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Sample records for group care programs

  1. How does the culture of medical group practices influence the types of programs used to assure quality of care?

    Science.gov (United States)

    Kaissi, Amer; Kralewski, John; Curoe, Ann; Dowd, Bryan; Silversmith, Janet

    2004-01-01

    It is widely acknowledged that the culture of medical group practices greatly influences the quality of care, but little is known about how cultures are translated into specific types of programs focused on quality. This study explores this issue by assessing the influence of the organizational culture on these types of programs in medical group practices in the upper Midwest. Data were obtained from two surveys of medical group practices. The first survey was designed to assess the culture of the practice using a nine-dimension instrument developed previously. The second survey was designed to obtain organizational structure data including the programs identified by the literature as important to the quality of care in medical practices. Completed surveys were obtained from eighty-eight medical groups. The relationship of the group practice culture to structural programs focused on quality of care was analyzed using logistic regression equations. Several interesting patterns emerged. As expected, practices with a strong information culture favor electronic data systems and formal programs that provide comparative or evidence-based data to enhance their clinical practices. However, those with a quality-centered culture appear to prefer patient satisfaction surveys to assess the quality of their care, while practices that are more business-oriented rely on bureaucratic strategies such as benchmarking and physician profiling. Cultures that emphasize the autonomy of physician practice were negatively (but not at a statistically significant level) associated with all the programs studied. Practices with a highly collegial culture appear to rely on informal peer review mechanisms to assure quality rather than any of the structural programs included in this analysis. This study suggests that the types of quality programs that group practices develop differ according to their cultures. Consequently, it is important for practice administrators and medical directors to

  2. Group prenatal care.

    Science.gov (United States)

    Mazzoni, Sara E; Carter, Ebony B

    2017-06-01

    Patients participating in group prenatal care gather together with women of similar gestational ages and 2 providers who cofacilitate an educational session after a brief medical assessment. The model was first described in the 1990s by a midwife for low-risk patients and is now practiced by midwives and physicians for both low-risk patients and some high-risk patients, such as those with diabetes. The majority of literature on group prenatal care uses CenteringPregnancy, the most popular model. The first randomized controlled trial of CenteringPregnancy showed that it reduced the risk of preterm birth in low-risk women. However, recent meta-analyses have shown similar rates of preterm birth, low birthweight, and neonatal intensive care unit admission between women participating in group prenatal care and individual prenatal care. There may be subgroups, such as African Americans, who benefit from this type of prenatal care with significantly lower rates of preterm birth. Group prenatal care seems to result in increased patient satisfaction and knowledge and use of postpartum family planning as well as improved weight gain parameters. The literature is inconclusive regarding breast-feeding, stress, depression, and positive health behaviors, although it is theorized that group prenatal care positively affects these outcomes. It is unclear whether group prenatal care results in cost savings, although it may in large-volume practices if each group consists of approximately 8-10 women. Group prenatal care requires a significant paradigm shift. It can be difficult to implement and sustain. More randomized trials are needed to ascertain the true benefits of the model, best practices for implementation, and subgroups who may benefit most from this innovative way to provide prenatal care. In short, group prenatal care is an innovative and promising model with comparable pregnancy outcomes to individual prenatal care in the general population and improved outcomes in some

  3. Social work in a pediatric primary health care team in a group practice program.

    Science.gov (United States)

    Coleman, J V; Lebowitz, M L; Anderson, F P

    1976-01-01

    The inclusion of a psychiatric social worker as a member of a pediatric team in a prepaid group practice extends the range of pediatric mental health services to children. This paper discusses the collaboration of the social worker with the pediatricians and allied health personnel on the team in dealing with the emotional problems of referred children and their parents. Case examples are included. All cases seen by the social worker during a 6-month period are reviewed. With available psychiatric backup a wide range of emotional problems are identified, and effective mental health care is provided.

