidad de cuidados. Se describen los recursos sanitarios, sociales y personales de los que dispone la población a la que va dirigido y la forma de intervención, con el tipo de actuaciones que se realizan. Por último, se señalan algunos riesgos en el desarrollo y mantenimiento de los programas de continuidad de cuidados.The case management program of Chamartin Mental Health Center in Madrid is presented to illustrate with an experience outside the Anglo-Saxon context, where such programs arise, the theory advanced in the first part about the emergence, development and philosophy of continuity of care programs. Finally, some risks in the development and maintenance of continuity of care programs are pointed out. The health, social and staff resources are described, and also the population to be targeted, the form of intervention and the type of actions that are performed. Finally, we point out some risks in the development and maintenance of continuity of care programs.

  16. Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria

    Directory of Open Access Journals (Sweden)

    Prosper Okonkwo

    2014-01-01

    Full Text Available Background. Decentralization of antiretroviral therapy (ART services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1% were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P<0.001 and 24 weeks (P<0.001 with similar responses at 48 weeks (P=0.11 and higher rates of viral suppression (<400 c/mL at 12 (P<0.001 and 48 weeks (P=0.03, but similar responses at 24 weeks (P=0.21. Mortality was 2.3% versus 5.0% (P<0.001 at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (P=0.001 at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care.

  17. Similar clinical outcome after unicompartmental knee arthroplasty using a conventional or accelerated care program: a randomized, controlled study of 40 patients

    DEFF Research Database (Denmark)

    Borgwardt, Lotte; Zerahn, Bo; Bliddal, Henning

    2009-01-01

    BACKGROUND AND PURPOSE Over the last 5 years, there has been increasing interest in reducing length of hospitalization (LOS) through accelerated programs. We examined the clinical outcome of patients undergoing a unicompartmental knee replacement (UKR) in an accelerated care program (A group...... within 3 months, contact with a general physician or nurse, and level of satisfaction were registered. Patients in the A group attended an information meeting. An intraarticular infiltration with Marcaine and adrenaline was used peroperatively. Patients in the C group had an epidural pump for 2 or 3 days......) compared to a conventional care program (C group). METHODS: 40 patients randomized into 2 groups were included (A group: 17 patients; C group: 23 patients). Nausea, micturition problems, lower limb dysfunction, pain (VAS), opiate consumption, Knee Society score (KSS), day of discharge, rehospitalization...

  18. Service learning in Guatemala: using qualitative content analysis to explore an interdisciplinary learning experience among students in health care professional programs

    Directory of Open Access Journals (Sweden)

    Fries KS

    2013-02-01

    Full Text Available Kathleen S Fries,1 Donna M Bowers,2 Margo Gross,3 Lenore Frost31Nursing Program, 2Department of Physical Therapy and Human Movement Science, 3Graduate Program in Occupational Therapy, College of Health Professions, Sacred Heart University, Fairfield, CT, USAIntroduction: Interprofessional collaboration among health care professionals yields improved patient outcomes, yet many students in health care programs have limited exposure to interprofessional collaboration in the classroom and in clinical and service-learning experiences. This practice gap implies that students enter their professions without valuing interprofessional collaboration and the impact it has on promoting positive patient outcomes.Aim: The aim of this study was to describe the interprofessional experiences of students in health care professional programs as they collaborated to provide health care to Guatemalan citizens over a 7-day period.Methods: In light of the identified practice gap and a commitment by college administration to fund interprofessional initiatives, faculty educators from nursing, occupational therapy, and physical therapy conducted a qualitative study to explore a service-learning initiative focused on promoting interprofessional collaboration. Students collaborated in triads (one student from each of the three disciplines to provide supervised health care to underserved Guatemalan men, women, children, and infants across a variety of community and health care settings. Eighteen students participated in a qualitative research project by describing their experience of interprofessional collaboration in a service-learning environment. Twice before arriving in Guatemala, and on three occasions during the trip, participants reflected on their experiences and provided narrative responses to open-ended questions. Qualitative content analysis methodology was used to describe their experiences of interprofessional collaboration.Results: An interprofessional service

