WorldWideScience

Sample records for care system results

  1. Measuring the Mental Health-Care System Responsiveness: Results of an Outpatient Survey in Tehran

    OpenAIRE

    Forouzan, Setareh; Padyab, Mojgan; Rafiey, Hassan; Ghazinour, Mehdi; Dejman, Masoumeh; San Sebastian, Miguel

    2016-01-01

    As explained by the World Health Organization (WHO) in 2000, the concept of health system responsiveness is one of the core goals of health systems. Since 2000, further efforts have been made to measure health system responsiveness and the factors affecting responsiveness, yet few studies have applied responsiveness concepts to the evaluation of mental health systems. The present study aims to measure responsiveness and its related domains in the mental health-care system of Tehran. Utilizing...

  2. Measuring the mental health care system responsiveness: results of an outpatient survey in Tehran

    OpenAIRE

    Setareh eForouzan; Mojgan ePadyab; Hassan eRafiey; Mehdi eGhazinour; Masoumeh eDejman; Miguel eSan Sebastian

    2016-01-01

    AbstractAs explained by the World Health Organisation (WHO) in 2000, the concept of health system responsiveness is one of the core goals of health systems. Since 2000, further efforts have been made to measure health system responsiveness and the factors affecting responsiveness, yet few studies have applied responsiveness concepts to the evaluation of mental health systems. The present study aims to measure responsiveness and its related domains in the mental health care system of Tehran. U...

  3. Measuring the Mental Health-Care System Responsiveness: Results of an Outpatient Survey in Tehran.

    Science.gov (United States)

    Forouzan, Setareh; Padyab, Mojgan; Rafiey, Hassan; Ghazinour, Mehdi; Dejman, Masoumeh; San Sebastian, Miguel

    2015-01-01

    As explained by the World Health Organization (WHO) in 2000, the concept of health system responsiveness is one of the core goals of health systems. Since 2000, further efforts have been made to measure health system responsiveness and the factors affecting responsiveness, yet few studies have applied responsiveness concepts to the evaluation of mental health systems. The present study aims to measure responsiveness and its related domains in the mental health-care system of Tehran. Utilizing the same method used by the WHO for its responsiveness survey, responsiveness for outpatient mental health care was evaluated using a validated Farsi questionnaire. A sample of 500 public mental health service users in Tehran participated and subsequently completed the questionnaire. On average, 47% of participants reported experiencing poor responsiveness. Among responsiveness domains, confidentiality and dignity were the best performing factors while autonomy, access to care, and quality of basic amenities were the worst performing. Respondents who reported their social status as low were more likely to experience poor responsiveness overall. Attention and access to care were responsiveness dimensions that performed poorly but were considered to be highly important by study participants. In summary, the study suggests that measuring responsiveness could provide guidance for further development of mental health-care systems to become more patient orientated and provide patients with more respect. PMID:26858944

  4. Measuring the mental health care system responsiveness: results of an outpatient survey in Tehran

    Directory of Open Access Journals (Sweden)

    Setareh eForouzan

    2016-01-01

    Full Text Available AbstractAs explained by the World Health Organisation (WHO in 2000, the concept of health system responsiveness is one of the core goals of health systems. Since 2000, further efforts have been made to measure health system responsiveness and the factors affecting responsiveness, yet few studies have applied responsiveness concepts to the evaluation of mental health systems. The present study aims to measure responsiveness and its related domains in the mental health care system of Tehran. Utilising the same method used by the WHO for its responsiveness survey, responsiveness for outpatient mental health care was evaluated using a validated Farsi questionnaire. A sample of 500 public mental health service users in Tehran participated and subsequently completed the questionnaire. On average, 47% of participants reported experiencing poor responsiveness. Among responsiveness domains, confidentiality and dignity were the best performing factors while autonomy, access to care and quality of basic amenities were the worst performing. Respondents who reported their social status as low were more likely to experience poor responsiveness overall. Autonomy, quality of basic amenities and clear communication were responsiveness dimensions that performed poorly but were considered to be important by study participants. In summary, the study suggests that measuring responsiveness could provide guidance for further development of mental health care systems to become more patient orientated and provide patients with more respect.

  5. The development of a telemedical cancer center within the Veterans Affairs Health Care System: a report of preliminary clinical results.

    Science.gov (United States)

    Billingsley, Kevin G; Schwartz, David L; Lentz, Susan; Vallières, Eric; Montgomery, R Bruce; Schubach, William; Penson, David; Yueh, Bevan; Chansky, Howard; Zink, Claudia; Parayno, Darla; Starkebaum, Gordon

    2002-01-01

    In order to optimize the delivery of multidisciplinary cancer care to veterans, our institution has developed a regional cancer center with a telemedical outreach program. The objectives of this report are to describe the organization and function of the telemedical cancer center and to report our early clinical results. The Veterans Affairs Health Care System is organized into a series of integrated service networks that serve veterans within different areas throughout the United States. Within Veterans Integrated Service Network 20 (Washington, Alaska, Idaho, Oregon) we have developed a regional cancer center with telemedicine links to four outlying facilities within the service area. The telemedical outreach effort functions through the use of a multidisciplinary telemedicine tumor board. The tumor board serves patients in outlying facilities by providing comprehensive, multidisciplinary consultation for the complete range of malignancies. For individuals who do require referral to the cancer center, the tumor board serves to coordinate the logistical and clinical details of the referral process. This program has been in existence for 1 year. During that time 85 patients have been evaluated in the telemedicine tumor board. Sixty-two percent of the patients were treated at their closest facility; 38% were referred to the cancer center for treatment and/or additional diagnostic studies. The patients' diagnoses included the entire clinical spectrum of malignant disease. Preliminary clinical results demonstrate the program is feasible and it improves access to multidisciplinary cancer care. Potential benefits include improved referral coordination and minimization of patient travel and treatment delays. PMID:12020412

  6. Health care delivery systems.

    OpenAIRE

    Stevens, F; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective, meaningful, and socially accepted. From a sociological point of view, the analysis of health care delivery systems implies recognition of their distinct history over time, their specific values an...

  7. Health care delivery systems.

    NARCIS (Netherlands)

    Stevens, F.; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

  8. Systems architecture for integrated care

    OpenAIRE

    2012-01-01

    Introduction Telehealth and telecare projects do not always pay enough attention to the wider information systems architecture required to deliver integrated care. They often focus on technologies to support specific diseases or social care problems which can result in information silos that impede integrated care of the patient. While these technologies can deliver discrete benefits, they could potentially generate unintended disbenefits in terms of creating data silos which may cause patien...

  9. A Simple, Visually Oriented Communication System to Improve Postoperative Care Following Microvascular Free Tissue Transfer: Development, Results, and Implications.

    Science.gov (United States)

    Henderson, Peter W; Landford, Wilmina; Gardenier, Jason; Otterburn, David M; Rohde, Christine H; Spector, Jason A

    2016-07-01

    Background Communication, particularly transmission of information between the surgical and nursing teams, has been identified as one of the most crucial determinants of patient outcomes. Nonetheless, transfer of information among and between the physician and nursing teams in the immediate postoperative period is often informal, verbal, and inconsistent. Methods An iterative process of multidisciplinary information gathering was undertaken to create a novel postoperative communication system (the "Pop-form"). Once developed, nurses were surveyed on multiple measures regarding the perceived likelihood that it would improve their ability to provide directed patient care. Data were quantified using a Likert scale (0-10), and statistically analyzed. Results The Pop-form records and transfers operative details, specific anatomic monitoring parameters, and senior physician contact information. Sixty-eight nurses completed surveys. The perceived usefulness of different components of the Pop-form system was as follows: 8.9 for the description of the procedure; 9.3 for the operative diagram; 9.4 for the monitoring details and parameters; and 9.4 for the direct contact information for the appropriate surgical team member. All respondents were in favor of widespread adoption of the Pop-form. Conclusion This uniform, visual communication system requires less than 1 minute to compose, yet formalizes and standardizes inter-team communication, and therefore shows promise for improving outcomes following microvascular free tissue transfer. We believe that this simple, innovative communication tool has the potential to be more broadly applied to many other health care settings. PMID:26872024

  10. Reforms of health care system in Romania

    OpenAIRE

    Bara, AC; Van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.

    2002-01-01

    Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of the health care system. Results. The reforms of the health care system in Romania have been realized in a rather difficult context of scarcity of financial and human resources. The Gross Domestic Pro...

  11. Which aspects of non-clinical quality of care are most important? Results from WHO's general population surveys of "health systems responsiveness" in 41 countries.

    Science.gov (United States)

    Valentine, Nicole; Darby, Charles; Bonsel, Gouke J

    2008-05-01

    Quality of care research has reached some agreement on concepts like structure, process and outcome, and non-clinical versus clinical processes of care. These concepts are commonly explored through surveys measuring patient experiences, yet few surveys have focused on patient, or "user", priorities across different quality dimensions. Population surveys on priorities can contribute to, although not replace participation in, policy decision making. Using 105,806 survey interview records from the World Health Organization's (WHO's) general population surveys in 41 countries, this paper describes the relative importance of eight domains in the non-clinical quality of care concept WHO calls "health systems responsiveness". Responsiveness domains are divided into interpersonal domains (dignity, autonomy, communication and confidentiality) and structural domains (quality of basic amenities, choice, access to social support networks and prompt attention). This paper explores variations in domain importance by country-level variables (country of residence, human development, health system expenditure, and "geographic zones") and by subpopulations defined by sex, age, education, health status, and utilization. Most respondents selected prompt attention as the most important domain. Dignity was selected second, followed by communication. Access to social support networks was identified as the least important domain. In general, convergence in rankings was stronger across subpopulations within countries than across countries. Yet even across diverse countries, there was more convergence than divergence in views. These results provide a ranking of quality of care criteria for consideration during health reform processes further to the usual emphasis on clinical quality and supply-side efficiency. PMID:18313822

  12. Trauma care system in Iran

    Institute of Scientific and Technical Information of China (English)

    Moussa Zargar; Sarah Ganji; Mahmoud Khodabandeh; Shahab Abdollahi Far; Morteza Abdollahi; Mohammad Reza Zarei; Seyed Mohammad Reza Kalantar Motamedi; Mojgan Karbakhsh; Seyed Mohammad Ghodsi; Vafa Rahimi-Movaghar; Farzad Panahi; Soheil Saadat; Ali Khaji; Seyed Mahdi Davachi

    2011-01-01

    Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries,but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement,hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance,financial resources), it is not yet established in our system of trauma care.Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

  13. Benchmarking the quality of breast cancer care in a nationwide voluntary system: the first five-year results (2003–2007) from Germany as a proof of concept

    International Nuclear Information System (INIS)

    The main study objectives were: to establish a nationwide voluntary collaborative network of breast centres with independent data analysis; to define suitable quality indicators (QIs) for benchmarking the quality of breast cancer (BC) care; to demonstrate existing differences in BC care quality; and to show that BC care quality improved with benchmarking from 2003 to 2007. BC centres participated voluntarily in a scientific benchmarking procedure. A generic XML-based data set was developed and used for data collection. Nine guideline-based quality targets serving as rate-based QIs were initially defined, reviewed annually and modified or expanded accordingly. QI changes over time were analysed descriptively. During 2003–2007, respective increases in participating breast centres and postoperatively confirmed BCs were from 59 to 220 and from 5,994 to 31,656 (> 60% of new BCs/year in Germany). Starting from 9 process QIs, 12 QIs were developed by 2007 as surrogates for long-term outcome. Results for most QIs increased. From 2003 to 2007, the most notable increases seen were for preoperative histological confirmation of diagnosis (58% (in 2003) to 88% (in 2007)), appropriate endocrine therapy in hormone receptor-positive patients (27 to 93%), appropriate radiotherapy after breast-conserving therapy (20 to 79%) and appropriate radiotherapy after mastectomy (8 to 65%). Nationwide external benchmarking of BC care is feasible and successful. The benchmarking system described allows both comparisons among participating institutions as well as the tracking of changes in average quality of care over time for the network as a whole. Marked QI increases indicate improved quality of BC care

  14. Working with a domestic assessment system to estimate the need of support and care of elderly and disabled persons: results from field studies.

    Science.gov (United States)

    Hein, Andreas; Steen, Enno-Edzard; Thiel, Andreas; Hülsken-Giesler, Manfred; Wist, Thorben; Helmer, Axel; Frenken, Thomas; Isken, Melvin; Schulze, Gisela C; Remmers, Hartmut

    2014-01-01

    This article describes the results of field studies performed over a period between five months and 24 months. The objectives of these studies were to collect long-term real-life data to evaluate how these data can be mapped to items on standardized assessment tests and which presentation method is most suitable to inform caregivers about critical situations and changes in health or care needs. A Home-monitoring system which uses modern sensor technologies was developed for and used in these field studies. It was installed in living environments of seven people (three who were not in need of care, two in need of care, and two with mental disabilities). The data were generated by sensor data acquisition and questionnaire reporting. Four types of data analysis and representation were evaluated to support caregivers. Results show that sensor data can be used to determine information directly or indirectly, which can be mapped to relevant assessment items and presented with different degrees of granularity. It is also feasible to determine and present additional information of potential interest which cannot be directly mapped to any assessment item. Sensor data can also be displayed in a live view. This live data representation led to a decrease in the caregivers' workload when assessed according to the German version of the Perceived Stress Questionnaire. PMID:25148558

  15. Care initiation area yields dramatic results.

    Science.gov (United States)

    2009-03-01

    The ED at Gaston Memorial Hospital in Gastonia, NC, has achieved dramatic results in key department metrics with a Care Initiation Area (CIA) and a physician in triage. Here's how the ED arrived at this winning solution: Leadership was trained in and implemented the Kaizen method, which eliminates redundant or inefficient process steps. Simulation software helped determine additional space needed by analyzing arrival patterns and other key data. After only two days of meetings, new ideas were implemented and tested. PMID:19275059

  16. Quality systems in Dutch health care institutions.

    OpenAIRE

    Casparie, Anton; Sluijs, Emmy; Wagner, Cordula; de Bakker, Dinny

    1997-01-01

    The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire-derived from the European Quality Award-was sent to 1594 health care institutions; the response was 74%. The results showed that in 13% of the institutions a coherent quality system had been implemented. These ...

  17. [A Maternal Health Care System Based on Mobile Health Care].

    Science.gov (United States)

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals. PMID:27382731

  18. [Corruption and health care system].

    Science.gov (United States)

    Marasović Šušnjara, Ivana

    2014-06-01

    Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions. PMID:26016214

  19. The Chinese Health Care System

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi

    In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...

  20. Developing a web 2.0 diabetes care support system with evaluation from care provider perspectives.

    Science.gov (United States)

    Lin, Yung-Hsiu; Chen, Rong-Rong; Guo, Sophie Huey-Ming; Chang, Hui-Yu; Chang, Her-Kun

    2012-08-01

    Diabetes is a life-long illness condition that many diabetic patients end up with related complications resulted largely from lacking of proper supports. The success of diabetes care relies mainly on patient's daily self-care activities and care providers' continuous support. However, the self-care activities are socially bounded with patient's everyday schedules that can easily be forgotten or neglected and the care support from providers has yet been fully implemented. This study develops a Web 2.0 diabetes care support system for patients to integrate required self-care activities with different context in order to enhance patient's care knowledge and behavior adherence. The system also supports care managers in a health service center to conduct patient management through collecting patient's daily physiological information, sharing care information, and maintaining patient-provider relationships. After the development, we evaluate the acceptance of the system through a group of nursing staffs. PMID:21369781

  1. A telemedicine health care delivery system

    Science.gov (United States)

    Sanders, Jay H.

    1991-01-01

    The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described.

  2. Dementia Care: Intersecting Informal Family Care and Formal Care Systems

    OpenAIRE

    Prabhjot Singh; Rafat Hussain; Adeel Khan; Lyn Irwin; Roslyn Foskey

    2014-01-01

    Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions rel...

  3. Reciprocal learning and chronic care model implementation in primary care: results from a new scale of learning in primary care

    OpenAIRE

    Noël Polly H; Jordan Michelle; McDaniel Reuben R; Lanham Holly; Palmer Ray; Leykum Luci K; Parchman Michael

    2011-01-01

    Abstract Background Efforts to improve the care of patients with chronic disease in primary care settings have been mixed. Application of a complex adaptive systems framework suggests that this may be because implementation efforts often focus on education or decision support of individual providers, and not on the dynamic system as a whole. We believe that learning among clinic group members is a particularly important attribute of a primary care clinic that has not yet been well-studied in ...

  4. An Electronic System for Home Care Protocols

    OpenAIRE

    Saba, Virginia K.; Irwin, Ruth Galten

    2001-01-01

    This is demonstration of an Electronic Tracking System being implemented in several Home Health Agencies in the US. It uses the Home Health Care Classification (HHCC) System, a standardized terminology designed and developed to document patient care. The goal it to take the coded data to design the Electronic Tracking System as a method for predicting resource requirements, tracking care needs, and measuring the outcomes of the care.

  5. Child Poverty and the Health Care System.

    Science.gov (United States)

    Racine, Andrew D

    2016-04-01

    The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty. PMID:27044708

  6. Trauma care systems in Spain.

    Science.gov (United States)

    Queipo de Llano, E; Mantero Ruiz, A; Sanchez Vicioso, P; Bosca Crespo, A; Carpintero Avellaneda, J L; de la Torre Prado, M V

    2003-09-01

    Trauma care systems in Spain are provided by the Nacional Health Service in a decentralized way by the seventeen autonomous communities whose process of decentralization was completed in January 2002. Its organisation is similar in all of them. Public sector companies of sanitary emergencies look after the health of citizens in relation to medical and trauma emergencies with a wide range of up to date resources both technical and human. In the following piece there is a description of the emergency response teams divided into ground and air that are responsible for the on site care of the patients in coordination with other public services. They also elaborate the prehospital clinical history that is going to be a valuable piece of information for the teams that receive the patient in the Emergency Hospital Unit (EHU). From 1980 to 1996 the mortality rate per 10.000 vehicles and the deaths per 1.000 accidents dropped significantly: in 1980 6.4 and 96.19% and in 1996, 2.8 and 64.06% respectively. In the intrahospital organisation there are two differentiated areas to receive trauma patients the casualty department and the EHU. In the EHU the severe and multiple injured patients are treated by the emergency hospital doctors; first in the triage or resuscitation areas and after when stabilised they are passed too the observation area or to the Intensive Care Unit (ICU) and from there the EHU or ICU doctors call the appropriate specialists. There is a close collaboration and coordination between the orthopaedic surgeon the EHU doctors and the other specialists surgeons in order to comply with treatment prioritization protocols. Once the patient has been transferred an entire process of assistance continuity is developed based on interdisciplinary teams formed in the hospital from the services areas involved in trauma assistance and usually coordinated by the ICU doctors. There is also mentioned the assistance registry of trauma patients, the ICU professional training

  7. Reforms of health care system in Romania

    NARCIS (Netherlands)

    Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.

    2002-01-01

    Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of th

  8. Paediatric intensive care admissions for respiratory syncytial virus bronchiolitis in France: results of a retrospective survey and evaluation of the validity of a medical information system programme.

    Science.gov (United States)

    Soilly, A-L; Ferdynus, C; Desplanches, O; Grimaldi, M; Gouyon, J B

    2012-04-01

    The purpose of this study was to describe the characteristics of patients with bronchiolitis admitted to a paediatric intensive care unit (PICU), and to evaluate a national registry of hospitalizations (Programme de Médicalisation des Systèmes d'Information; PMSI) as a potential source of epidemiological data. Of the 49 French PICUs invited to take part in a retrospective survey of children aged PMSI data was good only for mechanical ventilation (0·63) and the death rate (0·86). PMID:21733254

  9. Health care system in bangladesh

    Directory of Open Access Journals (Sweden)

    Dibyajyoti Saha

    2015-10-01

    Full Text Available Pharmacists are healthcare professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use. The role of pharmacist has shifted from the classical “lick, stick and pour” dispensary role, to being an integrated member of the health care team directly involved in patient care. But, in our country pharmacists are mainly engaged with manufacturing of drugs, which is secondary responsibility of pharmacist.

  10. Health care system in bangladesh

    OpenAIRE

    Dibyajyoti Saha,

    2015-01-01

    Pharmacists are healthcare professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use. The role of pharmacist has shifted from the classical “lick, stick and pour” dispensary role, to being an integrated member of the health care team directly involved in patient care. But, in our country pharmacists are mainly engaged with manufacturing of drugs, which is secondary responsibility of pharmacist.

  11. Fostering the coexistence of caring philosophy and economics in today's health care system.

    Science.gov (United States)

    Cara, Chantal M; Nyberg, Jan J; Brousseau, Sylvain

    2011-01-01

    For the past decade, several health care systems are undergoing continuous administrative restructuring, whose main objective is cost reduction. These changes often result in the patients' needs not being met because nurses are continuously affected by widespread budget cuts and staff downsizing. Have we reached a point, where we are setting aside our prime directive of patient well-being for the sake of finances? If so, are we at risk of forsaking our professional identity as nurses? The authors believe that caring management and economical constraints can coexist while promoting quality patient care. The purpose of this article is to show how nurse managers and administrators can facilitate caring practices while maintaining their financial responsibilities within the health care organization. This article suggests several strategies for assisting nurse managers in promoting caring in the health care environment. PMID:21157259

  12. Ambivalent implications of health care information systems: a study in the Brazilian public health care system

    Directory of Open Access Journals (Sweden)

    João Porto de Albuquerque

    2011-01-01

    Full Text Available This article evaluates social implications of the "SIGA" Health Care Information System (HIS in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

  13. [A theoretical analysis of coordination in the field of health care: application to coordinated care systems].

    Science.gov (United States)

    Sebai, Jihane

    2016-01-01

    Various organizational, functional or structural issues have led to a review of the foundations of the former health care system based on a traditional market segmentation between general practice and hospital medicine, and between health and social sectors and marked by competition between private and public sectors. The current reconfiguration of the health care system has resulted in “new” levers explained by the development of a new organizational reconfiguration of the primary health care model. Coordinated care structures (SSC) have been developed in this context by making coordination the cornerstone of relations between professionals to ensure global, continuous and quality health care. This article highlights the contributions of various theoretical approaches to the understanding of the concept of coordination in the analysis of the current specificity of health care. PMID:27392057

  14. Care credits in the British pension system

    OpenAIRE

    Vlachantoni, Athina

    2009-01-01

    The paper is a brief outline of the first stage of a comparative research project in the role and adequacy of care credits in the British and German pension systems. The provision of care credits has been an essential part of pension reforms around Europe, which significantly changes the prospects of carers to accumulate adequate pension contributions through their life course. But although the policy significance of care credits is due to rise in line with an increasing demand...

  15. Financial management in leading health care systems.

    Science.gov (United States)

    Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L

    2000-01-01

    To understand better the financial management practices and strategies of modern health care organizations, we conducted interviews with chief financial officers (CFOs) of several leading health care systems. In this introduction, we present an overview of the project and summary responses on corporate financial structures and strategic challenges facing CFOs. PMID:10845383

  16. A newly introduced comprehensive consultation fee in the national health insurance system in Japan. A promotive effect of multidisciplinary medical care in the field of radiation oncology. Results from a questionnaire survey

    International Nuclear Information System (INIS)

    The consultation fee for outpatient radiotherapy was newly introduced in the national health insurance system in Japan in April 2012. We conducted a survey on the use of this consultation fee and its effect on clinical practices. The health insurance committee of the Japanese Society of Therapeutic Radiology and Oncology conducted a questionnaire survey. The questionnaire form was mailed to 160 councilors of the Society, the target questionees. A total of 94 answers (58% of the target questionees) sent back were used for analyses. The analyses revealed that 75% of the hospitals charged most of the patients who receive radiotherapy in an outpatient setting a consultation fee. The introduction of the consultation fee led to some changes in radiation oncology clinics, as evidenced by the response of 'more careful observations by medical staff' in 37% of questionees and a 12% increase in the number of full-time radiation oncology nurses. It was also shown that the vast majority (92%) of radiation oncologists expected a positive influence of the consultation fee on radiation oncology clinics in Japan. Our questionnaire survey revealed the present status of the use of a newly introduced consultation fee for outpatient radiotherapy, and the results suggested its possible effect on promoting a multidisciplinary medical care system in radiation oncology departments in Japan. (author)

  17. Critical care nursing: Embedded complex systems.

    Science.gov (United States)

    Trinier, Ruth; Liske, Lori; Nenadovic, Vera

    2016-01-01

    Variability in parameters such as heart rate, respiratory rate and blood pressure defines healthy physiology and the ability of the person to adequately respond to stressors. Critically ill patients have lost this variability and require highly specialized nursing care to support life and monitor changes in condition. The critical care environment is a dynamic system through which information flows. The critical care unit is typically designed as a tree structure with generally one attending physician and multiple nurses and allied health care professionals. Information flow through the system allows for identification of deteriorating patient status and timely interventionfor rescue from further deleterious effects. Nurses provide the majority of direct patient care in the critical care setting in 2:1, 1:1 or 1:2 nurse-to-patient ratios. The bedside nurse-critically ill patient relationship represents the primary, real-time feedback loop of information exchange, monitoring and treatment. Variables that enhance information flow through this loop and support timely nursing intervention can improve patient outcomes, while barriers can lead to errors and adverse events. Examining patient information flow in the critical care environment from a dynamic systems perspective provides insights into how nurses deliver effective patient care and prevent adverse events. PMID:27047997

  18. Preventive health care and payment systems

    OpenAIRE

    Martínez Giralt, Xavier; Barros, Pedro Pita

    2003-01-01

    Prevention has been a main issue of recent policy orientations in health care. This renews the interest on how different organizational designs and the definition of payment schemes to providers may affect the incentives to provide preventive health care. We focus on the externality resulting from referral decisions from primary to acute care providers. This makes our analysis complementary to most works in the literature allowing to address in a more direct way the issue of preventive health...

  19. Health Care Information System (HCIS) Data File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A...

  20. Catastrophic disasters and the design of disaster medical care systems.

    Science.gov (United States)

    Mahoney, L E; Reutershan, T P

    1987-09-01

    The National Disaster Medical System (NDMS) is aimed at medical care needs resulting from catastrophic earthquakes, which may cause thousands of deaths and injuries. Other geophysical events may cause great mortality, but leave few injured survivors. Weather incidents, technological disasters, and common mass casualty incidents cause much less mortality and morbidity. Catastrophic disasters overwhelm the local medical care system. Supplemental care is provided by disaster relief forces; this care should be adapted to prevalent types of injuries. Most care should be provided at the disaster scene through supplemental medical facilities, while some can be provided by evacuating patients to distant hospitals. Medical response teams capable of stabilizing, sorting, and holding victims should staff supplemental medical facilities. The NDMS program includes hospital facilities, evacuation assets, and medical response teams. The structure and capabilities of these elements are determined by the medical care needs of the catastrophic disaster situation. PMID:3631673

  1. EarthCARE/CPR design results and PFM development status

    Science.gov (United States)

    Maruyama, Kenta; Tomita, Eiichi; Nakatsuka, Hirotaka; Aida, Yoshihisa; Seki, Yoshihiro; Okada, Kazuyuki; Ishii, Yasuyuki; Tomiyama, Nobuhiro; Takahashi, Nobuhiro; Ohno, Yuichi; Horie, Hiroaki; Sato, Kenji

    2015-10-01

    Earth Clouds, Aerosols and Radiation Explorer (EarthCARE) is a Japanese-European collaborative earth observation satellite mission aimed to deepen understanding of the interaction process between clouds and aerosols and their effects on the Earth's radiation. The outcome of this mission is expected to improve the accuracy of global climate change prediction. As one of instruments for EarthCARE, the Cloud Profiling Radar (CPR) is the world's first space-borne Doppler cloud radar jointly developed by the Japan Aerospace Exploration Agency (JAXA) and the National Institute of Information and Communications Technology (NICT). In Japan, the critical design review of the CPR has been completed in 2013, and CPR proto-flight model was manufactured and integrated until summer in 2015. Finally, the proto-flight test have been just started. This paper describes the design results and current status of CPR proto-flight test.

  2. Trauma care systems in India - An overview

    Directory of Open Access Journals (Sweden)

    Joshipura M

    2004-01-01

    Full Text Available Trauma-care systems in India are at a nascent stage of development. Industrialized cities, rural towns and villages coexist, with variety of health care facilities and almost complete lack of organized trauma care. There is gross disparity between trauma services available in various parts of the country. Rural India has inefficient services for trauma care, due to the varied topography, financial constraints and lack of appropriate health infrastructure. There is no national lead agency to coordinate various components of a trauma system. No mechanism for accreditation of trauma centres and professionals exists. Education in trauma life-support skills has only recently become available. A nationwide survey encompassing various facilities has demonstrated significant deficiencies in current trauma systems. Although injury is a major public-health problem, the government, medical fraternity and the society are yet to recognize it as a growing challenge.

  3. Comprehensive Child Care Program: Phase 1 - Evaluation Results.

    Science.gov (United States)

    Harachi, Tracy; Anthony, Emily; Bleisner, Siri

    Seattle's Comprehensive Child Care Program (CCCP) (Washington) is made up of a child care subsidy to offset child care costs for working and student families with low incomes, and quality assurance and technical assistance for 150 child care providers, including on-site evaluations, public health consulting, continuing education for providers, and…

  4. Challenges for the German Health Care System.

    Science.gov (United States)

    Dietrich, C F; Riemer-Hommel, P

    2012-06-01

    The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate. PMID:22660990

  5. [Health care systems and impossibility theorems].

    Science.gov (United States)

    Penchas, Shmuel

    2004-02-01

    results are Kurt Godel's seminal paper in 1931: "Ueber formal unentscheidbare Saetze der Principia Mathematica and verwandter System I" and Arrow's Nobel Prize winning "Impossibility Theorem" (Social Choice and Individual Values, 1951). Godel showed, unequivocally, that there is an enormous gap between what is being perceived as truth and what in fact can be proven as such. Arrow showed that the translation of individual preferences into a social order is impossible--except in a dictatorship. The unsolved controversies concerning the desirable or ideal structure of health care systems are impinged upon by these findings generally, and, in the case of the impossibility theorem, also directly. There is the impossibility of aggregating preferences and, at a deeper level, the impossibility of defining certain fundamental values, coupled with the problematic use of certain words, the absence of the possibility of creating, on a logically defined base, a complex system, complete and comprehensive in its own right. This is added to the fact that according to the elaboration by Stephen Wolfram in "A New Kind of Science", it is not easy to reduce complicated systems to simple components and to predict the continuation of their development even from simple basic laws without complicated calculations. All of these factors impede the construction of satisfying health care systems and leave obvious problems which overshadow the structure and the operation of health care systems. PMID:15143703

  6. Occupational health of home care aides: results of the safe home care survey

    OpenAIRE

    Quinn, Margaret M; Markkanen, Pia K; Galligan, Catherine J; Sama, Susan R; Kriebel, David; Gore, Rebecca J.; Brouillette, Natalie M; Okyere, Daniel; Sun, Chuan; Punnett, Laura; Laramie, Angela K; Davis, Letitia

    2015-01-01

    Objectives In countries with ageing populations, home care (HC) aides are among the fastest growing jobs. There are few quantitative studies of HC occupational safety and health (OSH) conditions. The objectives of this study were to: (1) assess quantitatively the OSH hazards and benefits for a wide range of HC working conditions, and (2) compare OSH experiences of HC aides who are employed via different medical and social services systems in Massachusetts, USA. Methods HC aides were recruited...

  7. Permanency and the Foster Care System.

    Science.gov (United States)

    Lockwood, Katie K; Friedman, Susan; Christian, Cindy W

    2015-10-01

    Each year over 20,000 youth age out of the child welfare system without reaching a permanent placement in a family. Certain children, such as those spending extended time in foster care, with a diagnosed disability, or adolescents, are at the highest risk for aging out. As young adults, this population is at and increased risk of incarceration; food, housing, and income insecurity; unemployment; educational deficits; receipt of public assistance; and mental health disorders. We reviewed the literature on foster care legislation, permanency, outcomes, and interventions. The outcomes of children who age out of the child welfare system are poor. Interventions to increase permanency include training programs for youth and foster parents, age extension for foster care and insurance coverage, an adoption tax credit, and specialized services and programs that support youth preparing for their transition to adulthood. Future ideas include expanding mentoring, educational support, mental health services, and post-permanency services to foster stability in foster care placements and encourage permanency planning. Children in the child welfare system are at a high risk for physical, mental, and emotional health problems that can lead to placement instability and create barriers to achieving permanency. Failure to reach the permanency of a family leads to poor outcomes, which have negative effects on the individual and society. Supporting youth in foster care throughout transitions may mediate the negative outcomes that have historically followed placement in out-of-home care. PMID:26403649

  8. CO2CARE - Site Closure Assessment Research - Recent Results

    Science.gov (United States)

    Wipki, Mario; Liebscher, Axel; Kühn, Michael; Lüth, Stefan; Durucan, Sevket; Deflandre, Jean-Pierre; Wollenweber, Jens; Chadwick, Andy; Böhm, Gualtiero

    2013-04-01

    The EU project CO2CARE, which started in January 2011, supports the large scale demonstration of CCS technology by addressing requirements of operators and regulators face in terms of CO2 storage site abandonment. The CO2CARE consortium, consisting of 24 project partners from universities, research institutes, and the industry, investigate technologies and procedures for abandonment and post-closure safety, satisfying the regulatory requirements for the transfer of responsibility. Nine key injections sites in Europe, USA, Japan, and Australia, each with a specific (hydro) geological and environmental character, were selected for investigations. These sites can be divided into the CO2 storage types on-shore, off-shore, natural CO2 reservoir, depleted gas reservoirs, and saline aquifers. The project mainly focuses on three key areas: - well abandonment and long-term integrity; - reservoir management and prediction from closure to the long-term; - risk management methodologies for long-term safety. These key areas are in turn closely linked to the three high-level requirements of the EU Directive 2009/31/EC, Article 18 for CO2 storage which are: (i) absence of any detectable leakage, (ii) conformity of actual behaviour of the injected CO2 with the modeled behaviour, and (iii) the storage site is evolving towards a situation of long-term stability. The identification of criteria and the development of site abandonment procedures and technologies, which guarantee the fulfillment of the high-level requirements, are the major objectives in CO2CARE. These criteria have to be fulfilled prior to subsequent transfer of responsibility to the competent authorities, typically 20 or 30 years after site closure. Finally, the essential results of the different working groups in CO2CARE will feed into overall guidelines for regulatory compliance and "Best Practice" for site abandonment. Dissemination of the results will show policy makers and the general public how site abandonment

  9. Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study

    Directory of Open Access Journals (Sweden)

    O'Sullivan Bernadette

    2009-04-01

    Full Text Available Abstract Background Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. Methods Postal survey of random sample of general practitioners undertaken (N = 204; 46% response. Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. Results Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. Conclusion General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care.

  10. Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study.

    LENUS (Irish Health Repository)

    Whitford, David L

    2009-01-01

    BACKGROUND: Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. METHODS: Postal survey of random sample of general practitioners undertaken (N = 204; 46% response). Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. RESULTS: Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. CONCLUSION: General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care.

  11. The chinese health care system

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter Raahave; Yu, Yi

    2011-01-01

    We describe the structure and present situation of the Chinese healthcare system and discuss its primary problems and challenges. We discuss problems with inefficient burden sharing, adverse provider incentives and huge inequities, and seek explanations in the structural features of the Chinese h...

  12. The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems

    Directory of Open Access Journals (Sweden)

    Menizibeya Osain Welcome

    2011-01-01

    Full Text Available Objectives : As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. This study aims to review the state of the Nigerian health care system and to provide possible recommendations to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, this study also aims at reviewing the dynamics of health care in the United States, Britain, and Europe with regards to methods of medical intelligence/surveillance. Materials and Methods : Databases were searched for relevant literatures using the following keywords: Nigerian health care, Nigerian health care system, and Nigerian primary health care system. Additional keywords used in the search were as follows: United States (OR Europe health care dynamics, Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system. Literatures were searched in scientific databases Pubmed and African Journals OnLine. Internet searches were based on Google and Search Nigeria. Results : Medical intelligence and surveillance represent a very useful component in the health care system and control diseases outbreak, bioattack, etc. There is increasing role of automated-based medical intelligence and surveillance systems, in addition to the traditional manual pattern of document retrieval in advanced medical setting such as those in western and European countries. Conclusion : The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine

  13. [Informatics in the Croatian health care system].

    Science.gov (United States)

    Kern, Josipa; Strnad, Marija

    2005-01-01

    Informatization process of the Croatian health care system started relatively early. Computer processing of data of persons not covered by health insurance started in 1968 in Zagreb. Remetinec Health Center served as a model of computer data processing (CDP) in primary health care and Sveti Duh General Hospital in inpatient CDP, whereas hospital administration and health service were first introduced to Zagreb University Hospital Center and Sestre Milosrdnice University Hospital. At Varazdin Medical Center CDP for health care services started in 1970. Several registries of chronic diseases have been established: cancer, psychosis, alcoholism, and hospital registries as well as pilot registries of lung tuberculosis patients and diabetics. Health statistics reports on healthcare services, work accidents and sick-leaves as well as on hospital mortality started to be produced by CDP in 1977. Besides alphanumeric data, the modern information technology (IT) can give digital images and signals. Communication in health care system demands a standardized format of all information, especially for telemedicine. In 2000, Technical Committee for Standardization in Medical Informatics was founded in Croatia, in order to monitor the activities of the International Standardization Organization (ISO) and Comite Européen de Normalisation (CEN), and to implement their international standards in the Croatian standardization procedure. The HL7 Croatia has also been founded to monitor developments in the communication standard HL7. So far, the Republic of Croatia has a number of acts regulating informatization in general and consequently the informatization of the health care system (Act on Personal Data Confidentiality, Act on Digital Signature, Act of Standardization) enacted. The ethical aspect of data security and data protection has been covered by the Code of Ethics for medical informaticians. It has been established by the International Medical Informatics Association (IMIA

  14. Evaluation of Ambulatory Care Information Systems

    OpenAIRE

    Simborg, Donald W.; Whiting-O'Keefe, Quinn E.

    1980-01-01

    The central purpose of an ambulatory care information system is to communicate information to the practitioner to facilitate clinical decision making. The clinical decision can be considered the dependent output variable in a process having the information system, the patient, clinician characteristics, and the environment as the independent input variables. Evaluation approaches using patient outcomes are problematic because of the indirect relationship between the information system and pat...

  15. Application of database systems in diabetes care.

    Science.gov (United States)

    Kopelman, P G; Sanderson, A J

    1996-01-01

    The St Vincent Declaration includes a commitment to continuous quality improvement in diabetes care. This necessitates the collection of appropriate information to ensure that diabetes services are efficient, effective and equitable. The quantity of information, and the need for rapid access, means that this must be computer-based. The choice of architecture and the design of a database for diabetes care must take into account available equipment and operational requirements. Hardware topology may be determined by the operating system and/or netware software. An effective database system will include: user-friendliness, rapid but secure access to data, a facility for multiple selections for analysis and audit, the ability to be used as part of the patient consultation process, the ability to interface or integrate with other applications, and cost efficiency. An example of a clinical information database for diabetes care, Diamond, is described. PMID:9244825

  16. Enhancing Health-Care Services with Mixed Reality Systems

    Science.gov (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.

  17. Corral Monitoring System assessment results

    International Nuclear Information System (INIS)

    This report describes the results of a functional and operational assessment of the Corral Monitoring Systems (CMS), which was designed to detect and document accountable items entering or leaving a monitored site. Its development was motivated by the possibility that multiple sites in the nuclear weapons states of the former Soviet Union might be opened to such monitoring under the provisions of the Strategic Arms Reduction Treaty. The assessment was performed at three levels. One level evaluated how well the planned approach addressed the target application, and which involved tracking sensitive items moving into and around a site being monitored as part of an international treaty or other agreement. The second level examined the overall design and development approach, while the third focused on individual subsystems within the total package. Unfortunately, the system was delivered as disassembled parts and pieces, with very poor documentation. Thus, the assessment was based on fragmentary operating data coupled with an analysis of what documents were provided with the system. The system design seemed to be a reasonable match to the requirements of the target application; however, important questions about site manning and top level administrative control were left unanswered. Four weaknesses in the overall design and development approach were detected: (1) poor configuration control and management, (2) inadequate adherence to a well defined architectural standard, (3) no apparent provision for improving top level error tolerance, and (4) weaknesses in the object oriented programming approach. The individual subsystems were found to offer few features or capabilities that were new or unique, even at the conceptual level. The CMS might possibly have offered a unique combination of features, but this level of integration was never realized, and it had no unique capabilities that could be readily extracted for use in another system

  18. Corral Monitoring System assessment results

    Energy Technology Data Exchange (ETDEWEB)

    Filby, E.E.; Haskel, K.J.

    1998-03-01

    This report describes the results of a functional and operational assessment of the Corral Monitoring Systems (CMS), which was designed to detect and document accountable items entering or leaving a monitored site. Its development was motivated by the possibility that multiple sites in the nuclear weapons states of the former Soviet Union might be opened to such monitoring under the provisions of the Strategic Arms Reduction Treaty. The assessment was performed at three levels. One level evaluated how well the planned approach addressed the target application, and which involved tracking sensitive items moving into and around a site being monitored as part of an international treaty or other agreement. The second level examined the overall design and development approach, while the third focused on individual subsystems within the total package. Unfortunately, the system was delivered as disassembled parts and pieces, with very poor documentation. Thus, the assessment was based on fragmentary operating data coupled with an analysis of what documents were provided with the system. The system design seemed to be a reasonable match to the requirements of the target application; however, important questions about site manning and top level administrative control were left unanswered. Four weaknesses in the overall design and development approach were detected: (1) poor configuration control and management, (2) inadequate adherence to a well defined architectural standard, (3) no apparent provision for improving top level error tolerance, and (4) weaknesses in the object oriented programming approach. The individual subsystems were found to offer few features or capabilities that were new or unique, even at the conceptual level. The CMS might possibly have offered a unique combination of features, but this level of integration was never realized, and it had no unique capabilities that could be readily extracted for use in another system.

  19. Collaborative Decision Support Systems for Primary Health care Managers

    Directory of Open Access Journals (Sweden)

    Gunjan Pahuja

    2012-03-01

    Full Text Available In this paper, a collaborative DSS Model for health care systems and results obtained are described. The proposed framework [1] embeds expert knowledge within DSS to provide intelligent decision support, and implements the intelligent DSS using collaboration technologies. The problem space contains several Hub and Spoke networks. Information about such networks is dynamically captured and represented in a Meta-data table. This master table enables collaboration between any two networks in the problem space, through load transfer, between them. In order to show the collaboration the sample database of 15 health care centers is taken assuming that there are 5 health care centers in one network.

  20. Applicability of the assessment of chronic illness care (ACIC instrument in Germany resulting in a new questionnaire: questionnaire of chronic illness care in primary care

    Directory of Open Access Journals (Sweden)

    Campbell Stephen

    2011-07-01

    Full Text Available Abstract Background The Chronic Care Model (CCM is an evidence based, population based approach to improve care for people with chronic conditions. The Assessment of Chronic Illness Care (ACIC instrument is widely used to measure to what extent within a healthcare system the CCM is implemented. The aim of this study was to translate and culturally adapt the ACIC Instrument for the German healthcare system. Methods For translating the ACIC instrument, principles of Good Practice for the Translation and Cultural Adaptation Process by the ISPOR Task Force were followed. Focus groups were additionally conducted with general practitioners to adapt the items culturally. Results The ACIC instrument can not be used in the German healthcare system easily due to a multifaceted understanding of words, different levels of knowledge of the CCM and fundamental differences between health systems. Conclusions As following the CCM leads to benefits for patients with chronic illnesses, measuring to which extent it is implemented is of major interest. A new questionnaire using the CCM as its theoretical basis, sensitive to the healthcare systems of the host country has to be created. Knowledge transfer between countries by using an instrument from a different healthcare system can lead to a completely new questionnaire.

  1. Challenges in Translating GWAS Results to Clinical Care.

    Science.gov (United States)

    Scheinfeldt, Laura B; Schmidlen, Tara J; Gerry, Norman P; Christman, Michael F

    2016-01-01

    Clinical genetic testing for Mendelian disorders is standard of care in many cases; however, it is less clear to what extent and in which situations clinical genetic testing may improve preventive efforts, diagnosis and/or prognosis of complex disease. One challenge is that much of the reported research relies on tag single nucleotide polymorphisms (SNPs) to act as proxies for assumed underlying functional variants that are not yet known. Here we use coronary artery disease and melanoma as case studies to evaluate how well reported genetic risk variants tag surrounding variants across population samples in the 1000 Genomes Project Phase 3 data. We performed a simulation study where we randomly assigned a "functional" variant and evaluated how often this simulated functional variant was correctly tagged in diverse population samples. Our results indicate a relatively large error rate when generalizing increased genetic risk of complex disease across diverse population samples, even when generalizing within geographic regions. Our results further highlight the importance of including diverse populations in genome-wide association studies. Future work focused on identifying functional variants will eliminate the need for tag SNPs; however, until functional variants are known, caution should be used in the interpretation of genetic risk for complex disease using tag SNPs. PMID:27527156

  2. The equity lens in the health care performance evaluation system.

    Science.gov (United States)

    Barsanti, Sara; Nuti, Sabina

    2014-01-01

    The main objective of this paper is to describe how indicators of the equity of access to health care according to socioeconomic conditions may be included in a performance evaluation system (PES) in the regional context level and in the planning and strategic control system of healthcare organisations. In particular, the paper investigates how the PES adopted, in the experience of the Tuscany region in Italy, indicators of vertical equity over time. Studies that testify inequality of access to health services often remain just a research output and are not used as targets and measurements in planning and control systems. After a brief introduction to the concept of horizontal and vertical equity in health care systems and equity measures in PES, the paper describes the 'equity process' by which selected health indicators declined by socioeconomic conditions were shared and used in the evaluation of health care institutions and in the CEOs' rewarding system, and subsequently analyses the initial results. Results on the maternal and child path and the chronicity care path not only show improvements in addressing health care inequalities, but also verify whether the health system responds appropriately to different population groups. PMID:23722829

  3. Embedding effective depression care: using theory for primary care organisational and systems change

    Directory of Open Access Journals (Sweden)

    Gunn Jane M

    2010-08-01

    Full Text Available Abstract Background Depression and related disorders represent a significant part of general practitioners (GPs daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting. Methods We used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT was identified as an analytical theory to guide the conceptual framework development. Results Five privately owned primary care organisations (general practices and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action

  4. [President Obama's health care reform: lessons to and from the Israeli health care system].

    Science.gov (United States)

    Balicer, Ran D; Shadmi, Efrat

    2011-08-01

    In March 2010 the United States enacted the most significant health care reform in several decades. The Patient Protection and Affordable Care Act, amongst other provisions, addresses two of the main current shortcomings of the U.S. health system: the large portion of the population that are uninsured and the high percentage of hsealth expenditures (mostly private] which amounts to about 16% of the GDP. Changes to the current structure and financing of the U.S. health system will have implications for other health systems, for science (e.g., through enhanced federal funding for comparative effectiveness research), and for technological advance (e.g., through accelerated development and use of electronic health records). There are several lessons from the reform, and the factors leading to its implementation, for the Israeli health system. Firstly, the basic principles of the Israeli health system are a source of pride, and undermining its main values can have deleterious effects. Overreliance on private, out-of-pocket, spending and lack of support for public practice of medicine (in community and hospital settings) will weaken the public sector, strengthen the private sector, and could result in a tiered lower quality and less accessible public system with greater widening of gaps in health and health care utilization. This paper reviews the main provisions of the U.S. health care reform and the potential implications for the IsraeLi health system. PMID:21939111

  5. Toward a 21st-century health care system: Recommendations for health care reform

    NARCIS (Netherlands)

    K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a

  6. Systems modelling for improving health care

    OpenAIRE

    Pitt, Martin; Monks, Thomas; Allen, Michael

    2016-01-01

    The growing complexity of health care coupled with the ever-increasing pressures to ensure efficient and effective use of limited resources have encouraged policy makers to turn to system modelling solutions. Such techniques have been available for decades, but despite ample research which demonstrates potential, their application in health services to date is limited. This presentation surveys the breadth of approaches available to support delivery and design across many areas and levels of ...

