Sample records for care service hubs

  1. Visioning for secondary palliative care service hubs in rural communities: a qualitative case study from British Columbia's interior

    Directory of Open Access Journals (Sweden)

    Hanlon Neil


    Full Text Available Abstract Background As the populations of many developed nations continue to age at rapid rates it is becoming increasingly important to enhance palliative care service delivery in order to meet anticipated demand. Rural areas face a number of challenges in doing this, and thus dedicated attention must be given to determining how to best enhance service delivery in ways that are sensitive to their particular needs. The purposes of this article are to determine the vision for establishing secondary palliative care service hubs (SPCH in rural communities through undertaking a case study, and to ascertain the criteria that need to be considered when siting such hubs. Methods A rural region of British Columbia, Canada was selected for primary data collection, which took place over a five-month period in 2008. Formal and informal palliative care providers (n = 31 were interviewed. A purposeful recruitment strategy was used to maximize occupational and practice diversity. Interviews were conducted by phone using a semi-structured guide. Interviews were audio recorded and transcribed verbatim. Data were managed using NVivo8™ software and analyzed thematically, using investigator triangulation to strengthen interpretation. Results Four themes emerged from the dataset: (1 main SPCH features; (2 determining a location; (3 value-added outcomes; and (4 key considerations. It was found that participants generally supported implementing a SPCH in the rural region of focus. Several consistent messages emerged, including that: (1 SPCHs must create opportunities for two-way information exchange between specialists and generalists and communities; (2 SPCHs should diffuse information and ideas throughout the region, thus serving as a locus for education and a means of enhancing training opportunities; and (3 hubs need not be physical sites in the community (e.g., an office in a hospice or hospital, but may be virtual or take other forms based upon local needs

  2. North West Surrey's locality hubs - delivering integrated care


    Compton, Lisa; Wilkinson, Peter; Lawn, Liz


    Introduction: North West Surrey CCG (NWSCCG) is establishing Locality Hubs – physical buildings offering a fully integrated GP-led, multi-disciplinary ‘one-stop-shop’ services in the community for a defined cohort of frail elderly patients with multiple core morbidities. Hubs will ultimately deliver proactive and reactive care, available 24 hours a day, 365 days a year.The key drivers are;Ageing population, people living longer & more people living with chronic conditionsCost & demand...

  3. Strategies for contracting gas storage and hub services

    International Nuclear Information System (INIS)

    Auld, J.


    The many efficiencies that can be gained by the natural gas industry in effectively using storage, were demonstrated. The circumstances under which the natural gas industry uses storage and how Market Centres or Hub Services can be strategically used in offering companies the highest flexibility in a tough marketplace, were explained. For example, in North America, storage played an important role during the winter of 95/96, which will be remembered for its extreme cold. That year provided the first true opportunity to test the natural gas delivery system since deregulation in 1985. The fact that natural gas supplies continued to be delivered throughout the entire winter was attributed to the use of stored gas held in reserves to meet the severe demand. The companies that did well, relied on storage and also on the services offered by Hub Services which increased margins for all players in the natural gas industry. Using storage, companies can ensure that field deliveries of gas are kept constant by having storage facilities absorb the swings in market demand. The companies that learn to use storage effectively can create competitive edges over their competition and provide more value to their customers. The three main categories of hub services were also described. These are parking (interruptible storage), gas loans (stored gas can be offered to customers on a term basis for low daily rates), and title exchange (the transfer of gas between buyer and seller). The strategic use of parking, loaned gas, title exchange, direct connections, and InterHub Services can provide customers even greater benefits than are provided by storage-based services. 6 figs


    Directory of Open Access Journals (Sweden)

    Kirill Iurievich Bely


    Full Text Available Article contains approaches to development and functioning of transport-logistic nodes – hubs – in modern conditions. There is hub classification and examples of them on different transport modes. An important component in providing reliability of hub work is automobile transport.

  5. A novel virtual hub approach for multisource downstream service integration (United States)

    Previtali, Mattia; Cuca, Branka; Barazzetti, Luigi


    A large development of downstream services is expected to be stimulated starting from earth observations (EO) datasets acquired by Copernicus satellites. An important challenge connected with the availability of downstream services is the possibility for their integration in order to create innovative applications with added values for users of different categories level. At the moment, the world of geo-information (GI) is extremely heterogeneous in terms of standards and formats used, thus preventing a facilitated access and integration of downstream services. Indeed, different users and data providers have also different requirements in terms of communication protocols and technology advancement. In recent years, many important programs and initiatives have tried to address this issue even on trans-regional and international level (e.g. INSPIRE Directive, GEOSS, Eye on Earth and SEIS). However, a lack of interoperability between systems and services still exists. In order to facilitate the interaction between different downstream services, a new architectural approach (developed within the European project ENERGIC OD) is proposed in this paper. The brokering-oriented architecture introduces a new mediation layer (the Virtual Hub) which works as an intermediary to bridge the gaps linked to interoperability issues. This intermediation layer de-couples the server and the client allowing a facilitated access to multiple downstream services and also Open Data provided by national and local SDIs. In particular, in this paper an application is presented integrating four services on the topic of agriculture: (i) the service given by Space4Agri (providing services based on MODIS and Landsat data); (ii) Gicarus Lab (providing sample services based on Landsat datasets) and (iii) FRESHMON (providing sample services for water quality) and services from a several regional SDIs.

  6. How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study (United States)

    Volpi, Annalisa; Gordini, Giovanni; Ventura, Chiara; Barozzi, Marco; Caspani, Maria Luisa Rita; Fabbri, Andrea; Ferrari, Anna Maria; Ferri, Enrico; Giugni, Aimone; Marino, Massimiliano; Martino, Costanza; Pizzamiglio, Mario; Ravaldini, Maurizio; Russo, Emanuele; Trabucco, Laura; Trombetti, Susanna; De Palma, Rossana


    Objective To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system. Setting ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million. Participants 5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012. Patients were classified by the Abbreviated Injury Score as follows: (1) traumatic brain injury (2) multiple injuriesand (3) extracranial lesions. The SIATs were divided into those with at least one neurosurgical level II trauma centre (TC) and those with a neurosurgical unit in the level I TC only. Results A higher proportion of patients (out of all SIAT patients) were admitted to the level I TC at the head of the SIAT with no additional neurosurgical facilities (1083/1472, 73.6%) compared with the level I TCs heading SIATs with neurosurgical level II TCs (1905/3815; 49.9%). A similar percentage of patients were admitted to level I TCs (1905/3815; 49.9%) and neurosurgical level II TCs (1702/3815, 44.6%) in the SIATs with neurosurgical level II TCs. Observed versus expected mortality (OE) was not statistically different among the three types of centre with a neurosurgical unit; however, the best mean OE values were observed in the level I TC in the SIAT with no neurosurgical unit. Conclusion The Hub and Spoke concept was fully applied in the SIAT in which neurosurgical facilities were available in the level I TC only. The performance of this system suggests that competition among level I and level II TCs in the same Trauma System reduces performance in both. The density of neurosurgical centres must be considered by public health system governors before implementing trauma systems. PMID:28965094

  7. An Investigation of the Views of Parents in Otago on Dental Care for Primary School-Aged Children by the Community Oral Health Service Prior to the Introduction of the Hub-Based Clinic System. (United States)

    Drummond, B K; Gaffney, M; Marshall, K


    Prior to the introduction of the Southern District Health Board's reconfigured Community Oral Health Service in Otago, a project was undertaken with parents to investigate their knowledge, understanding and views of the historical School Dental Service and of the Community Oral Health Service that was being introduced. Focus groups were run during 2011 in ten selected schools (parents with children in years 1-8) across two areas in Otago to represent ur ban and rural settings and to represent parents who were already travelling to dental services. Parents valued the traditional School Dental Service in Otago highly, generally agreeing that the service based in schools was accessible and convenient for parents and children. Rural parents who had always taken their children to dental appointments viewed it as a normal process, accepting that there could not be a service located in every school. Parents were aware that facilities were out-of-date. They highlighted the challenges of locating therapists since they started moving from school to school in the later 1990s and felt it was difficult for children seeing different therapists at each recall. There were diverse views on the proposed new system. Some parents felt that school-aged children should go to dental clinics on their own or with peers, while other parents welcomed the opportunity to attend when their child was having health care. It appears that the Community Oral Health Services should have an ongoing process to seek the views of parents and children about the service.

  8. Sharing environmental models: An Approach using GitHub repositories and Web Processing Services (United States)

    Stasch, Christoph; Nuest, Daniel; Pross, Benjamin


    The GLUES (Global Assessment of Land Use Dynamics, Greenhouse Gas Emissions and Ecosystem Services) project established a spatial data infrastructure for scientific geospatial data and metadata (, where different regional collaborative projects researching the impacts of climate and socio-economic changes on sustainable land management can share their underlying base scenarios and datasets. One goal of the project is to ease the sharing of computational models between institutions and to make them easily executable in Web-based infrastructures. In this work, we present such an approach for sharing computational models relying on GitHub repositories ( and Web Processing Services. At first, model providers upload their model implementations to GitHub repositories in order to share them with others. The GitHub platform allows users to submit changes to the model code. The changes can be discussed and reviewed before merging them. However, while GitHub allows sharing and collaborating of model source code, it does not actually allow running these models, which requires efforts to transfer the implementation to a model execution framework. We thus have extended an existing implementation of the OGC Web Processing Service standard (, the 52°North Web Processing Service ( platform to retrieve all model implementations from a git ( repository and add them to the collection of published geoprocesses. The current implementation is restricted to models implemented as R scripts using WPS4R annotations (Hinz et al.) and to Java algorithms using the 52°North WPS Java API. The models hence become executable through a standardized Web API by multiple clients such as desktop or browser GIS and modelling frameworks. If the model code is changed on the GitHub platform, the changes are retrieved by the service and the processes will be updated

  9. Natural Gas Market Hubs (United States)

    Department of Homeland Security — A hub is a physical transfer point for natural gas where several pipelines are connected. A market center is a hub where the operator offers services that facilitate...

  10. Googling Service Boundaries for Endovascular Clot Retrieval Hub Hospitals in a Metropolitan Setting: Proof-of-Concept Study. (United States)

    Phan, Thanh G; Beare, Richard; Chen, Jian; Clissold, Benjamin; Ly, John; Singhal, Shaloo; Ma, Henry; Srikanth, Velandai


    There is great interest in how endovascular clot retrieval hubs provide services to a population. We applied a computational method to objectively generate service boundaries for such endovascular clot retrieval hubs, defined by traveling time to hub. Stroke incidence data merged with population census to estimate numbers of stroke in metropolitan Melbourne, Australia. Traveling time from randomly generated addresses to 4 endovascular clot retrieval-capable hubs (Royal Melbourne Hospital [RMH], Monash Medical Center [MMC], Alfred Hospital [ALF], and Austin Hospital [AUS]) estimated using Google Map application program interface. Boundary maps generated based on traveling time at various times of day for combinations of hubs. In a 2-hub model, catchment was best distributed when RMH was paired with MMC (model 1a, RMH 1765 km 2 and MMC 1164 km 2 ) or with AUS (model 1c, RMH 1244 km 2 and AUS 1685 km 2 ), with no statistical difference between models ( P =0.20). Catchment was poorly distributed when RMH was paired with ALF (model 1b, RMH 2252 km 2 and ALF 676 km 2 ), significantly different from both models 1a and 1c (both P AUS was superior to that of RMH, MMC, and ALF in catchment distribution and travel time. The method was also successfully applied to the city of Adelaide demonstrating wider applicability. We provide proof of concept for a novel computational method to objectively designate service boundaries for endovascular clot retrieval hubs. © 2017 American Heart Association, Inc.

  11. The FUTUREVOLC Supersite's e-Infrastructure - A multidisciplinary data hub and data service for Icelandic Volcanoes (United States)

    Vogfjörd, Kristín S.; Sigmundsson, Freysteinn; Sverrisson, Sverrir Th.; Sigurdsson, Sigurdur F.; Ófeigsson, Benedikt G.; Arnarsson, Ólafur S.; Kristinsson, Ingvar; Ilyinskaya, Evgenia; Oddsdóttir, Thorarna Ýr; Bergsveinsson, Sölvi Th.; Hjartansson, Kristján R.


    The FUTUREVOLC volanological supersite will establish a data hub and dataservice, where researchers, hazard managers and other stake holders can freely obtain access to multidisciplinary data and products on activity, unrest and eruptions at Icelandic volcanoes. The supersite is firmly founded on close interaction between the main Icelandic volcanological research and monitoring institutions, in coordination with expertise from European researchers participating in FUTUREVOLC. The hub is located at the Icelandic Meteorological Office (IMO), an institution responsible for monitoring and archiving data on all natural hazards in Iceland and, which also has a mandate as the state volcano observatory. This association will ensure a long-term sustainable data service. The data accessible at the hub include in-situ and space-based observations, products and models from all the relevant disciplines contributing to volcanological research and local as well as cross-border hazard management, i.e. Earth sciences, atmospheric science, hydrology, remote sensing and space science. Access to the data will be in compliance with the access policy of the GEO (Group on Earth Observations), providing registered users with easy and timely access to data and products of documented quality. This commitment has already led to the acceptance of FUTUREVOLC as a permanent geohazard supersite by CEOS (Committee on Earth Observation Satellites), which will ensure access to additional satellite data and products on Icelandic volcanoes. To facilitate services to seismological data at the supersite hub, the IMO is reconstructing its existing data base and utilizing the SeisComp3 software to manage waveform and parameter data. The accompanying ArcLink component will be used to provide access to event data and waveforms. Access to GPS data will be provided by the GSAC web service which has been installed at the IMO through collaboration with UNAVCO. If appropriate, the format and data base

  12. Why primary care practices should become digital health information hubs for their patients. (United States)

    Baird, Aaron; Nowak, Samantha


    Two interesting health care trends are currently occurring: 1) patient-facing technologies, such as personal health records, patient portals, and mobile health apps, are being adopted at rapid rates, and 2) primary care, which includes family practice, is being promoted as essential to reducing health care costs and improving health care outcomes. While these trends are notable and commendable, both remain subject to significant fragmentation and incentive misalignments, which has resulted in significant data coordination and value generation challenges. In particular, patient-facing technologies designed to increase care coordination, often fall prey to the very digital fragmentation issues they are supposed to overcome. Additionally, primary care providers are treating patients that may have considerable health information histories, but generating a single view of such multi-source data is nearly impossible. We contribute to this debate by proposing that primary care practices become digital health information hubs for their patients. Such hubs would offer health data coordination in a medically professional setting with the benefits of expert, trustworthy advice coupled with active patient engagement. We acknowledge challenges including: costs, information quality and provenance, willingness-to-share information and records, willingness-to-use (by both providers and patients), primary care scope creep, and determinations of technical and process effectiveness. Even with such potential challenges, we strongly believe that more debate is needed on this topic prior to full implementation of various health information technology incentives and reform programs currently being designed and enacted throughout the world. Ultimately, if we do not provide a meaningful way for the full spectrum of health information to be used by both providers and patients, especially early in the health care continuum, effectively improving health outcomes may remain elusive. We view

  13. Home Care Services (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... are chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help ...

  14. Telefacturing Based Distributed Manufacturing Environment for Optimal Manufacturing Service by Enhancing the Interoperability in the Hubs

    Directory of Open Access Journals (Sweden)

    V. K. Manupati


    Full Text Available Recent happenings are surrounding the manufacturing sector leading to intense progress towards the development of effective distributed collaborative manufacturing environments. This evolving collaborative manufacturing not only focuses on digitalisation of this environment but also necessitates service-dependent manufacturing system that offers an uninterrupted approach to a number of diverse, complicated, dynamic manufacturing operations management systems at a common work place (hub. This research presents a novel telefacturing based distributed manufacturing environment for recommending the manufacturing services based on the user preferences. The first step in this direction is to deploy the most advanced tools and techniques, that is, Ontology-based Protégé 5.0 software for transforming the huge stored knowledge/information into XML schema of Ontology Language (OWL documents and Integration of Process Planning and Scheduling (IPPS for multijobs in a collaborative manufacturing system. Thereafter, we also investigate the possibilities of allocation of skilled workers to the best feasible operations sequence. In this context, a mathematical model is formulated for the considered objectives, that is, minimization of makespan and total training cost of the workers. With an evolutionary algorithm and developed heuristic algorithm, the performance of the proposed manufacturing system has been improved. Finally, to manifest the capability of the proposed approach, an illustrative example from the real-time manufacturing industry is validated for optimal service recommendation.

  15. The NCAR Digital Asset Services Hub (DASH): Implementing Unified Data Discovery and Access (United States)

    Stott, D.; Worley, S. J.; Hou, C. Y.; Nienhouse, E.


    The National Center for Atmospheric Research (NCAR) Directorate created the Data Stewardship Engineering Team (DSET) to plan and implement an integrated single entry point for uniform digital asset discovery and access across the organization in order to improve the efficiency of access, reduce the costs, and establish the foundation for interoperability with other federated systems. This effort supports new policies included in federal funding mandates, NSF data management requirements, and journal citation recommendations. An inventory during the early planning stage identified diverse asset types across the organization that included publications, datasets, metadata, models, images, and software tools and code. The NCAR Digital Asset Services Hub (DASH) is being developed and phased in this year to improve the quality of users' experiences in finding and using these assets. DASH serves to provide engagement, training, search, and support through the following four nodes (see figure). DASH MetadataDASH provides resources for creating and cataloging metadata to the NCAR Dialect, a subset of ISO 19115. NMDEdit, an editor based on a European open source application, has been configured for manual entry of NCAR metadata. CKAN, an open source data portal platform, harvests these XML records (along with records output directly from databases) from a Web Accessible Folder (WAF) on GitHub for validation. DASH SearchThe NCAR Dialect metadata drives cross-organization search and discovery through CKAN, which provides the display interface of search results. DASH search will establish interoperability by facilitating metadata sharing with other federated systems. DASH ConsultingThe DASH Data Curation & Stewardship Coordinator assists with Data Management (DM) Plan preparation and advises on Digital Object Identifiers. The coordinator arranges training sessions on the DASH metadata tools and DM planning, and provides one-on-one assistance as requested. DASH Repository

  16. Health Care Services (United States)

    Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice , 2017 Warning - A phone number that was once used for the Denali KidCare program is now being used to ask people for their credit card number in order to win a prize. The phone number related to this

  17. DisasterHub: A mobile application for enabling crowd generated data fusion in Earth Observation disaster management services (United States)

    Tsironis, Vassilis; Herekakis, Themistocles; Tsouni, Alexia; Kontoes, Charalampos Haris


    by DisasterHub, an application proposal that won the MYGEOSS Second Call for Innovative Apps ( DisasterHub will fill the gap by introducing a mobile application that will act as a middleware between mobile users and BEYOND services, building on the concept of citizen observatories in support of Copernicus, GEO, GEOSS, and UN-SPIDER. In this context the roadmap for generating beneficial EO services through DisasterHub is sketched in two main branches: (i) ingestion, processing and fusion of big multimodal data with additional spatiotemporal evidences (originated from Core Copernicus, GEO, GEOSS) for deriving higher value DRR and EMS products, (ii) interlinking the web and mobile platforms for the exchange and ease access of the societies to open EO/crowd generated data. The benefited communities will be effectively enlarged through DisasterHub mobile app. Mutually the BEYOND ecosystem will profit from the large amount of tagged information returned from the field, forming a unique input to the production chains and assimilation of predictive modeling. In conclusion DisasterHub will showcase in the EO community an enhanced EO services ecosystem with a software infrastructure for easy access of mobile users to the real-time monitoring and early-warning systems of BEYOND and tools for incorporating crowd-sourced data with open geospatial and socioeconomic data via open/linked data ingestion mechanisms (APIs), retrieved from the GEOSS Data-CORE, Copernicus and other EU portals.

  18. Using hub technology to facilitate information system integration in a health-care enterprise. (United States)

    Gendler, S M; Friedman, B A; Henricks, W H


    The deployment and maintenance of multiple point-to-point interfaces between a clinical information system, such as a laboratory information system, and other systems within a healthcare enterprise is expensive and time consuming. Moreover, the demand for such interfaces is increasing as hospitals consolidate and clinical laboratories participate in the development of regional laboratory networks and create host-to-host links with laboratory outreach clients. An interface engine, also called a hub, is an evolving technology that could replace multiple point-to-point interfaces from a laboratory information system with a single interface to the hub, preferably HL7 based. The hub then routes and translates laboratory information to other systems within the enterprise. Changes in application systems in an enterprise where a centralized interface engine has been implemented then amount to thorough analysis, an update of the enterprise's data dictionary, purchase of a single new vendor-supported interface, and table-based parameter changes on the hub. Two other features of an interface engine, support for structured query language and information store-and-forward, will facilitate the development of clinical data repositories and provide flexibility when interacting with other host systems. This article describes the advantages and disadvantages of an interface engine and lists some problems not solved by the technology. Finally, early developmental experience with an interface engine at the University of Michigan Medical Center and the benefits of the project on system integration efforts are described, not the least of which has been the enthusiastic adoption of the HL7 standard for all future interface projects.

  19. How Big is Too Big for Hubs: Marginal Profitability in Hub-and-Spoke Networks (United States)

    Ross, Leola B.; Schmidt, Stephen J.


    Increasing the scale of hub operations at major airports has led to concerns about congestion at excessively large hubs. In this paper, we estimate the marginal cost of adding spokes to an existing hub network. We observe entry/non-entry decisions on potential spokes from existing hubs, and estimate both a variable profit function for providing service in markets using that spoke as well as the fixed costs of providing service to the spoke. We let the fixed costs depend upon the scale of operations at the hub, and find the hub size at which spoke service costs are minimized.

  20. Community care and social services.


    Renwick, D.


    The aim of community care is to enable people with various types of disability to live in their own homes, rather than in institutions. This involves the provision of support and services at home by various agencies. After a critical report in 1986 identified problems with coordination and flexibility of community care services, the white paper Caring for People (1989) stated the government's aim to provide a "needs led," responsive range of services, promoting maximum independence of those w...

  1. Health care's service fanatics. (United States)

    Merlino, James I; Raman, Ananth


    The Cleveland Clinic has long had a reputation for medical excellence. But in 2009 the CEO acknowledged that patients did not think much of their experience there and decided to act. Since then the Clinic has leaped to the top tier of patient-satisfaction surveys, and it now draws hospital executives from around the world who want to study its practices. The Clinic's journey also holds Lessons for organizations outside health care that must suddenly compete by creating a superior customer experience. The authors, one of whom was critical to steering the hospital's transformation, detail the processes that allowed the Clinic to excel at patient satisfaction without jeopardizing its traditional strengths. Hospital leaders: Publicized the problem internally. Seeing the hospital's dismal service scores shocked employees into recognizing that serious flaws existed. Worked to understand patients' needs. Management commissioned studies to get at the root causes of dissatisfaction. Made everyone a caregiver. An enterprisewide program trained everyone, from physicians to janitors, to put the patient first. Increased employee engagement. The Clinic instituted a "caregiver celebration" program and redoubled other motivational efforts. Established new processes. For example, any patient, for any reason, can now make a same-day appointment with a single call. Set patients' expectations. Printed and online materials educate patients about their stays--before they're admitted. Operating a truly patient-centered organization, the authors conclude, isn't a program; it's a way of life.

  2. Maritime Domain Awareness Architecture Management Hub Strategy

    National Research Council Canada - National Science Library


    This document provides an initial high level strategy for carrying out the responsibilities of the national Maritime Domain Awareness Architecture Management Hub to deliver a standards based service...

  3. Solving Hub Network Problem Using Genetic Algorithm

    Directory of Open Access Journals (Sweden)

    Mursyid Hasan Basri


    Full Text Available This paper addresses a network problem that described as follows. There are n ports that interact, and p of those will be designated as hubs. All hubs are fully interconnected. Each spoke will be allocated to only one of available hubs. Direct connection between two spokes is allowed only if they are allocated to the same hub. The latter is a distinct characteristic that differs it from pure hub-and-spoke system. In case of pure hub-and-spoke system, direct connection between two spokes is not allowed. The problem is where to locate hub ports and to which hub a spoke should be allocated so that total transportation cost is minimum. In the first model, there are some additional aspects are taken into consideration in order to achieve a better representation of the problem. The first, weekly service should be accomplished. Secondly, various vessel types should be considered. The last, a concept of inter-hub discount factor is introduced. Regarding the last aspect, it represents cost reduction factor at hub ports due to economies of scale. In practice, it is common that the cost rate for inter-hub movement is less than the cost rate for movement between hub and origin/destination. In this first model, inter-hub discount factor is assumed independent with amount of flows on inter-hub links (denoted as flow-independent discount policy. The results indicated that the patterns of enlargement of container ship size, to some degree, are similar with those in Kurokawa study. However, with regard to hub locations, the results have not represented the real practice. In the proposed model, unsatisfactory result on hub locations is addressed. One aspect that could possibly be improved to find better hub locations is inter-hub discount factor. Then inter-hub discount factor is assumed to depend on amount of inter-hub flows (denoted as flow-dependent discount policy. There are two discount functions examined in this paper. Both functions are characterized by

  4. Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments. (United States)

    Dyson, Kate; Kruger, Estie; Tennant, Marc


    This study examines the cost effectiveness of a model of remote area oral health service. Retrospective financial analysis. Rural and remote primary health services. Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  5. Care Services in Periurban Ghana

    Directory of Open Access Journals (Sweden)

    Paa Kobina Turkson


    Full Text Available The study used logistic regression modelling to determine predictors of satisfaction with delivery of animal health care services for 889 clients (livestock and poultry keepers in periurban Ghana. Of the 15 indicators tested as predictors of satisfaction in this study, 8 were included in the best fit model. These were accessibility, availability of services, service charge, effectiveness, efficiency, quality of services, meeting client needs, and getting help. Efficiency and effectiveness were perceived by the respondents to be synonymous, as were service quality and effectiveness, as suggested by ORs>10 when cross tabulated. Therefore, one or the other could be used in future studies but not both to avoid collinearity. The identified predictors could be targeted for improvement in quality of service delivery to livestock and poultry keepers in Ghana.

  6. Home Care Services: Questions to Ask (United States)

    Healthy Lifestyle Healthy aging Home care services range from medical care to help with daily household chores. If ... 12, 2017 Original article: ...

  7. Joint Hub Network Development


    Cruijssen, F.C.A.M.; Borm, P.E.M.; Dullaert, W.; Hamers, H.J.M.


    This paper introduces a framework for joint hub network development. Building a joint physical hub for transhipment of goods is expensive and therefore involves considerable risks for the cooperating companies. In a practical setting, it is unlikely that an entire network will be built at once. Rather, the partners will have a more cautious attitude and build the hub facilities one-by-one. In the proposed framework, every time a new hub is introduced, partners will have the opportunity to dec...

  8. Dynamic hubs show competitive and static hubs non-competitive regulation of their interaction partners.

    Directory of Open Access Journals (Sweden)

    Apurv Goel

    Full Text Available Date hub proteins have 1 or 2 interaction interfaces but many interaction partners. This raises the question of whether all partner proteins compete for the interaction interface of the hub or if the cell carefully regulates aspects of this process? Here, we have used real-time rendering of protein interaction networks to analyse the interactions of all the 1 or 2 interface hubs of Saccharomyces cerevisiae during the cell cycle. By integrating previously determined structural and gene expression data, and visually hiding the nodes (proteins and their edges (interactions during their troughs of expression, we predict when interactions of hubs and their partners are likely to exist. This revealed that 20 out of all 36 one- or two- interface hubs in the yeast interactome fell within two main groups. The first was dynamic hubs with static partners, which can be considered as 'competitive hubs'. Their interaction partners will compete for the interaction interface of the hub and the success of any interaction will be dictated by the kinetics of interaction (abundance and affinity and subcellular localisation. The second was static hubs with dynamic partners, which we term 'non-competitive hubs'. Regulatory mechanisms are finely tuned to lessen the presence and/or effects of competition between the interaction partners of the hub. It is possible that these regulatory processes may also be used by the cell for the regulation of other, non-cell cycle processes.

  9. Quadratic Assignment of Hubs in p-Hub Median Problem

    DEFF Research Database (Denmark)

    Gelareh, Shahin

    We introduce Generalized p-Hub Median Problem (GpHMP) that seeks to locate p hub nodes and install p distinct hub facilities/operators on the hubs while discount factor resulted by consolidation of flow on the hub links depends on the facilities/operators that are installed/operating on both hub...

  10. Hub and Axis


    Hansen, Gary Alan


    The project is for the central building of a community center used by the communities of Blacksburg and Christiansburg. The building is a space configured as a hub that uses axes to determine entering, exiting and vertical movement. The hub configuration of the building is in concentric rings around the atrium in both space and materials. As materials were brought into the building, they enhanced the strong axial configuration and emphasized the layers surrounding the central hub space of ...

  11. Virtual Campus Hub technology

    DEFF Research Database (Denmark)

    Vercoulen, Frank; Badger, Merete; Monaco, Lucio

    This deliverable briefly describes which technological components have been delivered for the Virtual Campus Hub and how they can be used. A detailed discussion of the technical details of the components, how they were realized and how they fit the VCH concept can be found in deliverables D5.......4. Virtual Campus Hub Technology Evaluation Report and D6.7 The Virtual Campus Hub Concept....

  12. Home care services for sick children

    DEFF Research Database (Denmark)

    Castor, Charlotte; Hallström, Inger; Hansson, Eva Helena


    as challenging for healthcare professionals in home care services used to providing care predominately for adults. DESIGN: An inductive qualitative design. METHOD: Seven focus group interviews were performed with 36 healthcare professionals from multidisciplinary home care services. Data were analysed stepwise......AIMS AND OBJECTIVES: To explore healthcare professionals' conceptions of caring for sick children in home care services. BACKGROUND: Families often prefer home care to hospital care, and the number of home care services for children is increasing. Caring for children at home has been recognised...... using a phenomenographic analysis. RESULTS: Three description categories emerged: "A challenging opportunity", "A child perspective", and "Re-organise in accordance with new prerequisites." Providing home care services for children was conceived to evoke both professional and personal challenges...

  13. Long-Term Care Services for Veterans (United States)


    includes but is not limited to home physical , occupational, or speech therapy ; wound care; and intravenous (IV) care. A VA physician determines that a...restoring/rehabilitating the veteran’s health, such as skilled nursing care, physical therapy , occupational therapy , and IV therapy Same as HBPC... geriatric evaluation,  palliative care,  adult day health care,  homemaker/home health aide care,  respite care, Long-Term Care Services for

  14. Improving Customer Service in Elderly Care


    Nielsen, Chris


    The elderly care sector is increasingly facing more competition and demanding customers. This leads to a growing pressure on elderly care home providers to find new and improved solutions that will enhance their level of customer service. The will ensure that the elderly service provider is remaining competitive in the elderly care service marketplace. The purpose of this thesis is to identify areas for improvements and propose implementable solutions for enhancing the elderly care custom...

  15. Innovation Hub How-To

    DEFF Research Database (Denmark)

    Berger, Andreas; Brem, Alexander


    in establishing an innovative environment: carefully considering the decision to set up such a center, hiring the right people, designing a framework for effective output, creating a buffer from bureaucratic distractions, securing a leader to champion the effort, focusing on business outcomes, fostering...... disruptive over incremental innovation, and being patient. Regardless of where an innovation hub is established, the key to success lies in hiring creative, intrinsically motivated staff and then giving them the freedom to do what they do best....

  16. PolarHub: A Global Hub for Polar Data Discovery (United States)

    Li, W.


    This paper reports the outcome of a NSF project in developing a large-scale web crawler PolarHub to discover automatically the distributed polar dataset in the format of OGC web services (OWS) in the cyberspace. PolarHub is a machine robot; its goal is to visit as many webpages as possible to find those containing information about polar OWS, extract this information and store it into the backend data repository. This is a very challenging task given huge data volume of webpages on the Web. Three unique features was introduced in PolarHub to make it distinctive from earlier crawler solutions: (1) a multi-task, multi-user, multi-thread support to the crawling tasks; (2) an extensive use of thread pool and Data Access Object (DAO) design patterns to separate persistent data storage and business logic to achieve high extendibility of the crawler tool; (3) a pattern-matching based customizable crawling algorithm to support discovery of multi-type geospatial web services; and (4) a universal and portable client-server communication mechanism combining a server-push and client pull strategies for enhanced asynchronous processing. A series of experiments were conducted to identify the impact of crawling parameters to the overall system performance. The geographical distribution pattern of all PolarHub identified services is also demonstrated. We expect this work to make a major contribution to the field of geospatial information retrieval and geospatial interoperability, to bridge the gap between data provider and data consumer, and to accelerate polar science by enhancing the accessibility and reusability of adequate polar data.

  17. Joint Hub Network Development

    NARCIS (Netherlands)

    Cruijssen, F.C.A.M.; Borm, P.E.M.; Dullaert, W.; Hamers, H.J.M.


    This paper introduces a framework for joint hub network development. Building a joint physical hub for transhipment of goods is expensive and therefore involves considerable risks for the cooperating companies. In a practical setting, it is unlikely that an entire network will be built at once.

  18. Home Health Care: Services and Cost (United States)

    Widmer, Geraldine; And Others


    Findings from a study of home care services in one New York district document the value and relatively modest costs of home health care for the chronically ill and dependent elderly. Professional nurses coordinated the care, but most of the direct services were provided by home health aides and housekeepers. (MF)

  19. A new transport hub

    CERN Multimedia

    Corinne Pralavorio


    CERN’s new Mobility Centre, allowing you to switch easily from one mode of transport to another, has just been officially opened.   Inauguration of the CERN Mobility Centre by Martin Steinacher, Director for Finance and Human Resources, and Lluis Miralles, Head of the SMB department. CERN’s new Mobility Centre, on the car park next to the Globe of Science and Innovation was officially opened on Tuesday, 22 March. The centre brings together all of CERN’s transport options in a single location. "Our aim is to create an intermodal hub where CERN users and personnel can switch from one mode of transport to another, and from CERN transport to public transport," explains Lluis Miralles, head of the Site Management and Buildings (SMB) department. The Mobility Centre incorporates the CERN bike and car rental services, the self-service car- and bike-sharing schemes, and SIXT car rental facilities (for long-distance journeys). It is located right ne...

  20. Home Care Services and the Rural Elderly. (United States)

    Hayslip, Bert, Jr.; And Others


    Independent studies examined a needs v an agency perspective on home health care service needs within a rural county. Interviews with 299 elderly, aged 60-93, revealed there were substantial needs for home health care services and the desire for services varied with residence within the county. (Author)

  1. Ask! Your Library at the HUB: Penn State Libraries’ Experiences Providing Reference Services at the Campus Student Union Building

    Directory of Open Access Journals (Sweden)

    Anne Charlotte Behler


    Full Text Available The Web 2.0 generation presents many service challenges to libraries. College students of today have work styles that emphasize collaboration, preference for flexible and comfortable spaces, and independent discovery of information. Given that challenge, it is important for libraries to experiment with new and unique models of service. Librarians and Staff at the Penn State University Libraries explored offering library service at the main campus’s student union building during two trials, during the Spring and Fall semesters of 2006.

  2. Aircraft Propeller Hub Repair

    Energy Technology Data Exchange (ETDEWEB)

    Muth, Thomas R [ORNL; Peter, William H [ORNL


    The team performed a literature review, conducted residual stress measurements, performed failure analysis, and demonstrated a solid state additive manufacturing repair technique on samples removed from a scrapped propeller hub. The team evaluated multiple options for hub repair that included existing metal buildup technologies that the Federal Aviation Administration (FAA) has already embraced, such as cold spray, high velocity oxy-fuel deposition (HVOF), and plasma spray. In addition the team helped Piedmont Propulsion Systems, LLC (PPS) evaluate three potential solutions that could be deployed at different stages in the life cycle of aluminum alloy hubs, in addition to the conventional spray coating method for repair. For new hubs, a machining practice to prevent fretting with the steel drive shaft was recommended. For hubs that were refurbished with some material remaining above the minimal material condition (MMC), a silver interface applied by an electromagnetic pulse additive manufacturing method was recommended. For hubs that were at or below the MMC, a solid state additive manufacturing technique using ultrasonic welding (UW) of thin layers of 7075 aluminum to the hub interface was recommended. A cladding demonstration using the UW technique achieved mechanical bonding of the layers showing promise as a viable repair method.

  3. Managing Cancer Care - Finding Health Care Services (United States)

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

  4. C-HUB: a communication and network platform targeting the Generation Plus and their social and care networks

    DEFF Research Database (Denmark)

    Asboe, Mark; Fernandes, Joao; Grönvall, Erik


    This paper presents an ongoing project that focuses on improving the quality of life for senior citizens by developing IT support for independent living in their homes. We introduce a concept that explores and supports coordination within a social and care community targeting elderly people...

  5. The delivery of primary care services.

    NARCIS (Netherlands)

    Wilson, A.; Windak, A.; Oleszczyk, M.; Wilm, S.; Hasvold, T.; Kringos, D.


    This chapter will be devoted to the dimensions which have been grouped in the framework as “process” and that focus on essential features of service delivery in primary care. In addition to the breadth of services delivered, a comparative overview will be provided of variation in access to services,

  6. Redesigning the regulatory framework for ambulatory care services in New York. (United States)

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


    care services. From the state government's perspective, this clarification requires better reporting from new health care entities (eg, retail clinics), connections with regional and state health information technology hubs, and coordination among state agencies. A uniform nomenclature also would improve consumers' understanding of rights and responsibilities. Finally, the regulatory mechanisms employed-from mandatory reporting to licensure to regional planning to the certificate of need-should remain flexible and match the degree of consensus regarding the appropriate regulatory path. Few other states have embarked on a wide-ranging assessment of their regulation of ambulatory care services. By moving toward adopting the regulatory approach described here, New York aims to balance sound oversight with pluralism and innovation in health care delivery. © 2014 Milbank Memorial Fund.


    Directory of Open Access Journals (Sweden)

    Nuket SUBASI


    Full Text Available Home care services can be provided as an alternative to institutional care to people, in case of their demand, who need care because of aging and chronic diseases. Structured home care service in health system does not exist in Turkey. Relatives try to provide care at home to those people. In this cross-sectional study, household was selected as a sampling unit, determining prevalence of home care at the households and gathering some information about home care in Cankaya district of Ankara was intended. It was found that in one-month period before this study was carried out, home care services were provided at 8.7% of the households in Cankaya district. 62.5% of people who received home care service were women, 15.3% of them were belonging to 65-74 age group; 31.7% of those were illiterate and 12.5% had no social and health insurance. Among people, 15.4% were receiving home care after surgical operation, 15.4% were receiving care because of stroke and cerebrovascular diseases and 9.6% were cancer patients. 81.7% of adults who were taken care at home were found to be dependent at different levels while performing daily living activities, the most common treatment method was detected as oral medication (81.4%. These people were in need of preventive, curative and rehabilitative and supportive services. A home care service model, which takes into consideration the social characteristics of the country, should be developed at this district where there is a large elderly population. [TAF Prev Med Bull 2006; 5(1.000: 19-31

  8. The home hemodialysis hub: physical infrastructure and integrated governance structure. (United States)

    Marshall, Mark R; Young, Bessie A; Fox, Sally J; Cleland, Calli J; Walker, Robert J; Masakane, Ikuto; Herold, Aaron M


    An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes. © 2015 International Society for Hemodialysis.

  9. Nurses' Needs for Care Robots in Integrated Nursing Care Services. (United States)

    Lee, Jai-Yon; Song, Young Ae; Jung, Ji Young; Kim, Hyun Jeong; Kim, Bo Ram; Do, Hyun-Kyung; Lim, Jae-Young


    To determine the need for care robots among nurses and to suggest how robotic care should be prioritized in an integrated nursing care services. Korea is expected to be a super-aged society by 2030. To solve care issues with elderly inpatient caused by informal caregivers, the government introduced 'integrated nursing care services'; these are comprehensive care systems staffed by professionally trained nurses. To assist them, a care robot development project has been launched. The study applied a cross-sectional survey. In 2016, we conducted a multi-center survey involving 302 registered nurses in five hospitals including three tertiary and two secondary hospitals in Korea. The questionnaire consisted of general characteristics of nurses and their views on and extents of agreement about issues associated with robotic care. Trial center nurses and those with ≥10 years of experience reported positively on the prospects for robotic care. The top three desired primary roles for care robots were 'measuring/monitoring', 'mobility/activity' and 'safety care'. 'Reduction in workload', especially in terms of 'other nursing services' which were categorized as non-value-added nursing activities, was the most valued feature. The nurses approved of the aid by care robots but were concerned about device malfunction and interruption of rapport with patients. Care robots are expected to be effective in integrated nursing care services, particularly in 'measuring/monitoring'. Such robots should decrease nurses' workload and minimize non-value-added nursing activities efficiently. No matter how excellent care robots are, they must co-operate with and be controlled by nurses. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  10. Improving the delivery of preventive care services. (United States)

    Hung, Dorothy Y


    Performance of preventive services is an important indicator of high-quality health care, but many recommended services are not regularly offered in primary care practices. Health risk assessments, counseling, and referral to community-based programs help address risk behaviors, many of which are leading causes of preventable death and disability in the United States. This study examined various influences on the delivery of preventive services designed to address smoking, excessive consumption of alcohol, unhealthy diets, and sedentary lifestyles. More than 300 health care providers in 52 practices nationwide have contributed data to this study. Staff participation in quality improvement enhanced work relationships and also diminished the effect of practice size on the performance of preventive care. The use of nurse practitioners, allied health professionals, clinician reminders, and patient registries were positively associated with care delivery.

  11. Liner shipping hub network design in a competitive environment

    DEFF Research Database (Denmark)

    Gelareh, Shahin; Nickel, Stefan; Pisinger, David


    A mixed integer programming formulation is proposed for hub-and-spoke network design in a competitive environment. It addresses the competition between a newcomer liner service provider and an existing dominating operator, both operating on hub-and-spoke networks. The newcomer company maximizes i...

  12. Barriers to emergency obstetric care services

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique


    Introduction: Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore...... barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. Methods: A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced...... decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay...

  13. Using the CER Hub to ensure data quality in a multi-institution smoking cessation study. (United States)

    Walker, Kari L; Kirillova, Olga; Gillespie, Suzanne E; Hsiao, David; Pishchalenko, Valentyna; Pai, Akshatha Kalsanka; Puro, Jon E; Plumley, Robert; Kudyakov, Rustam; Hu, Weiming; Allisany, Art; McBurnie, MaryAnn; Kurtz, Stephen E; Hazlehurst, Brian L


    Comparative effectiveness research (CER) studies involving multiple institutions with diverse electronic health records (EHRs) depend on high quality data. To ensure uniformity of data derived from different EHR systems and implementations, the CER Hub informatics platform developed a quality assurance (QA) process using tools and data formats available through the CER Hub. The QA process, implemented here in a study of smoking cessation services in primary care, used the 'emrAdapter' tool programmed with a set of quality checks to query large samples of primary care encounter records extracted in accord with the CER Hub common data framework. The tool, deployed to each study site, generated error reports indicating data problems to be fixed locally and aggregate data sharable with the central site for quality review. Across the CER Hub network of six health systems, data completeness and correctness issues were prevalent in the first iteration and were considerably improved after three iterations of the QA process. A common issue encountered was incomplete mapping of local EHR data values to those defined by the common data framework. A highly automated and distributed QA process helped to ensure the correctness and completeness of patient care data extracted from EHRs for a multi-institution CER study in smoking cessation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  14. Managing effective and efficient hub operations : a study of ground time management

    NARCIS (Netherlands)

    Yunita, Theresia


    This Logistics Design Project was carried out at KLM Aircraft Services (AS), from February 2008 - April 2009. The project focuses on ideal description of KLM operational controls for daily executions at the hub and within the AS processes. The daily execution at the hub is managed by the Hub Control

  15. Analysis of Eye Care Services in Yemen


    Saleh A. Al-Akily; Mutahar Y. Al-Shaer; Mahfouth A. Bamashmus; Abdulmoghni O. Al-Barrag; Tawfik K. Alkhatib; Hisham A. Al-Akhlee


    Purpose: The objective of this study was to undertake an analysis of the eye care services situation in Yemen and to assess ophthalmic human resources, eye units’ ownership and ophthalmic equipments. Methods: Eye care providers were surveyed by a standardized questionnaire which was sent to the 184 eye units in governmental, university, military, private and charity clinics and hospitals in Yemen and covered the period between 01 January to 31 December 2012. The questionnaire determined l...

  16. Models of care and organization of services. (United States)

    Markova, Alina; Xiong, Michael; Lester, Jenna; Burnside, Nancy J


    This article examines the overall organization of services and delivery of health care in the United States. Health maintenance organization, fee-for-service, preferred provider organizations, and the Veterans Health Administration are discussed, with a focus on structure, outcomes, and areas for improvement. An overview of wait times, malpractice, telemedicine, and the growing population of physician extenders in dermatology is also provided. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Creating Service Concepts for Finnish Elderly Care : Case: Virtual Interactive Care Service


    Nwagu, Promise


    This thesis looks at creating service concept by evaluating the research project of Virtual Interactive Care Service. The research project was initiated and implemented by the author together with Hovi Group Oy and Suomen kotilääkäripalvelu Oy. The goal was to provide a virtual care service business that uses interactive and stimulating activities to improve the wellbeing of elderly people in Finland. The study employed qualitative research method by reviewing existing works particularly...

  18. Transaction hubs: can tame energy market communications

    Energy Technology Data Exchange (ETDEWEB)

    Hamilos, C.


    The nature and function of transaction hubs is described in view of their growing usefulness as electric industry deregulation takes hold and with it the urgent requirement for trading partners to exchange information quickly and efficiently. The paper stresses the many difficulties involved in communications between trading partners since each partner operates under a different set of business rules, with the result that there are 'language differences' to overcome, not to mention the sheer volume of data that must be handled. To make it all work, companies turn increasingly to products like communication hubs. They are able to overcome the fact that different companies have different systems, different data formats and different business rules, and are able to help companies to package, transmit, receive and process information. The principal advantage of a hub is that no one has to learn anyone else's interface. Everyone can continue to use their own data format and transaction models. The hub supplies the protocols and processing rules needed to work with any of the partners connected to the hub. In order to achieve the level of efficiency and reliability required in a hub, certain design principles must be satisfied. These are : scalability, facilities for load balancing, availability of standard routine services, ability to recognize a process as consisting of various transactions, and a transaction as belonging to a specific process, ability to allow the user to configure expiration times around the business processes according to market rules, facility to easily configure validation rules, ability to handle exceptions, ability to interoperate with many middle-ware products, and to manage work flow in a manner that is transparent to operating personnel.