  19. Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651

    Directory of Open Access Journals (Sweden)

    Anema Johannes R

    2007-09-01

    Full Text Available Abstract Background Chronic low back pain (LBP is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW. The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP. Methods/Design The design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam (the Netherlands. Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient's general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6

  20. Quality of life and its association with cardiovascular risk factors in a community health care program population

    Directory of Open Access Journals (Sweden)

    Luiz Mário Baptista Martinelli

    2008-01-01

    Full Text Available OBJECTIVE: To evaluate quality of life in a population that attended a specific community event on health care education, and to investigate the association of their quality of life with the presence of cardiovascular risk factors INTRODUCTION: Interest in health-related quality of life is growing worldwide as a consequence of increasing rates of chronic disease. However, little is known about the association between quality of life and cardiovascular risk factors. METHODS: This study included 332 individuals. Demographics, blood pressure, body mass index, and casual glycemia were evaluated. The brief version of the World Health Organization Quality of Life questionnaire on quality of life was given to them. The medians of the scores obtained for the physical, psychological, emotional, and environmental domains were used as cutoffs to define "higher" and "lower" scores. A multinomial logistic regression model was used to define the parameters associated with lower scores. RESULTS: Diabetes mellitus, dyslipidemia, and obesity were associated with lower scores in the physical domain. Dyslipidemia was also associeted with lower scores in the psychological domain. Male gender and regular physical activity had protective effects on quality of life. Aging was inversely associated with decreased quality of life in the environmental domain. CONCLUSION: The presence of cardiovascular risk factors is related to a decreased quality of life. Conversely, male gender and regular physical activity had protective effects on quality of life. These findings suggest that exercising should be further promoted by health-related public programs, with a special focus on women.

  1. Integrated approach to prevent functional decline in hospitalized elderly: the Prevention and Reactivation Care Program (PReCaP

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    de Vos Annemarie JBM

    2012-03-01

    Full Text Available Abstract Background Hospital related functional decline in older patients is an underestimated problem. Thirty-five procent of 70-year old patients experience functional decline during hospital admission in comparison with pre-illness baseline. This percentage increases considerably with age. Methods/design To address this issue, the Vlietland Ziekenhuis in The Netherlands has implemented an innovative program (PReCaP, aimed at reducing hospital related functional decline among elderly patients by offering interventions that are multidisciplinary, integrated and goal-oriented at the physical, social, and psychological domains of functional decline. Discussion This paper presents a detailed description of the intervention, which incorporates five distinctive elements: (1 Early identification of elderly patients with a high risk of functional decline, and if necessary followed by the start of the reactivation treatment within 48 h after hospital admission; (2 Intensive follow-up treatment for a selected patient group at the Prevention and Reactivation Centre (PRC; (3 Availability of multidisciplinary geriatric expertise; (4 Provision of support and consultation of relevant professionals to informal caregivers; (5 Intensive follow-up throughout the entire chain of care by a casemanager with geriatric expertise. Outcome and process evaluations are ongoing and results will be published in a series of future papers. Trial registration The Netherlands National Trial Register: NTR2317

  2. Exploring states of panacea and perfidy of family and community volunteerism in palliative care giving in Kanye CHBC program, Botswana

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    Simon Kangethe

    2010-01-01

    Recommendations: The study recommends: (1 Socializing boys early enough in life into care giving; (2 Offering incentives to the caregivers; (3 Use of public forums to persuade men to accept helping women in carrying out care giving duties; (4 And enlisting support of all leaders to advocate for men′s involvement in care giving.

