WorldWideScience

Sample records for care program population

  1. Medicine and health care along the Silk Road. China's population control program among the national minorities.

    Science.gov (United States)

    Cheng, T O

    1985-01-01

    Travel along the Silk Road where many of China's national minorities live gives a new insight into the population growth problem. As a whole China's "one-child-for-one-family" campaign seems to have succeeded in controlling its national population, although the government takes a more liberal attitude toward the national minorities.

  2. Improving Diabetes Care in the Latino Population: The Emory Latino Diabetes Education Program

    Science.gov (United States)

    Rotberg, Britt; Greene, Rachel; Ferez-Pinzon, Anyul M.; Mejia, Robert; Umpierrez, Guillermo

    2016-01-01

    Background: The incidence of diabetes in Latinos is 12.8% compared to 9.3% of the general population. Latinos suffer from a higher prevalence of diabetic complications and mortality than whites yet receive less monitoring tests and education. Purpose: (1) Identify changes in clinical indicators among subjects with type 2 diabetes participating in…

  3. Quality of life and its association with cardiovascular risk factors in a community health care program population

    Directory of Open Access Journals (Sweden)

    Luiz Mário Baptista Martinelli

    2008-01-01

    Full Text Available OBJECTIVE: To evaluate quality of life in a population that attended a specific community event on health care education, and to investigate the association of their quality of life with the presence of cardiovascular risk factors INTRODUCTION: Interest in health-related quality of life is growing worldwide as a consequence of increasing rates of chronic disease. However, little is known about the association between quality of life and cardiovascular risk factors. METHODS: This study included 332 individuals. Demographics, blood pressure, body mass index, and casual glycemia were evaluated. The brief version of the World Health Organization Quality of Life questionnaire on quality of life was given to them. The medians of the scores obtained for the physical, psychological, emotional, and environmental domains were used as cutoffs to define "higher" and "lower" scores. A multinomial logistic regression model was used to define the parameters associated with lower scores. RESULTS: Diabetes mellitus, dyslipidemia, and obesity were associated with lower scores in the physical domain. Dyslipidemia was also associeted with lower scores in the psychological domain. Male gender and regular physical activity had protective effects on quality of life. Aging was inversely associated with decreased quality of life in the environmental domain. CONCLUSION: The presence of cardiovascular risk factors is related to a decreased quality of life. Conversely, male gender and regular physical activity had protective effects on quality of life. These findings suggest that exercising should be further promoted by health-related public programs, with a special focus on women.

  4. The residency program in social medicine of Montefiore Medical Center: 37 years of mission-driven, interdisciplinary training in primary care, population health, and social medicine.

    Science.gov (United States)

    Strelnick, A H; Swiderski, Debbie; Fornari, Alice; Gorski, Victoria; Korin, Eliana; Ozuah, Philip; Townsend, Janet M; Selwyn, Peter A

    2008-04-01

    Founded in 1970 to train physicians to practice in community health centers and underserved areas, the Residency Program in Social Medicine (RPSM) of Montefiore Medical Center, Bronx, New York, has graduated 562 board-eligible family physicians, general internists, and pediatricians whose careers fulfill this mission. The RPSM was a model for federal funding for primary care residency programs and has received Title VII grants during most of its history. The RPSM has tailored its mission and structured its curriculum to promote a community and population orientation and to provide the requisite knowledge and skills for integrating social medicine into clinical practice. Six unique hallmarks of RPSM training are (1) mission-oriented resident recruitment/selection and self-management, (2) interdisciplinary collaborative training among primary care professionals, (3) community-health-center-based and community-oriented primary care education, (4) biopsychosocial and ecological family systems curriculum, (5) the social medicine core curriculum and projects, and (6) grant support through Title VII. These hallmark curricular, training, and funding elements, in which population health is deeply embedded, have been carefully evaluated, regularly revised, and empirically validated since the program's inception. Practice outcomes for RPSM graduates as leaders in and advocates for population health and the care of underserved communities are described and discussed in this case study.

  5. Relics: penguin population programs.

    Science.gov (United States)

    Sun, L; Xie, Z

    2001-01-01

    What has been responsible for the increase in Chinstrap penguin populations during the past 40 years in maritime Antarctica? One view ascribes it to an increase in availability of their prey brought on by the decrease in baleen whale stocks. The contrary opinion, attributes it to environmental warming. This causes a gradual decrease in the frequency of cold years with extensive winter sea ice cover. A number of penguin monitoring programs are in progress and are expected to provide some answers to these questions. Unfortunately, it is not easy to distinguish natural variability from anthropogenic change since penguins are easily accessible predators of krill and the feeding range of the penguins has almost overlapped with the krill fishery in time and space in the last four decades. Therefore it is important to reconstruct the change of ancient penguin abundance and distribution in the absence of human activity. Many efforts have focused on surveying the abandoned penguin rookeries, but this method has not been able to give a continuous historical record of penguin populations. In several recent studies, ancient penguin excreta was scooped from the penguin relics in the sediments of the lake on penguin rookery, Ardley Island, maritime Antarctica. In these studies, penguin droppings or guano soil deposited in the lake and changes in sediment geochemistry have been used to calculate penguin population changes based upon the geochemical composition of the sediment core. The results suggest that climate change has a significant impact on penguin populations.

  6. The Second Annual Primary Care Conference--Programming to eliminate health disparities among ethnic minority populations: an introduction to proceedings.

    Science.gov (United States)

    Heisler, Michael; Blumenthal, Daniel S; Rust, George; Dubois, Anne M

    2003-01-01

    From October 31, 2002 through November 2, 2002, the Second Annual Primary Care Conference was held, sponsored by the Morehouse School of Medicine's National Center for Primary Care and its Prevention Research Center. The conference was designed as a collaborative activity with the Atlanta Regional Health Forum; The Carter Center; Emory University's School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Georgia Chapter of the American College of Physicians/American Society of Internal Medicine; Georgia Nurses Foundation; Southeastern Primary Care Consortium, Inc./Atlanta Area Health Education Center; St. Joseph's Mercy Care Services; United States Department of Health and Human Services: Agency for Healthcare Research and Quality; Centers for Disease Control and Prevention; Health and Human Services (Region IV); Health Resources and Services Administration; Office of Minority Health (Region IV); and Office on Women's Health (Region IV). The 2 and a half-day conference featured 5 plenary sessions and 3 tracks of medical education for primary care physicians and other healthcare providers. The tracks were categorized as: Track A: Adult Health; Track B: Public Health and Prevention; and Track C: Maternal/Child/Youth Health. Within each track, 6 working sessions were presented on topic areas including diabetes, obesity, cardiovascular disease, cancer, mental health, infectious disease, behavioral and social health, women's health, stroke, and asthma. A total of 18 working sessions took place and each working session included 3 presentations. Continuing medical education credits or continuing education units were granted to participants. In all, 485 individuals participated in the conference, with the majority of the participants from the southeastern United States. Of the attendees, 35% were physicians (MD); 13% were nurses (RN); 12% held master-level degrees; and 12% held other doctorate-level degrees.

  7. Toward population management in an integrated care model.

    Science.gov (United States)

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

    2013-01-01

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

  8. Primary care NPs: Leaders in population health.

    Science.gov (United States)

    Swartwout, Kathryn D

    2016-08-18

    A 2012 Institute of Medicine report calls primary and public healthcare workers to action, tasking them with working together to improve population health outcomes. A Practical Playbook released in 2014 enables this public health/primary care integration. Primary care NPs are in an excellent position to lead the charge and make this integration happen.

  9. Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care

    Science.gov (United States)

    Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care, a 2010 workshop sponsored by the Epidemiology and Genomics Research Program.

  10. Breast Cancer Screening in a Low Income Managed Care Population

    Science.gov (United States)

    1998-10-01

    the morbidity and mortality of breast cancer among the population of low income women who have incomes less than 200% of the national poverty level...34Journal for Health Care for the Poor and Underserved" (see appendix). Entitled "Difficulty in Reaching Low Income Women for Screening Mammography...useful insights for future program planning and research design. Keywords: screening mammography, low income , managed care and barriers Poverty is

  11. Population Growth: Family Planning Programs.

    Science.gov (United States)

    Doberenz, Alexander R., Ed.; Taylor, N. Burwell G., Ed.

    These proceedings of the second annual symposium on population growth bring together speeches and panel discussions on family planning programs. Titles of speeches delivered are: Communicating Family Planning (Mrs. Jean Hutchinson); Effects of New York's Abortion Law Change (Dr. Walter Rogers); The Law and Birth Control, Sterilization and Abortion…

  12. Quality of Care in Family Planning Program in China

    Institute of Scientific and Technical Information of China (English)

    Zhen-ming XIE; Hong-yan LIU

    2006-01-01

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

  13. The Nordic maintenance care program

    DEFF Research Database (Denmark)

    Malmqvist, Stefan; Leboeuf-Yde, Charlotte

    2009-01-01

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

  14. HIV care for geographically mobile populations.

    Science.gov (United States)

    Taylor, Barbara S; Garduño, L Sergio; Reyes, Emily V; Valiño, Raziel; Rojas, Rita; Donastorg, Yeycy; Brudney, Karen; Hirsch, Jennifer

    2011-01-01

    The interaction between geographic mobility and risk for human immunodeficiency virus infection is well recognized, but what happens to those same individuals, once infected, as they transition to living with the infection? Does mobility affect their transition into medical care? If so, do mobile and nonmobile populations achieve similar success with antiretroviral treatment? The definition of mobility has changed over the centuries to encompass a complex phenotype including permanent migration, frequent travel, circular migration, and travel to and from treatment centers. The heterogeneity of these definitions leads to discordant findings. Investigations show that mobility has an impact on infection risk, but fewer data exist on the impact of geographic mobility on medical care and treatment outcomes. This review will examine existing data regarding the impact of geographic mobility on access to and maintenance in medical care and on adherence to antiretroviral therapy for those living with human immunodeficiency virus infection. It will also expand the concept of mobility to include data on the impact of the distance from residence to clinic on medical care and treatment adherence. Our conclusions are that the existing literature is limited by varying definitions of mobility and the inherent oversimplification necessary to apply a "mobility measure" in a statistical analysis. The impact of mobility on antiretroviral treatment outcomes deserves further exploration to both define the phenomenon and target interventions to these at-risk populations.

  15. Shared Heritage: An Intergenerational Child Care Program.

    Science.gov (United States)

    Hawkeye Area Community Action Program, Cedar Rapids, IA.

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

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

    Science.gov (United States)

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

    2013-03-01

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

  17. The Nordic maintenance care program

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  18. Public dental health care program for persons with disability

    DEFF Research Database (Denmark)

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

    2005-01-01

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

  19. Long-Term Care Ombudsman Program

    Science.gov (United States)

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

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

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-04-01

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

  1. A multilingual population health management program.

    Science.gov (United States)

    Tsui, Edison W; Wang, Grace; Zahler, Abbie; Simoyan, Olapeju M; White, Mark V; Mckee, Michael

    2013-01-01

    Many small- and medium-sized physician practices have developed specific programs and models toward becoming a successful patient-centered medical home. This article reports on a case-control quality improvement study of a multilingual population health management program for chronic disease management at International Community Health Services. In its first 2.5 years of operation, the International Community Health Services Population Health Management program for patients with hypertension and diabetes is associated with significant improvements in key health outcome measures for blood pressure and hemoglobin A1c control. This has significant implications for similar practices.

  2. [Health care expenditures and the aging population].

    Science.gov (United States)

    Felder, S

    2012-05-01

    The impact of a longer life on future health care expenditures will be quite moderate because of the high costs of dying and the compression of mortality in old age. If not age per se but proximity to death determines the bulk of expenditures, a shift in the mortality risk to higher ages will not significantly affect lifetime health care expenditures, as death occurs only once in every life. A calculation of the demographic effect on health care expenditures in Germany up until 2050 that explicitly accounts for costs in the last years of life leads to a significantly lower demographic impact on per-capita expenditures than a calculation based on crude age-specific health expenditures.

  3. Program management of telemental health care services.

    Science.gov (United States)

    Darkins, A

    2001-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jann Paquette-Warren

    2006-10-01

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

  5. Teaching nurses to focus on the health needs of populations: a Master's Degree Program in Population Health Nursing.

    Science.gov (United States)

    Frisch, Noreen Cavan; George, Valerie; Govoni, Amy L; Jennings-Sanders, Andrea; McCahon, Cheryl P

    2003-01-01

    Responding to the mandate to prepare nurses for practice in population-based healthcare, the faculty at Cleveland State University (CSU) developed a unique Master of Science in Nursing program to prepare Population Health Nurse Experts. The program prepares nurses to examine the health status of populations and to design, implement, and evaluate nursing interventions accounting for the varied factors impacting on the health of a defined group. The speciality of population health nursing is practiced by nurses who can use population sciences (epidemiology, demography, population projections, and population behavioral theories) along with post-baccalaureate nursing competencies to work with defined populations across care environments. The authors discuss a curriculum that prepares nurses for this emerging speciality.

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

    Stephens, Samuel A.

    2016-01-01

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

  8. Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh

    Directory of Open Access Journals (Sweden)

    Ali Mohammed

    2011-10-01

    Full Text Available Abstract Background Poor neonatal health is a major contributor to under-five mortality in developing countries. A major constraint to effective neonatal survival programme has been the lack of population level data in developing countries. This study investigated the consultation patterns of caregivers during neonatal fatal illness episodes in the rural Matlab sub-district of eastern Bangladesh. Methods Neonatal deaths were identified through a population-based demographic surveillance system in Matlab ICDDR,B maternal and child health (MCH project area and an adjoining government service area. Trained project staff administered a structured questionnaire on care seeking to mothers at home who had experienced a neonatal death. Univariate, bivariate and binary multivariate logistic regressions were performed to describe care seeking during the fatal illness episode. Results Of the 365 deaths recorded during 2003 and 2004, 84% died in the early (0-7 days neonatal period, with the remaining deaths occurring over the subsequent 8 to 28 days. The first resort of care by parents was a qualified doctor or paramedic in 37% of cases, followed by traditional and unqualified health care providers in 25%, while 38% sought no care. Thus, almost two thirds (63% of neonates who died received only traditional and unqualified care or no care at all during their final illness episode. About 22% sought care from more than one provider, including 6% from 3 or more providers. Such plurality in care seeking was more likely among male infants, in the late neonatal period, and in the MCH project area. Conclusions The high proportion of neonatal deaths that had received traditional care or no medical care in a rural area of Bangladesh highlights the need to develop community awareness about prompt medical care seeking for neonatal illnesses and to improve access to effective health care. Integration of traditional care providers into mainstream health programs should

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

    OpenAIRE

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

    2010-01-01

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

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

    Science.gov (United States)

    Parker, Michael D.

    1989-01-01

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

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

    Science.gov (United States)

    Khan-Mayberry, Noreen; Bassett, Stephanie

    2010-01-01

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

  12. Integrated population-development program performance: the Malaysian Felda experience.

    Science.gov (United States)

    Fong, C O

    1985-01-01

    Program performance of the Malaysian Felda program, an integrated population development program, is examined in this report. It also evaluates the relationship of the performance of this program with its organizational, integrational, and community support factors. Starting in 1956, Felda had, by the end of 1981, developed 308 land schemes covering an area of 1.4 million acres planted predominantly with oil palm (59.4%) and rubber (31.6%). The land schemes have settled a total of 70,600 families or over 400,000 people. The integrated programs existing in the Felda schmes are the focus of analysis for this study. Out of the universe of 308 Felda schemes, 26 schemes were randomly selected for the study. In each scheme, 2 surveys were conducted: first, the staff surveys to gather information on the organizational factors and extent of integration in existence in the scheme and then household surveys to gather information on the extent of community support for the integrated program and the performance of the program. In the case of the performance variables, the information gathered from the household survey was supplemented by the records from the Felda scheme office. In the sample of 26 schemes, a total of 1641 settler households were selected for the household survey and 363 staff were selected for the staff survey. The surveys were conducted in the 1st quarter of 1982. The results indicate that the Felda mode of delivering population and community development services has been very effective. Over 55.2% of the eligible women were found to be practicing family planning (compared to about 35.5% for the national rural average), while over 78.9% of the eligible women utilized postnatal health care facilities. About 1 in 3 of the eligible children in Felda schemes attend kindergarten classes, while over 46.9% of the Felda households are involved in some form of extramural income generating activities. The more integrated the program in a particular community, the more

  13. Commentary: educating the present and future health care workforce to provide care to populations.

    Science.gov (United States)

    Garr, David R; Margalit, Ruth; Jameton, Andrew; Cerra, Frank B

    2012-09-01

    The crisis of the rising cost of health care in the United States is stimulating major changes in the way care is being delivered. New models such as patient-centered medical homes and accountable care organizations are being developed with the expectation that health care professionals will address and improve the health of populations. Electronic health records and interprofessional teams will be critical to achieving the goal of better health. It is now time to bring together educators and clinicians at academic health centers, public health educators and practitioners, along with researchers, representatives from the health care delivery and financing systems, and community partners to reengineer health professions education to prepare health professions students for the health care system of the future.

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

    Directory of Open Access Journals (Sweden)

    Seekles Wike

    2009-06-01

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

  15. Understanding Panel Management: A Comparative Study of an Emerging Approach to Population Care

    Science.gov (United States)

    Neuwirth, Esther (Estee) B; Schmittdiel, Julie A; Tallman, Karen; Bellows, Jim

    2007-01-01

    Context: Panel management is an innovative approach for population care that is tightly linked with primary care. This approach, which is spreading rapidly across Kaiser Permanente, represents an important shift in population-care structure and emphasis, but its potential and implications have not been previously studied. Objective: To inform the ongoing spread of panel management by providing an early understanding of its impact on patients, physicians, and staff and to identify barriers and facilitators. Design: Qualitative studies at four sites, including patient focus groups, physician and staff interviews, and direct observation. Findings: Panel management allows primary care physicians to use dedicated time to direct proactive care for their patients, uses staff support to conduct outreach, and leverages new panel-based information technology tools. Patients reported appreciating the panel management outreach, although some also reported coordination issues. Two of four study sites seemed to provide a more coordinated patient experience of care; factors common to these sites included longer maturation of their panel management programs and a more circumscribed role for outreach staff. Some physicians reported tension in the approach's implementation: All believed that panel management improved care for their patients but many also expressed feeling that the approach added more tasks to their already busy days. Challenges yet to be fully addressed include providing program oversight to monitor for safe and reliable coordination of care and incorporation of self-management support. Conclusion: Subsequent spread of panel management should be informed by these lessons and findings from early adopters and should include continued monitoring of the impact of this rapidly developing approach on quality, patient satisfaction, primary care sustainability, and cost. PMID:21461107

  16. Population ageing and its implications on aggregate health care demand: empirical evidence from 22 OECD countries.

    Science.gov (United States)

    Palangkaraya, Alfons; Yong, Jongsay

    2009-12-01

    Recent evidence indicates that the relationship between age and health care expenditure is not as straightforward as it appears. In fact, micro-level studies find that time to death, rather than ageing, is possibly the main driver of the escalating health care costs in developed countries. Unfortunately, the evidence at the macro level is less clear and often depends on the specification of the empirical model used. We use an aggregate demand framework to assess whether health expenditure is more likely to be driven by ageing per se or proximity to death. Using panel data from 22 OECD countries from the first half of the 1990s, we find population ageing to be negatively correlated with health expenditure once proximity to death is accounted for. This suggests that the effects of ageing on health expenditure growth might be overstated while the effects of the high costs of medical care at the end of life are potentially underestimated. With respect to the latter, our finding highlights the importance of long-term and hospice care management. An expanded long-term care program may not only improve patient welfare, but also reduce costs of care by reducing the duration of hospital care for terminally ill patients. If expensive medical treatment for patients near the end of life can be controlled for, health expenditure growth resulting from population ageing is unlikely to present a most serious problem.

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

    Science.gov (United States)

    Blank, Jerome W.; Popovich, Nicholas G.

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

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

    Science.gov (United States)

    Martini, Gilbert R., Jr.

    1991-01-01

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

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

    Science.gov (United States)

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

    2012-09-01

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

  20. Patient satisfaction with nursing care in a colorectal surgical population.

    Science.gov (United States)

    Lumby, J; England, K

    2000-06-01

    This paper describes one arm of a much larger, multi-site study whose hypothesis was that evidence-based nursing practice is more effective than routine nursing care in improving patient outcomes and health gain. This arm of the study investigated patient satisfaction as an outcome measure for those patients undergoing colorectal surgery. The study's relevance for nurses is in the potential feedback for reviewing nursing practice and health care delivery. Patient satisfaction with nursing care was measured through a validated questionnaire, the SERVQUAL, followed by interviews with a percentage of the study population. The results of this arm of the study confirm the importance of measuring patient satisfaction through a triangulated method which investigates thoroughly, providing feedback for continuous quality improvement. The in-depth interviews provided greater insight into the results of the questionnaire, enabling clear feedback to nursing staff at the different sites of the study. Results of the questionnaire revealed age, sex and education levels of patients as major influences on individual perceptions of nursing care. Patients whose surgery resulted in stomas were also less satisfied with health-care delivery.

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

    Science.gov (United States)

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

    2016-07-15

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

  2. Burden of acute gastroenteritis, norovirus and rotavirus in a managed care population.

    Science.gov (United States)

    Karve, Sudeep; Krishnarajah, Girishanthy; Korsnes, Jennifer S; Cassidy, Adrian; Candrilli, Sean D

    2014-01-01

    This study assessed and described the episode rate, duration of illness, and health care utilization and costs associated with acute gastroenteritis (AGE), norovirus gastroenteritis (NVGE), and rotavirus gastroenteritis (RVGE) in physician office, emergency department (ED), and inpatient care settings in the United States (US). The retrospective analysis was conducted using an administrative insurance claims database (2006-2011). AGE episode rates were assessed using medical (ICD-9-CM) codes for AGE; whereas a previously published "indirect" method was used in assessing estimated episode rates of NVGE and RVGE. We calculated per-patient, per-episode and total costs incurred in three care settings for the three diseases over five seasons. For each season, we extrapolated the total economic burden associated with the diseases to the US population. The overall AGE episode rate in the physician office care setting declined by 15% during the study period; whereas the AGE episode rate remained stable in the inpatient care setting. AGE-related total costs (inflation-adjusted) per 100 000 plan members increased by 28% during the 2010-2011 season, compared with the 2006-2007 season ($832,849 vs. $1 068 116) primarily due to increase in AGE-related inpatient costs. On average, the duration of illness for NVGE and RVGE was 1 day longer than the duration of illness for AGE (mean: 2 days). Nationally, the average AGE-related estimated total cost was $3.88 billion; NVGE and RVGE each accounted for 7% of this total. The episodes of RVGE among pediatric populations have declined; however, NVGE, RVGE and AGE continue to pose a substantial burden among managed care enrollees. In conclusion, the study further reaffirms that RVGE has continued to decline in pediatric population post-launch of the rotavirus vaccination program and provides RVGE- and NVGE-related costs and utilization estimates which can serve as a resource for researchers and policy makers to conduct cost

  3. Underutilization of palliative care services in the liver transplant population

    Science.gov (United States)

    Kathpalia, Priya; Smith, Alexander; Lai, Jennifer C

    2016-01-01

    AIM To evaluate use of palliative care services in patients with end-stage liver disease who do not have access to liver transplant. METHODS Evaluated were end-stage liver disease patients who were removed from the liver transplant wait-list or died prior to transplant at a single transplant center over a 2-year period. Those who were removed due to noncompliance or ultimately transplanted elsewhere were excluded from this study. Patient characteristics associated with palliative care consultation were assessed using logistic regression analysis. RESULTS Six hundred and eighty-three patients were listed for liver transplant in 2013-2014 with 107 (16%) dying (n = 62) or removed for clinical decompensation prior to liver transplant (n = 45): Median age was 58 years, and the majority were male (66%), Caucasian (53%), had Child C cirrhosis (61%) or hepatocellular carcinoma (52%). The palliative care team was consulted in only 18 of the 107 patients (17%) who died or were removed, 89% of which occurred as inpatients. Half of these consultations occurred within 72 h of death. In univariable analysis, patients of younger age, white race, and higher end-stage liver disease scores at time of listing and delisting were more likely to receive palliative care services. Only younger age [Odds ratio (OR) = 0.92; P = 0.02] and Caucasian race (OR = 4.90; P = 0.02) were still associated with integration of palliative care services through multivariable analysis. CONCLUSION Palliative care services are grossly underutilized in older, non-white patients with cirrhosis on the liver transplant wait-list. We encourage early integration of these services into clinical decision-making in the transplant population, with further studies aimed at understanding barriers to consultation. PMID:27683638

  4. Kidney Disease Population Health Management in the Era of Accountable Care: A Conceptual Framework for Optimizing Care Across the CKD Spectrum.

    Science.gov (United States)

    Mendu, Mallika L; Waikar, Sushrut S; Rao, Sandhya K

    2017-01-23

    Since its passage in 2010, the Affordable Care Act has led to the creation of numerous accountable care organizations that face the challenge of transforming the traditional care delivery model to provide more patient-centered, high-quality, and low-cost care. Complex patients, including those with chronic kidney disease (CKD), present the most challenges and opportunities. CKD is a condition with significant morbidity, mortality, and cost and thought to be partly secondary to known gaps in care delivery. Successful population management for CKD requires consideration of the needs of patients at all phases of the disease. In this article, we offer a comprehensive framework for a population-based approach to CKD and examples of programs we are implementing in each area. These initiatives include the development and implementation of an electronic nephrology consult (e-consult) platform, CKD quality metrics, CKD registry, CKD collaborative care agreement, multidisciplinary care clinic for advanced CKD, end-stage renal disease care coordinator program, shared decision-making tools for renal replacement, CKD education videos, and a tablet-based CKD patient-reported outcome measures tool.

  5. Treatment of osteoporosis in an older home care population

    Directory of Open Access Journals (Sweden)

    Maxwell Colleen J

    2005-02-01

    Full Text Available Abstract Background Previous research indicates that many patients with fractures indicative of underlying osteoporosis are not receiving appropriate diagnostic follow-up and therapy. We assessed osteoporosis treatment coverage in older home care clients with a diagnosis of osteoporosis and/or prevalent fracture. Methods Subjects included 330 home care clients, aged 65+, participating in a longitudinal study of medication adherence and health-related outcomes. Data on clients' demographic, health and functional status and service utilization patterns were collected using the Minimum Data Set for Home Care (MDS-HC. A medication review included prescribed and over-the-counter medications taken in the past 7 days. Criteria for indications for osteoporosis therapy included diagnosis of osteoporosis or a recent fracture. Coverage for treatment was examined for anti-osteoporotic therapies approved for use in 2000. Results Of the 330 home care clients, 78 (24% had a diagnosis of osteoporosis (n = 47 and/or had sustained a recent fracture (n = 34. Drug data were available for 77/78 subjects. Among the subjects with osteoporosis or a recent fracture, 45.5% were receiving treatment for osteoporosis; 14% were receiving only calcium and vitamin D, and an additional 31% were receiving drug therapy (bisphosphonate or hormone replacement therapy. The remaining 54.5% of subjects were not receiving any approved osteoporosis therapy. Conclusions The high prevalence of undertreatment among a population of older adults with relatively high access to health care services raises concern regarding the adequacy of diagnosis and treatment of osteoporosis in the community.

  6. 75 FR 79323 - Health Care for Homeless Veterans Program

    Science.gov (United States)

    2010-12-20

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

  7. 45 CFR 1306.35 - Family child care program option.

    Science.gov (United States)

    2010-10-01

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

  8. Psychotropic Medication Management in a Residential Group Care Program

    Science.gov (United States)

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

    2010-01-01

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

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

    Science.gov (United States)

    Spielberger, Julie; Zanoni, Wladimir; Barisik, Elizabeth

    2013-01-01

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

  10. Strengthening Integrated Care Through Population-Focused Primary Care Services: International Experiences Outside the United States.

    Science.gov (United States)

    Loewenson, Rene; Simpson, Sarah

    2017-03-20

    Many high- and middle-income countries (HMICs) are experiencing a burden of comorbidity and chronic diseases. Together with increasing patient expectations, this burden is raising demand for population health-oriented innovation in health care. Using desk review and country case studies, we examine strategies applied in HMICs outside the United States to address these challenges, with a focus on and use of a new framework for analyzing primary care (PC). The article outlines how a population health approach has been supported by focusing assessment on and clustering services around social groups and multimorbidity, with support for community roles. It presents ways in which early first contact and continuity of PC, PC coordination of referral, multidisciplinary team approaches, investment in PC competencies, and specific payment and incentive models have all supported comprehensive approaches. These experiences locate PC as a site of innovation, where information technology and peer-to-peer learning networks support learning from practice.

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

    Science.gov (United States)

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

    2014-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Daniel Alyeshmerni

    2014-07-01

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

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

    Science.gov (United States)

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

    2008-07-01

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

  14. An innovative night service program in home care.

    Science.gov (United States)

    Tennant, J; Narayan, M C

    1997-05-01

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

  15. Health care issues among lesbian, gay, bisexual, transgender and intersex (LGBTI) populations in the United States: Introduction.

    Science.gov (United States)

    Johnson, Carey V; Mimiaga, Matthew J; Bradford, Judith

    2008-01-01

    This supplemental issue of the Journal of Homosexuality presents research that explores a variety of health care issues encountered by lesbian, gay, bisexual, transgender and intersex (LGBTI) population groups in the United States over the 10-year period from 1993 to 2002. Topics include access to health care, utilization of care, training of medical and mental health providers, and the appropriate preparation of clinical offices and waiting areas. Authors used a variety of community-based public health research methods, including participant and provider surveys and retrospective chart reviews of patients, to develop this body of research, providing a recent-historical perspective on the complex health care and health-related needs of sexual and gender minorities. Particularly for transgender and intersex populations, the state of research describing their health care needs is in its infancy, and much remains to be done to design effective medical and mental health programs and interventions.

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

    Science.gov (United States)

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

    2011-08-01

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

  17. A Care Coordination Program for Substance-Exposed Newborns

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

    1982-06-01

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

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

    Science.gov (United States)

    Sabin, James E; Cochran, David

    2007-01-01

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

  20. Safe practice of population-focused nursing care: Development of a public health nursing concept.

    Science.gov (United States)

    Issel, L Michele; Bekemeier, Betty

    2010-01-01

    Patient safety, a cornerstone of quality nursing care in most healthcare organizations, has not received attention in the specialty of public health nursing, owing to the conceptual challenges of applying this individual level concept to populations. Public health nurses (PHNs), by definition, provide population-focused care. Safe practice of population-focused nursing care involves preventing errors that would affect the health of entire populations and communities. The purpose of this article is to conceptually develop the public health nursing concept of safe practice of population-focused care and calls for related research. Key literature on patient safety is reviewed. Concepts applying to population-focused care are organized based on Donabedian's Framework. Structural, operational and system failures and process errors of omission and commission can occur at the population level of practice and potentially influence outcomes for population-patients. Practice, research and policy implications are discussed. Safe PHN population-focused practice deserves attention.

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

    Science.gov (United States)

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

    2015-08-01

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

  2. Disease management programs for heart failure: not just for the 'sick' heart failure population.

    Science.gov (United States)

    McDonald, Ken; Conlon, Carmel; Ledwidge, Mark

    2007-02-01

    The development of disease management programs has been a major advance in heart failure care, bringing about significant improvements for the heart failure population, with reduction in readmission, better use of guideline therapy and improved survival. However, at present, the majority of such programs focus their attention only on the sicker segment of this population, with little application of this important service to the broader heart failure population, where potentially benefits may be even more impressive. This has led to an imbalance in the care of patients with heart failure, where aspects of management such as regular structured review and education are preferentially given to the group at the later stages of the natural history of the syndrome. This paper argues for a far wider application of the disease management program concept in heart failure care so as to bring the benefits of specialist care, patient education and follow-up to patients at an earlier stage in the natural history of heart failure.

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

    Science.gov (United States)

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

    2016-06-01

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

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

    NARCIS (Netherlands)

    Cramer, Hendrik; Dewulf, Geert; Voordijk, Hans

    2014-01-01

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

  5. Integrating Population and Clinical Medicine: A New Third-Year Curriculum to Prepare Medical Students for the Care of Individuals, Panels, and Populations.

    Science.gov (United States)

    White, Jordan; Riese, Alison; Clyne, Brian; Vanvleet, Marcia W; George, Paul

    2015-09-01

    Population and Clinical Medicine (PCM) I & II constitute two of the nine courses established for the Warren Alpert Medical School of Brown University's (AMS) innovative dual-degree Primary Care-Population Medicine (PC-PM) program. The courses will run consecutively during students' third year in the program, in conjunction with the Longitudinal Integrated Clerkship (LIC). Throughout the courses, students will examine the intersection between population and clinical medicine with a focus on vulnerable populations, the social and community context of care, quality improvement, and leadership. In addition to attending class sessions in which students will engage with leaders in relevant fields, students will also draw from patient and population-level experiences in the LIC to plan and implement two projects: a community-based intervention to address a particular health issue, and a quality improvement project to change a small aspect of care delivery at a clinical site. Finally, leadership skills development sessions will be incorporated, and leadership practice will occur during implementation of student projects.

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

    Science.gov (United States)

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

    2016-08-01

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

  7. 75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

    Science.gov (United States)

    2010-06-08

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

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

    Science.gov (United States)

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

    2013-12-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  10. 78 FR 79619 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization...