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

    Directory of Open Access Journals (Sweden)

    Leboeuf-Yde Charlotte

    2009-06-01

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

  5. Child Care Program Office

    Science.gov (United States)

    Information Medicaid Public Health Centers Temporary "Cash" Assistance Senior Benefits Program the proposed regulation changes, including the potential costs to private persons of complying with Heating Assistance Medicaid Senior Benefits Temporary Assistance Get Help Food Health Care Cash Child Care

  6. Review of the President's Fiscal Year 2009 Budget Request for the Defense Health Program's Private Sector Care Budget Activity Group

    National Research Council Canada - National Science Library

    Fantone, Denise M; Pickup, Sharon

    2008-01-01

    ... Private Sector Care BAG. To do this, we reviewed (1) DOD's justification for the request for the Private Sector Care BAG, including the underlying estimates and the extent to which DOD considered historical information; and (2...

  7. Innovation in survivor care: group visits.

    Science.gov (United States)

    Trotter, Kathryn; Frazier, Alana; Hendricks, Colleen K; Scarsella, Heidi

    2011-04-01

    The Centering Cancer Survivorship (CCS) follow-up care program is an innovation in healthcare delivery that meets the needs of cancer survivors and cancer centers. Piloted in a breast cancer clinic, the program provides an avenue for provision of psychological support and health-promotion activities, as well as surveillance for recurrence or late effects. The program empowers each survivor by enlisting her to produce a written breast cancer survivorship care plan for personal use and to share with her primary care provider. Concurrently, this innovation should enhance the viability of the primary cancer center by freeing appointment slots for oncologists who provide expensive therapies to newly diagnosed patients. The CCS program's central feature is the implementation of a multidisciplinary clinic designated specifically for breast cancer survivors in which follow-up care is provided through a group visit medical model. This model of care provides opportunities for health assessment, patient empowerment, and patient education within a framework of social support from peers with similar issues. The group visit model may be well suited to addressing the unique chronic healthcare needs of breast cancer survivors. Further evaluation is needed to verify cost-benefit analysis.

  8. Group Prenatal Care: A Financial Perspective.

    Science.gov (United States)

    Rowley, Rebecca A; Phillips, Lindsay E; O'Dell, Lisa; Husseini, Racha El; Carpino, Sarah; Hartman, Scott

    2016-01-01

    Multiple studies have demonstrated improved perinatal outcomes for group prenatal care (GPC) when compared to traditional prenatal care. Benefits of GPC include lower rates of prematurity and low birth weight, fewer cesarean deliveries, improved breastfeeding outcomes and improved maternal satisfaction with care. However, the outpatient financial costs of running a GPC program are not well established. This study involved the creation of a financial model that forecasted costs and revenues for prenatal care groups with various numbers of participants based on numerous variables, including patient population, payor mix, patient show rates, staffing mix, supply usage and overhead costs. The model was developed for use in an urban underserved practice. Adjusted revenue per pregnancy in this model was found to be $989.93 for traditional care and $1080.69 for GPC. Cost neutrality for GPC was achieved when each group enrolled an average of 10.652 women with an enriched staffing model or 4.801 women when groups were staffed by a single nurse and single clinician. Mathematical cost-benefit modeling in an urban underserved practice demonstrated that GPC can be not only financially sustainable but possibly a net income generator for the outpatient clinic. Use of this model could offer maternity care practices an important tool for demonstrating the financial practicality of GPC.

  9. Review of the President's Fiscal Year 2009 Budget Request for the Defense Health Program's Private Sector Care Budget Activity Group

    National Research Council Canada - National Science Library

    Fantone, Denise M; Pickup, Sharon

    2008-01-01

    The Conference Report accompanying the Fiscal Year 2008 Department of Defense Appropriations bill directed us to review the President's fiscal year 2009 budget request for the Defense Health Program's...