  3. Getting it right: the impact of a continuing medical education program on hepatitis B knowledge of Australian primary care providers

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    Robotin MC

    2013-03-01

    Full Text Available Monica Robotin,1,2 Yumi Patton,3 Jacob George1,4 1School of Medicine, University of Sydney, Sydney, Australia; 2Cancer Council New South Wales, Sydney, Australia; 3Faculty of Engineering, University of New South Wales, Sydney, Australia; 4Storr Liver Unit, Westmead Millennium Institute, Westmead Hospital, Sydney, Australia Introduction: In Australia, chronic hepatitis B (CHB disproportionately affects migrants born in hepatitis B endemic countries, but its detection and management in high risk populations remains suboptimal. We piloted a primary care based program for CHB detection and management in an area of high disease prevalence in Sydney, Australia. Prior to its launch, all local general practitioners were invited to take part in a continuing medical education (CME program on hepatitis B diagnosis and management. Material and methods: Preceding each CME activity, participants completed an anonymous survey recording demographic data and hepatitis B knowledge, confidence in CHB management, and preferred CME modalities. We compared knowledge scores of first-time and repeat attendees. Results: Most participants (75% were males, spoke more than one language with their patients (91%, self-identified as Asian-Australians (91%, and had graduated over 20 years previously (69%. The majority (97% knew what patient groups require CHB and hepatocellular cancer screening, but fewer (42%–75% answered hepatitis B management and vaccination questions correctly. Knowledge scores were not significantly improved by seminar attendance and the provision of hepatitis B resources. At baseline, participants were fairly confident about their ability to screen for CHB, provide vaccinations, and manage CHB. This did not change with repeat attendances, and did not correlate with survey outcomes. Large group CMEs were the preferred learning modality. Discussion: Knowledge gaps in hepatitis B diagnosis and management translate into missed opportunities to screen for

  4. What part of the total care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs

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    Christel van Dijk

    2011-12-01

    Full Text Available Background: Disease management programs (DMP aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs.Research design and methods: Healthcare utilization for diabetes patients was analyzed using 2008 self-reported data (N=316 and data from electronic medical records (EMR (N=9023, and divided whether or not care was described in the Dutch type 2 diabetes multidisciplinary healthcare standard.Results: On average 4.3 different disciplines of healthcare providers were involved in the care for diabetes patients. 96% contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthcare standard. Only a limited part of total healthcare utilization of diabetes patients was included in the healthcare standard and therefore theoretically included in DMPs.Conclusion: Organizing the care for diabetics in a DMP might harm the coordination and quality of all healthcare for diabetics. DMPs should be integrated in the overall organization of care.

  5. What part of the total care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs

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    Christel van Dijk

    2011-12-01

    Full Text Available Background: Disease management programs (DMP aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs. Research design and methods: Healthcare utilization for diabetes patients was analyzed using 2008 self-reported data (N=316 and data from electronic medical records (EMR (N=9023, and divided whether or not care was described in the Dutch type 2 diabetes multidisciplinary healthcare standard. Results: On average 4.3 different disciplines of healthcare providers were involved in the care for diabetes patients. 96% contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthcare standard. Only a limited part of total healthcare utilization of diabetes patients was included in the healthcare standard and therefore theoretically included in DMPs. Conclusion: Organizing the care for diabetics in a DMP might harm the coordination and quality of all healthcare for diabetics. DMPs should be integrated in the overall organization of care.

  6. What part of the total care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs

    Science.gov (United States)

    van Dijk, Christel E.; Verheij, Robert A.; Swinkels, Ilse C.S.; Rijken, Mieke; Schellevis, François G.; Groenewegen, Peter P.; de Bakker, Dinny H.

    2011-01-01

    Background Disease management programs (DMP) aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs. Research design and methods Healthcare utilization for diabetes patients was analyzed using 2008 self-reported data (n=316) and data from electronic medical records (EMR) (n=9023), and divided whether or not care was described in the Dutch type 2 diabetes multidisciplinary healthcare standard. Results On average 4.3 different disciplines of healthcare providers were involved in the care for diabetes patients. Ninety-six percent contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthcare standard. Only a limited part of total healthcare utilization of diabetes patients was included in the healthcare standard and therefore theoretically included in DMPs. Conclusion Organizing the care for diabetics in a DMP might harm the coordination and quality of all healthcare for diabetics. DMPs should be integrated in the overall organization of care. PMID:22359520

  7. Barriers and facilitators to evidence based care of type 2 diabetes patients: experiences of general practitioners participating to a quality improvement program