    Science.gov (United States)

    2013-12-31

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

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

    Science.gov (United States)

    Angus, D E; Lay, C M

    2000-01-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

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

    Science.gov (United States)

    Yu, Ying; Fu, Xiaobing

    2012-12-01

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

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

    Science.gov (United States)

    McCormack, J

    1997-02-01

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

  15. 78 FR 29441 - Child Care and Development Fund (CCDF) Program

    Science.gov (United States)

    2013-05-20

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

  16. Unregulated health care workers in the care of aging populations: Similarities and differences between Brazil and Canada

    Directory of Open Access Journals (Sweden)

    Mirella Veras

    2016-02-01

    Full Text Available Introduction: The world’s population is rapidly aging. Unregulated health care workers (UHCWs are emerging as a potentially important workforce in the care of older adults. Objective: A review was conducted to identify the activities of UHCWs with respect to contributions and limitations. Methods: A systematic integrative literature review was conducted using online databases (LILACS, PubMed, EMBASE, CINAHL, and grey literature. The inclusion criteria were as follows: (i description of UHCW activities related to older adults; and (ii description of UHCW activities performed in Brazil or Canada. Results: Eleven papers were included in this review. In both countries, UHCW activities included health promotion, mental health care, and rehabilitation. In Brazil, UHCWs performed integrated care, while in Canada UHCWs performed personal care and housekeeping. Conclusion: These results highlight the potential and limits of UHCWs who provide care for the aging population. Such information is important to health and social policy making and household decision making.

  17. SECPOP90: Sector population, land fraction, and economic estimation program

    Energy Technology Data Exchange (ETDEWEB)

    Humphreys, S.L.; Rollstin, J.A.; Ridgely, J.N.

    1997-09-01

    In 1973 Mr. W. Athey of the Environmental Protection Agency wrote a computer program called SECPOP which calculated population estimates. Since that time, two things have changed which suggested the need for updating the original program - more recent population censuses and the widespread use of personal computers (PCs). The revised computer program uses the 1990 and 1992 Population Census information and runs on current PCs as {open_quotes}SECPOP90.{close_quotes} SECPOP90 consists of two parts: site and regional. The site provides population and economic data estimates for any location within the continental United States. Siting analysis is relatively fast running. The regional portion assesses site availability for different siting policy decisions; i.e., the impact of available sites given specific population density criteria within the continental United States. Regional analysis is slow. This report compares the SECPOP90 population estimates and the nuclear power reactor licensee-provided information. Although the source, and therefore the accuracy, of the licensee information is unknown, this comparison suggests SECPOP90 makes reasonable estimates. Given the total uncertainty in any current calculation of severe accidents, including the potential offsite consequences, the uncertainty within SECPOP90 population estimates is expected to be insignificant. 12 refs., 55 figs., 7 tabs.

  18. The Philippine Population Program strategic plan (1981-1985).

    Science.gov (United States)

    1980-01-01

    The challenge of the population problem is to effectively mobilize the country's population for productive activity. Rather than simply concern with controlling numbers, emphasis is on human resource management, the structure of employment, labor productivity and income distribution. The long-term Philippine Development Plans reflect recognition of the dynamic interaction between fertility, productivity and welfare. Objectives of the 5-Year Philippine Development Plan 1978-1982, the 10-Year Plan 1978-1987, and the Long-Term Plan to year 2000 integrate population concerns and socioeconomic goals. These objectives include the following: promotion of social development and social justice; attainment of self-sufficiency in food and greater self-reliance in energy; increased development of lagging regions, especially rural areas; improvements of habitat through the development of human settlements and proper management of the environment; and maintenance of population growth at levels conducive to national welfare. Some population concerns that are directly relevant to welfare (in addition to those related to productivity) are distribution patterns of social goods and services, access to services by sectors of the population, and buying power of families. As a total population policy should establish closer linkages, operationally, between the demographic aspects and the productivity and welfare aspects of development, the mission of the National Population Program encompasses 3 areas: fertility; productivity; and welfare. Strategic policies include the following: abortion is unacceptable as a contraceptive method; the population program shall be non-coercive; and the program shall view individual and family welfare in the context and as the main objective of national socioeconomic programs.

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

    Science.gov (United States)

    Silberstein, Dalia; Litmanovitz, Ita

    2016-01-01

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

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

    Science.gov (United States)

    Oberlies, Amanda Stefancyk

    2014-09-01

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

  1. Sustaining salmonid populations: A caring understanding of naturalness of taxa

    Science.gov (United States)

    Nielsen, J.L.; Regier, H.A.

    2004-01-01

    Species of the family of Salmonidae occur naturally in Northern Hemisphere waters that remain clear and cool to cold in summer. For purposes of reproduction, salmonids generally behaviorally respond to the currents of streams and lakes in recently glaciated areas. For feeding and maturation, many larger species migrate into existing systems of large lakes, seas, and oceans. The subfamilies include Salmoninae, Coregoninae, and Thymallinae. In many locales and regions of the hemisphere, numerous species of these subfamilies evolved and self-organized into species flocks or taxocenes of bewildering complexity. For example, any individual species may play different or unique ecological roles in different taxocenes. The northern Pacific and Atlantic Ocean ecosystems, with their seas and tributaries, each contained a metacomplex of such taxocenes that, in their natural state some centuries ago, resembled each other but differed in many ways. Humans have valued all species of this family for subsistence, ceremonial, naturalist, gustatory, angling, and commercial reasons for centuries. Modern progressive humans (MPHs), whose industrial and commercial enterprises have gradually spread over this hemisphere in recent time, now affect aquatic ecosystems at all scales from local to global. These human effects mingle in complex ways that together induce uniquely natural salmonid taxocenes to disintegrate with the loss of species, including those groups least tolerant to human manipulations, but extending more recently to those taxa more adapted to anthropogenic change. As we leave the modern era, dominated by MPHs, will we find ways to live sustainably with salmonid taxocenes that still exhibit self-organizational integrity, or will only individual, isolated populations of salmonid species, derived from those most tolerant of MPHs, survive? To achieve future sustainability of salmonids, we suggest implementation of a search for intuitive knowledge based on faith in the wisdom of

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

    Science.gov (United States)

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

    2009-01-01

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

  3. Specialized dermatological care for marginalized populations and education at the primary care level: is community dermatology a feasible proposal?

    Science.gov (United States)

    Estrada, Roberto; Chavez-Lopez, Guadalupe; Estrada-Chavez, Guadalupe; Paredes-Solis, Sergio

    2012-11-01

    Skin diseases have a very high frequency either in developed as well as in undeveloped countries. Guerrero, Chiapas, and Oaxaca are the most impoverished states in Mexico, where 24% of the population lacks basic health care, and only 15% are estimated to have access to specialists. Community Dermatology program was founded in 1991 with the intention of improving the dermatological health of remote, marginalized inhabitants of the state of Guerrero. The program consists of a two-day visit to a pre-selected community; the first day includes a basic dermatology training course for local providers, and day 2 is a "Jornada",which means a day of free medical consultation and treatment. Pityriasis albus Cloasma, vitiligo, and acne continue to be the most frequent diagnosed primary disorders, as in rural areas occupational obligations include prolonged sun exposure. The experience and success of Community Dermatology over the last 20 years has demonstrated that this model of healthcare delivery and instruction is economically feasible, provides practical and quantifiable benefits for the communities served, and could be emulated by other disciplines within medicine.

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

    Science.gov (United States)

    2011-11-02

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

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

    Science.gov (United States)

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

    2001-06-01

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

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

  7. Testing cost-benefit models of parental care evolution using lizard populations differing in the expression of maternal care.

    Directory of Open Access Journals (Sweden)

    Wen-San Huang

    Full Text Available Parents are expected to evolve tactics to care for eggs or offspring when providing such care increases fitness above the costs incurred by this behavior. Costs to the parent include the energetic demands of protecting offspring, delaying future fecundity, and increased risk of predation. We used cost-benefit models to test the ecological conditions favoring the evolution of parental care, using lizard populations that differ in whether or not they express maternal care. We found that predators play an important role in the evolution of maternal care because: (1 evolving maternal care is unlikely when care increases predation pressure on the parents; (2 maternal care cannot evolve under low levels of predation pressure on both parents and offspring; and (3 maternal care evolves only when parents are able to successfully defend offspring from predators without increasing predation risk to themselves. Our studies of one of the only known vertebrate species to exhibit interpopulation differences in the expression of maternal care provide clear support for some of the hypothesized circumstances under which maternal care should evolve (e.g., when nests are in exposed locations, parents are able to defend the eggs from predators, and egg incubation periods are brief, but do not support others (e.g., when nest-sites are scarce, life history strategies are "risky", reproductive frequency is low, and environmental conditions are harsh. We conclude that multiple pathways can lead to the evolution of parental care from a non-caring state, even in a single population of a widespread species.

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

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

    2013-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

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

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

    Directory of Open Access Journals (Sweden)

    Emily Piraino

    2012-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Emily Piraino

    2012-08-01

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

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

    Science.gov (United States)

    Kalhan, S C; Wilson-Costello, D

    2013-04-01

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

  13. The availability of medical care as an obligatory social health predictor of the population in Russia

    Directory of Open Access Journals (Sweden)

    Yerugina M.V.

    2016-06-01

    Full Text Available Problems of social conditionality of population health are a traditional topic to discuss both in medical and social sciences. Availability of health care is considered from the perspective of social factors of macro level, representing the widest context of social factors to health risk. In Russia, the increasing availability of health care for the population is considered as a priority of social policy. The authors of the review publications consider the trends of accessibility of medical care to the population of contemporary Russia. It is noted in the article that currently the availability and quality of medical care, pretentiousness of state assurances for free medical care, and their imbalance with available financial resources are considered as one of the major Russian health care problems.

  14. Residency education, preventive medicine, and population health care improvement: the Dartmouth-Hitchcock Leadership Preventive Medicine approach.

    Science.gov (United States)

    Foster, Tina; Regan-Smith, Martha; Murray, Carolyn; Dysinger, Wayne; Homa, Karen; Johnson, Lisa M; Batalden, Paul B

    2008-04-01

    In 2003, Dartmouth-Hitchcock Medical Center (DHMC) inaugurated its Leadership Preventive Medicine residency (DHLPMR), which combines two years of leadership preventive medicine (LPM) training with another DHMC residency. The aim of DHLPMR is to attract and develop physicians who seek to become capable of leading change and improvement of the systems where people and health care meet. The capabilities learned by residents are (1) leadership -- including design and redesign -- of small systems in health care, (2) measurement of illness burden in individuals and populations, (3) measurement of the outcomes of health service interventions, (4) leadership of change for improvement of quality, value, and safety of health care of individuals and populations, and (5) reflection on personal professional practice enabling personal and professional development. The DHLPMR program includes completion of an MPH degree at The Dartmouth Institute for Health Policy and Clinical Practice (formerly the Center for Evaluative Clinical Sciences) and a practicum during which the resident leads change to improve health care for a defined population of patients. Residents also complete a longitudinal public health experience in a governmental public health agency. A coach in the resident's home clinical department helps the resident develop his or her practicum proposal, which must then be approved by a practicum review board (PRB). Twelve residents have graduated as of July 2007. Residents have combined anesthesia, family medicine, internal medicine, infectious disease, pain medicine, pathology, psychiatry, pulmonary and critical care medicine, surgery, gastroenterology, geriatric psychiatry, obstetrics-gynecology, and pediatrics with preventive medicine.

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

    Science.gov (United States)

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

    2008-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

  17. Treatment of osteoporosis in an older home care population

    OpenAIRE

    Maxwell Colleen J; Vik Shelly A; Hanley David A

    2005-01-01

    Abstract Background Previous research indicates that many patients with fractures indicative of underlying osteoporosis are not receiving appropriate diagnostic follow-up and therapy. We assessed osteoporosis treatment coverage in older home care clients with a diagnosis of osteoporosis and/or prevalent fracture. Methods Subjects included 330 home care clients, aged 65+, participating in a longitudinal study of medication adherence and health-related outcomes. Data on clients' demographic, he...

  18. Understanding Health Care Costs in a Wisconsin Acute Leukemia Population

    Directory of Open Access Journals (Sweden)

    Patricia Steinert

    2016-08-01

    Full Text Available Purpose: We investigated factors driving health care costs of patients with a diagnosis of acute myeloid and acute lymphoblastic leukemia. Methods: Standard costs identified in insurance claims data obtained from the Wisconsin Health Information Organization were used in a sample of 837 acute leukemia patients from April 2009 to June 2011. The Andersen behavioral model of health care utilization guided selection of patient and community factors expected to influence health care costs. A generalized linear model fitting gamma-distributed data with log-link technique was used to analyze cost. Results: Type of treatment received and disease severity represented significant cost drivers, and patients receiving at least some of their treatment from academic medical centers experienced higher costs. Inpatient care and pharmacy costs of patients who received treatment from providers located in areas of higher poverty experienced lower costs, raising questions of potential treatment and medical practice disparities between provider locations. Directions of study findings were not consistent between different types of services received and underscore the complexity of investigating health care cost. Conclusions: While prevalence of acute leukemia in the United States is low compared to other diseases, its extreme high cost of treatment is not well understood and potentially influences treatment decisions. Acute leukemia health care costs may not follow expected patterns; further exploration of the relationship between cost and the treatment decision, and potential treatment disparities between providers in different socioeconomic locations, is needed.

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

    Science.gov (United States)

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

    2015-02-01

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

  20. Wearable technology. Health-care solutions for a growing global population.

    Science.gov (United States)

    Rutherford, Jesse Jayne

    2010-01-01

    Wearable technology may provide an integral part of the solution for providing health care to a growing world population that will be strained by a ballooning aging population. By providing a means to conduct telemedicine-the monitoring, recording, and transmission of physiological signals from outside of the hospital-wearable technology solutions could ease the burden on health-care personnel and use hospital space for more emergent or responsive care. In addition, employing wearable technology in professions where workers are exposed to dangers or hazards could help save their lives and protect health-care personnel.

  1. Provision of critical care services for the obstetric population.

    Science.gov (United States)

    Sultan, P; Arulkumaran, N; Rhodes, A

    2013-12-01

    Management of the peripartum patient is a challenging aspect of critical care that requires consideration of both the physiological changes associated with pregnancy as well as the well-being of the foetus. In the UK, for every maternal death, approximately 118 near-miss events or severe acute maternal morbidities (SAMMs) occur. While a dedicated anaesthetic cover is usually provided on larger labour wards in the UK and US, a close communication with intensive care and other medical specialties must still be maintained. Medical outreach teams and early warning scores may help facilitate the early identification of clinical deterioration and prompt treatment. Ultimately level of care is allocated according to the clinical need, not the location, which may be a designated room, a normal labour room or a recovery area. Specialist obstetric units that provide high-dependency care facilities show lower rates of maternal transfer to critical care units and improved continuity of care before and after labour. The benefits of obstetric high-dependency units (HDUs) are likely to be determined by a number of logistic aspects of the hospital organisation, including hospital size and available resources. There remains a striking contrast in the burden of maternal mortality and morbidity and intensive care unit (ICU) resources between high- and low-income countries. The countries with the highest maternal mortality rates have the lowest number of ICU beds per capita. In under-resourced countries, patients admitted to ICUs tend to have higher illness severity scores, suggesting delayed admission to the ICU. The appropriate training of midwives is essential for successful HDUs located within labour wards.

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

    Science.gov (United States)

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

    2006-06-01

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

  3. Integrated Pest Management: A Curriculum for Early Care and Education Programs

    Science.gov (United States)

    California Childcare Health Program, 2011

    2011-01-01

    This "Integrated Pest Management Toolkit for Early Care and Education Programs" presents practical information about using integrated pest management (IPM) to prevent and manage pest problems in early care and education programs. This curriculum will help people in early care and education programs learn how to keep pests out of early…

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

    Directory of Open Access Journals (Sweden)

    Lewin GF

    2013-10-01

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

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

    Science.gov (United States)

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

    2014-06-01

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

  6. Role of private sector in providing tuberculosis care: Evidence from a population-based survey in India

    Directory of Open Access Journals (Sweden)

    Indrajit Hazarika

    2011-01-01

    Full Text Available Background: In India, a large segment of the population seeks health care services from individual or institutional private health-care providers for health care. We analyzed a nationally representative data to identify the role of private providers in delivering health care for patients with tuberculosis. Materials and Methods: The primary data source for the present analysis was the 60 th round of the National Sample Survey. Distribution frequencies were used to analyze the distribution of key sociodemographic variables and multiple logistic regression was used to analyze the association between these variables and healthcare seeking behavior. Results: A sample of 2203 respondents who had received ambulatory care for tuberculosis, and 4568 respondents who had received inpatient treatment were analyzed. About half of the respondents had attended private facilities for TB care. Sociodemographic variables such as paediatric age group, females, higher level of education, and economic groups were associated with attendance at private sector. Dissatisfaction with services in government facilities was cited as the main reason for preferring private facilities. Conclusions: Private providers play an important role in providing health care services to a large proportion of patients with tuberculosis. There is a need for innovative measures to increase participation of the private sector in the national TB control program and to improve the quality of services in government facilities.

  7. A future for primary care for the Greek population

    NARCIS (Netherlands)

    Groenewegen, P.P.; Jurgutis, A.

    2013-01-01

    Background: Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care an

  8. Caring for an Ageing Population: Are Physiotherapy Graduates Adequately Prepared?

    Science.gov (United States)

    Ramklass, Serela S.; Butau, Anne; Ntinga, Nomusa; Cele, Nozipho

    2010-01-01

    In view of South African policy developments related to the care of older persons, it was necessary to examine the nature of the geriatrics content within physiotherapy curricula. A survey was conducted amongst final-year student physiotherapists at South African universities, together with content analysis of physiotherapy curricula. Very little…

  9. 76 FR 43254 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2011-07-20

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

  10. 75 FR 41793 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2010-07-19

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

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

    Directory of Open Access Journals (Sweden)

    Akhilesh S Pathipati

    2016-07-01

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

  12. Access to general health care services by a New Zealand population with serious mental illness.

    Directory of Open Access Journals (Sweden)

    Wheeler A

    2014-03-01

    Full Text Available INTRODUCTION: Literature suggests that good quality health care access can have a positive impact on the health of people with serious mental illness (SMI, but literature relating to patterns of access by this group is equivocal. AIM: This study was designed to explore health care access patterns in a group of people with SMI and to compare them with a general New Zealand population group, in order for health providers to understand how they might contribute to positive health outcomes for this group. METHODS: The study surveyed 404 mental health consumers aged 18-65 years receiving care from one district health board in Auckland about their patterns of health care access. Results were compared with those from the New Zealand Health Survey of the general population. RESULTS: Findings suggest that the SMI consumer respondents had poorer physical health than the general population respondents, accessed health care services in more complex ways and were more particular about who they accessed for their care than the general population respondents. There was some concern from SMI consumers around discrimination from health care providers. The study also suggested that some proactive management with SMI consumers for conditions such as metabolic syndrome was occurring within the health care community. DISCUSSION: The first point of access for SMI consumers with general health problems is not always the family general practitioner and so other health professionals may sometimes need to consider the mental and physical health of such consumers in a wider context than their own specialism.

  13. Evaluation of the european heart failure self-care behaviour scale in a united kingdom population

    NARCIS (Netherlands)

    Shuldham, Caroline; Theaker, Chris; Jaarsma, Tiny; Cowie, Martin R.

    2007-01-01

    Title. Evaluation of the European Heart Failure Self-care Behaviour Scale in a United Kingdom population Aim. This paper is a report of a study to test the internal consistency, reliability and validity of the 12-item European Heart Failure Self-care Behaviour Scale in an English-speaking sample in

  14. Space maintenance in a child dental care program.

    Science.gov (United States)

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

    1975-04-01

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

  15. Improving population management through pharmacist-primary care integration: a pilot study.

    Science.gov (United States)

    Kennedy, Amanda G; Chen, Harry; Corriveau, Michele; MacLean, Charles D

    2015-02-01

    Pharmacists have unique skills that may benefit primary care practices. The objective of this demonstration project was to determine the impact of integrating pharmacists into patient-centered medical homes, with a focus on population management. Pharmacists were partnered into 5 primary care practices in Vermont 1 day per week to provide direct patient care, population-based medication management, and prescriber education. The main measures included a description of drug therapy problems identified and cost avoidance models. The pharmacists identified 708 drug therapy problems through direct patient care (336/708; 47.5%), population-based strategies (276/708; 38.9%), and education (96/708; 13.6%). Common population-based strategies included adjusting doses and discontinuing unnecessary medications. Pharmacists' recommendations to correct drug therapy problems were accepted by prescribers 86% of the time, when data about acceptance were known. Of the 49 recommendations not accepted, 47/49 (96%) were population-based and 2/49 (4%) were related to direct patient care. The cost avoidance model suggests $2.11 in cost was avoided for every $1.00 spent on a pharmacist ($373,092/$176,690). There was clear value in integrating pharmacists into primary care teams. Their inclusion prevented adverse drug events, avoided costs, and improved patient outcomes. Primary care providers should consider pharmacists well suited to offer direct patient care, population-based management, and prescriber education to their practices. To be successful, pharmacists must have full permission to document findings in the primary care practices' electronic health records. Given that many pharmacist services do not involve billable activities, sustainability requires identifying alternative funding mechanisms that do not rely on a traditional fee-for-service approach.

  16. Population aging and its impacts: strategies of the health-care system in Taipei.

    Science.gov (United States)

    Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung

    2010-11-01

    Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities.

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

    Science.gov (United States)

    Essary, Alison C; Wade, Nathaniel L

    2016-01-01

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

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

    Science.gov (United States)

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

    2005-01-01

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

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

    Science.gov (United States)

    Braun, Kathryn L.; Rose, Charles L.

    1989-01-01

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

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

    Science.gov (United States)

    Giannoni, Peggy P.; Kass, Philip H.

    2010-01-01

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

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

    Science.gov (United States)

    Eisenthal, Sherman; And Others

    1994-01-01

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

  2. Strategies for piloting a breast health promotion program in the Chinese-Australian population.

    Science.gov (United States)

    Koo, Fung Kuen; Kwok, Cannas; White, Kate; D'Abrew, Natalie; Roydhouse, Jessica K

    2012-01-01

    In Australia, women from non-English-speaking backgrounds participate less frequently in breast cancer screening than English-speaking women, and Chinese immigrant women are 50% less likely to participate in breast examinations than Australian-born women. Chinese-born Australians comprise 10% of the overseas-born Australian population, and the immigrant Chinese population in Australia is rapidly increasing. We report on the strategies used in a pilot breast health promotion program, Living with Healthy Breasts, aimed at Cantonese-speaking adult immigrant women in Sydney, Australia. The program consisted of a 1-day education session and a 2-hour follow-up session. We used 5 types of strategies commonly used for cultural targeting (peripheral, evidential, sociocultural, linguistic, and constituent-involving) in a framework of traditional Chinese philosophies (Confucianism, Taoism, and Buddhism) to deliver breast health messages to Chinese-Australian immigrant women. Creating the program's content and materials required careful consideration of color (pink to indicate femininity and love), symbols (peach blossoms to imply longevity), word choice (avoidance of the word death), location and timing (held in a Chinese restaurant a few months after the Chinese New Year), communication patterns (the use of metaphors and cartoons for discussing health-related matters), and concern for modesty (emphasizing that all presenters and team members were female) to maximize cultural relevance. Using these strategies may be beneficial for designing and implementing breast cancer prevention programs in Cantonese-speaking Chinese immigrant communities.

  3. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    Science.gov (United States)

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  4. Anaesthesia care for emergency endoscopy for peptic ulcer bleeding. A nationwide population-based cohort study

    DEFF Research Database (Denmark)

    Duch, Patricia; Haahr Raunkjær, Camilla; Møller, Morten Hylander;

    2016-01-01

    describe the prevalence and inter-hospital variation of anaesthesia care in Denmark and identify clinical predictors for choosing anaesthesia care. MATERIAL AND METHODS: This population-based cohort study included all emergency EGDs for PUB in adults during 2012-2013. About 90-day all-cause mortality after...... of the endoscopist. Some 16.7% of the patients undergoing EGD with anaesthesia care died within 90 days after the procedure, compared to 9.8% of the patients who had no anaesthesia care, adjusted OR = 1.51 (95% CI = 1.25-1.83). Comparing the two hospitals with the most frequent (98.6% of al EGDs) and least frequent...... EGD was estimated by crude and adjusted logistic regression. Clinical predictors of anaesthesia care were identified in another logistic regression model. RESULTS: Some 3.056 EGDs performed at 21 hospitals were included; 2074 (68%) received anaesthesia care and 982 (32%) were managed under supervison...

  5. 76 FR 33306 - Medicare Program; Pioneer Accountable Care Organization Model, Request for Applications; Correction

    Science.gov (United States)

    2011-06-08

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

  6. "Family planning and population programs" a book review article.

    Science.gov (United States)

    Hauser, P M

    1967-03-01

    RESUMEN: El volumen Planeamiento Familiar y Programas de Poblacion es un libro indispensable tanto para demógrafos como para otras personas interesadas en el control de población. Tiene sus limitaciones dodo su caracter heterogéneo, su falta de autocrítica, el no tratar sobre la validez y confiabilidad de las encuestas de conocimientos, attitudes y prácticas (KAP), su injustificado tono optimista, y su fracaso al no explorar y considerar alternativas para las presunciones y premisas sobre las cuales se basan los actuates programas de planeamiento familiar. Es sin embargo un importante hito que resume las contribuciones de las ciencias sociales y biomédicas al campo de la demografía.SummaryThe volume Family Planning and Population Programs is an indispensable book to demographers as well as to others concerned with population control. It is not without limitations because of its heterogeneous character, its lack of self-criticism, its failure to deal with the reliability and validity of KAP surveys, its unwarranted optimistic aura, and its failure to explore and consider alternatives to the basic assumptions and premises on which present family planning programs are based. It is, nevertheless, a landmark in its summarization of the contribution of the social and biomedical sciences to demographic engineering.

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

    Science.gov (United States)

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

    2015-02-01

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

  8. Users’ dissatisfaction with dental care: a population-based household study

    Science.gov (United States)

    Martins, Andréa Maria Eleutério de Barros Lima; Ferreira, Raquel Conceição; dos Santos, Pedro Eleutério; Carreiro, Danilo Lima; Souza, João Gabriel Silva; Ferreira e Ferreira, Efigênia

    2015-01-01

    OBJECTIVE To examine whether demographic, socioeconomic conditions, oral health subjectivity and characterization of dental care are associated with users’ dissatisfaction with such are. METHODS Cross-sectional study of 781 people who required dental care in Montes Claros, MG, Southeastern Brazil, in 2012, a city with of medium-sized population situated in the North of Minas Gerais. Household interviews were conducted to assess the users’ dissatisfaction with dental care (dependent variable), demographic, socioeconomic conditions, oral health subjectivity and characterization of dental care (independent variables). Sample calculation was used for the finite population, with estimates made for proportions of dissatisfaction in 50.0% of the population, a 5.0% error margin, a non-response rate of 5.0% and a 2.0% design effect. Logistic regression was used, and the odds ratio was calculated with a 5% significance level and 95% confidence intervals. RESULTS Of the interviewed individuals, 9.0% (7.9%, with correction for design effect) were dissatisfied with the care provided. These were associated with lower educational level; negative self-assessment of oral health; perception that the care provider was unable to give dental care; negative evaluation of the way the patient was treated, the cleanliness of the rooms, based on the examination rooms and the toilets, and the size of the waiting and examination rooms. CONCLUSIONS The rate of dissatisfaction with dental care was low. This dissatisfaction was associated with socioeconomic conditions, subjectivity of oral health, skill of the health professionals relating to the professional-patient relationship and facility infrastructure. Educational interventions are suggested that aim at improving the quality of care among professionals by responsible agencies as is improving the infrastructure of the care units. PMID:26270017

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

    Science.gov (United States)

    Arunasalam, Mark; Paulson, Albert; Wallace, William

    2003-01-01

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

  10. Health care utilization and costs in Saskatchewan's registered Indian population with diabetes

    Directory of Open Access Journals (Sweden)

    Johnson Jeffrey A

    2007-08-01

    Full Text Available Abstract Background The prevalence of diabetes in North American is recognized to be higher in Aboriginal populations. The relative magnitude of health care utilization and expenditures between Aboriginal and non-Aboriginal populations is uncertain, however. Our objective was to compare health care utilization and per capita expenditures according to Registered Indian and diabetes status in the province of Saskatchewan. Methods Administrative databases from Saskatchewan Health were used to identify registered Indians and the general population diabetes cases and two controls for each diabetes case. Health care resource utilization (physician visits, hospitalizations, day surgeries and dialysis and costs for these individuals in the 2001 calendar year were determined. The odds of having used each resource category, adjusted for age and location of residence, was assessed according to Registered Indian and diabetes status. The average number of encounters for each resource category and per capita healthcare expenditures were also determined. Results Registered Indian diabetes cases were younger than general population cases (45.7 ± 14.5 versus 58.4 ± 16.4 years, p Conclusion Relative to individuals without the disease, both registered Indians and the general population with diabetes had substantially higher health care utilization and costs. Excess hospitalization and dialysis suggested that registered Indians with and without diabetes experienced greater morbidity than the general population.

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

    DEFF Research Database (Denmark)

    Prætorius, Thim

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

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

    Directory of Open Access Journals (Sweden)

    Andrés Felipe Ardila Rodríguez

    2016-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Barry Knishkowy

    2006-01-01

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

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

    Science.gov (United States)

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

    2013-04-16

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

  15. 76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2011-07-26

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

    2012-03-23

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

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

    Science.gov (United States)

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

    2011-04-01

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

  19. Long-Term Impact of an Electronic Health Record-Enabled, Team-Based, and Scalable Population Health Strategy Based on the Chronic Care Model

    Science.gov (United States)

    Kawamoto, Kensaku; Anstrom, Kevin J; Anderson, John B; Bosworth, Hayden B; Lobach, David F; McAdam-Marx, Carrie; Ferranti, Jeffrey M; Shang, Howard; Yarnall, Kimberly S H

    2016-01-01

    The Chronic Care Model (CCM) is a promising framework for improving population health, but little is known regarding the long-term impact of scalable, informatics-enabled interventions based on this model. To address this challenge, this study evaluated the long-term impact of implementing a scalable, electronic health record (EHR)- enabled, and CCM-based population health program to replace a labor-intensive legacy program in 18 primary care practices. Interventions included point-of-care decision support, quality reporting, team-based care, patient engagement, and provider education. Among 6,768 patients with diabetes receiving care over 4 years, hemoglobin A1c levels remained stable during the 2-year pre-intervention and post-intervention periods (0.03% and 0% increases, respectively), compared to a 0.42% increase expected based on A1c progression observed in the United Kingdom Prospective Diabetes Study long-term outcomes cohort. The results indicate that an EHR-enabled, team- based, and scalable population health strategy based on the CCM may be effective and efficient for managing population health.

  20. Health characteristics and nursing diagnosis in the home care population of the Community Health Care Center of Castellar del Vallès

    Directory of Open Access Journals (Sweden)

    Montserrat Ballester Rubio

    2008-01-01

    Full Text Available The increasing growth of life expectancy in western societies brings along higher rates of chronic, limiting and invalidating diseases. Amongst these services being offered to the dependent elder, the ATDOM program is intended to provide health support for elders at home.The project was first developed to assess the health characteristics for patients included in ATDOM program.To reach that objective a Descriptive study was developed. The study population were the 87 patients included in the ATDOM program at the Community Health Care Center of Castellar del Vallès. Measurement instruments used for assessing some of the main variables were Barthel scale, Braden scale and Zarit test. NANDA classification was used to identify Nursing diagnoses.Average age of our population was 82’90 years, 35’6% of them being male and 64’4% female. 98’9% of these patients reported having an identified caregiver. Average age of caregivers was 62’94, 82’6% being women. 21’8% of patients presented with severe or total dependence levels. 26’1% of caregivers reported being overloaded by caregiving burden. Only 1’4% had high risk of having bedsore.Most prevailing nursing diagnoses were related to skin injury and difficulties with physical mobility as well as to lack of autonomy on daily living activities.

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

    Science.gov (United States)

    2016-05-01

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

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

    Science.gov (United States)

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

    2016-07-01

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

  3. Quality of mental health care at a student-run clinic: care for the uninsured exceeds that of publicly and privately insured populations.