  10. Translational study of obesity management using the Diabetes Prevention Program "Group Lifestyle Balance" in primary care clinics and public hospitals from Mexico: study protocol

    Directory of Open Access Journals (Sweden)

    Rolando Giovanni Díaz-Zavala

    2017-12-01

    Full Text Available Introduction: Obesity is the main modifiable risk factor for the development of chronic diseases in Mexico. Several randomized controlled trials have shown that intensive lifestyle programs are efficacious for the management of obesity. These programs include frequent sessions (14 or more contacts in the first 6 months focused on diet and physical activity and use a behavior change protocol. However, most Mexican primary care clinics and public hospitals apply traditional treatments for obesity management with limited results on weight loss. The purpose of the study is to evaluate the effectiveness of the Diabetes Prevention Program (DPP “Group Lifestyle Balance” for weight loss among adults with overweight and obesity from baseline to 6 months and from baseline to 12 months in primary care clinics and public hospitals from Sonora, Mexico. Material and Methods: This is a translational, multi-center, non-controlled, 6 and 12-month follow-up clinical study with a pre-test and post-test design. Healthcare providers from two primary care clinics, two hospitals and one university clinic will be trained with the DPP protocol to implement on their patients with overweight and obesity. Body weight, body mass index, waist circumference, systolic and diastolic blood pressure, depression, quality of life and stress scales will be measured in participants receiving the program at baseline, 6 and 12 months. Biochemical parameters will be measured at baseline and 12 months. The primary outcome is the change in body weight at 6 and 12 months. Discussion: This study will provide scientific evidence of the effectiveness of the DPP protocol as a model for obesity management in real world clinical practice among the adult Mexican population.

  11. Measuring Group Care Worker Interventions in Residential Youth Care

    NARCIS (Netherlands)

    Bastiaanssen, I.L.W.; Kroes, G.; Nijhof, K.S.; Delsing, M.J.M.H.; Engels, R.C.M.E.; Veerman, J.W.

    2012-01-01

    Background By interacting with children, group care workers shape daily living environments to influence treatment. Current literature provides little knowledge about the content of youth residential care. Objective In this study, a questionnaire called the Group care worker Intervention

  12. Seismic analysis program group: SSAP

    International Nuclear Information System (INIS)

    Uchida, Masaaki

    2002-05-01

    A group of programs SSAP has been developed, each member of which performs seismic calculation using simple single-mass system model or multi-mass system model. For response of structures to a transverse s-wave, a single-mass model program calculating response spectrum and a multi-mass model program are available. They perform calculation using the output of another program, which produces simulated earthquakes having the so-called Ohsaki-spectrum characteristic. Another program has been added, which calculates the response of one-dimensional multi-mass systems to vertical p-wave input. It places particular emphasis on the analysis of the phenomena observed at some shallow earthquakes in which stones jump off the ground. Through a series of test calculations using these programs, some interesting information has been derived concerning the validity of superimposing single-mass model calculation, and also the condition for stones to jump. (author)

  13. Resident-Assisted Montessori Programming (RAMP): use of a small group reading activity run by persons with dementia in adult day health care and long-term care settings.

    Science.gov (United States)

    Skrajner, Michael J; Camp, Cameron J

    2007-01-01

    Six persons in the early to middle stages of dementia ("leaders") were trained in Resident-Assisted Montessori Programming (RAMP) to lead a reading activity for 22 persons with more advanced dementia ("participants") in an adult day health center (ADHC) and a special care unit (SCU) in a skilled nursing facility. Researchers assessed the leaders' abilities to learn and follow the procedures of leading a group, as well as their satisfaction with their roles. In addition, participants' engagement and affect were measured, both during standard activities programming and during client-led activities. Results of this study suggest that persons with dementia can indeed successfully lead small group activities, if several important prerequisites are met. Furthermore, the engagement and affect of participants was more positive in client-led activities than in standard activities programming.

  14. Group Prenatal Care Attendance: Determinants and Relationship with Care Satisfaction.

    Science.gov (United States)

    Cunningham, Shayna D; Grilo, Stephanie; Lewis, Jessica B; Novick, Gina; Rising, Sharon Schindler; Tobin, Jonathan N; Ickovics, Jeannette R

    2017-04-01

    Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n = 547) receiving group prenatal care in New York City (2008-2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean = 8.16, SD = 3.08); 87 % of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63 %. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE) = 11.46 (3.46), p = 0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE) = 0.11 (0.02), p prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care.