  19. Liner Shipping Hub Network Design in a Competitive Environment

    DEFF Research Database (Denmark)

    Gelareh, Shahin; Nickel, Stefan; Pisinger, David

    A new mixed integer programming formulation is proposed for hub-and-spoke network design in a competitive environment. It addresses competition between a newcomer liner service provider and an alliance, both operating on hub-and-spoke networks. The newcomer company maximizes its market share...... — proportional to service time and transportation cost —by locating a predefined number of hubs at candidate ports and designing its network. While general-purpose solvers do not solve instances of even small size, an accelerated lagrangian method coupled with a primal heuristic obtains very good bounds. Our...

  20. Robots and service innovation in health care. (United States)

    Oborn, Eivor; Barrett, Michael; Darzi, Ara


    Robots have long captured our imagination and are being used increasingly in health care. In this paper we summarize, organize and criticize the health care robotics literature and highlight how the social and technical elements of robots iteratively influence and redefine each other. We suggest the need for increased emphasis on sociological dimensions of using robots, recognizing how social and work relations are restructured during changes in practice. Further, we propose the usefulness of a 'service logic' in providing insight as to how robots can influence health care innovation. The Royal Society of Medicine Press Ltd 2011.

  1. Identifying barriers to emergency care services. (United States)

    Cannoodt, Luk; Mock, Charles; Bucagu, Maurice


    This paper aims to present a review of published evidence of barriers to emergency care, with attention towards both financial and other barriers. With the keywords (financial) accessibility, barriers and emergency care services, citations in PubMed were searched and further selected in the context of the objective of this article. Forty articles, published over a period of 15 years, showed evidence of significant barriers to emergency care. These barriers often tend to persist, despite the fact that the evidence was published many years ago. Several publications stressed the importance of the financial barriers in foregoing or delaying potentially life-saving emergency services, both in poor and rich countries. Other publications report non-financial barriers that prevent patients in need of emergency care (pre-hospital and in-patient care) from seeking care, from arriving in the proper emergency department without undue delay or from receiving proper treatment when they do arrive in these departments. It is clear that timely access to life-saving and disability-preventing emergency care is problematic in many settings. Yet, low-cost measures can likely be taken to significantly reduce these barriers. It is time to make an inventory of these measures and to implement the most cost-effective ones worldwide. Copyright © 2011 John Wiley & Sons, Ltd.

  2. Students' perspectives to health care services in lithuania


    Brancevič, Jolita


    Students' Perspectives to Health Care Services in Lithuania Introduction. The Rights of Patients and Compensation for the Damage to Their Health Act defines health care services as safe and effective means to take care of health, identify, diagnose and treat diseases and provide nursing services. The aims set out in a policy of health care services are fairly broad and, among others, include the improvement of both the quality and the availability of health care services. The issues of increa...

  3. Marketing service guarantees for health care. (United States)

    Levy, J S


    The author introduces the concept of service guarantees for application in health care and differentiates between explicit, implicit, and conditional vs. unconditional types of guarantees. An example of an unconditional guarantee of satisfaction is provided by the hospitality industry. Firms conveying an implicit guarantee are those with outstanding reputations for products such as luxury automobiles, or ultimate customer service, like Nordstrom. Federal Express and Domino's Pizza offer explicit guarantees of on-time delivery. Taking this concept into efforts to improve health care delivery involves a number of caveats. Customers invited to use exceptional service cards may use these to record either satisfaction or dissatisfaction. The cards need to provide enough specific information about issues so that "immediate action could be taken to improve processes." Front-line employees should be empowered to respond to complaints in a meaningful way to resolve the problem before the client leaves the premises.

  4. The Banana Genome Hub (United States)

    Droc, Gaëtan; Larivière, Delphine; Guignon, Valentin; Yahiaoui, Nabila; This, Dominique; Garsmeur, Olivier; Dereeper, Alexis; Hamelin, Chantal; Argout, Xavier; Dufayard, Jean-François; Lengelle, Juliette; Baurens, Franc-Christophe; Cenci, Alberto; Pitollat, Bertrand; D’Hont, Angélique; Ruiz, Manuel; Rouard, Mathieu; Bocs, Stéphanie


    Banana is one of the world’s favorite fruits and one of the most important crops for developing countries. The banana reference genome sequence (Musa acuminata) was recently released. Given the taxonomic position of Musa, the completed genomic sequence has particular comparative value to provide fresh insights about the evolution of the monocotyledons. The study of the banana genome has been enhanced by a number of tools and resources that allows harnessing its sequence. First, we set up essential tools such as a Community Annotation System, phylogenomics resources and metabolic pathways. Then, to support post-genomic efforts, we improved banana existing systems (e.g. web front end, query builder), we integrated available Musa data into generic systems (e.g. markers and genetic maps, synteny blocks), we have made interoperable with the banana hub, other existing systems containing Musa data (e.g. transcriptomics, rice reference genome, workflow manager) and finally, we generated new results from sequence analyses (e.g. SNP and polymorphism analysis). Several uses cases illustrate how the Banana Genome Hub can be used to study gene families. Overall, with this collaborative effort, we discuss the importance of the interoperability toward data integration between existing information systems. Database URL: PMID:23707967

  5. Flow Merging and Hub Route Optimization in Collaborative Transportation

    Directory of Open Access Journals (Sweden)

    Kerui Weng


    Full Text Available This paper studies the optimal hub routing problem of merged tasks in collaborative transportation. This problem allows all carriers’ transportation tasks to reach the destinations optionally passing through 0, 1, or 2 hubs within limited distance, while a cost discount on arcs in the hub route could be acquired after paying fixed charges. The problem arises in the application of logistics, postal services, airline transportation, and so forth. We formulate the problem as a mixed-integer programming model, and provide two heuristic approaches, respectively, based on Lagrangian relaxation and Benders decomposition. Computational experiments show that the algorithms work well.

  6. Child Health Care Services in Austria. (United States)

    Kerbl, Reinhold; Ziniel, Georg; Winkler, Petra; Habl, Claudia; Püspök, Rudolf; Waldhauser, Franz


    We describe child health care in Austria, a small country in Central Europe with a population of about 9 million inhabitants of whom approximately 1.7 million are children and adolescents under the age of 20 years. For children and adolescents, few health care indicators are available. Pediatric and adolescent health provision, such as overall health provision, follows a complex system with responsibilities shared by the Ministry of Health, 19 social insurance funds, provinces, and other key players. Several institutions are affiliated with or cooperate with the Ministry of Health to assure quality control. The Austrian public health care system is financed through a combination of income-based social insurance payments and taxes. Pediatric primary health care in Austria involves the services of general pediatricians and general practitioners. Secondary care is mostly provided by the 43 children's hospitals; tertiary care is (particularly) provided in 4 state university hospitals and 1 private university hospital. The training program of residents takes 6 years and is completed by a final examination. Every year, this training program is completed by about 60 residents. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Adoption of Lean Thinking and Service Improvement for Care Home Service


    Chuang-Chun Chiou


    Ageing population is a global trend; therefore the need of care service has been increasing dramatically. There are three basic forms of service delivered to the elderly: institution, community, and home. Particularly, the institutional service can be seen as an extension of medical service. The nursing home or so-called care home which is equipped with professional staff and facilities can provide a variety of service including rehabilitation service, short-term care, and long term care. Sim...

  8. Air ambulance services--integrated emergency care. (United States)

    Ferdinand, M


    In the name of cost-conscious care, air ambulance program directors and service contractors are seeing the dawn of integrated networks as a boon to their business. As integrated networks form, facilities will become increasingly specialized in the types of services they provide. Patients will need to be moved around the system, resulting in more frequent patient transport and more points of transfer. Many programs are considering aircraft replacement and additions, rather than leasing. Financial benefits could come on depreciation and the high resale value of aircraft. Unless reimbursement levels increase, more program mergers and affiliations may take place to spread and reduce cost. Air ambulance services will increasingly become part of a facility's strategic plan.

  9. Enriching the tactical network design of express service carriers with fleet scheduling characteristics

    NARCIS (Netherlands)

    Meuffels, W.J.M.; Fleuren, H.A.; Cruijssen, F.C.A.M.; Dam, E.R.


    Express service carriers provide time-guaranteed deliveries of parcels via a network consisting of nodes and hubs. In this, nodes take care of the collection and delivery of parcels, and hubs have the function to consolidate parcels in between the nodes. The tactical network design problem assigns

  10. Service Users' Involvement and Engagement in Interprofessional Care. (United States)

    Kaini, B K


    Interprofessional care is joint working between health care professionals by pooling their skills, knowledge and expertise, to make joint decisions and learn from each other for the benefits of service users and healthcare professionals. Service users involvement is considered as one of the important aspects of planning, management and decision making process in the delivery of health care to service users. Service users' involvement is not the same as public involvement and partnership arrangements in health care. The active involvement and engagement of service users in health care positively contributes to improve quality of care, to promote better health and to shape the future of health services. Service users are always at the centre of health care professionals' values, work ethics and roles. Moreover, service users centred interprofessional team collaboration is very important to deliver effective health services.

  11. Guiding Principles for Data Architecture to Support the Pathways Community HUB Model. (United States)

    Zeigler, Bernard P; Redding, Sarah; Leath, Brenda A; Carter, Ernest L; Russell, Cynthia


    The Pathways Community HUB Model provides a unique strategy to effectively supplement health care services with social services needed to overcome barriers for those most at risk of poor health outcomes. Pathways are standardized measurement tools used to define and track health and social issues from identification through to a measurable completion point. The HUB use Pathways to coordinate agencies and service providers in the community to eliminate the inefficiencies and duplication that exist among them. Experience with the Model has brought out the need for better information technology solutions to support implementation of the Pathways themselves through decision-support tools for care coordinators and other users to track activities and outcomes, and to facilitate reporting. Here we provide a basis for discussing recommendations for such a data infrastructure by developing a conceptual model that formalizes the Pathway concept underlying current implementations. The main contribution is a set of core recommendations as a framework for developing and implementing a data architecture to support implementation of the Pathways Community HUB Model. The objective is to present a tool for communities interested in adopting the Model to learn from and to adapt in their own development and implementation efforts. Experience with the Community Health Access Project (CHAP) data base system (the core implementation of the Model) has identified several issues and remedies that have been developed to address these issues. Based on analysis of issues and remedies, we present several key features for a data architecture meeting the just mentioned recommendations. Presentation of features is followed by a practical guide to their implementation allowing an organization to consider either tailoring off-the-shelf generic systems to meet the requirements or offerings that are specialized for community-based care coordination. Looking to future extensions, we discuss the

  12. Care pathways as boundary objects between primary and secondary care: Experiences from Norwegian home care services. (United States)

    Håland, Erna; Røsstad, Tove; Osmundsen, Tonje C


    The need for integration of healthcare services and collaboration across organisational boundaries is highlighted as a major challenge within healthcare in many countries. Care pathways are often presented as a solution to this challenge. In this article, we study a project of developing, introducing and using a care pathway across healthcare levels focusing on older home-dwelling patients in need of home care services after hospital discharge. In so doing, we use the concept of boundary object, as described by Star and Griesemer, to explore how care pathways can act as tools for translation between specialist healthcare services and home care services. Based on interviews with participants in the project, we find that response to existing needs, local tailoring, involvement and commitment are all crucial for the care pathway to function as a boundary object in this setting. Furthermore, the care pathway, as we argue, can be used to push boundaries just as much as it can be used as a tool for bridging across them, thus potentially contributing to a more equal relationship between specialist healthcare services and home care services. © The Author(s) 2015.

  13. Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service. (United States)

    Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren


    Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care

  14. Emergency mobile care service: trauma epidemiology in prehospital care

    Directory of Open Access Journals (Sweden)

    Mateus Kist Ibiapino


    Full Text Available Objective: to characterize trauma victims assisted by the Mobile Emergency Care Service (SAMU 192 in the city of Ilhéus, Bahia, Brazil. Method: this is a descriptive and retrospective study in which 1,588 records of traumatic events were analyzed from the following variables: sex, age, day of the week, period of the day, trauma mechanism, topography and type of injuries, revised trauma score, type of mobile unit used, professional responsible for care, time to hospital care, procedures performed and deaths. Results: there was a predominance of male victims (69.5% and age between 18 and 37 (46.5%. Occurrences were concentrated at weekends (37.8% and in the evening (52.0%. It revealed traffic accidents (41.3% as the main mechanism of trauma, among which prevailed the involvement of motorcycles (73.0%. Regarding the topographic distribution of lesions, the majority affected the limbs (58.2%. The most adopted conducts in prehospital care were immobilization (26.3% and compression dressing (25.9%. The deaths accounted for 2.7% of the total sample. Conclusion: The population most affected by traumatic events in Ilhéus shown to be composed of young men involved in traffic accidents, mainly motorcyclists, during the weekends.

  15. Control networks and hubs. (United States)

    Gratton, Caterina; Sun, Haoxin; Petersen, Steven E


    Executive control functions are associated with frontal, parietal, cingulate, and insular brain regions that interact through distributed large-scale networks. Here, we discuss how fMRI functional connectivity can shed light on the organization of control networks and how they interact with other parts of the brain. In the first section of our review, we present convergent evidence from fMRI functional connectivity, activation, and lesion studies that there are multiple dissociable control networks in the brain with distinct functional properties. In the second section, we discuss how graph theoretical concepts can help illuminate the mechanisms by which control networks interact with other brain regions to carry out goal-directed functions, focusing on the role of specialized hub regions for mediating cross-network interactions. Again, we use a combination of functional connectivity, lesion, and task activation studies to bolster this claim. We conclude that a large-scale network perspective provides important neurobiological constraints on the neural underpinnings of executive control, which will guide future basic and translational research into executive function and its disruption in disease. © 2017 Society for Psychophysiological Research.

  16. Developing a Business Plan for Critical Care Pharmacy Services. (United States)

    Erstad, Brian L; Mann, Henry J; Weber, Robert J


    Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service. The structure and approach of this business plan can be applied to a variety of pharmacy services. By following the format and information listed in this article, the pharmacy director can move closer to developing patient-centered pharmacy services for ICU patients.

  17. Managed Care for Children: Effect on Access to Care and Utilization of Health Services. (United States)

    Szilagyi, Peter G.


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

  18. Home health services in primary care: What can we do?

    Directory of Open Access Journals (Sweden)

    Yasemin Çayır


    Full Text Available Home health services is to give examination, diagnosis,treatment, and rehabilitation services to the patients whobedridden, have difficulties to access health facility due toa variety of chronic or malignant disease by professionalhealth care team. Family physicians that providing healthcare in primary care is responsible for to determine whowill need home health care services, and to make homevisit on a regular basis among registered patients in theirpopulations. It is seems that the biggest shortcoming thecontent and scope of this service is not yet a standard. Inthis article, how home health services should be given willbe discussed.Key words: Primary health care, home health care, bedriddenpatient

  19. Quantitative comparison of measurements of urgent care service quality. (United States)

    Qin, Hong; Prybutok, Victor; Prybutok, Gayle


    Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

  20. Soft hub for bearingless rotors (United States)

    Dixon, Peter G. C.


    Soft hub concepts which allow the direct replacement of articulated rotor systems by bearingless types without any change in controllability or need for reinforcement to the drive shaft and/or transmission/fuselage attachments of the helicopter were studied. Two concepts were analyzed and confirmed for functional and structural feasibility against a design criteria and specifications established for this effort. Both systems are gimballed about a thrust carrying universal elastomeric bearing. One concept includes a set of composite flexures for drive torque transmittal from the shaft to the rotor, and another set (which is changeable) to impart hub tilting stiffness to the rotor system as required to meet the helicopter application. The second concept uses a composite bellows flexure to drive the rotor and to augment the hub stiffness provided by the elastomeric bearing. Each concept was assessed for weight, drag, ROM cost, and number of parts and compared with the production BO-105 hub.

  1. Barriers to Accessing Eye Care Services in the Federal Capital ...

    African Journals Online (AJOL)

    This study was carried out to determine the barriers to accessing eye care services in the Federal ... 153(61.7%), others were high cost of services, lack of money, non-availability of eye care services, long ... Barrier studies are being conducted.

  2. Looking Into Pandora's Box: The Content Of Sci-Hub And Its Usage


    Greshake, Bastian


    Despite the growth of Open Access, potentially illegally circumventing paywalls to access scholarly publications is becoming a more mainstream phenomenon. The web service Sci-Hub is amongst the biggest facilitators of this, offering free access to around 62 million publications. So far it is not well studied how and why its users are accessing publications through Sci-Hub. By utilizing the recently released corpus of Sci-Hub and comparing it to the data of  ~28 million downloads done through ...

  3. Planning a regional palliative care services network. (United States)

    Zalot, G N


    Table 1 summarizes the role of task force members and staff for each of the main tasks of the process of planning. The number of meetings required for each stage of the process is estimated in the last column. Planning for a regional palliative care services network is a process involving "hard" and "soft" elements. Hard elements involve the organizational structure, task force meetings, information/statistical data bases and the discrete tasks summarized in Table 1. These elements are well known, if nokt always well organized in practice. It is the "softer" elements that usually mean the difference between a dull bureaucratic exercise and a creative exchange of ideas and concepts with a vision for the future. Not to be underestimated is the critical role of group development in this process. The Task Force, supported by professional staff expertise and judgment, hopes to achieve a level of group development termed "synergy," that is, where the group outperforms (in terms of quality and quantity of work) its best individual member. Not a small feat, but critical to a successful planning exercise! Any regional planning implies a commitment to change. After all, new services will be added, some phased out, others revised, and others enhanced, resulting in changes in roles and responsibilities of providers. Change should not be greeted with disdain but viewed as a natural part of the environment in which we plan and provide services. A major advantage to the process of planning is that the level of support for change is already mobilized through the various stages of the process highlighted.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Experiencing health care service quality: through patients' eyes. (United States)

    Schembri, Sharon


    The primary aim of the present study was to consider health care service quality from the patients' perspective, specifically through the patient's eyes. A narrative analysis was performed on 300 patient stories. This rigorous analysis of patient stories is designed to identify and describe health care service quality through patients' eyes in an authentic and accurate, experiential manner. The findings show that there are variant and complex ways that patients experience health care service quality. Patient stories offer an authentic view of the complex ways that patients experience health care service quality. Narrative analysis is a useful tool to identify and describe how patients experience health care service quality. Patients experience health care service quality in complex and varying ways.

  5. Rural Health Information Hub (United States)

    ... U.S. (2011-2015): Individual-level & Placed-based Disparities Source: Southwest Rural Health Research Center Online Library » Resource and Referral Service Need help finding information? RHIhub can provide free assistance customized to your ...

  6. The influence of nursing care integration services on nurses' work satisfaction and quality of nursing care. (United States)

    Ryu, Jeong-Im; Kim, Kisook


    To investigate differences in work satisfaction and quality of nursing services between nurses from the nursing care integration service and general nursing units in Korea. The nursing care integration service was recently introduced in Korea to improve patient health outcomes through the provision of high quality nursing services and to relieve the caregiving burden of patients' families. In this cross-sectional study, data were collected from a convenience sample of 116 and 156 nurses working in nursing care integration service and general units, respectively. The data were analysed using descriptive statistics, t tests and one-way analysis of variance. Regarding work satisfaction, nursing care integration service nurses scored higher than general unit nurses on professional status, autonomy and task requirements, but the overall scores showed no significant differences. Scores on overall quality of nursing services, responsiveness and assurance were higher for nursing care integration service nurses than for general unit nurses. Nursing care integration service nurses scored higher than general unit nurses on some aspects of work satisfaction and quality of nursing services. Further studies with larger sample sizes will contribute to improving the quality of nursing care integration service units. These findings can help to establish strategies for the implementation and efficient operation of the nursing care integration service system, for the improvement of the quality of nursing services, and for successfully implementing and expanding nursing care integration service services in other countries. © 2018 John Wiley & Sons Ltd.

  7. Combining service marketing and strategic alliances in health care. (United States)

    Lazarus, I R


    With or without federal health care reform to impact the delivery of health care services in the U.S., hospitals must commit to service marketing and strategic alliances as a fundamental business strategy. Service marketing not only differentiates the provider, but with the proper programs in place, it may actually facilitate the formation of strategic alliances. The combination of these strategies will be particularly effective in preparing for any health care policy change.

  8. Skilled antenatal care service utilization and its association with the ...

    African Journals Online (AJOL)

    Data were entered into EPI info version 7 statistical software and exported to STATA ... Conclusions: Skilled ANC service utilization is the joint effect of individual and ... analysis, skilled antenatal care service, women's health development team ...

  9. Scope of neonatal care services in major Nigerian hospitals

    African Journals Online (AJOL)


    Oct 12, 2015 ... Quality of newborn care by level of services offered is a critical determinant of ... natal unit capacity, personnel, trainings in newborn cardio-pulmonary ... The availability of surfactant replacement service was also solicited.

  10. A model for ageing-home-care service process improvement


    Yu, Shu-Yan; Shie, An-Jin


    The purpose of this study was to develop an integrated model to improve service processes in ageing-home-care. According to the literature, existing service processes have potential service failures that affect service quality and efficacy. However, most previous studies have only focused on conceptual model development using New Service Development (NSD) and fail to provide a systematic model to analyse potential service failures and facilitate managers developing solutions to improve the se...

  11. Relationship between home care service use and changes in the care needs level of Japanese elderly. (United States)

    Kato, Gohei; Tamiya, Nanako; Kashiwagi, Masayo; Sato, Mikiya; Takahashi, Hideto


    With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels. The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician. In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to

  12. 38 CFR 17.111 - Copayments for extended care services. (United States)


    ... therapeutic outpatient care program that provides medical services, rehabilitation, therapeutic activities... vehicle; food for veteran, veteran's spouse, and veteran's dependents; education for veteran, veteran's...

  13. Developing a culturally appropriate mental health care service for Samoa. (United States)

    Enoka, Matamua Iokapeta Sina; Tenari, Aliilelei; Sili, Tupou; Peteru, Latama; Tago, Pisaina; Blignault, Ilse


    Mental Health Care Services are part of the National Health Services for Samoa. Their function is to provide mental health care services to the population of Samoa, which numbers 180,000 people. However, like many other countries in the Pacific region, mental health is considered a low priority. The mental health budget allocation barely covers the operation of mental health care services. More broadly, there is a lack of political awareness about mental health care services and mental health rarely becomes an issue of deliberation in the political arena. This article outlines the recent development of mental health care services in Samoa, including the Mental Health Policy 2006 and Mental Health Act 2007. It tells the story of the successful integration of aiga (family) as an active partner in the provision of care, and the development of the Aiga model utilizing Samoan cultural values to promote culturally appropriate family-focused community mental health care for Samoa. Mental Health Care Services today encompass both clinical and family-focused community mental health care services. The work is largely nurse-led. Much has been achieved over the past 25 years. Increased recognition by government and increased resourcing are necessary to meet the future health care needs of the Samoan people. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

  14. Long term care needs and personal care services under Medicaid: a survey of administrators. (United States)

    Palley, H A; Oktay, J S


    Home and community based care services constitute a public initiative in the development of a long term care service network. One such home based initiative is the personal care service program of Medicaid. The authors conducted a national survey of administrators of this program. They received a response from 16 administrators of such programs in 1987-1988. The responses raise significant issues regarding training, access to and equity of services, quality of services, administrative oversight and the coordination of home-based care in a network of available services. Based on administrator responses, the authors draw several conclusions.

  15. Integrating evidence into policy and sustainable disability services delivery in western New South Wales, Australia: the 'wobbly hub and double spokes' project. (United States)

    Veitch, Craig; Lincoln, Michelle; Bundy, Anita; Gallego, Gisselle; Dew, Angela; Bulkeley, Kim; Brentnall, Jennie; Griffiths, Scott


    Policy that supports rural allied health service delivery is important given the shortage of services outside of Australian metropolitan centres. The shortage of allied health professionals means that rural clinicians work long hours and have little peer or service support. Service delivery to rural and remote communities is further complicated because relatively small numbers of clients are dispersed over large geographic areas. The aim of this five-year multi-stage project is to generate evidence to confirm and develop evidence-based policies and to evaluate their implementation in procedures that allow a regional allied health workforce to more expeditiously respond to disability service need in regional New South Wales, Australia. The project consists of four inter-related stages that together constitute a full policy cycle. It uses mixed quantitative and qualitative methods, guided by key policy concerns such as: access, complexity, cost, distribution of benefits, timeliness, effectiveness, equity, policy consistency, and community and political acceptability. Stage 1 adopts a policy analysis approach in which existing relevant policies and related documentation will be collected and reviewed. Policy-makers and senior managers within the region and in central offices will be interviewed about issues that influence policy development and implementation. Stage 2 uses a mixed methods approach to collecting information from allied health professionals, clients, and carers. Focus groups and interviews will explore issues related to providing and receiving allied health services. Discrete Choice Experiments will elicit staff and client/carer preferences. Stage 3 synthesises Stage 1 and 2 findings with reference to the key policy issues to develop and implement policies and procedures to establish several innovative regional workforce and service provision projects. Stage 4 uses mixed methods to monitor and evaluate the implementation and impact of new or adapted

  16. Influence of home care services on caregivers' burden and satisfaction. (United States)

    Kim, Eun-Young; Yeom, Hyun-E


    To examine the factors affecting the burden and satisfaction of family caregivers, focusing on the beneficial impacts of home care service use. Long-term care for older patients is a multifaceted process that brings both burden and satisfaction to family caregivers. It is expected that home care services offered by the Korean long-term care insurance may contribute to decreasing the burden of family caregivers and enhancing their satisfaction by assisting with practical caregiving tasks. A cross-sectional study. A convenience sample of 157 family caregivers was recruited from five home care service agencies in South Korea. Information about the caregivers, caregiving history, older care recipients and use of home care services was assessed. The effects of home care service use on caregiving burden and satisfaction were tested using hierarchical multiple regression analyses after adjusting for the characteristics of the caregivers, caregiving history and older care recipients. There was no significant influence of home care service use on reducing caregiving burden or on increasing caregivers' satisfaction. Although several factors were associated with caregiving burden and satisfaction, family functioning was the most unique factor to significantly affect both caregiving burden and satisfaction. Home care services might not automatically have a positive impact on caregivers' burden and satisfaction, but maintaining healthy family functioning is an important issue for family caregivers. The findings highlight the important need to reconsider ways to provide home care services and to develop nursing interventions to reinforce supportive family functioning. Practical strategies for providing home care services should be developed through a concrete assessment of the family dynamics and the needs of family caregivers. Health professionals should play a pivotal role in performing the assessment and in developing interventions to strengthen supportive family functioning

  17. CER Hub: An informatics platform for conducting comparative effectiveness research using multi-institutional, heterogeneous, electronic clinical data. (United States)

    Hazlehurst, Brian L; Kurtz, Stephen E; Masica, Andrew; Stevens, Victor J; McBurnie, Mary Ann; Puro, Jon E; Vijayadeva, Vinutha; Au, David H; Brannon, Elissa D; Sittig, Dean F


    Comparative effectiveness research (CER) requires the capture and analysis of data from disparate sources, often from a variety of institutions with diverse electronic health record (EHR) implementations. In this paper we describe the CER Hub, a web-based informatics platform for developing and conducting research studies that combine comprehensive electronic clinical data from multiple health care organizations. The CER Hub platform implements a data processing pipeline that employs informatics standards for data representation and web-based tools for developing study-specific data processing applications, providing standardized access to the patient-centric electronic health record (EHR) across organizations. The CER Hub is being used to conduct two CER studies utilizing data from six geographically distributed and demographically diverse health systems. These foundational studies address the effectiveness of medications for controlling asthma and the effectiveness of smoking cessation services delivered in primary care. The CER Hub includes four key capabilities: the ability to process and analyze both free-text and coded clinical data in the EHR; a data processing environment supported by distributed data and study governance processes; a clinical data-interchange format for facilitating standardized extraction of clinical data from EHRs; and a library of shareable clinical data processing applications. CER requires coordinated and scalable methods for extracting, aggregating, and analyzing complex, multi-institutional clinical data. By offering a range of informatics tools integrated into a framework for conducting studies using EHR data, the CER Hub provides a solution to the challenges of multi-institutional research using electronic medical record data. Copyright © 2015. Published by Elsevier Ireland Ltd.

  18. Accuracy of Caregiver Proxy Reports of Home Care Service Use. (United States)

    Chappell, Neena L; Kadlec, Helena


    Although much of the research on service use by older adults with dementia relies on proxy reports by informal caregivers, little research assesses the accuracy of these reports, and that which does exist, does not focus on home care services. This brief report compares proxy reports by family caregivers to those with dementia with provincial Ministry of Health records collected for payment and monitoring. The four home care services examined include home nursing care, adult day care, home support, and respite care. Data come from a province-wide study of caregivers in British Columbia, Canada. Caregiver reports are largely consistent with Ministry records, ranging from 81.0% agreement for home support to 96.6% for respite care. Spouses living with the care recipient (the vast majority of the sample) are the most accurate. Others, whether living with the care recipient or not, have only a 50-50 chance of being correct.

  19. The ethics of advertising for health care services. (United States)

    Schenker, Yael; Arnold, Robert M; London, Alex John


    Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly.

  20. The Virtual Campus Hub Concept

    DEFF Research Database (Denmark)

    Badger, Merete; Prag, Sidsel-Marie Winther; Monaco, Lucio

    of Technology in Sweden, Politecnico di Torino in Italy, and Eindhoven University of Technology in the Netherlands. The project is partially funded by the European Commission under the 7th Framework Programme (project no. RI-283746). This report describes the final concept of Virtual Campus Hub. It gives...

  1. Democratic Citizenship and Service Learning: Advancing the Caring Self. (United States)

    Rhoads, Robert A.


    Discusses how service learning can promote the development of a "caring self" in college students by drawing on the ideas of John Dewey, George Herbert Mead, and contemporary critical theorists. Links this caring self to democratic citizenship and uses students' narratives to illustrate how it develops through service learning contexts.…

  2. Customer service: the key to remaining competitive in managed care. (United States)

    Howard, J E


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

  3. Commissioning of specialist palliative care services in England. (United States)

    Lancaster, Harriet; Finlay, Ilora; Downman, Maxwell; Dumas, James


    Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise. We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services. 29 CCGs provided information about the number of patients with some form of palliative care needs in their population. For specialist palliative care services, CCGs allocated budgets ranging from £51.83 to £2329.19 per patient per annum. 163 CCGs (77.90%) currently commission 7-day admission to their specialist palliative care beds. 82.84% of CCGs commission 7-day specialist palliative care services in patients' own homes and out-of-hours services rely heavily on hospice provision. 64 CCGs (31.37%) commission pain control teams, the majority of whom only operate in regular working hours. 68.14% of CCGs reported commissioning palliative care education of any sort for healthcare professionals and 44.85% of CCGs had no plans to update or review their palliative care services. The most important finding from this exercise is that the information CCGs hold about their population and services is not standardised. However, information based on data that are more objective, for example, population and total budget for palliative care, demonstrate wide variations in commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  4. Composite hub/metal blade compressor rotor (United States)

    Yao, S.


    A low cost compressor rotor was designed and fabricated for a small jet engine. The rotor hub and blade keepers were compression molded with graphite epoxy. Each pair of metallic blades was held in the hub by a keeper. All keepers were locked in the hub with circumferential windings. Feasibility of fabrication was demonstrated in this program.

  5. Models for Primary Eye Care Services in India

    Directory of Open Access Journals (Sweden)

    Vasundhra Misra


    In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.

  6. Speak Up: Help Prevent Errors in Your Care: Laboratory Services (United States)

    SpeakUP TM Help Prevent Errors in Your Care Laboratory Services To prevent health care errors, patients are urged to... SpeakUP TM ... are more likely to get better faster. To help prevent health care mistakes, patients are urged to “ ...

  7. Medicaid Home Care Services and Survival in New York City (United States)

    Albert, Steven M.; Simone, Bridget; Brassard, Andrea; Stern, Yaakov; Mayeux, Richard


    Purpose: New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults. Design and Methods: Administrative data from New York City's Medicaid…

  8. Mothers' health services utilization and health care seeking ...

    African Journals Online (AJOL)

    Background: data from different studies showed health care behaviour and estimated per capita health care expenditure for the general population, but the specific data for infants at different levels of care are lacking. The objectives of this study were to describe mothers' health service utilization during pregnancy and ...

  9. Application of hydraulically assembled shaft coupling hubs to large agitators

    International Nuclear Information System (INIS)

    Murray, W.E.; Anderson, T.D.; Bethmann, H.K.


    This paper describes the basis for and implementation of hydraulically assembled shaft coupling hubs for large tank-mounted agitators. This modification to the original design was intended to minimize maintenance personnel exposure to ionizing radiation and also provide for disassembly capability without damage to shafts or hubs. In addition to realizing these objectives, test confirmed that the modified couplings reduced agitator shaft end runouts approximately 65%, thereby reducing bearing loads and increasing service life, a significant enhancement for a nuclear facility. 5 refs

  10. Reimbursement for school nursing health care services: position statement. (United States)

    Lowe, Janet; Cagginello, Joan; Compton, Linda


    Children come to school with a variety of health conditions, varying from moderate health issues to multiple, severe chronic health illnesses that have a profound and direct impact on their ability to learn. The registered professional school nurse (hereinafter referred to as school nurse) provides medically necessary services in the school setting to improve health outcomes and promote academic achievement. The nursing services provided are reimbursable services in other health care settings, such as hospitals, clinics, and home care settings. The National Association of School Nurses (NASN) believes that school nursing services that are reimbursable nursing services in other health care systems should also be reimbursable services in the school setting, while maintaining the same high quality care delivery standards. Traditionally, local and state tax revenues targeted to fund education programs have paid for school nursing health services. School nurses are in a strategic position to advocate for improving clinical processes to better fit with community health care providers and to align reimbursements with proposed changes. Restructuring reimbursement programs will enable health care funding streams to assist in paying for school nursing services delivered to students in the school setting. Developing new innovative health financing opportunities will help to increase access, improve quality, and reduce costs. The goal is to promote a comprehensive and cost-effective health care delivery model that integrates schools, families, providers, and communities.

  11. 32 CFR 728.71 - Ex-service maternity care. (United States)


    ... 32 National Defense 5 2010-07-01 2010-07-01 false Ex-service maternity care. 728.71 Section 728.71... FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other Persons § 728.71 Ex-service maternity... certified by medical authorities that the pregnancy existed prior to entry into service (EPTE), maternity...

  12. Patients' satisfaction with eye care services in a Nigerian Teaching ...

    African Journals Online (AJOL)

    ... will recommend the hospital to others strongly, 145 (47.2%) will do so hesitantly. Conclusion: Majority of the patients were satisfied with the services received. The major dissatisfaction points were cost of services and inadequate toilet facilities. Key words: Developing country, eye care services, patient satisfaction ...

  13. Sci-Hub provides access to nearly all scholarly literature. (United States)

    Himmelstein, Daniel S; Romero, Ariel Rodriguez; Levernier, Jacob G; Munro, Thomas Anthony; McLaughlin, Stephen Reid; Greshake Tzovaras, Bastian; Greene, Casey S


    The website Sci-Hub enables users to download PDF versions of scholarly articles, including many articles that are paywalled at their journal's site. Sci-Hub has grown rapidly since its creation in 2011, but the extent of its coverage has been unclear. Here we report that, as of March 2017, Sci-Hub's database contains 68.9% of the 81.6 million scholarly articles registered with Crossref and 85.1% of articles published in toll access journals. We find that coverage varies by discipline and publisher, and that Sci-Hub preferentially covers popular, paywalled content. For toll access articles, we find that Sci-Hub provides greater coverage than the University of Pennsylvania, a major research university in the United States. Green open access to toll access articles via licit services, on the other hand, remains quite limited. Our interactive browser at allows users to explore these findings in more detail. For the first time, nearly all scholarly literature is available gratis to anyone with an Internet connection, suggesting the toll access business model may become unsustainable. © 2018, Himmelstein et al.

  14. Developing a costing framework for palliative care services. (United States)

    Mosoiu, Daniela; Dumitrescu, Malina; Connor, Stephen R


    Palliative care services have been reported to be a less expensive alternative to traditional treatment; however, little is known about how to measure the cost of delivering quality palliative care. The purpose of this project was to develop a standardized method for measuring the cost of palliative care delivery that could potentially be replicated in multiple settings. The project was implemented in three stages. First, an interdisciplinary group of palliative care experts identified standards of quality palliative care delivery in the inpatient and home care services. Surveys were conducted of government agencies and palliative care providers to identify payment practices and budgets for palliative care services. In the second phase, unit costs were defined and a costing framework was designed to measure inpatient and home-based palliative care unit costs. The final phase was advocacy for inclusion of calculated costs into the national funding system. In this project, a reliable framework for determining the cost of inpatient and home-based palliative care services was developed. Inpatient palliative care cost in Romania was calculated at $96.58 per day. Home-based palliative care was calculated at $30.37 per visit, $723.60 per month, and $1367.71 per episode of care, which averaged 45 visits. A standardized methodology and framework for costing palliative care are presented. The framework allows a country or provider of care to substitute their own local costs to generate cost information relevant to the health-care system. In Romania, this allowed the palliative care provider community to advocate for a consistent payment system. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  15. Obstetric critical care services in South Africa

    Directory of Open Access Journals (Sweden)

    Gladness Nethathe


    Full Text Available More than half of all global maternal deaths occur in Africa. A large percentage of these deaths are preventable, and lack of access to adequate critical care facilities is a contributing factor. There are limited published data on the clinical and management challenges presented by the critically ill obstetric patient admitted to the intensive care unit in our setting, and more data are required in order to better define the critical care needs of this group of patients.

  16. Optimal hub location in pipeline networks

    Energy Technology Data Exchange (ETDEWEB)

    Dott, D.R.; Wirasinghe, S.C.; Chakma, A. [Univ. of Calgary, Alberta (Canada)


    This paper discusses optimization strategies and techniques for the location of natural gas marketing hubs in the North American gas pipeline network. A hub is a facility at which inbound and outbound network links meet and freight is redirected towards their destinations. Common examples of hubs used in the gas pipeline industry include gas plants, interconnects and market centers. Characteristics of the gas pipeline industry which are relevant to the optimization of transportation costs using hubs are presented. Allocation techniques for solving location-allocation problems are discussed. An outline of the research in process by the authors in the field of optimal gas hub location concludes the paper.

  17. Maternity Care Services Provided by Family Physicians in Rural Hospitals. (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  18. Estimated time spent on preventive services by primary care physicians

    Directory of Open Access Journals (Sweden)

    Gradison Margaret


    Full Text Available Abstract Background Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services. Methods We analyzed a large dataset of primary care (family and internal medicine visits using the National Ambulatory Medical Care Survey (2001–4; analyses were conducted 2007–8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates. Results Preventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively. New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA, cholesterol, Papanicolaou (Pap smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence" services, tobacco cessation and Pap smear (in preventive visits, and one "B" rated ("at least fair evidence" service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness", PSA and exercise counseling. Conclusion Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.

  19. Learning Graphical Models With Hubs. (United States)

    Tan, Kean Ming; London, Palma; Mohan, Karthik; Lee, Su-In; Fazel, Maryam; Witten, Daniela


    We consider the problem of learning a high-dimensional graphical model in which there are a few hub nodes that are densely-connected to many other nodes. Many authors have studied the use of an ℓ 1 penalty in order to learn a sparse graph in the high-dimensional setting. However, the ℓ 1 penalty implicitly assumes that each edge is equally likely and independent of all other edges. We propose a general framework to accommodate more realistic networks with hub nodes, using a convex formulation that involves a row-column overlap norm penalty. We apply this general framework to three widely-used probabilistic graphical models: the Gaussian graphical model, the covariance graph model, and the binary Ising model. An alternating direction method of multipliers algorithm is used to solve the corresponding convex optimization problems. On synthetic data, we demonstrate that our proposed framework outperforms competitors that do not explicitly model hub nodes. We illustrate our proposal on a webpage data set and a gene expression data set.

  20. Service robots, care ethics, and design

    NARCIS (Netherlands)

    van Wynsberghe, Amy Louise


    It should not be a surprise in the near future to encounter either a personal or a professional service robot in our homes and/or our work places: according to the International Federation for Robots, there will be approx 35 million service robots at work by 2018. Given that individuals will

  1. Barriers to formal emergency obstetric care services' utilization. (United States)

    Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe


    Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be

  2. Nutrition services in managed care: new paradigms for dietitians. (United States)

    Laramee, S H


    Managed care systems are transforming the health care system in the United States. Dietitians will need to review practice opportunities in new and different settings, and develop additional skills to make a successful transition to the transformed health care environment. The shift in health care financing from a fee-for-service model to a capitated system will have the most dramatic impact on the profession. Not all the answers are available, but the focus for the future is clear--customer satisfaction, outcomes research, and cost-effective nutrition services.

  3. Improving palliative care outcomes for Aboriginal Australians: service providers' perspectives. (United States)

    Shahid, Shaouli; Bessarab, Dawn; van Schaik, Katherine D; Aoun, Samar M; Thompson, Sandra C


    Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers' experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the 'cultural security' framework. Thematic analysis was carried out that identified patterns within data. Fifteen palliative care providers were interviewed. Overall they reported lack of understanding of Aboriginal culture and being uncertain of the needs and priorities of Aboriginal people during end-of-life care. According to several participants, very few Aboriginal people had an understanding of palliative care. Managing issues such as anger, denial, the need for non-medical support due to socioeconomic disadvantage, and dealing with crises and conflicts over funeral arrangements were reported as some of the tensions between Aboriginal patients and families and the service providers. Early referral to palliative care is important in demonstrating and maintaining a caring therapeutic relationship. Paramount to meeting the needs for Aboriginal patients was access to appropriate information and logistical, psychological and emotional support. These were often seen as essential but additional to standard palliative care services. The broader context of Aboriginal history and historical distrust of mainstream services was seen to impinge on Aboriginal people's willingness and

  4. Care satisfaction among older people receiving public care and service at home or in special accommodation. (United States)

    Karlsson, Staffan; Edberg, Anna-Karin; Jakobsson, Ulf; Hallberg, Ingalill R


    To explore care satisfaction in relation to place of living, health-related quality of life, functional dependency and health complaints among people 65 years or older, receiving public care and service. The concept public care and service concerns formal care from the municipality, including home help, home nursing care, rehabilitation and a special accommodation. To be able to provide care and service of high quality to older people, knowledge about factors influencing their experience of satisfaction with the care is essential. Cross-sectional, including comparison and correlation. One-hundred sixty-six people receiving public care and service from the municipality were interviewed regarding demography, functional ability, perceived health complaints and care. Health-related quality of life was measured with SF-12, and self-rated care satisfaction was measured with a questionnaire. Low self-rated care satisfaction was associated with dependency in Instrumental Activities of Daily Living, blindness, faeces incontinence and anxiety, while high self-rated care satisfaction was associated with dependency in Personal Activities of Daily Living. Those at home rated an overall higher care satisfaction and were more satisfied with care continuity and personal relations; they thought that the staff had more time and were more respectful and quiet, than the ratings by those in a special accommodation (equivalent to a nursing home). Care satisfaction and health-related quality of life among older people was more associated with functional impairment and health complaints than to whether care and service was received at home or in a special accommodation. An approach using intervention focused on functional ability and health complaints is important for development of improved care satisfaction for older people receiving public care and service. © 2013 Blackwell Publishing Ltd.

  5. Can home care services achieve cost savings in long-term care for older people? (United States)

    Greene, V L; Ondrich, J; Laditka, S


    To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

  6. Obstetric critical care services in South Africa

    African Journals Online (AJOL)

    time of their first pregnancy, and assisted reproductive technology that has made it ... transport between levels of care, unavailability of blood and blood products ... 0.24%. Severe obstetric haemorrhage, hypertension and sepsis were the most ...

  7. Poverty, Access to Health Care Services and Human Capital ...

    African Journals Online (AJOL)


    socio-economic development because it is essential for a virile labour force ... Poverty and access to health care services are major development problems ..... including preventive, curative and palliative intervention, whether directed to.

  8. 20 CFR 638.510 - Health care and services. (United States)


    ... UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.510 Health care and services. The center operator shall provide a health program, including basic medical, dental, and mental...

  9. Assessment of Emergency Obstetric Care Services in Ibadan ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    ORIGINAL RESEARCH ARTICLE ... Nigeria's high maternal mortality has been attributed to poor utilization of obstetric care services to handle ... Poor obstetric outcome in middle and low-income ... Evidence also showed that access to.

  10. Patterns of maternity care service utilization in Southern Ethiopia ...

    African Journals Online (AJOL)

    Patterns of maternity care service utilization in Southern Ethiopia: Evidence from a community ... PROMOTING ACCESS TO AFRICAN RESEARCH ... Result: The study revealed that only 26.1 % and 3.3% of the women received antenatal and ...

  11. Marriage, Cohabitation, and Men's Use of Preventive Health Care Services (United States)

    ... from the 2011–2012 National Health Interview Survey (NHIS), selected measures of preventive health care service use ... any gender and age. Data source and methods NHIS is a multipurpose health survey conducted continuously throughout ...

  12. Medical Service: 40 years of outpatient care

    CERN Multimedia


    On 1st June 2005 the Medical Service will be celebrating its fortieth birthday. This will mark forty years of service to the health of CERN's personnel by the Medical Service's small team of doctors, nurses, laboratory assistants and secretaries. Since 1965, 27 280 medical files have been archived and computerised. The Medical Service. From left to right, front row : Mireille Vosdey, Marloeke Bol and Nicole De Matos. From left to right, back row : Katie Warrilow-Thomson, Dr Eric Reymond, Dr Véronique Fassnacht, Isabelle Auvigne and Françoise Lebrun-Klauser. The Medical Service was founded on 1st June 1965, with a staff of four: the doctor, Jean-Paul Diss, a nurse, a laboratory assistant and a secretary. Previously, a private medical practitioner had come to CERN to perform the medical check-ups on the personnel and the Fire Brigade was responsible for first aid. However, in view of increasing staff numbers and the specific needs of a Laboratory like CERN, an on-site Medical Service had become ess...

  13. The management of health care service quality. A physician perspective. (United States)

    Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L


    Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective.


    DEFF Research Database (Denmark)

    Poulsen, Peter Behrensdorff; Benatto, Gisele Alves dos Reis; Riedel, Nicholas


    connections, providing opportunity to stream music via Bluetooth and play it from a handheld device to the table and lastly to provide LED lighting on the table during the dark hours. 3 prototypes of the system was built and tested at the Roskilde Festival 2017. Electrical logger units were built into the 3...... on festivals where people camps for several days it can be hard to have your portable units charged. In this this work we report a solar powered hub, as an add-on to a table in the urban environment for charging mobile phones and tablets and other handheld devices through USBs, charging laptops through AC...