  7. Addressing Tobacco in Managed Care: Results of the 2002 Survey

    Directory of Open Access Journals (Sweden)

    Carol McPhillips-Tangum

    2004-10-01

    Full Text Available Introduction In the United States, tobacco use is the leading preventable cause of death and disease. The health and cost consequences of tobacco dependence have made treatment and prevention of tobacco use a key priority among multiple stakeholders, including health plans, insurers, providers, employers, and policymakers. In 2002, the third survey of tobacco control practices and policies in health plans was conducted by America’s Health Insurance Plans’ technical assistance office as part of the Addressing Tobacco in Managed Care (ATMC program. Methods The ATMC survey was conducted in the spring of 2002 via mail, e-mail, and fax. A 19-item survey instrument was developed and pilot-tested. Of the 19 items, 12 were the same as in previous years, four were modified to collect more detailed data on areas of key interest, and three were added to gain information about strategies to promote smoking cessation. The sample for the survey was drawn from the 687 plans listed in the national directory of member and nonmember health plans in America's Health Insurance Plans. Results Of the 246 plans in the sample, 152 plans (62% representing more than 43.5 million health maintenance organization members completed the survey. Results show that health plans are using evidence-based programs and clinical guidelines to address tobacco use. Compared to ATMC survey data collected in 1997 and 2000, the 2002 ATMC survey results indicate that more health plans are providing full coverage for first-line pharmacotherapies and telephone counseling for smoking cessation. Plans have also shown improvement in their ability to identify at least some members who smoke. Similarly, a greater percentage of plans are employing strategies to address smoking cessation during the postpartum period to prevent smoking relapse and during pediatric visits to reduce or eliminate children’s exposure to environmental tobacco smoke. Conclusion The results of the 2002 ATMC survey

  8. Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

    Science.gov (United States)

    Powers, Sharon; Bacon, Cynthia Thornton

    2016-01-01

    The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges. PMID:27259130

  9. Bellco Formula Domus Home Care System.

    Science.gov (United States)

    Trewin, Elizabeth

    2004-01-01

    There are certain characteristics in a dialysis machine that would be desirable for use in home and limited care environments. These features relate to safety, ease of use, consideration of physical space, and reliability. The Bellco Formula Domus Home Care System was designed to meet all these requirements. Bellco's philosophy of patient treatment centers on global biocompatibility. This is evident in the design of the Formula Domus Home Care System. It has the smallest hydraulic fluid pathway of any dialysis machine on the market. Formula is capable of preparing ultrapure dialysate. The ultrafiltration measurement mechanism, the patented Coriolis flow meter, measures the mass of the dialysate, not the volume. For this reason it is the only dialysis machine that detects actual backfiltration, not just the theoretical possibility of it based on transmembrane pressure. The Coriolis flow meter also ensures that dialysate flow is a true single pass. The operator interface is a single window operating control. It is possible to select up to 14 different languages. There is an online help key to assist patients with troubleshooting. Programmable start-up and shutdown times save time for the patient. Formula is the only dialysis machine to offer a backup battery feature. Formula is capable of communicating with any software available. The focus on global biocompatibility ensures the best quality dialysis treatments for a population of patients who will likely remain on dialysis for a longer period of time than conventional dialysis patients. PMID:15043621

  10. Seamless health care for chronic diseases in a dual health care system: managed care and the role of family physicians.

    Science.gov (United States)

    Lee, A

    1998-01-01

    Neither private nor state run health care systems are perfect. Although there is increasing evidence that Health Maintenance Organizations (HMOs) provide comparable care at lower cost, HMOs tend to select healthy patients. The dual health care system in Hong Kong spends about 3.9 per cent of GDP, with health indices among the best in the world. Hong Kong still faces the problem of escalating health care expenditure. One should take advantage of the dual health care system to evolve a new paradigm for a primary-led seamless health care service. The Diabetes Centre of a university teaching hospital together with the University of Community and Family Medicine has started a structured shared care programme in diabetes mellitus, involving general practitioners in both the private and public sectors integrating the primary and secondary care, and the private and public sectors. This programme starts to develop an infrastructure for providing quality care at an affordable cost for a large pool of patients with chronic disease. Unlike other "managed care schemes", this one is not run by profit-oriented companies, but by health professionals with an interest in providing best possible care at an affordable cost. The "disease management" approach needs a care delivery system without traditional boundaries; and a continuous improvement process which develops and refines the knowledge base, guidelines and delivery system. PMID:10351265

  11. Implementing a stepped-care approach in primary care: results of a qualitative study.

    NARCIS (Netherlands)

    Franx, G.C.; Oud, M.; Lange, J.; Wensing, M.J.; Grol, R.P.

    2012-01-01

    BACKGROUND: Since 2004, 'stepped-care models' have been adopted in several international evidence-based clinical guidelines to guide clinicians in the organisation of depression care. To enhance the adoption of this new treatment approach, a Quality Improvement Collaborative (QIC) was initiated in t

  12. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    Science.gov (United States)

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  13. The Taiwanese health care system under efficiency scrutiny

    OpenAIRE

    Schreyögg, Jonas

    2004-01-01

    This thesis describes the status quo of the Taiwanese health care system in the year 2000, 5 years after the reforms, analyses the economic efficiency of single components of the new health care system and searches for possible solutions to solve uncovered problems. For a better understanding of the Taiwanese health care system, the economic, political and demographic environment is described first of all. Although the Taiwanese economy developed rapidly, the health care system was still look...

  14. [Justice in health care systems from an economic perspective].

    Science.gov (United States)

    Schreyögg, J

    2004-01-01

    Due to rising health care expenditures international comparisons of health care systems are recently gaining more importance. These benchmarks can provide interesting information for improving health care systems. Many of these comparisons implicitly assume that countries have a universal understanding of justice. But this assumption is rather questionable. With regard to the existing cultural differences in the understanding of justice the transferability of elements of health care systems is not always assured. A transfer usually requires a thorough examination of the judicial systems in each country. This article analyses the influence of different judicial systems applying to health care. In this context theories of justice by Rawls, Nozick and Confucius representing the possible understanding of justice in different cultures are described and analysed with regards to their influence on health care systems. The example of financing health care shows that the three theories of justice have very different consequences for designing health care systems especially concerning the role of governments. PMID:14767785

  15. Corruption in health-care systems and its effect on cancer care in Africa.

    Science.gov (United States)

    Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan

    2015-08-01

    At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. PMID:26248847

  16. Unfinished nursing care: An important performance measure for nursing care systems.

    Science.gov (United States)

    VanFosson, Christopher A; Jones, Terry L; Yoder, Linda H

    2016-01-01

    Performance measurement is a core administrative function and an essential component of organizational quality programs. The prevalence of performance measurement initiatives increased significantly after the release of the Institute of Medicine series on quality. Nursing performance measures are limited in their scope, resulting in an underrepresentation of process measures. Development of performance indicators that reflect how effectively organizational units actually transform nursing resources into nursing services should be a high priority. Unfinished nursing care is a nursing process performance measure that reflects the complexity of the nursing care environment and can be useful in comparing process performance across systems and organizations. Unfinished nursing care is congruent with many of the National Quality Forum requirements for endorsement and warrants further refinement as an important nurse-sensitive performance measure. PMID:26850334

  17. Can casemix-systems be applied in Danish primary care?

    DEFF Research Database (Denmark)

    Halling, Anders; Kristensen, Troels

    Data", which covers the collection, storage, analysis, processing and interpretation of large amounts of data can via a casemix system provide new and insightful information about the morbidity burden of populations in terms of co-morbidity in addition to index conditions/multi-morbidity and related......Background: New technology in terms of IT systems, better data infrastructure and improved registrations of health data provide new opportunities for health care systems to improve the care experience of individual patients, improve public health and reduce healthcare costs. Application of "Big...... resource consumption. . Aim: The objective of this study was to conduct a preliminary analysis of the usefulness of the ACG casemix system in Denmark. This includes presenting the results for a region of Denmark and assessment of the usefulness and quality of the results. Methods and Data: This cross...

  18. Quality improvement and accountability in the Danish health care system.

    Science.gov (United States)

    Mainz, Jan; Kristensen, Solvejg; Bartels, Paul

    2015-12-01

    Denmark has unique opportunities for quality measurement and benchmarking since Denmark has well-developed health registries and unique patient identifier that allow all registries to include patient-level data and combine data into sophisticated quality performance monitoring. Over decades, Denmark has developed and implemented national quality and patient safety initiatives in the healthcare system in terms of national clinical guidelines, performance and outcome measurement integrated in clinical databases for important diseases and clinical conditions, measurement of patient experiences, reporting of adverse events, national handling of patient complaints, national accreditation and public disclosure of all data on the quality of care. Over the years, Denmark has worked up a progressive and transparent just culture in quality management; the different actors at the different levels of the healthcare system are mutually attentive and responsive in a coordinated effort for quality of the healthcare services. At national, regional, local and hospital level, it is mandatory to participate in the quality initiatives and to use data and results for quality management, quality improvement, transparency in health care and accountability. To further develop the Danish governance model, it is important to expand the model to the primary care sector. Furthermore, a national quality health programme 2015-18 recently launched by the government supports a new development in health care focusing upon delivering high-quality health care-high quality is defined by results of value to the patients. PMID:26443814

  19. Implementing a stepped-care approach in primary care: results of a qualitative study

    OpenAIRE

    Franx Gerdien; Oud Matthijs; de Lange Jacomine; Wensing Michel; Grol Richard

    2012-01-01

    Abstract Background Since 2004, 'stepped-care models' have been adopted in several international evidence-based clinical guidelines to guide clinicians in the organisation of depression care. To enhance the adoption of this new treatment approach, a Quality Improvement Collaborative (QIC) was initiated in the Netherlands. Methods Alongside the QIC, an intervention study using a controlled before-and-after design was performed. Part of the study was a process evaluation, utilizing semi-structu...

  20. [Differences and similarities of Primary Care in the German and Spanish Health Care Systems].

    Science.gov (United States)

    Salvador Comino, María Rosa; Krane, Sibylla; Schelling, Jörg; Regife García, Víctor

    2016-02-01

    An efficient primary care is of particular importance for any countries' health care system. Many differences exist on how distinctive countries try to obtain the goal of an efficient, cost-effective primary care for its population. In this article we conducted a selective literature review, which includes both scientific and socio-political publications. The findings are complemented with the experience of a Spanish physician from Seville in her last year of training in family medicine, who completed a four months long rotation in the German health care system. We highlighted different features by comparing both countries, including their health care expenditure, the relation between primary and secondary care, the organization in the academic field and the training of future primary care physicians. It is clear that primary care in both countries plays a central role, have to deal with shortcomings, and in some points one system can learn from the other. PMID:26363955

  1. Antimicrobial stewardship programs in health care systems.

    Science.gov (United States)

    MacDougall, Conan; Polk, Ron E

    2005-10-01

    Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources. PMID:16223951

  2. Evaluating the Quality of Colorectal Cancer Care in the State of Florida: Results From the Florida Initiative for Quality Cancer Care

    OpenAIRE

    Siegel, Erin M; Jacobsen, Paul B.; Malafa, Mokenge; Fulp, William; Fletcher, Michelle; Lee, Ji-Hyun; Smith, Jesusa Corazon R.; Brown, Richard; Levine, Richard; Cartwright, Thomas; Abesada-Terk, Guillermo; Kim, George; Alemany, Carlos; Faig, Douglas; Sharp, Philip

    2012-01-01

    Although the quality of care delivered within the Florida Initiative for Quality Cancer Care practices seems to be high, several components of care were identified that warrant further scrutiny on a systemic level and at individual centers.

  3. Guidelines for Psychological Practice in Health Care Delivery Systems

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

    Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

  4. Measuring the strength of primary care systems in Europe.

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.G.W.

    2009-01-01

    Background: The investment in primary care (PC) reforms to improve the overall performance of health care systems has been substantial in Europe. There is however a lack of up to date comparable information to evaluate the development and strength of PC systems. This EU-funded Primary Health Care A

  5. Regionalized trauma care: a methodological proposal from the system dynamics

    Directory of Open Access Journals (Sweden)

    Piedad Roldán J

    2009-08-01

    Full Text Available Studies relating to trauma are mainly multicausal, but when we observe the impact of interventions on their causes, there is no clarity about the best way for prevention and control. Objective: To approach the problem of trauma from an integral point of view that facilitates understanding the phenomenon from its complex interrelationships. Methodology: using the system dynamics raised by Forrester to propose a dynamic model capable of predicting situations related to prevention and care, to raise public policies towards reducing the incidence and mortality. The process included six steps of the dynamics of systems to deliver a model for the analysis of existing and potential scenarios in their care, based on simulations of the behavior of the trauma, including the incidence and prevention of variables in interaction with prehospital care and hospitable. Results: the proposal was ideal in the care of trauma described in the dynamic scenario put “appropriate care of the patient described in the appropriate institution, is guaranteed to reduce the mortality for trauma”.

  6. Predictors of postoperative pulmonary complications after liver resection: Results from a tertiary care intensive care unit

    Directory of Open Access Journals (Sweden)

    Anirban Hom Choudhuri

    2014-01-01

    Full Text Available Background: Postoperative pulmonary complication (PPC is a serious complication after liver surgery and is a major cause of mortality and morbidity in the intensive care unit (ICU. Therefore, the early identification of risk factors of PPCs may help to reduce the adverse outcomes. Objective: The aim of this retrospective study was to determine the predictors of PPCs in patients undergoing hepatic resection. Design: Retrospective, observational. Methods: The patients admitted after hepatic resection in the gastrosurgical ICU of our institute between October 2009 and June 2013 was identified. The ICU charts were retrieved from the database to identify patients who developed PPCs. A comparison of risk factors was made between the patients who developed PPC (PPC group against the patients who did not (no-PPC group. Results: Of 117 patients with hepatic resection, 28 patients developed PPCs. Among these, pneumonia accounted for 12 (42.8% followed by atelectasis in 8 (28.5% and pleural effusion in 3 (10.7%. Among the patients developing PPCs, 16 patients were over a 70-year-old (57.1%, 21 patients were smokers (75% and 8 patients (28.5% had chronic obstructive pulmonary disease (COPD. The requirement for blood transfusion and duration of mechanical ventilation were greater in the patients developing PPC (2000 ± 340 vs. 1000 ± 210 ml; 10 ± 4.5 vs. 3 ± 1.3 days. Conclusion: Old age, chronic smoking, COPD, increased blood product transfusion, increased duration of mechanical ventilation and increased length of ICU stay increased the relative risk of PPC, presence of diabetes and occurrence of surgical complications (leak, dehiscence, etc. were independent predictive variables for the development of PPC.

  7. Health Care System Responses to Children Exposed to Domestic Violence.

    Science.gov (United States)

    Culross, Patti L.

    1999-01-01

    Summarizes health care approaches to identifying and treating child and adult victims of domestic violence. Describes innovative programs that tie children's well-being to that of their mothers and proposes strategies for improving current health care system responses. (SLD)

  8. Organizational Fragmentation and Care Quality in the U.S. Health Care System

    OpenAIRE

    Randall D. Cebul; James B. Rebitzer; Taylor, Lowell J.; Mark Votruba

    2008-01-01

    Many goods and services can be readily provided through a series of unconnected transactions, but in health care close coordination over time and within care episodes improves both health outcomes and efficiency. Close coordination is problematic in the US health care system because the financing and delivery of care is distributed across a variety of distinct and often competing entities, each with its own objectives, obligations and capabilities. These fragmented organizational structures l...

  9. Toward a 21st-century health care system: Recommendations for health care reform

    OpenAIRE

    Arrow, Kenneth; Auerbach, Alan; Bertko, John; Casalino, Lawrence Peter; Crosson, Francis; Enthoven, Alain; Falcone, E.; Feldman, R.C.; Fuchs, Victor; Garber, Alan; Gold, Marthe Rachel; Goldman, D A; Hadfield, Gillian; Hall, Mark Ann; Horwitz, Ralph

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspective...

  10. [Costs of maternal-infant care in an institutionalized health care system].

    Science.gov (United States)

    Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L

    1998-01-01

    Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities. PMID:9528219

  11. Health disparities and health care financing: restructuring the American health care system.

    Science.gov (United States)

    Diggs, Schnequa N

    2012-01-01

    For more than seven decades there has been a systematic disregard for the health needs of certain groups of individuals. Discrepancies in treatment and privilege based on race/ethnicity, gender, sexual orientation, class, and socio-economic status have been significant players in any portrait of American health care and have helped frame considerations of those who deserve and those undeserving of quality health care. Continuous incidences of inequitable health care practices strongly suggest a need for drastic changes in our current health care system. Although growing interest in social inequalities in health preside, health policy makers struggle to find appropriate intervention strategies to alleviate health disparities. The purpose of this article is to depict a clearer portrait of the American health care system within the context of health disparities and recognize intervention strategies to reduce/eliminate health care disparities. This article concludes with suggestions on how to refinance the American health care system based on equality principles. PMID:22894023

  12. Health-Care Waste Management System

    Directory of Open Access Journals (Sweden)

    T. Subramani

    2014-06-01

    Full Text Available The main purpose of this paper is to give A view of the hospital waste management and environmental problem in india. The objective of this study is to analyze the health care waste management system, including practices and compliances. Most countries of the world, especially the developing countries, are facing the grim situation arising out of environmental pollution due to pathological waste arising from increasing populations and the consequent rapid growth in the number of hospital units. In india, there are about 6 lakhs hospital beds, over 23,000 primary health centers, more than 15,000 small and private hospitals. In india, the biomedical waste (management and handling rules 1998 make it mandatory for hospitals, clinics, and other medical and veterinary institutes to dispose of bio medical wastes strictly according to the rules.

  13. CHINs in the context of an evolving health care system.

    OpenAIRE

    Duncan, K. A.

    1996-01-01

    Community Health Information Network (CHIN) developments have slowed, due to the chaotic change in the health care system and stakeholders' attendant short-sighted focus. CHINs are a long-term investment that is necessary for the health care system's evolution to maturity. Several arenas of essential CHIN activity are given that would be characteristic of a mature, goal-directed health care system Lack of enterprise-wide computer-based patient record systems is a major barrier. Even in the sh...

  14. Provider's Constraints and Difficulties in Primary Health Care System

    OpenAIRE

    Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Anu

    2014-01-01

    Background: The contractualization of human resource in recent years has resulted into various human resource management issues. Objective: To explore the administrative and management issues of contractual model of human resource under primary health care system in Delhi. Materials and Methods: Comparative study was conducted on randomly selected sample of 333, comprised of Medical Officers, ANMs, Pharmacist and Laboratory Assistants and Technicians, both regular and contractual cadre. The d...

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

    Directory of Open Access Journals (Sweden)

    Joanna Kobza

    2014-08-01

    Full Text Available Time-based management (TBM is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms. Over the past two decades a systematic review of Polish literature (since 1990 and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011 have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary

  16. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Stewart Allison

    2008-05-01

    Full Text Available Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Results Participating health centres had distinct areas of strength and weakness in each component of systems: 1 organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2 community linkages – facilitated by working together with community organisations (e.g. local stores and running community-based programs (e.g. "health week", but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3 self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4 decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5 delivery system

  17. Open architecture for health care systems: the European RICHE experience.

    Science.gov (United States)

    Frandji, B

    1997-01-01

    Groupe RICHE is bringing to the market of health IT the Open Systems approach allowing a new generation of health information systems to arise with benefit for patients, health care professionals, hospital managers, agencies and citizens. Groupe RICHE is a forum for exchanging information, expertise around open systems in health care. It is open to any organisation interested by open systems in health care and wanting to participate and influence the work done by its user, marketing and technical committees. The Technical Committee is in charge of the maintenance of the architecture and impact the results of industrial experiences on new releases. Any Groupe RICHE member is entitled to participate to this process. This unique approach in Europe allows health care professionals to benefit from applications supporting their business processes, including providing a cooperative working environment, a shared electronic record, in an integrated system where the information is entered only once, customised according to the user needs and available to the administrative applications. This allows Hospital managers to satisfy their health care professionals, to smoothly migrate from their existing environment (protecting their investment), to choose products in a competitive environment, being able to mix and match system components and services from different suppliers, being free to change suppliers without having to replace their existing system (minimising risk), in line with national and regional strategies. For suppliers, this means being able to commercialise products well fitted to their field of competence in a large market, reducing investments and increasing returns. The RICHE approach also allows agencies to define a strategy, allowing to create a supporting infrastructure, organising the market leaving enough freedom to health care organisations and suppliers. Such an approach is based on the definition of an open standard architecture. The RICHE esprit project

  18. A decision technology system for health care electronic commerce.

    Science.gov (United States)

    Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

    1999-08-01

    Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice. PMID:10539421

  19. Primary care training and the evolving healthcare system.

    Science.gov (United States)

    Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V

    2012-01-01

    With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. PMID:22786734

  20. Direct Release of Test Results to Patients Increases Patient Engagement and Utilization of Care.

    Directory of Open Access Journals (Sweden)

    Francesca Pillemer

    Full Text Available An important focus for meaningful use criteria is to engage patients in their care by allowing them online access to their health information, including test results. There has been little evaluation of such initiatives. Using a mixed methods analysis of electronic health record data, surveys, and qualitative interviews, we examined the impact of allowing patients to view their test results via patient portal in one large health system. Quantitative data were collected for new users and all users of the patient portal. Qualitative interviews occurred with patients who had received an HbA1c or abnormal Pap result. Survey participants were active patient portal users. Our main measures were patient portal usage, factors associated with viewing test results and utilizing care, and patient and provider experiences with patient portal and direct release. Usage data show 80% of all patient portal users viewed test results during the year. Of survey respondents, 82.7% noted test results to be a very useful feature and 70% agreed that patient portal has made their provider more accessible to them. Interviewed patients reported feeling they should have direct access to test results and identified the ability to monitor results over time and prepare prior to communicating with a provider as benefits. In interviews, both patients and physicians reported instances of test results leading to unnecessary patient anxiety. Both groups noted the benefits of results released with provider interpretation. Quantitative data showed patient utilization to increase with viewing test results online, but this effect is mitigated when results are manually released by physicians. Our findings demonstrate that patient portal access to test results was highly valued by patients and appeared to increase patient engagement. However, it may lead to patient anxiety and increase rates of patient visits. We discuss how such unintended consequences can be addressed and larger

  1. Validity Assessment of Referral Decisions at a VA Health Care System Polytrauma System of Care.

    Science.gov (United States)

    Chung, Joyce; Aguila, Fatima; Harris, Odette

    2015-01-01

    There has been intensive interest to ensure equitable and appropriate access to the specialized rehabilitative services of the VA Polytrauma System of Care (PSC) for patients sustaining polytrauma and traumatic brain injuries (TBI). A retrospective cohort study with prospective data acquisition was conducted to assess validity and objectivity of the acceptance decision algorithm to the VA Palo Alto Health Care System (VAPAHCS) PSC. Our hypotheses are (1) VAPAHCS PSC referral decisions were appropriate and without bias and (2) the identified needs of redirected referrals were addressed. This analysis included 1,025 referrals (906 patients); 813 patients (89.7%) were accepted, and 93 (10.3%) were redirected. Redirected cases were older, were more often active duty service members, and were not from the West Coast. There were more females redirected due to concomitant spinal cord injury. These are rationale differences. In redirected patients, the most commonly identified rehabilitation needs were psychological support, mobility/physical therapy, and communication/speech services; >75% of patients had these services offered elsewhere outside of the PSC resources. While balancing financial stewardship and meeting our mission to provide outstanding rehabilitative care to veterans and service members, we demonstrated that acceptance decisions were valid and without bias, and redirected patients received appropriate alternate resources. PMID:26180664

  2. Princeton HealthCare System name reflects comprehensive services. New brand identity focuses on 'Redefining Care'.

    Science.gov (United States)

    Botvin, Judith D

    2004-01-01

    The Medical Center at Princeton, Princeton, N.J., introduced its new name last June, both to its community and its internal stakeholders. It is now known as Princeton HealthCare System, a name chosen to reflect its growth and diversity. It's being branded as a unique institution that combines the sensitive, caring serice of a community hospital with the sophisticated care of a teaching hospital. PMID:15162577

  3. [The revised system of hospitalization for medical care and protection].

    Science.gov (United States)

    Fukuo, Yasuhisa

    2014-01-01

    community by persons with mental disorders, efforts will be made to enhance psychiatric care for them, with guidelines to be developed to ensure the provision of medical care to persons with mental disorders. The revised law clarifies that members of psychiatric review boards shall be "persons with expert knowledge and experience pertaining to the health and/or welfare of persons with mental disorders." Provision is made for a review of conditions related to implementation of the revised law approximately three years after it takes effect, with measures to be taken as necessary based on results of the review. The main focus of this presentation will be the revisions to the system of hospitalization for medical care and protection, and the deletion of provisions relating to the system of guardianship. PMID:24864562

  4. Impact of Low Procalcitonin Results on Antibiotic Administration in Hospitalized Patients at a Tertiary Care Center.

    Science.gov (United States)

    Brennan, Meghan B; Osterby, Kurt; Schulz, Lucas; Lepak, Alexander J

    2016-06-01

    Procalcitonin is a sensitive and specific marker of bacterial infection; low results allow clinicians to safely de-escalate antibiotics. This retrospective cohort study aimed to determine the effect of low procalcitonin results on withholding, discontinuing, or de-escalating antibiotics in hospitalized patients at a tertiary care center. Antibiotics were initiated or continued without de-escalation in 55% of patients with low procalcitonin results. Among patients with low procalcitonin results, the primary service, but not measures of patient complexity, disease severity, or underlying disease process (lower respiratory tract infection evaluation versus systemic inflammatory response syndrome/possible sepsis) was associated with initiation or continued broad-spectrum antibiotic use. Provider-level factors may be an important variable in the initiation or continued use of broad-spectrum antibiotics for patients with low procalcitonin levels. PMID:27251126

  5. Health care systems in Sweden and China: Legal and formal organisational aspects

    Directory of Open Access Journals (Sweden)

    Hjelm Katarina

    2010-06-01

    Full Text Available Abstract Background Sharing knowledge and experience internationally can provide valuable information, and comparative research can make an important contribution to knowledge about health care and cost-effective use of resources. Descriptions of the organisation of health care in different countries can be found, but no studies have specifically compared the legal and formal organisational systems in Sweden and China. Aim To describe and compare health care in Sweden and China with regard to legislation, organisation, and finance. Methods Literature reviews were carried out in Sweden and China to identify literature published from 1985 to 2008 using the same keywords. References in recent studies were scrutinized, national legislation and regulations and government reports were searched, and textbooks were searched manually. Results The health care systems in Sweden and China show dissimilarities in legislation, organisation, and finance. In Sweden there is one national law concerning health care while in China the law includes the "Hygienic Common Law" and the "Fundamental Health Law" which is under development. There is a tendency towards market-orientated solutions in both countries. Sweden has a well-developed primary health care system while the primary health care system in China is still under development and relies predominantly on hospital-based care concentrated in cities. Conclusion Despite dissimilarities in health care systems, Sweden and China have similar basic assumptions, i.e. to combine managerial-organisational efficiency with the humanitarian-egalitarian goals of health care, and both strive to provide better care for all.

  6. The next pandemic: anticipating an overwhelmed health care system.

    OpenAIRE

    Duley, Mary Grace Keating

    2005-01-01

    INTRODUCTION: In September 2005, an overview of current health care system planning efforts was presented to the audience at the Yale University Ethics Symposium on Avian and Pandemic Influenza. The speaker, also the author of this article, provided the audience with a summary of what was being undertaken with the use of federal preparedness funds to improve the overall infrastructure of the health care system. All of Connecticut's 31 acute care hospitals, the Veteran's Administration Hospita...

  7. Usage Analysis of a Shared Care Planning System

    OpenAIRE

    Warren, Jim; Gu, Yulong; Humphrey, Gayl

    2012-01-01

    We examined the content of electronically mediated communications in a trial of shared care planning (SCP) for long-term condition management. Software supports SCP by sharing patient records and care plans among members of the multidisciplinary care team (with patient access). Our analysis focuses on a three-month period with 73 enrolled patients, 149 provider-assigned tasks, 64 clinical notes and 48 care plans with 162 plan elements. Results show that content of notes entries is often relat...

  8. Informal Care and Inter-vivos Transfers: Results from the National Longitudinal Survey of Mature Women.

    Science.gov (United States)

    Norton, Edward C; Nicholas, Lauren H; Huang, Sean Sheng-Hsiu

    2013-05-01

    Informal care is the largest source of long-term care for elderly, surpassing home health care and nursing home care. By definition, informal care is unpaid. It remains a puzzle why so many adult children give freely of their time. Transfers of time to the older generation may be balanced by financial transfers going to the younger generation. This leads to the question of whether informal care and inter-vivos transfers are causally related. We analyze data from the 1999 and 2003 waves of National Longitudinal Survey of Mature Women. We examine whether the elderly parents give more inter-vivos monetary transfers to adult children who provide informal care, by examining both the extensive and intensive margins of financial transfers and of informal care. We find statistically significant results that a child who provides informal care is more likely to receive inter-vivos transfers than a sibling who does not. If a child does provide care, there is no statistically significant effect on the amount of the transfer. PMID:25285181

  9. Costs of coordinated versus uncoordinated care in Germany: results of a routine data analysis in Bavaria

    OpenAIRE

    Schneider, Antonius; Donnachie, Ewan; Tauscher, Martin; Gerlach, Roman; Maier, Werner; Mielck, Andreas; Linde, Klaus; Mehring, Michael

    2016-01-01

    Objectives The efficiency of a gatekeeping system for a health system, as in Germany, remains unclear particularly as access to specialist ambulatory care is not restricted. The aim was to compare the costs of coordinated versus uncoordinated patients (UP) in ambulatory care; with additional subgroup analysis of patients with mental disorders. Design Retrospective routine data analysis of patients with statutory health insurance, using claims data held by the Bavarian Association of Statutory...

  10. Foster Care and College: The Educational Aspirations and Expectations of Youth in the Foster Care System

    Science.gov (United States)

    Kirk, Chris M.; Lewis, Rhonda K.; Nilsen, Corinne; Colvin, Deltha Q.

    2013-01-01

    Despite an overall increase in college attendance, low-income youth and particularly those in the foster care system are less likely to attend college (Wolanin, 2005). Although youth in foster care report high educational aspirations, as little as 4% obtain a 4-year college degree (Nixon & Jones, 2007). The purpose of this study is to explore…

  11. Iraqi primary care system in Kurdistan region: providers’ perspectives on problems and opportunities for improvement

    Directory of Open Access Journals (Sweden)

    Shabila Nazar P

    2012-09-01

    Full Text Available Abstract Background As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers’ perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system. Methods A qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis. Results Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene, health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system, shortage in resources (shortage and low quality of medical supplies and shortage in financing, poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring. Conclusions This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq’s Kurdistan region from the perspective of primary care providers. From their experience

  12. Does corruption undermine trust in health care? Results from public opinion polls in Croatia.

    Science.gov (United States)

    Radin, Dagmar

    2013-12-01

    Health and health care provision are one of the most important topics in public policy, and often a highly debated topic in the political arena. The importance of considering trust in the health care sector is highlighted by studies showing that trust is associated, among others, with poor self-related health, and poorer health outcomes. Similarly, corruption has shown to create economic costs and inefficiencies in the health care sector. This is particularly important for a newly democratized country such as Croatia, where a policy responsive government indicates a high level of quality of democracy (Roberts, 2009) and where a legacy of corruption in the health care sector has been carried over from the previous regime. In this study, I assess the relationship between health care corruption and trust in public health care and hypothesize that experience with health care corruption as well as perception of corruption has a negative effect on trust in public care facilities. Data were collected in two surveys, administered in 2007 and 2009 in Croatia. Experience with corruption and salience with corruption has a negative effect on trust in public health care in the 2007 survey, but not in the 2009 survey. While the results are mixed, they point to the importance of further studying this relationship. PMID:24331881

  13. New systems of care for substance use disorders: treatment, finance, and technology under health care reform.

    Science.gov (United States)

    Pating, David R; Miller, Michael M; Goplerud, Eric; Martin, Judith; Ziedonis, Douglas M

    2012-06-01

    This article outlined ways in which persons with addiction are currently underserved by our current health care system. However, with the coming broad scale reforms to our health care system, the access to and availability of high-quality care for substance use disorders will increase. Addiction treatments will continue to be offered through traditional substance abuse care systems, but these will be more integrated with primary care, and less separated as treatment facilities leverage opportunities to blend services, financing mechanisms, and health information systems under federally driven incentive programs. To further these reforms, vigilance will be needed by consumers, clinicians, and policy makers to assure that the unmet treatment needs of individuals with addiction are addressed. Embedded in this article are essential recommendations to facilitate the improvement of care for substance use disorders under health care reform. Ultimately, as addiction care acquires more of the “look and feel” of mainstream medicine, it is important to be mindful of preexisting trends in health care delivery overall that are reflected in recent health reform legislation. Within the world of addiction care, clinicians must move beyond their self-imposed “stigmatization” and sequestration of specialty addiction treatment. The problem for addiction care, as it becomes more “mainstream,” is to not comfortably feel that general slogans like “Treatment Works,” as promoted by Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment during its annual Recovery Month celebrations, will meet the expectations of stakeholders outside the specialty addiction treatment community. Rather, the problem is to show exactly how addiction treatment works, and to what extent it works-there have to be metrics showing changes in symptom level or functional outcome, changes in health care utilization, improvements in workplace attendance and

  14. Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

    Science.gov (United States)

    Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

    2012-04-01

    This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

  15. [Prospective qualification requirements in nursing care. Results and conclusions of the BMBF research network FreQueNz].

    Science.gov (United States)

    Schüler, G; Klaes, L; Rommel, A; Schröder, H; Köhler, T

    2013-08-01

    Demographic change, advances in medicine, and innovative health care services are leading to changes in the professional qualification requirements for nursing and care staff. Detecting future trends in relation to these requirements was the focus of a Delphi study developed as part of the BMBF FreQueNz initiative. After qualitative expert interviews, data collection was organized in three consecutive steps, with 243 interviews realized in the second wave. It was found that home care will further diversify in the fields of supporting and counseling services as well as in palliative care, resulting in the necessary expansion of specific qualifications (e.g., intensive care). Moreover, there will be an increased need for interprofessional, intersectoral, and intercultural coordination and communication skills. As a consequence of the delegation of medical tasks, new duties for nonmedical professions in inpatient and outpatient care will also arise. For instance, qualifications need to be tailored to the new demands of assessment, diagnostics, therapy, and patient education and they should take into account evidence-based knowledge as well as clinical practice guidelines. Consequently, the system of care professionals will further diversify through advanced training programs and the continued academization of nursing. PMID:23884530

  16. Large-System Transformation in Health Care: A Realist Review

    OpenAIRE

    Best, Allan; Greenhalgh, Trisha; Lewis, Stephen; Saul, Jessie E.; Carroll, Simon; Bitz, Jennifer

    2012-01-01

    Context: An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait l...

  17. System impact research - increasing public health and health care system performance.

    Science.gov (United States)

    Malmivaara, Antti

    2016-06-01

    Background Interventions directed to system features of public health and health care should increase health and welfare of patients and population. Aims To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). Methods The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. Results The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. Conclusions System Impact Research - creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population. Key messages The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features. SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and

  18. Promoting patient-centred fundamental care in acute healthcare systems.

    Science.gov (United States)

    Feo, Rebecca; Kitson, Alison

    2016-05-01

    Meeting patients' fundamental care needs is essential for optimal safety and recovery and positive experiences within any healthcare setting. There is growing international evidence, however, that these fundamentals are often poorly executed in acute care settings, resulting in patient safety threats, poorer and costly care outcomes, and dehumanising experiences for patients and families. Whilst care standards and policy initiatives are attempting to address these issues, their impact has been limited. This discussion paper explores, through a series of propositions, why fundamental care can be overlooked in sophisticated, high technology acute care settings. We argue that the central problem lies in the invisibility and subsequent devaluing of fundamental care. Such care is perceived to involve simple tasks that require little skill to execute and have minimal impact on patient outcomes. The propositions explore the potential origins of this prevailing perception, focusing upon the impact of the biomedical model, the consequences of managerial approaches that drive healthcare cultures, and the devaluing of fundamental care by nurses themselves. These multiple sources of invisibility and devaluing surrounding fundamental care have rendered the concept underdeveloped and misunderstood both conceptually and theoretically. Likewise, there remains minimal role clarification around who should be responsible for and deliver such care, and a dearth of empirical evidence and evidence-based metrics. In explicating these propositions, we argue that key to transforming the delivery of acute healthcare is a substantial shift in the conceptualisation of fundamental care. The propositions present a cogent argument that counters the prevailing perception that fundamental care is basic and does not require systematic investigation. We conclude by calling for the explicit valuing and embedding of fundamental care in healthcare education, research, practice and policy. Without this

  19. Some results on stability of difference systems

    Directory of Open Access Journals (Sweden)

    Xiao-Song Yang

    2002-01-01

    Full Text Available This paper presents some new results on existence and stability of equilibrium or periodic points for difference systems. First sufficient conditions of existence of asymptotically stable equilibrium point as well as the asymptotic stability of given equilibrium point are given for second order or delay difference systems. Then some similar results on existence of asymptotically stable periodic (equilibrium points to general difference systems are presented.

  20. Characterizing emergency departments to improve understanding of emergency care systems

    OpenAIRE

    Steptoe, Anne P; Corel, Blanka; Sullivan, Ashley F; Camargo, Carlos A.

    2011-01-01

    International emergency medicine aims to understand different systems of emergency care across the globe. To date, however, international emergency medicine lacks common descriptors that can encompass the wide variety of emergency care systems in different countries. The frequent use of general, system-wide indicators (e.g. the status of emergency medicine as a medical specialty or the presence of emergency medicine training programs) does not account for the diverse methods that contribute t...

  1. Effects of Quality Improvement System for Child Care Centers

    Science.gov (United States)

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace

    2011-01-01

    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  2. Physician leadership: a health-care system's investment in the future of quality care.

    Science.gov (United States)

    Orlando, Rocco; Haytaian, Marcia

    2012-08-01

    The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system. PMID:23248866

  3. Functional systemic approach to the resuscitation and intensive care

    Directory of Open Access Journals (Sweden)

    Sadchikov D.V.

    2014-09-01

    Full Text Available Functional systemic approach to the resuscitation and intensive care may be considered as a direct correlation between analysis and synthesis, induction and deduction, and, in general, between the formal and dialectical categories. The realization of this system should be started with the interaction and formation of the final beneficial result. Therefore the experience assessment on the basis of functional systematic approach will enable us to formulate more precisely the subject and methods of resuscitation from the philosophical point of view taking into consideration the interaction of the human life integrity with death phenomenon as fixed in ontogenesis and will allow to methodically justify the distinguishing of functional systems and standard processes both in sanogenesis and thanatogenesis.

  4. Central nervous system infections in the intensive care unit

    Directory of Open Access Journals (Sweden)

    B. Vengamma

    2014-04-01

    Full Text Available Neurological infections constitute an uncommon, but important aetiological cause requiring admission to an intensive care unit (ICU. In addition, health-care associated neurological infections may develop in critically ill patients admitted to an ICU for other indications. Central nervous system infections can develop as complications in ICU patients including post-operative neurosurgical patients. While bacterial infections are the most common cause, mycobacterial and fungal infections are also frequently encountered. Delay in institution of specific treatment is considered to be the single most important poor prognostic factor. Empirical antibiotic therapy must be initiated while awaiting specific culture and sensitivity results. Choice of empirical antimicrobial therapy should take into consideration the most likely pathogens involved, locally prevalent drug-resistance patterns, underlying predisposing, co-morbid conditions, and other factors, such as age, immune status. Further, the antibiotic should adequately penetrate the blood-brain and blood- cerebrospinal fluid barriers. The presence of a focal collection of pus warrants immediate surgical drainage. Following strict aseptic precautions during surgery, hand-hygiene and care of catheters, devices constitute important preventive measures. A high index of clinical suspicion and aggressive efforts at identification of aetiological cause and early institution of specific treatment in patients with neurological infections can be life saving.

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

    Science.gov (United States)

    Vonhermann, Pieter; Pintz, Adam

    1994-01-01

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

  6. Antimicrobial Stewardship Programs in Health Care Systems

    OpenAIRE

    MacDougall, Conan; Polk, Ron E.

    2005-01-01

    Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based o...

  7. Medicaid Managed Care in an Integrated Health Care Delivery System: Lessons from Geisinger's Early Experience.

    Science.gov (United States)

    Maeng, Daniel D; Snyder, Susan R; Baumgart, Charles; Minnich, Amy L; Tomcavage, Janet F; Graf, Thomas R

    2016-08-01

    Many states in the United States, including Pennsylvania, have opted to rely on private managed care organizations to provide health insurance coverage for their Medicaid population in recent years. Geisinger Health System has been one such organization since 2013. Based on its existing care management model involving data-driven population management, advanced patient-centered medical homes, and targeted case management, Geisinger's Medicaid management efforts have been redesigned specifically to accommodate those with complex health care issues and social service needs to facilitate early intervention, effective and efficient care support, and ultimately, a positive impact on health care outcomes. An analysis of Geisinger's claims data suggests that during the first 19 months since beginning Medicaid member enrollment, Geisinger's Medicaid members, particularly those eligible for the supplemental security income benefits, have incurred lower inpatient, outpatient, and professional costs of care compared to expected levels. However, the total cost savings were partially offset by the higher prescription drug costs. These early data suggest that an integrated Medicaid care management effort may achieve significant cost of care savings. (Population Health Management 2016;19:257-263). PMID:26565693

  8. The POIS (Parkland On-Line Information System) Implementation of the IBM Health Care Support/Patient Care System

    OpenAIRE

    Mishelevich, David J.; Hudson, Betty G.; Van Slyke, Donald; Mize, Elaine I.; Robinson, Anna L.; Brieden, Helen C.; Atkinson, Jack; Robertson, James

    1980-01-01

    The installation of major components of a comprehensive Hospital Information System (HIS) called POIS, the Parkland On-line Information System, including identified success factors is described for the Dallas County Hospital District (DCHD) known also as the Parkland Memorial Hospital. Installation of the on-line IBM Health Care Support (HCS) Registration and Admissions Packages occurred in 1976 and implementation of the HCS Patient Care System (PCS) began in 1977 which includes on-line suppo...

  9. Would you care for some integrated care in your fragmented health system? A participatory action research to improve integration between levels of care in a Belgian urban setting.

    OpenAIRE

    Belche, Jean; Duchesnes, Christiane; Darras, Christian; Van der Vennet, Jean; Monet, Francis; Unger, Jean-Pierre; Giet, Didier

    2016-01-01

    Integration between levels of care is not facilitated by the Belgian health system. Indeed, patients have uninhibited access to every level of care, there is no gatekeeping system, and no structural coordination between levels of care. Meanwhile, on one hand, the occurrence of more complex care situations in the ambulatory setting is enhancing the need for coordination while on the other hand, hospitals face financial constraints to provide care in the community. The aim of the research ...

  10. Diabetes care for emerging adults: transition from pediatric to adult diabetes care systems

    OpenAIRE

    Lee, Young Ah

    2013-01-01

    With the increasing prevalence of diabetes mellitus in children, transitioning patients from childhood to adulthood are increasing. High-risk behaviors and poor glycemic control during the transition period increase the risk for hypoglycemia and hyperglycemia as well as chronic microvascular and macrovascular complications. Discussions regarding complications and preparations for transition must take place before the actual transition to adult care systems. Pediatric care providers should foc...

  11. Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.

    Directory of Open Access Journals (Sweden)

    Surya Dharma

    Full Text Available AIM: Guideline implementation programs are of paramount importance in optimizing acute ST-elevation myocardial infarction (STEMI care. Assessment of performance indicators from a local STEMI network will provide knowledge of how to improve the system of care. METHODS AND RESULTS: Between 2008-2011, 1505 STEMI patients were enrolled. We compared the performance indicators before (n = 869 and after implementation (n = 636 of a local STEMI network. In 2011 (after introduction of STEMI networking compared to 2008-2010, there were more inter-hospital referrals for STEMI patients (61% vs 56%, p12 hours after symptom onset were similar (53% vs 51%, NS. Moreover, the numbers of patients with door-to-balloon time ≤ 90 minutes were similar (49.1% vs 51.3%, NS, and in-hospital mortality rates were similar (8.3% vs 6.9%, NS in 2011 compared to 2008-2010. CONCLUSION: After a local network implementation for patients with STEMI, there were significantly more inter-hospital referral cases, primary PCI procedures, and patients with a door-to-needle time ≤ 30 minutes, compared to the period before implementation of this network. However, numbers of patients who presented very late, the targeted door-to-balloon time and in-hospital mortality rate were similar in both periods. To improve STEMI networking based on recent guidelines, existing pre-hospital and in-hospital protocols should be improved and managed more carefully, and should be accommodated whenever possible.

  12. Uncovering the systemic issues that reside in home care

    OpenAIRE

    Giannasi, Wynona

    2012-01-01

    This video clip comprises the Keynote Address: “Uncovering the systemic issues that reside in home care” held at the 21st Annual John K. Friesen Conference, "Innovations in Home Care: A Public Policy Perspective," MAY 16-17, 2012, Vancouver, BC. Presented by Wynona Giannasi, Partner, Howegroup – Public Sector Consultants, Vancouver BC. It is well known that jurisdictions with more comprehensive and integrated home care delivery systems are able to extend independent living for older p...

  13. Using Electronic Health Record Systems in Diabetes Care: Emerging Practices.

    Science.gov (United States)

    Veinot, Tiffany C; Zheng, Kai; Lowery, Julie C; Souden, Maria; Keith, Rosalind

    2010-01-01

    While there has been considerable attention devoted to the deployment of electronic health record (EHR) systems, there has been far less attention given to their appropriation for use in clinical encounters - particularly in the context of complex, chronic illness. The Department of Veterans' Affairs (VA) has been at the forefront of EHR adoption and, as such, provides a unique opportunity to examine a mature EHR system in widespread use. Moreover, with a high prevalence of diabetes in its patient population, the VA provides a useful platform for examining EHR use in the context of chronic disease care. We conducted a sequential, exploratory qualitative study at two VA Medical Centers in the Midwest. First, we conducted observations of 64 clinical consultations with diabetes patients. These observations involved 31 different health care providers. Second, using insights from these observations, we conducted in-depth, semi-structured interviews with 39 health care providers focusing on their use of information in diabetes patient care. Field notes and interview transcripts were analyzed using a grounded theory approach. Our analysis generated several categories of EHR use in clinical encounters: priming, structuring, assessing, informing, and continuing. We also outline some mismatches between EHR system design and VA diabetes care practices. We conclude by discussing implications of these emergent system uses for improving the software design of EHRs to better support chronic disease care, as well as for our understanding of the integration of technologies in health care. PMID:25264545

  14. Perceived quality of health care services among people with osteoarthritis – results from a nationwide survey

    Directory of Open Access Journals (Sweden)

    Grønhaug G

    2015-09-01

    Full Text Available Gudmund Grønhaug,1 Jon Hagfors,2 Ingebjørg Borch,2 Nina Østerås,1 Kåre Birger Hagen11National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 2Norwegian Rheumatism Association, Oslo, NorwayObjective: To assess the perceived quality of care received by people with osteoarthritis (OA in Norway and explore factors associated with the quality of care.Methods: A national survey in which members of the Norwegian Rheumatism Association with OA registered as their main diagnosis completed a questionnaire. The perceived quality of care was reported on a 17-item OsteoArthritis Quality Indicator questionnaire, covering both pharmacological and non-pharmacological aspects of OA care. In addition, the four-page questionnaire covered areas related to demographic characteristics, the location and impact of the OA, and utilization and satisfaction with health care services. The quality of care is calculated as pass rates, where the numerator represents the number of indicators passed and the denominator represents the number of eligible persons.Results: In total, 1,247 participants (response rate 57% completed the questionnaire. Mean age was 68 years (standard deviation 32 and 1,142 (92% were women. Respondents reported OA in hand only (12.4%, hip only (7.3%, knee only (10.4%, in two locations (42% or all three locations (27%. The overall OsteoArthritis Quality Indicator pass rate was 47% (95% confidence interval [CI] 46%–48%, and it was higher for pharmacological aspects (53% [51%–54%] than for non-pharmacological aspects of care (44% [43%–46%]. The pass rate for the individual quality indicators ranged from 8% for “referral for weight reduction” to 81% for “receiving advice about exercises”. Satisfaction with care was strongly associated with perceived quality. The pass rate for those who were “very satisfied” was 33% (25%–40% higher than those who were “very unsatisfied” with care.Conclusion: While the OA

  15. A clinician-driven home care delivery system.

    Science.gov (United States)

    August, D A; Faubion, W C; Ryan, M L; Haggerty, R H; Wesley, J R

    1993-12-01

    The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal. PMID:8242586

  16. Integrated Care for Older Adults Improves Perceived Quality of Care : Results of a Randomized Controlled Trial of Embrace

    NARCIS (Netherlands)

    Uittenbroek, Ronald J; Kremer, Hubertus P H; Spoorenberg, Sophie L W; Reijneveld, Sijmen A; Wynia, Klaske

    2016-01-01

    BACKGROUND: All community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care. OBJECTIVE: To examine the impact of Embrace, a community-based integrated primary care service, on perceived quality of care.

  17. The Resultant of an Unmixed Bivariate System

    OpenAIRE

    Khetan, Amit

    2002-01-01

    This paper gives an explicit method for computing the resultant of any sparse unmixed bivariate system with given support. We construct square matrices whose determinant is exactly the resultant. The matrices constructed are of hybrid Sylvester and B\\'ezout type. We make use of the exterior algebra techniques of Eisenbud, Fl{\\o}ystad, and Schreyer.

  18. Prenatal care in the primary health care network in FortalezaCE: an assessment of the structure, process and results

    Directory of Open Access Journals (Sweden)

    Rebeca Silveira Rocha

    2012-09-01

    Full Text Available Objective: To evaluate the prenatal care assistance in the primary health care network in Fortaleza-CE, considering the structure, process and results. Methods: A cross sectional descriptive study, of quantitative approach, performed between October 2009 and February 2011, in 30 Health Units randomly selected, keeping the ratio for each Regional Executive Secretary. For analysis of the structure, the information obtained was scored and classified as: excellent, satisfactory, precarious or insufficient. The form used was submitted to four experts for validation. In evaluating the process and results, data was available by the Municipal Health Secretary of Fortaleza for obtainance of the indicators recommended by the Ministry of Health. Results: There was, in general, a satisfactory structure. As for the process and result, we obtained: pregnant women who had, at least, six prenatal visits (7.6%; pregnant women who received tetanus immunization (22.8%; newborns with congenital syphilis (1.4%; newborns with neonatal tetanus (0%; maternal mortality rate (78.5% in 2008 and 51% in 2009 and total neonatal mortality rate (10.1% in 2008 and 11.2% in 2009. Conclusions: Despite good results with regard to the structure, the reflections on the process and outcome indicators were not positive, with low rates compared to those expected by the World Health Organization or the Ministry of Health, or in comparison with other regions.