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    Hannes Karen

    2009-07-01

    Full Text Available Abstract Objective To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs who participated in an 18-month quality improvement program (QIP. This QIP was implemented to promote compliance with international guidelines. Methods Twenty out of the 120 participating GPs in the QIP underwent semi-structured interviews that focused on three questions: 'Which changes did you implement or did you observe in the quality of diabetes care during your participation in the QIP?' 'According to your experience, what induced these changes?' and 'What difficulties did you experience in making the changes?' Results Most GPs reported that enhanced knowledge, improved motivation, and a greater sense of responsibility were the key factors that led to greater compliance with diabetes care guidelines and consequent improvements in diabetes care. Other factors were improved communication with patients and consulting specialists and reliance on diabetes nurse educators. Some GPs were reluctant to collaborate with specialists, and especially with diabetes educators and dieticians. Others blamed poor compliance with the guidelines on lack of time. Most interviewees reported that a considerable minority of patients were unwilling to change their lifestyles. Conclusion Qualitative research nested in an experimental trial may clarify the improvements that a QIP may bring about in a general practice, provide insight into GPs' approach to diabetes care and reveal the program's limits. Implementation of a QIP encounters an array of cognitive, motivational, and relational obstacles that are embedded in a patient-healthcare provider relationship.

  8. Improving clinician confidence and skills: piloting a web-based learning program for clinicians in supportive care screening of cancer patients.

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    Beattie, Jill; Brady, Lisa; Tobias, Tracey

    2014-03-01

    Lean thinking and quality improvement processes identified a need to develop and implement a short concise web-based program for clinicians to increase their confidence and skills in supportive care screening of cancer patients. An independent pretest-posttest design evaluated the program which consisted of three modules, a self-directed learning quiz, and multimedia. Questionnaires were completed anonymously via SurveyMonkey®. There was an increase in mean scores from pre- to post-program in perceived knowledge (pre M = 1.97 SD = .847; post M = 3.05 SD = .486; 3 months M = 2.72 SD = .575), educational preparedness (pre M = 2.33 SD = .957; post M = 3.45 SD = .510; 3 months M = 3.05 SD = .486), and confidence (pre M = 2.39 SD = .998; post M = 3.32 SD = .646; 3 months M = 3.28 SD = .826), indicating improvement in readiness to implement supportive care screening. The number of participants using the tool increased from 57.57% pre-program to 77.78% 3 months post-program. Overall, participants agreed that screening elicited more patient information (post M = 3.82 SD = 1.006; 3 months M = 3.83 SD = .786) and would assist in addressing patients' supportive care needs (post M = 4.00 SD.926; 3 months M = 3.94 SD = .998). It was unclear whether they had made more appropriate referrals as a result of their participation in the program (post M = 3.29 SD = 1.102; 3 months M = 3.11 SD = .963). The majority of participants agreed that the web-based program provided the required information to implement supportive care screening (post M = 3.83 SD = 1.032; 3 months M = 3.61 SD = .702), and that the quiz helped their learning (post M = 3.68 SD = 1.041; 3 months M = 3.65 SD = .702). This pilot indicates that provision of a short concise web-based program may improve clinicians' confidence and skills to implement supportive care

  9. Two Year Virologic Outcomes of an Alternative AIDS Care Model: Evaluation of a Peer Health Worker and Nurse-Staffed Community-Based Program in Uganda

    Science.gov (United States)

    Chang, Larry W.; Alamo, Stella; Guma, Samuel; Christopher, Jason; Suntoke, Tara; Omasete, Richard; Montis, Jennifer P.; Quinn, Thomas C.; Juncker, Margrethe; Reynolds, Steven J