  15. Symptoms of burnout among staff of direct service care


    ZICHOVÁ, Eliška


    This dissertation was focused on burnout syndrome among the staff of direct service care. The degree of burnout was estimated using Copenhagen Burnout Inventory questionnaire which was completed by the respondents from six Prague homes for seniors. The burnout incidence in this group was 30-45 %, whereas it was only 18-32 % among Czech Army employees who were studied for comparison. The staff of direct service care had significantly higher degree of personal, work-related, client-related and ...



    Dušan Teodorović; Milica Šelmić; Ivana Vukićević


    Hub facilities serve as switching and transshipment points in transportation and communication networks as well as in logistic systems. Hub networks have an influence on flows on the hub-to-hub links and ensure benefit from economies of scale in inter-hub transportation. The key factors for designing a successful hub-and-spoke network are to determine the optimal number of hubs, to properly locate hubs, and to allocate the non-hubs to the hubs. This paper presents the model to determine the l...

  17. A service model for delivering care closer to home. (United States)

    Dodd, Joanna; Taylor, Charlotte Elizabeth; Bunyan, Paul; White, Philippa Mary; Thomas, Siân Myra; Upton, Dominic


    Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects.

  18. Public health capacity in the provision of health care services. (United States)

    Valdmanis, Vivian; DeNicola, Arianna; Bernet, Patrick


    In this paper, we assess the capacity of Florida's public health departments. We achieve this by using bootstrapped data envelopment analysis (DEA) applied to Johansen's definition of capacity utilization. Our purpose in this paper is to measure if there is, theoretically, enough excess capacity available to handle a possible surge in the demand for primary care services especially after the implementation of the Affordable Care Act that includes provisions for expanded public health services. We measure subunit service availability using a comprehensive data source available for all 67 county health departments in the provision of diagnostic care and primary health care. In this research we aim to address two related research questions. First, we structure our analysis so as to fix budgets. This is based on the assumption that State spending on social and health services could be limited, but patient needs are not. Our second research question is that, given the dearth of primary care providers in Florida if budgets are allowed to vary is there enough medical labor to provide care to clients. Using a non-parametric approach, we also apply bootstrapping to the concept of plant capacity which adds to the productivity research. To preview our findings, we report that there exists excess plant capacity for patient treatment and care, but question whether resources may be better suited for more traditional types of public health services.

  19. Service quality perceptions in primary health care centres in Greece (United States)

    Papanikolaou, Vicky; Zygiaris, Sotiris


    Abstract Context  The paper refers to the increased competition between health care providers and the need for patient‐centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective  To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy  SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results  The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients’ perceptions rather than expectations. Discussion and conclusions  This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations–perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. PMID:22296402

  20. Service quality perceptions in primary health care centres in Greece. (United States)

    Papanikolaou, Vicky; Zygiaris, Sotiris


    The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. THIS paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. © 2012 John Wiley & Sons Ltd.

  1. Adolescents perception of reproductive health care services in Sri Lanka. (United States)

    Agampodi, Suneth B; Agampodi, Thilini C; Ukd, Piyaseeli


    Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17-19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners. Adolescent health services are inadequate and available services

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

    Directory of Open Access Journals (Sweden)

    Rafat Rezapour Nasrabad


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

  3. Understanding patient e-loyalty toward online health care services. (United States)

    Martínez-Caro, Eva; Cegarra-Navarro, Juan Gabriel; Solano-Lorente, Marcelina


    Public health institutions are making a great effort to develop patient-targeted online services in an attempt to enhance their effectiveness and reduce expenses. However, if patients do not use those services regularly, public health institutions will have wasted their limited resources. Hence, patients' electronic loyalty (e-loyalty) is essential for the success of online health care services. In this research, an extended Technology Acceptance Model was developed to test e-loyalty intent toward online health care services offered by public health institutions. Data from a survey of 256 users of online health care services provided by the public sanitary system of a region in Spain were analyzed. The research model was tested by using the structural equation modeling approach. The results obtained suggest that the core constructs of the Technology Acceptance Model (perceived usefulness, ease of use, and attitude) significantly affected users' behavioral intentions (i.e., e-loyalty intent), with perceived usefulness being the most decisive antecedent of affective variables (i.e., attitude and satisfaction). This study also reveals a general support for patient satisfaction as a determinant of e-loyalty intent in online health care services. Policy makers should focus on striving to get the highest positive attitude in users by enhancing easiness of use and, mainly, perceived usefulness. Because through satisfaction of patients, public hospitals will enlarge their patient e-loyalty intent, health care providers must always work at obtaining satisfied users and to encourage them to continue using the online services.

  4. Capacitated Hub Routing Problem in Hub-and-Feeder Network Design: Modeling and Solution Algorithm


    Gelareh , Shahin; Neamatian Monemi , Rahimeh; Semet , Frédéric


    International audience; In this paper, we address the Bounded Cardinality Hub Location Routing with Route Capacity wherein eachhub acts as a transshipment node for one directed route. The number of hubs lies between a minimum anda maximum and the hub-level network is a complete subgraph. The transshipment operations take place atthe hub nodes and flow transfer time from a hub-level transporter to a spoke-level vehicle influences spoketo-hub allocations. We propose a mathematical model and a b...

  5. Megamarketing strategies for health care services. (United States)

    Mobley, M F; Elkins, R L


    Megamarketing, as coined by Kotler (1968), is a strategic way of thinking which takes an enlarged view of the skills and resources needed to enter and operate in obstructed or protected markets. The concept of megamarketing emphasizes the mastering and coordination of economic, psychological, political, and public relation skills and suggest that organizations can take a proactive stance in shaping macroenvironmental conditions. As health care delivery is characterized by a highly regulated environment, this marketing approach has definite applications for the health care marketer.

  6. Antenatal care service utilization and associated factors in Metekel ...

    African Journals Online (AJOL)

    socioeconomic and some obstetric factors have been stated by few studies in other areas, the factors associated with low utilization of Antenatal care in Metekel Zone are not well assed before. Therefore, the objective of this study was to assess the status of Antenatal care service utilization and associated factors among ...

  7. Patients‟ perceptions of primary health care services in the Eastern ...

    African Journals Online (AJOL)

    Seeking to understand patient perspectives is an important step in the efforts to improve the quality of health care. The purpose of this study was to examine patient satisfaction with primary health care (PHC) services. A purposive sample of 19136 patients aged 18 years and above was interviewed at 266 PHC clinics in ...

  8. Improving Services for Women with Depression in Primary Care Settings (United States)

    Katon, Wayne J.; Ludman, Evette J.


    Women have a higher prevalence of depressive disorders compared to men. The current system of care for women with depressive disorders provides significant financial barriers for patients with lower incomes to access mental health services. Primary care systems are used extensively by women and have the potential to diagnose patients at early…

  9. Factors affecting maternal health care services utilization in rural ...

    African Journals Online (AJOL)

    Results: Mother's age at birth, mother's educational level, sex of head of household, household wealth status, employment/work status of mothers, region, religion, birth order and partner's/husband's level of educational were found to be predictors of utilization of delivery care and postnatal care services. Religion and sex of ...

  10. The Role of Quality Obstetric Care Services on Reducing Maternal ...

    African Journals Online (AJOL)

    The study recommends that, special initiative should be done to bring changes on reducing maternal mortality, such as ensure essential equipments and ... Enforcement in providing quality of obstetric care services in maternal health services especially in rural areas where majority of people in Tanzania reside is not an ...

  11. Antenatal care services utilization among women of reproductive ...

    African Journals Online (AJOL)

    Methods: A cross-sectional study was carried out between September and October 2013 among 425 women of reproductive age using a multi-stage sampling technique. Results: Almost all the respondents (93.9%) were aware of antenatal care services. A good proportion of the mothers (90.1%) used antenatal services, ...

  12. Social Support and the Receipt of Home Care Services. (United States)

    Chappell, Neena L.


    Compares differences between elderly who use formal home care services and those who do not. Data revealed users as less healthy and less active and as receiving more assistance from both formal and informal sources. Suggests that formal and informal services complement rather than substitute for one another. (NRB)

  13. Pharmacist Advancement of Transitions of Care to Home (PATCH) Service. (United States)

    Trang, Joseph; Martinez, Amanda; Aslam, Sadaf; Duong, Minh-Tri


    There is a paucity of literature on a well-defined role of a pharmacist in different aspects of transition of care service (TCS). Although health care institutions have specific details on the discharge process, there is a need for a sustainable TCS with a well-defined role of pharmacists. To describe the impact of a pharmacist-led TCS on acute health care utilization, clinic quality indicators, and identification and resolution of medication-related problems (MRPs). A pharmacist-managed TCS service, referred to as the Pharmacist Advancement of Transitions of Care to Home (PATCH) service, was established at an academic medical center, where high-risk patients received a postdischarge phone call from a pharmacist followed by a face-to-face meeting with the pharmacist and the patient's primary care provider (PCP). In a prospective transitions of care group (n = 74), outcomes of patients such as acute health care utilization (an emergency department visit or an inpatient readmission, within 30 days post discharge), clinic quality indicators, and identification and resolution of MRPs were compared to a retrospective control group (n = 87) who received the standard of care. Utilization of acute health care services was significantly lower in the prospective group compared to the retrospective control group (23% vs 41.4%; P = .013). A total of 49 MRPs were discovered in patients who received the TCS. Pharmacists play an integral role in improving the transitions of care to reduce acute health care utilization. In addition, they may improve care transitions by optimizing clinic quality indicators and by identifying and resolving MRPs.

  14. Exploring care for human service profession

    DEFF Research Database (Denmark)

    Høy, Bente


    maintain their dignity, it is important to explore, how dignity is maintained in such situations. Views of dignity and factors influencing dignity have been studied from both the nursing homes residents´ and the care providers´ perspective. However, little is known about how the residents’ experience...

  15. Reimbursement for critical care services in India (United States)

    Jayaram, Raja; Ramakrishnan, Nagarajan


    There are significant variations in critical care practices, costs, and reimbursements in various countries. Of note, there is a paucity of reliable information on remuneration and reimbursement models for intensivists in India. This review article aims to analyze the existing reimbursement models in United States and United Kingdom and propose a frame-work model that may be applicable in India. PMID:23833469

  16. Assessing the market for long-term care services. (United States)

    Rice, J A; Taylor, S


    Traditionally, long-term care services have been used by a diverse marketplace. The chronically ill, developmentally disabled, mentally ill and aging population has looked to long-term care support services as a means of physical and emotional support. Much of the time these services were housed together for the sake of efficiency. The enormous burden these services are creating on the economy, and the growing aging population, have forced the recognition that long-term care service delivery systems must change. Alternate programming for long-term care services that reach out into the community and into individual homes is becoming an attractive approach to meeting the growing demands of the marketplace. Home health, specialized housing and creative funding mechanisms such as HMOs, are examples of initiatives undertaken by healthcare organizations that view diversification as a vehicle for survival. Market research techniques that have been used in other industries are being adapted to the healthcare industry to ensure the proper mix of services that are demanded by older, more knowledgeable consumers. The programs of the future will be market driven, with the ability of the individual to pay for such services playing a significant role. The healthcare provider of today is in a position to serve the community in new ways. By becoming an integral link in the long-term care system and by developing new programs, the organization can serve as a catalyst for change. It is up to the governing bodies and managers of these facilities to become visionaries and to accept responsibility for assessing the market for long-term care services and to guide their organization into the future.

  17. The hub-and-spoke organization design revisited: a lifeline for rural hospitals. (United States)

    Elrod, James K; Fortenberry, John L


    Characterized by declining populations, high poverty, reduced employment opportunities, and high numbers of uninsured residents, rural communities pose significant challenges for healthcare providers desirous of addressing these medically underserved areas. Such difficult environments, in fact, have forced the closure of many rural hospitals across America, with scores facing the same threat, compelling intensive efforts to identify pathways which will yield an improved future. Collaborations with stronger urban or suburban healthcare institutions offer a prudent avenue for rural hospitals to continue serving their patients. Such relationships can be structured in many different ways, but Willis-Knighton Health System found that its use of the hub-and-spoke organization design set the stage for the institution to cast a vital lifeline to neighboring rural hospitals, affording the relatively seamless integration and assimilation of partner facilities into its network, ensuring continuity of services in remote regions. This article supplies an overview of the hub-and-spoke network and discusses Willis-Knighton Health System's use of it to facilitate the establishment of productive partnerships with rural hospitals. The delivery of healthcare services in rural environments is essential, but with small community hospitals increasingly being under threat, the outlook is not particularly attractive. Partnerships with better positioned healthcare entities offer significant hope, but care must be taken to structure these arrangements optimally. Willis-Knighton Health System found utility and value in its hub-and-spoke organization design, with the insights presented in this account potentially offering a pathway for others to follow as they go about addressing the healthcare needs of rural populations.

  18. Factors shaping intersectoral action in primary health care services. (United States)

    Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael


    To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

  19. Participative management in health care services

    Directory of Open Access Journals (Sweden)

    M. Muller


    Full Text Available The need and demand for the highest-quality management of all health care delivery activities requires a participative management approach. The purpose with this article is to explore the process of participative management, to generate and describe a model for such management, focusing mainly on the process of participative management, and to formulate guidelines for operationalisation of the procedure. An exploratory, descriptive and theory-generating research design is pursued. After a brief literature review, inductive reasoning is mainly employed to identify and define central concepts, followed by the formulation of a few applicable statements and guidelines. Participative management is viewed as a process of that constitutes the elements of dynamic interactive decision-making and problem-solving, shared governance, empowerment, organisational transformation, and dynamic communication within the health care organisation. The scientific method of assessment, planning, implementation and evaluation is utilised throughout the process of participative management.

  20. Hub location proplems under polyhedral demand uncertainty


    Meraklı, Merve


    Cataloged from PDF version of thesis. Includes bibliographical references (leaves 69-74). Thesis (M.S.): Bilkent University, Department of Industrial Engineering, İhsan Doğramacı Bilkent University, 2015. Hubs are points of consolidation and transshipment in many-to-many distribution systems that bene t from economies of scale. In hub location problems, the aim is to locate hub facilities such that each pairwise demand is satis ed and the total cost is minimized. The problem...

  1. P-1139 - Increased utilization of health care services after psychotherapy

    DEFF Research Database (Denmark)

    Fenger, Morten Munthe; Mortensen, Erik Lykke; Poulsen, Stig Bernt


    Background Psychotherapeutic treatment is associated with significant reduction of symptoms in patients, and it is generally assumed that treatment improves health and decreases the need for additional health care. The present study investigates the long-term changes in utilization of health care...... services for patients referred to psychotherapeutic treatment in 2004 and 2005. Method The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation...... period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment. Results Of the 761 patients, 216 patients did not show up for treatment, while...

  2. [eLearning service for home palliative care]. (United States)

    Sakuyama, Toshikazu; Komatsu, Kazuhiro; Inoue, Daisuke; Fukushima, Osamu


    In order to support the home palliative care learning, we made the eLearning service for home palliative care (beta version) and tried to teach the palliative care to the medical staffs in the community. The various learners (such as nurses, pharmacists and the like) accessed to the online learning and used this eLearning service. After the learners finished eLearning for home palliative care, some questionnaires were distributed to the learners and analyzed by us. The analysis of questionnaires revealed that almost all were satisfied with our eLearning services. Especially the learners were not only interested in using the skills of opioids and the management of pain control, but they had a good cognition for the usage of opioids.

  3. Facilitators and Barriers for Successful Implementation of Interconception Care in Preventive Child Health Care Services in the Netherlands

    NARCIS (Netherlands)

    Sijpkens, M.K. (Meertien K.); E.A.P. Steegers (Eric); Rosman, A.N. (Ageeth N.)


    textabstractObjectives Successful implementation of preconception and interconception care contributes to optimizing pregnancy outcomes. While interconception care to new mothers could potentially be provided by Preventive Child Health Care services, this care is currently not routinely available in

  4. Participative management in health care services. (United States)

    Muller, M


    The need and demand for the highest-quality management of all health care delivery activities requires a participative management approach. The purpose with this article is to explore the process of participative management, to generate and describe a model for such management, focusing mainly on the process of participative management, and to formulate guidelines for operationalization of the procedure. An exploratory, descriptive and theory-generating research design is pursued. After a brief literature review, inductive reasoning is mainly employed to identify and define central concepts, followed by the formulation of a few applicable statements and guidelines. Participative management is viewed as a process of that constitutes the elements of dynamic interactive decision-making and problem-solving, shared governance, empowerment, organisational transformation, and dynamic communication within the health care organisation. The scientific method of assessment, planning, implementation and evaluation is utilised throughout the process of participative management. A continuum of interactive decision-making and problem-solving is described, the different role-players involved, as well as the levels of interactive decision-making and problem-solving. The most appropriate decision-making strategy should be employed in pro-active and reactive decision-making. Applicable principles and assumptions in each element of participative management is described. It is recommended that this proposed model for participative management be refined by means of a literature control, interactive dialogue with experts and a model case description or participative management, to ensure the trustworthiness of this research.

  5. Mental health care roles of non-medical primary health and social care services. (United States)

    Mitchell, Penny


    Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

  6. Enhancing Health-Care Services with Mixed Reality Systems (United States)

    Stantchev, Vladimir

    This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

  7. Improving palliative care outcomes for Aboriginal Australians: service providers’ perspectives (United States)


    Background Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers’ experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. Methods In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the ‘cultural security’ framework. Thematic analysis was carried out that identified patterns within data. Results Fifteen palliative care providers were interviewed. Overall they reported lack of understanding of Aboriginal culture and being uncertain of the needs and priorities of Aboriginal people during end-of-life care. According to several participants, very few Aboriginal people had an understanding of palliative care. Managing issues such as anger, denial, the need for non-medical support due to socioeconomic disadvantage, and dealing with crises and conflicts over funeral arrangements were reported as some of the tensions between Aboriginal patients and families and the service providers. Conclusion Early referral to palliative care is important in demonstrating and maintaining a caring therapeutic relationship. Paramount to meeting the needs for Aboriginal patients was access to appropriate information and logistical, psychological and emotional support. These were often seen as essential but additional to standard palliative care services. The broader context of Aboriginal history and historical distrust of mainstream services was seen to

  8. Customer assessment of long-term care pharmacy provider services. (United States)

    Clark, Thomas R


    Assess performance of long-term care pharmacy providers on key services offered to nursing facilities. Cross-sectional; nursing facility team. Random phone survey of nursing facility team members. 485 nursing facility team members (practicing in nursing facilities, interacting with > or = 1 consultant pharmacist); 46 members excluded, unable to identify facility's pharmacy provider. Directors of nursing, medical directors, and administrators were asked to rate long-term care pharmacy provider performance of eight commonly offered pharmacy services. All groups evaluated pharmacy provider performance of these services using a five-point scale. Results are broken down by employer type. Average rating for eight pharmacy services was 3.64. Top two services: "Labeling medications accurately" ranked in top 1-2 services for all groups (combined rating of 3.97) and "Provides medication administration system" ranked in top 1-3 services for all groups (combined rating of 3.95). One service, "Provides educational inservices," ranked lowest for all groups (combined rating of 3.54). In general, when looking at the eight services in combination for all providers, all services were ranked between Good and Very Good (average score of 3.64). Therefore, while the pharmacy provider is performing above average for these services, there is room for improvement in all of these services. These results can be used as a benchmark. Detailed data results and sample surveys are available online at These surveys can be used by the pharmacy provider to solicit assessments from their own facilities on these services.

  9. Occupational Health Services Integrated in Primary Health Care in Iran. (United States)

    Rafiei, Masoud; Ezzatian, Reza; Farshad, Asghar; Sokooti, Maryam; Tabibi, Ramin; Colosio, Claudio


    A healthy workforce is vital for maintaining social and economic development on a global, national and local level. Around half of the world's people are economically active and spend at least one third of their time in their place of work while only 15% of workers have access to basic occupational health services. According to WHO report, since the early 1980s, health indicators in Iran have consistently improved, to the extent that it is comparable with those in developed countries. In this paper it was tried to briefly describe about Health care system and occupational Health Services as part of Primary Health care in Iran. To describe the health care system in the country and the status of occupational health services to the workers and employers, its integration into Primary Health Care (PHC) and outlining the challenges in provision of occupational health services to the all working population. Iran has fairly good health indicators. More than 85 percent of the population in rural and deprived regions, for instance, have access to primary healthcare services. The PHC centers provide essential healthcare and public-health services for the community. Providing, maintaining and improving of the workers' health are the main goals of occupational health services in Iran that are presented by different approaches and mostly through Workers' Houses in the PHC system. Iran has developed an extensive network of PHC facilities with good coverage in most rural areas, but there are still few remote areas that might suffer from inadequate services. It seems that there is still no transparent policy to collaborate with the private sector, train managers or provide a sustainable mechanism for improving the quality of services. Finally, strengthening national policies for health at work, promotion of healthy work and work environment, sharing healthy work practices, developing updated training curricula to improve human resource knowledge including occupational health

  10. Family-centred care delivery: comparing models of primary care service delivery in Ontario. (United States)

    Mayo-Bruinsma, Liesha; Hogg, William; Taljaard, Monica; Dahrouge, Simone


    To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC. Cross-sectional study. Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery. A total of 137 practices, 363 providers, and 5144 patients. Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations. Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural. Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC.

  11. A systematic review of integrated working between care homes and health care services (United States)


    Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in

  12. Regional Hub port development : the case of Montevideo, Uruguay


    Wilmsmeier, Gordon; Martínez Zarzoso, Inmaculada; Fiess, Norbert


    This paper reflects on port development in Uruguay in an environment of trilateral interport competition. The regional characteristics of port development in terms of their geographical, functional and operational characteristics are discussed by analysing the port system’s evolution. The case of Montevideo as the success or failure of a regional hub port development strategy is analysed in detail. Particular attention is given to the evolution and impact of the liner shipping service network...

  13. Logistics hubs: an integration of transport infrastructure

    CSIR Research Space (South Africa)

    Botha, M


    Full Text Available " that have jumped on the band wagon pushing for logistics hubs to be established in their regions or within their areas of jurisdiction. The feasibility of a logistics hub is dependent on a number of criteria with access to ideally more than two...

  14. Virtual Campus Hub technical evaluation report

    DEFF Research Database (Denmark)

    Vercoulen, Frank; Badger, Merete; Monaco, Lucio

    This report describes and discusses the technical achievements of the Virtual Campus Hub project and formulates a brief agenda for the future.......This report describes and discusses the technical achievements of the Virtual Campus Hub project and formulates a brief agenda for the future....

  15. Quality of emergency rooms and urgent care services: user satisfaction. (United States)

    Lima, Cássio de Almeida; Santos, Bruna Tatiane Prates dos; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; Costa, Fernanda Marques da; Carneiro, Jair Almeida


    To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself.

  16. Service Users' and Caregivers' Perspectives on Continuity of Care in Out-of-Hours Primary Care.

    LENUS (Irish Health Repository)

    Gallagher, Niamh


    Modernization policies in primary care, such as the introduction of out-of-hours general practice cooperatives, signify a marked departure from many service users\\' traditional experiences of continuity of care. We report on a case study of accounts of service users with chronic conditions and their caregivers of continuity of care in an out-of-hours general practice cooperative in Ireland. Using Strauss and colleagues\\' Chronic Illness Trajectory Framework, we explored users\\' and caregivers\\' experiences of continuity in this context. Whereas those dealing with "routine trajectories" were largely satisfied with their experiences, those dealing with "problematic trajectories" (characterized by the presence of, for example, multimorbidity and complex care regimes) had considerable concerns about continuity of experiences in this service. Results highlight that modernization policies that have given rise to out-of-hours cooperatives have had a differential impact on service users with chronic conditions and their caregivers, with serious consequences for those who have "problematic" trajectories.

  17. Assessment of quality of care in family planning services in Jimma ...

    African Journals Online (AJOL)

    Background: Providing quality of care in family planning services is an important task for care providers so as to increase service utilization and coverage; however, little is known about the existing quality of care in such services. Objective: To assess quality of care in family planning services in Jimma Zone, southwest ...

  18. Developing supplemental activities for primary health care maternity services. (United States)

    Panitz, E


    Supplemental health care activities are described in the context of the augmented product. The potential benefits of supplemental services to recipients and provider are discussed. The author describes a study that was the basis for (re)developing a supplemental maternity service. The implementation of the results in terms of changes in the marketing mix of this supplemental program is discussed. The effects of the marketing mix changes on program participation are presented.

  19. The Bromhead Care Home Service: the impact of a service for care home residents with dementia on hospital admission and dying in preferred place of care. (United States)

    Garden, Gill; Green, Suzanne; Pieniak, Susan; Gladman, John


    People with dementia have worse outcomes associated with hospital admission, are more likely to have interventions and are less likely to be offered palliative care than people without dementia. Advance care planning for care home residents has been shown to reduce hospital admissions without increasing mortality. Studies have shown that staff confidence in managing delirium, a common reason for admission, improves with training. A service combining education for care home staff and advance care planning for care home residents with dementia was introduced to care homes in Boston, UK. There were improvements in staff confidence in recognition, prevention, management and knowledge of factors associated with delirium and dysphagia. 92% of carers rated the service >9/10. Admissions fell by 37% from baseline in the first year and 55% in the second and third years. All but one resident died in the preferred place of care. © 2016 Royal College of Physicians.

  20. The application of design criteria for locating a hub configured supply chain for a restaurant cluster in the Stellenbosch area

    Directory of Open Access Journals (Sweden)

    Claudia B. Struwig


    Full Text Available Restaurants, in general, utilise numerous suppliers. Normally they deliver on different days in the week and at different times during the day, logistically not an optimum approach. Not only does the current practice cause frequent interruptions, but by segregating the food supply chain unnecessary traffic is generated. This article investigated the need for developing a third party supplier hub, the best positioning of that hub and the most economical routes to the customers. With the aim of providing non-franchised restaurants with the necessary leverage to become market leaders, the hub is planned to only service the restaurants within the vicinity of the Stellenbosch area. In such a hub-configured supply chain, the suppliers would be delivering to the proposed hub, from where once-off deliveries to all the restaurants may be made on days and/or times determined by them. In order to investigate the benefits of providing such a hub structure, a systematic implementation approach was used. The first step was to do market research in order to establish the need for such a hub. That is, the viability of the hub from a restaurant’s perspective was established. The next step entailed the investigation of the design criteria needed in determining a favourable hub location. Four possible hub locations were identified. The Clark and Wright’s savings algorithm was then used to determine the optimal hub location and the feasibility of the results was verified with the aid of a global positioning system (GPS device. The last steps followed involved the determination of an effective hub floor plan that may be utilised, possible products that can be supplied to the restaurants and the necessary assets needed to provide the hub’s service. Finally, by incorporating all these facets, a cost analysis was done to determine the hub’s profitability.

  1. Adolescents perception of reproductive health care services in Sri Lanka (United States)

    Agampodi, Suneth B; Agampodi, Thilini C; UKD, Piyaseeli


    Background Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. Methods This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17–19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Results Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners. Conclusions and recommendations

  2. Adolescents perception of reproductive health care services in Sri Lanka

    Directory of Open Access Journals (Sweden)

    Agampodi Thilini C


    Full Text Available Abstract Background Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. Methods This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17–19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Results Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners

  3. Virtual Hubs for facilitating access to Open Data (United States)

    Mazzetti, Paolo; Latre, Miguel Á.; Ernst, Julia; Brumana, Raffaella; Brauman, Stefan; Nativi, Stefano


    In October 2014 the ENERGIC-OD (European NEtwork for Redistributing Geospatial Information to user Communities - Open Data) project, funded by the European Union under the Competitiveness and Innovation framework Programme (CIP), has started. In response to the EU call, the general objective of the project is to "facilitate the use of open (freely available) geographic data from different sources for the creation of innovative applications and services through the creation of Virtual Hubs". In ENERGIC-OD, Virtual Hubs are conceived as information systems supporting the full life cycle of Open Data: publishing, discovery and access. They facilitate the use of Open Data by lowering and possibly removing the main barriers which hampers geo-information (GI) usage by end-users and application developers. Data and data services heterogeneity is recognized as one of the major barriers to Open Data (re-)use. It imposes end-users and developers to spend a lot of effort in accessing different infrastructures and harmonizing datasets. Such heterogeneity cannot be completely removed through the adoption of standard specifications for service interfaces, metadata and data models, since different infrastructures adopt different standards to answer to specific challenges and to address specific use-cases. Thus, beyond a certain extent, heterogeneity is irreducible especially in interdisciplinary contexts. ENERGIC-OD Virtual Hubs address heterogeneity adopting a mediation and brokering approach: specific components (brokers) are dedicated to harmonize service interfaces, metadata and data models, enabling seamless discovery and access to heterogeneous infrastructures and datasets. As an innovation project, ENERGIC-OD will integrate several existing technologies to implement Virtual Hubs as single points of access to geospatial datasets provided by new or existing platforms and infrastructures, including INSPIRE-compliant systems and Copernicus services. ENERGIC OD will deploy a

  4. Location of an intermediate hub for port activities (United States)

    Burciu, Ş.; Ştefănică, C.; Roşca, E.; Dragu, V.; Ruscă, F.


    An intermediate hub might increase the accessibility level of ports but also hinterland and so it can be considered more than a facility with a transhipment role. These hubs might lead to the development of other transport services and enhance their role in gathering and covering economic centres within hinterlands and also getting the part of logistic facility for the ports, with effects on port utilization and its connectivity to global economy. A new location for a hub terminal leads to reduced transport distances within hinterland, with decreased transport costs and external effects, so with gains in people's life quality. Because the production and distribution systems are relatively fixed on short and medium term and the location decisions are strategic and on long term, the logistic chains activities location models have to consider the uncertainties regarding the possible future situations. In most models, production costs are considered equal, the location problem reducing itself to a problem that aims to minimize the total transport costs, meaning the transport problem. The main objective of the paper is to locate a hub terminal that links the producers of cereals that are going to be exported by naval transportation with the Romanian fluvial-maritime ports (Galaţi, Brăila). GIS environment can be used to integrate and analyse a great amount of data and has the ability of using functions as location - allocation models necessary both to private and public sector, being able to determine the optimal location for services like factories, warehouses, logistic platforms and other public services.

  5. Building evaluative culture in community services: Caring for evidence. (United States)

    Mayne, John


    An organization with a strong evaluative culture engages in self-reflection, evidence-based learning and experimentation. It sees evidence as essential for managing well, but building such a culture is challenging. Community service organizations seek to provide effective services for their clients. To build an evaluative culture, they need to acquire basic monitoring and evaluation capabilities, be provided with opportunities for using these capabilities and be adequately motivated to care about evidence as a means to improve services to their clients. Leadership along with a phased in approach are key in bringing about these behaviour changes. Copyright © 2017. Published by Elsevier Ltd.

  6. Managed Care Approaches to Children's Services within Public Systems of Care. (United States)

    Pumariega, Andres; Fallon, Theodore, Jr.

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

  7. Cloud based emergency health care information service in India. (United States)

    Karthikeyan, N; Sukanesh, R


    A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the

  8. Adolescent health care: improving access by school-based service. (United States)

    Gonzales, C; Mulligan, D; Kaufman, A; Davis, S; Hunt, K; Kalishman, N; Wallerstein, N


    Participants in this discussion of the potential of school-based health care services for adolescents included family medicine physicians, school health coordinators, a school nurse, and a community worker. It was noted that health care for adolescents tends to be either inaccessible or underutilized, largely because of a lack of sensitivity to adolescent culture and values. An ideal service for adolescents would offer immediate services for crises, strict confidentiality, ready access to prescribed medications, a sliding-scale scheme, and a staff that is tolerant of divergent values and life-styles. School-based pilot adolescent clinics have been established by the University of New Mexico's Department of Family, Community, and Emergency Medicine to test the community-oriented health care model. On-site clinics provide urgent medical care, family planning, pregnancy testing, psychological counseling, alcohol and drug counseling, and classroom health education. Experience with these programs has demonstrated the necessity for an alliance among the health team and the school administration, parents, and students. Financial, ethical, and political factors can serve as constraints to school-based programs. In some cases, school administrators have been resistant to the provision of contraception to students on school grounds and parents have been unwilling to accept the adolescent's right to confidentiality. These problems in part stem from having 2 separate systems, each with its own values, orientation, and responsibilities, housed in 1 facility. In addition, there have been problems generating awareness of the school-based clinic among students. Health education theater groups, peer counseling, and student-run community services have been effective, however, in increasing student participation. It has been helpful to mold clinic services to meet the needs identified by teenagers themselves. There is an interest not only in curative services, but in services focused

  9. Quality assessment of child care services in primary health care settings of Central Karnataka (Davangere District

    Directory of Open Access Journals (Sweden)



    Full Text Available Background: Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. Aims and Objectives: To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client satisfaction. To assess utilization of facilities by the community. Materials and Methods: Study Type: Cross-sectional community-based study. Quality assessment was done by taking 30-50%, of the service provider. Client satisfaction was determined with 1 Immunization and child examination-90 clients each. Utilization of services was assessed among 478 households. Statistical Analysis: Proportions, Likert′s scale to grade the services and Chi-square. Results: Immunization service: Identification of needed vaccine, preparation and care was average. Vaccination technique, documentation, EPI education, maintenance of cold chain and supplies were excellent. Client satisfaction was good. Growth monitoring: It was excellent except for mother′s education andoutreach educational session . Acute respiratory tract infection care: History, physical examination, ARI education were poor. Classification, treatment and referral were excellent. Client satisfaction was good. Diarrheal disease care: History taking was excellent. But examination, classification, treatment, ORT education were poor. Conclusion: Mothers education was not stressed by service providers. Service providers′ knowledge do not go with the quality of service rendered. Physical examination of the child was not good. Except for immunization other services were average.

  10. The effect of restructuring of health care services on caesarean ...

    African Journals Online (AJOL)



    Jun 24, 2005 ... The effect of restructuring of health care services on caesarean section rates. ARTICLE. Medical Research Council/ University of KwaZulu-Natal, Pregnancy Hypertension Research. Unit and Department of Obstetrics and Gynaecology, Nelson R Mandela School of Health. Sciences, University of ...

  11. Factors Influencing Antenatal Care Service Utilization in Hadiya Zone

    African Journals Online (AJOL)

    Therefore, the objective of this study was to explore factors influencing antenatal care services utilization in Southern Ethiopia. METHODS: A community-based cross sectional study was conducted in Hadiya Zone of Southern Ethiopia from January to February 2009. A multi stage sampling technique was used to select the ...

  12. The Role of Pharmacist in Dental Care Services | Kalala | Tanzania ...

    African Journals Online (AJOL)

    The Role of Pharmacist in Dental Care Services. WM Kalala. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  13. Quality of Antenatal care services in eastern Uganda: implications ...

    African Journals Online (AJOL)

    Good quality Antenatal Care (ANC) provides opportunity to detect and respond to risky maternal conditions. This study assessed quality of ANC services in eastern Uganda with a goal of benchmarking implications for interventions. Methods Data was collected from 15 health facilities in Eastern Uganda to establish capacity ...

  14. Utilization of antenatal care services among teenagers in Ethiopia: A ...

    African Journals Online (AJOL)

    Background: Teenaged women suffer from a disproportionate share of reproductive health problem. The purpose of this study was to estimate the utilization of antenatal care (ANC) services among teenagers (13-19 years) during delivery in Ethiopia. Methodology: Raw data collected from all part of the country on child ...

  15. Primary health care facility infrastructure and services and the ...

    African Journals Online (AJOL)

    ... Research Council ae Currently from Cape Peninsula University of Technology ... Keywords: primary health care facilities; nutritional status; children; caregivers' rural; South Africa ... underlying causes of malnutrition in children, while poor food quality, .... Information on PHC facility infrastructure and services was obtained.

  16. Evaluation of Service Station Attendant-Auto Care Project. (United States)

    Cress, Ronald J.

    The project described offers an approach to providing occupational skills to socially and educationally handicapped youth, specifically the skills necessary for a service station attendant in driveway salesmanship and auto care. The 10-page evaluation report presents project goals and objectives with evaluation data (represented graphically) and…

  17. Point of Care Testing Services Delivery: Policy Analysis using a ...

    African Journals Online (AJOL)

    Annals of Biomedical Sciences ... The service providers (hospital management) and the testing personnel are faced with the task of trying to explain these problems. Objective of the study: To critically do a policy analysis of the problems of point of care testing with the aim of identifying the causes of these problems and ...


    Women's Bureau (DOL), Washington, DC.


  19. Uptake Of Eye Care Services In University Of Calabar Teaching ...

    African Journals Online (AJOL)

    This study was carried out to determine the importance of alternative sources of eye care services in delay in seeking ophthalmic treatment in University of Calabar teaching hospital (UCTH).Atotal of 580 patients who visited the hospital within 3 months of the study period October 2003 to December 2003, were examined ...

  20. Poverty, Access to Health Care Services and Human Capital ...

    African Journals Online (AJOL)

    The paper is aimed at examining the poverty profile of Nigeria and its consequences on access to health care services and human capital development in the country. It is a startling paradox that about two – thirds of Nigerians are poor despite living in a country with vast potential wealth. Apart from looking at the theoretical ...

  1. Mobile health service for HIV screening and care in resource ...

    African Journals Online (AJOL)

    particularly those living in remote areas, to reduce loss-to-follow-up, and to improve patient outcomes. With a reduction in HIV-related stigma and associated discrimination by using these services, the mobile strategy may assist decentralisation of programs devoted to HIV screening, anti-retroviral treatment and HIV care.

  2. Clients satisfaction of antenatal care services in public and private ...

    African Journals Online (AJOL)

    Background: Antenatal care involves screening for health and socioeconomic conditions likely to increase the possibility of specific adverse pregnancy outcomes, providing therapeutic interventions known to be effective and educating pregnant women about planning for safe birth. Quality and customer service have been ...

  3. Paramedic-Initiated Home Care Referrals and Use of Home Care and Emergency Medical Services. (United States)

    Verma, Amol A; Klich, John; Thurston, Adam; Scantlebury, Jordan; Kiss, Alex; Seddon, Gayle; Sinha, Samir K


    We examined the association between paramedic-initiated home care referrals and utilization of home care, 9-1-1, and Emergency Department (ED) services. This was a retrospective cohort study of individuals who received a paramedic-initiated home care referral after a 9-1-1 call between January 1, 2011 and December 31, 2012 in Toronto, Ontario, Canada. Home care, 9-1-1, and ED utilization were compared in the 6 months before and after home care referral. Nonparametric longitudinal regression was performed to assess changes in hours of home care service use and zero-inflated Poisson regression was performed to assess changes in the number of 9-1-1 calls and ambulance transports to ED. During the 24-month study period, 2,382 individuals received a paramedic-initiated home care referral. After excluding individuals who died, were hospitalized, or were admitted to a nursing home, the final study cohort was 1,851. The proportion of the study population receiving home care services increased from 18.2% to 42.5% after referral, representing 450 additional people receiving services. In longitudinal regression analysis, there was an increase of 17.4 hours in total services per person in the six months after referral (95% CI: 1.7-33.1, p = 0.03). The mean number of 9-1-1 calls per person was 1.44 (SD 9.58) before home care referral and 1.20 (SD 7.04) after home care referral in the overall study cohort. This represented a 10% reduction in 9-1-1 calls (95% CI: 7-13%, p home care referral and 0.79 (SD 6.27) after home care referral, representing a 7% reduction (95% CI: 3-11%, p home care records were included in the analysis, the reductions in 9-1-1 calls and ambulance transports to ED were attenuated but remained statistically significant. Paramedic-initiated home care referrals in Toronto were associated with improved access to and use of home care services and may have been associated with reduced 9-1-1 calls and ambulance transports to ED.

  4. Library and information services: impact on patient care quality. (United States)

    Marshall, Joanne Gard; Morgan, Jennifer Craft; Thompson, Cheryl A; Wells, Amber L


    The purpose of this paper is to explore library and information service impact on patient care quality. A large-scale critical incident survey of physicians and residents at 56 library sites serving 118 hospitals in the USA and Canada. Respondents were asked to base their answers on a recent incident in which they had used library resources to search for information related to a specific clinical case. Of 4,520 respondents, 75 percent said that they definitely or probably handled patient care differently using information obtained through the library. In a multivariate analysis, three summary clinical outcome measures were used as value and impact indicators: first, time saved; second, patient care changes; and third, adverse events avoided. The outcomes were examined in relation to four information access methods: first, asking librarian for assistance; second, performing search in a physical library; third, searching library's web site; or fourth, searching library resources on an institutional intranet. All library access methods had consistently positive relationships with the clinical outcomes, providing evidence that library services have a positive impact on patient care quality. Electronic collections and services provided by the library and the librarian contribute to patient care quality.

  5. 75 FR 15495 - Agency Information Collection (Application for Furnishing Long-Term Care Services to... (United States)


    ... (Application for Furnishing Long- Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care... Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170. b. Residential Care... application used by a residential care facility or home that wishes to provide residential home care to...

  6. SEQUenCE: a service user-centred quality of care instrument for mental health services. (United States)

    Hester, Lorraine; O'Doherty, Lorna Jane; Schnittger, Rebecca; Skelly, Niamh; O'Donnell, Muireann; Butterly, Lisa; Browne, Robert; Frorath, Charlotte; Morgan, Craig; McLoughlin, Declan M; Fearon, Paul


    To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service. The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses. All participants were attending an independent mental health service in Ireland. Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder. Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test-retest and convergent validity analyses; 33 completed the resulting 40-item instrument. Test-retest reliability, internal consistency and convergent validity of the instrument. The final instrument showed acceptable test-retest reliability at 5-7 days (r = 0.65; P Service Satisfaction Scale (r = 0.84, P internal consistency (Cronbach's alpha = 0.87). SEQUenCE is a valid, reliable scale that is grounded in the service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  7. A Home-Based Palliative Care Consult Service for Veterans. (United States)

    Golden, Adam G; Antoni, Charles; Gammonley, Denise


    We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.

  8. Prison hospice and pastoral care services in California. (United States)

    Linder, John F; Knauf, Keith; Enders, Sheila R; Meyers, Frederick J


    Hospice at the California Medical Facility (CMF) Vacaville dates back to the mid-1980s, when the acquired immune deficiency syndrome (AIDS) epidemic began to be felt throughout California's Department of Corrections. Vacaville has served for decades as the principal location for delivering health services to California's incarcerated men. Informal hospice-like services were inspired by Elisabeth Kubler-Ross and through inmate and community calls for more humane care for dying inmates. By 1990, efforts to formally establish a hospice were under way. In 1996, a 17-bed, state-licensed hospice began caring for dying inmates. An interdisciplinary team plans and delivers the care, meeting weekly to admit and review patients. The Pastoral Care Services (PCS) inmate volunteer program, with more than 50 trained participants, provides care and comfort to dying patients in hospice and to ill patients on the general medicine service. PCS volunteers perform many duties, including sitting vigil with actively dying inmates. Inmates enrolling in hospice have to forgo further curative therapy, consent to the program in writing, and have a 6-month or less survival prognosis; patients are not required to have a do-not-resuscitate (DNR) order, but are encouraged to consider one. Training for physicians, staff and PCS volunteers is provided by the University of California, Davis faculty of the West Coast Center for Palliative Education. Bereavement services are provided for PCS volunteers, other inmate "family" and staff. Family and friends of the deceased in the free community are followed by phone, mail, and primarily through referral to resources in their local area.

  9. Channel Bonding in Linux Ethernet Environment using Regular Switching Hub

    Directory of Open Access Journals (Sweden)

    Chih-wen Hsueh


    Full Text Available Bandwidth plays an important role for quality of service in most network systems. There are many technologies developed to increase host bandwidth in a LAN environment. Most of them need special hardware support, such as switching hub that supports IEEE Link Aggregation standard. In this paper, we propose a Linux solution to increase the bandwidth between hosts with multiple network adapters connected to a regular switching hub. The approach is implemented as two Linux kernel modules in a LAN environment without modification to the hardware and operating systems on host machines. Packets are dispatched to bonding network adapters for transmission. The proposed approach is backward compatible, flexible and transparent to users and only one IP address is needed for multiple bonding network adapters. Evaluation experiments in TCP and UDP transmission are shown with bandwidth gain proportionally to the number of network adapters. It is suitable for large-scale LAN systems with high bandwidth requirement, such as clustering systems.


    Directory of Open Access Journals (Sweden)

    Elka Atanasova


    Full Text Available Background: In all European countries, an important policy objective is the equity of access to health care. The factors that affect access to health care can differ as the demand- and supply-side factors. Moreover, there are many tools to assess the extent of inequity in access to services. One simple tool is the assessing reports of unmet needs for health care. Purpose: The study has two objectives: to examine the evidence of self-reported unmet needs and to analyze the relationship between foregone medical care and both type of residence and socioeconomic status. Materials and Methods: We use data from the European Union Statistics on Income and Living Conditions. The access to health care is measured using the concept of unmet need for medical examination or treatment during the last 12 months. The relationship between foregone medical care and both type of residence and socioeconomic status is examined through the representative survey conducted in 2014. Results: The Eurostat results show that treatment costs are the most common reason for foregone medical care in Bulgaria. We observe a gradual decrease in the share of people who reported having unmet needs due to being too expensive. According to the 2014 survey, significant differences between urban and rural areas as well as among the income groups are identified. The results show the problems in access to health care services mainly in small towns and villages. Conclusion: Although major essential changes were made in the Bulgarian health care system, the equity problems remain an important challenge to policy-makers.

  11. Self-care of patients with diabetes mellitus cared for at an emergency service in Mexico. (United States)

    Baquedano, Irasema Romero; dos Santos, Manoel Antônio; Martins, Tatiane Aparecida; Zanetti, Maria Lúcia


    This study examines the self-care ability of type 2 diabetes mellitus patients and relates it to sociodemographic and clinical variables. The study included 251 patients who were cared for by an emergency service in Mexico, in 2007. Data were obtained through structured interviews held at participants' households, through a form, a questionnaire and the Self-Care Ability Scale. Descriptive and correlation statistics were used for data analysis. The results show that 83 (33.5%) individuals displayed good self-care ability and 168 (66.5%) individuals displayed regular ability. A directly proportional correlation was found between self-care ability and schooling (r=0.124; pdiabetes mellitus displayed regular ability for self-care. Self-care ability is related to multiple variables that should be taken into account by health professionals when suggesting educational programs.

  12. [Relationship of the effectiveness of care management services and burdens of primary family caregivers]. (United States)

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


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

  13. The Flexible Care Service: a third-sector service for older people with mental health needs. (United States)

    Ryder, Elaine


    Demographic patterns indicate that by 2030, one in five people in England will be over 65. Together with the fact that as people age they are more likely to suffer from comorbidities, it is of paramount importance that local services are designed to meet the needs of individual older people. The Flexible Care Service is a resource for older people with mental health problems. Through the use of client case studies, the Department of Health's 'six Cs' (care, compassion, competence, communication, courage and commitment) are used as a framework to demonstrate how a third-sector service such as Flexible Care can offer a person-centred approach in order to meet the diverse needs of individual clients. The framework is also used to demonstrate the high level of skills needed by flexible carers in order to provide this support.

