Ahmed, Osman I
With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.
Phillips, Robert L; Han, Meiying; Petterson, Stephen M; Makaroff, Laura A; Liaw, Winston R
In 2006, Illinois established Illinois Health Connect (IHC), a primary care case management program for Medicaid that offered enhanced fee-for-service, capitation payments, performance incentives, and practice support. Illinois also implemented a complementary disease management program, Your Healthcare Plus (YHP). This external evaluation explored outcomes associated with these programs. We analyzed Medicaid claims and enrollment data from 2004 to 2010, covering both pre- and post-implementation. The base year was 2006, and 2006-2010 eligibility criteria were applied to 2004-2005 data to allow comparison. We studied costs and utilization trends, overall and by service and setting. We studied quality by incorporating Healthcare Effectiveness Data and Information Set (HEDIS) measures and IHC performance payment criteria. Illinois Medicaid expanded considerably between 2006 (2,095,699 full-year equivalents) and 2010 (2,692,123). Annual savings were 6.5% for IHC and 8.6% for YHP by the fourth year, with cumulative Medicaid savings of $1.46 billion. Per-beneficiary annual costs fell in Illinois over this period compared to those in states with similar Medicaid programs. Quality improved for nearly all metrics under IHC, and most prevention measures more than doubled in frequency. Medicaid inpatient costs fell by 30.3%, and outpatient costs rose by 24.9% to 45.7% across programs. Avoidable hospitalizations fell by 16.8% for YHP, and bed-days fell by 15.6% for IHC. Emergency department visits declined by 5% by 2010. The Illinois Medicaid IHC and YHP programs were associated with substantial savings, reductions in inpatient and emergency care, and improvements in quality measures. This experience is not typical of other states implementing some, but not all, of these same policies. Although specific features of the Illinois reforms may have accounted for its better outcomes, the limited evaluation design calls for caution in making causal inferences. © 2014 Annals of
Rehner, Tim; Brazeal, Michelle; Doty, Stephanie T
The focus of this case study was the implementation of a fully integrated system of care that brought mental health into a federally qualified health center's primary care activities. The Mississippi Integrated Health and Disaster Program aimed to increase the federally qualified health center's capacity for providing mental health services and in so doing increase patients' access to mental and behavioral health services in primary care. Included are the historical origins of the program and the context in which these clinics operate, as well as successful processes that reduced barriers between medical providers and social workers and ultimately resulted in improved patient outcomes. Data indicated that the Mississippi Integrated Health and Disaster Program's integrated health model significantly improved depression, anxiety, and self-care among chronic care patients. This integrated health approach transformed the treatment culture of patient care in primary care clinics and improved patient outcomes. This study highlights the benefits possible when behavioral health provided by social workers is fully integrated into primary care. This case study illustrates the importance of developing a care model that meets the patient populations' specific and varied needs while concurrently establishing an integrated service delivery culture within local clinics and within the organization's administrative structures.
... gov/ency/patientinstructions/000133.htm Daily bowel care program To use the sharing features on this page, ... Work with your health care provider. Basic Bowel Program Keeping active helps prevent constipation. Try to walk, ...
Leontjevas, R.; Gerritsen, D.L.; Koopmans, R.T.C.M.; Smalbrugge, M.; Vernooij-Dassen, M.F.J.
Background: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): " Act in case of Depression" (AiD). Objective: Before effect analyses, to evaluate AiD
Leontjevas, R.; Gerritsen, D.L.; Koopmans, R.T.C.M.; Smalbrugge, M.; Vernooij-Dassen, M.J.F.J.
BACKGROUND: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): "Act in case of Depression" (AiD). OBJECTIVE: Before effect analyses, to evaluate AiD
The Holland Day Care Center in Michigan serves a diverse community of Anglo children of Dutch ancestry and children of former migrant workers of Chicano, Black, Puerto Rican and Cuban origins who have settled in the area. Located in two churches which are about three blocks apart, the program divides children by ability and age into five…
Low, Lee-Fay; Baker, Jessica Rose; Harrison, Fleur; Jeon, Yun-Hee; Haertsch, Maggie; Camp, Cameron; Skropeta, Margaret
The Lifestyle Engagement Activity Program (LEAP) incorporates social support and recreational activities into case-managed home care. This study's aim was to evaluate the effect of LEAP on engagement, mood, and behavior of home care clients, and on case managers and care workers. Quasi-experimental. Five Australian aged home care providers, including 2 specializing in care for ethnic minorities. Clients (n = 189) from 5 home care providers participated. The 12-month program had 3 components: (1) engaging support of management and staff; (2) a champion to drive practice change; (3) staff training. Case managers were trained to set meaningful social and/or recreational goals during care planning. Care workers were trained in good communication, to promote client independence and choice, and in techniques such as Montessori activities, reminiscence, music, physical activity, and humor. Data were collected 6 months before program commencement, at baseline, and 6 and 12 months. The Homecare Measure of Engagement Staff report and Client-Family interview were primary outcomes. Secondary outcomes were the Cohen-Mansfield Agitation Inventory; apathy, dysphoria, and agitation subscales of the Neuropsychiatric Inventory-Clinician Rating; the geriatric depression scale; UCLA loneliness scale; and home care satisfaction scale. Staff provided information on confidence in engaging clients and the Utrecht Work Engagement Scale. Twelve months after program commencement, clients showed a significant increase in self- or family-reported client engagement (b = 5.39, t[113.09] = 3.93, P engage clients (b = 0.52, t(21.33) = 2.80, P = .011, b = 0.29, t(198.69) = 2.58, P = .011, respectively). There were no significant changes in care worker-rated client engagement or client or family self-complete measures of depression or loneliness (P > .05). Client and family self-rated apathy increased over 12 months (b = 0.04, t(43.36) = 3.06, P = .004; b = 3.63, t(34.70) = 2.20, P = .035
Joilda Silva Nery
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.
Ota, Ken S; Beutler, David S; Gerkin, Richard D; Weiss, Jessica L; Loli, Akil I
Despite a variety of national efforts to improve transitions of care for patients at risk for rehospitalization, 30-day rehospitalization rates for patients with heart failure have remained largely unchanged. This is a retrospective review of 73 patients enrolled in our hospital-based, physican-directed Heart Failure Transitional Care Program (HFTCP). This study evaluated the 30- and 90- day readmission rates before and after enrollment in the program. The Transitionalist's services focused on bedside consultation prior to hospital discharge, follow-up home visits within 72 hours of discharge, frequent follow-up phone calls, disease-specific education, outpatient intravenous diuretic therapy, and around-the-clock telephone access to the Transitionalist. The pre-enrollment 30-day readmission rates for acute decompensated heart failure (ADHF) and all-cause readmission was 26.0% and 28.8%, respectively, while the post-enrollment rates for ADHF and all-cause readmission were 4.1% (P < 0.001) and 8.2% (P = 0.002), respectively. The pre-enrollment 90-day all-cause and ADHF readmission rates were 69.8%, and 58.9% respectively, while the post-enrollment rates for all-cause and ADHF were 27.3% (P < 0.001) and 16.4% (P < 0.001) respectively. Our physician-implemented HFTCP reduced rehospitalization risk for patients enrolled in the program. This program may serve as a model to assist other hospital systems to reduce readmission rates of patients with HF.
Park, Myung-Sook; Kweon, Young-Ran
The purpose of this study was to examine the effects of a cultural competence improvement program for maternity nurses. A quasi-experimental study using a non-equivalent control group pre and posttest design was used. Participants were 67 maternity nurses caring for multicultural pregnant women in G city. The cultural competence improvement program was developed based on the 3-D Puzzle Model and was provided using case-based small group learning methods for the experimental group (n=31). The control group (n=36) did not receive any intervention. Data were collected using self-report structured questionnaires at two time points: prior to the intervention and after the intervention and were analyzed with descriptive statistics, χ²-test, and t-test. Compared to the control group, the experimental group reported significant positive changes for cultural knowledge (t=6.39, pawareness (t=3.50, pmulticultural maternity care. Further, strategies to improve cultural nursing behavior should be developed to promote culturally congruent nursing care.
Polak, Rani; Dill, Diana; Abrahamson, Martin J; Pojednic, Rachele M; Phillips, Edward M
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 coaching has the potential to help people with diabetes improve their practical 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.
Hvalič-Touzery, Simona; Hopia, Hanna; Sihvonen, Sanna; Diwan, Sadhna; Sen, Soma; Skela-Savič, Brigita
Internationalization of practical training in health and social care study programs is an important aspect of higher education. However, field mentors' and classroom teachers' competence in guiding culturally diverse students varies widely in European countries, and the majority does not have enough training in guiding foreign students. This study aimed to examine which factors enhance the efficacy of international practical placement experiences in health and social care study programs. A qualitative descriptive case study design was used. The study was conducted at six higher education institutions-two in Finland and one in Croatia, Estonia, the Netherlands and Slovenia. A convenience sample of 14 mentors, 15 teachers and 14 students with international experiences from six higher education institutions which are part of the Bologna Process was recruited. The data were collected from six focus groups using a semi-structured questionnaire based on a literature review. Each higher education institution conducted one group interview that was tape-recorded, transcribed and analysed for themes. Participants made several recommendations for enhancing the practical placement experience of students, teachers, and mentors. Most recommendations dealt with practical supervision of students. Three major themes noted were: 'Attitudes towards internationalization of practical placements', 'Factors impacting the international placement experience', and 'Pedagogical methods used and structural support available for internationalization.' The study highlights the need for strengthening the multicultural knowledge and skills of mentors and teachers. The findings provide practical guidelines for improving the international placement experience across health and social care fields. Copyright Â© 2016 Elsevier Ltd. All rights reserved.
Dill, Diana; Abrahamson, Martin J.; Pojednic, Rachele M.; Phillips, Edward M.
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 chef coaching has the potential to help people with diabetes improve their practical 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. PMID:25568831
the coordination of case managers, interagency councils, and multidisciplinary intervention assessment means for handicapped children (It should be...rare genetic disease called Nager Acrofacial Dystosis Syndrome. This has resulted in numerous disabling afflictions which include deafness, cleft ... palate , microcephaly and a gastrostomy for feeding. Treatments and medical equipment that have been required in the seven years since his birth include
Allen, Suzanne M; Ballweg, Ruth A; Cosgrove, Ellen M; Engle, Kellie A; Robinson, Lawrence R; Rosenblatt, Roger A; Skillman, Susan M; Wenrich, Marjorie D
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.
This document describes the Alzheimer Case Management and In-Home Respite Program begun in 1985 in California. Training provided to nurses and selected homemakers in the program is discussed and sources of referrals are identified. Initial nursing visits which involved physical and behavioral assessment of the patient and discussions with stressed…
Pereira, José; Contant, Jocelyne; Barton, Gwen; Klinger, Christopher
Regionalization promotes planning and coordination of services across settings and providers to meet population needs. Despite the potential advantages of regionalization, no regional hospice palliative care program existed in Ontario, Canada, as of 2010. This paper describes the process and early results of the development of the first regional hospice palliative care program in Ontario. The various activities and processes undertaken and the formal agreements, policies and documents are described. A participative approach, started in April 2009, was used. It brought together over 26 health service providers, including residential hospices, a palliative care unit, community and hospital specialist consultation teams, hospitals, community health and social service agencies (including nursing), individual health professionals, volunteers, patients and families. An extensive stakeholder and community vetting process was undertaken that included work groups (to explore key areas such as home care, the hospital sector, hospice and palliative care unit beds, provision of care in rural settings, e-health and education), a steering committee and input from over 320 individuals via e-mail and town-halls. A Transitional Leadership Group was elected to steer the implementation of the Regional Program over the summer of 2010. This group established the by-laws and details regarding the governance structure of the Regional Program, including its role, responsibilities, reporting structures and initial performance indicators that the Local Health Integration Network (LHIN) approved. The Regional Program was formally established in November 2010 with a competency-based Board of 14 elected members to oversee the program. Early work involved establishing standards and performance indicators for the different sectors and settings in the region, and identifying key clinical needs such as the establishment of more residential hospice capacity in Ottawa and a rural framework to ensure
Full Text Available Abstract Background Chiropractic treatment for low back pain (LBP can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care. Method The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team. Results Replies were received from 59 (60% of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care. Conclusion To a reasonable extent, Swedish chiropractors participating in this
Hobson, Kristin A.; Burkhardt, Jason T.
Background: A music education program with a goal of enhancing cognitive development of preschool-aged children enrolled in local preschools is evaluated by The Evaluation Center at Western Michigan University. The budget for the evaluation was small, and therefore presented several challenges to the evaluation team. Purpose: Through a case study…
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.
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
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
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...
Malmqvist, Stefan; Leboeuf-Yde, Charlotte
Maintenance care is a well known concept among chiropractors, although there is little knowledge about its exact definition, its indications and usefulness. As an initial step in a research program on this phenomenon, it was necessary to identify chiropractors' rationale for their use of maintena......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...
Dworkin, Samuel F; Huggins, Kimberly H; Wilson, Leanne; Mancl, Lloyd; Turner, Judith; Massoth, Donna; LeResche, Linda; Truelove, Edmond
To carry out a randomized clinical trial (RCT) contrasting usual conservative treatment of TMD by clinical TMD specialists with a structured self-care intervention, targeted to clinic cases independent of TMD physical diagnosis, who were reporting minimal levels of psychosocial dysfunction; the intervention was delivered by dental hygienists in lieu of usual treatment. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used to target subjects who exhibited minimal TMD-related psychosocial interference. Criteria for study inclusion were: (1) self-report of facial and/or masticatory muscle pain discomfort for which usual care was prescribed by the clinic TMD specialist; (2) RDC/TMD Axis II graded scale of chronic pain (GCP) score of 0, I, or II-Low. (3) Age 18 to 70 years. On 1-year follow-up, while both groups showed improvement in all clinical and self-report categories measured, patients in the tailored self-care treatment program compared to usual TMD treatment showed significantly; (a) decreased TMD pain, (b) decreased pain-related interference in activity; (c) reduced number of masticatory muscles painful; (d) fewer additional visits for TMD treatment. Groups were comparable with regard to measures of vertical range of motion. The self-care program was associated with consistent, but non-statistically significant, trends towards lower levels of depression and somatization. Ability to cope with TMD, knowledge concerning TMD and patient satisfaction was significantly enhanced for the self-care group. No participating patients experienced physical or personal adverse effects during the 1-year post-treatment follow-up period. Use of RDC/TMD psychosocial assessment criteria can contribute to successful clinical decision-making for the management of TMD.
Nyström, Monica Elisabeth; Strehlenert, Helena; Hansson, Johan; Hasson, Henna
Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies. A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries. This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care. There is no blue-print on how to approach the challenging task of
Vernooij-Dassen Myrra JFJ
Full Text Available Abstract Background The aim of this study is evaluating the (cost- effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the management of depression, including standardized use of measurement instruments and diagnostical methods, and protocolized psychosocial, psychological and pharmacological treatment. Methods/Design In a 19-month longitudinal controlled study using a stepped wedge design, 14 somatic and 14 dementia special care units will implement the care program. All residents who give informed consent on the participating units will be included. Primary outcomes are the frequency of depression on the units and quality of life of residents on the units. The effect of the care program will be estimated using multilevel regression analysis. Secondary outcomes include accuracy of depression-detection in usual care, prevalence of depression-diagnosis in the intervention group, and response to treatment of depressed residents. An economic evaluation from a health care perspective will also be carried out. Discussion The care program is expected to be effective in reducing the frequency of depression and in increasing the quality of life of residents. The study will further provide insight in the cost-effectiveness of the care program. Trial registration Netherlands Trial Register (NTR: NTR1477
Full Text Available Abstract Background Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people. Methods The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity. Results A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity. Discussion The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time. Trial registration ClinicalTrials.gov, NCT01260493.
Griswold, Carol H.; Nasso, Jacqueline T.; Swider, Susan; Ellison, Brenda R.; Griswold, Daniel L.; Brooks, Marilyn
School absenteeism and poor compliance with prenatal appointments are concerns for pregnant teens. The Prenatal Care at School (PAS) program is a new model of prenatal care involving local health care providers and school personnel to reduce the need for students to leave school for prenatal care. The program combines prenatal care and education…
Kuehn, Chuck; Tidwell, George; Vhugen, Jann; Sharma, Anjali
In 2008, the United States government mandated transition of internationally managed HIV care and treatment programs to local country ownership. Three case studies illustrate the US Health Resources Services Administration's fiscal assessment and technical assistance (TA) processes to strengthen local organizations' capabilities to absorb and manage United States government funding. Review of initial, TA and follow-up reports reveal that the 1 Botswanan and 2 Zambian organizations closed 10 of 17 financial capacity gaps, with Health Resources Services Administration assisting on 2. Zambian organizations requested and absorbed targeted TA on the basis of the consultant's desk review, their finance staff revised fiscal policies and procedures, and accordingly trained other staff. In Botswana, delays in integrating recommendations necessitated on-site TA for knowledge building and role modeling. Organizational maturity may explain differences in responsiveness, ownership, and required TA approaches. Clarifying expectations of capacity building, funding agreement, and nonmonetary donor involvement can help new organizations determine and act on intervening actions.
Sakusic, Amra; Rabinstein, Alejandro A
The practice of neurocritical care encompasses multiple acute neurologic and neurosurgical diseases and requires detailed knowledge of neurology and critical care. This article presents 5 cases that illustrate just some of the conditions encountered in the daily practice of neurocritical care and exemplify some of the common diagnostic, therapeutic, and prognostic challenges facing the neurointensivist. Life-threatening medical complications after severe acute ischemic stroke, seizures and extreme agitation from autoimmune encephalitis, refractory seizures after subdural hemorrhage, neurologic and systemic complications related to aneurysmal subarachnoid hemorrhage, and status epilepticus after cardiac arrest are discussed in this article. Published by Elsevier Inc.
C.H.M. Smits (Carolien); A. Harps (Annelies); A.M.V. Stoopendaal (Annemiek); A.M. Kamper (Ad); M.M.H. Strating (Mathilde); R.A. Bal (Roland)
markdownabstractBackground: The Care for Better Region program was developed to achieve sustainable care improvement focusing onfall prevention. Key ingredients involved improvement teams developing and implementing a falls reduction plan, PracticeDevelopment; facilitation of
Full Text Available Primary care providers are critical in providing and optimizing health care to an aging population. This paper describes the volunteer component of a program (Health TAPESTRY which aims to encourage the delivery of effective primary health care in novel and proactive ways. As part of the program, volunteers visited older adults in their homes and entered information regarding health risks, needs, and goals into an electronic application on a tablet computer. A total of 657 home visits were conducted by 98 volunteers, with 22.45% of volunteers completing at least 20 home visits over the course of the program. Information was summarized in a report and electronically sent to the health care team via clients’ electronic medical records. The report was reviewed by the interprofessional team who then plan ongoing care. Volunteer recruitment, screening, training, retention, and roles are described. This paper highlights the potential role of a volunteer in a unique connection between primary care providers and older adult patients in their homes.
Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.
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,…
You, Emily Chuanmei; Dunt, David; Doyle, Colleen
Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers' professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers' practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts. © The Author(s) 2015.
Chen, Min-Chia; Chiu, Yi-Chen; Wei, Pi-Mei; Hsu, Wen-Chuin
The long-term care of cognitively impaired patients with concomitant behavioral problems brings great stress and burdens to family caregivers. The present article describes a family caregiver with multiple chronic diseases who concurrently shouldered primary care responsibilities for her husband, a patient with mild cognitive impairment, problematic behaviors, and medication non-adherence issues. The period of care was between September 23rd and December 29th, 2015. Data on physiological, psychological, and social burdens were collected based on a stress process model for family caregiving. We then applied a home-based, individually tailored intervention, which included nursing education, skills training, listening/counseling, and resource connecting, that effectively helped the family caregiver reduce her burdens. Our assessment identified nursing-care-related problems as the primary source of caregiver burden in this case, with identified stressors including a lack of knowledge regarding patient care, medication management problems, sleep disorders, and inadequate social resources. Using continuous care interactions, we established a trust relationship with the family caregiver, prioritized her needs, and provided dementia care knowledge and skills, which gradually improved her caregiving competence. Our instruction included increasing caregiver understanding of the disease course of dementia, related problematic behaviors, and medication management. Our intervention enhanced the disease awareness of the caregiver and helped her become more positive about her caregiving tasks. Therefore, the negative impacts on her family were reduced. Social support and long-term care resources further reduced her burden and improved her quality of life.
Romesberg, Tricia L
The concept of palliative care, well recognized in the adult population, has not been fully implemented in the pediatric population. Yet there is an urgent need to define and provide excellence in end-of-life care for infants and their families. Beneficent end-of-life care for the dying neonate includes efforts directed at comfort care, assistance with end-of-life decision making, and bereavement support. Through research and education, the challenges to implementing neonatal palliative care programs can be overcome. This article describes the components of neonatal palliative care, identifies the challenges associated wiith the implementation of such programs, and proposes strategies for addressing these challenges.
Tucker, Cary; Sloan, Sarah K.; Vance, Mary; Brownson, Chris
This case study describes 1 international student's treatment experience with an integrated health program on a college campus. This program uses a multidisciplinary, mind-body approach, which incorporates individual counseling, primary care, psychiatric consultation, a mindfulness-based cognitive therapy class, and a meditation group.
Myburgh, Corrie; Brandborg-Olsen, Dorthe; Albert, Hanne
To describe and interpret Danish Chiropractors' perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics.......To describe and interpret Danish Chiropractors' perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics....
The Department of Veterans Affairs (VA) amends its medical regulations concerning eligibility for the Health Care for Homeless Veterans (HCHV) program. The HCHV program provides per diem payments to non-VA community-based facilities that provide housing, outreach services, case management services, and rehabilitative services, and may provide care and/or treatment to homeless veterans who are enrolled in or eligible for VA health care. The rule modifies VA's HCHV regulations to conform to changes enacted in the Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012. Specifically, the rule removes the requirement that homeless veterans be diagnosed with a serious mental illness or substance use disorder to qualify for the HCHV program. This change makes the program available to all homeless veterans who are enrolled in or eligible for VA health care. The rule also updates the definition of homeless to match in part the one used by the Department of Housing and Urban Development (HUD). The rule further clarifies that the services provided by the HCHV program through non-VA community-based providers must include case management services, including non-clinical case management, as appropriate.
Sederer, L I; Eisen, S V; Dill, D; Grob, M C; Gougeon, M L; Mirin, S M
A fixed-prepayment system (case-based reimbursement) for patients initially requiring hospital-level care was evaluated for one year through an arrangement between a private nonprofit psychiatric hospital and a self-insured company desiring to provide psychiatric services to its employees. This clinical and financial experiment offered a means of containing costs while monitoring quality of care. A two-group, case-control study was undertaken of treatment outcomes at discharge, patient satisfaction with hospital care, and service use and costs during the program's first year. Compared with costs for patients in the control group, costs for those in the program were lower per patient and per admission; cumulative costs for patients requiring rehospitalization were also lower. However, costs for outpatient services for patients in the program were not calculated. Treatment outcomes and patients' satisfaction with hospital care were comparable for the two groups.
Wolf, Kathryn R; Taylor, Zachary A; Placek, Sarah B; Tsai, Michael W; Franklin, Brenton R; Ritter, E Matthew
. Elective cases were more likely to meet documentation requirements than acute care cases, and we purport that this is possibly secondary to restricted work hours. We expect that other programs would find similar compliance in the documentation of comprehensive care. These results question whether the requirement for documenting comprehensive care to log a surgical case is practical in surgical residency training, particularly with an increasing demand for operative volume in the setting of limited work hours. Published by Elsevier Inc.
... 25 Indians 1 2010-04-01 2010-04-01 false What information is required in the foster care case file... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.506 What information is required in the foster care case file? At a minimum the following information is required: (a) Tribal...
Álvarez-Cordovés, M M; Mirpuri-Mirpuri, P G; Gonzalez-Losada, J; Chávez-Díaz, B
We present a case of a patient diagnosed with glioblastoma multiforme refractory to treatment. Glioblastoma multiforme is the most common primary brain tumour and unfortunately the most aggressive, with an estimated mortality of about 90% in the first year after diagnosis. In our case the patient had reached a stage of life where quality of life was importsnt, with palliative care being the only recourse. The family is the mainstay in the provision of care of terminally ill patients, and without their active participation it would be difficult to achieve the objectives in patient care. We must also consider the family of the terminally ill in our care aim, as its members will experience a series of changes that will affect multiple areas where we should take action. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.
... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services. 440.168... care case management services. (a) Primary care case management services means case management related... services. (b) Primary care case management services may be offered by the State— (1) As a voluntary option...
O'Meara, Peter; Stirling, Christine; Ruest, Michel; Martin, Angela
Community paramedicine programs have emerged throughout North America and beyond in response to demographic changes and health system reform. Our aim was to identify and analyse how community paramedics create and maintain new role boundaries and identities in terms of flexibility and permeability and through this develop and frame a coherent community paramedicine model of care that distinguish the model from other innovations in paramedic service delivery. Using an observational ethnographic case study approach, we collected data through interviews, focus groups and field observations. We then applied a combination of thematic analysis techniques and boundary theory to develop a community paramedicine model of care. A model of care that distinguishes community paramedicine from other paramedic service innovations emerged that follows the mnemonic RESPIGHT: Response to emergencies; Engaging with communities; Situated practice; Primary health care; Integration with health, aged care and social services; Governance and leadership; Higher education; Treatment and transport options. Community engagement and situated practice distinguish community paramedicine models of care from other paramedicine and out-of-hospital health care models. Successful community paramedicine programs are integrated with health, aged care and social services and benefit from strong governance and paramedic leadership.
Lamb, Melissa, Ed.; And Others
This self-employment training program case study booklet has been developed for general use in exploring the feasibility of this kind of development tool. The case studies describe a number of comprehensive, self-employment training and assistance programs, from the local to the national level. Chapter II includes information on the training plan,…
Linmans, Joris J; Viechtbauer, Wolfgang; Koppenaal, Tjarco; Spigt, Mark; Knottnerus, J André
The increasing prevalence of diabetes suggests a gap between real world and controlled trial effectiveness of lifestyle interventions, but real-world investigations are rare. Electronic medical registration facilitates research on real-world effectiveness, although such investigations may require specific methodology and statistics. We investigated the effects of real-world primary care for patients with type 2 diabetes mellitus (T2DM). We used medical records of patients (n=2,549) with T2DM from 10 primary health care centers. A mixed-effects regression model for repeated measurements was used to evaluate the changes in weight and Hemoglobin A1c (HbA1c) over time. There was no statistically significant change in weight (+0.07 kg, P=0.832) and HbA1c (+0.03%, P=0.657) during the observation period of 972 days. Most patients maintained their physical activity level (70%), and 54 % had an insufficient activity level. The variability in the course of weight and HbA1c was because of differences between patients and not between health care providers. Despite effective lifestyle interventions in controlled trial settings, we found that real-world primary care is only able to stabilize weight and HbA1c in patients with T2DM over time. Medical registration can be used to monitor the actual effectiveness of interventions in primary care. Copyright © 2012 Elsevier Inc. All rights reserved.
Kubicki, Mark A; McGain, Forbes; O'Shea, Catherine J; Bates, Samantha
The provision of health care has significant direct environmental effects such as energy and water use and waste production, and indirect effects, including manufacturing and transport of drugs and equipment. Recycling of hospital waste is one strategy to reduce waste disposed of as landfill, preserve resources, reduce greenhouse gas emissions, and potentially remain fiscally responsible. We began an intensive care unit recycling program, because a significant proportion of ICU waste was known to be recyclable. To determine the weight and proportion of ICU waste recycled, the proportion of incorrect waste disposal (including infectious waste contamination), the opportunity for further recycling and the financial effects of the recycling program. We weighed all waste and recyclables from an 11-bed ICU in an Australian metropolitan hospital for 7 non-consecutive days. As part of routine care, ICU waste was separated into general, infectious and recycling streams. Recycling streams were paper and cardboard, three plastics streams (polypropylene, mixed plastics and polyvinylchloride [PVC]) and commingled waste (steel, aluminium and some plastics). ICU waste from the waste and recycling bins was sorted into those five recycling streams, general waste and infectious waste. After sorting, the waste was weighed and examined. Recycling was classified as achieved (actual), potential and total. Potential recycling was defined as being acceptable to hospital protocol and local recycling programs. Direct and indirect financial costs, excluding labour, were examined. During the 7-day period, the total ICU waste was 505 kg: general waste, 222 kg (44%); infectious waste, 138 kg (27%); potentially recyclable waste, 145 kg (28%). Of the potentially recyclable waste, 70 kg (49%) was actually recycled (14% of the total ICU waste). In the infectious waste bins, 82% was truly infectious. There was no infectious contamination of the recycling streams. The PVC waste was 37% contaminated
Mishra, Kirtishri; Snow-Lisy, Devon C; Ross, Jonathan; Goldfarb, David A; Goldman, Howard; Campbell, Steven C
To address the challenges that today's trainees encounter, such as information overload and reduced immersion in the field, and recognizing their preference for novel educational resources, an electronic case-based urology learning program was developed. Each case was designed to illustrate the basic principles of the disease process and the fundamentals of evaluation and management using the Socratic method, recapitulating a prototypical patient encounter. A 21-question survey was developed after review of published reports of classroom and clinical learning environment surveys. The target group was 2 pilot urology training programs (the Cleveland Clinic and University Hospitals-Case Medical Center). The responses were entirely anonymous. A total of 32 trainees participated (8 fellows and 24 residents), representing a 53% response rate. Most trainees (79%) were able to process cases within an average of ≤ 10 minutes. Of the trainees, 91% reported referring back to particular cases for patient care, to review for examinations, or for studying. Most trainees believed a case-based urology learning program would be a potentially important resource for clinical practice (69%) and for preparing for the in-service (63%) or board (69%) examinations. Most trainees believed the program met its goals of illustrating the basics principles of the disease process (88%), outlining the fundamentals of evaluation and management (94%), and improving the trainees' knowledge base (91%). An electronic case-based urology learning program is feasible and useful and stimulates learning at all trainee levels. Copyright © 2013 Elsevier Inc. All rights reserved.
Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R
Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.
Stephens, Samuel A.
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…
Ostergren, Carol S.; Riley, David A.; Wehmeier, Jenny M.
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…
McEwan, Phil; Bergenheim, Klas; Yuan, Yong; Tetlow, Anthony P; Gordon, Jason P
Simulation techniques are well suited to modelling diseases yet can be computationally intensive. This study explores the relationship between modelled effect size, statistical precision, and efficiency gains achieved using variance reduction and an executable programming language. A published simulation model designed to model a population with type 2 diabetes mellitus based on the UKPDS 68 outcomes equations was coded in both Visual Basic for Applications (VBA) and C++. Efficiency gains due to the programming language were evaluated, as was the impact of antithetic variates to reduce variance, using predicted QALYs over a 40-year time horizon. The use of C++ provided a 75- and 90-fold reduction in simulation run time when using mean and sampled input values, respectively. For a series of 50 one-way sensitivity analyses, this would yield a total run time of 2 minutes when using C++, compared with 155 minutes for VBA when using mean input values. The use of antithetic variates typically resulted in a 53% reduction in the number of simulation replications and run time required. When drawing all input values to the model from distributions, the use of C++ and variance reduction resulted in a 246-fold improvement in computation time compared with VBA - for which the evaluation of 50 scenarios would correspondingly require 3.8 hours (C++) and approximately 14.5 days (VBA). The choice of programming language used in an economic model, as well as the methods for improving precision of model output can have profound effects on computation time. When constructing complex models, more computationally efficient approaches such as C++ and variance reduction should be considered; concerns regarding model transparency using compiled languages are best addressed via thorough documentation and model validation.
Goodrich, Suzanne; Ndege, Samson; Kimaiyo, Sylvester; Some, Hosea; Wachira, Juddy; Braitstein, Paula; Sidle, John E; Sitienei, Jackline; Owino, Regina; Chesoli, Cleophas; Gichunge, Catherine; Komen, Fanice; Ojwang, Claris; Sang, Edwin; Siika, Abraham; Wools-Kaloustian, Kara
Widespread violence followed the 2007 presidential elections in Kenya resulting in the deaths of a reported 1,133 people and the displacement of approximately 660,000 others. At the time of the crisis the United States Agency for International Development-Academic Model Providing Access to Healthcare (USAID-AMPATH) Partnership was operating 17 primary HIV clinics in western Kenya and treating 59,437 HIV positive patients (23,437 on antiretroviral therapy (ART)). This case study examines AMPATH's provision of care and maintenance of patients on ART throughout the period of disruption. This was accomplished by implementing immediate interventions including rapid information dissemination through the media, emergency hotlines and community liaisons; organization of a Crisis Response leadership team; the prompt assembly of multidisciplinary teams to address patient care, including psychological support staff (in clinics and in camps for internally displaced persons (IDP)); and the use of the AMPATH Medical Records System to identify patients on ART who had missed clinic appointments. These interventions resulted in the opening of all AMPATH clinics within five days of their scheduled post-holiday opening dates, 23,949 patient visits in January 2008 (23,259 previously scheduled), uninterrupted availability of antiretrovirals at all clinics, treatment of 1,420 HIV patients in IDP camps, distribution of basic provisions, mobilization of outreach services to locate missing AMPATH patients and delivery of psychosocial support to 300 staff members and 632 patients in IDP camps. Key lessons learned in maintaining the delivery of HIV care in a crisis situation include the importance of advance planning to develop programs that can function during a crisis, an emphasis on a rapid programmatic response, the ability of clinics to function autonomously, patient knowledge of their disease, the use of community and patient networks, addressing staff needs and developing effective
Kotarba, Joseph A.
Addresses nontraditional health care issues by placing internship students in different health care agencies such as (1) workplace wellness programs; (2) centers for independent living for the physically handicapped; and (3) an Acquired Immune Deficiency Syndrome (AIDS) intervention program. Examines new problems in health care and the importance…
Wilson, Howard K.; And Others
Two internal medicine residency programs at Baylor College of Medicine are discussed. The traditional program emphasizes experience in the care of acute problems within a hospital inpatient environment. The primary care residency program emphasizes training in the outpatient environment and in noninternal medicine disciplines. (MLW)
Martin, Michael; Tummons, John; Ball, Anna; Bird, William
The purpose of this bounded single case study was to explore how an urban high school veterinary program impacted students' affective skill development. The program was unique because students were required to participate in internships with local animal care businesses and care for animals within the school veterinary laboratory. The…
Harper, John P
One of the responsibilities of clinical educators is to identify learning needs of staff and to develop education programs to meet those needs. A new outpatient diagnostic cardiac catheterization program required patients to be transferred postprocedure to the short procedure unit until discharge. The author describes the development, the implementation, and the evaluation of an education program on postcardiac catheterization care for ambulatory care nurses as well as initiation of a new care program postcardiac catheterization.
Nemeth, Noel N.; Janosik, Lesley A.; Gyekenyesi, John P.; Powers, Lynn M.
Report discusses physical and mathematical basis of Ceramics Analysis and Reliability Evaluation of Structures LIFE prediction (CARES/LIFE) computer program, described in "Program for Evaluation of Reliability of Ceramic Parts" (LEW-16018).
Hall, Karen Lynn; Rafalson, Lisa; Mariano, Kathleen; Michalek, Arthur
This study evaluated current hospital-based palliative care programs using recommendations from the Center to Advance Palliative Care (CAPC) as a framework. Seven hospitals located in Buffalo, New York were included based on the existence of a hospital-based palliative care program. Data was collected from August through October of 2013 by means of key informant interviews with nine staff members from these hospitals using a guide comprised of questions based on CAPC's recommendations. A gap analysis was conducted to analyze the current state of each hospital's program based upon CAPC's definition of a quality palliative care program. The findings identify challenges facing both existing/evolving palliative care programs, and establish a foundation for strategies to attain best practices not yet implemented. This study affirms the growing availability of palliative care services among these selected hospitals along with opportunities to improve the scope of services in line with national recommendations. © The Author(s) 2014.
Brock, Estelle; Travis, Nancy
This manual explains what is involved in sponsoring a Child Care Food Program (CCFP) for family day care providers. It draws on the experience of Save the Children's Southern States Office in sponsoring the "Child Care Food Umbrella," a CCFP program serving over 1,000 providers, which Save the Children has operated for 6 years. Chapter 1…
W. Seekles (Wike); G.A. Widdershoven (Guy); P.B.M. Robben (Paul); G. Van Dalfsen (Gonny); B. Molewijk (Bert)
textabstractBackground: Moral case deliberation (MCD) as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of
Buckingham, Robert W., III; Foley, Susan H.
Pressure for greater accountability is being exerted on programs for care of terminally ill and increasing demand for evaluation research. Components, implications, and limitations of evaluation systems are discussed, and their application in the terminal care setting addressed. Buckingham evaluation of hospice home care service is cited as a…
Kinney, L; Wilson, T.; Lewis, G. [Synertech Systems Corp. (United States); MacDonald, M. [Oak Ridge National Lab., TN (United States)
The multifamily case studies that are the subject of this report were conducted to provide a better understanding of the approach taken by program operators in weatherizing large buildings. Because of significant variations in building construction and energy systems across the country, five states were selected based on their high level of multifamily weatherization. This report summarizes findings from case studies conducted by multifamily weatherization operations in five cities. The case studies were conducted between January and November 1994. Each of the case studies involved extensive interviews with the staff of weatherization subgrantees conducting multifamily weatherization, the inspection of 4 to 12 buildings weatherized between 1991 and 1993, and the analysis of savings and costs. The case studies focused on innovative techniques which appear to work well.
Latimer, Deborah J.
Discusses how early childhood programs offer a wealth of opportunities for intergenerational experiences. Describes the benefits of intergenerational programs for children, teachers, and parents; offers tips for building a successful program; and provides some options for creating different kinds of programs. Outlines nine factors to consider…
Charles D. Phillips
Full Text Available Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.
Akhilesh S Pathipati
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.
Wallace, Cara L
This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.
Perme, Christiane; Chandrashekar, Rohini
.... An early mobility and walking program was developed to provide guidelines for early mobility that would assist clinicians working in intensive care units, especially clinicians working with patients...
Huston, Carol J
Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.
Morris, Deborah A; Galicia-Castillo, Marissa
To describe the CARES program, a model of palliative care for nursing home residents. Descriptive analysis of the Caring About Residents' Experiences and Symptoms (CARES) Program that provides palliative care services to nursing home residents. The CARES Program serves as an example of collaborative efforts to meet community needs. To evaluate the program, we document the services provided as well as process outcomes (changes to care plans, hospitalizations, location of death, and hospice utilization) for residents referred. 170 nursing home residents were seen by CARES Program between February 2013 to December 2015, 48% for skilled services, and 52% for long term care. Majority of referrals were for goals of care and concurrent symptom management. Following consultation, 67% of residents had a change in code status. Of residents desiring a palliative course 90% were never hospitalized. Overall, 53% of residents died; and those in long term care dying more often with hospice. The CARES program of palliative consultation addresses the needs of nursing home residents. The model has potential to be reproducible in in other communities.
van der Plas, Annicka G M; Deliens, Luc; van de Watering, Marlies; Jansen, Wim J J; Vissers, Kris C; Onwuteaka-Philipsen, Bregje D
In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the content of care and organisational characteristics of case management in palliative care is needed. To investigate how many case management initiatives for palliative care there are in the Netherlands for patients living at home; to describe the characteristics of these initiatives with regard to content and organisation of care. Primary care. A nationwide survey of all 50 coordinators of networks in palliative care in the Netherlands was conducted. Additional respondents were found through snowball sampling. We looked at 33 possible initiatives using interviews (n=33) and questionnaires (n=30). We identified 20 initiatives for case management. All stated that case management is supplemental to other care. In all initiatives the case managers are registered nurses and most possess higher vocational education and/or further training. All initiatives seek to identify the multidimensional care needs of the patients and the relatives and friends who care for them. Almost all provide information and support and refer patients who need care. Differences are found between the organisations offering the case management, their target groups, the names of the initiatives and whether direct patient care is provided by the case manager. In the Netherlands, case management in palliative care is new. Several models of delivery were identified. Research is needed to gain insight into the best way to deliver case management. By describing characteristics of case management in palliative care, an important first step is made in identifying effective elements of case management. Copyright © 2013 Elsevier Ltd. All rights reserved.
Lalonde, Lyne; Goudreau, Johanne; Hudon, Éveline; Lussier, Marie-Thérèse; Bareil, Céline; Duhamel, Fabie; Lévesque, Lise; Turcotte, Alain; Lalonde, Gilles
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. 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. 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. 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. 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.
Mealer, Meredith; Hodapp, Rachel; Conrad, David; Dimidjian, Sona; Rothbaum, Barbara O; Moss, Marc
Workplace stress can affect job satisfaction, increase staff turnover and hospital costs, and reduce quality of patient care. Highly resilient nurses adapt to stress and use a variety of skills to cope effectively. To gain data on a mindfulness-based cognitive therapy resilience intervention for intensive care unit nurses to see if the intervention program would be feasible and acceptable. Focus-group interviews were conducted by videoconference with critical care nurses who were members of the American Association of Critical-Care Nurses. The interview questions assessed the feasibility and acceptability of a mindfulness-based cognitive therapy program to reduce burnout syndrome in intensive care unit nurses. Thirty-three nurses participated in 11 focus groups. Respondents identified potential barriers to program adherence, incentives for adherence, preferred qualifications of instructors, and intensive care unit-specific issues to be addressed. The mindfulness-based cognitive therapy pilot intervention was modified to incorporate thematic categories that the focus groups reported as relevant to intensive care unit nurses. Institutions that wish to design a resilience program for intensive care unit nurses to reduce burnout syndrome need an understanding of the barriers and concerns relevant to their local intensive care unit nurses. ©2017 American Association of Critical-Care Nurses.
Nørbjerg, Jacob; Havn, Erling; Bansler, Jørgen P.
The production of goods and services is becoming more and more international, or even global, as large transnational corporations and networks of small and medium sized companies distribute their activities across the world in their quest for cheap labour or other economic resources. The production...... of advanced communication technologies such as high-speed data links and video conferencing. The project explores a number of in-depth case studies of Danish and Indian companies engaged in offshore programming....
Dannemeyer, Deborah; Jalandoni, Cecile; Vonderheide, Dawn
This article will explain one organization's experience in developing a licensed vocational nurse residency program in an ambulatory setting, the barriers and challenges, and program outcomes. It outlines results of the program in building competence and confidence for vocational nurses to perform as effective team members in the primary care office setting. Learnings from this experience may be applied to enhance new and transitioning employee orientation and education programs in ambulatory and inpatient settings.
Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C; Wendel, Christopher S; Krouse, Robert
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.
Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C.; Wendel, Christopher S.; Krouse, Robert
Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self Management Program, which was informed by (1) evidence on published quality of life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies. PMID:23104143
Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas
To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
Shega, Joseph W; Levin, Amy; Hougham, Gavin W; Cox-Hayley, Deon; Luchins, Daniel; Hanrahan, Patricia; Stocking, Carol; Sachs, Greg A
Hospice is the standard method for providing quality end-of-life care in the United States. However, studies reveal that persons with dementia are infrequently referred to hospice, that barriers exist to increasing hospice utilization in this population, and that patients with dementia would benefit from hospice or hospice-like services earlier in the disease course. The Palliative Excellence in Alzheimer Care Efforts (PEACE) program responds to these deficiencies, striving to improve end-of-life care of persons with dementia and to integrate palliative care into the primary care of patients with dementia throughout the course of the illness. The PEACE program is a disease management model for dementia that incorporates advance planning, patient-centered care, family support, and a palliative care focus from the diagnosis of dementia through its terminal stages. PEACE is coordinated through the primary care geriatrics practice of the University of Chicago. Patients and caregivers are interviewed every 6 months for 2 years, and a postdeath interview is conducted with caregivers. These interviews assess care domains important for the optimal care of persons with dementia and their caregivers. A nurse coordinator reviews interviews and provides feedback to physicians, facilitating enhanced individual care and continuous quality improvement for the practice. Initial feedback suggests patients have adequate pain control, satisfaction with quality of care, appropriate attention to prior stated wishes, and death occurring in the patient's location of choice. Families voiced similar high marks regarding quality of care. This program demonstrates an innovative model of providing quality palliative care for dementia patients and their caregivers.