  15. Adapting and Implementing a Community Program to Improve Retention in Care among Patients with HIV in Southern Haiti: “Group of 6”

    Directory of Open Access Journals (Sweden)

    John A. Naslund

    2014-01-01

    Full Text Available Objective. In Mozambique, a patient-led Community ART Group model developed by Médecins Sans Frontières improved retention in care and adherence to antiretroviral therapy (ART among persons with HIV. We describe the adaptation and implementation of this model within the HIV clinic located in the largest public hospital in Haiti’s Southern Department. Methods. Our adapted model was named Group of 6. Hospital staff enabled stable patients with HIV receiving ART to form community groups with 4–6 members to facilitate monthly ART distribution, track progress and adherence, and provide support. Implementation outcomes included recruitment success, participant retention, group completion of monthly monitoring forms, and satisfaction surveys. Results. Over one year, 80 patients from nine communities enrolled into 15 groups. Six participants left to receive HIV care elsewhere, two moved away, and one died of a non-HIV condition. Group members successfully completed monthly ART distribution and returned 85.6% of the monthly monitoring forms. Members reported that Group of 6 made their HIV management easier and hospital staff reported that it reduced their workload. Conclusions. We report successful adaptation and implementation of a validated community HIV-care model in Southern Haiti. Group of 6 can reduce barriers to ART adherence, and will be integrated as a routine care option.

  16. Pregnant teenagers' group: contributions to prenatal care.

    Science.gov (United States)

    Queiroz, Maria Veraci Oliveira; Menezes, Giselle Maria Duarte; Silva, Thaís Jormanna Pereira; Brasil, Eysler Gonçalves Maia; Silva, Raimunda Magalhães da

    2017-06-05

    To describe changes in nurses' care following the implementation of a group of pregnant teenagers in prenatal care based on the expectations and experiences of pregnant teenagers. Qualitative and descriptive study conducted from February to November 2013 at a Primary Care Unit in Fortaleza, Ceará, Brazil, through focus groups with 16 adolescents from the group of pregnant women in the second or third trimester of pregnancy. The analysis identified central ideas and units of meanings that formed the categories. The strategy of a group of pregnant teenagers, which provides a space for coexistence and the establishment of ties encourages these individuals to talk about their needs, re-signifying their ties. Educational strategies to promote self-care of pregnant teenagers and care for their babies involve the sharing of experiences, doubts and beliefs. Considerations and suggestions of the adolescents contributed to guide nurses' practice and provide a strategic space of care and support for pregnant adolescents in primary care.

  17. [Differences in eating habits and self-care behavior in a group of obese people before and after the weight loss program].

    Science.gov (United States)

    Bak-Sosnowska, Monika; Zahorska-Markiewicz, Barbara; Trzcieniecka-Green, Anna

    2005-01-01

    In common beliefs the care of obese people for their health and appearance is not sufficient, which is both the cause and the result of their obesity. The aim of the present study was to check whether obese and normal weight persons are different in selected behaviours connected with eating and self-care, and also whether providing them with knowledge about the desired behaviour changes would improve the effects of weight loss. Authors used structured interview of 20 limited questions. The participants were 32 obese women taking part in group weight loss programme organized in "Waga" treatment center in Katowice. The measures were taken before and after the programme. The comparing group constituted women of normal body weight. Obese women before the treatment comparing to normal weight women, presented more disadvantageous behaviours in the range of: fast eating and reaching for the food in time of strain (p eating daily no more than two meals. Statistically significant improvements were observed in: greater physical activity, greater care for appearance and meals aesthetics (p wrong meal ingredients (p eating habits and self-care behaviour. The exception was that obese women reached for food more often in the situations of strain and stress. The weight loss of the participants cannot be attributed solely to the change in their behaviour, but could be influenced also by group support and/or by emotional, cognitive and social changes. It might serve as a starting point for further investigations. Researching the long term effects of the treatment (how permanent is the alteration in the participants' weight and self-care behaviour) seems to be essential to answer those questions.

  18. Association of Group Prenatal Care in US Family Medicine Residencies With Maternity Care Practice: A CERA Secondary Data Analysis.