  14. Dental care as a vital service response for disaster victims. (United States)

    Mosca, Nicholas G; Finn, Emanuel; Joskow, Renée


    Hurricane Katrina's impact on the infrastructure of public health and the health care system in the affected areas was unprecedented in the United States. Many dental offices were flood-bound in New Orleans and over 60% of dental practices were partially or completely damaged in affected counties in Mississippi. Most needs assessments conducted during the initial recovery operations did not include questions about access to oral health care. However, the extent of the destruction of the health care infrastructure demonstrated the need for significant state and federal support to make dental treatment accessible to survivors and evacuees. The Katrina response is one of the few times that state and federal government agencies responded to provide dental services to victims as part of disaster response and recovery. The purpose of this paper is to share our experiences in Mississippi and the District of Columbia providing urgent dental care to disaster victims as part of a crisis response.

  15. Temporary services for patients in need of chronic care

    DEFF Research Database (Denmark)

    Hesse, Morten


    Background A project is a temporary endeavour undertaken to create a product or service. Projects are frequently used for the testing and development of new approaches in social work. Projects can receive grants from central, often national or international institutions, and allow for more...... experimentation than work placed within existing institutions. Discussion For socially marginalized groups who need continuing support and care, receiving help in a project means that the clients will have to be transferred to other services when the project ends. There is also a risk that clients will experience...... a decline in services, as staff members have to seek new employment towards the end of the project, or begin to focus more on the evaluation than the services. This raises some ethical issues concerning the use of human subjects in projects. Conclusion Project managers should consider ethical issues...

  16. Utilization of health care services by migrants in Europe

    DEFF Research Database (Denmark)

    Graetz, V.; Rechel, B.; Groot, W.


    : Compared with previous systematic reviews, the results indicate a clearer picture of the differences in health service utilization between migrants and non-migrants in Europe. Areas timely for developing research: A comprehensive comparison across European countries is impossible because the number......Introduction: Our study reviewed the empirical evidence on the utilization of health care services by migrants in Europe, and on differences in health service utilization between migrants and non-migrants across European countries. Sources of data: A systematic literature review was performed......, searching the databases Medline, Cinahl and Embase and covering the period from January 2009 to April 2016. The final number of articles included was 39. Areas of agreement: Utilization of accident and emergency services and hospitalizations were higher among migrants compared with non-migrants in most...

  17. Billing third party payers for pharmaceutical care services. (United States)

    Poirier, S; Buffington, D E; Memoli, G A


    To describe the steps pharmacists must complete when seeking compensation from third party payers for pharmaceutical care services. Government publications; professional publications, including manuals and newsletters; authors' personal experience. Pharmacists in increasing numbers are meeting with success in getting reimbursed by third party payers for patient care activities. However, many pharmacists remain reluctant to seek compensation because they do not understand the steps involved. Preparatory steps include obtaining a provider/supplier number, procuring appropriate claim forms, developing data collection and documentation systems, establishing professional fees, creating a marketing plan, and developing an accounting system. To bill for specific patient care services, pharmacists need to collect the patient's insurance information, obtain a statement of medical necessity from the patient's physician, complete the appropriate claim form accurately, and submit the claim with supporting documentation to the insurer. Although many claims from pharmacists are rejected initially, pharmacists who work with third party payers to understand the reasons for denial of payment often receive compensation when claims are resubmitted. Pharmacists who follow these guidelines for billing third party payers for pharmaceutical care services should notice an increase in the number of paid claims.

  18. [Organization of health services and tuberculosis care management]. (United States)

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


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

  19. 38 CFR 17.35 - Hospital care and medical services in foreign countries. (United States)


    ... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35 Hospital care and medical services in foreign countries. The Secretary may furnish hospital care and... associated with and held to be aggravating a service-connected disability; (b) If the care is furnished to a...

  20. Supervised hub-detection for brain connectivity

    DEFF Research Database (Denmark)

    Kasenburg, Niklas; Liptrot, Matthew George; Reislev, Nina Linde


    , but can smooth discriminative signals in the population, degrading predictive performance. We present a novel hub-detection optimized for supervised learning that both clusters network nodes based on population level variation in connectivity and also takes the learning problem into account. The found......A structural brain network consists of physical connections between brain regions. Brain network analysis aims to find features associated with a parameter of interest through supervised prediction models such as regression. Unsupervised preprocessing steps like clustering are often applied...... hubs are a low-dimensional representation of the network and are chosen based on predictive performance as features for a linear regression. We apply our method to the problem of finding age-related changes in structural connectivity. We compare our supervised hub-detection (SHD) to an unsupervised hub...

  1. Zoning Districts - Volusia County HUB Zones (United States)

    NSGIC Local Govt | GIS Inventory — Historically Underutilized Business (HUB) Zones in Volusia County. Go to or contact the Department of Economic Development (386) 248-8048...

  2. Ponseti Treatment in the Management of Clubfoot Deformity – A Continuing Role for Paediatric Orthopaedic Services in Secondary Care Centres (United States)

    Docker, Charles EJ; Lewthwaite, Simon; Kiely, Nigel T


    INTRODUCTION The Ponseti technique is a well-proven way of managing paediatric clubfoot deformity. We describe a management set-up which spreads the care between secondary and tertiary care with no loss of quality. PATIENTS AND METHODS In our audit of the first 2 years of Ponseti casting in the treatment of idiopathic congenital talipes equinovarus (CTEV, clubfoot) deformity, we identified 77 feet having been treated in 50 patients. Forty-nine feet were treated primarily in Oswestry, a tertiary referral centre for paediatric orthopaedic conditions, and 13 feet were treated in conjunction with the physiotherapy department at one of the region's district general hospitals (Leighton Hospital, Crewe, Cheshire). RESULTS Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found in both cohorts. CONCLUSIONS This ‘hub-and-spoke’ approach would appear to be efficient in terms of resource utilisation. Additional benefits atients and their carers include ease of access to services and reduced financial and transport burdens. PMID:17688726

  3. Ponseti treatment in the management of clubfoot deformity - a continuing role for paediatric orthopaedic services in secondary care centres. (United States)

    Docker, Charles E J; Lewthwaite, Simon; Kiely, Nigel T


    The Ponseti technique is a well-proven way of managing paediatric clubfoot deformity. We describe a management set-up which spreads the care between secondary and tertiary care with no loss of quality. In our audit of the first 2 years of Ponseti casting in the treatment of idiopathic congenital talipes equinovarus (CTEV, clubfoot) deformity, we identified 77 feet having been treated in 50 patients. Forty-nine feet were treated primarily in Oswestry, a tertiary referral centre for paediatric orthopaedic conditions, and 13 feet were treated in conjunction with the physiotherapy department at one of the region's district general hospitals (Leighton Hospital, Crewe, Cheshire). Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found in both cohorts. This 'hub-and-spoke' approach would appear to be efficient in terms of resource utilisation. Additional benefits for patients and their carers include ease of access to services and reduced financial and transport burdens.

  4. Description of the Implementation of Home Care Servicer at RS Murni Teguh, Medan


    Manalu, Ayu P Sary


    Home care service constitutes providing service and nurses’ equipment for patients and their families at home in order to keep their health, education, prevention from diseases, palliative therapy, and rehabilitation. Home care service at RS Murni Teguh, Medan, has its specification in management, compared with home care service in other places. The objective of the research was to find out the description of the implementation of home care service at RS Murni Teguh, Medan. The research used ...

  5. Occupational Therapy experience in family care in a primary health care service

    Directory of Open Access Journals (Sweden)

    Gisele Baissi


    Full Text Available Occupational therapy is presented as the core knowledge involved in the remodeling and strengthening of Primary Health Care in the Brazilian Unified Health Care System (Sistema Único de Saúde – SUS. In this study, we aimed to describe the interventions in the process of occupational therapy in supervised family care in a primary health care service in the municipality of Várzea Paulista, São Paulo state. In this case study, the moments of care were described and analyzed in light of narratives on the supervised practice of occupational therapy with a family. The results showed forms of intervention that characterize the process of occupational therapy focused on family health needs in favor of creativity and the role for changes in health practices in everyday life. Through the accomplishment of occupational activities directed to self-care, Occupational Therapy can aid families to cope with daily life adversity.

  6. Service innovations breaking institutionalized rules of health care

    DEFF Research Database (Denmark)

    Wallin, Arto; Fuglsang, Lars


    .e. regulations, normative rules, and cultural-cognitive beliefs) protecting the field by introducing digitally enabled service innovations into health care markets. Design/methodology/approach – The study is qualitative and interpretative in nature and utilizes case study as a research strategy. The paper...... is based on data that were collected through narrative interviews and document analysis from seven new ventures participating in a start-up accelerator program. Findings – Results indicate that service innovations that require a change in the institutional structures of the health care system are enacted...... through three highly iterative key processes: institutional sensemaking that creates an understanding of prevailing institutional arrangements and that constructs meaning for institutional change efforts, theorization of change through linguistic device, and modifications of institutions by building...

  7. Perceptions of the care received from Australian palliative care services: A caregiver perspective. (United States)

    Pidgeon, Tanya M; Johnson, Claire E; Lester, Leanne; Currow, David; Yates, Patsy; Allingham, Samuel F; Bird, Sonia; Eagar, Kathy


    ABSTRACTBackground:Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families. Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services. Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE-2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire. Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI95% = 0.32, 0.98), and with family support (OR = 0.52; CI95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI95% = 0.97, 0.98) and carer payments (OR = 0.99; CI95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI95% = 0.45, 0.81). While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in community settings. Caregiver surveys can facilitate the

  8. Youth with special health care needs: transition to adult health care services. (United States)

    Oswald, Donald P; Gilles, Donna L; Cannady, Mariel S; Wenzel, Donna B; Willis, Janet H; Bodurtha, Joann N


    Transition to adult services for children and youth with special health care needs (CYSHCN) has emerged as an important event in the life course of individuals with disabilities. Issues that interfere with efficient transition to adult health care include the perspectives of stakeholders, age limits on pediatric service, complexity of health conditions, a lack of experienced healthcare professionals in the adult arena, and health care financing for chronic and complex conditions. The purposes of this study were to develop a definition of successful transition and to identify determinants that were associated with a successful transition. The 2007 Survey of Adult Transition and Health dataset was used to select variables to be considered for defining success and for identifying predictors of success. The results showed that a small percentage of young adults who participated in the 2007 survey had experienced a successful transition from their pediatric care.

  9. Care services for older people in Europe - Challenges for Labour


    Lethbridge, Jane


    This report is published (March 2011) at a time when Europe stands at a crossroads. The economic crisis, austerity measures and the proposed European economic governance package risk not only to increase poverty and social exclusion but to have a devastating impact on the potential to build a sustainable and cohesive Europe.\\ud \\ud As the report notes, there is growing demand for more and better care services to address the needs of an ageing population. Potentially, Europe has the capacity t...

  10. Emergency Medical Services Capacity for Prehospital Stroke Care

    Centers for Disease Control (CDC) Podcasts


    In this audio podcast, lead author and Preventing Chronic Disease’s 2013 Student Research Contest Winner, Mehul D. Patel, talks about his article on stroke care and emergency medical services.  Created: 9/5/2013 by Preventing Chronic Disease (PCD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 9/5/2013.

  11. Capacitated Bounded Cardinality Hub Routing Problem: Model and Solution Algorithm


    Gelareha, Shahin; Monemic, Rahimeh Neamatian; Semetd, Frederic


    In this paper, we address the Bounded Cardinality Hub Location Routing with Route Capacity wherein each hub acts as a transshipment node for one directed route. The number of hubs lies between a minimum and a maximum and the hub-level network is a complete subgraph. The transshipment operations take place at the hub nodes and flow transfer time from a hub-level transporter to a spoke-level vehicle influences spoke- to-hub allocations. We propose a mathematical model and a branch-and-cut algor...

  12. A panchayat level primary-care approach for adolescent services. (United States)

    Nair, M K C; Leena, M L; George, Babu; Sunitha, R M; Prasanna, G L; Russell, P S


    To develop a model for providing community adolescent care services in the primary care setting Need assessment was done among adolescents and perceived problems of adolescents were studied using qualitative and quantitative methods. Based on the results of these studies, a Family Life Education (FLE) module was prepared. Awareness programs were organized for all stakeholders in the community on adolescent issues. All anganwadi workers in the panchayat were trained to take interactive sessions for all the adolescents in the panchayat using the FLE module. Ward based Teen Clubs were formed in all the 13 wards of the Panchayat separately for boys and girls and FLE classes were given to them through anganwadi workers. An Adolescent Clinic was set up to provide necessary medical and counseling facilities. Adolescent Health Card was distributed to all Teen Club members and those who attended the adolescent clinics. The present approach stresses the need and feasibility of adolescent-centered, community-based interventions. The authors' experience showed that before starting any adolescent program, community awareness generation about the need and content of the program is very important for its success. The experience of this model has made it possible to up-scale the program to seven districts of southern Kerala as a service model. The experiences of the program gave a realistic picture of the needs and problems of adolescents and a simple feasible model for providing services to adolescents in the primary care setting that can be easily replicated in other parts of India.

  13. Identifying profiles of service users in housing services and exploring their quality of life and care needs

    NARCIS (Netherlands)

    Bitter, N.A.; Roeg, D.P.K.; Van Nieuwenhuizen, Ch.; Van Weeghel, J.


    Background Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not

  14. Does integrated care lead to both improved service quality and lower care cost (United States)

    Waldeyer, Regina; Siegel, Achim; Daul, Gisela; Gaiser, Karin; Hildebrandt, Helmut; Köster, Ingrid; Schubert, Ingrid; Stunder, Brigitte; Stützle, Yvonne


    Purpose and context ‘Gesundes Kinzigtal’ is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The management company and its contracting partners (the physicians’ network in the region and two statutory health insurers) strive to reach a higher quality of care at a lower overall cost as compared with the German standard. During its first two years of operation (2006–2007), the Kinzigtal project achieved surprisingly positive financial results compared with its reference value. To gain independent evidence on the quality aspects of the system, the management company and its partners provided a remarkable budget for its evaluation by independent scientific institutions. Case description and data sources We will present interim results of a population-based controlled cohort study. In this study, quality of care is checked by relying on health and service quality indicators that have been constructed from health insurers’ administrative data (claims data). Interim results are presented for the intervention region (Kinzigtal area) and the control region (the rest of Baden-Württemberg, i.e., Southwest Germany). Preliminary conclusions and discussion The evaluation of ‘Gesundes Kinzigtal’ is in full progress. Until now, there is no evidence that the surprisingly positive financial results of the Kinzigtal system have been achieved at the expense of care quality. Rather, Gesundes Kinzigtal Integrated Care seems to be about to increasingly realize comparative advantages regarding health service quality (in comparison to the control region).

  15. Teaching wound care to family medicine residents on a wound care service

    Directory of Open Access Journals (Sweden)

    Little SH


    Full Text Available Sahoko H Little,1,2 Sunil S Menawat,1,3 Michael Worzniak,1 Michael D Fetters2 1Oakwood Annapolis Family Medicine Residency, Wayne, Michigan, USA; 2University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, USA; 3Ghent Family Medicine Residency, Eastern Virginia Medical School, Norfolk, Virginia, USA Abstract: Primary care physicians often care for patients with chronic wounds, and they can best serve patients if they have knowledge and proficient skills in chronic wound care, including sharp debridement. The Oakwood Annapolis Family Medicine Residency in Michigan, USA developed a Wound Care Service, incorporating wound care training during the surgical rotation. Effectiveness of the wound care training was evaluated through pre- and posttesting of residents, to assess changes in knowledge and comfort in treating chronic wounds. The results demonstrate significant improvement in residents’ knowledge and comfort in wound care. This innovation demonstrates the feasibility of educating residents in chronic wound care through hands-on experience. Keywords: wound care education, primary care, residency education, surgery rotation, curriculum development

  16. Cancer patients, emergencies service and provision of palliative care

    Directory of Open Access Journals (Sweden)

    Bruno Miranda


    Full Text Available SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011 with a minimum length of hospital stay of two hours. Student’s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%. 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%, breast (13.6% and prostate (10.5%; 70.7% were in advanced stages (IV, 47.1%; 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.

  17. netCare, a new collaborative primary health care service based in Swiss community pharmacies. (United States)

    Erni, Pina; von Overbeck, Jan; Reich, Oliver; Ruggli, Martine


    The Swiss Pharmacists Association has launched a new collaborative project, netCare. Community pharmacists provide a standard form with structured triage based on decision trees and document findings. As a backup, they can collaborate with physicians via video consultation. The aim of the study was to evaluate the impact of this service on the Swiss health care system. All pharmacists offering netCare completed two training courses, a course covering the most common medical conditions observed in primary health care and a specific course on all of the decision trees. The pharmacists were free to decide whether they would provide the usual care or offer netCare triage. The patient was also free to accept or refuse netCare. Pharmacists reported the type of ailment, procedure of the consultation, treatment, patient information and outcomes of the follow-up call on a standardized form submitted to the study center. Pharmacists from 162 pharmacies performed 4118 triages over a period of 21 months. A backup consultation was needed for 17% of the cases. In follow-up calls, 84% of the patients who were seen only by pharmacists reported complete relief or symptom reduction. netCare is a low-threshold service by which pharmacists can manage common medical conditions with physician backup, if needed. This study showed that a pharmacist could resolve a large proportion of the cases. However, to be efficient and sustainable, this service must be fully integrated into the health care system. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Utilization of Routine Primary Care Services Among Dancers. (United States)

    Alimena, Stephanie; Air, Mary E; Gribbin, Caitlin; Manejias, Elizabeth


    This study examines the current utilization of primary and preventive health care services among dancers in order to assess their self-reported primary care needs. Participants were 37 dancers from a variety of dance backgrounds who presented for a free dancer health screening in a large US metropolitan area (30 females, 7 males; mean age: 27.5 ± 7.4 years; age range: 19 to 49 years; mean years of professional dancing: 6.4 ± 5.4 years). Dancers were screened for use of primary care, mental health, and women's health resources using the Health Screen for Professional Dancers developed by the Task Force on Dancer Health. Most dancers had health insurance (62.2%), but within the last 2 years, only approximately half of them (54.1%) reported having a physical examination by a physician. Within the last year, 54.1% of dancers had had a dental check-up, and 56.7% of female dancers received gynecologic care. Thirty percent of female participants indicated irregular menstrual cycles, 16.7% had never been to a gynecologist, and 16.7% were taking birth control. Utilization of calcium and vitamin D supplementation was 27.0% and 29.7%, respectively, and 73.0% were interested in nutritional counseling. A high rate of psychological fatigue and sleep deprivation was found (35.1%), along with a concomitant high rate of self-reported need for mental health counseling (29.7%). Cigarette and recreational drug use was low (5.4% and 5.4%); however, 32.4% engaged in binge drinking within the last year (based on the CDC definition). These findings indicate that dancers infrequently access primary care services, despite high self-reported need for nutritional, mental, and menstrual health counseling and treatment. More studies are warranted to understand dancers' primary health care seeking behavior.

  19. Management of pharmaceutical services in the Brazilian primary health care. (United States)

    Gerlack, Letícia Farias; Karnikowski, Margô Gomes de Oliveira; Areda, Camila Alves; Galato, Dayani; Oliveira, Aline Gomes de; Álvares, Juliana; Leite, Silvana Nair; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis


    To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

  20. Spatial analysis of elderly access to primary care services

    Directory of Open Access Journals (Sweden)

    Lozano-Gracia Nancy


    Full Text Available Abstract Background Admissions for Ambulatory Care Sensitive Conditions (ACSCs are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates. Results We examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas. Conclusion The relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across

  1. 76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service... (United States)


    ... 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 of Day Care Homes for the Period July 1, 2011 Through June 30, 2012 Correction In notice document 2011-18257 appearin...

  2. Expectations of Health Care Professionals Regarding the Services

    Directory of Open Access Journals (Sweden)

    Somayeh Hanafi


    Full Text Available Background: The provision of accurate and timely drug information to health care professionals is an important mechanism to promote safe and effective drug therapy for patients. World’s Drug and Poison Information Centers (DPICs are mainly affiliated to hospitals, rather rarely with faculties of pharmacy or with faculties of medicine and other related organizations.Methods: Data was collected from a questionnaire which was distributed among 400 health care providers in April 2009. Data were analyzed using SPSS software (version 17.Results: Medical reference books and drug information textbooks (36.7% and expert colleagues (29.7% were the “most commonly” used drug information resources. In addition, 77.8% of respondents “almost never” use DPICs. About 77% of respondents were non- acquainted with these centers’ activities. Five expectations were considered ‘very important’ by respondents: Provide information on IV drugs incompatibilities (74%, Provide drug interaction information (70.1%, Provide new drugs information (56.5%, Education/training of health care professionals regarding rational drug therapy and prevention of medication errors (54.9%, Providing information on dosage forms of drugs available in Iran (53.5%.Conclusion: Being non acquaintance with services of DPIC centers can be considered as the most important reason of not using them. Considering “announcement of availability of drugs in pharmacy” as one of the activities of DPICs, shows that the health care professionals are not acquainted with real services of these centers. It shows an urgent need for culture building activities to introduce them to these centers services.

  3. Dimensions of quality of antenatal care service at Suez, Egypt

    Directory of Open Access Journals (Sweden)

    Hanan Abbas Abdo Abdel Rahman El Gammal


    Full Text Available Introduction: The 5 th millennium development goal aims at reducing maternal mortality by 75% by the year 2015. According to the World Health Organization, there was an estimated 358,000 maternal deaths globally in 2008. Developing countries accounted for 99% of these deaths of which three-fifths occurred in Sub-Saharan Africa. In primary health care (PHC, quality of antenatal care is fundamental and critically affects service continuity. Nevertheless, medical research ignores the issue and it is lacking scientific inquiry, particularly in Egypt. Aim of the Study: The aim of the following study is to assess the quality of antenatal care in urban Suez Governorate, Egypt. Materials and Methods: A cross-sectional primary health care center (PHCC based study conducted at five PHCC in urban Suez, Egypt. The total sample size collected from clients, physicians and medical records. Parameters assessed auditing of medical records, assessing provider and pregnant women satisfaction. Results: Nearly 97% of respondents were satisfied about the quality of antenatal care, while provider′s satisfaction was 61% and for file, auditing was 76.5 ° 5.6. Conclusion: The present study shows that client satisfaction, physicians′ satisfaction and auditing of medical record represent an idea about opportunities for improvement.

  4. Bowel management systems in critical care: a service evaluation. (United States)

    Ritzema, Jennifer


    Aim Many patients who are critically ill develop faecal incontinence associated with diarrhoea, and require a bowel management system (BMS) to prevent skin excoriation. Following guidelines produced by the National Institute for Health and Care Excellence, early rehabilitation has resulted in a reduction in the number of days that patients receive mechanical ventilation. However, patients with a BMS are potentially mechanically ventilated for longer because they are cared for in bed. The aim of this evaluation was to investigate whether patients with a BMS are mechanically ventilated for longer than those without a BMS. Method This was a retrospective service evaluation, in which a database search was conducted to identify patients admitted to the critical care department in one healthcare organisation during 2013. The search was narrowed to identify patients admitted to the critical care department who had received advanced respiratory support (mechanical ventilation), to compare the mean number of mechanically ventilated days between patients with and without a BMS (n = 122). Data were analysed using the Mann-Whitney U test. Results There was a significant difference in the number of mechanically ventilated days (Pcritically ill patients with a BMS are placed in a sitting position for short periods of time. Further research should explore alternative bowel care options for patients who are critically ill.

  5. Children With Special Health Care Needs: Child Health and Functioning Outcomes and Health Care Service Use. (United States)

    Caicedo, Carmen

    This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  6. Using the Contextual Hub Analysis Tool (CHAT) in Cytoscape to Identify Contextually Relevant Network Hubs. (United States)

    Muetze, Tanja; Lynn, David J


    Highly connected nodes in biological networks are called network hubs. Hubs are topologically important to the structure of the network and have been shown to be preferentially associated with a range of phenotypes of interest. The relative importance of a hub node, however, can change depending on the biological context. Here, we provide a step-by-step protocol for using the Contextual Hub Analysis Tool (CHAT), an application within Cytoscape 3, which enables users to easily construct and visualize a network of interactions from a gene or protein list of interest, integrate contextual information, such as gene or protein expression data, and identify hub nodes that are more highly connected to contextual nodes than expected by chance. © 2017 by John Wiley & Sons, Inc. Copyright © 2017 John Wiley & Sons, Inc.

  7. Quality of Prenatal Care Services in Karabuk Community Health Center

    Directory of Open Access Journals (Sweden)

    Binali Catak


    Full Text Available The aim of the study was to evaluate the quality and quantity of prenatal care services according to gestastional week in Karabuk Community Health Center (CHC. Methods: In this descriptive study 365 pregnant women was selected as sample among 753 pregnant women registered at Karabuk CHC in 18/01/2011. 93.0% of women in the selected sample has been visited in their homes and the face to face interviews were done. The questionnaire was prepared according to Prenatal Care Management Guidelines (PCMG of Ministry of Health. Findings The number of follow-ups was not complete in 23.7% of 15-24 month, 34.4% of 25-32 month, 52,1% of 33-42 month pregnant women. At least four follow-up visits were completed only in 66,7% of postpartum women. Timing of first visit was after 15th week in 15,6% of women. In follow up visits 62.5% of of women’s height were never measured, in 13,0% the women hearth sound of infants didn’t monitored at least once. Laboratory test numbers were under the level required by PCMG. The delivery conditions weren’t planned in 41,8% of last trimester and postpartum women and training about breastfeeding wasn’t given to 15,5 of the same group. Result In family medicine model in Karabuk CHC developments in number of prenatal follow-up visits were observed, but no substantial improvements were found in quality of prenatal visits. Regular in service trainings shoud be given to family doctors and midwives. The use of prenatal care guideline published by MoH should be increased. Keywords: Prenatal care, pregnancy, timing of first visit, qality of prenatal care [TAF Prev Med Bull 2012; 11(2.000: 153-162

  8. Contextual Hub Analysis Tool (CHAT): A Cytoscape app for identifying contextually relevant hubs in biological networks. (United States)

    Muetze, Tanja; Goenawan, Ivan H; Wiencko, Heather L; Bernal-Llinares, Manuel; Bryan, Kenneth; Lynn, David J


    Highly connected nodes (hubs) in biological networks are topologically important to the structure of the network and have also been shown to be preferentially associated with a range of phenotypes of interest. The relative importance of a hub node, however, can change depending on the biological context. Here, we report a Cytoscape app, the Contextual Hub Analysis Tool (CHAT), which enables users to easily construct and visualize a network of interactions from a gene or protein list of interest, integrate contextual information, such as gene expression or mass spectrometry data, and identify hub nodes that are more highly connected to contextual nodes (e.g. genes or proteins that are differentially expressed) than expected by chance. In a case study, we use CHAT to construct a network of genes that are differentially expressed in Dengue fever, a viral infection. CHAT was used to identify and compare contextual and degree-based hubs in this network. The top 20 degree-based hubs were enriched in pathways related to the cell cycle and cancer, which is likely due to the fact that proteins involved in these processes tend to be highly connected in general. In comparison, the top 20 contextual hubs were enriched in pathways commonly observed in a viral infection including pathways related to the immune response to viral infection. This analysis shows that such contextual hubs are considerably more biologically relevant than degree-based hubs and that analyses which rely on the identification of hubs solely based on their connectivity may be biased towards nodes that are highly connected in general rather than in the specific context of interest. CHAT is available for Cytoscape 3.0+ and can be installed via the Cytoscape App Store (

  9. Price elasticity of expenditure across health care services. (United States)

    Duarte, Fabian


    Policymakers in countries around the world are faced with rising health care costs and are debating ways to reform health care to reduce expenditures. Estimates of price elasticity of expenditure are a key component for predicting expenditures under alternative policies. Using unique individual-level data compiled from administrative records from the Chilean private health insurance market, I estimate the price elasticity of expenditures across a variety of health care services. I find elasticities that range between zero for the most acute service (appendectomy) and -2.08 for the most elective (psychologist visit). Moreover, the results show that at least one third of the elasticity is explained by the number of visits; the rest is explained by the intensity of each visit. Finally, I find that high-income individuals are five times more price sensitive than low-income individuals and that older individuals are less price-sensitive than young individuals. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers (United States)


    ... concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing... to ``RIN 2900-AN98--Payment for home health and services and hospice care by non-VA providers...

  11. Spatial Accessibility to Health Care Services: Identifying under-Serviced Neighbourhoods in Canadian Urban Areas.

    Directory of Open Access Journals (Sweden)

    Tayyab Ikram Shah

    Full Text Available Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods.This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population, was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons. An integrated geocoding approach was used to establish PHC locations.The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs.The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood

  12. Estimating Implementation and Operational Costs of an Integrated Tiered CD4 Service including Laboratory and Point of Care Testing in a Remote Health District in South Africa (United States)

    Cassim, Naseem; Coetzee, Lindi M.; Schnippel, Kathryn; Glencross, Deborah K.


    Background An integrated tiered service delivery model (ITSDM) has been proposed to provide ‘full-coverage’ of CD4 services throughout South Africa. Five tiers are described, defined by testing volumes and number of referring health-facilities. These include: (1) Tier-1/decentralized point-of-care service (POC) in a single site; Tier-2/POC-hub servicing processing 600 samples/day and serving >100 or >200 health-clinics, respectively. The objective of this study was to establish costs of existing and ITSDM-tiers 1, 2 and 3 in a remote, under-serviced district in South Africa. Methods Historical health-facility workload volumes from the Pixley-ka-Seme district, and the total volumes of CD4 tests performed by the adjacent district referral CD4 laboratories, linked to locations of all referring clinics and related laboratory-to-result turn-around time (LTR-TAT) data, were extracted from the NHLS Corporate-Data-Warehouse for the period April-2012 to March-2013. Tiers were costed separately (as a cost-per-result) including equipment, staffing, reagents and test consumable costs. A one-way sensitivity analyses provided for changes in reagent price, test volumes and personnel time. Results The lowest cost-per-result was noted for the existing laboratory-based Tiers- 4 and 5 ($6.24 and $5.37 respectively), but with related increased LTR-TAT of >24–48 hours. Full service coverage with TAT cost-per-result of $32.32 and $15.88 respectively. A single district Tier-3 laboratory also ensured ‘full service coverage’ and Implementing a single Tier-3/community laboratory to extend and improve delivery of services in Pixley-ka-Seme, with an estimated local ∼12–24-hour LTR-TAT, is ∼$2 more than existing referred services per-test, but 2–4 fold cheaper than implementing eight Tier-2/POC-hubs or providing twenty-seven Tier-1/POCT CD4 services. PMID:25517412

  13. Development of indicators for patient care and monitoring standards for secondary health care services of Mumbai. (United States)

    Malik, Seema S; D'Souza, Roshni Cynthia; Pashte, Pramod Mukund; Satoskar, Smita Manohar; D'Souza, Remilda Joyce


    The Qualitative aspect of health care delivery is one of the major factors in reducing morbidity and mortality in a health care setup. The expanding suburban secondary health care delivery facilities of the Municipal Corporation of Greater Mumbai are an important part of the healthcare backbone of Mumbai and therefore the quality of care delivered here needed standardization. The project was completed over a period of one year from Jan to Dec, 2013 and implemented in three phases. The framework with components and sub-components were developed and formats for data collection were standardized. The benchmarks were based on past performance in the same hospital and probability was used for development of normal range. An Excel spreadsheet was developed to facilitate data analysis. The indicators comprise of 3 components--Statutory Requirements, Patient care & Cure and Administrative efficiency. The measurements made, pointed to the broad areas needing attention. The Indicators for patient care and monitoring standards can be used as a self assessment tool for health care setups for standardization and improvement of delivery of health care services.

  14. The Patient Protection and Affordable Care Act and Utilization of Preventive Health Care Services

    Directory of Open Access Journals (Sweden)

    Victor Eno


    Full Text Available We examined how (a health insurance coverage, and (b familiarity with the Patient Protection and Affordable Care Act (ACA’s or ObamaCare mandate of cost-free access to preventive health services, affect the use of preventive services by residents of a minority community. It was based on primary data collected from a survey conducted during March to April 2012 among a sample of self-identified African American adults in Tallahassee-Leon County area of northwest Florida. The Statistical Package for the Social Sciences (SPSS Version 22 was used for running frequency analysis on the data set and multivariable regression modeling. The results showed that of 524 respondents, 382 (73% had health insurance while 142 (27% lacked insurance. Majority of insured respondents, 332 (87%, used preventive health services. However, the remaining 13% of respondents did not use preventive services because they were unfamiliar with the ACA provision of free access to preventive services for insured people. Regression analysis showed a high (91.04% probability that, among the insured, the use of preventive health services depended on the person’s age, income, and education. For uninsured residents, the lack of health insurance was the key reason for non-use of preventive health services, while among the insured, lack of knowledge about the ACA benefit of free access contributed to non-use of preventive services. Expansion of Medicaid eligibility can increase insurance coverage rates among African Americans and other minority populations. Health promotion and awareness campaigns about the law’s benefits by local and state health departments can enhance the use of preventive services.

  15. Patients' perceptions of services and preferences for care in amyotrophic lateral sclerosis: A review.

    LENUS (Irish Health Repository)

    Foley, Geraldine


    Abstract Service providers and service users often have different perspectives on health and social care services. We have undertaken a systematic review of empirical data between 1988 and March 2011 relating to ALS service users\\' perspectives on health and social care services. Forty-seven texts were extracted and a narrative synthesis conducted. Few studies have explored ALS patients\\' experiences in relation to their satisfaction with services. Our review showed that ALS patients expect dignified care but they are often dissatisfied with health care services and have unmet expectations of their care. Most studies of decision-making and preferences for care have focused on end-of-life intervention. Various factors influence preferences for care from the service user perspective and people with ALS may adjust their use of services as they negotiate change. In conclusion, further research on the timeliness of services to meet changing needs of service users is required. The service user experience of allied health care services prior to end-of-life care also warrants investigation. Service providers need to support people with ALS as they negotiate feelings of acceptance and independence. Research to identify the key parameters of the ALS patient experience of services is required.

  16. Personal care services provided to children with special health care needs (CSHCN) and their subsequent use of physician services. (United States)

    Miller, Thomas R; Elliott, Timothy R; McMaughan, Darcy M; Patnaik, Ashweeta; Naiser, Emily; Dyer, James A; Fournier, Constance J; Hawes, Catherine; Phillips, Charles D


    Medicaid Personal Care Services (PCS) help families meet children's needs for assistance with functional tasks. However, PCS may have other effects on a child's well-being, but research has not yet established the existence of such effects. To investigate the relationship between the number of PCS hours a child receives with subsequent visits to physicians for evaluation and management (E&M) services. Assessment data for 2058 CSHCN receiving PCS were collected in 2008 and 2009. Assessment data were matched with Medicaid claims data for the period of 1 year after the assessment. Zero-inflated negative binomial and generalized linear multivariate regression models were used in the analyses. These models included patient demographics, health status, household resources, and use of other medical services. For every 10 additional PCS hours authorized for a child, the odds of having an E&M physician visit in the next year were reduced by 25%. However, the number of PCS hours did not have a significant effect on the number of visits by those children who did have a subsequent E&M visit. A variety of demographic and health status measures also affect physician use. Medicaid PCS for CSHCN may be associated with reduced physician usage because of benefits realized by continuity of care, the early identification of potential health threats, or family and patient education. PCS services may contribute to a child's well-being by providing continuous relationships with the care team that promote good chronic disease management, education, and support for the family. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. 78 FR 17777 - Proposed Information Collection (Application for Furnishing Long-Term Care Service to... (United States)


    ... (Application for Furnishing Long- Term Care Service to Beneficiaries of Veterans Affairs, and Residential Care.... Application for Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170. b. Residential Care Home Program--Sponsor Application, VA Form 2407. OMB Control Number: 2900-0616. Type of...

  18. 75 FR 2595 - Proposed Information Collection (Application for Furnishing Long-Term Care Services to... (United States)


    ... (Application for Furnishing Long- Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care... comments for information needed to determine non-Federal nursing home or residential care home... information technology. Titles: a. Application for Furnishing Long-Term Care Services to Beneficiaries of...

  19. Health care: a community concern? : developments in the organization of Canadian health services

    National Research Council Canada - National Science Library

    Crichton, Anne


    ... Canadian Health Care Organizational Policies 1967-86 IV Service Delivery Systems and Their Response to the Need for Change to a Collective Care Organization 9. Care in the Doctor's Office 10. Support Services for Physicians in General Practice 11. Medical Practice Organization: Alternative Medical Care Delivery Models 12. Evolution of Public H...

  20. Home care clients in the last year of life: is material deprivation associated with service characteristics? (United States)

    Goodridge, Donna; Buckley, Alan; Marko, Josh; Steeves, Megan; Turner, Hollie; Whitehead, Steve


    To compare demographic, social, medical, and health care characteristics of home care clients in the last year of life by quintile of deprivation and examine associations between material deprivation and service characteristics. This retrospective study used administrative data for 700 clients who died while receiving home care services. Outcome measures were the receipt of supportive or palliative home care. Associations were assessed using multiple logistic regression. Material deprivation was not associated with either the hours of home care received or the receipt of supportive home care services. Clients with dementia or stroke, those were older than 80 years and those who were single were less likely to receive palliative care services than other groups. Inequalities in allocation of home care services based on age, diagnosis, and marital status, but not material deprivation, suggest the need to carefully match service with need at the end of life.

  1. Report on survey on international hub

    International Nuclear Information System (INIS)

    Ebisawa, Hirobumi; Hoshino, Junko; Hashimoto, Kazuichiro; Okada, Sohei


    Japan Atomic Energy Agency (JAEA) is promoting initiative to form an international hub in line with its aim to accept more researchers/engineers from all over the world. Establishment of 'the Committee for JAEA Internationalization Initiative' was planned in 2010 so as to intensify this initiative, and in February, 2010, we visited research institutions in Europe, which include European Organization for Nuclear Research (CERN), the construction site of ITER in Cadarache, and Rutherford Appleton Laboratory (RAL), with the intention to survey and learn their advanced activities and systems in regard to the International Hub, so that the committee will be able to make fruitful discussion. This report describes strategy taken in each institution for an International Hub, and the state of each institution regarding acceptance and management of overseas researchers and engineers, research environment, living environment/health and welfare, and PR activities/coexistence with the local community. (author)

  2. Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider


    Douglas, Heather E; Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I


    Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to su...

  3. Postrape care services to minors in Kenya: are the services healing or hurting survivors?

    Directory of Open Access Journals (Sweden)

    Wangamati CK


    Full Text Available Cynthia Khamala Wangamati,1 Viva Combs Thorsen,1 Abdi Ali Gele,2 Johanne Sundby1 1Department of Community Medicine, Faculty of Medicine, University of Oslo, 2Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway Abstract: Child sexual abuse is a global problem and a growing concern in Sub-Saharan Africa. It constitutes a profound violation of human rights. To address this problem, Kenya has established the Sexual Offences Act. In addition, Kenya has developed national guidelines on the management of sexual violence to grant minors access to health care. However, little is known about the experiences of sexually abused minors when they interact with the health and legal system. Accordingly, this study uses a triangulation of methods in the follow-up of two adolescent girls. Health records were reviewed, interactions between the girls and service providers were observed, in-depth interviews were conducted with the girls, and informal discussions were held with guardians and service providers. Findings indicated that the minors’ rights to quality health care and protection were being violated. Protocols on postrape care delivery were unavailable. Furthermore, the health facility was ill equipped and poorly stocked. Health providers showed little regard for informed assent, confidentiality, and privacy while offering postrape care. Similarly, in the justice system, processing was met with delays and unresponsive law enforcement. Health providers and police officers are in grave need of training in sexual and gender-based violence, its consequences, comprehensive postrape care, and sexual and reproductive health rights to ensure the protection of minors’ rights. Health administrators should ensure that facilities are equipped with skilled health providers, medical supplies, and equipment. Additionally, policies on the protection and care of sexually abused

  4. Increasing Registered Nurse Retention Using Mentors in Critical Care Services. (United States)

    Schroyer, Coreena C; Zellers, Rebecca; Abraham, Sam


    Recruiting and training 1 newly hired registered nurse can cost thousands of dollars. With a high percentage of these newly hired nurses leaving their first place of employment within their first year, the financial implications may be enormous. It is imperative that health care facilities invest in recruiting and retention programs that retain high-quality nurses. Mentorship programs in retaining and easing the transition to practice for new graduate nurses, re-entry nurses, and nurses new to a specialty area are critical in nurse retention. Discussion in this study includes the effect of implementing a mentor program into the critical care services area of a 325-bed not-for-profit community hospital in northern Indiana. Based on this study, nurses with a mentor were retained at a 25% higher rate than those not mentored. Implementation of a mentor program reduced the training cost to the facility and increased retention and morale.

  5. Patient satisfaction with primary health-care services in Kuwait. (United States)

    Alotaibi, Muhammad; Alazemi, Talal; Alazemi, Fahad; Bakir, Yusif


    The study aims to evaluate patient satisfaction with respect to primary health-care services in Kuwait.A total of 245 patients completed the General Practice Assessment Questionnaire postconsultation version 2.0. Two statistically significant differences of patients' satisfaction with sex and level of education were found. Overall satisfaction was higher among men than women (P = 0.002), and it was also higher among those with university degree of education than the other levels of education (P = 0.049). We also found statistically significant differences of patients' responses over sex for three themes, namely: satisfaction with receptionists, satisfaction with access and satisfaction with communication; and over the age for one theme: satisfaction with access. There was no statistically significant differences of patients' responses over nationality for all themes. Satisfaction is a multifactorial and no one factor alone could provide satisfaction with primary health services in Kuwait. © 2014 Wiley Publishing Asia Pty Ltd.

  6. Planning the Marketing Activity in the Health Care Services

    Directory of Open Access Journals (Sweden)

    Violeta Radulescu


    Full Text Available The integration of marketing in the field of health care, starting with the 50’s, was accompanied by a series of controversies generated by the ethical and moral aspects that this type of services imply, as well as by the difficulty in determining exactly the demand, the unequal access to information of participants, the regulated mechanism for the establishment of prices and of rates and the intervention of the third party payer, the significant role of the state in ensuring the fair access of population to basic services, etc.The formulation of the marketing strategies, in the marketing planning process, starts from the generic strategy chosen by the organization according to its mission and objectives. As it has to adapt to the environment where it acts, to cope with the changes that appear, the organization must benefit from a perspective vision, all its actions must be subordinated to this vision in a whole marketing policy.

  7. Hub Status and Indexation of Container Ports

    Directory of Open Access Journals (Sweden)

    Yong-An Park


    This study develops two sub-indexes of port classification and capacity, and combines cases of these two sub-indexes into various types in order to find a proper port hub index. The paper demonstrates how different types of port hub index are useful measurements for evaluating outputs and inputs of container ports. In a case analysis we show that the indexes of period variables and lagged variables have more explanatory power with regard to changes of port throughputs and high correlation with inputs.

  8. Permasalahan P-Hub Median Dengan Lintasan Terpendek


    Pasaribu, Raja David


    Hub are facilities that serve as sorting, switching, and transhipment in a transportation network. P-hub median problem is a discrete case location allocation problem which all hub is fully connected. In this paper will be intoduced Mixed Integrer Linear Programming (MILP) formulation models of cost for p-hub median problem allocation for uncapacitaced single allocation p-hub median(USApHMP). In this paper also introduced Floyd-Warshall shortest path algorithm to solve p-hub median problems a...

  9. [Care quality in intensive care evaluated by the patients using a service quality scale (SERVQUAL)]. (United States)

    Regaira Martínez, E; Sola Iriarte, M; Goñi Viguria, R; Del Barrio Linares, M; Margall Coscojuela, M A; Asiain Erro, M C


    The evaluation made by the patients on the quality of service received is important to introduce improvement strategies in the care quality. 1. To evaluate the care quality through the analysis of the differences obtained between expectations and perceptions, that the patients have of the service received in the ICU. 2. To analyze if there is any relationship between care quality evaluated by the patients and the sociodemographic variables. A total of 86 patients who were conscious and oriented during their stay in the ICU were studied prospectively. At 24h of the discharge from the ICU, the SERVQUAL (Service Quality) scale, adapted for the hospital setting by Babakus and Mangold (1992), was applied. This scale measures the care quality based on the difference in scores obtained between expectations and perceptions of the patients. The positive scores indicate that the perceptions of the patients exceed their expectations. The scale has 5 dimensions: Tangibility, Reliability, Responsiveness, Assurances and Empathy. It includes 15 items for perceptions and the same for expectations, with 5 grades of response (1 totally disagree - 5 totally agree). The mean score of perceptions 66.92) exceeded that of the expectations (62.30). The mean score of the difference between perceptions and expectations for the total of the SERVQUAL scale was 4.62. It was also positive for each one of the dimensions: Tangibility=1.44, Reliability=0.53, Responsiveness=0.95, Assurances=0.99, Empathy=0.71. No statistically significant associations were found between care quality evaluated by the patients and the sociodemographic variables. The care quality perceived by the patients in the ICU exceeds their expectations, and had no relationship with the sociodemographic characteristics. Copyright 2009 Elsevier España, S.L. y SEEIUC. All rights reserved.

  10. Research on the cultivation path of smart home-based care service mode in Internet+ vision


    Peng Qingchao


    Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explor...

  11. Gas and LNG trading hubs, hub indexation and destination flexibility in East Asia

    International Nuclear Information System (INIS)

    Shi, Xunpeng; Padinjare Variam, Hari Malamakkavu


    In the East Asian gas markets, issues like gas trading hubs, hub indexed pricing, and destination flexibility are being debated. This paper examines the impact of a change in East Asia's pricing benchmark and contract flexibility on the regional and global gas markets. The paper uses the Nexant World Gas Model, a linear program with global cost minimization as the objective. To our knowledge, this study on hub competition, price benchmark change and contract flexibility improvement in East Asia will be the first in the literature and have real policy relevance. The results show that both price benchmark change and contract flexibility improvements will create an overall benefit for the world and East Asia importers, but the impacts are different among exporters and importers. However, there is no evidence of competition among different benchmark hubs and no evidence that destination restrictions cause the “Asia Premium”. It implies that removal of destination clauses has higher priority than the change to hub indexation for Japan, Korea and Chinese Taipei, but both should be treated equally in China. The study also suggests that East Asian importers should cooperate among themselves and with exporters to facilitate the hub creation and contract changes in East Asia. - Highlights: •Gas trading hubs in Japan and China are not mutually exclusive. •Both price benchmark changes and contract flexibility improvements are beneficial. •The “Asian Premium” is not caused by destination restriction. •Destination flexibility is much more important than hub indexation in East Asia except China. •Hub indexation is as important as destination flexibility in China due to pipeline imports.