    Science.gov (United States)

    Liberman, Kate M; Meah, Yasmin S; Chow, Andrew; Tornheim, Jeffrey; Rolon, Omayra; Thomas, David C

    2011-10-01

    Diagnosing and treating depression in a primary care practice is an important, yet difficult task, especially for safety-net practices serving the uninsured. In the United States healthcare system, there is a mismatch between the need for mental health care and access to services. This disparity is most striking among the uninsured. Mental health disorders are more prevalent among the uninsured, and even when diagnosed with mental illness, they are less likely to obtain necessary treatment than insured patients. Given the increasing burden of depression on society, growing numbers of uninsured and negative repercussions of untreated mental illness, improvements in screening and management protocols are becoming more important in primary care practices serving this population. The quality of depression treatment at commercial and public insurance plans in New York City (NYC) and New York State (NYS) were compared to that of the East Harlem Health Outreach Partnership (EHHOP), the student-run clinic of the Mount Sinai School of Medicine. Based on the comparison, the study made recommendations for an integrated, on-site mental health service program at the community health clinic. A cohort of 49 depressed patients were evaluated and treated at the EHHOP clinic. The quality of the mental health care was evaluated according to variables from the Healthcare Effectiveness Data and Information Set (HEDIS). Indicators of quality included demographics, method of diagnosis, type of pharmacological treatment, referral to specialty care, patient adherence to follow-up care and adherence to pharmacologic treatment. When compared to insured patients in NYS, more EHHOP patients had the appropriate number of physician contacts after being diagnosed with depression than patients with commercial health plans (P = 0.008) and Medicaid (P = 0.09). Similarly, a greater number of EHHOP patients had better acute phase (P = 0.001; P = 0.096) and continuous phase (P = 0.049; P

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

    Science.gov (United States)

    Cramm, Jane Murray; Nieboer, Anna Petra

    2014-01-01

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

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

    Science.gov (United States)

    2016-09-30

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

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

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

  8. Population genetics analysis using R and the Geneland program

    DEFF Research Database (Denmark)

    Guillot, Gilles; Santos, Filipe; Estoup, Arnaud

    2011-01-01

    Geneland program documentation 2011 Program distributed under GNU license as an R package on the Comprehensive R Archive Network.......Geneland program documentation 2011 Program distributed under GNU license as an R package on the Comprehensive R Archive Network....

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

    Science.gov (United States)

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

    2016-10-25

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

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

    Science.gov (United States)

    Steinman, Theodore I

    2002-01-01

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

  11. The Elderly Population with Chronic Functional Disability: Implications for Home Care Eligibility.

    Science.gov (United States)

    Stone, Robyn I.; Murtaugh, Christopher M.

    1990-01-01

    Assessed effect of changes in minimum number of activities of daily living (ALD) and instrumental activities of daily living (IADL) limitations, types of help, and duration of disability required on size of population potentially eligible for home care benefits. Only 411,000 elders met restrictive disability criteria; over 4 million would qualify…

  12. Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study

    NARCIS (Netherlands)

    Zwart, J.J.; Dupuis, J.R.O.; Richters, A.; Öry, F.; Roosmalen, J. van

    2010-01-01

    Purpose: As part of a larger nationwide enquiry into severe maternal morbidity, our aim was to assess the incidence and possible risk factors of obstetric intensive care unit (ICU) admission in the Netherlands. Methods: In a 2-year nationwide prospective population-based cohort study, all ICU admiss

  13. Occupational Therapy in Primary Health Care: reflections on the populations assisted

    Directory of Open Access Journals (Sweden)

    Mariana Leme Gomes

    2012-12-01

    Full Text Available This work is the result of reflections of a group discussion among professionals, students and teachersheld during the First Symposium on Occupational Therapy in Primary Health Care (PHC in 2011, which aimedto reflect on issues related to the populations assisted by the occupational therapist in PHC. The discussionssuggested two areas of consideration: (1 the challenges in the composition of care lines as well as living conditionsof the population assisted by occupational therapy; (2 the general practice of occupational therapists and theirinclusion in interdisciplinary teams. Participants reported that, in PHC, they provide assistance to populationstraditionally accompanied by Occupational Therapy such as people under psychological distress, people with disabilities, children with developmental delay, among others. The discussion pointed out that the difficultyof access to services, the weakness in the constitution of the lines of comprehensive health care and neglectof services to a number of groups that are excluded from care, define the profile of the population monitoredand the potential of assistance. These factors are related to the formation of PHC and “SUS” (Brazilian HealthSystem in the country. On the other hand, the living conditions of the population assisted, marked by povertyand social exclusion, the fragmentation of PHC practices, and the need for the professional to have a generalistprofile, being able to act interdisciplinarily and intersectorally, were considered crucial for the construction ofnew working tolls, theoretical improvement, and greater theoretical basis of professional performance in PHC.

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

    Science.gov (United States)

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

    2014-01-01

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

  15. Hospice care in a commercial preferred provider organization population in Tennessee.

    Science.gov (United States)

    Coulter, Steven L; Melvin, Terry; Carden, J Payne; Mathis, Rick S

    2015-03-01

    This study was undertaken to examine two aspects of care at the end of life. First, we wanted to see whether the cost savings demonstrated repeatedly in the US Medicare hospice population would also be observed in a commercial population in Tennessee. They were. The second primary interest we had was whether there were certain medical services that seemed to presage death. We found four categories of services that profoundly increase in number as the end of life is approached: primary care, hospital-based specialist, non-hospital based specialist, and oncologist services. It is hoped that these findings could lead to a simple predictive model based on readily available claims data to help identify candidates for Hospice Care earlier.

  16. Complexity in caring for an ageing heart failure population: concomitant chronic conditions and age related impairments.

    Science.gov (United States)

    De Geest, Sabina; Steeman, Els; Leventhal, Marcia E; Mahrer-Imhof, Romy; Hengartner-Kopp, Beatrice; Conca, Antoinette; Bernasconi, Arlette T; Petry, Heidi; Brunner-La Rocca, Hanspeter

    2004-12-01

    The complexity of caring for the ageing heart failure (HF) population is further complicated by concomitant chronic conditions (i.e., polypharmacy, depression), age related impairments (i.e., hearing, visual and cognitive impairments, impairments in activities of daily living (ADL/IADL), and other issues (e.g., health illiteracy, lack of social support). This paper provides an overview of these risk factors, outlines how they individually and in interplay endanger favourable outcome by putting patients at risk for poor self-management. Moreover, suggestions are made on how these issues could be addressed and integrated in heart failure management by applying gerontological care principles in caring for the ageing heart failure population.

  17. Family reintegration of children and adolescents in foster care in Brazilian municipalities with different population sizes.

    Science.gov (United States)

    Iannelli, Andrea M; Assis, Simone Gonçalves; Pinto, Liana Wernersbach; Pinto, Liana Wenersbach

    2015-01-01

    The scope of this article is to present and analyze data from Brazilian foster care services for children / adolescents from the perspective of family reintegration. It also seeks to support the implementation of public policies in order to provide effective reintegration in accordance with the differing local contexts. It uses data from 1,157 municipalities that have foster care services. The methodology takes into account the data collection of 2,624 Brazilian centers and 36,929 children and adolescents in care. The growing number of children/adolescents in care is in line with the increase in population size: 8.4 per small city; 60 per large city and 602.4 per metropolis. With respect to care residence in a different municipality there are varying indices: 12.4% in metropolises and 33.6% in small cities, revealing the absence of centers close to family units in the smaller communities. Regarding the activities promoted together with families, it was seen that there are still units that do not perform any activities, which runs contrary to Brazilian law. It is clear that policies for the child/adolescent in foster care centers need to consider the capacity of the municipality in accordance with population size to implement support actions for families to assist in family reintegration.

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

    Science.gov (United States)

    Freis, Ruth; Miller, Miriam

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

  19. 42 CFR 1001.201 - Conviction relating to program or health care fraud.

    Science.gov (United States)

    2010-10-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  1. 76 FR 50540 - Pilot Program of Enhanced Contract Care Authority for Veterans in Highly Rural Areas

    Science.gov (United States)

    2011-08-15

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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

    Briley, Margaret E.; Grey, Cynthia R.

    2000-01-01

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

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

    Science.gov (United States)

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

    2012-06-01

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

  5. Linking community programs in environment to programs in population: towards sustainable communities that sustain sanctuaries.

    Science.gov (United States)

    Cincotta, R P

    1994-01-01

    This article briefly reviews several nongovernmental organization (NGO) programs that address environmental and population issues. A framework is constructed that identifies how linked programs are supposed to work. The potential for sustainable communities is explored. It is concluded that sanctuaries in developing countries will not survive unless population in surrounding communities is stabilized and the economic and ecological relationships between the community and the sanctuary ecosystem are sustainable. In developed countries resource needs must be identified in regional planning in order for environmental protection to occur. The author finds that NGOs can be instrumental in securing community participation in environmental protection. NGOs operating in Chiapas, Mexico, provide management assistance and public health and family planning awareness to displaced indigenous farmers and conservative professionals. Another NGO outside the Ranthambhore National Park in Rajasthan, India, works to promote alternative fuel and grazing sources among local farmers. Near Chautara, in Nepal, farmers are aided by NGOs in laying sanitary water pipes, which reduces the amount of women's time required for fetching water and increases the amount of time women can spend gardening or getting involved in environmental projects. NGO efforts that reduce women's time absorbed by domestic burdens help women fulfill family planning desires and allow for greater investment in the education of children. Environmental sustainability will be dependent on family planning and other population-related processes and on the awareness that public health is an environmental issue. Opposition to integrated environment and population programs stems from donor opposition, opposition to investment in low-density areas, and a priority on biodiversity issues over development of public health services near sanctuaries. This paper was presented at an international forum at the George Washington

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

    Directory of Open Access Journals (Sweden)

    Cantón Sonia

    2010-07-01

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

  7. Role of nursing personnel in the system of medical and social care for aged population

    Directory of Open Access Journals (Sweden)

    Chunakova V.V.

    2012-12-01

    Full Text Available

    Objective: The analysis of accessibility and quality of providing medical and social care for aged population. Methods: The analysis of the work of institutions of medical and social care has been carried out. According to the time-study of the working day of nurses the characteristics of nursing personnel have been determined. Results: Data on the arrangement of medical aid at home for aged patients of the Saratov region have been provided. The importance of nursing personnel in the system of complex medical and social care has been assessed and the main areas of nursing activity have been found out. Conclusion: The article has been stated that creation of quality control system for nursing personnel is of great necessity to provide effective medical and social care.

  8. Pittsburgh as a High Risk Population: The Potential Savings of a Personalized Dental Care Plan

    Science.gov (United States)

    Ng, Andrew J.

    2016-01-01

    Objectives. Little evidence exists for the current standard of two annual preventative care visits. The purpose of this study was investigate this claim by modeling the potential savings of implementing a personalized care plan for high risk individuals in the Pittsburgh region. Methods. Using radiographs from 39 patients in the University of Pittsburgh Dental Registry and DNA Repository database, two models were created to analyse the direct savings of implementing a more aggressive preventative treatment plan and to view the longitudinal cost of increased annual yearly visits. Results. There is a significant decrease (p < 0.001) between original and modeled treatment cost when treatment severity is reduced. In addition, there is a significant decrease in adult lifetime treatment cost (p < 0.001) for up to four annual visits. Conclusions. Patients in high risk populations may see significant cost benefits in treatment cost when a personalized care plan, or higher annual preventative care visits, is implemented. PMID:27006657

  9. Pittsburgh as a High Risk Population: The Potential Savings of a Personalized Dental Care Plan

    Directory of Open Access Journals (Sweden)

    Andrew J. Ng

    2016-01-01

    Full Text Available Objectives. Little evidence exists for the current standard of two annual preventative care visits. The purpose of this study was investigate this claim by modeling the potential savings of implementing a personalized care plan for high risk individuals in the Pittsburgh region. Methods. Using radiographs from 39 patients in the University of Pittsburgh Dental Registry and DNA Repository database, two models were created to analyse the direct savings of implementing a more aggressive preventative treatment plan and to view the longitudinal cost of increased annual yearly visits. Results. There is a significant decrease (p<0.001 between original and modeled treatment cost when treatment severity is reduced. In addition, there is a significant decrease in adult lifetime treatment cost (p<0.001 for up to four annual visits. Conclusions. Patients in high risk populations may see significant cost benefits in treatment cost when a personalized care plan, or higher annual preventative care visits, is implemented.

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

    Science.gov (United States)

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

    2014-12-01

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

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

    Science.gov (United States)

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

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

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

    Directory of Open Access Journals (Sweden)

    Gray Leonard C

    2012-03-01

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

  13. [Factors affecting access to health care institutions by the internally displaced population in Colombia].

    Science.gov (United States)

    Mogollón-Pérez, Amparo Susana; Vázquez, María Luisa

    2008-04-01

    In Colombia, the on-going armed conflict causes displacement of thousands of persons that suffer its economic, social, and health consequences. Despite government regulatory efforts, displaced people still experience serious problems in securing access to health care. In order to analyze the institutional factors that affect access to health care by the internally displaced population, a qualitative, exploratory, and descriptive study was carried out by means of semi-structured individual interviews with a criterion sample of stakeholders (81). A narrative content analysis was performed, with mixed generation of categories and segmentation of data by themes and informants. Inadequate funding, providers' problems with reimbursement by insurers, and lack of clear definition as to coverage under the Social Security System in Health pose barriers to access to health care by the internally displaced population. Bureaucratic procedures, limited inter- and intra-sector coordination, and scarce available resources for public health service providers also affect access. Effective government action is required to ensure the right to health care for this population.

  14. Local environment but not genetic differentiation influences biparental care in ten plover populations.

    Directory of Open Access Journals (Sweden)

    Orsolya Vincze

    Full Text Available Social behaviours are highly variable between species, populations and individuals. However, it is contentious whether behavioural variations are primarily moulded by the environment, caused by genetic differences, or a combination of both. Here we establish that biparental care, a complex social behaviour that involves rearing of young by both parents, differs between closely related populations, and then test two potential sources of variation in parental behaviour between populations: ambient environment and genetic differentiation. We use 2904 hours behavioural data from 10 geographically distinct Kentish (Charadrius alexandrinus and snowy plover (C. nivosus populations in America, Europe, the Middle East and North Africa to test these two sources of behavioural variation. We show that local ambient temperature has a significant influence on parental care: with extreme heat (above 40 °C total incubation (i.e. % of time the male or female incubated the nest increased, and female share (% female share of incubation decreased. By contrast, neither genetic differences between populations, nor geographic distances predicted total incubation or female's share of incubation. These results suggest that the local environment has a stronger influence on a social behaviour than genetic differentiation, at least between populations of closely related species.

  15. The seduction of general practice and illegitimate birth of an expanded role in population health care.

    Science.gov (United States)

    Buetow, Stephen; Docherty, Barbara

    2005-08-01

    To reduce health inequalities and improve quality in health care, health policy initiatives in countries including New Zealand and the United Kingdom are expecting general practice to share responsibilities for a population approach to health care. This is giving increased emphasis to preventative care, including health promotion. Reasoned debate on this policy is overdue, not least in New Zealand, where clinicians within general practice appear to have been seduced by the lack of clarity in health policy into accepting this policy without question. They appear to disregard implications of the policy for redefining the nature and scope of their discipline (and of public health), including their own role as providers of personal care. This paper suggests that a population health approach is inappropriate in general practice when this approach weakens personal care and involves health promotion activity of unknown safety and effectiveness. The example of intentional weight loss to reduce overweight is used to illustrate these issues. We argue for a restricted range of general practice services.

  16. Population preferences for health care in liberia: insights for rebuilding a health system.

    Science.gov (United States)

    Kruk, Margaret E; Rockers, Peter C; Tornorlah Varpilah, S; Macauley, Rose

    2011-12-01

    OBJECTIVE. To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. DATA SOURCES/STUDY SETTING. Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. DATA COLLECTION. The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. PRINCIPAL FINDINGS. Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. CONCLUSIONS. Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes.

  17. Prescription Practice for Diabetes Management among a Female Population in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Fouzia A. ALHreashy

    2014-01-01

    Full Text Available Introduction. Prescription for diabetes care is an important practice in primary care. Methods. This is a descriptive study carried out on at primary care clinics over a five-month period at Al Imam Medical Complex, Riyadh, Saudi Arabia. It was cross-sectional study of 160 female diabetic patients, who visited the services between January and May, 2012. Data were collected from the medical records on the clinical characteristics and drugs prescribed for their diabetic management. Results. The majority of the sample population (82% was older than 40 years old. Half of them had concomitant hypertension, hyperlipidemia, and obesity. There were 500 prescriptions for diabetes management. More than 57% of participants were on two or more drugs for hyperglycemia. Metformin was the most common drug prescribed. Metformin and sulphonylurea were the most common combined medications. Most of cases ( 70% were on a combination of antihypertensive drugs. ACE or ARBs and diuretic was the most common combined prescriptions. Statins and aspirin were used by 41% and 23.8% of the research population, respectively. Conclusion. Polypharmacy is a feature in diabetes care. Most of the prescription practice for diabetic care follows the recommended guidelines for hyperglycemia and hypertension. Management of dyslipidemia among diabetic patients, however, is an area that needs to be developed.

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

    Directory of Open Access Journals (Sweden)

    Beth Rachlis

    2013-04-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Leboeuf-Yde Charlotte

    2009-06-01

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

  1. Leading from the Middle: Replication of a Re-Engagement Program for Veterans with Mental Disorders Lost to Follow-Up Care

    Directory of Open Access Journals (Sweden)

    David E. Goodrich

    2012-01-01

    Full Text Available Objectives. Persons with mental disorders experience functional impairments and premature mortality. Limited continuity of care may contribute to disparities in this group. We describe the replication of an evidence-based outreach program (Re-Engage to reconnect Veterans with mental disorders into care who have dropped out of services. Methods. Using the Enhanced Replicating Effective Programs framework, population-based registries were used to identify Veterans lost-to-care, and providers used this information to determine Veteran disposition and need for care. Providers recorded Veteran preferences, health status, and care utilization, and formative process data was collected to document implementation efforts. Results. Among Veterans who dropped out of care (n=126, the mean age was 49 years, 10% were women, and 29% were African-American. Providers determined that 39% of Veterans identified for re-engagement were deceased, hospitalized, or ineligible for care. Of the remaining 68 Veterans, outreach efforts resulted in contact with 20, with 7 returning to care. Providers averaged 14.2 hours over 4 months conducting re-engagement services and reported that gaining facility leadership support and having service agreements for referrals were essential for program implementation. Conclusions. Population-level, panel management strategies to re-engage Veterans with mental disorders are potentially feasible if practices are identified to facilitate national rollout.

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

    Science.gov (United States)

    Blum, Cynthia A

    2014-09-01

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

  3. Do homosexual persons use health care services more frequently than heterosexuals persons: findings from a Dutch population survey.

    NARCIS (Netherlands)

    Bakker, F.C.; Sandfort, T.G.M.; Vanwesenbeeck, I.; Lindert, H. van; Westert, G.P.

    2006-01-01

    Use of health care services has been suggested to be lower among homo- or bisexual persons than among heterosexual persons, due to a lack of trust in the health care system. However, population-based studies on differences in health care utilization according to sexual orientation are scarce. The pu

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

    Directory of Open Access Journals (Sweden)

    Takahashi PY

    2014-07-01

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

  5. Availability and structure of primary medical care services and population health and health care indicators in England

    Directory of Open Access Journals (Sweden)

    Adams Geoffrey

    2004-06-01

    Full Text Available Abstract Background It has been proposed that greater availability of primary medical care practitioners (GPs contributes to better population health. We evaluated whether measures of the supply and structure of primary medical services are associated with health and health care indicators after adjusting for confounding. Methods Data for the supply and structure of primary medical services and the characteristics of registered patients were analysed for 99 health authorities in England in 1999. Health and health care indicators as dependent variables included standardised mortality ratios (SMR, standardised hospital admission rates, and conceptions under the age of 18 years. Linear regression analyses were adjusted for Townsend score, proportion of ethnic minorities and proportion of social class IV/ V. Results Higher proportions of registered rural patients and patients ≥ 75 years were associated with lower Townsend deprivation scores, with larger partnership sizes and with better health outcomes. A unit increase in partnership size was associated with a 4.2 (95% confidence interval 1.7 to 6.7 unit decrease in SMR for all-cause mortality at 15–64 years (P = 0.001. A 10% increase in single-handed practices was associated with a 1.5 (0.2 to 2.9 unit increase in SMR (P = 0.027. After additional adjustment for percent of rural and elderly patients, partnership size and proportion of single-handed practices, GP supply was not associated with SMR (-2.8, -6.9 to 1.3, P = 0.183. Conclusions After adjusting for confounding with health needs of populations, mortality is weakly associated with the degree of organisation of practices as represented by the partnership size but not with the supply of GPs.

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

    Directory of Open Access Journals (Sweden)

    Abigail Wickson-Griffiths

    2014-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  8. 76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative

    Science.gov (United States)

    2011-10-03

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

  9. Interpreting the psychometric properties of the components of primary care instrument in an elderly population

    Directory of Open Access Journals (Sweden)

    Cheryl B Aspy

    2012-01-01

    Full Text Available Objective: To determine the psychometric properties of the Components of Primary Care Instrument (CPCI in a patient population aged 65 or older. Materials and Methods: 795 participants in the OKLAHOMA Studies, a longitudinal population-based study of predominantly Caucasian, elderly patients, completed the CPCI. Reliability analysis and confirmatory factor analysis were done to provide psychometric properties for this elderly sample. Models were constructed and tested to determine the best fit for the data including the addition of a method factor for negatively worded items. Results: Cronbach′s alphas were comparable to values reported in prior studies. The confirmatory factor analysis with factor inter-correlations and a method factor each improved the fit of the factor model to the data. The combined model′s fit approached the level conventionally recognized as adequate. Conclusion: CPCI appears to be a reliable tool for describing patient perceptions of the quality of primary care for patients over age 65.

  10. Improving validated depression screen among adolescent population in primary care practice using electronic health records (EHR).

    OpenAIRE

    2015-01-01

    Adolescent depression, has been identified as one of the important risk factors for adolescent safety. The American Academy of Pediatrics (AAP) recommends screening the adolescent population for depression with a validated screening tool at least once a year. Given the time constraints in primary care, many physicians tend to rely more on clinical questioning to screen depression.This has the potential to miss many adolescents who may have mild to moderate depression which may prove detriment...

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

    Directory of Open Access Journals (Sweden)

    L M G Steuten

    2008-12-01

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

  12. A social pedagogy approach to residential care: balancing education and placement in the development of an innovative child welfare residential program in Ontario, Canada.

    Science.gov (United States)

    Gharabaghi, Kiaras; Groskleg, Ron

    2010-01-01

    This paper chronicles the exploration and development of a residential program of the child welfare authority of Renfrew County in Ontario, Canada. Recognizing that virtually its entire population of youth in care was failing to achieve positive outcomes in education, Renfrew County Family and Children Services embarked on a program development process that included many unique elements within the Ontario child welfare context. This process introduced the theoretical framework of social pedagogy to the provision of residential care, and it replaced the idea of psychotherapy as the primary agent of change for youth with the concept of living and learning. The result is a template for the Ottawa River Academy, a living and learning program for youth in care that exemplifies the possibilities embedded in creative thought, attention to research and evidence, and a preparedness to transcend traditional assumptions with respect to service designs and business models for residential care in child welfare.

  13. Advancing the Integration of Population Medicine into Medical Curricula at The Warren Alpert Medical School of Brown University: A New Master's Degree Program.

    Science.gov (United States)

    Mello, Michael J; Feller, Edward; George, Paul; Borkan, Jeffrey

    2015-09-01

    Additional knowledge, attitudes and skills are required for the next generation of medical students as they expand the traditional focus on individual patients to include population-based health and scholarly investigation. The Warren Alpert Medical School of Brown University (AMS) is initiating a master's degree program as a key component of the new Primary Care-Population Medicine program at AMS leading to both a Doctorate in Medicine (MD) and Master of Science in Population Medicine (ScM) degrees in four years. The ScM is composed of a series of nine courses, integrated into the four-year MD curriculum, as well as a thesis. Additional attention will be given to leadership and quality improvement training. The goal is to produce graduates competent in the care of individual patients, panels, communities, and populations.

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

    Directory of Open Access Journals (Sweden)

    Pervin Jesmin

    2012-10-01

    Full Text Available Abstract Background Antenatal Care (ANC during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006 and after (2008–2009 implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR 1.91; 95% confidence intervals (CI: 1.50, 2.42 among women who received ≤1 ANC compared to women who received ≥3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78 to non-significance (OR 0.81; 95% CI: 0.65, 1.01, when comparing cohorts before

  15. Effects on health care use and associated cost of a home visiting program for older people with poor health status: a randomized clinical trial in the Netherlands.

    NARCIS (Netherlands)

    Bouman, A.; Rossum, E. van; Evers, S.; Ambergen, T.; Kempen, G.; Knipschild, P.

    2008-01-01

    BACKGROUND: Home visiting programs have been developed to improve the functional abilities of older people and subsequently to reduce the use of institutional care services. The results of trials have been inconsistent and their cost-effectiveness uncertain. Home visits for a high-risk population ra

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

    Science.gov (United States)

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

    2016-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Shirtcliff R Mike

    2010-02-01

    Full Text Available Abstract Background A community-based public health program to provide a dental home for women covered by the Oregon Health Plan (Medicaid in Klamath County, Oregon USA was instituted with the long-term goal to promote preventive oral care for both mothers and their new infants provided by dental managed care companies. Methods As part of the evaluation of the program, children in Klamath and comparable non-program counties were examined in their 2nd year of life to begin to determine if benefits accrued to the offspring of the mothers in Klamath County. Results Eighty-five and 58.9% of the children were caries free in the Klamath and comparison county samples, respectively (RR = 1.48, 95% CI 1.13, 1.93. The mean (SD number of teeth with any decay was .75 (2.5 in the test population and 1.6 (2.5 in the comparison population (t = 2.08, p = .04. Conclusions The assessment showed that children of mothers in the Klamath County program were about one and a half times more likely to be caries free than children in the comparison counties. Additional controlled studies are being undertaken.

  18. An intervention program to reduce the number of hospitalizations of elderly patients in a primary care clinic

    Directory of Open Access Journals (Sweden)

    Asher Maya

    2008-02-01

    Full Text Available Abstract Background The elderly population consumes a large share of medical resources in the western world. A significant portion of the expense is related to hospitalizations. Objectives To evaluate an intervention program designed to reduce the number of hospitalization of elderly patients by a more optimal allocation of resources in primary care. Methods A multidimensional intervention program was conducted that included the re-engineering of existing work processes with a focus on the management of patient problems, improving communication with outside agencies, and the establishment of a system to monitor quality of healthcare parameters. Data on the number of hospitalizations and their cost were compared before and after implementation of the intervention program. Results As a result of the intervention the mean expenditure per elderly patient was reduced by 22.5%. The adjusted number of hospitalizations/1,000 declined from 15.1 to 10.7 (29.3%. The number of adjusted hospitalization days dropped from 132 to 82 (37.9% and the mean hospitalization stay declined from 8.2 to 6.7 days (17.9%. The adjusted hospitalization cost ($/1,000 patients dropped from $32,574 to $18,624 (42.8%. The overall clinic expense, for all age groups, dropped by 9.9%. Conclusion Implementation of the intervention program in a single primary care clinic led to a reduction in hospitalizations for the elderly patient population and to a more optimal allocation of healthcare resources.

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

    Science.gov (United States)

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

    2004-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Michael J. Stewart

    2013-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Michael J. Stewart

    2013-02-01

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

  2. 78 FR 42778 - Medicare Program; Comprehensive ESRD Care Initiative; Extension of the Submission Deadlines for...

    Science.gov (United States)

    2013-07-17

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

  3. 78 FR 48688 - Medicare Program; Comprehensive ESRD Care Initiative; Extension of the Submission Deadlines for...

    Science.gov (United States)

    2013-08-09

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

  4. 78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2013-07-26

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

  5. Population-focused nursing: advocacy for vulnerable populations in an RN-BSN program.

    Science.gov (United States)

    Jones, Melissa; Smith, Paul

    2014-01-01

    The purpose of this article is to describe an innovative learning activity for online RN-BSN students designed to foster advocacy for vulnerable populations. The Vulnerable Population Advocacy Assignment, included as a component of the online Population-Focused Nursing class, provides students with the opportunity to identify and develop an awareness of issues impacting vulnerable populations and to advocate for policy changes that will influence the health of individuals, families, and populations. RN-BSN students build on previous knowledge and skills in professional communication and advocacy as they develop a policy statement designed to address health disparities impacting local, national, and global populations.

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

    Science.gov (United States)

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

    2010-03-01

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

  7. Overlaps and disconnects in reproductive health care: global policies, national programs, and the micropolitics of reproduction in northern Senegal.

    Science.gov (United States)

    Foley, Ellen E

    2007-01-01

    The International Conference on Population and Development (ICPD) held in Cairo in 1994 called for a global commitment to increasing women's agency and reproductive options by promoting a reproductive health agenda. Voluntary contraceptive use and the quality of reproductive health care have become the predominant emphases in family planning initiatives. Yet, many programs worldwide demonstrate a continued commitment to fertility reduction and slowing population growth. This article explores three arenas of contemporary discourse about reproductive health and family planning. Using Senegal as a case study, it highlights the significant overlaps and disconnects among global reproductive health policy, national priorities and programs, and the biopolitics of gender, marriage, and fertility that shape Senegalese women's reproductive behavior. The article points to the slow decline in national fertility rates to explore how family planning initiatives fail to address reproduction in the context of women's socio-economic challenges and cultural and religious fertility ideals.

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

    Science.gov (United States)

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

    2014-01-01

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

  9. Population management, systems-based practice, and planned chronic illness care: integrating disease management competencies into primary care to improve composite diabetes quality measures.

    Science.gov (United States)

    Kimura, Joe; DaSilva, Karen; Marshall, Richard

    2008-02-01

    The increasing prevalence of chronic illnesses in the United States requires a fundamental redesign of the primary care delivery system's structure and processes in order to meet the changing needs and expectations of patients. Population management, systems-based practice, and planned chronic illness care are 3 potential processes that can be integrated into primary care and are compatible with the Chronic Care Model. In 2003, Harvard Vanguard Medical Associates, a multispecialty ambulatory physician group practice based in Boston, Massachusetts, began implementing all 3 processes across its primary care practices. From 2004 to 2006, the overall diabetes composite quality measures improved from 51% to 58% for screening (HgA1c x 2, low-density lipoprotein, blood pressure in 12 months) and from 13% to 17% for intermediate outcomes (HgA1c system integrated these disease management functions into the front lines of primary care and the positive impact of those changes on overall diabetes quality of care.

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

    Science.gov (United States)

    Leeman, Jennifer; Mark, Barbara

    2006-01-01

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

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

    Science.gov (United States)

    Vonhermann, Pieter; Pintz, Adam

    1994-01-01

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

  12. Health care utilization in the elderly Mexican population: Expenditures and determinants

    Directory of Open Access Journals (Sweden)

    García-Peña Carmen

    2011-03-01

    Full Text Available Abstract Background Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social or because of the increase that comes with older age (individual. Objective To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly. Methods A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT, 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age. Results Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization. Conclusions The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age

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

    Science.gov (United States)

    Meret-Hanke, Louise A.

    2011-01-01

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

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

    Science.gov (United States)

    Brown, Corinne; Bornstein, Elizabeth; Wilcox, Catina

    2012-02-01

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

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

    OpenAIRE

    2013-01-01

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

  16. 75 FR 44 - Temporary Suspension of the Population Estimates and Income Estimates Challenge Programs

    Science.gov (United States)

    2010-01-04

    ... Program (also known as Procedure for Challenging Certain Population and Income Estimates) to accommodate... necessary to review the July 1, 2009, population or per capita income estimates for state, and other general... procedures for initiating informal challenges to certain population or per capita income estimates...

  17. 75 FR 27322 - Capacity Building Program for Traditionally Underserved Populations-Technical Assistance for...

    Science.gov (United States)

    2010-05-14

    ... Capacity Building Program for Traditionally Underserved Populations--Technical Assistance for American... Populations to fund a grant that will establish a training and technical assistance center to support the... for Traditionally Underserved Populations under section 21(b)(2)(C) of the Act (29 U.S.C....

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

    Science.gov (United States)

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

    2003-01-01

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

  19. Application of Mobile Technology for Improving Expanded Program on Immunization Among Highland Minority and Stateless Populations in Northern Thailand Border

    Science.gov (United States)

    Apidechkul, Tawatchai; Jandee, Kasemsak; Khamsiriwatchara, Amnat; Lawpoolsri, Saranath; Sawang, Surasak; Sangvichean, Aumnuyphan; Wansatid, Peerawat; Krongrungroj, Sarinya

    2015-01-01

    Background Studies of undervaccinated children of minority/stateless populations have highlighted significant barriers at individual, community, and state levels. These include geography-related difficulties, poverty, and social norms/beliefs. Objective The objective of this study was to assess project outcomes regarding immunization coverage, as well as maternal attitudes and practices toward immunization. Methods The “StatelessVac” project was conducted in Thailand-Myanmar-Laos border areas using cell phone-based mechanisms to increase immunization coverage by incorporating phone-to-phone information sharing for both identification and prevention. With limitation of the study among vulnerable populations in low-resource settings, the pre/post assessments without comparison group were conducted. Immunization coverage was collected from routine monthly reports while behavior-change outcomes were from repeat surveys. Results This study revealed potential benefits of the initiative for case identification; immunization coverage showed an improved trend. Prevention strategies were successfully integrated into the routine health care workflows of immunization activities at point-of-care. A behavior-change-communication package contributes significantly in raising both concern and awareness in relation to child care. Conclusions The mobile technology has proven to be an effective mechanism in improving a children’s immunization program among these hard-to-reach populations. Part of the intervention has now been revised for use at health centers across the country. PMID:25589367

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

    OpenAIRE

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

    2014-01-01

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

  1. The HIV Care Continuum among Female Sex Workers: A Key Population in Lilongwe, Malawi.

    Directory of Open Access Journals (Sweden)

    Kathryn Elizabeth Lancaster

    Full Text Available The HIV care continuum among female sex workers (FSW, a key population, has not been well characterized, especially within the generalized epidemics of sub-Saharan Africa. This was the first study to characterize the HIV care continuum among FSW in Lilongwe, Malawi.From July through September 2014, we used venue-based sampling to enroll 200 adult FSW in Lilongwe, Malawi into a cross-sectional evaluation assessing HIV care continuum outcomes. Seropositive FSW, identified using HIV rapid testing, received rapid CD4 counts in addition to viral loads using dried blood spots. We calculated proportions of HIV-infected FSW who had history of care, were on ART, and had suppressed viral load and we used Poisson regression to estimate the associations of demographic characteristics and transmission risk behaviors with each outcome.HIV seroprevalence was 69% (n = 138. Among all FSW the median age was 24 years (IQR: 22-28. Among the 20% who were newly diagnosed and reported previously testing negative, the median time since last HIV test was 11 months (interquartile range: 3-17. The majority (69% of HIV-infected FSW had a history of HIV care, 52% reported current ART use, and 45% were virally suppressed. Of the FSW who reported current ART use, 86% were virally suppressed. Transmission risk behaviors were not associated with continuum outcomes.FSW in Lilongwe were predominately young and have a high HIV prevalence. Only half of HIV-infected FSW reported current ART use, but the majority of those on ART were virally suppressed. To reduce ongoing transmission and improve health outcomes, increased HIV testing, care engagement, and ART coverage is urgently needed among FSW. Universal testing and treatment strategies for all FSW in Malawi must be strongly considered.