    Science.gov (United States)

    Barr, Wendy B; Tong, Sebastian T; LeFevre, Nicholas M

    2017-03-01

    Group prenatal care has been shown to improve both maternal and neonatal outcomes. With increasing adaption of group prenatal care by family medicine residencies, this model may serve as a potential method to increase exposure to and interest in maternity care among trainees. This study aims to describe the penetration, regional and program variations, and potential impacts on future maternity care practice of group prenatal care in US family medicine residencies. The CAFM Educational Research Alliance (CERA) conducted a survey of all US family medicine residency program directors in 2013 containing questions about maternity care training. A secondary data analysis was completed to examine relevant data on group prenatal care in US family medicine residencies and maternity care practice patterns. 23.1% of family medicine residency programs report provision of group prenatal care. Programs with group prenatal care reported increased number of vaginal deliveries per resident. Controlling for average number of vaginal deliveries per resident, programs with group prenatal care had a 2.35 higher odds of having more than 10% of graduates practice obstetrics and a 2.93 higher odds of having at least one graduate in the past 5 years enter an obstetrics fellowship. Residency programs with group prenatal care models report more graduates entering OB fellowships and practicing maternity care. Implementing group prenatal care in residency training can be one method in a multifaceted approach to increasing maternity care practice among US family physicians.

  19. Modern community care program

    International Nuclear Information System (INIS)

    Nordin, Staffan

    2000-01-01

    Going into the next millennium do we see nuclear energy? Yes we will see an expanding nuclear sector in the modem community. he modem community that cares for people, health and environment needs nuclear. Energy saves lives. Electricity is efficient use of energy. Energy will be the key to a sustainable society, energy is life. Nuclear energy protects the environment. Nuclear is an integral part of the modern community caring for people, health and environment. The dynamics of the public opinion-forming process and its effects on the nuclear industry are a challenge of the global nuclear industry. Current communications strategy and its consequences are on of the key issues. The nuclear industry must be perceived in certain ways in order to move towards achieving the vision and avoiding the harassment scenario. Each perception goal does not bear the same function within the communications process. As the nuclear industry is oe of the keys to a sustainable society, it must achieve legitimacy in its capacity as an interesting agenda-setter for tackling problems and as an expert. We have to build our communication activities on an open and honest attitude and we have to establish trust and confidence. The nuclear industry must also prove its ability and performance. If this could be achieved there will be an option for the future

  20. A Decentralized Group Treatment Program.

    Science.gov (United States)

    Conrow, Douglas C.

    Old style and new style mental hospitals are criticized for not dealing directly with a person's inability to live within his community and relate effectively with significant people. The comprehensive mental health programs, which arose in reaction to the deficits of previous facilities and treatment, are viewed as frequently following a similar,…

  1. The Prenatal Care at School Program

    Science.gov (United States)

    Griswold, Carol H.; Nasso, Jacqueline T.; Swider, Susan; Ellison, Brenda R.; Griswold, Daniel L.; Brooks, Marilyn

    2013-01-01

    School absenteeism and poor compliance with prenatal appointments are concerns for pregnant teens. The Prenatal Care at School (PAS) program is a new model of prenatal care involving local health care providers and school personnel to reduce the need for students to leave school for prenatal care. The program combines prenatal care and education…

  2. An equivalence evaluation of a nurse-moderated group-based internet support program for new mothers versus standard care: a pragmatic preference randomised controlled trial

    Science.gov (United States)