  19. Primary Care Clinicians’ Perspectives on Reducing Low-Value Care in an Integrated Delivery System

    Science.gov (United States)

    Buist, Diana SM; Chang, Eva; Handley, Matt; Pardee, Roy; Gundersen, Gabrielle; Cheadle, Allen; Reid, Robert J

    2016-01-01

    Context: Perceptions about low-value care (eg, medical tests and procedures that may be unnecessary and/or harmful) among clinicians with capitated salaries are unknown. Objective: Explore clinicians’ perceived use of and responsibility for reducing low-value care by focusing on barriers to use, awareness of the Choosing Wisely campaign, and response to reports of peer-comparison resource use and practice patterns. Methods: Electronic, cross-sectional survey, distributed in 2013, to 304 salaried primary care physicians and physician assistants at Group Health Cooperative. Main Outcome Measures: Attitudes, awareness, and barriers of low-value care strategies and initiatives. Results: A total of 189 clinicians responded (62% response rate). More than 90% believe cost is important to various stakeholders and believe it is fair to ask clinicians to be cost-conscious. Most found peer-comparison resource-use reports useful for understanding practice patterns and prompting peer discussions. Two-thirds of clinicians were aware of the Choosing Wisely campaign; among them, 97% considered it a legitimate information source. Although 88% reported being comfortable discussing low-value care with patients, 80% reported they would order tests or procedures when a patient insisted. As key barriers in reducing low-value care, clinicians identified time constraints (45%), overcoming patient preferences/values (44%), community standards (43%), fear of patients’ dissatisfaction (41%), patients’ knowledge about the harms of low-value care (38%), and availability of tools to support shared decision making (37%). Conclusions: Salaried clinicians are aware of rising health care costs and want to be stewards of limited health care resources. Evidence-based initiatives such as the Choosing Wisely campaign may help motivate clinicians to be conscientious stewards of limited health care resources. PMID:26562308

  20. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care

    Science.gov (United States)

    van den Dungen, Pim; Moll van Charante, Eric P.; van de Ven, Peter M.; van Marwijk, Harm W. J.; van der Horst, Henriëtte E.; van Hout, Hein P. J.

    2016-01-01

    Purpose Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. Methods In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. Results Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326) of persons in the intervention, and in 30.5% (98/321) in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60–3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%), there were no differences in mental health between the intervention and control group. Conclusions We found a non-significant increase in the number of new MCI

  1. 40 CFR 792.43 - Test system care facilities.

    Science.gov (United States)

    2010-07-01

    ... CONTROL ACT (CONTINUED) GOOD LABORATORY PRACTICE STANDARDS Facilities § 792.43 Test system care facilities. (a) A testing facility shall have a sufficient number of animal rooms or other test system areas, as... different tests. (b) A testing facility shall have a number of animal rooms or other test system...

  2. The health-care system: an assessment and reform agenda.

    Science.gov (United States)

    Mataria, Awad; Khatib, Rana; Donaldson, Cam; Bossert, Thomas; Hunter, David J; Alsayed, Fahed; Moatti, Jean-Paul

    2009-04-01

    Attempts to establish a health plan for the occupied Palestinian territory were made before the 1993 Oslo Accords. However, the first official national health plan was published in 1994 and aimed to regulate the health sector and integrate the activities of the four main health-care providers: the Palestinian Ministry of Health, Palestinian non-governmental organisations, the UN Relief and Works Agency, and a cautiously developing private sector. However, a decade and a half later, attempts to create an effective, efficient, and equitable system remain unsuccessful. This failure results from arrangements for health care established by the Israeli military government between 1967 and 1994, the nature of the Palestinian National Authority, which has little authority in practice and has been burdened by inefficiency, cronyism, corruption, and the inappropriate priorities repeatedly set to satisfy the preferences of foreign aid donors. Although similar problems exist elsewhere, in the occupied Palestinian territory they are exacerbated and perpetuated under conditions of military occupation. Developmental approaches integrated with responses to emergencies should be advanced to create a more effective, efficient, and equitable health system, but this process would be difficult under military occupation. PMID:19268349

  3. Revisiting the symptom iceberg in today's primary care: results from a UK population survey

    Directory of Open Access Journals (Sweden)

    Hannaford Philip C

    2011-04-01

    Full Text Available Abstract Background Recent changes in UK primary care have increased the range of services and healthcare professionals available for advice. Furthermore, the UK government has promoted greater use of both self-care and the wider primary care team for managing symptoms indicative of self-limiting illness. We do not know how the public has been responding to these strategies. The aim of this study was to describe the current use of different management strategies in the UK for a range of symptoms and identify the demographic, socio-economic and symptom characteristics associated with these different approaches. Methods An age and sex stratified random sample of 8,000 adults (aged 18-60, drawn from twenty general practices across the UK, were sent a postal questionnaire. The questionnaire collected detailed information on 25 physical and psychological symptoms ranging from those usually indicative of minor illness to those which could be indicative of serious conditions. Information on symptom characteristics, actions taken to manage the symptoms and demographic/socio-economic details were also collected. Results Just under half of all symptoms reported resulted in respondents doing nothing at all. Lay-care was used for 35% of symptoms and primary care health professionals were consulted for 12% of symptoms. OTC medicine use was the most common lay-care strategy (used for 25% of all symptom episodes. The GP was the most common health professional consulted (consulted for 8% of all symptom episodes while use of other primary care health professionals was very small (each consulted for less than 2% of symptom episodes. The actions taken for individual symptoms varied substantially although some broad patterns emerged. Symptom characteristics (in particular severity, duration and interference with daily life were more commonly associated with actions taken than demographic or socio-economic characteristics. Conclusion While the use of lay-care was

  4. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care.

    Directory of Open Access Journals (Sweden)

    Pim van den Dungen

    Full Text Available Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes.In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1 resulted in more mild cognitive impairment (MCI and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2 added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2. FPs of 15 primary care practices (PCPs = clusters judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual.Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326 of persons in the intervention, and in 30.5% (98/321 in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60-3.76. Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%, there were no differences in mental health between the intervention and control group.We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude

  5. Structuring Community Care using Multi-Agent Systems

    Science.gov (United States)

    Beer, Martin D.

    Community care is a complex operation that requires the interaction of large numbers of dedicated individuals, managed by an equally wide range of organisations. They are also by their nature highly mobile and flexible, moving between clients in whatever order person receiving care is that they receive what they expect regularly, reliably and when they expect to receive it. Current systems are heavily provider focused on providing the scheduled care with as high apparent cost effectiveness as possible. Unfortunately, the lack of focus on the client often leads to inflexibility with expensive services being provided when they are not needed, large scale duplication of effort or inadequate flexibility to change the care regime to meet changing circumstances. Add to this the problems associated with the lack of integration of emergency and routing care and the extensive support given by friends and family and many opportunities exist to improve both the levels of support and the efficiency of care. The move towards Individual Care Plans requires much closer monitoring to ensure that the care specified for each individual is actually delivered and when linked with smart home technology in conjunction with appropriate sensors allows a much richer range of services to be offered which can be customised to meet the needs of each individual, giving them the assurance to continue to live independently.

  6. Managed care in four managed competition OECD health systems.

    Science.gov (United States)

    Shmueli, Amir; Stam, Piet; Wasem, Jürgen; Trottmann, Maria

    2015-07-01

    Managed care emerged in the American health system in the 1980s as a way to manage suppliers' induced demand and to contain insurers' costs. While in Israel the health insurers have always been managed care organizations, owning health care facilities, employing medical personnel or contracting selectively with independent providers, European insurers have been much more passive, submitting themselves to collective agreements between insurers' and providers' associations, accompanied by extensive government regulation of prices, quantities, and budgets. With the 1990s reforms, and the introduction of risk-adjusted "managed competition", a growing pressure to allow the European insurers to manage their own care - including selective contracting with providers - has emerged, with varying speed of the introduction of policy changes across the individual countries. This paper compares experiences with managed care in Israel, The Netherlands, Germany and Switzerland since the 1990s. After a brief description of the health insurance markets in the four countries, we focus comparatively on the emergence of managed care in the markets for ambulatory care and inpatient market care. We conclude with an evaluation of the current situation and a discussion of selected health policy issues. PMID:25776034

  7. Clinician Adoption Patterns and Patient Outcome Results in Use of Evidence-Based Nursing Plans of Care

    Science.gov (United States)

    Kim, Tae Youn; Lang, Norma M.; Berg, Karen; Weaver, Charlotte; Murphy, Judy; Ela, Sue

    2007-01-01

    Delivery of safe, effective and appropriate health care is an imperative facing health care organizations globally. While many initiatives have been launched in a number of countries to address this need from a medical perspective, a similar focus for generating evidence-based nursing knowledge has been missing [1]. This paper reports on a collaborative evidence-based practice (EBP) research initiative that adds nursing knowledge into computerized care protocols. Here, a brief overview of the study’s aims, purpose and methodology is presented as well as results of data analysis and lessons learned. The research team examined nurses’ adoption patterns of EBP recommendations with respect to activity tolerance using four-month patient data collected from a pilot hospital. Study findings indicate a need for more focus on the system design and implementation process with the next rollout phase to promote evidence-based nursing practice. PMID:18693871

  8. Establishing a community-based lung cancer multidisciplinary clinic as part of a large integrated health care system: aurora health care.

    Science.gov (United States)

    Bjegovich-Weidman, Marija; Haid, Max; Kumar, Santhosh; Huibregtse, Carol; McDonald, Jean; Krishnan, Santosh

    2010-11-01

    A community cancer clinic, through cooperation with its parent health care system, developed a lung cancer multidisciplinary clinic (MDC) to enhance patient care and prevent out-migration to competing health care systems. The local medical and radiation oncologists collaborated with a thoracic surgeon from the tertiary care hospital in establishing the lung MDC. All the participating physicians are employed by the health care system. A cancer care coordinator assured that all necessary tests were obtained and available to the physicians at least 1 day before the clinic. The multidisciplinary team also included a pulmonologist and met every third week. Other sub-specialists were involved as necessary. Final treatment recommendations using National Comprehensive Cancer Network guidelines were made for each patient at the MDC visit. This clinic, once established, resulted in significant improvements in the quality of care, patient satisfaction and retention of patients. Time from diagnosis to initiation of treatment was reduced to a mean of 18 days from a mean of 24 days. The community cancer clinic had an increase in lung cancer patient care by 28% and a 9.1% increase in gross revenue. The tertiary care hospital benefited by providing all patients with definitive surgery, including minimally invasive surgery. The tertiary hospital thoracic surgeon had a 75% increase in referrals from the lung MDC geographic area over the previous year. This collaboration in the development of MDCs demonstrates how patients, caregivers, and the health care system benefit from MDCs. PMID:21358947

  9. The Nuka System of Care: improving health through ownership and relationships.

    Science.gov (United States)

    Gottlieb, Katherine

    2013-01-01

    Southcentral Foundation's Nuka System of Care, based in Anchorage, Alaska, is a result of a customer-driven overhaul of what was previously a bureaucratic system centrally controlled by the Indian Health Service. Alaska Native people are in control as the "customer-owners" of this health care system. The vision and mission focus on physical, mental, emotional, and spiritual wellness and working together as a Native Community. Coupled with operational principles based on relationships, core concepts and key points, this framework has fostered an environment for creativity, innovation and continuous quality improvement. Alaska Native people have received national and international recognition for their work and have set high standards for performance excellence, community engagement, and overall impact on population health. In this article, the health care transformation led by Alaska Native people is described and the benefits and results of customer ownership and the relationship-based Nuka System of Care are discussed. PMID:23984269

  10. The Nuka System of Care: improving health through ownership and relationships

    Directory of Open Access Journals (Sweden)

    Katherine Gottlieb

    2013-08-01

    Full Text Available Southcentral Foundation’s Nuka System of Care, based in Anchorage, Alaska, is a result of a customer-driven overhaul of what was previously a bureaucratic system centrally controlled by the Indian Health Service. Alaska Native people are in control as the “customer-owners” of this health care system. The vision and mission focus on physical, mental, emotional, and spiritual wellness and working together as a Native Community. Coupled with operational principles based on relationships, core concepts and key points, this framework has fostered an environment for creativity, innovation and continuous quality improvement. Alaska Native people have received national and international recognition for their work and have set high standards for performance excellence, community engagement, and overall impact on population health. In this article, the health care transformation led by Alaska Native people is described and the benefits and results of customer ownership and the relationship-based Nuka System of Care are discussed.

  11. Systems and processes that ensure high quality care.

    Science.gov (United States)

    Bassett, Sally; Westmore, Kathryn

    2012-10-01

    This is the second in a series of articles examining the components of good corporate governance. It considers how the structures and processes for quality governance can affect an organisation's ability to be assured about the quality of care. Complex information systems and procedures can lead to poor quality care, but sound structures and processes alone are insufficient to ensure good governance, and behavioural factors play a significant part in making sure that staff are enabled to provide good quality care. The next article in this series looks at how the information reporting of an organisation can affect its governance. PMID:23252087

  12. Hysterectomy at a Canadian tertiary care facility: results of a one year retrospective review

    Directory of Open Access Journals (Sweden)

    Gorwill R Hugh

    2004-11-01

    Full Text Available Abstract Background The purpose of this study was to investigate the indications for and approach to hysterectomy at Kingston General Hospital (KGH, a teaching hospital affiliated with Queen's University at Kingston, Ontario. In particular, in light of current literature and government standards suggesting the superiority of vaginal versus abdominal approaches and a high number of concurrent oophorectomies, the aim was to examine the circumstances in which concurrent oophorectomies were performed and to compare abdominal and vaginal hysterectomy outcomes. Methods A retrospective chart audit of 372 consecutive hysterectomies performed in 2001 was completed. Data regarding patient characteristics, process of care and outcomes were collected. Data were analyzed using descriptive statistics, t-tests and linear and logistic regression. Results Average age was 48.5 years, mean body mass index (BMI was 28.6, the mean length of stay (LOS was 5.2 days using an abdominal approach and 3.0 days using a vaginal approach without laparoscopy. 14% of hysterectomies were performed vaginally, 5.9% were laparoscopically assisted vaginal hysterectomies and the rest were abdominal hysterectomies. The most common indication was dysfunctional or abnormal uterine bleeding (37%. The average age of those that had an oophorectomy (removal of both ovaries was 50.8 years versus 44.3 years for those that did not (p Conclusions A significant reduction in LOS was found using the vaginal approach. Both the patient and the health care system may benefit from the tendency towards an increased use of vaginal hysterectomies. The audit process demonstrated the usefulness of an on-going review mechanism to examine trends associated with common surgical procedures.

  13. Organisational Culture Matters for System Integration in Health Care

    OpenAIRE

    Munir, Samina K.; Kay, Stephen

    2003-01-01

    This paper illustrates the importance of organisational culture for Clinical Information Systems (CIS) integration. The study is based on data collected in intensive care units in the UK and Denmark. Data were collected using qualitative methods, i.e., observations, interviews and shadowing of health care providers, together with a questionnaire at each site. The data are analysed to extract salient variables for CIS integration, and it is shown that these variables can be separated into two ...

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

    OpenAIRE

    Joanna Kobza; Magdalena Syrkiewicz-Świtała

    2014-01-01

    Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011) have be...

  15. [The Chilean Health Care System: the task ahead].

    Science.gov (United States)

    Goic, Alejandro

    2015-06-01

    The most important event in Chilean public health in the XXth Century was the creation of the National Health Service (NHS), in 1952. Systematic public policies for the promotion of health, disease prevention, medical care, and rehabilitation were implemented, while a number of more specific programs were introduced, such as those on infant malnutrition, complementary infant feeding, medical control of pregnant women and healthy infants, infant and adult vaccination, and essential sanitation services. In 1981, a parallel private health care system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80%. From 1952 to 2014, public health care policies made possible a remarkable improvement in Chile's health indexes: downward trends in infant mortality rate (from 117.8 to 7.2 x 1,000 live births), maternal mortality (from 276 to 18.5 x 100,000), undernourished children schooling, and years of primary school education, were significantly improved as well. Nevertheless, compared with OECD countries, Chile has a relatively low public investment in health (45.7% of total national investment), a deficit in the number of physicians (1.7 x 1,000 inhabitants) and nurses (4.8 x 1,000), in the number of hospital beds (2.1 x 1,000), and in the availability of generic drugs in the market (30%). Chile and the USA are the two OECD countries with the lowest public investment in health. A generalized dissatisfaction with the current Chilean health care model and the need of the vast majority of the population for timely access to acceptable quality medical care are powerful arguments which point to the need for a universal public health care system. The significant increase in public expenditure on health care which such a system would demand requires a sustainable growth of the Chilean economy. PMID:26230561

  16. Results from the STAR TPC system test

    International Nuclear Information System (INIS)

    A system test of various components of the Solenoidal Tracker at RHIC (STAR) detector, operating in concern, has recently come on-line. Communication between a major sub-detector, a sector of the Time Projection Chamber (TPC), and the trigger, data acquisition and slow controls systems has been established, enabling data from cosmic ray muons to be collected. First results from an analysis of the TPC data are presented. These include measurements of system noise, electronic parameters such as amplifier gains and pedestal values, and tracking resolution for cosmic ray muons and laser induced ionization tracks. A discussion on the experience gained in integrating the different components for the system test is also given

  17. DKIST Adaptive Optics System: Simulation Results

    Science.gov (United States)

    Marino, Jose; Schmidt, Dirk

    2016-05-01

    The 4 m class Daniel K. Inouye Solar Telescope (DKIST), currently under construction, will be equipped with an ultra high order solar adaptive optics (AO) system. The requirements and capabilities of such a solar AO system are beyond those of any other solar AO system currently in operation. We must rely on solar AO simulations to estimate and quantify its performance.We present performance estimation results of the DKIST AO system obtained with a new solar AO simulation tool. This simulation tool is a flexible and fast end-to-end solar AO simulator which produces accurate solar AO simulations while taking advantage of current multi-core computer technology. It relies on full imaging simulations of the extended field Shack-Hartmann wavefront sensor (WFS), which directly includes important secondary effects such as field dependent distortions and varying contrast of the WFS sub-aperture images.

  18. Reviewing Security and Privacy Aspects in Combined Mobile Information System (CMIS) for health care systems

    OpenAIRE

    Kunwar, Ramesh; Al-Leddawi, Mustafa

    2007-01-01

    Medical area has been benefited by the use of ICT (Information and Communication Technology) in recent days. CMIS (Combined Mobile Information System), our proposed model system, is such a system targeted for health care system. IMIS (Integrated Mobile Information System), a system for diabetic healthcare, which is being developed in Blekinge Institute of Technology will be taken as a case study for our proposed system. CMIS is a multi-role system with core service being medical-care related ...

  19. Care and Conversing in Dialogical Systems

    DEFF Research Database (Denmark)

    Steffensen, Sune Vork

    2012-01-01

    positions, a theory of dialogical systems is developed, on the basis of current thinking within the enactive program (e.g. De Jaegher and Di Paolo, 2007), the distributed language movement (e.g. Cowley, 2011b), and values-realizing theory (e.g. Hodges, 2009). Dialogical systems are systems of co...... in a tradition that is ecological, embodied and distributed. Its specific take on human interaction pursues these perspectives by claiming that language can neither be reduced to social rules in the micro-sociological domain, nor to biological properties of the individual being. As an alternative to these two...

  20. Impact of Low Procalcitonin Results on Antibiotic Administration in Hospitalized Patients at a Tertiary Care Center

    OpenAIRE

    Brennan, Meghan B.; Osterby, Kurt; Schulz, Lucas; Lepak, Alexander J.

    2016-01-01

    Procalcitonin is a sensitive and specific marker of bacterial infection; low results allow clinicians to safely de-escalate antibiotics. This retrospective cohort study aimed to determine the effect of low procalcitonin results on withholding, discontinuing, or de-escalating antibiotics in hospitalized patients at a tertiary care center. Antibiotics were initiated or continued without de-escalation in 55% of patients with low procalcitonin results. Among patients with low procalcitonin result...

  1. A person-focused model of care for the twenty-first century: a system-of-systems perspective.

    Science.gov (United States)

    Greene, Robert A; Dasso, Edwin; Ho, Sam; Genaidy, Ash M

    2014-06-01

    The US health care system is challenged to provide high-quality care and is burdened with unsustainable expenditures, making it difficult for health care participants (patients, payers, providers, caregivers) to create value. This communication presents the theoretical foundation for a person-focused model of care that addresses a number of these challenges. The model integrates aspects of prior models of chronic care with new empiric findings and complex adaptive system (CAS) theory. The model emphasizes the relationship among all health care stakeholders. The health care delivery process is examined in terms of the role of each stakeholder and the value each adds to and receives from the process. The authors present pilot results illustrating the implications of CAS theory in regard to multi-morbidity, disease management programs, multi-morbid households, and person- and household-focused care. The model incorporates the physical, mental, and social dimensions of health, and operationalizes an individual patient's health as a CAS, identifying CASs for each of the other stakeholders as well. Health care can then be conceptualized as a system-of-systems with a person's health as its output. Deploying the model need not require major infrastructure investments or changes. It can be implemented by repurposing, aligning, and better integrating currently available interventions. The authors believe that the model creates not only survival value (health) but also purposeful value. The model offers a unifying focus for all participants in the health care delivery process, thereby constructing a health care system that is structurally person-focused and meaningful for all participants. PMID:24720637

  2. The Durham Family Initiative: A Preventive System of Care

    Science.gov (United States)

    Dodge, Kenneth A.; Berlin, Lisa J.; Epstein, Matthew; Spitz-Roth, Adele; O'Donnell, Karen; Kaufman, Martha; Amaya-Jackson, Lisa; Rosch, Joel; Christopoulos, Christina

    2004-01-01

    This article describes the Durham Family Initiative (DFI), an innovative effort to bring together child welfare and juvenile justice systems to reach DFI's goal of reducing the child abuse rate in Durham, North Carolina, by 50% within the next 10 years. DFI will follow principles of a preventive system of care (PSoC), which focuses on nurturing…

  3. 40 CFR 160.43 - Test system care facilities.

    Science.gov (United States)

    2010-07-01

    ... GOOD LABORATORY PRACTICE STANDARDS Facilities § 160.43 Test system care facilities. (a) A testing... testing facility shall have a number of animal rooms or other test system areas separate from those... sanitary storage of waste before removal from the testing facility. Disposal facilities shall be...

  4. The Role of Education in Systems of Care.

    Science.gov (United States)

    Liberton, Cindy J., Ed.; And Others

    Eight papers presented at a March 1993 conference address the role of education in systems of care for children's mental health. Papers have the following titles and authors: (1) "Interagency Collaboration through a School-Based Wraparound Approach: A Systems Analysis Summary of Project WRAP" (Lucille Eber and Carol Stieper); (2) "Baseline…

  5. Evidence Based Order Sets as a Nursing Care Planning System

    OpenAIRE

    LaCrosse, Lisa M.; Heermann, Judith; Azevedo, Karen; Sorrentino, Catherine; Straub, Dawn; O'Dowd, Gloria

    2002-01-01

    The process for developing the nursing care planning (NCP) function for integration into a clinical information system (CIS) will be described. This NCP system uses evidence based order sets or interventions that are specific to a problem with associated patient focused goals or outcomes. The problem, order set, goal framework will eventually be used by all disciplines in the patient focused record.

  6. Motivation Driven Multiagent Systems Coordination in Health Care

    OpenAIRE

    Zhang, Peng; Bai, Guohua

    2005-01-01

    This paper explores MultiAgent Systems coordination from a socio-psychological point of view. Activity Theory is introduced to explain the coordination among intelligent agents. The hierarchy and motivation thinking from Activity Theory is used to define the motivation driven MultiAgent Systems coordination mechanism. Finally, we apply this mechanism into a health care scenario.

  7. The Danish patient safety experience: the Act on Patient Safety in the Danish Health care system

    DEFF Research Database (Denmark)

    Lundgaard, Mette; Rabøl, Louise; Jensen, Elisabeth Agnete Brøgger;

    2005-01-01

    This paper describes the process that lead to the passing of the Act for Patient Safety in the Danisk health care sytem, the contents of the act and how the act is used in the Danish health care system. The act obligates frontline health care personnel to report adverse events, hospital owners to...... act on the reports and the National Board of Health to commuicate the learning nationally. The act protects health care providers from sanctions as a result of reporting. In January 2004, the Act on Patient Safety in the Danish health care system was put into force. In the first twelve months 5740...... adverse events were reported. the reports were analyzed locally (hospital and region), anonymized ad then sent to the National Board af Health. The Act on Patient Safety has driven the work with patient safety forward but there is room for improvement. Continuous and improved feedback from all parts of...

  8. Difficulties reporting system in intensive care

    Directory of Open Access Journals (Sweden)

    Claudio Bianchin

    2008-02-01

    Full Text Available In 2005, Belluno Health Authority’s Resuscitation Unit took part in a regional project coordinated by Veneto Regional Health and Social Services to test an incident re p o rting system. The main aims were to experiment an electronic incident rep o rting sheet and the relative computerised procedure for data e n t ry and analysis with the aim of developing an incident rep o rting system. The Australian Incident Monitoring System (AIMS was designed to obtain information about the event, the context and concomitant causes. We observed 58 anonymous incident reports over a six-month period. The main incidents include issues relating to the management of medication, the a i rways, catheters and equipment. Most incidents had modest consequences or led to temporary disability and they often caused longer hospitalisation or further treatment and investigations. Communication problems, inadequate superv i s i o n , poor teamwork and difficulties in applying procedures and protocols were the contributory factors most frequently identified as the concomitant causes of the incidents. The report sheet and experience as a whole were evaluated favourably by the operators involved. This reporting system does not provide the real frequency of the adverse events, but it does provide useful information for improving patient safety.

  9. Continuity of Care in the Family Medicine Residency: Results of a national survey of program directors

    OpenAIRE

    Moore, Lisa; Busing, Nick

    1993-01-01

    Based on the results of a survey of family medicine residency program directors across the country, there is a need for a national consensus on the definition of continuity of care, and on structures for teaching it and methods of evaluating it.

  10. Effectively marketing prepaid medical care with decision support systems.

    Science.gov (United States)

    Forgionne, G A

    1991-01-01

    The paper reports a decision support system (DSS) that enables health plan administrators to quickly and easily: (1) manage relevant medical care market (consumer preference and competitors' program) information and (2) convert the information into appropriate medical care delivery and/or payment policies. As the paper demonstrates, the DSS enables providers to design cost efficient and market effective medical care programs. The DSS provides knowledge about subscriber preferences, customer desires, and the program offerings of the competition. It then helps administrators structure a medical care plan in a way that best meets consumer needs in view of the competition. This market effective plan has the potential to generate substantial amounts of additional revenue for the program. Since the system's data base consists mainly of the provider's records, routine transactions, and other readily available documents, the DSS can be implemented at a nominal incremental cost. The paper also evaluates the impact of the information system on the general financial performance of existing dental and mental health plans. In addition, the paper examines how the system can help contain the cost of providing medical care while providing better services to more potential beneficiaries than current approaches. PMID:10111964

  11. Exposure management systems in emergencies as comprehensive medical care

    International Nuclear Information System (INIS)

    The emergency management of nuclear hazards relies on a comprehensive medical care system that includes accident prevention administration, environmental monitoring, a health physics organization, and a medical institution. In this paper, the care organization involved in the criticality accident at Tokai-mura is described, and the problems that need to be examined are pointed out. In that incident, even the expert was initially utterly confused and was unable to take appropriate measures. The author concluded that the members of the care organization were all untrained for dealing with nuclear hazards and radiation accidents. The education and training of personnel at the job site are important, and they are even more so for the leaders. Revisions of the regional disaster prevention plans and care manual are needed. (K.H.)

  12. AUDIT-C Alcohol Screening Results and Postoperative Inpatient Health Care Use

    DEFF Research Database (Denmark)

    Rubinsky, Anna D; Sun, Haili; Blough, David K;

    2012-01-01

    BACKGROUND: Alcohol screening scores ≥5 on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) up to a year before surgery have been associated with postoperative complications, but the association with postoperative health care use is unknown. This study evaluated whether AUDIT...... September 2006) and were hospitalized for nonemergent noncardiac major operations in the following year. Postoperative health care use was evaluated across 4 AUDIT-C risk groups (scores 0, 1 to 4, 5 to 8, and 9 to 12) using linear or logistic regression models adjusted for sociodemographics, smoking status...... surgery, but not increased hospital readmission within 30 days postdischarge, relative to the low-risk group. CONCLUSIONS: AUDIT-C screening results could be used to identify patients at risk for increased postoperative health care use who might benefit from preoperative alcohol interventions....

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

    Science.gov (United States)

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

    2015-01-01

    BACKGROUND According to the reports of World Health Organization (WHO) and Centers for Disease Control and Prevention, the prevalence of chronic hepatitis B infection in Iran has decreased from 2-7% in 2001 to 1.3-0.8% in children aged 2-14 years. In 2010 the Institute of Medicine recommended more comprehensive screening by primary care physicians (PCPs) for evaluation, vaccination, and management of infected patients for further decrease in the prevalence of chronic HBV infection. Thus, with contribution of the Health Department, we developed a practical flowchart for PCPs to start active screening of hepatitis B virus (HBV) in all visited patients and refer the positive cases for further evaluation and management to Taleghani Hospital. METHODS With collaboration of Health Department of Shahid Beheshti University of Medical Sciences), physicians of health centers were asked to screen all their patients for HBsAg. Positive cases were referred to Taleghani Hospital. They were first registered and educated about their disease, life style, and prevention methods. Their first degree families were screened for HBV infection too and were referred for vaccination if needed. According to the results of lab tests, appropriate management was done by a hepatologist. RESULTS Since implementation of this program, we have encountered a significant rise in patient detection (even in high risk groups). Many of them were not aware of their disease and most of those who were aware of their disease were not managed appropriately. Family screening and vaccination were inadequate and need more emphasis. CONCLUSION Although health system is active about screening of HBV infection in high risk populations, it is not perfect. It seems that health system needs to upgrade the screening and management programs of HBV infection. PMID:26609351

  14. The impact of prospective pricing on the information system in the health care industry.

    Science.gov (United States)

    Matta, K F

    1988-02-01

    The move from a retrospective payment system (value added) to a prospective payment system (diagnostic related) has not only influenced the health care business but also changed their information systems' requirements. The change in requirements can be attributed both to an increase in data processing tasks and also to an increase in the need for information to more effectively manage the organization. A survey was administered to capture the response of health care institutions, in the area of information systems, to the prospective payment system. The survey results indicate that the majority of health care institutions have responded by increasing their information resources, both in terms of hardware and software, and have moved to integrate the medical and financial data. In addition, the role of the information system has changed from a cost accounting system to one intended to provide a competitive edge in a highly competitive marketing environment. PMID:3397683

  15. Incorporation of the Health Care System in the West

    OpenAIRE

    Floro Hermes Gomez Pineda

    2015-01-01

    Reflection is made from an interpretive perspective on the specific situation of the historical evolution of health care, since this became a way of intervening patients and an instrument for the healing of diseases, focusing on presentation of original sources that account for results of historical research completed, which range from the fifteenth century to the present day. To do this, try to understand (comprehend) the health care as an ideographic body of knowledge consisting of five pie...

  16. Infection control and changing health-care delivery systems.

    OpenAIRE

    Jarvis, W. R.

    2001-01-01

    In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term care for the elderly. The home-care industry and managed care have become major providers of health ca...

  17. Managing health care system in small island countries: Palau.

    Science.gov (United States)

    Kuartei, Stevenson

    2006-09-01

    Managing health systems in small island countries carry with it challenges that are common with other small communities around the world but also articulates for unique challenges that are intrinsically that of small island countries. Sustainability of economies and the small population in small island countries in the Pacific dictates how health care services align and organize to meet the needs of their population. This paper is an attempt to outline possible strategies that could be implemented in view of the ever decreasing meager resources. It will outline a step approach toward realignment and reengineering a viable health care system that is hopefully both cost effective and outcome oriented. PMID:18181405

  18. An intelligent partner system for improving chronic illness care

    Directory of Open Access Journals (Sweden)

    Tibor Deutsch

    2003-02-01

    Full Text Available Chronic care consists of a sequence of actions to treat a specific clinical disorder over time as a function of the ways in which illness progresses and patients respond to management actions. Outcomes depend on physicians' skills to select the actions best suited for their patients and competent self-management. This paper presents the architecture of an intelligent partner system (IPS, which helps to provide doctors with relevant data and skills and empowers chronically ill patients with the information and confidence to manage their health wisely. The services of this intelligent system are presented as 'therapies' for the information-processing 'pathologies' associated with traditional chronic illness care.

  19. What is Clinical Safety in Electronic Health Care Record Systems?

    Science.gov (United States)

    Davies, George

    There is mounting public awareness of an increasing number of adverse clinical incidents within the National Health Service (NHS), but at the same time, large health care projects like the National Programme for IT (NPFIT) are claiming that safer care is one of the benefits of the project and that health software systems in particular have the potential to reduce the likelihood of accidental or unintentional harm to patients. This paper outlines the approach to clinical safety management taken by CSC, a major supplier to NPFIT; discusses acceptable levels of risk and clinical safety as an end-to-end concept; and touches on the future for clinical safety in health systems software.

  20. Digital remote viewing system for coronary care unit

    International Nuclear Information System (INIS)

    A digital remote viewing system developed for the coronary care unit at the UCLA Medical Center has been in clinical operation since March 1, 1987. The present system consists of three 512-line monitors, VAX 11/750, Gould IP8500 image processor and a broad-band communication system. The patients' images are acquired with a computed radiography system and are transmitted to the coronary care unit, which is five floors above the radiology department. This exhibit presents the architecture and the performance characteristics of the system. Also, the second-generation system, which consists of an intelligent local work station with three 1,024-line monitors and a fast digital communication network, will be introduced

  1. Reconfigurable point-of-care systems designed with interoperability standards.

    Science.gov (United States)

    Warren, Steve; Yao, Jianchu; Schmitz, Ryan; Lebak, Jeff

    2004-01-01

    Interoperability standards, if properly applied to medical system design, have the potential to decrease the cost of point-of-care monitoring systems while better matching systems to patient needs. This paper presents a brief editorial overview of future monitoring environments, followed by a short listing of smart-home and wearable-device efforts. This is followed by a summary of recent efforts in the Medical Component Design Laboratory at Kansas State University to address interoperability issues in point-of-care systems by incorporating the Bluetooth Host Controller Interface, the IEEE 1073 Medical Information Bus, and Health Level 7 (HL7) into a monitoring system that hosts wearable or nearby wireless devices. This wireless demonstration system includes a wearable electrocardiogram, wearable pulse oximeter, wearable data logger, weight scale, and LabVIEW base station. Data are exchanged between local and remote MySQL databases using the HL7 standard for medical information exchange. PMID:17270979

  2. Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

    Directory of Open Access Journals (Sweden)

    Kantonen Jarmo

    2012-01-01

    Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital. A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month as compared to the three previous years in the EDs

  3. Systemic racism and U.S. health care.

    Science.gov (United States)

    Feagin, Joe; Bennefield, Zinobia

    2014-02-01

    This article draws upon a major social science theoretical approach-systemic racism theory-to assess decades of empirical research on racial dimensions of U.S. health care and public health institutions. From the 1600s, the oppression of Americans of color has been systemic and rationalized using a white racial framing-with its constituent racist stereotypes, ideologies, images, narratives, and emotions. We review historical literature on racially exploitative medical and public health practices that helped generate and sustain this racial framing and related structural discrimination targeting Americans of color. We examine contemporary research on racial differentials in medical practices, white clinicians' racial framing, and views of patients and physicians of color to demonstrate the continuing reality of systemic racism throughout health care and public health institutions. We conclude from research that institutionalized white socioeconomic resources, discrimination, and racialized framing from centuries of slavery, segregation, and contemporary white oppression severely limit and restrict access of many Americans of color to adequate socioeconomic resources-and to adequate health care and health outcomes. Dealing justly with continuing racial "disparities" in health and health care requires a conceptual paradigm that realistically assesses U.S. society's white-racist roots and contemporary racist realities. We conclude briefly with examples of successful public policies that have brought structural changes in racial and class differentials in health care and public health in the U.S. and other countries. PMID:24507906

  4. Japanese Bereaved Family Members' Perspectives of Palliative Care Units and Palliative Care: J-HOPE Study Results.

    Science.gov (United States)

    Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Shoji, Ayaka; Chiba, Yurika; Miyazaki, Tamana; Tsuneto, Satoru; Shima, Yasuo

    2016-06-01

    The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care. PMID:25852202

  5. New uses of legacy systems: examples in perinatal care.

    OpenAIRE

    Margolis, A; Vázquez, R.; Mendoza, G.; Zignago, A.; López, A.; Lucián, H.

    1999-01-01

    In this article, new uses of the Perinatal Information System at the Uruguayan Social Security health care facilities are described. The perinatal information system has been in place for over 13 years, with about 40 thousand clinical records on electronic files. A newly created Web interface allows a distributed access to existing perinatal information within the National Social Security Wide Area a Network. Perinatal data is also exported to a management information system, allowing to dyna...

  6. Psychiatric Assessment and Screening for the Elderly in Primary Care: Design, Implementation, and Preliminary Results

    Directory of Open Access Journals (Sweden)

    Robert C. Abrams

    2015-01-01

    Full Text Available Introduction. We describe the design and implementation of a psychiatric collaborative care model in a university-based geriatric primary care practice. Initial results of screening for anxiety and depression are reported. Methods and Materials. Screens for anxiety and depression were administered to practice patients. A mental health team, consisting of a psychiatrist, mental health nurse practitioner, and social worker, identified patients who on review of screening and chart data warranted evaluation or treatment. Referrals for mental health interventions were directed to members of the mental health team, primary care physicians at the practice, or community providers. Results. Subjects (N=1505 comprised 38.2% of the 3940 unique patients seen at the practice during the 4-year study period. 37.1% (N=555 screened positive for depression, 26.9% (N=405 for anxiety, and 322 (21.4% screened positive for both. Any positive score was associated with age (P<0.033, female gender (P<0.006, and a nonsignificant trend toward living alone (P<0.095. 8.87% had suicidal thoughts. Conclusions. Screening captured the most affectively symptomatic patients, including those with suicidal ideation, for intervention. The partnering of mental health professionals and primary care physicians offers a workable model for addressing the scarcity of expertise in geriatric psychiatry.

  7. Architecture of a prehospital emergency patient care report system (PEPRS).

    Science.gov (United States)

    Majeed, Raphael W; Stöhr, Mark R; Röhrig, Rainer

    2013-01-01

    In recent years, prehospital emergency care adapted to the technology shift towards tablet computers and mobile computing. In particular, electronic patient care report (e-PCR) systems gained considerable attention and adoption in prehospital emergency medicine [1]. On the other hand, hospital information systems are already widely adopted. Yet, there is no universal solution for integrating prehospital emergency reports into electronic medical records of hospital information systems. Previous projects either relied on proprietary viewing workstations or examined and transferred only data for specific diseases (e.g. stroke patients[2]). Using requirements engineering and a three step software engineering approach, this project presents a generic architecture for integrating prehospital emergency care reports into hospital information systems. Aim of this project is to describe a generic architecture which can be used to implement data transfer and integration of pre hospital emergency care reports to hospital information systems. In summary, the prototype was able to integrate data in a standardized manner. The devised methods can be used design generic software for prehospital to hospital data integration. PMID:23920925

  8. Health Care Performance Indicators for Health Information Systems.

    Science.gov (United States)

    Hyppönen, Hannele; Ronchi, Elettra; Adler-Milstein, Julia

    2016-01-01

    Health Information Systems (HISs) are expected to have a positive impact on quality and efficiency of health care. Rapid investment in and diffusion of HISs has increased the importance of monitoring the adoption and impacts of them in order to learn from the initiatives, and to provide decision makers evidence on the role of HISs in improving health care. However, reliable and comparable data across initiatives in various countries are rarely available. A four-phase approach is used to compare different HIS indicator methodologies in order to move ahead in defining HIS indicators for monitoring effects of HIS on health care performance. Assessed approaches are strong on different aspects, which provide some opportunities for learning across them but also some challenges. As yet, all of the approaches do not define goals for monitoring formally. Most focus on health care structural and process indicators (HIS availability and intensity of use). However, many approaches are generic in description of HIS functionalities and context as well as their impact mechanisms on health care for HIS benchmarking. The conclusion is that, though structural and process indicators of HIS interventions are prerequisites for monitoring HIS impacts on health care outputs and outcomes, more explicit definition is needed of HIS contexts, goals, functionalities and their impact mechanisms in order to move towards common process and outcome indicators. A bottom-up-approach (participation of users) could improve development and use of context-sensitive HIS indicators. PMID:27198102

  9. Environmental management system objectives & targets results summary :

    Energy Technology Data Exchange (ETDEWEB)

    Vetter, Douglas Walter

    2014-04-01

    Sandia National Laboratories/New Mexicos (SNL/NM) Environmental Management System is the integrated approach for members of the workforce to identify and manage environmental risks. Each Fiscal Year (FY) SNL/NM performs an analysis to identify environmental aspects, and the environmental programs associated with them are charged with the task of routinely monitoring and measuring the objectives and targets that are established to mitigate potential impacts of SNL/NMs operations on the environment. An annual summary of the results achieved towards meeting established Sandia Corporation and SNL/NM Site-specific objectives and targets provides a connection to, and rational for, annually revised environmental aspects. The purpose of this document is to summarize the results achieved and documented in FY2013.

  10. The Danish health care system from a British perspective.

    Science.gov (United States)

    Hurst, Jeremy

    2002-02-01

    The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weakness, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a one-week visit to health care authorities, providers and key persons. The present paper includes the main findings by one of the panel members. The dominance of tax financing helps to achieve control over the level of health care expenditure, as well as securing equity in financing the services. The reliance on local government for financing and running health care has both advantages and disadvantages, and the split between county and municipal responsibility leads to problems of co-ordination. The remuneration of general practitioners by a mix of capitation payment and fee for services has the advantage of capping expenditure whilst leaving the GPs with an incentive to compete for patients by providing them with good services. The GP service is remarkably economical. The hospital sector displays much strength, but there seem to be problems with respect to: (i) perceived lack of resources and waiting lists; (ii) impersonal care, lack of continuity of care and failures in communication between patients and staff; (iii) management problems and sometimes demotivated staff. The relationship between patients and providers is facilitated by free access to GPs and absence of any charges for hospital treatment. The biggest threat is continuation of avoidable illness caused by poor health habits in the population. The biggest opportunity is to strengthen public health measures to tackle these poor health habits. PMID:11755995

  11. Awareness of bispectral index monitoring system among the critical care nursing personnel in a tertiary care hospital of India

    Directory of Open Access Journals (Sweden)

    Shikha Thakur

    2011-01-01

    Full Text Available Background: Bispectral index monitoring system (BIS is one of the several systems used to measure the effects of anaesthetic and sedative drugs on the brain and to track changes in the patient′s level of sedation and hypnosis. BIS monitoring provides information clinically relevant to the adjustment of dosages of sedating medication. It can help the nursing personnel in preventing under- and over sedation among intensive care unit (ICU patients. Objective: The present study was conducted to assess the knowledge of nursing personnel working in the ICU regarding BIS. Methods: Fifty-four subjects participated in the study. A structured questionnaire was developed to assess the knowledge of the nursing personnel regarding BIS. Focus group discussions were held among the nursing personnel to know their views regarding BIS. Results: Mean age (years of the subjects was 30.7΁7.19 (21-47 years, with a female preponderance. Although the use of BIS in ICU is not common, majority (94.44% were aware of BIS and its purpose. 79.62% of the subjects knew about its implication in patient care. The mean knowledge score of the subjects was 11.87΁2.43 (maximum score being 15. Conclusion: There exists an awareness among the critical care nursing staff in our institution regarding BIS and its clinical implications. Its use in the critical care setting may benefit the patients in terms of providing optimal sedation.

  12. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey

    Directory of Open Access Journals (Sweden)

    Saliku Teresa

    2009-03-01

    Full Text Available Abstract Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1 delay in making the decision to seek care; 2 delay in reaching an appropriate obstetric facility; and 3 delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden

  13. Rationing and competition in the Dutch health-care system.

    Science.gov (United States)

    Schut, Frederik T; Van de Ven, Wynand P M M

    2005-09-01

    In this paper we examine the goals and effects of health-care policy in the Netherlands over the period 1980--2000. During this period Dutch health-care policy is marked by a peculiar combination of increasingly stringent cost-containment policies alongside a persistent pursuit of market-oriented reforms. The main goal of cost containment was to keep labour costs down under the restriction of universal equal access to health care. Supply and price control policies were quite successful in achieving cost containment, but in due course prolonged quantity rationing began to jeopardise universal physical access to health services. The main goal of market-oriented health-care reforms is to increase the system's efficiency and its responsiveness to patient's needs, while maintaining equal access. The feasibility of the reforms crucially hinges on the realisation of adequate methods of risk adjustment, product classification and quality measurement, an appropriate consumer information system and an effective competition policy. Realising these preconditions requires a lengthy and cautious implementation process. Although considerable progress has been made in setting the appropriate stage for regulated competition in Dutch health care, the role of the market is still limited. PMID:16161190

  14. Modeling Malaysia's Energy System: Some Preliminary Results

    Directory of Open Access Journals (Sweden)

    Ahmad M. Yusof

    2011-01-01

    Full Text Available Problem statement: The current dynamic and fragile world energy environment necessitates the development of new energy model that solely caters to analyze Malaysia’s energy scenarios. Approach: The model is a network flow model that traces the flow of energy carriers from its sources (import and mining through some conversion and transformation processes for the production of energy products to final destinations (energy demand sectors. The integration to the economic sectors is done exogeneously by specifying the annual sectoral energy demand levels. The model in turn optimizes the energy variables for a specified objective function to meet those demands. Results: By minimizing the inter temporal petroleum product imports for the crude oil system the annual extraction level of Tapis blend is projected at 579600 barrels per day. The aggregate demand for petroleum products is projected to grow at 2.1% year-1 while motor gasoline and diesel constitute 42 and 38% of the petroleum products demands mix respectively over the 5 year planning period. Petroleum products import is expected to grow at 6.0% year-1. Conclusion: The preliminary results indicate that the model performs as expected. Thus other types of energy carriers such as natural gas, coal and biomass will be added to the energy system for the overall development of Malaysia energy model.

  15. Primary Health Care in Canada: Systems in Motion

    OpenAIRE

    Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

    2011-01-01

    Context: During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged.

  16. The Changing Medical Care System: Some Implications for Medical Education.

    Science.gov (United States)

    Foreman, Spencer

    1986-01-01

    The medical care system is undergoing widespread and significant changes. Individual hospitals may be disappearing as mergers, acquisitions, and a variety of multi-institutional arrangements become the dominant form and as a host of free-standing medical enterprises spread out into the community. (MLW)

  17. Medical Information Management System (MIMS) CareWindows.

    Science.gov (United States)

    Stiphout, R. M.; Schiffman, R. M.; Christner, M. F.; Ward, R.; Purves, T. M.

    1991-01-01

    The demonstration of MIMS/CareWindows will include: (1) a review of the application environment and development history, (2) a demonstration of a very large, comprehensive clinical information system with a cost effective graphic user server and communications interface. PMID:1807755

  18. Indonesia health care system and Asean economic community

    Directory of Open Access Journals (Sweden)

    Joko Gunawan

    2015-07-01

    However, AEC, by looking at this challenges, is expected to improve health care system and service in Indonesia, and close the gap by collaborating among ten ASEAN member countries through 4 modes of AEC consisting of cross border supply, consumption abroad, commercial presence, and movement of natural persons. [Int J Res Med Sci 2015; 3(7.000: 1571-1577

  19. Emotion-Aware Assistive System for Humanistic Care Based on the Orange Computing Concept

    Directory of Open Access Journals (Sweden)

    Jhing-Fa Wang

    2012-01-01

    Full Text Available Mental care has become crucial with the rapid growth of economy and technology. However, recent movements, such as green technologies, place more emphasis on environmental issues than on mental care. Therefore, this study presents an emerging technology called orange computing for mental care applications. Orange computing refers to health, happiness, and physiopsychological care computing, which focuses on designing algorithms and systems for enhancing body and mind balance. The representative color of orange computing originates from a harmonic fusion of passion, love, happiness, and warmth. A case study on a human-machine interactive and assistive system for emotion care was conducted in this study to demonstrate the concept of orange computing. The system can detect emotional states of users by analyzing their facial expressions, emotional speech, and laughter in a ubiquitous environment. In addition, the system can provide corresponding feedback to users according to the results. Experimental results show that the system can achieve an accurate audiovisual recognition rate of 81.8% on average, thereby demonstrating the feasibility of the system. Compared with traditional questionnaire-based approaches, the proposed system can offer real-time analysis of emotional status more efficiently.

  20. Trauma in elderly people: access to the health system through pre-hospital care1

    OpenAIRE

    da Silva, Hilderjane Carla; Pessoa, Renata de Lima; de Menezes, Rejane Maria Paiva

    2016-01-01

    Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Tr...