  2. Evaluation of Quality in Social Care: Aplus Program

    Science.gov (United States)

    Dutrenit, Jean-Marc

    2005-01-01

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

  3. GESP: A computer program for modeling genetic effective population size, inbreeding, and divergence in substructured populations.

    Science.gov (United States)

    Olsson, Fredrik; Laikre, Linda; Hössjer, Ola; Ryman, Nils

    2017-03-24

    The genetically effective population size (Ne) is of key importance for quantifying rates of inbreeding and genetic drift, and is often used in conservation management to set targets for genetic viability. The concept was developed for single, isolated populations and the mathematical means for analyzing the expected Ne in complex, subdivided populations have previously not been available. We recently developed such analytical theory and central parts of that work have now been incorporated into a freely available software tool presented here. GESP (Genetic Effective population size, inbreeding, and divergence in Substructured Populations) is R-based and designed to model short and long term patterns of genetic differentiation and effective population size of subdivided populations. The algorithms performed by GESP allow exact computation of global and local inbreeding and eigenvalue effective population size, predictions of genetic divergence among populations (GST) as well as departures from random mating (FIS, FIT) while varying i) subpopulation census and effective size, separately or including trend of the global population size, ii) rate and direction of migration between all pairs of subpopulations, iii) degree of relatedness and divergence among subpopulations, iv) ploidy (haploid or diploid), and v) degree of selfing. Here, we describe GESP and exemplify its use in conservation genetics modeling. This article is protected by copyright. All rights reserved.

  4. Winter population numbers [Fort Niobrara NWR fenced animal program

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This data set is for winter population numbers for bison, elk and longhorn from January 1st of the calendar year and is part of the Fort Niobrara Fenced Animal...

  5. International Population Assistance and Family Planning Programs: Issues for Congress

    Science.gov (United States)

    2006-06-06

    AIDS; ! restoration of maternal health care in locations hit by natural disasters; ! elimination of female genital mutilation ; and ! access by...particularly through the Administrative Procedure Law enacted in October 1990. Chinese authorities have termed female infanticide an “intolerable crime” that

  6. Adaptation of the Critical Care Family Need Inventory to the Turkish population and its psychometric properties

    Directory of Open Access Journals (Sweden)

    Sibel Büyükçoban

    2015-08-01

    Full Text Available In the complex environment of intensive care units, needs of patients’ relatives might be seen as the lowest priority. On the other hand, because of their patients’ critical and often uncertain conditions, stress levels of relatives are quite high. This study aims to adapt the Critical Care Family Need Inventory, which assesses the needs of patients’ relatives, for use with the Turkish-speaking population and to assess psychometric properties of the resulting inventory. The study was conducted in a state hospital with the participation of 191 critical care patient relatives. Content validity was assessed by expert opinions, and construct validity was examined by exploratory factor analysis (EFA. Cronbach’s alpha coefficient was used to determine internal consistency. The translated inventory has a content validity ratio higher than the minimum acceptable level. Its construct validity was established by the EFA. Cronbach’s alpha coefficient for the entire scale was 0.93 and higher than 0.80 for subscales, thus demonstrating the translated version’s reliability. The Turkish adaptation appropriately reflects all dimensions of needs in the original CCFNI, and its psychometric properties were acceptable. The revised tool could be useful for helping critical care healthcare workers provide services in a holistic approach and for policymakers to improve quality of service.

  7. Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

    Directory of Open Access Journals (Sweden)

    Bordonaba-Bosque Daniel

    2011-06-01

    Full Text Available Abstract Background There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC utilisation patterns between immigrants and the native population with regard to their morbidity burden. Methods This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain. Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System®. Results The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p Conclusions Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain.

  8. Classification of a palliative care population in a comprehensive cancer centre

    DEFF Research Database (Denmark)

    Benthien, K.S; Nordly, M.; Videbæk, K.;

    2016-01-01

    and receiving specialist palliative care (SPC). METHODS: This is a cross-sectional screening study of patients with cancer in the Department of Oncology, Rigshospitalet, Copenhagen University Hospital for 6 months. Patients were assessed to be included in the DOMUS study: a randomised controlled trial...... of accelerated transition to SPC at home (NCT01885637). The PCP was classified as patients with incurable cancer and limited or no antineoplastic treatment options. Patients with performance status 2-4 were further classified as the essential palliative care population (EPCP). RESULTS: During the study period......, 3717 patients with cancer were assessed. The PCP comprised 513 patients yielding a prevalence of 14 %. The EPCP comprised 256 patients (7 %). The EPCP was older, more likely inpatients, had a higher comorbidity burden and 38 % received SPC. Women, patients without caregivers and patients with breast...

  9. Clinical informatics to improve quality of care: a population-based system for patients with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Rajeev Chaudhry

    2009-06-01

    Conclusions A clinical informatics system, used to deliver proactive, co-ordinated care to a population of patients with diabetes mellitus, can improve process and also quality outcome measures. Larger studies are needed to confirm these early findings.

  10. Using health information technology to manage a patient population in accountable care organizations.

    Science.gov (United States)

    Wu, Frances M; Rundall, Thomas G; Shortell, Stephen M; Bloom, Joan R

    2016-06-20

    Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications - Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications - ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value - Using new empirical data, this study increases understanding of the extent of ACOs' current and developing HIT capabilities to support ongoing care management.

  11. 76 FR 34541 - Child and Adult Care Food Program Improving Management and Program Integrity

    Science.gov (United States)

    2011-06-13

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

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

    Science.gov (United States)

    Khan-Mayberry, Noreen; Bassett, Stephanie

    2010-01-01

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

  13. Effect of interventions to improve health care services for ethnic minority populations

    Directory of Open Access Journals (Sweden)

    Louise Forsetlund

    2011-03-01

    available evidence for the other interventions was too low to draw reliable conclusions. We found no studies that only included young patients, but we suggest that interventions targeted at health personnel or health organisations may be applicable regardless of the age of the patient population. This review reveals that the evidence for interventions to improve health care for minorities is sparse and generally of low quality.

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

    NARCIS (Netherlands)

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

    2007-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    Science.gov (United States)

    Lemmer, Corinne

    2002-01-01

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

  17. 7 CFR 250.61 - Child and Adult Care Food Program (CACFP).

    Science.gov (United States)

    2010-01-01

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

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

    Science.gov (United States)

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

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

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

    Directory of Open Access Journals (Sweden)

    Severina Alice da Costa Uchôa

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  1. Combining data on health care utilization and socioeconomic status of a defined population: use of a population oriented health information system for regional planning.

    Science.gov (United States)

    Brommels, M; Heinonen, M O; Tuomola, S

    1987-01-01

    Health services planning on a regional or national level needs information on health care utilization as well as data on the population to be served. Health or hospital information systems usually cover services provision and utilization, and population data for planning purposes must be obtained from other sources. In the health information system presented, hospital performance data are combined with census and socioeconomic data of the population. That makes cautious analysis of reasons for variation in health care utilization within the planning area possible. The HIS is regional, including 11 health care providers, and population based, linking data to municipality (38 in all). The system is described, including its structure, input registration, file content and output formats. An output example is presented. Necessary conditions for use of the HIS in planning activities are that the corresponding health care delivery system is comprehensive, the population served well defined, and that good control of patient flow and user behaviour is achieved. Use is limited by the character of information stored in the HIS: it is registered retrospectively and by routine. In a system covering various hospitals and municipalities, engaging different types of clerical and health care personnel, data reliability is also a critical issue.

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

    Science.gov (United States)

    Macstravic, Scott

    2006-01-01

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

  3. Web-based screening for diabetic retinopathy in a primary care population: The EyeCheck Project

    NARCIS (Netherlands)

    Abramoff, M.D.; Suttorp-Schulten, M.S.A.

    2005-01-01

    The objective of this study was to evaluate the feasibility of ATA category 2 Web-based screening for diabetic retinopathy in a primary care population in the Netherlands. A total of 1,676 patients in a primary care setting, with diabetes, without known diabetic retinopathy, and without previous scr

  4. Towards Excellence in Asthma Management: Final report of an eight-year program aimed at reducing care gaps in asthma management in Quebec

    Science.gov (United States)

    Boulet, Louis-Philippe; Dorval, Eileen; Labrecque, Manon; Turgeon, Michel; Montague, Terrence; Thivierge, Robert L

    2008-01-01

    BACKGROUND AND OBJECTIVES: Asthma care in Canada and around the world persistently falls short of optimal treatment. To optimize care, a systematic approach to identifying such shortfalls or ‘care gaps’, in which all stakeholders of the health care system (including patients) are involved, was proposed. METHODS: Several projects of a multipartner, multidisciplinary disease management program, developed to optimize asthma care in Quebec, was conducted in a period of eight years. First, two population maps were produced to identify regional variations in asthma-related morbidity and to prioritize interventions for improving treatment. Second, current care was evaluated in a physician-patient cohort, confirming the many care gaps in asthma management. Third, two series of peer-reviewed outcome studies, targeting high-risk populations and specific asthma care gaps, were conducted. Finally, a process to integrate the best interventions into the health care system and an agenda for further research on optimal asthma management were proposed. RESULTS: Key observations from these studies included the identification of specific patterns of noncompliance in using inhaled corticosteroids, the failure of increased access to spirometry in asthma education centres to increase the number of education referrals, the transient improvement in educational abilities of nurses involved with an asthma hotline telephone service, and the beneficial effects of practice tools aimed at facilitating the assessment of asthma control and treatment needs by general practitioners. CONCLUSIONS: Disease management programs such as Towards Excellence in Asthma Management can provide valuable information on optimal strategies for improving treatment of asthma and other chronic diseases by identifying care gaps, improving guidelines implementation and optimizing care. PMID:18818784

  5. The Puerto Rican parrot reintroduction program: sustainable management of the aviary population.

    Science.gov (United States)

    Earnhardt, Joanne; Vélez-Valentín, Jafet; Valentin, Ricardo; Long, Sarah; Lynch, Colleen; Schowe, Kate

    2014-01-01

    The cornerstone of the recovery plan for the critically endangered Puerto Rican parrot (Amazona vitatta) is an actively managed, long-term reintroduction program. One captive population distributed across two aviaries in Puerto Rico is the sole source for release but its ability to persist as a managed resource has not been evaluated since 1989. We conducted an assessment for sustainable management of the aviary population while harvesting for release. To assess demographic rates such as population growth, vital rates, and age/sex structure, we compiled a studbook database on all living, dead, and released individuals in the aviary population. Using an individual-based risk assessment model we applied population specific data based on the management period from 1993 to 2012 to simulate future aviary population dynamics and evaluate future potential production. We modeled four potential management strategies to harvest parrots for proposed releases; these scenarios vary the number of parrots and the life stage. Our simulations revealed that the aviary population can be simultaneously managed for sustainability and harvesting of parrots for release. However, without cautious management, overharvesting can jeopardize sustainability of the aviary population. Our analysis of the aviary breeding program provides a rare opportunity to review progress relative to conservation program objectives after four decades of active management. The successful growth of the aviary population and its ability to serve as a sustainable source for reintroductions supports the 1973 decision to build a breeding program from a small population of 13 parrots.

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

    Directory of Open Access Journals (Sweden)

    James M Lightwood

    2008-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Francisco J. Ramos-Gomez

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-02-01

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

  9. A Program for Clinical Care in Physical Trauma.

    Science.gov (United States)

    2014-09-26

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

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

    Science.gov (United States)

    Rucker, Bronwyn; Browning, David M

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Warmington K

    2015-08-01

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

  12. Epidemiology and resistance patterns in urinary pathogens from long-term care facilities and GP populations.

    LENUS (Irish Health Repository)

    Brabazon, E D

    2012-06-01

    Urinary tract infections (UTIs) are a major source of antimicrobial prescribing in the clinical setting and a potential reservoir for the emergence of resistant organisms. Although studies have been published on resistance rates for urinary pathogens from both hospital and general practitioner (GP) settings, there is little information from Long-Term Care Facilities (LTCFs) in Ireland. This study aimed to document the epidemiology and resistance rates in urinary isolates, in the LTCF and GP setting, from samples submitted to a typical microbiology laboratory. In 2010, there were 963 urinary isolates from LTCFs and 1,169 urinary isolates from GPs, identified from patients 65 years and over, with cytology suggestive of infection. E. coil was the most common causative organism identified. There were significantly higher levels of resistance to ampicillin, co-amoxiclav, ciprofloxacin, nitrofurantoin, trimethoprim, and piperacillin\\/tazobactam in the LTCF population compared to the GP population (e.g. for E. coli, 86%-v-69%; 30%-v- 21%; 58%-v-26%, 10%-v-3%, 68%-v-48%, 10%-v- 4% respectively). Isolates with resistance mechanisms to beta-lactams, were identified in both populations. Results presented in this paper demonstrate significant differences between resistance rates in LTCF and GP populations which suggest that there are implications for empiric antimicrobial prescribing for UTIs in the LTCF setting.

  13. Research on population and employment under the world employment program.

    Science.gov (United States)

    1974-01-01

    In 1972 the ILO launched a comprehensive research project to: 1) for mulate a series of economic-demographic simulation models dealing with the direct and indirect effects of population on employment, output, and income distribution, and vice versa; 2) fund empirical studies dealing with important elements in the relationship between population and employment growth and focusing on policy issues. The project has 2 special features, the feedback between the empirical research and the model activity and the joint participation of the ILO with national research organizations in different regions. A large number of economic-demographic models have been developed in recent years. However, most of them take demographic variables as exogenous and analyze consequences in a neoclassical framework or they seek to analyze demographic responses to economic and social changes which are treated as exogenous variables. Interaction among different sets of variables is closer to reality, not uni-directional causation. Effective demand is as important as the increase in resource inputs. The situation in de veloping economies is further complicated by the coexistence of modern and traditional sectors which show many fundamental differences. Detail ed descriptions of several models under development are given. Studies being conducted include: labor force analysis, with special emphasis on developing countries; the socioeconomic determinants of fertility; studies on population, consumption patterns, and savings; an analysis of the extent to which the labor market signals through wage adjustments the rapid growth of population and labor force and the resulting excess supply of labor in relation to modern sector jobs; capital accumulation and employment in a labor-surplus situation; and the effects of population pressure on land tenure, agricultural productivity, and employment. It is hoped this research will suggest possible optimal mixes of demographic, economic, and social policies

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

    Directory of Open Access Journals (Sweden)

    Lyne Lalonde

    2014-02-01

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

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

    Science.gov (United States)

    2010-07-30

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

  16. Equity of inpatient health care in rural Tanzania: a population- and facility-based survey

    Directory of Open Access Journals (Sweden)

    Ferry Grace A

    2012-02-01

    Full Text Available Abstract Objective To explore the equity of utilization of inpatient health care at rural Tanzanian health centers through the use of a short wealth questionnaire. Methods Patients admitted to four rural health centers in the Kigoma Region of Tanzania from May 2008 to May 2009 were surveyed about their illness, asset ownership and demographics. Principal component analysis was used to compare the wealth of the inpatients to the wealth of the region's general population, using data from a previous population-based survey. Results Among inpatients, 15.3% were characterized as the most poor, 19.6% were characterized as very poor, 16.5% were characterized as poor, 18.9% were characterized as less poor, and 29.7% were characterized as the least poor. The wealth distribution of all inpatients (p Conclusion The findings indicated that while current Tanzanian health financing policies may have improved access to health care for children under five, additional policies are needed to further close the equity gap, especially for obstetric inpatients.

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

    Science.gov (United States)

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

    2013-07-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    Koch, Edward F

    2012-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Manisha V Ghate

    2014-01-01

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

  1. 76 FR 52575 - Health Care for Homeless Veterans Program

    Science.gov (United States)

    2011-08-23

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

  2. 78 FR 36449 - State Long-Term Care Ombudsman Program

    Science.gov (United States)

    2013-06-18

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

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

    NARCIS (Netherlands)

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

    1999-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Stefanie Leistner

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

  5. Ethnic differences in antenatal care use in a large multi-ethnic urban population in the Netherlands

    NARCIS (Netherlands)

    Chote, Anushka A.; de Groot, Christianne J. M.; Bruijnzeels, Marc A.; Redekop, Ken; Jaddoe, Vincent W. V.; Hofman, Albert; Steegers, Eric A. P.; Mackenbach, Johan P.; Foets, Marleen

    2011-01-01

    Objective: to determine differences in antenatal care use between the native population and different ethnic minority groups in the Netherlands. Design: the Generation R Study is a multi-ethnic population-based prospective cohort study. Setting: seven midwife practices participating in the Generatio

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

    Science.gov (United States)

    Wood, Siri; Foster, Jennifer; Kols, Adrienne

    2012-08-01

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

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

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

    2013-07-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  10. Prevalence and risk factors for developing posttraumatic stress disorder in a general intensive care population - a literature review

    OpenAIRE

    Nilsen, Cecilie Bræin

    2016-01-01

    Aim: 1) To investigate prevalence of posttraumatic stress disorder (PTSD) and symptoms of posttraumatic stress (PTSS) in a general intensive care patient population, and risk factors for post ICU-PTSD/PTSS. 2) To investigate how instruments and loss to follow-up could influence the prevalence of PTSD/PTSS in this patient population. Background: Studies have found a wide variance of PTSD/PTSS in this patient population. A number of risk factors were associated with developing post-ICU ...

  11. Population size influences amphibian detection probability: implications for biodiversity monitoring programs.

    Directory of Open Access Journals (Sweden)

    Lorenzo G Tanadini

    Full Text Available Monitoring is an integral part of species conservation. Monitoring programs must take imperfect detection of species into account in order to be reliable. Theory suggests that detection probability may be determined by population size but this relationship has not yet been assessed empirically. Population size is particularly important because it may induce heterogeneity in detection probability and thereby cause bias in estimates of biodiversity. We used a site occupancy model to analyse data from a volunteer-based amphibian monitoring program to assess how well different variables explain variation in detection probability. An index to population size best explained detection probabilities for four out of six species (to avoid circular reasoning, we used the count of individuals at a previous site visit as an index to current population size. The relationship between the population index and detection probability was positive. Commonly used weather variables best explained detection probabilities for two out of six species. Estimates of site occupancy probabilities differed depending on whether the population index was or was not used to model detection probability. The relationship between the population index and detectability has implications for the design of monitoring and species conservation. Most importantly, because many small populations are likely to be overlooked, monitoring programs should be designed in such a way that small populations are not overlooked. The results also imply that methods cannot be standardized in such a way that detection probabilities are constant. As we have shown here, one can easily account for variation in population size in the analysis of data from long-term monitoring programs by using counts of individuals from surveys at the same site in previous years. Accounting for variation in population size is important because it can affect the results of long-term monitoring programs and ultimately the

  12. Population size influences amphibian detection probability: implications for biodiversity monitoring programs.

    Science.gov (United States)

    Tanadini, Lorenzo G; Schmidt, Benedikt R

    2011-01-01

    Monitoring is an integral part of species conservation. Monitoring programs must take imperfect detection of species into account in order to be reliable. Theory suggests that detection probability may be determined by population size but this relationship has not yet been assessed empirically. Population size is particularly important because it may induce heterogeneity in detection probability and thereby cause bias in estimates of biodiversity. We used a site occupancy model to analyse data from a volunteer-based amphibian monitoring program to assess how well different variables explain variation in detection probability. An index to population size best explained detection probabilities for four out of six species (to avoid circular reasoning, we used the count of individuals at a previous site visit as an index to current population size). The relationship between the population index and detection probability was positive. Commonly used weather variables best explained detection probabilities for two out of six species. Estimates of site occupancy probabilities differed depending on whether the population index was or was not used to model detection probability. The relationship between the population index and detectability has implications for the design of monitoring and species conservation. Most importantly, because many small populations are likely to be overlooked, monitoring programs should be designed in such a way that small populations are not overlooked. The results also imply that methods cannot be standardized in such a way that detection probabilities are constant. As we have shown here, one can easily account for variation in population size in the analysis of data from long-term monitoring programs by using counts of individuals from surveys at the same site in previous years. Accounting for variation in population size is important because it can affect the results of long-term monitoring programs and ultimately the conservation of

  13. [Use of social marketing in population health programs (literature review)].

    Science.gov (United States)

    Kholmogorova, G T; Gladysheva, N V

    1991-01-01

    At present health education programmes abroad make wide use of social marketing strategy. Unlike commercial marketing whose purpose is competition and struggle for the expansion of commodity markets, social marketing is aimed at disseminating certain ideas or introducing certain practices, using largely the technological base and strategy of commercial marketing. The authors give 8 fundamental principles of social marketing (consumer orientation, the theory of barter, the analysis of audience and segmentation, special surveys to detect the orientation of population, the choice of channels for information transmission application of "marketing mixture", control of ongoing programme and marketing management). Application fields of social marketing in public health are discussed.

  14. [The scientometric analysis of dissertation studies in the field of specialty public health and health care concerning children population].

    Science.gov (United States)

    Albitskiy, V S; Ustinova, N V; Antonova, Ye V

    2014-01-01

    The article considers trends and priority directions of research studies of the field of public health and health care of children population. The interpretative content analysis was applied to study dissertations in the field of public health and health care in 1991-2012. The sampling included 4194 units of information. The first stage of study established that problems of children population are considered in 14.8% dissertations defended on the mentioned specialty. The next stage the categories of content-analysis were examined. They were divided on the following axes: axis I "Main problem of study", axis II "Localization of study", axis III "Examined age groups", axis IV "Distribution of studies on gender of examined contingent", axis V "Examined contingent", axis VI "Additional medical specialty". It is established that in dissertations on public health and health care of children population on axis I prevails organizational subject matter (27.2%). The health condition of various contingents of children population (16.8%), preventive aspects of pediatrics (12.2%), examination of particular conditions/diseases/classes of diseases (10.8%) are fixed as priority directions. In the most dissertations the regional character of studies is presented (98.2%). The prevailing age group in studies is the adolescent group (19.9%). The inter-disciplinary relationships of dissertations on problems of public health and health care of children population are revealed with such specialties as "Pediatrics" (16.2%), "Obstetrics and gynecology" (3.8%) and "Hygiene" (3.4%). With consideration for recognition of health promotion and optimization of health care of children population as priority directions of public health policy amount of research studies in this field is to be admitted as inadequate. With purpose of optimization of scientific knowledge and development of system of medical social care to children population it is needed to promote research studies of problems of

  15. Implementing women's cancer screening programs in American Indian and Alaska Native populations.

    Science.gov (United States)

    Lantz, Paula M; Orians, Carlyn E; Liebow, Edward; Joe, Jennie R; Burhansstipanov, Linda; Erb, Julie; Kenyon, Kathryn

    2003-01-01

    The National Breast and Cervical Cancer Early Detection Program provides funding to tribes and tribal organizations to implement comprehensive cancer screening programs using a program model developed for state health departments. We conducted a multiple-site case study using a participatory research process to describe how 5 tribal programs implemented screening services, and to identify strategies used to address challenges in delivering services to American Indian and Alaska Native women. We analyzed data from semistructured interviews with 141 key informants, 16 focus groups with 132 program-eligible women, and program documents. Several challenges regarding the delivery of services were revealed, including implementing screening programs in busy acute-care environments, access to mammography, providing culturally sensitive care, and providing diagnostic/treatment services in rural and remote locations. Strategies perceived as successful in meeting program challenges included identifying a "champion" or main supporter of the program in each clinical setting, using mobile mammography, using female providers, and increasing the capacity to provide diagnostic services at screening sites. The results should be of interest to an international audience, including those who work with health-related programs targeting indigenous women or groups that are marginalized because of culture, geographic isolation, and/or socioeconomic position.

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

    Science.gov (United States)

    Smith, Lauren E; Flanders, Sonya A

    2014-12-01

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

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

    Science.gov (United States)

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

    2000-11-14

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

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

    Science.gov (United States)

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

    2015-10-01

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

  19. Knowledge on preconceptional folic acid supplementation and intention to seek for preconception care among men and women in an urban city: A population-based cross-sectional study

    NARCIS (Netherlands)

    S. Temel (Sevilay); Ö. Erdem (Özcan); T. Voorham (Toon); G.J. Bonsel (Gouke); E.A.P. Steegers (Eric); S. Denktaş (Semiha)

    2015-01-01

    textabstractBackground: To study the knowledge of a large city population on preconception folic acid supplementation and intention to seek for preconception care within an urban perinatal health program. Methods: Cross-sectional surveys run in Rotterdam, the Netherlands, in 2007 and annually from 2

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

    Science.gov (United States)

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

    2016-03-01

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

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

    Science.gov (United States)

    Stoller, James K

    2013-01-01

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

  2. Can universal pre-kindergarten programs improve population health and longevity? Mechanisms, evidence, and policy implications.

    Science.gov (United States)

    Muennig, Peter

    2015-02-01

    Recent research has found that children who attended pre-kindergarten programs in childhood were more likely to be healthy as adults. One intuitive way of improving population health and longevity may therefore be to invest in pre-kindergarten programs. However, much of the research linking pre-kindergarten programs to health is very recent and has not been synthesized. In this paper, I review the mechanisms linking pre-kindergarten programs in childhood to adult longevity, and the experimental evidence backing up these linkages. I conclude with a critical exploration of whether investments in pre-kindergarten programs could also serve as investments in public health.

  3. Child Care in Denmark: Part I. Policies and Daytime Programs in Their Social Context.

    Science.gov (United States)

    Dubin-Snyder, Constance G.

    This study offers a description of the daytime programs and facilities serving the preschool population in Denmark, with emphasis on the types of programs offered, their administrative organization, minimum standards, scope and cost, and supply and demand. The greatest detail is given to the "bornehave" and "bornehaveklasse"…

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

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    Minjung Park

    2014-01-01

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

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

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    Molina Emilio Herrera

    2013-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  7. Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract

    Directory of Open Access Journals (Sweden)

    H. Hildebrandt

    2010-06-01

    Full Text Available Introduction: Integrated care solutions need supportive financial incentives. In this paper we describe the financial architecture and operative details of the integrated pilot 'Gesundes Kinzigtal'. Description of integrated care case: Located in Southwest Germany, 'Gesundes Kinzigtal' is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The system serving around half of the population of the region is run by a regional health management company (Gesundes Kinzigtal GmbH in coope­ration with the physicians' network in the region (MQNK, a German health care management company with a background in medical sociology and health economics (OptiMedis AG and with two statutory health insurers (among them is the biggest health insurer in Southwest Germany: AOK Baden-Württemberg. Discussion and (preliminary conclusion: The shared savings contract between Gesundes Kinzigtal GmbH and the two health insurers, providing financial incentives for managers and health care providers to realize a sub­stantial efficiency gain, could be an appropriate contractual base of Gesundes Kinzigtal's population health gain approach. This approach is based on the assumption that a more effective trans-sector organisation of Germany's health care system and increased investments in well-designed preventive programmes will lead to a reduction in  morbidity, and in particular to a reduced incidence and prevalence of chronic diseases. This, in turn, is to lead to a comparative reduction in health care cost. Although the comparative cost in the Kinzigtal region has been reduced from the onset of Gesundes Kinzigtal Integrated Care, only future research will have to demonstrate whether - and to what extent - cost reduction may be attributed to a real population health gain.

  8. Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract

    Directory of Open Access Journals (Sweden)

    H. Hildebrandt

    2010-06-01

    Full Text Available Introduction: Integrated care solutions need supportive financial incentives. In this paper we describe the financial architecture and operative details of the integrated pilot Gesundes Kinzigtal.Description of integrated care case: Located in Southwest Germany, Gesundes Kinzigtal is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The system serving around half of the population of the region is run by a regional health management company (Gesundes Kinzigtal GmbH in coope­ration with the physicians' network in the region (MQNK, a German health care management company with a background in medical sociology and health economics (OptiMedis AG and with two statutory health insurers (among them is the biggest health insurer in Southwest Germany: AOK Baden-Württemberg.Discussion and (preliminary conclusion: The shared savings contract between Gesundes Kinzigtal GmbH and the two health insurers, providing financial incentives for managers and health care providers to realize a sub­stantial efficiency gain, could be an appropriate contractual base of Gesundes Kinzigtal's population health gain approach. This approach is based on the assumption that a more effective trans-sector organisation of Germany's health care system and increased investments in well-designed preventive programmes will lead to a reduction in  morbidity, and in particular to a reduced incidence and prevalence of chronic diseases. This, in turn, is to lead to a comparative reduction in health care cost. Although the comparative cost in the Kinzigtal region has been reduced from the onset of Gesundes Kinzigtal Integrated Care, only future research will have to demonstrate whether - and to what extent - cost reduction may be attributed to a real population health gain.

  9. [The provision of population of the Russian Federation with basic personnel resource of public health care system].

    Science.gov (United States)

    Schepin, V O

    2013-01-01

    The article presents the results of complex scientific analysis of number and structure of physicians and paramedical personnel of public and municipal health care system of the Russian Federation. The provision of country population, its federal okrugs and federation subjects with physicians and paramedical personnel of various specialties are analyzed too, including ratio of physicians and paramedical personnel and territorial differentiation of provision of population with basic medical personnel. The study results demonstrate that in 2012 provision of population (per 10 000 of population) with physicians increased from 43.9 to 44.7. At the same time provision with paramedical personnel decreased from 92.3 to 90.8. in the Russian Federation are preserved significant territorial disproportions of provision of population with medical personnel resource. The provision of population with physicians and paramedical personnel is 4.3 times and 1.9 times higher in cities than in rural area. The differences between extreme indicators of provision of population of the Russian Federation with physicians and paramedical personnel are 2.9 and 2.4 times correspondingly. The differences between indicators of provision with physicians of clinical specialties are 2.6 times. The average ratio between physician and paramedical personnel is 1:2.03. The structure of medical manpower corresponds to the need of population in medical care in incomplete measure. The materials substantiate necessity to continue modernization, optimization and development of manpower support of public health care system in the Russian Federation.

  10. Designing & Evaluating General Individual Preconception Care : - The Ready for a Baby program -

    NARCIS (Netherlands)

    S. Temel (Sevilay)

    2016-01-01

    markdownabstractPreconception Care (PCC) entails risk assessment, health promotion, counselling, and intervention. The Dutch Health Council categorized PCC into general PCC targeted at couples planning a pregnancy within the general population, and specialist PCC for couples with a known or predefin

  11. Vitamin status and cognitive function in a long-term care population

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    Meckling Kelly A

    2005-12-01

    Full Text Available Abstract Background Ageing can be associated with poor dietary intake, reduced nutrient absorption, and less efficient utilization of nutrients. Loss of memory and related cognitive function are also common among older persons. This study aimed to measure the prevalence of inadequate vitamin status among long-term care patients and determine if an association exists between vitamin status and each of three variables; cognitive function, vitamin supplementation, and medications which alter gastric acid levels. Methods Seventy-five patients in a long-term care hospital in Guelph, Ontario were recruited to a cross-sectional study. 47 were female and the mean age was 80.7 (+/-11.5 years, ranging from 48 to 100 years. Blood was used to measure levels of vitamins B12 (cobalamin, B6 (pyridoxal-5'-phosphate/PLP, erythrocyte folate, vitamin B3 (niacin and homocysteine (Hcy. The Standardized Mini-Mental State Examination (SMMSE was administered to measure cognitive function. A list of medications and vitamin supplementation for each patient was provided by the pharmacy. Results The prevalence of low vitamin (B12, B6, erythrocyte folate, niacin or high metabolite (homocysteine levels among 75 patients were as follows: B12 13.3 μmol/L in 31/75 (41.3%. There was no significant difference among residents grouped into marked (n = 44, mild (n = 14, or normal (n = 9 cognitive function when evaluating the effect of vitamin status. There were no significant differences in mean B12 and homocysteine levels between users and non-users of drug therapy (Losec, Zantac, or Axid. Compared to vitamin supplement non-users, supplemented residents had significantly higher mean B12 (p Conclusion Given the prevalence data on vitamin status in this sample population, the possible benefits of vitamin supplementation should be considered in clinical intervention studies using these populations of elderly.