    2009-01-01

    Background There is growing concern about the human resources needed to care for increasing numbers of patients receiving antiretroviral therapy in resource-limited settings. We evaluated an alternative model, community-based, comprehensive antiretroviral program staffed primarily by peer health workers and nurses. Methods We conducted a retrospective cohort study of patients receiving antiretroviral therapy during the first 10 months of program enrollment beginning in late 2003. Virologic, immunologic, clinical, and adherence data were collected. Results Of 360 patients started on treatment, 258 (72%) were active and on therapy approximately two years later. Viral load testing demonstrated that 86% of active patients (211 of 246 tested) had a viral load <400 copies/mL. The median CD4 increase for active patients was 197 cells/mm3 (IQR, 108–346). Patients with either a history of antiretroviral use or lack of CD4 response were more likely to experience virologic failure. Survival was 84% at one year and 82% at two years. WHO stage 4 was predictive of both not sustaining therapy and increased mortality. Conclusions A community-based antiretroviral treatment program in a resource-limited setting can provide excellent AIDS care over at least a two year period. A comprehensive program based upon peer health workers and nurses provides an effective alternative model for AIDS care. PMID:19194316

  10. Positive impact of child feeding training program for primary care health professionals: a cluster randomized field trial

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    Márcia Regina Vitolo

    2014-12-01

    Full Text Available OBJECTIVE: To assess the impact of a child feeding training program for primary care health professionals about breastfeeding and complementary feeding practices. METHODS: Cluster-randomized field trial conducted in the city of Porto Alegre, (RS, Brazil. Twenty primary health care centers (HCC were randomized into intervention (n = 9 and control (n = 11 groups. The health professionals (n = 200 at the intervention group centers received training about healthy feeding practices. Pregnant women were enrolled at the study. Up to six months of child's age, home visits were made to obtain variables related to breastfeeding and introduction of foods. RESULTS: 619 children were evaluated: 318 from the intervention group and 301 from the control group. Exclusive breastfeeding prevalence in the first (72.3 versus 59.4%; RR = 1.21; 95%CI 1.08 - 1.38, second (62.6 versus 48.2%; RR = 1.29; 95%CI 1.10 - 1.53, and third months of life (44.0% versus 34.6%; RR = 1.27; 95%CI 1.04 - 1.56 was higher in the intervention group compared to the control group. The prevalence of children who consumed meat four or five times per week was higher in the intervention group than in the control group (36.8 versus 22.6%; RR = 1.62; 95%CI 1.32 - 2.03. The prevalence of children who had consumed soft drinks (34.9 versus 52.5%; RR = 0.66; 95%CI 0.54 - 0.80, chocolate (24.5 versus 36.7% RR = 0.66 95%CI 0.53 - 0.83, petit suisse (68.9 versus 79.7; 95%CI 0.75 - 0.98 and coffee (10.4 versus 20.1%; RR = 0.51; 95%CI 0.31 - 0.85 in their six first months of life was lower in the intervention group. CONCLUSION: The training of health professionals had a positive impact on infant feeding practices, contributing to the promotion of child health.

  11. Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya's safe motherhood voucher scheme.

    Science.gov (United States)

    Watt, Claire; Abuya, Timothy; Warren, Charlotte E; Obare, Francis; Kanya, Lucy; Bellows, Ben

    2015-01-01

    This study tests the group-level causal relationship between the expansion of Kenya's Safe Motherhood voucher program and changes in quality of postnatal care (PNC) provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I) and facilities accredited since 2010-2011 (phase II) relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH) voucher program's causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02), where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02), with the largest quality improvements in counseling on family planning methods (IRR 5.0; p=0.01) and return to fertility (IRR 2.6; p=0.01). Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and newborn. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement.

  12. Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya's safe motherhood voucher scheme.

    Directory of Open Access Journals (Sweden)

    Claire Watt

    Full Text Available This study tests the group-level causal relationship between the expansion of Kenya's Safe Motherhood voucher program and changes in quality of postnatal care (PNC provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I and facilities accredited since 2010-2011 (phase II relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH voucher program's causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02, where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02, with the largest quality improvements in counseling on family planning methods (IRR 5.0; p=0.01 and return to fertility (IRR 2.6; p=0.01. Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and newborn. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement.

  13. Daily bowel care program

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    ... eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 136. Koyle MA, Lorenzo AJ. ... eds. Campbell-Walsh Urology . 11th ed. Philadelphia, PA: Elsevier; 2016:chap 144. Lembo AJ. Constipation. In: Feldman ...