  1. Ensuring the security and privacy of information in mobile health-care communication systems

    OpenAIRE

    Ademola P. Abidoye; Henry O. Nyongesa; Ronald Februarie; Kehinde K. Agbele; Ademola O. Adesina

    2011-01-01

    The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of a patient’s data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel. Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hosp...

  2. Vermont STep Ahead Recognition System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Vermont's STep Ahead Recognition System (STARS) prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for All Child Care Programs;…

  3. General practitioners' attitudes towards research in primary care: qualitative results of a cross sectional study

    OpenAIRE

    Szecsenyi Joachim; Rosemann Thomas

    2004-01-01

    Abstract Background Research in General Practice requires the participation of General practitioners (GPs). In Germany there is little tradition of research in this field, and GPs are not used to be participants in research. Little is known about German GPs attitudes towards research. Therefore the aim of our study was to assess the willingness of German General Practitioners to participate in primary care research and their attitude towards research in general practice. The results should en...

  4. [Female migrants in the health care system. Health care utilisation, access barriers and health promotion strategies].

    Science.gov (United States)

    Wimmer-Puchinger, B; Wolf, H; Engleder, A

    2006-09-01

    Due to the evident interaction between social factors and health, migrants are exposed to specific risk factors and access barriers to health services. Some examples are the lower education level, the low social position and/or the insufficient language skills. This concept is further elaborated in the multi-factorial impacts of health literacy. Female migrants often experience additional discrimination because of their gender. Despite the lack of representative data, consistent studies show that female migrants do not regularly take advantage of health care prevention and present themselves with higher degrees of stress. The current "inadequate health care" manifests itself in a lack of care in the areas of prevention and health education and an abundance in the context of medication and diagnostic procedures. To meet these demands and to further reduce barriers, in particular language barriers, specific strategies for this target group involving both politics and the health care system have to be developed. Besides the employment of interpreters with a native cultural background and the distribution of information booklets, it is an important strategy to reduce structural obstacles such as cultural diversity. To contact these women in their living environment should help to increase their self-determined health promotion. Selected models of good practice in Austria with regard to the themes of FGM (female genital mutilation), violence, heart disease and breast cancer are presented to highlight the specific health situation and risk factors of female migrants as well as successful strategies to confront them. PMID:16927035

  5. The Durham Family Initiative: A Preventive System of Care

    OpenAIRE

    Dodge, Kenneth A.; Lisa J. Berlin; Epstein, Matthew; Spitz-Roth, Adele; O’Donnell, Karen; Kaufman, Martha; Amaya-Jackson, Lisa; Rosch, Joel; Christopoulos, Christina

    2004-01-01

    This article describes the Durham Family Initiative (DFI), an innovative effort to bring together child welfare and juvenile justice systems to reach DFI’s goal of reducing the child abuse rate in Durham, North Carolina, by 50% within the next 10 years. DFI will follow principles of a preventive system of care (PSoC), which focuses on nurturing the healthy parent-child relationship. A community collaborative of government agency directors has signed a memorandum of agreement to implement the ...

  6. HTRAK, a computerized health maintenance tracking system for primary care.

    OpenAIRE

    Frame, P. S.; Werth, P. L.

    1992-01-01

    This presentation describes a computerized health maintenance tracking system for primary care designed to be linked to the practice billing system. Providers enter health maintenance data along with billing data on an encounter form. Physician and patient reminders are generated once a year for all patients regardless of appointment status. Multiple entry options are available and the frequency of procedures can be varied for individual patients. Summary reports are generated to assist compl...

  7. Health Care Professionals Devise Ways to Get Around Using Electronic Health Record Systems

    Science.gov (United States)

    ... Task Force Improving Primary Care Practice Health IT Integration Health Care/System Redesign Clinical-Community Linkages Care Coordination Capacity Building Behavioral and Mental Health Self-Management Support Resources Clinical Community Relationships ...

  8. A SUSTAINABLE HEALTH CARE SYSTEM REQUIRES MANAGEMENT TRANSFORMATION

    Directory of Open Access Journals (Sweden)

    Kanellopoulos Dimitros

    2011-12-01

    Full Text Available In order to be the health care system sustainable , management transformations must be based on very precise diagnostic analysis that includes complete and current information. It is necessary to implement an information system that collects information in real time, that watches the parameters that significantly influence the sustainability of the system. Such an information system should point out a radiography(a scan of the system at some time under following aspects:: 1. An overview of system; 2 An overview of the economic situation; 3 A technical presentation ;4. A legal overview; 5. A social overview ; 6. A management overview .Based on these Xrays of the health system, it outlines a series of conclusions and recommendations together with a SWOT analysis that highlights the potential internal (strengths and weaknesses and external potential (opportunities and threats. Based on this analysis and recommendations, the management is going to redesign the system in order to be adapted to the changing environmental requirements. Management transformation is recommended to be by following steps. :1. The development of a new management system that would make a positive change in the health care system 2. Implementation of the new management system 3. Assessment of the changes

  9. Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem

    2013-09-01

    Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

  10. Magnetic Resonance Imaging Results Can Affect Therapy Decisions in Hyperacute Stroke Care

    International Nuclear Information System (INIS)

    Background: Despite some limitations, a perfusion/diffusion mismatch can provide a working estimate of the ischemic penumbra in hyperacute stroke and has successfully been used to triage patients. Purpose: To evaluate whether the addition of magnetic resonance imaging (MRI) to clinical and non-contrast computed tomography (CT) data alters diagnosis and choice of therapy. Material and Methods: We retrospectively analyzed clinical records, and CT and MRI data fully available in 97 of 117 patients. Upon clinical examination and CT, a diagnosis and treatment path was scored and compared to treatment path after addition of MRI data. The MRI protocol included T2-weighted images, diffusion-weighted images (DWI), and perfusion-weighted images (PWI), and MR angiography (MRA). Results: MRI data were acquired in less than 15 min. In 20 of 97 patients (21%), the diagnosis changed after MRI. In 25 of 97 patients (26%), the presumptive treatment plan was changed after MRI evaluation. Thirteen patients had their treatment changed from thrombolytic to nonthrombolytic therapy. Three patients were changed from nonthrombolytic to intraarterial (IA) thrombolysis. In one patient, treatment was changed from intravenous (IV) to IA thrombolysis, and in five patients it was changed from IA to IV thrombolysis. In two patients, systemic heparin was added to antiplatelet therapy. Conclusion: The expansion of the acute stroke protocol to include MRI altered the therapy plan in 26% of our patients. The utility of MRI, shown here to improve patient stratification into best-treatment options, demonstrates the value of using MRI to optimize care in hyperacute stroke patients

  11. Sharing clinical information across care settings: the birth of an integrated assessment system

    Directory of Open Access Journals (Sweden)

    Henrard Jean-Claude

    2009-04-01

    Full Text Available Abstract Background Population ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific. Methods From 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system. Results The rationale and development strategy for the suite is described, together with a description of potential applications. To date, ten instruments comprise the suite, each comprising "core" items shared among the majority of instruments and "optional" items that are specific to particular care settings or situations. Conclusion This comprehensive suite offers the opportunity for integrated multi-domain assessment, enabling electronic clinical records, data transfer, ease of interpretation and streamlined training.

  12. Applying principles of health system strengthening to eye care

    Directory of Open Access Journals (Sweden)

    Karl Blanchet

    2012-01-01

    Full Text Available Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions.

  13. Applying principles of health system strengthening to eye care

    Science.gov (United States)

    Blanchet, Karl; Patel, Daksha

    2012-01-01

    Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries) often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions. PMID:22944762

  14. Equity improvements in maternal and newborn care indicators: results from the Bardiya district of Nepal.

    Science.gov (United States)

    Nonyane, Bareng As; Kc, Ashish; Callaghan-Koru, Jennifer A; Guenther, Tanya; Sitrin, Debora; Syed, Uzma; Pradhan, Yasho V; Khadka, Neena; Shah, Rashed; Baqui, Abdullah H

    2016-05-01

    Community-based maternal and newborn care interventions have been shown to improve neonatal survival and other key health indicators. It is important to evaluate whether the improvement in health indicators is accompanied by a parallel increase in the equitable distribution of the intervention activities, and the uptake of healthy newborn care practices. We present an analysis of equity improvements after the implementation of a Community Based Newborn Care Package (CB-NCP) in the Bardiya district of Nepal. The package was implemented alongside other programs that were already in place within the district. We present changes in concentration indices (CIndices) as measures of changes in equity, as well as percentage changes in coverage, between baseline and endline. The CIndices were derived from wealth scores that were based on household assets, and they were compared usingt-tests. We observed statistically significant improvements in equity for facility delivery [CIndex: -0.15 (-0.24, -0.06)], knowledge of at least three newborn danger signs [-0.026(-0.06, -0.003)], breastfeeding within 1 h [-0.05(-0.11, -0.0001)], at least one antenatal visit with a skilled provider [-0.25(-0.04, -0.01)], at least four antenatal visits from any provider [-0.15(-0.19, -0.10)] and birth preparedness [-0.09(-0.12, -0.06)]. The largest increases in practices were observed for facility delivery (50%), immediate drying (34%) and delayed bathing (29%). These results and those of similar studies are evidence that community-based interventions delivered by female community health volunteers can be instrumental in improving equity in levels of facility delivery and other newborn care behaviours. We recommend that equity be evaluated in other similar settings within Nepal in order to determine if similar results are observed. PMID:26303057

  15. The French Health Care System: What Can We Learn?

    Directory of Open Access Journals (Sweden)

    El Taguri A

    2008-01-01

    Full Text Available All public systems look for the best organizational structure to funnel part of their national income into healthcare services. Appropriate policies may differ widely across country settings. Most healthcare systems fall under one of two broad categories, either Bismark or Beveridge systems. There is no simple ideal model for the organization of health services, but most healthcare systems that follow the Beveridge healthcare model are poor performers. The Libyan Health system is a low responsive, inefficient and underperforming system that lacks goals and/or SMART. (Specific, Measurable, Achievable, Realistic, Time specific objectives. A look at different organization models in the world would reinforce efforts to reorganize and improve the performance of the Libyan National Healthcare services.The French Health Care System (FHCS ranked first according to the WHO and the European Health Consumer Powerhouse. The FHCS was described to have a technically efficient, generous healthcare system that provides the best overall health care. This makes the FHCS a practical model of organization having many of the essential aspects of a modern national health service. In this review, we describe the main features of the FHCS, current challenges and future trends with particular attention paid to aspects that could be of importance to the Libyan Healthcare System.

  16. Barriers of Referral System to Health Care Provision in Rural Societies in Iran

    Directory of Open Access Journals (Sweden)

    Manijeh Eskandari

    2013-08-01

    Full Text Available Introduction: Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. This study aimed to describe barriers of health care process in rural societies in Iran. Methods: In this qualitative study, 26 participants (21 rural health care providers and five rural patients were selected through purposive sampling. The data was collected via semi-structured individual interviews and small focus group discussions. Data was analyzed with qualitative content analysis.Results: One category, “ineffective referral system”, and five subcategories, i.e. being far from the ideal referral system, lack of adequate governmental referral system, lack of connection between different levels of the referral system, self-referential and bypassing the referral system, and insufficient knowledge about the referral system, were found. Conclusion: Considering the obstacles to the referral system, improvements in its structure are necessary to promote the quality of health care in rural areas. Such changes require coordination between the three levels of the referral system, strengthening the public sector of the system, increasing public awareness about the referral system, and prevention of self-referential.

  17. Expenditures in the health care system in Brazil: the participation of states and the Federal District in financing the health care system from 2002 to 2013

    Directory of Open Access Journals (Sweden)

    Renata Maria de Deus Costa

    2015-04-01

    Full Text Available OBJECTIVE: To analyze the public expenditures of states on health care and the participation of states and the Federal District in financing the Unified Health System, better known by the acronym SUS. To develop the research, two targets were used: “to rescue expenses per government source (federal, state and municipal during the period from 2002 to 2013” and “to rescue resource transfers from the federal SUS to the states and also to municipalities”. METHODS: This research is bibliographic, documentary and descriptive and used a quantitative approach. Data were extracted from the Information System Public Health Budget, and additional data were collected from the public managers of states, municipalities and the Federal District during the period from 2002 to 2013. Federal data from the Undersecretary of Planning and Budget (originally extracted from the Integrated System of Financial Administration of the Federal Government and available on the Budget Public Health System webpage were also collected. RESULTS: The data revealed that during the same researched period, the Federal District has maintained the health care system budget, whereas states and municipalities have increased their budgets for the same spending. CONCLUSIONS: By analyzing the results, there is clearly a disparity regarding the investment expended by the entities of the Federation. Although municipalities and states have gradually increased their application of resources to health care, the federal state has maintained the same budget. These results reveal a bit of concern about public health funding.

  18. Interprofessional curriculum development achieves results: Initial evidence from a dementia-care protocol.

    Science.gov (United States)

    Annear, Michael James; Goldberg, Lynette R; Lo, Amanda; Robinson, Andrew

    2016-05-01

    This report describes the outcomes of a five-day, protocol-based interprofessional education (IPE) initiative to prepare undergraduate medical, nursing, and paramedic students for collaborative work with adults with dementia. Clinical placements provided a structured and supervised IPE experience for 127 students in two Residential Aged Care Facilities (RACFs) in Hobart, Australia, during 2013 and 2014. The IPE activity was based on a seven-step protocol formulated by an interprofessional team of educators and aged care practitioners that revolved around collaborative assessments of adults with complex health needs. This article describes the IPE protocol and presents the results of a pre- and post-placement attitude questionnaire and knowledge quiz administered to evaluate student attitudes towards IPE and knowledge of dementia. Data suggest that a five-day, supervised, and protocol-based IPE experience in a dementia-care setting can inculcate positive changes in student attitudes about collaborative practice and may encourage dementia-related learning outcomes. PMID:27029913

  19. The dynamic system of parental work of care for children with special health care needs: A conceptual model to guide quality improvement efforts

    Directory of Open Access Journals (Sweden)

    Hexem Kari R

    2011-10-01

    Full Text Available Abstract Background The work of care for parents of children with complex special health care needs may be increasing, while excessive work demands may erode the quality of care. We sought to summarize knowledge and develop a general conceptual model of the work of care. Methods Systematic review of peer-reviewed journal articles that focused on parents of children with special health care needs and addressed factors related to the physical and emotional work of providing care for these children. From the large pool of eligible articles, we selected articles in a randomized sequence, using qualitative techniques to identify the conceptual components of the work of care and their relationship to the family system. Results The work of care for a child with special health care needs occurs within a dynamic system that comprises 5 core components: (1 performance of tasks such as monitoring symptoms or administering treatments, (2 the occurrence of various events and the pursuit of valued outcomes regarding the child's physical health, the parent's mental health, or other attributes of the child or family, (3 operating with available resources and within certain constraints (4 over the passage of time, (5 while mentally representing or depicting the ever-changing situation and detecting possible problems and opportunities. These components interact, some with simple cause-effect relationships and others with more complex interdependencies. Conclusions The work of care affecting the health of children with special health care needs and their families can best be understood, studied, and managed as a multilevel complex system.

  20. Estimating the Cost of Increasing Retention in Care for HIV-Infected Patients: Results of the CDC/HRSA Retention in Care Trial

    Science.gov (United States)

    Shrestha, Ram K.; Gardner, Lytt; Marks, Gary; Craw, Jason; Malitz, Faye; Giordano, Thomas P.; Sullivan, Meg; Keruly, Jeanne; Rodriguez, Allan; Wilson, Tracey E.; Mugavero, Michael

    2016-01-01

    Background Retaining HIV patients in medical care promotes access to antiretroviral therapy, viral load suppression, and reduced HIV transmission to partners. We estimate the programmatic costs of a US multisite randomized controlled trial of an intervention to retain HIV patients in care. Methods Six academically affiliated HIV clinics randomized patients to intervention (enhanced personal contact with patients across time coupled with basic HIV education) and control [standard of care (SOC)] arms. Retention in care was defined as 4-month visit constancy, that is, at least 1 primary care visit in each 4-month interval over a 12-month period. We used microcosting methods to collect unit costs and measure the quantity of resources used to implement the intervention in each clinic. All fixed and variable labor and nonlabor costs of the intervention were included. Results Visit constancy was achieved by 45.7% (280/613) of patients in the SOC arm and by 55.8% (343/615) of patients in the intervention arm, representing an increase of 63 patients (relative improvement 22.1%; 95% confidence interval: 9% to 36%; P estimated cost per additional patient retained in care beyond SOC was $3834. Conclusions Our analyses showed that a retention in care intervention consisting of enhanced personal contact coupled with basic HIV education may be delivered at fairly low cost. These results provide useful information for guiding decisions about planning or scaling-up retention in care interventions for HIV-infected patients. PMID:25469520

  1. Quality of care in single-payer and multipayer health systems.

    Science.gov (United States)

    Feldman, Roger

    2009-08-01

    In this article, I argue that unregulated markets will not find the right level of health care quality but that at the same time it is not clear that single-payer systems will do any better. My perspective combines the economic theory of public goods and the institutional payment arrangements found in many single-payer systems. If, as I believe, health care quality is a public good, it will be underprovided in a multipayer system. Single-payer systems often allocate a fixed budget to health care professionals or administrators and give them considerable discretion in determining quality as well as quantity of service. With care being free or almost free at the point of use, patients will demand more services than administrators want to provide. The result is rationing by waiting -- which should be present in all such systems and is present in most of them. I develop several implications of the theory and an agenda for future research on quality of care in single-payer and multipayer health systems. PMID:19633227

  2. Decentralized data systems - results and recommendations

    International Nuclear Information System (INIS)

    A Decentralized Data Systems (DDS) is defined as a utility, industry, or regulatory agency data system dealing with power plant performance. DDSs in use or planned for use on an industry, regional, or utility basis have not been studied in sufficient detail to identify methods of coordinating them with the Information System for Generation Availability (ISGA), which is under development. A survey of utility, industry, and regulatory agency DDSs was made by Southwest Research Institute. Information was gathered on twelve utility data systems, two industry data systems, two regulatory agency data systems and one government-owned utility data system. The objectives of this study are to identify existing DDSs that are potential candidates for integration into the ISGA, and to identify methods by which that integration can be accomplished. A matrix of the data elements and formats was prepared for the data systems, which allowed comparison to determine which DDSs were potential candidates for integration into the ISGA. Utility data systems emphasize outage data collection. A composite of GADS, NPRDS, and piece-part data from Utah Power and Light encompass nearly all data elements identified in the survey. Of the computer system configurations considered as potentially viable for ISGA, integrated, centralized, interfaced, and distributed, the authors believe the centralized system for data retrieval is the least expensive to implement, and the most acceptable to the users. An in-depth study of ISGA hadware/software options is the subject of another EPRI contract. The information and system configuration overviews presented in this report will support that effort

  3. Primary care providers' experiences notifying parents of cystic fibrosis newborn screening results.

    Science.gov (United States)

    Finan, Caitlin; Nasr, Samya Z; Rothwell, Erin; Tarini, Beth A

    2015-01-01

    This study examines primary care provider (PCP) experiences with the initial parental disclosure of cystic fibrosis (CF) newborn screening (NBS) results in order to identify methods to improve parent-provider communication during the CF NBS process. PCPs of infants who received positive CF NBS results participated in semistructured phone interviews. Interviews were analyzed using a qualitative content analysis. PCPs acknowledged the difficulty of "breaking bad news" to parents, and emphasized minimizing parental anxiety and maximizing parental understanding. PCPs used a variety of methods to notify parents, and shared varying information about the significance of the results. Variation in the method of parental notification, information discussed, and attention to parents' emotional needs may limit successful follow-up of children with positive CF NBS results. A multifaceted intervention to improve PCP knowledge, management, and communication could improve provider confidence, optimize information transfer, and minimize parental distress during the initial disclosure of CF NBS results. PMID:25104730

  4. Primary Care Providers’ Experiences Notifying Parents of Cystic Fibrosis Newborn Screening Results

    Science.gov (United States)

    Finan, Caitlin; Nasr, Samya Z.; Rothwell, Erin; Tarini, Beth A.

    2014-01-01

    This study examines primary care provider (PCP) experiences with the initial parental disclosure of cystic fibrosis (CF) newborn screening (NBS) results in order to identify methods to improve parent-provider communication during the CF NBS process. PCPs of infants who received positive CF NBS results participated in semistructured phone interviews. Interviews were analyzed using a qualitative content analysis. PCPs acknowledged the difficulty of “breaking bad news” to parents, and emphasized minimizing parental anxiety and maximizing parental understanding. PCPs used a variety of methods to notify parents, and shared varying information about the significance of the results. Variation in the method of parental notification, information discussed, and attention to parents’ emotional needs may limit successful follow-up of children with positive CF NBS results. A multifaceted intervention to improve PCP knowledge, management, and communication could improve provider confidence, optimize information transfer, and minimize parental distress during the initial disclosure of CF NBS results. PMID:25104730

  5. Preparing a health care delivery system for Space Station

    Science.gov (United States)

    Logan, J. S.; Stewart, G. R.

    1985-01-01

    NASA's Space Station is viewed as the beginning of man's permanent presence in space. This paper presents the guidelines being developed by NASA's medical community in preparing a quality, permanent health care delivery system for Space Station. The guidelines will be driven by unique Space Station requirements such as mission duration, crew size, orbit altitude and inclination, EVA frequency and rescue capability. The approach will emphasize developing a health care system that is modular and flexible. It will also incorporate NASA's requirements for growth capability, commonality, maintainability, and advanced technology development. Goals include preventing unnecessary rescue attempts, as well as maintaining the health and safety of the crew. Proper planning will determine the levels of prevention, diagnosis, and treatment necessary to achieve these goals.

  6. Organisational culture matters for system integration in health care.

    Science.gov (United States)

    Munir, Samina K; Kay, Stephen

    2003-01-01

    This paper illustrates the importance of organisational culture for Clinical Information Systems (CIS) integration. The study is based on data collected in intensive care units in the UK and Denmark. Data were collected using qualitative methods, i.e., observations, interviews and shadowing of health care providers, together with a questionnaire at each site. The data are analysed to extract salient variables for CIS integration, and it is shown that these variables can be separated into two categories that describe the 'Actual Usefulness' of the system and the 'Organisational Culture'. This model is then extended to show that CIS integration directly affects the work processes of the organisation, forming an iterative process of change as a CIS is introduced and integrated. PMID:14728220

  7. A Systems Approach to Improving Rural Care in Ethiopia

    OpenAIRE

    Bradley, Elizabeth H.; Byam, Patrick; Alpern, Rachelle; Thompson, Jennifer W.; Zerihun, Abraham; Abeb, Yigeremu; Leslie A Curry

    2012-01-01

    Background Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation i...

  8. The meaning of integrated care: a systems approach

    OpenAIRE

    Edgren, Lars

    2008-01-01

    Introduction In all well developed societies, such as those that we live in, there tend to be strong borders or barriers between different organisations and different professions. People with different kinds of knowledge are kept well apart. So how can we—should we—manage health and social services that are located in different organisations? If we are to improve the capability of a health care organisation to function as an integrated part of a locally driven health and social service system...

  9. Quality systems in health care: A sociotechnical approach

    OpenAIRE

    Harteloh, Peter

    2003-01-01

    textabstractIn this paper, we explore a sociotechnical approach to construct quality systems as an alternative to the traditional, ISO orientated approach. A sociotechnical approach is characterised as bottom-up, incremental, information technology facilitated and indicator driven. Its purpose is to ground quality assurance in medical practice and to provide meaning to those directly involved (patients, health care providers and medical professionals). Meaning depends on information. Accordin...

  10. Health care system reform. Ontario family physicians' reactions.

    OpenAIRE

    2001-01-01

    OBJECTIVE: To determine the effect on a cohort of family physicians of health care system reforms in Ontario and the relationship of reforms to their career satisfaction. DESIGN: Follow-up survey in 1999 of a cohort initially studied in 1993, posing many of the original questions along with some new ones. Four focus groups of other Ontario family physicians. SETTING: Family practices in Ontario. PARTICIPANTS: All family physicians who had received certification after completing a family medic...

  11. The Swedish health care system--an economist's view.

    Science.gov (United States)

    Blomqvist, A G

    1992-01-01

    This article compares the organization of the Swedish health care system with that in three other countries, the U.S., the U.K., and Canada, focussing on three main areas: (1) the provision and financing (public or private) of health insurance, including the question of the quality of the insurance protection offered; (2) the organization of the production of health services, and the economic incentives on the system's decision-makers (doctors, hospital managers, politicians, etc.). Possible answers are suggested to the question why one country (the U.K.) is able to provide health care to its population at an average cost considerably below that of the others: Differences in the quality of the insurance protection and health services; in the incentives on the system managers to exercise cost control; and in the incentives on service providers such as physicians, to consider cost-effectiveness when making treatment decisions. An attempt is made to suggest lessons for health care reform in Sweden and elsewhere. PMID:10119959

  12. Test Results of a Phi Monitoring System

    CERN Document Server

    Figueroa, Carlos; Burgos, C; Ferrrando, A; Matorras, Francisco; Molinero, Antonio; Rodriguo, T; Shvachkin, V

    1997-01-01

    The development and tests of a Phi monitoring system prototype designed for the CMS Muon Spectrometer alignment are described. The system, using a sweeping laser beam, defines a light reference plane to be used for the continuous monitoring of the Muon detectors. The performance of the system in the Laboratory was satisfactory. It showed good stability and linearity response behaviour. With the appropriate selection of components it can monitor large range position shifts ( up to 1-2 cm) with good accuracy at long distances ( ~ 60 mu accuracy at 10 m).

  13. "Fighting the system": Families caring for ventilator-dependent children and adults with complex health care needs at home

    Directory of Open Access Journals (Sweden)

    Nielsen Erik W

    2011-07-01

    Full Text Available Abstract Background An increasing number of individuals with complex health care needs now receive life-long and life-prolonging ventilatory support at home. Family members often take on the role of primary caregivers. The aim of this study was to explore the experiences of families giving advanced care to family members dependent on home mechanical ventilation. Methods Using qualitative research methods, a Grounded Theory influenced approach was used to explore the families' experiences. A total of 15 family members with 11 ventilator-dependent individuals (three children and eight adults were recruited for 10 in-depth interviews. Results The core category, "fighting the system," became the central theme as family members were asked to describe their experiences. In addition, we identified three subcategories, "lack of competence and continuity", "being indispensable" and "worth fighting for". This study revealed no major differences in the families' experiences that were dependent on whether the ventilator-dependent individual was a child or an adult. Conclusions These findings show that there is a large gap between family members' expectations and what the community health care services are able to provide, even when almost unlimited resources are available. A number of measures are needed to reduce the burden on these family members and to make hospital care at home possible. In the future, the gap between what the health care can potentially provide and what they can provide in real life will rapidly increase. New proposals to limit the extremely costly provision of home mechanical ventilation in Norway will trigger new ethical dilemmas that should be studied further.

  14. A Laboratory Test Expert System for Clinical Diagnosis Support in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Rodrigo Fernandez-Millan

    2015-08-01

    Full Text Available Clinical Decision Support Systems have the potential to reduce lack of communication and errors in diagnostic steps in primary health care. Literature reports have showed great advances in clinical decision support systems in the recent years, which have proven its usefulness in improving the quality of care. However, most of these systems are focused on specific areas of diseases. In this way, we propose a rule-based expert system, which supports clinicians in primary health care, providing a list of possible diseases regarding patient’s laboratory tests results in order to assist previous diagnosis. Our system also allows storing and retrieving patient’s data and the history of patient’s analyses, establishing a basis for coordination between the various health care levels. A validation step and speed performance tests were made to check the quality of the system. We conclude that our system could improve clinician accuracy and speed, resulting in more efficiency and better quality of service. Finally, we propose some recommendations for further research.

  15. Unraveling care integration: Assessing its dimensions and antecedents in the Italian Health System.

    Science.gov (United States)

    Calciolari, Stefano; Ilinca, Stefania

    2016-01-01

    In recent decades, consensus has grown on the need to organize health systems around the concept of care integration to better confront the challenges associated with demographic trends and financial sustainability. However, care integration remains an imprecise umbrella term in both the academic and policy arenas. In addition, little substantive knowledge exists on the success factors for integration initiatives. We propose a composite measure of care integration and a conceptual framework suggesting its relationships with three types of antecedents: contextual, cultural, and organizational factors. Our framework was tested using data from the Italian National Health System (NHS). We administered an ad-hoc questionnaire to all Italian local health units (LHUs), with a 60.4% response rate, and used structural equation modeling to assess the relationships between the relevant latent constructs. The results validated our measure of care integration and supported the hypothesized relationships. In particular, integration was found to be fostered by results-oriented institutional settings, a professional culture conducive to inclusiveness and shared goals, and organizational arrangements promoting clear expectations among providers. Thus, integration improves care and mediates the effects of specific operating means on care enhancement. PMID:26725643

  16. Cost-effectiveness of dronedarone and standard of care compared with standard of care alone: US results of an ATHENA lifetime model

    Directory of Open Access Journals (Sweden)

    Reynolds MR

    2013-01-01

    Full Text Available Matthew R Reynolds,1 Jonas Nilsson,2 Örjan Åkerborg,2 Mehul Jhaveri,3 Peter Lindgren2,41Beth Israel Deaconess Medical Center, VA Boston Healthcare System, Boston, MA, USA; 2OptumInsight, Stockholm, Sweden; 3sanofi-aventis Inc, Bridgewater, NJ, USA; 4Institute of Environmental Medicine, Karolinska Institute, Stockholm, SwedenBackground: The first antiarrhythmic drug to demonstrate a reduced rate of cardiovascular hospitalization in atrial fibrillation/flutter (AF/AFL patients was dronedarone in a placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation/atrial flutter (ATHENA trial. The potential cost-effectiveness of dronedarone in this patient population has not been reported in a US context. This study assesses the cost-effectiveness of dronedarone from a US health care payers’ perspective.Methods and results: ATHENA patient data were applied to a patient-level health state transition model. Probabilities of health state transitions were derived from ATHENA and published data. Associated costs used in the model (2010 values were obtained from published sources when trial data were not available. The base-case model assumed that patients were treated with dronedarone for the duration of ATHENA (mean 21 months and were followed over a lifetime. Cost-effectiveness, from the payers' perspective, was determined using a Monte Carlo microsimulation (1 million fictitious patients. Dronedarone plus standard care provided 0.13 life years gained (LYG, and 0.11 quality-adjusted life years (QALYs, over standard care alone; cost/QALY was $19,520 and cost/LYG was $16,930. Compared to lower risk patients, patients at higher risk of stroke (Congestive heart failure, history of Hypertension, Age ≥ 75 years, Diabetes mellitus, and past history of Stroke or transient ischemic attack (CHADS2 scores 3

  17. The Swedish National Care Programme for Anal Carcinoma. Implementation and overall results

    International Nuclear Information System (INIS)

    The Swedish National Care Programme for Anal Carcinoma (SNCPAC) was instituted in order to create a uniform handling policy for anal cancer and thus to accrue a population-based material allowing unbiased analyses. This study evaluates the degree of implementation of the SNCPAC guidelines, and presents overall treatment results in a total of 356 patients with epidermoid cancer of the anus and the perianal region diagnosed in Sweden between 1985 and 1989. Primary treatment according to the guidelines was irradiation up to 40 Gy. Bleomycin was administered intramuscularly before the first 18 fractions. After a 3-week pause, radiotherapy was to be continued up to a dose of 60-64 Gy, if at least an almost complete response was achieved. Otherwise, the patient was recommended surgery within a week. The guidelines were applied in 90% of cases where such treatment was possible. The 5-year tumour-specific survival rate was 72%. The survival rate was more favourable in perianal tumours (90%) than in anal canal tumours (68%, p<0.01). The 5-year probability of having a preserved anus was 64% (anal canal/perianal 58%/91%, p<0.001). Bleomycin did not appear to have any effect on treatment results. The care programme has had a rapid and almost complete nation-wide penetration, and has created the desired uniformity allowing proper analyses. The treatment results also appear comparable with specialised referral centres. (orig.)

  18. Toward a 21st Century Quality-Measurement System for Managed-Care Organizations

    OpenAIRE

    Armstead, Rodney C.; Elstein, Paul; Gorman, John

    1995-01-01

    As the Nation's largest managed-care purchaser, the Health Care Financing Administration (HCFA) is working to develop a uniform data and performance-measurement system for all enrollees in managed-care plans. This effort will ultimately hold managed-care plans accountable for continuous improvement in the quality of care they provide and will provide information to consumers and purchasers to make responsible managed-care choices. The effort entails overhauling peer review organization (PRO) ...

  19. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    OpenAIRE

    Stewart Allison; Dowden Michelle; Robinson Gary; Cunningham Joan; Bailie Ross; Si Damin; Connors Christine; Weeramanthri Tarun

    2008-01-01

    Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territ...

  20. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

    OpenAIRE

    Darko Gvozdanovi_; Miroslav Kon_ar; Vinko Kojund_i_; Hrvoje Jezid_i_

    2007-01-01

    In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on...

  1. A systems approach to improving rural care in Ethiopia.

    Directory of Open Access Journals (Sweden)

    Elizabeth H Bradley

    Full Text Available BACKGROUND: Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI, we identified PHCUs with consistently higher performance (n = 2, most improved performance (n = 3, or consistently lower performance (n = 2 in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51, we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1 managerial problem solving capacity, 2 relationship with the woreda (district health office, and 3 community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs. CONCLUSIONS/SIGNIFICANCE: Effective health strengthening efforts may require intensive

  2. Systemization of leadership for the systemization health care of health care: the unaddressed issue in health care reform.

    Science.gov (United States)

    Degeling, Pieter; Carr, Adrian

    2004-01-01

    The case literature strongly suggests that both in England and in Australia health care reforms have had very little impact in terms of "improved performance". It is in the context of a perceived failure in the implementation of the reforms that an interest has arisen in leadership at the level of individual clinical units (e.g an orthopaedics unit or birth unit), as the possible "fix" for bridging the promise-performance gap. Drawing upon extensive case studies that highlight the problem and context for appropriate forms of leadership, this paper argues that the appropriate discourse, in terms of leadership in health reform, needs to focus upon the issue of authorization. In making this argument, addresses the current conceptions of leadership that have been advanced in the discourse before offering some case study material that is suggestive of why attention should be focused on the issue of authorization. Illustrates how and why the processes of leading, central to implementing reform, cannot be construed as socially disembodied processes. Rather, leading and following are partial and partisan processes whose potential is circumscribed by participants' position-takings and what is authorized in the institutional settings in which they are located Argues that the "following" that clinical unit managers could command was shaped by the sub-cultures and "regulatory ideals" with which staff of each profession are involved In the interests of reform, policy players in health should not be focusing attention solely upon the performative qualities and potential leadership abilities of middle level management, but also on their own performance. They should consider how their actions affect what is authorized institutionally and which sets the scope and limits of the leadership-followership dialectic in clinical settings. PMID:15588011

  3. Information needs of gay, lesbian, bisexual, and transgendered health care professionals: results of an Internet survey

    OpenAIRE

    Fikar, Charles R.; Keith, Latrina (NYAM)

    2004-01-01

    Objectives: To obtain basic facts and considered opinions from health care professionals and students (nonlibrarian and librarian) about the information needs of gay, lesbian, bisexual, and transgendered (GLBT) health care professionals and their interactions with medical librarians.

  4. Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment

    Directory of Open Access Journals (Sweden)

    Peiris David

    2012-10-01

    Full Text Available Abstract Background Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment. Methods Two theories informed the study: (1 ‘candidacy’, which explores “the ways in which people’s eligibility for care is jointly negotiated between individuals and health services”; and (2 kanyini or ‘holding’, a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed. Results Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is ‘tractable’ and ‘navigable’ to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still

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

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-04-01

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

  6. Effects of Family Policy Reforms in Norway. Results from a Joint Labor Supply and Child Care Choice Microsimulation Analysis

    OpenAIRE

    Kornstad, Tom; Thoresen, Thor Olav

    2006-01-01

    Mothers of preschool children represent one part of the population that might be able to increase its labor supply. We discuss effects of family policy changes that encourage the labor supply of these mothers, as child care fee reductions and increased availability of center-based care. Effects of policy changes are described by employing a joint labor supply and child care choice decision model. Detailed empirical results are provided with respect to mothers’ labor supply, famili...

  7. Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Djibo Ali

    2011-05-01

    Full Text Available Abstract Background Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases. Methods A cluster survey was done on 35 clusters of 21 children under 5 years of age in each of four districts of the Maradi Region, Niger. Caretakers were asked about diarrhea of the child during the recall period and their health seeking behavior in case of diarrhea. A weighted cluster analysis was conducted to determine the prevalence of diarrhea, as well as the proportion of consultations and types of health structures consulted. Results In total, the period prevalence of diarrhea and severe diarrhea between April 24th and May 21st 2009 were 36.8% (95% CI: 33.7 - 40.0 and 3.4% (95% CI: 2.2-4.6, respectively. Of those reporting an episode of diarrhea during the recall period, 70.4% (95% CI: 66.6-74.1 reported seeking care at a health structure. The main health structures visited were health centers, followed by health posts both for simple or severe diarrhea. Less than 10% of the children were brought to the hospital. The proportion of consultations was not associated with the level of education of the caretaker, but increased with the number of children in the household. Conclusions The proportion of consultations for diarrhea cases in children under 5 years old was higher than those reported in previous surveys in Niger and elsewhere. Free health care for under 5 years old might have participated in this improvement. In this type of decentralized health systems, the WHO recommended hospital-based surveillance of

  8. Oral health care systems in developing and developed countries

    DEFF Research Database (Denmark)

    Kandelman, Daniel; Arpin, Sophie; Baez, Ramon J;

    2012-01-01

    Health care systems are essential for promoting, improving and maintaining health of the population. Through an efficient health service, patients can be advised of disease that may be present and so facilitate treatment; risks factors whose modification could reduce the incidence of disease...... and illness in the future can be identified, and further, how controlling such factors can contribute to maintain a good quality of life. In developed countries, clinics or hospitals may be supported by health professionals from various specialties that allow their cooperation to benefit the patient......; these institutions or clinics may be equipped with the latest technical facilities. In developing countries, health services are mostly directed to provide emergency care only or interventions towards certain age group population. The most common diseases are dental caries and periodontal disease and frequently...

  9. Patient Experienced Continuity of Care in the Psychiatric Healthcare System

    DEFF Research Database (Denmark)

    Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne;

    2014-01-01

    . For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of Int. J. Environ. Res. Public Health 2014, 11 9740 individualised care, trauma, additional vulnerability, and taboo concerning mental illness were...... of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field......Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse...

  10. Communication between Older People and Their Health Care Agents: Results of an Intervention

    Science.gov (United States)

    Gutheil, Irene A.; Heyman, Janna C.

    2005-01-01

    This study examined an intervention to help high-functioning community-dwelling older people communicate their wishes for care at the end of life with someone they would trust to make health care decisions for them if necessary. Groups consisted of dyads of older people and their potential or designated health care agents randomly assigned to the…

  11. Complexity in practice: understanding primary care as a complex adaptive system

    Directory of Open Access Journals (Sweden)

    Beverley Ellis

    2010-06-01

    Conclusions The results are real-world exemplars of the emergent properties of complex adaptive systems. Improving clinical governance in primary care requires both complex social interactions and underpinning informatics. The socio-technical lessons learned from this research should inform future management approaches.

  12. The quality of preventive health care delivered to adults: results from a cross-sectional study in Southern Italy

    Directory of Open Access Journals (Sweden)

    Nobile Carmelo GA

    2010-06-01

    Full Text Available Abstract Background It is assumed that providing clinical preventive services to patients can identify or detect early important causes of adult mortality. The aim of this study was to quantify access to preventive services in Southern Italy and to assess whether and how the provision of preventive care was influenced by any specific characteristics of patients. Methods In a cross-sectional study adults aged 18 years and over attending primary care physician (PCP offices located in Southern Italy were interviewed from June through December 2007. Quality indicators of preventive health care developed from RAND's Quality Assessment Tools and Behavioral Risk Factor Surveillance System (BRFSS were used. Multivariate analysis was performed to identify and to assess the role of patients' characteristics on delivery of clinical preventive services. Results A total of 1467 subjects participated in the study. Excepting blood pressure preventive check (delivered to 64.4% of eligible subjects and influenza vaccination (recommended to 90.2% of elderly, the rates of delivery of clinical preventive services were low across all measures, particularly for screening and counseling on health habits. Rates for providing cancer screening tests at recommended times were 21.3% for colonoscopy, 51.5% for mammography and 52.4% for Pap smear. Statistical analysis showed clear disparities in the provision of clinical preventive services associated with age, gender, education level, perceived health status, current health conditions and primary care access measures. Conclusions There is overwhelming need to develop and implement effective interventions to improve delivery of routine clinical preventive services.

  13. Mapping Out Point-of-Care Review Screens for Omaha System Data.

    Science.gov (United States)

    Lee, Seonah

    2016-02-01

    Omaha System data are text data that consist of standardized terminology and customized descriptions. The customized descriptions related to patient care reveal changes in a client's status over time. These data help public health nurses to understand the patient's progress and to plan future care. However, most electronic health records do not provide clinicians with efficient displays of stored text data. The purpose of this study is to develop point-of-care review screens for Omaha System data on an individual patient level and examine nurse perceptions of the usefulness of the displayed data in improving patient care. Individual patients' data were organized on a Web-based overview page to present all of the health problems that a client had and on detailed pages to present all records of Omaha System data regarding each health problem. Nurse survey results indicated the usefulness of at-a-glance displays of text data on patient care and nurses' decision making. The meaningful review of patient data using a health information system supports patient-data-driven, evidence-based practice and decision making. PMID:26765656

  14. Retention in a public health care system with free access to treatment

    DEFF Research Database (Denmark)

    Helleberg, Marie; Engsig, Frederik N; Kronborg, Gitte; Larsen, Carsten S; Pedersen, Gitte; Pedersen, Court; Gerstoft, Jan; Obel, Niels

    2012-01-01

    National Hospital Registry and The Danish Civil Registration System. Incidence rates (IR), risk factors for LTFU and return to care and mortality rate ratios (MRR) were estimated using Poisson regression analyses. RESULTS:: We included 4,745 HIV patients who were followed for 36,692 person-years. Patients.......0-1.3)). Five years after LTFU the probability of return to care was 0.87 (95% CI: 0.84-0.90). The risk of death was significantly increased after LTFU (MRR 1.9 (95% CI: 1.6-2.6)) and =6 months after return to care (MRR=10.9 (95% CI: 5.9-19.9)). CONCLUSIONS:: Retention in care of Danish HIV patients is high......, especially after initiation of HAART. Absence from HIV care is associated with increased mortality. We conclude that high rates of retention can be achieved in a health care system with free access to treatment and is associated with a favorable outcome....

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

  16. Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative.

    Science.gov (United States)

    Frayne, Daniel J; Verbiest, Sarah; Chelmow, David; Clarke, Heather; Dunlop, Anne; Hosmer, Jennifer; Menard, M Kathryn; Moos, Merry-K; Ramos, Diana; Stuebe, Alison; Zephyrin, Laurie

    2016-05-01

    Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status before a pregnancy, which may be affected by many different service points within a health care system. The Clinical Workgroup of the National Preconception Health and Health Care Initiative proposes nine core measures that can be assessed at initiation of prenatal care to index a woman's preconception wellness. A two-stage web-based modified Delphi survey and a face-to-face meeting of key opinion leaders in women's reproductive health resulted in identifying seven criteria used to determine the core measures. The Workgroup reached unanimous agreement on an aggregate of nine preconception wellness measures to serve as a surrogate but feasible assessment of quality preconception care within the larger health community. These include indicators for: 1) pregnancy intention, 2) access to care, 3) preconception multivitamin with folic acid use, 4) tobacco avoidance, 5) absence of uncontrolled depression, 6) healthy weight, 7) absence of sexually transmitted infections, 8) optimal glycemic control in women with pregestational diabetes, and 9) teratogenic medication avoidance. The focus of the proposed measures is to quantify the effect of health care systems on advancing preconception wellness. The Workgroup recommends that health care systems adopt these nine preconception wellness measures as a metric to monitor performance of preconception care practice. Over time, monitoring these baseline measures will establish benchmarks and allow for comparison within and among regions, health care systems, and communities to drive improvements. PMID:27054935

  17. A holistic system of care for Native Americans in an urban environment.

    Science.gov (United States)

    Nebelkopf, Ethan; King, Janet

    2003-01-01

    The Native American Health Center has implemented a holistic system of care in the San Francisco Bay Area as a result of a multiyear strategic planning process that included a needs assessment based on the community-readiness model. The strategic plan links substance abuse, mental health, HIV/AIDS, and social services in a holistic approach congruent with Native American values and traditions. The plan also links prevention with treatment in a continuum of care. Based on a collaboration of Native American nonprofit community-based organizations and public agencies, the plan has resulted in bringing significant resources to the community. PMID:12733757

  18. Understanding inequities in home health care outcomes: staff views on agency and system factors.

    Science.gov (United States)

    Davitt, Joan K; Bourjolly, Joretha; Frasso, Rosemary

    2015-01-01

    Results regarding staff perspectives on contributing factors to racial/ethnic disparities in home health care outcomes are discussed. Focus group interviews were conducted with home health care staff (N = 23) who represented various agencies from three Northeastern states. Participants identified agency and system factors that contribute to disparities, including: (a) administrative staff bias/discretion, (b) communication challenges, (c) patient/staff cultural discordance, (d) cost control, and (e) poor access to community resources. Participants reported that bias can influence staff at all levels and is expressed via poor coverage of predominantly minority service areas, resulting in reduced intensity and continuity of service for minority patients. PMID:25706958

  19. Controlled drug delivery systems towards new frontiers in patient care

    CERN Document Server

    Rossi, Filippo; Masi, Maurizio

    2016-01-01

    This book offers a state-of-the-art overview of controlled drug delivery systems, covering the most important innovative applications. The principles of controlled drug release and the mechanisms involved in controlled release are clearly explained. The various existing polymeric drug delivery systems are reviewed, and new frontiers in material design are examined in detail, covering a wide range of polymer modification techniques. The concluding chapter is a case study focusing on use of a drug-eluting stent. The book is designed to provide the reader with a complete understanding of the mechanisms and design of controlled drug delivery systems, and to this end includes numerous step-by-step tutorials. It illustrates how chemical engineers can advance medical care by designing polymeric delivery systems that achieve either temporal or spatial control of drug delivery and thus ensure more effective therapy that eliminates the potential for both under-and overdosing.