  12. Assessment of Customer Service in Academic Health Care Libraries (ACSAHL): an instrument for measuring customer service. (United States)

    Crossno, J E; Berkins, B; Gotcher, N; Hill, J L; McConoughey, M; Walters, M


    In a pilot study, the library had good results using SERVQUAL, a respected and often-used instrument for measuring customer satisfaction. The SERVQUAL instrument itself, however, received some serious and well-founded criticism from the respondents to our survey. The purpose of this study was to test the comparability of the results of SERVQUAL with a revised and shortened instrument modeled on SERVQUAL. The revised instrument, the Assessment of Customer Service in Academic Health Care Libraries (ACSAHL), was designed to better assess customer service in academic health care libraries. Surveys were sent to clients who had used the document delivery services at three academic medical libraries in Texas over the previous twelve to eighteen months. ACSAHL surveys were sent exclusively to clients at University of Texas (UT) Southwestern, while the client pools at the two other institutions were randomly divided and provided either SERVQUAL or ACSAHL surveys. Results indicated that more respondents preferred the shorter ACSAHL instrument to the longer and more complex SERVQUAL instrument. Also, comparing the scores from both surveys indicated that ACSAHL elicited comparable results. ACSAHL appears to measure the same type of data in similar settings, but additional testing is recommended both to confirm the survey's results through data replication and to investigate whether the instrument applies to different service areas.

  13. Which need characteristics influence healthcare service utilization in home care arrangements in Germany? (United States)

    Dorin, Lena; Turner, Suzi C; Beckmann, Lea; große Schlarmann, Jörg; Faatz, Andreas; Metzing, Sabine; Büscher, Andreas


    We see a growing number of older adults receiving long-term care in industrialized countries. The Healthcare Utilization Model by Andersen suggests that individual need characteristics influence utilization. The purpose of this study is to analyze correlations between need characteristics and service utilization in home care arrangements. 1,152 respondents answered the questionnaire regarding their integration of services in their current and future care arrangements. Care recipients with high long-term care needs answered the questionnaire on their own, the family caregiver assisted the care recipient in answering the questions, or the family caregiver responded to the questionnaire on behalf of the care recipient. They were asked to rank specific needs according to their situation. We used descriptive statistics and regression analysis. Respondents are widely informed about services. Nursing services and counseling are the most used services. Short-term care and guidance and training have a high potential for future use. Day care, self-help groups, and mobile services were the most frequently rejected services in our survey. Women use more services than men and with rising age utilization increases. Long waiting times and bad health of the primary caregiver increases the chance of integrating services into the home care arrangements. The primary family caregiver has a high impact on service utilization. This indicates that the whole family should be approached when offering services. Professionals should react upon the specific needs of care dependents and their families.

  14. Research on the cultivation path of smart home-based care service mode in Internet+ vision

    Directory of Open Access Journals (Sweden)

    Peng Qingchao


    Full Text Available Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explores the path to realize the establishment of Internet+ home-based care service mode so as to promote the healthy development of home-based care service in China.

  15. Product and service design for patient centered diabetes care

    Directory of Open Access Journals (Sweden)

    Soumitri Varadarajan


    Full Text Available Design plays a marginal part in the discourse of diabetes care, mainly in visualizing the form and packaging of medical technologies. The authors however have a practice that advocates that design orientated solutions can add much needed dimensions to problems that havetraditionally been the exclusive preserve of expert discourses. This position has for long been a validated and largely accepted approach in design’s engagement withissues in sustainability and development studies. A similar approach in the area of medicine has been constructed bythe authors and marks out a position of advocacy where the designer takes on agency to intervene on behalf of the user community. This position contains a healthy critique of thetraditional approach of product design for manufacture while simultaneously amplifying a desire to intervene and make a substantial improvement in the quality of life ofpeople with diabetes. This article first opens out contemporary diabetes care as a contested domain and then goes on to sketch out the key aspects of a design practice focussed upon delivering positive health outcomes in diabetes care. The specific context of discussion for this article is the practice of teaching in design studios wherestudents of design listen to the voices of people with diabetes and visualize ways for design to provide products and service solutions that transform the lived experiences of people with diabetes.

  16. Emerging Education Hubs: The Case of Singapore (United States)

    Sidhu, Ravinder; Ho, K.-C.; Yeoh, Brenda


    In anticipation of a globalising post-Fordist political economy, countries and universities are increasingly pursuing strategic transnational education and research alliances. This article analyses the Global Schoolhouse, a key education policy platform that aims to transform Singapore into a knowledge and innovation hub by establishing networks…

  17. Hub location problems in transportation networks

    DEFF Research Database (Denmark)

    Gelareh, Shahin; Nickel, Stefan


    In this paper we propose a 4-index formulation for the uncapacitated multiple allocation hub location problem tailored for urban transport and liner shipping network design. This formulation is very tight and most of the tractable instances for MIP solvers are optimally solvable at the root node....... also introduce fixed cost values for Australian Post (AP) dataset....

  18. Exploring hubness in Regional Trade Agreements

    NARCIS (Netherlands)

    Vaal, A. de


    In the plethora of Regional Trade Agreements (RTAs) some countries take in a more central position than others in the sense that some countries are much more engaged with other countries through RTAs. Furthermore, the position of some countries is that of a hub: they have (many) trade

  19. Hubs and spokes in Regional Trade Agreements

    NARCIS (Netherlands)

    Vaal, A. de


    In the plethora of Regional Trade Agreements (RTAs) some countries are involved in much more RTAs than others. Furthermore, some countries take in a position as a hub: they have trade agreements with many other countries, while their partner countries are much less involved in RTA relations. Even

  20. Home care: from adequate funding to integration of services. (United States)

    Hébert, Réjean


    With the aging of the population, the healthcare system needs to shift from the actual hospital-centred system developed in the past century for dealing with acute diseases and a young population toward a home-centred system, more appropriate for serving older people with chronic diseases. Funding of home care should not only be significantly increased but also be managed differently. We propose the introduction of an autonomy support benefit (ASB) to cover costs related to disabilities, irrespective of living environment, and to set up a public universal autonomy insurance program that will cover the ASB. This insurance should be at least partly capitalized to provide for the aging of the population and to ensure intergenerational equity. Also, since the home is a much more complicated service-delivery environment than the hospital, these services must be coordinated and integrated. The Program of Research to Integrate the Services for the Maintenance of Autonomy (PRISMA) is a coordination-type model of integration that was implemented and evaluated in three areas (one urban and two rural) in and around Sherbrooke, Quebec. A four-year longitudinal quasi-experimental study with over 1,500 participants demonstrated its efficiency in improving system effectiveness at no extra cost.

  1. Health care demand elasticities by type of service. (United States)

    Ellis, Randall P; Martins, Bruno; Zhu, Wenjia


    We estimate within-year price elasticities of demand for detailed health care services using an instrumental variable strategy, in which individual monthly cost shares are instrumented by employer-year-plan-month average cost shares. A specification using backward myopic prices gives more plausible and stable results than using forward myopic prices. Using 171 million person-months spanning 73 employers from 2008 to 2014, we estimate that the overall demand elasticity by backward myopic consumers is -0.44, with higher elasticities of demand for pharmaceuticals (-0.44), specialists visits (-0.32), MRIs (-0.29) and mental health/substance abuse (-0.26), and lower elasticities for prevention visits (-0.02) and emergency rooms (-0.04). Demand response is lower for children, in larger firms, among hourly waged employees, and for sicker people. Overall the method appears promising for estimating elasticities for highly disaggregated services although the approach does not work well on services that are very expensive or persistent. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. The role of nurses in commissioning services within primary care. (United States)

    Leach, Katherine; Shepherd, Alison Burton


    This article is a critical reflection on the role of the nurse in commissioning a service within the primary care setting. It will use the fictitious example of commissioning a nurse-led crisis prevention service in the London borough of Lambeth as an exemplar to highlight the difficulties surrounding the commissioning process. In placing particular focus on the prevalence of smoking, it is suggested that designing services based around tackling 'clusters' of unhealthy risk factors such as smoking, diet and excessive alcohol consumption may be a more holistic approach to delivering better healthcare outcomes for more socioeconomically deprived populations as opposed to previous national siloed attempts (Buck and Forsini 2012;1). It will argue that despite multifaceted and evolving roles, community nurses are ideally placed to recognise compounding risk factors detrimental to health as they work at the interface between the individual and their environment. This awareness can be used to positively impact on the commissioning process but only if greater attention is paid towards enhancing leadership skills throughout nursing, and the rhetoric of effective collaboration across agencies is translated into practice (Ham et al, 2012; NHS Commissioning Board (NHS CB), 2012), NHS Alliance, 2011).

  3. Access to emergency care services: a transversal ecological study about Brazilian emergency health care network. (United States)

    Rocha, T A H; da Silva, N C; Amaral, P V; Barbosa, A C Q; Rocha, J V M; Alvares, V; de Almeida, D G; Thumé, E; Thomaz, E B A F; de Sousa Queiroz, R C; de Souza, M R; Lein, A; Toomey, N; Staton, C A; Vissoci, J R N; Facchini, L A


    Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). Cross-sectional ecological study. Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  4. [Current Status of Home Visit Programs: Activities and Barriers of Home Care Nursing Services]. (United States)

    Oh, Eui Geum; Lee, Hyun Joo; Kim, Yukyung; Sung, Ji Hyun; Park, Young Su; Yoo, Jae Yong; Woo, Soohee


    The purpose of this study was to examine the current status of home care nursing services provided by community health nurses and to identify barriers to the services. A cross-sectional survey was conducted with three types of community health care nurses. Participants were 257 nurses, 46 of whom were hospital based home care nurses, 176 were community based visiting nurses, and 35 were long term care insurance based visiting nurses. A structured questionnaire on 7 domains of home care nursing services with a 4-point Likert scale was used to measure activities and barriers to care. Data were analyzed using SPSS WIN 21.0 program. Hospital based home care nurses showed a high level of service performance activity in the domain of clinical laboratory tests, medications and injections, therapeutic nursing, and education. Community based visiting nurses had a high level of service performance in the reference domain. Long term care insurance based visiting nurses showed a high level of performance in the service domains of fundamental nursing and counseling. The results show that although health care service provided by the three types of community health nurse overlapped, the focus of the service is differentiated. Therefore, these results suggest that existing home care services will need to be utilized efficiently in the development of a new nursing care service for patients living in the community after hospital discharge.

  5. Clients' perception of service quality of care in health facilities in ...

    African Journals Online (AJOL)

    Introduction: Clients perception of service quality is important for utilization of health services. Clients with positive perception are more likely to comply with treatment and to continue to use health care services. Assessing clients' perception of services offered is crucial for improving delivery and organization of the services.

  6. Home and community care services: a major opportunity for preventive health care

    Directory of Open Access Journals (Sweden)

    Lujic Sanja


    Full Text Available Abstract Background In Australia, the Home and Community Care (HACC program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk. Methods We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models. Results 4,978 (4.8% participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis

  7. Multiple-Localization and Hub Proteins (United States)

    Ota, Motonori; Gonja, Hideki; Koike, Ryotaro; Fukuchi, Satoshi


    Protein-protein interactions are fundamental for all biological phenomena, and protein-protein interaction networks provide a global view of the interactions. The hub proteins, with many interaction partners, play vital roles in the networks. We investigated the subcellular localizations of proteins in the human network, and found that the ones localized in multiple subcellular compartments, especially the nucleus/cytoplasm proteins (NCP), the cytoplasm/cell membrane proteins (CMP), and the nucleus/cytoplasm/cell membrane proteins (NCMP), tend to be hubs. Examinations of keywords suggested that among NCP, those related to post-translational modifications and transcription functions are the major contributors to the large number of interactions. These types of proteins are characterized by a multi-domain architecture and intrinsic disorder. A survey of the typical hub proteins with prominent numbers of interaction partners in the type revealed that most are either transcription factors or co-regulators involved in signaling pathways. They translocate from the cytoplasm to the nucleus, triggered by the phosphorylation and/or ubiquitination of intrinsically disordered regions. Among CMP and NCMP, the contributors to the numerous interactions are related to either kinase or ubiquitin ligase activity. Many of them reside on the cytoplasmic side of the cell membrane, and act as the upstream regulators of signaling pathways. Overall, these hub proteins function to transfer external signals to the nucleus, through the cell membrane and the cytoplasm. Our analysis suggests that multiple-localization is a crucial concept to characterize groups of hub proteins and their biological functions in cellular information processing. PMID:27285823

  8. Cancer preventive services, socioeconomic status, and the Affordable Care Act. (United States)

    Cooper, Gregory S; Kou, Tzuyung Doug; Dor, Avi; Koroukian, Siran M; Schluchter, Mark D


    Out-of-pocket expenditures are thought to be an important barrier to the receipt of cancer preventive services, especially for those of a lower socioeconomic status (SES). The Affordable Care Act (ACA) eliminated out-of-pocket expenditures for recommended services, including mammography and colonoscopy. The objective of this study was to determine changes in the uptake of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after ACA implementation. Using Medicare claims data, this study identified women who were 70 years old or older and had not undergone mammography in the previous 2 years and men and women who were 70 years old or older, were at increased risk for colorectal cancer, and had not undergone colonoscopy in the past 5 years. The receipt of procedures in the 2-year period before the ACA's implementation (2009-2010) and after its implementation (2011 to September 2012) was also identified. Multivariate generalized estimating equation models were used to determine the independent association and county-level quartile of median income and education with the receipt of testing. For mammography, a lower SES quartile was associated with less uptake, but the post-ACA disparities were smaller than those in the pre-ACA period. In addition, mammography rates increased from the pre-ACA period to the post-ACA period in all SES quartiles. For colonoscopy, in both the pre- and post-ACA periods, there was an association between uptake and educational level and, to some extent, income. However, there were no appreciable changes in colonoscopy and SES after implementation of the ACA. The removal of out-of-pocket expenditures may overcome a barrier to the receipt of recommended preventive services, but for colonoscopy, other procedural factors may remain as deterrents. Cancer 2017;123:1585-1589. © 2017 American Cancer Society. © 2017 American Cancer Society.

  9. Technologies for HIV prevention and care: challenges for health services. (United States)

    Maksud, Ivia; Fernandes, Nilo Martinez; Filgueiras, Sandra Lucia


    This article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.

  10. Data Collection and Management with ENSITE HUB: ENSITE HUB Version 1.0 (United States)


    ER D C/ CE RL S R- 17 -1 4 Engineer Site Identification for the Tactical Environment (ENSITE) Data Collection and Management with ENSITE...and Management with ENSITE HUB ENSITE HUB Version 1.0 Juliana M. Wilhoit, Natalie R. Myers, and George W. Calfas Construction Engineering Research...and standardized manner. With such a tool, CB planners (as well as designers, operators, and manag - ers) can rapidly assess possible current and

  11. Barriers to utilization of antenatal care services in Eastern Nepal

    Directory of Open Access Journals (Sweden)

    Krishna Kumar eDeo


    Full Text Available BackgroundWorld Health Organization (WHO recommends at least four pregnancy check-ups for normal pregnancies. Ministry of Health and Population (MOHP Nepal has introduced various strategies to promote prenatal care and institutional delivery to reduce maternal and child deaths. However, maternal health service utilization is low in some selected and socio-economic and ethnic groups. Hence, this study aims to assess barriers to the recommended four antenatal care (4ANC visits in eastern Nepal.MethodsA cross-sectional quantitative study was conducted in Sunsari district. A total of 372 randomly selected women who delivered in the last year preceding the survey were interviewed using a semi-structured questionnaire. Bivariate and multivariate logistic regression analysis was carried out to identify barriers associated with 4ANC visits.ResultsMore than two-third women (69% attended at least 4ANC visits. The study revealed that women exposed to media had higher chance of receiving four or more ANC visits with an adjusted Odds Ratio (aOR=3.5, 95% CI: 1.2-10.1 in comparison to women who did not. Women from an advantaged ethnic group had more chance of having 4ANC visits than respondents from a disadvantaged ethnic group (aOR=2.4, 95% CI: 2.1-6.9. Similarly, women having a higher level of autonomy were nearly three times more likely (aOR= 2.9, 95%CI: 1.5-5.6 and richer women were twice (aOR=2.3, 95% CI: 1.1-5.3 as likely to have at least 4ANC visits compared to women who had a lower level of autonomy and were economically poor.ConclusionBeing from disadvantaged ethnicity, lower women?s autonomy, poor knowledge of maternal health service and incentive upon completion of ANC, less media exposure related to maternal health service, and lower wealth rank were significantly associated with fewer than the recommended 4ANC visits. Thus, maternal health programs need to address such socio-cultural barriers for effective health care utilization.

  12. The role of affect in consumer evaluation of health care services. (United States)

    Ng, Sandy; Russell-Bennett, Rebekah


    Health care services are typically consumed out of necessity, typically to recover from illness. While the consumption of health care services can be emotional given that consumers experience fear, hope, relief, and joy, surprisingly, there is little research on the role of consumer affect in health care consumption. We propose that consumer affect is a heuristic cue that drives evaluation of health care services. Drawing from cognitive appraisal theory and affect-as-information theory, this article tests a research model (N = 492) that investigates consumer affect resulting from service performance on subsequent service outcomes.

  13. Socioeconomic inequalities in the access to and quality of health care services

    Directory of Open Access Journals (Sweden)

    Bruno Pereira Nunes


    Full Text Available OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days for assistance, and waiting time (in hours in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.

  14. Schools as Community Hubs: Policy Contexts, Educational Rationales, and Design Challenges (United States)

    McShane, Ian; Watkins, Jerry; Meredyth, Denise


    There is increasing interest in making more effective use of schools as community hubs, both in Australia and internationally. Investment in shared facilities aims to engage parents and local communities in schooling, encourage civic participation, co-ordinate educational and community services and overcome disadvantages of location or service…

  15. Fleet deployment, network design and hub location of liner shipping companies

    DEFF Research Database (Denmark)

    Gelareh, Shahin; Pisinger, David


    A mixed integer linear programming formulation is proposed for the simultaneous design of network and fleet deployment of a deep-sea liner service provider. The underlying network design problem is based on a 4-index (5-index by considering capacity type) formulation of the hub location problem...

  16. VHA Support Service Center Primary Care Management Module (PCMM) (United States)

    Department of Veterans Affairs — The Primary Care Management Module (PCMM) was developed to assist VA facilities in implementing Primary Care. PCMM supports both Primary Care and non-Primary Care...

  17. Modelagem para localização de hubs no transporte de encomendas expressas Modelling for location hubs in the express cargo transport

    Directory of Open Access Journals (Sweden)

    Javier Antonio Timaná Alamo


    Full Text Available Na presente pesquisa se propõe um modelo matemático de programação linear com variáveis binárias 0/1, para projetar a configuração de uma rede de distribuição de encomendas expressas, visando minimizar os custos e garantindo um bom nível de serviço. O modelo, que é uma modificação da formulação proposta por O’Kelly, define as posições dos hubs, a alocação deles às demais instalações físicas e a construção de roteiros com apenas uma parada intermediária, o que confere mais agilidade ao atendimento da demanda de transporte de carga. Considera-se a instalação de um único hub maior (Hub Principal, que serve como ponto de transbordo para os fluxos de carga entre as distintas regiões de um território, e um conjunto de terminais regionais (mini-hubs, servindo como ponto de conexão, unicamente, para os fluxos de carga existentes em um determinado raio de cobertura. Foram propostas extensões que incluem uma restrição da capacidade operacional do Hub Principal, para evitar seu congestionamento, e duas diferentes estratégias de induzir o aumento de fluxo de carga manipulado pelos mini-hubs. O modelo proposto e suas extensões foram aplicados ao estudo de um caso real, obtendo-se resultados consistentes e uma redução significativa no custo total da rede de distribuição da empresa analisada.This study proposes a mathematical model of linear programming with binary variables 0/1 to project the configuration of a distribution network for express cargo which aims to minimize costs and guarantee a high level of service. The model, which is a modification of the formulation proposed by O’Kelly, defines the position of the hubs, their allocation regarding the other physical installations, and the building of itineraries with only one intermediate stop, which increases agility in meeting the demand of cargo transport. It assumes the installation of a single, major hub (Main Hub, which serves as the transfer point for

  18. Variation in critical care services across North America and Western Europe

    NARCIS (Netherlands)

    Wunsch, Hannah; Angus, Derek C.; Harrison, David A.; Collange, Olivier; Fowler, Robert; Hoste, Eric A. J.; de Keizer, Nicolette F.; Kersten, Alexander; Linde-Zwirble, Walter T.; Sandiumenge, Alberto; Rowan, Kathryn M.


    Objective: Critical care represents a large percentage of healthcare spending in developed countries. Yet, little is known regarding international variation in critical care services. We sought to understand differences in critical care delivery by comparing data on the distribution of services in

  19. Transforming Data into Practical Information: Using Consumer Input to Improve Home-Care Services (United States)

    Applebaum, Robert; Kunkel, Suzanne; Wilson, Ken


    Purpose: As funds have increased for the provision of in-home care, so too have concerns about the quality of services. In response, care management agencies and home-care providers have developed an array of monitoring activities designed to ensure the quality of services. In this article, we show how an area agency on aging both collected and…

  20. Dental Care Presents The Highest Level Of Financial Barriers, Compared To Other Types Of Health Care Services. (United States)

    Vujicic, Marko; Buchmueller, Thomas; Klein, Rachel


    The Affordable Care Act is improving access to and the affordability of a wide range of health care services. While dental care for children is part of the law's essential health benefits and state Medicaid programs must cover it, coverage of dental care for adults is not guaranteed. As a result, even with the recent health insurance expansion, many Americans face financial barriers to receiving dental care that lead to unmet oral health needs. Using data from the 2014 National Health Interview Survey, we analyzed financial barriers to a wide range of health care services. We found that irrespective of age, income level, and type of insurance, more people reported financial barriers to receiving dental care, compared to any other type of health care. We discuss policy options to address financial barriers to dental care, particularly for adults. Project HOPE—The People-to-People Health Foundation, Inc.

  1. Reconstructing continuity of care in mental health services : a multilevel conceptual framework

    NARCIS (Netherlands)

    Wierdsma, Andre; Mulder, Cornelis; de Vries, Sanne; Sytema, Sjoerd

    Continuity of mental health care is a key issue in the organization and evaluation of services for patients with disabling chronic conditions. Over many years, health services researchers have been exploring the conceptual boundaries between continuity of care and other service characteristics. On

  2. Physicians' perceptions about the quality of primary health care services in transitional Albania

    NARCIS (Netherlands)

    Kellici, Neritan; Dibra, Arvin; Mihani, Joana; Kellici, Suela; Burazeri, Genc

    AIM: To date, the available information regarding the quality of primary health care services in Albania is scarce. The aim of our study was to assess the quality of primary health care services in Albania based on physicians' perceptions towards the quality of the services provided to the general

  3. Improving Older Adults' Functional Ability through Service Use in a Home Care Program in Hong Kong (United States)

    Cheung, Chau-kiu; Ngan, Raymond Man-hung


    Objective: Despite past findings about the contribution of home care services to older users' functional ability, the effective processes and components of the services are not transparent. Such processes appear to rely on the actual use of component services of the home care program. Method: The study gathered 116 observations during 2 years…

  4. Supply and Demand for Child Care Services in Turkey : A Mixed Methods Study


    World Bank


    Despite increases in availability of center based child care and preschool services in Turkey over the last decade, both the supply of services and utilization remain low. There are regional disparities in availability and the majority of children and households remain unserved in terms of child care and preschool services. This report has collected and assessed information on the supply a...

  5. Collaboration in the provision of mental health care services

    DEFF Research Database (Denmark)

    Jaruseviciene, L.; Valius, L.; Lazarus, J.V.


    collaboration with mental health teams were a lack of GPs'confidence in their communication skills and ability to diagnose the most frequent mental disorders, prompt referral to mental health team specialists, low estimation of the prevalence of non-managed mental disorders, and location of mental health team......Background. General practitioners (GPs) often become the first point of care for mental health issues. Improved collaboration between GPs and mental health teams can make a GP's mental health services more efficient. Objective. The aim of this study was to assess the collaboration between GPs...... and mental health team members and determine predictors for better collaboration. Methods. In this cross-sectional study, a 41- item questionnaire was distributed to a random sample of 797 Lithuanian GPs. The purpose of this questionnaire was to obtain knowledge about current practices of GPs in providing...

  6. Midwest gas and power markets, hubs, pipelines, and interconnects

    International Nuclear Information System (INIS)

    Wirick, J.


    The existing interstate pipelines and proposed pipeline projects for the Chicago hub area were illustrated. The presentation explained why energy suppliers in the current competitive market need to balance and manage energy and transportation services for gas-fired power generators in terms of hourly winter and summer peaking services. The new infrastructure of the energy market will include new pipelines, storage and balancing to meet the ever increasing power demand. One of the options to meet power demand is to increase natural gas supply, transportation, storage, and hourly balancing capabilities. Other options are to build nuclear or coal-fired power generating facilities, or to go with renewables such as solar and wind power. Energy conservation and the reduction of natural gas usage per capita is another option to eliminate blackouts. This presentation also addressed the role that local distribution companies (LDC) and unbundling will play in the choice of these options. tabs., figs

  7. Southwest Regional Climate Hub and California Subsidiary Hub assessment of climate change vulnerability and adaptation and mitigation strategies (United States)

    Emile Elias; Caiti Steele; Kris Havstad; Kerri Steenwerth; Jeanne Chambers; Helena Deswood; Amber Kerr; Albert Rango; Mark Schwartz; Peter Stine; Rachel Steele


    This report is a joint effort of the Southwest Regional Climate Hub and the California Subsidiary Hub (Sub Hub). The Southwest Regional Climate Hub covers Arizona, California, Hawai‘i and the U.S. affiliated Pacific Islands, Nevada, New Mexico, and Utah and contains vast areas of western rangeland, forests, and high-value specialty crops (Figure 1). The California Sub...

  8. Planning future care services: Analyses of investments in Norwegian municipalities. (United States)

    Hagen, Terje P; Tingvold, Laila


    To analyse whether the Norwegian Central Government's goal of subsidizing 12,000 places in nursing homes or sheltered housing using an earmarked grant was reached and to determine towards which group of users the planned investments were targeted. Data from the investment plans at municipal level were provided by the Norwegian Housing Bank and linked to variables describing the municipalities' financial situation as well as variables describing the local needs for services provided by Statistics Norway. Using regression analyses we estimated the associations between municipal characteristics and planned investments in total and by type of care place. The Norwegian Central Government reached its goal of giving subsidies to 12,000 new or rebuilt places in nursing homes and sheltered housing. A total of 54% of the subsidies (6878 places) were given to places in nursing homes. About 7500 places were available by the end of the planning period and the rest were under construction. About 50% of the places were planned for user groups aged Investments in nursing homes were correlated with the share of the population older than 80 years and investments in sheltered houses were correlated with the share of users with intellectual disabilities. Earmarked grants to municipalities can be adequate measures to affect local resource allocation and thereby stimulate investments in future care. With the current institutional setup the municipalities adapt investments to local needs.

  9. Absenteeism and its implications for nursing care in emergency services

    Directory of Open Access Journals (Sweden)

    Ione Carvalho Pinto


    Full Text Available The aim of this study was to identify the frequency of absenteeism among nursing teams and its determinants in healthcare emergency services. A cross-sectional study was carried out by means of secondary data from records of a coordination of human resources. Occurrences with 208 nursing professionals were identified. Univariate analysis was carried out with frequency calculation of the variables age, gender, professional category, workplace, and days and reasons for absenteeism. Fisher’s exact test was applied, fixing the error type I in 5%. The mean age of the participants was 47.2 years, with a prevalence of the female gender (79.8%. A total of 5,778 occurrences of absenteeism were found (mean of 28 per professional, and illness was the main determinant for absenteeism (2,671 occurrences; 46.2%. There was a prevalence of short-term absenteeism (3,020 occurrences; 52.3%. The findings observed in emergency services were similar, with a potential impact on planning, workforce, and quality of care.

  10. Effectiveness of regionalization of trauma care services: a systematic review. (United States)

    Vali, Y; Rashidian, A; Jalili, M; Omidvari, A H; Jeddian, A


    Improving trauma systems in various forms has always been an important aspect of health policy. While several papers have reported the implementation of a structured trauma system of care, research evidence on the effectiveness of such regionalization for improvement in trauma outcome is limited. Systematic review. Medline, EMbase, EconLit and Health Management Information Consortium were searched, using sensitive search terms, for interventional studies that reported a trauma regionalization system as their intervention, and compared important outcomes such as mortality and preventable deaths. At least two authors assessed eligibility for inclusion and risk of bias, and extracted data from the included studies. As meta-analysis was not possible for all studies, two controlled before-after studies were included in the meta-analysis, and a narrative analysis was conducted for the other studies. After title and abstract sifting, 66 papers were retrieved. After reading the full texts, a total of 24 studies from the USA, UK, Canada, Australia, and the Netherlands were included in this review. In spite of variation in study specifications, most were before-after studies with a high risk of bias. Although a reduction in mortality was shown in most studies, only two studies were eligible for meta-analysis, and the results showed a significant reduction in mortality after implementation of an organized trauma system (odds ratio 0.840, 95% confidence interval 0.756-0.924; P = 0.00). Correlation was found between a regionalized network of trauma care and a reduction in trauma-related mortality, based on studies that did not exclude the effects of other concurrent changes on observed reductions. It is recommended that more studies with robust research designs should be conducted in a more diverse range of countries to assess the effectiveness of regionalization. Despite this limitation, the present findings support the regionalization of trauma care services. Copyright

  11. A comparison of the home-care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home-care service. (United States)

    Lewin, Gill; Allan, Janine; Patterson, Candice; Knuiman, Matthew; Boldy, Duncan; Hendrie, Delia


    Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure--the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. © 2014 The Authors. Health and Social Care in the Community published by John

  12. Using assistive technology services at differing levels of care: healthy older couples' perceptions. (United States)

    Harrefors, Christina; Axelsson, Karin; Sävenstedt, Stefan


    The aim of the study was to describe healthy older couples' perceptions of using assistive technology services when needing assistance with care. The use of information technology-based assistive technology services in elder care has increased as a result of an increase of care performed in private homes. The use of assistive technology services in care of older people at home has been evaluated as something positive by patients, relatives and nursing staff, while as resistance to their increased use has also been noted. Twelve healthy couples, aged over 70 years, from northern Sweden were interviewed in 2005 about their perceptions of using assistive technology services in the case of being in need of assistance with personal care. Open, individual semi-structured interviews supported by written vignettes describing three levels of caring needs were used and the data analysed with content analysis. The findings were interpreted as one main theme with three categories: Asset or threat depends on caring needs and abilities. Three categories were identified within the theme: Assistive technology services provide an opportunity; The consequences of using assistive technology services are hard to anticipate; and Fear of assistive technology services when completely dependent on care. Trust and security in the care of older people who are severely ill, dependent on care and living at home should be a hallmark in using assistive technology services. Human presence is an important dimension and must be considered when developing concepts for use of assistive technology services.

  13. The development of hospitalbased palliative care services in public hospitals in the Western Cape South Africa

    Directory of Open Access Journals (Sweden)

    L Gwyther


    Full Text Available With the recent approval of a South African (SA National Policy Framework and Strategy for Palliative Care by the National Health Council, it is pertinent to reflect on initiatives to develop palliative care services in public hospitals. This article reviews the development of hospital-based palliative care services in the Western Cape, SA. Palliative care services in SA started in the non-governmental sector in the 1980s. The first SA hospital-based palliative care team was established in Charlotte Maxeke Johannesburg Academic Hospital in 2001. The awareness of the benefit of palliative care in the hospital setting led to the development of isolated pockets of excellence providing palliative care in the public health sector in SA. This article describes models for palliative care at tertiary, provincial and district hospital level, which could inform development of hospital-based palliative care as the national policy for palliative care is implemented in SA.

  14. The BioHub Knowledge Base: Ontology and Repository for Sustainable Biosourcing. (United States)

    Read, Warren J; Demetriou, George; Nenadic, Goran; Ruddock, Noel; Stevens, Robert; Winter, Jerry


    The motivation for the BioHub project is to create an Integrated Knowledge Management System (IKMS) that will enable chemists to source ingredients from bio-renewables, rather than from non-sustainable sources such as fossil oil and its derivatives. The BioHubKB is the data repository of the IKMS; it employs Semantic Web technologies, especially OWL, to host data about chemical transformations, bio-renewable feedstocks, co-product streams and their chemical components. Access to this knowledge base is provided to other modules within the IKMS through a set of RESTful web services, driven by SPARQL queries to a Sesame back-end. The BioHubKB re-uses several bio-ontologies and bespoke extensions, primarily for chemical feedstocks and products, to form its knowledge organisation schema. Parts of plants form feedstocks, while various processes generate co-product streams that contain certain chemicals. Both chemicals and transformations are associated with certain qualities, which the BioHubKB also attempts to capture. Of immediate commercial and industrial importance is to estimate the cost of particular sets of chemical transformations (leading to candidate surfactants) performed in sequence, and these costs too are captured. Data are sourced from companies' internal knowledge and document stores, and from the publicly available literature. Both text analytics and manual curation play their part in populating the ontology. We describe the prototype IKMS, the BioHubKB and the services that it supports for the IKMS. The BioHubKB can be found via .

  15. Design and Development of an Integrated Workstation Automation Hub

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Andrew; Ghatikar, Girish; Sartor, Dale; Lanzisera, Steven


    Miscellaneous Electronic Loads (MELs) account for one third of all electricity consumption in U.S. commercial buildings, and are drivers for a significant energy use in India. Many of the MEL-specific plug-load devices are concentrated at workstations in offices. The use of intelligence, and integrated controls and communications at the workstation for an Office Automation Hub – offers the opportunity to improve both energy efficiency and occupant comfort, along with services for Smart Grid operations. Software and hardware solutions are available from a wide array of vendors for the different components, but an integrated system with interoperable communications is yet to be developed and deployed. In this study, we propose system- and component-level specifications for the Office Automation Hub, their functions, and a prioritized list for the design of a proof-of-concept system. Leveraging the strength of both the U.S. and India technology sectors, this specification serves as a guide for researchers and industry in both countries to support the development, testing, and evaluation of a prototype product. Further evaluation of such integrated technologies for performance and cost is necessary to identify the potential to reduce energy consumptions in MELs and to improve occupant comfort.

  16. Report on survey on international Hub

    International Nuclear Information System (INIS)

    Ebisawa, Hirobumi; Hoshino, Junko; Hashimoto, Kazuichiro; Okada, Sohei


    Japan Atomic Energy Agency (JAEA) is promoting initiative to form an international Center of Excellence in line with its aim to accept more researchers/engineers from all over the world. Establishment of 'the Committee for JAEA Internationalization Initiative' was planned in 2010 so as to intensify this initiative, and in February, 2010, we visited research institutions in Europe, which include European Organization for Nuclear Research (CERN), the construction site of ITER in Cadarache, and Rutherford Appleton Laboratory (RAL), with the intention to survey and learn their advanced activities and systems in regard to the International Hub, so that the committee will be able to make fruitful discussion. This report describes strategy taken in each institution for an International Hub, and the state of each institution regarding acceptance and management of overseas researchers and engineers, research environment, living environment/health and welfare, and PR activities/coexistence with the local community. (author)

  17. Functional Hubs in Mild Cognitive Impairment (United States)

    Navas, Adrián; Papo, David; Boccaletti, Stefano; Del-Pozo, F.; Bajo, Ricardo; Maestú, Fernando; Martínez, J. H.; Gil, Pablo; Sendiña-Nadal, Irene; Buldú, Javier M.

    We investigate how hubs of functional brain networks are modified as a result of mild cognitive impairment (MCI), a condition causing a slight but noticeable decline in cognitive abilities, which sometimes precedes the onset of Alzheimer's disease. We used magnetoencephalography (MEG) to investigate the functional brain networks of a group of patients suffering from MCI and a control group of healthy subjects, during the execution of a short-term memory task. Couplings between brain sites were evaluated using synchronization likelihood, from which a network of functional interdependencies was constructed and the centrality, i.e. importance, of their nodes was quantified. The results showed that, with respect to healthy controls, MCI patients were associated with decreases and increases in hub centrality respectively in occipital and central scalp regions, supporting the hypothesis that MCI modifies functional brain network topology, leading to more random structures.

  18. Conceptualising health services in terms of level and location of care

    African Journals Online (AJOL)

    location of care, are complex combinations of services. They encompass all levels of care ... expression in the recently published ANC health plan. This more comprehensive ..... business of training PHC providers and basic specialists as.

  19. Webcasting in home and hospice care services: virtual communication in home care. (United States)

    Smith-Stoner, Marilyn


    The access to free live webcasting over home computers was much more available in 2007, when three military leaders from West Point, with the purpose of helping military personnel stay connected with their families when deployed, developed There are many types of Web-based video streaming applications. This article describes Ustream, a free and effective communication tool to virtually connect staff. There are many features in Ustream, but the most useful for home care and hospice service providers is its ability to broadcast sound and video to anyone with a broadband Internet connection, a chat room for users to interact during a presentation, and the ability to have a "co-host" or second person also broadcast simultaneously. Agencies that provide community-based services in the home will benefit from integration of Web-based video streaming into their communication strategy.

  20. Hub River: A private power prototype

    International Nuclear Information System (INIS)

    Sachs, J.L.


    This article examines the challenges of financing an independent power project in a developing country. The oil-fired plant is to be located on the Hub River in Baluchistan on the Arabian Sea coast. The topics of the article include a description of the team that put the project together, the financing plans, the risk in the face of political unrest and change of governments, and the beginning of construction of the project

  1. A State Cyber Hub Operations Framework (United States)


    current and future decision support. Finally, the Hub operations team must track and report key performance indictors ( KPIs ) (established by the state...Region); then mutually agreed-upon core KPIs should be identified and reported at this time. The goal of the Act Element is to implement the decision...Force Headquarters Page 58 JIE Joint Information Environment JMC JIE Management Construct KPI Key Performance Indicator LEA Law Enforcement

  2. Primary Care Providers' experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle


    Full Text Available This study explored primary care providers' (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 "MTM is just part of our team approach to the practice of medicine": MTM as an integral part of PCPs' practices; (2 "Frankly it's education for the patient but it's also education for me": MTM services as a source of education; (3 "It's not exactly just the pharmacist that passes out the medicines at the pharmacy": The MTM practitioner is different from the dispensing pharmacist; (4 "So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved": MTM services as preventative health care efforts; (5"I think that time is the big thing": MTM pharmacists spend more time with patients; (6 "There's an access piece, there's an availability piece, there's a finance piece": MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge äóñmedication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients' medications, and their capability to

  3. Primary Care Providers’ experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle, Pharm.D.


    Full Text Available This study explored primary care providers’ (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 “MTM is just part of our team approach to the practice of medicine”: MTM as an integral part of PCPs’ practices; (2 “Frankly it’s education for the patient but it’s also education for me”: MTM services as a source of education; (3 “It’s not exactly just the pharmacist that passes out the medicines at the pharmacy”: The MTM practitioner is different from the dispensing pharmacist; (4 “So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved”: MTM services as preventative health care efforts; (5“I think that time is the big thing”: MTM pharmacists spend more time with patients; (6 “There’s an access piece, there’s an availability piece, there’s a finance piece”: MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge –medication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients

  4. Awareness, knowledge, and barriers to low vision services among eye care practitioners

    Directory of Open Access Journals (Sweden)

    Judy Jose


    Conclusion: The study results showed that there is a lack of awareness among eye care practitioners about low vision services, which acts as a major barrier in the effective delivery of these services.

  5. Is There Time Enough? Temporal Resources and Service Performance in the Danish Home Care Sector

    DEFF Research Database (Denmark)

    Tufte, Pernille


    constitutes a challenge to care workers’ own sense and valuation of their work. The article is informed by two theoretical perspectives: standardization of care services and performance of care work in private homes. Empirically, the article examines how care workers perceive the relations between...

  6. 78 FR 38810 - Proposed Information Collection (Application for Furnishing Long-Term Care Service to... (United States)


    ... (Application for Furnishing Long- Term Care Service to Beneficiaries of Veterans Affairs, and Residential Care.... 2900-0616.'' SUPPLEMENTARY INFORMATION: Title: Residential Care Home Program--Sponsor Application, VA... collection. Abstract: VA Form 10-2407 is an application used by a residential care facility or home that...

  7. Nature and determinants of customer expectations of service recovery in health care. (United States)

    Dasu, S; Rao, J


    Service recovery refers to the service provider's response to a dissatisfied customer. This article proposes a model of customer expectations of service recovery in health care services. The model discusses two types of service recovery expectations: will and should. An exploratory study indicates that industry reputation and personal experiences drive customers' "will-expectations" of service recovery while "should-expectations" can be explained via norm, fairness, social contract and hospitality theories.

  8. Perceived needs of pharmaceutical care services among healthcare professionals in South Korea: a qualitative study. (United States)

    Lee, Iyn-Hyang; Rhie, Sandy Jeong; Je, Nam Kyung; Rhew, Ki Yon; Ji, Eunhee; Oh, Jung Mi; Lee, Euni; Yoon, Jeong-Hyun


    Purpose To explore the need for pharmaceutical care services, key features of desirable pharmacy services, and perceived barriers for advancing the services in hospital environments with doctors and nurses who are key co-workers of the interdisciplinary team care services.Methods Semi-structured, in-depth interviews with eighteen doctors and fifteen nurses employing purposive and snowballing sampling strategies were conducted in ten hospitals in South Korea. Results The level of pharmaceutical care was varied across regions or institutions in South Korea. The concept of pharmaceutical care was insufficiently defined, and tended to be limited to some parts of medication counseling. Through pharmaceutical care services, doctors desired to acquire comprehensive drug information from and to share clinical responsibilities with pharmacists. Nurses wished to lower their burdens of medication counseling services from their daily practices. Doctors and nurses asked for pharmacists providing essential and carefully selected medication information to their patients in a patient-centered manner. The listed barriers to pharmaceutical care included the lack of appropriate systems for reward, insufficient accessibility to patient records by pharmacists, ambiguous role descriptions of pharmacist, and absence of effective communication among professionals. Conclusion A successful pharmaceutical care service model should allow efficient exchange of information among healthcare professionals to build inter-professional trust and to provide a continuity of care both in terms of time and setting. As prerequisites of such system, it was warranted to develop clinical evidence and an appropriate reward system for pharmaceutical care services.

  9. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    Directory of Open Access Journals (Sweden)

    Koopmanschap Marc A


    Full Text Available Abstract Background Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses patient costs after stroke and compares costs between regular and stroke service care. Methods Costs were calculated within the framework of the evaluation of three experiments with stroke services in the Netherlands. Cost calculations are base on medical consumption data and actual costs. Results 598 patients were consecutively admitted to hospital after stroke. The average total costs of care per patient for the 6 month follow-up are estimated at €16,000. Costs are dominated by institutional and accommodation costs. Patients who die after stroke incur less costs. For patients that survive the acute phase, the most important determinants of costs are disability status and having a partner – as they influence patients' stroke careers. These determinants also interact. The most efficient stroke service experiment was most successful in co-ordinating patient flow from hospital to (nursing home, through capacity planning and efficient discharge procedures. In this region the costs of stroke service care are the same as for regular stroke care. The other experiments suffered from waiting lists for nursing homes and home care, leading to "blocked beds" in hospitals and nursing homes and higher costs of care. Costs of co-ordination are estimated at about 3% of total costs of care. Conclusion This paper demonstrates that by organising care for stroke patients in a stroke service, better health effects can be achieved with the same budget. In addition, it provides insight in need, predisposing and enabling factors that determine costs of care after stroke.

  10. Quality evaluation in health care services based on customer-provider relationships. (United States)

    Eiriz, Vasco; Figueiredo, José António


    To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. Systematic review of the literature. Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non-technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence). This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing-oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.

  11. Measuring quality of dental care: Caries prevention services for children. (United States)

    Herndon, Jill Boylston; Tomar, Scott L; Catalanotto, Frank A; Rudner, Nancy; Huang, I-Chan; Aravamudhan, Krishna; Shenkman, Elizabeth A; Crall, James J


    The authors conducted a study to validate the following 3 evidence-based, process-of-care quality measures focused on dental caries prevention for children with an elevated risk of experiencing caries: sealants for 6- to 9-year-olds, sealants for 10- to 14-year-olds, and topical fluoride. Using evidence-based guidelines, the Dental Quality Alliance developed measures for implementation with administrative data at the plan and program levels. To validate the measures, the authors used data from the Florida and Texas Medicaid programs and Children's Health Insurance Programs and from national commercial dental benefit plans. Data were extracted from 414 randomly selected dental office records to validate the use of administrative data to accurately calculate the measures. The authors also assessed statistically significant variations in overall measure performance. Agreement between administrative data and dental records was 95% for sealants (κ = 0.82) and 90% for topical fluoride (κ = 0.78). Sensitivity and specificity were 90.7% and 88.5% for topical fluoride and 77.8% and 98.8% for sealants, respectively. Variation in overall measure performance was greatest for topical fluoride (χ(2) = 5,887.1; P caries received at least 2 topical fluoride applications during the reporting year. Although there was greater variation in performance for sealants for 6- to 9-year-olds (range, 21.0-31.3%; χ(2) = 548.6; P caries prevention process-of-care quality measures can be implemented feasibly and validly using administrative claims data. The measures can be used to assess, monitor, and improve the proportion of children with an elevated risk of experiencing dental caries who receive evidence-based caries prevention services. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

  12. Parent and child usual source of care and children's receipt of health care services. (United States)

    DeVoe, Jennifer E; Tillotson, Carrie J; Wallace, Lorraine S; Angier, Heather; Carlson, Matthew J; Gold, Rachel


    PURPOSE In the United States, children who have a usual source of care (USC) have better access to health care than those who do not, but little is known about how parental USC affects children's access. We examined the association between child and parent USC patterns and children's access to health care services. METHODS We undertook a secondary analysis of nationally representative, cross-sectional data from children participating in the 2002-2007 Medical Expenditure Panel Survey (n = 56,302). We assessed 10 outcome measures: insurance coverage gaps, no doctor visits in the past year, less than yearly dental visits, unmet medical and prescription needs, delayed care, problems getting care, and unmet preventive counseling needs regarding healthy eating, regular exercise, car safety devices, and bicycle helmets. RESULTS Among children, 78.6% had a USC and at least 1 parent with a USC, whereas 12.4% had a USC but no parent USC. Children with a USC but no parent USC had a higher likelihood of several unmet needs, including an insurance coverage gap (adjusted risk ratio [aRR] 1.33; 95% confidence interval [CI], 1.21-1.47), an unmet medical or prescription need (aRR 1.70; 95% CI 1.09-2.65), and no yearly dental visits (aRR 1.12; 95% CI 1.06-1.18), compared with children with a USC whose parent(s) had a USC. CONCLUSIONS Among children with a USC, having no parent USC was associated with a higher likelihood of reporting unmet needs when compared with children whose parent(s) had a USC. Policy reforms should ensure access to a USC for all family members.