  12. MEDICO-SOCIAL CHARACTERISTICS OF POPULATION GROUPS SEEKING FOR DENTAL CARE IN POLYCLINICS SMOLENSK

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    Светлана Николаевна Дехнич

    2013-09-01

    Full Text Available The research’s aim is to give health-social characteristic of contingents of the urban population, seeking for outpatient dental care, including a comparative estimation of stomatological index of life quality (SILQ by doctors and patients.Novelty: Was installed the difference in the estimation of work sets SILQ by doctors and patients.Methodology of the research work. It was used an advantage «Card of studying the dental health» for holding the research, including the objective and subjective expert estimations of the dental patient’s status by doctors. This information was comparing with the subjective estimation of SILQ by patients. The sample volume was about 400 people out of number of people, seeking for outpatient dental care in state budget dental clinics during 2011-2012 years.Results. Was installed mostly very high level of prevalence of caries, the destruction of fabrics of parodont reaches 100 % with the age. The stomatological index of life quality among the patients, seeking for outpatient care is low. One of the reasons- a low population’s sanitary culture. A big part of patients seek in case of acute pain(40%. Out of three components of SILQ the criteria of social welfare got rather high estimation. The lowest estimation was given to moral psychological well-being criteria. In this case the moral psychological well-being criteria was given a higher estimation by doctors then by patients (in 1,8. The criteria of the physical and social well-being is lower compared with the patient’s (in 1,8 and 1,2 times respectively.Practical implication: Indicators SILQ may be the basis for planning activities of stomatological polyclinics, including the preventive dentists’ work.DOI: http://dx.doi.org/10.12731/2218-7405-2013-6-46

  13. Affordability of population towards dental care in Mathura City—A household survey

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    Maj Kundan Kumar

    2013-01-01

    Full Text Available Objectives The purpose of this study was to assess the factors of affordability towards dental care in Mathura city. Material and Methods The present study included 100 households from which 100 persons were interviewed above the age group of 25 years. Data was collected with the help of structured Questionnaires & Face interviews. Information was collected regarding Socio-demographic variables & attitudes of the subjects towards the utilization of dental service and the affordability of the dental services. The data was then statistically analyzed using chi square test. Results In the present study it was found that the income and education were significantly associated with the affordability of the dental services. Individuals having an income of above Rs 20, 000/ were found to afford the available dental care. Individuals having educational qualification of graduate and above were utilizing the dental services better than others. Conclusion Within the limitation of this study, we can conclude that the utilization of dental services is not very high among Mathura city population. The affordability factor such as income, education and occupation were identified as the major factor towards utilization of dental services. However place of visit differs according to income, education and occupation.

  14. Sexually transmitted infections treatment and care available to high risk populations in Pakistan.

    Science.gov (United States)

    Rahimtoola, Minal; Hussain, Hamidah; Khowaja, Saira N; Khan, Aamir J

    2008-01-01

    Limited literature exists on the quality and availability of treatment and care of sexually transmitted infections (STIs) in Pakistan. This article aims to document existing services for the care and treatment of STIs available in Pakistan's public and private sectors to high risk groups (HRG), particularly the transgendered population. We conducted a cross-sectional survey to document STI services in Lahore, Karachi, Rawalpindi, Peshawar, and Quetta. Seventy-three interviews were administered with health service providers at the 3 largest public sector hospitals in each city, as well as with general physicians and traditional healers in the private sector. Twenty-five nongovernmental organizations (NGO) providing STI services were also interviewed. Fewer than 45% of private and public sector general practitioners had been trained in STI treatment after the completion of their medical curriculum, and none of the traditional healers had received any formal training or information on STIs. The World Health Organization (WHO) syndromic management guidelines were followed for STI management by 29% of public and private sector doctors and 5% of traditional healers. STI drugs were available at no cost at 44% of NGOs and at some public sector hospitals. Our findings show that although providers do treat HRGs for STIs, there are significant limitations in their ability to provide these services. These deterrents include, but are not limited to, a lack of STI training of service providers, privacy and adherence to recommended WHO syndromic management guidelines, and costly diagnostic and consultation fees.

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

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    Faucher J

    2016-08-01

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

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

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    Hamid Ravaghi

    2014-01-01

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

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

    Science.gov (United States)

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

    2007-10-01

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

  18. Serving a diverse population: the role of speech-language pathology professional preparation programs.

    Science.gov (United States)

    Stewart, Sharon R; Gonzalez, Lori S

    2002-01-01

    A national survey of 228 program directors was conducted to determine how master's level professional preparation programs are meeting the challenge of preparing speech-language pathologists to provide quality services to an increasingly diverse population. A total of 91 respondents provided information regarding their programs' efforts to address diversity by increasing the diversity of speech-language pathology professionals, preparing students in research for diverse populations, and providing students with the didactic knowledge and clinical experience required to serve diverse populations. Results indicated that professional preparation programs continue to lag in their enrollment of minority students, but there are efforts actively to recruit and retain students from diverse groups. Much variation in preparation in research was found across programs. Graduate students are being presented with information concerning diversity issues, but clinical experiences vary greatly according to the geographic location of the preparation program and individual practicum placements. Implications of these findings for speech-language pathology preparation programs and other allied health programs are discussed.

  19. Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy.

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    Joilda Silva Nery

    2014-11-01

    Full Text Available Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP and primary health care (Family Health Program-FHP programs on new case detection rate of leprosy.We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004-2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI  =0.74-0.83 and significantly increased in municipalities with FHP coverage in the medium (72-95% (Risk Ratio 1.05; 95% CI  =1.02-1.09 and higher coverage tertiles (>95% (Risk Ratio 1.12; 95% CI  =1.08-1.17.At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.

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

    Science.gov (United States)

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

    2014-05-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Science.gov (United States)

    Kapp, Marshall B.

    2000-01-01

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

  3. 75 FR 70165 - Medicare Program; Request for Information Regarding Accountable Care Organizations and the...

    Science.gov (United States)

    2010-11-17

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

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

    Science.gov (United States)

    Adams, Brian

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

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

    NARCIS (Netherlands)

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

    1991-01-01

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

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

    Science.gov (United States)

    Thinhuatoey, Benjamard; Songwathana, Praneed; Petpichetchian, Wongchan

    2016-01-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

  8. Analysis of genetic structure and relationship among nine indigenous Chinese chicken populations by the Structure program

    Indian Academy of Sciences (India)

    H. F. Li; W. Han; Y. F. Zhu; J. T. Shu; X. Y. Zhang; K. W. Chen

    2009-08-01

    The multi-locus model-based clustering method Structure program was used to infer the genetic structure of nine indigenous Chinese chicken (Gallus gallus) populations based on 16 microsatellite markers. Twenty runs were carried out at each chosen value of predefined cluster numbers $(K)$ under admixture model. The Structure program properly inferred the presence of genetic structure with 0.999 probabilities. The genetic structure not only indicated that the nine kinds of chicken populations were defined actually by their locations, phenotypes or culture, but also reflected the underlying genetic variations. At $K = 2$, nine chicken populations were divided into two main clusters, one light-body type, including Chahua chicken (CHA), Tibet chicken (TIB), Xianju chicken (XIA), Gushi chicken (GUS) and Baier chicken (BAI); and the other heavy-body type, including Beijing You chicken (YOU), Xiaoshan chicken (XIA), Luyuan chicken (LUY) and Dagu chicken (DAG). GUS and DAG were divided into independent clusters respectively when equaled 4, 5, or 6. XIA and BIA chicken, XIA and LUY chicken, TIB and CHA chicken still clustered together when equaled 6, 7, and 8, respectively. These clustering results were consistent with the breeding directions of the nine chicken populations. The Structure program also identified migrants or admixed individuals. The admixed individuals were distributed in all the nine chicken populations, while migrants were only distributed in TIB, XIA and LUY populations. These results indicated that the clustering analysis using the Structure program might provide an accurate representation of the genetic relationship among the breeds.

  9. A Reproductive Management Program for an Urban Population of Eastern Grey Kangaroos (Macropus giganteus

    Directory of Open Access Journals (Sweden)

    Andrew Tribe

    2014-09-01

    Full Text Available Traditionally, culling has been the expedient, most common, and in many cases, the only tool used to control free-ranging kangaroo populations. We applied a reproductive control program to a population of eastern grey kangaroos confined to a golf course in South East Queensland. The program aimed to reduce fecundity sufficiently for the population to decrease over time so that overgrazing of the fairways and the frequency of human–animal conflict situations were minimised. In 2003, 92% of the female kangaroos above 5 kg bodyweight were implanted with the GnRH agonist deslorelin after darting with a dissociative anaesthetic. In 2007, 86% of the females above 5 kg were implanted with deslorelin and also 87% of the males above 5 kg were sterilised by either orchidectomy or vasectomy. In 2005, 2008 and 2009, the population was censused to assess the effect of each treatment. The 2003 deslorelin program resulted in effective zero population growth for approximately 2.5 years. The combined deslorelin–surgery program in 2007 reduced the birth rate from 0.3 to 0.06%/year for 16 months, resulting in a 27% population reduction by November 2009. The results were consistent with implants conferring contraception to 100% of implanted females for at least 12 months. The iatrogenic mortality rates for each program were 10.5% and 4.9%, respectively, with 50% of all mortalities due to darting-related injuries, exertional myopathy/hyperthermia or recovery misadventure. The short term sexual and agonistic behaviour of the males was assessed for the 2007 program: no significant changes were seen in adult males given the vasectomy procedure, while sexual behaviours’ were decreased in adult males given the orchidectomy procedure. It is concluded that female reproduction was effectively controlled by implantation with deslorrelin and male reproductive behaviour was reduced by orchidectomy, which together achieved population control.

  10. Psychopathology of the General Population Referred by Primary Care Physicians for Urgent Assessment in Psychiatric Hospitals

    Directory of Open Access Journals (Sweden)

    Judith McLenan

    2016-12-01

    Full Text Available Objective: The aim of this study was to evaluate the type, severity and progression of psychiatric pathologies in a sample of 372 outpatients (age range 18–65 years referred by their primary general practitioners (GPs to an Urgent Referral Team (URT based in a psychiatric hospital in Aberdeen, Scotland. This team offers immediate appointments (1- to 7-day delays for rapid assessments and early interventions to the outpatients referred by their primary family doctors.Method: One-sample t-test and z statistic were used for data analysis. From the total population, a convenience sample of 40 people was selected and assessed to evaluate whether follow-up appointments after the first visit could reduce the severity of suicidal ideation, depression and anxiety in the outpatients seen by the URT. A two-sample t-test and a Wilcoxon signed-rank test were used to assess the variations in the scores during the follow-up visits.Results: We found a statistically significant prevalence of depressive disorders, comorbid with anxiety at first presentation in people who were females, white, never married, living with a partner, not studying and not in paid employment. The common presentation of borderline personality disorder and dysthymia in this population underscores its vulnerability to major socioeconomic challenges.Conclusion: The data confirmed the impact that primary care cooperation with psychiatric hospitals can have on the psychiatric system, and as a reflection, on the population’s mental health and well-being. In fact, active cooperation and early diagnosis and intervention will help detect cases at risk in the general population and reduce admissions into hospitals.

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

    Directory of Open Access Journals (Sweden)

    Ruikes Franca GH

    2012-12-01

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

  12. The Affordable Care Act and integrated care.

    Science.gov (United States)

    Kuramoto, Ford

    2014-01-01

    The Patient Protection and Affordable Care Act (ACA) of 2010 offers a comprehensive, integrated health insurance reform program for those who are eligible to enroll. A core feature of the ACA is the integration of primary health, behavioral health, and related services in a new national program for the first time. This article traces the history of past federal services integration efforts and identify varying approaches for implementing them to improve care, especially for underserved populations. The business case for integrated care, reducing escalating health care costs and overcoming barriers to implementation, is also discussed.

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

    Science.gov (United States)

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

    2016-01-01

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

  14. After the flood. A strategic primary health care plan for homeless and migrant populations during an environmental disaster.

    Science.gov (United States)

    Washington, G T

    1998-01-01

    An environmental crisis, such as a flood, can significantly affect health care delivery and services in a community. Environmental disasters can be particularly devastating to already vulnerable populations such as the homeless and migrants, who, because of social, political, and economic constraints, experience special health care needs. In 1993, after Iowa experienced the worst flood in its history, President Clinton declared the entire state a federal disaster area. Later, the Iowa Department of Public Health received a federal grant to evaluate the health care delivered during the flood and develop a strategic plan to enhance primary health care for the homeless and migrant populations during future environmental disasters. The plan was based on data obtained during and after the flood in three critical areas--communication, health care delivery, and community. These areas were themes that emerged from a series of interviews with representatives from health care agencies and clients themselves. Each theme became the focus of specific, comprehensive recommendations and strategies to meet the daily challenges of the homeless and migrants, as well as to enhance the delivery of primary health care services in the future.

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

    Science.gov (United States)

    St Andre, Arthur

    2015-04-01

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

  16. Community health workers in primary care practice: redesigning health care delivery systems to extend and improve diabetes care in underserved populations.

    Science.gov (United States)

    Collinsworth, Ashley; Vulimiri, Madhulika; Snead, Christine; Walton, James

    2014-11-01

    New, comprehensive, approaches for chronic disease management are needed to ensure that patients, particularly those more likely to experience health disparities, have access to the clinical care, self-management resources, and support necessary for the prevention and control of diabetes. Community health workers (CHWs) have worked in community settings to reduce health care disparities and are currently being deployed in some clinical settings as a means of improving access to and quality of care. Guided by the chronic care model, Baylor Health Care System embedded CHWs within clinical teams in community clinics with the goal of reducing observed disparities in diabetes care and outcomes. This study examines findings from interviews with patients, CHWs, and primary care providers (PCPs) to understand how health care delivery systems can be redesigned to effectively incorporate CHWs and how embedding CHWs in primary care teams can produce informed, activated patients and prepared, proactive practice teams who can work together to achieve improved patient outcomes. Respondents indicated that the PCPs continued to provide clinical exams and manage patient care, but the roles of diabetes education, nutritional counseling, and patient activation were shifted to the CHWs. CHWs also provided patients with social support and connection to community resources. Integration of CHWs into clinical care teams improved patient knowledge and activation levels, the ability of PCPs to identify and proactively address specific patient needs, and patient outcomes.

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

    Directory of Open Access Journals (Sweden)

    Soma Hewa

    2011-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Lewin G

    2016-06-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

  20. Interview with a quality leader: Dr. Eric Coleman, on care for geriatric populations. Interview by Kathleen Tornow Chai.

    Science.gov (United States)

    Coleman, Eric

    2011-09-01

    Dr. Coleman serves as the founding Director of The Care Transitions Program, a national program with a mission to improve quality and safety at times of transitions or care "hand-offs" across settings for persons with complex care needs. This program recognizes that a multifaceted strategy is needed and has taken action to address the problem from multiple angles, including supporting patients and their family caregivers, articulating the key roles and competencies for practitioners, developing and testing quality performance measures, creating new tools to identify medical errors, promoting the role of health information technology, and working directly with policy makers. To date, over 400 leading healthcare organizations have adopted the Care Transitions Intervention. The National Quality Forum endorsed and subsequently re-endorsed the Care Transitions Measure for use in performance measurement and public reporting and over 3,500 organizations in 15 countries have requested permission for its use. To meet this demand, the Care Transitions Measure is available in seven languages. Dr. Coleman is currently a Professor of Medicine at the University of Colorado, Denver. He is currently the Primary Investigator for seven active grants.

  1. 75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

    Science.gov (United States)

    2010-11-03

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

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

    Science.gov (United States)

    Souhrada, Julie

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

  3. 78 FR 25591 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Science.gov (United States)

    2013-05-02

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

  4. 78 FR 75581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Science.gov (United States)

    2013-12-12

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

  5. 78 FR 6851 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

    Science.gov (United States)

    2013-01-31

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

  6. 75 FR 62635 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

    Science.gov (United States)

    2010-10-12

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

  7. 77 FR 69550 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

    Science.gov (United States)

    2012-11-19

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

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

    Science.gov (United States)

    Jarrott, Shannon E; Gigliotti, Christina M

    2010-12-01

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

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

    Science.gov (United States)

    Kelly, Ronald; Godin, Lori

    2015-01-01

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

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

    Science.gov (United States)

    Nemeth, Noel N.

    2002-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Vallath Nandini

    2011-01-01

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

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Gout treatment and comorbidities: a retrospective cohort study in a large US managed care population

    Directory of Open Access Journals (Sweden)

    Plana Estel

    2011-05-01

    Full Text Available Abstract Background Gout prevalence increased in recent years to become one of the most common causes of inflammatory arthritis in most industrialised countries. Comorbidities may affect the disease severity and treatment patterns. We describe the main characteristics of gout patients, gout-related treatment patterns and prevalent comorbidities in a managed care population. Methods From the large US PharMetrics Patient-Centric Database, patients aged 20-89 with at least 2 claims for a diagnosis of gout (ICD9 274.xx and related prescriptions between January 1, 1996 and December 31, 2008 were included. Gout flares were ascertained during follow-up. Sex-specific multivariable Poisson regression models were used to assess factors associated with number of flares. Results 177,637 gout patients were included (mean age 55.2 years; men 75.6%. Overall, more than half (58.1% had any of the considered comorbidities; hypertension (36.1%, dyslipidemia (27.0% and diabetes (15.1% being the most common. Nonselective NSAIDs were the most commonly dispensed (in 38.7% of patients. Notably, 39% of patients did not receive any prescription medication for gout. Patients with comorbidities were significantly more likely to receive anti-gout prescriptions. During an acute episode the prescription of NSAIDs and colchicine increased; and 29.9% of patients received allopurinol. The risk of flares was associated with cardiometabolic comorbidities and older age in women (highest at age 60-69, while in men it decreased by age. Women with these conditions were 60% more likely to have flares (incidence rate ratio, IRR 1.60;1.48-1.74, while men were 10% (IRR 1.10; 1.06-1.13 more likely. Conclusions Comorbidities affected gout treatment patterns and the occurrence and frequency of acute attacks. Cardiometabolic comorbidities, common in this patients' population, were associated with an increased risk of flares.

  15. Population and Service Characteristics of Youth with Schizophrenia-Spectrum Diagnoses in the Hawaii System of Care

    Science.gov (United States)

    Schiffman, Jason; Daleiden, Eric L.

    2006-01-01

    Background: Population and service characteristics were compared for youth (age 0-18 years) with and without schizophrenia-spectrum disorders, who received public mental health services in Hawaii's comprehensive system of care between July 1, 2000 and June 30, 2001. Methods: Electronic records of youth with a diagnosis in the…

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

    Science.gov (United States)

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

    2016-06-01

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

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

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    Shahbodaghi Z

    2014-11-01

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

  18. A study of longitudinal data examining concomitance of pain and cognition in an elderly long-term care population

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    Burfield AH

    2012-03-01

    Full Text Available Allison H Burfield1, Thomas TH Wan2, Mary Lou Sole3, James W Cooper41Gerontology Program, School of Nursing, College of Health and Human Services, University of North Carolina, Charlotte, NC, USA; 2Health Services, Administration, and Medical Education, Director, Doctoral Program in Public Affairs, Associate Dean for Research, College of Health and Public Affairs, 3College of Nursing, University of Central Florida, Orlando, FL, USA; 4College of Pharmacy, University of Georgia, Athens, GA, USAPurpose: To examine if a concomitant relationship exists between cognition and pain in an elderly population residing in long-term care.Background/significance: Prior research has found that cognitive load mediates interpretation of a stimulus. In the presence of decreased cognitive capacity as with dementia, the relationship between cognition and increasing pain is unknown in the elderly.Patients and methods: Longitudinal cohort design. Data collected from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI from the 2001–2003 annual assessments of nursing home residents. A covariance model was used to evaluate the relationship between cognition and pain at three intervals.Results: The sample included 56,494 subjects from nursing homes across the United States, with an average age of 83 ± 8.2 years. Analysis of variance scores (ANOVAs indicated a significant effect (P < 0.01 for pain and cognition, with protected t test revealing scores decreasing significantly with these two measures. Relative stability was found for pain and cognition over time. Greater stability was found in the cognitive measure than the pain measure. Cross-legged effects observed between cognition and pain measures were inconsistent. A concomitant relationship was not found between cognition and pain. Even though the relationship was significant at the 0.01 level, the correlations were low (r ≤ 0.08, indicating a weak association between cognition and pain

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

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    Critchley Patrick

    2006-05-01

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

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

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    Paula Alvarenga de Figueiredo

    2016-01-01

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

  1. Accelerated Training of Skilled Birth Attendants in a Marginalized Population on the Thai-Myanmar Border: A Multiple Methods Program Evaluation

    Science.gov (United States)

    White, Adrienne Lynne; Min, Thaw Htwe; Gross, Mechthild M.; Kajeechiwa, Ladda; Thwin, May Myo; Hanboonkunupakarn, Borimas; Than, Hla Hla; Zin, Thet Wai; Rijken, Marcus J.; Hoogenboom, Gabie; McGready, Rose

    2016-01-01

    Background To evaluate a skilled birth attendant (SBA) training program in a neglected population on the Thai-Myanmar border, we used multiple methods to show that refugee and migrant health workers can be given effective training in their own environment to become SBAs and teachers of SBAs. The loss of SBAs through resettlement to third countries necessitated urgent training of available workers to meet local needs. Methods and Findings All results were obtained from student records of theory grades and clinical log books. Qualitative evaluation of both the SBA and teacher programs was obtained using semi-structured interviews with supervisors and teachers. We also reviewed perinatal indicators over an eight-year period, starting prior to the first training program until after the graduation of the fourth cohort of SBAs. Results Four SBA training programs scheduled between 2009 and 2015 resulted in 79/88 (90%) of students successfully completing a training program of 250 theory hours and 625 supervised clinical hours. All 79 students were able to: achieve pass grades on theory examination (median 80%, range [70–89]); obtain the required clinical experience within twelve months; achieve clinical competence to provide safe care during childbirth. In 2010–2011, five experienced SBAs completed a train-the-trainer (TOT) program and went on to facilitate further training programs. Perinatal indicators within Shoklo Malaria Research Unit (SMRU), such as place of birth, maternal and newborn outcomes, showed no significant differences before and after introduction of training or following graduate deployment in the local maternity units. Confidence, competence and teamwork emerged from qualitative evaluation by senior SBAs working with and supervising students in the clinics. Conclusions We demonstrate that in resource-limited settings or in marginalized populations, it is possible to accelerate training of skilled birth attendants to provide safe maternity care

  2. The AMC Linear Disability Score project in a population requiring residential care: psychometric properties

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    Vermeulen Marinus

    2004-08-01

    Full Text Available Abstract Background Currently there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes, including functional status. However, there are few item banks, which have been developed to quantify functional status, as expressed by the ability to perform activities of daily life. Method This paper examines the psychometric properties of the AMC Linear Disability Score (ALDS project item bank using an item response theory model and full information factor analysis. Data were collected from 555 respondents on a total of 160 items. Results Following the analysis, 79 items remained in the item bank. The remaining 81 items were excluded because of: difficulties in presentation (1 item; low levels of variation in response pattern (28 items; significant differences in measurement characteristics for males and females or for respondents under or over 85 years old (26 items; or lack of model fit to the data at item level (26 items. Conclusions It is conceivable that the item bank will have different measurement characteristics for other patient or demographic populations. However, these results indicate that the ALDS item bank has sound psychometric properties for respondents in residential care settings and could form a stable base for measuring functional status in a range of situations, including the implementation of computerised adaptive testing of functional status.

  3. The AMC Linear Disability Score project in a population requiring residential care: psychometric properties

    Science.gov (United States)

    Holman, Rebecca; Lindeboom, Robert; Vermeulen, Marinus; de Haan, Rob J

    2004-01-01

    Background Currently there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes, including functional status. However, there are few item banks, which have been developed to quantify functional status, as expressed by the ability to perform activities of daily life. Method This paper examines the psychometric properties of the AMC Linear Disability Score (ALDS) project item bank using an item response theory model and full information factor analysis. Data were collected from 555 respondents on a total of 160 items. Results Following the analysis, 79 items remained in the item bank. The remaining 81 items were excluded because of: difficulties in presentation (1 item); low levels of variation in response pattern (28 items); significant differences in measurement characteristics for males and females or for respondents under or over 85 years old (26 items); or lack of model fit to the data at item level (26 items). Conclusions It is conceivable that the item bank will have different measurement characteristics for other patient or demographic populations. However, these results indicate that the ALDS item bank has sound psychometric properties for respondents in residential care settings and could form a stable base for measuring functional status in a range of situations, including the implementation of computerised adaptive testing of functional status. PMID:15291958

  4. Accidental intoxication of the infant-juvenile population in households: profiles of emergency care

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    Jackeline Gonçalves Brito

    2015-06-01

    Full Text Available OBJECTIVE Analyzing profiles of intoxication and accidental poisoning of infant-juvenile population (0-24 years in the household, treated at a reference facility for Emergency and Primary Care, during the year 2013. METHOD A descriptive, cross-sectional study. Data were analyzed using Epi-Info, by way of simple and bivariate analyzes. The project was approved by the Research Ethics Committee (protocol 405.578. RESULTS There were 45 intoxications, with a prevalence of males (60.0%, aged 1-4 years (71.1%. Among children under one, there was a higher frequency of pesticide poisoning (66.6%, between the ages of 1-4 by cleaning products (34.4%, and between 5-9 years of age by pharmacological substances (66.6%. The primary assistance was provided only at health institutions, with hospital admissions in 24.4% of the cases. CONCLUSION The importance of prevention through legislation is evident, in order to ensure greater safety in packaging of various products, and community awareness to eliminate risks in the household environment.

  5. Do Health and Demographic Surveillance Systems benefit local populations? Maternal care utilisation in Butajira HDSS, Ethiopia

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    Mesganaw Fantahun Afework

    2014-07-01

    Full Text Available Background: The benefits of Health and Demographic Surveillance sites for local populations have been the topic of discussion as countries such as Ethiopia take efforts to achieve their Millennium Development Goal targets, on which they lag behind. Ethiopia's maternal mortality ratio is very high, and in the 2011 Ethiopia Demographic and Health Survey (2011 EDHS it was estimated to be 676/100,000 live births. Recent Global Burden of Disease (GBD and estimates based on the United Nations model reported better, but still unacceptably high, figures of 497/100,000 and 420/100,000 live births for 2013. In the 2011 EDHS, antenatal care (ANC utilization was estimated at 34%, and delivery in health facilities was only 10%. Objectives: To compare maternal health service utilization among populations in a Health and Demographic Surveillance System (HDSS to non-HDSS populations in Butajira district, south central Ethiopia. Design: A community-based comparative cross-sectional study was conducted in January and February 2012 among women who had delivered in the 2 years before the survey. Results: A total of 2,296 women were included in the study. One thousand eight hundred and sixty two (81.1% had attended ANC at least once, and 37% of the women had attended ANC at least four times. A quarter of the women delivered their last child in a health facility. Of the women living outside the HDSS areas, 715 (75.3% attended ANC at least once compared to 85.1% of women living in the HDSS areas [adjusted odds ratio (AOR 0.59; 95% CI 0.46, 0.74]. Of the women living outside the HDSS areas, only 170 (17.9% delivered in health facilities and were assisted by skilled attendants during delivery, whereas 30.0% of those living in HDSS areas delivered in health facilities (AOR 0.66; 95% CI 0.48, 0.91. Conclusion: This paper provides possible evidence that living in an HDSS site has a positive influence on maternal health. In addition, there may be a positive influence on

  6. Linkage to and engagement in HIV care in western Kenya: An observational study using population-based estimates from home-based counseling and testing

    Science.gov (United States)

    Genberg, Becky L.; Naanyu, Violet; Wachira, Juddy; Hogan, Joseph W.; Sang, Edwin; Nyambura, Monicah; Odawa, Michael; Duefield, Corey; Ndege, Samson; Braitstein, Paula

    2015-01-01

    Summary Background There is limited research characterizing the HIV care continuum with population-based data in sub-Saharan Africa. The objectives of this study were to: 1) describe engagement in care among all known HIV-positive adults in one sub-county of western Kenya; and 2) determine the time to and predictors of linkage and engagement among adults newly diagnosed via home-based counseling and testing (HBCT). Methods AMPATH (Academic Model Providing Access to Healthcare) has provided HIV care in western Kenya since 2001 and HBCT since 2007. Following a widespread HBCT program in Bunyala sub-county, electronic medical records (EMR) were reviewed to identify uptake of care among individuals with previously known (self-reported) infection and new (identified by HBCT) HIV diagnoses as of June 2014. Engagement in HIV care was defined as an initial encounter with an HIV care provider. Cox regression analysis was used to examine the predictors of engagement among those newly diagnosed. Findings Of the 3,482 infected adults identified, 61% had previously known infections, among whom 84% (n = 1778/2122) had ever had at least one clinical encounter within AMPATH. While 73% were registered in the EMR, only 15% (n = 209/1360) of the newly diagnosed had seen a clinician over a median of 3·4 years. The median time to engagement among the newly diagnosed was 60 days (interquartile range: 10–411 days). Interpretation Engagement in care was high among those who at the time of HBCT were already known HIV-positive, but few who were newly diagnosed in HBCT saw an HIV care provider. Funding This research was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID under the terms of Cooperative Agreement No. AID-623-A-12-0001. The HBCT program was supported by grants from Abbott Laboratories, the Purple ville Foundation, and the Global Business Coalition. Abbott Laboratories provided test kits and logistical support. Further support was provided by

  7. Programas de continuidad de cuidados: el ejemplo del distrito de Chamartín de Madrid Continuity of care programs: the example of Madrid Chamartin district

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    Ana González Rodríguez

    2011-12-01

    Full Text Available Se presenta el programa de continuidad de cuidados del Centro de Salud Mental de Chamartín en Madrid, para ilustrar con una experiencia fuera del ámbito anglosajón donde surgen estos programas, la teoría expuesta en la primera parte acerca del surgimiento, desarrollo y filosofía de los programas de continuidad de cuidados. Se describen los recursos sanitarios, sociales y personales de los que dispone la población a la que va dirigido y la forma de intervención, con el tipo de actuaciones que se realizan. Por último, se señalan algunos riesgos en el desarrollo y mantenimiento de los programas de continuidad de cuidados.The case management program of Chamartin Mental Health Center in Madrid is presented to illustrate with an experience outside the Anglo-Saxon context, where such programs arise, the theory advanced in the first part about the emergence, development and philosophy of continuity of care programs. Finally, some risks in the development and maintenance of continuity of care programs are pointed out. The health, social and staff resources are described, and also the population to be targeted, the form of intervention and the type of actions that are performed. Finally, we point out some risks in the development and maintenance of continuity of care programs.

  8. Screening history in women with cervical cancer in a Danish population-based screening program

    DEFF Research Database (Denmark)

    Kirschner, Benny; Poll, Susanne; Rygaard, Carsten;

    2011-01-01

    The aim of this study was to explore the screening histories of all cervical cancers in a Danish screening population. The intention was to decide suboptimal sides of the screening program and to evaluate the significance of routine screening in the development of cervical cancer....

  9. Cost-effectiveness of screening programs for Chlamydia trachomatis - A population-based dynamic approach

    NARCIS (Netherlands)

    Welte, R; Kretzschmar, M; Leidl, R; Van den Hoek, A; Jager, JC; Postma, MJ

    2000-01-01

    Background: Models commonly used for the economic assessment of chamydial screening programs do not consider population effects. Goal: To develop a novel dynamic approach for the economic evaluation of chlamydial prevention measures and to determine the cost-effectiveness of a general practitioner-b

  10. Depression Care for Low-Income, Minority, Safety Net Clinic Populations with Comorbid Illness

    Science.gov (United States)

    Ell, Kathleen; Lee, Pey-Jiuan; Xie, Bin

    2010-01-01

    Objective: Increasingly, mental health care is provided within the general health care sector. Accompanying this significant change is the demand for evidence-based as well as cost-effective or cost-neutral care models. Method: The authors present a pooled analysis of three large randomized clinical trials in which social workers provide…

  11. An apocalyptic vision of ageing in China: Old age care for the largest elderly population in the world.

    Science.gov (United States)

    Liu, Tao; Sun, Li

    2015-06-01

    According to the National Bureau of Statistics of China, by 2010 the number of people aged 60 or over had reached 178 million in China or 13% of its population. With the largest elderly population in the world in absolute numbers, China faces a challenge of providing care for the elderly both in the present and the future. Unlike old age pensions and health protection for the elderly, in Chinese society elderly care had never been considered to be a social problem but rather the individual family's responsibility. After the turn of the millennium, as the repercussions of increasingly ageing demographics, the results of the One-Child Policy and drastic changes in traditional family structures gradually became more apparent, this issue of elderly care has increasingly become one of the most pressing concerns for the ageing society. As there is little existing research on this particular topic, this article aims to shed light on elderly care in China, focusing on the care of elderly needing assistance with activities of daily living, since this group of elderly are most in need of care, their numbers having risen to 33 million in 2010. This article argues it is urgent for China to switch from informal family-based elderly care to the state's formal long-term care, illustrates that a model of social insurance (e.g. as in Germany) is advocated by many Chinese scholars and points out the ways in which it is different from both the commercialized models (e.g. as in the USA) and state organized "Beveridge" models (e.g. as in Sweden).