  20. Health system challenges in organizing quality diabetes care for urban poor in South India.

    Directory of Open Access Journals (Sweden)

    Upendra Bhojani

    Full Text Available BACKGROUND: Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. METHODS: We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. RESULT: There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. CONCLUSIONS: Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes

  1. Calculation results for systems with steel reflector

    International Nuclear Information System (INIS)

    This presentation shows the results of Joint JNC-IPPE experiment BFS-62 for UOX and MOX cores with different types of radial blankets: uranium dioxide and steel reflector. Results of analysis of BN-600 hybrid core uncertainties are presented. The following parameters are shown: multiplication factor; U-235 and Pu-239 fission reaction rates for the core, uranium blanket, steel reflector; U-238 fission reaction rates for for the core, uranium blanket, steel reflector. Thus the steel reflector problem was revealed. The presentation includes the ABBN calculation scheme as well as resutlts related to ZPR-3-53, ZPR-3-54 and CIRANO experiments

  2. An innovative national health care waste management system in Kyrgyzstan.

    Science.gov (United States)

    Toktobaev, Nurjan; Emmanuel, Jorge; Djumalieva, Gulmira; Kravtsov, Alexei; Schüth, Tobias

    2015-02-01

    A novel low-cost health care waste management system was implemented in all rural hospitals in Kyrgyzstan. The components of the Kyrgyz model include mechanical needle removers, segregation using autoclavable containers, safe transport and storage, autoclave treatment, documentation, recycling of sterilized plastic and metal parts, cement pits for anatomical waste, composting of garden wastes, training, equipment maintenance, and management by safety and quality committees. The gravity-displacement autoclaves were fitted with filters to remove pathogens from the air exhaust. Operating parameters for the autoclaves were determined by thermal and biological tests. A hospital survey showed an average 33% annual cost savings compared to previous costs for waste management. All general hospitals with >25 beds except in the capital Bishkek use the new system, corresponding to 67.3% of all hospital beds. The investment amounted to US$0.61 per capita covered. Acceptance of the new system by the staff, cost savings, revenues from recycled materials, documented improvements in occupational safety, capacity building, and institutionalization enhance the sustainability of the Kyrgyz health care waste management system. PMID:25649402

  3. Patterns of Care outcome Studies: results of the national practice in adenocarcinoma of the prostate

    International Nuclear Information System (INIS)

    The Patterns of Care Study reviewed the processes and outcome of 682 patients with carcinoma of the prostate treated with radiation therapy from 1973-1976. The study and patient sampling were designed to reflect a valid representation of how prostate cancer is treated by radiation oncologists in the United States. The outcome results represent national benchmarks. The three year actuarial survival was 91% for Stage A, 88% for Stage B, and 76% for Stage C. Stage, grade, elevated serum acid phosphatase, Karnofsky performance status, previous hormonal therapy, age, and prior transurethral resection were identified by multivariate regression analysis to be important independent prognostic variables. Local control was related to the dose of the primary site, paraprostatic region, and pelvic sidewall. Major complications occurred in 9% of patients with Stage A, 2% of Stage B, and 6% with Stage C disease. Complications were related to dose and treatment technique. The Patterns of Care Process Survey identified that only 60% of patients surveyed had the necessary pretreatment evaluation studies required for best current management of adenocarcinoma of the prostate

  4. When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

    Directory of Open Access Journals (Sweden)

    Ciara Kierans

    Full Text Available BACKGROUND: Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs. Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. METHODS: The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. RESULTS: In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. CONCLUSIONS: Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so

  5. An assessment of routine primary care health information system data quality in Sofala Province, Mozambique

    Directory of Open Access Journals (Sweden)

    Cuembelo Fatima

    2011-05-01

    Full Text Available Abstract Background Primary health care is recognized as a main driver of equitable health service delivery. For it to function optimally, routine health information systems (HIS are necessary to ensure adequate provision of health care and the development of appropriate health policies. Concerns about the quality of routine administrative data have undermined their use in resource-limited settings. This evaluation was designed to describe the availability, reliability, and validity of a sample of primary health care HIS data from nine health facilities across three districts in Sofala Province, Mozambique. HIS data were also compared with results from large community-based surveys. Methodology We used a methodology similar to the Global Fund to Fight AIDS, Tuberculosis and Malaria data verification bottom-up audit to assess primary health care HIS data availability and reliability. The quality of HIS data was validated by comparing three key indicators (antenatal care, institutional birth, and third diptheria, pertussis, and tetanus [DPT] immunization with population-level surveys over time. Results and discussion The data concordance from facility clinical registries to monthly facility reports on five key indicators--the number of first antenatal care visits, institutional births, third DPT immunization, HIV testing, and outpatient consults--was good (80%. When two sites were excluded from the analysis, the concordance was markedly better (92%. Of monthly facility reports for immunization and maternity services, 98% were available in paper form at district health departments and 98% of immunization and maternity services monthly facility reports matched the Ministry of Health electronic database. Population-level health survey and HIS data were strongly correlated (R = 0.73, for institutional birth, first antenatal care visit, and third DPT immunization. Conclusions Our results suggest that in this setting, HIS data are both reliable and

  6. Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo

    Directory of Open Access Journals (Sweden)

    Marco Matteo Ciccone

    2010-04-01

    Full Text Available Marco Matteo Ciccone1, Ambrogio Aquilino2, Francesca Cortese1, Pietro Scicchitano1, Marco Sassara1, Ernesto Mola3, Rodolfo Rollo4,Pasquale Caldarola5, Francesco Giorgino6, Vincenzo Pomo2, Francesco Bux21Section of Cardiovascular Disease, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari, Bari, Italy; 2Agenzia Regionale Sanitaria – Regione Puglia (ARES, Apulia, Italy; 3ASL, Lecce, Italy; 4ASL, Brindisi, Italy; 5Cardiologia, Ospedale “Sarcone”, Terlizzi, Italy; 6Section of Endocrinology, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari, Bari, ItalyPurpose: Project Leonardo represented a feasibility study to evaluate the impact of a disease and care management (D&CM model and of the introduction of “care manager” nurses, trained in this specialized role, into the primary health care system. Patients and methods: Thirty care managers were placed into the offices of 83 general practitioners and family physicians in the Apulia Region of Italy with the purpose of creating a strong cooperative and collaborative “team” consisting of physicians, care managers, specialists, and patients. The central aim of the health team collaboration was to empower 1,160 patients living with cardiovascular disease (CVD, diabetes, heart failure, and/or at risk of cardiovascular disease (CVD risk to take a more active role in their health. With the support of dedicated software for data collection and care management decision making, Project Leonardo implemented guidelines and recommendations for each condition aimed to improve patient health outcomes and promote appropriate resource utilization.Results: Results show that Leonardo was feasible and highly effective in increasing patient health knowledge, self-management skills, and readiness to make changes in health behaviors. Patient skill-building and ongoing monitoring by the health care team of diagnostic tests and services

  7. [A study on the establishment of a fee system for hospital based home nursing care].

    Science.gov (United States)

    Kim, C J

    1993-01-01

    This study was done in order to provide basic data to a Fee System for hospital based Home Health Care services in Korea in the future. It was done by investigating activities provided to possible Home Health Care clients who could be discharged early from general hospitals and then estimating the nursing care fee according to each nursing activity based upon the time used for activity. The subjects of the study were selected by convenience sampling and consisted of 35 clients who might be clients for Home Nursing Care and were presently admitted to a medical-surgical ward of Y University Medical Center located in Seoul, Korea. The data collection period was from September 1, 1991 to September 30, 1991. The research instruments utilized for the study were a client selection criteria for Home Health Care developed by Choo (1991) and a check-list of nursing activity developed by researcher. The results of the study were as follows: 1. There were 44 different nursing activities provided in the seven days but the time was calculated for only 25 of the nursing activities. 2. Fees for the 25 different nursing activities were calculated by multiplying the median of the average wage of a staff nurse having five years experience in an A grade general hospital to the time of the nursing activity. The results were compared with the insurance fee which the government recognized as an appropriate fee for that activity. The nursing activities with a lower calculated fee than the insurance fee were suction, catheterization, exercise education and dressing change. The nursing activities with a higher calculated fee than the government recognized fee were IM injection and vital sign check. 3. There was a range of 1-15 nursing activities provided daily to the client. For the average number of nursing activities per day of 6.26 events the nursing care fee was calculated at W 6136 per day. 4. Based upon the results of the study, a recommendation for a Home Health Care fee per visit

  8. The Australian experiment: how primary health care organizations supported the evolution of a primary health care system.

    Science.gov (United States)

    Nicholson, Caroline; Jackson, Claire L; Marley, John E; Wells, Robert

    2012-03-01

    Primary health care in Australia has undergone 2 decades of change. Starting with a vision for a national health strategy with general practice at its core, Australia established local meso-level primary health care organizations--Divisions of General Practice--moving from focus on individual practitioners to a professional collective local voice. The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional integration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system. PMID:22403246

  9. Assessment of a prototype for the Systemization of Nursing Care on a mobile device

    Directory of Open Access Journals (Sweden)

    Laura Cristhiane Mendonça Rezende

    2016-01-01

    Full Text Available Abstract Objectives: assess a prototype for use on mobile devices that permits registering data for the Systemization of Nursing Care at a Neonatal Intensive Care Unit. Method: an exploratory and descriptive study was undertaken, characterized as an applied methodological research, developed at a teaching hospital. Results: the mobile technology the nurses at the Neonatal Intensive Care Unit use was positive, although some reported they faced difficulties to manage it, while others with experience in using mobile devices did not face problems to use it. The application has the functions needed for the Systematization of Nursing Care at the unit, but changes were suggested in the interface of the screens, some data collection terms and parameters the application offers. The main contributions of the software were: agility in the development and documentation of the systemization, freedom to move, standardization of infant assessment, optimization of time to develop bureaucratic activities, possibilities to recover information and reduction of physical space the registers occupy. Conclusion: prototype software for the Systemization of Nursing Care with mobile technology permits flexibility for the nurses to register their activities, as the data can be collected at the bedside.

  10. Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system

    Directory of Open Access Journals (Sweden)

    Pécoud Alain

    2007-10-01

    Full Text Available Abstract Background Medical care for asylum seekers is a complex and critical issue worldwide. It is influenced by social, political, and economic pressures, as well as premigration conditions, the process of migration, and postmigration conditions in the host country. Increasing needs and healthcare costs have led public health authorities to put nurse practitioners in charge of the management of a gatekeeping system for asylum seekers. The quality of this system has never been evaluated. We assessed the competencies of nurses and physicians in identifying the medical needs of asylum seekers and providing them with appropriate treatment that reflects good clinical practice. Methods This cross-sectional descriptive study evaluated the appropriateness of care provided to asylum seekers by trained nurse practitioners in nursing healthcare centers and by physicians in private practices, an academic medical outpatient clinic, and the emergency unit of the university hospital in Lausanne, Switzerland. From 1687 asylum seeking patients who had consulted each setting between June and December 2003, 450 were randomly selected to participate. A panel of experts reviewed their medical records and assessed the appropriateness of medical care received according to three parameters: 1 use of appropriate procedures to identify medical needs (medical history, clinical examination, complementary investigations, and referral, 2 provision of access to treatment meeting medical needs, and 3 absence of unnecessary medical procedures. Results In the nurse practitioner group, the procedures used to identify medical needs were less often appropriate (79% of reports vs. 92.4% of reports; p Conclusion Although the nursing gatekeeping system provides appropriate treatment to asylum seekers, it might be improved with further training in recording medical history and performing targeted clinical examination.

  11. Modelling Extortion Racket Systems: Preliminary Results

    Science.gov (United States)

    Nardin, Luis G.; Andrighetto, Giulia; Székely, Áron; Conte, Rosaria

    Mafias are highly powerful and deeply entrenched organised criminal groups that cause both economic and social damage. Overcoming, or at least limiting, their harmful effects is a societally beneficial objective, which renders its dynamics understanding an objective of both scientific and political interests. We propose an agent-based simulation model aimed at understanding how independent and combined effects of legal and social norm-based processes help to counter mafias. Our results show that legal processes are effective in directly countering mafias by reducing their activities and changing the behaviour of the rest of population, yet they are not able to change people's mind-set that renders the change fragile. When combined with social norm-based processes, however, people's mind-set shifts towards a culture of legality rendering the observed behaviour resilient to change.

  12. Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

    Directory of Open Access Journals (Sweden)

    Sahota Navdeep

    2011-08-01

    Full Text Available Abstract Background Acute medical care often demands timely, accurate decisions in complex situations. Computerized clinical decision support systems (CCDSSs have many features that could help. However, as for any medical intervention, claims that CCDSSs improve care processes and patient outcomes need to be rigorously assessed. The objective of this review was to systematically review the effects of CCDSSs on process of care and patient outcomes for acute medical care. Methods We conducted a decision-maker-researcher partnership systematic review. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases (Cochrane Database of Systematic Reviews, DARE, ACP Journal Club, and others, and the Inspec bibliographic database were searched to January 2010, in all languages, for randomized controlled trials (RCTs of CCDSSs in all clinical areas. We included RCTs that evaluated the effect on process of care or patient outcomes of a CCDSS used for acute medical care compared with care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results Thirty-six studies met our inclusion criteria for acute medical care. The CCDSS improved process of care in 63% (22/35 of studies, including 64% (9/14 of medication dosing assistants, 82% (9/11 of management assistants using alerts/reminders, 38% (3/8 of management assistants using guidelines/algorithms, and 67% (2/3 of diagnostic assistants. Twenty studies evaluated patient outcomes, of which three (15% reported improvements, all of which were medication dosing assistants. Conclusion The majority of CCDSSs demonstrated improvements in process of care, but patient outcomes were less likely to be evaluated and far less likely to show positive results.

  13. Development of the trauma emergency care system based on the three links theory

    Institute of Scientific and Technical Information of China (English)

    JIANG Guan-yu; SHEN Wei-feng; GAN Jian-xin

    2005-01-01

    The three links theory applied in trauma emergency care system refers to an integrated system with the three important components of trauma emergency care system, viz. prehospital trauma services, hospital trauma services and critical care services. The development of the trauma emergency care system should be guided by the three links theory so as to set up a practical and highly efficient system: a prompt operating and monitoring transportation system, a smooth and real-time information system, a rational and sustainable system of regulations and contingency plans, and a system for cultivating all-round trauma physicians.

  14. The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain.

    Science.gov (United States)

    Giovanella, Lígia; Stegmüller, Klaus

    2014-11-01

    The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms' impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems. PMID:25493982

  15. The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain

    Directory of Open Access Journals (Sweden)

    Lígia Giovanella

    2014-11-01

    Full Text Available The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date, and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms’ impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.

  16. Regulated competition in health care: switching and barriers to switching in the Dutch health insurance system.

    OpenAIRE

    Rijken Mieke; de Jong Judith D; Rooijen Margreet

    2011-01-01

    Abstract Background In 2006, a number of changes in the Dutch health insurance system came into effect. In this new system mobility of insured is important. The idea is that insured switch insurers because they are not satisfied with quality of care and the premium of their insurance. As a result, insurers will in theory strive for a better balance between price and quality. The Dutch changes have caught the attention, internationally, of both policy makers and researchers. In our study we ex...

  17. How integrated are neurology and palliative care services?:Results of a multicentre mapping exercise

    OpenAIRE

    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; Irene J Higginson; OPTCARE Neuro

    2016-01-01

    BACKGROUND: 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.METHODS: 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 ne...

  18. Sufficient competence in community elderly care? Results from a competence measurement of nursing staff

    OpenAIRE

    Bing-Jonsson, Pia C; Hofoss, Dag; Kirkevold, Marit; Bjørk, Ida T; Foss, Christina

    2016-01-01

    Background Multi-morbidity, poly-pharmacy and cognitive impairment leave many old patients in a frail condition with a high risk of adverse outcomes if proper health care is not provided. Knowledge about available competence is necessary to evaluate whether we are able to offer equitable and balanced health care to older persons with acute and/or complex health care needs. This study investigates the sufficiency of nursing staff competence in Norwegian community elderly car...

  19. Effects of group prenatal care on psychosocial risk in pregnancy: Results from a randomised controlled trial

    OpenAIRE

    Ickovics, Jeannette R.; Reed, Elizabeth; Magriples, Urania; Westdahl, Claire; Rising, Sharon Schindler; Kershaw, Trace S.

    2011-01-01

    Few interventions have succeeded in reducing psychosocial risk among pregnant women. The objective of this study was to determine whether an integrated group prenatal care intervention already shown to improve perinatal and sexual risk outcomes can also improve psychosocial outcomes compared to standard individual care. This randomised controlled trial included pregnant women ages 14–25 from two public hospitals (N = 1047) who were randomly assigned to standard individual care, group prenatal...

  20. How integrated are neurology and palliative care services? Results of a multicentre mapping exercise

    OpenAIRE

    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; ,

    2016-01-01

    Background 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. Methods 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 neu...

  1. Analysis of American Health Care System with respect to current affairs: Is Universal Health Care a Potential Reality?

    OpenAIRE

    Šotolová, Petra

    2009-01-01

    The main task of the Thesis is to analyze an American health care system, its management and behavior including its pros and cons. To describe and study the system will help to understand its eventual future progress and to answer a basic question "Is Universal Health Care a Potential Reality in U.S.A.?". With a respect to current affairs, as was the comprehensive health care reform signing, it will be possible to think and forecast relevant course of events that might improve consciousness a...

  2. The study of optimal nursing position in health care delivery system in Iran

    OpenAIRE

    Shahshahani, Maryam Sadat; Salehi, Shayesteh; Rastegari, Mohammad; Rezayi, Abdollah

    2010-01-01

    BACKGROUND: In the recent decade, due to the overwhelming importance of health and prevention of diseases, nurses, the greatest part of the health care system, are acting in any position of the health care delivery system; because nursing have a key role in promotion of health and health care everywhere. The objective of this research was to study the desired positions of nursing in the health care delivery system in Iran. METHODS: This was a triangulation study done on three steps during 200...

  3. Trauma in elderly people: access to the health system through pre-hospital care1

    Science.gov (United States)

    da Silva, Hilderjane Carla; Pessoa, Renata de Lima; de Menezes, Rejane Maria Paiva

    2016-01-01

    Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25%) and in the age range between 60 and 69 years (38.25%), average age 74.19 years (standard deviation±10.25). Among the mechanisms, falls (56.75%) and traffic accidents (31.25%) stood out, showing a significant relation with the pre-hospital care services (p<0.001). Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8%) were the most used, with trauma referral hospitals as the main destination (56.7%). Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims. PMID:27143543

  4. Trauma in elderly people: access to the health system through pre-hospital care

    Directory of Open Access Journals (Sweden)

    Hilderjane Carla da Silva

    2016-01-01

    Full Text Available Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25% and in the age range between 60 and 69 years (38.25%, average age 74.19 years (standard deviation±10.25. Among the mechanisms, falls (56.75% and traffic accidents (31.25% stood out, showing a significant relation with the pre-hospital care services (p<0.001. Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8% were the most used, with trauma referral hospitals as the main destination (56.7%. Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims.

  5. Better care for the dying. Hawaii healthcare system develops a manual for end-of-life care.

    Science.gov (United States)

    Kalua, P M; Tan, S Y; Bacon, J G

    1999-01-01

    In early 1996, as it became clear that Americans were becoming increasingly concerned about end-of-life care, the leaders of St. Francis Healthcare System (SFHS), Honolulu, convened a meeting at which local people--community and parish representatives as well as healthcare professionals--discussed the matter. The meeting's participants identified 10 issues as essential in end-of-life care: decision making, pain management and comfort care, pastoral and spiritual care, psychosocial care, hospice and home care, cardiopulmonary resuscitation, futility, withholding and withdrawing treatment, artificial nutrition and hydration, physician-assisted suicide and euthanasia. The participants then divided themselves into 10 teams, each of which spent six months studying one of the identified essential issues. In each case, the team reviewed the relevant SFHS policies and procedures and compared them with national standards. The team also interviewed staff members about the policies and procedures, comparing the written versions with actual practices. Each team then wrote a chapter on its assigned issue, after which a core committee wove the chapters into an end-of-life care manual for SFHS. The manual was published in June 1997. The system's leaders currently use the manual to educate staff members in good end-of-life care. PMID:10351504

  6. Leveraging geographic information systems in an integrated health care delivery organization.

    Science.gov (United States)

    Clift, Kathryn; Scott, Luther; Johnson, Michael; Gonzalez, Carlos

    2014-01-01

    A handful of the many changes resulting from the Affordable Care Act underscore the need for a geographic understanding of existing and prospective member communities. Health exchanges require that health provider networks are geographically accessible to underserved populations, and nonprofit hospitals nationwide are required to conduct community health needs assessments every three years. Beyond these requirements, health care providers are using maps and spatial analysis to better address health outcomes that are related in complex ways to social and economic factors.Kaiser Permanente is applying geographic information systems, with spatial analytics and map-based visualizations, to data sourced from its electronic medical records and from publicly and commercially available datasets. The results are helping to shape an understanding of the health needs of Kaiser Permanente members in the context of their communities. This understanding is part of a strategy to inform partnerships and interventions in and beyond traditional care delivery settings. PMID:24694317

  7. Antihypertensive combination therapy in primary care offices: results of a cross-sectional survey in Switzerland

    Directory of Open Access Journals (Sweden)

    Roas S

    2014-12-01

    Full Text Available Susanne Roas,1 Felix Bernhart,2 Michael Schwarz,3 Walter Kaiser,4 Georg Noll5 1Department of Internal Medicine, University Hospital, Zurich, 2Private Practice, Biberist, 3Ambulatorium Wiesendamm, Basel, 4Healthworld (Schweiz AG, Steinhausen, 5HerzKlinik Hirslanden, Zurich, Switzerland Background: Most hypertensive patients need more than one substance to reach their target blood pressure (BP. Several clinical studies indicate the high efficacy of antihypertensive combinations, and recent guidelines recommend them in some situations even as initial therapies. In general practice they seem widespread, but only limited data are available on their effectiveness under the conditions of everyday life. The objectives of this survey among Swiss primary care physicians treating hypertensive patients were: to know the frequency of application of different treatment modalities (monotherapies, free individual combinations, single-pill combinations; to see whether there are relationships between prescribed treatment modalities and patient characteristics, especially age, treatment duration, and comorbidities; and to determine the response rate (percentage of patients reaching target BP of different treatment modalities under the conditions of daily practice. Methods: This cross-sectional, observational survey among 228 randomly chosen Swiss primary care physicians analyzed data for 3,888 consecutive hypertensive patients collected at one single consultation. Results: In this survey, 31.9% of patients received monotherapy, 41.2% two substances, 20.9% three substances, and 4.7% more than three substances. By combination mode, 34.9% took free individual combinations and 30.0% took fixed-dose single-pill combinations. Combinations were more frequently given to older patients with a long history of hypertension and/or comorbidities. In total, 67.8% of patients achieved their BP target according to their physician's judgment. When compared, single

  8. A democratic responsiveness approach to real reform: an exploration of health care systems' resilience.

    Science.gov (United States)

    Grignon, Michel

    2012-08-01

    Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered to explain why such reforms are so difficult: institutional gridlock, path dependency, and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that as a result public resistance to real reform may more accurately reflect citizens' personal convictions, self-interest, or even active social choices. "Conscientious objectors" may do more to derail reform than previously recognized. PMID:22466049

  9. Study on Korean Radiological Emergency System-Care System- and National Nuclear Emergency Preparedness System Development

    International Nuclear Information System (INIS)

    Care system; Radiological Emergency Supporting System. Environmental radiology level is the main aspect that should be concerned deal with the utilization of nuclear energy. The usage of informational technology in nuclear area gives significant contribution to anticipate and to protect human and environment. Since 1960, South Korea has developed environment monitoring system as the effort to protect the human and environment in the radiological emergency condition. Indonesia has possessed several nuclear installations and planned to build and operate nuclear power plants (PLTN) in the future. Therefore, Indonesia has to prepare the integrated system, technically enables to overcome the radiological emergency. Learning from the practice in South Korea, the system on the radiological emergency should be prepared and applied in Indonesia. However, the government regulation draft on National Radiological Emergency System, under construction, only touches the management aspect, not the technical matters. Consequently, when the regulation is implemented, it will need an additional regulation on technical aspect including the consideration on the system (TSS), the organization of operator and the preparation of human resources development of involved institution. For that purpose, BAPETEN should have a typical independence system in regulatory frame work. (author)

  10. Factors affecting antenatal care attendance: results from qualitative studies in Ghana, Kenya and Malawi.

    Directory of Open Access Journals (Sweden)

    Christopher Pell

    Full Text Available BACKGROUND: Antenatal care (ANC is a key strategy to improve maternal and infant health. However, survey data from sub-Saharan Africa indicate that women often only initiate ANC after the first trimester and do not achieve the recommended number of ANC visits. Drawing on qualitative data, this article comparatively explores the factors that influence ANC attendance across four sub-Saharan African sites in three countries (Ghana, Kenya and Malawi with varying levels of ANC attendance. METHODS: Data were collected as part of a programme of qualitative research investigating the social and cultural context of malaria in pregnancy. A range of methods was employed interviews, focus groups with diverse respondents and observations in local communities and health facilities. RESULTS: Across the sites, women attended ANC at least once. However, their descriptions of ANC were often vague. General ideas about pregnancy care - checking the foetus' position or monitoring its progress - motivated women to attend ANC; as did, especially in Kenya, obtaining the ANC card to avoid reprimands from health workers. Women's timing of ANC initiation was influenced by reproductive concerns and pregnancy uncertainties, particularly during the first trimester, and how ANC services responded to this uncertainty; age, parity and the associated implications for pregnancy disclosure; interactions with healthcare workers, particularly messages about timing of ANC; and the cost of ANC, including charges levied for ANC procedures - in spite of policies of free ANC - combined with ideas about the compulsory nature of follow-up appointments. CONCLUSION: In these socially and culturally diverse sites, the findings suggest that 'supply' side factors have an important influence on ANC attendance: the design of ANC and particularly how ANC deals with the needs and concerns of women during the first trimester has implications for timing of initiation.

  11. Treatment and follow-up results of children with electrical burn who observed in burn intensive care unit

    Directory of Open Access Journals (Sweden)

    Çiğdem Aliosmanoğlu

    2011-06-01

    Full Text Available Electrical burns are infrequent relative to other injuries, but they are associated with high morbidity and mortality. The aim of this study was to assess management and follow-up results of pediatric patients’ who observed in intensive care unit and also review the precautions for preventing electrical burns.Materials and methods: Totally 22 patients aged under 17 years who were observed in the burn intensive care unit of Şanlıurfa Education and Research Hospital during the period between July 2009-October 2010. Cases were investigated retrospectively. The patients’ age, gender, total burn surface area, length of stay in hospital, musculo-skeletal system complication, cardiovascular system complication, kidney damage and attempts were recorded.Results: Of the 22 cases, 19 (86.3% were male and 3 (13.7% were female. The mean age of the patients was 11.5 years. In 10 (45.4% children burns were occurred in workplace and working area and 12 (54.6% were occurred in the home environment. Depth of burns were third degree in 10 (45.4% children and second degree in 12 (54.6%. The mean percentage of burn surface area was 25.9%. The mean length of stay in hospital was 17 days. Debridement and grafting were performed to 12 (54.6% cases and 10 (45.4% children were treated with dressings. No patient had increased creatinine kinase levels, oliguria, myoglobuinuria and arrhythmia. The mean hospitalization time was 17 days.Conclusion: Nearly half of patients underwent debridement plus grafting. None of our patients developed renal failure other severe system dysfunction.

  12. Colorectal cancer screening practices of primary care providers: results of a national survey in Malaysia.

    Science.gov (United States)

    Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim

    2014-01-01

    The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics. PMID:24761922

  13. The nonhospital costs of care of patients with CF in The Netherlands : Results of a questionnaire

    NARCIS (Netherlands)

    Wildhagen, MF; Verheij, JBGM; Verzijl, JG; Gerritsen, J; Bakker, W; Hilderink, HBM; tenKate, LP; Tijmstra, T; Kooij, L; Habbema, JDF

    1996-01-01

    Cystic fibrosis (CF) causes a relatively high medical consumption, A large part of the treatment takes place at home, Because data regarding nonhospital care are lacking, we wished to determine the costs of care of patients with CF outside the hospital. A questionnaire was sent to 73 patients with C

  14. A quality management model for integrated care : results of a Delphi and Concept Mapping study

    NARCIS (Netherlands)

    Minkman, Mirella; Ahaus, Kees; Fabbricotti, Isabelle; Nabitz, Udo; Huijsman, Robbert

    2009-01-01

    The objective of this study is to identify the elements and clusters of a quality management model for integrated care. In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts comme

  15. A quality management model for integrated care: results of a Delphi and Concept Mapping study

    NARCIS (Netherlands)

    M. Minkman; K. Ahaus; I. Fabbricotti; U. Nabitz; R. Huijsman

    2009-01-01

    The objective of this study is to identify the elements and clusters of a quality management model for integrated care. In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts comme

  16. Communities Putting Prevention to Work: Results of an Obesity Prevention Initiative in Child Care Facilities

    Science.gov (United States)

    Natale, Ruby; Camejo, Stephanie; Sanders, Lee M.

    2016-01-01

    Obesity is a significant public health issue affecting even our youngest children. Given that a significant amount of young children are enrolled in child care, the goal of this project was to evaluate the effectiveness of a child care facility-based obesity prevention program. Over 1,000 facilities participated in the study. The intervention…

  17. Sensor network infrastructure for a home care monitoring system.

    Science.gov (United States)

    Palumbo, Filippo; Ullberg, Jonas; Stimec, Ales; Furfari, Francesco; Karlsson, Lars; Coradeschi, Silvia

    2014-01-01

    This paper presents the sensor network infrastructure for a home care system that allows long-term monitoring of physiological data and everyday activities. The aim of the proposed system is to allow the elderly to live longer in their home without compromising safety and ensuring the detection of health problems. The system offers the possibility of a virtual visit via a teleoperated robot. During the visit, physiological data and activities occurring during a period of time can be discussed. These data are collected from physiological sensors (e.g., temperature, blood pressure, glucose) and environmental sensors (e.g., motion, bed/chair occupancy, electrical usage). The system can also give alarms if sudden problems occur, like a fall, and warnings based on more long-term trends, such as the deterioration of health being detected. It has been implemented and tested in a test environment and has been deployed in six real homes for a year-long evaluation. The key contribution of the paper is the presentation of an implemented system for ambient assisted living (AAL) tested in a real environment, combining the acquisition of sensor data, a flexible and adaptable middleware compliant with the OSGistandard and a context recognition application. The system has been developed in a European project called GiraffPlus. PMID:24573309

  18. Sensor Network Infrastructure for a Home Care Monitoring System

    Directory of Open Access Journals (Sweden)

    Filippo Palumbo

    2014-02-01

    Full Text Available This paper presents the sensor network infrastructure for a home care system that allows long-term monitoring of physiological data and everyday activities. The aim of the proposed system is to allow the elderly to live longer in their home without compromising safety and ensuring the detection of health problems. The system offers the possibility of a virtual visit via a teleoperated robot. During the visit, physiological data and activities occurring during a period of time can be discussed. These data are collected from physiological sensors (e.g., temperature, blood pressure, glucose and environmental sensors (e.g., motion, bed/chair occupancy, electrical usage. The system can also give alarms if sudden problems occur, like a fall, and warnings based on more long-term trends, such as the deterioration of health being detected. It has been implemented and tested in a test environment and has been deployed in six real homes for a year-long evaluation. The key contribution of the paper is the presentation of an implemented system for ambient assisted living (AAL tested in a real environment, combining the acquisition of sensor data, a flexible and adaptable middleware compliant with the OSGistandard and a context recognition application. The system has been developed in a European project called GiraffPlus.

  19. Insights on a New Era Under a Reforming Health Care System.

    Science.gov (United States)

    Mulvihill, James E.

    1995-01-01

    Economic and social trends that will affect the health care system are examined, including federal health care reform efforts, federal budget trimming through managed care and cost-cutting, declines in state spending, adoption of single-payer systems, growing competition in the private sector (mergers, alliances, acquisitions), dominance of health…

  20. The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain

    OpenAIRE

    Lígia Giovanella; Klaus Stegmüller

    2014-01-01

    The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, r...

  1. Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study

    DEFF Research Database (Denmark)

    Peyrol, Mark; Rubin, Richard R.; Lauritzen, Torsten;

    2006-01-01

    respondent characteristics and outcomes varied by country. Conclusions/interpretation There is much need for improvement in applying the chronic-care model to the treatment and prevention of diabetes in all of the countries studied. Each country must develop its own priorities for improving diabetes care and......Aims/hypothesis We assessed country-level and individual-level patterns in patient and provider perceptions of diabetes care. Methods The study used a cross-sectional design with face-to-face or telephone interviews of diabetic patients and healthcare providers in 13 countries from Asia, Australia......, Europe and North America. Participants were randomly selected adults with type 1 or type 2 diabetes (n=5,104), and randomly selected diabetes-care providers, including primary-care physicians (n=2,070), diabetes specialist physicians (n=635) and nurses (n=1,122). Multivariate analysis was used to examine...

  2. The Soviet health care system: Glasnost, Perestroika, and health problems of the 1990s.

    Science.gov (United States)

    Moody, L E

    1992-03-01

    Worsening economic conditions and political turmoil in the Soviet Union have led to significant health care problems in the 90s. The Soviet people are calling for reforms of education and the health care system that extend beyond the unsuccessful program of glasnost and perestroika. The purposes of this article are to (a) describe the health care system in the Soviet Union, (b) highlight health issues and concerns of the Soviet people, (c) describe the education of physicians and nurses, and (d) compare and contrast common and unique factors about Soviet health care with health care in the West. The data base for the article was collected from observational site visits, on-site focused interviews with key informants in Kiev and Moscow, and extensive computerized and manual literature searches. Data were also gathered from questionnaires distributed to a convenience sample of 17 nurses in Moscow. Study results include demographic information and the state of nursing education and research, including availability and access to resources to conduct nursing research in Moscow. PMID:1293203

  3. The Team Approach to Home-Based Primary Care: Restructuring Care to Meet Patient, Program, and System Needs

    Science.gov (United States)

    Reckrey, Jennifer M.; Soriano, Theresa A.; Hernandez, Cameron R.; DeCherrie, Linda V.; Chavez, Silvia; Zhang, Meng; Ornstein, Katherine

    2016-01-01

    Team-based models of care are an important way to meet the complex medical and psychosocial needs of the homebound. As part of a quality improvement project to address patient, program, and system needs, we restructured a portion of our large, physician-led academic home-based primary care practice into a team-based model. With support from an office-based nurse practitioner, a dedicated social worker, and a dedicated administrative assistant, physicians were able to care for a larger number of patients. Hospitalizations, readmissions, and patient satisfaction remained the same while physician panel size increased and physician satisfaction improved. Our Team Approach is an innovative way to improve interdisciplinary, team-based care though practice restructuring and serves as an example of how other practices can approach the complex task of caring for the homebound. PMID:25645568

  4. Developing a Total Quality Management Model for Health Care Systems

    Directory of Open Access Journals (Sweden)

    AM Mosadegh Rad

    2005-10-01

    Full Text Available Background: Total quality management (TQM is a managerial practice to improve the effectiveness, efficiency, flexibility, and competitiveness of a business as a whole. However, in practice, these TQM benefits are not easy to achieve. Despite its theoretical promise and the enthusiastic response to TQM, recent evidence suggests that attempts to implement it are often unsuccessful. Many of these TQM programmes have been cancelled, or are in the process of being cancelled, as a result of the negative impact on profits. Therefore, there is a pressing need for a clinical approach to establishing TQM. Method: The aim of this article is therefore: “To identify the strengths and weakness of TQM, the logical steps towards TQM, and to develop a model so that health care organizations aiming at using TQM to achieve excellence can follow through easily”. Based on the research questions proposed in this study, the research strategies of a literature review, a questionnaire survey, semi-structured interviews, and a participatory action research were adopted in this study. For determining the success and barriers of TQM in health care organizations, a questionnaire survey has done in 90 health acre organizations in Isfahan Province, which implement TQM. The results of this survey were used for introducing a new model of TQM. This model will be developed via a semi-structured interview with at minimum 10 health care and quality managers. Then, through a participatory action research, this model will be implemented in 3 sites. At this time, the questionnaire survey has done and the model is introduced. Therefore, developing the model and its implementation will be done later. Results: In this survey, the mean score of TQM success was 3.48±0.68 (medium from 5 credits. Implementation of TQM was very low, low, medium, high and very high successful respectively in 3.6, 10.9, 21.8, 56.4 and 7.3 percent of health care organizations. TQM had the most effect on

  5. Regional Decentralisation in the Greek Health Care System: Rhetoric and Reality.

    Science.gov (United States)

    Athanasiadis, Athanasios; Kostopoulou, Stella; Philalithis, Anastas

    2015-11-01

    Decentralisation is a complex, yet basic feature of health care systems in many countries entailing the transfer of authority or dispersal of power in public planning, management and decision making from higher to lower levels of government. This paper describes the attempts made in Greece from 1923 until today to decentralise its highly centralised health care system, drawing on a thorough documentary analysis of legislative acts and official reports regarding regional health policy. The analysis shows that, although decentralisation has been attempted on several occasions, in the end it was abandoned every time. The first ever implementation of a decentralised system of governance in 2001 was also curtailed, resulting in only minor decentralisation of authority and real powers. It is suggested that decentralisation has been impeded by many factors, especially obstruction by opposition from key interest groups, absence of policy continuity between governments, the inability to tackle the bureaucratic and highly centralised system and lack of political will. PMID:26153163

  6. Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia's Experience.

    Science.gov (United States)

    Rannan-Eliya, Ravindra P; Anuranga, Chamara; Manual, Adilius; Sararaks, Sondi; Jailani, Anis S; Hamid, Abdul J; Razif, Izzanie M; Tan, Ee H; Darzi, Ara

    2016-05-01

    Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources. PMID:27140990

  7. Comprehensive care of pain: Developing systems and tools to improve patient care and resident education.

    Science.gov (United States)

    Rickert, Julie; Devlin, Kwanza; Krohn, Kimberly

    2016-05-01

    Chronic non-cancer pain is a common condition associated with tremendous risk for morbidity and mortality. In many settings, the management of chronic non-cancer pain by primary care providers, although customary, can be difficult due to inadequate training and conflicts between patient expectations and best practices. Resident physicians, faculty, and staff of this family medicine residency program developed a comprehensive chronic pain management program to address these issues while improving patient outcomes. The program was aligned with evidence-based chronic non-cancer pain management strategies yet tailored to the needs of the providers and patients and the strengths of the clinic. In the end, the societal demand for improved chronic non-cancer pain management resulted in a massive curricular and clinical practice overhaul for this residency program. PMID:27497454

  8. Designing an Operational Planning Model for Level-one Iranian Primary Health Care Systems

    Directory of Open Access Journals (Sweden)

    Amir-Ashkan Nasiripour

    2008-01-01

    Full Text Available Introduction: This research was performed in 2008 in order to design an operational planning model for Iranian primary health care systems at level one. Methods: In this applied study, which was done in a descriptive and cross-sectional manner, some countries and international organizations which had comprehensive planning systems and some local organizations were studied. The required data from the selected countries were collected through data collection forms, and for local organizations, the data were collected through interview, and the initial model was presented accordingly. The model was tested via Delphi technique and taking the authorities’ views into account, the required changes were made and the ultimate model was prepared. Results: All the studied overseas and indigenous organizations had programming systems. However, none of the level-one Iranian primary health care units had a coherent planning system, and they did not follow any specific models. Since 2008, the model of operational planning has also been utilized by Iranian Ministry of Health, Care and Medical Education at headquarters levels; however, there was no model at lower levels especially in rural and urban health care centers. In all selected countries, the model of programs included title, objectives or expected results, schedule, activities, budget system and evaluation and monitoring indexes. Though these parts existed in the common models in Iran, no scientific basis could be observed in compiling the operational programs. The mechanism of designing the initial suggested operational planning had eight stages, but after three stages of reviewing by authorities, seven stages were ratified. Conclusion: Utilizing the suggested operational planning model can enhance the level-one performance indicators of health care networks in Iran

  9. North Carolina Star Rated License System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

  10. Improving end of life care: an information systems approach to reducing medical errors.

    Science.gov (United States)

    Tamang, S; Kopec, D; Shagas, G; Levy, K

    2005-01-01

    Chronic and terminally ill patients are disproportionately affected by medical errors. In addition, the elderly suffer more preventable adverse events than younger patients. Targeting system wide "error-reducing" reforms to vulnerable populations can significantly reduce the incidence and prevalence of human error in medical practice. Recent developments in health informatics, particularly the application of artificial intelligence (AI) techniques such as data mining, neural networks, and case-based reasoning (CBR), presents tremendous opportunities for mitigating error in disease diagnosis and patient management. Additionally, the ubiquity of the Internet creates the possibility of an almost ideal network for the dissemination of medical information. We explore the capacity and limitations of web-based palliative information systems (IS) to transform the delivery of care, streamline processes and improve the efficiency and appropriateness of medical treatment. As a result, medical error(s) that occur with patients dealing with severe, chronic illness and the frail elderly can be reduced.The palliative model grew out of the need for pain relief and comfort measures for patients diagnosed with cancer. Applied definitions of palliative care extend this convention, but there is no widely accepted definition. This research will discuss the development life cycle of two palliative information systems: the CONFER QOLP management information system (MIS), currently used by a community-based palliative care program in Brooklyn, New York, and the CAREN case-based reasoning prototype. CONFER is a web platform based on the idea of "eCare". CONFER uses XML (extensible mark-up language), a W3C-endorced standard mark up to define systems data. The second system, CAREN, is a CBR prototype designed for palliative care patients in the cancer trajectory. CBR is a technique, which tries to exploit the similarities of two situations and match decision-making to the best

  11. Task-role-based Access Control Model in Smart Health-care System

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

    As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for...

  12. Economic crisis and counter-reform of universal health care systems: Spanish case

    OpenAIRE

    Paulo Antônio de Carvalho Fortes; Regina Ribeiro Parizi Carvalho; Marília Cristina Prado Louvison

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, ...

  13. A proposed 'health literate care model' would constitute a systems approach to improving patients' engagement in care.

    Science.gov (United States)

    Koh, Howard K; Brach, Cindy; Harris, Linda M; Parchman, Michael L

    2013-02-01

    Improving health outcomes relies on patients' full engagement in prevention, decision-making, and self-management activities. Health literacy, or people's ability to obtain, process, communicate, and understand basic health information and services, is essential to those actions. Yet relatively few Americans are proficient in understanding and acting on available health information. We propose a Health Literate Care Model that would weave health literacy strategies into the widely adopted Care Model (formerly known as the Chronic Care Model). Our model calls for first approaching all patients with the assumption that they are at risk of not understanding their health conditions or how to deal with them, and then subsequently confirming and ensuring patients' understanding. For health care organizations adopting our model, health literacy would then become an organizational value infused into all aspects of planning and operations, including self-management support, delivery system design, shared decision-making support, clinical information systems to track and plan patient care, and helping patients access community resources. We also propose a measurement framework to track the impact of the new Health Literate Care Model on patient outcomes and quality of care. PMID:23381529

  14. [A reflection upon an organizational system model for nursing care centered on best practices].

    Science.gov (United States)

    Kempfer, Silvana Silveira; Birolo, Ioná Vieira Bez; Meirelles, Betina Homer Schlindwein; Erdmann, Alacoque Lorenzini

    2010-09-01

    This article aims at reflecting on nursing best practices and these practices as a perspective of systemizing care. Quality of nursing becomes evident from management practices instituted as a result of its development throughout time. Thinkers of the management area have really influenced nursing both at professional acting and theoretical basis levels. It is imperative that nursing comes closer to best practices, which are considered as a non linear manner of perceiving the world, where structuring of its actions is centered on complex perspective; the use of registers as a way for planning organization and care to take effect, as well as professional identification with issues that transcend personal care and are closer to universal ethics. Best practices are linked to social responsibility, sustainability and ecology as an essence of human actions to conduct management practices. PMID:21574344

  15. The relative importance of leadership and payment system. Effects on quality of care and work environment.

    Science.gov (United States)

    Forsberg, Ewa; Axelsson, Runo; Arnetz, Bengt

    2004-07-01

    The key question addressed in this study is whether the introduction of stronger financial incentives in health care give rise to such a restrictive context that leadership has only a minor influence? Or is good leadership, on the contrary, important to the achievement of both financial and other goals, regardless of contextual factors? Physicians in one Swedish County Council with performance-based reimbursement and in 10 councils without such a system were studied in a cross-sectional questionnaire study. The result of this study indicates that although contextual factors were of substantial importance there is scope for leaders to act, and their actions make a considerable difference, both for the experience of the work process and for the outcome in terms of work environment and quality of care. A good leadership may be able to shield the health care organisation from unwanted side effects of increased financial pressure. PMID:15484608

  16. System Change: Quality Assessment and Improvement for Medicaid Managed Care

    OpenAIRE

    Smith, Wally R.; Cotter, J. James; Louis F Rossiter

    1996-01-01

    Rising Medicaid health expenditures have hastened the development of State managed care programs. Methods to monitor and improve health care under Medicaid are changing. Under fee-for-service (FFS), the primary concern was to avoid overutilization. Under managed care, it is to avoid underutilization. Quality enhancement thus moves from addressing inefficiency to addressing insufficiency of care. This article presents a case study of Virginia's redesign of Quality Assessment and Improvement (Q...

  17. Radiotherapy of Langerhans' cell histiocytosis. Results and Implications of a national patterns-of-care study

    International Nuclear Information System (INIS)

    Purpose: This patterns-of-care study was performed to define the current clinical experience with radiotherapy of Langerhans' cell histiocytosis in adults in Germany and to define open questions resulting from this study. Material and Methods: A standardized questionnaire was sent to 198 German radiotherapy institutions. Data about patient characteristics, stage of disease, practice and fractionation of radiotherapy, outcome of therapy, etc. were systematically evaluated. 123 of 198 institutions answered the complete questionnaire (62.1%). Results: Only 23 of the 123 institutions (18.7%) reported experience with radiotherapy of Langerhans' cell histiocytosis of adults. 18 institutions with 98 patients were evaluable. The majority of patients (72 of 98) was treated on a linear accelerator. The median single dose of radiotherapy was 2 Gy, while the median total dose was 24 Gy. 81 of 89 evaluable patients (91%) reached a local control of the treated lesion(s), 69 of those had a complete remission. Eight of 89 patients (9%) developed an in-field recurrence. 87.8% of patients experienced no acute and 97% of patients no late side effects of radiotherapy. Conclusion: Clinical experience with radiotherapy of Langerhans' cell histiocytosis in adults in Germany is still very limited. Nevertheless, the clinical results - with high remission and local control rates - confirm the effectiveness of radiotherapy in the multidisciplinary treatment of this disease. Due to the small number of patients in this study despite higher incidence rates, the knowledge of this disease has to be multiplied in Germany. Future patients should be systematically included into a prospective radiotherapy registry. (orig.)

  18. Are teamwork and professional autonomy compatible, and do they result in improved hospital care?

    OpenAIRE

    Rafferty, A; Ball, J.; Aiken, L.

    2001-01-01

    A postal questionnaire survey of 10 022 staff nurses in 32 hospitals in England was undertaken to explore the relationship between interdisciplinary teamwork and nurse autonomy on patient and nurse outcomes and nurse assessed quality of care. The key variables of nursing autonomy, control over resources, relationship with doctors, emotional exhaustion, and decision making were found to correlate with one another as well as having a relationship with nurse assessed quality of care and nurse sa...

  19. Towards Patient-Oriented Diabetes Care: Results from Two KORA Surveys in Southern Germany

    OpenAIRE

    Michaela Schunk; Renée Stark; Peter Reitmeir; Christa Meisinger; Rolf Holle

    2015-01-01

    Objective. This study aims to examine the relationship of diabetes care processes and patient outcomes with an expanded set of indicators regarding patient-oriented care delivery, such as treatment satisfaction, the quality of patient-physician relationship, and a wider range of patient outcomes such as self-management, health behaviour, disease-related burden, and health-related quality of life (HRQL). Methods. The study population consisted of 486 participants with type 2 diabetes in two po...

  20. What outcome measures should be developed for pre-hospital care?: results of a consensus event

    OpenAIRE

    Turner, Janette; Coster, Joanne; Wilson, Richard; Phung, Viet-Hai; Siriwardena, A Niroshan

    2013-01-01

    Background: The PhOEBE (Pre-hospital Outcomes for Evidence Based Evaluation) project is a 5-year research programme which aims to develop new ways of measuring the performance, quality and impact of ambulance service care. As part of this programme we conducted 2 systematic reviews to identify potential measures and held a consensus event to prioritise these measures. Methods: Actual or potential measures or indicators for assessing ambulance service performance or quality of care were ide...

  1. On residents’ satisfaction with community health services after health care system reform in Shanghai, China, 2011

    Directory of Open Access Journals (Sweden)

    Li Zhijian

    2012-06-01

    Full Text Available Abstract Background Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents’ satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform. Methods Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents’ satisfaction. Results Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1 the health insurance system; 2 essential drugs; 3 basic clinical services; and 4 public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied and the public health/preventive services (average score=3.62; but less satisfied with the provision of essential drugs (average score=3.20 and health insurance schemes (average score=3.23. The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes had overall poorer satisfaction levels on these four aspects of health care (P Conclusion The respondents showed more satisfaction with the clinical services (average score=3.79 and public health services/interventions (average score=3.79; and less satisfaction with the health insurance system (average score=3.23 and the essential drug system

  2. [Military medical and health care system in the Song Dynasty].

    Science.gov (United States)

    DU, J

    2016-05-01

    The military medical and health care system in the Song Dynasty manifested as two aspects, namely disease prevention and medical treatment. Disease prevention included ensuring food and drink safety, avoiding dangerous stations and enjoying regular vacations, etc. Medical treatment included sending medical officials to patrol, stationing military physicians to follow up, applying emergency programs, establishing military medical and pharmacy centers, dispensing required medicines, and accommodating and nursing sick and injured personnel, etc. Meanwhile, the imperial court also supervised the implementation of military medical mechanism, in order to check the soldiers' foods, check and restrict the military physicians' responsibilities, etc., which did play a positive role in protecting soldier's health, guaranteeing the military combat effectiveness, and maintaining national security. PMID:27485867

  3. Assessing access barriers to tuberculosis care with the tool to Estimate Patients' Costs: pilot results from two districts in Kenya

    Directory of Open Access Journals (Sweden)

    Kirubi Beatrice

    2011-01-01

    Full Text Available Abstract Background The poor face geographical, socio-cultural and health system barriers in accessing tuberculosis care. These may cause delays to timely diagnosis and treatment resulting in more advanced disease and continued transmission of TB. By addressing barriers and reasons for delay, costs incurred by TB patients can be effectively reduced. A Tool to Estimate Patients' Costs has been developed. It can assist TB control programs in assessing such barriers. This study presents the Tool and results of its pilot in Kenya. Methods The Tool was adapted to the local setting, translated into Kiswahili and pretested. Nine public health facilities in two districts in Eastern Province were purposively sampled. Responses gathered from TB patients above 15 years of age with at least one month of treatment completed and signed informed consent were double entered and analyzed. Follow-up interviews with key informants on district and national level were conducted to assess the impact of the pilot and to explore potential interventions. Results A total of 208 patients were interviewed in September 2008. TB patients in both districts have a substantial burden of direct (out of pocket; USD 55.8 and indirect (opportunity; USD 294.2 costs due to TB. Inability to work is a major cause of increased poverty. Results confirm a 'medical poverty trap' situation in the two districts: expenditures increased while incomes decreased. Subsequently, TB treatment services were decentralized to fifteen more facilities and other health programs were approached for nutritional support of TB patients and sputum sample transport. On the national level, a TB and poverty sub-committee was convened to develop a comprehensive pro-poor approach. Conclusions The Tool to Estimate Patients' Costs proved to be a valuable instrument to assess the costs incurred by TB patients, socioeconomic situations, health-seeking behavior patterns, concurrent illnesses such as HIV, and social and

  4. Home Automated Telemanagement (HAT System to Facilitate Self-Care of Patients with Chronic Diseases

    Directory of Open Access Journals (Sweden)

    Joseph Finkelstein

    2003-06-01

    Full Text Available Successful patient self-management requires a multidisciplinary approach that includes regular patient assessment, disease-specific education, control of medication adherence, implementation of health behavior change models and social support. Existing systems for computer-assisted disease management do not provide this multidisciplinary patient support and do not address treatment compliance issues. We developed the Home Automated Telemanagement (HAT system for patients with different chronic health conditions to facilitate their self-care. The HAT system consists of a home unit, HAT server, and clinician units. Patients at home use a palmtop or a laptop connected with a disease monitor on a regular basis. Each HAT session consists of self-testing, feedback, and educational components. The self-reported symptom data and objective results obtained from disease-specific sensors are automatically sent from patient homes to the HAT server in the hospital. Any web-enabled device can serve as a clinician unit to review patient results. The HAT system monitors self-testing results and patient compliance. The HAT system has been implemented and tested in patients receiving anticoagulation therapy, patients with asthma, COPD and other health conditions. Evaluation results indicated high level of acceptance of the HAT system by the patients and that the system has a positive impact on main clinical outcomes and patient satisfaction with medical care.