  13. Transfer of patients from health care centres to special care services: analysis of travel distances in Nordic countries. (United States)

    Vuori, Jari; Kylänen, Marika; Tritter, Jonathan


    This paper highlights the importance of analysing patient transportation in Nordic circumpolar areas. The research questions we asked are as follows: How many Finnish patients have been transferred to special care intra-country and inter-country in 2009? Does it make any difference to health care policymakers if patients are transferred inter-country? We analysed the differences in distances from health care centres to special care services within Finland, Sweden and Norway and considered the health care policy implications. An analysis of the time required to drive between service providers using the "Google distance meter" (; conducting interviews with key Finnish stakeholders; and undertaking a quantitative analyses of referral data from the Lapland Hospital District. Finnish patients are generally not transferred for health care services across national borders even if the distances are shorter. Finnish patients have limited access to health care services in circumpolar areas across the Nordic countries for 2 reasons. First, health professionals in Norway and Sweden do not speak Finnish, which presents a language problem. Second, the Social Insurance Institution of Finland does not cover the expenditures of travel or the costs of medicine. In addition, it seems that in circumpolar areas the density of Finnish service providers is greater than Swedish ones, causing many Swedish citizens to transfer to Finnish health care providers every year. However, future research is needed to determine the precise reasons for this.

  14. Shared care between specialised psychiatric services and primary care: The experiences and expectations of General Practitioners in Ireland.

    LENUS (Irish Health Repository)

    Agyapong, Vincent Israel Opoku


    Objective. The study aims to explore the views of General Practitioners in Ireland on shared care between specialised psychiatric services and primary care. Method. A self-administered questionnaire was designed and posted to 400 randomly selected General Practitioners working in Ireland. Results. Of the respondents, 189 (94%) reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 124 (61.4%) reported that they foresaw difficulties for patients in implementing such a policy including: a concern that primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (113, 53.2%); a concern this would result in increased financial burden on some patients (89, 48.8%); a lack of adequate cooperation between primary care and specialised mental health services (84, 41.8%); a concern that some patients may lack confidence in GP care (55, 27.4%); and that primary care providers are not adequately trained to provide psychiatric care (29, 14.4% ). Conclusion. The majority of GPs in Ireland would support a policy of shared care of psychiatric patients; however they raise significant concerns regarding practical implications of such a policy in Ireland.

  15. Volunteers in Specialist Palliative Care: A Survey of Adult Services in the United Kingdom (United States)

    Burbeck, Rachel; Low, Joe; Sampson, Elizabeth L.; Bravery, Ruth; Hill, Matthew; Morris, Sara; Ockenden, Nick; Payne, Sheila


    Abstract Background: Worldwide, the demand for specialist palliative care is increasing but funding is limited. The role of volunteers is underresearched, although their contribution reduces costs significantly. Understanding what volunteers do is vital to ensure services develop appropriately to meet the challenges faced by providers of palliative care. Objective: The study's objective is to describe current involvement of volunteers with direct patient/family contact in U.K. specialist palliative care. Design: An online survey was sent to 290 U.K. adult hospices and specialist palliative care services involving volunteers covering service characteristics, involvement and numbers of volunteers, settings in which they are involved, extent of involvement in care services, specific activities undertaken in each setting, and use of professional skills. Results: The survey had a 67% response rate. Volunteers were most commonly involved in day care and bereavement services. They entirely ran some complementary therapy, beauty therapy/hairdressing, and pastoral/faith-based care services, and were involved in a wide range of activities, including sitting with dying patients. Conclusions: This comprehensive survey of volunteer activity in U.K. specialist palliative care provides an up-to-date picture of volunteer involvement in direct contact with patients and their families, such as providing emotional care, and the extent of their involvement in day and bereavement services. Further research could focus on exploring their involvement in bereavement care. PMID:24475743

  16. 25 CFR 20.508 - What must the social services agency do when a child is placed in foster care, residential care... (United States)


    ... PROGRAMS Child Assistance Foster Care § 20.508 What must the social services agency do when a child is placed in foster care, residential care or guardianship home? The social services agency must make... placed in foster care, residential care or guardianship home? 20.508 Section 20.508 Indians BUREAU OF...

  17. Care and Service at Home for Persons With Dementia in Europe. (United States)

    Bökberg, Christina; Ahlström, Gerd; Leino-Kilpi, Helena; Soto-Martin, Maria E; Cabrera, Esther; Verbeek, Hilde; Saks, Kai; Stephan, Astrid; Sutcliffe, Caroline; Karlsson, Staffan


    To describe available and utilized formal care and service at home for persons with dementia, from diagnosis to end-of-life stage, in eight European countries. A descriptive cross-country design concerning eight European countries as a part of the European research project RightTimePlaceCare. The research team in each country used a mapping system to collect country-specific information concerning dementia care and service system. The mapping system consists of 50 types of care and service activities. Sixteen of the 50 predefined activities concerning care and service at home were selected for this study and subdivided into three categories, following the stages of dementia. Availability was reported to be higher than utilization, and the findings indicated more similarities than differences among the eight countries involved. Even though there were several available activities of "basic care and services" and "healthcare interventions," they were utilized by few in most countries. Furthermore, "specialized dementia care and services" were sparsely available and even more sparsely utilized in the participating countries. The findings indicated that persons with dementia in Europe received formal care and service on a general, basic level but seldom adjusted to their specific needs. This study describes the gap between service provision and utilization enabling nurses to develop individually adjusted care plans for persons with dementia during the progress of the disease. The findings do not include matters of quality of care or how to best organize effective care and services. However, the activities of care and services presented here should shed light on what room there is for improvement when it comes to enabling persons with dementia to go on living at home. © 2015 Sigma Theta Tau International.

  18. Improving care planning and coordination for service users with medical co-morbidity transitioning between tertiary medical and primary care services. (United States)

    Cranwell, K; Polacsek, M; McCann, T V


    WHAT IS KNOWN ON THE SUBJECT?: Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments. Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services. Little is known about mental health nurses' perspectives about how to address these problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive. The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation. Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity. Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments. Introduction Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim To explore mental health nurses

  19. Urban-rural disparity in utilization of preventive care services in China. (United States)

    Liu, Xiang; Li, Ningxiu; Liu, Chaojie; Ren, Xiaohui; Liu, Danping; Gao, Bo; Liu, Yuanyuan


    Preventive care service is considered pivotal on the background of demographic ageing and a rise in chronic diseases in China. The disparity in utilization of preventive care services between urban and rural in China is a serious issue. In this paper, we explored factors associated with urban-rural disparity in utilization of preventive care services in China, and determined how much of the urban-rural disparity was attributable to each determinant of utilization in preventive care services. Using representative sample data from China Health and Nutrition Survey in 2011 (N = 12,976), the present study performed multilevel logistic model to examine the factors that affected utilization of preventive care services in last 4 weeks. Blinder-Oaxaca decomposition method was applied to divide the utilization of preventive care disparity between urban and rural residents into a part that can be explained by differences in observed covariates and unobserved part. The percentage of rural residents utilizing preventive care service in last 4 weeks was lower than that of urban residents (5.1% vs 9.3%). Female, the aged, residents with higher education level and household income, residents reporting self-perceived illness in last 4 weeks and physician-diagnosed chronic disease had higher likelihood of utilizing preventive care services. Household income was the most important factor accounting for 26.6% of urban-rural disparities in utilization of preventive care services, followed by education (21.5%), self-perceived illness in last 4 weeks (7.8%), hypertension (4.4%), diabetes (3.3%), other chronic diseases (0.8%), and health insurance (-1.0%). Efforts to reduce financial barriers for low-income individuals who cannot afford preventive services, increasing awareness of the importance of obtaining preventive health services and providing more preventive health services covered by health insurance, may help to reduce the gap of preventive care services utilization between

  20. Decision Makers' Allocation of Home-Care Therapy Services: A Process Map (United States)

    Poss, Jeff; Egan, Mary; Rappolt, Susan; Berg, Katherine


    ABSTRACT Purpose: To explore decision-making processes currently used in allocating occupational and physical therapy services in home care for complex long-stay clients in Ontario. Method: An exploratory study using key-informant interviews and client vignettes was conducted with home-care decision makers (case managers and directors) from four home-care regions in Ontario. The interview data were analyzed using the framework analysis method. Results: The decision-making process for allocating therapy services has four stages: intake, assessment, referral to service provider, and reassessment. There are variations in the management processes deployed at each stage. The major variation is in the process of determining the volume of therapy services across home-care regions, primarily as a result of financial constraints affecting the home-care programme. Government funding methods and methods of information sharing also significantly affect home-care therapy allocation. Conclusion: Financial constraints in home care are the primary contextual factor affecting allocation of therapy services across home-care regions. Given the inflation of health care costs, new models of funding and service delivery need to be developed to ensure that the right person receives the right care before deteriorating and requiring more costly long-term care. PMID:24403672

  1. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    N.J.A. van Exel (Job); M.A. Koopmanschap (Marc); J.D.H. van Wijngaarden (Jeroen); W.J.M. Scholte op Reimer (Wilma)


    textabstractBackground. Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses

  2. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    M.A. Koopmanschap (Marc); W.J.M. Scholte op Reimer (Wilma); J.D.H. van Wijngaarden (Jeroen); N.J.A. van Exel (Job)


    textabstractBACKGROUND: Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients.

  3. MyGeoHub: A Collaborative Geospatial Research and Education Platform (United States)

    Kalyanam, R.; Zhao, L.; Biehl, L. L.; Song, C. X.; Merwade, V.; Villoria, N.


    Scientific research is increasingly collaborative and globally distributed; research groups now rely on web-based scientific tools and data management systems to simplify their day-to-day collaborative workflows. However, such tools often lack seamless interfaces, requiring researchers to contend with manual data transfers, annotation and sharing. MyGeoHub is a web platform that supports out-of-the-box, seamless workflows involving data ingestion, metadata extraction, analysis, sharing and publication. MyGeoHub is built on the HUBzero cyberinfrastructure platform and adds general-purpose software building blocks (GABBs), for geospatial data management, visualization and analysis. A data management building block iData, processes geospatial files, extracting metadata for keyword and map-based search while enabling quick previews. iData is pervasive, allowing access through a web interface, scientific tools on MyGeoHub or even mobile field devices via a data service API. GABBs includes a Python map library as well as map widgets that in a few lines of code, generate complete geospatial visualization web interfaces for scientific tools. GABBs also includes powerful tools that can be used with no programming effort. The GeoBuilder tool provides an intuitive wizard for importing multi-variable, geo-located time series data (typical of sensor readings, GPS trackers) to build visualizations supporting data filtering and plotting. MyGeoHub has been used in tutorials at scientific conferences and educational activities for K-12 students. MyGeoHub is also constantly evolving; the recent addition of Jupyter and R Shiny notebook environments enable reproducible, richly interactive geospatial analyses and applications ranging from simple pre-processing to published tools. MyGeoHub is not a monolithic geospatial science gateway, instead it supports diverse needs ranging from just a feature-rich data management system, to complex scientific tools and workflows.

  4. Experimental Investigation of a Helicopter Rotor Hub Wake (United States)

    Reich, David; Elbing, Brian; Schmitz, Sven


    A scaled model of a notional helicopter rotor hub was tested in the 48'' Garfield Thomas Water Tunnel at the Applied Research Laboratory Penn State. The main objectives of the experiment were to understand the spatial- and temporal content of the unsteady wake downstream of a rotor hub up to a distance corresponding to the empennage. Primary measurements were the total hub drag and velocity measurements at three nominal downstream locations. Various flow structures were identified and linked to geometric features of the hub model. The most prominent structures were two-per-revolution (hub component: scissors) and four-per-revolution (hub component: main hub arms) vortices shed by the hub. Both the two-per-revolution and four-per-revolution structures persisted far downstream of the hub, but the rate of dissipation was greater for the four-per-rev structures. This work provides a dataset for enhanced understanding of the fundamental physics underlying rotor hub flows and serves as validation data for future CFD analyses.

  5. Caring for Our Future: The Content of Prenatal Care. A Report of the Public Health Service Expert Panel on the Content of Prenatal Care. (United States)

    National Institutes of Health (DHHS), Bethesda, MD.

    This report describes effective approaches for enhancing maternal, infant, and family outcomes based on the scientific and systematic assessment of the content of prenatal care conducted by the Public Health Service's Expert Panel on the Content of Prenatal Care. The range of risks, both medical and psychosocial, that the prenatal care provider…

  6. Association of British Clinical Diabetologists (ABCD): survey of specialist diabetes care services in the UK, 2000. 3. Podiatry services and related foot care issues. (United States)

    Winocour, P H; Morgan, J; Ainsworth, A; Williams, D R R


    To examine the provision of, and variations in, podiatry and other services for diabetic foot care in the UK. A postal survey of secondary care providers of diabetes services in the UK in 2000. Following two reminders a 77% response rate was achieved. The responses indicated that 97% had a state-registered podiatrist attached to the service, providing three (median) sessions each week for diabetes care, although only 44% had availability at all diabetic clinics, and only 3% had availability at paediatric diabetic services. Podiatry access at all diabetic clinics increased the likelihood of associated preventative as opposed to reactive ('trouble shooting') care (P podiatry input to patient education was common (84%), only 6% had received formal training in education. Guidelines and strategies for management of active foot problems were available in 50-74% of cases. Orthotic input was highly variable, and absent in 15% of responses. Podiatrist fitting and application of foot protective apparatus was only recorded in 22-61% of responses. Access to isotopic and/or MR foot imaging and peripheral angiography and angioplasty was recorded in 75-83% of responses. Separate specialist foot clinics were available in 49%, and where this was the case the use of newer foot ulcer healing applications was higher (P podiatry support to diabetes care over the last 10 years, the level of access and the nature of the services provided is much less than recommended in many advisory documents. The strategy of a co-ordinated 'team' approach to foot care still takes place in less than 50% of centres. There are clear regional differences in diabetes foot care services. Both providers and purchasers of diabetes services may not have given sufficient attention to this area, given the relatively small number of documented bids for service improvements in this area, and the very low success rate of such bids.

  7. Provision of NHS generalist and specialist services to care homes in England: review of surveys. (United States)

    Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire


    The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population

  8. Regional variations in the use of home care services in Ontario, 1993/95


    Coyte, P C; Young, W


    BACKGROUND: Although regional variations in the use of many health care services have been reported, little attention has been devoted to home care practices. Given the dramatic shift in care settings from hospitals to private homes, it is important to determine the extent to which home care practices vary by geographic region. METHODS: Data from the Canadian Institute for Health Information and the Ontario Home Care Administration System database were used to assess regional variations in ra...

  9. Patients' perceptions of service quality dimensions: an empirical examination of health care in New Zealand. (United States)

    Clemes, M D; Ozanne, L K; Laurensen, W L


    The 1984 liberalization of the New Zealand economy has resulted in a health care sector that has become very competitive (Zwier and Clarke, 1999). The private sector is now able to supply health care services and, as a result, a greater value is being placed on patient satisfaction (Zwier and Clarke, 1999). However, despite the increasing focus on customer satisfaction, research into health care patients' perceptions of the dimensions of service quality is scarce. This can be problematic, as quality of care is an essential issue in the strategic marketing of health care services (Turner and Pol, 1995). This study takes a step towards addressing this deficiency by identifying patients' perceptions of the dimensions of service quality in health care. The findings of this study are based on the empirical analysis of a sample of 389 respondents interviewed by telephone. The findings indicate that the service quality dimensions identified in this health care specific study differ in number and dimensional structure from the widely adopted service quality dimensions first identified by Parasuraman, Berry and Zeithaml (1988): reliability, responsiveness, assurance, empathy and tangibles. The service quality dimensions identified in this study were: reliability, tangibles, assurance, empathy, food, access, outcome, admission, discharge and responsiveness. In addition, health care patients perceive the service quality dimensions relating to the core product in health care delivery (for example, outcome and reliability) as more important than the service quality dimensions relating to the peripheral product in health care delivery (for example, food, access and tangibles). Finally, the results of this study suggest that patients with different geographic, demographic, and behavioristic characteristics have different needs and wants during health care delivery and therefore perceive different service quality dimensions as important.

  10. [Comparison of Patients and their Care in Urban and Rural Specialised Palliative Home Care - A Single Service Analysis]. (United States)

    Heckel, M; Stiel, S; Frauendorf, T; Hanke, R M; Ostgathe, C


    Specialised outpatient palliative care teams (in Germany called SAPV) aim to ensure best possible end-of-life care for outpatients with complex needs. Information on the influence of living areas (rural vs. urban) on patient and care related aspects is rare. This study aims to explore differences between palliative care patients in urban and rural dwellings concerning their nursing and service characteristics. A retrospective data analysis of documentary data for 502 patients supplied by SAPV team from December 2009 to June 2012 was conducted. Patients and care characteristics were investigated by frequency analysis and were compared for both groups of urban and rural dwelling patients (T test, Chi², Fisher's exact test p care, disease and service related aspects of palliative home care could be detected. An exception is that the rate of re-admittance to hospital is higher for rural dwelling patients (Fisher's exact test p=0.022). Although predominantly presumed, the single service analysis shows - except for the re-admittance rate to hospital - no considerable differences between palliative care patients regarding their living area. Our findings indicate that patients cared for in rural and urban settings have similar needs and impose similar requirements on palliative care teams. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Home care services for sick children: Healthcare professionals' conceptions of challenges and facilitators. (United States)

    Castor, Charlotte; Hallström, Inger; Hansson, Helena; Landgren, Kajsa


    To explore healthcare professionals' conceptions of caring for sick children in home care services. Families often prefer home care to hospital care, and the number of home care services for children is increasing. Caring for children at home has been recognised as challenging for healthcare professionals in home care services used to providing care predominately for adults. An inductive qualitative design. Seven focus group interviews were performed with 36 healthcare professionals from multidisciplinary home care services. Data were analysed stepwise using a phenomenographic analysis. Three description categories emerged: "A challenging opportunity", "A child perspective", and "Re-organise in accordance with new prerequisites." Providing home care services for children was conceived to evoke both professional and personal challenges such as feelings of inadequacy and fear and professional growth such as increased competence and satisfaction. Conceptions of whether the home or the hospital was the best place for care differed. Adapting to the child's care was conceived as important. Cooperation with paediatric departments and a well-functioning team work were important organisational aspects. Providing home care for children was a challenging but rewarding task for healthcare professionals used to care for adults. To provide care with a child perspective was experienced as important even though there were conflicting conceptions of how this should be done. Close cooperation with paediatric departments and teamwork were prerequisites that make up for the low number of paediatric patients and facilitate confidence and competence. A sufficient number of referred children and enabling healthcare professionals to be part of the re-organising and implementation processes might facilitate the home care services for sick children. Enough time and good teamwork must be emphasised. Early referrals, continuous cooperation with paediatric clinics complemented with

  12. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services. (United States)


    ... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE... level of understanding, involvement, and agreement with the plan of care, in accordance with the hospice... communication and integration, in accordance with the hospice's own policies and procedures, to— (1) Ensure that...

  13. Utilization of dental health services by Danish adolescents attending private or public dental health care systems

    DEFF Research Database (Denmark)

    Christensen, Lisa Bøge; Petersen, Poul Erik; Bastholm, Annelise


    The objectives of the study were: 1) to describe the choice of dental care system among 16-year-olds, 2) to describe the utilization of dental services among 16-17-year-olds enrolled in either public or private dental care systems, and to compare the dental services provided by the alternative...

  14. Treatment Foster Care Pre-Service Trainings: Changes in Parenting Attitudes and Fostering Readiness (United States)

    Strickler, Amy; Trunzo, Annette C.; Kaelin, Michael S.


    Background: Pre-service training of treatment parents is a requirement for all foster care models to ensure safety and well-being of children in care. Researchers theorize treatment parents benefit more from enhanced pre-service trainings; however, no rigorous studies exist indicating the effectiveness of these trainings for treatment parents.…

  15. Care coordinators: a controlled evaluation of an inpatient mental health service innovation. (United States)

    Stewart, Malcolm W; Wilson, Michael; Bergquist, Karla; Thorburn, John


    The study aimed to evaluate the impact of introducing designated care coordinators into an acute mental health inpatient unit in terms of service delivery, clinical outcomes, and service user and significant other perceptions. A pre-post-controlled design was implemented with a consecutive sample of 292 service users admitted and staying more than 5 days in two wards, with care coordinators introduced in one ward. Data were obtained from clinical records, standard measures, and service user and significant other surveys. Care coordinator input was associated with significant improvements in service delivery and stronger involvement of significant others and community resources. Care-coordinated clients showed significantly better clinical outcomes, including the Health of Nations Outcome Scales behaviour subscale, less time in the intensive care subunit, less community crisis team input in the week following discharge, and lower rates of readmission in the month following discharge. Care-coordinated service users and their significant others gave higher ratings of service delivery, outcome, and satisfaction. The results indicate that designated care coordinators significantly improve care processes, outcomes, and service user experience in acute inpatient mental health settings. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

  16. Incorporating Multifaceted Mental Health Prevention Services in Community Sectors-of-Care (United States)

    Gewirtz, Abigail H.; August, Gerald J.


    This article proposes a framework for embedding prevention services into community sectors-of-care. Community sectors-of-care include both formal and grassroot organizations distributed throughout a community that provide various resources and services to at-risk children and their families. Though the child population served by these…

  17. Racial/Ethnic Differences in Use of Health Care Services for Diabetes Management (United States)

    Chandler, Raeven Faye; Monnat, Shannon M.


    Research demonstrates consistent racial/ethnic disparities in access to and use of health care services for a variety of chronic conditions. Yet we know little about whether these disparities exist for use of health care services for diabetes management. Racial/ethnic minorities disproportionately suffer from diabetes, complications from diabetes,…

  18. Barriers to Accessing Good Eye Care Services in Nigeria: A Focus ...

    African Journals Online (AJOL)

    Certain forms of blindness can be prevented if the right steps and treatments are applied at the right times, but this is not always possible due to the challenges patients face in accessing eye care services. The aim of this study was to explore and identify the barriers in accessing good eye care services in Anambra State ...

  19. Air network performance and hub competitive position: evaluation of primary airports in East and South-East Asia

    NARCIS (Netherlands)

    Burghouwt, G.; de Wit, J.; Veldhuis, J.; Matsumoto, H.


    The growth of hub-and-spoke operations has changed the structure of competition among airlines and airports, meaning that airlines now compete both directly (air services from A to B) as well as indirectly (services from A to B via H). Traditional measures of airport performance, such as passenger

  20. Allocation of Rehabilitation Services for Older Adults in the Ontario Home Care System. (United States)

    Armstrong, Joshua J; Sims-Gould, Joanie; Stolee, Paul

    Background: Physiotherapy and occupational therapy services can play a critical role in maintaining or improving the physical functioning, quality of life, and overall independence of older home care clients. Despite their importance, however, there is limited understanding of the factors that influence how rehabilitation services are allocated to older home care clients. The aim of this pilot study was to develop a preliminary understanding of the factors that influence decisions to allocate rehabilitation therapy services to older clients in the Ontario home care system, as perceived by three stakeholder groups. Methods: Semi-structured interviews were conducted with 10 key informants from three stakeholder groups: case managers, service providers, and health system policymakers. Results: Drivers of the allocation of occupational therapy and physiotherapy for older adults included functional needs and postoperative care. Participants identified challenges in providing home care rehabilitation to older adults, including impaired cognition and limited capacity in the home care system. Conclusions: Considering the changing demands for home care services, knowledge of current practices across the home care system can inform efforts to optimize rehabilitation services for the growing number of older adults. Further research is needed to advance the understanding of, and optimize rehabilitation service allocation to, older frail clients with multiple morbidities. Developing novel decision-support mechanisms and standardized clinical care pathways for older client populations may be beneficial.

  1. Perceptions of informal care givers: health and support services provided to people with multiple sclerosis. (United States)

    Buchanan, Robert; Radin, Dagmar; Chakravorty, Bonnie J; Tyry, Tuula


    About 30% of people with multiple sclerosis (MS) need some form of home care assistance, with 80% of that assistance provided by informal or unpaid care givers. This study focuses on the care givers to 530 more disabled people with MS, with the objective to learn more about informal care giving to people with greater dependency and need for assistance. The data presented in this study were collected in a national survey of 530 informal care givers to people with MS who have greater levels of physical dependency. About 70% of informal care givers responded that assisting the person with MS perform daily activities or personal care took up the largest amount of their care giving time. Care givers also reported a range of home and community-based services that would make care giving easier or improve the care provided. However, informal care givers generally reported low satisfaction with health insurance coverage of these services, especially coverage by health maintenance organizations and other managed care plans. Lack of health insurance coverage of needed home and community-based services can reduce the quality of informal care provided, as well as increase the burden of informal care giving.

  2. Omni directional mobile robot capable of variable foot printing based on hub type drive module

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyo Joong; Cho, Chang Nho; Kim, Hwi Su; Song, Jae Bok [Korea Univ., Seoul (Korea, Republic of)


    In recent years, an increased amount of research has been carried out on mobile robots to improve the performance of service robots. Mobile robots maximize the mobility of service robots, thus allowing them to work in different areas. However, conventional service robots have their center of mass placed high above the ground, which may cause them to fall when moving at high speed. Furthermore, hub type actuators, which are often used for mobile robots, are large and expensive. In this study, we propose a mobile robot with a hub type actuator unit and a variable footprint mechanism. The proposed variable footprint mechanism greatly improves the stability and mobility of the robot, allowing it to move freely in a narrow space and carry out various tasks. The performance of the proposed robot is verified experimentally.

  3. African American Adolescents and Use of Prenatal Care Services. Is There a Relationship between Self-Esteem and Seeking Care? (United States)

    Spence, Susie A.; Adams, James P.


    Using a sample of 30 African American adolescents, explores the relationship between self-esteem and participation in a supportive prenatal care program designed specifically for this age group. Findings indicate no significant relationship between the overall self-esteem construct and use of prenatal care services. (GR)

  4. Organizing to Coordinate Child Care Services. (With an Appendix) The Greater Minneapolis Day Care Association: Early History. (United States)

    Ratliff, Patricia; Berryman, Pauline

    Systems of coordinating child care services are analyzed as a guide to organizing. Federal Community Child Care (4-C) are the focus of the analysis. In Part I, evolution of coordination, an initial steering committee is followed through its various phases of expansion--initial impetus, visibility, staffing patterns, parent involvement, community…

  5. Health care service for ostomy patients: profile of the clientele

    Directory of Open Access Journals (Sweden)

    Vanessa Damiana Menis Sasaki


    Full Text Available The study aimed to identify the profile of ostomy patients in a Health Care Service in São José do Rio Preto, São Paulo, Brazil. This is an exploratory, descriptive and retrospective study. Data were obtained by registration forms of patients assisted from January 1st, 2000, to December 31st, 2010. Out of the 252 ostomy patients, 51.1% were females and 48.9% were males; the age group with the highest concentration was from 68 to 78 years old (26.3% for both genders, with mean age of 73 years old. The main reason for making the stoma was rectal (35.0% and colon neoplasm (14.1%. The prevalent stoma was temporary colostomy (41.4% and the period of permanence of the collecting equipment was longer than 36 months. Even though the service provides full assistance to the ostomy patients, it is necessary to review human resources aspects to provide appropriate assistance to its clientele.O estudo teve como objetivo identificar o perfil de pacientes estomizados de um Serviço de Atenção ao Estomizado de São José do Rio Preto e Região. A pesquisa é exploratória, descritiva e retrospectiva. Os dados foram obtidos das fichas cadastrais dos pacientes atendidos no período de 1º de janeiro de 2000 a 31 de dezembro de 2010. Dos 252 estomizados, 51,1% eram mulheres e 48,9% homens, a faixa etária de maior concentração encontrou-se, em ambos os sexos, entre 68 a 78 anos (26,3% com média de idade de 73 anos. O principal motivo da confecção do estoma foi a neoplasia de reto (35,0% e cólon (14,1%. O estoma prevalente foi a colostomia temporária (41,4% e o tempo de permanência do equipamento coletor foi superior a 36 meses. O Serviço, embora proporcione assistência integral ao estomizado, necessita rever aspectos de recursos humanos à assistência adequada à clientela.

  6. Biaxial wheel/hub test facility. Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, G.; Grubisic, V. [eds.


    The 4{sup th} meeting aims to exchange the experience and knowledge of engineers during several presentations and discussions about new developments required for a reliable, time and cost reducing validation of the wheel/hub assembly. Tremendous development of the wheel performance, described by the ratio of the rated load (kg) versus the wheel weight (kg) had taken place during the last 5000 years. Starting from the ratio of 3 for wooden 2-piece-disc-wheels in Mesopotamia it needed nearly 1000 years to increase the ratio to approx 5 at light-weight spoke wheels for fighting carriages, found in the grave of king Tutenchamon in Egypt. Modern light alloy wheels of commercial vehicles reach values up to 160 kg/kg. Additionally the comlex design of the modern systems for cars and commercial vehicles comprising wheel, brake, hub, bearing, spindle and hub carrier, including different materials and their treatment, fasteners, press-fits, require an appropriate testing procedure. The variable loading conditions, caused by operational wheel forces, brake and torque moments including heating, may result in changing tolerances and press-fits during operation and consequently in different damage mechanisms. This can be simulated in the Biaxial Wheel Test Machine, whereby corresponding load programs are necessary. An overview about all biaxial test machines in usage at the end of 1999 is shown in the introduction. The total number is 17 for cars, 7 for commercial vehicles and 1 for trains. The six presentations of this meeting were consequently concentrated on: (a) recommendations for a standardization of load programs of the German Wheel Committee, (b) the simulation of brake and torque events and (c) the possibility for a numerical stress analyses and fatigue life assessment. (orig./AKF)

  7. Is There Time Enough? Temporal Resources and Service Performance in the Danish Home Care Sector

    Directory of Open Access Journals (Sweden)

    Pernille Tufte


    Full Text Available Reflecting on the temporal conditions of home care work, care workers are fairly critical, stressing that time frames are inflexible and time is limited and occasionally insufficient, altogether constituting a time pressure in work performance. Besides from the immediate consequences of time scarcity in the daily work performance, care workers relate the issue of time to a more fundamental discussion of what the performance of care does and should entail. The purpose of the article is to examine care workers’ perceptions of the temporal conditions of care work, investigating how time pressure constitutes a challenge to care workers’ own sense and valuation of their work. The article is informed by two theoretical perspectives: standardization of care services and performance of care work in private homes. Empirically, the article examines how care workers perceive the relations between the temporal framing and the possibilities to perform care work. Methodologically, the article is based on qualitative data, collected through focus group interviews and participant observation, and analyzed within the perspective of reflexive interpretation, using grounded theory method and hermeneutic approaches of analysis. A central focus of analysis is the concept of “additional care services.” The use of the concept reflects different understandings of care. Relying on the logic of standardization, managers articulate additional services as definite items, which could (and should be left out of the performance of care work. Care workers do, however, not accept this notion. Relying on their experience of work, they perceive additional services as an ambiguous concept, which recognizes the multiple character of care work. Conclusions are that time scarcity constitutes a pressure on work performance as a whole, reducing care workers’ flexibility, challenging their authority, but still keeping them in a position of responsibility. Ultimately, the

  8. Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service. (United States)

    Reeve, Carole; Humphreys, John; Wakerman, John; Carroll, Vicki; Carter, Maureen; O'Brien, Tim; Erlank, Carol; Mansour, Rafik; Smith, Bec


    The aim of this study was to describe the reorientation of a remote primary health-care service, in the Kimberley region of Australia, its impact on access to services and the factors instrumental in bringing about change. A unique community-initiated health service partnership was developed between a community-controlled Aboriginal health organisation, a government hospital and a population health unit, in order to overcome the challenges of delivering primary health care to a dispersed, highly disadvantaged Aboriginal population in a very remote area. The shared goals and clear delineation of responsibilities achieved through the partnership reoriented an essentially acute hospital-based service to a prevention-focussed comprehensive primary health-care service, with a focus on systematic screening for chronic disease, interdisciplinary follow up, health promotion, community advocacy and primary prevention. This formal partnership enabled the primary health-care service to meet the major challenges of providing a sustainable, prevention-focussed service in a very remote and socially disadvantaged area.

  9. Allocation of home care services by municipalities in Norway: a document analysis. (United States)

    Holm, Solrun G; Mathisen, Terje A; Sæterstrand, Torill M; Brinchmann, Berit S


    In Norway, elder care is primarily a municipal responsibility. Municipal health services strive to offer the 'lowest level of effective care,' and home healthcare services are defined as the lowest level of care in Norway. Municipalities determine the type(s) of service and the amount of care applicants require. The services granted are outlined in an individual decision letter, which serves as a contract between the municipality and the home healthcare recipient. The purpose of this study was to gain insight into the scope and duration of home healthcare services allocated by municipalities and to determine where home care recipients live in relation to home healthcare service offices. A document analysis was performed on data derived from 833 letters to individuals allocated home care services in two municipalities in Northern Norway (Municipality A = 500 recipients, Municipality B = 333 recipients). In Municipality A, 74% of service hours were allotted to home health nursing, 12% to practical assistance, and 14% to support contact; in Municipality B, the distribution was 73%, 19%, and 8%, respectively. Both municipalities allocated home health services with no service end date (41% and 85% of the total services, respectively). Among recipients of "expired" services, 25% in Municipality A and 7% in Municipality B continued to receive assistance. Our findings reveal that the municipalities adhered to the goal for home care recipients to remain at home as long as possible before moving into a nursing home. The findings also indicate that the system for allocating home healthcare services may not be fair, as the municipalities lacked procedures for revising individual decisions. Our findings indicate that local authorities should closely examine how they design individual decisions and increase their awareness of how long a service should be provided.

  10. Factors influencing women's utilization of public health care services ...

    African Journals Online (AJOL)

    the determinants influencing women's use of public health facilities at the time they give birth. Results: Of .... due to distance between their places of abode and health care facilities ..... care: what works for safe motherhood: Bull World Health.

  11. Maternal Health Care Services Utilization in Tea Gardens of ...

    African Journals Online (AJOL)


    Despite this, India is still struggling with a high maternal mortality and morbidity ..... care utilization and the mothers' age, religion and caste. However, women .... health care system and presents an opportunity to evaluate the mother's overall ...

  12. Factors affecting maternal health care services utilization in rural ...

    African Journals Online (AJOL)


    husband's level of ... countries, where women have access to basic health care, ... Democratic Republic of Congo, Ethiopia, India, ... existing information gap about maternal health care by providing empirical evidence-based on the data of the.

  13. factors affecting antenatal care service utilization in yem special ...

    African Journals Online (AJOL)


    assess antenatal care utilization and factors that affect it in Yem Special Woreda, South Western Ethiopia. METHODS: A ... A pre-tested structured questionnaire consisting of information on socio- ..... model and access to medical care: does it.

  14. Health Care Service Utilization of Dementia Patients before and after Institutionalization: A Claims Data Analysis

    Directory of Open Access Journals (Sweden)

    Larissa Schwarzkopf


    Full Text Available Background: Community-based and institutional dementia care has been compared in cross-sectional studies, but longitudinal information on the effect of institutionalization on health care service utilization is sparse. Methods: We analyzed claims data from 651 dementia patients via Generalized Estimation Equations to assess health care service utilization profiles and corresponding expenditures from four quarters before to four quarters after institutionalization. Results: In all domains, utilization increased in the quarter of institutionalization. Afterwards, the use of drugs, medical aids, and non-physician services (e.g., occupational therapy and physiotherapy remained elevated, but use of in- and outpatient treatment decreased. Cost of care showed corresponding profiles. Conclusion: Institutional dementia care seems to be associated with an increased demand for supportive services but not necessarily for specialized medical care.

  15. [Professional's expectations to improve quality of care and social services utilization in geriatric oncology]. (United States)

    Antoine, Valéry; de Wazières, Benoît; Houédé, Nadine


    Coordination of a multidisciplinary and multi-professional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social services utilization. Descriptive study in a French University Hospital. A 6-item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. The 37 respondents identified a total of 166 needs to improve quality of care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health care planning, were defined to answer to professional's needs with the aim of optimizing cancer treatment and global cares. Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014-2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Copyright © 2014 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  16. Electric wheel hub motor; Elektrischer Radnabenmotor

    Energy Technology Data Exchange (ETDEWEB)

    Groeninger, Michael; Kock, Alexander [IFAM Bremen (Germany); Horch, Felix [IFAM Bremen (Germany). Komponentenentwicklung; Pleteit, Hermann [IFAM Bremen (Germany). Abt. Giessereitechnologie und Komponentenentwicklung


    The bundled competences of the participating Fraunhofer Institutes have made it possible to develop a wheel hub motor that has essentially overcome currently existing technical hurdles, enabling its use in a vehicle. In addition to direct technical challenges such as sealing against external influences, high bearing stiffness requirements, necessary high torque densities and simple integration in the chassis, the safety aspects required by modern vehicles were also taken into account. A drive system that guarantees safe driving states, even in the case of malfunction, was developed through the combination of recuperative braking with a classic mechanical braking system and redundant motor design. (orig.)

  17. IAServ: an intelligent home care web services platform in a cloud for aging-in-place. (United States)

    Su, Chuan-Jun; Chiang, Chang-Yu


    As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients' needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform) to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet.

  18. IAServ: An Intelligent Home Care Web Services Platform in a Cloud for Aging-in-Place

    Directory of Open Access Journals (Sweden)

    Chang-Yu Chiang


    Full Text Available As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients’ needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet.

  19. 75 FR 62348 - Reimbursement Offsets for Medical Care or Services (United States)


    ... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN55 Reimbursement Offsets for Medical Care... Veterans Affairs (VA) proposes to amend its regulations concerning the reimbursement of medical care and... situations where third-party payers are required to reimburse VA for costs related to care provided by VA to...

  20. Automobile Accidents Attended by Mobile Emergency Care Service

    Directory of Open Access Journals (Sweden)

    Ana Virgínia Gomes Barros


    Full Text Available Background: Automobile accidents are increasing every day and are becoming a serious public health problem due to the high morbidity and mortality rate. The goal of the current study was to characterise the traffic accidents attended by the Mobile Emergency Care Service (MECS in Ibiara, PB. Methods: This exploratory, descriptive, documentary study adopted a quantitative approach and analysis of data. The population consisted of all victims of traffic accidents attended by MECS in the city of Ibiara, PB, from June 2015 to June 2016. The following variables were studied: age, gender, time and day of the week the accident occurred, nature of the incident, substance ingested by the victim, wearing personal protective equipment (PPE or not, the anatomical lesions on the victim and the body regions hit during the accident. Results: The sample consisted of 49 accident victims, and the majority (81.6% were male, predominately 30 to 59 years. Events occurring at night (63.3% and during the week (65.3% predominated. The most frequent type of accident was motorcycle fall (71.4%, with almost half having consumed alcohol (46.9% and most not wearing PPE (77.6%. The regions of the body most affected were the lower limbs (67.3% and upper limbs (53.1%. Conclusion: The main factor/cause of these accidents was due to imprudence and violation of traffic laws, highlighting the need to invest in traffic education policies, to direct campaigns for the prevention of traffic accidents, as well as expand the surveillance of traffic laws by authorities.

  1. Service availability and readiness for diabetes care at health ...

    African Journals Online (AJOL)


    2Addis Ababa University, College of Health Science, School of Medicine, Department of Internal Medicine, ... Results: Among all health facilities, 59% of health facilities offer services for .... provide good-quality client services for diabetes,.

  2. [Different forms of payment systems for dental services and their impact on care]. (United States)

    Sória, Marina Lara; Bordin, Ronaldo; da Costa Filho, Luiz Cesar


    The Brazilian dental care sector is facing a paradoxical crisis characterized by a surplus of dentists and a large contingent of people lacking dental care, thus highlighting the need to improve management strategies. One necessary step is to analyze the various payment schemes for dental services. This paper reviews two important approaches, fee for service and capitation, and considers the impacts and consequences of payment strategies on the dental care system.

  3. Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil


    Rocha, Thiago Augusto Hernandes; da Silva, N?bia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, Jo?o Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thum?, Elaine; Thomaz, Erika B?rbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A.; Vissoci, Jo?o Ricardo Nickenig


    Background Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. Methods The present work can be classified as a c...

  4. [Quality management is associated with high quality services in health care]. (United States)

    Nielsen, Tenna Hassert; Riis, Allan; Mainz, Jan; Jensen, Anne-Louise Degn


    In these years, quality management has been the focus in order to meet high quality services for the patients in Danish health care. This article provides information on quality management and quality improvement and it evaluates its effectiveness in achieving better organizational structures, processes and results in Danish health-care organizations. Our findings generally support that quality management is associated with high quality services in health care.

  5. Primary Caregivers Satisfaction and its Related Factors in Home Health Care Services

    Directory of Open Access Journals (Sweden)

    Shu-Ping Wei


    Conclusion: This study showed that the overall perceived performance is higher than expectation for home health care service provided. The primary caregiver who was older than 30 years, who had lower education level, and other than siblings showed higher satisfaction. The four items that need improving included “home health care nurses will provide detailed description of services,” “home health care nurses will provide knowledge of illness,” “home health care nurses can complete the promised tasks,” and “home health care nurses will actively inquire patient’s conditions and needs.”

  6. Experimental Investigation of a Helicopter Rotor Hub Flow (United States)

    Reich, David

    The rotor hub system is by far the largest contributor to helicopter parasite drag and a barrier to increasing helicopter forward-flight speed and range. Additionally, the hub sheds undesirable vibration- and instability-inducing unsteady flow over the empennage. The challenges associated with rotor hub flows are discussed, including bluff body drag, interactional aerodynamics, and the effect of the turbulent hub wake on the helicopter empennage. This study was conducted in three phases to quantify model-scale rotor hub flows in water tunnels at The Pennsylvania State University Applied research lab. The first phase investigated scaling and component interaction effects on a 1:17 scale rotor hub model in the 12-inch diameter water tunnel. Effects of Reynolds number, advance ratio, and hub geometry configuration on the drag and wake shed from the rotor hub were quantified using load cell measurements and particle-image velocimetry (PIV). The second phase focused on flow visualization and measurement on a rotor hub and rotor hub/pylon geometry in the 12-inch diameter water tunnel. Stereo PIV was conducted in a cross plane downstream of the hub and flow visualization was conducted using oil paint and fluorescent dye. The third phase concentrated on high accuracy load measurement and prediction up to full-scale Reynolds number on a 1:4.25 scale model in the 48-inch diameter water tunnel. Measurements include 6 degree of freedom loads on the hub and two-component laser-Doppler velocimetry in the wake. Finally, results and conclusions are discussed, followed by recommendations for future investigations.

  7. Improving client-centred care and services : the role of front/back-office configurations

    NARCIS (Netherlands)

    Broekhuis, Manda; de Blok, C.; Meijboom, B.

    Improving client-centred care and services: the role of front/back-officeconfigurations. This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care,

  8. Quantifying the demand for hospital care services: a time and motion study

    NARCIS (Netherlands)

    van Oostveen, Catharina J.; Gouma, Dirk J.; Bakker, Piet J.; Ubbink, Dirk T.


    The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch

  9. Models of home care services for persons with dementia: a narrative review. (United States)

    Low, Lee-Fay; Fletcher, Jennifer


    Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care. We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs. Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study. There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

  10. 78 FR 10117 - Use of Medicare Procedures To Enter Into Provider Agreements for Extended Care Services (United States)


    ... term `noninstitutional extended care services' means such alternatives to institutional extended care..., including alternatives to institutional extended care that [VA] may furnish directly, by contract, or... Rehabilitation Act of 1973, Worker Adjustment and Retraining Notification Act, Sarbanes-Oxley Act of 2002...

  11. Developing a framework of service convenience in health care: An exploratory study for a primary care provider. (United States)

    Tuzovic, Sven; Kuppelwieser, Volker


    From retail health clinics and online appointment scheduling to (mobile) kiosks that enable patient check-in and automate the collection of copays and open balances, convenience has become an important topic in the health care sector over the last few years. While service convenience has also gained much interest in academia, one common limitation is that authors have adopted a "goods-centered" perspective focusing primarily on retail settings. Results of this exploratory study reveal that health care service convenience encompasses seven different dimensions: decision, access, scheduling, registration and check-in, transaction, care delivery, and postconsultation convenience. Implications and future research suggestions are discussed.

  12. Access to primary health care services for Indigenous peoples: A framework synthesis. (United States)

    Davy, Carol; Harfield, Stephen; McArthur, Alexa; Munn, Zachary; Brown, Alex


    Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services. To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague's accessibility framework. Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs. Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague's accessibility framework should be broadened to include factors related to the health care system such as funding.

  13. Emergency residential care settings: A model for service assessment and design. (United States)

    Graça, João; Calheiros, Maria Manuela; Patrício, Joana Nunes; Magalhães, Eunice Vieira


    There have been calls for uncovering the "black box" of residential care services, with a particular need for research focusing on emergency care settings for children and youth in danger. In fact, the strikingly scant empirical attention that these settings have received so far contrasts with the role that they often play as gateway into the child welfare system. To answer these calls, this work presents and tests a framework for assessing a service model in residential emergency care. It comprises seven studies which address a set of different focal areas (e.g., service logic model; care experiences), informants (e.g., case records; staff; children/youth), and service components (e.g., case assessment/evaluation; intervention; placement/referral). Drawing on this process-consultation approach, the work proposes a set of key challenges for emergency residential care in terms of service improvement and development, and calls for further research targeting more care units and different types of residential care services. These findings offer a contribution to inform evidence-based practice and policy in service models of residential care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Integration of antenatal care services with health programmes in low– and middle– income countries: systematic review

    Directory of Open Access Journals (Sweden)

    Thyra E de Jongh


    Full Text Available Antenatal care (ANC presents a potentially valuable platform for integrated delivery of additional health services for pregnant women–services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low– and middle–income countries (LMICs. However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs.

  15. Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services (United States)

    Jacobs, Elizabeth A.; Shepard, Donald S.; Suaya, Jose A.; Stone, Esta-Lee


    Objectives. We assessed the impact of interpreter services on the cost and the utilization of health care services among patients with limited English proficiency. Methods. We measured the change in delivery and cost of care provided to patients enrolled in a health maintenance organization before and after interpreter services were implemented. Results. Compared with English-speaking patients, patients who used the interpreter services received significantly more recommended preventive services, made more office visits, and had more prescriptions written and filled. The estimated cost of providing interpreter services was $279 per person per year. Conclusions. Providing interpreter services is a financially viable method for enhancing delivery of health care to patients with limited English proficiency. PMID:15117713

  16. Traveling abroad for medical care: U.S. medical tourists' expectations and perceptions of service quality. (United States)

    Guiry, Michael; Vequist, David G


    The SERVQUAL scale has been widely used to measure service quality in the health care industry. This research is the first study that used SERVQUAL to assess U.S. medical tourists' expectations and perceptions of the service quality of health care facilities located outside the United States. Based on a sample of U.S. consumers, who had traveled abroad for medical care, the results indicated that there were significant differences between U.S. medical tourists' perceived level of service provided and their expectations of the service that should be provided for four of the five dimensions of service quality. Reliability had the largest service quality gap followed by assurance, tangibles, and empathy. Responsiveness was the only dimension without a significantly different gap score. The study establishes a foundation for future research on service quality in the rapidly growing medical tourism industry.