  14. Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

    Science.gov (United States)

    George, Susan; Leasure, A Renee

    2016-01-01

    Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care.

  15. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital

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    Kanwalpreet Sodhi

    2011-01-01

    Full Text Available Background: Guidelines on performing cardiopulmonary resuscitation (CPR have been published from time to time, and formal training programs are conducted based on these guidelines. Very few data are available in world literature highlighting the impact of these trainings on CPR outcome. Aim: The aim of our study was to evaluate the impact of the American Heart Association (AHA-certified basic life support (BLS and advanced cardiac life support (ACLS provider course on the outcomes of CPR in our hospital. Materials and Methods : An AHA-certified BLS and ACLS provider training programme was conducted in our hospital in the first week of October 2009, in which all doctors in the code blue team and intensive care units were given training. The retrospective study was performed over an 18-month period. All in-hospital adult cardiac arrest victims in the pre-BLS/ACLS training period (January 2009 to September 2009 and the post-BLS/ACLS training period (October 2009 to June 2010 were included in the study. We compared the outcomes of CPR between these two study periods. Results: There were a total of 627 in-hospital cardiac arrests, 284 during the pre-BLS/ACLS training period and 343 during the post-BLS/ACLS training period. In the pre-BLS/ACLS training period, 52 patients (18.3% had return of spontaneous circulation, compared with 97 patients (28.3% in the post-BLS/ACLS training period (P < 0.005. Survival to hospital discharge was also significantly higher in the post-BLS/ACLS training period (67 patients, 69.1% than in the pre-BLS/ACLS training period (12 patients, 23.1% (P < 0.0001. Conclusion : Formal certified BLS and ACLS training of healthcare professionals leads to definitive improvement in the outcome of CPR.

  16. Treatment outcome and factors affecting time to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program

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    Melkamu Merid Mengesha

    2016-07-01

    Full Text Available Background: The outpatient therapeutic care program (OTP of children with severe acute malnutrition (SAM has been decentralized to health post level in Ethiopia since 2008–2009. However, there is a lack of evidence regarding treatment outcomes and factors related to the duration of stay on treatment after its decentralization to health post level. Objective: This study was aimed to assess treatment outcome and factors affecting time to recovery in children with SAM treated at OTP. Design: Health facility–based retrospective cohort study was conducted using data from 348 patient cards. The outcome variable was time to recovery. Descriptive analysis was done using percentages for categorical data and mean/median for continuous variables. A robust method of analyzing time to event data, the Cox proportional-hazard regression, was used. All statistical tests in this study are declared significant at p<0.05. Result: 89.1% of children with kwashiorkor and 69.4% of children with marasmus were recovered. Of the total children studied, 22% were readmitted cases. The median time of recovery was 35 days for children with kwashiorkor and 49 days for children with marasmus. Children older than 3 years were 33% less likely to achieve nutritional recovery [adjusted hazard ratio, AHR=0.67, 95% confidence interval, CI (0.46, 0.97]. Similarly, marasmic children stayed longer on treatment [AHR=0.42, 95% CI (0.32, 0.56]. However, children who gained Mid-Upper Arm Circumference (MUAC ≥ 0.24 mm/day were 59% more likely to recover faster [AHR=1.59, 95% CI (1.23, 2.06]. Conclusions: Close monitoring of weight and MUAC gain to assess nutritional improvement with due emphasis given to children with lower admission weight, children of age 3 years and above and marasmic children will have a positive effect on treatment duration and outcome.