  5. Foreign-Born Latinos Living in Rural Areas are more likely to Experience Health Care Discrimination: Results from Proyecto de Salud para Latinos.

    Science.gov (United States)

    López-Cevallos, Daniel F; Harvey, S Marie

    2016-08-01

    Health care discrimination is increasingly considered a significant barrier to accessing health services among minority populations, including Latinos. However, little is known about the role of immigration status. The purpose of this study was to examine the association between immigration status and perceived health care discrimination among Latinos living in rural areas. Interviews were conducted among 349 young-adult Latinos (ages 18 to 25) living in rural Oregon, as part of Proyecto de Salud para Latinos. Over a third of participants experienced health care discrimination (39.5 %). Discrimination was higher among foreign-born (44.9 %) rather than US-born Latinos (31.9 %). Multivariate results showed that foreign-born Latinos were significantly more likely to experience health care discrimination, even after controlling for other relevant factors (OR = 2.10, 95 % CI 1.16-3.82). This study provides evidence that health care discrimination is prevalent among young-adult Latinos living in rural areas, particularly the foreign-born. Effective approaches towards reducing discrimination in health care settings should take into consideration the need to reform our broken immigration system. PMID:26399772

  6. Can a public health care system achieve equity? The Norwegian experience.

    Science.gov (United States)

    Grytten, J; Rongen, G; Sørensen, R

    1995-09-01

    Equity in health care provision is an important policy goal in Norway. This article addresses equality in the services provided by primary care physicians. These services are the responsibility of local government financed mainly through public funding. Patient fees are low. The local government system results in geographical variation in the number of physicians relative to local health demands. The authors present the hypothesis that this generates inequalities in health care utilization. The system of government finance is based on the assumption that utilization of health services is independent of patient income. Therefore, variation in income is expected to have only a small impact on utilization. The authors estimate a demand model by combining extensive micro data with aggregate data on municipal supply. There is very little relationship between indicators of access and health care utilization. The estimated income elasticities approximate zero, supporting the argument that equality in utilization has been achieved. However, the authors results also raise the question of whether equality has been achieved at the cost of limiting supply of services for people who could afford to consume more, or to pay for services of higher quality. PMID:7666707

  7. A Good Samaritan inspired foundation for a fair health care system.

    Science.gov (United States)

    Frangenberg, Elmar H

    2011-02-01

    Distributive justice on the income and on the service aspects is the most vexing modern day problem for the creation and maintenance of an all inclusive health care system. A pervasive problem of all current schemes is the lack of effective cost control, which continues to result in increasing burdens for all public and private stakeholders. This proposal posits that the responsibility and financial obligation to achieve an ideal outcome of equal and affordable access and benefits for all citizens is misplaced. The Good Samaritan demonstrated basic ethical principles, which are revisited, elaborated and integrated into a new approach to health care. The participants are limited to individual contributors and beneficiaries and organized as a citizen carried, closed, independent, and self-sufficient self-governing cooperative for their own and the benefit of a minority of disadvantaged health care consumers. The government assumes oversight, provides arbitration, enforces democratic decision making, a scheme of progressive taxation, a separate and transparent accounting system, and a balance between income and reinvestment in health care. The results are a fair distribution of cost, its effective control, and increased individual motivation to take on responsibility for personal health as a private good and a sharpened focus towards community health. At the sociopolitical level the government as well as employers are released from the inappropriate burden of catering to individual health. PMID:20556519

  8. Sistem Pelayanan Kesehatan Tanggap Darurat di Kabupaten Ciamis (Health Care Emergency Response System in Ciamis Regency

    Directory of Open Access Journals (Sweden)

    Lusi Kristiana

    2014-04-01

    Full Text Available Background: District of Ciamis is one of the disaster-prone areas in Indonesia with a high level of vulnerability to naturaldisasters, landslides, fl oods, hurricanes, and earthquakes. Disaster management requires the involvement of a wide rangeof institutions. This study aims to describe the health care system during disaster response with a case study in the districtof Ciamis, West Java province. Method: The study is a qualitative research, conducted in 2011. Collecting data by in- depth interviews, focus group discussions, and secondary data study. Informants as key person come from health care units(Primary Health Care, hospitals and agencies at district of Ciamis such as BPBD, Polres, Kodim, Dinsos, PMI, Dinkes.Results: The result shows that the major weakness of the current health care system in the District of Ciamis emergencyresponse is in the budget, resources and logistics. There is a good coordination among health sector, but other sectorsare still lacking. Recommandations: It is recommended that health sector improve coordination with relevant institution indisaster management, advocacy to executives, improving human health and socialization skills and disaster preparedness training to the community in disaster-prone areas.

  9. The System-of-Care Model: Implementation in Twenty-Seven Communities.

    Science.gov (United States)

    Vinson, Nina B.; Brannan, Ana Maria; Baughman, Lela N.; Wilce, Maureen; Gawron, Timothy

    2001-01-01

    A 4-year study of 27 system-of-care sites designed to provides mental health services to children and adolescents, found that despite many changes in each local service system, no site was able to fully implement all 16 key attributes comprising an ideal system-of-care model (including sites with previous system-building experience). (Contains…

  10. Exploring the Person-Centeredness of an Innovative E-Supportive System Aimed at Person-Centered Care: Prototype Evaluation of the Care Expert.

    Science.gov (United States)

    Ventura, Filipa; Koinberg, Ingalill; Sawatzky, Richard; Karlsson, Per; Öhlén, Joakim

    2016-05-01

    Integrated in a multiphase development project, the Care Expert is a prototype of a novel e-supportive system aiming to mediate person-centered care in the context of outpatient oncology. At this early stage of development, the current study was conducted aiming at exploring the person-centeredness concept underlying the Care Expert version 1.0 and its usability for patients receiving outpatient chemotherapy for breast cancer. Within a user-centered design, we followed a mixed-methods approach entailing subjective assessment and diagnostic evaluation of the prototype. Four women undergoing outpatient chemotherapy participated in individual sessions and rated highly the system's usability. Their accounts led to identifying three supportive functions: continuous communication, reinforcement of self-driven agency, and cooperative agency with a sense of being looked after. We discuss the results in relation to theoretical fields that might guide further the development of the supportive system and usability recommendations. Care Expert has the potential to mediate person-centered care in outpatient oncology. Nevertheless, additional cycles of iterative development with the software team and of participatory design focusing on oncology nurses' perspectives are required before departing to the feasibility phase in intervention research. PMID:26909537

  11. Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?

    OpenAIRE

    Chomi, EN; Mujinja, PG; Enemark, U; K Hansen; Kiwara, AD

    2014-01-01

    Background Many countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups. However, existence of multiple health insurance funds may also cause variation in access to health care, due to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple...

  12. [Functionality determinants of the integrated systems dedicated to health care institutions].

    Science.gov (United States)

    Sokołowski, Adam; Sroka, Mariusz

    2013-01-01

    The Authors of the hereby dissertation aimed at presenting the functionality concept of the integrated e-service platform dedicated to health care institutions. In the form of a problem repository the research results allowing the identification of the functionality determinants were presented. Finally, the study presents the system's structure as well as analyzing the needs for e-services in terms of society and their usefulness evaluated by branch experts. PMID:23905430

  13. Making Our Health and Care Systems Fit for an Ageing Population: Considerations for Canada

    Science.gov (United States)

    Andrew, Melissa K.; Rockwood, Kenneth

    2014-01-01

    A report from the United Kingdom on making health and care systems fit for an ageing population proposes a range of interventions to make care better for older adults, especially those who are frail. Here, we discuss the proposed shift for the acute care hospital to other models of care. The key for these models of care requires a fundamental shift to care that addresses the full range of an individual’s needs, rather than being based around single diseases. How this might apply in the Canadian context is considered. We emphasize strategies to keep people out of hospital but still receive needed care, make acute hospital care less hazardous, and improve the interface between acute and long-term care. PMID:25452826

  14. The Arizona Health Care Cost Containment System: A Prepayment Model for a National Health Service?

    OpenAIRE

    Orient, Jane M.

    1986-01-01

    The Arizona Health Care Cost Containment System (AHCCCS), the Arizona Medicaid alternative, is an experiment in contracting “prepaid” indigent health care to the lowest bidding group. The consequences have been substantial cost overruns and serious unanswered questions about the quality and avilability of care.

  15. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care.

    Science.gov (United States)

    Gvozdanović, Darko; Koncar, Miroslav; Kojundzić, Vinko; Jezidzić, Hrvoje

    2007-01-01

    In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related data management in support of decision-making processes; (2) to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution. PMID:18005567

  16. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

    Directory of Open Access Journals (Sweden)

    Darko Gvozdanovi_

    2007-09-01

    Full Text Available In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1 to provide efficient healthcare-related data management in support of decision-making processes; (2 to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

  17. A systematic review of complex system interventions designed to increase recovery from depression in primary care

    Directory of Open Access Journals (Sweden)

    Hegarty Kelsey

    2006-07-01

    Full Text Available Abstract Background Primary care is being encouraged to implement multiprofessional, system level, chronic illness management approaches to depression. We undertook this study to identify and assess the quality of RCTs testing system level depression management interventions in primary care and to determine whether these interventions improve recovery. Method Searches of Medline and Cochrane Controlled Register of Trials. 'System level' interventions included: multi-professional approach, enhanced inter-professional communication, scheduled patient follow-up, structured management plan. Results 11 trials met all inclusion criteria. 10 were undertaken in the USA. Most focussed on antidepressant compliance. Quality of reporting assessed using CONSORT criteria was poor. Eight trials reported an increase in the proportion of patients recovered in favour of the intervention group, yet did not account for attrition rates ranging from 5 to 50%. Conclusion System level interventions implemented in the USA with patients willing to take anti-depressant medication leads to a modest increase in recovery from depression. The relevance of these interventions to countries with strong primary care systems requires testing in a randomised controlled trial.

  18. Impact of intensive care on renal function before graft harvest: results of a monocentric study

    OpenAIRE

    Blasco, Valéry; Leone, Marc; Bouvenot, Julien; Geissler, Alain; Albanèse, Jacques; Martin, Claude

    2007-01-01

    Background The aim of life-support measures in brain-dead donors is to preserve the functional value of their organs. In renal transplantation, serum creatinine level is one of the criteria for graft harvest. The aim of this study was to assess the impact of intensive care on donor renal function through two criteria: preharvesting serum creatinine level above 120 μmol/L and the elevation of serum creatinine level above 20% between intensive care unit (ICU) admission and graft harvest. Method...

  19. The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation

    Science.gov (United States)

    O'Brien, Rosaleen; Fitzpatrick, Bridie; Higgins, Maria; Guthrie, Bruce; Watt, Graham; Wyke, Sally

    2016-01-01

    Objectives To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. Methods Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients. Results Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients. Discussion We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial. PMID:27068113

  20. Health System Quality Improvement: Impact of Prompt Nutrition Care on Patient Outcomes and Health Care Costs.

    Science.gov (United States)

    Meehan, Anita; Loose, Claire; Bell, Jvawnna; Partridge, Jamie; Nelson, Jeffrey; Goates, Scott

    2016-01-01

    Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. We implemented a quality improvement program that positioned early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications, guided and monitored by medication administration records. Post-quality improvement program, pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced. PMID:26910129

  1. 日本的医疗制度①%Japan Health Care System SEISHIRO Kudo. Japan Health Care System

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    This paper gives a detailed introduction to the Japanese health care system and medical insurance system, from the section of how public medical insurance works, the differences between social insurance and national health insurance, how medical expenses are paid, how national health insurance is maintained, how medical payment system works, and the health legislation and education system, which the Japanese are particularly proud of. Japan used to implement a voluntary national health insurance system. However, since the new national health insurance system was implemented in 1961, all of the voluntary insurance has become compulsory, which laid the groundwork to pro-vide equal medical services to all citizens.%  本文从各种公共医疗保险,社会保险和国民健康保险的区别,医疗给付、全民保险制度的维持,诊疗报酬制度,医疗相关法律及专业等方面详细介绍了日本的医疗制度和日本引为自豪的医疗保险制度。以前日本实施的是自愿参保的国民医疗保险制度,但从1961年新的国民健康保险制度实施以来,所有的自愿参保都变成强制参保,奠定了为所有国民提供平等医疗服务的基础。

  2. Ensuring the security and privacy of information in mobile health-care communication systems

    Directory of Open Access Journals (Sweden)

    Ademola P. Abidoye

    2011-09-01

    Full Text Available The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of a patient’s data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel. Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hospital. With the implementation of electronic patient records and the Internet and Intranets, medical information sharing amongst relevant health-care providers was made possible. But the vital issue in this method of information sharing is security: the patient’s privacy, as well as the confidentiality and integrity of the health-care information system, should not be compromised. We examine various ways of ensuring the security and privacy of a patient’s electronic medical information in order to ensure the integrity and confidentiality of the information.

  3. How do integrated health care systems address racial and ethnic disparities in colon cancer?

    OpenAIRE

    Rhoads, KF; Patel, MI; Ma, Y.; Schmidt, LA

    2015-01-01

    © 2015 by American Society of Clinical Oncology. Purpose: Colorectal cancer (CRC) disparities have persisted over the last two decades. CRC is a complex disease requiring multidisciplinary care from specialists who may be geographically separated. Few studies have assessed the association between integrated health care system (IHS) CRC care quality, survival, and disparities. The purpose of this study was to determine if exposure to an IHS positively affects quality of care, risk of mortality...

  4. Role of individual psychotherapy of people diagnosed with schizophrenia in the Polish system of psychiatric care

    OpenAIRE

    Łukasz Cichocki

    2015-01-01

    This paper takes up the subject of the place and role of individual psychotherapy of people diagnosed with schizophrenia in the Polish system of psychiatric care. It describes various therapeutic contexts in which such psychotherapy can take place: inpatient ward, outpatient ward, ambulatory care, community care team. It also touches upon the issue of psychotherapy in contact with a chronically ill patient who participates in rehabilitation at occupational therapy workshops or at a day care c...

  5. Finding economies of scale and coordination of care along the continuum to achieve true system integration.

    Science.gov (United States)

    Davies, Maura

    2014-01-01

    Is it time to reduce hospitals and replace them with digitally enabled distributed specialty service delivery channels that focus on ambulatory care, urgent care, and patient reactivation? Is delivery system integration immaterial if care is standardized and supported by integrated information systems? Maybe Lean methodology needs to be applied across the entire delivery systems, not just within its component functions and processes. Comments are offered on each of these perspectives. PMID:25671876

  6. The core of the Nordic health care system is not empty

    OpenAIRE

    Carl Hampus Lyttkens;; Terkel Christiansen; Unto Häkkinen; Oddvar Kaarboe; Matt Sutton; Anna Welander

    2016-01-01

    The Nordic countries are well-known for their welfare states. A very important feature of the welfare state is that it aims at easy and equal access to adequate health care for the entire population. For many years, the Nordic systems were automatically viewed as very similar, and they were placed in the same group when the OECD classified health care systems around the world. However, close inspection soon reveals that there are important differences between the health care systems of Denmar...

  7. On robust methodologies for managing public health care systems.

    Science.gov (United States)

    Nimmagadda, Shastri L; Dreher, Heinz V

    2014-01-01

    Authors focus on ontology-based multidimensional data warehousing and mining methodologies, addressing various issues on organizing, reporting and documenting diabetic cases and their associated ailments, including causalities. Map and other diagnostic data views, depicting similarity and comparison of attributes, extracted from warehouses, are used for understanding the ailments, based on gender, age, geography, food-habits and other hereditary event attributes. In addition to rigor on data mining and visualization, an added focus is on values of interpretation of data views, from processed full-bodied diagnosis, subsequent prescription and appropriate medications. The proposed methodology, is a robust back-end application, for web-based patient-doctor consultations and e-Health care management systems through which, billions of dollars spent on medical services, can be saved, in addition to improving quality of life and average life span of a person. Government health departments and agencies, private and government medical practitioners including social welfare organizations are typical users of these systems. PMID:24445953

  8. On Robust Methodologies for Managing Public Health Care Systems

    Directory of Open Access Journals (Sweden)

    Shastri L. Nimmagadda

    2014-01-01

    Full Text Available Authors focus on ontology-based multidimensional data warehousing and mining methodologies, addressing various issues on organizing, reporting and documenting diabetic cases and their associated ailments, including causalities. Map and other diagnostic data views, depicting similarity and comparison of attributes, extracted from warehouses, are used for understanding the ailments, based on gender, age, geography, food-habits and other hereditary event attributes. In addition to rigor on data mining and visualization, an added focus is on values of interpretation of data views, from processed full-bodied diagnosis, subsequent prescription and appropriate medications. The proposed methodology, is a robust back-end application, for web-based patient-doctor consultations and e-Health care management systems through which, billions of dollars spent on medical services, can be saved, in addition to improving quality of life and average life span of a person. Government health departments and agencies, private and government medical practitioners including social welfare organizations are typical users of these systems.

  9. [Problems in the development of the emergency health care system].

    Science.gov (United States)

    Hasić, Z; Sisić, I

    2000-01-01

    Since February 1994, during and after 4-years supervision of American specialists, Emergency department of Zenica hospital has been trying to implement Anglo-American working system within the hospital framework (video). Principles of quality functioning of Emergency Medical Service (EMS) are based on: Population that depends on different demographic factors and prevention programme (education of population, quality functioning of health legislation). Pre-hospital treatment depends on good quality communication and transport. Hospital treatment based on good functioning of Emergency department and Intensive care unit as well as proper coordination with other specialties. Proper implementation of items stated above depends on top-class teaching and compulsory periodical screening of attained knowledge and skills, properly organized communication, transport and technical equipment. Emergency medicine is not only a sum of urgencies from the existing conditions but a special medical discipline and it has special and unique approach to diagnosis and therapy of acute health disorders. Therefore, a main weakness in the development of emergency medicine is: no recognition of emergency medicine as a unique specialty in the most European countries, non-existing departments of emergency medicine at medical faculties, no unification of BiH emergency medicine system, undeveloped monitoring and development evaluation of emergency medicine etc. The World Association of Emergency Medicine should have an important role for emergency medicine recognition, and in its future development through links with health legislation and educational associations (ACLS, ATLS, APLS). PMID:11117025

  10. International comparison of health care systems using resource profiles.

    OpenAIRE

    2000-01-01

    The most frequently used bases for comparing international health care resources are health care expenditures, measured either as a fraction of gross domestic product (GDP) or per capita. There are several possible reasons for this, including the widespread availability of historic expenditure figures; the attractiveness of collapsing resource data into a common unit of measurement; and the present focus among OECD member countries and other governments on containing health care costs. Despit...

  11. Empowering primary care workers to improve health services: results from Mozambique's leadership and management development program

    Directory of Open Access Journals (Sweden)

    Perry Cary

    2008-07-01

    Full Text Available Abstract This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The series of six articles has been contributed by Management Sciences for Health (MSH and will be published article-by-article over the next few weeks. The third article presents a successful application in Mozambique of a leadership development program created by Management Sciences for Health (MSH. Through this program, managers from 40 countries have learned to work in teams to identify their priority challenges and act to implement effective responses. From 2003 to 2004, 11 health units in Nampula Province, participated in a leadership and management development program called the Challenges Program. This was following an assessment which found that the quality of health services was poor, and senior officials determined that the underlying cause was the lack of human resource capacity in leadership and management in a rapidly decentralizing health care system. The program was funded by the US Agency for International Development (USAID and implemented in partnership between the Mozambican Ministry of Health (MOH Provincial Directorate in Nampula and Management Sciences for Health (MSH. The Challenges Program used simple management and leadership tools to assist the health units and their communities to address health service challenges. An evaluation of the program in 2005 showed that 10 of 11 health centers improved health services over the year of the program. The Challenges Program used several strategies that contributed to successful outcomes. It integrated leadership strengthening into the day-to-day challenges that staff were facing in the health units. The second success factor in the Challenges Program was the creation of participatory teams. After the program, people no longer waited passively to be trained but instead proactively requested training in needed areas. MOH workers

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  13. Venous leg ulcer patient priorities and quality of care: results of a survey

    DEFF Research Database (Denmark)

    Kjaer, Monica Linda; Mainz, Jan; Sorensen, Lars Tue;

    2004-01-01

    -sectional study to assess the quality of and assign priority to 28 aspects of medical technical, interpersonal, and organizational care. The response rate to the mailed questionnaire and follow-up telephone survey was 80%. Almost half (46%) of patients (median age 76 years, range 30 to 92) had an ulcer history of...

  14. Principles of justice as a basis for conceptualizing a health care system.

    Science.gov (United States)

    Bryant, J H

    1977-01-01

    This paper opens with a concern for the causes of the maldistribution of health care throughout most of the world. It then explores briefly the question of entitlement to health care, focusing on the appropriateness of expressing that entitlement in terms of social justice. Some principles of justice as related to health care are formulated, drawing on the thinking of John Rawls and his Theory of Justice, and the ideas of distributive justice that have been set forth by Nicholas Rescher. These principles are then used as a basis for planning a theoretical health care system in the setting of a less-developed country. This theoretical health care system is intended to reflect a just distribution of health care under conditions of varying limitations of resources, including those in which resources are not adequate to provide care for all of the people. Some of the technical, social, and political implications of such a system are discussed. PMID:914402

  15. The Catalonia WHO Demonstration Project of Palliative Care: Results at 25 Years (1990-2015).

    Science.gov (United States)

    Gómez-Batiste, Xavier; Blay, Carles; Martínez-Muñoz, Marisa; Lasmarías, Cristina; Vila, Laura; Espinosa, José; Costa, Xavier; Sánchez-Ferrin, Pau; Bullich, Ingrid; Constante, Carles; Kelley, Ed

    2016-07-01

    In 2015, the World Health Organization (WHO) Demonstration Project on Palliative Care in Catalonia (Spain) celebrated its 25th anniversary. The present report describes the achievements and progress made through this project. Numerous innovations have been made with regard to the palliative care (PC) model, organization, and policy. As the concept of PC has expanded to include individuals with advanced chronic conditions, new needs in diverse domains have been identified. The WHO resolution on "Strengthening of palliative care as a component of comprehensive care throughout the life course," together with other related WHO initiatives, support the development of a person-centered integrated care PC model with universal coverage. The Catalan Department of Health, together with key institutions, developed a new program in the year 2011 to promote comprehensive and integrated PC approach strategies for individuals with advanced chronic conditions. The program included epidemiologic research to describe the population with progressive and life-limiting illnesses. One key outcome was the development of a specific tool (NECPAL CCOMS-ICO(©)) to identify individuals in the community in need of PC. Other innovations to emerge from this project to improve PC provision include the development of the essential needs approach and integrated models across care settings. Several educational and research programs have been undertaken to complement the process. These results illustrate how a PC program can respond and adapt to emerging needs and demands. The success of the PC approach described here supports more widespread adoption by other key care programs, particularly chronic care programs. PMID:27233146

  16. [Legislation on primary care in Brazilian Unified National Health System: document analysis].

    Science.gov (United States)

    Domingos, Carolina Milena; Nunes, Elisabete de Fátima Polo de Almeida; Carvalho, Brígida Gimenez; Mendonça, Fernanda de Freitas

    2016-03-01

    A reflection on Brazil's legislation for primary care helps understand the way health policy is implemented in the country. This study focuses on the legal provisions aimed at strengthening primary care, drawing on an analysis of documents from the Ministry of Health's priority actions, programs, and strategies. A total of 224 provisions were identified, in two groups of documents, so-called instituting provisions and complementary provisions. The former include the principles and guidelines of the Brazilian Unified National Health System (SUS) and also involve the expansion of actions. Financing was a quantitatively central theme, especially in the complementary provisions. The analysis led to reflection on the extent to which these strategies can induce linkage between health system managers and civil society in building a political project resulting in improvements and meeting the population's health needs. PMID:27027459

  17. Novel approach to evaluation of medical care quality delivered to patients with ST-segment elevation acute coronary syndrome: course to clinical result

    Directory of Open Access Journals (Sweden)

    Posnenkova О.М.

    2014-09-01

    Full Text Available The purpose was to implement system analysis of clinical cases for development of healthcare quality indicators for STe-ACS patients, aimed at achievement of clinical result — decrease of in-hospital mortality. Mathehal and Methods. National recommendations on diagnostic and treatment of patients with myocardial infarction with ST-segment elevation on ECG (2007 were used to determine clinical result of treatment and key measures of medical care. To reveal major causes of clinical result non-achievement fishbone diagram was used. Results. Early reperfusion and optimal medical therapy were determined as the key measures of medical care delivered to patients with STe-ACS. The following indicators were developed to control these measures: «Primary reperfusion», «Thrombolysis in 30 minutes», «Primary percutaneous coronary intervention in 90 minutes», «Dual antiplatelet therapy in hospital», «Beta-blockers administration», «ACE-is/ARBs administration». The major causes of in-hospital mortality were separated. Indicators for assessment the major causes of clinical result non-achievement were proposed. Principal stages of performance measures creation were posed. Conclusion. Recommendation-based and clear definition of clinical result of treatment and key measures of the result achievement combined with methods of systems analysis allows development of evidence-based measures for assessment the quality of care delivered to patients with STe-ACS.

  18. Toward a Learning Health-care System - Knowledge Delivery at the Point of Care Empowered by Big Data and NLP.

    Science.gov (United States)

    Kaggal, Vinod C; Elayavilli, Ravikumar Komandur; Mehrabi, Saeed; Pankratz, Joshua J; Sohn, Sunghwan; Wang, Yanshan; Li, Dingcheng; Rastegar, Majid Mojarad; Murphy, Sean P; Ross, Jason L; Chaudhry, Rajeev; Buntrock, James D; Liu, Hongfang

    2016-01-01

    The concept of optimizing health care by understanding and generating knowledge from previous evidence, ie, the Learning Health-care System (LHS), has gained momentum and now has national prominence. Meanwhile, the rapid adoption of electronic health records (EHRs) enables the data collection required to form the basis for facilitating LHS. A prerequisite for using EHR data within the LHS is an infrastructure that enables access to EHR data longitudinally for health-care analytics and real time for knowledge delivery. Additionally, significant clinical information is embedded in the free text, making natural language processing (NLP) an essential component in implementing an LHS. Herein, we share our institutional implementation of a big data-empowered clinical NLP infrastructure, which not only enables health-care analytics but also has real-time NLP processing capability. The infrastructure has been utilized for multiple institutional projects including the MayoExpertAdvisor, an individualized care recommendation solution for clinical care. We compared the advantages of big data over two other environments. Big data infrastructure significantly outperformed other infrastructure in terms of computing speed, demonstrating its value in making the LHS a possibility in the near future. PMID:27385912

  19. CURRENT ECONOMIC AND MEDICAL REFORMS IN THE ROMANIAN HEALTH CARE SYSTEM

    Directory of Open Access Journals (Sweden)

    Dragoi Mihaela Cristina

    2011-12-01

    Full Text Available The issue of health has always been, both in social reality and in academia and research, a sensitive topic considering the relationship each individual has with his own health and the health care system as a public policy. At public opinion levels and not only, health care is the most important sector demanding the outmost attention, considering that individual health is the fundamental prerequisite for well-being, happiness and a satisfying life. The ever present research and practical question is on the optimal financing of the health care system. Any answer to this question is also a political decision, reflecting the social-economic value of health for a particular country. The size of the resource pool and the criteria and methods for resource allocation are the central economic problems for any health system. This paper takes into consideration the limited resources of the national health care system (the rationalization of health services, the common methods of health financing, the specificity of health services market (the health market being highly asymmetric, with health professionals knowing most if not all of the relevant information, such as diagnosis, treatment options and costs and consumers fully dependent on the information provided in each case and the performance of all hospitals in Romania, in order to assess the latest strategic decisions (introduction of co-payment and merging and reconversion of hospitals taken within the Romanian health care system and their social and economic implications. The main finding show that, even though the intention of reforming and transforming the Romanian health care system into a more efficient one is obvious, the lack of economic and demographic analysis may results into greater discrepancies nationwide. This paper is aimed to renew the necessity of joint collaboration between the economic and medical field, since the relationship between health and economic development runs both ways

  20. The effect of the development of an emergency transfer system on the travel time to tertiary care centres in Japan

    Directory of Open Access Journals (Sweden)

    Arima Hideaki

    2006-06-01

    Full Text Available Abstract Background In Japan, the emergency medical system is categorized into three levels: primary, secondary, and tertiary, depending on the severity of the condition of the patient. Tertiary care centres accept patients who require 24-h monitoring. In this research, the average travel times (minutes from the centroids of all municipalities in Japan to the nearest tertiary care centre were estimated, using the geographic information system. The systems affecting travel time to tertiary care centres were also examined. Regression analysis was performed to determine the factors affecting the travel time to tertiary care centres, using selected variables representing road conditions and the emergency transfer system. Linear regression analysis was performed to identify specific benchmarks that would be effective in reducing the average travel time to tertiary care centres in prefectures with travel times longer than the average 57 min. Results The mean travel time was 57 min, the range was 83 min, and the standard deviation was 20.4. As a result of multiple regression analysis, average coverage area per tertiary care centre, kilometres of highway road per square kilometre, and population were selected as variables with impact on the average travel time. Based on results from linear regression analysis, benchmarks for the emergency transfer system that would effectively reduce travel time to the mean value of 57 min were identified: 26% pavement ratio of roads (percentage of paved road to general roads, and three tertiary care centres and 108 ambulances. Conclusion Regional gaps in the travel time to tertiary care centres were identified in Japan. The systems we should focus on to reducing travel time were identified. Further reduction of travel time to tertiary care centres can be effectively achieved by improving these specific systems. Linear regression analysis showed that a 26% pavement ratio and three tertiary care centres are beneficial to

  1. Long term effects of preventive activities of youth health care in The Netherlands: results of a four-part study

    Directory of Open Access Journals (Sweden)

    Pieter A. Wiegersma

    2004-12-01

    Full Text Available

    Background. In this article the results are presented of a four part study on the effect of screening for scoliosis and (repeated well-care visits and freely accessible consultation hours at secondary schools, on the incidence and prevalence of (parasuicide, mental health, adolescent health compromising behaviour and lastly obesity.

    Methods. An ecologic case-referent study design was used with data from the Netherlands Bureau of Statistics, the Ministry of Defence, the 1992 High-School Student Study, all of the youth health care departments in The Netherlands and relevant censuses.

    Results. Attention to mental and physical health and health compromising behaviour, either during screening, open consultation hours or during well-care visits seems to be ineffective and in some instances even detrimental to youth health.

    Of the 18 different outcome measurements, 5 were significantly negative and none were significantly positive.

    Conclusions. This four part study does not support the hypothesis that on a population level, the preventive activities of youth health care departments such as screening for scoliosis, (more frequent well-care visits or offering open consultation hours at secondary schools, have a beneficial effect on prevention of (parasuicide, poor mental health, health compromising behaviour or obesity.

  2. Womens' opinions on antenatal care in developing countries: results of a study in Cuba, Thailand, Saudi Arabia and Argentina

    Directory of Open Access Journals (Sweden)

    Farnot Ubaldo

    2003-05-01

    Full Text Available Abstract Background The results of a qualitative study carried out in four developing countries (Cuba, Thailand, Saudi Arabia and Argentina are presented. The study was conducted in the context of a randomised controlled trial to test the benefits of a new antenatal care protocol that reduced the number of visits to the doctor, rationalised the application of technology, and improved the provision of information to women in relation to the traditional protocol applied in each country. Methods Through focus groups discussions we were able to assess the concepts and expectations underlying women's evaluation of concepts and experiences of the care received in antenatal care clinics. 164 women participated in 24 focus groups discussion in all countries. Results Three areas are particularly addressed in this paper: a concepts about pregnancy and health care, b experience with health services and health providers, and c opinions about the modified Antenatal Care (ANC programme. In all three topics similarities were identified as well as particular opinions related to country specific social and cultural values. In general women have a positive view of the new ANC protocol, particularly regarding the information they receive. However, controversial issues emerged such as the reduction in the number of visits, particularly in Cuba where women are used to have 18 ANC visits in one pregnancy period. Conclusion Recommendations to improve ANC services performance are being proposed. Any country interested in the application of a new ANC protocol should regard the opinion and acceptability of women towards changes.

  3. Portable point-of-care blood analysis system for global health (Conference Presentation)

    Science.gov (United States)

    Dou, James J.; Aitchison, James Stewart; Chen, Lu; Nayyar, Rakesh

    2016-03-01

    In this paper we present a portable blood analysis system based on a disposable cartridge and hand-held reader. The platform can perform all the sample preparation, detection and waste collection required to complete a clinical test. In order to demonstrate the utility of this approach a CD4 T cell enumeration was carried out. A handheld, point-of-care CD4 T cell system was developed based on this system. In particular we will describe a pneumatic, active pumping method to control the on-chip fluidic actuation. Reagents for the CD4 T cell counting assay were dried on a reagent plug to eliminate the need for cold chain storage when used in the field. A micromixer based on the active fluidic actuation was designed to complete sample staining with fluorescent dyes that was dried on the reagent plugs. A novel image detection and analysis algorithm was developed to detect and track the flight of target particles and cells during each analysis. The handheld, point-of-care CD4 testing system was benchmarked against clinical cytometer. The experimental results demonstrated experimental results were closely matched with the flow cytometry. The same platform can be further expanded into a bead-array detection system where other types of biomolecules such as proteins can be detected using the same detection system.

  4. Computerized clinical decision support systems for primary preventive care: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

    Directory of Open Access Journals (Sweden)

    Wilczynski Nancy L

    2011-08-01

    Full Text Available Abstract Background Computerized clinical decision support systems (CCDSSs are claimed to improve processes and outcomes of primary preventive care (PPC, but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63% RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34% trials assessed patient outcomes, and four (29% reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15% and two (5% trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects. Conclusions

  5. The quality of health care in prison: results of a year's programme of semistructured inspections.

    OpenAIRE

    Reed, J.; Lyne, M

    1997-01-01

    OBJECTIVES: To assess, as part of wider inspections by HM Inspectorate of Prisons, the extent and quality of health care in prisons in England and Wales. DESIGN: Inspections based on a set of "expectations" derived mainly from existing healthcare quality standards published by the prison service and existing ethical guidelines; questionnaire survey of prisoners. SUBJECTS: 19 prisons in England and Wales, 1996-7. MAIN OUTCOME MEASURES: Appraisals of needs assessment and the commissioning and d...

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

    OpenAIRE

    Van Royen Paul; Vermeire Etienne; Wens Johan; Nobels Frank; Snauwaert Boris; Feyen Luc; Bastiaens Hilde; Sunaert Patricia; De Maeseneer Jan; De Sutter An; Willems Sara

    2009-01-01

    Abstract Background Most research publications on Chronic Care Model (CCM) implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Bel...

  7. Investigating the health care delivery system in Japan and reviewing the local public hospital reform

    OpenAIRE

    Zhang X.; Oyama T

    2016-01-01

    Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying ...

  8. Explaining public satisfaction with health care systems: findings from a nationwide survey in China

    OpenAIRE

    Munro, Neil; Duckett, Jane

    2016-01-01

    Objective: To identify factors and covariates associated with health care system satisfaction in China. Context: Recent research suggests that socio-demographic characteristics, self-reported health, income and insurance, ideological beliefs, health care utilization, media use and perceptions of services may affect health care system satisfaction, but the relationships between these factors are poorly understood. New data from China offers the opportunity to test theories about the source...

  9. Physicians' views on resource availability and equity in four European health care systems

    Directory of Open Access Journals (Sweden)

    Slowther Anne-Marie

    2007-08-01

    Full Text Available Abstract Background In response to limited resources, health care systems have adopted diverse cost-containment strategies and give priority to differing types of interventions. The perception of physicians, who witness the effects of these strategies, may provide useful insights regarding the impact of system-wide priority setting on access to care. Methods We conducted a cross-sectional survey to ascertain generalist physicians' perspectives on resources allocation and its consequences in Norway, Switzerland, Italy and the UK. Results Survey respondents (N = 656, response rate 43% ranged in age from 28–82, and averaged 25 years in practice. Most respondents (87.7% perceived some resources as scarce, with the most restrictive being: access to nursing home, mental health services, referral to a specialist, and rehabilitation for stroke. Respondents attributed adverse outcomes to scarcity, and some respondents had encountered severe adverse events such as death or permanent disability. Despite universal coverage, 45.6% of respondents reported instances of underinsurance. Most respondents (78.7% also reported some patient groups as more likely than others to be denied beneficial care on the basis of cost. Almost all respondents (97.3% found at least one cost-containment policy acceptable. The types of policies preferred suggest that respondents are willing to participate in cost-containment, and do not want to be guided by administrative rules (11.2% or restrictions on hospital beds (10.7%. Conclusion Physician reports can provide an indication of how organizational factors may affect availability and equity of health care services. Physicians are willing to participate in cost-containment decisions, rather than be guided by administrative rules. Tools should be developed to enable physicians, who are in a unique position to observe unequal access or discrimination in their health care environment, to address these issues in a more targeted way.

  10. Deployment and validation of a smart system for screening of language disorders in primary care.

    Science.gov (United States)

    Martín-Ruiz, María Luisa; Duboy, Miguel Ángel Valero; de la Cruz, Iván Pau

    2013-01-01

    Neuro-evolutive development from birth until the age of six years is a decisive factor in a child's quality of life. Early detection of development disorders in early childhood can facilitate necessary diagnosis and/or treatment. Primary-care pediatricians play a key role in its detection as they can undertake the preventive and therapeutic actions requested to promote a child's optimal development. However, the lack of time and little specific knowledge at primary-care avoid to applying continuous early-detection anomalies procedures. This research paper focuses on the deployment and evaluation of a smart system that enhances the screening of language disorders in primary care. Pediatricians get support to proceed with early referral of language disorders. The proposed model provides them with a decision-support tool for referral actions to trigger essential diagnostic and/or therapeutic actions for a comprehensive individual development. The research was conducted by starting from a sample of 60 cases of children with language disorders. Validation was carried out through two complementary steps: first, by including a team of seven experts from the fields of neonatology, pediatrics, neurology and language therapy, and, second, through the evaluation of 21 more previously diagnosed cases. The results obtained show that therapist positively accepted the system proposal in 18 cases (86%) and suggested system redesign for single referral to a speech therapist in three remaining cases. PMID:23752564

  11. Deployment and Validation of a Smart System for Screening of Language Disorders in Primary Care

    Directory of Open Access Journals (Sweden)

    Iván Pau de la Cruz

    2013-06-01

    Full Text Available Neuro-evolutive development from birth until the age of six years is a decisive factor in a child’s quality of life. Early detection of development disorders in early childhood can facilitate necessary diagnosis and/or treatment. Primary-care pediatricians play a key role in its detection as they can undertake the preventive and therapeutic actions requested to promote a child’s optimal development. However, the lack of time and little specific knowledge at primary-care avoid to applying continuous early-detection anomalies procedures. This research paper focuses on the deployment and evaluation of a smart system that enhances the screening of language disorders in primary care. Pediatricians get support to proceed with early referral of language disorders. The proposed model provides them with a decision-support tool for referral actions to trigger essential diagnostic and/or therapeutic actions for a comprehensive individual development. The research was conducted by starting from a sample of 60 cases of children with language disorders. Validation was carried out through two complementary steps: first, by including a team of seven experts from the fields of neonatology, pediatrics, neurology and language therapy, and, second, through the evaluation of 21 more previously diagnosed cases. The results obtained show that therapist positively accepted the system proposal in 18 cases (86% and suggested system redesign for single referral to a speech therapist in three remaining cases.

  12. The Colombian health insurance system and its effect on access to health care.

    Science.gov (United States)

    Alvarez, Luz Stella; Salmon, J Warren; Swartzman, Dan

    2011-01-01

    In 1993, the Colombian government sought to reform its health care system under the guidance of international financial institutions (the World Bank and International Monetary Fund). These institutions maintain that individual private health insurance systems are more appropriate than previously established national public health structures for overcoming inequities in health care in developing countries. The reforms carried out following international financial institution guidelines are known as "neoliberal reforms." This qualitative study explores consumer health choices and associated factors, based on interviews with citizens living in Medellin, Colombia, in 2005-2006. The results show that most study participants belonging to low-income and middle-income strata, even with medical expense subsidies, faced significant barriers to accessing health care. Only upper-income participants reported a selection of different options without barriers, such as complementary and alternative medicines, along with private Western biomedicine. This study is unique in that the informal health system is linked to overall neo-liberal policy change. PMID:21563628

  13. Who cares for former child soldiers? Mental health systems of care in Sierra Leone

    NARCIS (Netherlands)

    S. Song; H. van den Brink; J. de Jong

    2013-01-01

    While numerous studies on former child soldiers (FCS) have shown mental health needs, adequate services are a challenge. This study aimed to identify priorities, barriers and facilitators of mental health care for Sierra Leonean FCS. Thematic analysis was done on 24 qualitative interviews with parti

  14. Do Breast Cancer Patients Tested in the Oncology Care Setting Share BRCA Mutation Results with Family Members and Health Care Providers?

    Directory of Open Access Journals (Sweden)

    Susan T. Vadaparampil

    2012-01-01

    Full Text Available BRCA genetic test results provide important information to manage cancer risk for patients and their families. Little is known on the communication of genetic test results by mutation status with family members and physicians in the oncology care setting. As part of a longitudinal study evaluating the impact of genetic counseling and testing among recently diagnosed breast cancer patients, we collected patients' self-reported patterns of disclosure. Descriptive statistics characterized the sample and determined the prevalence of disclosure of BRCA test results to family members and physicians. Of 100 patients who completed the baseline and the 6-month followup survey, 77 reported pursuing testing. The majority shared test results with female first-degree relatives; fewer did with males. Participants were more likely to share results with oncologists compared to surgeons, primary care physicians, or other specialty physicians. These findings suggest that while breast cancer patients may communicate results to at-risk female family members and their medical oncologist, they may need education and support to facilitate communication to other first-degree relatives and providers.

  15. The Impact of the Health Care System Reform on the Romanian Nurses Professionalization Process

    Directory of Open Access Journals (Sweden)

    Silvia POPOVICI

    2012-06-01

    Full Text Available The Romanian health sector went through a process of reform began in 2000 which entered into a final adjustment phase in 2010 when the economic crisis, the health professionals accelerated trend of labour migration, the precarious health of the population brought new challenges to the unsolved existing problems. Nurses are numerically the most important category of health professionals. Since 1994 they experienced a convergent movement of professionalization in the interior of the nurse profession. The aim of the study is to explore the nurses’ perceptions of the impact of the health care system reform on their own profession and on the internal process of professionalization. As a result a quantitative research was conducted on a sample including 411 nurses of different specialties working in Iasi county. The results of the research point out the significant impact of factors related to the reform of the health care system on the quality of the care process, on the nurses’ work conditions and professional satisfaction. The external disruptive factors produce negative effects on nurses’ group cohesion, despite the centripetal efforts of the professional organization and induce a slowdown movement of the nurses professionalization process.

  16. Results of the 03-05 patterns of care study nationwide survey for small-cell lung cancer

    International Nuclear Information System (INIS)

    The Japanese Patterns of Care Study (PCS) conducted a third nationwide survey of care process for patients with limited-disease small cell lung cancer (PCS 03-05). The PCS investigated changes in the care process including continuous technical evolution in radiotherapy as compared with preceding surveys (PCS 95-97, PCS 99-01) and assessed their influence on early outcome. PCS 99-01 showed that evidence based practice pattern had well penetrated into clinical practice. PCS 03-05 demonstrated several changes in patterns of radiotherapy. Decrease in the use of twice-daily radiotherapy did not influence early outcome. Results support the general consideration that technical evolution in radiotherapy has essential role in the era of intensive chemoradiation for small cell lung cancer. (author)

  17. 78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-05-10

    ... fiscal year FPL Federal poverty line FQHC Federally qualified health center FR Federal Register FTE Full... CFR Parts 412, 418, 482, et al. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed Fiscal...

  18. 77 FR 4908 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-02-01

    ... INFORMATION: I. Background In FR Doc. 2011-19719 of August 18, 2011 (76 FR 51476), the final rule entitled... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates; Corrections AGENCY: Centers...

  19. 40 CFR 792.90 - Animal and other test system care.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 31 2010-07-01 2010-07-01 true Animal and other test system care. 792... SUBSTANCES CONTROL ACT (CONTINUED) GOOD LABORATORY PRACTICE STANDARDS Testing Facilities Operation § 792.90 Animal and other test system care. (a) There shall be standard operating procedures for the...

  20. Implications of managed care for health systems, clinicians, and patients.

    OpenAIRE

    Fairfield, G.; Hunter, D.J.; Mechanic, D.; Rosleff, F.

    1997-01-01

    The rhetoric and realities of managed care are easily confused. The rapid growth of managed care in the United States has had many implications for patients, doctors, employers, state and federal programmes, the health insurance industry, major medical institutions, medical research, and vulnerable patient populations. It has restricted patients' choice of doctors and limited access to specialists, reduced the professional autonomy and earnings of doctors, shifted power from the non-profit to...

  1. Impact of health care worker policy awareness on hand hygiene and urinary catheter care in nursing homes: Results of a self-reported survey

    OpenAIRE

    Montoya, Ana; Chen, Shu; Galecki, Andrzej; McNamara, Sara; Lansing, Bonnie; Mody, Lona

    2013-01-01

    Utilizing a self-administered questionnaire in 440 health care workers (81% response rate), we evaluated the impact of health care workers policy awareness on hand hygiene and urinary catheter care in nursing homes. We show that health care workers aware of their nursing home policies are more likely to report wearing gloves and practicing hand hygiene as per evidence-based recommendations during urinary catheter care compared with those who are unaware of their facility policies.

  2. Recent Clinical Characteristics of Labors Using Three Japanese Systems of Midwife-Led Primary Delivery Care

    Science.gov (United States)

    Suzuki, Shunji

    2016-01-01

    Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care. PMID:27034827

  3. Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States.