  17. The Association between Freedom of Choice and Effectiveness of Home Care Services. (United States)

    Steffansson, Marina; Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka


    The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients' subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients' opinions and to thereby improve the effectiveness of home care services.

  18. Availability and Primary Health Care Orientation of Dementia-Related Services in Rural Saskatchewan, Canada. (United States)

    Morgan, Debra G; Kosteniuk, Julie G; Stewart, Norma J; O'Connell, Megan E; Kirk, Andrew; Crossley, Margaret; Dal Bello-Haas, Vanina; Forbes, Dorothy; Innes, Anthea


    Community-based services are important for improving outcomes for individuals with dementia and their caregivers. This study examined: (a) availability of rural dementia-related services in the Canadian province of Saskatchewan, and (b) orientation of services toward six key attributes of primary health care (i.e., information/education, accessibility, population orientation, coordinated care, comprehensiveness, quality of care). Data were collected from 71 rural Home Care Assessors via cross-sectional survey. Basic health services were available in most communities (e.g., pharmacists, family physicians, palliative care, adult day programs, home care, long-term care facilities). Dementia-specific services typically were unavailable (e.g., health promotion, counseling, caregiver support groups, transportation, week-end/night respite). Mean scores on the primary health care orientation scales were low (range 12.4 to 17.5/25). Specific services to address needs of rural individuals with dementia and their caregivers are limited in availability and fit with primary health care attributes.

  19. Utilization of post-abortion care services in three regional states of ...

    African Journals Online (AJOL)

    Background: In Ethiopia, utilization of post-abortion care service is minimal and it seems that the expanding services are underutilized. The purpose of this study was to assess factors which influence decisions for utilization of abortion related services at community level. Methodology: The study was carried out in six ...

  20. Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

    Directory of Open Access Journals (Sweden)

    Heather E Douglas


    Full Text Available Introduction: There is limited evidence of the benefits of information and communication technology (ICT to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Methods: Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Results: Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. Conclusions: There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

  1. Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider. (United States)

    Douglas, Heather E; Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I


    There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

  2. Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider (United States)

    Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I


    Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Methods: Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Results: Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. Conclusions: There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients. PMID:29042851

  3. Identifying profiles of service users in housing services and exploring their quality of life and care needs. (United States)

    Bitter, Neis A; Roeg, Diana P K; van Nieuwenhuizen, Chijs; van Weeghel, Jaap


    Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not always match their recovery. In order to improve the quality of care, this study aims to explore whether subgroups of service users exist based on three dimensions of recovery and to examine and compare the quality of life and care needs of the persons in these subgroups. Latent class analysis was performed with data from 263 service users of housing services in the Netherlands. Classes were based on three variables: personal recovery (Mental Health Recovery Measure), social recovery (Social Functioning Scale), and clinical recovery (Brief Symptom Inventory). Subsequently, the quality of life (MANSA) and care needs (CANSAS) of the different classes were analysed by the use of descriptive and inferential statistics. Three classes could be distinguished. Class 1 (45%) comprised of people who score the highest of the three classes in terms of personal and social recovery and who experience the least number of symptoms. People in class 2 (44%) and class 3 (11%) score significantly lower on personal and social recovery, and they experience significantly more symptoms compared to class 1. The distinction between class 2 and 3 can be made on the significantly higher number of symptoms in class 3. All three classes differ significantly on quality of life and unmet needs. The quality of life of service users of housing services needs improvement, as even persons in the best-recovered subgroup have a lower quality of life than the average population. Workers of housing services need to be aware of the recovery of a client and what his or her individual needs and goals are. Furthermore, better care (allocation) concerning mental and physical health and rehabilitation is needed. Care should be

  4. An exploratory study of services marketing in global markets: major areas of inquiry for the health care services industry. (United States)

    Young, S; Erdem, S A


    It has been stated that one of the major challenges for the international marketer is the design of an efficient strategy for marketing services to international markets. This paper reviews some of the issues associated with services marketing in global markets along with the basic variables of service industries. An exploratory assessment of the health care services industry results in a list composed of several inquiry areas which should be examined by multinational companies. It is hoped that the review of the issues raised in this paper provides a basis for decision making and further research.

  5. Numerical study of hub taper angle on podded propeller performance

    International Nuclear Information System (INIS)

    Islam, M.F.; Veitch, B.; Bose, N.; Liu, P.


    Presently, the majority of podded propulsion systems are of the pulling type, because this type provides better hydrodynamic efficiency than the pushing type. There are several possible explanations for the better overall performance of a puller type podded propulsor. One is related to the difference in hub shape. Puller and pusher propellers have opposite hub taper angles, hence different hub and blade root shape. These differences cause changes in the flow condition and possibly influence the overall performance. The current study focuses on the variation in performance of pusher and puller propellers with the same blade sections, but different hub taper angles. A hyperboloidal low order source doublet steady/unsteady time domain panel method code was modified and used to evaluate effects of hub taper angle on the open water propulsive performance of some fixed pitch screw propellers used in podded propulsion systems. The modified code was first validated against measurements of two model propellers in terms of average propulsive performance and good agreement was found. Major findings include significant effects of hub taper angle on propulsive performance of tapered hub propellers and noticeable effects of hub taper angle on sectional pressure distributions of tapered hub propeller blades. (author)

  6. [Poverty and disease: users of the primary care social services of a primary care center]. (United States)

    Doz Mora, J F; Mengual, L; Torné, M; Bonilla, P


    To find the individual and socio-family characteristics of that sector of the population which uses Primary Care Social Services (PCSS) at the Primary Care Centre (PCC) and the social problems which occasion demand. A retrospective descriptive study, based on checking over social work case files. A PCC situated in Barcelona's second industrial belt, serving a population with a low socio-economic level. The population group under study were the users with social work files open from January 1st 1985 to July 31st 1991 (a total of 690 case histories). A representative sample of 296 was selected. In comparison with the population of the basic Health Area, the user population of the PCSS at the PCC was predominantly women, and had an older average age, a higher proportion of divorce/separation and widowhood, and, in the labour context, higher unemployment and retirement. A high proportion of one-parent families (12.8%) was found. Analysis of the work situation showed that 50% of the workers were temporary and 75% of the unemployed received no benefit. 51% of the retired people received the minimum pension and 11% received no pension. Monthly family income, recorded for 46.5% of the cases, was 75,362 pesetas (SD 37,643). The most common problems were those related to the "HEALTH" section (61%). The user population of the PCSS at the PCC is, in socio-economic terms, deteriorated, a condition closely related to the development of chronic illnesses. Tackling health inequalities from Primary Care is under discussion.

  7. Study of Marketing Components Affecting Health Care Services in Hospitals

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Akbarian Bafghi


    Full Text Available Background: Hospitals, in extreme competition, have accepted principles of marketing designed for industrial goods and customers. One of the important factors in health services marketing is the type of services. Organizations, including health centers, require meeting the clients' needs in order to survive and try to promote the way of providing services effectively. The present study aims to identify effective components in providing clinical services in hospitals. Methods: This was a practical and cross-sectional study. Data were collected using a questionnaire completed through random sampling after confirming the validity and reliability. Data were analyzed by SPSS 21 and Lisrel 8.50 using descriptive statistics and factor analysis. Results: The results of this study indicated that nine components had the highest impact on providing health services. Confirmatory factor analysis showed that the quality of providing services in the hospital, offering distinctive services compared with other hospitals, and considering quality of service beyond the patient's expectation had the greatest impact on marketing services in the hospital. Conclusion: Providing quality and distinctive services beyond the patient's expectation enables hospitals to improve their marketing activities and, beside higher level of patient satisfaction, develop their clinical services market share.

  8. Quality of care provided to patients with diabetes mellitus in Puerto Rico; managed care versus fee-for-service experience. (United States)

    Rodríguez-Vigil, Efraín; Kianes-Pérez, Zaira


    To evaluate and compare the quality of diabetes care in a large managed care system and fee-for-service payment system in Puerto Rico. This retrospective cross-sectional study assessed the adherence to standards of diabetes care in 1,687,202 subjects--226,210 from a fee-for-service population and 1,460,992 from a managed care group. Patients with diabetes mellitus were identified from insurance claims reports. Type of health-care provider, service location, number of visits, and laboratory utilization were also assessed. From the analysis, we identified 90,616 patients with diabetes (5.4% of the overall study group). Of these, 66,587 (73.5%) were found to have at least one encounter with a physician in a medical visit. Of the 66,586 patients with diabetes who visited a physician, only 4% were treated by an endocrinologist. General laboratory utilization was 34% for the entire population of patients with diabetes studied. In the group of patients with documented laboratory tests, 93% had a documented fasting blood glucose test; in contrast, hemoglobin A lc testing was performed in only 9% of the patients. The fee-for-service group had a higher rate of visits to medical specialists and general laboratory utilization, whereas the managed care group had a higher rate of hospital admissions and emergency department visits. The quality of diabetes management and the subsequent outcomes are related to patient and health-care provider adherence to standards of care. In this analysis, we found that patients and physicians are responsible for low compliance with recognized standards of diabetes care in Puerto Rico. The lack of adequate management will lead to increased mortality, development and severity of chronic complications, and increased emergency department utilization. Therefore, health-care providers and payers should find ways to achieve more effective promotion of adherence to accepted standards of care for patients with diabetes.

  9. Orbital Hub: a concept for human spaceflight beyond ISS operations (United States)

    Jahnke, Stephan S.; Maiwald, Volker; Philpot, Claudia; Quantius, Dominik; Romberg, Oliver; Seboldt, Wolfgang; Vrakking, Vincent; Zeidler, Conrad


    The International Space Station (ISS) is the greatest endeavour in low-Earth orbit since the beginning of the space age and the culmination of human outposts like Skylab and Mir. While a clear schedule has yet to be drafted, it is expected that ISS will cease operation in the 2020s. What could be the layout for a human outpost in LEO with lessons learnt from ISS? What are the use cases and applications of such an outpost in the future? The System Analysis Space Segment group of the German Aerospace Center investigated these and other questions and developed the Orbital Hub concept. In this paper an overview is presented of how the overall concept has been derived and its properties and layouts are described. Starting with a workshop involving the science community, the scientific requirements have been derived and Strawman payloads have been defined for use in further design activities. These design activities focused on Concurrent Engineering studies, where besides DLR employees participants from the industry and astronauts were involved. The result is an expandable concept that is composed of two main parts, the Base Platform, home for a permanent crew of up to three astronauts, and the Free Flyer, an uncrewed autonomous research platform. This modular approach provides one major advantage: the decoupling of the habitat and payload leading to increased quality of the micro-gravity environment. The former provides an environment for human physiology experiments, while the latter allows science without the perturbations caused by a crew, e.g. material experiments or Earth observation. The Free Flyer is designed to operate for up to 3 months on its own, but can dock with the space station for maintenance and experiment servicing. It also has a hybrid propulsion system, chemical and electrical, for different applications. The hub's design allows launch with just three launches, as the total mass of all the hub parts is about 60,000 kg. The main focus of the design is

  10. Review of research on AFPM hub motor

    Directory of Open Access Journals (Sweden)

    Jianguo DAI


    Full Text Available The industrialization of new energy vehicles is an important way to promote the sustainable development of automobile industry, and it is also the key measure to solve the problems of energy and environment. As an important type of new energy vehicles, electric vehicles will play an important role in the future competition in the automotive industry, especially in the field of electric vehicle driven by wheel. With the advantages of compact structure, high power density, low working noise and good heat dissipation performance, the AFPM motor has gradually become the preferred object of the hub driving device. Based on the statement of the technical development and research status about AFPM motor, this paper mainly analyzes the engineering application and technical problems of AFPM motor in hub drive, especially the matching of AFPM motor with other systems and the problem of heat dissipation at high load conditions, and looks forward to the key role in the future development of the automotive industry. This paper will play a certain reference and guiding role in the application of AFPM motor in the field of new energy vehicles.

  11. The development of gas hubs in Europe

    International Nuclear Information System (INIS)

    Miriello, Caterina; Polo, Michele


    This paper investigates the development of wholesale markets for natural gas at the different stages of market liberalization. We identify three steps in the process: wholesale trade initially develops to cope with balancing needs when the shippers and suppliers segments become more fragmented; once the market becomes more liquid, it turns out to be a second source of gas procurement in alternative to long term contracts; finally, to manage price risk financial instruments are traded. We review in detail the different regulatory measures that must be introduced to create an efficient and functioning wholesale gas market. Finally, we analyze the evolution of gas hubs in the UK, the Netherlands, Germany and Italy in terms of market rules and market liquidity. We argue that each of these country cases can be easily located into the evolutionary path we have highlighted at the beginning, with the UK and the Netherlands leading the process, Germany and Italy constrained by limited supply; Italy is also showing an interesting counterfactual. -- Highlights: •The paper illustrates development paths for natural gas hubs in Europe. •Wholesale trade increases with competition. •The regulatory settings of UK, Netherlands, Germany and Italy are reviewed. •Each country is located into the evolutionary path highlighted in the analytical framework

  12. Coordination of care in the Chinese health care systems: a gap analysis of service delivery from a provider perspective. (United States)

    Wang, Xin; Birch, Stephen; Zhu, Weiming; Ma, Huifen; Embrett, Mark; Meng, Qingyue


    Increases in health care utilization and costs, resulting from the rising prevalence of chronic conditions related to the aging population, is exacerbated by a high level of fragmentation that characterizes health care systems in China. There have been several pilot studies in China, aimed at system-level care coordination and its impact on the full integration of health care system, but little is known about their practical effects. Huangzhong County is one of the pilot study sites that introduced organizational integration (a dimension of integrated care) among health care institutions as a means to improve system-level care coordination. The purposes of this study are to examine the effect of organizational integration on system-level care coordination and to identify factors influencing care coordination and hence full integration of county health care systems in rural China. We chose Huangzhong and Hualong counties in Qinghai province as study sites, with only Huangzhong having implemented organizational integration. A mixed methods approach was used based on (1) document analysis and expert consultation to develop Best Practice intervention packages; (2) doctor questionnaires, identifying care coordination from the perspective of service provision. We measured service provision with gap index, overlap index and over-provision index, by comparing observed performance with Best Practice; (3) semi-structured interviews with Chiefs of Medicine in each institution to identify barriers to system-level care coordination. Twenty-nine institutions (11 at county-level, 6 at township-level and 12 at village-level) were selected producing surveys with a total of 19 schizophrenia doctors, 23 diabetes doctors and 29 Chiefs of Medicine. There were more care discontinuities for both diabetes and schizophrenia in Huangzhong than in Hualong. Overall, all three index scores (measuring service gaps, overlaps and over-provision) showed similar tendencies for the two conditions

  13. 78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service... (United States)


    ...This notice announces the annual adjustments to the national average payment rates for meals and snacks served in child care centers, outside-school-hours care centers, at-risk afterschool care centers, and adult day care centers; the food service payment rates for meals and snacks served in day care homes; and the administrative reimbursement rates for sponsoring organizations of day care homes, to reflect changes in the Consumer Price Index. Further adjustments are made to these rates to reflect the higher costs of providing meals in the States of Alaska and Hawaii. The adjustments contained in this notice are made on an annual basis each July, as required by the laws and regulations governing the Child and Adult Care Food Program.

  14. 25 CFR 20.509 - What must the social services worker do when a child is placed in foster care or residential care... (United States)


    ... home or residential care facility to law enforcement and protective services in accordance with tribal... Assistance Foster Care § 20.509 What must the social services worker do when a child is placed in foster care... tribal or state licensed foster home or residential care facility evaluating how the home has fulfilled...

  15. Productivity and quality improvements in health care through airboss mobile messaging services. (United States)

    Shah, P J; Martinez, R; Cooney, E


    The US health care industry is in the midst of revolutionary changes. Under tremendous pressures from third-party payers and managed care programs to control costs while providing high quality medical services, health care entities are now looking at information technologies to help them achieve their goals. These goals typically include improved productivity, efficiency and decision-making capabilities among staff members. Moreover, hospitals and other health care facilities that provide a broad and integrated range of inpatient and outpatient care, wellness and home care services are in the best position to offer comprehensive packages to managed care and private insurers. Many health care providers and administrators are considered mobile employees. This mobility can range from intra-building and intra-campus to multi-site and metropolitan areas. This group often relies on a variety of information technologies such as personal computers, communicating laptops, pagers, cellular phones, wireline phones, cordless phones and fax machines to stay in touch and handle information needs. These health care professionals require mobile information access and messaging tools to improve communications, control accessibility and enhance decision-making capabilities. AirBoss mobile messaging services could address the health care industry's need for improved messaging capabilities for its mobile employees. The AirBoss family of services supports integrated voice services, data messaging, mobile facsimile and customized information delivery. This paper describes overview of the current mobile data networking capability, the AirBoss architecture, the health care-related applications it addresses and long-term benefits. In addition, a prototype application for mobile home health care workers is illustrated. This prototype application provides integrated e-mail, information services, web access, real-time access and update of patient records from wireline or wireless networks

  16. Palliative care services for Indian migrants in Australia: Experiences of the family of terminally Ill patients

    Directory of Open Access Journals (Sweden)

    Sujatha Shanmugasundaram


    Full Text Available Background: The way that health care systems in developing countries like India care for dying patients, has an impact on the expectations of such care for those who migrate to other countries faces. At the end of life, cultural issues may impact on the quality of life remaining and for that reason, it is important that particular cultural practices are understood. This paper describes a study that investigated the cultural issues of access to palliative care services for Indian migrants in Australia. Purpose of the Study: To investigate the experiences of the family members of terminally ill Indian migrants in Victoria, Australia. Objective of the Study: To explore the issues related to accessing palliative care services for Indian migrants; to identify the effectiveness of palliative care in supporting the patient and family and to recommend strategies for improving this care. Materials and Methods: A qualitative descriptive design was utilized. Up to 6 family members were selected for in-depth interviews in understanding cultural issues related to the palliative care services for a family member. Results: Analysis of the interviews revealed that families of Indian patients experience difficulties whilst receiving palliative care services, which fell into three main categories: Indian support systems, cultural issues, and caring experiences. Although each of these issues had a direct influence on the experience of terminal care that their family member received, cultural issues and support systems also influenced the caring experiences. Conclusion: Despite the successful implementation of palliative care services across Australia, there are still problems in accessing and receiving the services among minority and disadvantaged groups like various cultural groups.

  17. 78 FR 23702 - Copayment for Extended Care Services (United States)


    ... considered unavailable when calculating the veteran's maximum monthly copayment obligation for extended care... a material way the economy, a sector of the economy, productivity, competition, jobs, the...

  18. Physical activity levels of older adults receiving a home care service. (United States)

    Burton, Elissa; Lewin, Gill; Boldy, Duncan


    The 3 study objectives were to compare the activity levels of older people who had received a restorative home care service with those of people who had received "usual" home care, explore the predictors of physical activity in these 2 groups, and determine whether either group met the minimum recommended activity levels for their age group. A questionnaire was posted to 1,490 clients who had been referred for a home care service between 2006 and 2009. Older people who had received a restorative care service were more active than those who had received usual care (p = .049), but service group did not predict activity levels when other variables were adjusted for in a multiple regression. Younger individuals who were in better physical condition, with good mobility and no diagnosis of depression, were more likely to be active. Investigation of alternatives to the current exercise component of the restorative program is needed.

  19. Implementation of nutrition care service development plan at Banning Memorial Hospital: a case study. (United States)

    Ben Oumlil, A; Rao, C P


    Health care service markets in general and hospital care service markets in particular are characterized by many competitive developments. Hence, hospital marketing managers are forced to respond to these emerging competitive pressures. However, in formulating appropriate marketing management strategies, hospital managers need to have detailed knowledge about consumers and their behaviors in the marketplace. This paper focuses on the Nutrition Care division of the Department of Nutrition Service at a hospital and its venture into new service development. This case study is intended to emphasize the significance of acquiring adequate knowledge of customers in the health care services industry. It particularly emphasizes the critical role that this type of information concerning customer behavior plays in the development and implementation of an appropriate business expansion strategy. Furthermore, the aim of this case study is to help the reader to relate the acquired marketing information to the problem at hand, and make the appropriate marketing management decision.

  20. Hub exchange operations in intermodal hub-and spoke networks: A performance comparison of rail-rail exchange facilities


    Bontekoning, Y.M.


    The implementation of hub-and-spoke networks in intermodal transport is suggested as one of the potential solutions for helping to increase the intermodal market share. Traditionally, trains are shunted at hubs; this is a time-consuming process. Since the early 1990s a new type of intermodal terminal, specifically designed for fast tran-shipment at nodes in hub-and-spoke networks, has been introduced in Europe. These hub terminals could replace this time-consuming shunting. Studies on the new...

  1. Assessing care-givers' satisfaction with child immunisation services in Zambia: Evidence from a national survey. (United States)

    Chama-Chiliba, Chitalu Miriam; Masiye, Felix; Mphuka, Chrispin


    The main aim of this study was to assess care-giver satisfaction with vaccination services in public health facilities in Zambia, and examine its determinants. This study used data from a recent population-based household survey, conducted from May to August 2015. Respondent satisfaction with vaccination services received during the last visit was measured on a five point Likert scale ranging from 1 to 5. We used an ordered logistic regression model to analyse the significance of perceived quality of vaccination services, immunisation delivery mode and a range of individual characteristics in predicting care-giver satisfaction. Findings show that one in five care givers were unsatisfied with the vaccination services that they had received, with rural populations showing a significantly higher level of satisfaction. Poor quality of care, defined by long waiting times, poor quality of communication between health staff and care givers, long distance to vaccination sites, mode of delivery, and personal characteristics were among major factors driving care-giver satisfaction ratings. We also find that receiving a vaccination at outreach mode of delivery was associated with higher odds of greater satisfaction compared to on-facility vaccination services. The odds of satisfaction were lower for respondents living further away from a health facility, which emphasizes the importance of access in seeking vaccination services. These findings suggest that major improvements in quality of vaccination and service organisation will be needed to increase client satisfaction and service utilisation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. How integrated are neurology and palliative care services? Results of a multicentre mapping exercise. (United States)

    van Vliet, Liesbeth M; Gao, Wei; DiFrancesco, Daniel; Crosby, Vincent; Wilcock, Andrew; Byrne, Anthony; Al-Chalabi, Ammar; Chaudhuri, K Ray; Evans, Catherine; Silber, Eli; Young, Carolyn; Malik, Farida; Quibell, Rachel; Higginson, Irene J


    Patients affected by progressive long-term neurological conditions might benefit from specialist palliative care involvement. However, little is known on how neurology and specialist palliative care services interact. This study aimed to map the current level of connections and integration between these services. The mapping exercise was conducted in eight centres with neurology and palliative care services in the United Kingdom. The data were provided by the respective neurology and specialist palliative care teams. Questions focused on: i) catchment and population served; ii) service provision and staffing; iii) integration and relationships. Centres varied in size of catchment areas (39-5,840 square miles) and population served (142,000-3,500,000). Neurology and specialist palliative care were often not co-terminus. Service provisions for neurology and specialist palliative care were also varied. For example, neurology services varied in the number and type of provided clinics and palliative care services in the settings they work in. Integration was most developed in Motor Neuron Disease (MND), e.g., joint meetings were often held, followed by Parkinsonism (made up of Parkinson's Disease (PD), Multiple-System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP), with integration being more developed for MSA and PSP) and least in Multiple Sclerosis (MS), e.g., most sites had no formal links. The number of neurology patients per annum receiving specialist palliative care reflected these differences in integration (range: 9-88 MND, 3-25 Parkinsonism, and 0-5 MS). This mapping exercise showed heterogeneity in service provision and integration between neurology and specialist palliative care services, which varied not only between sites but also between diseases. This highlights the need and opportunities for improved models of integration, which should be rigorously tested for effectiveness.

  3. Experiences of homosexual patients' access to primary health care services in Umlazi, KwaZulu-Natal. (United States)

    Cele, Nokulunga H; Sibiya, Maureen N; Sokhela, Dudu G


    Homosexual patients are affected by social factors in their environment, and as a result may not have easy access to existing health care services. Prejudice against homosexuality and homosexual patients remains a barrier to them seeking appropriate healthcare. The concern is that lesbians and gays might delay or avoid seeking health care when they need it because of past discrimination or perceived homophobia within the health care thereby putting their health at risk. The aim of the study was to explore and describe the experiences of homosexual patients utilising primary health care (PHC) services in Umlazi in the province ofKwaZulu-Natal (KZN). A qualitative, exploratory, descriptive study was conducted which was contextual innature. Semi-structured interviews were conducted with 12 participants. The findings of this study were analysed using content analysis. Two major themes emerged from the data analysis, namely, prejudice against homosexual patients by health care providers and other patients at the primary health care facilities, and, homophobic behaviour from primary health care personnel. Participants experienced prejudice and homophobic behaviour in the course of utilising PHC clinics in Umlazi, which created a barrier to their utilisation of health services located there. Nursing education institutions, in collaboration with the National Department of Health, should introduce homosexuality and anti-homophobia education programmes during the pre-service and in-service education period. Such programmes will help to familiarise health care providers with the health care needs of homosexual patients and may decrease homophobic attitudes.

  4. Integrating Social Services and Home-Based Primary Care for High-Risk Patients. (United States)

    Feinglass, Joe; Norman, Greg; Golden, Robyn L; Muramatsu, Naoko; Gelder, Michael; Cornwell, Thomas


    There is a consensus that our current hospital-intensive approach to care is deeply flawed. This review article describes the research evidence for developing a better system of care for high-cost, high-risk patients. It reviews the evidence that home-centered care and integration of health care with social services are the cornerstones of a more humane and efficient system. The article describes the strengths and weaknesses of research evaluating the effects of social services in addressing social determinants of health, and how social support is critical to successful acute care transition programs. It reviews the history of incorporating social services into care management, and the prospects that recent payment reforms and regulatory initiatives can succeed in stimulating the financial integration of social services into new care coordination initiatives. The article reviews the literature on home-based primary care for the chronically ill and disabled, and suggests that it is the emergence of this care modality that holds the greatest promise for delivery system reform. In the hope of stimulating further discussion and debate, the authors summarize existing viewpoints on how a home-centered system, which integrates social and medical services, might emerge in the next few years.

  5. Determinants of psychology service utilization in a palliative care outpatient population. (United States)

    Azuero, Casey; Allen, Rebecca Sue; Kvale, Elizabeth; Azuero, Andres; Parmelee, Patricia


    Research has demonstrated that treating cancer patients' psychological and physical health leads to improved overall health. This may be especially true for palliative care patients facing serious illness. This study examines the proportion and determinants of psychology service utilization in an outpatient palliative care population. Data from an existing clinical database in an outpatient palliative clinic utilizing a collaborative care model to deliver psychology services were explored. This study was framed by Andersen's Behavioral Model of Health Service Use, which incorporates three main components: predisposing, enabling, and need factors to model health service utilization. The sample (N = 149) was majority middle aged, female, and White with a primary diagnosis of cancer. Cross-tabulations were conducted to determine how many patients who met screening criteria for depression or anxiety sought psychology services. Logistic regression analyses were conducted to assess for predisposing, enabling, and need factor determinants of psychology service utilization. Among patients who met criteria for moderate depression or anxiety, 50% did not access readily available psychology services. Enabling factors were the strongest determinant of psychology utilization. Factors associated with need for psychology services (i.e., emotional distress and psychological symptom burden) did not reach significance in determining psychology service use. This study extends current knowledge about psychology utilization to palliative care outpatients receiving care within a collaborative care model. Directions for future research include further investigation of care models that optimize enabling strategies to enhance access to these services, and examination of patient-reported barriers to receiving this care. Copyright © 2013 John Wiley & Sons, Ltd.

  6. Developmental Changes in Brain Network Hub Connectivity in Late Adolescence. (United States)

    Baker, Simon T E; Lubman, Dan I; Yücel, Murat; Allen, Nicholas B; Whittle, Sarah; Fulcher, Ben D; Zalesky, Andrew; Fornito, Alex


    The human brain undergoes substantial development throughout adolescence and into early adulthood. This maturational process is thought to include the refinement of connectivity between putative connectivity hub regions of the brain, which collectively form a dense core that enhances the functional integration of anatomically distributed, and functionally specialized, neural systems. Here, we used longitudinal diffusion magnetic resonance imaging to characterize changes in connectivity between 80 cortical and subcortical anatomical regions over a 2 year period in 31 adolescents between the ages of 15 and 19 years. Connectome-wide analysis indicated that only a small subset of connections showed evidence of statistically significant developmental change over the study period, with 8% and 6% of connections demonstrating decreased and increased structural connectivity, respectively. Nonetheless, these connections linked 93% and 90% of the 80 regions, respectively, pointing to a selective, yet anatomically distributed pattern of developmental changes that involves most of the brain. Hub regions showed a distinct tendency to be highly connected to each other, indicating robust "rich-club" organization. Moreover, connectivity between hubs was disproportionately influenced by development, such that connectivity between subcortical hubs decreased over time, whereas frontal-subcortical and frontal-parietal hub-hub connectivity increased over time. These findings suggest that late adolescence is characterized by selective, yet significant remodeling of hub-hub connectivity, with the topological organization of hubs shifting emphasis from subcortical hubs in favor of an increasingly prominent role for frontal hub regions. Copyright © 2015 the authors 0270-6474/15/359078-10$15.00/0.

  7. Perceived need for care and mental health service utilization among college students with suicidal ideation. (United States)

    Nam, Boyoung; Wilcox, Holly C; Hilimire, Matthew; DeVylder, Jordan E


    This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.

  8. Satisfaction with health facility delivery care services and ssociated ...

    African Journals Online (AJOL)

    Proportion satisfied varied in different aspects of care ranging from 30% reporting to be satisfied with management of labour pains to 96% reporting to be satisfied with care of the newborn. Only age of the mother showed significant association with satisfaction. Women with formal education and those delivering for the first ...

  9. Enhancing the Empowerment of Youth in Foster Care: Supportive Services (United States)

    Kaplan, Sandra J.; Skolnik, Louise; Turnbull, Ayme


    This paper reviews the research on youth empowerment in seven child welfare programmatic areas. A lack of studies specifically focused on the empowerment of youth in foster care was found. Conceptual perspectives and existing data, however, suggest that the empowerment of youth in and transitioning out of care is essential and should be overtly…

  10. Primary care perceptions of neurology and neurology services. (United States)

    Loftus, Angela M; Wade, Carrie; McCarron, Mark O


    Neurophobia (fear of neural sciences) and evaluation of independent sector contracts in neurology have seldom been examined among general practitioners (GPs). A questionnaire determined GPs' perceptions of neurology compared with other medical specialties. GP experiences of neurology services with independent sector companies and the local National Health Service (NHS) were compared. Areas of potential improvement in NHS neurology services were recorded from thematic analyses. Among 76 GPs neurology was perceived to be as interesting as other medical specialties. GPs reported less knowledge, more difficulty and less confidence in neurology compared with other medical specialties. There was a preference for a local NHS neurology service (pneurology services provided better patient satisfaction. GPs prefer local NHS neurology services to independent sector contracts. GPs' evaluations should inform commissioning of neurology services. Combating neurophobia should be an integral part of responsive commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  11. Tele-operated service robots for household and care

    NARCIS (Netherlands)

    Osch, van M.P.W.J.; Bera, D.; Koks, Y.; Hee, van K.M.; Bronswijk, van J.E.M.H.; Maas, G.J.; Gassel, van F.J.M.


    Purpose: Service robots are a relatively new branch of robotics after the successful industry robots and the experimental humanoids. Service robots are supposed to perform tasks that normally are done by humans in particular daily life activities. However they do not have to do it in the same way as

  12. Development and Psychometric Testing of a Novel Food Service Satisfaction Questionnaire for Food Service Staff of Aged Care Homes. (United States)

    Miller, M; Hamilton, J; Scupham, R; Matwiejczyk, L; Prichard, I; Farrer, O; Yaxley, A


    Food service staff are integral to delivery of quality food in aged care homes yet measurement of their satisfaction is unable to be performed due to an absence of a valid and reliable questionnaire. The aim of this study was to develop and perform psychometric testing for a new Food Service Satisfaction Questionnaire developed in Australia specifically for use by food service staff working in residential aged care homes (Flinders FSSQFSAC). A mixed methods design utilizing both a qualitative (in-depth interviews, focus groups) and a quantitative approach (cross sectional survey) was used. Content validity was determined from focus groups and interviews with food service staff currently working in aged care homes, related questionnaires from the literature and consultation with an expert panel. The questionnaire was tested for construct validity and internal consistency using data from food service staff currently working in aged care homes that responded to an electronic invitation circulated to Australian aged care homes using a national database of email addresses. Construct validity was tested via principle components analysis and internal consistency through Cronbach's alpha. Temporal stability of the questionnaire was determined from food service staff undertaking the Flinders FSSQFSAC on two occasions, two weeks apart, and analysed using Pearson's correlations. Content validity for the Flinders FSSQFSAC was established from a panel of experts and stakeholders. Principle components analysis revealed food service staff satisfaction was represented by 61-items divided into eight domains: job satisfaction (α=0.832), food quality (α=0.871), staff training (α=0.922), consultation (α=0.840), eating environment (α=0.777), reliability (α=0.695), family expectations (α=0.781) and resident relationships (α=0.429), establishing construct validity in all domains, and internal consistency in all (α>0.5) except for "resident relationships" (α=0.429). Test

  13. Transformation by stealth: the retargeting of home care services in Finland. (United States)

    Kröger, Teppo; Leinonen, Anu


    This paper analyses the trends and changes that home care services for older people have undergone during the last two decades in Finland. The data used come from national social care statistics, covering the time period from 1990-2010. The results show that, in contrast to many other European nations that have expanded their home care provisions, the coverage levels in Finland have dropped dramatically during this period. Those with the highest needs do receive increased amounts of support, but others have become excluded from publicly funded home care provisions and often need to rely on family members. In most localities, public service provision is focused on personal care, and no longer covers household tasks. This major change of the character of the service is connected to three other recent trends that structure current provisions: the amalgamation of home-based social and healthcare services, the marketisation and emerging privatisation of care and the integration of informal family care into the formal care system. Overall, the changes represent weakening defamilisation, that is, decreasing public responsibility for the needs of many older people and, correspondingly, an increasing reliance on family carers. This full-scale transformation of home care has taken place without any real policy debate or major modification of legislation. No actual decision was ever made to thoroughly alter the character of home care in Finland: the transformation happened by stealth. © 2011 Blackwell Publishing Ltd.

  14. The exhausting dilemmas faced by home-care service providers when enhancing participation among older adults receiving home care. (United States)

    Vik, Kjersti; Eide, Arne H


    Older adults wish to stay at home, participate in society and manage on their own as long as possible. Many older adults will, however, eventually become dependent on care and help to maintain their daily living. Thus, to enhance activity and participation also among older adults that receive home-based services, there is a strong need for development of knowledge-based practice regarding participation. The specific aim of this study is to explore how service providers perceive that their working conditions influence on their possibilities to promote participation among older adults, and more specifically, how they perceive the influence of their working conditions. A purposeful sampling strategy was applied, and six focus groups with professionals in two municipalities were conducted. The focus groups comprised four and six participants of varying ages, length of working experience and professions. A total of 30 service providers participated. The data were analysed by a constant comparative method following the guidelines from Grounded Theory. The analysis identified the categories 'encountering needs that cannot be met', 'expectations about participation', 'organisation of services' and 'professional standards' influencing the service delivery. During this analytical process, 'being on the verge' emerged as a core category that describes the service providers' experience of a stressful workday, i.e. when they had the feeling of working against their own professional standards and being pushed to their limits. The findings indicate how the professional standards of service providers on the whole are in line with health policy for in-home services. Policy objectives are, however, not always followed owing to different constraints at the level of service delivery. Along the path from political ideals to the practical execution of services, external circumstances related to the organisation of services are perceived as crucial. © 2012 The Authors. Scandinavian

  15. Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan. (United States)

    Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko


    The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

  16. Long-term care-service use and increases in care-need level among home-based elderly people in a Japanese urban area. (United States)

    Koike, Soichi; Furui, Yuji


    The objective of this study was to examine the effects of home-based long-term care insurance services on an increase in care need levels and discuss its policy implications. We analyzed care need certification and long-term care service use data for 3006 non-institutionalized elderly persons in a Tokyo ward effective as of October 2009 and 2010. Individual care need assessment intervals and their corresponding changes in care need level were calculated from data at two data acquisition points of care need assessment. Those who had been certified but did not use any long-term care insurance service were defined as the control group. The Cox proportionate hazard model was used to determine whether the use of a long-term care insurance service is associated with increased care need level. After adjusting for sex, age, and care need level, the hazard ratio for the probability of increased care need level among service users was calculated as 0.75 (95% confidence interval, 0.64-0.88; p Home-based long-term care service use may prevent an increase in care need level. Administrative data on care need certification and services use could be an effective tool for evaluating the long-term care insurance system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  17. Health care needs and use of health care services among newly arrived Syrian refugees: a cross-sectional study. (United States)

    Oda, Anna; Tuck, Andrew; Agic, Branka; Hynie, Michaela; Roche, Brenda; McKenzie, Kwame


    Canada welcomed 33 723 Syrian refugees between November 2015 and November 2016. This paper reports the results of a rapid assessment of health care needs and use of health care services among newly arrived Syrian refugees in Toronto. A cross-sectional study was conducted in Toronto among Syrian refugees aged 18 years or more who had been in Canada for 12 months or less. Participants were recruited initially through distribution of flyers in hotels and through direct referrals and communication with community and settlement agency partners, and then through snowball sampling. We collected sociodemographic information and data on self-perceived physical health and mental health, unmet health care needs and use of health care services. A total of 400 Syrian refugees (221 women [55.2%] and 179 men [44.8%]) were enrolled. Of the 400, 209 (52.2%) were privately sponsored refugees, 177 (44.2%) were government-assisted refugees, and 12 (3.0%) were refugees under the Blended Visa Office-Referred Program. They reported high levels of self-perceived physical and mental health. Over 90% of the sample saw a doctor in their first year in Canada, and 79.8% had a family doctor they saw regularly. However, almost half (49.0%) of the respondents reported unmet health care needs, with the 3 most common reasons reported being long wait times, costs associated with services and lack of time to seek health care services. Many factors may explain our respondents' high levels of self-perceived physical and mental health during the first year of resettlement, including initial resettlement support and eligibility for health care under the Interim Federal Health Program. However, newly arrived Syrian refugees report unmet health care needs, which necessitates more comprehensive care and management beyond the initial resettlement support. Copyright 2017, Joule Inc. or its licensors.

  18. Impact of prenatal care provider on the use of ancillary health services during pregnancy (United States)


    Background Recent declines in the provision of prenatal care by family physicians and the integration of midwives into the Canadian health care system have led to a shift in the pattern of prenatal care provision; however it is unknown if this also impacts use of other health services during pregnancy. This study aimed to assess the impact of the type of prenatal care provider on the self-reported use of ancillary services during pregnancy. Methods Data for this study was obtained from the All Our Babies study, a community-based prospective cohort study of women’s experiences during pregnancy and the post-partum period. Chi-square tests and logistic regression were used to assess the association between type of prenatal care provider and use of ancillary health services in pregnancy. Results During pregnancy, 85.8% of women reported accessing ancillary health services. Compared to women who received prenatal care from a family physician, women who saw a midwife were less likely to call a nurse telephone advice line (OR = 0.30, 95% CI: 0.18-0.50) and visit the emergency department (OR = 0.47, 95% CI: 0.24-0.89), but were more likely receive chiropractic care (OR = 4.07, 95% CI: 2.49-6.67). Women who received their prenatal care from an obstetrician were more likely to visit a walk-in clinic (OR = 1.51, 95% CI: 1.11-2.05) than those who were cared for by a family physician. Conclusions Prenatal care is a complex entity and referral pathways between care providers and services are not always clear. This can lead to the provision of fragmented care and create opportunities for errors and loss of information. All types of care providers have a role in addressing the full range of health needs that pregnant women experience. PMID:23497179

  19. The impact of intermediate care services on job satisfaction, skills and career development opportunities. (United States)

    Nancarrow, Susan


    The purpose of this study was to examine, in depth, the impact of intermediate care services on staff job satisfaction, skills development and career development opportunities. Recruitment and retention difficulties present a major barrier to the effective delivery of intermediate care services in the UK. The limited existing literature is contradictory, but points to the possibility of staff deskilling and suggests that intermediate care is poorly understood and may be seen by other practitioners as being of lower status than hospital work. These factors have the potential to reduce staff morale and limit the possibilities of recruiting staff. The research is based on interviews with 26 staff from case studies of two intermediate care services in South Yorkshire. Participants reported high levels of job satisfaction, which was because of the enabling philosophy of care, increased autonomy, the setting of care and the actual teams within which the workers were employed. For most disciplines, intermediate care facilitated the application of existing skills in a different way; enhancing some skills, while restricting the use of others. Barriers to career development opportunities were attributed to the relative recency of intermediate care services, small size of the services and lack of clear career structures. Career development opportunities in intermediate care could be improved through staff rotations through acute, community and intermediate care to increase their awareness of the roles of intermediate care staff. The non-hierarchical management structures limits management career development opportunities, instead, there is a need to enhance professional growth opportunities through the use of consultant posts and specialization within intermediate care. This study provides insight into the impact of an increasingly popular model of care on the roles and job satisfaction of workers and highlights the importance of this learning for recruitment and retention of

  20. ABACUS and AQME: Semiconductor Device and Quantum Mechanics Education on


    Klimeck, Gerhard; Vasileska, Dragica


    The ABACUS and AQME on-line tools and their associated wiki pages form one-stop shops for educators and students of existing university courses. They are geared towards courses like "introduction to Semiconductor Devices" and "Quantum Mechanics for Engineers". The service is free to anyone and no software installation is required on the user's computer. All simulations, including advanced visualization are performed at a remote computer. The tools have been deployed on in August 2...

  1. A comprehensive approach to quality management of intensive care services. (United States)

    Hariharan, Seetharaman; Dey, Prasanta Kumar


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

  2. A versatile framework for cooperative hub network development

    NARCIS (Netherlands)

    Cruijssen, F.C.A.M.; Borm, P.; Dullaert, W.; Hamers, H.


    This paper introduces a framework for cooperative hub network development. Building a joint physical hub for the transshipment of goods is expensive and, therefore, involves considerable risks for cooperating companies. In a practical setting, it is unlikely that an entire network will be built at

  3. A versatile framework for cooperative hub network development

    NARCIS (Netherlands)

    Cruijssen, Frans; Borm, Peter; Dullaert, Wout; Hamers, Herbert

    This paper introduces a framework for cooperative hub network development. Building a joint physical hub for the transshipment of goods is expensive and, therefore, involves considerable risks for cooperating companies. In a practical setting, it is unlikely that an entire network will be built at

  4. Soft Power and Cultural Diplomacy: Emerging Education Hubs in Asia (United States)

    Lee, Jack T.


    Several education hubs have emerged in Asia and the Middle East in recent years with a specific focus on cross-border higher education. Through considerable efforts in policy planning and generous funding, these hubs aim to transform a country or city into an eminent destination for education, research, and training. The inherent design of these…

  5. International Education Hubs: Collaboration for Competitiveness and Sustainability (United States)

    Knight, Jane


    This chapter focuses on the development of education hubs, a recent phenomenon in international higher education. Three models of hubs are examined in relation to the forces, risks, and opportunities of globalization and how local and international collaborations are essential for both global competitiveness and sustainability.

  6. Climate programs update: USDA Southwest Regional Climate Hub update (United States)

    PROGRAM OVERVIEW: The overarching goal of the USDA SW Climate Hub is to assist farmers, ranchers and foresters in addressing the effects of climate change including prolonged drought, increased insect outbreaks and severe wildfires. In the first year of operations, the SW Climate Hub (est. Februa...

  7. Lean GHTorrent : GitHub data on demand

    NARCIS (Netherlands)

    Gousios, G.; Vasilescu, B.N.; Serebrenik, A.; Zaidman, A.


    In recent years, GitHub has become the largest code host in the world, with more than 5M developers collaborating across 10M repositories. Numerous popular open source projects (such as Ruby on Rails, Homebrew, Bootstrap, Django or jQuery) have chosen GitHub as their host and have migrated their

  8. Development of Europe's gas hubs: Implications for East Asia

    Directory of Open Access Journals (Sweden)

    Xunpeng Shi


    Full Text Available Gas trading hubs have been initially developed in the US in 1980s, UK in 1990s, more recently in European in the 2000s and mulled in East Asia now. Due to its freshness and diversification in nationality, governance and culture, the European hub experience can offer valuable lessons for East Asia. This paper seeks to advance understanding of gas hub development in Europe and provide lessons for East Asia. The European experience highlights that market liberalization and transition of gas pricing mechanism are necessary in creating the competitive markets that are needed for functional gas hubs. Political will and regulations further safeguard the competition environment needed for hub development. Natural factors, such as significant domestic production and culture could have a significant impact on the hub development and transition of pricing mechanism. In East Asia, the path to gas trading hubs might be more difficult than in Europe but a growing market creates an opportunity to start new terms with new contracts. Nevertheless, East Asian needs to work hard to development its indigenous gas or LNG trading hubs.

  9. CE: Original Research: Primary Care Providers and Screening for Military Service and PTSD. (United States)

    Mohler, Kristin Michelle; Sankey-Deemer, Cydnee


    : Background: Most veterans have the option of receiving their health care from the Veterans Health Administration or through primary care providers in the private sector. However, there is some evidence that fewer than half of community-based, private sector primary care and mental health providers screen their patients for military service, particularly in rural areas, leaving these veterans less likely to be screened for posttraumatic stress disorder (PTSD) and other military service-related conditions. To determine whether primary care providers in the private sector are screening patients for military service and subsequent PTSD. We designed and piloted a survey to determine whether primary care providers in a rural Pennsylvania region routinely screen for military service and service-related PTSD. We distributed the survey to a convenience sample of more than 250 primary care providers in central and western Pennsylvania through the U.S. Postal Service, via Facebook, and via work e-mails for those who worked in a local health system. Among 50 eligible respondents, only four (8%) said they screen all their patients for military service, and 20 (40%) reported screening none; only two respondents (4%) screened all their patients who have served in the military for PTSD, and 30 (60%) screened none. Veterans who rely on private sector providers may not receive evidence-based care for military service-related health problems, including PTSD. To improve care for these patients, providers in the private sector should be educated on why all patients should be screened for military service, how to conduct such screening properly, and veterans' general health concerns.