Moore, Jason E; Oropello, John M; Stoltzfus, Daniel; Masur, Henry; Coopersmith, Craig M; Nates, Joseph; Doig, Christopher; Christman, John; Hite, R Duncan; Angus, Derek C; Pastores, Stephen M; Kvetan, Vladimir
Academic medical centers in North America are expanding their missions from the traditional triad of patient care, research, and education to include the broader issue of healthcare delivery improvement. In recent years, integrated Critical Care Organizations have developed within academic centers to better meet the challenges of this broadening mission. The goal of this article was to provide interested administrators and intensivists with the proper resources, lines of communication, and organizational approach to accomplish integration and Critical Care Organization formation effectively. The Academic Critical Care Organization Building section workgroup of the taskforce established regular monthly conference calls to reach consensus on the development of a toolkit utilizing methods proven to advance the development of their own academic Critical Care Organizations. Relevant medical literature was reviewed by literature search. Materials from federal agencies and other national organizations were accessed through the Internet. The Society of Critical Care Medicine convened a taskforce entitled "Academic Leaders in Critical Care Medicine" on February 22, 2016 at the 45th Critical Care Congress using the expertise of successful leaders of advanced governance Critical Care Organizations in North America to develop a toolkit for advancing Critical Care Organizations. Key elements of an academic Critical Care Organization are outlined. The vital missions of multidisciplinary patient care, safety, and quality are linked to the research, education, and professional development missions that enhance the value of such organizations. Core features, benefits, barriers, and recommendations for integration of academic programs within Critical Care Organizations are described. Selected readings and resources to successfully implement the recommendations are provided. Communication with medical school and hospital leadership is discussed. We present the rationale for critical
... availability of family child care homes capable of serving children and families with disabilities affecting... 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, HEAD...
Spielberger, Julie; Zanoni, Wladimir; Barisik, Elizabeth
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…
Plas, A.G. van der; Deliens, L.; Watering, M. van de; Jansen, W.J.; Vissers, K.C.P.; Onwuteaka-Philipsen, B.D.
BACKGROUND: In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the
van der Plas, A.G.M.; Deliens, L.; van de Watering, M.; Jansen, W.J.J.; Vissers, K.C.; Onwuteaka-Philipsen, B.D.
Background: In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the
Elias, Joseph Abraham; Morgenroth, David Crespi
The aim of this study was to assess amputee care-related educational offerings and barriers to further educational opportunities in United States physical medicine and rehabilitation residency programs. A two-part survey was distributed to all United States physical medicine and rehabilitation residency program directors. Part 1 assessed the use of educational tools in amputee education. Part 2 assessed the potential barriers to amputee care-related education. Sixty-nine percent of the program directors responded. Seventy-five percent or more of the programs that responded have didactic lectures; grand rounds; reading lists; self-assessment exam review; gait analysis training; training with prosthetists; faculty with amputee expertise; and amputee care during inpatient, outpatient, and consult rotations. Less than 25% of the programs use intranet resources. No more than 14% of the programs said any one factor was a major barrier. However, some of the most prominent major barriers were limited faculty number, finances, and patient volume. The factors many of the programs considered somewhat of a barrier included lack of national standardized resources for curriculum, resident time, and faculty time. This study identified the most commonly used amputee educational opportunities and methods in physical medicine and rehabilitation residencies as well as the barriers to furthering resident amputee education. Developing Web-based resources on amputee care and increasing awareness of physiatrists as perioperative consultants could improve resident amputee education and have important implications toward optimizing care of individuals with amputation.
Anderson, Wendy G; Puntillo, Kathleen; Cimino, Jenica; Noort, Janice; Pearson, Diana; Boyle, Deborah; Grywalski, Michelle; Meyer, Jeannette; O'Neil-Page, Edith; Cain, Julia; Herman, Heather; Barbour, Susan; Turner, Kathleen; Moore, Eric; Liao, Solomon; Ferrell, Bruce; Mitchell, William; Edmonds, Kyle; Fairman, Nathan; Joseph, Denah; MacMillan, John; Milic, Michelle M; Miller, Monica; Nakagawa, Laura; O'Riordan, David L; Pietras, Christopher; Thornberry, Kathryn; Pantilat, Steven Z
Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. To implement and evaluate a palliative care professional development program for ICU bedside nurses. From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds. Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P palliative care needs and created plans to address them. Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs. ©2017 American Association of Critical-Care Nurses.
Harvey, C V
Traction can sometimes seem like an overwhelming challenge in the critical care setting not only to the patient and family, but also to the nurse. Critical care nurses must know the principles, purposes, methods, and patient care considerations necessary to be able to provide appropriate care and teaching for the patient in traction. This article describes these principles and then illustrates them through a case study. The case describes a patient who experiences multiple trauma and focuses on the nurse's role in the care of this patient in traction.
Parker, Deborah; Clifton, Karen; Tuckett, Anthony; Walker, Helen; Reymond, Elizabeth; Prior, Teresa; McAnelly, Kristien; Jenkin, Peter; Israel, Fiona; Greeve, Kim; Glaetzer, Karen
This paper examines the use of structured Palliative Care Case Conferences in long-term care. The issues families bring to the Palliative Care Case Conference, their level of distress prior to the conference, the extent to which these issues are addressed by staff and family satisfaction with this process are described. In most developed countries, up to 30% of older people die in long-term care. A palliative approach generally refers to the resident and family as the 'unit of care'. Interventions, which include family in palliative care, are required in this setting. Descriptive and thematic results from the intervention arm of a pre-post, sequential mixed method study. Examination of documents of 32 resident/family dyads participating in a Palliative Care Case Conference, and interviews with the residents' family postintervention. Main concerns raised by family members prior to a Palliative Care Case Conference were physical and medical needs, pain, end-of-life care planning and nutrition and hydration. Families rated a high level of concern, 7.5 on a 10-point rating scale, prior to the Palliative Care Case Conference. A formalised Palliative Care Case Conference process ensured issues relating to end-of-life care planning, pastoral care, pain and comfort and physical and medical needs were well documented by staff. Issues relating to care processes and the family role in care were less well documented. All families, interviewed postintervention, recommended Palliative Care Case Conferences; and over 90% of families felt their issues were addressed to their satisfaction. Families also reported an increased understanding of the resident's current and future care. The Palliative Care Case Conference in long-term care provides an important platform for family to voice concerns. Palliative Care Case Conference documentation indicates that staff are attending to these issues, although more reference to concerns relating to care processes and the family role could be
Twomey, Jean E.; Caldwell, Donna; Soave, Rosemary; Fontaine, Lynne Andreozzi; Lester, Barry M.
The Vulnerable Infants Program of Rhode Island (VIP-RI) was established as a care coordination program to promote permanency for substance-exposed newborns in the child welfare system. Goals of VIP-RI were to optimize parents' opportunities for reunification and increase the efficacy of social service systems involved with families affected by…
Full Text Available Introduction: Annually more than 27,000 persons die of cancer in the Czech Republic and the overall incidence of malignancies is still increasing. These data shows the need for affordable and good follow-up care especially for patients without any cancer treatment due to irreversible progression of tumor. Currently the outpatient palliative cancer care gets more into the forefront. Prerequisite for a well working outpatient palliative care is cooperation with general practitioners and home health care agencies. The purpose of the so called program of palliative cancer care is to guide a patient in palliative cancer care and to improve the cooperation among health care providers. Methods: During the period from January 2008 to October 2010 we evaluated in patient without any oncology treatment due to irreversible progression of tumor. Results: In palliative outpatient clinic we treated 446 patients, 119 of them received home care services with average length of 27.8 days. 77 patients died at home, 51 in health facilities and 41 in inpatient hospice care. Conclusion: We present pilot study focusing on outpatient palliative cancer care which shows the real benefit from early indication of palliative cancer care. This type of care allows patients to stay as long as possible at home among their close relatives.
Birkeland, Søren; Christensen, René dePont; Damsbo, Niels
Limited knowledge exists about factors increasing the risk of general practitioners becoming involved in a complaint case or getting disciplined in connection with a complaint case.......Limited knowledge exists about factors increasing the risk of general practitioners becoming involved in a complaint case or getting disciplined in connection with a complaint case....
Kim, Ae-Sook; Jennings, Edward
This article utilizes a theoretical framework of policy innovation, diffusion, and reinvention to investigate the evolving nature of Medicaid managed care programs over time. By estimating two separate models, one for primary care case management (PCCM) and a second for risk-based program enrollment, this study seeks to disentangle two different paths of learning (internal and external), investigate the potential effects of vertical diffusion of policy, and examine the impact of internal state characteristics on the extent of Medicaid managed care. With respect to diffusion and learning, the data reveal that earlier adopters implement more extensive programs. The data fail to reveal much internal learning, although there is evidence of some. External impacts are clear: managed care enrollments in neighboring states and changes in the federal waiver process affect states' decisions. Other policy choices are important: states with more generous Medicaid eligibility rules implement more extensive managed care programs. Complementing other studies of Medicaid, we find that politics and economics make a difference for the extent of managed care programs; unlike other Medicaid studies, we find no effect of race and ethnicity.
DNA isolated from serum and plasma on high density single nucleotide polymorphism arrays. J Mol Diagn 2008; 10:249-257. Field LA , Jordan RM, Hadix...apolipoproteins in an Ornish lifestyle modification program. American Heart Journal 2006; 151:484-491. Ru QC, Katenhusen RA, Zhu LA , Silberman J, Yang... metformin . N Engl J Med. 2002;346:393–403. 30. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially mod- ifiable risk factors associated with
Alfieri, Emanuela; Ferrini, Anna Chiara; Gianfrancesco, Francesca; Lise, Gianluca; Messana, Giovanni; Tirelli, Lorenzo; Lorenzo, Ana; Sarli, Leopoldo
Since the recent introduction of the Case/Care Manager's professional figure, it is quite difficult to identify properly his/her own particular features, which could be mainly be found revising mainly in American studies. Therefore, the present study intended to identify the Case/Care Manager's skills and professional profile in an Intensive Care Unit experience, taking into consideration the staff's activities, perception and expectations towards the Case/Care Manager. In particular, it has been compared the experience of an Intensive Care Units where the Case/Care Manager's profile is operational to a different Unit where a Case/Care Manager is not yet in force. a Levati's model was used to map the Case/Care Manager's skills, involving each unit whole working staff, executives and caregivers through semi-structured interviews. It has been taken into consideration the Anaesthesia Unit and Emergency Unit of Cesena's healthcare organisation (AUSL of Romagna) and a Cardiology Intensive Care Unit of Piacenza's healthcare organisation, where the Case/Care Manager's profile has not been experimented yet. Firstly, it a data collection in each healthcare organization has been organised. Subsequently, semi-structured interviews to doctors, unit nurses, caregivers, nurses' coordinators and medical staff have been used to compare each healthcare system. The interviewees' described their expectations in relation to the Case/Care Manager working in a critical area. Then, every data collected during interviews has been organised to map a Case/Care Manager's essential professional profile to work in a critical area together with medical staff. Piacenza's O.U. critical area experience reported a major demand for patients' and patient's families' assistance. On the other hand, the very same aspects seem to have been better achieved in Cesena's O.U., where a Case/Care Manager's recent introduction has actually helped to overcome the void in organising systems. a Case/Care Manager
Christensen, Lisa Bøge; Hede, Børge; Petersen, Poul Erik
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...... of knowledge of oral health and oral health care for persons with disability were barriers to equal access to the program. Preventive dental services were the most frequent services delivered, although relatively few oral hygienists were involved in the program. Special training was most frequent in large...... municipalities. To secure equal access for persons with disability, it is recommended that joint collaboration between smaller municipalities should be made regarding procedures of such programs. Special training of dental personnel and of the staff responsible for selecting persons for the program should...
Bryk, Jodie; Fischer, Gary S; Lyons, Anita; Shroff, Swati; Bui, Thuy; Simak, Deborah; Kapoor, Wishwa
The aim was to evaluate pre-post quality of care measures among super-utilizer patients enrolled in the Enhanced Care Program (ECP), a primary care intensive care program. A pre-post analysis of metrics of quality of care for diabetes, hypertension, cancer screenings, and connection to mental health care for participants in the ECP was conducted for patients enrolled in ECP for 6 or more months. Patients enrolled in ECP showed statistically significant improvements in hemoglobin A1c, retinal exams, blood pressure measurements, and screenings for colon cancer, and trends toward improvement in diabetic foot exams and screenings for cervical and breast cancer. There was a significant increase in connecting patients to mental health care. This study shows that super-utilizer patients enrolled in the ECP had significant improvements in quality metrics from those prior to enrollment in ECP.
Mun, Eluned; Umbarger, Lillian; Ceria-Ulep, Clementina; Nakatsuka, Craig
Palliative Care Teams have been shown to be instrumental in the early identification of multiple aspects of advanced care planning. Despite an increased number of services to meet the rising consultation demand, it is conceivable that the numbers of palliative care consultations generated from an ICU alone could become overwhelming for an existing palliative care team. Improve end-of-life care in the ICU by incorporating basic palliative care processes into the daily routine ICU workflow, thereby reserving the palliative care team for refractory situations. A structured, palliative care, quality-improvement program was implemented and evaluated in the ICU at Kaiser Permanente Medical Center in Hawaii. This included selecting trigger criteria, a care model, forming guidelines, and developing evaluation criteria. These included the early identification of the multiple features of advanced care planning, numbers of proactive ICU and palliative care family meetings, and changes in code status and treatment upon completion of either meeting. Early identification of Goals-of-Care, advance directives, and code status by the ICU staff led to a proactive ICU family meeting with resultant increases in changes in code status and treatment. The numbers of palliative care consultations also rose, but not significantly. Palliative care processes could be incorporated into a daily ICU workflow allowing for integration of aspects of advanced care planning to be identified in a systematic and proactive manner. This reserved the palliative care team for situations when palliative care efforts performed by the ICU staff were ineffective.
O'Toole, Robert E
Caregiving for aging parents or other disabled family members takes a heavy toll on work and family life, as well as the company bottom line. Research reveals that the two primary responses to elder-care issues in the workplace are employer-paid consultation and referral programs, and employee-paid long-term care insurance (LTCI) plans.
Qiu, Xiao Ling
Business education has been booming in China due to the increasing demand of business graduates since China's economic reform. Chinese health care professionals are eager for business education to improve their competencies. The purpose of the study was to investigate the determinants of a successful health care management program for Chinese…
Castro, Emily; Click, Elizabeth; Douglas, Sara; Friedman, Isabel
Professionalism is paramount to the formation and functioning of new graduate critical care nurses. In this project, a sample of 110 new graduate nurses used a descriptive self-report electronic survey with Hall's Professionalism Inventory Scale. A great percentage of these new graduate critical care nurse fellows with high professionalism scores may be related to their participation in the Critical Care Nurse Fellowship orientation program. Perhaps, Nursing Professional Development specialists should incorporate classes on professional advancement planning for new graduate nurses.
Rose, Steven H; Long, Timothy R; Kor, Daryl J; Onigkeit, James A; Brown, Daniel R
To review national data on anesthesiology critical care medicine (ACCM) fellowship program enrollment and to describe a program that successfully recruited ACCM fellows and faculty at a single academic medical center. An incentive program known as the Mayo Clinic Scholar program, designed to recruit ACCM fellows and faculty, was reviewed. Interviews were conducted to assess the impact of the Mayo Clinic Scholar program. Academic health center. ACCM fellowship program enrollment data were compared with similar data for critical care medicine fellowship programs in internal medicine, pulmonary medicine, pediatrics, and surgery.The results of a program to recruit ACCM fellows and faculty were reviewed. Only 89 of 147 (60.5%) ACCM fellowship positions available nationally were filled during the 2010-2011 academic year, and only 89 of the 896 (9.9%) critical care medicine fellows anticipated to graduate in 2011 were in ACCM programs. The Mayo Clinic ACCM fellowship enrolled 28 fellows from January 1, 2000 through July 1, 2010 (range 0-6 per yr). Ten of the 28 (35.7%) were United States medical graduates (USMGs) and 6 of the 10 (60.0%) USMGs who were graduates of the Mayo Clinic residency were appointed as Mayo Clinic Scholars. All 6 Mayo Clinic Scholars were retained as ACCM faculty. Only two of the 6 (33.3%) Mayo Clinic Scholars would have completed ACCM training without a Mayo Clinic Scholar appointment. All recommend ACCM training to others and plan to continue to practice ACCM. The Mayo Clinic Scholar program effectively recruited ACCM fellows and faculty in a single institution. Incentive-based programs should be considered to support the involvement of anesthesiologists in perioperative medicine. Copyright © 2011 Elsevier Inc. All rights reserved.
Powell, D R; Sharp, S L; Farnell, S D; Smith, P T
1. One way to reduce health care costs is to reduce the demand for health care services. This can be accomplished by teaching employees to make better decisions about when they should see the health care provider or go to the emergency department versus treating themselves at home using self care. 2. In an effort to reduce health care costs, a manufacturing company implemented a self care program using a publication called the HealthyLife Self Care Guide. The guide was distributed to employees during a 50 minute workshop. 3. Analysis of claims data 1 year prior to distribution of the Guide and 1 year after distribution showed a savings of $39.65 per employee (a 24.4% decrease in costs) due to reduced health care provider and emergency department visits. This amounted to a return on investment of 2.6:1. 4. It appears that implementing a self care program in a worksite setting can be an effective way to reduce employer health care costs.
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.
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. PMID:27165489
The Equal Opportunity Committee at the Swedish university where this study was performed has a specific plan for equality with respect to sexual orientation and gender identity which concerns both students as well as employees. The overall purpose of this study was to investigate nursing students' and medical students' experience of LGBT issues within their respective educations. A qualitative semi-structured group interview study was carried out in autumn 2007. Five nursing students and 3 medical students from semester 2 to 6 participated. The students who participated described LGBT people as an invisible minority in all circumstances and that it was not easy to discuss and promote the theme since the student risked coming out involuntarily. The students felt that teachers and administrators were too passive when it came to LGBT issues and, the students themselves felt excluded. The students felt that heteronormativity governed in both the nursing and the medical education programs. This paper suggests that the law regarding equal treatment of students must be adhered to by administrators, and universities must begin to provide education on LGBT to employees and students. So why not recruit qualified LGBT instructors and lecturers similar to the gender lecturers employed at several other universities in Sweden. Copyright © 2010. Published by Elsevier Ltd.
Charmel, Patrick A; Frampton, Susan B
Hospitals that provide patient-centered care reap a number of financial benefits, including: Reduced length of stay. Lower cost per case. Decreased adverse events. Higher employee retention rates. Reduced operating costs. Decreased malpractice claims. Increased market share.
Ali Akbar Vaezi
Full Text Available Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU.Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P<0.05. Conclusion: Creating necessary modifications in nursing environments through the management development program by head nurses may improve nurses' clinical competency.
Loerzel, Victoria Wochna; Crosby, William Woodfin; Reising, Ellen; Sole, Mary Lou
Home care of a patient with a tracheostomy after surgery for head and neck cancer requires caregivers to be comfortable with handling medical equipment and to be competent and proficient with completing many new and complex tasks. However, the responsibility of managing an artificial airway may increase caregiver anxiety, which may subsequently lead to improper care of the patient with head and neck cancer and increase the risk for complications and rate of readmission to oncology units. This article describes the development and outcomes of the Tracheostomy Care Anxiety Relief Through Education and Support (T-CARES) program, developed in response to high readmission rates for patients with head and neck cancer discharged with a tracheostomy. T-CARES consists of an 18-minute video demonstration, group discussion, return demonstration, and skills assessment. The course also incorporates hands-on practice on a low-cost anatomical task trainer created by the authors. A significant reduction in caregiver anxiety was noted after participation in the T-CARES program. T-CARES and similar programs can be developed to teach self-care for a variety of conditions that patients and caregivers are expected to manage at home.
Examines private individual defamation cases that include discussion of whether the reasonably prudent publisher/editor or the reasonably prudent person should set the standard of care when negligence is at issue. Considers the implication of judicial reasoning in adopting one standard of care rather than the other. (RS)
Young, Alice; Tacon, Catherine; Smith, Simon; Reeves, Ben; Wiseman, Greg; Hanson, Josh
With prompt administration of appropriate antimicrobial therapy and access to modern intensive care support, fatal pediatric melioidosis is very unusual. We describe cases of two children in whom the possibility of melioidosis was recognized relatively early, but who died of the disease, despite receiving optimal supportive care. We discuss the resulting implications for bacterial virulence factors in disease pathogenesis.
Efficient health care service delivery using network analysis: a case study of Kwara State, Nigeria. ... Ethiopian Journal of Environmental Studies and Management ... This paper addresses challenges with prompt health care delivery using Network Analysis of Critical Path Model (CPM) to plan the hospital capacity with a ...
Avelino, Mariza M; Amaral, Waldemar N; Rodrigues, Isolina M X; Rassi, Alan R; Gomes, Maria B F; Costa, Tatiane L; Castro, Ana M
Control programs have been executed in an attempt to reduce vertical transmission and the severity of congenital infection in regions with a high incidence of toxoplasmosis in pregnant women. We aimed to evaluate whether treatment of pregnant women with spiramycin associated with a lack of monitoring for toxoplasmosis seroconversion affects the prognosis of patients. We performed a prospective cohort study with 246 newborns (NB) at risk for congenital toxoplasmosis in Goiânia (Brazil) between October 2003 and October 2011. We analyzed the efficacy of maternal treatment with spiramycin. A total of 40.7% (66/162) of the neonates were born seriously infected. Vertical transmission associated with reactivation during pregnancy occurred in 5.5% (9/162) of the NB, with one showing severe infection (systemic). The presence of specific immunoglobulins (fetal IgM and NB IgA) suggested the worst prognosis. Treatment of pregnant women by spiramycin resulted in reduced vertical transmission. When infected pregnant women did not undergo proper treatment, the risk of severe infection (neural-optical) in NB was significantly increased. Fetal IgM was associated with ocular impairment in 48.0% (12/25) of the fetuses and neonatal IgA-specific was related to the neuro-ophthalmologic and systemic forms of the disease. When acute toxoplasmosis was identified in the postpartum period, a lack of monitoring of seronegative pregnant women resulted in a higher risk of severe congenital infection. Treatment of pregnant women with spiramycin reduces the possibility of transmission of infection to the fetus. However, a lack of proper treatment is associated with the onset of the neural-optical form of congenital infection. Primary preventive measures should be increased for all pregnant women during the prenatal period and secondary prophylaxis through surveillance of seroconversion in seronegative pregnant woman should be introduced to reduce the severity of congenital infection in the
Background Control programs have been executed in an attempt to reduce vertical transmission and the severity of congenital infection in regions with a high incidence of toxoplasmosis in pregnant women. We aimed to evaluate whether treatment of pregnant women with spiramycin associated with a lack of monitoring for toxoplasmosis seroconversion affects the prognosis of patients. Methods We performed a prospective cohort study with 246 newborns (NB) at risk for congenital toxoplasmosis in Goiânia (Brazil) between October 2003 and October 2011. We analyzed the efficacy of maternal treatment with spiramycin. Results A total of 40.7% (66/162) of the neonates were born seriously infected. Vertical transmission associated with reactivation during pregnancy occurred in 5.5% (9/162) of the NB, with one showing severe infection (systemic). The presence of specific immunoglobulins (fetal IgM and NB IgA) suggested the worst prognosis. Treatment of pregnant women by spiramycin resulted in reduced vertical transmission. When infected pregnant women did not undergo proper treatment, the risk of severe infection (neural-optical) in NB was significantly increased. Fetal IgM was associated with ocular impairment in 48.0% (12/25) of the fetuses and neonatal IgA-specific was related to the neuro-ophthalmologic and systemic forms of the disease. When acute toxoplasmosis was identified in the postpartum period, a lack of monitoring of seronegative pregnant women resulted in a higher risk of severe congenital infection. Conclusion Treatment of pregnant women with spiramycin reduces the possibility of transmission of infection to the fetus. However, a lack of proper treatment is associated with the onset of the neural-optical form of congenital infection. Primary preventive measures should be increased for all pregnant women during the prenatal period and secondary prophylaxis through surveillance of seroconversion in seronegative pregnant woman should be introduced to reduce the
Harvey, Nina R; Stanton, Marietta P
The purpose of this case study is to provide a specific example of the disease trajectory for one patient's experience with intensive care unit-acquired weakness (ICUAW). This case study provides those in case management with an overview of some of the common signs and symptoms of ICUAW, as well as the possible prognosis and recovery from ICUAW. The events in this case study take place in the acute care setting including the intensive care unit of a mid-sized health center, a general medical-surgical (med-surg) unit, and a long-term acute care facility. ICUAW affects the clinical, functional, and financial outcomes of patients. If the patient survives, their quality of life and the quality of life of their family members could be severely impacted. Case management practice has a significant role in coordinating care for those diagnosed with ICUAW. Case managers can use knowledge about ICUAW to improve the patient's transition throughout the hospital stay, improve discharge recommendations, and improve the patient's short-term and long-term outcomes. This may reduce unnecessary utilization of health care resources.
Meredith Loomis Quinlan
Full Text Available Through face-to-face conversations and open-ended questions designed to elicit stories and deeper interactions, the Michigan People’s Campaign (MPC may have altered voting patterns more effectively than using traditional electoral engagement strategies. During the 2016 election, by campaigning on issues of family care, MPC helped elect a progressive state house candidate in a Downriver Detroit district that Republican presidential candidate Donald Trump carried by over 6,000 votes.
Eagle, Kim A; Koelling, Todd M; Montoye, Cecelia K
The American College of Cardiology Acute Myocardial Infarction Guidelines Applied in Practice program in Michigan, USA, was an initiative designed to improve the quality of cardiovascular care by bringing the American College of Cardiology/American Heart Association practice guidelines to the point of care. The program consisted of three different projects, involving a total of 33 hospitals. The program was implemented in five phases-planning, tool implementation, monitoring of tool use, remeasurement and reporting of results-by use of a collaborative model, which included a series of learning sessions for staff members that focused on the five phases. The goal was to identify the highest care priorities for patients with acute coronary syndromes and to incorporate these into the care itself. This aim was achieved with a standardized set of clinical-care tools, such as admission orders and discharge contracts; the use of such tools is associated with improvement in adherence to guidelines. Strategies were, however, tailored to each hospital by local teams. Performance was assessed by the use of tracking tools, which facilitate rapid improvement by enabling key performance indicators founded on the guidelines to be monitored. Using qualitative surveys of the project leaders, we identified an optimum timeline and correlations between hospital-specific attributes and greater or lesser success in achieving positive change. In this review, we describe our experience and identify the most useful strategies for future implementation of such a project.
Hager, David R; Persaud, Rosemary A; Naseman, Ryan W; Choudhary, Kavish; Carter, Kristen E; Hansen, Amanda
Background: While hospital beds continue to decline as patients previously treated as inpatients are stabilized in ambulatory settings, the number of critical care beds available in the United States continues to rise. Growth in pharmacy student graduation, postgraduate year 2 critical care (PGY2 CC) residency programs, and positions has also increased. There is a perception that the critical care trained pharmacist market is saturated, yet this has not been evaluated since the rise in pharmacy graduates and residency programs. Purpose: To describe the current perception of critical care residency program directors (CC RPDs) and directors of pharmacy (DOPs) on the critical care pharmacist job market and to evaluate critical care postresidency placement and anticipated changes in PGY2 CC programs. Methods: Two electronic surveys were distributed from October 2015 to November 2015 through Vizient/University HealthSystem Consortium, American Society of Health-System Pharmacists (ASHP), Society of Critical Care Medicine, and American College of Clinical Pharmacy listservs to target 2 groups of respondents: CC RPDs and DOPs. Questions were based on the ASHP Pharmacy Forecast and the Pharmacy Workforce Center's Aggregate Demand Index and were intended to identify perceptions of the critical care market of the 2 groups. Results: Of 116 CC RPDs, there were 66 respondents (56.9% response rate). Respondents have observed an increase in applicants; however, they do not anticipate increasing the number of positions in the next 5 years. The overall perception is that there is a balance in supply and demand in the critical care trained pharmacist market. A total of 82 DOPs responded to the survey. Turnover of critical care pharmacists within respondent organizations is expected to be low. Although a majority of DOPs plan to expand residency training positions, only 9% expect to increase positions in critical care PGY2 training. Overall, DOP respondents indicated a balance of
van den Brink, W.; Leenstra, A.; Ormel, J.; van de Willige, G.
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
Friedman, Eliot L; Chawla, Neetu; Morris, Paul T; Castro, Kathleen M; Carrigan, Angela C; Das, Irene Prabhu; Clauser, Steven B
The National Cancer Institute Community Cancer Centers Program (NCCCP) began in 2007 with a goal of expanding cancer research and delivering quality care in communities. The NCCCP Quality of Care (QoC) Subcommittee was charged with developing and improving the quality of multidisciplinary care. An assessment tool with nine key elements relevant to MDC structure and operations was developed. Fourteen NCCCP sites reported multidisciplinary care assessments for lung, breast, and colorectal cancer in June 2010, June 2011, and June 2012 using an online reporting tool. Each site evaluated their level of maturity (level 1 = no multidisciplinary care, level 5 = highly integrated multidisciplinary care) in nine elements integral to multidisciplinary care. Thematic analysis of open-ended qualitative responses was also conducted. The proportion of sites that reported level 3 or greater on the assessment tool was tabulated at each time point. For all tumor types, sites that reached this level increased in six elements: case planning, clinical trials, integration of care coordination, physician engagement, quality improvement, and treatment team integration. Factors that enabled improvement included increasing organizational support, ensuring appropriate physician participation, increasing patient navigation, increasing participation in national quality initiatives, targeting genetics referrals, engaging primary care providers, and integrating clinical trial staff. Maturation of multidisciplinary care reflected focused work of the NCCCP QoC Subcommittee. Working group efforts in patient navigation, genetics, and physician conditions of participation were evident in improved multidisciplinary care performance for three common malignancies. This work provides a blueprint for health systems that wish to incorporate prospective multidisciplinary care into their cancer programs. Copyright © 2015 by American Society of Clinical Oncology.
Holt, Cheryl L.; Steward, Jocelyn L.; Jones, Richard N.; Roth, David L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa W.; Austin, Erika L.; Henry, Stephen Randal; Kay Johnson, N.; Shanette Granstaff, U.; O’Connell, James J.; Golden, Joya F.; Young, Alexander S.; Davis, Lori L.; Pollio, David E.
Objectives. We compared homeless patients’ experiences of care in health care organizations that differed in their degree of primary care design service tailoring. Methods. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the “Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Results. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P homelessness. PMID:24148052
Kertesz, Stefan G; Holt, Cheryl L; Steward, Jocelyn L; Jones, Richard N; Roth, David L; Stringfellow, Erin; Gordon, Adam J; Kim, Theresa W; Austin, Erika L; Henry, Stephen Randal; Kay Johnson, N; Shanette Granstaff, U; O'Connell, James J; Golden, Joya F; Young, Alexander S; Davis, Lori L; Pollio, David E
We compared homeless patients' experiences of care in health care organizations that differed in their degree of primary care design service tailoring. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the "Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P homelessness.
Goldberg, Capt Kathy F; Green, Bart; Moore, Jacqueline; Wyatt, Marilynn; Boulanger, Lynn; Belnap, Brian; Harsch, Peter; Donaldson, David S
The purpose of this study is to describe the musculoskeletal rehabilitation model used to care for combat and severely wounded or ill US military service members at an integrated Comprehensive Combat and Complex Casualty Care center located at Naval Medical Center San Diego. Through a collaborative and iterative process, providers from the various services included at the Comprehensive Combat and Complex Casualty Care program developed a description of the integration of services provided at this location. After construction of the facility in 2007, the program has provided services for approximately 2 years. Eighteen different health care providers from 10 different specialties provide integrated musculoskeletal services, which include primary care, physical therapy, occupational therapy, vestibular therapy, gait analysis, prosthetics, recreational therapy, and chiropractic care. At the time of this writing (early 2009), the program had provided musculoskeletal rehabilitation care to approximately 500 patients, 58 with amputations, from the operational theater, Veterans Affairs, other military treatment facilities, and local trauma centers. The complex nature of combat wounded and polytrauma patients requires an integrated and interdisciplinary team that is innovative, adaptable, and focused on the needs of the patient. This article presents a description of the model and the experiences of our musculoskeletal rehabilitation team; it is our hope that this article will assist other centers and add to the small but emerging literature on this topic.
Bentham, Wayne D; Ratzliff, Anna; Harrison, David; Chan, Ya-Fen; Vannoy, Steven; Unützer, Jürgen
Primary care providers participating in a statewide implementation of an integrated mental health care program for "safety-net" patients in primary care clinics were surveyed to elicit their experiences and level of satisfaction. Quantitative analyses were performed to identify respondent characteristics and satisfaction with the program. Qualitative analyses were done to identify common themes in response to the question "How could psychiatric consultation [in the program] be improved?" Primary care providers were generally satisfied with the integrated mental health care program and raised several concerns that suggest important principles for successful future implementations of these types of programs.
Dean, Katie M; Hatfield, Laura A; Jena, Anupam B; Cristman, David; Flair, Michael; Kator, Kylie; Nudd, Geoffrey; Grabowski, David C
Home care recipients are often hospitalized for potentially avoidable reasons. A pilot program (Intervention in Home Care to Improve Health Outcomes (In-Home)) was designed to help home care providers identify acute clinical changes in condition and then manage the condition in the home and thereby avoid a costly hospitalization. Caregivers answer simple questions about the care recipient's condition during a telephone-based "clock-out" at the end of each shift. Responses are electronically captured in the agency management software that caregivers use to "clock-in," manage care, and "clock-out" on every shift. These are transmitted to the agency's care manager, who follows up on the change in condition and escalates appropriately. A description of the In-Home model is presented, and pilot data from 22 home care offices are reported. In the pilot, caregivers reported a change in condition after 2% of all shifts, representing an average of 1.9 changes per care recipient in a 6-month period. Changes in behavior and skin condition were the most frequently recorded domains. Interviews with participating caregivers and care managers suggested positive attitudes regarding the intervention; challenges included resistance to change on the part of home care staff and difficulties in applying a uniform intervention to individuals with varying needs in home care offices with varying capacities. In an ongoing randomized trial, the success of the overall program will be measured primarily according to the potential reduction in avoidable hospitalizations of home care recipients and the effect this potential reduction has on spending and healthcare outcomes. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Geltz, Ronald M.
Discusses child sex abuse cases from a prosecutor's view with particular emphasis on the Little Rascals Day Care Center case (Edenton, NC). The author addresses issues that can lead to a successful prosecution, such as pretrial preparation and having witnesses approach the jury with clear, concise statements. (JPS)
Arnáez, J; Vega, C; García-Alix, A; Gutiérrez, E P; Caserío, S; Jiménez, M P; Castañón, L; Esteban, I; Hortelano, M; Hernández, N; Serrano, M; Prada, T; Diego, P; Barbadillo, F
Newborns with perinatal indicators of a potential hypoxic-ischemic event require an integrated care in order to control the aggravating factors of brain damage, and the early identification of candidates for hypothermia treatment. The application of a prospective, populational program that organizes and systematizes medical care during the first 6 hours of life to all newborns over 35 weeks gestational age born with indicators of a perinatal hypoxic-ischemic insult. The program includes 12 hospitals (91,217 m(2)); two level i centers, five level ii centers, and five level iii hospitals. The program establishes four protocols: a) detection of the newborn with a potential hypoxic-ischemic insult, b) surveillance of the neurological repercussions and other organ involvement, c) control and treatment of complications, d) procedures and monitoring during transport. From June 2011 to June 2013, 213 of 32325 newborns above 35 weeks gestational age met the criteria of a potential hypoxic-ischemic insult (7.4/1000), with 92% of them being cared for following the program specifications. Moderate-severe hypoxic-ischemic encephalopathy was diagnosed in 33 cases (1/1,000), and 31 out of the 33 received treatment with hypothermia (94%). The program for the Integrated Care of Newborns with Perinatal Hypoxic-Ischemic Insult has led to providing a comprehensive care to the newborns with a suspected perinatal hypoxic-ischemic insult. Aggravators of brain damage have been controlled, and cases of moderate-severe hypoxic-ischemic encephalopathy have been detected, allowing the start of hypothermia treatment within the first six hours of life. Populational programs are fundamental to reducing the mortality and morbidity of hypoxic-ischemic encephalopathy. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.
Landry, Craig M; Jackson, Aurora P; Tang, Lingqi; Miranda, Jeanne; Chung, Bowen; Jones, Felica; Ong, Michael K; Wells, Kenneth
This study examined the effects of a depression care quality improvement (QI) intervention implemented by using Community Engagement and Planning (CEP), which supports collaboration across health and community-based agencies, or Resources for Services (RS), which provides technical assistance, on training participation and service delivery by primarily unlicensed, racially and ethnically diverse case managers in two low-income communities in Los Angeles. The study was a cluster-randomized trial with program-level assignment to CEP or RS for implementation of a QI initiative for providing training for depression care. Staff with patient contact in 84 health and community-based programs that were eligible for the provider outcomes substudy were invited to participate in training and to complete baseline and one-year follow-up surveys; 117 case managers (N=59, RS; N=58, CEP) from 52 programs completed follow-up. Primary outcomes were time spent providing services in community settings and use of depression case management and problem-solving practices. Secondary outcomes were depression knowledge and attitudes and perceived system barriers. CEP case managers had greater participation in depression training, spent more time providing services in community settings, and used more problem-solving therapeutic approaches compared with RS case managers (pcommunity settings, and use of problem-solving skills among primarily unlicensed, racially and ethnically diverse case managers were greater in programs that used CEP rather than RS to implement depression care QI, suggesting that CEP offers a model for including case managers in communitywide depression care improvement efforts.
Hope, Aluko A; Hsieh, S Jean; Howes, Jennifer M; Keene, Adam B; Fausto, James A; Pinto, Priya A; Gong, Michelle Ng
Although expert communication between intensive care unit clinicians with patients or surrogates improves patient- and family-centered outcomes, fellows in critical care medicine do not feel adequately trained to conduct family meetings. We aimed to develop, implement, and evaluate a communication skills program that could be easily integrated into a U.S. critical care fellowship. We developed four simulation cases that provided communication challenges that critical care fellows commonly face. For each case, we developed a list of directly observable tasks that could be used by faculty to evaluate fellows during each simulation. We developed a didactic curriculum of lectures/case discussions on topics related to palliative care, end-of-life care, communication skills, and bioethics; this month-long curriculum began and ended with the fellows leading family meetings in up to two simulated cases with direct observation by faculty who were not blinded to the timing of the simulation. Our primary measures of effectiveness were the fellows' self-reported change in comfort with leading family meetings after the program was completed and the quality of the communication as measured by the faculty evaluators during the family meeting simulations at the end of the month. Over 3 years, 31 critical care fellows participated in the program, 28 of whom participated in 101 family meeting simulations with direct feedback by faculty facilitators. Our trainees showed high rates of information disclosure during the simulated family meetings. During the simulations done at the end of the month compared with those done at the beginning, our fellows showed significantly improved rates in: (1) verbalizing an agenda for the meeting (64 vs. 41%; Chi-square, 5.27; P = 0.02), (2) summarizing what will be done for the patient (64 vs. 39%; Chi-square, 6.21; P = 0.01), and (3) providing a follow-up plan (60 vs. 37%; Chi-square, 5.2; P = 0.02). More than 95% of our participants (n = 27
Pahlavanzadeh, Saied; Asgari, Zohreh; Alimohammadi, Nasrollah
High level of stress in intensive care unit nurses affects the quality of their nursing care. Therefore, this study aimed to determine the effects of a stress management program on the quality of nursing care of intensive care unit nurses. This study is a randomized clinical trial that was conducted on 65 nurses. The samples were selected by stratified sampling of the nurses working in intensive care units 1, 2, 3 in Al-Zahra Hospital in Isfahan, Iran and were randomly assigned to two groups. The intervention group underwent an intervention, including 10 sessions of stress management that was held twice a week. In the control group, placebo sessions were held simultaneously. Data were gathered by demographic checklist and Quality Patient Care Scale before, immediately after, and 1 month after the intervention in both groups. Then, the data were analyzed by Student's t-test, Mann-Whitney, Chi-square, Fisher's exact test, and analysis of variance (ANOVA) through SPSS software version 18. Mean scores of overall and dimensions of quality of care in the intervention group were significantly higher immediately after and 1 month after the intervention, compared to pre-intervention (P quality of care in the intervention group was significantly higher immediately after and 1 month after the intervention, compared to the control group (P quality of care, the staffs are recommended to consider it in improvement of the quality of nursing care.
Mehta, Bella H; Rodis, Jennifer L; Nahata, Milap C; Bennett, Marialice S
The development, implementation, and outcomes assessment of an innovative pharmacist-managed ambulatory care and community pharmacy practice clinic are described. The Clinical Partners Program at The Ohio State University (OSU) provides an active learning environment for students and residents, offers a patient-focused practice model based on pharmaceutical care principles, and serves as an arena for applied research in pharmacy practice. The program offers multiple services, including anticoagulation management, diabetes self-management, cholesterol management, hepatitis C education, herbal product and dietary supplement consultations, medication management, smoking cessation, and wellness. The practice is currently staffed by two faculty members from the college of pharmacy, with a 0.8 full-time-equivalent (FTE) pharmacist and a 0.65 FTE community pharmacy resident. It has served as a training site for 17 pharmacy residents, 28 bachelor of science (B.S.) in pharmacy students, 30 post-B.S. doctor of pharmacy (Pharm.D.) students, and 132 entry-level Pharm.D. students at various levels of training. The most successful methods of reimbursement for programs have been contracted services with OSU Managed Health Care Systems, Inc., which serves OSU faculty and staff and fee-for-service billing, charged directly to non-OSU patients. Numerous studies have shown that Clinical Partners has consistently demonstrated improved therapeutic outcomes over those achieved in traditional practice. Faculty are exploring outreach services, including the development of advanced practice community sites for the college, establishing patient care services within physician offices, and providing disease management services for self-insured employers. The Clinical Partners Program has improved patient care and provided education and training opportunities for pharmacy students and residents.
Offenheiser, R C
health workers were given intensive courses over 12 weeks in the dispensary in Santarem, where they learned to do basic laboratory examinations to identify the 9 most common intestinal parasites in the region, to organize vaccination campaigns including record keeping, to provide prenatal care and attend deliveries, to recognize a variety of diseases, and to refer doubtful cases to the dispensary in Santarem along with complete medical histories. They also provided follow-up care for surgical patients. A program to dig wells provided the benefits of clean water, a reduction of parasite infections, increased prestige for the health workers who were active in the campaign, and more free time for the women and children who had previously carried water from the rivers. The Hope Foundation cooperated with the medical faculty of a nearby university to train medical personnel for community health in the Amazon basin, but found little interest among new graduates. The foundation recently contracted to train health promoters to serve other regions of the state of Para.