  12. 76 FR 19527 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

    Science.gov (United States)

    2011-04-07

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

  13. Primary health care utilization by the mexican indigenous population: the role of the Seguro popular in socially inequitable contexts.

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    Rene Leyva-Flores

    Full Text Available OBJECTIVE: To analyze the relationship between primary health care utilization and extended health insurance coverage under the Seguro Popular (SP among Mexican indigenous people. METHODOLOGY: A cross-sectional analysis was conducted using data from the Mexican National Nutrition Survey 2012 (n = 194,758. Quasi-experimental matching methods and nonlinear regression probit models were used to estimate the influence of SP on primary health care utilization. RESULTS: 25% of the Mexican population reported having no health insurance coverage, while 59% of indigenous versus 35% of non-indigenous reported having SP coverage. Health problems were reported by 13.9% of indigenous vs. 10.5% of non-indigenous; of these, 52.8% and 57.7% respectively, received primary health care (p<0.05. Economic barriers were the most frequent reasons for not using primary health care services. The probability of utilizing primary health care services was 11.5 percentage points higher (p<0.01 for indigenous SP affiliates in comparison with non-indigenous, in similar socioeconomic conditions. CONCLUSION: Socioeconomic conditions, not ethnicity per-se, determine whether people utilize primary health care services. Therefore, SP can be conceived as a public policy strategy which acts as a social buffer by enhancing health care utilization regardless of ethnicity. Further analysis is required to explore the potential gaps as a result of SP coverage among socially vulnerable groups.

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

    Science.gov (United States)

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

    2004-12-01

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

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

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    Keenum Michael

    2006-08-01

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

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

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    Ali Akbar Vaezi

    2011-03-01

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

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

    Science.gov (United States)

    Lauri, S

    1992-01-01

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

  18. A FORTRAN program to simulate the evolution of genetic variability in a small population.

    Science.gov (United States)

    Fournet, F; Hospital, F; Elsen, J M

    1995-10-01

    This paper presents a FORTRAN-77 program that performs Monte Carlo simulation of the evolution of genetic structure in a small population under selection. The aim is to study the possibility of foreseeing a response plateau in a theoretical population, depending on population size and management, and to apply this to small populations actually selected, to predict a possible exhaustion of genetic variability. A set of subroutines describing the different steps in a selection cycle (birth, expression of phenotypic value, genetic evaluation, selection, reproduction, death) is available and the user can choose the sequence of subroutines, the characteristics of individuals submitted to each step, and also build more personal subroutines if necessary. The program is based on the generation of exact genotypes and their transmission from parents to offspring, through simulation of meiosis and pairing of gametes. Parameters concerning the genome, the initial structure of the population and its management are required. The genetic mean and variance of the population for each new cycle of selection are given as outputs. Examples of applications are given and discussed.

  19. Internação domiciliar: o perfil dos pacientes assistidos pelo Programa HU em Casa Home care: profile of patients attended by a home care program

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    Daniella Reis Barbosa Martelli

    2011-01-01

    Full Text Available Internação domiciliar é uma modalidade de atendimento à saúde que está se transformando em uma alternativa importante para minimizar alguns dos principais problemas inerentes aos sistemas de saúde vigentes, especialmente os da rede pública. O objetivo do estudo foi descrever o perfil sociodemográfico e clínico da população assistida pelo Programa de Internação Domiciliar (PID HU em Casa do Hospital Universitário Clemente de Faria da Universidade Estadual de Montes Claros. O estudo foi descritivo e retrospectivo por meio da análise de prontuários, realizada de maio de 2005 a maio de 2008. Foram analisados 137 pacientes, sendo 75 do gênero feminino (54,7% e 62 do masculino (45,3%. O grupo de 61 a 80 anos foi mais prevalente (37,2% e 73% dos pacientes residiam em bairros periféricos do município de Montes Claros-MG. Dos agravos mais comuns na primeira internação, a pneumonia foi prevalente, 22 casos (16,1%. A maioria dos pacientes foi encaminhada ao PID pela clinica médica (84,7%, com intervalo de maior prevalência de duas a três internações (42,4%. Do total de pacientes, 120 (87,6% permaneceram internados por 16 a 30 dias e 51,8% não necessitaram passar novamente pelo PID para uma segunda internação. Com relação à resolutividade clínica, 130 (94,9% tiveram alta clínica, no PID, na primeira internação. O PID mostrou-se ser um programa de alta resolutividade, atendendo mais ao público idoso feminino, de baixa renda e com períodos de internação relativamente curtos.The home care is a modality of health care which is becoming an important alternative to minimize some of mainly relevant problems of world health, especially the public health network. This paper aimed to describe the socio-demographic and clinical population assisted by the Home Care Program HU em Casa, of the University Hospital Clemente de Faria, Universidade Estadual de Montes Claros. It is a descriptive and retrospective study analyzing

  20. Primary Health Care Challenges in Rural/Remote Areas of Yakutia and Use of Automated Systems for the Medical Screening Examination of the Pediatric Population

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    Sardana A. Evseeva

    2015-12-01

    Full Text Available The negative consequences of social and economic changes in recent decades have primarily affected the rural population and violated the main principles of medical care organization for this group. The reduction by one third in the number of district hospitals, uncompensated by adequate development of outpatient care, and a shortage of doctors in rural clinics led to reduced availability of primary care. Specialized medical assistance in regional and national hospitals has also become less accessible to the rural population due to the high cost of travel. The number of doctors and nurses in rural areas is lower by 3.4 and 1.6 times, respectively, than in cities. In this regard, the burden and responsibility for rural health workers is much higher. Study of the opinions of the medical staff of the Northern and Arctic regions is an important part of the decision-making system in health care, allowing us to carry out modernization programs in the industry and increase their efficiency through feedback mechanisms. This article presents the available data on the problems of organizing medical assistance for residents of the Northern and Arctic regions of Yakutia, because dealing with these problems is still the most socially significant task for the authorities and carries a great load of negative experience, stereotypes, and scientific-methodological errors. To assess the quality of medical care, we conducted an anonymous survey of parents and medical staff of the Northern and Arctic regions of Yakutia. A total of 1,415 parents and 322 health specialists were interviewed between 2011 and 2012. The results of the anonymous survey revealed that in the Northern and Arctic regions of Yakutia there is a deficit of qualified specialists of different profiles, an unsatisfactory infrastructure of medical offices and hospitals, and a low level of income for medical personnel and the whole population. All above listed are some of the reasons for developing

  1. Recruitment issues when primary care population clusters are used in randomised controlled clinical trials: climbing mountains or pushing boulders uphill?

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    Hoddinott, Pat; Britten, Jane; Harrild, Kirsten; Godden, David J

    2007-05-01

    Cluster randomised controlled trials for health promotion, education, public health or organisational change interventions are becoming increasingly common to inform evidence-based policy. However, there is little published methodological evidence on recruitment strategies for primary care population clusters. In this paper, we discuss how choosing which population cluster to randomise can impact on the practicalities of recruitment in primary care. We describe strategies developed through our experiences of recruiting primary care organisations to participate in a national randomised controlled trial of a policy to provide community breastfeeding groups for pregnant and breastfeeding mothers, the BIG (Breastfeeding in Groups) trial. We propose an iterative qualitative approach to recruitment; collecting data generated through the recruitment process, identifying themes and using the constant comparative method of analysis. This can assist in developing successful recruitment strategies and contrasts with the standardised approach commonly used when recruiting individuals to participate in randomised controlled trials. Recruiting primary care population clusters to participate in trials is currently an uphill battle in Britain. It is a complex process, which can benefit from applying qualitative methods to inform trial design and recruitment strategy. Recruitment could be facilitated if health service managers were committed to supporting peer reviewed, funded and ethics committee approved research at national level.

  2. Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study.

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    Thomas E Cowling

    Full Text Available BACKGROUND: The number of visits to hospital emergency departments (EDs in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS. Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. METHODS: A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001. Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.

  3. Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study

    Science.gov (United States)

    Cowling, Thomas E.; Cecil, Elizabeth V.; Soljak, Michael A.; Lee, John Tayu; Millett, Christopher; Majeed, Azeem; Wachter, Robert M.; Harris, Matthew J.

    2013-01-01

    Background The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. Methods A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. Main Result and Conclusion General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation. PMID:23776694

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

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    Melissa Cowart-Osborne

    2014-08-01

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

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

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    Hodapp, Theodore

    2016-03-01

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

  6. Common Infections in Patients Prescribed Systemic Glucocorticoids in Primary Care: A Population-Based Cohort Study.

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    Laurence Fardet

    2016-05-01

    Full Text Available Little is known about the relative risk of common bacterial, viral, fungal, and parasitic infections in the general population of individuals exposed to systemic glucocorticoids, or about the impact of glucocorticoid exposure duration and predisposing factors on this risk.The hazard ratios of various common infections were assessed in 275,072 adults prescribed glucocorticoids orally for ≥15 d (women: 57.8%, median age: 63 [interquartile range 48-73] y in comparison to those not prescribed glucocorticoids. For each infection, incidence rate ratios were calculated for five durations of exposure (ranging from 15-30 d to >12 mo, and risk factors were assessed. Data were extracted from The Health Improvement Network (THIN primary care database. When compared to those with the same underlying disease but not exposed to glucocorticoids, the adjusted hazard ratios for infections with significantly higher risk in the glucocorticoid-exposed population ranged from 2.01 (95% CI 1.83-2.19; p < 0.001 for cutaneous cellulitis to 5.84 (95% CI 5.61-6.08; p < 0.001 for lower respiratory tract infection (LRTI. There was no difference in the risk of scabies, dermatophytosis and varicella. The relative increase in risk was stable over the durations of exposure, except for LRTI and local candidiasis, for which it was much higher during the first weeks of exposure. The risks of infection increased with age and were higher in those with diabetes, in those prescribed higher glucocorticoid doses, and in those with lower plasma albumin level. Most associations were also dependent on the underlying disease. A sensitivity analysis conducted on all individuals except those with asthma or chronic obstructive pulmonary disease produced similar results. Another sensitivity analysis assessing the impact of potential unmeasured confounders such as disease severity or concomitant prescription of chemotherapy suggested that it was unlikely that adjusting for these potential

  7. Assessing Health Status Differences Between Veterans Affairs Home-Based Primary Care and State Medicaid Waiver Program Clients

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    Wharton, Tracy C.; Nnodim, Joseph; Hogikyan, Robert; Mody, Lona; James, Mary; Montagnini, Marcos; Fries, Brant E.

    2013-01-01

    Objectives Comprehensive health care for older adults is complex, involving multiple comorbidities and functional impairments of varying degrees and numbers. In response to this complexity and associated barriers to care, home-based care models have become prevalent. The home-based primary care (HBPC) model, based at a Michigan Department of Veterans Affairs Medical Center, and the Michigan Waiver Program (MWP) that includes home-based care are 2 of these. Although both models are formatted to address barriers to effective and efficient health care, there are differences in disease prevalence and functional performance between groups. The objective of this study was to explore the differences between the 2 groups, to shed some light on potential trends that could suggest areas for resource allocation by service providers. Design Using a retrospective analysis of data collected using the interRAI-home care, we examined a cross-sectional representation of clients enrolled in HBPC and MWP in 2008. Participants The HBPC sample had 89 participants. The MWP database contained 9324 participants from across the State of Michigan and were weighted to be comparable to the HBPC population in sex and age, and to simulate the HBPC sample size. Results Veterans were more independent in basic activities of daily living performance, but there was no difference in the rate of reported falls between the 2 groups. Veterans had more pain and a higher prevalence of coronary artery disease (z = 7.0; P <.001), Chronic obstructive pulmonary disease (z = 3.9; P < .001), and cancer (z = 8.5; P < .001). There was no statistically significant difference between the 2 groups in terms of the prevalence of geriatric syndromes. Scores on subscales of the interRAI-home care indicated a lower risk of serious health decline and adverse outcomes for MWP compared with HBPC clients (1.4 ± 1.1 vs 0.9 ± 0.1; z = 2.5; P = .012). Veterans receiving home-based care through the Veterans Affairs Medical

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

    Science.gov (United States)

    Fronstin, Paul; Roebuck, M Christopher

    2015-08-01

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

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

    Science.gov (United States)

    Mui, A C

    2001-01-01

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

  10. Population uptake of antiretroviral treatment through primary care in rural South Africa

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    Bärnighausen Till W

    2010-09-01

    Full Text Available Abstract Background KwaZulu-Natal is the South African province worst affected by HIV and the focus of early modeling studies investigating strategies of antiretroviral treatment (ART delivery. The reality of antiretroviral roll-out through primary care has differed from that anticipated and real world data are needed to inform the planning of further scaling up of services. We investigated the factors associated with uptake of antiretroviral treatment through a primary healthcare system in rural South Africa. Methods Detailed demographic, HIV surveillance and geographic information system (GIS data were used to estimate the proportion of HIV positive adults accessing antiretroviral treatment within northern KwaZulu-Natal, South Africa in the period from initiation of antiretroviral roll-out until the end of 2008. Demographic, spatial and socioeconomic factors influencing the likelihood of individuals accessing antiretroviral treatment were explored using multivariable analysis. Results Mean uptake of ART among HIV positive resident adults was 21.0% (95%CI 20.1-21.9. Uptake among HIV positive men (19.2% was slightly lower than women (21.8%, P = 0.011. An individual's likelihood of accessing ART was not associated with level of education, household assets or urban/rural locale. ART uptake was strongly negatively associated with distance from the nearest primary healthcare facility (aOR = 0.728 per square-root transformed km, 95%CI 0.658-0.963, P = 0.002. Conclusions Despite concerns about the equitable nature of antiretroviral treatment rollout, we find very few differences in ART uptake across a range of socio-demographic variables in a rural South African population. However, even when socio-demographic factors were taken into account, individuals living further away from primary healthcare clinics were still significantly less likely to be accessing ART

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

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    Fitri Haryanti

    2014-12-01

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

  12. Priorities for treatment, care and information if faced with serious illness: a comparative population-based survey in seven European countries

    NARCIS (Netherlands)

    Higginson, I.J.; Gomes, B.; Calanzani, N.; Gao, W.; Bausewein, C.; Daveson, B.A.; Deliens, L.; Ferreira, P.L.; Toscani, F.; Gysels, M.; Ceulemans, L.; Simon, S.T.; Cohen, J.; Harding, R.

    2014-01-01

    BACKGROUND: Health-care costs are growing, with little population-based data about people's priorities for end-of-life care, to guide service development and aid discussions. AIM: We examined variations in people's priorities for treatment, care and information across seven European countries. DESIG

  13. Early HIV diagnosis through use of rapid diagnosis test (RDT in the community and direct link to HIV care: a pilot project for vulnerable populations in Athens, Greece

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    Eleni Kakalou

    2014-11-01

    Full Text Available Introduction: An increase in the incidence of HIV new infections among intravenous drug users (IDUs by 1500%, was noted in the center of Athens in 2011. Increasing problematic drug use, homelessness, health cuts amidst the economic crisis, have contributed to the epidemic. New cases doubled within a year, challenging the HIV care delivery system (1. Materials and Methods: A pilot project funded by the National Strategic Reference Framework (NSRF 2007–2013 of the European Union (EU, was launched from August 2012 to March 2014. It was a partnership between the HIV Clinic of Evangelismos Hospital and the NGO PRAKSIS. The project is aimed at offering early diagnosis and comprehensive care to hard to reach populations. RDT diagnosis through mobile units, direct linkage to care, elimination of waiting times, flexibility, psychosocial support and link to harm reduction services for active IDUs were offered to the beneficiaries. Results: A total of 117 people enrolled in the program following HIV RDT offered by mobile units of the NGO PRAKSIS in community sites. Sixty-eight percent were IDUs, 12% were men who have sex with men (MSM and 19.5% were heterosexuals. Men were 74.3% and women were 25.6%. Country born patients were 43.5% and non-country born patients were 56.4%. Nine people were HIV negative but needed post-exposure prophylaxis (PEP, treatment for Hepatitis C and one test was false positive. Two deaths occurred and six people were deported. Of the remaining 100 patients, 84 enrolled in the care program. Of those 77% (65/84 remain in care for three months after the end of the project. Care retention was 73.5% (39/53 for IDUs, 91% (10/11 for MSM, 80% (16/20 for heterosexuals, 73% (25/35 for country born and 82% (40/49 for non-country born individuals. Among those that remain in care, 77.7% (42/54 with 90% have undetectable viral load. Mean value of CD4 cells at enrollment was 298 cells/mm3. At follow up, three months after the end of the

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

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    Abdullah M Al-Wahbi

    2010-10-01

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

  15. Effects of a Hypertension Management Program by Seongcheon Primary Health Care Post in South Korea: An Analysis of Changes in the Level of Knowledge of Hypertension in the Period from 2004 to 2009

    Science.gov (United States)

    Song, In Han; Kim, Sang-A; Park, Woong-Sub

    2012-01-01

    The objective of this study was to examine the effects of a hypertension management program provided by a primary health care post located in a distant rural area in South Korea on the level of knowledge of hypertension. The panel data consisted of a total of 319 people or the entire population aged above 40 years of five villages located in…

  16. Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations

    Science.gov (United States)

    Andrulis, Dennis P.; Brach, Cindy

    2016-01-01

    Objective To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection. Methods Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed. Results Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP). The lack of integration results in health care that is unresponsive to some vulnerable groups’ needs. A vision for integrated care is presented. Conclusion Clinicians, the health care team, and health care organizations have important roles to play in addressing challenges related to literacy, culture, and language. PMID:17931131

  17. Home-Based Hospice Care Reduces End-of-Life Expenditure in Taiwan: A Population-Based Study.

    Science.gov (United States)

    Chen, Li-Fu; Chang, Chun-Ming; Huang, Chih-Yuan

    2015-09-01

    Inpatient hospice care can reduce futile treatment and medical costs. However, the cost trimming effect of home-based hospice care in hospital has yet not been explored. This study evaluates the impact of home-based hospice care on end-of-life expenditure in hospitals with different spending intensity. This is a population-based retrospective study in Taiwan. Cancer decedents were identified in the National Health Insurance Research Database (NHIRD) from 2009 to 2011. They are categorized by hospital spending intensity. A hierarchical linear regression model with a random-intercept model was used to analyze the relationship between end-of-life expenditure (dependent variable) with and without home-based hospice, and both patient-level and hospital-level characteristics. A total of 78,613 cancer decedents were identified in the NHIRD from 2009 to 2011. Of these decedents, 17,638, 43,286, and 17,689 were categorized by hospital spending intensity as high, moderate, and low, respectively. Decedents with home-based hospice care were associated with US$2452 less in expenditure per patient compared with those without home-based hospice care. The majority of savings occurred in the last 3 months of life. These savings with home-based hospice care were consistent in hospitals with different levels of spending intensity. Home-based hospice reduced one-fifth expenditure at the end of life of cancer decedents treated in hospitals with different spending intensity.

  18. Recommendations for improving the end-of-life care system for homeless populations: A qualitative study of the views of Canadian health and social services professionals

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    McNeil Ryan

    2012-09-01

    Full Text Available Abstract Background Homeless populations have complex and diverse end-of-life care needs. However, they typically die outside of the end-of-life care system. To date, few studies have explored barriers to the end-of-life care system for homeless populations. This qualitative study involving health and social services professionals from across Canada sought to identify barriers to the end-of-life care system for homeless populations and generate recommendations to improve their access to end-of-life care. Methods Semi-structured qualitative interviews were conducted with 54 health and social services professionals involved in end-of-life care services delivery to homeless persons in six Canadian cities (Halifax, Hamilton, Ottawa, Thunder Bay, Toronto and Winnipeg. Participants included health administrators, physicians, nurses, social workers, harm reduction specialists, and outreach workers. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Results Participants identified key barriers to end-of-life care services for homeless persons, including: (1 insufficient availability of end-of-life care services; (2 exclusionary operating procedures; and, (3 poor continuity of care. Participants identified recommendations that they felt had the potential to minimize these barriers, including: (1 adopting low-threshold strategies (e.g. flexible behavioural policies and harm reduction strategies; (2 linking with population-specific health and social care providers (e.g. emergency shelters; and, (3 strengthening population-specific training. Conclusions Homeless persons may be underserved by the end-of-life care system as a result of barriers that they face to accessing end-of-life care services. Changes in the rules and regulations that reflect the health needs and circumstances of homeless persons and measures to improve continuity of care have the potential to increase equity in the end-of-life care system for this

  19. Current Challenges to the United States’ AIDS Drug Assistance Program and Possible Implications of the Affordable Care Act

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    Kathleen A. McManus

    2013-01-01

    Full Text Available AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are the “payer of last resort” for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS. ADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased their contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living longer; the antiretroviral therapy (ART guidelines have been changed to recommend initiation of treatment for all; the United States is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding, ADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not sustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation of the Affordable Care Act (ACA. Lessons learned from the challenges associated with providing sustainable access to ART for vulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after the implementation of the ACA.

  20. Impact of a dental care program on the quality of life of children with and without caries.

    Science.gov (United States)

    Paula, Janice Simpson de; Sarracini, Karin Luciana Migliato; Ambrosano, Gláucia Maria Bovi; Pereira, Antônio Carlos; Meneghim, Marcelo de Castro; Mialhe, Fábio Luiz

    2016-12-22

    The aim of the present study was to evaluate the long-term effects of the caries treatment provided by a dental care program on changes in schoolchildren's OHRQoL. A one-year follow-up was conducted with a sample of 372 children aged 8 to 10 years which were clinically examined and divided into two matched groups according to their caries experience: dental treatment group (DTG) and group without caries (GWC). Both groups were assessed three times (at baseline, at 4 weeks, and at 1 year) using the Child Perceptions Questionnaire (CPQ8-10). The normality test was performed for the statistical analyses; the Friedman test was used for the dependent variables (longitudinal assessment repeated three times for the same group); and the Mann-Whitney test was used for the independent variables (test and control groups in each time period). There was improvement in all domains and in overall CPQ8-10 (p 0.05) were observed at baseline for overall CPQ8-10 and for the emotional well-being domain in the GWC. The comparison between groups demonstrated that OHRQoL was persistently better for the GWC (p dental caries treatment has a long-term positive impact on schoolchildren's OHRQoL, highlighting the importance of health policies that promote access to dental care for this population.

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

    Science.gov (United States)

    Engel, Nora; Pant Pai, Nitika

    2015-01-01

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

  2. Integration of Medical Care and Endowment: A New Exploration of Endowment Mode in the Context of Population Aging

    Institute of Scientific and Technical Information of China (English)

    Xinpeng; XU; Xiaopeng; FU

    2015-01-01

    China’s aging pressure is increasingly serious. The elderly people are difficult to seek medical advice,the elderly dependency ratio is soaring,finance fails to bear such heavy load,and social endowment service pressure is also constantly increasing. Traditional endowment mode is already incapable of satisfying current endowment demands. On the basis of the population aging,this paper came up with the new endowment mode " hospital + nursing home" and analyzed its feasibility. Finally,it reached the conclusion that this endowment mode is helpful for solving problems of endowment and medical care,and alleviating the problem of population aging.

  3. Population-Level Density Dependence Influences the Origin and Maintenance of Parental Care.

    Science.gov (United States)

    Reyes, Elijah; Thrasher, Patsy; Bonsall, Michael B; Klug, Hope

    2016-01-01

    Parental care is a defining feature of animal breeding systems. We now know that both basic life-history characteristics and ecological factors influence the evolution of care. However, relatively little is known about how these factors interact to influence the origin and maintenance of care. Here, we expand upon previous work and explore the relationship between basic life-history characteristics (stage-specific rates of mortality and maturation) and the fitness benefits associated with the origin and the maintenance of parental care for two broad ecological scenarios: the scenario in which egg survival is density dependent and the case in which adult survival is density dependent. Our findings suggest that high offspring need is likely critical in driving the origin, but not the maintenance, of parental care regardless of whether density dependence acts on egg or adult survival. In general, parental care is more likely to result in greater fitness benefits when baseline adult mortality is low if 1) egg survival is density dependent or 2) adult mortality is density dependent and mutant density is relatively high. When density dependence acts on egg mortality, low rates of egg maturation and high egg densities are less likely to lead to strong fitness benefits of care. However, when density dependence acts on adult mortality, high levels of egg maturation and increasing adult densities are less likely to maintain care. Juvenile survival has relatively little, if any, effect on the origin and maintenance of egg-only care. More generally, our results suggest that the evolution of parental care will be influenced by an organism's entire life history characteristics, the stage at which density dependence acts, and whether care is originating or being maintained.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Eva Ekvall Hansson

    2009-05-01

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

  6. Importance of Health and Social Care Research into Gender and Sexual Minority Populations in Nepal.

    Science.gov (United States)

    Regmi, Pramod R; van Teijlingen, Edwin

    2015-11-01

    Despite progressive legislative developments and increased visibility of sexual and gender minority populations in the general population, mass media often report that this population face a wide range of discrimination and inequalities. LGBT (lesbian, gay, and bisexual, and transgender) populations have not been considered as priority research populations in Nepal. Research in other geographical settings has shown an increased risk of poor mental health, violence, and suicide and higher rates of smoking, as well as alcohol and drugs use among LGBT populations. They are also risk for lifestyle-related illness such as cancer, diabetes, and heart diseases. Currently, in Nepal, there is a lack of understanding of health and well-being, social exclusion, stigma, and discrimination as experienced by these populations. Good-quality public health research can help design and implement targeted interventions to the sexual and gender minority populations of Nepal.

  7. [THE STATE AND PERSPECTIVES OF DEVELOPMENT OF TRAUMATOLOGICAL ORTHOPEDIC OUT-PATIENT CARE TO POPULATION OF THE PRIVOLJSKII FEDERAL OKRUG].

    Science.gov (United States)

    Norkin, I A; Baratov, A W; Andreeva, T M; Yushina, B S; Fedonnikov, A S

    2015-01-01

    The article presents the results of analysis ofmanpower support of specialized out-patient traumatological orthopedic care in the Privoljskii federal okrug. The manpower deficiency of traumatologist-orthopedist at the out-patient stage was established especially especially in rural area. This is cause of low indicators ofdispensary monitoring of patients with consequences of traumas and diseases of musculo-skeletal system and factual unavailability of rehabilitation care to patients of given profile. The experience oftraining and re-training of traumatologist-orthopedist is presented. The organization of hospital-substituting forms of medical service of profile patients in the Saratovskaia oblast. The directions of development of organization of specialized out-patient care to population of the region.

  8. Integrating Compliance, Communication, and Culture: Delivering Health Care to an Aging Population

    Science.gov (United States)

    Langer, Nieli

    2008-01-01

    Older adults often get lost in the process of assessment, diagnosis and service brokering. If our concern as care providers is to enable older persons to remain independent or in the community for as long as possible, we must tap into their personal values, cultural identity and health beliefs in order to foster enhanced health care communication.…

  9. Within-population variation in mating system and parental care patterns in the Sander ling (

    NARCIS (Netherlands)

    Reneerkens, J.; van Veelen, P.; van der Velde, M.; Luttikhuizen, P.; Piersma, T.

    2014-01-01

    Sandpipers and allies (Scolopacidae) show an astounding diversity in mating and parental care strategies. Comparative studies have tried to interpret this variation in terms of phylogenetic constraints and ecological shaping factors. In such analyses, mating and parental care systems are necessarily

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

    Science.gov (United States)

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

    2016-04-01

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

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

    Science.gov (United States)

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

    2004-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  13. A population-based model for priority setting across the care continuum and across modalities

    Directory of Open Access Journals (Sweden)

    Mortimer Duncan

    2006-03-01

    Full Text Available Abstract Background The Health-sector Wide (HsW priority setting model is designed to shift the focus of priority setting away from 'program budgets' – that are typically defined by modality or disease-stage – and towards well-defined target populations with a particular disease/health problem. Methods The key features of the HsW model are i a disease/health problem framework, ii a sequential approach to covering the entire health sector, iii comprehensiveness of scope in identifying intervention options and iv the use of objective evidence. The HsW model redefines the unit of analysis over which priorities are set to include all mutually exclusive and complementary interventions for the prevention and treatment of each disease/health problem under consideration. The HsW model is therefore incompatible with the fragmented approach to priority setting across multiple program budgets that currently characterises allocation in many health systems. The HsW model employs standard cost-utility analyses and decision-rules with the aim of maximising QALYs contingent upon the global budget constraint for the set of diseases/health problems under consideration. It is recognised that the objective function may include non-health arguments that would imply a departure from simple QALY maximisation and that political constraints frequently limit degrees of freedom. In addressing these broader considerations, the HsW model can be modified to maximise value-weighted QALYs contingent upon the global budget constraint and any political constraints bearing upon allocation decisions. Results The HsW model has been applied in several contexts, recently to osteoarthritis, that has demonstrated both its practical application and its capacity to derive clear evidenced-based policy recommendations. Conclusion Comparisons with other approaches to priority setting, such as Programme Budgeting and Marginal Analysis (PBMA and modality-based cost

  14. Using AFLP markers and the Geneland program for the inference of population genetic structure

    DEFF Research Database (Denmark)

    Guillot, Gilles; Santos, Filipe

    2010-01-01

    The use of dominant markers such as amplified fragment length polymorphism (AFLP) for population genetics analyses is often impeded by the lack of appropriate computer programs and rarely motivated by objective considerations. The point of the present note is twofold: (i) we describe how the comp......The use of dominant markers such as amplified fragment length polymorphism (AFLP) for population genetics analyses is often impeded by the lack of appropriate computer programs and rarely motivated by objective considerations. The point of the present note is twofold: (i) we describe how...... such as single nucleotide polymorphisms (SNP) markers but this difference becomes negligible for data sets of common size (number of individuals n≥100, number of markers L≥200). The latest Geneland version (3.2.1) handling dominant markers is freely available as an R package with a fully clickable graphical...

  15. Increasing Public Awareness of Direct-to-Consumer Genetic Tests: Health Care Access, Internet Use, and Population Density Correlates

    Directory of Open Access Journals (Sweden)

    Lila J. Finney Rutten

    2012-01-01

    Full Text Available Uncertainty around the value of and appropriate regulatory models for direct-to-consumer (DTC genetic testing underscores the importance of tracking public awareness of these services. We analyzed nationally representative, cross-sectional data from the Health Information National Trends Survey in 2008 (n=7,674 and 2011 (n=3,959 to assess population-level changes in awareness of DTC genetic testing in the U.S. and to explore sociodemographic, health care, Internet use, and population density correlates. Overall, awareness increased significantly from 29% in 2008 to 37% in 2011. The observed increase in awareness from 2008 to 2011 remained significant (OR=1.39 even when adjusted for sociodemographic variables, health care access, Internet use, and population density. Independent of survey year, the odds of awareness of DTC genetic tests were significantly higher for those aged 50–64 (OR=1.64, and 65–74 (OR=1.60; college graduates (OR=2.02; those with a regular source of health care (OR=1.27; those with a prior cancer diagnosis (OR=1.24; those who use the Internet (OR=1.27; and those living in urban areas (OR=1.25. Surveillance of awareness—along with empirical data on use of and response to genetic risk information—can inform public health and policy efforts to maximize benefits and minimize risks of DTC genetic testing.

  16. Prevalence of nephropathy in the German diabetes population-Is early referral to nephrological care a realistic demand today?

    Science.gov (United States)

    Pommer, Wolfgang

    2008-10-01

    In Germany, diabetes mellitus in the general population has increased to ∼8 million people. The implication of this trend for future nephrological care is not well known, as data on this issue are rather limited. Results from different population-based studies suggest that microalbuminuria in diabetic patients is present in 20-30% of the cases. Findings from the diabetes disease management programme in the North-Rhine area revealed the prevalence of chronic kidney disease (CKD) stage II in half of the participants (CKD stage III was present in ∼20%). Only a small proportion of this cohort (∼1-2%) will reach end-stage renal failure, probably due to the excess mortality risks attributed to advanced kidney disease. Results from the QUASI-Niere registry, which reports on renal replacement therapy in Germany, indicate almost constant incidence and prevalence rates of diabetes in the last 5 years (30.6-34.2% and 23.6-27.1%, respectively). The high percentages of early stages of CKD in the diabetes population indicate a potentially high burden of future nephrological care, especially if patients are referred to nephrologists at an early stage. In reality, in nephrological care, bearing this burden is impossible without expanding the resources for this patient group.

  17. Perspectives on Health, Health Needs and Health Care Services among Select Nomad Tribal Populations of Rajasthan, India

    Directory of Open Access Journals (Sweden)

    Bandana Sachdev

    2015-02-01

    Full Text Available Objective: To study the opinion of select nomad tribal communities of Rajasthan State in India on health, health needs, and health care services. Methods: A cross-sectional study involving 1113 nomadic populations in select districts of Jhunjhunu, Sikar and Churu were undertaken. A perception on regarding various health issues among the study populations were obtained through semi-structured questionnaires. Results: The major insight of nomad tribal populations on health, health need and health care services are lack of infrastructures, inaccessibility to health institutions, ill-treated by government hospitals staff, acceptability and affordability are some of the main problems contributing to their poor health status. Conclusion: The Nomad tribal environment and sense of community with its associated strong social networks are identified as key determinants for common perception in all communities. However, the inaccessibility to health care and reluctance to seek help for health issues remain a significant problem in nomad tribal areas. In considering priorities for health, greater effort and resources are required to increase their awareness and change attitudes towards health issues

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

    Directory of Open Access Journals (Sweden)

    Uswatun Khasanah

    2014-01-01

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

  19. Genetic variability and population structure of Salvia lachnostachys: implications for breeding and conservation programs.