  10. Non-communicable diseases and HIV care and treatment: models of integrated service delivery. (United States)

    Duffy, Malia; Ojikutu, Bisola; Andrian, Soa; Sohng, Elaine; Minior, Thomas; Hirschhorn, Lisa R


    Non-communicable diseases (NCD) are a growing cause of morbidity in low-income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. We describe models of NCD and HIV integration, challenges and lessons learned. A literature review of published articles on integrated NCD and HIV programs in low-income countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration. Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models. Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. Operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled-up by managers and policymakers seeking to address all the chronic care needs of their patients. © 2017 John Wiley & Sons Ltd.

  11. Using the "customer service framework" to successfully implement patient- and family-centered care. (United States)

    Rangachari, Pavani; Bhat, Anita; Seol, Yoon-Ho


    Despite the growing momentum toward patient- and family-centered care at the federal policy level, the organizational literature remains divided on its effectiveness, especially in regard to its key dimension of involving patients and families in treatment decisions and safety practices. Although some have argued for the universal adoption of patient involvement, others have questioned both the effectiveness and feasibility of patient involvement. In this article, we apply a well-established theoretical perspective, that is, the Service Quality Model (SQM) (also known as the "customer service framework") to the health care context, to reconcile the debate related to patient involvement. The application helps support the case for universal adoption of patient involvement and also question the arguments against it. A key contribution of the SQM lies in highlighting a set of fundamental service quality determinants emanating from basic consumer service needs. It also provides a simple framework for understanding how gaps between consumer expectations and management perceptions of those expectations can affect the gap between "expected" and "perceived" service quality from a consumer's perspective. Simultaneously, the SQM also outlines "management requirements" for the successful implementation of a customer service strategy. Applying the SQM to the health care context therefore, in addition to reconciling the debate on patient involvement, helps identify specific steps health care managers could take to successfully implement patient- and family-centered care. Correspondingly, the application also provides insights into strategies for the successful implementation of policy recommendations related to patient- and family-centered care in health care organizations.

  12. Informed use of patients' records on trusted health care services. (United States)

    Sahama, Tony; Miller, Evonne


    Health care is an information-intensive business. Sharing information in health care processes is a smart use of data enabling informed decision-making whilst ensuring. the privacy and security of patient information. To achieve this, we propose data encryption techniques embedded Information Accountability Framework (IAF) that establishes transitions of the technological concept, thus enabling understanding of shared responsibility, accessibility, and efficient cost effective informed decisions between health care professionals and patients. The IAF results reveal possibilities of efficient informed medical decision making and minimisation of medical errors. Of achieving this will require significant cultural changes and research synergies to ensure the sustainability, acceptability and durability of the IAF.

  13. Professional carers' experiences of providing a pediatric palliative care service in Ireland. (United States)

    Clarke, Jean; Quin, Suzanne


    In this article the authors present findings on professional carers' experience of providing pediatric palliative care to children with life-limiting conditions. For this qualitative study, part of a national pediatric palliative care needs analysis, the authors engaged in 15 focus group interviews and drew on the responses of open-ended questions to give voice to the experiences of professional carers and to situate the humanity of their caring reality. This humanity is articulated through three themes: clarity of definition and complexity of engagement, seeking to deliver a palliative care service, and the emotional cost of providing palliative care. Further analysis of these themes points to a work-life experience of skilled and emotional engagement with children, and their parents, in complex processes of caregiving and decision making. Pediatric palliative care occurs in an environment where parents shoulder a large burden of the care and professionals find themselves working in underresourced services.

  14. Complaints against health-care professionals providing police custodial and forensic medical/health-care services and sexual offence examiner services in England, Wales and Northern Ireland. (United States)

    Kennedy, Kieran M; Green, Peter G; Payne-James, J Jason


    Complaints management is an integral component of good clinical governance and an essential contributor to patient safety. Little is known about complaints against health-care professionals (HCPs) in police custodial settings and sexual assault referral centres. This study explored the frequency with which complaints are made against such HCPs working in England, Wales and Northern Ireland. It explored the nature of those complaints and the procedures by which they are investigated. Relevant information was requested from all police services in England, Wales and Northern Ireland; professional regulatory bodies; and the Independent Police Complaints Commission under the Freedom of Information Act (FOIA). Eighty-nine per cent of police services responded to the FOIA request. However, only a minority of these provided detailed information. Many police services cited the provision of health-care services by external providers as the reason for not holding information upon complaints. There was no evidence of any upward trend in the numbers of complaints over the study period. Delayed response to a request for attendance, incivility, medication issues and issues regarding the quality of reports and evidence were amongst the most common types of complaints described. A small number of responders provided copies of the disciplinary procedures used to manage complaints against HCPs. Significant heterogeneity exists in respect of complaints handling procedures across custodial and forensic medical/health-care services and sexual offence examiner services. An opportunity to identify learning for improvement is being missed as a result of the absence of standardised complaints handling procedures.

  15. On the Predictability of Hub Height Winds

    DEFF Research Database (Denmark)

    Draxl, Caroline

    Wind energy is a major source of power in over 70 countries across the world, and the worldwide share of wind energy in electricity consumption is growing. The introduction of signicant amounts of wind energy into power systems makes accurate wind forecasting a crucial element of modern electrical...... grids. These systems require forecasts with temporal scales of tens of minutes to a few days in advance at wind farm locations. Traditionally these forecasts predict the wind at turbine hub heights; this information is then converted by transmission system operators and energy companies into predictions...... of power output at wind farms. Since the power available in the wind is proportional to the wind speed cubed, even small wind forecast errors result in large power prediction errors. Accurate wind forecasts are worth billions of dollars annually; forecast improvements will result in reduced costs...

  16. Socioeconomic disparities in home health care service access and utilization: a scoping review. (United States)

    Goodridge, Donna; Hawranik, Pamela; Duncan, Vicky; Turner, Hollie


    Home health care services are expanding at a rapid pace in order to meet the needs of the growing population of older adults and those with chronic illnesses. Because of current restrictions on home health care as an insured service in some countries, individuals may be required to pay for some or all of their home care services out of pocket. These payments may potentially limit access to needed home care services for persons in the lowest socioeconomic strata. Previous research demonstrates a clear socioeconomic gradient in access to acute and primary care services, where those most in need of services are the most disadvantaged and under-serviced. There has been little attention paid thus far, however, to the way in which socioeconomic status may affect the receipt of home health care services. To determine what is known from existing literature about socioeconomic disparities in home health care access and utilization. A scoping review was used to map the extent and nature of the literature in this area. A search of the databases CINAHL, Medline, SocIndex and Sociological Abstracts as well as Dissertations International. A total of 206 potentially relevant articles were published between 2000 and April 2011. Two reviewers independently reviewed the articles, leaving 15 research articles to be included in the scoping review. The majority of articles reported secondary analyses of administrative datasets related to utilization of home health care. Several studies examined access and utilization using qualitative approaches. The distinction between professional and supportive home care services was not always clear in the articles. Individual and composite measures of socioeconomic status were reported, with the most frequently used indicator being income. Several studies used more complex composite ecological indicators of socieconomic status. There was general agreement that utilization of home health services favored persons with greater economic disadvantage

  17. [Challenges for home care services in the pain management of cancer patients : A qualitative study]. (United States)

    Gnass, I; Krutter, S; Nestler, N


    People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation. By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted. On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment. Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.

  18. Services Use of Children and Adolescents before Admission to Psychiatric Inpatient Care. (United States)

    Zechmeister-Koss, Ingrid; Winkler, Roman; Fritz, Corinna; Thun-Hohenstein, Leonhard; Tuechler, Heinz


    Although 20% of children and adolescents in Europe suffer from overt mental health problems, their illness-related service utilisation is often unknown. If at all, existing research has only addressed the health care sector while services requirements in mental health care go far beyond the health care system, including the social, the educational and the criminal justice system. This paper aims at describing the service contact patterns of children and adolescents within and outside the health care sector before they are admitted to a child and adolescent mental health hospital. Additionally, we evaluate the private out-of-pocket payments that occur for primary carers. A cohort of consecutive admissions to a child and adolescent hospital in Austria was prospectively analysed. We collected data on service use and out-of-pocket expenses before hospital admission from primary carers through face-to-face interviews using an adapted version of the European Child and Adolescent Mental Health Service Receipt Inventory (EU-CAMHSRI). Clinical data came from validated questionnaires (CBCL, YSR) and from the anamnestic documentation. Ninety percent from a cohort of 441 patients had some contact with services or took medication before they were admitted to hospital. Most often, services in the health care outpatient setting were used. Outside of the health care system, support in school, as well as counselling services, were used most frequently, whereas the persons hardly sought support in living or employment. Roughly 32,400 per 100 patients was spent privately, yet these out-of pocket expenses were very unevenly distributed. Service use and out-of-pocket spending increased with social status and were gender-specific. The more severe external behaviour symptoms were, the more non-health care services were used. Mentally ill children and adolescents use a broad range of services across sectors before admission to hospital. Service use is associated with specific symptoms of

  19. Agency ownership, patient payment source, and length of service in home care, 1992 2000. (United States)

    Han, Beth; McAuley, William J; Remsburg, Robin E


    Little is known about whether an association exists between agency ownership and length of service among home care patients with different payment sources. This study investigated how for-profit and not-for-profit agencies responded to policy changes in the 1990s with respect to length of service. We examined length of service among 37,364 home care patients using the 1992, 1994, 1996, 1998, and 2000 National Home and Hospice Care Surveys. We used Kaplan-Meier methods and Cox regression models. After we adjusted for patient and agency characteristics, our results revealed that agency ownership was not associated with length of service for patients with private insurance, Medicare, Medicaid, Medicare plus Medicaid, or Medicare plus private insurance. This finding was consistent from 1992 through 2000. Length of service among patients with Medicare decreased significantly from 1998 through 2000, but length of service among patients with Medicaid did not change significantly from 1992 through 2000. Agency ownership is not associated with patient length of service in home care. Regardless of the policy changes in the home care arena in the 1990s, for-profit and not-for-profit home health agencies behaved similarly with regard to length of service among patients within differently structured payment systems.

  20. Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study. (United States)

    Catalao, Raquel; Eshetu, Tigist; Tsigebrhan, Ruth; Medhin, Girmay; Fekadu, Abebaw; Hanlon, Charlotte


    In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia. A qualitative study was carried out using interviews with purposively sampled service users (n = 13) and caregivers (n = 3) from a community-ascertained cohort of people with epilepsy receiving integrated services in primary care in rural Ethiopia. Interviews followed a topic guide with questions regarding acceptability, satisfaction, barriers to access care, pathways through care and impact of services. Framework analysis was employed to analyse the data. Proximity of the new service in local primary health centers decreased the cost of transportation for the majority of service users thus improving access to services. First-hand experience of services was in some cases associated with a willingness to promote the services and inform others of the existence of effective biomedical treatment for epilepsy. However, most service users and their caregivers continued to seek help from traditional healers alongside biomedical care. Most of the care received was focused on medication provision with limited information provided on how to manage their illness and its effects. Caregivers and service users spoke about the high emotional and financial burden of the disease and lack of ongoing practical and emotional support. The majority of participants reported clinical improvement on medication, which in over half of the participants was associated with ability to return to money generating activities. Task-sharing improved the accessibility of epilepsy care for

  1. Assessment of Service Availability and Health Care Workers ...

    African Journals Online (AJOL)

    Health care workers' (HCWs') opinions about sexual and reproductive health ... women ignore information they receive about HIV and pregnancy prevention. ... for young women; all recognized the importance of condoms for dual protection.

  2. Numerical investigation of hub clearance flow in a Kaplan turbine (United States)

    Wu, H.; Feng, J. J.; Wu, G. K.; Luo, X. Q.


    In this paper, the flow field considering the hub clearance flow in a Kaplan turbine has been investigated through using the commercial CFD code ANSYS CFX based on high-quality structured grids generated by ANSYS ICEM CFD. The turbulence is simulated by k-ω based shear stress transport (SST) turbulence model together with automatic near wall treatments. Four kinds of simulations have been conducted for the runner geometry without hub clearance, with only the hub front clearance, with only the rear hub clearance, and with both front and rear clearance. The analysis of the obtained results is focused on the flow structure of the hub clearance flow, the effect on the turbine performance including hydraulic efficiency and cavitation performance, which can improve the understanding on the flow field in a Kaplan turbine.

  3. Numerical investigation of hub clearance flow in a Kaplan turbine

    International Nuclear Information System (INIS)

    Wu, H; Feng, J J; Wu, G K; Luo, X Q


    In this paper, the flow field considering the hub clearance flow in a Kaplan turbine has been investigated through using the commercial CFD code ANSYS CFX based on high-quality structured grids generated by ANSYS ICEM CFD. The turbulence is simulated by k-ω based shear stress transport (SST) turbulence model together with automatic near wall treatments. Four kinds of simulations have been conducted for the runner geometry without hub clearance, with only the hub front clearance, with only the rear hub clearance, and with both front and rear clearance. The analysis of the obtained results is focused on the flow structure of the hub clearance flow, the effect on the turbine performance including hydraulic efficiency and cavitation performance, which can improve the understanding on the flow field in a Kaplan turbine.

  4. Location of Urban Logistic Terminals as Hub Location Problem

    Directory of Open Access Journals (Sweden)

    Jasmina Pašagić Škrinjar


    Full Text Available In this paper the problems of locating urban logistic terminals are studied as hub location problems that due to a large number of potential nodes in big cities belong to hard non-polynomial problems, the so-called NP-problems. The hub location problems have found wide application in physical planning of transport and telecommunication systems, especially systems of fast delivery, networks of logistic and distribution centres and cargo traffic terminals of the big cities, etc. The paper defines single and multiple allocations and studies the numerical examples. The capacitated single allocation hub location problems have been studied, with the provision of a mathematical model of selecting the location for the hubs on the network. The paper also presents the differences in the possibilities of implementing the exact and heuristic methods to solve the actual location problems of big dimensions i.e. hub problems of the big cities.

  5. Development of an improved low profile hub seal refurbishment tool

    International Nuclear Information System (INIS)

    Wagg, L.


    The hub seal area of a fuel channel feeder coupling can be exposed to oxygen in the atmosphere if protective measures are not taken during maintenance outages. Exposure to oxygen can lead to pitting of the hub seal area. Although this is a rare occurrence, the resulting possibility of the feeder coupling leakage led to the development of a feeder hub refurbishment tool. To reduce time and man-rem exposure during feeder hub seal refurbishment, an improved low profile hub seat refurbishing tool has been developed. The improved tool design will allow for quick and controlled removal of material, and the restoration of a roll-burnished finish equivalent to the original requirements. The new tool can be used in maintenance operations, with the end fitting present, as well as under retube-type circumstances, with the end fitting removed. (author)

  6. Effects of home-based long-term care services on caregiver health according to age. (United States)

    Chen, Ming-Chun; Kao, Chi-Wen; Chiu, Yu-Lung; Lin, Tzu-Ying; Tsai, Yu-Ting; Jian, Yi-Ting Zhang; Tzeng, Ya-Mei; Lin, Fu-Gong; Hwang, Shu-Ling; Li, Shan-Ru; Kao, Senyeong


    Caregiver health is a crucial public health concern due to the increasing number of elderly people with disabilities. Elderly caregivers are more likely to have poorer health and be a care recipient than younger caregivers. The Taiwan government offers home-based long-term care (LTC) services to provide formal care and decrease the burden of caregivers. This study examined the effects of home-based LTC services on caregiver health according to caregiver age. This cross-sectional study included a simple random sample of care recipients and their caregivers. The care recipients had used LTC services under the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. Data were collected through self-administered questionnaires from September 2012 to January 2013. The following variables were assessed for caregivers: health, sex, marital status, education level, relationship with care recipient, quality of relationship with care recipient, job, household monthly income, family income spent on caring for the care recipient (%) and caregiving period. Furthermore, the following factors were assessed for care recipients: age, sex, marital status, education level, living alone, number of family members living with the care recipient, quality of relationship with family and dependency level. The health of the caregivers and care recipients was measured using a self-rated question (self-rated health [SRH] was rated as very poor, poor, fair, good and very good). The study revealed that home nursing care was significantly associated with the health of caregivers aged 65 years or older; however, caregivers aged less than 65 who had used home nursing care, rehabilitation or respite care had poorer health than those who had not used these services. In addition, the following variables significantly improved the health of caregivers aged 65 years or older: caregiver employment, 20% or less of family income spent on caregiving than 81%-100% and higher care recipient health. The

  7. ED services: the impact of caring behaviors on patient loyalty. (United States)

    Liu, Sandra S; Franz, David; Allen, Monette; Chang, En-Chung; Janowiak, Dana; Mayne, Patricia; White, Ruth


    This article describes an observational study of caring behaviors in the emergency departments of 4 Ascension Health hospitals and the impact of these behaviors on patient loyalty to the associated hospital. These hospitals were diverse in size and geography, representing 3 large urban community hospitals in metropolitan areas and 1 in a midsized city. Research assistants from Purdue University (West Lafayette, IN) conducted observations at the first study site and validated survey instruments. The Purdue research assistants trained contracted observers at the subsequent study sites. The research assistants conducted observational studies of caregivers in the emergency departments at 4 study sites using convenience sampling of patients. Caring behaviors were rated from 0 (did not occur) to 5 (high intensity). The observation included additional information, for example, caregiver roles, timing, and type of visit. Observed and unobserved patients completed exit surveys that recorded patient responses to the likelihood-to-recommend (loyalty) questions, patient perceptions of care, and demographic information. Common themes across all study sites emerged, including (1) the area that patients considered most important to an ED experience (prompt attention to their needs upon arrival to the emergency department); (2) the area that patients rated as least positive in their actual ED experience (prompt attention to their needs upon arrival to the emergency department); (3) caring behaviors that significantly affected patient loyalty (eg, making sure that the patient is aware of care-related details, working with a caring touch, and making the treatment procedure clearly understood by the patient); and (4) the impact of wait time to see a caregiver on patient loyalty. A number of correlations between caring behaviors and patient loyalty were statistically significant (P loyalty but that occurred least frequently. The study showed through factor analysis that some caring

  8. Complexities of Providing Dental Hygiene Services in Community Care Settings. (United States)

    Zarkowski, Pamela; Aksu, Mert N


    Direct access care provided by dental hygienists can reduce oral health disparities for the underserved, yet legal, regulatory, and ethical considerations create complexities and limits. Individual state dental practice acts regulate the scope of practice and level of supervision required when dental hygienists deliver care. Yet, inconsistent state practice act regulations contribute to ethical and legal limitations and dilemmas for practitioners. The dental hygienist is positioned to assume an increasingly larger role in the management of oral health disparities. However, there are several legal and ethical considerations that impact both dental hygienists and dentists providing care in complex community settings. This article informs dental hygienists and other related constituencies about conundrums that are encountered when providing care 'beyond the operatory.' An evidence-based view of ways in which dental hygienists are reducing oral health disparities illustrates the complex issues involved in providing such care. Potential scenarios that can occur during care provision in underserved settings provide the basis for a discussion of legal and other associated issues impacting dental hygiene practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Why Care About Aquatic Insects: Uses, Benefits, and Services (United States)

    Mayflies and other aquatic insects are common subjects of ecological research, and environmental monitoring and assessment. However, their important role in protecting and restoring aquatic ecosystems is often challenged, because their benefits and services to humans are not obv...

  10. Patients' satisfaction with eye care services in a Nigerian teaching ...

    African Journals Online (AJOL)


    Mar 7, 2014 ... Background: Understanding the patients' perception of services received is ... The questionnaire asked questions regarding satisfaction with the time spent in the .... corresponding values for the aforementioned studies were.

  11. Undermining the rules in home care services for the elderly in Norway: flexibility and cooperation. (United States)

    Wollscheid, Sabine; Eriksen, John; Hallvik, Jørgen


    This study explores the provision of home care services (home nursing and domiciliary help) for the elderly in Norwegian municipalities with purchaser-provider split model. The study draws on the assumption that flexibility in adjusting services to the care receivers' needs, and cooperation between provider and purchasers are indicators of good quality of care. Data were collected through semi-structured telephone interviews with 22 team leaders of provider units in nine municipalities. Data were collected in 2008-2009. The study has been approved by the Norwegian Social Science Data Services. We identified four different ways of organising home care services under a purchaser-provider split model: Provider empowerment, New Public Management, Vague instructions and undermining the rules. High flexibility in providing care and cooperation with the purchaser unit were identified by the team leaders as characteristics for good care. Our findings suggest that the care providers use individual strategies that allow flexibility and cooperation rather than rigidly abiding to the regulations the purchaser-provider split models implies. Ironically, in provider units where the 'rules were undermined', the informants (team leaders of provider units) seemed to be most satisfied with the quality of home care that they delivered. © 2012 Nordic College of Caring Science.

  12. Transforming Health Care Service Delivery and Provider Selection


    Reiner, Bruce I.


    Commoditization pressures in medicine have risked transforming service provider selection from “survival of the fittest” to “survival of the cheapest.” Quality- and safety-oriented mandates by the Institute of Medicine have led to the creation of a number of data-driven quality-centric initiatives including Pay for Performance and Evidence-Based Medicine. A synergistic approach to creating quantitative accountability in medical service delivery is through the creation of consumer-oriented per...

  13. Bundling Post-Acute Care Services into MS-DRG Payments (United States)

    U.S. Department of Health & Human Services — A bundled hospital payment system that encompasses both acute and post-acute care has been proposed as a means of creating financial incentives in the Medicare...

  14. Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries

    DEFF Research Database (Denmark)

    Pandian, Jeyaraj Durai; William, Akanksha G; Kate, Mahesh P


    subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. CONCLUSION: In this systematic review, we found several reports...... on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary......BACKGROUND: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. AIMS AND OBJECTIVES: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence...

  15. What Factors Influence Employee Service Recovery Performance and What Are the Consequences in Health Care? (United States)

    Nadiri, Halil; Tanova, Cem


    We analyzed the extent to which the service recovery performance of frontline employees in private health care institutions is influenced by employee perceptions of manager attitudes toward service quality, workplace support, and manager fairness and organizational commitment. We also examined the relationship of service recovery performance to employee job satisfaction and turnover intentions. Partial least square path modeling of data from 178 frontline employees in private health care institutions in North Cyprus was utilized. Although empowerment and role clarity were positively related to service recovery performance, perceived managerial attitudes toward hospital customer service, teamwork, and customer service-oriented training as indicators of workplace support were not related to frontline employees' service recovery performance. Organizational justice was related to affective commitment, which in turn was related to service recovery performance. Although service recovery performance was not related to employee turnover intentions, it was related to job satisfaction. Managerial implications of these study findings are presented in the light of the cognitive evaluation theory. Health services differ from other service organizations in the way that intrinsic and extrinsic rewards influence the service recovery efforts of frontline employees. To ensure high quality services, managers should focus on intrinsic rewards, empower and give more autonomy to staff.

  16. Service user involvement in mental health care: an evolutionary concept analysis. (United States)

    Millar, Samantha L; Chambers, Mary; Giles, Melanie


    The concept of service user involvement is an evolving concept in the mental health-care literature. This study sought to explore and analyse the concept of service user involvement as used in within the field of mental health care. An evolutionary concept analysis was conducted using a literature-based sample extracted from an electronic database search. One hundred and thirty-four papers met the inclusion criteria and were analysed to discover key attributes, antecedents and consequences of service user involvement and to produce a definition of the concept. Five key attributes of service user involvement within the context of mental health care were identified: a person-centred approach, informed decision making, advocacy, obtaining service user views and feedback and working in partnership. Clarity of the attributes and definition of the concept of service user involvement aims to promote understanding of the concept among key stakeholders including mental health professionals, service users and community and voluntary organizations. The findings of the research have utility in the areas of theory and policy development, research on service user involvement in mental health care and service user involvement in mental health practice. Directions for further research regarding the concept are identified. © 2015 John Wiley & Sons Ltd.

  17. What causes treatment failure - the patient, primary care, secondary care or inadequate interaction in the health services?

    Directory of Open Access Journals (Sweden)

    Lange Ove


    Full Text Available Abstract Background Optimal treatment gives complete relief of symptoms of many disorders. But even if such treatment is available, some patients have persisting complaints. One disorder, from which the patients should achieve complete relief of symptoms with medical or surgical treatment, is gastroesophageal reflux disease (GERD. Despite the fact that such treatment is cheap, safe and easily available; some patients have persistent complaints after contact with the health services. This study evaluates the causes of treatment failure. Methods Twelve patients with GERD and persistent complaints had a semi-structured interview which focused on the patients' evaluation of treatment failure. The interviews were taped, transcribed and evaluated by 18 physicians, (six general practitioners, six gastroenterologists and six gastrointestinal surgeons who completed a questionnaire for each patient. The questionnaires were scored, and the relative responsibility for the failure was attributed to the patient, primary care, secondary care and interaction in the health services. Results Failing interaction in the health services was the most important cause of treatment failure, followed by failure in primary care, secondary care and the patient himself; the relative responsibilities were 35%, 28%, 27% and 10% respectively. There was satisfactory agreement about the causes between doctors with different specialities, but significant inter-individual differences between the doctors. The causes of the failures differed between the patients. Conclusions Treatment failure is a complex problem. Inadequate interaction in the health services seems to be important. Improved communication between parts of the health services and with the patients are areas of improvement.

  18. Up-to-Date on Preventive Care Services Under Affordable Care Act: A Trend Analysis From MEPS 2007-2014. (United States)

    Hong, Young-Rock; Jo, Ara; Mainous, Arch G


    The utilization of preventive care services has been less than optimal. As part of an effort to address this, the Affordable Care Act (ACA) mandated that private health insurance plans cover evidence-based preventive services. To evaluate whether the provisions of ACA have increased being up-to-date on recommended preventive care services among privately insured individuals aged 18-64. Multivariate linear regression models were used to examine trends in prevalence of being up-to-date on selected preventive services, diagnosis of health conditions, and health expenditures between pre-ACA (2007-2010) and post-ACA (2011-2014). Adjusted difference-in-difference analyses were used to estimate changes in those outcomes in the privately insured that differed from changes in the uninsured (control group). After the passage of ACA, up-to-date rates of routine checkup (2.7%; 95% confidence interval, 0.8%-4.7%; P=0.007) and flu vaccination (5.9%; 95% confidence interval, 4.2%-7.6%; Ppreventive care services. Additional efforts may be required to take full advantage of the elimination of cost-sharing under the ACA.

  19. Satisfaction of clients with disabilities with services offered at primary health care centres in Ndola, Zambia

    Directory of Open Access Journals (Sweden)

    N. Mlenzana


    Full Text Available To establish satisfaction level of persons with disabilitiesregarding health services at primary health care centres in Ndola, Zambia.Key stakeholders views on satisfaction of services is an important componentof service rendering thus obtaining information is important in assistingwith the evaluation of health care service delivery. This will assist in improvingeffectiveness and availability of health care services to persons with physicaldisabilities.All persons with disabilities attending both rehabilitation centres andprimary health care centres in Ndola, Zambia, were targeted for this study. Willing participants were convenientlyselected to take part in the study.A cross sectional, descriptive study design using quantitative methods of data collection was used. The GeneralPractice Assessment Questionnaire was adjusted, piloted for Ndola population and used in this study to establishsatisfaction of participants. The study was ethically cleared at the University of the Western Cape and Zambia.Information and consent forms were signed by participants.Quantitative data was analysed descriptively and was reported in percentages.In the current study there were 191 participants of whom 56% were male and 44% were female with age rangefrom 18-65 years. Fifty-two percent of the participants presented with learning disabilities and 38% of persons withphysical disabilities. Majority of clients (54% were dissatisfied with availability of services and health care servicesat the health care centres. Areas that clients were dissatisfied with were accessibility, consultation with health professionals,waiting times and opening hours of the health care centres.Clients with disabilities who accessed health care services from selected health centres in Ndola were dissatisfiedwith aspects of health services. Accessibility, consultation with health professionals, waiting times and opening hoursof the health care centres were the origin of client dissatisfaction

  20. Service user involvement in care planning: the mental health nurse's perspective. (United States)

    Anthony, P; Crawford, P


    A dissonance between espoused values of consumerism within mental health care and the 'reality' of clinical practice has been firmly established in the literature, not least in terms of service user involvement in care planning. In order to begin to minimize such dissonance, it is vital that mental health nurse perceptions of service user involvement in the core activity of care planning are better understood. The main findings of this qualitative study, which uses semistructured interviews, suggest that mental health nurses value the concept of user involvement but consider it to be problematic in certain circumstances. The study reveals that nurses hold similar views about the 'meaning' of patient involvement in care planning but limited resources, individual patients characteristics and limitations in nursing care are the main inhibiting factors. Factors perceived as promoting and increasing user involvement included: provision of accurate information, 'user-friendly' documentation, mechanisms for gaining service user feedback, and high staff morale.

  1. Accessibility to primary health care services in the state of Goiás

    Directory of Open Access Journals (Sweden)

    Juliana Pires Ribeiro


    Full Text Available The objective of this study was to evaluate accessibility to primary health care services in the state of Goiás. A descriptive cross-sectional study was conducted based on secondary data from the National Program to Improve Access to and Quality of Primary Health Care. The study sample was composed of health professionals from 1,216 primary health care units. Results showed that 68.5% of the health units miss a screening room, thus considerably damaging prompt decision-making by professionals. The lack of medical offices in 2% of the sites hinders the primary health care services accessibility in Goiás. As regards opening hours and work shifts, 86% of the units are open five days a week in eight-hour shifts, which does not favor accessibility for users. This study confirms the lack of accessibility to health services and the need for additional investments to strengthen primary health care.

  2. What influences patients’ acceptance of a blood pressure telemonitoring service in primary care? A qualitative study

    Directory of Open Access Journals (Sweden)

    Abdullah A


    Full Text Available Adina Abdullah,1 Su May Liew,1 Nik Sherina Hanafi,1 Chirk Jenn Ng,1 Pauline Siew Mei Lai,1 Yook Chin Chia,1 Chu Kiong Loo2 1Department of Primary Care Medicine, Faculty of Medicine, University Malaya Primary Care Research Group, University of Malaya, Kuala Lumpur, Malaysia; 2Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, University of Malaya, Kuala Lumpur, Malaysia Background: Telemonitoring of home blood pressure (BP is found to have a positive effect on BP control. Delivering a BP telemonitoring service in primary care offers primary care physicians an innovative approach toward management of their patients with hypertension. However, little is known about patients’ acceptance of such service in routine clinical care.Objective: This study aimed to explore patients’ acceptance of a BP telemonitoring service delivered in primary care based on the technology acceptance model (TAM.Methods: A qualitative study design was used. Primary care patients with uncontrolled office BP who fulfilled the inclusion criteria were enrolled into a BP telemonitoring service offered between the period August 2012 and September 2012. This service was delivered at an urban primary care clinic in Kuala Lumpur, Malaysia. Twenty patients used the BP telemonitoring service. Of these, 17 patients consented to share their views and experiences through five in-depth interviews and two focus group discussions. An interview guide was developed based on the TAM. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used for analysis.Results: Patients found the BP telemonitoring service easy to use but struggled with the perceived usefulness of doing so. They expressed confusion in making sense of the monitored home BP readings. They often thought about the implications of these readings to their hypertension management and overall health. Patients wanted more feedback from their doctors and

  3. Integrating mental health services into primary HIV care for women: the Whole Life project.


    Dodds, Sally; Nuehring, Elane M.; Blaney, Nancy T.; Blakley, Theresa; Lizzotte, Jean-Marie; Lopez, Myriam; Potter, JoNell E.; O'Sullivan, Mary J.


    The high rate of mental health problems in HIV-infected women jeopardizes the health of this vulnerable population, and constitutes a mandate for integrating mental health services into HIV primary care. The Whole Life project-a collaboration of the departments of Psychiatry and Obstetrics/Gynecology at the University of Miami School of Medicine-successfully integrated mental health services into primary HIV care for women. This article describes the conceptual framework of the integration, i...

  4. Characteristics of Indigenous primary health care service delivery models: a systematic scoping review. (United States)

    Harfield, Stephen G; Davy, Carol; McArthur, Alexa; Munn, Zachary; Brown, Alex; Brown, Ngiare


    Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified - accessible health services, community

  5. Public health approaches to end-of-life care in the UK: an online survey of palliative care services. (United States)

    Paul, Sally; Sallnow, Libby


    The public health approach to end-of-life care has gained recognition over the past decade regarding its contribution to palliative care services. Terms, such as health-promoting palliative care, and compassionate communities, have entered the discourse of palliative care and practice; examples exist in the UK and globally. This scoping study aimed to determine if such initiatives were priorities for hospices in the UK and, if so, provide baseline data on the types of initiatives undertaken. An online survey was designed, piloted and emailed to 220 palliative care providers across the four UK countries. It included a total of six questions. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically. There was a 66% response rate. Of those providers, 60% indicated that public health approaches to death, dying and loss were a current priority for their organisation. Respondents identified a range of work being undertaken currently in this area. The most successful were felt to be working with schools and working directly with local community groups. The findings demonstrate the relevance of a public health approach for palliative care services and how they are currently engaging with the communities they serve. Although the approach was endorsed by the majority of respondents, various challenges were highlighted. These related to the need to balance this against service provision, and the need for more training and resources to support these initiatives, at both national and community levels.

  6. Quantifying low-value services by using routine data from Austrian primary care. (United States)

    Sprenger, Martin; Robausch, Martin; Moser, Adrian


    Open debates about the reduction of low-value services, unnecessary diagnostic tests and ineffective therapeutic procedures and initiatives like "Choosing Wisely "in the USA and Canada are still absent in Austria. The objectives of this study are: (i) to establish a list of ineffective or low-value services possibly provided in Austrian primary care, (ii) to explore how many of these services are quantifiable using routine data and (iii) to estimate the number of affected beneficiaries and avoidable costs arising from the provision of these services. In May 2014, we identified low-value care services relevant for primary care in Austria. For our analysis we used routine data sets from the Austrian health insurance. All analysis refer to the insured population of the Lower Austrian Sickness Fund (n = 1 168 433) in the year 2013. (i) We found 453 low-value services possibly offered in Austrian primary care. (ii) Only 34 (7.5%) services were quantifiable using routine data. (iii) In the year 2013, these 34 services were provided to at least 246 131 beneficiaries and the estimated avoidable costs arising were at least 11.38 million Euros. This accounts for 1.2% of overall spending of the Lower Austrian Sickness Fund for drugs and services provided by primary care doctors in the year 2013. The absence of a homogeneous, transparent and accessible coding system for diagnosis in Austrian primary care restrained our assessment. However, our study findings illustrate the potential utility and limitations of using claims-based measures to identify low-value care. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  7. Convenience, quality and choice: Patient and service-provider perspectives for treating primary care complaints in urgent care settings. (United States)

    Sturgeon, David


    To investigate why patients chose to attend two, nurse-led, minor injury units (MIUs) to access primary healthcare services rather than attend their GP practice. Since the 1980's, healthcare organisations in the UK and elsewhere have implemented an increasingly consumer-orientated model of healthcare provision. As a result, patients with non-urgent presentations are attending Emergency Departments (EDs) and other urgent care facilities in growing numbers. A comparative case study approach was adopted and between October 2014 and May 2015 the researcher was embedded as a participant observer as part of the emergency nurse practitioner team at two, nurse-led, MIUs (site A and B). During this time, 40 patients, 17 service-providers and 1 senior manager were interviewed. Patients and service-providers at both sites identified convenience and quality of care as the principle reasons patients presented for primary healthcare services at MIUs rather than their GP practice. Service-providers were aware that by providing treatment, they established a precedent and a sense of expectation for future care. Patients are acting rationally and predictably in response to healthcare policy promises regarding choice, expectation created by service-providers, and local demographic factors. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  8. The impact of health care professionals' service orientation on patients' innovative behavior. (United States)

    Henrike, Hannemann-Weber; Schultz, Carsten


    The increasing availability of medical information and the rising relevance of patient communities drive the active role of health consumers in health care processes. Patients become experts on their disease and provide valuable stimuli for novel care solutions. Medical encounters evolve toward a more collaborative health care service process, where patients are accepted as equal partners. However, the patient's active role depends on the interaction with the involved health care professionals. The aim of this article is to examine whether the service orientation of health care professionals and their proactive and adaptive work behavior and the extent of shared goals within the necessary interdisciplinary health professional team influence patients' innovative behavior. We address six rare diseases and use interview and survey data to test theoretically derived hypotheses. The sample consists of 86 patients and their 160 health care professionals. Sixty patients provided additional information via interviews. Patients' innovative behavior is reflected by the number of generated ideas as well as the variety of ideas. The service orientation of work teams plays an important role in the innovation process of patients. As hypothesized, the extent of shared goals within the health care teams has a direct effect on patients' idea generation. Work adaptivity and proactivity and shared goals both reinforce the positive effect of service orientation. Furthermore, significant associations between the three independent variables and the second outcome variable of patient's idea variety are confirmed. The study underlines (1) the important role of patients within health care service innovation processes, (2) the necessity of a service-oriented working climate to foster the development of innovative care solutions for rare diseases, and (3) the need for an efficient cooperation and open mindset of health care professionals to motivate and support patient innovation.

  9. Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data. (United States)

    Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Warland, Andrew; Westbrook, Johanna


    To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  10. Retention in Differentiated Care: Multiple Measures Analysis for a Decentralized HIV Care and Treatment Program in North Central Nigeria (United States)

    Agaba, Patricia A; Genberg, Becky L; Sagay, Atiene S; Agbaji, Oche O; Meloni, Seema T; Dadem, Nancin Y; Kolawole, Grace O; Okonkwo, Prosper; Kanki, Phyllis J; Ware, Norma C


    Objective Differentiated care refers collectively to flexible service models designed to meet the differing needs of HIV-infected persons in resource-scarce settings. Decentralization is one such service model. Retention is a key indicator for monitoring the success of HIV treatment and care programs. We used multiple measures to compare retention in a cohort of patients receiving HIV care at “hub” (central) and “spoke” (decentralized) sites in a large public HIV treatment program in north central Nigeria. Methods This retrospective cohort study utilized longitudinal program data representing central and decentralized levels of care in the Plateau State Decentralization Initiative, north central Nigeria. We examined retention with patient- level (retention at fixed times, loss-to-follow-up [LTFU]) and visit-level (gaps-in-care, visit constancy) measures. Regression models with generalized estimating equations (GEE) were used to estimate the effect of decentralization on visit-level measures. Patient-level measures were examined using survival methods with Cox regression models, controlling for baseline variables. Results Of 15,650 patients, 43% were enrolled at the hub. Median time in care was 3.1 years. Hub patients were less likely to be LTFU (adjusted hazard ratio (AHR)=0.91, 95% CI: 0.85-0.97), compared to spoke patients. Visit constancy was lower at the hub (−4.5%, 95% CI: −3.5, −5.5), where gaps in care were also more likely to occur (adjusted odds ratio=1.95, 95% CI: 1.83-2.08). Conclusion Decentralized sites demonstrated better retention outcomes using visit-level measures, while the hub achieved better retention outcomes using patient-level measures. Retention estimates produced by incorporating multiple measures showed substantial variation, confirming the influence of measurement strategies on the results of retention research. Future studies of retention in HIV care in sub-Saharan Africa will be well-served by including multiple measures

  11. Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project. (United States)

    Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G


    Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

  12. Service quality of delivered care from the perception of women with caesarean section and normal delivery. (United States)

    Tabrizi, Jafar S; Askari, Samira; Fardiazar, Zahra; Koshavar, Hossein; Gholipour, Kamal


    Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 - (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women's perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). A notable gap between the participants‟ expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.

  13. What patients think about choice in healthcare? A study on primary care services in Finland. (United States)

    Aalto, Anna-Mari; Elovainio, Marko; Tynkkynen, Liina-Kaisa; Reissell, Eeva; Vehko, Tuulikki; Chydenius, Miisa; Sinervo, Timo


    The ongoing Finnish health and social service reform will expand choice by opening the market for competition between public and private service providers. This study examined the attitudes of primary care patients towards choice and which patient-related factors are associated with these attitudes. A sample of attenders during one week in health centres of 12 big cities and municipal consortiums (including seven outsourced local units) and in primary care units of one private company providing outsourced services for municipalities (aged 18-95, n=8128) was used. The questionnaire included questions on choice-related attitudes, sociodemographic factors, health status, use of health services and patient satisfaction. Of the responders, 77% regarded choice to be important, 49% perceived genuine opportunities to make choices and 35% were satisfied with the choice-relevant information. Higher age, low education, having a chronic illness, frequent use of services, having a personal physician and being satisfied with the physician and with waiting times were related to assigning more importance on choice. Younger patients, those with higher education as well as those with chronic illness regarded their opportunities of choosing the service provider and availability of choice-relevant information poorer. The Finnish primary care patients value choice, but they are critical of the availability of choice-relevant information. Choices of patients with complex health care needs should be supported by developing integrated care alternatives and by increasing the availability of information on existing care alternatives to meet their needs.

  14. Income-Related Inequalities in Access to Dental Care Services in Japan. (United States)

    Nishide, Akemi; Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira


    Background : This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods : The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results : Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions : There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system.

  15. Predictors of acceptance of offered care management intervention services in a quality improvement trial for dementia. (United States)

    Kaisey, Marwa; Mittman, Brian; Pearson, Marjorie; Connor, Karen I; Chodosh, Joshua; Vassar, Stefanie D; Nguyen, France T; Vickrey, Barbara G


    Care management approaches have been proven to improve outcomes for patients with dementia and their family caregivers (dyads). However, acceptance of services in these programs is incomplete, impacting effectiveness. Acceptance may be related to dyad as well as healthcare system characteristics, but knowledge about factors associated with program acceptance is lacking. This study investigates patient, caregiver, and healthcare system characteristics associated with acceptance of offered care management services. This study analyzed data from the intervention arm of a cluster randomized controlled trial of a comprehensive dementia care management intervention. There were 408 patient-caregiver dyads enrolled in the study, of which 238 dyads were randomized to the intervention. Caregiver, patient, and health system factors associated with participation in offered care management services were assessed through bivariate and multivariate regression analyses. Out of the 238 dyads, 9 were ineligible for this analysis, leaving data of 229 dyads in this sample. Of these, 185 dyads accepted offered care management services, and 44 dyads did not. Multivariate analyses showed that higher likelihood of acceptance of care management services was uniquely associated with cohabitation of caregiver and patient (p management participation could result in increased adoption of successful programs to improve quality of care. Using these factors to revise both program design as well as program promotion may also benefit external validity of future quality improvement research trials. Copyright © 2011 John Wiley & Sons, Ltd.

  16. The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities. (United States)

    Ascoli, Micol; Palinski, Andrea; Owiti, John Arianda; De Jongh, Bertine; Bhui, Kamaldeep S


    Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering "culture" in the presentation and expression of mental distress. The narratives reveal an overall "culture of understanding cultural issues" and specific "cultures of care". These emerged as necessary foci of intervention to improve service user outcomes. Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.

  17. The place of assisted living in long-term care and related service systems. (United States)

    Stone, Robyn I; Reinhard, Susan C


    The purpose of this article is to describe how assisted living (AL) fits with other long-term-care services. We analyzed the evolution of AL, including the populations served, the services offered, and federal and state policies that create various incentives or disincentives for using AL to replace other forms of care such as nursing home care or home care. Provider models that have emerged include independent senior housing with services, freestanding AL, nursing home expansion, and continuing care retirement communities. Some integrated health systems have also built AL into their array of services. Federal and state policy rules for financing and programs also shape AL, and states vary in how deliberately they try to create an array of options with specific roles for AL. Among state policies reviewed are reimbursement and rate-setting policies, admission and discharge criteria, and nurse practice policies that permit or prohibit various nursing tasks to be delegated in AL settings. Recent initiatives to increase flexible home care, such as nursing home transition programs, cash and counseling, and money-follows-the-person initiatives may influence the way AL emerges in a particular state. There is no single easy answer about the role of AL. To understand the current role and decide how to shape the future of AL, researchers need information systems that track the transitions individuals make during their long-term-care experiences along with information about the case-mix characteristics and service needs of the clientele.

  18. Quality Assessment of Family Planning Sterilization Services at Health Care Facilities: Case Record Audit. (United States)

    Mathur, Medha; Goyal, Ram Chandra; Mathur, Navgeet


    Quality of sterilization services is a matter of concern in India because population control is a necessity. Family Planning Sterilization (FPS) services provided at public health care facilities need to be as per Standard Operating Procedures. To assess the quality of FPS services by audit of case records at selected health care facilities. This cross-sectional study was conducted for two and a half year duration at selected public health care facilities of central India by simple random sampling where FPS services were provided. As per the standards of Government of India, case records were audited and compliance was calculated to assess the quality of services. Results of record audit were satisfactory but important criteria like previous contraceptive history and postoperative counselling were found to be deviated from standards. At Primary Health Centres (PHCs) only 89.5% and at Community Health Centres (CHCs) 58.7% of records were having details of previous contraceptive history. Other criteria like mental illness (only 70% at CHCs) assessment were also inadequate. Although informed consent was found to be having 100% compliance in all records. Quality of care in FPS services is the matter of concern in present scenario for better quality of services. This study may enlighten the policy makers regarding improvements needed for providing quality care.

  19. "Just like I'm saving money in the bank": client perspectives on care coordination services. (United States)

    Freij, Maysoun; Weiss, Linda; Gass, Jonathon; Trezza, Claudia; Wiener, Abigail; Melly, Jeannine; Volland, Patricia


    Older adults face many challenges to community living. The literature has not sufficiently explored the roles of care coordination in the maintenance of housing and access to health care among older adults, particularly from their own perspectives. This qualitative study analyzes the findings from 25 interviews and 6 focus group discussions (48 participants) with a multiethnic sample of older adults in the New York City area. Care coordination services appear to assist older adults access health care, and to a lesser extent, maintain affordable housing. Disparities in access to care coordination appear to remain for immigrant, minority and suburban populations.

  20. Importance of good teamwork in urgent care services. (United States)

    Meier, Curtis


    High quality, safe care for patients depends on effective teamwork, and where multi-professional teams work together there is higher patient satisfaction, increased staff innovation, less stress and more communication ( West 2013 ). Conversely, lapses in teamwork and poor communication can result in adverse events ranging from retained foreign objects to perinatal events and medication errors ( Peter and Pronovost 2013 ), and even the death of patients ( Resuscitation Council UK 2011 ). Teamwork requires a set of skills and behaviours that, once learned by clinicians, can save lives ( Peter and Pronovost 2013 ). This article refers to a case study to explore the topic of teamwork in a tertiary care emergency setting.