Nielsen, Jeppe Agger; Mathiassen, Lars
Mobile technologies have emerged as important tools that health care personnel can use to gain easy access to client data anywhere. This is particularly useful for nurses and care workers in home health care as they provide services to clients in many different settings. Although a growing body of evidence supports the use of mobile technologies, the diverse implications of mobile health have yet to be fully documented. Our objective was to examine a large-scale government-sponsored mobile health implementation program in the Danish home care sector and to understand how the technology was used differently across home care agencies. We chose to perform a longitudinal case study with embedded units of analysis. We included multiple data sources, such as written materials, a survey to managers across all 98 Danish municipalities, and semistructured interviews with managers, care workers, and nurses in three selected home care agencies. We used process models of change to help analyze the overall implementation process from a longitudinal perspective and to identify antecedent conditions, key events, and practical outcomes. Strong collaboration between major stakeholders in the Danish home care sector (government bodies, vendors, consultants, interest organizations, and managers) helped initiate and energize the change process, and government funding supported quick and widespread technology adoption. However, although supported by the same government-sponsored program, mobile technology proved to have considerable interpretive flexibility with variation in perceived nature of technology, technology strategy, and technology use between agencies. What was first seen as a very promising innovation across the Danish home care sector subsequently became the topic of debate as technology use arrangements ran counter to existing norms and values in individual agencies. Government-sponsored programs can have both positive and negative results, and managers need to be aware
Hartnett, Erin; Krainovich-Miller, Barbara
Early childhood dental caries (dental cavities) is an infectious process. The development of oral problems during cancer care results in pain, fever, and delay in treatment. . The objective of this project was to integrate preventive oral care into pediatric oncology care. . This project consisted of an educational program for pediatric oncology providers who completed pre- and postprogram surveys assessing oral health knowledge, attitudes, and practice; attended an oral health education session; and performed oral assessment and fluoride varnish application on children during cancer treatment. . Three major outcomes resulted from this project.
Call Mañosa, S; Pujol Garcia, A; Chacón Jordan, E; Martí Hereu, L; Pérez Tejero, G; Gómez Simón, V; Estruga Asbert, A; Gallardo Herrera, L; Vaquer Araujo, S; de Haro López, C
An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy. Copyright © 2016. Published by Elsevier España, S.L.U.
Nishita, Christy M; Hayashida, Cullen; Kim, Emelyn
The Kupuna Adult Care Home Project is an innovative training program designed to improve the skills of care home and adult foster home operators in Hawaii. Clients in residential settings are increasingly likely to have complex problems. The project developed nine modules on topics such as dementia care, diabetes, and fall prevention based on stakeholder input and a national scan of best practices. A total of 787 persons were trained. An evaluation indicated that training significantly improved knowledge and that trainees were highly satisfied with the training. A secondary State of the Industry survey indicated that many care home and adult foster home caregivers are aging themselves and their children may not take over the family business. By combining practical knowledge and active learning strategies to work through real-life scenarios, the Kupuna Adult Care Home project is a promising training model.
Oberlies, Amanda Stefancyk
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.
Piacentino, Justin J; Williams, Karl G
To discuss changes in the law that allow community pharmacy loyalty programs to include and offer incentives to Medicare and Medicaid beneficiaries. The retailer rewards exception of the Patient Protection and Affordable Care Act of 2010 and its change to the definition of remuneration in the civil monetary penalties of the Anti-Kickback Statute now allow incentives to be earned on federal benefit tied prescription out-of-pocket costs. The criteria required to design a compliant loyalty program are discussed. Community pharmacies can now include Medicare and Medicaid beneficiaries in compliant customer loyalty programs, where allowed by state law. There is a need for research directly on the influence of loyalty programs and nominal incentives on adherence.
Daiane Medeiros da Silva
Full Text Available Abstract OBJECTIVE: To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. METHOD: Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum. RESULTS: The organization of care for tuberculosis and supported self-care presented reasonable capacity.In the coordination with the community, the presence of the community agent presented optimum capacity.Partnership with organizations of the community and involvement of experts presented limited capacity.The qualification of professionals, the system for scheduling and monitoring tuberculosis in the community, and the clinical information system presented basic capacity. CONCLUSION: The capacity of the primary health care services to produce tuberculosis-related care according to the elements of the Chronic Care Model is still limited.Overcoming the fragmentation of care and prioritizing a systemic operation between actions and services of the health care network remains as a major challenge.
Wheatley, Laura; Doyle, Winnie; Evans, Cheryl; Gosse, Carolyn; Smith, Kevin
Calls for transformational change of our healthcare system are increasingly clear, persuasive and insistent. They resonate at all levels, with those who fund, deliver, provide and receive care, and they are rooted in a deep understanding that the system, as currently rigidly structured, most often lacks the necessary flexibility to comprehensively meet the needs of patients across the continuum of care. The St. Joseph's Health System (SJHS) Integrated Comprehensive Care (ICC) Program, which bundles care and funding across the hospital to home continuum, has reduced fragmentation of care, and it has delivered improved outcomes for patients, providers and the system. This case study explores the essential contribution of nursing leadership to this successful transformation of healthcare service delivery.
Wade, Gail Holland; Herrman, Judy; McBeth-Snyder, Lisa
Preconception healthcare is a way to enhance positive pregnancy outcomes by encouraging women to engage in healthy lifestyles before they become pregnant. Because approximately 50% of pregnancies are unplanned, fetal development may be affected before a woman receives prenatal care. Young women are especially vulnerable to poor outcomes due to risky behaviors. Education about preconception health is not common practice. This article describes a peer education preconception health program for college women that provided a basis for an expanded program with larger, more diverse populations. Nursing students as peer educators presented the program to over 100 young women using the mnemonic REFRAMED PLUS to address eight preconception risk areas and reproductive life planning. Materials to augment the program, developed by peer educators, included a brochure on preconception health, a risk assessment tool, a DVD with stories of young women who experienced unplanned pregnancies, and a Reproductive Life Plan book. Peer educators administered a pretest, showed the DVD, guided discussions, assessed each woman's health risks and administered a posttest. The risk assessment revealed that young women have several preconception health risks. Following the preconception program, posttest scores indicated increased knowledge of preconception health. For preconception healthcare to be successful, preconception risk assessments, education and counseling must be addressed by nurses every time a young woman receives care. When possible, peer educators should be used to disseminate the message to all women of childbearing age.
Stewart, Donald F.
The stated goal of this meeting is to examine the use of telemedicine in disaster management, public health, and remote health care. NASA has a vested interest in providing health care to crews in remote environments. NASA has unique requirements for telemedicine support, in that our flight crews conduct their job in the most remote of all work environments. Compounding the degree of remoteness are other environmental concerns, including confinement, lack of atmosphere, spaceflight physiological deconditioning, and radiation exposure, to name a few. In-flight medical care is a key component in the overall support for missions, which also includes extensive medical screening during selection, preventive medical programs for astronauts, and in-flight medical monitoring and consultation. This latter element constitutes the telemedicine aspect of crew health care. The level of in-flight resources dedicated to medical care is determined by the perceived risk of a given mission, which in turn is related to mission duration, planned crew activities, and length of time required for return to definitive medical care facilities.
Silberstein, Dalia; Litmanovitz, Ita
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.
Davis, Elizabeth; Tamayo, Aracely; Fernandez, Alicia
Case management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants' perspectives on case management interventions. This qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program. FOUR RECURRENT THEMES EMERGED: (1) Participants described profound social isolation prior to case management program enrollment; (2) Participants perceived that caring personal relationships with case managers were key to the program; (3) Participants valued assistance with navigating medical and social systems; and (4) Participants perceived that their health improved through both the interpersonal and the practical aspects of case management. Chronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients.
Horn, Brady P; Crandall, Cameron; Moffett, Maurice; Hensley, Michael; Howarth, Sam; Binder, Douglas S; Sklar, David
High-cost, medically complex patients have been a challenging population to manage in the US health care system, in terms of both improving health outcomes and containing costs. This paper evaluated the economic impact of Care One, an intensive care management program (data analysis, evaluation, empanelment, specialist disease management, nurse case management, and social support) designed to target the most expensive 1% of patients in a university health care system. Data were collected for a cohort of high-cost, medically complex patients (N = 753) who received care management and a control group (N = 794) of similarly complex health system users who did not receive access to the program. A pre-post empirical model estimated the Care One program to be associated with a per-patient reduction in billed charges of $92,227 (95% confidence interval [CI]: $83,988 to $100,466). A difference-in-difference model, which utilized the control group, estimated a per-patient reduction in billing charges of $44,504 (95% CI: $29,195 to $59,813). Results suggest that care management for high-cost, medically complex patients in primary care can reduce costs compared to a control group. In addition, significant reversion to the mean is found, providing support for the use of a difference-in-difference estimator when evaluating health programs for high-cost, medically complex patients.
DeSoucy, Erik; Shackelford, Stacy; DuBose, Joseph J; Zweben, Seth; Rush, Stephen C; Kotwal, Russ S; Montgomery, Harold R; Keenan, Sean
Prolonged field care (PFC) is field medical care applied beyond doctrinal planning time-lines. As current and future medical operations must include deliberate and contingency planning for such events, data are lacking to support efforts. A case review was conducted to define the epidemiology, environment, and operational factors that affect PFC outcomes. A survey distributed to US military medical providers solicited details of PFC encounters lasting more than 4 hours and included patient demographics, environmental descriptors, provider training, modes of transportation, injuries, mechanism of injury, vital signs, treatments, equipment and resources used, duration of PFC, and morbidity and mortality status on delivery to the next level of care. Descriptive statistics were used to analyze survey responses. Surveys from 54 patients treated during 41 missions were analyzed. The PFC provider was on scene at time of injury or illness for 40.7% (22/54) of cases. The environment was described as remote or austere for 96.3% (52/54) of cases. Enemy activity or weather also contributed to need for PFC in 37.0% (20/54) of cases. Care was provided primarily outdoors (37.0%; 20/54) and in hardened nonmedical structures (37.0%; 20/54) with 42.6% (23/54) of cases managed in two or more locations or transport platforms. Teleconsultation was obtained in 14.8% (8/54) of cases. The prehospital time of care ranged from 4 to 120 hours (median 10 hours), and five (9.3%) patients died prior to transport to next level of care. PFC in the prehospital setting is a vital area of military medicine about which data are sparse. This review was a novel initial analysis of recent US military PFC experiences, with descriptive findings that should prove helpful for future efforts to include defining unique skillsets and capabilities needed to effectively respond to a variety of PFC contingencies. 2017.
Bowerman, S; Bellman, M; Saltsman, P; Garvey, D; Pimstone, K; Skootsky, S; Wang, H J; Elashoff, R; Heber, D
Most primary care physicians do not treat obesity, citing lack of time, resources, insurance reimbursement, and knowledge of effective interventions as significant barriers. To address this need, a 10-minute intervention delivered by the primary care physician was coupled with individual dietary counseling sessions delivered by a registered dietitian via telephone with an automated calling system (House-Calls, Mobile, AL). Patients were seen for follow-up by their physician at weeks 4, 12, 24, 36 and 52. A total of 252 patients (202 women and 50 men) were referred by 18 primary care physicians to the program. The comorbid conditions reported for all patients at baseline included low back pain, 29% (n = 72); hypertension, 45% (n = 113); hypercholesterolemia, 41% (n = 104); type 2 diabetes, 10% (n = 26); and sleep apnea, 5% (n = 12). When offered a choice of meal plans based on foods or meal replacements, two-thirds of patients (n = 166) chose to use meal replacements (Ultra Slim-Fast; Slim-Fast Foods Co., West Palm Beach, FL) at least once daily. Baseline weights of subjects averaged 200 +/- 46 lb for women (n = 202) and 237 +/- 45 lb for men (n = 50). Patients completing 6 months in the program lost an average of 19.0 +/- 4.0 lb for women (n = 94) and 15.5 +/- 8.2 lb for men (n = 26). Physicians reported a high degree of satisfaction with the program, suggesting that a brief, effective physician-directed program with nutritionist support by telephone can be implemented in a busy primary care office.
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.
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.
Noje, Corina; Bernier, Meghan L; Costabile, Philomena M; Klein, Bruce L; Kudchadkar, Sapna R
To present our single-center's experience with three palliative critical care transports home from the PICU for terminal extubation. We performed a retrospective chart review of patients transported between January 1, 2012, and December 31, 2014. All cases were identified from our institutional pediatric transport database. Patients were terminally ill children unable to separate from mechanical ventilation in the PICU, who were transported home for terminal extubation and end-of-life care according to their families' wishes. Patients underwent palliative care transport home for terminal extubation. The rate of palliative care transports home for terminal extubation during the study period was 2.6 per 100 deaths. The patients were 7 months, 6 years, and 18 years old and had complex chronic conditions. The transfer process was protocolized. The families were approached by the PICU staff during multidisciplinary goals-of-care meetings. Parental expectations were clarified, and home hospice care was arranged pretransfer. All transports were performed by our pediatric critical care transport team, and all terminal extubations were performed by physicians. All patients had unstable medical conditions and urgent needs for transport to comply with the families' wishes for withdrawal of life support and death at home. As such, all three cases presented similar logistic challenges, including establishing do-not-resuscitate status pretransport, having limited time to organize the transport, and coordinating home palliative care services with available community resources. Although a relatively infrequent practice in pediatric critical care, transport home for terminal extubation represents a feasible alternative for families seeking out-of-hospital end-of-life care for their critically ill technology-dependent children. Our single-center experience supports the need for development of formal programs for end-of-life critical care transports to include patient screening tools
Herrel, Lindsey A; Ayanian, John Z; Hawken, Scott R; Miller, David C
Although Accountable Care Organizations (ACOs) are defined by the provision of primary care services, the relationship between the intensity of primary care and population-level utilization and costs of health care services has not been examined during early implementation of Medicare Shared Savings Program (MSSP) ACOs. Our objective was to evaluate the association between primary care focus and healthcare utilization and spending in the first performance period of the Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). In this retrospective cohort study, we divided the 220 MSSP ACOs into quartiles of primary care focus based on the percentage of all ambulatory evaluation and management services delivered by a PCP (internist, family physician, or geriatrician). Using multivariable regression, we evaluated rates of utilization and spending during the initial performance period, adjusting for the percentage of non-white patients, region, number of months enrolled in the MSSP, number of beneficiary person years, percentage of dual eligible beneficiaries and percentage of beneficiaries over the age of 74. The proportion of ambulatory evaluation and management services delivered by a PCP ranged from focus) to >46% (highest quartile, ACOs with greatest PCP focus). ACOs in the highest quartile of PCP focus had higher adjusted rates of utilization of acute care hospital admissions (328 per 1000 person years vs 292 per 1000 person years, p = 0.01) and emergency department visits (756 vs 680 per 1000 person years, p = 0.02) compared with ACOs in the lowest quartile of PCP focus. ACOs in the highest quartile of PCP focus achieved no greater savings per beneficiary relative to their spending benchmarks ($142 above benchmark vs $87 below benchmark, p = 0.13). Primary care focus was not associated with increased savings or lower utilization of healthcare during the initial implementation of MSSP ACOs.
Cetin Kursad Akpinar
Full Text Available Acute Bacterial Parotitis (ABP is an infection seen in very early and old ages. The infection can be prevented by sufficient fluid support, mouth hygiene, oral feeding and avoiding multiple medication use. Parotis ultrasonography can be used for diagnosis. Acute Bacterial Parotitis can be treated in a short time and free of problems with early diagnosis and appropriate antibiotics. Mortality can be seen in cases which are late diagnosed and which are resistant to antibiotic treatment. This article presents four case reports over the age of 65 with a diagnosis of ABP, who are monitored in the intensive care. It is thought that the first case developed ABP because of multiple medication use, liquid restriction and oral feeding difficulty, the second case because of oral feeding difficulty, the third case because of bad mouth hygiene, dementia and not getting enough liquid and the fourth case because of oral feeding difficulty. If the cases with the stated risk factors are carefully followed, intensive care hospitalization period will not be prolonged and mortality rates will not increase.
Full Text Available Abstract Background While it is recommended that records are kept between primary care providers (PCPs and specialists during patient transitions from hospital to community care, this communication is not currently standardized. We aimed to assess the transmission of cardiac rehabilitation (CR program intake transition records to PCPs and to explore PCPs' needs in communication with CR programs and for intake transition record content. Method 144 PCPs of consenting enrollees from 8 regional and urban Ontario CR programs participated in this cross-sectional study. Intake transition records were tracked from the CR program to the PCP's office. Sixty-six PCPs participated in structured telephone interviews. Results Sixty-eight (47.6% PCPs received a CR intake transition record. Fifty-eight (87.9% PCPs desired intake transition records, with most wanting it transmitted via fax (n = 52, 78.8%. On a 5-point Likert scale, PCPs strongly agreed that the CR transition record met their needs for providing patient care (4.32 ± 0.61, with 48 (76.2% reporting that it improved their management of patients' cardiac risk. PCPs rated the following elements as most important to include in an intake transition record: clinical status (4.67 ± 0.64, exercise test results (4.61 ± 0.52, and the proposed patient care plan (4.59 ± 0.71. Conclusions Less than half of intake transition records are reaching PCPs, revealing a large gap in continuity of patient care. PCP responses should be used to develop an evidence-based intake transition record, and procedures should be implemented to ensure high-quality transitional care.
Arbury, Sheila; Hodgson, Michael; Zankowski, Donna; Lipscomb, Jane
Commercial workplace violence (WPV) prevention training programs differ in their approach to violence prevention and the content they present. This study reviews 12 such programs using criteria developed from training topics in the Occupational Safety and Health Administration's (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and a review of the WPV literature. None of the training programs addressed all the review criteria. The most significant gap in content was the lack of attention to facility-specific risk assessment and policies. To fill this gap, health care facilities should supplement purchased training programs with specific training in organizational policies and procedures, emergency action plans, communication, facility risk assessment, and employee post-incident debriefing and monitoring. Critical to success is a dedicated program manager who understands risk assessment, facility clinical operations, and program management and evaluation.
Full Text Available OBJECTIVE: To identify the main strengths, weaknesses, and challenges of the Ecuador-Peru "peri-border" health care program and to analyze the legislative, managerial, and organizational arrangements adopted to integrate the two country's national health systems in the border area. METHODS: A descriptive, qualitative case study was carried out using three complementary methods: literature review and analysis of official Peruvian and Ecuadoran national and binational documents, 18 semi-structured interviews of key informants, and a survey of the entire health worker population of the Suyo-Macará binational micro-network. RESULTS: The key program challenge was the absence of reciprocity; Peruvian citizens were entitled to free health care services in Ecuador but Ecuadoran citizens did not receive the same benefit in Peru. The need for improvements in the binational system's human resources was also identified. The program's main strength was its organizational structure, which is designed mainly for the implementation of 1 the binational network and 2 a patient referral / counter-referral system that includes the transfer of patient clinical information. CONCLUSIONS: Notwithstanding considerable challenges, peri-border programs are feasible and replicable. Program success seems to be highly dependent on the completion of a number of steps, including 1 consolidation of the original binational memorandum into a binding binational agreement between the two countries; 2 achievement of similar standards in both countries for the provision and quality of health care services, focusing on complementarities; and 3 development of an integrated binational information system.
Cafagna, Gianluca; Missoni, Eduardo; Beingolea, Rosa Luz Benites de
To identify the main strengths, weaknesses, and challenges of the Ecuador-Peru "peri-border" health care program and to analyze the legislative, managerial, and organizational arrangements adopted to integrate the two country's national health systems in the border area. A descriptive, qualitative case study was carried out using three complementary methods: literature review and analysis of official Peruvian and Ecuadoran national and binational documents, 18 semi-structured interviews of key informants, and a survey of the entire health worker population of the Suyo-Macará binational micro-network. The key program challenge was the absence of reciprocity; Peruvian citizens were entitled to free health care services in Ecuador but Ecuadoran citizens did not receive the same benefit in Peru. The need for improvements in the binational system's human resources was also identified. The program's main strength was its organizational structure, which is designed mainly for the implementation of 1) the binational network and 2) a patient referral / counter-referral system that includes the transfer of patient clinical information. Notwithstanding considerable challenges, peri-border programs are feasible and replicable. Program success seems to be highly dependent on the completion of a number of steps, including 1) consolidation of the original binational memorandum into a binding binational agreement between the two countries; 2) achievement of similar standards in both countries for the provision and quality of health care services, focusing on complementarities; and 3) development of an integrated binational information system.
Molina, Emilio Herrera; Nuño-Solinis, Roberto; Idioaga, Gorka Espiau; Flores, Silvia Librada; Hasson, Naomi; Orueta Medía, Juan F
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. 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 Outcome Scale).Ethical approval for the study was given by
Molina Emilio Herrera
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
Lemmens, Lidwien C.; Molema, C.C. M.; Versnel, Nathalie; Baan, C.A.; de Bruin, Simone R.
Objective Presently, little is known about the characteristics and impact of integrated care programs for patients with psychological comorbidity. The aim was to provide an overview of these integrated care programs and their effectiveness. Methods Systematic literature review including papers
McMillen, J Curtis; Narendorf, Sarah Carter; Robinson, Debra; Havlicek, Judy; Fedoravicius, Nicole; Bertram, Julie; McNelly, David
.... This paper reports on the development and piloting of a manualized treatment foster care program designed to step down older youth with high psychiatric needs from residential programs to treatment foster care homes...
Fritsch, Michelle A; Culver, Nathan; Culhane, Nicole; Thigpen, Jonathan; Lin, Anne
Objective. To incorporate direct patient care and service components throughout a 4-year pharmacy program to enable students to apply knowledge learned in the classroom and develop the human and caring dimensions of Fink's Taxonomy of Significant Learning. Design. Groups of 10-12 students and a faculty advisor partnered with a local agency serving an underserved population of the greater Baltimore area to provide seven hours of service per student each semester. Activities were determined based on students' skills and agency needs. Assessment. Over 10 000 hours of care were provided from fall 2009 through spring 2014 for clients at 12 partner agencies. Student feedback was favorable. Conclusion. Cocurricular learning enables students to use their skills to benefit local communities. Through an ongoing partnership, students are able to build on experiences and sustain meaningful care initiatives.
Davidovitch, Nitza; Yavich, Roman
The Ariel University has a unique interdisciplinary program in healthcare management that targets experienced healthcare professionals who wish to earn an academic degree. Only one academic study has been held so far on the integration of graduates of an academic university-level school in healthcare management in the field. In the current study,…
This report reviews the California Railroad-Highway Grade Crossing Program, analyzing the factors influencing the reduction in grade crossing accidents. The repor concludes that the greater than average success in grade crossing installation and main...
Thomas, Ian G.
Described is the evaluation of the Master of Environmental Science program at Monash University (Australia). The design of the evaluation is discussed, and the use of multiple sources of data and an innovative style are highlighted. (Author/CW)
Koch, Edward F
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.
Hernandez, Maria; Hojman, Nayla; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S; Litman, Rebecca; Marcin, James P
Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care. We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided. During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%). This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.
Martín Asuero, Andrés; Rodríguez Blanco, Teresa; Pujol-Ribera, Enriqueta; Berenguera, Anna; Moix Queraltó, Jenny
To determine the long-term effects of a mindfulness program on burnout, mood states, empathy, and mindfulness in primary care professionals. A repeated measures before-after study was performed in 87 participants working in primary care. The variables evaluated were scores of the Burnout Inventory (Maslach), mood states (Profile of Mood States [POMS]), empathy (Jefferson Scale of Physician Empathy [JSPE]) and mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), adherence to the intervention, and changes in attitudes. Evaluations were performed at baseline, at 8 weeks, and at 6 and 12 months. The intervention lasted for 1 year and consisted of two training phases, an intensive first phase lasting 28 hours, spread over 8 weeks, and a second, maintenance phase of 25 hours spread over 10 months. The effect of the intervention was assessed through observed change, standardized response mean (SRM), and linear mixed-effects models on repeated measures. The scores of all the scales improved significantly during the follow-up compared with baseline scores. The greatest differences were obtained at 12 months, especially in the the FFMQ (SRM: 1.4), followed by the POMS (SRM: 0,8). The greatest improvement in the maintenance phase was found in the difference between consecutive scores. The only scale that showed major changes in all phases was the FFMQ scale. At the end of the intervention, 89% of participants practiced the exercises of the program on their own and 94% reported improvements in self-care and greater professionalism. A psychoeducational program based on mindfulness reduces burnout and improves mood states, empathy, and mindfulness, while encouraging better self-care. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.
Stringfellow, J. [ed.
The Industry Coupled Case Study Program was conceived as a short-term cooperative program between the Federal government and private industry. Federal funds were committed to stimulate geothermal exploration and development between 1977 and 1979, although some work under the program continues into 1982. Federal funding has been phased out and the remaining information developed during the program is being disseminated and reported. This report presents an overview of the program and documents the technical results and open-file data base resulting from the program.
Jagt-van Kampen, Charissa Thari; Kremer, Leontien C M; Verhagen, A A Eduard; Schouten-van Meeteren, Antoinette Y N
A national clinical practice guideline for pediatric palliative care was published in 2013. So far there are only few reports available on whether an educational program fosters compliance with such a guideline implementation. We aimed to test the effect of the education program on actual compliance as well as documentation of compliance to the guideline. We performed a prospective study with pre- and post-intervention evaluation on compliance to the guideline of the nurse specialists of a pediatric palliative care team for case management at a children's university hospital. Eleven quality indicators were selected from 192 recommendations from the pediatric palliative care guideline, based on frequency, measurability and relevance. The multifaceted education program included e-learning and an interactive educational meeting. Four e-learning modules addressed 19 patient cases on symptoms, diagnostics and treatment, and a chart-documentation exercise. During the interactive educational meeting patient cases were discussed on how to use the guideline. Documentation of compliance to the guideline in the web-based patient-charts as well as actual compliance to the guideline through weekly web-based parent reports was measured before and after completion of the e-learning. Eleven quality indicators were selected. The educational program did not result in significant improvement in compliance for any of these indicators. The indicators "treatment of nausea", "pain medications two steps ahead" and "pain medication for 48 h present", measured through parent reports, scored a compliance beyond 80 % before and after e-learning. The remaining indicators measuring compliance, as well as six indicators measuring documentation by chart review, showed a compliance below 80 % before and after e-learning. The multifaceted education program did not lead to improvement in documentation of compliance to the guideline. Parent reported outcome revealed better performance and might be
Hudmon, Karen Suchanek; Mark, Michael; Livin, Adam L; Corelli, Robin L; Schroeder, Steven A
Exposure to tobacco smoke impacts the onset or exacerbation of most respiratory disorders, and respiratory therapists are well positioned to identify tobacco use and provide cessation assistance. The purpose of this study was to characterize the level of tobacco cessation education provided to students in U.S. respiratory care training programs. A national survey of 387 respiratory care programs assessed the extent to which tobacco is addressed in required coursework, methods of instruction, perceived importance, and adequacy of current levels of tobacco education in curricula and perceived barriers to enhancing the tobacco-related education. A total of 244 surveys (63.0% response) revealed a median of 165 min (IQR, 88-283) of tobacco education throughout the degree program. Pathophysiology of tobacco-related disease (median, 45 min) is the most extensively covered content area followed by aids for cessation (median, 20 min), assisting patients with quitting (median, 15 min), and nicotine pharmacology and principles of addiction (median, 15 min). More than 40% of respondents believed that latter 3 content areas are inadequately covered in the curriculum. Key barriers to enhancing tobacco training are lack of available curriculum time, lack of faculty expertise, and lack of access to comprehensive evidence-based resources. Nearly three-fourths of the respondents expressed interest in participating in a nationwide effort to enhance tobacco cessation training. Similar to other disciplines, enhanced tobacco cessation education is needed in respiratory care programs to equip graduates with the knowledge and the skills necessary to treat tobacco use and dependence. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Weaver, Richard G.; Gray, Carolyn F.; Colangelo, Gary A.; Ferretti, Gerald A.; Galbally, James F.; Garrison, Raymond S.; Martens, Les; Hayes, Kathy L.
Presents results of a work group convened by the American Association of Dental Schools to examine experiences related to postdoctoral general dentistry (PGD) programs linked with managed care systems and clinical settings. The group identified factors and conditions believed to be critical to the planning, development, and conduct of PGD programs…
Each year in the United States, 31% of elders who die do so in hospitals, accounting for over half a million deaths often involving expensive and unnecessary treatments (Zhao & Encinosa, 2010 ). Re-hospitalizations of frail elders with end-stage illnesses are a concern for the hospitals that have discharged them and for the facilities in which they live. In 2011, Schervier Nursing Care Center, a 364-bed skilled nursing and rehabilitation facility in the Bronx, NY, looked at its re-hospitalization rates. It was discovered that a large percentage of the residents being sent to the hospital were from the long-term and subacute populations with end-stage diseases that were no longer responding to treatment. This article describes the development of two innovative programs whose goals were to increase the number of residents receiving palliative care, increase the number of completed advance directives, reduce re-hospitalizations, and increase hospital referrals to the nursing home for palliative care. The key components of both programs and their outcomes are described. The development and implementation of these programs were the author's capstone project for the Zelda Foster Social Work Leadership Fellowship in Palliative and End-of-Life Care.
Johnson, Kristen; Wagner, Dennis
Objective: In 1997, Michigan's Family Independence Agency piloted case management procedures designed to expedite permanency and improve services to children in foster care. Method: A 3-year evaluation examined outcomes in nine pilot and nine comparison counties to determine if children in the pilot counties achieved permanency, either returned…
Purvis, Karyn; Cross, David; Jones, Daren; Buff, Gary
The authors report on a small organizational case study highlighting the dimensions of trauma-informed care, the processes of organizational change, and the growth of caregiver expertise. The article is framed by the notion of caregiving cultures, which refers to the beliefs, languages, and practices of caregivers and caregiving organizations.…
Conlon, Thomas W; Himebauch, Adam S; Fitzgerald, Julie C; Chen, Aaron E; Dean, Anthony J; Panebianco, Nova; Darge, Kassa; Cohen, Meryl S; Greeley, William J; Berg, Robert A; Nishisaki, Akira
To determine the feasibility and describe the process of implementing a pediatric critical care bedside ultrasound program in a large academic PICU and to evaluate the impact of bedside ultrasound on clinical management. Retrospective case series, description of program implementation. Single-center quaternary noncardiac PICU in a children's hospital. Consecutive patients from January 22, 2012, to July 22, 2012, with bedside ultrasounds performed and interpreted by pediatric critical care practitioners. A pediatric critical care bedside ultrasound program consisting of a 2-day immersive course followed by clinical performance with internal quality assurance review was implemented. Studies performed in the PICU following training were documented and reviewed against reference standards including subspecialist-performed ultrasound or clinical response. Seventeen critical care faculties and eight fellows recorded 201 bedside ultrasound studies over 6 months in defined core applications: 57 procedural (28%), 76 hemodynamic (38%), 35 thoracic (17%), and 33 abdominal (16%). A quality assurance review identified 23 studies (16% of all nonprocedural studies) as critical (affected clinical management or gave valuable information). Forty-eight percent of those studies (11/23) were within the hemodynamic core. The proportion of critical studies were not significantly different across the applications (hemodynamic, 11/76 [15%] vs thoracic and abdominal, 12/68 [18%]; p = 0.65). Examples of critical studies include evidence of tamponade secondary to pleural effusions, identification of pulmonary hypertension, hemodynamic assessment before tracheal intubation, recognition of hypovolemia and systemic vascular resistance abnormalities, determination of pneumothorax, location of chest tube and urinary catheter, and differentiation of pleural fluid from pulmonary consolidation. Implementation of a critical care bedside ultrasound program for critical care providers in a large
Walker, Tarik; Deutchman, Mark; Ingram, Beth; Walker, Ely; Westfall, John M
Colorectal cancer (CRC) is a significant source of morbidity and mortality in the United States. Colonoscopy can be an extension of the care provided by a family physician to help substantially reduce CRC morbidity and mortality. Family physicians trained in colonoscopy can provide access to care in rural and medically underserved areas. The Department of Family Medicine and the Colorado Area Health Education Center (AHEC) developed the Endoscopy Training for Primary Care (ETPC) program to teach primary care physicians to perform colonoscopy. The program included online didactic education, a formal endoscopy simulator experience, and proctoring by a current endoscopist. Participants completed a baseline and follow-up survey assessing CRC screening knowledge and the effectiveness of the endoscopy training for ongoing screening activities. To date, 94 practitioners and health professional students have participated in the study. Ninety-one (97%) completed the online didactic portion of the training. Sixty-five participants (77%) were physicians or medical students, and the majority (64%) was in the field of family medicine. The year 4 (2011) follow-up cohort was comprised of 62% respondents working in an urban background and 26% in rural communities. Many participants remain in a queue for proctoring by a trained endoscopist. Several participants are successfully performing a significant number of colonoscopies. ETPC program showed success in recruiting a large number of physicians and students to participate in training. The program enhanced perceptions about the value of colon cancer screening and providing screening endoscopy in primary care practice. Providing sites for simulation training throughout Colorado provided opportunity for providers in rural regions to participate. As a result of this training, thousands of patients underwent testing to prevent colon cancer. Future research relating to colonoscopy training by family physicians should focus on quality
Pynoos, Jon; Ohta, Russell J.
The home is clearly the major setting in which care is provided to individuals suffering from Alzheimer's disease. The Caring Home Program was a multi-disciplinary program designed to complement existing efforts to assist caregivers (N=12) with the in-home care of Alzheimer's disease patients. The program components consisted of an assessment of…
California Childcare Health Program, 2011
This "Integrated Pest Management Toolkit for Early Care and Education Programs" presents practical information about using integrated pest management (IPM) to prevent and manage pest problems in early care and education programs. This curriculum will help people in early care and education programs learn how to keep pests out of early…
... 42 Public Health 5 2010-10-01 2010-10-01 false Conviction relating to program or health care fraud. 1001.201 Section 1001.201 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES PROGRAM INTEGRITY-MEDICARE AND STATE HEALTH CARE PROGRAMS...
Payne, Jennifer I; Dunbar, Margaret J; Talbot, Pamela; Tan, Meng H
The Diabetes Care Program of Nova Scotia (DCPNS)'s mission is "to improve, through leadership and partnerships, the health of Nova Scotians living with, affected by, or at risk of developing diabetes." Working together with local, provincial and national partners, the DCPNS has improved and standardized diabetes care in Nova Scotia over the past 25 years by developing and deploying a resourceful and collaborative program model. This article describes the model and highlights its key achievements. With balanced representation from frontline providers through to senior decision makers in health care, the DCPNS works across the age continuum, supporting the implementation of national clinical practice guidelines and, when necessary, developing provincial guidelines to meet local needs. The development and implementation of standardized documentation and data collection tools in all diabetes centres created a robust opportunity for the development and expansion of the DCPNS registry. This registry provides useful clinical and statistical information to staff, providers within the circle of care, management and senior leadership. Data are used to support individual care, program planning, quality improvement and business planning at both the local and the provincial levels. The DCPNS supports the sharing of new knowledge and advances through continuous education for providers. The DCPNS's ability to engage diabetes educators and key physician champions has ensured balanced perspectives in the creation of tools and resources that can be effective in real-world practice. The DCPNS has evolved to become an illustrative example of the chronic care model in action. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.
Weaver, Christopher S; Myers, Isaac J; Huffman, Gretchen; Vohito, Rancia; Herceg, Dorian
With the undocumented immigrant population in the United States on the rise, an increase in the number of patients with end-stage renal disease without access to a regular dialysis chair continues. This leaves hospital systems with the difficult decision of how best to care for this population. We sought to evaluate the feasibility, effectiveness, and costs of a case manager-driven emergent dialysis program. We hypothesized that this program would be feasible and would result in similar costs as the previous regularly scheduled dialysis program in place at our institution. The study was conducted at Wishard Memorial Hospital, which is an urban public hospital in Indianapolis, IN. We performed a before (March 11, 2010, to June 11, 2010) and after (June 14, 2010, to September 14, 2010) study to compare the treatment of a 6-patient cohort of dialysis patients without a "dialysis home" before and after the case manager-driven emergent dialysis program, using secondary data. The case manager-driven emergent dialysis process was feasible and led to a total expense of $101,802 as compared with a total cost of $122,890 when providing regular dialysis to this subset of patients. There were no differences in intensive care unit days, length of stay, and complications between the 2 groups in the short study period. The dialysis population without a "dialysis home" is a high-risk population in need of intensive medical care but the approach to these patients continues to be debated. Although this study does not prove or necessarily support a dialysis on "emergent" basis approach over chronic, scheduled dialysis, the study does demonstrate that case management can play a significant role in the care of these patients. Case management oversight and management of our patient population resulted in costs equal to, or better than, those who received chronic dialysis care without a difference in complications over a 6-month study period.
Saurman, Emily; Lyle, David; Kirby, Sue; Roberts, Russell
The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telehealth solution providing specialist emergency mental health care to rural and remote communities across western NSW, Australia...
Khan-Mayberry, Noreen; Bassett, Stephanie
NASA has a rich history of scientific research that has been conducted throughout our numerous manned spaceflight programs. This scientific research has included animal test subjects participating in various spaceflight missions, including most recently, Space Shuttle mission STS-131. The Animal Care Program at Johnson Space Center (JSC) in Houston, Texas is multi-faceted and unique in scope compared to other centers within the agency. The animal care program at JSC has evolved from strictly research to include a Longhorn facility and the Houston Zoo's Attwater Prairie Chicken refuge, which is used to help repopulate this endangered species. JSC is home to more than 300 species of animals including home of hundreds of white-tailed deer that roam freely throughout the center which pose unique issues in regards to population control and safety of NASA workers, visitors and tourists. We will give a broad overview of our day to day operations, animal research, community outreach and protection of animals at NASA Johnson Space Center.
Full Text Available Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC ultrasound curriculum into an intensive care unit (ICU fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year. Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720. Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435. Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied.
Killu, Keith; Coba, Victor; Mendez, Michael; Reddy, Subhash; Adrzejewski, Tanja; Huang, Yung; Ede, Jessica; Horst, Mathilda
Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year. Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435). Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied. PMID:25478217
Maddux, Dugan W; Usvyat, Len A; DeFalco, Daniel; Kotanko, Peter; Kooman, Jeroen P; van der Sande, Frank M; Maddux, Franklin W
Pre-dialysis chronic kidney disease (CKD) care impacts dialysis start and incident dialysis outcomes. We describe the use of late stage CKD population data coupled with CKD case management to improve dialysis start. The Renal Care Coordinator (RCC) program is a nephrology practice and Fresenius Medical Care North America (FMCNA) partnership involving a case manager resource and data analytics. We studied patients starting dialysis between August 1, 2009 and February 28, 2013 in 9 nephrology practices partnering in the RCC program. Propensity score matching (PSM) was used to match patients who had participated in the RCC program to patients who had not. Primary outcomes were use of a permanent access or peritoneal dialysis (PD) at first outpatient dialysis. Serum albumin at the first outpatient dialysis treatment and mortality and hospitalization rates in the first 120 days of dialysis were secondary outcomes. In the nephrology practices studied, 7,626 patients started dialysis. Of these, 738 patients (9.7%) were enrolled in the RCC program; 693 RCC patients (93.9%) were matched with 693 patients who did not participate in the RCC program. Logistic regression analysis indicates that RCC program patients are more likely to start PD or use a permanent vascular access at dialysis start and are more likely to start treatment with a serum albumin level ≥ 4.0 g/ dL. Late stage CKD data-driven case management is associated with a higher rate of PD use, lower central venous catheter (CVC) use, and higher albumin levels at first outpatient dialysis.
Lewis, Bryan Rossiter
This capstone project conducted an intervention using video cases to scaffold traditional methods of concept presentation in a youth mentoring program. Video cases delivered online were chosen as a methodology to strengthen the support and practitioner aspects indicative of mentoring program success rates (D. L. DuBois, Holloway, Valentine, &…
Polydorou, Soteri; Ross, Stephen; Coleman, Peter; Duncan, Laura; Roxas, Nichole; Thomas, Anil; Mendoza, Sonia; Hansen, Helena
Objectives This report identifies the institutional barriers to, and benefits of, buprenorphine maintenance treatment (BMT) integration in an established hospital-based opioid treatment program (OTP). Methods This case study presents the authors’ experiences at the clinic, hospital, and corporation levels during efforts to integrate BMT into a hospital-based OTP in New York City and a descriptive quantitative analysis of the characteristics of hospital outpatients treated with buprenorphine from 2006 to 2013 (N=735). Results Integration of BMT into an OTP offered patients the flexibility to transition between intensive structured care and primary care or outpatient psychiatry according to need. Main barriers encountered were regulations, clinical logistics of dispensing medications, internal cost and reimbursement issues, and professional and cultural resistance. Conclusions Buprenorphine integration offers a model for other OTPs to facilitate partnerships among primary care and mental health clinics to better serve diverse patients with varying clinical needs and with varying levels of social support. PMID:27745534
McKinlay, Eileen M.; Morgan, Sonya J.; Gray, Ben V.; Macdonald, Lindsay M.; Pullon, Susan R.H.
Background The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. PMID
Wen, Timothy; Huang, Brian; Mosley, Virgie; Afsar-Manesh, Nasim
In recent years, patient satisfaction has been integrated into residency training practices through core competency requirements as set forth by the Accreditation Council of Graduate Medical Education (ACGME). In 2006, the UCLA Health Systems established a program designed to obtain patient feedback and assess the communication abilities of resident physicians with a standard tool through the Assessing Residents' C-I-CARE (ARC) Program. This Program utilized a 17-item questionnaire, completed via a facilitator-administered interview, which employed polar, Likert and comment scale questions to assess physician trainees' interpersonal and communication skills. From 2006 to 2010, the ARC Program provided patient feedback data to more than six clinical departments while collecting 5,634 surveys for 323 trainees. Scores for resident recognition and performance increased from the first to second year of activity by an average of 22.5%, while attending recognition scores decreased 19% over the four years. Additionally, residents and attendings in surgical specialties received higher recognition rates than those in non-surgical specialties. The ARC Program provided a standard tool for attaining patient feedback through a facilitator-administered survey that assisted in the accreditation process of training programs. Furthermore, hospitals, health organizations and medical schools may find the ARC Program valuable in collecting information for quality control as well as providing an opportunity for students to become involved in the healthcare field.
Nelson, Joan; Sassaman, Becky; Phillips, Alison
RN ladder programs are designed to inspire and reward clinical excellence. Kaiser Permanente Colorado's (KPCO) career ladder program emerged as a result of a labor-management partnership. Career ladder point assignments are reflective of the organization's priorities and values. KPCO's career ladder point tool awards RNs for formal and continuing education, professional presentations, organizational experience and experience as an RN, certifications and active professional memberships, leadership activities, research and publications, and nursing-related volunteer work. Participation in the RN career ladder requires that the nurse achieve a self-determined, manager-approved, measurable goal that will improve patient care. Career ladder nurses at KPCO were significantly more involved in leadership and interdisciplinary activities, quality improvement projects, and preceptorship.
Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M
The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.
Blanchard, Adie; Gilbert, Laura; Dawson, Tom
As a result of increasing demand in the face of reducing resources, technology has been implemented in many social and health care services to improve service efficiency. This paper outlines the experiences of deploying a 'Software as a Service' application in the UK social and health care sectors. The case studies demonstrate that every implementation is different, and unique to each organisation. Technology design and integration can be facilitated by ongoing engagement and collaboration with all stakeholders, flexible design, and attention to interoperability to suit services and their workflows.
Hassett, Michael; And Others
Fifteen adult education programs being conducted in Ireland are described in the case studies in this packet. The courses range from adult basic education to university degree courses in management and industrial relations, from marriage preparation to inservice teacher education. The following programs are profiled: (1) certificate in farming…
Sidhu, Ravindar S.; Walker, G. Ross
Objectives To provide baseline data on resident continuity of care experience, to describe the effect of ambulatory centre surgery on continuity of care, to analyse continuity of care by level of resident training and to assess a resident-run preadmission clinic’s effect on continuity of care. Design Data were prospectively collected for 4 weeks. All patients who underwent a general surgical procedure were included if a resident was present at operation. Setting The Division of General Surgery, Queen’s University, Kingston, Ont. Outcome measures Preoperative, operative and inhospital postoperative involvement of each resident with each case was recorded. Results Residents assessed preoperatively (before entering the operating room) 52% of patients overall, 20% of patients at the ambulatory centre and 83% of patients who required emergency surgery. Of patients assessed by the chief resident, 94% were assessed preoperatively compared with 32% of patients assessed by other residents ( p 0.1). Conclusions This study serves as a reference for the continuity of care experience in Canadian surgical programs. Residents assessed only 52% of patients preoperatively, and only 40% of patients had complete continuity of care. Factors such as ambulatory surgery and junior level of training negatively affected continuity experience. Such factors must be taken into account in planning surgical education. PMID:10526519
Mohfeld, Kathy I.