  17. Impact of the application of neurolinguistic programming to mothers of children enrolled in a day care center of a shantytown

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    Cláudio Torres de Miranda

    1999-03-01

    Full Text Available CONTEXT: Of the members of a family, the mother is without doubt the most important one, which provides justification for including an evaluation of her mental health as one of the variables to be considered as determining factors in each child’s level of development. OBJECTIVE: To assess the impact of the application of Neurolinguistic Programming (NLP on child development, home environment and maternal mental health. DESIGN: Randomised controlled trial. SETTING: The study included children enrolled in the municipal day care center of a shantytown in the City of São Paulo. PARTICIPANTS: 45 pairs of mothers and respective children between 18 and 36 months of age. MAIN MEASUREMENTS: Children’s development (Bayley scales; home environment variation (HOME; and maternal mental health (SRQ. Comparison between before and after the intervention was made in terms of children’s psychomotor development, home environment and maternal mental health. INTERVENTION: Application of the NLP technique to the experimental group and comparison with a control group. 1 - Experimental (EG, consisting of 23 children submitted to intervention by NLP; and 2 - Control (CG, with 22 children with no intervention. Length of intervention: 15 sessions of NLP. RESULTS: 37 children remained in the study (EG = 10, CG = 27. Variations in mental development (OR 1.21, IC 95% 0.0 to 23.08 in their home environment (Wilcoxon: p = 0.96 (before and p = 0.09 (after; in maternal mental health: p = 0.26, 2 df. CONCLUSIONS: There was a trend that indicated positive effects on the home environment from the intervention.

  18. Resident-Assisted Montessori Programming (RAMP): use of a small group reading activity run by persons with dementia in adult day health care and long-term care settings.

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    Skrajner, Michael J; Camp, Cameron J

    2007-01-01

    Six persons in the early to middle stages of dementia ("leaders") were trained in Resident-Assisted Montessori Programming (RAMP) to lead a reading activity for 22 persons with more advanced dementia ("participants") in an adult day health center (ADHC) and a special care unit (SCU) in a skilled nursing facility. Researchers assessed the leaders' abilities to learn and follow the procedures of leading a group, as well as their satisfaction with their roles. In addition, participants' engagement and affect were measured, both during standard activities programming and during client-led activities. Results of this study suggest that persons with dementia can indeed successfully lead small group activities, if several important prerequisites are met. Furthermore, the engagement and affect of participants was more positive in client-led activities than in standard activities programming.

  19. [The meaning of school failure to social activists who use the program of primary care school health--PROASE at the municipality of Ribeirao Preto].

    Science.gov (United States)

    Ferriani M das, G; Iossi, M A

    1998-12-01

    The present study has the purpose to identify and analyze the meaning of school failure to social actors that use or work in the Program of School Health Primary Care--PROASE (family members, health and education professionals) and to articulate their discourse with the official discourse in order to establish the program's future actions. Our study has a qualitative theoretical framework based in Minayo (1992). One area where PROASE develops its activities was chosen and by semistructured interviews and documentation analysis it was possible to know how the three segments that compose the sample understand the meaning of school failure.

  20. Effectiveness of a Staff Promoted Wellness Program to Improve Health in Residents of a Mental Health Long-Term Care Facility.

    Science.gov (United States)

    Hutchison, Shari L; Terhorst, Lauren; Murtaugh, Stephanie; Gross, Sarah; Kogan, Jane N; Shaffer, Sherry L

    2016-01-01

    The current study describes physical and mental health outcomes during a health promotion program for individuals with serious mental illness (SMI). A sample of 43 adults in a long-term residential facility volunteered for an individualized, healthy lifestyle program designed to promote physical activity and combat premature mortality among individuals with SMI. Nurses and residential counselors were trained in the program and encouraged to work collaboratively with the program's personal trainers. Weekly nutrition and activity logs were obtained over the year-long evaluation. Assessments of physical and psychological health indicators were collected quarterly. Qualitative data through focus groups described staff experience. Self-report of moderate and vigorous physical activity improved over time as did fitness level as measured through a walking challenge (p = .001). Significant decreases in weight (p < .001), BMI (p = .001), and total cholesterol (p < .001) were observed from baseline through 12 months. Mean recovery scores (RMQ) were significantly higher between baseline and all time points (p < .001). Participants reported decreasing levels of depression (PHQ-9) by the 12-month time point (p < .001). Staff encouraged participation in physical activity and observed improved motivation and socialization among participants. A health promotion program with participation encouraged by health care staff is effective for increasing physical activity and improving physical and mental health outcomes in individuals with SMI in long-term residential care.