    Science.gov (United States)

    Erbano, Marianna; Schühli, Guilherme Schnell E; Santos, Élide Pereira Dos

    2015-04-08

    The genetic diversity and population structure of Salvia lachnostachys Benth were assessed. Inter Simple Sequence Repeat (ISSR) molecular markers were used to investigate the restricted distribution of S. lachnostachys in Parana State, Brazil. Leaves of 73 individuals representing three populations were collected. DNA was extracted and submitted to PCR-ISSR amplification with nine tested primers. Genetic diversity parameters were evaluated. Our analysis indicated 95.6% polymorphic loci (stress value 0.02) with a 0.79 average Simpson's index. The Nei-Li distance dendrogram and principal component analysis largely recovered the geographical origin of each sample. Four major clusters were recognized representing each collected population. Nei's gene diversity and Shannon's information index were 0.25 and 0.40 respectively. As is typical for outcrossing herbs, the majority of genetic variation occurred at the population level (81.76%). A high gene flow (Nm = 2.48) was observed with a correspondingly low fixation index. These values were generally similar to previous studies on congeneric species. The results of principal coordinate analysis (PCA) and of arithmetic average (UPGMA) were consistent and all three populations appear distinct as in STRUCTURE analysis. In addition, this analysis indicated a majority intrapopulation genetic variation. Despite the human pressure on natural populations our study found high levels of genetic diversity for S. lachnostachys. This was the first molecular assessment for this endemic species with medicinal proprieties and the results can guide for subsequent bioprospection, breeding programs or conservation actions.

  20. Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651

    Directory of Open Access Journals (Sweden)

    Anema Johannes R

    2007-09-01

    Full Text Available Abstract Background Chronic low back pain (LBP is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW. The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP. Methods/Design The design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam (the Netherlands. Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient's general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6

  1. Common Infections in Patients Prescribed Systemic Glucocorticoids in Primary Care: A Population-Based Cohort Study

    Science.gov (United States)

    Fardet, Laurence; Petersen, Irene; Nazareth, Irwin

    2016-01-01

    Background Little is known about the relative risk of common bacterial, viral, fungal, and parasitic infections in the general population of individuals exposed to systemic glucocorticoids, or about the impact of glucocorticoid exposure duration and predisposing factors on this risk. Methods and Findings The hazard ratios of various common infections were assessed in 275,072 adults prescribed glucocorticoids orally for ≥15 d (women: 57.8%, median age: 63 [interquartile range 48–73] y) in comparison to those not prescribed glucocorticoids. For each infection, incidence rate ratios were calculated for five durations of exposure (ranging from 15–30 d to >12 mo), and risk factors were assessed. Data were extracted from The Health Improvement Network (THIN) primary care database. When compared to those with the same underlying disease but not exposed to glucocorticoids, the adjusted hazard ratios for infections with significantly higher risk in the glucocorticoid-exposed population ranged from 2.01 (95% CI 1.83–2.19; p < 0.001) for cutaneous cellulitis to 5.84 (95% CI 5.61–6.08; p < 0.001) for lower respiratory tract infection (LRTI). There was no difference in the risk of scabies, dermatophytosis and varicella. The relative increase in risk was stable over the durations of exposure, except for LRTI and local candidiasis, for which it was much higher during the first weeks of exposure. The risks of infection increased with age and were higher in those with diabetes, in those prescribed higher glucocorticoid doses, and in those with lower plasma albumin level. Most associations were also dependent on the underlying disease. A sensitivity analysis conducted on all individuals except those with asthma or chronic obstructive pulmonary disease produced similar results. Another sensitivity analysis assessing the impact of potential unmeasured confounders such as disease severity or concomitant prescription of chemotherapy suggested that it was unlikely that

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

    Science.gov (United States)

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

    2008-01-01

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

  3. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    Science.gov (United States)

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population.

  4. Screening for thalassemia and other hemoglobinopathies in a tertiary care hospital of West Bengal: implications for population screening.

    Science.gov (United States)

    Jain, Bhawna Bhutoria; Roy, Rabindra Nath; Ghosh, Sulekha; Ghosh, Tapan; Banerjee, Uma; Bhattacharya, Subodh Kumar

    2012-01-01

    Hemoglobinopathies are common genetic disorders of hemoglobin, which can be prevented by population screening and offering genetic counseling. In absence of population-based screening for hemoglobinopathies, the hospital-based diagnosis register provide idea about the extent of problem in the community. The present study was undertaken to find out the burden of hemoglobinopathies and spectrum of this disorders among the population who were screened in the hospital-based screening program. A record-basedanalysis of subjects who underwent screening for hemoglobinopathies in Burdwan Medical College and Hospital over a period of 3 years and 4 months revealed that overall 29.3% of subjects were positive for hemoglobinopathies. Beta thalassemia heterozygous was the most commonhemoglobinopathy in this region closely followed by hemoglobin E heterozygous. In view of high prevalence of hemoglobinopathies in this region, a routine premarital screening program is needed for identification and prevention of high-risk marriages.

  5. Population-based outreach versus care as usual to prevent suicide attempt: study protocol for a randomized controlled trial

    OpenAIRE

    Simon, Gregory E.; Beck, Arne; Rossom, Rebecca; Richards, Julie; Kirlin, Beth; King, Deborah; Shulman, Lisa; Ludman, Evette J; Penfold, Robert; Shortreed, Susan M.; Whiteside, Ursula

    2016-01-01

    Background Suicide remains the 10th-ranked most frequent cause of death in the United States, accounting for over 40,000 deaths per year. Nonfatal suicide attempts lead to over 200,000 hospitalizations and 600,000 emergency department visits annually. Recent evidence indicates that responses to the commonly used Patient Health Questionnaire (PHQ9) can identify outpatients who are at risk of suicide attempt and suicide death and that specific psychotherapy or Care Management programs can preve...

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

    Directory of Open Access Journals (Sweden)

    José Ignacio BENITO-OREJAS

    2016-03-01

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

  7. Survey of U.S. zoo and aquarium animal care staff attitudes regarding humane euthanasia for population management.

    Science.gov (United States)

    Powell, David M; Ardaiolo, Matthew

    2016-05-01

    The humane euthanasia of animals for population management, or culling, has been suggested as one possible tool for managing animal populations for sustainability, and recent, highly publicized euthanasia of zoo animals in Copenhagen has stimulated global conversation about population management in zoos. We conducted a nationwide survey of U.S. zoo and aquarium personnel, including keepers, managers, and leaders of AZA animal programs, to assess their overall attitudes regarding population management euthanasia. The surveyed populations were generally very aware of the concept of population management euthanasia. Managers and animal program leaders were more supportive of euthanasia than keepers. We found that regardless of role, men were more supportive of euthanasia than women. Those personnel who were aware of instances of population management euthanasia at their institutions before were more supportive of it than those who were not. Support for culling varied with the kind of animal being considered for it, with three general taxon acceptability groupings emerging. Education, tenure in the profession, taxonomic expertise, and whether or not the responder took the survey before or after the Copenhagen events were not strong predictors of attitudes. Overall, the surveyed populations were approximately evenly split in terms of being in favor of euthanasia, not supporting euthanasia, or being unsure. Most responders indicated that they would be more likely to accept culling if more information was provided on its rationale. These results will form the basis for further discussions on the role of humane euthanasia for population management. Zoo Biol. 35:187-200, 2016. © 2016 Wiley Periodicals, Inc.

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

    Science.gov (United States)

    Harrington, Linda

    2005-01-01

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

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

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    Bond GE

    2012-09-01

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

  10. Randomized Trial of Population-Based Clinical Decision Support to Facilitate Care Transitions.

    Science.gov (United States)

    Eisenstein, Eric L; Willis, Janese M; Edwards, Rex; Anstrom, Kevin J; Kawamoto, Kensaku; Fiol, Guilherme Del; Johnson, Fred S; Lobach, David F

    2017-01-01

    Medicaid beneficiaries in 6 North Carolina counties were randomly assigned to 1 of 3 clinical decision support (CDS) care transition strategies: (1) usual care (Control), (2) CDS messaging to patients and their medical homes (Reports), or (3) CDS messaging to patients, their medical homes, and their care managers (Reports+). We included 7146 Medicaid patients and evaluated transitions from specialist visit, ER and hospital encounters back to the patient's medical home. Patients enrolled in Medicare and Medicaid were not eligible. The number of care manager contacts was greater for patients in the Reports+ Group than in the Control Group. However, there were no treatment-related differences in emergency department (ED) encounter rates, or in the secondary outcomes of outpatient and hospital encounter rates and medical costs. Study monitors found study intervention documentation in approximately 60% of patient charts. These results highlight the importance of effectively integrating information interventions into healthcare delivery workflow systems.

  11. Knowledge and attitudes of primary health care physicians and nurses with regard to population screening for colorectal cancer in Balearic Islands and Barcelona

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    Puente Diana

    2010-09-01

    Full Text Available Abstract Background Primary health care (PHC professionals play a key role in population screening of colorectal cancer. The purposes of the study are: to assess knowledge and attitudes among PHC professionals with regard to colorectal cancer screening, as well as the factors that determine their support for such screening. Methods Questionnaire-based survey of PHC physicians and nurses in the Balearic Islands and in a part of the metropolitan area of Barcelona. Results We collected 1,219 questionnaires. About 84% of all professionals believe that screening for colorectal cancer by fecal occult blood test (FOBT is effective. Around 68% would recommend to their clients a colorectal cancer screening program based on FOBT and colonoscopy. About 31% are reluctant or do not know. Professionals perceive the fear of undergoing a colonoscopy as the main obstacle in getting patients to participate, and the invasive nature of this test is the main reason behind their resistance to this program. The main barriers to support the screening program among PHC professionals are lack of knowledge (nurses and lack of time (physicians. On multivariate analysis, the factors associated with reluctance to recommend colorectal cancer screening were: believing that FOBT has poor sensitivity and is complicated; that colonoscopy is an invasive procedure; that a lack of perceived benefit could discourage client participation; that only a minority of clients would participate; thinking that clients are fed up with screening tests and being unaware if they should be offered something to ensure their participation in the programme. Conclusions Two in every three PHC professionals would support a population screening program for colorectal cancer screening. Factors associated with reluctance to recommend it were related with screening tests characteristics as sensitivity and complexity of FOBT, and also invasive feature of colonoscopy. Other factors were related with patients

  12. Non-participation in population-based disease prevention programs in general practice

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    Koopmans Berber

    2012-10-01

    Full Text Available Abstract Background The number of people with a chronic disease will strongly increase in the next decades. Therefore, prevention of disease becomes increasingly important. The aim of this systematic review was to identify factors that negatively influence participation in population-based disease prevention programs in General Practice and to establish whether the program type is related to non-participation levels. Methods We conducted a systematic review in Pubmed, EMBASE, CINAHL and PsycINFO, covering 2000 through July 6th 2012, to identify publications including information about characteristics of non-participants or reasons for non-participation in population-based disease prevention programs in General Practice. Results A total of 24 original studies met our criteria, seven of which focused on vaccination, eleven on screening aimed at early detection of disease, and six on screening aimed at identifying high risk of a disease, targeting a variety of diseases and conditions. Lack of personal relevance of the program, younger age, higher social deprivation and former non-participation were related to actual non-participation. No differences were found in non-participation levels or factors related to non-participation between the three program types. The large variation in non-participation levels within the program types may be partly due to differences in recruitment strategies, with more active, personalized strategies resulting in higher participation levels compared to an invitation letter. Conclusions There is still much to be gained by tailoring strategies to improve participation in those who are less likely to do so, namely younger individuals, those living in a deprived area and former non-participants. Participation may increase by applying more active recruitment strategies.

  13. Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program - IQIC

    Directory of Open Access Journals (Sweden)

    Adilia Maria Pires Sciarra

    2014-03-01

    Full Text Available Introduction: Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. Objective: To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. Methods: The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Results: Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. Conclusion: It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases.

  14. The Program for the Prevention of Childhood Asthma: a specialized care program for children with wheezing or asthma in Brazil

    Science.gov (United States)

    Urrutia-Pereira, Marilyn; Avila, Jennifer; Solé, Dirceu

    2016-01-01

    Objective : To present the Programa Infantil de Prevenção de Asma (PIPA, Program for the Prevention of Childhood Asthma) and the characteristics of the patients followed in this program. Methods : Implemented in the city of Uruguaiana, Brazil, PIPA has as its target population children and adolescents ( 3 years of age, respectively. Physician-diagnosed asthma was reported in 26.5% and 82.2%, respectively. In the sample as a whole, the prevalence of passive smoking was high (> 36%), occurring during pregnancy in > 15%; > 40% of the patients had been born by cesarean section; and 30% had a mother who had had < 8 years of schooling. Conclusions : A prevention program for children with asthma is an effective strategy for controlling the disease. Knowledge of local epidemiological and environmental characteristics is essential to reducing the prevalence of the severe forms of asthma, to improving the use of health resources, and to preventing pulmonary changes that could lead to COPD in adulthood. PMID:26982040

  15. Studies of Health and Long-Term Care Expenditure Growth in Aging Populations

    NARCIS (Netherlands)

    C.A.M. de Meijer (Claudine)

    2012-01-01

    textabstractIn recent decades, elderly populations in most developed countries have increased considerably, both in absolute and relative terms. This growth of the elderly share of the population is mainly attributable to two demographic transitions: the (simultaneous) increase in longevity and decr

  16. Population pharmacokinetics and pharmacodynamics in anesthesia, intensive care and pain medicine

    NARCIS (Netherlands)

    Heeremans, Eleonora H.; Proost, Johannes H.; Eleveld, Douglas J.; Absalom, Anthony R.; Struys, Michel M. R. F.

    2010-01-01

    Purpose of review Population modeling is a relatively new pharmacological discipline, the development of which has largely been stimulated by the need for accurate models for the pharmacokinetics and dynamics of anesthetic agents. Recent findings Population-based modeling is now considered superior

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2013-06-01

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

  19. NCI Community Oncology Research Program (NCORP) | Division of Cancer Prevention

    Science.gov (United States)

    The NCI Community Oncology Research Program (NCORP) is a national network of cancer care investigators, providers, academia, and other organizations that care for diverse populations in health systems. View the list of publications from NCORP. | Clinical Trials network of cancer care professionals who care for diverse populations across the U.S.

  20. Free-roaming dog population estimation and status of the dog population management and rabies control program in Dhaka City, Bangladesh.

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    Tenzin Tenzin

    2015-05-01

    Full Text Available Beginning January 2012, a humane method of dog population management using a Catch-Neuter-Vaccinate-Release (CNVR program was implemented in Dhaka City, Bangladesh as part of the national rabies control program. To enable this program, the size and distribution of the free-roaming dog population needed to be estimated. We present the results of a dog population survey and a pilot assessment of the CNVR program coverage in Dhaka City. Free-roaming dog population surveys were undertaken in 18 wards of Dhaka City on consecutive days using mark-resight methods. Data was analyzed using Lincoln-Petersen index-Chapman correction methods. The CNVR program was assessed over the two years (2012-2013 whilst the coverage of the CNVR program was assessed by estimating the proportion of dogs that were ear-notched (processed dogs via dog population surveys. The free-roaming dog population was estimated to be 1,242 (95 % CI: 1205-1278 in the 18 sampled wards and 18,585 dogs in Dhaka City (52 dogs/km2 with an estimated human-to-free-roaming dog ratio of 828:1. During the two year CNVR program, a total of 6,665 dogs (3,357 male and 3,308 female were neutered and vaccinated against rabies in 29 of the 92 city wards. A pilot population survey indicated a mean CNVR coverage of 60.6% (range 19.2-79.3% with only eight wards achieving > 70% coverage. Given that the coverage in many neighborhoods was below the WHO-recommended threshold level of 70% for rabies eradications and since the CNVR program takes considerable time to implement throughout the entire Dhaka City area, a mass dog vaccination program in the non-CNVR coverage area is recommended to create herd immunity. The findings from this study are expected to guide dog population management and the rabies control program in Dhaka City and elsewhere in Bangladesh.

  1. Distress syndromes, illness behavior, access to care and medical utilization in a defined population.

    Science.gov (United States)

    Mechanic, D; Cleary, P D; Greenley, J R

    1982-04-01

    This article examines the use of general medical services in a representative sample from a defined geographic area and in a sample of persons seeking psychiatric care from the same area. Psychiatric patients made 100 per cent more general medical care visits in the retrospective period and 83 per cent more in the prospective period than persons who did not seek mental health care. The analysis focuses on the determinants in general medical care use between those who sought mental health care and those who did not. The first hypothesis is that physical symptoms and dysfunction concomitant with psychologic disorder explain the difference. The second argues that the association is a product of help-seeking orientations and illness behavior. The third focuses on variations due to differences in access. The first two types of factors are the most important. Using sex, physical symptoms and illness behavior measures, we explain 50 per cent of the differences in retrospective utilization and 40 per cent of the differences in prospective data.

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

    Science.gov (United States)

    Rønsen, Astrid; Hanssen, Ingrid

    2009-10-01

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

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

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    Zhang Wei

    2007-08-01

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

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

    Science.gov (United States)

    Coleman, B

    1990-05-01

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

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

    Science.gov (United States)

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

    2004-01-01

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

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

    Science.gov (United States)

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

    2009-10-01

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

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

    Science.gov (United States)

    Kaddoura, Mahmoud A

    2010-09-01

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

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

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    M R Rajagopal

    2014-01-01

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

  9. Atrial fibrillation in a primary care population: how close to NICE guidelines are we?

    LENUS (Irish Health Repository)

    Loo, Bryan

    2009-06-01

    The National Institute for Health and Clinical Excellence (NICE) guidelines for the management of atrial fibrillation were published in June 2006. It was anticipated that they would potentially lead to increased demand for echocardiography (ECHO), increased access to secondary care services (for example for cardioversion), and require additional resources for monitoring anticoagulation. A primary care survey was therefore initiated in South Devon, in advance of publication of the guidelines as a snapshot of existing practice, to determine any additional resources and education required to meet the new standards. The main aim was to determine what proportion of patients were managed exclusively in primary care, how frequently patients were investigated by ECHO and whether anticoagulation was being appropriately targeted at patients at high risk of thromboembolic events.

  10. Agricultural Set-aside Programs and Grassland Birds: Insights from Broad-scale Population Trends

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    S. Riffell

    2008-10-01

    Full Text Available The Conservation Reserve Program (CRP is a voluntary set-aside program in the United States designed to amelioratesoil erosion, control crop overproduction, enhance water quality, and provide wildlife habitat by replacing crops with other forms of land cover. Because CRP includes primarily grass habitats, it has great potential to benefitdeclining North American grassland bird populations. We looked at the change in national and state population trends of grassland birds and related changes to cover-specific CRP variables (previous research grouped all CRP practices. Changes in national trends after the initiation of the CRP were inconclusive, but we observed signficant bird-CRP relations at the state level. Most bird-CRP relations were positive, except for some species associated with habitats that CRP replaced. Practice- and configuration-specific CRP variables were related to grassland bird trends, rather than a generic measure of all CRP types combined. Considering all CRP land as a single, distinct habitat type may obscure actual relations between birds and set-aside characteristics. Understanding and predictingthe effects of set-aside programs (like CRP or agri-environment schemes on grassland birds is complex and difficult. Because available broad-scale datasets are less than adequate, studies should be conducted at a variety of spatial and temporal scales.

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

    Science.gov (United States)

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

    2015-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Burton E

    2013-12-01

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

  13. Genetic Variability and Population Structure of Salvia lachnostachys: Implications for Breeding and Conservation Programs

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    Marianna Erbano

    2015-04-01

    Full Text Available The genetic diversity and population structure of Salvia lachnostachys Benth were assessed. Inter Simple Sequence Repeat (ISSR molecular markers were used to investigate the restricted distribution of S. lachnostachys in Parana State, Brazil. Leaves of 73 individuals representing three populations were collected. DNA was extracted and submitted to PCR-ISSR amplification with nine tested primers. Genetic diversity parameters were evaluated. Our analysis indicated 95.6% polymorphic loci (stress value 0.02 with a 0.79 average Simpson’s index. The Nei-Li distance dendrogram and principal component analysis largely recovered the geographical origin of each sample. Four major clusters were recognized representing each collected population. Nei’s gene diversity and Shannon’s information index were 0.25 and 0.40 respectively. As is typical for outcrossing herbs, the majority of genetic variation occurred at the population level (81.76%. A high gene flow (Nm = 2.48 was observed with a correspondingly low fixation index. These values were generally similar to previous studies on congeneric species. The results of principal coordinate analysis (PCA and of arithmetic average (UPGMA were consistent and all three populations appear distinct as in STRUCTURE analysis. In addition, this analysis indicated a majority intrapopulation genetic variation. Despite the human pressure on natural populations our study found high levels of genetic diversity for S. lachnostachys. This was the first molecular assessment for this endemic species with medicinal proprieties and the results can guide for subsequent bioprospection, breeding programs or conservation actions.

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

    Directory of Open Access Journals (Sweden)

    Van Royen Paul

    2009-08-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  16. 2009 VHA Facility Quality and Safety Report - Population Quality of Care

    Data.gov (United States)

    Department of Veterans Affairs — The 2008 Hospital Report Card was mandated by the FY08 Appropriations Act, and focused on Congressionally-mandated metrics applicable to general patient populations....

  17. 'Pragmatic randomized controlled trial of individually prescribed exercise versus usual care in a heterogeneous cancer survivor population': A feasibility study PEACH Trial: Prescribed exercise after chemotherapy

    Directory of Open Access Journals (Sweden)

    Guinan Emer

    2010-02-01

    Full Text Available Abstract Background Many cancer survivors suffer a range of physical and psychological symptoms which may persist for months or years after cessation of treatment. Despite the known benefits of exercise and its potential to address many of the adverse effects of treatment, the role of exercise as well as optimum duration, frequency, and intensity in this population has yet to be fully elucidated. Many cancer rehabilitation programmes presented in the literature are very long and have tight eligibility criteria which make them non-applicable to the majority of cancer survivors. This paper presents the protocol of a novel 8-week intervention which aims to increase fitness, and address other physical symptoms in a heterogeneous cancer survivor population. Methods/design The aim is to recruit 64 cancer survivors 2-6 months after completion of chemotherapy, usually adjuvant, with curative intent. Subjects will be recruited through oncology clinics in a single institution and randomised to usual care or an exercise intervention. The exercise intervention consists of two specifically tailored supervised moderate intensity aerobic exercise sessions weekly over 8-weeks. All participants will be assessed at baseline (0 weeks, at the end of the intervention (8 weeks, and at 3-month follow-up. The primary outcome measure is fitness, and secondary patient-related outcome measures include fatigue, quality of life, and morphological outcomes. A further secondary outcome is process evaluation including adherence to and compliance with the exercise program. Discussion This study will provide valuable information about the physical outcomes of this 8-week supervised aerobic programme. Additionally, process information and economic evaluation will inform the feasibility of implementing this program in a heterogeneous population post cessation of chemotherapy. Trial Registration NCT01030887

  18. 'Pragmatic randomized controlled trial of individually prescribed exercise versus usual care in a heterogeneous cancer survivor population': a feasibility study PEACH trial: prescribed exercise after chemotherapy.

    LENUS (Irish Health Repository)

    Walsh, Julie M

    2010-01-01

    BACKGROUND: Many cancer survivors suffer a range of physical and psychological symptoms which may persist for months or years after cessation of treatment. Despite the known benefits of exercise and its potential to address many of the adverse effects of treatment, the role of exercise as well as optimum duration, frequency, and intensity in this population has yet to be fully elucidated. Many cancer rehabilitation programmes presented in the literature are very long and have tight eligibility criteria which make them non-applicable to the majority of cancer survivors. This paper presents the protocol of a novel 8-week intervention which aims to increase fitness, and address other physical symptoms in a heterogeneous cancer survivor population. METHODS\\/DESIGN: The aim is to recruit 64 cancer survivors 2-6 months after completion of chemotherapy, usually adjuvant, with curative intent. Subjects will be recruited through oncology clinics in a single institution and randomised to usual care or an exercise intervention. The exercise intervention consists of two specifically tailored supervised moderate intensity aerobic exercise sessions weekly over 8-weeks. All participants will be assessed at baseline (0 weeks), at the end of the intervention (8 weeks), and at 3-month follow-up. The primary outcome measure is fitness, and secondary patient-related outcome measures include fatigue, quality of life, and morphological outcomes. A further secondary outcome is process evaluation including adherence to and compliance with the exercise program. DISCUSSION: This study will provide valuable information about the physical outcomes of this 8-week supervised aerobic programme. Additionally, process information and economic evaluation will inform the feasibility of implementing this program in a heterogeneous population post cessation of chemotherapy.

  19. Identifying Elements of Patient-Centered Care in Underserved Populations: A Qualitative Study of Patient Perspectives

    Science.gov (United States)

    Raja, Sheela; Hasnain, Memoona; Vadakumchery, Tracy; Hamad, Judy; Shah, Raveena; Hoersch, Michelle

    2015-01-01

    Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes. PMID:25993110

  20. Coagulase-negative staphylococcal skin carriage among neonatal intensive care unit personnel: From population to infection

    NARCIS (Netherlands)

    V. Hira (Vishal); M. Sluijter (Marcel); W.H.F. Goessens (Wil); A. Ott (Alewijn); R. de Groot (Ronald); P.W.M. Hermans (Peter); R.F. Kornelisse (René)

    2010-01-01

    textabstractCoagulase-negative staphylococci (CoNS) are a major cause of sepsis in neonatal intensive care units (NICU) worldwide. Infecting strains of these commensal bacteria may originate from NICU personnel. Therefore, we studied the characteristics of CoNS isolates from NICU personnel and compa

  1. Coagulase-negative staphylococcal skin carriage among neonatal intensive care unit personnel: from population to infection.

    NARCIS (Netherlands)

    Hira, V.; Sluijter, M.; Goessens, W.H.F.; Ott, A.; Groot, R. de; Hermans, P.W.M.; Kornelisse, R.F.

    2010-01-01

    Coagulase-negative staphylococci (CoNS) are a major cause of sepsis in neonatal intensive care units (NICU) worldwide. Infecting strains of these commensal bacteria may originate from NICU personnel. Therefore, we studied the characteristics of CoNS isolates from NICU personnel and compared them to

  2. Identifying elements of patient-centered care in underserved populations: a qualitative study of patient perspectives.

    Directory of Open Access Journals (Sweden)

    Sheela Raja

    Full Text Available Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes.

  3. Evaluation of a cyanoacrylate protectant to manage skin tears in the acute care population.

    Science.gov (United States)

    Mamrosh, Martha A; Valk, Debbie L; Milne, Catherine T

    2013-01-01

    Skin tears are a common problem that can impact the quality of life due to pain and the potential of becoming complicated wounds if not treated properly. The use of a cyanoacrylate skin protectant to manage skin tears was evaluated in 30 patients in an acute care setting.

  4. Dental care for aging populations in Denmark, Sweden, Norway, United kingdom, and Germany

    DEFF Research Database (Denmark)

    Holm-Pedersen, Poul; Vigild, Merete; Nitschke, Ina

    2005-01-01

    to perceived need, a variety of social and behavioral factors as well as general health factors have been identified as determinants of dental service use. Frail and functionally dependent elderly have special difficulties in accessing dental care; private dental practitioners are hesitant to provide dental...

  5. Population diversification in a yeast metabolic program promotes anticipation of environmental shifts.

    Science.gov (United States)

    Venturelli, Ophelia S; Zuleta, Ignacio; Murray, Richard M; El-Samad, Hana

    2015-01-01

    Delineating the strategies by which cells contend with combinatorial changing environments is crucial for understanding cellular regulatory organization. When presented with two carbon sources, microorganisms first consume the carbon substrate that supports the highest growth rate (e.g., glucose) and then switch to the secondary carbon source (e.g., galactose), a paradigm known as the Monod model. Sequential sugar utilization has been attributed to transcriptional repression of the secondary metabolic pathway, followed by activation of this pathway upon depletion of the preferred carbon source. In this work, we demonstrate that although Saccharomyces cerevisiae cells consume glucose before galactose, the galactose regulatory pathway is activated in a fraction of the cell population hours before glucose is fully consumed. This early activation reduces the time required for the population to transition between the two metabolic programs and provides a fitness advantage that might be crucial in competitive environments.

  6. Population diversification in a yeast metabolic program promotes anticipation of environmental shifts.

    Directory of Open Access Journals (Sweden)

    Ophelia S Venturelli

    2015-01-01

    Full Text Available Delineating the strategies by which cells contend with combinatorial changing environments is crucial for understanding cellular regulatory organization. When presented with two carbon sources, microorganisms first consume the carbon substrate that supports the highest growth rate (e.g., glucose and then switch to the secondary carbon source (e.g., galactose, a paradigm known as the Monod model. Sequential sugar utilization has been attributed to transcriptional repression of the secondary metabolic pathway, followed by activation of this pathway upon depletion of the preferred carbon source. In this work, we demonstrate that although Saccharomyces cerevisiae cells consume glucose before galactose, the galactose regulatory pathway is activated in a fraction of the cell population hours before glucose is fully consumed. This early activation reduces the time required for the population to transition between the two metabolic programs and provides a fitness advantage that might be crucial in competitive environments.

  7. Enhanced statistical tests for GWAS in admixed populations: assessment using African Americans from CARe and a Breast Cancer Consortium.

    Directory of Open Access Journals (Sweden)

    Bogdan Pasaniuc

    2011-04-01

    Full Text Available While genome-wide association studies (GWAS have primarily examined populations of European ancestry, more recent studies often involve additional populations, including admixed populations such as African Americans and Latinos. In admixed populations, linkage disequilibrium (LD exists both at a fine scale in ancestral populations and at a coarse scale (admixture-LD due to chromosomal segments of distinct ancestry. Disease association statistics in admixed populations have previously considered SNP association (LD mapping or admixture association (mapping by admixture-LD, but not both. Here, we introduce a new statistical framework for combining SNP and admixture association in case-control studies, as well as methods for local ancestry-aware imputation. We illustrate the gain in statistical power achieved by these methods by analyzing data of 6,209 unrelated African Americans from the CARe project genotyped on the Affymetrix 6.0 chip, in conjunction with both simulated and real phenotypes, as well as by analyzing the FGFR2 locus using breast cancer GWAS data from 5,761 African-American women. We show that, at typed SNPs, our method yields an 8% increase in statistical power for finding disease risk loci compared to the power achieved by standard methods in case-control studies. At imputed SNPs, we observe an 11% increase in statistical power for mapping disease loci when our local ancestry-aware imputation framework and the new scoring statistic are jointly employed. Finally, we show that our method increases statistical power in regions harboring the causal SNP in the case when the causal SNP is untyped and cannot be imputed. Our methods and our publicly available software are broadly applicable to GWAS in admixed populations.

  8. The Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Adoption Scale: evaluating the diffusion of a tobacco treatment innovation to a statewide prenatal care program and providers.

    Science.gov (United States)

    Windsor, Richard; Cleary, Sean; Ramiah, Kalpana; Clark, Jeannie; Abroms, Lorien; Davis, Amanda

    2013-01-01

    When a new patient education program is being considered for adoption by a public health agency, it is essential to determine provider perceptions of its acceptability for routine use. In 2007, the West Virginia Bureau of Public Health Perinatal Program, Right From The Start (RFTS), decided to adopt the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Program. RFTS is a statewide perinatal home visitation initiative delivered by designated care coordinators (DCCs). The authors developed the SCRIPT Adoption Scale (SAS) in the absence of a valid instrument to assess the perceived attributes of a tobacco treatment innovation among the RFTS DCC population. They evaluated the validity of the five constructs of the Rogers' Diffusion of Innovations model in an organization (relative advantage, compatibility, complexity, observability, and trialability) to predict SCRIPT use. After reviewing the literature and developing draft SAS forms, 2 expert panel reviews established the face and content validity of a 43-item SAS. It was administered to 90% (85/90) of the RFTS DCC population. Psychometric analyses confirmed the validity and reliability of a 28-item scale. All 28 items had factor loadings greater than 0.40 (range = 0.43-0.81). All SAS subscales were strongly correlated, r = 0.51 to 0.97, supporting the convergent validity of a 5-factor SAS. There was a significant association between the DCC SAS score and DCC SCRIPT Program Implementation Index supporting the SAS convergent (construct) validity (r = 0.38). The SAS internal consistencyr = 0.93 and stabilityr = 0.76. Although 2 specific subscales need to be improved, the SAS can be adapted by prenatal care programs to measure the attributes of adoption of new, evidence-based patient education and counseling methods.