The central phenomenon researched in this case study was higher education administrators' decisions to institutionalize a safe ride program at a small, rural college. The purpose of this single/within-site case study was to describe the changes that happened at a rural public institution of higher education and the surrounding community in the…
... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2010 Through June 30, 2011 AGENCY: Food and Nutrition Service...
... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2013 Through June 30, 2014 AGENCY: Food and Nutrition Service...
... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012 Correction In notice document 2011...
Full Text Available Severe ovarian hyperstimulation syndrome (OHSS is characterized by increased capillary permeability and fluid retention in the third space. It is generally a complication of assisted reproduction therapy (ART with exogenous gonadotropins, but cases with natural onset of OHSS have been reported. The massive extravascular exudation can cause tense ascites, pleural and pericardial effusion, hypovolemic shock, oliguria, electrolyte imbalance (hyponatremia and hyperkalemia, and hemoconcentration, with a tendency for hypercoagulability and risk of life-threatening thromboembolic complications. The patient can rarely develop multi-organ failure (adult respiratory distress syndrome, renal failure and death. With increasing use of ART, this syndrome may be seen more frequently in the intensive care unit (ICU, requiring multidisciplinary care. We report the management of two cases of severe OHSS, which required admission to the ICU in our hospital.
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
Seekles, Wike; van Straten, Annemieke; Beekman, Aartjan; van Marwijk, Harm; Cuijpers, Pim
.... 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...
This paper considers recent developments in health care facility design and in the psychology literature that support a case for increased design sensitivity to the emotional experience of patient care. The author discusses several examples of innovative patient-centred health care design interventions. These generally resulted in improvements in the patient and staff experience of care, at less cost than major infrastructural interventions. The paper relates these developments in practice with recent neuroscience research, illustrating that the design of the built environment influences patient emotional stress. In turn, patient emotional stress appears to influence patient satisfaction, and in some instances, patient outcomes. This paper highlights the need for further research in this area.
The aim of the thesis Volunteer programs that support child in adoption or foster care is to monitor the offer of volunteer programs for children in adoption foster care in the Czech Republic and to show possibilities of support which volunteer program could bring to children, including demonstrations of experience from similar programs abroad. The theoretical part of thesis describes the foster care system with respect to the child's needs and ways of support that are available to them in bo...
This article is a case study of a 16-year-old female with congenital muscular dystrophy. It aims to raise awareness of some of the issues associated with complex illness during adolescence, particularly the transition from child to adult services. To improve care it is argued that the needs and values of the young person should be respected and interventions planned locally with the young person and their family where appropriate.
Title of bachelor's thesis: Case of physiotherapy care for patient with rheumatoid arthritis diagnosed Objectives: The aim of this thesis is to show using of physiotherapeutistic methods on patient with rheumatoid arthritis. One part of this thesis is casuistry of patient with rheumatoid arthritis. The summary: The thesis is divided into two parts, the theoretical part and the special part. The theoretical part is focused on issue of rheumatoid arthritis, its characteristic, division, diagnos...
LaGrone, Lacey N; Fuhs, Amy K; Egoavil, Eduardo Huaman; Rodriguez Castro, Manuel J A; Valderrama, Roberto; Isquith-Dicker, Leah N; Herrera-Matta, Jaime; Mock, Charles N
Evidence for the positive impact of quality improvement (QI) programs on morbidity, mortality, patient satisfaction, and cost is strong. Data regarding the status of QI programs in low- and middle-income countries, as well as in-depth examination of barriers and facilitators to their implementation, are limited. This cross-sectional, descriptive study employed a mixed-methods design, including distribution of an anonymous quantitative survey and individual interviews with healthcare providers who participate in the care of the injured at ten large hospitals in Lima, Peru. Key areas identified for improvement in morbidity and mortality (M&M) conferences were the standardization of case selection, incorporation of evidence from the medical literature into case presentation and discussion, case documentation, and the development of a clear plan for case follow-up. The key barriers to QI program implementation were a lack of prioritization of QI, lack of sufficient human and administrative resources, lack of political support, and lack of education on QI practices. A national program that makes QI a required part of all health providers' professional training and responsibilities would effectively address a majority of identified barriers to QI programs in Peru. Specifically, the presence of basic QI elements, such as M&M conferences, should be required at hospitals that train pre-graduate physicians. Alternatively, short of this national-level organization, efforts that capitalize on local examples through apprenticeships between institutions or integration of QI into continuing medical education would be expected to build on the facilitators for QI programs that exist in Peru.
Funderburk, Jennifer S; Shepardson, Robyn L
Designing systematic, scientifically rigorous program evaluations (PE) is 1 way to contribute to the significant need to build best practices and a stronger evidence base for integrated behavioral health care. However, there are many potential pitfalls when conducting PE in real-world settings, and many clinicians and administrators may be hesitant to engage in PE due to lack of training or resources. Rigorous PE can be achieved feasibly and efficiently. This article discusses common challenges that arise when conducting PE in integrated behavioral health care settings and illustrates ways to increase the methodological quality of PE efforts using lessons learned from 2 real-world case examples. The first example included a PE of a training program for brief alcohol interventions, and the second example included a PE of a depression medication monitoring service. The case examples demonstrate the need for strategic planning beforehand, including the use of a conceptual framework as well as appropriate study designs/methodology, measurement, and the need for consistency to achieve a well-designed PE. Using the recommendations within this article, it is hoped that the quality of PEs can be improved resulting in more generalizable data that can be used to inform organizations and policymakers to improve health care delivery. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Full Text Available The objectives of this case study were to describe comprehensively how the SEAMEO-VOCTECH Regional Center conducted the school adoption program, to gain information from teachers and related persons on the implementation of the programs, and to identify various interventions for achieving maximum outputs. The study employed a naturalistic qualitative method with Jerudong primary school and the VOCTECH Center as the major sites of the study. Three methods of data collection were enumeration techniques, participant observation and in-depth interview. The findings indicate how beneficial the program was to the school, and the program appears to be suitable to Indonesian schools, whose communities, conditions, and potencies vary
Doricci, Giovanna Cabral; Guanaes-Lorenzi, Carla; Pereira, Maria José Bistafa
In 2009, the Secretary of State for Health of Sao Paulo created a Program with a view to qualify the primary care in the state. This proposal includes a new job function, namely the articulator of primary care. Due to the scarcity of information about the practice of these new professionals in the scientific literature, this article seeks to analyze how articulators interpret their function and how they describe their daily routines. Thirteen articulators were interviewed. The interviews were duly analyzed by qualitative delineation. The results describe three themes: 1)Roles of the articulator: technical communicator and political advisor; 2) Activities performed to comply with the expected roles, examples being diagnosis of the municipalities, negotiation of proposals, participation in meetings, visits to municipalities; and 3) Challenges of the role, which are configured as challenges to the health reform process, examples being the lack of physical and human resources, activities of professionals in the medical-centered model, among others. The conclusion drawn is that the Program has great potential to provide input for the development and enhancement of Primary Care. Nevertheless, there are a series of challenges to be overcome, namely challenges to the context per se.
Background Mobile technologies have emerged as important tools that health care personnel can use to gain easy access to client data anywhere. This is particularly useful for nurses and care workers in home health care as they provide services to clients in many different settings. Although a growing body of evidence supports the use of mobile technologies, the diverse implications of mobile health have yet to be fully documented. Objective Our objective was to examine a large-scale government-sponsored mobile health implementation program in the Danish home care sector and to understand how the technology was used differently across home care agencies. Methods We chose to perform a longitudinal case study with embedded units of analysis. We included multiple data sources, such as written materials, a survey to managers across all 98 Danish municipalities, and semistructured interviews with managers, care workers, and nurses in three selected home care agencies. We used process models of change to help analyze the overall implementation process from a longitudinal perspective and to identify antecedent conditions, key events, and practical outcomes. Results Strong collaboration between major stakeholders in the Danish home care sector (government bodies, vendors, consultants, interest organizations, and managers) helped initiate and energize the change process, and government funding supported quick and widespread technology adoption. However, although supported by the same government-sponsored program, mobile technology proved to have considerable interpretive flexibility with variation in perceived nature of technology, technology strategy, and technology use between agencies. What was first seen as a very promising innovation across the Danish home care sector subsequently became the topic of debate as technology use arrangements ran counter to existing norms and values in individual agencies. Conclusions Government-sponsored programs can have both positive and
... 45 Public Welfare 4 2010-10-01 2010-10-01 false Foster care maintenance payments program... ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES REQUIREMENTS APPLICABLE TO TITLE IV-E § 1356.21 Foster care maintenance payments program...
... Medicaid Program; Payments for Services Furnished by Certain Primary Care Physicians and Charges for... ``Medicaid Program; Payments for Services Furnished by Certain Primary Care Physicians and Charges for...) 786-4576, or Linda Tavener, (410) 786-3838, for issues related to payments for primary care physicians...
Seekles, Wike; Widdershoven, Guy; Robben, Paul; van Dalfsen, Gonny; Molewijk, Bert
Moral case deliberation (MCD) as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regulatory bodies are regularly confronted with moral challenges. This pilot study describes and evaluates the use of MCD at the Dutch Health Care Inspectorate (IGZ). The objective of this pilot study is to investigate: 1) the current way of dealing with moral issues at the IGZ; 2) experience with and evaluation of MCD as clinical ethics support, and 3) future preferences and (perceived) needs regarding clinical ethics support for dealing with moral questions at the IGZ. We performed an explorative pilot study. The research questions were assessed by means of: 1) interviews with MCD participants during four focus groups; and 2) interviews with six key stakeholders at the IGZ. De qualitative data is illustrated by data from questionnaires on MCD outcomes, perspective taking and MCD evaluation. Professionals do not always recognize moral issues. Employees report a need for regular and structured moral support in health care regulation. The MCD meetings are evaluated positively. The most important outcomes of MCD are feeling secure and learning from others. Additional support is needed to successfully implement MCD at the Inspectorate. We conclude that the respondents perceive moral case deliberation as a useful form of clinical ethics support for dealing with moral questions and issues in health care regulation.
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.
Sturm, Roland; Goldman, William; McCulloch, Joyce
BACKGROUND: In the United States, insurance benefits for treating alcohol, drug abuse and mental health (ADM) problems have been much more limited than medical care benefits. To change that situation, more than 30 states were considering legislation that requires equal benefits for ADM and medical care ("parity") in the past year. Uncertainty about the cost consequences of such proposed legislation remains a major stumbling block. There has been no information about the actual experience of implementing parity benefits under managed care or the effects on access to care and utilization. AIMS OF THE STUDY: Document the experience of the State of Ohio with adopting full parity for ADM care for its state employee program under managed care. Ohio provides an unusually long time series with seven years of managed behavioral health benefits, which allows us to study inflationary trends in a plan with unlimited ADM benefits. METHODS: Primarily a case study, we describe the implementation of the program and track utilization, and costs of ADM care from 1989 to 1997. We use a variety of administrative and claims data and reports provided by United Behavioral Health and the state of Ohio. The analysis of the utilization and cost effect of parity and managed care is pre-post, with a multiyear follow-up period. RESULTS: The switch from unmanaged indemnity care to managed carve-out care was followed by a 75% drop in inpatient days and a 40% drop in outpatient visits per 1000 members, despite the simultaneous increase in benefits. The subsequent years saw a continuous decline in inpatient days and an increased use of intermediate services, such as residential care and intensive outpatient care. The number of outpatient visits stabilized in the range of 500-550 visits per 1000. There was no indication that costs started to increase during the study period; instead, costs continued to decline. A somewhat different picture emerges when comparing utilization under HMOs with
Graber, David R; Mitcham, Maralynne D; Coker-Bolt, Patty; Wise, Holly H; Jacques, Paul; Edlunc, Barbara; Annan-Coultas, Dusti
Caring attitudes and empathic behaviors are considered by most Americans to be an essential and intrinsic element of appropriate health care, yet little attention is given to this in the curricula of most healthcare professional training programs. This paper describes an ongoing educational intervention to develop healthcare professionals with caring attitudes and empathic behaviors that will be sustained in their professional practice environments. The Caring Professionals Program was designed to enhance and redesign existing learning experiences in four academic programs: physical therapy, occupational therapy, physician assistant, and nurse practitioner. Students entering in the summer of 2009 were engaged in the initial program and study. Six educational elements were employed in the Caring Professionals Program: experience, reflection, problem-solving, didactic, active participation, and role modeling. Educational interventions were designed to be appropriate to the students' temporal progress through their programs, specifically the early, middle or late stages. The Caring Professionals Program may serve as a model for other allied health schools and also contribute to a college culture that supports caring and humanism.
Poliana Remundini de Lima
Full Text Available A cross-sectional study aimed to describe the access and integrality of attention to children before one year old, born between January of 2010 and December of 2012 in a Brazilian city, in a newborn attention program. From the 24.560 children, 55.0% were users of the Unified Health System (SUS; 10.1% children presented low weight at birth; 6,332 (46.9% children received BCG vaccine at the nursing consultation day; 13,590 (79.5% children had neonatal screening being less than seven days old; 17,035 (69.4% children were vaccinated for Hepatitis B at birth. Within SUS users, 68% of children went to nursing consultation at their first week of life and, 37.8% went to a medical consultation being 10 days old. The study presents information of care after birth at the primary healthcare as potential instrument to coordinate assistance to this clientele.
Full Text Available The development of Environment Management Systems (EMS commenced as a response to global environmental issues and as a recognition of awareness that sustainable development is prerequisite for keeping the natural system in a proper balance. Transport of dangerous goods by road is quite a complex activity that poses a major potential threat to people and the environment. Therefore, the introduction of certain system tools (standardization of business contributes to a safer and better road transport operations of dangerous goods. Chemical industry combining their efforts for safety and the environment under the Responsible care program (RC. Such efforts have resulted in the development Safety and Quality Assessment System (SQAS to assess the haulers. This paper presents tools standardization of business as an opportunity to improve the market positions of dangerous goods haulers.
Full Text Available The development of Environment Management Systems (EMS commenced as a response to global environmental issues and as a recognition of awareness that sustainable development is prerequisite for keeping the natural system in a proper balance. Transport of dangerous goods by road is quite a complex activity that poses a major potential threat to people and the environment. Therefore, the introduction of certain system tools (standardization of business contributes to a safer and better road transport operations of dangerous goods. Chemical industry combining their efforts for safety and the environment under the Responsible care program (RC. Such efforts have resulted in the development Safety and Quality Assessment System (SQAS to assess the haulers. This paper presents tools standardization of business as an opportunity to improve the market positions of dangerous goods haulers.
Howard, Steven W; Zhang, Zidong; Buchanan, Paula; Bernell, Stephanie L; Williams, Christine; Pearson, Lindsey; Huetsch, Michael; Gill, Jeff; Pineda, Jose A
Inpatient care for children with severe traumatic brain injury (sTBI) is expensive, with inpatient charges averaging over $70,000 per case (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet.ahrq.gov/#setup ]). This ranks sTBI in the top quartile of pediatric conditions with the greatest inpatient costs (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet.ahrq.gov/#setup ]). The Brain Trauma Foundation developed sTBI intensive care guidelines in 2003, with revisions in 2012 (Kochanek, Carney, et. al. PCCM 3:S1-S2, 2012). These guidelines have been widely disseminated, and are associated with improved health outcomes (Pineda, Leonard. et. al. LN 12:45-52, 2013), yet research on the cost of associated hospital care is limited. The objective of this study was to assess the costs of providing hospital care to sTBI patients through a guideline-based Pediatric Neurocritical Care Program (PNCP) implemented at St. Louis Children's Hospital, a pediatric academic medical center in the Midwest United States. This is a retrospective cohort study. We used multi-level regression to estimate pre-/post-implementation effects of the PNCP program on inflation adjusted total cost of in-hospital sTBI care. The study population included 58 pediatric patient discharges in the pre-PNCP implementation group (July 15, 1999 - September 17, 2005), and 59 post-implementation patient discharges (September 18, 2005 - January 15, 2012). Implementation of the PNCP was associated with a non-significant difference in the cost of care between the pre- and post-implementation periods (eβ = 1.028, p = 0
Fillyaw, Michael J.
Case reports are an established form of scholarship used for teaching and learning in medicine and health care, but there are few examples of the teaching and learning activities used to prepare students to write a case report. This report describes the implementation of two courses that prepare physical therapy students to write and disseminate a…
Zachary, Wayne; Maulitz, Russell Charles; Zachary, Drew A
Care coordination (CC) is an important fulcrum for pursuing a range of health care goals. Current research and policy analyses have focused on aggregated data rather than on understanding what happens within individual cases. At the case level, CC emerges as a complex network of communications among providers over time, crossing and recrossing many organizational boundaries. Micro-level analysis is needed to understand where and how CC fails, as well as to identify best practices and root causes of problems. Coordination Process Diagramming (CPD) is a new framework for representing and analyzing CC arcs at the micro level, separating an arc into its participants and roles, communication structure, organizational structures, and transitions of care, all on a common time line. Comparative CPD analysis across a sample of CC arcs identifies common CC problems and potential root causes, showing the potential value of the framework. The analyses also suggest intervention strategies that could be applied to attack the root causes of CC problems, including organizational changes, education and training, and additional health information technology development.
Viljoen, Myra; Coetzee, Isabel; Heyns, Tanya
Society demands competent and safe health care, which obligates professionals to deliver quality patient care using current knowledge and skills. Participation in continuous professional development programs is a way to ensure quality nursing care. Despite the importance of continuous professional development, however, critical care nurse practitioners' attendance rates at these programs is low. To explore critical care nurses' reasons for their unsatisfactory attendance at a continuous professional development program. A nominal group technique was used as a consensus method to involve the critical care nurses and provide them the opportunity to reflect on their experiences and challenges related to the current continuous professional development program for the critical care units. Participants were 14 critical care nurses from 3 critical care units in 1 private hospital. The consensus was that the central theme relating to the unsatisfactory attendance at the continuous professional development program was attitude. In order of importance, the 4 contributing priorities influencing attitude were communication, continuous professional development, time constraints, and financial implications. Attitude relating to attending a continuous professional development program can be changed if critical care nurses are aware of the program's importance and are involved in the planning and implementation of a program that focuses on the nurses' individual learning needs. ©2016 American Association of Critical-Care Nurses.
Andrés Felipe Ardila Rodríguez
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.
D.Cur. (Nursing Management) A health maintenance organisation (HMO) that implements managed care is the health care service provider for a mine group. Case management is an integral part of managed care. Case management in a managed care setting within this mine group should be to the holistic benefit of both the client/patient and the service provider. Within the case management environment, nurse case managers (CMs) and their counterparts (professional nurses) should provide and facilita...
... Episode-of-Care for Acute Myocardial Infarction (AMI) Measure 7. Electronic Clinical Quality Measures 8... for Acute Care Hospitals and the Long Term Care; Hospital Prospective Payment System and Fiscal Year... 0938-AR73 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...
Guerrero Caballero, Laura; Ramos Blanes, Rafel; Alcolado Aranda, Ana; López Dolcet, Maria Josep; Pons La Laguna, Juan Lucas; Quesada Sabaté, Miquel
To improve quality of life, anxiety and depression in caregivers of patients in home care. We performed a randomized clinical trial in 79 main caregivers (39 control group and 40 intervention group) of patients in the home care program of a primary care health center between 2000 and 2001. Quality of life, anxiety and depression were measured by the COOP/WONCA and Goldberg questionnaires, respectively, at the beginning and at the end of the study. Interventions consisted of two medical visits to take a bio-psychosocial history of the caregiver and a nurse visit for health education. Two letters, adapted to each carer's needs, were sent and two telephone calls were made. The intervention group scored significantly better than the control group in relation to WONCA-feelings (p=0.03), WONCA-social activities (p=0.05), and WONCA-quality of life (p=0.02). A short multidisciplinary intervention program adapted to routine consultations could prevent deterioration in caregivers' quality of life.
Lau, Rosalind; Willetts, Georgina; Hood, Kerry; Cross, Wendy
To evaluate an aged care program in developing self-efficacy of newly graduated registered nurses. An evaluation of the program was conducted using a mixed methods approach. Twenty-four nurses completed the pre- and post-survey of aged care nursing self efficacy and attended one of three focus groups held to gain in-depth understanding of their insight into the program. There was an increase in nurses' self-efficacy post-program. The increased self-efficacy and new knowledge gained enhanced nurses' confidence and enabled them to critically appraise their workplace practices. The improved confidence resulting from increased self-efficacy and new knowledge gained from the aged care program enabled nurses to critically appraise the practices in their workplace, demonstrating the program's effectiveness. Aged care service providers should support continuing education for aged care nurses to ensure sustainability of a competent workforce to manage the increasing aged care population. © 2014 ACOTA.
Zavala Aguilar, K; Gutiérrez Pineda, F; Bozalongo de Aragón, E
Onychocryptosis (ingrown toenail) is a condition commonly seen in Primary Care clinics. It is uncomfortable and restrictive for patients and has a high incidence in males between second and third decades of life. It is of unknown origin, with a number of predisposing triggering factors being involved. Treatment depends on the stage of the ingrown nail and the procedures may range from conservative to minor surgery that can be performed by the Primary Care physician in the health centre. We report the case of a 25-year onychocryptosis that did not respond to conservative management, and was extracted with partial matricectomy of the nail. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.
CREDO is a framework for understanding human expertise and for designing and deploying systems that support cognitive tasks like situation and risk assessment, decision-making, therapy planning and workflow management. The framework has evolved through an extensive program of research on human decision-making and clinical practice. It draws on concepts from cognitive science, and has contributed new results to cognitive theory and understanding of human expertise and knowledge-based AI. These results are exploited in a suite of technologies for designing, implementing and deploying clinical services, early versions of which were reported by Das et al. (1997)  and Fox and Das (2000) . A practical outcome of the CREDO program is a technology stack, a key element of which is an agent specification language (PROforma: Sutton and Fox (2003) ) which has proved to be a versatile tool for designing point of care applications in many clinical specialties and settings. Since software became available for implementing and deploying PROforma applications many kinds of services have been successfully built and trialed, some of which are in large-scale routine use. This retrospective describes the foundations of the CREDO model, summarizes the main theoretical, technical and clinical contributions, and discusses benefits of the cognitive approach. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.
Takeuchi, Noriko; Yamamoto, Tatsuo; Hirai, Aya; Morita, Manabu; Kodera, Ryousei
Health care costs have been increasing year by year and health programs are needed which will allow reduction in the burden. The present community-based ecological study examined the relationship between implementation of dental health care programs and health care costs for the metabolic syndrome. We calculated the monthly health care cost for the metabolic syndrome per capita for each municipality in Okayama Prefecture (n = 27) using the national health insurance receipts for 1997 and 2007 for diabetes mellitus, hypertension, cardiovascular disorder, cerebral vascular disorder, and atherosclerosis as principal diseases. Information was obtained from each municipality on the implementation of public dental health services consisting of 10 programs, including visits for oral hygiene guidance, health consultation for periodontal disease, preventive long-term care, participation of dental hygienists in public health service, programs for improving oral function in the aged, and etc. The municipalities were divided into two groups based on the implementation/non-implementation of each dental health program. Then, the change in health care cost for metabolic syndrome per capita between 1997 and 2007 was compared between the two groups according to each dental health program. RESULTS Health care costs for metabolic syndrome were reduced in decade in the municipalities which executed dental health care programs such as 'preventive long-term care' or 'health consultation for periodontal disease', being greater in the municipalities which did not. More decrease in health care costs was further observed in the municipalities where the other seven programs were also implemented. Any direct relationship between dental health programs and health care costs for the metabolic syndrome remains unclear. However, our data suggests that costs might be decreased in municipalities which can afford to implement dental health programs. Health care costs for the metabolic syndrome in
Full Text Available In the past few years, healthcare systems have been facing a growing demand related to the high prevalence of chronic diseases. Case management programs have emerged as an integrated care approach for the management of chronic disease. Nevertheless, there is little scientific evidence on the impact of using a case management program for patients with complex multimorbidity regarding hospital resource utilisation. We evaluated an integrated case management intervention set up by community-based care at outpatient clinics with nurse case managers from a telemedicine unit. The hypothesis to be tested was whether improved continuity of care resulting from the integration of community-based and hospital services reduced the use of hospital resources amongst patients with complex multimorbidity. A retrospective cohort study was performed using a sample of 714 adult patients admitted to the program between January 2012 and January 2015. We found a significant decrease in the number of emergency room visits, unplanned hospitalizations, and length of stay, and an expected increase in the home care hospital-based episodes. These results support the hypothesis that case management interventions can reduce the use of unplanned hospital admissions when applied to patients with complex multimorbidity.
Stall, Nathan; Nowaczynski, Mark; Sinha, Samir K
To describe the effect of home-based primary care for homebound older adults on individual, caregiver, and systems outcomes. A systematic review of home-based primary care interventions for community-dwelling older adults (aged ≥65) using the Cochrane, PubMed, and MEDLINE databases from the earliest available date through March 15, 2014. Studies were included if the house calls visitor was the ongoing primary care provider and if the intervention measured emergency department visits, hospitalizations, hospital beds days of care, long-term care admissions, or long-term care bed days of care. Home-based primary care programs. Homebound community-dwelling older adults (N = 46,154). Emergency department visits, hospitalizations, hospital bed days of care, long-term care admissions, long-term care bed days of care, costs, program design, and individual and caregiver quality of life and satisfaction with care. Of 357 abstracts identified, nine met criteria for review. The nine interventions were all based in North America, with five emerging from the Veterans Affairs system. Eight of nine programs demonstrated substantial effects on at least one inclusion outcome, with seven programs affecting two outcomes. Six interventions shared three core program components: interprofessional care teams, regular interprofessional care meetings, and after-hours support. Specifically designed home-based primary care programs may substantially affect individual, caregiver and systems outcomes. Adherence to the core program components identified in this review could guide the development and spread of these programs. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Johnson, Tracy L; Brewer, Daniel; Estacio, Raymond; Vlasimsky, Tara; Durfee, Michael J; Thompson, Kathy R; Everhart, Rachel M; Rinehart, Deborath J; Batal, Holly
The Center for Medicare and Medicaid Innovation (CMMI) awarded Denver Health's (DH) integrated, safety net health care system $19.8 million to implement a "population health" approach into the delivery of primary care. This major practice transformation builds on the Patient Centered Medical Home (PCMH) and Wagner's Chronic Care Model (CCM) to achieve the "Triple Aim": improved health for populations, care to individuals, and lower per capita costs. This paper presents a case study of how DH integrated published predictive models and front-line clinical judgment to implement a clinically actionable, risk stratification of patients. This population segmentation approach was used to deploy enhanced care team staff resources and to tailor care-management services to patient need, especially for patients at high risk of avoidable hospitalization. Developing, implementing, and gaining clinical acceptance of the Health Information Technology (HIT) solution for patient risk stratification was a major grant objective. In addition to describing the Information Technology (IT) solution itself, we focus on the leadership and organizational processes that facilitated its multidisciplinary development and ongoing iterative refinement, including the following: team composition, target population definition, algorithm rule development, performance assessment, and clinical-workflow optimization. We provide examples of how dynamic business intelligence tools facilitated clinical accessibility for program design decisions by enabling real-time data views from a population perspective down to patient-specific variables. We conclude that population segmentation approaches that integrate clinical perspectives with predictive modeling results can better identify high opportunity patients amenable to medical home-based, enhanced care team interventions.
Maulsby, Catherine; Jain, Kriti M; Weir, Brian W; Enobun, Blessing; Riordan, Maura; Charles, Vignetta E; Holtgrave, David R
Persons diagnosed with HIV but not retained in HIV medical care accounted for the majority of HIV transmissions in 2009 in the United States (US). There is an urgent need to implement and disseminate HIV retention in care programs; however little is known about the costs associated with implementing retention in care programs. We assessed the costs and cost-saving thresholds for seven Retention in Care (RiC) programs implemented in the US using standard methods recommended by the US Panel on Cost-effectiveness in Health and Medicine. Data were gathered from accounting and program implementation records, entered into a standardized RiC economic analysis spreadsheet, and standardized to a 12 month time frame. Total program costs for from the societal perspective ranged from $47,919 to $423,913 per year or $146 to $2,752 per participant. Cost-saving thresholds ranged from 0.13 HIV transmissions averted to 1.18 HIV transmission averted per year. We estimated that these cost-saving thresholds could be achieved through 1 to 16 additional person-years of viral suppression. Across a range of program models, retention in care interventions had highly achievable cost-saving thresholds, suggesting that retention in care programs are a judicious use of resources.
Smith, Debbie; Murauski, Jackie
Pulmonary embolism (PE) is a complication that can occur at any time during the perioperative period. The patient undergoing surgery to repair a hip fracture is at a high risk of developing a PE due to venous thrombosis, tissue, or fat emboli. The signs and symptoms of a PE are often nonspecific and can be obscured in the patient receiving or recovering from general anesthesia. This case study describes the presentation, diagnosis, and treatment of a patient experiencing a pulmonary embolism in the postanesthesia care unit (PACU) after surgery to repair a hip fracture. Copyright Â© 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
Spear, Shawn; Sim, Vasiliy; Moore, Frederick A; Todd, S Rob
In 2009, the Society of Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) published "Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient." To improve our surgery residents' understanding of intensive care unit (ICU) nutrition, we developed a nutrition education program based on these guidelines. The purpose of this pilot study was to assess its effectiveness. We hypothesized that our nutrition education program would improve our residents' knowledge of ICU nutrition. This was a prospective observational pilot study performed in the surgical ICU of an academic medical center. Based on the SCCM/A.S.P.E.N. nutrition guidelines, we developed a nutrition education program (lectures covering selected guidelines and interactive case studies). Pre- and posttesting were performed to assess short-term comprehension. Long-term retention was assessed 3 months after the initial education program. The primary outcome measure was the change in ICU nutrition knowledge. Significance was set at P nutrition education program. Their mean age was 27.8 ± 1.2 years, and 50% were male. The mean test scores were as follows: pretest, 45% ± 9%; posttest, 81% ± 5%; and 3-month test, 65% ± 8%. The differences between the pretest and both posttest scores were significant (P nutrition. This is confirmed by the pretest results of the current study. Our nutrition education program improved both short-term and long-term ICU nutrition knowledge of our surgery residents. Future studies should evaluate the effect such education has on the clinical outcomes of ICU patients.
The Physics Entrepreneurship Program is a new, two-year Master's Program designed to empower physicists as entrepreneurs. Launched by the Dept. of Physics at Case Western Reserve University in close cooperation with the Weatherhead School of Management, the program is now in its second year. This innovative new program has already attracted important attention from the business community, including seed funding of a student launched venture, international press coverage, including an article in Business Week, and government interest, including an invitation to brief the Advisory Board of the Mathematical and Physical Sciences Division of the National Science Foundation. This talk will discuss the structure and content of the program, the lessons we are learning, and early indicators of success including a student-launched new business venture that has already secured more than $ 250,000 in seed funding.
Knowles, Lynnette; O'Dowd, Corina; Hewett, David G; Schafer, Jennifer; Fracgp, Dranzcog; Wilkinson, David
Changes in modern healthcare's provision, complexity, and workforce demands provide a compelling rationale for an increasing emphasis on leadership development at all levels of training within the medical profession. Undergraduate medical education has traditionally focused on the development of clinical acumen with little emphasis on the development of leadership skills or on the operational and systemic issues surrounding healthcare delivery. Incorporating leadership education and competencies presents a number of challenges to medical schools, including defining the subject area, determining the specific skills and knowledge bases that should constitute the basis of the program, and optimizing training to be integrated into the existing clinical curriculum. We present a case study of the Medical Leadership Program at The University of Queensland School of Medicine that runs concurrent to the undergraduate medical degree. We outline the inception of the program, its aims, participant selection, and program components and reflect on the program to date.
Full Text Available Life-long education programs are rather new in Romania, and there is much confusion about their structure, meaning, purposes and usefulness; although there is a clear necessity for these kinds of programs, they were implemented in our country only after recommendations were made by the European institutions. The Babeş-Bolyai University is one of the first and few Romanian universities that actually develop continuing education programs, directed at public services for the use of the local community. In this paper we present a particular case, the Program of Continuous Learning – Defense and Security Studies, designed to assist the 4th Territorial Army Corps based in Cluj-Napoca in its efforts to meet NATO standards. The program offers courses for military personnel in fields like strategic management, decision making processes, human resources management, and, of course, European security, and represents the first project of cooperation between a university and the Romanian army.
Roze des Ordons, Amanda; Kassam, Aliya; Simon, Jessica
Residents are commonly involved in establishing goals of care for hospitalized patients. While education can improve the quality of these conversations, whether and how postgraduate training programs integrate such teaching into their curricula is not well established. The objective of this study was to characterize perceptions of current teaching and assessment of goals of care conversations, and program director interest in associated curricular integration. An electronic survey was sent to all postgraduate program directors at the University of Calgary. Quantitative data was analyzed using descriptive statistics and qualitative comments were analyzed using thematic analysis. The survey response rate was 34% (22/64). Formal goals of care conversation teaching is incorporated into 63% of responding programs, and most commonly involves lectures. Informal teaching occurs in 86% of programs, involving discussion, direct observation and role modeling in the clinical setting. Seventy-three percent of programs assess goals of care conversation skills, mostly in the clinical setting through feedback. Program directors believe that over two-thirds of clinical faculty are prepared to teach goals of care conversations, and are interested in resources to teach and assess goals of care conversations. Themes that emerged include 1) general perceptions, 2) need for teaching, 3) ideas for teaching, and 4) assessment of goals of care conversations. The majority of residency training programs at the University of Calgary incorporate some goals of care conversation teaching and assessment into their curricula. Program directors are interested in resources to improve teaching and assessment of goals of care conversations.
Bailey, Steven; Gilmore, Kathryn; Yerkes, Lauren; Rhodes, Anne
Incarcerated individuals are disproportionately affected by HIV and often experience risk factors associated with poor maintenance of HIV care upon release. Therefore, the transition period from incarceration to the community is a particularly critical time for persons living with HIV to ensure continuity of care and treatment. By building relationships with Department of Corrections staff and community partners, the Virginia Department of Health developed a program to link recently incarcerated persons living with HIV to care and treatment immediately upon release from correctional facilities across Virginia. Findings show that clients served by the program have better outcomes along the HIV continuum of care than the overall population living with HIV in Virginia. This paper describes the development, implementation and health outcomes of the Care Coordination program for recently incarcerated persons living with HIV in Virginia.
Nunez, Elizabeth; Gibson, Gretchen; Jones, Judith A; Schinka, John A
...) transitional housing intervention program. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did...
Abdullah M Al-Wahbi
Full Text Available Abdullah M Al-WahbiDepartment of Surgery, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyahd, Kingdom of Saudi ArabiaBackground: Diabetic foot complications are a leading cause of lower extremity amputation. With the increasing incidence of diabetes mellitus in the Arab world, specifically in the Kingdom of Saudi Arabia, the rate of amputation will rise significantly. A diabetic foot care program was implemented at King Abdulaziz Medical City in Riyadh, Saudi Arabia, in 2002. The program was directed at health care staff and patients to increase their awareness about diabetic foot care and prevention of complications. The purpose of this study was to perform a primary evaluation of the program’s impact on the rate of lower extremity amputation due to diabetic foot complications.Method: This pilot study was the first analysis of the diabetic foot care program and examined two groups of participants for comparison, ie, a “before” group having had diabetic foot ulcers managed between 1983, when the hospital was first established, and 2002 when the program began and an “after group” having had foot ulcers managed between 2002 and 2004, in the program’s initial phase. A total of 41 charts were randomly chosen retrospectively. A data sheet containing age, gender, medical data, and the presentation, management, and outcome of diabetic foot cases was used for the analysis.Results: The before group contained 20 patients (17 males and the after group contained 21 patients (16 males. There was no difference between the two groups with regard to age and comorbidities. The rate of amputation was 70% in the before group and 61.9% in the after group. There was a decrease in the percentage of toe amputation in the after group and an increase in the percentage of below-knee amputation in the before group. However, these changes were not significant.Conclusion: The program, although evaluated at an early
Hutschemaekers, Giel J.M.; Tiemens, Bea G.; Winter, M. de
Purpose Description and analysis of the effects and side-effects of integrated mental health care in the Netherlands. Context of case Due to a number of large-scale mergers, Dutch mental health care has become an illustration of integration and coherence of care services. This process of
Hutschemaekers, G.J.M.; Tiemens, B.G.; Winter, M. de
Purpose: Description and analysis of the effects and side-effects of integrated mental health care in the Netherlands. Context of case: Due to a number of large-scale mergers, Dutch mental health care has become an illustration of integration and coherence of care services. This process of
Nosek, Carl A; Buck, W Chris; Caviness, Alison C; Foust, Abbie; Nyondo, Yewo; Bottomani, Madalitso; Kazembe, Peter N
The scale up of pediatric antiretroviral treatment programs across Sub-Saharan Africa over the last decade has brought increasing numbers of children into HIV care. This patient population requiring life-long care presents new challenges in the outpatient and inpatient settings. We sought to describe hospitalizations from a large pediatric HIV treatment facility to better understand the scope of the situation and identify areas for improved care delivery. We conducted a retrospective case series of all HIV-infected and exposed patients <18 years enrolled at Baylor College of Medicine Children's Foundation Malawi, from October 2004-October 2010. Patients admitted to the hospital on or after the day of enrollment were included. Data were extracted from electronic clinic records. Analysis was done at the patient and admission level, as some patients had multiple admissions. Of 5062 patients enrolled in care, 877 (17.3 %) had 1137 admissions at median age 24 months (IQR: 12-62). 191 (21.8 %) patients had multiple admissions. A high proportion of admissions occurred in patients under two years (49.4 %), those within one month of clinic enrollment (32.9 %), those with severe immune suppression (44.0 %), and those not on ART (48.5 %). The frequency of primary admission diagnoses varied across these same variables, with malnutrition, pneumonia, and malaria being the most common. Illness requiring hospitalization is common in HIV-infected and exposed children and these results reinforce the need for a comprehensive care package with special attention to nutrition. Strengthened programs for malaria prevention and expanded access to pneumococcal vaccine are also needed. The high burden of admissions in children under 24 months and those newly enrolled in care suggests a need for continued improvement of early infant diagnosis and provider-initiated testing programs to link patients to care before they are symptomatic. Similarly, the high proportion of admissions in
This research aims to contribute to the development of theory regarding inter-organizational designs for these care-cure conditions through a combination of case study research and simulation. The case setting chosen is that of perinatal care in the Netherlands. The research consists of three phases
Kuchar, Ernest; Nitsch-Osuch, Aneta; Szenborn, Leszek
We discuss the changing epidemiological situation of pertussis observed in recent years, with a focus on the shift of cases from young children to older age groups, teenagers and adults. Whooping cough may affect healthcare workers who belong to a high-risk group and cause hospital infections. We present a case report of pertussis in a nurse and the recommended prophylactic measures in healthcare workers. The current definition and diagnosis of pertussis is also discussed. The clinical course of pertussis can be significantly alleviated and highly non-specific, with no typical coughing and vomiting in people vaccinated against whooping cough a few years earlier. Pertussis should be considered in the differential diagnosis of cough lasting more than fourteen days. Improvement of the epidemiological situation requires, besides immunization of infants, regular and universal booster immunization for adolescents and adults. Vaccinations for health care workers of neonatal and pediatric wards are recommended in the National Program of Immunization for 2013. It seems that booster vaccination of health care workers with a triple vaccine against diphtheria, tetanus and acellular pertussis (dTpa) of the reduced quantity of antigens, particularly of health workers caring for infants, children and the elderly, may be the most effective way to reduce the risk of pertussis transmission in the health care environment.
Full Text Available We discuss the changing epidemiological situation of pertussis observed in recent years, with a focus on the shift of cases from young children to older age groups, teenagers and adults. Whooping cough may affect healthcare workers who belong to a high-risk group and cause hospital infections. We present a case report of pertussis in a nurse and the recommended prophylactic measures in healthcare workers. The current definition and diagnosis of pertussis is also discussed. The clinical course of pertussis can be significantly alleviated and highly non-specific, with no typical coughing and vomiting in people vaccinated against whooping cough a few years earlier. Pertussis should be considered in the differential diagnosis of cough lasting more than fourteen days. Improvement of the epidemiological situation requires, besides immunization of infants, regular and universal booster immunization for adolescents and adults. Vaccinations for health care workers of neonatal and pediatric wards are recommended in the National Program of Immunization for 2013. It seems that booster vaccination of health care workers with a triple vaccine against diphtheria, tetanus and acellular pertussis (dTpa of the reduced quantity of antigens, particularly of health workers caring for infants, children and the elderly, may be the most effective way to reduce the risk of pertussis transmission in the health care environment. Med Pr 2013;64(5:731–739
The Africanisation of Academic Development Programs: A case study. Phillip Higgs, RMH Moeketsi. Abstract. The question this article addresses is: what does the Africanisation of academic development programmes involve? In trying to answer this question, we shall discuss the African concepts of ubuntu and communality ...
Ament, Stephanie M C; Gillissen, Freek; Moser, Albine; Maessen, José M C; Dirksen, Carmen D; von Meyenfeldt, Maarten F; van der Weijden, Trudy
Sustainability of innovations is a relatively new concept in health care research and has become an issue of growing interest. The current study explored factors related to the sustainability of 2 multidisciplinary hospital-based programs 3 to 6 years after achieving early implementation success. An exploratory qualitative study was conducted into 2 implementation cases, an Enhanced Recovery After Surgery program for colorectal surgery and a short-stay program for breast cancer surgery. Semistructured interviews were held with key persons involved in the care process in 14 hospitals from both cases minimally 3 years after the implementation, between March 2012 and May 2013. The Consolidated Framework for Implementation Research was used to direct the development of the interview guide, during data collection and during analysis. A directed content analysis was performed. A total of 21 interviews with 26 individuals were held, 18 regarding the Enhanced Recovery After Surgery case and 8 regarding the short-stay program case. Respondents mentioned the following factors associated with sustainability of the programs: modification and adaptability of the program, cost-effectiveness, institutionalization into existing systems, short communication lines within the multidisciplinary team, an innovative culture, benefits for patients, cosmopolitanism, the existence of external policies and incentives, trust and belief in the program, and spread of the program to other settings. Two factors are not covered by the Consolidated Framework for Implementation Research, ie, modification of the program over the years and spread of the program to other contexts. The factors associated with sustainability put forward in both cases were largely the same. Leadership and the implementation project were not mentioned as having influenced the long-term sustainability of the benefits achieved. Sustainability of the innovations is influenced by determinants stemming from all ecological
Ramos-Gomez, Francisco J.
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 ca...
Setiawan, Agus; Dignam, Denise; Waters, Cheryl; Dawson, Angela
Objectives In order to reduce infant mortality in Indonesia, community case management (CCM) was introduced. CCM is a community-based service delivery model to improve children's wellness and longevity, involving the delivery of lifesaving, curative interventions to address common childhood illnesses, particularly where there are limited facility-based services. This paper reports the findings of a qualitative study that investigated the implementation of CCM in the Kutai Timur district, East Kalimantan Indonesia from the perspective of mothers who received care. Methods Seven mothers and health workers were observed during a consultation and these mothers were interviewed in their home weeks after delivery. Field notes and the interview transcriptions were analysed thematically. Findings Mothers reported that their access to care had improved, along with an increase in their knowledge of infant danger signs and when to seek care. Family compliance with care plans was also found to have improved. Mothers expressed satisfaction with the care provided under the CCM model. The mothers expressed a need for a nurse or midwife to be posted in each village, preferably someone from that village. However two mothers did not wish their children to receive health interventions as they did not believe these to be culturally appropriate. Conclusion CCM is seen by rural Indonesian mothers to be a helpful model of care in terms of increasing access to health care and the uptake of lifesaving interventions for sick children. However there is a need to modify the program to demonstrate cultural sensitivity and meet cultural needs of the target population. While CCM is a potentially effective model of care, further integrative strategies are required to embed this model into maternal and child health service delivery.