    Science.gov (United States)

    Hatcher, M

    2001-10-01

    This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, usersatisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals. PMID:11508906

  4. Recommendations for improving the end-of-life care system for homeless populations: A qualitative study of the views of Canadian health and social services professionals

    Directory of Open Access Journals (Sweden)

    McNeil Ryan

    2012-09-01

    Full Text Available Abstract Background Homeless populations have complex and diverse end-of-life care needs. However, they typically die outside of the end-of-life care system. To date, few studies have explored barriers to the end-of-life care system for homeless populations. This qualitative study involving health and social services professionals from across Canada sought to identify barriers to the end-of-life care system for homeless populations and generate recommendations to improve their access to end-of-life care. Methods Semi-structured qualitative interviews were conducted with 54 health and social services professionals involved in end-of-life care services delivery to homeless persons in six Canadian cities (Halifax, Hamilton, Ottawa, Thunder Bay, Toronto and Winnipeg. Participants included health administrators, physicians, nurses, social workers, harm reduction specialists, and outreach workers. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Results Participants identified key barriers to end-of-life care services for homeless persons, including: (1 insufficient availability of end-of-life care services; (2 exclusionary operating procedures; and, (3 poor continuity of care. Participants identified recommendations that they felt had the potential to minimize these barriers, including: (1 adopting low-threshold strategies (e.g. flexible behavioural policies and harm reduction strategies; (2 linking with population-specific health and social care providers (e.g. emergency shelters; and, (3 strengthening population-specific training. Conclusions Homeless persons may be underserved by the end-of-life care system as a result of barriers that they face to accessing end-of-life care services. Changes in the rules and regulations that reflect the health needs and circumstances of homeless persons and measures to improve continuity of care have the potential to increase equity in the end-of-life care system for this

  5. Blueprint for action: steps toward a high-quality, high-value maternity care system.

    Science.gov (United States)

    Angood, Peter B; Armstrong, Elizabeth Mitchell; Ashton, Diane; Burstin, Helen; Corry, Maureen P; Delbanco, Suzanne F; Fildes, Barbara; Fox, Daniel M; Gluck, Paul A; Gullo, Sue Leavitt; Howes, Joanne; Jolivet, R Rima; Laube, Douglas W; Lynne, Donna; Main, Elliott; Markus, Anne Rossier; Mayberry, Linda; Mitchell, Lynn V; Ness, Debra L; Nuzum, Rachel; Quinlan, Jeffrey D; Sakala, Carol; Salganicoff, Alina

    2010-01-01

    Childbirth Connection hosted a 90th Anniversary national policy symposium, Transforming Maternity Care: A High Value Proposition, on April 3, 2009, in Washington, DC. Over 100 leaders from across the range of stakeholder perspectives were actively engaged in the symposium work to improve the quality and value of U.S. maternity care through broad system improvement. A multi-disciplinary symposium steering committee guided the strategy from its inception and contributed to every phase of the project. The "Blueprint for Action: Steps Toward a High Quality, High Value Maternity Care System", issued by the Transforming Maternity Care Symposium Steering Committee, answers the fundamental question, "Who needs to do what, to, for, and with whom to improve the quality of maternity care over the next five years?" Five stakeholder workgroups collaborated to propose actionable strategies in 11 critical focus areas for moving expeditiously toward the realization of the long term "2020 Vision for a High Quality, High Value Maternity Care System", also published in this issue. Following the symposium these workgroup reports and recommendations were synthesized into the current blueprint. For each critical focus area, the "Blueprint for Action" presents a brief problem statement, a set of system goals for improvement in that area, and major recommendations with proposed action steps to achieve them. This process created a clear sightline to action that if enacted could improve the structure, process, experiences of care, and outcomes of the maternity care system in ways that when anchored in the culture can indeed transform maternity care. PMID:20123180

  6. Patient Safety in Critical Care Unit: Development of a Nursing Quality Indicator System.

    Science.gov (United States)

    Lima, Camila S P; Barbosa, Sayonara F F

    2015-01-01

    This is a methodological study and technological production that aims to describe the development of a computerized system of nursing care quality indicators for the Intensive Care Unit. The study population consisted of a systems analyst and fifteen critical care nurses. For the development of the system we adopted some of the best practices of the Unified Process methodology using the Unified Modeling Language and the programming language Java Enterprise Edition 7. The system consists of an access menu with the following functions: Home (presents general information), New Record (records the indicator), Record (record search), Census (add information and indicators of the patient), Report (generates report of the indicators) and Annex (accesses the Braden Scale). This information system allows for measurement of the quality of nursing care and to evaluate patient safety in intensive care unit by monitoring quality indicators in nursing. PMID:26262049

  7. Cloud based intelligent system for delivering health care as a service.

    Science.gov (United States)

    Kaur, Pankaj Deep; Chana, Inderveer

    2014-01-01

    The promising potential of cloud computing and its convergence with technologies such as mobile computing, wireless networks, sensor technologies allows for creation and delivery of newer type of cloud services. In this paper, we advocate the use of cloud computing for the creation and management of cloud based health care services. As a representative case study, we design a Cloud Based Intelligent Health Care Service (CBIHCS) that performs real time monitoring of user health data for diagnosis of chronic illness such as diabetes. Advance body sensor components are utilized to gather user specific health data and store in cloud based storage repositories for subsequent analysis and classification. In addition, infrastructure level mechanisms are proposed to provide dynamic resource elasticity for CBIHCS. Experimental results demonstrate that classification accuracy of 92.59% is achieved with our prototype system and the predicted patterns of CPU usage offer better opportunities for adaptive resource elasticity. PMID:24139021

  8. An exploration of the leadership attributes and methods associated with successful lean system deployments in acute care hospitals.

    Science.gov (United States)

    Steed, Airica

    2012-01-01

    The lean system has been shown to be a viable and sustainable solution for the growing number of cost, quality, and efficiency issues in the health care industry. While there is a growing body of evidence to support the outcomes that can be achieved as a result of the successful application of the lean system in hospital organizations, there is not a complete understanding of the leadership attributes and methods that are necessary to achieve successful widespread mobilization and sustainment. This study was an exploration of leadership and its relevant association with successful lean system deployments in acute care hospitals. This research employed an exploratory qualitative research design encompassing a research questionnaire and telephonic interviews of 25 health care leaders in 8 hospital organizations across the United States. The results from this study identified the need to have a strong combination of personal characteristics, learned behaviors, strategies, tools, and tactics that evolved into a starting adaptable framework for health care leaders to leverage when starting their own transformational change journeys using the lean system. Health care leaders could utilize the outcomes reported in this study as a conduit to enhance the effective deployment, widespread adoption, and sustainment of the lean system in practice. PMID:22207019

  9. Applying User Input to the Design and Testing of an Electronic Behavioral Health Information System for Wraparound Care Coordination.

    Science.gov (United States)

    Bruns, Eric J; Hyde, Kelly L; Sather, April; Hook, Alyssa N; Lyon, Aaron R

    2016-05-01

    Health information technology (HIT) and care coordination for individuals with complex needs are high priorities for quality improvement in health care. However, there is little empirical guidance about how best to design electronic health record systems and related technologies to facilitate implementation of care coordination models in behavioral health, or how best to apply user input to the design and testing process. In this paper, we describe an iterative development process that incorporated user/stakeholder perspectives at multiple points and resulted in an electronic behavioral health information system (EBHIS) specific to the wraparound care coordination model for youth with serious emotional and behavioral disorders. First, we review foundational HIT research on how EBHIS can enhance efficiency and outcomes of wraparound that was used to inform development. After describing the rationale for and functions of a prototype EBHIS for wraparound, we describe methods and results for a series of six small studies that informed system development across four phases of effort-predevelopment, development, initial user testing, and commercialization-and discuss how these results informed system design and refinement. Finally, we present next steps, challenges to dissemination, and guidance for others aiming to develop specialized behavioral health HIT. The research team's experiences reinforce the opportunity presented by EBHIS to improve care coordination for populations with complex needs, while also pointing to a litany of barriers and challenges to be overcome to implement such technologies. PMID:26060099

  10. The Danish patient safety experience: the Act on Patient Safety in the Danish health care system

    OpenAIRE

    Mette Lundgaard; Louise Raboel; Elisabeth Broegger Jensen; Jacob Anhoej; Beth Lilja Pedersen; Danish Society for Patient Safety

    2005-01-01

    This paper describes the process that lead to the passing of the Act for Patient Safety in the Danish health care system, the contents of the act and how the act is used in the Danish health care system.

    The act obligates frontline health care personnel to report adverse events, hospital owners to act on the reports and the National Board of Health to communicate the learning nationally.

    The act protects health care providers from sanctions as a re...

  11. Economic crisis and counter-reform of universal health care systems: Spanish case

    Science.gov (United States)

    Fortes, Paulo Antônio de Carvalho; Carvalho, Regina Ribeiro Parizi; Louvison, Marília Cristina Prado

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities. PMID:26083942

  12. Economic crisis and counter-reform of universal health care systems: Spanish case

    Directory of Open Access Journals (Sweden)

    Paulo Antônio de Carvalho Fortes

    2015-01-01

    Full Text Available The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities.

  13. Economic crisis and counter-reform of universal health care systems: Spanish case.

    Science.gov (United States)

    Fortes, Paulo Antônio de Carvalho; Carvalho, Regina Ribeiro Parizi; Louvison, Marília Cristina Prado

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities. PMID:26083942

  14. Results from commissioning the AGS Booster orbit system

    Energy Technology Data Exchange (ETDEWEB)

    Bleser, E.

    1993-06-01

    This note reports results from the commissioning of three systems in the AGS Booster. The beam position monitor system, which works to a relative accuracy of 0.36 millimeters; the uncorrected Booster orbit, which has quite large excursions; and the passive eddy current correction system, which eliminates all but a few percent of the eddy current dipole effect.

  15. The tyranny of profit: concentration of wealth, corporate globalization, and the failed US health care system.

    Science.gov (United States)

    Schroeder, Carole

    2003-01-01

    In this article, I argue that the concentration of wealth and power in the United States and its accompanying ideals of corporate capitalism and globalization are destroying not only the economic security of US families, but also our health care system and the ideals of a participatory democracy. The article is composed of 2 parts. Part I is a portrayal of the US economic and health care system as it is, one that enacts an ideology of never-ending profit, inequality, and exclusion based on class, color, and ability to pay. Initially, I outline the wealth gap in our society and deconstruct the popular myth that most US families benefited from the stock market gains of the 80s and 90s; next I discuss the process of corporatization and globalization of business and the resultant attack on the ideals of participatory democracy. Finally, I briefly trace the history of the corporatization of US health care and outline its impact on costs, access, quality, and population health. Part II is a more philosophical discussion of ways out of the dilemmas portrayed in Part I. Among other things, I discuss how a deepening of our political commitment is needed, a process that entails a move away from the current politics of the Prince toward a politics of the people. This deeper way of living our politics makes every act a political act, enabling us to resist what we are told, denounce that which is unacceptable, unite around common ground, and enact previously unimagined alternatives. PMID:12945653

  16. Treatment preferences in juvenile idiopathic arthritis – a comparative analysis in two health care systems

    Directory of Open Access Journals (Sweden)

    Hugle Boris

    2013-01-01

    Full Text Available Abstract Background Variations in the treatment of juvenile idiopathic arthritis (JIA may impact on quality of care. The objective of this study was to identify and compare treatment approaches for JIA in two health care systems. Methods Paediatric rheumatologists in Canada (n=58 and Germany/Austria (n=172 were surveyed by email, using case-based vignettes for oligoarticular and seronegative polyarticular JIA. Data were analysed using descriptive statistics; responses were compared using univariate analysis. Results Total response rate was 63%. Physicians were comparable by age, level of training and duration of practice, with more Canadians based in academic centres. For initial treatment of oligoarthritis, only approximately half of physicians in both groups used intra-articular steroids. German physicians were more likely to institute DMARD treatment in oligoarthritis refractory to NSAID (p Conclusions Treatment of oligo- and polyarticular JIA with DMARD is mostly uniform, with availability and funding obviously influencing physician choice. Usage of intra-articular steroids is variable within physician groups. Physiotherapy has a fundamentally different role in the two health care systems.

  17. Environmental Impacts of the U.S. Health Care System and Effects on Public Health

    Science.gov (United States)

    Eckelman, Matthew J.; Sherman, Jodi

    2016-01-01

    The U.S. health care sector is highly interconnected with industrial activities that emit much of the nation’s pollution to air, water, and soils. We estimate emissions directly and indirectly attributable to the health care sector, and potential harmful effects on public health. Negative environmental and public health outcomes were estimated through economic input-output life cycle assessment (EIOLCA) modeling using National Health Expenditures (NHE) for the decade 2003–2013 and compared to national totals. In 2013, the health care sector was also responsible for significant fractions of national air pollution emissions and impacts, including acid rain (12%), greenhouse gas emissions (10%), smog formation (10%) criteria air pollutants (9%), stratospheric ozone depletion (1%), and carcinogenic and non-carcinogenic air toxics (1–2%). The largest contributors to impacts are discussed from both the supply side (EIOLCA economic sectors) and demand side (NHE categories), as are trends over the study period. Health damages from these pollutants are estimated at 470,000 DALYs lost from pollution-related disease, or 405,000 DALYs when adjusted for recent shifts in power generation sector emissions. These indirect health burdens are commensurate with the 44,000–98,000 people who die in hospitals each year in the U.S. as a result of preventable medical errors, but are currently not attributed to our health system. Concerted efforts to improve environmental performance of health care could reduce expenditures directly through waste reduction and energy savings, and indirectly through reducing pollution burden on public health, and ought to be included in efforts to improve health care quality and safety. PMID:27280706

  18. [Nursing care of a school-age child with asthma: an ecological system theory approach].

    Science.gov (United States)

    Tzeng, Yu-Fen; Gau, Bih-Shya

    2012-02-01

    This research applied the Ecological System Theory of Dr. Bronfenbrenner (1979) to evaluate and analyze the impact of a school-age asthmatic child's ecological environment on the child's development. This project ran from March 16th to April 16th, 2010. A full range of data was collected during clinical care, outpatient follow-up services, telephone interviews, home visits, and school visits and then identified and analyzed. Results indicated that the family, household environment, campus, teachers, classmates, physical education program, and medical staffs comprised the most immediate microsystem and that parents, school nurses, teachers, and classmates formed the child's mesosystem. Researchers found a lack of understanding and appreciation in the mesosystem regarding asthmatic patient care needs. Hidden factors in the environment induced asthma, which eventually caused the child to be unable to obtain necessary medical care assistance. The exosystem reflected adequacy of the family social economy. The father's flexible working hours allowed him to allocate more time to childcare responsibilities. The government Asthma Medical Payment program also facilitated effective care. The macrosystem demonstrated parental cognition related to asthma treatment and caring to be deeply influenced by local customs. Thus, rather than using advanced medical treatments, parents preferred to follow traditional Chinese medicinal practices. Evaluation using the Ecological of Human Development Theory showed the subject's ecology environment relationships as based upon a foundation of family and school. Therefore, active family and school support for an asthma management plan appropriate to the subject's needs was critical. Asthma symptoms were better controlled after the child and his parents invested greater effort in mastering asthma management protocols. PMID:22314656

  19. Europe's strong primary care systems are linked to better population health but also to higher health spending.

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.; Zee, J. van der; Groenewegen, P.

    2013-01-01

    Strong primary care systems are often viewed as the bedrock of health care systems that provide high-quality care, but the evidence supporting this view is somewhat limited. We analyzed comparative primary care data collected in 2009-10 as part of a European Union-funded project, the Primary Health

  20. [Esophageal bezoar resulting from nasogastric enteral feeding in an intensive care unit].

    Science.gov (United States)

    Lartigue, C; Karayan, J; Beau, P; Kaffy, F

    2001-04-01

    We report two cases of oesophageal bezoar in patients given enteral nutrition by nasogastric tubing in an intensive care unit. These two complications occurred during the year following the replacement of our standard enteral feed by a new preparation enriched in proteins. In both patients, the bezoar could be endoscopically removed. The enteral feeding solution is likely to be responsible for the development of this complication because no other factor known to favour this complication such as concomitant administration of sulfacrate or anti-acid agents was given to the patients; and the bezoar developed shortly after the new enteral feeding solution was used, a hypothesis supported by several similar case reports in the medical literature. PMID:11392248

  1. Developing Governance Structures in Health Care System Consolidation: A Framework for Nurse Leaders.

    Science.gov (United States)

    Swartz, Colleen H; Bentley, Sarah

    2016-01-01

    Given the acceleration and increasing complexity of integrative care models across health systems, the question how governance and management structure(s) should be operationalized and evolved to achieve peak system performance is paramount. In a recent evaluation of partnerships with the University of Kentucky HealthCare (UK HealthCare), the conceptualization of the integration management model was explored. It was recognized that nursing leadership, governance structure, and relationships are vital for successful movement and migration of appropriate care models. In this case, the evolving governance models and the forecasted impact on models of care delivery were carefully considered. This included the potential impact on nursing practice. As the model was developed, a conceptual framework was utilized to examine potential variant relationship arrangements and to provide organization to key constructs. Utilization of a blueprint to optimize decision making and provide a replicable approach was essential to management of the integration philosophy. PMID:27584887

  2. DWPF melter feed system: Model description and results

    International Nuclear Information System (INIS)

    The melter feed system is the last leg in the DWPF process. Slurry from the melter feed tank (MFT) is fed continuously to the melter by two parallel feed systems, each system having a nomina feed rate of 0.45 gpm. Each feed system can provide flow rates between 0.2 and 0.9 gprn. The acceptance criteria for the melter feed controllers is a maximum deviation from the desires fee flow rate of +0.25 and -0.10 gpm. Some recent tests of the DWPF melter feed systems have failed this criterion. Steady-state hydraulic models of the melter feed systems have been developed to help understand the hydraulic behaviors of the two systems. Test results and model results indicate that entrained air in the feed systems is probably the cause of control problems with the systems. This cannot be stated categorically since the models are single-phase, and the dynamic behavior is not modelled, but a compelling case can be made that there is entrained air in the systems, and it affects system performance. There are the operating characteristics of the two melter feed systems. System No. 1 return flow at the bottom of the tank through a dip tube, and system No. 2 return flow at the top of the tank. The dip tube on system No. 1 is the major geometric difference between the two systems. Model results indicate that there is a pocket in the dip tube, and therefore the dip tube serves to carry entrained air in the melter feed loop down to the bottom of the MFT. This hypothesis is supported by a simple drift-flux analysis of the flow in the dip tube, and the logical conclusion is in the balance the impact of the dip tube on melter feed system performance is adverse

  3. HEALTH CARE DATA WAREHOUSE SYSTEM ARCHITECTURE FOR INFLUENZA (FLU DISEASES

    Directory of Open Access Journals (Sweden)

    Rajib Dutta

    2013-02-01

    Full Text Available Data Warehouse is the most reliable technology used by the company for planning, forecasting and management. Critical business management data was contained in several unrelated and disconnected databases, both internally managed and from external sources. Client was unable to view the data from an integrated viewpoint. The data warehousing is one of the best technique to integrate data. This paper presents the Influenza (Flu diseases specific data warehouse architecture for health care. This could be used by the database administrator or executive manager, doctors, nurses, other staff members of the health care. Health care data warehouse is mostly important to integrate different data format from different data source. All information about patient including their medical test reports are store in the database, the executive manager needs to access those data and make a report. By seeing the report, the doctor takes action.

  4. The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

    Directory of Open Access Journals (Sweden)

    Odeyemi IA

    2013-03-01

    Full Text Available Isaac AO Odeyemi,1 John Nixon21Senior Director and Head of Health Economics and Outcomes Research, Astellas Pharma UK Ltd, Chertsey, UK; 2Teaching Associate in Health Economics, Department of Economics and Related Studies, University of York, York, UKBackground: Social and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI. This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity.Methods: A representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia that illustrates the principal forms and roles of PHI. Literature describing each country's health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity.Results: In the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system.Conclusion: PHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications

  5. Analysis of ACCOS system results reproducibility and results of first pre-mass production PWO certification

    International Nuclear Information System (INIS)

    One of the most important requirement of the ACCOS (Automatic Crystal Control System)system is the reproducibility of the results of measurements. Series of measurements dedicated to the analysis of the results reproducibility were made. The data presented show high reproducibility of the measurement results obtained with the ACCOS system and allow one to consider this system suitable for certification of the PWO lead tungstate crystals in conditions of long-term mass production. The first full-sized tests of the PWO(leads tungstate) crystals on the ACCOS system were carried out with the purposes of fine-tuning a method for the routine certification of the crystals parameters and to test the system itself. The PWO crystals produced at the Bogoroditsk Techno-Chemical Plant in the framework of the mass production preparation were used for these tests. In total, 35 full-sized PWO elements including 20 crystals of the first pre-mass production lot of 100 PWO crystals were analyzed. The results presented show that the proposed approach to the PWO crystals certification and the equipment for its realization, including the ACCOS system allow one to provide reliable certification of the scintillators for CMS ECAL construction. (authors)

  6. An ICT-Based Diabetes Management System Tested for Health Care Delivery in the African Context

    OpenAIRE

    Claude Takenga; Rolf-Dietrich Berndt; Olivier Musongya; Joël Kitero; Remi Katoke; Kakule Molo; Basile Kazingufu; Malikwisha Meni; Mambo Vikandy; Henri Takenga

    2014-01-01

    The demand for new healthcare services is growing rapidly. Improving accessibility of the African population to diabetes care seems to be a big challenge in most countries where the number of care centers and medical staff is reduced. Information and communication technologies (ICT) have great potential to address some of these challenges faced by several countries in providing accessible, cost-effective, and high-quality health care services. This paper presents the Mobil Diab system which i...

  7. Health care systems in Sweden and China: Legal and formal organisational aspects

    OpenAIRE

    Hjelm Katarina; Albin Björn; Chang Zhang Wen

    2010-01-01

    Abstract Background Sharing knowledge and experience internationally can provide valuable information, and comparative research can make an important contribution to knowledge about health care and cost-effective use of resources. Descriptions of the organisation of health care in different countries can be found, but no studies have specifically compared the legal and formal organisational systems in Sweden and China. Aim To describe and compare health care in Sweden and China with regard to...

  8. Characteristics of physical activity programs in the Brazilian primary health care system

    OpenAIRE

    Grace Angélica de Oliveira Gomes; Eduardo Kokubun; Grégore Iven Mieke; Luiz Roberto Ramos; Michael Pratt; Diana C. Parra; Eduardo Simões; Florindo, Alex A; Mario Bracco; Danielle Cruz; Deborah Malta; Felipe Lobelo; Hallal, Pedro C.

    2014-01-01

    The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF). We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units repo...

  9. The suitability of care pathways for integrating processes and information systems in healthcare

    OpenAIRE

    Crocker, TF; Johnson, OA; King, SF

    2009-01-01

    Purpose: This paper examines the suitability of current care pathway modelling techniques for supporting business improvement and the development of information systems. This is in the light of current UK government policies advocating the use of care pathways as part of the £12.4 billion programme for IT and as a key strategy to reducing waiting times. Approach: We conducted a qualitative analysis of the variety in purpose, syntax and semantics in a selection of existing care pathways. Findi...

  10. Directors' duty of care to monitor information systems in HMOs: some lessons from the Oxford Health Plan.

    Science.gov (United States)

    O'Byrne, M E

    This paper examines the legal and strategic issues raised by the use of information systems in health maintenance organizations (HMOs) and other managed care organizations. Given the critical nature of information systems to an HMO's business success and regulatory compliance, the large financial investment HMOs make in their systems, and the widely publicized concerns over the year 2000 "millennium bug" problem, information systems are appropriately a matter of concern to an HMO's board of directors. The recent experience of Oxford Health Plans, Inc. offers a case study in the apparent failure of the directors to monitor adequately the in-house development of an information system. The systems disaster which this corporation suffered in 1997 led to a dramatic drop in stock price, from which the company has yet to recover, as well as intense scrutiny by state and federal regulators and countless shareholder derivative actions against the directors. Corporate directors are subject to the fiduciary duty of care. Despite statutes in some states requiring directors to act prudently, state courts almost always apply the standard of gross negligence. As a result, even when directors act without due deliberation in their decision, it is rare that a court will find them to have failed in their duty of care. The business and regulatory community may find otherwise, however, when directors fail to evaluate information systems options carefully and the business suffers as a result. PMID:11187367

  11. Do Effects of Early Child Care Extend to Age 15 Years? Results From the NICHD Study of Early Child Care and Youth Development

    OpenAIRE

    Vandell, Deborah Lowe; Belsky, Jay; Burchinal, Margaret; Vandergrift, Nathan; STEINBERG, LAURENCE

    2010-01-01

    Relations between nonrelative child care (birth to 4 ½ years) and functioning at age 15 were examined (N = 1364). Both quality and quantity of child care were linked to adolescent functioning. Effects were similar in size as those observed at younger ages. Higher quality care predicted higher cognitive-academic achievement at age 15, with escalating positive effects at higher levels of quality. The association between quality and achievement was mediated, in part, by earlier child care effect...

  12. Prescriber and staff perceptions of an electronic prescribing system in primary care: a qualitative assessment

    Directory of Open Access Journals (Sweden)

    Sittig Dean F

    2010-11-01

    Full Text Available Abstract Background The United States (US Health Information Technology for Economic and Clinical Health Act of 2009 has spurred adoption of electronic health records. The corresponding meaningful use criteria proposed by the Centers for Medicare and Medicaid Services mandates use of computerized provider order entry (CPOE systems. Yet, adoption in the US and other Western countries is low and descriptions of successful implementations are primarily from the inpatient setting; less frequently the ambulatory setting. We describe prescriber and staff perceptions of implementation of a CPOE system for medications (electronic- or e-prescribing system in the ambulatory setting. Methods Using a cross-sectional study design, we conducted eight focus groups at three primary care sites in an independent medical group. Each site represented a unique stage of e-prescribing implementation - pre/transition/post. We used a theoretically based, semi-structured questionnaire to elicit physician (n = 17 and staff (n = 53 perceptions of implementation of the e-prescribing system. We conducted a thematic analysis of focus group discussions using formal qualitative analytic techniques (i.e. deductive framework and grounded theory. Two coders independently coded to theoretical saturation and resolved discrepancies through discussions. Results Ten themes emerged that describe perceptions of e-prescribing implementation: 1 improved availability of clinical information resulted in prescribing efficiencies and more coordinated care; 2 improved documentation resulted in safer care; 3 efficiencies were gained by using fewer paper charts; 4 organizational support facilitated adoption; 5 transition required time; resulted in workload shift to staff; 6 hardware configurations and network stability were important in facilitating workflow; 7 e-prescribing was time-neutral or time-saving; 8 changes in patient interactions enhanced patient care but required education; 9 pharmacy

  13. Do Effects of Early Child Care Extend to Age 15 Years? Results from the NICHD Study of Early Child Care and Youth Development

    Science.gov (United States)

    Vandell, Deborah Lowe; Belsky, Jay; Burchinal, Margaret; Steinberg, Laurence; Vandergrift, Nathan

    2010-01-01

    Relations between nonrelative child care (birth to 4 1/2 years) and functioning at age 15 were examined (N = 1,364). Both quality and quantity of child care were linked to adolescent functioning. Effects were similar in size as those observed at younger ages. Higher quality care predicted higher cognitive-academic achievement at age 15, with…

  14. Assessment of Systems for Paying Health Care Providers in Mongolia

    OpenAIRE

    Joint Learning Network; Mongolia Ministry of Health; World Bank; World Health Organization,

    2015-01-01

    Achieving access to basic health services for the entire population without risk of financial hardship or impoverishment from out-of-pocket expenditures (‘universal health coverage’ or UHC) is a challenge that continues to confront most low- and middle-income countries. As coverage expands in these countries, issues of financial sustainability, efficiency, and quality of care quickly rise ...

  15. Transforming to a computerized system for nursing care: organizational success within Magnet idealism.

    Science.gov (United States)

    Lindgren, Carolyn L; Elie, Leslie G; Vidal, Elizabeth C; Vasserman, Alex

    2010-01-01

    In reaching the goal for standardized, quality care, a not-for-profit healthcare system consisting of seven institutional entities is transforming nursing practice guidelines, patient care workflow, and patient documents into electronic, online, real-time modalities for use across departments and all healthcare delivery entities of the system. Organizational structure and a strategic plan were developed for the 2-year Clinical Transformation Project. The Siemens Patient Care Document System was adopted and adapted to the hospitals' documentation and information needs. Two fast-track sessions of more than 100 nurses and representatives from other health disciplines were held to standardize assessments, histories, care protocols, and interdisciplinary plans of care for the top 10 diagnostic regulatory groups. Education needs of the users were addressed. After the first year, a productive, functional system is evidenced. For example, the bar-coded Medication Administration Check System is in full use on the clinical units of one of the hospitals, and the other institutional entities are at substantial stages of implementation of Patient Care Documentation System. The project requires significant allocation of personnel and financial resources for a highly functional informatics system that will transform clinical care. The project exemplifies four of the Magnet ideals and serves as a model for others who may be deciding about launching a similar endeavor. PMID:20182156

  16. Counting on commitment; the quality of primary care-led diabetes management in a system with minimal incentives

    Directory of Open Access Journals (Sweden)

    Mc Hugh Sheena

    2011-12-01

    Full Text Available Abstract Background The aim of the present study was to assess the performance of three primary care-led initiatives providing structured care to patients with Type 2 diabetes in Ireland, a country with minimal incentives to promote the quality of care. Methods Data, from three primary care initiatives, were available for 3010 adult patients with Type 2 diabetes. Results were benchmarked against the national guidelines for the management of Type 2 diabetes in the community and results from the National Diabetes Audit (NDA for England (2008/2009 and the Scottish Diabetes Survey (2009. Results The recording of clinical processes of care was similar to results in the UK however the recording of lifestyle factors was markedly lower. Recording of HbA1c, blood pressure and lipids exceeded 85%. Recording of retinopathy screening (71% was also comparable to England (77% and Scotland (90%. Only 63% of patients had smoking status recorded compared to 99% in Scotland while 70% had BMI recorded compared to 89% in England. A similar proportion of patients in this initiative and the UK achieved clinical targets. Thirty-five percent of patients achieved a target HbA1c of 30 kg/m2 in Ireland (50%, n = 1060 compared to Scotland (54%. Conclusions This study has demonstrated what can be achieved by proactive and interested health professionals in the absence of national infrastructure to support high quality diabetes care. The quality of primary care-led diabetes management in the three initiatives studied appears broadly consistent with results from the UK with the exception of recording lifestyle factors. The challenge facing health systems is to establish quality assurance a responsibility for all health care professionals rather than the subject of special interest for a few.

  17. PATIENT DATA MANAGEMENT SYSTEM IN INTENSIVE CARE UNIT (ICU) USING LABVIEW

    OpenAIRE

    Amritjot Kaur*, Shimi S. L

    2016-01-01

    This paper proposes a new system that takes the benefits of data flow technology. Its objective is to collect the data from monitoring system in the intensive care unit (ICU) and store that data for further analysis. Then it will be available for medical personnel to analyze data and take the suitable medication for patients. In fact, the monitoring system in intensive care unit provides a large amount of data quickly and continuously. Most units operate with a very limited storage capacity w...

  18. Novel wireless electroencephalography system with a minimal preparation time for use in emergencies and prehospital care

    OpenAIRE

    Jakab, Andrei; Kulkas, Antti; Salpavaara, Timo; Kauppinen, Pasi; Verho, Jarmo; Heikkilä, Hannu; Jäntti, Ville

    2014-01-01

    Background Although clinical applications such as emergency medicine and prehospital care could benefit from a fast-mounting electroencephalography (EEG) recording system, the lack of specifically designed equipment restricts the use of EEG in these environments. Methods This paper describes the design and testing of a six-channel emergency EEG (emEEG) system with a rapid preparation time intended for use in emergency medicine and prehospital care. The novel system comprises a quick-applicati...

  19. Effect of Collaborative Care System (CCS) on Blood Glucose Levels in Type 2 Diabetes Mellitus Outpatient

    OpenAIRE

    Nuryati Kuman; Bangunawati Rahajeng

    2016-01-01

    Some health system in various countries in the world is highly fragmented and is unable to resolve health problems. With collaborative care system, it is expected that DM patients can be managed well. We conducted a study to determine the effect of collaborative care system on blood glucose levels of patients with type 2 diabetes mellitus. This study uses a quasi-experimental design. Data was obtained by measuring random blood glucose levels in patients with type 2 diabetes mellitus. The samp...

  20. Development of a Daily Life Support System for Elderly Persons with Dementia in the Care Facility.

    Science.gov (United States)

    Takahashi, Yoshiyuki; Kawai, Toshihiro; Komeda, Takashi

    2015-01-01

    Taking care for dementia persons with BPSD is burdening on caregivers. To reduce caregivers' burdens and improve dementia persons' quality of life, monitoring and communication intervention system has been proposed. A part of the system, wandering and falling down detection system has been developed. It is designed based on the requirement of the caregivers working in the care facility. Functional test was carried out and had positive impressions from the caregivers. PMID:26294607

  1. Long term effects of preventive activities of youth health care in The Netherlands: results of a four-part study

    OpenAIRE

    Wiegersma, Pieter A; Albert Hofman; Gerhard A. Zielhuis

    2004-01-01

    Background. In this article the results are presented of a four part study on the effect of screening for scoliosis and (repeated) well-care visits and freely accessible consultation hours at secondary schools, on the incidence and prevalence of (para)suicide, mental health, adolescent health compromising behaviour and lastly obesity.

    Methods. An ecologic case-referent study design was used with data from the...

  2. Womens' opinions on antenatal care in developing countries: results of a study in Cuba, Thailand, Saudi Arabia and Argentina

    OpenAIRE

    Farnot Ubaldo; Carroli Guillermo; Ba'aqeel Hassan; Al-Mazrou Yagob; Garcia Jo; Villar José; Al-Osimy Muneera; Rojas Georgina; Romero Mariana; Kuchaisit Chusri; Langer Ana; Nigenda Gustavo; Lumbiganon Pisake; Belizán José; Bergsjo Per

    2003-01-01

    Abstract Background The results of a qualitative study carried out in four developing countries (Cuba, Thailand, Saudi Arabia and Argentina) are presented. The study was conducted in the context of a randomised controlled trial to test the benefits of a new antenatal care protocol that reduced the number of visits to the doctor, rationalised the application of technology, and improved the provision of information to women in relation to the traditional protocol applied in each country. Method...

  3. Counseling and Wellness Services Integrated with Primary Care: A Delivery System That Works

    OpenAIRE

    Van Beek, Ken; Duchemin, Steve; Gersh, Geniene; Pettigrew, Susanne; Silva, Pamela; Luskin, Barb

    2008-01-01

    Introduction: The continuity and coordination of care between medical and behavioral health services is a major issue facing our health care delivery system. Barriers to basic communication between providers of medical services and providers of behavioral health services, include: no coordination of services, and poor recognition of the relationship between medical and behavioral issues.

  4. Patterns of care for brachytherapy in Europe (PC BE) in Spain and Poland: Comparative results

    International Nuclear Information System (INIS)

    Background: Cancer incidence and its mortality depend on a number of factors, including age, socio-economic status and geographic situation, and its incidence is growing around the world. Cancer incidence in Europe is now about 4000 patients per million per year and due to the ageing population a yearly increase of 1 - 1.5 % in cancer cases is estimated in the next two decades. Most of the cancer treatments will include external beam radiotherapy or brachytherapy. Brachytherapy has increased its use as a radical or palliative treatment and become more sophisticated with the spread of pulsed dose rate and high dose rate afterloading machines, and the use of new planning systems has additionally improved quality of treatment. Aim: The aim of the present study was to compare two countries (Poland and Spain) and to report the differences in the use of brachytherapy in these countries. For this reason, several characteristics related to brachytherapy were compared. Materials/Methods: The data used were collected using a web site questionnaire for the year 2002 where every centre that participated in the survey could introduce, change or update the information requested. Hospitals included in the study were those that provided data on brachytherapy, because our objective was to compare the brachytherapy facilities between Poland and Spain. Results: Data were available for 22 centres in Poland and 39 centres in Spain that provided brachytherapy in 2002. Spain having more centres that applied brachytherapy (1.0 centre per 1,000,000 inhabitants in Spain vs. 0.6 centre per 1,000,000 inhabitants in Poland), the average number of brachytherapy patients per centre is lower in Spain than in Poland, 137 and 382 respectively. The 5 main tumour sites treated with brachytherapy in Poland were: gynaecological (73.7 %), bronchus (13.0 %), breast (2.8 %), prostate (2.4 %) and head and neck (1.6 %). In Spain they were: gynaecological (59.7 %), breast (15.4 %), prostate (12.8 %), head

  5. The March 4, 2002 Law: An Announced Metamorphosis of the Health Care System?

    Directory of Open Access Journals (Sweden)

    Vialla F

    2002-09-01

    Full Text Available On March 4, 2002, law N° 2002-303 relating to patients’ rights and the quality of the health care system was finally passed. After a long waiting-period, this unusually long text underwent a lengthy maturation before being formally proposed as a law. In contrast, congressional debate on the subject was rapidly concluded in a climate of emergency and, regretfully, in the absence of a veritable parliamentary discussion. Consequently, the result appears somewhat unfinished. Assuredly, this law represents a major reform of the French health care system but many unclear areas persist due to numerous imperfections in its drafting. The law provides major advances with respect to the rights of patients who are transformed from objects receiving health benefits into subjects with full membership in the system. Patient rights have been systematically increased. They are now entitled to veritable general (generous? rights. In the future, the patient controls the medical decisions concerning him! Access to information and the right to obtain information directly related to his case are significant clauses written into the new law. Directly or through his proxy, the patient becomes an integral part of the decision-making process and of the management of the health care system which has been reformed, sometimes profoundly, by the text. Finally, the new law modifies the legal aspects of medical responsibility by creating, notably, the obligation to receive medical coverage and provides for the resolution of disagreements though methods other than litigation. However, in practice, the complexities and incongruities of the actual text risk obscuring even more a subject which was intended to be simplified.

  6. System and Patient Barriers to Care among People Living with HIV/AIDS in Houston/Harris County, Texas: HIV Medical Care Providers' Perspectives.

    Science.gov (United States)

    Mgbere, Osaro; Khuwaja, Salma; Bell, Tanvir K; Rodriguez-Barradas, Maria C; Arafat, Raouf; Essien, Ekere James; Singh, Mamta; Aguilar, Jonathan; Roland, Eric

    2015-01-01

    In the United States, a considerable number of people diagnosed with HIV are not receiving HIV medical care due to some barriers. Using data from the Medical Monitoring Project survey of HIV medical care providers in Houston/Harris County, Texas, we assessed the HIV medical care providers' perspectives of the system and patient barriers to HIV care experienced by people living with HIV/AIDS (PLWHA). The study findings indicate that of the 14 HIV care barriers identified, only 1 system barrier and 7 patient barriers were considered of significant (P ≤ .05) importance, with the proportion of HIV medical care providers' agreement to these barriers ranging from 73.9% (cost of health care) to 100% (lack of social support systems and drug abuse problems). Providers' perception of important system and patient barriers varied significantly (P ≤ .05) by profession, race/ethnicity, and years of experience in HIV care. To improve access to and for consistent engagement in HIV care, effective intervention programs are needed to address the barriers identified especially in the context of the new health care delivery system. PMID:24943655

  7. The results of a national survey regarding nutritional care of obese burn patients.

    Science.gov (United States)

    Coen, Jennifer R; Carpenter, Annette M; Shupp, Jeffrey W; Matt, Sarah E; Shaw, Jesse D; Flanagan, Katherine E; Pavlovich, Anna R; Jeng, James C; Jordan, Marion H

    2011-01-01

    nutritional care of obese burn patients. This indicates the need for further research to determine consistent best practices. PMID:21785364

  8. Integrated alarm annunciation and entry control systems -- Survey results

    Energy Technology Data Exchange (ETDEWEB)

    Clever, J.J.; Arakaki, L.H.; Monaco, F.M.; Juarros, L.E.; Quintana, G.R.

    1993-10-01

    This report provides the results and analyses of a detailed survey undertaken in Summer 1993 to address integrated intrusion detection alarm annunciation and entry control system issues. This survey was undertaken as a first attempt toward beginning to answer questions about integrated systems and commercial capabilities to meet or partially meet US Department of Energy (DOE) site needs.

  9. On the quadratic stability of switched interval systems: Preliminary results

    OpenAIRE

    Zeheb, Ezra; Mason, Oliver; SOLMAZ, Selim; Shorten, Robert

    2005-01-01

    In this paper we present some preliminary results on the quadratic stability of switched systems with uncertain parameters. We show that the quadratic stability of a class of switched uncertain systems may be readily verified using simple algebraic conditions. Examples are presented to demonstrate the efficacy of our techniques.

  10. A belt charging system for the Vivitron - design, early results

    International Nuclear Information System (INIS)

    A specific belt charging system has been designed, built and assembled for the 35 MV Vivitron. 100 m long belt is used. Together with main features of the design, experimental studies, tests in a pilot machine and the results of the very early tests of the real system are reviewed

  11. First results with the charging system of the Vivitron

    International Nuclear Information System (INIS)

    An original, Van de Graaff type, belt charging system has been designed, built and assembled for the Vivitron, a 35 MV Tandem accelerator. Together with a detailed description of it, experimental studies, tests in a pilot machine and the results of the very first tests of the real system are reviewed

  12. Integrated alarm annunciation and entry control systems -- Survey results

    International Nuclear Information System (INIS)

    This report provides the results and analyses of a detailed survey undertaken in Summer 1993 to address integrated intrusion detection alarm annunciation and entry control system issues. This survey was undertaken as a first attempt toward beginning to answer questions about integrated systems and commercial capabilities to meet or partially meet US Department of Energy (DOE) site needs

  13. Interventions geared towards strengthening the health system of Namibia through the integration of palliative care

    Science.gov (United States)

    Freeman, Rachel; Luyirika, Emmanuel BK; Namisango, Eve; Kiyange, Fatia

    2016-01-01

    The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation’s public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation.

  14. Creating a continuum. The goal is to provide an integrated system of care.

    Science.gov (United States)

    Evashwick, C J

    1989-06-01

    The idea of a continuum of care is hardly new. In its purest form, it is simply the essence of good patient care. Today, the complex U.S. healthcare organization has emerged as a highly sophisticated but fragmented collection of service providers. We now must put energy and resources into rebuilding the comprehensiveness and continuity that represent high-quality care. The rationale for a continuum of care is that it is appropriate for patients' needs, demanded by today's consumers, an organized way of maximizing use of healthcare resources, and cost-effective for providers, patients, and payers. A continuum of care comprises services and integrating mechanisms. The services can be broken into seven basic categories: extended care, acute hospital care, ambulatory care, home care, outreach, wellness, and housing. The four basic integrating mechanisms are interentity planning and management, care coordination, case-based financing, and integrated information systems. Shaping a continuum mandates translating broad principles into pragmatic application suitable for the organization and community. The organization should define goals and objectives, identify a target population, assess services, evaluate integrating mechanisms, communicate, and prepare a business plan. PMID:10293328

  15. Circumventing Picture Archiving and Communication Systems Server with Hadoop Framework in Health Care Services

    Directory of Open Access Journals (Sweden)

    Gopinath Ganapathy

    2010-01-01

    Full Text Available Problem statement: Features and challenges of the PACS server solutions are elaborated in the context of large scale computing. Approach: Hadoop is a pivotal piece of the data mining renaissance offers the ability to tackle large data sets in ways that weren’t previously feasible and clarifies certain functionalities such as MapReducer and Hadoop distributed file system. Results: The PACS server was highlighted in Health Care System with primary Functions of DICOM and basic operations of query, retrieval and routing were performed on various images. The study attempted to propose a concept called Hadoop Picture Archiving and Communication System (HPACS same as any other PACS server except that is uses distributed storage and distributed computing on commodity of hardware. Conclusion/Recommendations: The features of PACS and HPACS are compared in terms of storage, backup, cost, performance, turnaround time and backup. Finally, the advantages of Hadoop solution were explained.

  16. Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra; Ziebe, Søren; Mikkelsen Englund, Anne L; Hald, Finn; Boivin, Jacky; Schmidt, Lone

    2014-01-01

    To examine the costs to the public health care system of couples in medically assisted reproduction.......To examine the costs to the public health care system of couples in medically assisted reproduction....

  17. The PERS(2) ON score for systemic assessment of symptomatology in palliative care: a pilot study.

    Science.gov (United States)

    Masel, E K; Berghoff, A S; Schur, S; Maehr, B; Schrank, B; Simanek, R; Preusser, M; Marosi, C; Watzke, H H

    2016-07-01

    The comprehensive assessment of symptoms is the basis for effective, individualised palliative treatment. Established scoring systems provide in-depth information but are often lengthy and hence unsuitable. We introduce the PERS(2) ON score as a short and practically feasible score to evaluate symptom burden. Fifty patients admitted to a Palliative Care Unit rated seven items, i.e. pain, eating (loss of appetite/weight loss), rehabilitation (physical impairment), social situation (possibility for home care), suffering (anxiety/burden of disease/depression), O2 (dyspnoea) and nausea/emesis, on a scale ranging from 0 (absence) to 10 (worst imaginable), resulting in a score ranging from 0 to 70. Assessments were performed at admission, 7 days after admission and at the day of discharge. Symptom intensity scores were calculated, and change over time was evaluated. A significant improvement was observed from the PERS²ON score between admission and 7 days (P evaluation to evaluation on the day of discharge was observed (P = 0.001; paired t-test). This study provides initial evidence that the PERS²ON score is both feasible and sensitive to changes of the most prominent symptoms in palliative care. It may be useful in clinical practice to direct palliative treatment strategies and provide targeted symptom management. PMID:26564404

  18. Simulation of diurnal thermal energy storage systems: Preliminary results

    Science.gov (United States)

    Katipamula, S.; Somasundaram, S.; Williams, H. R.

    1994-12-01

    This report describes the results of a simulation of thermal energy storage (TES) integrated with a simple-cycle gas turbine cogeneration system. Integrating TES with cogeneration can serve the electrical and thermal loads independently while firing all fuel in the gas turbine. The detailed engineering and economic feasibility of diurnal TES systems integrated with cogeneration systems has been described in two previous PNL reports. The objective of this study was to lay the ground work for optimization of the TES system designs using a simulation tool called TRNSYS (TRaNsient SYstem Simulation). TRNSYS is a transient simulation program with a sequential-modular structure developed at the Solar Energy Laboratory, University of Wisconsin-Madison. The two TES systems selected for the base-case simulations were: (1) a one-tank storage model to represent the oil/rock TES system; and (2) a two-tank storage model to represent the molten nitrate salt TES system. Results of the study clearly indicate that an engineering optimization of the TES system using TRNSYS is possible. The one-tank stratified oil/rock storage model described here is a good starting point for parametric studies of a TES system. Further developments to the TRNSYS library of available models (economizer, evaporator, gas turbine, etc.) are recommended so that the phase-change processes is accurately treated.

  19. Do Pediatric Patients Who Receive Care Across Multiple Health Systems Have Higher Levels of Repeat Testing?

    Science.gov (United States)

    Knighton, Andrew J; Payne, Nathaniel R; Speedie, Stuart

    2016-04-01

    Repetition by clinicians of the same tests for a given patient is common. However, not all repeat tests are necessary for optimal care and can result in unnecessary hardship. Limited evidence suggests that an electronic health record may reduce redundant laboratory testing and imaging by making previous results accessible to physicians. The purpose of this study is to establish a baseline by characterizing repeat testing in a pediatric population and to identify significant risk factors associated with repeated tests, including the impact of using multiple health systems. A population-based retrospective cross-sectional design was used to examine initial and repeat test instances, defined as a second test following an initial test of the same type for the same patient. The study population consisted of 8760 children with 1-25 test claims over a 1-year period. The study setting included all health care service organizations in Minnesota that generated these claims. In all, 17.2% of tests met the definition of repeat test instances, with several risk factors associated with per patient repeat test levels. The incidence of repeat test instances per patient was significantly higher when patients received care from more than 1 health system (adjusted incidence rate ratio 1.4; 95% confidence interval: 1.3-1.5). Repeat test levels are significant in pediatric populations and potentially actionable. Interoperable health information technology may reduce the incidence of repeat test instances in pediatric populations by making prior test results readily accessible. (Population Health Management 2016;19:102-108). PMID:26086359

  20. Process of care and preliminary outcome in limited-stage small-cell lung cancer: results of the 1995-1997 patterns of care study in Japan

    International Nuclear Information System (INIS)

    Purpose: To evaluate the practice process using the national average (Na); to compare differences in the process of care by age group; and to provide a preliminary outcome data for limited-stage small-cell lung cancer in Japan. Methods and Materials: The Patterns of Care Study conducted a nationwide survey of the care process for Stage I-III small-cell lung cancer in Japan. Patients were divided into three age groups: <65 years (younger group, n = 73); between 65 and 74 years (intermediate group, n = 81); and ≥75 years (elderly group, n = 20). Results: The NA for the total dose was 49.0 Gy, and for use of photon energy ≥6 MV, chemotherapy, and prophylactic cranial irradiation was 77.3%, 93.2%, and 1.69%, respectively. Age stratification had no impact on the variables of radiotherapy (RT) such as total dose and field size. Only 37% of patients received chemotherapy and thoracic RT concurrently. The proportion of patients who received chemotherapy and RT concurrently was 44%, 27%, and 25% of the younger, intermediate, and elderly groups, respectively (p = 0.029). Etoposide and cisplatin were less frequently used in the elderly group (≥75 years old). Overall survival at 3 years for the entire group was 26%. The 3-year survival rate was 30% in the younger group, 28% in the intermediate group, and 9% in the elderly group. Variables found to have a significant impact on survival by multivariate analysis were the use of chemotherapy (p = 0.030), age (p 0.032), and T stage (p = 0.042). Conclusion: Calculated NAs showed that the results of clinical study had favorably penetrated into the practice process in Japan. The results demonstrated that patient age significantly influenced the process of chemotherapy such as the use of etoposide and cisplatin for limited-stage small-cell lung cancer in Japan. More concurrent chemotherapy and thoracic RT and the application of prophylactic cranial irradiation for complete responders need to be investigated in the future

  1. Mining care trajectories using health administrative information systems: the use of state sequence analysis to assess disparities in prenatal care consumption

    OpenAIRE

    Meur, Nolwenn Le; Gao, Fei; Bayat, Sahar

    2015-01-01

    Background Pregnant women are a vulnerable population. Although regular follow-ups are recommended during pregnancy, not all pregnant women seek care. This pilot study wanted to assess whether the integration of data from administrative health information systems and socio-economic features allows identifying disparities in prenatal care trajectories. Methods Prenatal care trajectories were extracted from the permanent sample of the French health insurance information system linked to the hos...

  2. Problems and tendencies in management optimisation of hospital sector within health care system of Republic of Bulgaria

    Directory of Open Access Journals (Sweden)

    M.G. Stoycheva

    2013-03-01

    Full Text Available The aim of the article. The purpose of this article is to analyze the specifics, priorities and tendencies of the reforms in hospital sector management within the health care system of Republic of Bulgaria, the hospital care organization practices in relation to the National discussions on issues of hospital sector of the health care system.The results of the analysis. The accession of Republic of Bulgaria to the EU has created new conditions in defining the priorities in the area of public health care, including hospital medical aid. Summarizing, accumulation and transfer of experience in reforming of health care systems of the European Union member states, development of unified requirements, harmonization of legislation, financing, structure of functioning and management of hospital care within the health care system, lead to the need of deep analysis of situation, strategic priorities renewal, management optimization of whole health care system, and in particular the hospital care system in Republic of Bulgaria.In the article the author analyses the research and publications of some major materials, regulations and documents, which provided the basis for the reforms in the health care management system in Republic of Bulgaria in its continuing integration into the pan-European system. Illustrating current situation analysis, the author shares the opinion that the most important part in the organization of common management system in health care is the sector responsible for the development of hospital financing.The author pays special attention to the issues of economic activity of health care institutions.The author cites a number of documents of the National Centre for Medical Information (NCMI noting that leading specialists of the Centre: .Dikov, R.Kolarova, T.Hundurzhievhave prepared detailed reports on economics 2001-2008 and comparative analysis of the medical institutions operation as well as those for outpatient care in Republic of

  3. Stroke burden and stroke care system in Asia

    OpenAIRE

    Suwanwela, Nijasri C.; Niphon Poungvarin; the Asian Stroke Advisory Panel

    2016-01-01

    Background: Stroke is a major cause of death and disability. Asia is the largest and mostly populated continent of the world. The Asian Stroke Advisory Panel (ASAP) consists of stroke neurologists from 12 different countries in 13 Asian regions. It has been established for 17 years, and holds regular meetings for reviewing the stroke activities in Asia. It also helps in conducting several multinational research projects. This study is one of the ASAP projects and aims to explore stroke care s...