  9. Hypertension Screening and Follow-up Management by Primary Health Care System among Chinese Population Aged 35 Years and Above

    Institute of Scientific and Technical Information of China (English)

    FENG Ya Jing; WANG Hui Cheng; LI Yi Chong; ZHAO Wen Hua

    2015-01-01

    Objective To describe hypertension screening and follow-up management among Chinese population aged 35 years and above within the primary health care system. Methods Data from 2010 China Chronic Disease and Risk Factor Surveillance System were used. We investigated previous hypertension diagnosis, screening, and follow-up assessments within the primary health care system. The prevalence of self-reported and criterion-based hypertension, screening rates, demographic and socioeconomic characteristics associated with screening, and patterns of follow-up assessments were recorded. The SAS software system was used for statistical analyses. Results About 17.1% reported a previous hypertension diagnosis. The rate difference between the two measures of prevalence was 27.2%. Among those without self-reported hypertension, 27.7%reported never visiting a clinic during the past 1 year and 60.4%of those attending a clinic reported ever being screened. Younger age group was associated with lower screening proportion;odds ratios of 35-, 45-, 55-, and≥65 years were 1.7 (95%CI:1.5-1.9), 1.5 (95%CI:1.3-1.7), 1.3 (95%CI:1.2-1.4), and 1.0, respectively. About 35.1% of the patients had undergone follow-up assessments four or more times during the past 1 year. Conclusion Majority of the Chinese population aged 35 years and above, particularly the less educated, elderly population, and rural residents were unaware of that they were suffering from hypertension. Most patients did not receive enough management services by the primary health care system. Thus, strengthening both the screening and follow-up management is needed.

  10. Epidemiological study on Buccal Health in the 12 years old population of Health Care Area VIII in Cienfuegos.

    Directory of Open Access Journals (Sweden)

    Yumaidi Colina Sánchez

    2007-08-01

    Full Text Available Background: The 12 years-old children population is worldwide taken as a reference age to compare the buccal health condition of different countries, by means of various indicators that measure the presence of the main buccal diseases. The knowledge of these epidemiological profiles generates information to guide the services planning policies of the Primary Health Care. Objective: To characterize 12 years-old population's buccal health condition. Methods: Cross- sectional descriptive correlative study with a stratified probabilistic sample of 90 children starting from a universe conformed by the 269 adolescents that constitute the total of the 12 years old population of the Health Care Area VIII in Cienfuegos municipality. Pearson’s chi-square and Mantel-Haenszel lineal tendency tests were used with the determination of the relative risk and reliance intervals of 95%. Results: The decay prevalence reached 54, 4%. The COP-D index was 2, 45 being the decayed component the major percentage with 4.6%. The periodontal disease was more frequent in boys than in girls, with 54, 9% and 30, 8% respectively. 80,9% of the segments is healthy. In those affected, the calculation prevailed in 11,7%. It was determined that faulty obturations, inheritance and faulty buccal hygiene were the most affecting risk factors for children with decays, while in the periodontal disease it was faulty buccal hygiene. Malocclusions presented a prevalence rate of 40%. Out of which, 55,6% required secondary level attention. Those with habits present a risk 2 times superior of making sick. The sick epidemiological category was present in 77,8% of the total. Conclusions: We emphasize the prevention need as core issue of the primary medical care in the world today; being the General-Integral Dentist a transforming agent that according to his/her formation is capable to assume the existent health problem and to modify it positively, acting from the earliest ages.

  11. Psychiatric symptomatology and personality in a population of primary care patients

    Directory of Open Access Journals (Sweden)

    Maja Biała

    2014-06-01

    Full Text Available introduction and objective. Psychiatric disorders (and their high rates of prevalence in primary care have been widely analyzed, but the problem of underdiagnosis remains unresolved. This becomes increasingly more important in rural health centres in the face of lack of epidemiological data from these centres. The aim of this study is focused on the relationship between general health, psychiatric symptomatology and personality characteristics in the context of an adequate diagnosis. materials and methods. 518 primary care patients in 6 Polish urban clinical centres were studied using (in order of administration: a sociodemographic questionnaire, the General Health Questionnaire (GHQ-28 and Eysenck Personality Questionnaire (EPQ-R. results. The investigated sample was representative for urban primary care patients. The findings confirmed a significant association between neuroticism and general health. The strongest relation with current functioning and mental distress of the patients (GHQ general score was observed in case of symptoms of anxiety and insomnia. The symptoms of depression may be the most difficult to identify (psychiatric symptoms assessed using GHQ sub-scales. conclusions. According to the GHQ assumptions and confirmed by the presented study, sub-threshold psychiatric symptomatology affects the functioning of primary care patients and their general health. This correlates with personality factors. Improving adequacy of diagnosis becomes extremely important, as it may often be the only chance for appropriate therapy of mental problems for people living in rural areas due to lower availability of specialistic mental services. Further epidemiological studies concerning rural primary care and prevalence of the spectrum of mental disorders need to be conducted.

  12. Care Seeking Patterns of STIs-Associated Symptoms in Iran: Findings of a Population-Based Survey

    Directory of Open Access Journals (Sweden)

    Maryam Nasirian

    2016-01-01

    Full Text Available Background Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs and how care is sought for those symptoms are important components of STIs control and prevention. People’s preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system. Methods This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables and the dependent variables of history of STIs-associated symptom and seeking care. Results Around 57% (677 out of 1190; men: 29.70% and women: 81.80% had experienced at least one STIsassociated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR] = 0.34, CI 95%: 0.17-0.67. Women who were married, in older ages, and had higher educations were more likely to report a recent (past year STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR = 2.48, 95% CI: 1.60-3.84. Conclusion The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants

  13. Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations

    Directory of Open Access Journals (Sweden)

    Jenkins Rachel

    2010-06-01

    Full Text Available Abstract Background Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. Methods A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care; development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. Results The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines

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

    Science.gov (United States)

    Sakamoto, Ryota; Miura, Yasushi

    2016-01-01

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

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

    Science.gov (United States)

    Bulduk, Serap; Usta, Esra; Dinçer, Yeliz

    2017-06-01

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

  16. Hospice Care

    Science.gov (United States)

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

  17. Geographic distribution of need and access to health care in rural population: an ecological study in Iran

    Directory of Open Access Journals (Sweden)

    Najafi Behzad

    2011-09-01

    Full Text Available Abstract Introduction Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran's rural population between 2006 and 2009. Methods Census data on population's characteristics in each province were obtained from the Statistical Centre of Iran and National Organization for civil registration. Data about the Rural Health Houses (RHHs were obtained from the Ministry of Health. The Health Houses-to-rural population ratio (RHP, crude birth rate (CBR and crude mortality rate (CMR in rural population were calculated in order to compare their distribution among the provinces. Lorenz curves of RHHs, CMR and CBR were plotted and their decile ratio, Gini Index and Index of Dissimilarity were calculated. Moreover, Spearman rank-order correlation was used to examine the relation between RHHs and CMR and CBR. Results There were substantial differences in RHHs, CMR and CBR across the provinces. CMR and CBR experienced changes toward more equal distributions between 2006 and 2009, while inverse trend was seen for RHHs. Excluding three provinces with markedly changes in data between 2006 and 2009 as outliers, did not change observed trends. Moreover; there was a significant positive relationship between CMR and RHP in 2009 and a significant negative association between CBR and RHP in 2006 and 2009. When three provinces with outliers were excluded, these significant associations were disappeared. Conclusion Results showed that there were significant variations in the distribution of RHHs, CMR and CBR across the country. Moreover, the distribution of RHHs did not reflect the needs for health care in terms of CMR and CBR in the study period.

  18. Barriers to accessing eye care services among visually impaired populations in rural Andhra Pradesh, South India

    Directory of Open Access Journals (Sweden)

    Kovai Vilas

    2007-01-01

    Full Text Available Purpose: To understand the reasons why people in rural south India with visual impairment arising from various ocular diseases do not seek eye care. Materials and Methods: A total of 5,573 persons above the age of 15 were interviewed and examined in the South Indian state of Andhra Pradesh covering the districts of Adilabad, West Godavari and Mahaboobnagar. A pre-tested structured questionnaire on barriers to eye care was administered by trained field investigators. Results: Of the eligible subjects, 1234 (22.1%, N=5573 presented with distant visual acuity < 20/60 or equivalent visual field loss in the better eye. Of these, 898 (72.7%, N=1234 subjects had not sought treatment despite noticing a decrease in vision citing personal, economic and social reasons. The analysis also showed that the odds of seeking treatment was significantly higher for literates [odds ratio (OR 1.91, 95% confidence interval (CI 1.38 to 2.65], for those who would be defined as blind by visual acuity category (OR 1.35, 95% CI 0.96 to 1.90 and for those with cataract and other causes of visual impairment (OR 1.50, 95% CI 1.11 to 2.03. Barriers to seeking treatment among those who had not sought treatment despite noticing a decrease in vision over the past five years were personal in 52% of the respondents, economic in 37% and social in 21%. Conclusion: Routine planning for eye care services in rural areas of India must address the barriers to eye care perceived by communities to increase the utilization of services.

  19. Nurses in emotional competence: exploratory study on population of continued care national network

    OpenAIRE

    Lopes, Tânia; Veiga-Branco, Augusta; Baptista, Gorete

    2014-01-01

    The relevance of this study - the first empirical research (to our knowledge) in Continued Care National Network (RCNN) context - emerge to understand the role of emotions in workplace behaviour (Côté, 2005; Austin, Dore & Donovan, 2008; Liu et al. 2008; Barsade, Ramarajan, Burack, 2008), but here, with terminally ill people and great physical and psychological weakness. Recent scientific literature is exposing a significatly negative correlations between Emotional Intelligence...

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

    Science.gov (United States)

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

    2016-12-01

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

  1. [THE EFFECTIVENESS OF EDUCATIONAL PROGRAMS FOR THE IMPROVEMENT OF POPULATION DIETARY PATTERNS AND PREVENTION OF ANEMIAS].

    Science.gov (United States)

    Glagoleva, O N; Turchaninov, D V; Vilms, E A

    2015-01-01

    There was performed an experimental study of the use of educational programs as tools of the improvement of the structure of nutrition and primary prevention of anemias associated with nutrition. Educational programs were differentiated for each of the target audience (pupils of 5-7 classes, 1-4 year students of the medical school, the adult unorganized population; n = 645). Their efficacy was evaluated with the use of issues included in the educational program and analysis of the actual nutrition (only in groups of students and adults). Performance assessment were: testing on the issues included in the educational program and analysis of actual of dietary intake (only in groups of students and adults). Testing was performed at the points: before the intervention, immediately after 6 and 12 months after intervention. An analysis of the frequency of food consumption with an estimation of the actual consumption of nutrients was carried out at the initial and final points. There was noted the low level of public knowledge about the principles ofrational nutrition: the proportion ofcorrect answers, reflecting the level of awareness ofconstructing an optimal diet in the starting point of the study was 25%for schoolchildren, 45%--in adults, 35%--the students, after the intervention--75%, 90% and 85% respectively. One year after the implementation of the educational program the level ofresidual knowledge of study participants remained at a level above the original (the proportion of correct answers during testing of schoolchildren--50% (p < 0.001 to baseline), in adults--60% (p = 0.0005), students--60% (p < 0.001). There were also noted positive changes in the structure of nutrition of study participants 12 months after the intervention: in relation to the initial level there was increased consumption of ascorbic acid and calcium in students, decreased consumption of animal fats in adults and students, there was noted a trend towards increased consumption of dietary iron

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

    Science.gov (United States)

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

    2014-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Khouri RI

    2011-06-01

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

  4. Linking population, health, and the environment: an overview of integrated programs and a case study in Nepal.

    Science.gov (United States)

    Hahn, Sigrid; Anandaraja, Natasha; D'Agnes, Leona

    2011-01-01

    Population, health, and environment programs are cross-sectoral development initiatives that link conservation, health, and family planning interventions. These programs are generally located in biodiversity hotspots, where population pressure is among the factors contributing to environmental degradation. This review describes the general structure of population, health, and environment programs and provides selected examples to highlight various aspects of this approach. We focus in depth on a case study from the Integrating Population and Health into Forestry Management Agendas program in Nepal that simultaneously addressed deforestation from fuel-wood harvesting, indoor air pollution from wood fires, acute respiratory infections related to smoke inhalation, as well as family planning in communities in Nepal's densely populated forest corridors. Keys to the success of the Nepal project included empowerment of community forest user groups with population, health, and environment program know-how and appropriate technology. Lessons learned in Nepal point to the critical role that nongovernmental organizations can play as catalysts of cross-sectoral responses to complex development issues such as this one. The population, health, and environment approach can be an effective method for achieving sustainable development and meeting both conservation and health objectives.

  5. Early experience with digital advance care planning and directives, a novel consumer-driven program.

    Science.gov (United States)

    Fine, Robert L; Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-07-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digital ACP/AD tool, to achieve proportional representation of all 50 states by population size and then reviewed their responses. The 900 participants had an average age of 50.8 years (SD = 16.6); 84% of the men and 91% of the women were in self-reported good health when signing their ADs. Among the respondents, 94% wanted their physicians to consult a supportive and palliative care team if they were seriously ill; nearly 85% preferred cessation of life-sustaining treatments during their final days; 76% preferred to spend their final days at home or in a hospice; and 70% would accept attempted cardiopulmonary resuscitation in limited circumstances. Most respondents wanted an autopsy under certain conditions, and 62% wished to donate their organs. In conclusion, analysis of early experience with this ACP/AD platform demonstrates that individuals of different ages and conditions can engage in an interrogatory process about values, develop ADs that are more nuanced than traditional paper-based ADs in reflecting those values, and easily make changes to their ADs. Online ADs have the potential to remove barriers to ACP/AD and thus further improve patient-centered end-of-life care.

  6. Considering the needs of indigenous and local populations in conservation programs.

    Science.gov (United States)

    Kohler, Florent; Brondizio, Eduardo S

    2017-04-01

    Local rural and indigenous communities have assumed increasing responsibility for conservation within and between areas buffering the impacts of agricultural or resource-extraction zones and protected areas. Empowering local communities as central partners in conservation and climate-change mitigation has allowed many people to gain access to land and citizenship rights but has provided limited improvements in access to social services and economic opportunities even as expectation about their role as environmental stewards grows. These expectations, however, are inconsistent with reality. We conducted multiple field studies in Brazil since the mid-1980s to illustrate the discrepancies between conservation programs and local conditions and expectations. We suggest that public policies and conservation programs should not delegate responsibility for managing protected areas to local and indigenous communities without considering local needs and expectations and locals' attitudes toward conservation. In other words, behavior that maintains or improves the environment should not be treated as traditional based on the expectations of outsiders. Framing local populations as traditional environmentalists creates contradictions and frustrations for local populations and for conservation professionals and policy makers.

  7. Impact of requiring influenza vaccination for children in licensed child care or preschool programs--Connecticut, 2012-13 influenza season.

    Science.gov (United States)

    Hadler, James L; Yousey-Hindes, Kimberly; Kudish, Kathy; Kennedy, Erin D; Sacco, Vincent; Cartter, Matthew L

    2014-03-01

    Preschool-aged children are at increased risk for severe influenza-related illness and complications. Congregate child care settings facilitate influenza transmission among susceptible children. To protect against influenza transmission in these settings, in September 2010, Connecticut became the second U.S. state (after New Jersey) to implement regulations requiring that all children aged 6-59 months receive at least 1 dose of influenza vaccine each year to attend a licensed child care program. To evaluate the impact of this regulation on vaccination levels and influenza-associated hospitalizations during the 2012-13 influenza season, vaccination data from U.S. and Connecticut surveys and the Emerging Infections Program (EIP) were analyzed. After the regulation took effect, vaccination rates among Connecticut children aged 6-59 months increased from 67.8% during the 2009-10 influenza season to 84.1% during the 2012-13 season. During the 2012-13 influenza season, among all 11 EIP surveillance sites, Connecticut had the greatest percentage decrease (12%) in the influenza-associated hospitalization rate from 2007-08 among children aged ≤4 years. Additionally, the ratio of the influenza-associated hospitalization rates among children aged ≤4 years to the overall population rate (0.53) was lower than for any other EIP site. Requiring vaccination for child care admission might have helped to increase vaccination rates in Connecticut and reduced serious morbidity from influenza.

  8. An audit of intensive care unit admission in a pediatric cardio-thoracic population in Enugu, Nigeria

    Directory of Open Access Journals (Sweden)

    Azike Jerome

    2010-08-01

    Full Text Available BACKGROUND: The study aimed to perform an audit of intensive care unit admissions in the paediatric cardio-thoracic population in Enugu, Nigeria and examine the challenges and outcome in this high risk group. Ways of improvement based on this study are suggested. METHODS: The hospital records of consecutive postoperative pediatric cardiothoracic admissions to the multidisciplinary and cardiothoracic intensive care units of the University of Nigeria Teaching Hospital (UNTH Enugu, Nigeria to determine their Intensive Care Unit management and outcome over a 2 year span - June 2002 to June 2004 were retrospectively reviewed. Data collected included patient demographics, diagnosis, duration of stay in the intensive care unit, therapeutic interventions and outcome. RESULTS: There were a total of thirty consecutive postoperative paediatric admissions to the intensive care unit over the 2 year study period. The average age of the patients was 5.1 years with a range of 2 weeks to 13 years. Twelve patients had cardiac surgery with cardiopulmonary bypass (CPB, three patients had colon transplant, four patients had pericardiotomy/pericardicectomy, and five patients had diagnostic/therapeutic bronchoscopy. The remaining patients had the following surgeries, thoracotomy for repair of diaphragmatic hernia/decortications, delayed primary repair of esophageal atresia and gastrostomy. Two patients had excision of a cervical teratoma and cystic hygroma. The average duration of stay in the intensive care unit was 6.2 days. Ten patients (33% received pressor agents for organ support. Five patients (17% had mechanical ventilation, while twenty-five patients (83% received oxygen therapy via intranasal cannula or endotracheal tube. Seven patients (23% received blood transfusion in the ICU. There was a 66% survival rate with ten deaths. CONCLUSION: Paediatric cardio-thoracic services in Nigeria suffer from the problems of inadequate funding and manpower flight to better

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

    OpenAIRE

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2008-12-01

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

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

    Science.gov (United States)

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

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

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

    Science.gov (United States)

    Pitkajarvi, Marianne; Eriksson, Elina; Kekki, Pertti

    2011-08-01

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

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

    Science.gov (United States)

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

    1993-05-01

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

  14. What drives donor funding in population assistance programs? Evidence from OECD countries.

    Science.gov (United States)

    van Dalen, Hendrik P; Reuser, Mieke

    2006-09-01

    The 1994 International Conference on Population and Development (ICPD) established goals for the expansion of population assistance. To date, the financial promises made by donor countries in 1994 have not been met. To unravel the gap between ambitions and contributions, we use panel estimation methods to see what lies behind the level of donor contributions and the sharing of burdens across the various categories of population and HIV/AIDS assistance in 21 donor countries for the years 1996-2002. Contributions by donors depend heavily on the economic wealth and subjective preferences of donor countries. The sharing of the ICPD burden within the group of OECD/DAC countries is in line with the countries' ability to pay, although within the aggregate we observe a specialization in channels for aid: small countries predominantly use multilateral aid agencies, whereas large countries rely more on bilateral aid channels. Catholic countries are averse to donating unrestricted funds (flowing primarily to multilateral agencies) or restricted funds targeted at family planning programs.

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

    Science.gov (United States)

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

    2011-09-01

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

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

    Science.gov (United States)

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

    2013-05-01

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

  17. Initial feasibility and validity of a prospective memory training program in a substance use treatment population.

    Science.gov (United States)

    Sweeney, Mary M; Rass, Olga; Johnson, Patrick S; Strain, Eric C; Berry, Meredith S; Vo, Hoa T; Fishman, Marc J; Munro, Cynthia A; Rebok, George W; Mintzer, Miriam Z; Johnson, Matthew W

    2016-10-01

    Individuals with substance use disorders have shown deficits in the ability to implement future intentions, called prospective memory. Deficits in prospective memory and working memory, a critical underlying component of prospective memory, likely contribute to substance use treatment failures. Thus, improvement of prospective memory and working memory in substance use patients is an innovative target for intervention. We sought to develop a feasible and valid prospective memory training program that incorporates working memory training and may serve as a useful adjunct to substance use disorder treatment. We administered a single session of the novel prospective memory and working memory training program to participants (n = 22; 13 men, 9 women) enrolled in outpatient substance use disorder treatment and correlated performance to existing measures of prospective memory and working memory. Generally accurate prospective memory performance in a single session suggests feasibility in a substance use treatment population. However, training difficulty should be increased to avoid ceiling effects across repeated sessions. Consistent with existing literature, we observed superior performance on event-based relative to time-based prospective memory tasks. Performance on the prospective memory and working memory training components correlated with validated assessments of prospective memory and working memory, respectively. Correlations between novel memory training program performance and established measures suggest that our training engages appropriate cognitive processes. Further, differential event- and time-based prospective memory task performance suggests internal validity of our training. These data support the development of this intervention as an adjunctive therapy for substance use disorders. (PsycINFO Database Record

  18. The Effect of a Self-Care Education Program on a Military Medical Beneficiary Population.

    Science.gov (United States)

    1995-09-01

    drink diluted juice. Bus avoid beer, other alcohol or anything C-6 with caffeine , because these cause you to urinate away your fluids, • Get in...risk of burning is greatest during that time. Arbas said swimmers are not protected from the sun’s rays while in the water and should use...can drink if you’re exercising and need to replenish your body fluid"—as weil as drinks with caffeine such as coffee, tea and many soft drinks

  19. Exploring impacts of multi-year, community-based care programs for orphans and vulnerable children: a case study from Kenya.

    Science.gov (United States)

    Larson, Bruce A; Wambua, Nancy; Masila, Juliana; Wangai, Susan; Rohr, Julia; Brooks, Mohamad; Bryant, Malcolm

    2013-01-01

    The Community-Based Care for Orphans and Vulnerable Children (CBCO) program operated in Kenya during 2006-2010. In Eastern Province, the program provided support to approximately 3000 orphans and vulnerable children (OVC) living in 1500 households. A primary focus of the program was to support savings and loan associations composed of OVC caregivers (typically elderly women) to improve household and OVC welfare. Cross-sectional data were collected in 2011 from 1500 randomly selected households from 3 populations: program participants (CBCO group, n=500), households in the same villages as program participants but not in the program (the local-community-group = Group L, n=300), and households living in nearby villages where the program did not operate (the adjacent-community-group, Group A, n=700). Primary welfare outcomes evaluated are household food security, as measured by the Household Food Insecurity Access instrument, and OVC educational attainment. We compared outcomes between the CBCO and the subset of Group L not meeting program eligibility criteria (L-N) to investigate disparities within local communities. We compared outcomes between the CBCO group and the subset of Group A meeting eligibility criteria (A-E) to consider program impact. We compared outcomes between households not eligible for the program in the local and adjacent community groups (L-N and A-N) to consider if the adjacent communities are similar to the local communities. In May-June 2011, at the end of the OVC program, the majority of CBCO households continued to be severely food insecure, with rates similar to other households living in nearby communities. Participation rates in primary school are high, reflecting free primary education. Among the 18-22 year olds who were "children" during the program years, relatively few children completed secondary school across all study groups. Although the CBCO program likely provided useful services and benefits to program participants, disparities

  20. Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng

    2014-01-01

    Full Text Available Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23 service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P<0.01, those undergoing wide local excision (P<0.01 and those with ductal carcinoma-in situ or early stage breast cancer (P<0.01, were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

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

    OpenAIRE

    2012-01-01

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

  2. The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis.

    Science.gov (United States)

    Battaglia, Tracy A; Darnell, Julie S; Ko, Naomi; Snyder, Fred; Paskett, Electra D; Wells, Kristen J; Whitley, Elizabeth M; Griggs, Jennifer J; Karnad, Anand; Young, Heather; Warren-Mears, Victoria; Simon, Melissa A; Calhoun, Elizabeth

    2016-08-01

    Patient navigation is emerging as a standard in breast cancer care delivery, yet multi-site data on the impact of navigation at reducing delays along the continuum of care are lacking. The purpose of this study was to determine the effect of navigation on reaching diagnostic resolution at specific time points after an abnormal breast cancer screening test among a national sample. A prospective meta-analysis estimated the adjusted odds of achieving timely diagnostic resolution at 60, 180, and 365 days. Exploratory analyses were conducted on the pooled sample to identify which groups had the most benefit from navigation. Clinics from six medical centers serving vulnerable populations participated in the Patient Navigation Research Program. Women with an abnormal breast cancer screening test between 2007 and 2009 were included and received the patient navigation intervention or usual care. Patient navigators worked with patients and their care providers to address patient-specific barriers to care to prevent delays in diagnosis. A total of 4675 participants included predominantly racial/ethnic minorities (74 %) with public insurance (40 %) or no insurance (31 %). At 60 days and 180 days, there was no statistically significant effect of navigation on achieving timely diagnostic care, but a benefit of navigation was seen at 365 days (aOR 2.12, CI 1.36-3.29). We found an equal benefit of navigation across all groups, regardless of race/ethnicity, language, insurance status, and type of screening abnormality. Patient navigation resulted in more timely diagnostic resolution at 365 days among a diverse group of minority, low-income women with breast cancer screening abnormalities. Trial registrations clinicaltrials.gov Identifiers: NCT00613275, NCT00496678, NCT00375024, NCT01569672.

  3. A comparison of the health status and health care utilization patterns between foreigners and the national population in Spain: new evidence from the Spanish National Health Survey.

    Science.gov (United States)

    Hernández-Quevedo, Cristina; Jiménez-Rubio, Dolores

    2009-08-01

    The increasing proportion of immigrants in Spanish society is placing pressure on the National Health Care System to accommodate the needs of this population group while keeping costs under control. In the year 2000, a law was approved in Spain according to which all people, regardless of their nationality, are entitled to use health care services under the same conditions as Spanish citizens, provided that they are registered in the local population census. However, empirical evidence about differences in health status and health care utilization between the immigrant and the Spanish population is insufficient. This paper uses the 2003 and 2006 Spanish National Health Surveys to explore the existence of inequalities in health and in the access to health services for the immigrant population living in Spain, relative to that of Spaniards. Our results show that there are different patterns in the level of health and the medical care use between the national and the foreign population in Spain: while immigrants' self-reported health relative to that of the Spanish population depends upon individual nationality, all immigrants, regardless of their nationality, seem to face barriers of entry to specialized care. Further research is needed to understand the nature of these barriers in order to design more effective health policies.

  4. Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study

    Directory of Open Access Journals (Sweden)

    Emery Jonathan D

    2011-11-01

    Full Text Available Abstract Background Health care disparity is a public health challenge. We compared the prevalence of diabetes, quality of care and outcomes between mental health clients (MHCs and non-MHCs. Methods This was a population-based longitudinal study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia (WA from 1990 to 2006, using linked data of mental health registry, electoral roll registrations, hospital admissions, emergency department attendances, deaths, and Medicare and pharmaceutical benefits claims. Diabetes was identified from hospital diagnoses, prescriptions and diabetes-specific primary care claims (17,045 MHCs, 26,626 non-MHCs. Both univariate and multivariate analyses adjusted for socio-demographic factors and case mix were performed to compare the outcome measures among MHCs, category of mental disorders and non-MHCs. Results The prevalence of diabetes was significantly higher in MHCs than in non-MHCs (crude age-sex-standardised point-prevalence of diabetes on 30 June 2006 in those aged ≥20 years, 9.3% vs 6.1%, respectively, P 1c, microalbuminuria, blood lipids was suboptimal in both groups, but was lower in MHCs (for all tests combined; adjusted OR 0.81, 95% CI 0.78 to 0.85, at one year; and adjusted rate ratio (RR 0.86, 95% CI 0.84 to 0.88, during the study period. MHCs also had increased risks of hospitalisation for diabetes complications (adjusted RR 1.20, 95% CI 1.17 to 1.24, diabetes-related mortality (1.43, 1.35 to 1.52 and all-cause mortality (1.47, 1.42 to 1.53. The disparities were most marked for alcohol/drug disorders, schizophrenia, affective disorders, other psychoses and personality disorders. Conclusions MHCs warrant special attention for primary and secondary prevention of diabetes, especially at the primary care level.

  5. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study

    Science.gov (United States)

    Boyle, Elaine M; Johnson, Samantha; Manktelow, Bradley; Seaton, Sarah E; Draper, Elizabeth S; Smith, Lucy K; Dorling, Jon; Marlow, Neil; Petrou, Stavros; Field, David J

    2015-01-01

    Objective To describe neonatal outcomes and explore variation in delivery of care for infants born late (34–36  weeks) and moderately (32–33 weeks) preterm (LMPT). Design/setting Prospective population-based study comprising births in four major maternity centres, one midwifery-led unit and at home between September 2009 and December 2010. Data were obtained from maternal and neonatal records. Participants All LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls. Outcome measures Neonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored. Results 1146 (83%) LMPT and 1258 (79% of eligible) term-born infants were recruited. LMPT infants were significantly more likely to receive resuscitation at birth (17.5% vs 7.4%), respiratory (11.8% vs 0.9%) and nutritional support (3.5% vs 0.3%) and were less likely to be fed breast milk (64.2% vs 72.2%) than term infants. For all interventions and morbidities, a gradient of increasing risk with decreasing gestation was evident. Although 60% of late preterm infants were never admitted to a NNU, 83% required medical input on postnatal wards. Clinical management differed significantly between services. Conclusions LMPT infants place high demands on specialist neonatal services. A substantial amount of previously unreported specialist input is provided in postnatal wards, beyond normal newborn care. Appropriate expertise and planning of early care are essential if such infants are managed away from specialised neonatal settings. Further research is required to clarify optimal and cost-effective postnatal management for LMPT babies. PMID:25834169

  6. Insecticide Rotation Programs with Entomopathogenic Organisms for Suppression of Western Flower Thrips (Thysanoptera: Thripidae) Adult Populations under Greenhouse Conditions.

    Science.gov (United States)

    Kivett, Jessica M; Cloyd, Raymond A; Bello, Nora M

    2015-08-01

    Western flower thrips, Frankliniella occidentalis (Pergande), is one of the most destructive insect pests of greenhouse production systems with the ability to develop resistance to a wide variety of insecticides. A common resistance management strategy is rotating insecticides with different modes of action. By incorporating entomopathogenic organisms (fungi and bacteria), which have discrete modes of action compared to standard insecticides, greenhouse producers may preserve the effectiveness of insecticides used for suppression of western flower thrips populations. The objective of this study was to determine how different rotation programs that include entomopathogenic organisms (Beauveria bassiana, Isaria fumosoroseus, Metarhizium anisopliae, and Chromobacterium subtsugae) and commonly used standard insecticides (spinosad, chlorfenapyr, abamectin, and pyridalyl) may impact the population dynamics of western flower thrips adult populations by means of suppression. Eight-week rotation programs were applied to chrysanthemum, Dendranthema x morifolium plants and weekly counts of western flower thrips adults captured on yellow sticky cards were recorded as a means to evaluate the impact of the rotation programs. A final quality assessment of damage caused by western flower thrips feeding on foliage and flowers was also recorded. Furthermore, a cost comparison of each rotation program was conducted. Overall, insecticide rotation programs that incorporated entomopathogenic organisms were not significantly different than the standard insecticide rotation programs without entomopathogenic organisms in suppressing western flower thrips adult populations. However, there were no significant differences among any of the rotation programs compared to the water control. Moreover, there was no differential effect of the rotation programs on foliage and flower quality. Cost savings of up to 34% (in US dollars) are possible when including entomopathogenic organisms in the

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

    Science.gov (United States)

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

    2014-01-01

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

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

    OpenAIRE

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

    2010-01-01

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

  9. Estado de salud y utilización de recursos sanitarios de una población de ancianos atendidos en domicilio Health conditions and use of social care resources in a population of the elderly taken care at home

    Directory of Open Access Journals (Sweden)

    Carmen Gálvez-Romero

    2007-09-01

    Full Text Available La población de personas mayores, respecto a la población general en España, representa un 15,4%, proporción que aumentará en el futuro, sobre todo en mayores de 80 años. La atención domiciliaria de esta población es alternativa a su institucionalización, por lo que interesa conocer sus características sociodemográficas, clínicas y de utilización de recursos sanitarios para responder a sus necesidades reales. Se realizó un estudio de corte transversal en pacientes incluidos en un programa de incapacitados. Se estudiaron variables sociodemográficas y clínicas, capacidad funcional y cognitiva, y utilización de recursos sociosanitarios. Nuestros pacientes son una población mayor, presentan deterioro cognitivo importante, nivel elevado de dependencia y comorbilidad. Una quinta parte considera su estado de salud como malo. Utilizan con frecuencia los servicios de urgencia y, en menor medida, ingresan en el hospital. Algunas características sociodemográficas de estos pacientes determinan su nivel de audición y estado mental, tales como la edad, ocupación en su etapa laboral e ingresos económicos. Se mostraron determinantes de la utilización de los servicios sanitarios las patologías crónicas, la polifarmacia, escasamente las incapacidades funcionales y los ingresos económicos.Older persons represent 15,4% of the population of Spain. This proportion will increase in the future, especially for persons older than 80 years of age. As home care for this population is an alternative to their institutionalization, it is necessary to determine their sociodemographic and clinical characteristics, as well as their use of health care resources, in order to respond to their true needs. We undertook a cross-sectional study of patients included in an Incapacity Program. Variables studied included sociodemographic and clinical factors, functional and cognitive capacity, and the use of health and social care resources. The patients were

  10. Potentially inappropriate prescribing in an Irish elderly population in primary care.

    LENUS (Irish Health Repository)

    Ryan, Cristín

    2009-12-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

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

    Science.gov (United States)

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