... national average payment rates for centers reflect a 2.18 percent increase during the 12-month period, May... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of...
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Office of Clinical and Preventive Services; Elder Care Initiative Long-Term Care Grant Program Announcement Type: New. Funding Announcement Number: HHS-2010-IHS-EHC-0001...
Baughman, Reagan A; Smith, Kristin
Despite growing demand for nursing and home health care as the US population ages, compensation levels in the low-skill nursing labor market that provides the bulk of long-term care remain quite low. The challenge facing providers of long-term care is that Medicaid reimbursement rates for nursing home and home health care severely restrict the wage growth that is necessary to attract workers, resulting in high turnover and labor shortages. Almost half of US states have responded by enacting "pass-through" provisions in their Medicaid programs, channeling additional long-term care funding directly to compensation of lower-skill nursing workers. We test the effect of Medicaid wage pass-through programs on hourly wages for direct care workers. We estimate several specifications of wage models using employment data from the 1996 and 2001 panels of the Survey of Income and Program Participation for nursing, home health, and personal care aides. The effect of pass-through programs is identified by an indicator variable for states with programs; 20 states adopted pass-throughs during the sample period. Workers in states with pass-through programs earn as much as 12% more per hour than workers in other states after those programs are implemented. Medicaid wage pass-through programs appear to be a viable policy option for raising compensation levels of direct care workers, with an eye toward improving recruitment and retention in long-term care settings.
Gorski, Lisa A; Johnson, Kathy
This article describes a collaborative approach to manage patients with heart failure between a home care agency and a care management agency. The resulting disease management program used a combination of home visits and phone contact. Care management plans emphasized patient education on increasing adherence to medical and diet regimens, and recognizing early symptoms of exacerbation that could lead to rehospitalization. Clinician activities and patient outcomes are described.
Offenheiser, R C
For the past 15 years, the Fundac Esperanca, a private organization founded in Santarem by a North American Franciscan priest, has been working to provide the widely scattered rural residents in the mid-Amazon region of Brazil with effective health care. Early efforts focused on Esperanca's hospital boat, which traveled up and down the river to reach the remote settlements. During the 1st decade of operation, Esperanca vaccinated some 150,000 people and provided general medical and surgical services to countless others. Yet, by the late 1970s, the program's staff were beginning to question the longterm effectiveness of their efforts. In 1979, Esperanca decided it could have a longer lasting impact on health in the mid-Amazon region if it could mobilize rural communities to improve family diets and sanitary practices and carry out comprehensive vaccination campaigns. Supported by a grant from Private Agencies Collaborating Together (PACT), it launched its own primary health care program. This initiative began with a health survey of the region. The studies revealed that 1/3 of the children under age 6 were malnourished, 90% had untreated cavities, and 2/3 of the 10,000 people tested showed evidence of parasitosis. There were higher than normal incidences of malaria, anemia, tuberculosis, diphtheria, uterine cancer in women, smallpox, and visual problems. The social, cultural, and demographic characteristics of the region also were discouraging. Most people lived in widely scattered river villages and were illiterate, with little understanding of hygiene, nutrition, or public health. None of the settlements had formal health care systems. Esperanca chose to make the community paramedic the keystone of its program, stating clearly that the outreach worker is the conduit to clinical services in Santarem. In time, it was decided to phase out the hospital boat's activities. It had come to signal the wrong message, i.e., the doctors were coming and good health was on the
Silva, Daiane Medeiros da; Farias, Hérika Brito Gomes de; Villa, Tereza Cristina Scatena; Sá, Lenilde Duarte de; Brunello, Maria Eugênia Firmino; Nogueira, Jordana de Almeida
To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum. The organization of care for tuberculosis and supported self-care presented reasonable capacity.In the coordination with the community, the presence of the community agent presented optimum capacity.Partnership with organizations of the community and involvement of experts presented limited capacity.The qualification of professionals, the system for scheduling and monitoring tuberculosis in the community, and the clinical information system presented basic capacity. The capacity of the primary health care services to produce tuberculosis-related care according to the elements of the Chronic Care Model is still limited.Overcoming the fragmentation of care and prioritizing a systemic operation between actions and services of the health care network remains as a major challenge. Analisar,segundo os elementos doChronicCareModel,a produção do cuidado aos casos de tuberculose nos serviços de Atenção Primária à Saúde. Estudo transversal, realizado em capital do nordeste brasileiro, envolvendo 83 profissionais da Estratégia Saúde da Família. Aplicou-se um instrumento estruturado, adaptado para atenção à tuberculose no Brasil. A análise pautou-se na construção de indicadores, cujacapacidade para produção de cuidados variou entre limitada a ótima. A organização da atenção à tuberculose e o autocuidado apoiado apresentaram capacidade razoável. Na articulação com a comunidade, a presençadoagente comunitário de saúde apresentou capacidade ótima. A parceria com organizações da
Kogut, Stephen J; Johnson, Scott; Higgins, Tara; Quilliam, Brian
Medication copayment reduction can be integrated with disease management programs to incentivize patient engagement in chronic care management. While disease management programs in diabetes have been evaluated across a range of settings and designs, less is known regarding the effectiveness of copayment reduction as a component of disease management. To evaluate the short-term results of a diabetes-focused disease management program that included copayment reduction, care coordination, and patient goal setting, focusing on rates of evidence-based care processes and all-cause pharmacy and health care costs. Blue Cross Blue Shield of Rhode Island offered large employer groups the opportunity to participate in a diabetes disease management initiative that featured reduced copayments (from $7/$25/$40 for generic, tier 2, and tier 3 drugs, respectively, to $0 for generic and $0-$2 for brand drugs) for diabetes-related medications. In return for the copayment reduction, participants agreed to the following: (a) participate in care coordination with a case manager, (b) have an annual physical examination, (c) have a hemoglobin A1c blood test at least twice annually, and (d) have a low-density lipoprotein cholesterol (LDL-C) test at least once annually. Patients received personalized support provided by a registered nurse and dietician, disease-related education provided by nurses, and intensified case management services, including working with a health coach to establish healthy behavioral change goals. All study subjects were aged 18 years or older and had at least 1 ICD-9-CM code for diabetes and at least 1 claim for an antidiabetic drug during a 12-month measurement period, which was each subject's most recent 12-month period of continuous enrollment from January 1, 2008, through May 31, 2010. Administrative claims data were used to determine the percentage of intervention (participating) and nonintervention (nonparticipating) subjects from among all of the plan
Respiratory care education programs are being held accountable for student retention. Increasing student retention is necessary for the respiratory therapy profession, which suffers from a shortage of qualified therapists needed to meet the increased demand. The present study investigated the relationship between student retention rate and program resources, in order to understand which and to what extent the different components of program resources predict student retention rate. The target population of this study was baccalaureate of science degree respiratory care education programs. After utilizing a survey research method, Pearson correlations and multiple regression analysis were used for data analysis. With a 63% response rate (n = 36), this study found a statistically significant relationship between program resources and student retention rate. Financial and personnel resources had a statistically significant positive relationship with student retention. The mean financial resources per student was responsible for 33% of the variance in student retention, while the mean personnel resources per student accounted for 12% of the variance in student retention. Program financial resources available to students was the single best predictor of program performance on student retention. Respiratory care education programs spending more money per student and utilizing more personnel in the program have higher mean performance in student retention. Therefore, respiratory care education programs must devote sufficient resources to retaining students so that they can produce more respiratory therapists and thereby make the respiratory therapy profession stronger.
Izzo, Charles V; Smith, Elliott G; Holden, Martha J; Norton, Catherine I; Nunno, Michael A; Sellers, Deborah E
The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening "upstream" at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions.
Yu, Chai Ping; Whynes, David K; Sach, Tracey H
Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help
Sach Tracey H
Full Text Available Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO and a regressive finance source (indirect taxes. Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers
Background 'Protocol based care' was envisioned by policy makers as a mechanism for delivering on the service improvement agenda in England. Realistic evaluation is an increasingly popular approach, but few published examples exist, particularly in implementation research. To fill this gap, within this paper we describe the application of a realistic evaluation approach to the study of protocol-based care, whilst sharing findings of relevance about standardising care through the use of protocols, guidelines, and pathways. Methods Situated between positivism and relativism, realistic evaluation is concerned with the identification of underlying causal mechanisms, how they work, and under what conditions. Fundamentally it focuses attention on finding out what works, for whom, how, and in what circumstances. Results In this research, we were interested in understanding the relationships between the type and nature of particular approaches to protocol-based care (mechanisms), within different clinical settings (context), and what impacts this resulted in (outcomes). An evidence review using the principles of realist synthesis resulted in a number of propositions, i.e., context, mechanism, and outcome threads (CMOs). These propositions were then 'tested' through multiple case studies, using multiple methods including non-participant observation, interviews, and document analysis through an iterative analysis process. The initial propositions (conjectured CMOs) only partially corresponded to the findings that emerged during analysis. From the iterative analysis process of scrutinising mechanisms, context, and outcomes we were able to draw out some theoretically generalisable features about what works, for whom, how, and what circumstances in relation to the use of standardised care approaches (refined CMOs). Conclusions As one of the first studies to apply realistic evaluation in implementation research, it was a good fit, particularly given the growing emphasis on
Stolper, Margreet; Molewijk, Bert; Widdershoven, Guy
Moral case deliberation (MCD) is a dialogue among health care professionals about moral issues in practice. A trained facilitator moderates the dialogue, using a conversation method. Often, the facilitator is an ethicist. However, because of the growing interest in MCD and the need to connect MCD to practice, healthcare professionals should also become facilitators themselves. In order to transfer the facilitating expertise to health care professionals, a training program has been developed. This program enables professionals in health care institutions to acquire expertise in dealing with moral questions independent of the expertise of an (external) ethicist. Over the past 10 years, we developed a training program with a specific mix of theory and practice, aiming to foster the right attitude, skills and knowledge of the trainee. The content and the didactics of the training developed in line with the philosophy of MCD: pragmatic hermeneutics, dialogical ethics and Socratic epistemology. Central principles are: 'learning by doing', 'reflection instead of ready made knowledge', and 'dialogue on dialogue'. This paper describes the theoretical background and the didactic content of the current training. Furthermore, we present didactic tools which we developed for stimulating active learning. We also go into lessons we learned in developing the training. Next, we provide some preliminary data from evaluation research of the training program by participants. The discussion highlights crucial aspects of educating professionals to become facilitators of MCD. The paper ends with concluding remarks and a plea for more evaluative evidence of the effectiveness and meaning of this training program for doing MCD in institutions.
Lin, Hsiu-Ying; Chen, Shu-Ching; Peng, Hsi-Ling; Chen, Mu-Kuan
The aim of this study is to identify the effects of a case management program on knowledge about oral cancer, preventive behavior for oral cancer, and level of uncertainty for patients with oral precancerous lesions. A randomized controlled trial was conducted with two groups, using a pre- and posttest design. The experimental group received a case management program and telephone follow-up sessions; the control group received routine care. Patients were assessed at three time points: first visit to the otolaryngology clinic for biopsy examination (T0), and then at 2 weeks (T1) and 4 weeks (T2) after the biopsy examination. Patients in both groups had significantly higher levels of knowledge about oral cancer, preventive behavior for oral cancer, and lower level of uncertainty at T2 compared to T0. At T2, participants in the experimental group had significantly greater knowledge about oral cancer, more preventive behavior for oral cancer, and less uncertainty compared to those in the control group. The case management program with telephone counseling effectively improved knowledge about oral cancer, preventive behavior for oral cancer, and uncertainty levels in patients with oral precancerous lesions in the four weeks after receiving a biopsy examination. The case management program can be applied with positive results to patients receiving different types of cancer screening, including colorectal, breast, and cervical screening.
Magarian, Edward O.; Peterson, Charles D.
An IBM-compatible information storage and retrieval software program was developed to support an eight-week community pharmacy ambulatory care clerkship for entry-level Doctor of Pharmacy students. The program helps evaluate and identify patients for health and medication problems, perform patient risk-factor assessment, monitor drug therapy,…
Hsieh, S. Jean; Howes, Jennifer M.; Keene, Adam B.; Fausto, James A.; Pinto, Priya A.; Gong, Michelle Ng
Rationale: Although expert communication between intensive care unit clinicians with patients or surrogates improves patient- and family-centered outcomes, fellows in critical care medicine do not feel adequately trained to conduct family meetings. Objectives: We aimed to develop, implement, and evaluate a communication skills program that could be easily integrated into a U.S. critical care fellowship. Methods: We developed four simulation cases that provided communication challenges that critical care fellows commonly face. For each case, we developed a list of directly observable tasks that could be used by faculty to evaluate fellows during each simulation. We developed a didactic curriculum of lectures/case discussions on topics related to palliative care, end-of-life care, communication skills, and bioethics; this month-long curriculum began and ended with the fellows leading family meetings in up to two simulated cases with direct observation by faculty who were not blinded to the timing of the simulation. Our primary measures of effectiveness were the fellows’ self-reported change in comfort with leading family meetings after the program was completed and the quality of the communication as measured by the faculty evaluators during the family meeting simulations at the end of the month. Measurements and Main Results: Over 3 years, 31 critical care fellows participated in the program, 28 of whom participated in 101 family meeting simulations with direct feedback by faculty facilitators. Our trainees showed high rates of information disclosure during the simulated family meetings. During the simulations done at the end of the month compared with those done at the beginning, our fellows showed significantly improved rates in: (1) verbalizing an agenda for the meeting (64 vs. 41%; Chi-square, 5.27; P = 0.02), (2) summarizing what will be done for the patient (64 vs. 39%; Chi-square, 6.21; P = 0.01), and (3) providing a follow-up plan (60 vs. 37%; Chi
Huynh, Truong-Giang; Covalesky, Miranda; Sinclair, Samantha; Gunter, Heather; Norton, Tamara; Chen, Alice; Yi, Cassia
Patients discharged from intensive care units are at risk of short- and long-term physical, cognitive, and emotional symptoms known as post-intensive care syndrome. Family members of intensive care unit patients are at risk of similar symptoms known as post-intensive care syndrome-family. Both syndromes are common, and strategies to reduce risk factors should be employed. An intensive care unit diary project to help reduce these syndromes was implemented in 2 intensive care units using an evidence-based framework. The effects of these diaries were studied using the Family Satisfaction with Care in the Intensive Care Unit survey. Rates of referrals to a postintensive care unit recovery clinic were also observed in relation to the diaries. Although preliminary data did not reveal a significant increase in family satisfaction, the surveys provided important staff feedback. The diaries fostered feelings of compassion and caring as well as built trust between staff and family members of intensive care unit patients. The diaries increased referrals to the postintensive care unit recovery clinic. ©2017 American Association of Critical-Care Nurses.
Tandon, Pooja S.; Garrison, Michelle M.; Christakis, Dimitri A.
Objective: To describe and compare obesity prevention practices related to physical activity and beverages in home- and center-based child care programs. Methods: A telephone survey of licensed home- and center-based child care programs in Florida, Massachusetts, Michigan, and Washington between October and December 2008. Results: Most programs…
Lee, Linda; Weston, W. Wayne; Hillier, Loretta M.
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…
Hayes, J R; Menke, J A
This program provides the nonprogrammer a tool to develop easily modified computer assisted tutorials, tests, and simulations with a word processor. In addition, by using the branching and query features of this program, one can easily develop text files that provide rapid access to information related to patient care such as neonatal formularies and patient care algorithms.
Hansen, Lori A.; Talley, Robert C.
In the University of South Dakota's medical school clerkship program, students may choose one of three ambulatory-care settings. In one, the curriculum is problem based and student centered to enhance student interest in primary care. The new program has been successful and well received and is being further developed. (MSE)
Liddy, Clare; Rowan, Margo; Valiquette-Tessier, Sophie-Claire; Drosinis, Paul; Crowe, Lois; Hogg, William
To examine the barriers to and facilitators of practice facilitation experienced by participants in the Improving Delivery of Cardiovascular Care (IDOCC) project. Case studies of practice facilitators' narrative reports. Eastern Ontario. Primary care practices that participated in the IDOCC project. Cases were identified by calculating sum scores in order to determine practices' performance relative to their peers. Two case exemplars were selected that scored within ± 1 SD of the total mean score, and a qualitative analysis of practice facilitators' narrative reports was conducted using a 5-factor implementation framework to identify barriers and facilitators. Narratives were divided into 3 phases: planning, implementation, and sustainability. Barriers and facilitators fluctuated over the intervention's 3 phases. Site A reported more barriers (n = 47) than facilitators (n = 38), while site B reported a roughly equal number of barriers (n = 144) and facilitators (n = 136). In both sites, the most common barriers involved organizational and provider factors and the most common facilitators were associated with innovation and structural factors. Both practices encountered various barriers and facilitators throughout the IDOCC's 3 phases. The case studies reveal the complex interactions of these factors over time, and provide insight into the implementation of practice facilitation programs. Copyright© the College of Family Physicians of Canada.
Joshua M. Wiener
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.
Adams, Jennifer; Chacko, Karen; Guiton, Gretchen; Aagaard, Eva
The care of patients with HIV is increasingly focused on outpatient chronic disease management. It is not known to what extent internal medicine residents in the US are currently being trained in or encouraged to provide primary care for this population of patients. To survey internal medicine residency program directors about their attitudes regarding training in outpatient HIV care and current program practices. Program directors were surveyed first by email. Non-responding programs were mailed up to two copies of the survey. All internal medicine residency program directors in the US. Program director attitudes and residency descriptions. Of the 372 program directors surveyed, 230 responded (61.8 %). Forty-two percent of program directors agreed that it is important to train residents to be primary care providers for patients with HIV. Teaching outpatient-based HIV curricula was a priority for 45.1%, and 56.5% reported that exposing residents to outpatient HIV clinical care was a high priority. Only 46.5% of programs offer a dedicated rotation in outpatient HIV care, and 50.5% of programs have curricula in place to teach about outpatient HIV care. Only 18.8% of program directors believed their graduates had the skills to be primary providers for patients with HIV, and 70.6% reported that residents interested in providing care for patients with HIV pursued ID fellowships. The strongest reasons cited for limited HIV training during residency were beliefs that patients with HIV prefer to be seen and receive better care in ID clinics compared to general medicine clinics. With a looming HIV workforce shortage, we believe that internal medicine programs should create educational experiences that will provide their residents with the skills and knowledge necessary to meet the healthcare needs of this population.
Chan, Juliana C N; Ozaki, Risa; Luk, Andrea; Kong, Alice P S; Ma, Ronald C W; Chow, Francis C C; Wong, Patrick; Wong, Rebecca; Chung, Harriet; Chiu, Cherry; Wolthers, Troels; Tong, Peter C Y; Ko, Gary T C; So, Wing-Yee; Lyubomirsky, Greg
Diabetes is a global epidemic, and many affected individuals are undiagnosed, untreated, or uncontrolled. The silent and multi-system nature of diabetes and its complications, with complex care protocols, are often associated with omission of periodic assessments, clinical inertia, poor treatment compliance, and care fragmentation. These barriers at the system, patient, and care-provider levels have resulted in poor control of risk factors and under-usage of potentially life-saving medications such as statins and renin-angiotensin system inhibitors. However, in the clinical trial setting, use of nurses and protocol with frequent contact and regular monitoring have resulted in marked differences in event rates compared to epidemiological data collected in the real-world setting. The phenotypic heterogeneity and cognitive-psychological-behavioral needs of people with diabetes call for regular risk stratification to personalize care. Quality improvement initiatives targeted at patient education, task delegation, case management, and self-care promotion had the largest effect size in improving cardio-metabolic risk factors. The Joint Asia Diabetes Evaluation (JADE) program is an innovative care prototype that advocates a change in clinic setting and workflow, coordinated by a doctor-nurse team and augmented by a web-based portal, which incorporates care protocols and a validated risk engine to provide decision support and regular feedback. By using logistics and information technology, supported by a network of health-care professionals to provide integrated, holistic, and evidence-based care, the JADE Program aims to establish a high-quality regional diabetes database to reflect the status of diabetes care in real-world practice, confirm efficacy data, and identify unmet needs. Through collaborative efforts, we shall evaluate the feasibility, acceptability, and cost-effectiveness of this "high tech, soft touch" model to make diabetes and chronic disease care more
Frank, Mary, Ed.; Caldwell, Bettye M., Ed.
Contains seven papers divided into three sections addressing: (1) the application of marketing principles to child care organizations and ways of remedying the negative public image of child care; (2) training child care professionals to develop marketing skills; and (3) successful uses of five basic marketing skills illustrated through four case…
van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Francke, Anneke L; Jansen, Wim J J; Vissers, Kris C; Deliens, Luc
Three important elements of the World Health Organization (WHO) definition of palliative care are: 1) it includes patients who may have cure or life prolongation as treatment aims besides palliative care; 2) it is not exclusively for cancer patients; and 3) it includes attention to the medical, psychological, social, and spiritual needs of the patients and their families. Case managers (nurses with expertise in palliative care) may assist generalist primary care providers in delivery of good palliative care. This study investigates the referral of patients to case managers in primary care with regard to the three elements mentioned: diagnosis, treatment aims, and needs as reflected in reasons given for referral. In this cross-sectional survey in primary care among case managers and referrers to case management, case managers completed questionnaires for 687 patients; referrers completed 448 (65%). Most patients referred have a combination of treatment aims (69%). Life expectancy and functional status of patients are lower for those with a treatment aim of palliation. Almost all (96%) of those referred are cancer patients. A need for psychosocial support is frequently given as a reason for referral (66%) regardless of treatment aim. Referrals to case managers reflect two of three elements of the WHO definition. Mainly, patients are referred for support complementary to medical care, and relatively early in their disease trajectory. However, most of those referred are cancer patients. Thus, to fully reflect the definition, broadening the scope to reach other patient groups is important.
... medicine, general internal medicine, or pediatric medicine. Primary care for any population is critical to... medicine, and pediatric medicine qualify as primary care providers for purposes of increased payment. This... Medicaid Program; Payments for Services Furnished by Certain Primary Care Physicians and Charges for...
Giles, Lisa L; Martini, D Richard
Mental health integration in primary care is based on creating an environment that encourages collaboration and supports appropriate care for patients and families while offering a full range of services. Training programs for primary care practitioners should include sessions on how to build and maintain such a practice along with information on basic mental health competencies. Copyright © 2017 Elsevier Inc. All rights reserved.
... HUMAN SERVICES 45 CFR Part 98 Child Care and Development Fund (CCDF) Program; Reopening of Comment... comments on the proposed rule for the Child Care and Development Fund (CCDF), published in the Federal... proposed rule for the Child Care and Development Fund (CCDF) in the Federal Register on May 20, 2013 (78 FR...
... manager. In the absence of a TRICARE primary care manager in the remote location and if the active duty member is not assigned to a military primary care manager based on fitness for duty requirements, the... 32 National Defense 2 2010-07-01 2010-07-01 false Supplemental Health Care Program for active duty...
Ko, Nai-Ying; Hsieh, Chia-Yin; Chen, Yen-Chin; Tsai, Chen-Hsi; Liu, Hsiao-Ying; Liu, Li-Fang
Since 2005, the Taiwan Centers for Disease Control (Taiwan CDC) initiated an HIV case management program in AIDS-designated hospitals to provide integrative services and risk-reduction counseling for HIV-infected individuals. In light of the increasingly complex and highly specialized nature of clinical care, expanding and improving competency-based professional education is important to enhance the quality of HIV/AIDS care. The aim of this study was to develop the essential competency framework for HIV care for HIV case managers in Taiwan. We reviewed essential competencies of HIV care from Canada, the United Kingdom, and several African countries and devised descriptions of the roles of case managers and of the associated core competencies for HIV care in Taiwan. The modified Delphi technique was used to evaluate the draft framework of these roles and core competencies. A total of 15 HIV care experts were invited to join the expert panel to review and rank the draft framework. The final framework consisted of 7 roles and 27 competencies for HIV case managers. In Round 1, only 3 items did not receive consensus approval from the experts. After modification based on opinions of the experts, 7 roles and 27 competencies received 97.06% consensus approval in Round 2 and were organized into the final framework for HIV case managers. These roles and associated core competencies were: HIV Care Expert (9 competencies), Communicator (1 competency), Collaborator (4 competencies), Navigator (2 competencies), Manager (4 competencies), Advocate (2 competencies), and Professional (5 competencies). The authors developed an essential competency framework for HIV care using the consensus of a multidisciplinary expert panel. Curriculum developers and advanced nurses and practitioners may use this framework to support developments and to ensure a high quality of HIV care.
Sullivan, Amy M; Lakoma, Matthew D; Billings, J Andrew; Peters, Antoinette S; Block, Susan D
To evaluate the effectiveness of the Program in Palliative Care Education and Practice (PCEP), an intensive faculty development program at Harvard Medical School. PCEP is a two-week program offered annually with two on-site sessions in Boston, MA, and an interim period distance-learning component. Training integrates palliative care clinical skill development, learning theory and teaching methods, and leadership and organizational change. Longitudinal surveys (preprogram, retrospective preprogram, and postprogram) of participants from 2000-03 assessed self-reported preparation in providing and teaching palliative care; teaching and patient care practices; and satisfaction with program. The response rate was 96% (n=149) for Session I and 72% for both Session I and II (n=113). Questionnaire responses demonstrated statistically significant improvements with large effect sizes (range 0.7-1.8) on nearly all measures. Preparation increased from 3.0+/-1.1 to 4.2+/-0.7 for providing end-of-life care (1=not well prepared, 5=very well prepared), and from 2.6+/-1.0 to 4.3+/-0.7 for teaching this topic. Respondents reported behavioral changes in patient care and teaching; e.g., after the program, 63% noted that, specifically as a result of attending the course, they encouraged learners to reflect on their emotional responses to dying patients, and 57% conducted experiential exercises (e.g., role-play). Eighty-two percent rated the experience as "transformative," and many responses to open-ended items described powerful learning experiences. Participants rated the program highly (4.9+/-0.1, 1=lowest, 5=highest rating). Integrating clinical content with learning about educational methods is an efficient and effective approach to enhancing clinical faculty's capacity to model and teach clinical care. This program offers an educational model that engages practitioners, stimulates changes in practice, and offers opportunities for reflection and professional revitalization.
Filipski Marta I
Full Text Available Abstract Background Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC. Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Methods Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Results Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. Conclusions A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.
Donohue, SarahMaria; Haine, James E; Li, Zhanhai; Trowbridge, Elizabeth R; Kamnetz, Sandra A; Feldstein, David A; Sosman, James M; Wilke, Lee G; Sesto, Mary E; Tevaarwerk, Amye J
Survivorship care plans (SCPs) have been recommended as tools to improve care coordination and outcomes for cancer survivors. SCPs are increasingly being provided to survivors and their primary care providers. However, most primary care providers remain unaware of SCPs, limiting their potential benefit. Best practices for educating primary care providers regarding SCP existence and content are needed. We developed an education program to inform primary care providers of the existence, content, and potential uses for SCPs. The education program consisted of a 15-min presentation highlighting SCP basics presented at mandatory primary care faculty meetings. An anonymous survey was electronically administered via email (n = 287 addresses) to evaluate experience with and basic knowledge of SCPs pre- and post-education. A total of 101 primary care advanced practice providers (APPs) and physicians (35% response rate) completed the baseline survey with only 23% reporting prior receipt of a SCP. Only 9% could identify the SCP location within the electronic health record (EHR). Following the education program, primary care physicians and APPs demonstrated a significant improvement in SCP knowledge, including improvement in their ability to locate one within the EHR (9 vs 59%, p primary care physician and APP knowledge in these areas, which are prerequisites for using SCP in clinical practice.
Eckert, J B
The work in this report was conducted by the Analytic Studies Division (ASD) of the National Renewable Energy Laboratory (NREL) for the U.S. Department of Energy Office of Energy Efficiency and Renewable Energy, Office of Building Technologies. This case study describes the development and implementation of the Super Efficient Refrigerator Program (SERP), which awarded $30 million to the refrigerator manufacturer that developed and commercialized a refrigerator that exceeded 1993 federal efficiency standards by at least 25%. The program was funded by 24 public and private utilities. As the first Golden Carrot program to be implemented in the United States, SERP was studied as an example for future `market-pull` efforts.
van de Glind Irene M
Full Text Available Abstract Background Implementation of lifestyle interventions in patient care is a major challenge. Understanding factors that influence implementation is a first step in programs to enhance uptake of these interventions. A lifestyle-counseling intervention, Lively Legs, delivered by trained nurses, can effectively improve the lifestyle in patients with venous leg ulcers. The aim of this study was to identify factors that hindered or facilitated implementation of this intervention in outpatient dermatology clinics and in home care. Methods A mixed-methods multiple case study in five purposefully selected healthcare settings in the Netherlands was conducted. Measurements to identify influencing factors before and after implementation of Lively Legs included interviews, focus groups, questionnaires, and nurses’ registration. Analyses focused on qualitative data as the main data source. All data were compared across multiple cases to draw conclusions from the study as a whole. Results A total of 53 patients enrolled in the Lively Legs program, which was delivered by 12 trained nurses. Barriers for implementation were mainly organizational. It was difficult to effectively organize reaching and recruiting patients for the program, especially in home care. Main barriers were a lack of a standardized healthcare delivery process, insufficient nursing time, and a lack of motivated nurses to deliver the program. Facilitating factors were nurse-driven coordination of care and a standardized care process to tie Lively Legs into, as this resulted in better patient recruitment and better program implementation. Conclusions This study identified a range of factors influencing the implementation of a lifestyle-counseling program, mainly related to the organization of healthcare. Using a case study method proved valuable in obtaining insight into influencing factors for implementation. This study also shed light on a more general issue, which is that leg ulcer
BACKGROUND OF THE PROBLEM: Fall prevention programs are universally multidisciplinary, but nursing care plays the central role. Since October 2008, Medicare has no longer reimbursed acute care hospitals for the costs of additional care required due to hospital-acquired injuries (e.g., injurious falls). However, fall prevention programs for hospitalized patients have had limited success, and multifaceted strategies for implementing fall prevention programs cannot guarantee success. It is possible that cultivating and sustaining a caring attitude among clinicians is often overlooked as an intervention strategy. This article discusses the barriers to implementing fall prevention programs in acute care hospitals. The attributional theory of success and failure is used to analyze these barriers. In addition, the author discusses whether a lack of knowledge and/or a lack of caring attitude play a role as the underlying barriers to implementing a successful fall prevention program. A patient's story illustrates patients' expectations for the care environment to center on their needs. Possible educational strategies as interventions for fall prevention programs are discussed. It is suggested that education goals for nurses need to not only promote their professional knowledge and skills in implementing a fall prevention program but also cultivate their caring attitudes. © 2011 Wiley Periodicals, Inc.
Plas, A.G.M. van der; Francke, A.L.; Deliens, L.; Jansen, W.J.J.; Vissers, K.C.; Onwuteaka-Philipsen, B.D.
Introduction: Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal care givers. The case manager provides support in addition to the care provided by the home care nurse and
Reardon, Claudia L; Bentman, Adrienne; Cowley, Deborah S; Dunaway, Kristen; Forstein, Marshall; Girgis, Christina; Han, Jaesu; Hung, Erick; Jones, Jeralyn; Keeble, Tanya; McCarron, Robert M; Varley, Christopher K
Integrated care models are an evidence-based approach for integrating physical and behavioral health services. The American Association of Directors of Psychiatric Residency Training Integrated Care Task Force sought to describe current practices for providing training in integrated care to general and child and adolescent psychiatry residents. Directors of US general and child and adolescent psychiatric residency training programs were anonymously surveyed to examine current practices in educating their residents in integrated care. Based on themes that emerged from the survey, the authors make recommendations for integrated care education of general and child and adolescent psychiatry residents. Fifty-two of 197 (26%) general and 36 of 111 (32%) child and adolescent program directors responded. Results demonstrate that a majority of responding general psychiatry (78%) and child and adolescent psychiatry (CAP) (72%) training programs offer integrated care rotations, many of which are electives for senior residents. The Veterans Health Administration (VA) and Federally Qualified Health Centers are common venues for such rotations. Sustainable funding of these rotations is a concern. Fewer than half of programs offer integrated care didactics. This report is intended to help program directors consider options for starting or optimizing their own integrated care curricula. Future research should examine the educational value, and the overall value to health care systems, of training in the integrated care model.
de Vos, Annemarie; Cramm, Jane-Murray; van Wijngaarden, Jeroen D H; Bakker, Ton J E M; Mackenbach, Johan P; Nieboer, Anna P
The Prevention and Reactivation Care Program (PReCaP) provides a novel approach targeting hospital-related functional decline among elderly patients. Despite the high expectations, the PReCaP was not effective in preventing functional decline (ADL and iADL) among older patients. Although elderly PReCaP patients demonstrated slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2-0.6]), lower depression (Geriatric Depression Scale 15; -0.9 [95% -1.1 to -0.6]), and higher perceived health (Short-form 20; 5.6 [95% CI 2.8-8.4]) 1 year after admission than control patients, the clinical relevance was limited. Therefore, this study aims to identify factors impacting on the effectiveness of the implementation of the PReCaPand geriatric care 'as usual'. We conducted semi-structured interviews with 34 professionals working with elderly patients in three hospitals, selected for their comparable patient case mix and different levels of geriatric care. Five non-participatory observations were undertaken during multidisciplinary meetings. Patient files (n = 42), hospital protocols, and care plans were screened for elements of geriatric care. Clinical process data were analysed for PReCaP components. The establishment of a geriatric unit and employment of geriatricians demonstrates commitment to geriatric care in hospital A. Although admission processes are comparable, early identification of frail elderly patients only takes place in hosptial A. Furthermore, nursing care in the hospital A geriatric unit excels with regard to maximizing patient independency, an important predictor for hospital-related functional decline. Transfer nurses play a key role in arranging post-discharge geriatric follow-up care. Geriatric consultations are performed by geriatricians, geriatric nurses, and PReCaP case managers in hospital A. Yet hospital B consultative psychiatric nurses provide similar consultation services. The combination of
Full Text Available The Parent Child Psychological Support Program (PCPS was established in an area of South West Dublin in 2001. Since then until May 2008 it has offered its services to over 700 children and their parents. This preventative, parenting support service is available to all parents of children aged 3 to 18 months within its catchment area. During periodical visits, the infant’s development and growth are measured and parents receive specific information about their child’s progress. Parents are empowered in their parenting practices, thus promoting consistency and synchrony in parent-child interaction. Between 2001 and 2006, 538 parents and their infants participated in the Program. Out of these cases, 130 (24.16% were considered to require additional support and were included in the Monthly Meeting Case Review (MM based on initial concerns The aims of this study were: 1. to review the first five years of MM cases and to explore the socio-demographic profile of the MM cases in comparison to those not in need of additional support (non-MM and 2. To illustrate an approach to refining the case review process which will inform practice and provides the service providers with better understanding of the early detection of parent-child relation difficulties. In pursuing this goal the cases screened over five years of practice were analyzed to explore the structure of the different factors by using statistical techniques of data reduction, i.e. factor analysis. The results showed that the MM group differed on several socio-demographic dimensions from the non-MM group and there was a four factor structure underlying the case review decision process. Implications of this research are discussed.
Axén, Iben; Bodin, Lennart
Low back pain (LBP) is a prevalent condition and has been found to be recurrent and persistent in a majority of cases. Chiropractors have a preventive strategy, maintenance care (MC), aimed towards minimizing recurrence and progression of such conditions. The indications for recommending MC have been identified in the Nordic countries from hypothetical cases. This study aims to investigate whether these indications are indeed used in the clinical encounter. Data were collected in a multi-center observational study in which patients consulted a chiropractor for their non-specific LBP. Patient baseline information was a) previous duration of the LBP, b) the presence of previous episodes of LBP and c) early improvement with treatment. The chiropractors were asked if they deemed each individual patient an MC candidate. Logistic regression analyses (uni- and multi-level) were used to investigate the association of the patient variables with the chiropractor's decision. The results showed that "previous episodes" with LBP was the strongest predictor for recommending MC, and that the presence of all predictors strengthens the frequency of this recommendation. However, there was considerable heterogeneity among the participating chiropractors concerning the recommendation of MC. The study largely confirms the clinical use of the previously identified indications for recommending MC for recurrent and persistent LBP. Previous episodes of LBP was the strongest indicator.
Dill, Janette S; Chuang, Emmeline; Morgan, Jennifer C
Increasing concerns about quality of care and workforce shortages have motivated health care organizations and educational institutions to partner to create career ladders for frontline health care workers. Career ladders reward workers for gains in skills and knowledge and may reduce the costs associated with turnover, improve patient care, and/or address projected shortages of certain nursing and allied health professions. This study examines partnerships between health care and educational organizations in the United States during the design and implementation of career ladder training programs for low-skill workers in health care settings, referred to as frontline health care workers. Mixed methods data from 291 frontline health care workers and 347 key informants (e.g., administrators, instructors, managers) collected between 2007 and 2010 were analyzed using both regression and fuzzy-set qualitative comparative analysis (QCA). Results suggest that different combinations of partner characteristics, including having an education leader, employer leader, frontline management support, partnership history, community need, and educational policies, were necessary for high worker career self-efficacy and program satisfaction. Whether a worker received a wage increase, however, was primarily dependent on leadership within the health care organization, including having an employer leader and employer implementation policies. Findings suggest that strong partnerships between health care and educational organizations can contribute to the successful implementation of career ladder programs, but workers' ability to earn monetary rewards for program participation depends on the strength of leadership support within the health care organization. Copyright © 2014 Elsevier Ltd. All rights reserved.
Serricchio, Claudio; Caldas, Flaviana V. [PETROBRAS, Rio de Janeiro, RJ (Brazil); Akahori, Lisa [Telsan, Rio de Janeiro, RJ (Brazil); Jacomelli Junior, Jose Almir [AGF Engenharia, Araucaria, PR (Brazil)
Concerning the surrounding flora, the implementation of pipelines may cause fragmentation and isolation of the remaining natural vegetation, possibly changing the forest structure; thus raising the border effect; modifying the ratio of species and life forms, decreasing the vegetal diversity and/or causing a lack of connectivity among the remaining indigenous forest resources. In the case of pipelines, the most important environmental measure intended to mitigate the damage caused to the flora is the adoption of Indigenous Flora Rescue Programs. This paper is aimed at analyzing the programs currently applied during the implementation of the GASENE project, by conducting a case study. The main targets of such program are obtaining seeds and fruits with a view to subsidize the potential production of sapling to be further employed in the recovery of areas impacted by the pipeline works; and then relocate the most significant samples of species rescued from the suppressed areas in order to comprise forest areas adjacent to the pipeline's right-of-way. The programs had little differences in their methodology while being implemented, however, we consider that up to the present moment the results obtained in the preservation of species of native flora have been satisfactory. (author)
Mitty, Ethel; Mezey, Mathy
A telephone survey of home care agencies and providers revealed a need for the following: evidence of the effectiveness of nurse practitioners in home care, regulatory and financial support for nurse practitioner home care, and development of home care agencies as clinical sites for training. (SK)
Alshabanat, Abdulmajeed; Otterstatter, Michael C; Sin, Don D; Road, Jeremy; Rempel, Carmen; Burns, Jane; van Eeden, Stephan F; FitzGerald, J M
COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing. The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD. We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation. A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention (Pmanagement program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.
Boettcher, Iris; Turner, Rozanne; Briggs, Linda
The insurance plan case managers (CMs) of Priority Health, part of a regional healthcare system located in Michigan, work telephonically with frail patients who have multiple comorbidities. However, these CMs have lacked facilitation skills for advance care planning (ACP) discussions in this vulnerable population. In 2012, the findings of a six-month pilot study of telephonic ACP (TACP) with some of the plan's Medicare population were implemented with Medicare members under case management. Case mangers were trained and certified by Respecting Choices® to introduce and facilitate ACP discussions telephonically utilizing both First Steps and Last Steps protocols. The CMs identified appropriate patients using hospitalization and emergency room utilization data, severity of illness, and diagnostic criteria. The primary goal was to complete both the ACP discussion and the documentation for each protocol on identified patients. They also attempted to schedule facilitated conversations with the patients' healthcare advocates present. During a 12-month period, 576 health plan members were offered First Steps discussions, with 198 interested in engaging in further ACP. Some 152 members were identified for Last Steps TACP using established criteria; discussions occurred with 56 members. TACP implementation resulted in 55 new or updated First Steps documents and 4 Last Steps documents. A total of 50 discussions included the designated healthcare advocate. Following TACP implementation with the Medicare CM team and evaluation of the results, processes and methods were instituted to increase engagement and completion of discussions and documents. These included enhancements to the electronic assessment and ongoing support of the CM team to increase the engagement of patients and advocates. Dissemination of the project to the entire Medicare CM team demonstrated opportunities and lessons learned for facilitated TACP discussions. The TACP model has the potential to be
Evans-Agnew, Robin A; Mayer, Kala A; Miller, Lori L L
The integration of primary care and public health nursing may provide new opportunities for transforming nursing practice that addresses population health. Effective programs emphasize multilevel approaches that include both downstream (education) and upstream (policy change) actions. The purpose of this article is to identify downstream and upstream nursing actions that integrate public health and primary care practice through two case exemplars concerning disparities in physical activity and nutrition. Describe two research case exemplars: (1) a secondary analysis of school physical activity policy for female adolescents in 36 public middle schools and (2) a focus group study of African American adults in a community kitchen program. In exemplar 1, school policies lacked population-based standards and presented structural disadvantages to African American girls who were already obese. In exemplar 2, participants found the community kitchen program to be more effective than the federally funded nutrition program. Integrating primary care and public health nursing could improve the tailoring of physical activity and nutrition programs to local populations by following core principles of community engagement, infrastructural sustainability, aligned leadership, and data sharing for population health improvement. © 2017 Wiley Periodicals, Inc.
Haszu, Louis A.; McAtee, Sharon A.
While costs are no longer reported to the Child Care Food Program on the monthly reimbursement voucher, Federal regulations for the program require that each participating sponsor operate a nonprofit food service and that any income accrued from the program be used solely for the conduct of improvement of the food service operation. Therefore, it…
Block, Marvin J.; Walken, Jennifer W.
A program in dental care for the handicapped offered at the University of North Carolina is described. Results of a survey of program participants over a five-year period indicates that the program results in decreased fear and anxiety about treating handicapped patients. (JMF)
Ayers, David F.; Miller-Dyce, Cherrel; Carlone, David
Researchers asked 17 participants in a job-training program to describe their personal struggles following an economic restructuring. Examined through a critical theoretical lens, findings indicate that the learners enrolled in the program to reclaim security, dignity, meaningful work, and caring relationships. Program planners at community…
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
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.
Chandir, Subhash; Chandir, Subash; Hussain, Hamidah; Salahuddin, Naseem; Amir, Mohammad; Ali, Farheen; Lotia, Ismat; Khan, Amir Javed
To describe the types and treatment outcomes of the extra-pulmonary tuberculosis (EPTB) cases in a tertiary care hospital in a high burden tuberculosis country. A retrospective case series study was conducted at Liaquat National Hospital (LNH), the largest private tertiary care hospital in Karachi, Pakistan. All cases diagnosed and treated as EPTB between November 2005 and February 2007 were included. Data was retrieved from medical records on demographics, clinical, laboratory, and outcome status. A total of 194 patients treated for EPTB were identified. Mean age of patients was 34 +/- 16.4 years, and 75% of patients were female. Lymph nodes and spine were the most common sites involved (60%). The cure rate was 40.7%. There was no difference in cure rate of males and females (p=0.99). EPTB is an important clinical problem in Pakistan. Due to lack of guidelines for diagnosis and duration of treatment in EPTB most physicians in Pakistan treat patients based on clinical symptoms and for prolonged duration of 12, to even as long as 24 months. The National TB Program, and chest and infectious disease societies must develop standardized guidelines for the diagnosis and treatment of EPTB.