  4. [Assessment of pharmaceutical care for pregnant women treated in the public health system in Praia Grande, São Paulo State, Brazil].

    Science.gov (United States)

    Vieira, Marlene Rosimar da Silva; Lorandi, Paulo Angelo; Bousquat, Aylene

    2008-06-01

    The use of medication in primary health care has increased steadily in recent decades, thus highlighting the relevance of assessing the pharmaceutical care provided to patients in the primary care setting. This article aimed to evaluate the pharmaceutical care provided by the public system in Greater Metropolitan Santos, São Paulo State, Brazil, focusing specifically on women during gestation. Methods included secondary data analysis, document analysis, interviews with key players, and visits to health services and to the pharmaceutical supply center. Deficiencies were identified in most stages of pharmaceutical care: selection, planning, purchase, storage, distribution, and dispensing. The results suggest that in order to improve primary health care, with better access, equality, and comprehensiveness, the evaluation of pharmaceutical care should be incorporated as a routine procedure. PMID:18545767

  5. Community of Solution for the U.S. Health Care System: Lessons from the U.S. Educational System

    Science.gov (United States)

    DeVoe, Jennifer E.; Gold, Rachel

    2016-01-01

    The Folsom Group asserts that radical changes are needed to fix the health care system in the United States. The U.S. education system is one potential model to emulate. Could a future health care system-level community of solution be modeled after the U.S. education system? Could community health care services be planned, organized, and delivered at the neighborhood level by district, similar to the structure for delivering public education? Could community health centers, governed by community boards, serve every neighborhood? This essay imagines how U.S. health care system reforms could be designed using our public school system as a roadmap. Our intention is to challenge readers to recognize the urgent need for radical reform in the U.S. health care system, to introduce one potential model for reform, and to encourage creative thinking about other system-level communities of solution that could lead to profound change and improvements in the U.S. health care system. PMID:23657701

  6. Liaison neurologists facilitate accurate neurological diagnosis and management, resulting in substantial savings in the cost of inpatient care.

    LENUS (Irish Health Repository)

    Costelloe, L

    2012-02-01

    BACKGROUND: Despite understaffing of neurology services in Ireland, the demand for liaison neurologist input into the care of hospital inpatients is increasing. This aspect of the workload of the neurologist is often under recognised. AIMS\\/METHODS: We prospectively recorded data on referral and service delivery patterns to a liaison neurology service, the neurological conditions encountered, and the impact of neurology input on patient care. RESULTS: Over a 13-month period, 669 consults were audited. Of these, 79% of patients were seen within 48 h and 86% of patients were assessed by a consultant neurologist before discharge. Management was changed in 69% cases, and discharge from hospital expedited in 50%. If adequate resources for neurological assessment had been available, 28% could have been seen as outpatients, with projected savings of 857 bed days. CONCLUSIONS: Investment in neurology services would facilitate early accurate diagnosis, efficient patient and bed management, with substantial savings.

  7. Venous thromboembolism risk and prophylaxis in the acute hospital care setting: the Irish results of the ENDORSE study.

    LENUS (Irish Health Repository)

    Murphy, O

    2012-05-01

    ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting), is a multinational, cross-sectional survey of venous thromboembolism (VTE) risk prevalence and effective prophylaxis in the acute hospital care setting. Three Irish hospitals enrolled in the study. The American College of Chest Physicians (ACCP) guidelines were employed to evaluate VTE risk and prophylaxis. Of 552 patients, 297 (53.8%) and 255 (46.2%) were categorised as surgical or medical, respectively, with 175 (59%) surgical and 109 (43%) medical patients deemed to be at risk for VTE. Of these, only 112 (64%) and 51 (47%) received recommended VTE prophylaxis, respectively. The results are consistent with those observed in other countries and demonstrate a high prevalence of risk for VTE and a low rate of prophylaxis use, particularly in medical patients. Awareness of VTE guidelines should be an integral component of health policy.

  8. Improving Universality Results on Parallel Enzymatic Numerical P Systems

    OpenAIRE

    Leporati, Alberto; Porreca, Antonio E.; Zandron, Claudio; Mauri, Giancarlo; Research Group on Natural Computing (Universidad de Sevilla) (Coordinador)

    2013-01-01

    We improve previously known universality results on enzymatic numerical P systems (EN P systems, for short) working in all-parallel and one-parallel modes. By using a attening technique, we rst show that any EN P system working in one of these modes can be simulated by an equivalent one-membrane EN P system working in the same mode. Then we show that linear production functions, each depending upon at most one variable, su ce to reach universality for both computing modes....

  9. Measuring health care efficiency with a tripartite configuration under the "National" Health Insurance system

    Institute of Scientific and Technical Information of China (English)

    Victor B.Kreng; Yang Shao-wei; Lin Chien-Hsu

    2014-01-01

    Background The "National" Health Insurance (NHI) in Taiwan,China is a single-payer system that was introduced in 1995 to provide universal health care.It is worth noting that three stakeholders are involved in Taiwan's NHI,which can be seen as a triangular governance regime between the Bureau of "National" Health Insurance (BNHI),the insured and providers.Accordingly,this study intended to assess the efficiency of various different production processes that occur among these stakeholders in Taiwan's NHI system.Methods A two-stage relational Data Envelopment Analysis (DEA) model is adopted to investigate the sub-process efficiencies of the health care resources held by 23 cities and counties through stages Ⅰ or Ⅱ,where the outputs of the first stage serve the inputs of the second.The dataset was collected from the annual reports published by the Department of Health,Taiwan,China.Results Under the proposed framework,the efficiency of the whole process can be obtained from the product of productivity and allocative efficiency.Ten DMUs are efficient either in stages Ⅰ or Ⅱ,with only two DMUs being efficient with regard to both sub-processes.Conclusion The relational DEA model not only demonstrates the physical relationship between the whole process and the sub-process components,but also produces reliable outcomes in efficiency measurement among different stakeholders in Taiwan's NHI system.

  10. The Influence of Organizational Systems on Information Exchange in Long-Term Care Facilities: An Institutional Ethnography.

    Science.gov (United States)

    Caspar, Sienna; Ratner, Pamela A; Phinney, Alison; MacKinnon, Karen

    2016-06-01

    Person-centered care is heavily dependent on effective information exchange among health care team members. We explored the organizational systems that influence resident care attendants' (RCAs) access to care information in long-term care (LTC) settings. We conducted an institutional ethnography in three LTC facilities. Investigative methods included naturalistic observations, in-depth interviews, and textual analysis. Practical access to texts containing individualized care-related information (e.g., care plans) was dependent on job classification. Regulated health care professionals accessed these texts daily. RCAs lacked practical access to these texts and primarily received and shared information orally. Microsystems of care, based on information exchange formats, emerged. Organizational systems mandated written exchange of information and did not formally support an oral exchange. Thus, oral information exchanges were largely dependent on the quality of workplace relationships. Formal systems are needed to support structured oral information exchange within and between the microsystems of care found in LTC. PMID:26758177

  11. The main issues and the ways of improvement of health care for patients with diseases of the circulatory system

    OpenAIRE

    Sazanova G.Yu.

    2014-01-01

    Regulations and publications on the provision of quality health care for patients with diseases of the circulatory system of the native scientists have been studied. The majority of the issues concerns the disorganization of health care standards: the uneven distribution of diagnostic resources mostly in the hospitals and preventive health care organizations. The proposed ways to improve the patient care have been analyzed.

  12. Multi-faceted informatics system for digitising and streamlining the reablement care model.

    Science.gov (United States)

    Bond, Raymond R; Mulvenna, Maurice D; Finlay, Dewar D; Martin, Suzanne

    2015-08-01

    Reablement is new paradigm to increase independence in the home amongst the ageing population. And it remains a challenge to design an optimal electronic system to streamline and integrate reablement into current healthcare infrastructure. Furthermore, given reablement requires collaboration with a range of organisations (including national healthcare institutions and community/voluntary service providers), such a system needs to be co-created with all stakeholders involved. Thus, the purpose of this study is, (1) to bring together stakeholder groups to elicit a comprehensive set of requirements for a digital reablement system, (2) to utilise emerging technologies to implement a system and a data model based on the requirements gathered and (3) to involve user groups in a usability assessment of the system. In this study we employed a mixed qualitative approach that included a series of stakeholder-involved activities. Collectively, 73 subjects were recruited to participate in an ideation event, a quasi-hackathon and a usability study. The study unveiled stakeholder-led requirements, which resulted in a novel cloud-based system that was created using emerging web technologies. The system is driven by a unique data model and includes interactive features that are necessary for streamlining the reablement care model. In summary, this system allows community based interventions (or services) to be prescribed to occupants whilst also monitoring the occupant's progress of independent living. PMID:25998520

  13. A study of human resource policies and practices for primary health care system in Delhi

    Directory of Open Access Journals (Sweden)

    Pawan Kumar

    2014-10-01

    Full Text Available Background: A comprehensive health care services requires effective human resource (HR management policy to ensure organizational success. Government is primarily concerned with the size of the workforce rather than the contemporary HR practices. This resulted into lack of attention to HR management in health sector. Objective: To critically examine HR policies and practice for primary health care system in Delhi. Materials and Methods: For critical analysis of HR policies and practices for primary urban health centers, related documents were examined from year 2005 to 2012. The policies and practices were examined with reference to HR planning, recruitment, selection, hiring, staffing, probation, induction training, performance evaluation, salary and transfer policy in the organization. Results: At present, updated HR planning is not done regularly and due to lack of such updated information actual HR requirement is not calculated leading to shortage backlog. To fill up this shortage contractual model to recruit staff has been adopted by health department. There is no induction training and training need assessment done in the organization. There is wide disparity in pay and leave provisions for different category of regular and contractual staff working under the same roof of health facilities. Conclusion: Disparity in salary, leave provision and other privileges in organization have brought discrimination and demotivation among employees. To deal with conflicting climate in organization comprehensive HR policy is suggested. Policy content should include HR planning, training and development, institute capacity building, HR information system, motivation, and retention strategies for HR.

  14. HEALTH CARE GUIDE TO POLLUTION PREVENTION IMPLEMENTATION THROUGH ENVIRONMENTAL MANAGEMENT SYSTEMS

    Science.gov (United States)

    The Health Care Guide to Pollution Prevention Implementation through Environmental Management Systems provides example EMS procedures and forms used in four ISO 14001 EMS certified hospitals. The latest revisions include more EMS hospital case studies, more compliance resources, ...

  15. The Effects of Foster Care Intervention on Socially Deprived Institutionalized Children's Attention and Positive Affect: Results from the BEIP Study

    Science.gov (United States)

    Ghera, Melissa M.; Marshall, Peter J.; Fox, Nathan A.; Zeanah, Charles H.; Nelson, Charles A.; Smyke, Anna T.; Guthrie, Donald

    2009-01-01

    Background: We examined the effects of a foster care intervention on attention and emotion expression in socially deprived children in Romanian institutions. Methods: Institutionalized children were randomized to enter foster care or to remain under institutional care. Subsequently, the institutionalized and foster care groups, along with a…

  16. Hidden consequences of success in pediatrics: parental health-related quality of life—results from the Care Project

    NARCIS (Netherlands)

    J. Hatzmann; H.S.A. Heymans; A. Ferrer-i-Carbonell; B.M.S. van Praag; M.A. Grootenhuis

    2008-01-01

    CONTEXT. The number of parents who care for a chronically ill child is increasing. Because of advances in medical care, parental caring tasks are changing. A detailed description of parental health-related quality of life will add to the understanding of the impact of caring for a chronically ill ch

  17. Nuclear Power Safety Reporting System. Final evaluation results

    International Nuclear Information System (INIS)

    This document presents the results of a study conducted by the US Nuclear Regulatory Commission of an unobtrusive, voluntary, anonymous third-party managed, nonpunitive human factors data gathering system (the Nuclear power Safety Reporting System - NPSRS) for the nuclear electric power production industry. The data to be gathered by the NPSRS are intended for use in identifying and quantifying the factors that contribute to the occurrence of significant safety incidents involving humans in nuclear power plants. The NPSRS has been designed to encourage participation in the System through guarantees of reporter anonymity provided by a third-party organization that would be responsible for NPSRS management. As additional motivation to reporters for contributing data to the NPSRS, conditional waivers of NRC disciplinary action would be provided to individuals. These conditional waivers of immunity would apply to potential violations of NRC regulations that might be disclosed through reports submitted to the System about inadvertent, noncriminal incidents in nuclear plants. This document summarizes the overall results of the study of the NPSRS concept. In it, a functional description of the NPSRS is presented together with a review and assessment of potential problem areas that might be met if the System were implemented. Conclusions and recommendations resulting from the study are also presented. A companion volume (NUREG/CR-4133, Nuclear Power Safety Reporting System: Implementation and Operational Specifications'') presented in detail the elements, requirements, forms, and procedures for implementing and operating the System. 13 refs

  18. Updated test results of a pumped monopropellant propulsion system

    Science.gov (United States)

    Maybee, Jeffrey C.; Swink, Don G.; Whitehead, John C.

    1993-11-01

    Significant progress was made in 1992 and 1993 towards demonstration at the system level of a high-performance pumped monopropellant propulsion system. Two separate breadboard systems were designed, fabricated and tested with hydrazine at vacuum and sea level conditions. Both designs utilized improved warm-gas-driven reciprocating pumps to transfer fuel from a low-pressure hydrazine tank (70 psig) directly to a pair of 56-lbf thrusters operating at 580 psia chamber pressure. The system most recently tested included direct warm gas pressurization of the hydrazine tank. This novel propulsion system design has been presented and discussed in various configurations in previous papers. This paper will provide an update to test results presented in 1991. This recent testing of these latest system designs included a continuous 60-second burn of a 42-lbf thruster operating at sea level, in addition bootstrap and pulse-mode firings. These results have demonstrated that improvements to the 3-way valve design of the pump were successful, and have verified performance predictions obtained from a mathematical model of the system. Further testing of a more advanced breadboard system is planned for late 1993.

  19. Components of Equity-Oriented Health Care System: Perspective of Iranian Nurses

    OpenAIRE

    2014-01-01

    Equity in health is one of key objectives in health care systems world wide. This study aimed to explain the perspective of Iranian nurses about equity in the health care system. A qualitative exploratory design with thematic analysis approach was used to collect and analyze data. Using a purposeful sampling helped the researchers to recruit 16 eligible participants. Data were collected via in-depth semi-structured interviews. Five main categories were extracted through data analysis process ...

  20. THE SEEN AND UNSEEN FACE OF ETHICAL CODES WITHIN THE HEALTH CARE SYSTEM

    OpenAIRE

    Daniela Tatiana Agheorghiesei (Corodeanu)

    2012-01-01

    Our article makes a short review of several opinions and studies that exist within the specialized literature concerned with the role and the application of the code of ethics and professional conduct from the health care system. The theoretical process implied a necessary terminological clarification. Although we can see there are numerous professional codes that govern the activity of the health care system, both at national and supranational level, there are studies that highlight that the...

  1. LOCATION AND PLANNING OF HEALTH CARE DELIVERY SYSTEM AT THE DISTICT LEVEL

    OpenAIRE

    Rajguru. S. A

    2015-01-01

    There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious, or other coordinate bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often e...

  2. HealthStyles: a new psychographic segmentation system for health care marketers.

    Science.gov (United States)

    Endresen, K W; Wintz, J C

    1988-01-01

    HealthStyles is a new psychographic segmentation system specifically designed for the health care industry. This segmentation system goes beyond traditional geographic and demographic analysis and examines health-related consumer attitudes and behaviors. Four statistically distinct "styles" of consumer health care preferences have been identified. The profiles of the four groups have substantial marketing implications in terms of design and promotion of products and services. Each segment of consumers also has differing expectations of physician behavior. PMID:10288444

  3. The Evolving Role of the Radiologist within the Health Care System

    OpenAIRE

    Knechtges, Paul Martin; Carlos, Ruth C.

    2007-01-01

    The traditional view of the radiologist as a physician who adds value to the health care system solely by generating and interpreting diagnostic images is outdated. The radiologists’ roles have expanded to encompass economic gatekeeping, political advocacy, public health delivery, patient safety, quality of care improvement, and information technology. It is through these roles that radiologists will continue to find new ways to add value to the healthcare system.

  4. Transforming primary care: vision and reality: a whole systems approach to developing the workforce

    OpenAIRE

    Jackson, C; Manley, K.

    2015-01-01

    Assumptions underpinning presentation – whole systems approaches and the skills required for culture change. Developing a shared purpose for primary care. Drawing on: - Whole systems approach to urgent and emergency care - Implementing shared values - Developing shared purposes across organisations: EKHUFT/Community Trust/Mental Health Trust - Developing the skills sets to be leaders: - Aspiring Consultant Programme - CLP programmes across the multi-disciplinary team ...

  5. Evaluation of Arizona Health Care Cost Containment System, 1984-85

    OpenAIRE

    McCall, Nelda; Henton, Douglas; Haber, Susan; Paringer, Lynn; Crane, Michael; Wrightson, William; Freund, Deborah

    1987-01-01

    In this article, we describe the evaluation of the Arizona Health Care Cost Containment System (AHCCCS), Arizona's alternative to the acute care portion of Medicaid. We provide an assessment of implementation of the program's innovative features during its second 18 months of operation, from April 1984 through September 1985. Included in the evaluation are assessments of the administration of the program, provider relations, eligibility, enrollment and marketing, information systems, quality ...

  6. Implementation of genomic medicine in a health care delivery system: a value proposition?

    Science.gov (United States)

    Wade, Joanne E; Ledbetter, David H; Williams, Marc S

    2014-03-01

    The United States health care system is undergoing significant change and is seeking innovations in care delivery and reimbursement models that will lead to improved value for patients, providers, payers, and employers. Genomic medicine has the potential to be a disruptive innovation that if implemented intelligently can improve value. The article presents the perspective of the leaders of a large integrated healthcare delivery system regarding the decision to invest in implementation of genomic medicine. PMID:24619641

  7. Initial Implementation Indicators From a Statewide Rollout of SafeCare Within a Child Welfare System

    OpenAIRE

    Whitaker, Daniel J; Ryan, Kerry A.; Wild, Robert C.; Self-Brown, Shannon; John R. Lutzker; Shanley, Jenelle R.; Edwards, Anna M.; McFry, Erin A.; Moseley, Colby N.; Hodges, Amanda E.

    2011-01-01

    There is a strong movement toward implementation of evidence-based practices (EBP) in child welfare systems. The SafeCare parenting model is one of few parent-training models that addresses child neglect, the most common form of maltreatment. Here, the authors describe initial findings from a statewide effort to implement the EBP, SafeCare®, into a state child welfare system. A total of 50 agencies participated in training, with 295 individuals entering training to implement SafeCare. Analyse...

  8. Factors affecting attendance at and timing of formal antenatal care: results from a qualitative study in Madang, Papua New Guinea.

    Directory of Open Access Journals (Sweden)

    Erin V W Andrew

    Full Text Available BACKGROUND: Appropriate antenatal care (ANC is key for the health of mother and child. However, in Papua New Guinea (PNG, only a third of women receive any ANC during pregnancy. Drawing on qualitative research, this paper explores the influences on ANC attendance and timing of first visit in the Madang region of Papua New Guinea. METHODS: Data were collected in three sites utilizing several qualitative methods: free-listing and sorting of terms and definitions, focus group discussions, in-depth interviews, observation in health care facilities and case studies of pregnant women. Respondents included pregnant women, their relatives, biomedical and traditional health providers, opinion leaders and community members. RESULTS: Although generally reported to be important, respondents' understanding of the procedures involved in ANC was limited. Factors influencing attendance fell into three main categories: accessibility, attitudes to ANC, and interpersonal issues. Although women saw accessibility (distance and cost as a barrier, those who lived close to health facilities and could easily afford ANC also demonstrated poor attendance. Attitudes were shaped by previous experiences of ANC, such as waiting times, quality of care, and perceptions of preventative care and medical interventions during pregnancy. Interpersonal factors included relationships with healthcare providers, pregnancy disclosure, and family conflict. A desire to avoid repeat clinic visits, ideas about the strength of the fetus and parity were particularly relevant to the timing of first ANC visit. CONCLUSIONS: This long-term in-depth study (the first of its kind in Madang, PNG shows how socio-cultural and economic factors influence ANC attendance. These factors must be addressed to encourage timely ANC visits: interventions could focus on ANC delivery in health facilities, for example, by addressing healthcare staff's attitudes towards pregnant women.

  9. A Family Guide to Systems of Care for Children with Mental Health Needs = Guia para la familia de "Systems of Care" para la salud mental de sus hijos.

    Science.gov (United States)

    Dougherty, Janice; Harris, Pam; Hawes, Janet; Shepler, Rick; Tolin, Canice; Truman, Connie

    This bilingual (English-Spanish) guide is intended to assist parents and caregivers in seeking help for children with mental health problems. As part of the system of care, parents and caregivers need to work together to help the child in need. Caregivers and counselors can help families define their strengths, determine the things they want to…

  10. A miniaturised image based fluorescence detection system for point-of-care-testing of cocaine abuse

    Science.gov (United States)

    Walczak, Rafał; Krüger, Jan; Moynihan, Shane

    2015-08-01

    In this paper, we describe a miniaturised image-based fluorescence detection system and demonstrate its viability as a highly sensitive tool for point-of-care-analysis of drugs of abuse in human sweat with a focus on monitor individuals for drugs of abuse. Investigations of miniaturised and low power optoelectronic configurations and methodologies for real-time image analysis were successfully carried out. The miniaturised fluorescence detection system was validated against a reference detection system under controlled laboratory conditions by analysing spiked sweat samples in dip stick and then strip with sample pad. As a result of the validation studies, a 1 ng mL-1 limit of detection of cocaine in sweat and full agreement of test results with the reference detection system can be reported. Results of the investigations open the way towards a detection system that integrates a hand-held fluorescence reader and a wearable skinpatch, and which can collect and in situ analyse sweat for the presence of cocaine at any point for up to tenths hours.

  11. Recent results on cleaning and conditioning the ATF vacuum system

    International Nuclear Information System (INIS)

    Techniques for cleaning and conditioning the vacuum vessel of the Advanced Toroidal Facility (ATF) and its internal components are described. The vacuum vessel cleaning technique combines baking to 150 degree C and glow discharges with hydrogen gas. Chromium gettering is used to further condition the system. The major internal components are the anodized aluminum baffles in the Thomson scattering system, a graphite-shielded ICRF antenna, two graphite limiters, and a diagnostic graphite plate. Three independent heating systems are used to bake some of the major components of the system. The major characteristics used for assessing cleanliness and conditioning progress are the maximum pressure attained during bakeout, the results of gas analysis, and revelant plasma parameters (e.g., time to radiative decay). Details of the various cleaning and conditioning procedures and results are presented

  12. ADAPTIVE SYSTEMS THEORY: SOME BASIC CONCEPTS, METHODS AND RESULTS

    Institute of Scientific and Technical Information of China (English)

    GUO Lei

    2003-01-01

    The adaptive systems theory to be presented in this paper consists of two closely related parts: adaptive estimation (or filtering, prediction) and adaptive control of dynamical systems. Both adaptive estimation and control are nonlinear mappings of the on-line observed signals of dynamical systems, where the main features are the uncertainties in both the system's structure and external disturbances, and the non-stationarity and dependency of the system signals. Thus, a key difficulty in establishing a mathematical theory of adaptive systems lies in how to deal with complicated nonlinear stochastic dynamical systems which describe the adaptation processes. In this paper, we will illustrate some of the basic concepts, methods and results through some simple examples. The following fundamental questions will be discussed: How much information is needed for estimation? How to deal with uncertainty by adaptation? How to analyze an adaptive system? What are the convergence or tracking performances of adaptation? How to find the proper rate of adaptation in some sense? We will also explore the following more fundamental questions: How much uncertainty can be dealt with by adaptation ? What are the limitations of adaptation ? How does the performance of adaptation depend on the prior information ? We will partially answer these questions by finding some "critical values" and establishing some "Impossibility Theorems" for the capability of adaptation, for several basic classes of nonlinear dynamical control systems with either parametric or nonparametric uncertainties.

  13. The consumer choice model: a humane reconstruction of the U.S. health care system.

    Science.gov (United States)

    Coulter, C H

    2000-01-01

    "Consumer choice," "defined contribution health programs," "voucher systems," and "health marts" are variations on a theme: employees buying their own health care. This new approach to health care purchasing, which is designed to minimize the role of employers, is being proposed by an array of economists and by both Republican and Democratic legislators as the best way to address the nation's health care ills. Although enabling national legislation is unlikely to pass soon, the debate will nevertheless change the face of health care in America. The prospect is reminiscent of the debate over "Clinton Care" in 1993--although legislation was never passed, managed care rapidly came to dominate the U.S. health care system. As this reform takes hold, beneficiaries will make their own health plan selections but will have more responsibility and may bear more cost. Providers will have to adapt to new, customer-driven requirements for performance, accountability, and communications but will also find opportunities in a marketplace that they will have a major role in shaping. Physicians, health plans, and insurers should understand how these proposals will transform their role in health care. PMID:10847942

  14. Stability Results for a Class of Difference Systems with Delay

    Directory of Open Access Journals (Sweden)

    Kaslik Eva

    2009-01-01

    Full Text Available Abstract Considering the linear delay difference system , where , is a real matrix, and is a positive integer, the stability domain of the null solution is completely characterized in terms of the eigenvalues of the matrix . It is also shown that the stability domain becomes smaller as the delay increases. These results may be successfully applied in the stability analysis of a large class of nonlinear difference systems, including discrete-time Hopfield neural networks.

  15. A systems thinking approach to analysis of the Patient Protection and Affordable Care Act.

    Science.gov (United States)

    Williams, John C

    2015-01-01

    The public health community is challenged with understanding the many complexities presented by systems thinking and its applications in systems modeling. The model presented encompasses multiple variables needed (eg, model building) for the construction of a conceptual system model of the Patient Protection and Affordable Care Act (ACA). The model tracks the ACA from inception, through passage, March 2010, to its current state. Justification for the need to reform the current health care system rests, in part, on the heels of social justice. Proponents of the ACA have long argued that health reform was needed by the millions of uninsured person who suffered from health disparities, took little advantage of health prevention advice, and faced issues of access to providers as well as insurers. In addition the ACA seeks to address our uncontrollable spending on health care delivery. This article highlights the ACA from a systems perspective. The conceptual model presented encompasses both health reform variables (eg, health care provisions, key legislative components, system environment) and system variables (eg, inputs, outputs, feedback, and throughput) needed to understand current health care reform efforts from a systems perspective. The model presented shows how the interrelationships and interconnections of elements of a system come together to achieve its purpose or goal. PMID:25414950

  16. Undecidability Results for Bisimilarity on Prefix Rewrite Systems

    DEFF Research Database (Denmark)

    Jancar, Petr; Srba, Jiri

    2006-01-01

    We answer an open question related to bisimilarity checking on labelled transition systems generated by prefix rewrite rules on words. Stirling (1996, 1998) proved the decidability of bisimilarity for normed pushdown processes. This result was substantially extended by Senizergues (1998, 2005) who...... language) was left open; this was repeatedly indicated by both Stirling and Senizergues. Here we answer the question negatively, i.e., we show undecidability of bisimilarity on Type -1 systems, even in the normed case. We complete the picture by considering classes of systems that use rewrite rules of the...

  17. VERIFICATION OF TORSIONAL OSCILLATING MECHANICAL SYSTEM DYNAMIC CALCULATION RESULTS

    Directory of Open Access Journals (Sweden)

    Peter KAŠŠAY

    2014-09-01

    Full Text Available On our department we deal with optimization and tuning of torsional oscillating mechanical systems. When solving these problems we often use results of dynamic calculation. The goal of this article is to compare values obtained by computation and experimentally. For this purpose, a mechanical system built in our laboratory was used. At first, classical HARDY type flexible coupling has been applied into the system, then we used a pneumatic flexible shaft coupling developed by us. The main difference of these couplings over conventional flexible couplings is that they can change their dynamic properties during operation, by changing the pressure of the gaseous medium in their flexible elements.

  18. Physicians’ attitudes towards office-based delivery of methadone maintenance therapy: results from a cross-sectional survey of Nova Scotia primary-care physicians

    Directory of Open Access Journals (Sweden)

    Dooley Jessica

    2012-06-01

    Full Text Available Abstract Background Approximately 90,000 Canadians use opioids each year, many of whom experience health and social problems that affect the individual user, families, communities and the health care system. For those who wish to reduce or stop their opioid use, methadone maintenance therapy (MMT is effective and supporting evidence is well-documented. However, access and availability to MMT is often inconsistent, with greater inequity outside of urban settings. Involving community based primary-care physicians in the delivery of MMT could serve to expand capacity and accessibility of MMT programs. Little is known, however, about the extent to which MMT, particularly office-based delivery, is acceptable to physicians. The aim of this study is to survey physicians about their attitudes towards MMT, particularly office-based delivery, and the perceived barriers and facilitators to MMT delivery. Methods In May 2008, facilitated by the College of Physicians and Surgeons of Nova Scotia, a cross-sectional, e-mail survey of 950 primary-care physicians practicing in Nova Scotia, Canada was administered via the OPINIO on-line survey software, to assess the acceptability of office-based MMT. Logistic regressions, adjusted for physician sociodemographic characteristics, were used to examine the association between physicians’ willingness to participate in office-based MMT, and a series of measures capturing physician attitudes and knowledge about treatment approaches, opioid use, and methadone, as well as perceived barriers to MMT. Results Overall, 19.8% of primary-care physicians responded to the survey, with 56% who indicated that they would be willing to be involved in MMT under current or similar circumstances; however, willingness was associated with numerous attitudinal and systemic factors. The barriers to involvement in MMT that were frequently cited included a lack of training or experience in MMT, lack of support services, and potential

  19. Systems reliability Benchmark exercise part 1-Description and results

    International Nuclear Information System (INIS)

    The report describes aims, rules and results of the Systems Reliability Benchmark Exercise, which has been performed in order to assess methods and procedures for reliability analysis of complex systems and involved a large number of European organizations active in NPP safety evaluation. The exercise included both qualitative and quantitative methods and was structured in such a way that separation of the effects of uncertainties in modelling and in data on the overall spread was made possible. Part I describes the way in which RBE has been performed, its main results and conclusions

  20. Life cycle analysis of electricity systems: Methods and results

    International Nuclear Information System (INIS)

    The two methods for full energy chain analysis, process analysis and input/output analysis, are discussed. A combination of these two methods provides the most accurate results. Such a hybrid analysis of the full energy chains of six different power plants is presented and discussed. The results of such analyses depend on time, site and technique of each process step and, therefore have no general validity. For renewable energy systems the emissions form the generation of a back-up system should be added. (author). 7 figs, 1 fig

  1. CMS Muon Alignment: System Description and first results

    CERN Document Server

    Sobron, M

    2008-01-01

    The CMS detector has been instrumented with a precise and complex opto-mechanical alignment subsystem that provides a common reference frame between Tracker and Muon detection systems by means of a net of laser beams. The system allows a continuous and accurate monitoring of the muon chambers positions with respect to the Tracker body. Preliminary results of operation during the test of the CMS 4T solenoid magnet, performed in 2006, are presented. These measurements complement the information provided by the use of survey techniques and the results of alignment algorithms based on muon tracks crossing the detector.

  2. Prehospital electronic patient care report systems: early experiences from emergency medical services agency leaders.

    Directory of Open Access Journals (Sweden)

    Adam B Landman

    Full Text Available BACKGROUND: As the United States embraces electronic health records (EHRs, improved emergency medical services (EMS information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies. METHODS: We conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes. RESULTS: Twenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1 identify creative funding sources; 2 leverage regional health information organizations; and 3 build internal information technology capacity. CONCLUSION: EMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and

  3. Warning systems in a computerized nursing process for Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Daniela Couto Carvalho Barra

    2014-02-01

    Full Text Available A hybrid study combining technological production and methodological research aiming to establish associations between the data and information that are part of a Computerized Nursing Process according to the ICNP® Version 1.0, indicators of patient safety and quality of care. Based on the guidelines of the Agency for Healthcare Research and Quality and the American Association of Critical Care Nurses for the expansion of warning systems, five warning systems were developed: potential for iatrogenic pneumothorax, potential for care-related infections, potential for suture dehiscence in patients after abdominal or pelvic surgery, potential for loss of vascular access, and potential for endotracheal extubation. The warning systems are a continuous computerized resource of essential situations that promote patient safety and enable the construction of a way to stimulate clinical reasoning and support clinical decision making of nurses in intensive care.

  4. Test Results for a High Power Thermal Management System

    Science.gov (United States)

    Wrenn, Kimberly R.; Wolf, David A.

    2008-01-01

    In response to the identified needs of emerging high power spacecraft applications, a multiple evaporator hybrid loop heat pipe (H-LHP) was developed and tested as part of a Dual Use Science and Technology (DUS&T) program co-sponsored by ATK and AFRL/PRP. During the course of the DUS&T program, a two-kilowatt system with three evaporators was developed and tested to identify viable system architectures and characterize system performance capabilities as a function of heat load profiles and spatial distribution of the evaporators. Following the successful development of the two-kilowatt system, a 10-kilowatt system with six evaporators was fabricated and tested. Tests were performed with the system operating in a totally passive mode, where applying a small amount of power to a sweepage evaporator provides the auxiliary flow through the primary evaporators, and as a self-regulating, capillary-controlled mechanically pumped system. This paper will provide a description of the 10-kilowatt multi-evaporator system and present the results of the passive and mechanically pump test programs.

  5. Integrated thermal treatment system sudy: Phase 2, Results

    Energy Technology Data Exchange (ETDEWEB)

    Feizollahi, F.; Quapp, W.J.

    1995-08-01

    This report presents the second phase of a study on thermal treatment technologies. The study consists of a systematic assessment of nineteen thermal treatment alternatives for the contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. The treatment alternatives consist of widely varying technologies for safely destroying the hazardous organic components, reducing the volume, and preparing for final disposal of the MLLW. The alternatives considered in Phase 2 were innovative thermal treatments with nine types of primary processing units. Other variations in the study examined the effect of combustion gas, air pollution control system design, and stabilization technology for the treatment residues. The Phase 1 study, the results of which have been published as an interim report, examined ten initial thermal treatment alternatives. The Phase 2 systems were evaluated in essentially the same manner as the Phase 2 systems. The assumptions and methods were the same as for the Phase 1 study. The quantities, and physical and chemical compositions, of the input waste used in he Phase 2 systems differ from those in the Phase 1 systems, which were based on a preliminary waste input database developed at the onset of the Integrated Thermal Treatment System study. The inventory database used in the Phase 2 study incorporates the latest US Department of Energy information. All systems, both primary treatment systems and subsystem inputs, have now been evaluated using the same waste input (2,927 lb/hr).

  6. Integrated thermal treatment system sudy: Phase 2, Results

    International Nuclear Information System (INIS)

    This report presents the second phase of a study on thermal treatment technologies. The study consists of a systematic assessment of nineteen thermal treatment alternatives for the contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. The treatment alternatives consist of widely varying technologies for safely destroying the hazardous organic components, reducing the volume, and preparing for final disposal of the MLLW. The alternatives considered in Phase 2 were innovative thermal treatments with nine types of primary processing units. Other variations in the study examined the effect of combustion gas, air pollution control system design, and stabilization technology for the treatment residues. The Phase 1 study, the results of which have been published as an interim report, examined ten initial thermal treatment alternatives. The Phase 2 systems were evaluated in essentially the same manner as the Phase 2 systems. The assumptions and methods were the same as for the Phase 1 study. The quantities, and physical and chemical compositions, of the input waste used in he Phase 2 systems differ from those in the Phase 1 systems, which were based on a preliminary waste input database developed at the onset of the Integrated Thermal Treatment System study. The inventory database used in the Phase 2 study incorporates the latest US Department of Energy information. All systems, both primary treatment systems and subsystem inputs, have now been evaluated using the same waste input (2,927 lb/hr)

  7. Consumer-Centered, Collaborative, and Comprehensive Care: The Core Essentials of Recovery-Oriented System of Care.

    Science.gov (United States)

    DiClemente, Carlo C; Norwood, Amber E Q; Gregory, W Henry; Travaglini, Letitia; Graydon, Meagan M; Corno, Catherine M

    2016-01-01

    Recovery from substance abuse and mental health disorders represents a journey through which individuals move beyond treatment of provider-identified problems toward a path of achieving wellness and productive lives. Overcoming obstacles and barriers encountered along the recovery process, individuals reveal their own strengths and resilience necessary to cope, survive, and thrive in the face of adversity. Recovery-oriented system of care (ROSC) is a framework designed to address the multidimensional nature of recovery by creating a system for coordinating multiple systems, services, and supports that are person centered and build on the strengths and resiliencies of individuals, families, and communities. As is common knowledge among substance abuse and mental health providers, consumers often present with high rates of comorbidity, which complicates care. In addition, behavioral health consumers engage in risky health behaviors (e.g., smoking) at a disproportionate rate, which places them at increased risk for developing noncommunicable diseases. ROSCs are ideal for addressing the complicated and varied needs of consumers as they progress toward wellness. The challenges of creating an ROSC framework that is effective, efficient, and acceptable to consumers is formidable. It requires change on the part of agencies, organizations, providers, and consumers. The importance of comprehensive, integrated screening is highlighted as a critical component of ROSC. Key suggestions for initiating ROSC are offered. PMID:27272993

  8. When research seems like clinical care: a qualitative study of the communication of individual cancer genetic research results

    Directory of Open Access Journals (Sweden)

    Robert Jason S

    2008-02-01

    Full Text Available Abstract Background Research ethicists have recently declared a new ethical imperative: that researchers should communicate the results of research to participants. For some analysts, the obligation is restricted to the communication of the general findings or conclusions of the study. However, other analysts extend the obligation to the disclosure of individual research results, especially where these results are perceived to have clinical relevance. Several scholars have advanced cogent critiques of the putative obligation to disclose individual research results. They question whether ethical goals are served by disclosure or violated by non-disclosure, and whether the communication of research results respects ethically salient differences between research practices and clinical care. Empirical data on these questions are limited. Available evidence suggests, on the one hand, growing support for disclosure, and on the other, the potential for significant harm. Methods This paper explores the implications of the disclosure of individual research results for the relationship between research and clinical care through analysis of research-based cancer genetic testing in Ontario, Canada in the late 1990s. We analyze a set of 30 interviews with key informants involved with research-based cancer genetic testing before the publicly funded clinical service became available in 2000. Results We advance three insights: First, the communication of individual research results makes research practices seem like clinical services for our respondents. Second, while valuing the way in which research enables a form of clinical access, our respondents experience these quasi-clinical services as inadequate. Finally, our respondents recognize the ways in which their experience with these quasi-clinical services is influenced by research imperatives, but understand and interpret the significance and appropriateness of these influences in different ways. Conclusion

  9. Getting on with your computer is associated with job satisfaction in primary care: entrants to primary care should be assessed for their competency with electronic patient record systems

    Directory of Open Access Journals (Sweden)

    Simon de Lusignan

    2014-02-01

    Full Text Available Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user’s preferences. The use of electronic patient record (EPR systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences.

  10. Getting on with your computer is associated with job satisfaction in primary care: entrants to primary care should be assessed for their competency with electronic patient record systems.

    Science.gov (United States)

    de Lusignan, Simon; Pearce, Christopher; Munro, Neil

    2013-01-01

    Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user's preferences. The use of electronic patient record (EPR) systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences. PMID:24629650

  11. Trauma care and referral patterns in Rwanda: implications for trauma system development

    Science.gov (United States)

    Ntakiyiruta, Georges; Wong, Evan G.; Rousseau, Mathieu C.; Ruhungande, Landouald; Kushner, Adam L.; Liberman, Alexander S.; Khwaja, Kosar; Dakermandji, Marc; Wilson, Marnie; Razek, Tarek; Kyamanywa, Patrick; Deckelbaum, Dan L.

    2016-01-01

    Background Trauma remains a leading cause of death worldwide. The development of trauma systems in low-resource settings may be of benefit. The objective of this study was to describe operative procedures performed for trauma at a tertiary care facility in Kigali, Rwanda, and to evaluate geographical variations and referral patterns of trauma care. Methods We retrospectively reviewed all prospectively collected operative cases performed at the largest referral hospital in Rwanda, the Centre Hospitalier Universitaire de Kigali (CHUK), between June 1 and Dec. 1, 2011, for injury-related diagnoses. We used the Pearson χ2 and Fisher exact tests to compare cases arising from within Kigali to those transferred from other provinces. Geospatial analyses were also performed to further elucidate transfer patterns. Results Over the 6-month study period, 2758 surgical interventions were performed at the CHUK. Of these, 653 (23.7%) were for trauma. Most patients resided outside of Kigali city, with 337 (58.0%) patients transferred from other provinces and 244 (42.0%) from within Kigali. Most trauma procedures were orthopedic (489 [84.2%]), although general surgery procedures represented a higher proportion of trauma surgeries in patients from other provinces than in patients from within Kigali (28 of 337 [8.3%] v. 10 of 244 [4.1%]). Conclusion To our knowledge, this is the first study to highlight geographical variations in access to trauma care in a low-income country and the first description of trauma procedures at a referral centre in Rwanda. Future efforts should focus on maturing prehospital and interfacility transport systems, strengthening district hospitals and further supporting referral institutions. PMID:26812407

  12. Integrating traditional medicine into modern health care systems: examining the role of Chinese medicine in Taiwan.

    Science.gov (United States)

    Chi, C

    1994-08-01

    Since the World Health Organization officially promoted traditional medicine in developing countries in 1978, there have been increasing interests among developing countries in integrating traditional medicine into a national health care system. Most of these policies, however, tend to be the policy of coexistence instead of integration. This paper focuses on the rationale, strategies, and process of integrating traditional medicine into a modern health care system by using the experience of Chinese medicine in Taiwan as an example. After briefly describing the changing roles of Chinese medicine in Taiwan, the author critically reviews the government policies and regulations on Chinese medicine. Research findings and government statistics on the demand and supply of Chinese medicine are also described to provide some insights for developing recommendations for an appropriate integration policy. To effectively integrate traditional medicine into a modern health care system, this paper suggests that such integration should begin at the grass roots level, that is with the training of physicians and practitioners. A successful, integrated health care system would facilitate more efficient use of domestic medical resources, and enhance self-sufficiency in health development for resource poor countries. Integrating traditional medicine into a modern health care system, moreover, can benefit industrialized nations as well. After recommending several strategies for integration, the author proposes a further development of a unified medical system as the final stage of full integration. This unified medical system should be an inclusive medical system, which could help countries to expand the available medical resources. PMID:7939847

  13. A Novel Intrusion Detection System for Wireless Body Area Network in Health Care Monitoring

    Directory of Open Access Journals (Sweden)

    T. V.P. Sundararajan

    2010-01-01

    Full Text Available Problem statement: Health monitoring, telemedicine, military, interactive entertainment and portable audio/video systems were most promising applications where WBANs can be used. However, designers of such systems face a number of challenging tasks, as they need to address often quite conflicting requirements for size, operating time, precision and reliability. Network security is very important in Wireless Body Area Network (WBAN since the vital human life might be jeopardized, unless managed properly. Approach: This article presented security architecture of a wireless body area network for ambulatory health status monitoring. A novel Intrusion Detection System (IDS inspired by the biological immune system that use Negative Selection Algorithm (NSA was proposed to enhance the performance of Wireless Body Area Networks (WBAN to operate despite the presence of compromised (misbehaving nodes. Results: The proposed IDS scheme had been implemented using network simulator Qualnet v5.2. The performances of IDS scheme had been analyzed using AODV, DSR and DSDV routing protocols for parameters such as average detection rate and false alarm rate. These negative selection detectors are capable of distinguishing well behaving nodes from compromised nodes with good degree of accuracy. The high false positives rate is also minimized. Conclusion/Recommendations: Wireless Body Area Networks are an enabling technology for mobile health care. The IDS can be implemented on today’s devices as it only requires minimal and low-cost hardware changes. The authors strongly believe that adding sufficient security mechanisms to WBAN will study as a trigger in the acceptance of this technology for health care purposes. Simulation results indicate the non-degradability of network performance when these IDS is incorporated in the routing algorithm for security enhancements.

  14. Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada

    Directory of Open Access Journals (Sweden)

    Macaulay Ann C

    2011-10-01

    Full Text Available Abstract Background Aboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies. Methods In Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the Canadian First Nations Diabetes Clinical Management and Epidemiologic (CIRCLE study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated. Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities. Results the key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs. Conclusions Addressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services

  15. Developing a cost-effective home care management support system for small nursing homes in Taiwan.

    Science.gov (United States)

    Tu, Ming-Hsiang; Chang, Polun

    2009-01-01

    Home care is important in Taiwan but most of the institutes are small and cannot afford computerization. We develop a support system based on InterRAI case management system using Excel VBA which is the most "free" application in institutes. The prototype system shows promising. PMID:19592932

  16. The Role of System Alignment in Care and Education of Children from Birth to Grade 3

    Science.gov (United States)

    Ma, Xin; Shen, Jianping; Krenn, Huilan Y.; Yuan, Jing; Hu, Shanshan

    2015-01-01

    The emerging concept of system alignment refers to how different systems in care and education of young children can be integrated to work together as a whole system that is more effective, efficient, and equitable to produce excellent outcomes in children. The purpose of this article is to provide a review of the existing literature on system…

  17. Decision Criteria for Distributed Versus Non-Distributed Information Systems in the Health Care Environment

    OpenAIRE

    McGinnis, John W.

    1980-01-01

    The very same technological advances that support distributed systems have also dramatically increased the efficiency and capabilities of centralized systems making it more complex for health care managers to select the “right” system architecture to meet their particular needs.

  18. Fair equality of opportunity critically reexamined: the family and the sustainability of health care systems.

    Science.gov (United States)

    Engelhardt, H Tristram

    2012-12-01

    A complex interaction of ideological, financial, social, and moral factors makes the financial sustainability of health care systems a challenge across the world. One difficulty is that some of the moral commitments of some health care systems collide with reality. In particular, commitments to equality in access to health care and to fair equality of opportunity undergird an unachievable promise, namely, to provide all with the best of basic health care. In addition, commitments to fair equality of opportunity are in tension with the existence of families, because families are aimed at advantaging their own members in preference to others. Because the social-democratic state is committed to fair equality of opportunity, it offers a web of publicly funded entitlements that make it easier for persons to exit the family and to have children outside of marriage. In the United States, in 2008, 41% of children were born outside of wedlock, whereas, in 1940, the percentage was only 3.8%, and in 1960, 5%, with the further consequence that the social and financial capital generated through families, which aids in supporting health care in families, is diminished. In order to explore the challenge of creating a sustainable health care system that also supports the traditional family, the claims made for fair equality of opportunity in health care are critically reconsidered. This is done by engaging the expository device of John Rawls's original position, but with a thin theory of the good that is substantively different from that of Rawls, one that supports a health care system built around significant copayments, financial counseling, and compulsory savings, with a special focus on enhancing the financial and social capital of the family. This radical recasting of Rawls, which draws inspiration from Singapore, is undertaken as a heuristic to aid in articulating an approach to health care allocation that can lead past the difficulties of social-democratic policy. PMID

  19. Ethics, rhetoric, and expectations: responsibilities and obligations of health care systems.

    Science.gov (United States)

    Foreman, Thomas

    2014-09-01

    Health care organization foundations and other fund-raising departments often function at an arm's length from the system at large. As such, operations related to their mandate to raise funds and market the organization do not receive the same level of ethical scrutiny brought to bear on other arms within the organization. An area that could benefit from a more focused ethics lens is the use of language and rhetoric employed in order to raise funds and market the organization. Such departments and divisions often utilize overblown promises of miracles and extraordinary advances to convince donors to contribute and to persuade the general public. The result can be a heightened sense of expectation on the part of patients, their families, and the general public as to what can realistically be achieved by the health care system, leading to disappointment and conflict when these expectations are not or cannot be met. This article suggests that such advertising and marketing be subject to the same advertising standards as other businesses. PMID:24965439

  20. Quantitative results near the band edges of disordered systems

    International Nuclear Information System (INIS)

    By combining the coherent-potential approximation, the potential-well analogy, and theories for the near tail in the density of states, we obtain, for the first time, explicitly quantitative results for the various quantities of interest near the band edges of disordered systems. These results exhibit a certain universality and can be expressed in terms of simple analytic functions, provided that disorder is not larger than about (1/5) of the bandwidth