Bulduk, Serap; Usta, Esra; Dinçer, Yeliz
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.
van der Plas Annicka G M
Full Text Available Abstract Background Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands. Methods A modified version of the RAND®/University of California at Los Angeles (UCLA appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round. Results Nine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager. Conclusions Although aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent.
Caring has been described as the essence of nursing and some theorists assert that caring occurs only on the interpersonal level. The purpose of this paper is to illustrate caring beyond the individual to communities. Patterns of caring explicated from a case study were matched with concepts of caring defined in the literature. The concepts of caring were modified through a reevaluation of caring based on the findings from a community case study. Findings suggest concepts of caring as (1) a moral imperative, (2) an affect, (3) a personal interaction, and (4) an action, can be found at the community level. Modification of the original patterns of caring included broadening the concepts to include community interaction and preparatory caring action.
Dennis, Kristopher; Linden, Kelly; Balboni, Tracy; Chow, Edward
Palliating symptoms of advanced and metastatic cancers are one of the most common indications for radiation therapy (RT), and the demand for palliative RT is increasing. Dedicated rapid access palliative RT programs improve access to care, and can deliver RT in a more efficient and evidence-based manner than standard RT programs. In this narrative review, we discuss the role of palliative RT in comprehensive cancer care, and challenges that have faced patients trying to access it. We describe how rapid access programs developed to address these challenges and provide an overview of dedicated programs worldwide. Finally, we show how these programs can serve as models for multidisciplinary care and education, and sources of exciting research opportunities in clinical care and advanced technologies.
Background Revitalising primary health care (PHC) and the need to reach MDG targets requires developing countries to adapt current evidence about effective health systems to their local context. Timor-Leste in one of the world’s newest developing nations, with high maternal and child mortality rates, malaria, TB and malnutrition. Mountainous terrain and lack of transport pose serious challenges for accessing health services and implementing preventive health strategies. Methods We conducted a non-systematic review of the literature and identified six components of an effective PHC system. These were mapped onto three countries’ PHC systems and present a case study from Timor-Leste’s Servisu Integrado du Saude Comunidade (SISCa) focussing on MDGs. Some of the challenges of implementing these into practice are shown through locally collected health system data. Results An effective PHC system comprises 1) Strong leadership and government in human rights for health; 2) Prioritisation of cost-effective interventions; 3) Establishing an interactive and integrated culture of community engagement; 4) Providing an integrated continuum of care at the community level; 5) Supporting skilled and equipped health workers at all levels of the health system; 6) Creating a systems cycle of feedback using data to inform health care. The implementation case study from Timor-Leste (population 1 million) shows that in its third year, limited country-wide data had been collected and the SISCa program provided over half a million health interactions at the village level. However, only half of SISCa clinics were functional across the country. Attendances included not only pregnant women and children, but also adults and older community members. Development partners have played a key role in supporting this implementation process. Conclusion The SISCa program is a PHC model implementing current best practice to reach remote communities in a new developing country. Despite limited
L M G Steuten
Full Text Available L M G Steuten1, K M M Lemmens2, A P Nieboer2, H JM Vrijhoef31Maastricht University Medical Centre, School for Care and Public Health Research, Department of Health, Organisation, Policy and Economics, Maastricht, The Netherlands; 2Erasmus University Medical Centre, Institute of Health Policy and Management, Rotterdam, The Netherlands; 3Maastricht University Medical Centre, School for Care and Public Health Research, Department of Integrated Care, Maastricht, The NetherlandsObjective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified.Methods: Systematic search of Medline and Cochrane databases for evaluations of multi-component disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized.Results: Twenty articles describing 17 unique COPD programs were included. There is little evidence for significant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specific knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing ≥3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money.Conclusion: Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate significant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specific programs illustrated in this paper can, in the absence of ‘perfect data’, support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision
Aging populations have become a major concern in the developed world and are expected to require novel care strategies. Public policies, health-care regimes and technology developers alike stress the need for a more individualized care to meet the increased demand for care services in response to demographic change. Increasingly, care services are offered to individuals with diseases and or disabilities in their homes by means of Personalized Health-Monitoring (PHM) technologies. PHM-based home care is typically portrayed as the key to a cost-effective future care that better can accommodate the needs of an aging population and promote care recipients' independence. In light of the emerging technology-based home care, this article sets forth to investigate the significance and implications of a strong emphasis on independence in relation to this novel care form. Notions of independence as used by care planners, care providers and technology developers are examined in relation to ICT-based home care and the reasonableness of independence as an aim for future health-care is critically discussed. In conclusion, the need for a shift from a strong emphasis on independence to a right to healthy dependence is advocated.
Sendi, Pedram; Al, Maiwenn J; Zimmermann, Heinz
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.
Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle
Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating
Taylor, April; Lizzi, Michele; Marx, Alison; Chilkatowsky, Maryann; Trachtenberg, Symme W; Ogle, Sue
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. © 2012 National Association for Healthcare Quality.
Iwakiri, Kazuyuki; Matsudaira, Ko; Ichikawa, Kiyosi; Takahashi, Masaya
The purpose of this study was to investigate the effects of an intervention program to prevent care workers' low back pain by the systematic use of transfer equipment at elderly care facilities. Questionnaire surveys were administered to administrators and care workers before (baseline), 1 year after, and 2.5 year after starting the program at two elderly care facilities. Care workers at the intervention facility were requested to ensure the use of a transfer's hoist, sliding board, and sliding sheet when assisting in the transfer of residents who were judged as appropriate to use the equipment (27.5% of residents living the intervention facility). Care workers at the control facility received no instructions on the use of transfer equipment. The average response rate of administrators and care workers was 100% and 90.3%, respectively. The number of care workers who responded during all three survey periods was 29 at the intervention facility and 23 at the control facility, and they were subjected to the current analysis. At baseline, transfer equipment was already introduced in both facilities, but it was found that the care workers did not regularly use it for assisting transfer. At 2.5-year follow-up, 31.0% of the intervention group and 4.3% of the control group always used the transfer's hoist. Similarly, 27.6% of the intervention group and 4.3% of the control group always used the sliding board and sliding sheet. Further, 60%-70% of the care workers at both facilities reported of having low back pain, but no statistically significant difference was found between the facilities or over the measurement periods. Among the intervention group, however, the care workers who reported an active use of the transfer's hoist, sliding board, and sliding sheet showed an improvement in low back pain. In the control group, no significant association was found between the active use of transfer equipment and low back pain. These results indicated that the prevention of care
Kahler, Deborah; Salber, Patricia; Wilson, Thomas
to improve a case management (CM) program using the principles and tools of epidemiology. Specifically, to use epidemiology to describe the population being managed, to analyze factors influencing outcomes, to assess the degree to which the CM process (or intervention) is related to those outcomes, to utilize the findings in order to make recommendations (to take action) for both better evaluation and improved and more efficient CM process, to provide an estimate of the impact of the CM program based on the comparison of pre-CM and post-CM interventions, and finally to discuss the caveat that pre-CM period probably does not provide a prediction of patterns to be expected in the post-CM period had CM not been present (an ideal, but difficult-to-find referent population for this kind of effectiveness analysis). a Medicare Advantage health plan. there were a total of 12,185 individuals who met the continuous enrollment requirement of 6 months (28 days) prior to initial contact with the CM department and 6 months after the contact date: 53% were female; the average age was 73.9 (standard deviation = ± 9.5). There was a linear relationship between the average "dose" of CM-as measured by the number of times a case manager had contact with a case-and the risk profile of the case-as measured by a standard risk assessment tool provided by the Centers for Medicare & Medicaid Services. The month-to-month costs for the study population prior to CM showed a sharp rise in the month prior to the initial contact with CM and a sharp decline beginning before the contact. This pattern was consistent across different risk profiles and our operational definition of CM "dose."The average costs 6 months prior to CM were higher than the average costs 6 months after the CM. The difference in cost varied by "dose" category. When coupled with the number of cases per dosage category, the greatest value for the CM program was in the management of moderate risk cases called two to four times
Madhuvu, Auxillia E; Plummer, Virginia; Morphet, Julia
Transition to specialty practice programs were developed to support, educate and facilitate recruitment and retention of nurses in specialised areas of practice. The intensive care nursing transition to specialty practice program in this study was implemented in 2000. To date, in Australia there are no published studies which focus on intensive care nursing transition to specialty practice programs. The study aimed to explore the effects of an intensive care nursing transition to specialty practice program offered in two intensive care units in a single Australian health service. A cross-sectional survey design was used. Quantitative data were collected from nurses who participated in the transition to specialty practice program from 2005 to 2015 using an anonymous online survey. Summary statistics and Chi-square tests were used to analyse the data. The response rate was 51.8% (n=86). Most of the transition to specialty practice program participants had medical nursing experience (n=35, 40.7%) or surgical nursing experience (n=35, 40.7%) prior to enrolling into the program. More than half (n=46, 53.5%) of the participants had worked in the intensive care units for more than two years post program. The majority of the participants (n=60, 69.8%) undertook post graduate education after the transition to specialty practice program. Significant numbers of experienced nurses undertook transition to specialty practice program into intensive care and majority of the participants reported positive results of the program. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
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.
Davitt, Joan K.
Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…
...) that provides healthy meals and snacks in child and adult day care facilities. This report uses the Cost, Quality and Child Outcomes study to analyze the characteristics of three types of child care centers: (1...
Full Text Available Sima Djalali, Ryan Tandjung, Thomas Rosemann, Stefan Markun Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland Background: Facing the upcoming shortage of primary care physicians (PCPs, medical and governmental organizations have recently made major investments to foster vocational training programs in Switzerland, designed to provide context-specific training for trainees in primary care practices. Less is known about the impact of these programs on the skills and specific knowledge of trainees. We aimed to evaluate the Cantonal program for vocational primary care training in the Canton of Zurich, Switzerland’s largest Canton.Methods: We undertook a pretest–posttest study and surveyed physicians before and after participating in the Cantonal program for vocational primary care training in the Swiss Canton of Zurich. All trainees who participated in the program from 2013 until the end of 2015 were eligible. Primary outcome was the proportion of trainees being confident about their professional, organizational, examination and management skills before and after completing vocational training. Secondary outcomes were the proportion of trainees stating knowledge gain in entrepreneurship and the proportion of trainees being motivated to pursue a career as PCP.Results: Data of 47 trainees participating in the vocational training between 2013 and 2015 were eligible. In total, 35 (74.5% participated in the T1 survey and 34 (72.3% in the T2 survey. At T2, significantly more trainees (T1: 11%−89%, T2: 79%−100% stated to be at least “slightly confident” about their skills (p<0.05 for each individual skill. Knowledge gain in entrepreneurship was highly expected and experienced by the trainees (55%−77% of respondents in case of medicine-specific contents, but hardly expected in case of general business contents (≤47% of respondents. Concerning trainees’ motivation to pursue a career as PCP
Wang, Lin; Kuntz-Melcavage, Kara; Forrest, Christopher B; Lu, Yanyan; Piet, Leslie; Evans, Kathy; Uriyo, Maria; Sherry, Melissa; Richardson, Regina; Hawkins, Michelle; Neale, Donna
To develop and apply an outcomes assessment framework (OAF) for care management programs in health care delivery settings. Care management (CM) refers to a regimen of organized activities that are designed to promote health in a population with particular chronic conditions or risk profiles, with focus on the triple aim for populations: improving the quality of care, advancing health outcomes, and lowering health care costs. CM has become an integral part of a care continuum for population-based health care management. To sustain a CM program, it is essential to assure and improve CM effectiveness through rigorous outcomes assessment. To this end, we constructed the OAF as the foundation of a systematic approach to CM outcomes assessment. To construct the OAF, we first systematically analyzed the operation process of a CM program; then, based on the operation analysis, we identified causal relationships between interventions and outcomes at various implementation stages of the program. This set of causal relationships established a roadmap for the rest of the outcomes assessment. Built upon knowledge from multiple disciplines, we (1) formalized a systematic approach to CM outcomes assessment, and (2) integrated proven analytics methodologies and industrial best practices into operation-oriented CM outcomes assessment. This systematic approach to OAF for assessing the outcomes of CM programs offers an opportunity to advance evidence-based care management. In addition, formalized CM outcomes assessment methodologies will enable us to compare CM effectiveness across health delivery settings.
Robin I. Oosterholt
Full Text Available Introduction: Although the clinical attributes of total hip arthroplasty (THA care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. Theory: The outpatient THA care pathway enables patients to be discharged on the day of surgery, short- ening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. Methods: An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi- structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. Results: The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1 and mobilisation & discharge (4. The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. Conclusion: The design addressed existing problems and is an optimisation of the case hospital’s pathway. The network of actors consists of the patient (1, radiologist (1, anaesthetist (1, nurse specialist (1, pharmacist (1, orthopaedic surgeon (1,4, physiotherapist (1,4, nurse (4, doctor (4 and patient applica- tion (1,4. The critical value exchanges include patient preparation (mental and practical, patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.
Sheth, K N; Drogan, O; Manno, E; Geocadin, R G; Ziai, W
Limited information is available regarding the current state of neurocritical care education for neurology residents. The goal of our survey was to assess the need and current state of neurocritical care training for neurology residents. A survey instrument was developed and, with the support of the American Academy of Neurology, distributed to residency program directors of 132 accredited neurology programs in the United States in 2011. A response rate of 74% (98 of 132) was achieved. A dedicated neuroscience intensive care unit (neuro-ICU) existed in 64%. Fifty-six percent of residency programs offer a dedicated rotation in the neuro-ICU, lasting 4 weeks on average. Where available, the neuro-ICU rotation was required in the vast majority (91%) of programs. Neurology residents' exposure to the fundamental principles of neurocritical care was obtained through a variety of mechanisms. Of program directors, 37% indicated that residents would be interested in performing away rotations in a neuro-ICU. From 2005 to 2010, the number of programs sending at least one resident into a neuro-ICU fellowship increased from 14% to 35%. Despite the expansion of neurocritical care, large proportions of US neurology residents have limited exposure to a neuro-ICU and neurointensivists. Formal training in the principles of neurocritical care may be highly variable. The results of this survey suggest a charge to address the variability of resident education and to develop standardized curricula in neurocritical care for neurology residents.
Griffin, Brenda; Bushby, Philip A; McCobb, Emily; White, Sara C; Rigdon-Brestle, Y Karla; Appel, Leslie D; Makolinski, Kathleen V; Wilford, Christine L; Bohling, Mark W; Eddlestone, Susan M; Farrell, Kelly A; Ferguson, Nancy; Harrison, Kelly; Howe, Lisa M; Isaza, Natalie M; Levy, Julie K; Looney, Andrea; Moyer, Michael R; Robertson, Sheilah Ann; Tyson, Kathy
As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs.
Van Cleave, Jeanne; Holifield, Chloe; Perrin, James M
The Massachusetts Child Psychiatry Access Project (MCPAP) provides telephone support from mental health specialists to primary care providers (PCPs). Understanding PCPs' use may inform implementation of similar programs. We sought to examine PCPs' decision-making process to use or not use MCPAP when encountering mental health problems. We analyzed data regarding calls from PCPs to MCPAP from October 1, 2010, to July 31, 2011, and interviewed 14 PCPs with frequent use (≥7 calls) and infrequent use (≤4 calls). PCPs were asked about recent patients with mental health problems, and they were asked to describe reasons for calling or not calling MCPAP. Frequent callers were asked what sustained use; infrequent callers were asked about alternative management strategies. Comparisons were made between these groups in qualitative analysis. PCPs (n = 993) made 6526 calls (mean = 6.6; median = 3). Factors influencing calling included: MCPAP's guidance is timely and tailored to individual scope of practice; MCPAP's ability to arrange therapy referrals exceeds PCPs' ability; providing a plan at point of care relieves anxious families; and MCPAP's assistance helps accommodate families' preference to keep mental health in primary care. Some infrequent callers had gained skills through MCPAP before 2010 and now called only for complex cases. Other reasons for infrequent calling: PCPs have other consultation sources, have fear of being asked to manage more than they are comfortable, or have misperceptions of MCPAP's offerings. MCPAP enhanced PCPs' ability to deliver mental health care consistent with families' preferences. PCPs applied knowledge gained from calls to subsequent patients. Promoting MCPAP components through outreach and tailoring guidance to PCPs' scope of practice may entice greater use. Copyright © 2018. Published by Elsevier Inc.
Providing optimal care for the increasing number of frail older people with complex care needs is a major challenge in primary care. The current approach is reactive and does not meet the needs of older patients, resulting in unnecessary loss of daily functioning, suboptimal quality of life and high
Green, Alexander R; Betancourt, Joseph R; Park, Elyse R; Greer, Joseph A; Donahue, Elizabeth J; Weissman, Joel S
The Health Resources and Services Administration (HRSA) funds primary care residency programs through its Title VII training grants, with a goal of ensuring a well-prepared, culturally competent physician workforce. The authors sought to determine whether primary care residents in Title VII-funded training programs feel better prepared than those in nonfunded programs to provide care to culturally diverse patients. The authors analyzed data from a national mailed survey of senior resident physicians conducted in 2003-2004. Of 1,467 randomly selected family medicine, internal medicine, and pediatrics residents, 866 responded--403 in Title VII-funded programs and 463 in nonfunded programs (response rate = 59%). The survey included 28 Likert-response questions about residents' preparedness and perceived skills to provide cross-cultural care, sociodemographics, and residency characteristics. Residents in Title VII-funded programs were more likely than others to report being prepared to provide cross-cultural care across all 8 measures (odds ratio [OR] = 1.54-2.61, P experience related to cross-cultural care (e.g., role models, cross-cultural training, and attitudes of attending physicians) accounted for many of the differences in self-reported preparedness and skills. Senior residents in HRSA Title VII-funded primary care residency training programs feel better prepared than others to provide culturally competent care. This may be partially explained by better cross-cultural training experiences in HRSA Title VII-funded programs.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.
The Division of Research within KP-MCP conducts, publishes, and disseminates high-quality epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large.
Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients
Skillman, Megan; Cross-Barnet, Caitlin; Singer, Rachel Friedman; Ruiz, Sarah; Rotondo, Christina; Ahn, Roy; Snyder, Lynne Page; Colligan, Erin M; Giuriceo, Katherine; Moiduddin, Adil
To identify roles physicians assumed as part of new health care delivery models and related strategies that facilitated physician engagement across 21 Health Care Innovation Award (HCIA) programs. Site-level in-depth interviews, conducted from 2014 to 2015 (N = 672) with program staff, leadership, and partners (including 95 physicians) and direct observations. NORC conducted a mixed-method evaluation, including two rounds of qualitative data collected via site visits and telephone interviews. We used qualitative thematic coding for data from 21 programs actively engaging physicians as part of HCIA interventions. Establishing physician champions and ensuring an innovation-values fit between physicians and programs, including the strategies programs employed, facilitated engagement. Among engagement practices identified in this study, tailoring team working styles to meet physician preferences and conducting physician outreach and education were the most common successful approaches. We describe engagement strategies derived from a diverse range of programs. Successful programs considered physicians' values and engagement as components of process and policy, rather than viewing them as exogenous factors affecting innovation adoption. These types of approaches enabled programs to accelerate acceptance of innovations within organizations. © Health Research and Educational Trust.
... COMMISSION Comment Sought on Funding Pilot Program Participants Transitioning Out of the Rural Health Care... to fund Rural Health Care Pilot Program (Pilot Program) participants who will exhaust funding... year to provide time to establish a process to transition them into the permanent Rural Health Care...
Full Text Available Researchers have identified complex needs of custodial grandparent families and lack of access to needed resources such as housing, financial and legal assistance, and health care. Case management links these families with needed services while helping them develop skills to promote their health and well-being. This paper describes a case management program for custodial grandparent families using a nurse-social worker case management team. data were collected from 50 grandparents and 33 children using surveys and semi-structured instruments. Physical and mental health outcomes were measured using Short Form-12 Health Survey (SF 12 to measure the perceived quality of health for grandparents and the Child Behavior Checklist to measure the emotional and behavioral functioning of grandchildren. Grandparents more positively perceived their mental health after participating in the program. Perceptions about physical health were generally the same before and after the program. Grandparents' reported that many grandchildren had emotional and behavioral problems in the clinical range. These findings highlight the need for further research on the mental health needs of children being parented by grandparents as well as determining effective models and interventions to minimize adverse effects of parenting on grandparents.
Wong, Frances Kam Yuet; So, Ching; Ng, Alina Yee Man; Lam, Po-Tin; Ng, Jeffrey Sheung Ching; Ng, Nancy Hiu Yim; Chau, June; Sham, Michael Mau Kwong
Studies have shown positive clinical outcomes of specialist palliative care for end-stage heart failure patients, but cost-effectiveness evaluation is lacking. To examine the cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure patients as compared to the customary palliative care service. A cost-effectiveness analysis was conducted alongside a randomized controlled trial (Trial number: NCT02086305). The costs included pre-program training, intervention, and hospital use. Quality of life was measured using SF-6D. The study took place in three hospitals in Hong Kong. The inclusion criteria were meeting clinical indicators for end-stage heart failure patients including clinician-judged last year of life, discharged to home within the service area, and palliative care referral accepted. A total of 84 subjects (study = 43, control = 41) were recruited. When the study group was compared to the control group, the net incremental quality-adjusted life years gain was 0.0012 (28 days)/0.0077 (84 days) and the net incremental costs per case was -HK$7935 (28 days)/-HK$26,084 (84 days). The probability of being cost-effective was 85% (28 days)/100% (84 days) based on the cost-effectiveness thresholds recommended both by National Institute for Health and Clinical Excellence (£20,000/quality-adjusted life years) and World Health Organization (Hong Kong gross domestic product/capita in 2015, HK$328117). Results suggest that a transitional home-based palliative care program is more cost-effective than customary palliative care service. Limitations of the study include small sample size, study confined to one city, clinic consultation costs, and societal costs including patient costs and unpaid care-giving costs were not included.
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
Martin, Sandra L.; Ashley, Olivia Silber; White, LeBretia; Axelson, Sarah; Clark, Marc; Burrus, Barri
Background: This article provides an overview of the rationale and process for incorporating trauma-informed approaches into US school-based programs, using school-based adolescent pregnancy prevention programs as an example. Methods: Research literature is reviewed on the prevalence and outcomes of childhood trauma, including the links between…
Current social studies programs do not include the study of prosocial behaviors such as altruism, generosity, and compassion. This omission legitimizes the view that human behaviors are self-serving. Curriculum developers should fashion programs which provide prosocial models and opportunities for students to conceptualize such behaviors and…
Intervention programs through computer application should be used to persuade and support health awareness, treatment and prevention. This paper investigate and review studies using persuasive technology in health intervention program in Malaysia. It presents the main objective, the technology persuasive principles ...
Cramm, Jane Murray; Nieboer, Anna Petra
Previous studies have shown that relational coordination is positively associated with the delivery of hospital care, acute care, emergency care, trauma care, and nursing home care. The effect of relational coordination in primary care settings, such as disease-management programs, remains unknown. This study examined relational coordination between general practitioners and other professionals in disease-management programs and assessed the impact of relational coordination on the delivery of chronic illness care. Professionals (n = 188; response rate = 57%) in 19 disease-management programs located throughout the Netherlands completed surveys that assessed relational coordination and chronic care delivery. We used a cross-sectional study design. Our study demonstrated that the delivery of chronic illness care was positively related to relational coordination. We found positive relationships with community linkages (r = .210, p management support (r = .217, p management team members: practice nurses (M = 2.69 vs. 3.73; p management professionals with different disciplines is expected to improve chronic illness care delivery.
Hahn, Erin E; Ganz, Patricia A
THIS QUALITATIVE STUDY EXAMINED CANCER SURVIVORSHIP PROGRAMS AT FOUR HEALTH CARE ORGANIZATIONS IN LOS ANGELES COUNTY, CA: an academic medical center, a community hospital, a primary-care medical group, and a county hospital. The purpose was to describe the successful implementation of four distinctly different models of care, focusing on the creative development and use of the Institute of Medicine-recommended survivorship care plan (SCP) document in each setting. In-depth semistructured interviews were done with survivorship teams to characterize each program and the development and use of the SCP at each institution. Each survivorship program has developed and implemented unique types of SCP documents. Specifically, a comprehensive SCP at the academic center, completed by the clinical team, which covers many facets of cancer survivorship; a patient-directed SCP at the community hospital, completed by the survivor with assistance of an oncology nurse and focused on treatment history and appropriate surveillance; an adapted ASCO SCP template at the primary-care medical group, completed via a partnership with contracted oncologists and focused on the treatment history, surveillance, and shared care between oncology and primary care; an adapted ASCO SCP template at the county hospital, completed by the survivorship nurse practitioner and focused on patient education, post-treatment care, and institutional care coordination. The SCP document is a flexible tool that can be successfully adapted for use in extremely varied settings, from primary care to hospitals, to inform and educate patients and providers alike.
Nolet, Kim; Roberts, Tonya; Gilmore-Bykovskyi, Andrea; Roiland, Rachel; Gullickson, Colleen; Ryther, Brenda; Bowers, Barbara J
Preparing future nurses to care for the growing population of older adults has become a national priority. The demand for long term care services is expected to double between 2000 and 2040, yet the field remains stigmatized as an undesirable place for highly skilled nurses to work. Recent efforts to increase student preparation in geriatrics have been shown to improve student attitudes toward working with older adults and increase knowledge, but long term care settings remain unattractive to students. This article reports on the development, implementation, and evaluation of The Wisconsin Long Term Care Clinical Scholars Program, a nursing home internship for baccalaureate nursing students. The program couples a paid nursing home work experience with an evidence-based long term care nursing curriculum. The program increased student preparation and interest in working both with older adults and in nursing homes, while increasing the capacity of nursing homes to provide a positive student experience.
Nolet, Kim; Roberts, Tonya; Gilmore-Bykovskyi, Andrea; Roiland, Rachel; Gullickson, Colleen; Ryther, Brenda; Bowers, Barbara J.
Preparing future nurses to care for the growing population of older adults has become a national priority. The demand for long term care services is expected to double between 2000 and 2040, yet the field remains stigmatized as an undesirable place for highly-skilled nurses to work. Recent efforts to increase student preparation in geriatrics have been shown to improve student attitudes toward working with older adults and increase knowledge, but long term care settings remain unattractive to students. This paper reports on development, implementation and evaluation of The Wisconsin Long Term Care Clinical Scholars Program, a nursing home internship for baccalaureate nursing students. The program couples a paid nursing home work experience with an evidence-based long term care nursing curriculum. The program increased student preparation and interest in working with older adults and in nursing homes, while concurrently increasing the capacity of nursing homes to provide a positive student experience. PMID:25162659
Harris, Diane; Hillier, Loretta M; Keat, Nancy
This paper describes an education program designed to improve palliative care practice through the development of workplace hospice palliative care resources (PCRs), and its impact on knowledge transfer and longer-term changes to clinical practice. Evaluation methods included pre- and post-program questionnaires, and a survey of learners' (n=301) perceptions of program learning strategies. Interviews (n=21) were conducted with a purposeful sample of PCRs and representatives from their work sites. Ratings of the sessions indicated that they were relevant to learners' clinical practice. At follow up, the majority of learners (83%) continued to serve as PCRs. Many positive effects were identified, including enhanced pain and symptom management, staff education, and development of care policies and guidelines. Management support, particularly the prioritization of palliative care and staff development, were factors facilitating sustained implementation. These findings highlight the importance of multimodal learning strategies and supportive work environments in the development of PCRs to enhance palliative care practice.
Morris, Sue E; Block, Susan D
Although bereavement programs are a common element of palliative medicine and hospice programs, few health care institutions currently offer universal bereavement services to all their patients. The elevated risk of serious physical and mental health problems among the bereaved is a strong argument for the development of universal institution-based bereavement programs as an element of quality care for family members of all patients who die. We describe the development of the bereavement program at Dana-Farber Cancer Institute (DFCI) where we conceptualized bereavement services as a preventive model of care. We identified education, guidance and support as the primary constructs of the program. The essential components include a formal acknowledgement of the death of the patient by the cancer center, information about grief and what to expect, individual visits to assess coping, and staff support and education. One hundred and forty bereaved families completed a survey about the bereavement program. The findings indicated that the formal letter of condolence and the bereavement guide had a positive impact on the grieving of the respondents. Contact from the patient's oncologist and nurse was especially well received. Bereavement programs can both help bereaved individuals adapt to their loss, and positively impact hospitals by enhancing the reputation of the hospital within the community and providing an avenue for identifying opportunities for improvement in care processes. We recommend that all hospitals implement basic bereavement programs for families of all deceased patients as the standard of care.
Full Text Available In Software Reengineering, one of the central artifacts is the source code of the legacy system in question. In fact, in most cases it is the only definitive artifact, because over the time the code has diverged from the original architecture and design documents. The first task of any reengineering project is to gather an understanding of the system's architecture. Therefore, a common approach is to use parsers to translate the source code into a model conforming to the abstract syntax of the programming language the system is implemented in which can then be subject to querying. Despite querying, transformations can be used to generate more abstract views on the system's architecture. This transformation case deals with the creation of a state machine model out of a Java syntax graph. It is derived from a task that originates from a real reengineering project.
An, Guang-Hui; Tang, Xiao-Ting; Chen, Yao-Long; Zhao, Yi
To investigate the reporting characteristics of case reports of acupuncture therapy with CAse Report (CARE) guidelines, and to explore the applicability of the guidelines for these case reports. Case reports published from January 1, 2011 to December 31, 2013, were identified by searching PubMed and the China Biomedicine Database by using MeSH terms. Screening and data extraction of case reports were conducted by two independent researchers. Assessments based on CARE guidelines and data analysis were conducted by using Excel 2003 and RevMan 5.0. A total of 61 case reports published in 19 journals were identififi ed, which involved 16 major types of diseases. Fifteen (24.6%) case reports declared no conflict of interests, and 5 (8.2%) reported funding sources. None of these case reports met all items of CARE guidelines, and only 6 subordinate items were fully reported among 50% of the case reports. Subgroup analysis indicated that case reports published in English or those that did not have competing interests had higher reporting quality. The reporting quality of case reports of acupuncture therapy is rather low. The reason might be a lack of awareness among authors and the poor dissemination of information regarding CARE guidelines in China. More evaluation studies are needed to promote and improve adherence to CARE guidelines. Moreover, an extended version of CARE guidelines should be developed for cases reports of special interventions such as acupuncture or adverse events caused by interventions.
The nursing profession and university nursing programs both took great strides after universities first introduced nursing programs in and around the 1950s. The purpose of this phenomenological qualitative study was to describe the meaning of the apprenticeship of caring through in the Bachelor of Science in Nursing program. Watson's human caring philosophy (2008) suggested that researchers explore the meaning persons ascribe to phenomena. Based on semi-structured interviews this phenomenological study described the essence of the phenomenon and revealed that the apprenticeship of caring meant the harmonisation of the "self-perceived" and the "self-lived" that allows the embodiment of caring. The results of this research are available to teachers who may wish to consider its recommendations when planning and developing assessment and training programs for various kinds of nursing clienteles.
HemmatiMaslakpak, Masumeh; Farhadi, Masumeh; Fereidoni, Javid
.... Nero-linguistic programming (NLP) is one of the modern methods of psychotherapy. This study aimed to determine the effect of NLP on occupational stress in nurses working in critical care units of Urmia...
Ashenafi, Addis; Karim, Ali Mehryar; Ameha, Agazi; Erbo, Amano; Getachew, Nebiyu; Betemariam, Wuleta
In January 2011, Health Extension Workers (HEWs) of Ethiopia's Health Extension Program (HEP) began providing pneumonia case management for children less than five years of age through the integrated Community Case Management (iCCM) strategy. To report the effect of HEP, following the introduction of iCCM, and other accessibility factors on care-seeking behaviors for common childhood illnesses (acute respiratory infection [ARI], diarrhea, and fever). Three possible care-seeking outcomes for childhood illnesses were considered: not seeking appropriate care, seeking care from HEP sources, or seeking care from other appropriate sources. The baseline care-seeking outcomes from the Ethiopian Demographic and Health Survey, 2011, were compared with the care-seeking outcomes in a follow-up iCCM survey in December 2012. The effects of the HEP intensity and other factors on care-seeking outcomes were estimated using regression analyses. Appropriate care-seeking for children with acute respiratory infection, ARI, diarrhea, or fever increased two-fold, from 19% at baseline to 38% at follow-up, mainly due to an increase in seeking care for common child- hood illnesses from HEWs. Higher intensity of the HEP and other accessibility factors were associated with higher care-seeking for childhood illnesses from HEP sources. Incorporating iCCM within the HEP service package significantly improved the appropriate care-seeking behaviors for childhood illnesses in rural Ethiopia.
Kreps, Gary L
Health communication programs are essential and ubiquitous tools in the delivery of care and promotion of health. Yet, health promotion experts are not always well informed about the influences communication programs have on the audiences they are designed to help. Too often health communication programs evoke unintended, and even negative, responses from diverse audiences. It is critically important to conduct regular, rigorous, ongoing, and strategic evaluation of health communication programs to assess their effectiveness. Evaluation data should guide program refinements and strategic planning. This article outlines key strategies for conducting meaningful evaluation research for guiding the development, implementation, refinement, and institutionalization of effective health communication programs.
Sellars, Marcus; Detering, Karen M; Silvester, William
Advance care planning (ACP) is the process of planning for future healthcare that is facilitated by a trained healthcare professional, whereby a person's values, beliefs and treatment preferences are made known to guide clinical decision-making at a future time when they cannot communicate their decisions. Despite the potential benefits of ACP for community aged care clients the availability of ACP is unknown, but likely to be low. In Australia many of these clients receive services through Home Care Package (HCP) programs. This study aimed to explore current attitudes, knowledge and practice of advance care planning among HCP service managers and case managers. An invitation to take part in a cross-sectional online survey was distributed by email to all HCP services across Australia in November 2012. Descriptive analyses were used to examine overall patterns of responses to each survey item in the full sample. 120 (response rate 25%) service managers and 178 (response rate 18%) case managers completed the survey. Only 34% of services had written ACP policies and procedures in place and 48% of case managers had previously completed any ACP training. In addition, although most case managers (70%) had initiated an ACP discussion in the past 12 months and viewed ACP as part of their role, the majority of the conversations (80%) did not result in documentation of the client's wishes and most (85%) of the case managers who responded did not believe ACP was done well within their service. This survey shows low organisational ACP systems and support for case managers and a lack of a normative approach to ACP across Australian HCP services. As HCPs become more prevalent it is essential that a model of ACP is developed and evaluated in this setting, so that clients have the opportunity to discuss and document their future healthcare wishes if they choose to.
Foebel, A.D.; van Hout, H.P.J.; van der Roest, H.G.; Topinkova, E.; Garms-Homolova, V.; Frijters, D.H.M.; Finne-Soveri, H.; Jonsson, P.V.; Hirdes, J.P.; Bernabei, R.; Onder, G.
Background: Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the
Beitz, Janice M; van Rijswijk, Lia
To provide education based on evidence-based and validated wound care algorithms we designed and implemented an interactive, Web-based learning program for teaching wound care. A mixed methods quantitative pilot study design with qualitative components was used to test and ascertain the ease of use, validity, and reliability of the online program. A convenience sample of 56 RN wound experts (formally educated, certified in wound care, or both) participated. The interactive, online program consists of a user introduction, interactive assessment of 15 acute and chronic wound photos, user feedback about the percentage correct, partially correct, or incorrect algorithm and dressing choices and a user survey. After giving consent, participants accessed the online program, provided answers to the demographic survey, and completed the assessment module and photographic test, along with a posttest survey. The construct validity of the online interactive program was strong. Eighty-five percent (85%) of algorithm and 87% of dressing choices were fully correct even though some programming design issues were identified. Online study results were consistently better than previously conducted comparable paper-pencil study results. Using a 5-point Likert-type scale, participants rated the program's value and ease of use as 3.88 (valuable to very valuable) and 3.97 (easy to very easy), respectively. Similarly the research process was described qualitatively as "enjoyable" and "exciting." This digital program was well received indicating its "perceived benefits" for nonexpert users, which may help reduce barriers to implementing safe, evidence-based care. Ongoing research using larger sample sizes may help refine the program or algorithms while identifying clinician educational needs. Initial design imperfections and programming problems identified also underscored the importance of testing all paper and Web-based programs designed to educate health care professionals or guide
Lemmens, Lidwien C; Molema, Claudia C M; Versnel, Nathalie; Baan, Caroline A; de Bruin, Simone R
Presently, little is known about the characteristics and impact of integrated care programs for patients with psychological comorbidity. The aim was to provide an overview of these integrated care programs and their effectiveness. Systematic literature review including papers published between 1995 and 2014. An integrated care program had to consist of interventions related to at least two out of the six components of the Chronic Care Model. Programs had to address patients with psychological comorbidity, which is a psychological disease next to a somatic chronic disease. A meta-analysis was performed on depression treatment response and a best evidence synthesis was performed on other outcomes. Ten programs were identified, which mostly addressed comorbid depression and consisted of interventions related to three to five components of the Chronic Care Model. Meta-analysis showed significantly higher odds for depression treatment response for patients receiving integrated care (OR: 2.49, 95%CI [1.66-3.75]). Best evidence synthesis suggested moderate evidence for cost-effectiveness and for a beneficial effect on patient satisfaction and emotional well-being. Insufficient evidence was found for a beneficial effect on health-related quality of life, medication adherence, Hb1Ac levels and mortality. There are few studies evaluating integrated care programs for patients with psychological comorbidity. Although these studies suggest that integrated care programs could positively affect several patient outcomes and could be cost-effective, additional studies are recommended to further assess the value of integrated care for this patient group. This is especially important since the number of people with psychological comorbidity is rising. Copyright © 2015 Elsevier Inc. All rights reserved.
Kivinen, Tuula; Lammintakanen, Johanna
The purpose of this article is to describe perspectives on information availability and information use among users of a management information system in one specialized health care organization. The management information system (MIS) is defined as the information system that provides management with information about financial and operational aspects of hospital management. The material for this qualitative case study was gathered by semi-structured interviews. The interviewees were purposefully selected from one specialized health care organization. The organization has developed its management information system in recent years. Altogether 13 front-line, middle and top-level managers were interviewed. The two themes discussed were information availability and information use. The data were analyzed using inductive content analysis using ATLAS.ti computer program. The main category "usage of management information system" consisted of four sub-categories: (1) system quality, (2) information quality, (3) use and user satisfaction and (4) development of information culture. There were many organizational and cultural aspects which influence the use of MIS in addition to factors concerning system usability and users. The connection between information culture and information use was recognized and the managers proposed numerous ways to increase the use of information in management work. The implementation and use of management information system did not seem to be planned as an essential tool in strategic information management in the health care organization studied. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Franzmann, J; Haberstroh, J; Pantel, J
Improvement of communication skills in nursing home staff is key to provide better care for dementia patients and decrease occupational mental stress. An innovative train-the-trainer program to improve and maintain professional caregivers' social competencies in nursing home dementia care is described. Over a period of 6 months, a group of 6 senior staff members were qualified as program trainers (multiplicators) for the TANDEM training program, which qualified them to design, deliver, and evaluate training sessions that foster specific social competencies in dementia care. In a subsequent intervention study with 116 geriatric caregivers in 14 nursing homes, training was provided either by multiplicators (intervention group) or directly by project coworkers (control group). Participants in both groups improved their dementia-specific communication skills. In a follow-up survey, the intervention group also reported lasting reductions in mental stressors at work (p nursing homes to be multiplicators for the TANDEM train-the-trainer program for dementia-specific communication skills has a beneficial influence on social competencies, mental stressors at work, and occupational mental stress of staff who care for dementia patients and may contribute to a sustainable implementation of dementia-specific social competencies.
Wenzel, S L; Bakhtiar, L; Caskey, N H; Hardie, E; Redford, C; Sadler, N; Gelberg, L
This study addresses the relationship of homeless veterans' discharge status from a domiciliary care program to biopsychosocial characteristics presented at admission into the program. Hypotheses were that younger age, less education, and substance abuse or psychiatric disorder would predict an irregular discharge. Research participants were 367 homeless male veterans who had been admitted to a domiciliary care program at the West Los Angeles Veterans Affairs Medical Center for treatment of medical, psychiatric, or substance disorders. Status of veterans' program discharge (regular or irregular) served as the outcome measure. Logistic regression analysis revealed that irregular discharge from the program was more likely among veterans who were black, who had poor employment histories, or who had problems with alcohol. Results are discussed in light of the need to maintain homeless veterans in treatment programs so that they can achieve maximum benefit from available programs.
Martin, Sandra L; Ashley, Olivia Silber; White, LeBretia; Axelson, Sarah; Clark, Marc; Burrus, Barri
This article provides an overview of the rationale and process for incorporating trauma-informed approaches into US school-based programs, using school-based adolescent pregnancy prevention programs as an example. Research literature is reviewed on the prevalence and outcomes of childhood trauma, including the links between trauma and pregnancy. Information is then presented concerning the implementation of trauma-informed approaches in school settings, describing activities undertaken, barriers encountered, and outcomes achieved. Next, we describe the implications of this literature for school-based adolescent pregnancy prevention programs, outlining the reasons for including trauma-informed approaches in these programs, the prerequisites for doing so, and some examples of successful implementation. Many children in our country experience trauma, placing them at increased risk of multiple health concerns including adolescent pregnancy. In response to this situation, some schools have successfully incorporated trauma-informed approaches into adolescent pregnancy prevention programs, as well as other programming. Incorporating trauma-informed approaches into school settings, including school-based adolescent pregnancy prevention programs, is a viable and important way to address the multiple needs of traumatized children. © 2017, American School Health Association.
Gensichen, J; Beyer, M; Muth, C; Gerlach, FM; Von Korff, M; Ormel, J
Background. Deficits in the care of depression lead to poor medication adherence, which increases the risk of an unfavourable outcome for this care. This review evaluates effects on symptoms and medication adherence of case management in primary health care. Method. A systematic literature search
Michael J. Stewart
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
Michael J. Stewart
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
Yeun, Young-Ran; Kwon, Min; Lee, Kyoung-Soon
This study aimed to develop a "Palliative Care Professional" education program and evaluate its effects on the recognition of good death, palliative care, and the meaning of life for nurses. It was developed based on the hospice care program for volunteers being used in the Hospice Palliative Care Research Center of S University in Seoul. It was also based on the studies which investigated the educational needs of nurses in palliative care. This program consisted of 5 sessions and 16 content items for 2 weeks. A non-equivalent control group non-synchronized design was utilized and participants were assigned to the experimental group (n=42) or the control group (n=44). The recognition of a good death (F=11.44, p=.001), palliative care (F=4.15, p=.045), and the meaning of life (F=5.12, p=.026) increased more significantly for participants in the experimental group than in the control group. Participants felt that they gained further knowledge in palliative patient management and refined their clinical practice. The results of the study indicate that this program could serve as a practical program for palliative care nursing in the nursing field and suggests that more attention should be directed to the diverse educational needs of nurses.
Mato, Roberto; Rodríguez, M Susana
Hospital admission is a high-impact event in children. Adolescence is a critical and complex period of human development that may be adversely affected by hospitalization. At the Garrahan Hospital, where adolescents account for more than 30% of inpatients, a program for comprehensive care of adolescents was set up in 2008 with a special focus on their specific needs. As a part of this program, the aim of the Recreation Room for Hospitalized Adolescents is to provide a friendly environment to reduce stress and anxiety and to facilitate the learning of healthy behaviors, under the permanent care of nurses and medical doctors. Interventions in health, leisure time, education, and emotional care are effective in diminishing the negative impact of hospitalization and prevent risk behaviors. Our objective was to report our experience in the Recreation Room for Hospitalized Adolescents.
Some case managers, dissatisfied with the fragmented nature of the health care system, are attempting to eliminate obstacles between inpatient and outpatient care by positioning themselves at the front line; the physician's office. Getting physicians to accept and value case managers, however, requires a financial incentive. Capitation, which forces physicians to pay closer attention to costs, outcomes, and patient wellness, can do the trick. In areas with less managed care penetration, you can encourage physician acceptance of case management by helping reduce the hassle of caring for chronically ill patients.
Cnossen, Ingrid C; van Uden-Kraan, Cornelia F; Eerenstein, Simone E J; Jansen, Femke; Witte, Birgit I; Lacko, Martin; Hardillo, José A; Honings, Jimmie; Halmos, Gyorgy B; Goedhart-Schwandt, Noortje L Q; de Bree, Remco; Leemans, C René; Leeuw, Irma M Verdonck-de
The purpose of this study was to investigate the feasibility of an online self-care education program supporting early rehabilitation of patients after total laryngectomy (TLPs) and factors associated with satisfaction. Health care professionals (HCPs) were invited to participate and to recruit
... Payments for Care Improvement Deadline: Interested organizations must submit a Model 1 Open Period... HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Program; Bundled Payments for Care Improvement Model 1 Open Period AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice...
..., 485, and 489 RIN 0938-AP80; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY...: Correction of final rules and interim final rule with comment period. SUMMARY: This document corrects...
Korenman, Sanders; Abner, Kristin S.; Kaestner, Robert; Gordon, Rachel A.
Children spend a considerable amount of time in preschools and child care centers. As a result, these settings may have an influence on their diet, weight, and food security, and are potentially important contexts for interventions to address nutritional health. The Child and Adult Care Food Program (CACFP) is one such intervention. No national…
Bleijenberg, N.; Boeije, H.R.; Onderwater, A.T.; Schuurmans, M.J.
The aim of the current study was to explore frail older adults' perceptions and experiences with a proactive, integrated nurse-led primary care program. A qualitative study nested within a randomized trial in primary care was conducted. In total, 11 semistructured interviews were conducted in a
Foster, Karen B.
The success of the Champaign County Nursing Home Child Care Center (CCNHCCC) in Illinois provides a model for the establishment of child care centers in nursing homes. Needs assessment, financial support, licensing, staff hiring and training are all important factors that need to addressed in the start up and running of such a program. The…
Whitebook, Marcy; Ginsburg, Gerri
Results of a nonrandom nationwide survey of 89 child care workers in 20 states concerning work-related health and safety conditions confirm that similar hazardous conditions exist in child care programs throughout the nation. Results also confirm that concern and anger about such conditions and their potential consequences are widespread among…
Chen, Timothy C.; Hamlett-Berry, Kim W.; Watanabe, Jonathan H.; Bounthavong, Mark; Zillich, Alan J.; Christofferson, Dana E.; Myers, Mark G.; Himstreet, Julianne E.; Belperio, Pamela S.; Hudmon, Karen Suchanek
Background: Health care professionals can have a dramatic impact by assisting patients with tobacco cessation but most have limited training. Purpose: To evaluate the effectiveness of a 4-hour tobacco cessation training program. Methods: A team of multidisciplinary health care professionals created a veteran-specific tailored version of the Rx for…
Portwood, Sharon G.; Boyd, A. Suzanne; Murdock, Tamera B.
Background: There is a need to examine behavioral and mental health outcomes for children in out-of-home care across settings. Objective: Using a participatory research approach, researchers and agency personnel aimed to implement a program of scientific outcomes research in residential care settings. Data were used to examine children's…
... functional status, quality of life, and overall well-being, as well as increased beneficiary and caregiver... or enhancing the quality of care for Medicare, Medicaid, and Children's Health Insurance Program... an interdisciplinary care team that is led by a nephrologist, comprised of dialysis facilities...
Jagt-van Kampen, Charissa T.; Kars, Marijke C.; Colenbrander, Derk A.; Bosman, Diederik K.; Grootenhuis, Martha A.; Caron, Huib N.; Schouten-van Meeteren, Antoinette Y. N.
Case management is a subject of interest within pediatric palliative care. Detailed descriptions of the content of this type of case management are lacking. We aim to describe the contents of care provided, utilization of different disciplines, and times of usage of a pediatric palliative care case
Edwards, Asher; Nam, Samuel
As the baby boomer generation ages, the need for palliative care services will be paramount and yet training for palliative care physicians is currently inadequate to meet the current palliative care needs. Nonspecialty-trained physicians will need to supplement the gap between supply and demand. Yet, no uniform guidelines exist for the training of internal medicine residents in palliative care. To our knowledge, no systematic study has been performed to evaluate how internal medicine residencies currently integrate palliative care into their training. In this study, we surveyed 338 Accreditation Council for Graduate Medical Education-accredited internal medicine program directors. We queried how palliative care was integrated into their training programs. The vast majority of respondents felt that palliative care training was "very important" (87.5%) and 75.9% of respondents offered some kind of palliative care rotation, often with a multidisciplinary approach. Moving forward, we are hopeful that the data provided from our survey will act as a launching point for more formal investigations into palliative care education for internal medicine residents. Concurrently, policy makers should aid in palliative care instruction by formalizing required palliative care training for internal medicine residents.
Chumbler, Neale R; Kobb, Rita; Harris, Linda; Richardson, Lisa C; Darkins, Adam; Sberna, Melanie; Dixit, Neha; Ryan, Patricia; Donaldson, Molla; Kreps, Gary L
The 2001 Institute of Medicine report indicted that the US healthcare system fails to provide high-quality care, and offered 6 aims of improvement that would redesign the delivery of care for the 21st century. This study compared the use of Department of Veterans Affairs (VA) inpatient and outpatient services of cancer patients enrolled in a Cancer Care Coordination/Home-Telehealth (CCHT) program that involved remote management of symptoms (eg, emotional distress, pain) via home-telehealth technologies to a control group of cancer patients receiving standard VA care. Using a matched case-control design, 2 control patients per case were selected, matched by tumor type and cancer stage. There were 43 Cancer CCHT patients and 82 control group patients. Based on a medical record review of each patient, the total number of cancer-related services (defined as visits that were expected given the patients' cancer diagnosis and treatment protocol) and preventable services (defined as visits needed outside of those expected given the cancer diagnosis and planned treatment) were calculated over a 6-month period. Poisson multivariate regression models were used to estimate the adjusted relative risks (RRs) for the effects of the Cancer CCHT program on the service use outcomes. Cancer CCHT patients had significantly fewer preventable services (clinic visits: RR = 0.03, 95% confidence interval [CI] = 0.00-0.24; bed days of care (BDOC) for hospitalization [all-cause]: RR = 0.50, 95% CI = 0.37-0.67; hospitalizations [chemotherapy related]: RR = 0.43, 95% CI = 0.21-0.91; and BDOC for hospitalizations [chemotherapy related]: RR = 0.49, 95% CI = 0.34-0.71) than the control group. This study offered some preliminary evidence that patients enrolled in a Cancer CCHT program can successfully manage multiple complex symptoms without utilizing inpatient and outpatient services.
Following up on "Child Abuse Storm Scale--Part 1" ("Child Care Information Exchange," Jan-Feb 1999) and Part 2 (Mar-Apr 1999), this article shares the current status of prominent sexual abuse in child care cases. Cases include McMartin Preschool, Fells Acres Day Care, Wee Care Nursery School (the Kelly Michaels case), Little Rascals, and Breezy…
Minué-Lorenzo, Sergio; Fernández-Aguilar, Carmen
The detailed analysis of the chronic care plans developed by the Spanish regional health services show a surprising level of uniformity in their design and deployment, despite differences between these services. The reviews about theoretical models that support it and tools they develop does not provide conclusive evidence to support the chronic care models achieve better results than another alternatives of care. Although the whole Spanish chronic care plans includes assessment proposals no rigorous studies on their effect have been published to date. Given that, on the contrary, there is a strong and repeated evidence that health systems with Primary Care high performance obtains better outcomes, it is necessary to ask about the need to look for alternative models, when the proposed goals could be reached strengthen Primary Care. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Lienau, P.J.; Boyd, T.L.; Rogers, R.L.
Ground-source heat pump systems are one of the promising new energy technologies that has shown rapid increase in usage over the past ten years in the United States. These systems offer substantial benefits to consumers and utilities in energy (kWh) and demand (kW) savings. The purpose of this study was to determine what existing monitored data was available mainly from electric utilities on heat pump performance, energy savings and demand reduction for residential, school and commercial building applications. In order to verify the performance, information was collected for 253 case studies from mainly utilities throughout the United States. The case studies were compiled into a database. The database was organized into general information, system information, ground system information, system performance, and additional information. Information was developed on the status of demand-side management of ground-source heat pump programs for about 60 electric utility and rural electric cooperatives on marketing, incentive programs, barriers to market penetration, number units installed in service area, and benefits.
Thukral, Anu; Lockyer, Jocelyn; Bucher, Sherri L; Berkelhamer, Sara; Bose, Carl; Deorari, Ashok; Esamai, Fabian; Faremo, Sonia; Keenan, William J; McMillan, Douglas; Niermeyer, Susan; Singhal, Nalini
Essential Care for Every Baby (ECEB) is an evidence-based educational program designed to increase cognitive knowledge and develop skills of health care professionals in essential newborn care in low-resource areas. The course focuses on the immediate care of the newborn after birth and during the first day or until discharge from the health facility. This study assessed the overall design of the course; the ability of facilitators to teach the course; and the knowledge and skills acquired by the learners. Testing occurred at 2 global sites. Data from a facilitator evaluation survey, a learner satisfaction survey, a multiple choice question (MCQ) examination, performance on two objective structured clinical evaluations (OSCE), and pre- and post-course confidence assessments were analyzed using descriptive statistics. Pre-post course differences were examined. Comments on the evaluation form and post-course group discussions were analyzed to identify potential program improvements. Using ECEB course material, master trainers taught 12 facilitators in India and 11 in Kenya who subsequently taught 62 providers of newborn care in India and 64 in Kenya. Facilitators and learners were satisfied with their ability to teach and learn from the program. Confidence (3.5 to 5) and MCQ scores (India: pre 19.4, post 24.8; Kenya: pre 20.8, post 25.0) improved (p improvement. These included additional time for hands-on practice, including practice in a clinical setting, the addition of video learning aids and the adaptation of content to conform to locally recommended practices. ECEB program was highly acceptable, demonstrated improved confidence, improved knowledge and developed skills. ECEB may improve newborn care in low resource settings if it is part of an overall implementation plan that addresses local needs and serves to further strengthen health systems.
"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.
Neubeck, Truls; Elg, Mattias; Schneider, Thomas; Andersson-Gäre, Boel
This study examines the use of quality-improvement (QI) methods in social services. Particularly the key aspects-generalizable knowledge, interprofessional teamwork, and measurements-are studied in projects from the QI program Forum for Values in Sweden. This is a mixed-method case study. Two projects using standard QI methods and tools as used in health care were chosen as critical cases to highlight some problems and prospects with the use of QI in social services. The cases were analyzed through documented results and qualitative interviews with participants one year after the QI projects ended. The social service QI projects led to measurable improvements when they used standard methods and tools for QI in health care. One year after the projects, the improvements were either not continuously measured or not reported in any infrastructure for measurements. The study reveals that social services differ from health care regarding the availability and use of evidence, the role of professional expertise, and infrastructure for measurements. We argue that QI methods as used in health care are applicable in social services and can lead to measurable improvements. The study gives valuable insights for QI, not only in social services but also in health care, on how to assess and sustain improvements when infrastructures for measurements are lacking. In addition, when one forms QI teams, the focus should be on functions instead of professions, and QI methods can be used to support implementation of evidence-based practice.
Full Text Available Abstract Background Transitions in the location of care and in who provides such care can be extremely stressful for individuals facing death and for those close to them. The objective of this study was to describe the distribution of transitions in care experienced by palliative care patients following admission to a comprehensive palliative care program (PCP. A better understanding of these transitions may aid in reducing unnecessary change, help predict care needs, enhance transitions that improve quality of life, guide health care system communication links and maximize the cost-effective utilization of different care settings and providers. Methods Transition and demographic information pertaining to all patients registered in the PCP at the Queen Elizabeth II Health Sciences Centre (QEII, Halifax, Nova Scotia, Canada between January 1, 1998 and December 31, 2002 and who died on or prior to December 31, 2002 was extracted from the PCP database and examined. A transition was defined as either: (1 a change in location of where the patient was cared for by the PCP or, (2 a change in which clinical service provided care. Descriptive analysis provided frequencies and locations of transitions experienced from time of PCP admission to death and during the final two and four weeks of life, an examination of patient movement and a summary of the length of stay spent by patients at each care location. Results Over the five year period, 3974 adults admitted to the QEII PCP experienced a total of 5903 transitions (Mean 1.5; standard deviation 1.8; median 1. Patients with no transitions (28% differed significantly from those who had experienced at least one transition with respect to survival time, age, location of death and diagnosis (p Conclusion A relatively small number of patients under the care of the PCP at the end of life, made several transitions in care setting or service provider. These particular patients need closer scrutiny to understand
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
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 the program are improved clinical outcomes, reduction in the burden of chronic disease, and improved sustainability of the health-care system through improved CDPS in primary care. The BETTER 2 program aims to expand the implementation of the intervention used in the original BETTER trial into communities across Canada (Alberta, Ontario, Newfoundland and Labrador, the Northwest Territories and Nova Scotia). This proactive approach provides at-risk patients with an intervention from the prevention practitioner, a health-care professional. Using the BETTER toolkit, the prevention practitioner determines which CDPS actions the patient is eligible to receive, and through shared decision-making and motivational interviewing, develops a unique and individualized 'prevention prescription' with the patient. This intervention is 1) personalized; 2) addressing multiple conditions; 3) integrated through linkages to local, regional, or national resources; and 4) longitudinal by assessing patients over time. The BETTER 2 program brings together primary care providers, policy/decision makers and researchers to work towards improving CDPS in primary care. The target patient population is adults aged 40-65. The reach, effectiveness, adoption, implementation, maintain (RE-AIM) framework will inform the evaluation of the program through qualitative and quantitative methods. A composite index will be used to quantitatively assess the effectiveness of the prevention practitioner intervention. The CDPS actions
Sietsema, Margaret; Conroy, Lorraine M; Brosseau, Lisa M
Airborne biological hazards in hospitals require the use of respiratory protection. A well-implemented respiratory protection program can protect health care workers from these exposures. This study examines the relationship between written respiratory programs and reported practices in health care settings. Twenty-eight hospitals in Illinois and Minnesota were recruited to a study of respiratory protection programs and practices in acute care settings. Interviews were conducted with hospital managers, unit managers, and health care workers from departments where respirators are commonly required. Each hospital's written respiratory protection program was scored for the 11 elements required by the Occupational Safety and Health Administration (OSHA), using a standardized tool, for a maximum possible score of 22 (2 pts. per element). Twenty interview questions associated with program practices were also scored by percent correct responses. Written program scores ranged from 2-17 with an average of 9.2. Hospital and unit managers scored on average 82% and 81%, respectively, when compared to the OSHA standard; health care workers scored significantly lower, 71% (p respiratory protection programs in the study sites did not provide the level of detail required OSHA. Interview responses representing hospital practices surrounding respiratory protection indicated that hospitals were aware of and following regulatory guidelines.
Nunez, Elizabeth; Gibson, Gretchen; Jones, Judith A; Schinka, John A
In this retrospective longitudinal cohort study, we examined the impact of dental care on outcomes among homeless veterans discharged from a Department of Veterans Affairs (VA) transitional housing intervention program. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did not. Primary outcomes of interest were program completion, employment or stable financial status on discharge, and transition to permanent housing. We calculated descriptive statistics and compared the 2 study groups with respect to demographic characteristics, medical and psychiatric history (including alcohol and substance use), work and financial support, and treatment outcomes. Veterans who received dental care were 30% more likely than those who did not to complete the program, 14% more likely to be employed or financially stable, and 15% more likely to have obtained residential housing. Provision of dental care has a substantial positive impact on outcomes among homeless veterans participating in housing intervention programs. This suggests that homeless programs need to weigh the benefits and cost of dental care in program planning and implementation.
Di Duro Joseph O
Full Text Available Abstract Background The first chiropractic adjustment given in 1895 was reported to have cured deafness. This study examined the effects of a single, initial chiropractic visit on the central nervous system by documenting clinical changes of audiometry in patients after chiropractic care. Case presentation Fifteen patients are presented (9 male, 6 female with a mean age of 54.3 (range 34–71. A Welch Allyn AudioScope 3 was used to screen frequencies of 1000, 2000, 4000 and 500 Hz respectively at three standard decibel levels 20 decibels (dB, 25 dB and 40 dB, respectively, before and immediately after the first chiropractic intervention. Several criteria were used to determine hearing impairment. Ventry & Weinstein criteria of missing one or more tones in either ear at 40 dB and Speech-frequency criteria of missing one or more tones in either ear at 25 dB. All patients were classified as hearing impaired though greater on the right. At 40 dB using the Ventry & Weinstein criteria, 6 had hearing restored, 7 improved and 2 had no change. At 25 dB using the Speech-frequency criteria, none were restored, 11 improved, 4 had no change and 3 missed a tone. Conclusion A percentage of patients presenting to the chiropractor have a mild to moderate hearing loss, most notably in the right ear. The clinical progress documented in this report suggests that manipulation delivered to the neuromusculoskeletal system may create central plastic changes in the auditory system.
Askari, Marjan; Westerhof, Richard; Eslami, Saied; Medlock, Stephanie; de Rooij, Sophia E; Abu-Hanna, Ameen
To propose a combined disease management and process modeling approach for evaluating and improving care processes, and demonstrate its usability and usefulness in a real-world fall management case study. We identified essential disease management related concepts and mapped them into explicit questions meant to expose areas for improvement in the respective care processes. We applied the disease management oriented questions to a process model of a comprehensive real world fall prevention and treatment program covering primary and secondary care. We relied on interviews and observations to complete the process models, which were captured in UML activity diagrams. A preliminary evaluation of the usability of our approach by gauging the experience of the modeler and an external validator was conducted, and the usefulness of the method was evaluated by gathering feedback from stakeholders at an invitational conference of 75 attendees. The process model of the fall management program was organized around the clinical tasks of case finding, risk profiling, decision making, coordination and interventions. Applying the disease management questions to the process models exposed weaknesses in the process including: absence of program ownership, under-detection of falls in primary care, and lack of efficient communication among stakeholders due to missing awareness about other stakeholders' workflow. The modelers experienced the approach as usable and the attendees of the invitational conference found the analysis results to be valid. The proposed disease management view of process modeling was usable and useful for systematically identifying areas of improvement in a fall management program. Although specifically applied to fall management, we believe our case study is characteristic of various disease management settings, suggesting the wider applicability of the approach. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Herron, Michael C.; Quinn, Kevin M.
Case studies appear prominently in political science, sociology, and other social science fields. A scholar employing a case study research design in an effort to estimate causal effects must confront the question, how should cases be selected for analysis? This question is important because the results derived from a case study research program…
Schiøtz, Michaela L; Høst, Dorte; Christensen, Mikkel B; Domínguez, Helena; Hamid, Yasmin; Almind, Merete; Sørensen, Kim L; Saxild, Thomas; Holm, Rikke Høgsbro; Frølich, Anne
Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people with multimorbidity in the publicly funded healthcare system in Denmark. To investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three focus groups. Before each focus group, clinicians were asked to review patients' medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients. Further, two clinical pharmacologists reviewed the appropriateness of medications listed in patient records. The review of the patients' records conducted by three groups of clinicians revealed that around half of the patients received adequate care for the single condition which prompted the episode of care such as a hospitalization, a visit to an outpatient clinic or the general practitioner. Further, the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems. The review of the medication lists revealed that the majority of the medication lists contained inappropriate medications and that there were incongruity in medication listed in the primary and secondary care sector. Several barriers for providing high quality care were identified. These included relative short consultation times in general practice and outpatient clinics, lack of care coordinators, and lack of shared IT-system proving an overview of the treatment. Our findings reveal quality of care deficiencies for
Emily Saurman; David Lyle; Sue Kirby; Russell Roberts
The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telehealth solution providing specialist emergency mental health care to rural and remote communities across western NSW, Australia. This is the first time and motion (T&M) study to examine program efficiency and capacity for a telepsychiatry program. Clinical services are an integral aspect of the program accounting for 6% of all activities and 50% of the time spent conducting program activities, but half of this time ...
Rosenheck, R; Gallup, P; Frisman, L K
This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless mentally ill veterans on utilization and cost of health care services provided by the VA. Veterans at nine program sites (N = 1,748) were assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA health service utilization and health care costs were obtained from national VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after were analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of clinical need and to participation in the outreach program. Although utilization of inpatient service did not increase after veterans' initial contact with the program, use of domiciliary and outpatient services increased substantially. Total annual costs to the VA also increased by 35 percent, from $6,414 to $8,699 per veteran per year. Both clinical need and participation in the program were associated with increased use of health services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than others. Specialized programs to improve the access of homeless mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to engage in treatment.
Thompson, Jon M; Temple, April
Health care organizations are increasingly embracing leadership development programs. These programs include a variety of specific activities, such as formally structured leadership development, as well as mentoring, personal development and coaching, 360-degree feedback, and job enlargement, in order to increase the leadership skills of managers and high-potential staff. However, there is a lack of information on how early careerists in health care management view these programs and the degree to which they participate. This article reports on a study undertaken to determine how early careerists working in health care organizations view leadership development programs and their participation in such programs offered by their employers. Study findings are based on a survey of 126 early careerists who are graduates of an undergraduate health services administration program. We found varying levels of interest and participation in specific leadership development activities. In addition, we found that respondents with graduate degrees and those with higher compensation were more likely to participate in selected leadership development program activities. Implications of study findings for health care organizations and early careerists in the offering of, and participation in, leadership development programs are discussed.
Isehunwa, Oluwaseyi O; Carlton, Erik L; Wang, Yang; Jiang, Yu; Kedia, Satish; Chang, Cyril F; Fijabi, Daniel; Bhuyan, Soumitra S
There is little research at the national level on access to employee wellness programs and the use of preventive care services. This study examined the use of seven preventive care services among U.S working adults with access to employee wellness programs. The study population comprised 17,699 working adults aged ≥18 years, obtained from the 2015 National Health Interview Survey. Multivariate logistic regression models examined the relationship between access to employee wellness programs and use of seven preventive care services: influenza vaccination, blood pressure check, diabetes check, cholesterol check, Pap smear test, mammogram, and colon cancer screening. Data analysis began in Fall 2016. Overall, 46.6% of working adults reported having access to employee wellness programs in 2015. Working adults with access to employee wellness programs had higher odds of receiving influenza vaccination (OR=1.57, 95% CI=1.43, 1.72, paccess to employee wellness programs and the use of Pap smear test and colon cancer screening services. Using a nationally representative sample of individuals, this study found a positive association between access to employee wellness programs and the use of preventive care services. The results support favorable policies to encourage implementing wellness programs in all worksites, especially those with <50 employees. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
... I-O Input-Output IOM Institute of Medicine IPF Inpatient psychiatric facility IPFQR Inpatient... Disorders of the Circulatory System) a. Discharge/Transfer to Designated Disaster Alternative Care Site b... Program e. Proposed Disaster/Extraordinary Circumstance Waivers under the Hospital VBP Program 10...
Weaver, Richard G.; Gray, Carolyn F.; Demby, Neal A.; Cinotti, William R.; Clark, Nereyda P.; Hicks, Jeffrey L.
Reports results of a working group convened by the American Association of Dental Schools to examine establishment of dental education programs with significant affiliations with community-based clinical care settings. Identifies factors and conditions believed to be critical to successful program linkages, including goals and objectives, support…
Hagen, Jan L.; Davis, Liane V.
Explores mothers' perceptions of child care under a job training program and the effects of program participation on their children. Findings suggest that some preschool children benefit from their mothers' participation due to an increase of new learning opportunities for the children and through the mothers' improved parenting abilities. (RJM)
Jagt-van Kampen, Charissa Thari; Kremer, Leontien C. M.; Verhagen, A. A. Eduard; Schouten-van Meeteren, Antoinette Y. N.
Background: A national clinical practice guideline for pediatric palliative care was published in 2013. So far there are only few reports available on whether an educational program fosters compliance with such a guideline implementation. We aimed to test the effect of the education program on
van Wilgen, C.P.; Bloten, H.; Oeseburg, B.
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
Counsell, Colleen; Adorno, Gail; Guin, Peggy
The primary goal of end-of-life (EOL) care is to relieve suffering through measures that improve comfort and address the psychological, social, and spiritual needs of the dying. This article discusses the components of a pilot project that focused on palliative EOL care at an academic acute care hospital. An interdisciplinary team of nurses, social workers, chaplains, patient care coordinators, and advanced practice nurses established a common vision for the care of patients who were "in the dying process," or were expected to die during their hospitalizations. A nurse-social worker "Care-Pair Team" completed a consistent interdisciplinary EOL care needs assessment when treatment goals became strictly palliative. Interventions were driven by a clinical pathway and a pre-printed physician's order set that continually clarified the goals of treatment. Key elements of the program included leadership support, advance directives, education, communication, family involvement, symptom management, professional collaboration, and outcomes measurement.
Bleijenberg, Nienke; Boeije, Hennie R; Onderwater, Astrid T; Schuurmans, Marieke J
The aim of the current study was to explore frail older adults' perceptions and experiences with a proactive, integrated nurse-led primary care program. A qualitative study nested within a randomized trial in primary care was conducted. In total, 11 semistructured interviews were conducted in a subsample of participants who received nurse-led care in the intervention group. Generally, proactive, nurse-led care was well-received and four different nursing roles were observed: (a) monitor, (b) director, (c) coach, and (d) visitor. The monitor role (i.e., observing and assessing potential risks) was perceived as the most important. The relationship with the nurse, timing of visits, and provided care, as well as tailoring the care to individual needs, were identified as conditions related to appreciation. If the care was well-regarded, older adults were more likely to accept it, which helped them anticipate changes or handle consequences of aging more easily. Copyright 2015, SLACK Incorporated.
Kerr, Christopher W; Tangeman, John C; Rudra, Carole B; Grant, Pei C; Luczkiewicz, Debra L; Mylotte, Kathleen M; Riemer, William D; Marien, Melanie J; Serehali, Amin M
Outpatient programs have been traditionally offered in the U.S. under programs such as the Medicare Hospice Benefit. Recommendations now emphasize a blended model in which palliative care is offered concurrently with curative approaches at the onset of serious or life-limiting disease. The efficacy of nonhospice outpatient palliative care programs is not well understood. The aim of the study was to evaluate the clinical impact of a home-based palliative care program, Home Connections, implemented as a partnership between a not-for-profit hospice and two private insurers. This was a prospective, observational, database study of 499 Home Connections participants enrolled between July 1, 2008, and May 31, 2013. Measured outcomes were advance directive completion, site of death, symptom severity over time, program satisfaction, and hospice referral and average length of stay. Seventy-one percent of participants completed actionable advance directives after enrollment, and the site of death was home for 47% of those who died during or after participation in the program. Six of eight symptom domains (anxiety, appetite, dyspnea, well-being, depression, and nausea) showed improvement. Patients, caregivers, and physicians gave high program satisfaction scores (93%-96%). Home Connections participants who subsequently enrolled in hospice care had a longer average length of stay of 77.9 days compared with all other hospice referrals (average length of stay 56.5 days). A home-based palliative care program was developed between two local commercial payers and a not-for-profit hospice. Not only did this program improve symptom management, advance directive completion, and satisfaction, but it also facilitated the transition of patients into hospice care, when appropriate. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Rad, Steve; Ogunyemi, Dotun
To assess the utility of health-care matrix in teaching patient safety in terms of the Institute of Medicine Aims for health-care improvement and Accreditation Council for Graduate Medical Education competencies. As part of residency education, health-care matrix conference is held monthly. A multidisciplinary team is invited. Residents choose cases and develop a draft matrix under faculty supervision. The matrix is presented, and consensus action plan is generated after discussion. Approximately 2 years after initiation of the program, residents completed an anonymous 15-item survey. The study included 26 health-care matrix conferences from 2007 to 2009. Main reasons for residents' selection of cases were management issues (42%), bleeding complications (35%), and medication errors (23%). Major contributors to patient safety concerns by Institute of Medicine Aims were timeliness (65%), and those by Accreditation Council for Graduate Medical Education competencies were system issues (77%), medical knowledge (69%), and communication issues (66%).Residents agreed that the program was useful. No resident thought that the program should be cancelled. Only 39% feel their communication skills were improved, 48% felt that preparation was time consuming, and 29% felt awkward presenting errors of superiors. Review of action plans developed after each matrix showed that implementation of recommendations was initiated in 92% of the cases. The health-care matrix curriculum can be used to teach patient safety culture, assess system processes, and improve patient care. This report highlights the importance of system issues, timeliness, medical knowledge, and communication for patient safety concerns.
Full Text Available Introduction: Little is known about health care and social service professionals' perspective on the acceptability of long-term home-visit programs serving low-income, first-time mothers. This study describes the experiences and perspectives of these community care providers involved with program referrals or service delivery to mothers who participated in the Nurse-Family Partnership (NFP, a targeted nurse home-visit program. Methods: The study included two phases. Phase I was a secondary qualitative data analysis used to analyze a purposeful sample of 24 individual interviews of community care providers. This was part of a larger case study examining adaptations required to increase acceptability of the NFP in Hamilton, Ontario, Canada. In Phase II (n = 4, themes identified from Phase I were further explored through individual, semi-structured interviews with community health care and social service providers, giving qualitative description. Results: Overall, the NFP was viewed as addressing an important service gap for first-time mothers. Providers suggested that frequent communication between the NFP and community agencies serving these mothers could help improve the referral process, avoid service duplication, and streamline the flow of service access. The findings can help determine key components required to enhance the success of integrating a home-visit program into an existing network of community services. Conclusion: The function of home-visit programs should not be viewed in isolation. Rather, their potential can be maximized when they collaborate and share information with other agencies to provide better services for first-time mothers.
Ayalon, Liat; Baum, Nehami
In Israel, the government partially supports personal home care services (grooming, feeding, assistance with transfers) as a means to maintain frail individuals in their home environment for as long as possible. Social workers capture a prominent position in these arrangements as initiators and supervisors of personal home care services. This…
In the Netherlands around 4000 – 6700 children with life-limiting diseases could benefit from paediatric palliative care (PPC). However, adequate PPC is often absent due to the lack of continuity and coordination of care and limited expertise among healthcare professionals (HCP). Consequently, many
Full Text Available This essay is a reflection on the multidisciplinary team in palliative care, from the perspective of a final year MBBS student from the UK spending one month with an Indian pain and palliative care team at Institute Rotary Cancer Hospital (IRCH, AIIMS, New Delhi.
Lian Leng Low
Full Text Available Background: Organizing care into integrated practice units (IPUs around conditions and patient segments has been proposed to increase value. We organized transitional care into an IPU (THC-IPU for a patient segment of functionally dependent patients with limited community ambulation. Methods: 1,166 eligible patients were approached for enrolment into THC-IPU. THC-IPU patients received a comprehensive assessment within two weeks of discharge; medication reconciliation; education using standardized action plans and a dedicated nurse case manager for up to 90 days after discharge. Patients who rejected enrolment into THC-IPU received usual post-discharge care planned by their attending hospital physician, and formed the control group. The primary outcome was the proportion of patients with at least one unscheduled readmission within 30 days after discharge. Results: We found a statistically significant reduction in 30-day readmissions and emergency department visits in patients on THC-IPU care compared to usual care, even after adjusting for confounders. Conclusion: Delivering transitional care to patients with functional dependence in the form of home visits and organized into an IPU reduced acute hospital utilization in this patient segment. Extending the program into the pre-hospital discharge phase to include discharge planning can have incremental effectiveness in reducing avoidable hospital readmissions.
Low, Lian Leng; Tay, Wei Yi; Tan, Shu Yun; Chia, Elian Hui San; Towle, Rachel Marie; Lee, Kheng Hock
Organizing care into integrated practice units (IPUs) around conditions and patient segments has been proposed to increase value. We organized transitional care into an IPU (THC-IPU) for a patient segment of functionally dependent patients with limited community ambulation. 1,166 eligible patients were approached for enrolment into THC-IPU. THC-IPU patients received a comprehensive assessment within two weeks of discharge; medication reconciliation; education using standardized action plans and a dedicated nurse case manager for up to 90 days after discharge. Patients who rejected enrolment into THC-IPU received usual post-discharge care planned by their attending hospital physician, and formed the control group. The primary outcome was the proportion of patients with at least one unscheduled readmission within 30 days after discharge. We found a statistically significant reduction in 30-day readmissions and emergency department visits in patients on THC-IPU care compared to usual care, even after adjusting for confounders. Delivering transitional care to patients with functional dependence in the form of home visits and organized into an IPU reduced acute hospital utilization in this patient segment. Extending the program into the pre-hospital discharge phase to include discharge planning can have incremental effectiveness in reducing avoidable hospital readmissions.
Schiøtz, Michaela L; Høst, Dorte; Christensen, Mikkel B
focus groups. Before each focus group, clinicians were asked to review patients' medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients...... the episode of care such as a hospitalization, a visit to an outpatient clinic or the general practitioner. Further, the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems. The review......BACKGROUND: Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people...
Full Text Available Claire Blackmore,1 Vicki L Johnson-Warrington,2 Johanna EA Williams,2 Lindsay D Apps,2 Hannah ML Young,2 Claire LA Bourne,2 Sally J Singh2 1Kettering General Hospital National Health Service (NHS Trust, Kettering, Northamptonshire, 2Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Leicester, UK Background: With the growing burden of COPD and associated morbidity and mortality, a need for self-management has been identified. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD manual was developed to support self-management in COPD patients. Currently, there is no literature available regarding health care professionals’ training needs when supporting patients with COPD on self-management.Aim: This study sought to identify these needs to inform, design and develop a training program for health care professionals being trained to deliver a self-management program in COPD.Methods: Fourteen health care professionals from both primary and secondary care COPD services participated in face-to-face semistructured interviews. Thematic analysis was used to produce a framework and identify training needs and views on delivery of the SPACE for COPD self-management program. Components of training were web-based knowledge training, with pre- and posttraining knowledge questionnaires, and a 1-day program to introduce the self-management manual. Feedback was given after training to guide the development of the training program.Results: Health care professionals were able to identify areas where they required increased knowledge to support patients. This was overwhelming in aspects of COPD seen to be outside of their current clinical role. Skills in goal setting and behavioral change were not elicited as a training need, suggesting a lack of understanding of components of supporting self
Wang, Philip S; Simon, Gregory E; Kessler, Ronald C
Explore the business case for enhanced depression care and establish a return on investment rationale for increased organizational involvement by employer-purchasers. Literature review, focused on the National Institute of Mental Health-sponsored Work Outcomes Research and Cost-effectiveness Study. This randomized controlled trial compared telephone outreach, care management, and optional psychotherapy to usual care among depressed workers in large national corporations. By 12 months, the intervention significantly improved depression outcomes, work retention, and hours worked among the employed. Results of the Work Outcomes Research and Cost-effectiveness Study trial and other studies suggest that enhanced depression care programs represent a human capital investment opportunity for employers.
Name of the Thesis: The Case Interpretation of Physiotherapist's Care for the Patient after a Spinal Tumor Operation Summary: The general part of the bachelor thesis includes theoretical knowledge of anatomy and kinesiology of the spinal cord and peripheral nervous system. In addition, the bachelor thesis follows up a spinal tumor issue, diagnosis, treatment and rehabilitation care in case of complications. The special part includes the elaboration of patient's case interpretation after the o...
Alcaraz Quevedo, Manuela; Paredes-Carbonell, Joan J; Sancho Mestre, Carla; López-Sánchez, Pilar; García Moreno, J Luis; Vivas Consuelo, David
Intercultural Mediation is a strategy for quality health care aimed at reducing inequalities in immigrant population. The aim is to analyse main reasons consultation with the mediation service, women care profile and characteristics of intervention. Cross-sectional study of 339 episodes of care by two intercultural mediators (MI) from February 2008 to October 2011 in Valencia. Variables were analysed individual records of the consultations of the MI: reasons for referral to MI and professionals who refer, motives and problems identified by MI, kind of intervention, kind of derivation of MI and socio-economic variables. To evaluate the differences between countries, X2 test was used for qualitative variables and one-way ANOVA test for quantitative variables. 123 women (36,3%), were referred to the MI by the Sexual and Reproductive Health Centre and 98 (28,9%) by the midwife. 272 women (80,24%) were referred for information and demand for contraception. The MI conducted health education and detected social problems in 67 women (19,7%) and gender violence in 38 (11,21%). The women attending were Latin American immigrants (those of Bolivia showed more vulnerability) and were referred for contraception. The MI provided information, education and facilitated access to reproductive health services. Bolivian women showed more vulnerability factors: irregular situation, precarious work and low residence time.
Ma, Jun; Berra, Kathy; Haskell, William L; Klieman, Linda; Hyde, Shauna; Smith, Mark W; Xiao, Lan; Stafford, Randall S
Case management (CM) is a systematic approach to supplement physician-centered efforts to prevent cardiovascular disease (CVD). Research is limited on its implementation and efficacy in low-income, ethnic minority populations. We conducted a randomized clinical trial to evaluate a nurse- and dietitian-led CM program for reducing major CVD risk factors in low-income, primarily ethnic minority patients in a county health care system, 63.0% of whom had type 2 diabetes mellitus. The primary outcome was the Framingham risk score (FRS). A total of 419 patients at elevated risk of CVD events were randomized and followed up for a mean of 16 months (81.4% retention). The mean FRS was significantly lower for the CM vs usual care group at follow-up (7.80 [95% confidence interval, 7.21-8.38] vs 8.93 [8.36-9.49]; P = .001) after adjusting for baseline FRS. This is equivalent to 5 fewer heart disease events per 1000 individuals per year attributable to the intervention or to 200 individuals receiving the intervention to prevent 1 event per year. The pattern of group differences in the FRS was similar in subgroups defined a priori by sex and ethnicity. The main driver of these differences was lowering the mean (SD) systolic (-4.2 [18.5] vs 2.6 [22.7] mm Hg; P = .003) and diastolic (-6.0 [11.6] vs -3.0 [11.7] mm Hg; P = .02) blood pressures for the CM vs usual care group. Nurse and dietitian CM targeting multifactor risk reduction can lead to modest improvements in CVD risk factors among high-risk patients in low-income, ethnic minority populations receiving care in county health clinics. clinicaltrials.gov Identifier: NCT00128687.
James M Lightwood
Full Text Available 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.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.A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures.
Full Text Available In America, mental health needs surpass the availability of specialized providers. This vulnerable population also has other obstacles for comprehensive care including gaps in medical coverage, stigma, economic barriers, and a geographical mal‑distribution of qualified mental health professionals. A wide availability of primary care providers, including primary care and family nurse practitioners, are well-positioned to deliver integrated mental and physical health care. A case study from a Southern California Coachella Valley primary care clinic with integrated services is used to demonstrate the much-needed approach of care to address health disparities that face low‑income immigrants, migrant workers, and others without access to specialized care centers and providers. It is argued that mental health care should be part of all holistic treatment provided by primary care and family nurse practitioners. This has implications for curricula and practice development.
... consistent with the generally accepted ``disease model'' of alcoholism and drug addiction treatment, as well... burden on veterans by designing and implementing a single information technology program that agencies can use to share information about the veteran. Although we generally agree that technology increases...
Academy for Educational Development, 2008
Founded in 1961, the Academy for Educational Development (AED) is a nonprofit organization working globally to improve health, education, and economic opportunity--the foundation of thriving societies. With a global staff of more than 2,000 focusing on the underserved, AED implements more than 250 programs serving people in all 50 U.S. states and…
Academy for Educational Development, 2008
Founded in 1961, the Academy for Educational Development (AED) is a nonprofit organization working globally to improve health, education, and economic opportunity--the foundation of thriving societies. With a global staff of more than 2,000 focusing on the underserved, AED implements more than 250 programs serving people in all 50 U.S. states and…
Veinot, Paula; Lin, William; Woods, Nicole; Ng, Stella
Background Ambulatory care (AC) experiences within medical education are garnering increasing attention. We sought to understand how faculty and residents’ describe their experiences of AC and ambulatory care education (ACEduc) within, between, and across disciplinary contexts. Methods We designed a Stakian collective case study, applying constructivist grounded theory analytic methods. Using purposive and snowball sampling, we interviewed 17 faculty and residents across three instrumental cases: family medicine, psychiatry, surgery. Through constant comparative analysis, we identified patterns within, between, and across cases. Results Family medicine and psychiatry saw AC as an inherent part of continuous, longitudinal care; surgery equated AC with episodic experiences in clinic, differentiating it from operating. Across cases, faculty and residents cautiously valued ACEduc, and in particular, considered it important to develop non-medical expert competencies (e.g., communication). However, surgery residents described AC and ACEduc as less interesting and a lower priority than operating. Educational structures mediated these views. Conclusion Differences between cases highlight a need for further study, as universal assumptions about ACEduc’s purposes and approaches may need to be tempered by situated, contextually-rich perspectives. How disciplinary culture, program structure, and systemic structure influence ACEduc warrant further consideration as does the educational potential for explicitly framing learners’ perspectives. PMID:29098047
Vermeltfoort, Pit B. J.; Hooymans, Johanna M. M.; Busscher, Henk J.; van der Mei, Henny C.
The killing efficacies of multipurpose lens care solutions on planktonic and biofilm bacteria grown in polypropylene contact lens storage cases with and without silver impregnation and effects on bacterial transmission from storage cases to silicone hydrogel contact lenses were investigated. For
Hayen, Arthur P; van den Berg, Michael J; Meijboom, Bert R; Struijs, Jeroen N; Westert, Gert P
In several countries, health care policies gear toward strengthening the position of primary care physicians. Primary care physicians are increasingly expected to take accountability for overall spending and quality. Yet traditional models of paying physicians do not provide adequate incentives for taking on this new role. Under a so-called shared savings program physicians are instead incentivized to take accountability for spending and quality, as the program lets them share in cost savings when quality targets are met. We provide a structured approach to designing a shared savings program for primary care, and apply this approach to the design of a shared savings program for a Dutch chain of primary care providers, which is currently being piloted. Based on the literature, we defined five building blocks of shared savings models that encompass the definition of the scope of the program, the calculation of health care expenditures, the construction of a savings benchmark, the assessment of savings and the rules and conditions under which savings are shared. We apply insights from a variety of literatures to assess the relative merits of alternative design choices within these building blocks. The shared savings program uses an econometric model of provider expenditures as an input to calculating a casemix-corrected benchmark. The minimization of risk and uncertainty for both payer and provider is pertinent to the design of a shared savings program. In that respect, the primary care setting provides a number of unique opportunities for achieving cost and quality targets. Accountability can more readily be assumed due to the relatively long-lasting relationships between primary care physicians and patients. A stable population furthermore improves the confidence with which savings can be attributed to changes in population management. Challenges arise from the institutional context. The Dutch health care system has a fragmented structure and providers are typically
Rosenheck, R; Leda, C
Demographic and clinical data are presented on 4,138 veterans assessed in the 20-site Department of Veterans Affairs (VA) Domiciliary Care for Homeless Veterans program during its first year of operation. More than two-thirds of the veterans who were screened had been hospitalized in VA medical centers during the year before assessment, and 34 percent were hospitalized at the time of assessment. Compared with veterans who were not admitted for residential treatment, veterans who were admitted were more likely to be previously involved in mental health treatment, literally homeless rather than at risk for homelessness, and without public financial support. Specialized service programs for the homeless such as the VA domiciliary care program may also be called on to play a broader role in the discharge and rehabilitative efforts of public mental health service systems.
Baron, Steffen; Heider, Dirk; Gensichen, Jochen; Petersen, Juliana J; Gerlach, Ferdinand M; Krauth, Christian; A'Walelu, Okyta; König, Hans-Helmut
Case management by health care assistants in small primary care practices has proven effective in improving depression symptoms in depressive patients. Resource consumption and costs of this intervention have not been evaluated yet. Health care assistants and general practitioners of 15 participating practices were interviewed for intervention-related time expenditures. Intervention costs were based on individual labour costs. The annual time spent was 6.3 h per patient for health care assistants and 3.6 h for general practitioners (mean 8.9 patients per practice). The case management caused costs of € 277 per patient and year. A telephone-based case management as add-on therapy improves quality of primary care depression therapy while causing only moderate costs for health care providers. © Georg Thieme Verlag KG Stuttgart · New York.
Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A
Care management in primary care can be effective in helping patients with chronic disease improve their health status, however, primary care practices are often challenged with implementation. Further, there are different ways to structure care management that may make implementation more or less successful. Normalization process theory (NPT) provides a means of understanding how a new complex intervention can become routine (normalized) in practice. In this study, we used NPT to understand how care management structure affected how well care management became routine in practice. Data collection involved semi-structured interviews and observations conducted at 25 practices in five physician organizations in Michigan, USA. Practices were selected to reflect variation in physician organizations, type of care management program, and degree of normalization. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with NPT as a guiding framework. Seventy interviews and 25 observations were completed. Two key structures for care management organization emerged: practice-based care management where the care managers were embedded in the practice as part of the practice team; and centralized care management where the care managers worked independently of the practice work flow and was located outside the practice. There were differences in normalization of care management across practices. Practice-based care management was generally better normalized as compared to centralized care management. Differences in normalization were well explained by the NPT, and in particular the collective action construct. When care managers had multiple and flexible opportunities for communication (interactional workability), had the requisite knowledge, skills, and personal characteristics (skill set workability), and the organizational support and resources (contextual integration), a trusting professional relationship
Spice, Ron; Read Paul, Linda; Biondo, Patricia D
Specialized rural models of palliative care are greatly needed to address the challenges rural communities face in providing palliative care services and to ensure that their unique strengths and needs are considered. In late 2005, a Rural Palliative Care Program was developed to support primary care providers in delivering palliative care to patients in rural communities outside of Calgary, Alberta, Canada. The program was grounded in the needs of individual communities, incorporated integral roles for local champions, and adopted pre-existing, accepted rural structures and processes. Needs and gaps in rural palliative care service delivery were identified and prioritized. The following actions were taken to address the top six priorities: 1) more accessible palliative care education opportunities with a rural focus were provided to health care professionals; 2) linkages with rural and urban resources were strengthened and access to specialists and procedures was improved; 3) strategies were implemented to improve psychosocial support for patients and families; 4) resources were developed to facilitate rural home deaths; 5) opportunities were expanded for education and utilization of volunteers; and 6) a mobile specialist consultation team was developed to support rural health care professionals and their patients in their rural communities. In its first four years, the team consulted on 640 patients, nearly three-quarters of whom died in their rural communities. Rather than imposing an urban outreach strategy, the development of a rural-based program through respectful engagement of local providers has proven to be crucial to the success of this rural palliative care program. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Beazoglou, Tryfon; Bailit, Howard; Maule, Margaret Drozdowski
We analyzed the operation of one Connecticut federally qualified health center (FOHC) dental program with seven delivery sites. We assessed the financial operation of the different delivery sites and contrasted the overall performance of the FOHC with private practices. We obtained data from a pretested financial survey instrument, electronic patient visit records, and site visits. To assess clinic productivity, we used two output measures: patient visits and market value of services. For the latter, we estimated the implicit fee of each service provided in patient visits. On average, these clinics were running a modest deficit, mainly due to startup costs of two new clinics. The primary factor that impacted net revenues was low reimbursement rates, including privately insured patients. When FOHC dental revenues were adjusted to market rates, revenues were close to expenses. FOHC dental clinics are major components of the dental safety net system. This case study suggests that the established clinics use resources as effectively as private practices.
Grandes, Gonzalo; Arce, Verónica; Arietaleanizbeaskoa, María Soledad
To provide information about the process and results of the Primary Health Care Research Program 2010-2011 organised by the Primary Care Research Unit of Bizkaia. Descriptive study. Osakidetza primary care. The 107 health professionals who applied for the program from a total of 4,338 general practitioners, nurses and administrative staff who were informed about it. Application level, research topics classification, program evaluation by participants, projects funding and program costs. Percentage who applied, 2.47%; 95% CI 2.41-2.88%. Of the 28 who were selected and 19 completed. The research topics were mostly related to the more common chronic diseases (32%), and prevention and health promotion (18%). Over 90% of participants assessed the quality of the program as good or excellent, and half of them considered it as difficult or very difficult. Of the18 new projects generated, 12 received funding, with 16 grants, 10 from the Health Department of the Basque Government, 4 from the Carlos III Institute of Health of the Ministry of Health of Spain, and 2 from Kronikgune. A total of €500,000 was obtained for these projects. This program cost €198,327. This experience can be used by others interested in the promotion of research in primary care, as the program achieved its objectives, and was useful and productive. Copyright © 2013 Elsevier España, S.L. All rights reserved.
Fahy, Brenda G; Vasilopoulos, Terrie; White, Peggy; Culley, Deborah J
Academic productivity is an expectation for program directors of Accreditation Council for Graduate Medical Education-accredited subspecialty programs in critical care medicine. Within the adult critical care Accreditation Council for Graduate Medical Education-accredited programs, we hypothesized that program director length of time from subspecialty critical care certification would correlate positively with academic productivity, and primary field would impact academic productivity. This study received Institutional Review Board exemption from the University of Florida. Data were obtained from public websites on program directors from all institutions that had surgery, anesthesiology, and pulmonary Accreditation Council for Graduate Medical Education-accredited subspecialty critical care training programs during calendar year 2012. Information gathered included year of board certification and appointment to program director, academic rank, National Institutes of Health funding history, and PubMed citations. Specialty area was significantly associated with total (all types of publications) (p = 0.0002), recent (p research publications (p accounting for academic rank, years certified, and as a program director. These differences were most prominent in full professors, with surgery full professors having more total, recent, last author, and original research publications than full professors in the other critical care specialties. This study demonstrates that one's specialty area in critical care is an independent predictor of academic productivity, with surgery having the highest productivity. For some metrics, such as total and last author publications, surgery had more publications than both anesthesiology and pulmonary, whereas there was no difference between the latter groups. This suggests that observed differences in academic productivity vary by specialty.
Tam, O Y; Lam, S M; Shum, H P; Lau, C W; Chan, Kenny K C; Yan, W W
To evaluate the pattern of unplanned readmissions to the intensive care unit and identify patients at risk of readmission. Nested case-referent study. Tertiary hospital, Hong Kong. A total of 146 patients with unplanned intensive care unit readmission were compared with 292 control patients who were discharged from the intensive care unit alive and never readmitted. Cases and controls were matched for age, gender, and disease severity. Patient demographics, initial and pre-discharge clinical parameters, reasons for readmission, and outcomes were studied. During the 30-month study period, the readmission rate was 5.1%. Readmitted patients had significantly higher mortality and longer mean hospital lengths of stay (both Pintensive care unit readmission. Incomplete resolution of respiratory conditions remained an important reason for potentially preventable intensive care unit readmission. Attention to fluid balance and sputum quantity before intensive care unit discharge might prevent unplanned intensive care unit readmission.
Dukhanin, Vadim; Edrees, Hanan H; Connors, Cheryl A; Kang, Eric; Norvell, Matt; Wu, Albert W
While there is growing attention to making health care safer, there has been less emphasis on helping health care workers to cope with stressful patient related events (these workers are commonly referred to as second victims). We used the RISE (Resilience In Stressful Events) peer support program at the Johns Hopkins Hospital as a case study for evaluating effectiveness, and identifying barriers to addressing the needs of second victims. The study used a mixed-method approach that included: 1) quantitative analysis of surveys of health care workers in the Department of Pediatrics before RISE implementation and four years after, and 2) content analysis of open-ended commentaries about respondents' experience with seeking second victim support, as well as feedback on RISE. Survey response rates were 22.4% and 23.3% respectively. Quantitative analysis showed that respondents at the later time point were more likely to contact an organizational support structure, and had greater awareness of the availability of support. Respondents were very likely (93%) to recommend RISE to others. Content analysis identified barriers to using RISE: overcoming blame culture, need to promote the initiative, and need for more staff time to handle adverse events. Respondents reported varied preferences for the support format and specific support interventions. The mixed-method approach allowed a comprehensive evaluation of RISE and provided some evidence for its effectiveness in supporting pediatric health care workers. The findings suggest an important role of organizational culture in second victim support program implementation and evaluation. Copyright © 2018 Elsevier Inc. All rights reserved.
Djalali, Sima; Tandjung, Ryan; Rosemann, Thomas; Markun, Stefan
Facing the upcoming shortage of primary care physicians (PCPs), medical and governmental organizations have recently made major investments to foster vocational training programs in Switzerland, designed to provide context-specific training for trainees in primary care practices. Less is known about the impact of these programs on the skills and specific knowledge of trainees. We aimed to evaluate the Cantonal program for vocational primary care training in the Canton of Zurich, Switzerland's largest Canton. We undertook a pretest-posttest study and surveyed physicians before and after participating in the Cantonal program for vocational primary care training in the Swiss Canton of Zurich. All trainees who participated in the program from 2013 until the end of 2015 were eligible. Primary outcome was the proportion of trainees being confident about their professional, organizational, examination and management skills before and after completing vocational training. Secondary outcomes were the proportion of trainees stating knowledge gain in entrepreneurship and the proportion of trainees being motivated to pursue a career as PCP. Data of 47 trainees participating in the vocational training between 2013 and 2015 were eligible. In total, 35 (74.5%) participated in the T1 survey and 34 (72.3%) in the T2 survey. At T2, significantly more trainees (T1: 11%-89%, T2: 79%-100%) stated to be at least "slightly confident" about their skills (pKnowledge gain in entrepreneurship was highly expected and experienced by the trainees (55%-77% of respondents) in case of medicine-specific contents, but hardly expected in case of general business contents (≤47% of respondents). Concerning trainees' motivation to pursue a career as PCP, we observed only a minimal, statistically insignificant change, suggesting that the vocational training did not alter trainees' preconceived career plans as PCP. Given the measured increase in confidence, evaluation of training programs should focus
Djalali, Sima; Tandjung, Ryan; Rosemann, Thomas; Markun, Stefan
Background Facing the upcoming shortage of primary care physicians (PCPs), medical and governmental organizations have recently made major investments to foster vocational training programs in Switzerland, designed to provide context-specific training for trainees in primary care practices. Less is known about the impact of these programs on the skills and specific knowledge of trainees. We aimed to evaluate the Cantonal program for vocational primary care training in the Canton of Zurich, Switzerland’s largest Canton. Methods We undertook a pretest–posttest study and surveyed physicians before and after participating in the Cantonal program for vocational primary care training in the Swiss Canton of Zurich. All trainees who participated in the program from 2013 until the end of 2015 were eligible. Primary outcome was the proportion of trainees being confident about their professional, organizational, examination and management skills before and after completing vocational training. Secondary outcomes were the proportion of trainees stating knowledge gain in entrepreneurship and the proportion of trainees being motivated to pursue a career as PCP. Results Data of 47 trainees participating in the vocational training between 2013 and 2015 were eligible. In total, 35 (74.5%) participated in the T1 survey and 34 (72.3%) in the T2 survey. At T2, significantly more trainees (T1: 11%–89%, T2: 79%–100%) stated to be at least “slightly confident” about their skills (pentrepreneurship was highly expected and experienced by the trainees (55%–77% of respondents) in case of medicine-specific contents, but hardly expected in case of general business contents (≤47% of respondents). Concerning trainees’ motivation to pursue a career as PCP, we observed only a minimal, statistically insignificant change, suggesting that the vocational training did not alter trainees’ preconceived career plans as PCP. Conclusion Given the measured increase in confidence
Munson, Michelle; Proctor, Enola; Morrow-Howell, Nancy; Fedoravicius, Nicole; Ware, Norma
This study sought to understand how case managers in one publicly funded health and social service system, community long-term care, understand and address depression among their clients. Four focus groups with a total of 18 case managers were conducted. Case managers were asked a series of questions about their perspectives on the recognition and treatment of depression, including subthreshold depression, in community long-term care. Case managers perceived addressing depression as complex because of competing demands. Furthermore, case managers perceived conflict between their current role and what it would take to expand their role to include addressing depression. Case managers suggested that in order to successfully improve the detection and treatment of depression in community long-term care, systemic changes, such as increased support and training, may be necessary, along with a shift in the professional role of case managers.
Michelson, Kelly Nicole; Blehart, Kathleen; Hochberg, Todd; James, Kristin
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.
Edwards, Scott J; Abbott, Rick; Edwards, Jonathan; LeBlanc, Michael; Dranitsaris, George; Donnan, Jennifer; Laing, Kara; Whelan, Maria A; MacKinnon, Neil J
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.
Francisco J. Ramos-Gomez
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.
Ramos-Gomez, Francisco J
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.
Sanjoy Kumar Pal
.... The option of chemotherapy was discussed with the patient and his care givers. In view of the nature of the disease and the little likelihood of response, the patient did not consent for the same...
Abdol Aziz Shahraki
Full Text Available This is a research into the assessment of tourism industry quality and programing for its development in Iran. In a tough economic situation, the hypothesis is to grow and develop the national economy with the help of the tourism industry. A unified assessment of tourism industry quality, method is made use of in this study, which is based on the case study of all elements of Iran tourism industry system. Quality assessment by means of unified problems (indicators that hinder the maximum development of the tourism industry shows the reliability of the hypothesis. SWOT analysis aided to determine the weaknesses and threats aiming at raising the quality of the indicators. In addition, a linear programming from the standpoint of internal and external relations with national economy has been applied. The analysis revealed that the system of the tourism industry is unable to assist the macro economy. The failure corresponds to scarcely favorable natural environmental conditions, capacity for motivating to visitors, tourism marketing, and tourism infrastructures. After remedy actions, prospects for tourism industry development despite the complicated situation are quite favorable due to the advantageous climate, natural characteristics, cultural and ancient heritages, tourism resources, and educated labor. The methods applied by this paper suggest adaptive governance tools suitable to apply for optimization of the tourism industry everywhere similar to Iran.
Austin, Michael; Milos, Nadine; Raborn, G Wayne
Many publicly funded education programs and organizations have developed business plans to enhance accountability. In the case of the Department of Dentistry at the University of Alberta, the main impetus for business planning was a persistent deficit in the annual operating fund since a merger of a stand-alone dental faculty with the Faculty of Medicine. The main challenges were to balance revenues with expenditures, to reduce expenditures without compromising quality of teaching, service delivery and research, to maintain adequate funding to ensure future competitiveness, and to repay the accumulated debt owed to the university. The business plan comprises key strategies in the areas of education, clinical practice and service, and research. One of the strategies for education was to start a BSc program in dental hygiene, which was accomplished in September 2000. In clinical practice, a key strategy was implementation of a clinic operations fee, which also occurred in September 2000. This student fee helps to offset the cost of clinical practice. In research, a key strategy has been to strengthen our emphasis on prevention technologies. In completing the business plan, we learned the importance of identifying clear goals and ensuring that the goals are reasonable and achievable; gaining access to high-quality data to support planning; and nurturing existing positive relationships with external stakeholders such as the provincial government and professional associations.
Seyed Kazem Malakouti
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.
Malakouti, Seyed Kazem; Nojomi, Marzieh; Poshtmashadi, Marjan; Hakim Shooshtari, Mitra; Mansouri Moghadam, Fariba; Rahimi-Movaghar, Afarin; Afghah, Susan; Bolhari, Jafar; Bazargan-Hejazi, Shahrzad
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. 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. We identified a higher prevalence of depressive disorders in the intervention site versus the control site (χ (2) = 14.8, P 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. 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.
Malakouti, Seyed Kazem; Nojomi, Marzieh; Poshtmashadi, Marjan; Hakim Shooshtari, Mitra; Mansouri Moghadam, Fariba; Rahimi-Movaghar, Afarin; Afghah, Susan; Bolhari, Jafar; Bazargan-Hejazi, Shahrzad
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 (χ 2 = 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. PMID:25648221
Full Text Available Background: Periodic epidemiological studies are necessary to understand the pattern of poisoning in each region. This study was designed to evaluate the pattern of acute poisoning cases treated in a tertiary care hospital in Navi Mumbai, India. Methods: This cross sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre during July 2012 to July 2013. All cases of poisoning admitted to the hospital were included in this study. The patients’ data were obtained from medical records and were documented on a pre-structured proforma. Results: A total of 74 cases of acute poisoning were studied, of which 51.4% were men. Most of the patients aged 20 to 29 years (44.6%. In majority of cases, the route of exposure to poison was oral (86.5%. Most of the patients reside in urban areas (52.7%. Most of the patients were Hindus (85.1% followed by Muslims (14.9%. The exposure mostly occurred between 6:00 pm to 12:00 am (30% of cases. The majority of poisonings (44.6% was due to consumption of household products followed by pesticides (14.9% and pharmaceutical agents (13.5%. Neurologic manifestations were the most common clinical findings (64.8% followed by gastrointestinal manifestations (37%. All patients were treated successfully with no mortality. There was a significant correlation between gender and intention of poisoning (P < 0.001, as the suicidal attempts were higher in women (69.4%. Moreover, a significant relationship existed between marital status and intention of poisoning (P = 0.016 as the suicidal poisonings were most common among married individuals (45.7%. Conclusion:The trend in poisoning is never static. Household products were identified as the main cause of poisoning in urban areas of India. Educational programs with more emphasis on preventive measures are necessary to create awareness among the general public. How to cite this article: Patil A, Peddawad R, Verma VCS, Gandhi H. Profile of Acute
... economically significant regulatory action, defined as one that would result in an annual effect of $100... policies that have federalism implications that would have substantial direct effects on the States, on the...(a). (D) In the case of a former spouse of a retiree whose marriage was dissolved after the member...
Walus, Ashley N; Woloschuk, Donna M M
Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research
Mullen, P D; Leifer, B H
To develop strong health education programs, health educators working in complex medical care organizations must often secure professional cooperation across disciplines, coordination of services, and orientation of policies, procedures, and personnel toward patient preferences and needs. Frequently, they undertake these tasks against the tide, within a problematic organizational structure. The present case study illustrates the difficulties posed by introducing change in medical care organizations in the context of an education program to acquaint employees of a large HMO with a consumer bill of rights mandated by the consumer Board of Trustees. The underlying assumption was that in a bureaucratic institution, an employee-centered and modest system reform strategy would be effective in bringing about client-centered outcomes-in this case, increased recognition of client rights. The case analysis and results of a post-intervention, cross-sectional survey suggest that in units where a threshold level of participation was reached, there were improvements in knowledge about the Bill and employee attitudes. The program was less successful with hospital nurses whose feelings about physicians were not taken into account fully, and with physicians whose relative lack of integration into the policy and managerial domains made them harder to reach.
Veluchamy, S; Alder, H C
Today's progressive hospital and health care system managers look to new ways to retain or augment their market share and to position themselves in their service areas. Since diffusion of new technologies into health care is market driven, informed decisions on the adoption of certain emerging patient care technologies can place a health care organization in a favorable financial position. There is a compelling need for hospital management and the governing board to collaborate with their medical staff on the development of an acceptable process to quickly identify and implement appropriate new technologies into the patient care environment. This joint effort is vital to ensure the integration of sound clinical values and objectives with planned institutional business strategies. Mount Carmel Health, a multifaceted health care corporation in central Ohio, has met the challenge of managing patient needs, physician interests, and limited hospital resources by forming a unique entity within the organization for the effective assessment and adoption of the latest medical technology. The division, which is called the Advanced Treatment and Bionics Institute (ATBI), is charged with assessing the latest clinical technologies and managing a hospital's adoption of the most appropriate ones. It serves to organize and streamline the identification, acquisition, adoption, and implementation of innovative treatment technologies at Mount Carmel hospitals.
Martin, Carolyn; Odell, Kevin; Cappelleri, Joseph C; Bancroft, Tim; Halpern, Rachel; Sadosky, Alesia
Pharmacy cost-saving programs often aim to reduce costs for members and payers by encouraging use of lower-tier or generic medications and lower-cost sales channels. In 2010, a national U.S. health plan began a novel pharmacy program directed at reducing pharmacy expenditures for targeted medications, including pregabalin. The program provided multiple options to avoid higher cost sharing: use mail order pharmacy or switch to a lower-cost alternative medication via mail order or retail. Members who did not choose any option eventually paid the full retail cost of pregabalin. To evaluate the impact of the pharmacy program on pregabalin and alternative medication use, health care costs, and health care utilization. This retrospective analysis of claims data included adult commercial health plan members with a retail claim for pregabalin in the first 13 months of the pharmacy program (identification [ID] period: February 1, 2010-February 28, 2011). Members whose benefit plan included the pharmacy program were assigned to the program cohort; all others were assigned to the nonprogram cohort. The program cohort index date was the first retail pregabalin claim during the ID period and after the program start; the nonprogram cohort index date was the first retail pregabalin claim during the ID period. All members were continuously enrolled for 12 months pre- and post-index and had at least 1 inpatient claim or ≥ 2 ambulatory visit claims for a pregabalin-indicated condition. Cohorts were propensity score matched (PSM) 1:1 with logistic regression on demographic and pre-index characteristics, including mail order and pregabalin use, comorbidity, health care costs, and health care utilization. Pregabalin, gabapentin and other alternative medication use, health care costs, and health care utilization were measured. The program cohort was also divided into 2 groups: members who changed to gabapentin post-index and those who did not. A difference-in-differences (Di
Full Text Available This article describes the medical, psychological, and social challenges encountered during home-based, family-centred palliative care of a 3-year-old female with secondary histiocytic sarcoma diagnosed during treatment for T-cell acute lymphoblastic leukaemia. Histiocytic sarcoma is an exceedingly rare cancer in adults, but even less frequent and highly aggressive when presenting as a secondary cancer in children. Comprehensive, multidisciplinary paediatric hospice care services are not widely available across Slovakia,thus limiting the number of patients and families offered such highly specialized end-of-life care. This case study illustrates the primary benefits for the child and family of such a program as well as the impact on the medical and nursing professionals working in the fi eld of paediatric haematology-oncology.
Kovacikova, Lubica; Zahorec, Martin; Skrak, Peter; Hanna, Brian D; Lee Vogel, R
Telemedicine is a rapidly evolving form of modern information and communication technology used to deliver clinical services and educational activities. The aim of this article is to report and analyze our experience with transatlantic consultation via videoconferencing in pediatric cardiology. In February, 2013, videoconferencing project was launched between a medium-volume pediatric cardiac center in Bratislava, Slovakia and subspecialty experts from a high-volume pediatric cardiac program at The Children's Hospital of Philadelphia (CHOP), USA. During 1.5-2 hours videoconferences, 2-3 patients with similar complex clinical scenarios were presented to CHOP experts. The main goal of the project was consultation on individual patients to validate, alter or radically change clinical management plans. From February, 2013 to January, 2017, 25 videoconferences occurred and 73 cases were discussed. The median patient age was 52 months (range; 1 day-30 years). Forty-six discussed cases were outpatients, 21 patients were in the intensive care unit and 6 patients were discussed post mortem. Thirty-one CHOP experts from different subspecialties participated actively in patient consultations. The most frequent recommendations were related to single ventricle, pulmonary hypertension or heart failure patients and intervention in complex and/or rare cardiac diseases. Specialists from CHOP agreed completely with the original care plan in 16% of cases. In 52% cases, adjustments to original plan were suggested. Radical changes were recommended in 30% of cases. Receiving institution adopted recommendations to the patient care fully in 79% and partially in 13% of patients. Based on our 4-year experience we consider videoconferencing between medium-size pediatric cardiac center and subspecialty experts from a high-volume pediatric cardiac program a suitable form of medical consultations. Videoconferencing assists in clinical decision making for complex patient cases and serves as an
Heusinger, Josefine; Hämel, Kerstin; Kümpers, Susanne
The future development of home care services for older people in need of care is associated with great challenges. This article begins with a brief summary of the most urgent care problems from the perspective of people requiring care and that of caring relatives. The problems exhibit social and spatial inequalities and are characterized by coordination problems within a fragmented organizational system. Calls for a viable "care mix" are nothing new but have recently gained considerable traction under the label of "caring communities". This model is prioritized by the German government and addressed in its Seventh Report on Older People (Altenbericht). It seeks to assign neighbors and unpaid volunteers a more central role in the provision of care and assistance. In relation to "caring communities" a differentiation between cure and care is also proposed. The article discusses this model and the assumptions about the potential of neighborhood and civic engagement upon which it is based, and analyzes its impact on the nursing profession. It concludes with a critical discussion of the model's prospects of contributing to a resolution of the outlined problems.
California has 12 county-owned and operated hospital systems and 5 University of California hospitals designated as public hospitals. These organizations deliver the majority of inpatient care and a significant amount of outpatient care to Medicaid patients in the state. In 2010, California was the first state in the nation to implement a five-year Delivery System Reform Incentive Payment (DSRIP) program under the Section §1115 Medicaid "Bridge to Reform" waiver to improve the capacity of these hospitals to deliver high quality and more efficient care. The California DSRIP was the first program in a continuing national initiative to reform the Medicaid delivery system while remaining budget neutral. An extensive evaluation revealed major advances in infrastructure development, delivery of health care, and patient outcomes during the program. The results highlight the importance of joint federal and state investments in bolstering the capacity of safety net providers to deliver high-quality care, and they emphasize the need for continued investment in the safety net. The California DSRIP was followed by a program called Public Hospital Redesign and Incentives in Medi-Cal (PRIME), which incentivizes improvements in expanded and new areas of care not addressed by DSRIP
Full Text Available 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.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.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.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.
Cnossen, Ingrid C; van Uden-Kraan, Cornelia F; Eerenstein, Simone E J; Jansen, Femke; Witte, Birgit I; Lacko, Martin; Hardillo, José A; Honings, Jimmie; Halmos, Gyorgy B; Goedhart-Schwandt, Noortje L Q; de Bree, Remco; Leemans, C René; Verdonck-de Leeuw, Irma M
The purpose of this study was to investigate the feasibility of an online self-care education program supporting early rehabilitation of patients after total laryngectomy (TLPs) and factors associated with satisfaction. Health care professionals (HCPs) were invited to participate and to recruit TLPs. TLPs were informed on the self-care education program "In Tune without Cords" (ITwC) after which they gained access. A study specific survey was used (at baseline T0 and postintervention T1) on TLPs' uptake. Usage, satisfaction (general impression, willingness to use, user-friendliness, satisfaction with self-care advice and strategies, Net Promoter Score (NPS)), sociodemographic, and clinical factors were analyzed. HCPs of 6 out of 9 centers (67% uptake rate) agreed to participate and recruited TLPs. In total, 55 of 75 TLPs returned informed consent and the baseline T0 survey and were provided access to ITwC (73% uptake rate). Thirty-eight of these 55 TLPs used ITwC and completed the T1 survey (69% usage rate). Most (66%) TLPs were satisfied (i.e., score ≥7 (scale 1-10) on 4 survey items) with the self-care education program (mean score 7.2, SD 1.1). NPS was positive (+5). Satisfaction with the self-care education program was significantly associated with (higher) educational level and health literacy skills (P = .004, P = .038, respectively). No significant association was found with gender, age, marital status, employment status, Internet use, Internet literacy, treatment modality, time since total laryngectomy, and quality of life. The online self-care education program ITwC supporting early rehabilitation was feasible in clinical practice. In general, TLPs were satisfied with the program.
Kakumanu, Sujani; Antos, Nicholas; Szefler, Stanley J; Lemanske, Robert F
Children with asthma require care that is seamlessly coordinated so that asthma symptoms are recognized and managed at home and at school. The purpose of this review is to discuss recent consensus recommendations in school-based asthma care. The School-based Asthma Management Program (SAMPRO) provides a widely endorsed framework to coordinate care with schools and consists of four components: establishing a circle of support around the child with asthma; facilitating bidirectional communication between clinicians and schools; comprehensive asthma education for schools; and assessment and remediation of environmental asthma triggers at school. SAMPRO standardizes recommendations for school-based asthma care coordination and provides a toolkit with websites and resources useful for the care of children with asthma in the school setting. The review will discuss the need for coordinated school asthma partnerships, the inception and development of SAMPRO, and its vision to improve pediatric asthma care coordination within the circle of support, comprising clinicians, school nurses, families, and communities.
Macleod Jana B
Full Text Available Abstract Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%. Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.
Lin, Haizhen; Prince, Jeffrey T
To assess three possible determinants of individuals' response in their private insurance purchases to the availability of the Partnership for Long-Term Care (PLTC) insurance program: bequest motives, financial literacy, and program awareness. The health and retirement study (HRS) merged with data on states' implementation of the PLTC program. Individual-level decision on private long-term care insurance is regressed on whether the PLTC program is being implemented for a given state-year, asset dummies, policy determinant variable, two-way and three-way interactions of these variables, and other controls, using fixed effects panel regression. Analysis used a sample between 50 and 69 years of age from 2002 to 2010, resulting in 12,695 unique individuals with a total of 39,151 observations. We find mild evidence that intent to bequest influences individual purchase of insurance. We also find that program awareness is necessary for response, while financial literacy notably increases responsiveness. Increasing response to the PLTC program among the middle class (the stated target group) requires increased efforts to create awareness of the program's existence and increased education about the program's benefits, and more generally, about long-term care risks and needs. © Health Research and Educational Trust.
Foebel, Andrea D; van Hout, Hein P; van der Roest, Henriëtte G; Topinkova, Eva; Garms-Homolova, Vjenka; Frijters, Dinnus; Finne-Soveri, Harriet; Jónsson, Pálmi V; Hirdes, John P; Bernabei, Roberto; Onder, Graziano
Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales. Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology. A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark. The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.
Juers, Alison; Wheeler, Margaret; Pascoe, Helen; Gregory, Nicola; Steers, Cheryl
In November 1999, the Queensland Health (QH) Transition to Practice Nurse Education Program - Intensive Care (TPNEP-IC) was initiated in QH Intensive Care Units (ICUs) across Queensland. This 12-month, state-wide, workplace based education program has set minimum standards for intensive care nursing education and therefore minimum standards for intensive care nursing practice in QH. In the 12 years of operation, 824 nurses have completed TPNEP-IC, 761 achieving academic credit status and 453 utilising this academic credit status to undertake postgraduate study in critical/intensive care nursing at three Queensland universities. These outcomes were achieved through the appointment of nurse educators within ICUs who, through a united and strong commitment to this state-wide approach formed collaborative professional networks, which resulted in the development, implementation and maintenance of the program. Furthermore, these networks enabled a framework of support for discussion and dissemination of evidence based practice, to endorse quality processes for TPNEP-IC and to nurture leadership potential among educators. Challenges to overcome included obtaining adequate resources to support all aspects of the program, gaining local management and administrative support, and embedding TPNEP-IC within ICU culture. The 12 years of operation of the program have demonstrated its long term sustainability. The program is being launched through a new blended learning approach utilising e-learning strategies. To capitalise on the current success, a strong commitment by all stakeholders will be required to ensure the ongoing sustainability of the program. Copyright © 2011 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
Kayemba, Christine Nalwadda; Sengendo, Hanifah Naamala; Ssekitooleko, James; Kerber, Kate; Källander, Karin; Waiswa, Peter; Aliganyira, Patrick; Guenther, Tanya; Gamache, Nathalie; Strachan, Clare; Ocan, Charles; Magumba, Godfrey; Counihan, Helen; Mbonye, Anthony K.; Marsh, David R.
Uganda's Ministry of Health, together with partners, has introduced integrated community case management (iCCM) for children under 5 years. We assessed how the iCCM program addresses newborn care in three midwestern districts through document reviews, structured interviews, and focus group discussions with village health team (VHT) members trained in iCCM, caregivers, and other stakeholders. Almost all VHT members reported that they refer sick newborns to facilities and could identify at least three newborn danger signs. However, they did not identify the most important clinical indicators of severe illness. The extent of compliance with newborn referral and quality of care for newborns at facilities is not clear. Overall iCCM is perceived as beneficial, but caregivers, VHTs, and health workers want to do more for sick babies at facilities and in communities. Additional research is needed to assess the ability of VHTs to identify newborn danger signs, referral compliance, and quality of newborn treatment at facilities. PMID:23136277
Cruz-Oliver, Dulce M; Bernacki, Rachelle; Cooper, Zara; Grudzen, Corita; Izumi, Seiko; Lafond, Deborah; Lam, Daniel; LeBlanc, Thomas W; Tjia, Jennifer; Walter, Jennifer
There is a pressing workforce shortage and leadership scarcity in palliative care to adequately meet the demands of individuals with serious illness and their families. To address this gap, the Cambia Health Foundation launched its Sojourns Scholars Leadership Program in 2014, an initiative designed to identify, cultivate, and advance the next generation of palliative care leaders. This report intends to summarize the second cohort of Sojourns Scholars' projects and their reflection on their leadership needs. This report summarizes the second cohort of sojourns scholars' project and their reflection on leadership needs. After providing a written reflection on their own projects, the second cohort participated in a group interview (fireside chat) to elicit their perspectives on barriers and facilitators in providing palliative care, issues facing leadership in palliative care in the United States, and lessons from personal and professional growth as leaders in palliative care. They analyzed the transcript of the group interview using qualitative content analysis methodology. Three themes emerged from descriptions of the scholars' project experience: challenges in palliative care practice, leadership strategies in palliative care, and three lessons learned to be a leader were identified. Challenges included perceptions of palliative care, payment and policy, and workforce development. Educating and collaborating with other clinicians and influencing policy change are important strategies used to advance palliative care. Time management, leading team effort, and inspiring others are important skills that promote effectiveness as a leader. Emerging leaders have a unique view of conceptualizing contemporary palliative care and shaping the future. Providing comprehensive, coordinated care that is high quality, patient and family centered, and readily available depends on strong leadership in palliative care. The Cambia Scholars Program represents a unique opportunity.
The report evaluates a carpooling program in operation in the Boston, Massachusetts area from August, 1973 through August, 1974. The program, entitled the WBZ/ALA Commuter Computer Campaign, was the first program in the nation to promote and organize...
Baldor, R A; Luckmann, R
Declining hospitalization rates for children and an increased emphasis on ambulatory care may be affecting the way family practice residency programs train their residents in the care of children. We surveyed all US family practice residency program directors to determine the nature of the child care training that programs currently provide to residents. Responses were received from 78% of the programs. Residencies required a mean of 5.2 months of formal pediatric training (range: 1 to 11 months). Thirty percent of programs noted a declining inpatient census on inpatient pediatric teaching services, but since 1978, the mean duration of inpatient pediatric training increased by 0.4 months to a required mean of 2.7 months of general pediatric inpatient training (range: 0 to 6 months). The mean time devoted to structured outpatient pediatric training was only 1.6 months (range: 0 to 6 months). Nine percent of responding programs required no formal pediatric outpatient training other than family health center experience. Despite declining inpatient census and increased emphasis on comprehensive ambulatory care, family practice residencies require more formal inpatient pediatric training than formal outpatient training.
Ohsawa, Tomoji; Shimazoe, Takao
Due to the progression of aging in Japan, pharmacists need to participate in home medical care. To enable pharmacists with no previous experience to participate in home medical care of patients with various diseases in the home environment, it is necessary to adopt an approach of training them in advance. It is thought useful for such clinical training to include patient case studies, which may facilitate the training of pharmacists for home medical care through simulated experience. "The working group to create home clinical cases for education" was launched by a group of university faculty, who have educational knowledge, and trained pharmacists who work with the patients at home. The home care cases were compiled by the university faculty members and the home care practice pharmacists. Working pharmacists and students at pharmaceutical college studied the same case studies of home medical care, and their self-evaluations were compared. They showed that the students rated themselves higher than the pharmacists. One of the reasons was the systematic education of the case studies. The clinical case studies are a good educational tool to promote home care medicine in pharmacies and university pharmaceutical colleges.
Yoshioka, Saori; Moriyama, Michiko; Ohno, Yumiko
This study aimed to examine effectiveness of the End-of-life nursing care continuing education program for general ward nurses. A nonrandomized, before-after trial was conducted. The program was implemented for 25 nurses. The contents of the program consisted of the family assessment, general symptom management and practical use of theories and models regarding end-of-life nursing care. The primary outcome, implementation ability of end-of-life nursing care, was significantly improved after the program; improvements continued even at 2 months after. Similar results were obtained for nurses' confidence and knowledge concerning end-of-life nursing care. As for attitude toward end-of-life care, participants' scores were further elevated after the program. The participants rated the usefulness of the program as high. The effectiveness of the program was suggested from these results. In the future, this program should be widely used for in-service training. © The Author(s) 2013.
Canadian public officials are demanding that prisons segregate HIV-positive individuals and require mandatory HIV testing similar to the procedures used in correctional institutions in the United States. These measures have been consistently rejected as ineffective and punitive in Canada. The commissioner of the Correctional Service of Canada (CSC) does not consider forced testing or segregation as a useful part of their HIV/AIDS strategy. The issue raises concerns about prisoners' rights. Proponents of segregation say that creating specialized care units in some Federal institutions would guarantee state-of-the-art care; others charge that it is an admission of substandard care throughout the system. Voluntary segregation forces prisoners to choose between health care and proximity to family. It also deters voluntary testing, as some prisoners will decline testing if they do not want to be moved to another facility. Segregation stigmatizes everyone associated with an institution that has a specialized care unit. There are also problems associated with combining prisoners of varying security levels in the same unit. Compassionate release is preferable to segregation.
Rissi, Jill Jamison; Gelmon, Sherril; Saulino, Evan; Merrithew, Nicole; Baker, Robin; Hatcher, Paige
Health system reform is largely dependent upon the transformation of primary care in addition to the alignment of incentives that mediate the allocation of resources. The Patient-Centered Medical Home (PCMH) is a model of enhanced primary care that encourages coordination, patient-centered care, integration of public health services, and innovative methods for improving population health-all critical elements of health system reform. Because it changes the way primary care is organized and delivered, the PCMH model has been adopted as a foundational component of Oregon's health system transformation. This article presents insights drawn from an evaluation of the implementation of Oregon's Patient-Centered Primary Care Home (PCPCH) program and the adoption of the model by primary care providers. We used a mixed-methods approach consisting of 2 surveys of recognized PCPCH practices, qualitative document analysis, and key informant interviews. Evaluation research findings were triangulated with findings from PCPCH clinic site visits conducted as part of a regulatory verification process. Survey results describe a broad range of strategies and practices adopted by recognized PCPCH clinics within 6 defined core attributes: (1) access to care; (2) accountability; (3) comprehensive whole-person care; (4) continuity; (5) coordination and integration; and (6) person- and family-centered care. We also identify 4 key factors that influenced the conceptualization, development, and implementation of the PCPCH program: (1) support and motivations; (2) administrative barriers and resource constraints; (3) alignment of short- and long-term financial incentives; and (4) leadership and interpersonal relationships. This evaluation provides insights into the factors that influence implementation of a primary care home program as public policy; the strategies and challenges associated with implementation of the model; and the implications of both for other states that are engaged in
Rothman, David J; Blackwood, Kristy L; Adair, Whitney; Rothman, Sheila M
To evaluate the Washington State Health Technology Assessment Program (WHTAP). Washington State Health Technology Assessment Program proceedings in Seattle, Washington. We assessed the program through observation of its proceedings over a 5-year period, 2009-2014. We conducted detailed analyses of the documents it produced and reviewed relevant literature. Washington State Health Technology Assessment Program is unique compared to other state and federal programs. It has successfully applied evidence-based medicine to health care decision making, limited by the strength of available data. It claims cost savings, but they are not substantiated. Washington State Health Technology Assessment Program is a useful model for other states considering implementation of technology assessment programs. We provide key lessons for improving WHTAP's process. © Health Research and Educational Trust.
Dermody, Sarah M; Gao, William; McGinn, Johnathan D; Malekzadeh, Sonya
Objective (1) Evaluate the consistency and manner in which otolaryngology residents log surgical cases. (2) Assess the extent of instruction and guidance provided by program directors on case-logging practices. Study Design Cross-sectional national survey. Setting Accreditation Council for Graduate Medical Education otolaryngology residency programs in the United States. Subjects and Methods US otolaryngology residents, postgraduate year 2 through graduating chiefs as of July 2016, were recruited to respond to an anonymous questionnaire designed to characterize surgical case-logging practices. Program directors of US otolaryngology residency programs were recruited to respond to an anonymous questionnaire to elucidate how residents are instructed to log cases. Results A total of 272 residents and 53 program directors completed the survey, yielding response rates of 40.6% and 49.5%, respectively. Perceived accuracy of case logs is low among residents and program directors. Nearly 40% of residents purposely choose not to log certain cases, and 65.1% of residents underreport cases performed. More than 80% of program directors advise residents to log procedures performed outside the operating room, yet only 16% of residents consistently log such cases. Conclusion Variability in surgical case-logging behaviors and differences in provided instruction highlight the need for methods to improve consistency of logging practices. It is imperative to standardize practices across otolaryngology residency programs for case logs to serve as an accurate measure of surgical competency. This study provides a foundation for reform efforts within residency programs and for the Resident Case Log System.
Shriver, C., Hooke, J., & Liebman, M. "Bayesian and Non-Bayesian Computational Analyses of Heterogeneity in Breast Disease, A Case Study in Datamining ...J., & Liebman, M. "Bayesian and Non-Bayesian Computational Analyses of Heterogeneity in Breast Disease, A Case Study in Datamining Clinical Records
Vasquez, Elias Provencio; Pitts, Kathleen; Mejia, Nilson Enrique
Perinatal drug exposure costs our communities millions of dollars each year in hospital fees and in services such as foster care, child protection, and drug treatment. Infants and their families in this group require substantial long-term health care and community resources. Neonatal health care providers should take an active role in developing and implementing home visitation programs to support early hospital discharge and continuity of care for these high-risk infants and their families. Neonatal nurse practitioners should prepare in the future to practice not only in secondary-- and tertiary--level neonatal centers, but also in follow-up clinics, long-term developmental centers, and the community This article describes a home intervention program delivered by neonatal nurse practitioners for high-risk infants and their mothers. The target population is infants exposed prenatally to drugs and/or alcohol.
Power, Thomas J.; Blum, Nathan J.; Guevara, James P.; Jones, Heather A.; Leslie, Laurel K.
Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual…
... HUMAN SERVICES Health Resources and Services Administration Legislative Changes to Primary Care Loan... Care Act (ACA), Public Law 111-148. Section 5201 of the ACA changes the Primary Care Loan (PCL) program by: (1) Reducing the number of years for the primary health care service requirement; (2) lowering...
van der Plas, A.G.M.; Vissers, K.C.; Francke, A.L.; Donker, G.A.; Jansen, W.J.J.; Deliens, L.; Onwuteaka-Philipsen, B.D.
Background Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. Objectives To
Plas, A.G.M. van der; Visser, K.C.; Francke, A.L.; Donker, G.A.; Jansen, W.J.J.; Deliens, L.; Onwuteaka-Philipsen, B.D.
Background: Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. Objectives: To
Plas, A.G. van der; Vissers, K.C.P.; Francke, A.L.; Donker, G.A.; Jansen, W.J.; Deliens, L.; Onwuteaka-Philipsen, B.D.
BACKGROUND: Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. OBJECTIVES: To
... foster care maintenance cases. 302.52 Section 302.52 Public Welfare Regulations Relating to Public... Distribution of support collected in Title IV-E foster care maintenance cases. Effective October 1, 1984, the... collected in foster care maintenance cases shall be treated in accordance with the provisions of § 302.51(a...