    2014-01-01

    Background All mothers in South Australia are offered a clinic or home-visit by a Child and Family Health community nurse in the initial postnatal weeks. Subsequent support is available on request from staff in community clinics and from a telephone helpline. The aim of the present study is to compare equivalence of a single clinic-based appointment plus a nurse-moderated group-based internet intervention when infants were aged 0–6 months versus a single home-visit together with subsequent standard services (the latter support was available to mothers in both study groups). Methods/Design The evaluation utilised a pragmatic preference randomised trial comparing the equivalence of outcomes for mothers and infants across the two study groups. Eligible mothers were those whose services were provided by nurses working in one of six community clinics in the metropolitan region of Adelaide. Mothers were excluded if they did not have internet access, required an interpreter, or their nurse clinician recommended that they not participate due to issues such as domestic violence or substance abuse. Randomisation was based on the service identification number sequentially assigned to infants when referred to the Child and Family Health Services from birthing units (this was done by administrative staff who had no involvement in recruiting mothers, delivering the intervention, or analyzing results for the study). Consistent with design and power calculations, 819 mothers were recruited to the trial. The primary outcomes for the trial are parents’ sense of competence and self-efficacy measured using standard self-report questionnaires. Secondary outcomes include the quality of mother-infant relationships, maternal social support, role satisfaction and maternal mental health, infant social-emotional and language development, and patterns of service utilisation. Maternal and infant outcomes will be evaluated using age-appropriate questionnaires when infants are aged <2 months

  3. [Nutritional care in the cardiac rehabilitation program].

    Science.gov (United States)

    da Vico, Letizia; Biffi, Barbara; Masini, Maria Luisa; Fattirolli, Francesco

    2007-06-01

    There is some evidence of the efficacy of nutritional care in modifying eating habits and behavior in patients undergoing cardiac rehabilitation: nutritional care has a relevant role in the secondary prevention of cardiovascular disease. The dietitian is the qualified sanitary professional for nutritional care. The aim of this study was to define the role of dietitians within a health care team in programs of cardiac rehabilitation. In this setting, nutritional care starts with a dietary assessment, which includes a measurement of the anthropometric parameters, and a survey of the patient knowledge and eating habits. If there is no need for change in the patient lifestyle, the patient is addressed to the normal cardiac rehabilitation program with no further nutritional intervention except one session of counseling. When lifestyle changes are needed, the dietitian defines, together with the patient, therapeutic aims and expected results. The following phase is represented by group session with patients and their relatives during which nutritional topics are discussed and nutritional education is provided Afterwards, self-monitoring sheets of eating habits are individually discussed in one visit; a last individual visit is used for a final assessment of nutritional knowledge, dietary habits, and anthropometric parameters. In case of unsatisfactory results, patients are invited to participate to three group session to be held biweekly, during which they interact with the dietitian and take part to exercises and group discussions. When the established targets are reached, the nutritional program includes individual follow up visits at six and twelve months for further assessment of medium term results.

  4. The Nordic maintenance care program

    DEFF Research Database (Denmark)

    Malmqvist, Stefan; Leboeuf-Yde, Charlotte

    2009-01-01

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

  5. Extended parental care in communal social groups

    Directory of Open Access Journals (Sweden)

    Stephen H. Forbes

    2002-11-01

    Full Text Available Recent developments in social insect research have challenged the need for close kinship as a prerequisite for the evolution of stable group living. In a model communal bee species, Lasioglossum (Chilalictus hemichalceum, previous allozyme work indicated that groups of cooperating adult females are not relatives. Yet at any given time, not all group members perform the risky task of foraging. We previously hypothesized that tolerance for non-foragers was a component of extended parental care, previously known only for kin based social systems. DNA microsatellites were used to study colony genetic structure in order to test this hypothesis. Microsatellite polymorphism was substantial (He = 0.775. Overall intracolony relatedness, mainly of immatures, was low but significant in nine, late season nests (r = 0.136 plus or minus0.023, indicating that broods contain five to six unrelated sib ships. Detailed analyses of kinship between pairs of individuals revealed that most pairs were unrelated and most related pairs were siblings. Mothers are absent for 89-91% of the developing immature females, and 97% of developing males. Alternatively, 46% of adult females had neither sibs nor offspring in their nests. These findings indicate that the extended parental care model applies broadly to both kin based and nonkin based social systems in the Hymenoptera.

  6. Health promotion practices in primary care groups.

    Science.gov (United States)

    Heidemann, Ivonete Teresinha Schulter Buss; Alonso da Costa, Maria Fernanda Baeta Neves; Hermida, Patrícia Madalena Vieira; Marçal, Cláudia Cossentino Bruck; Antonini, Fabiano Oliveira; Cypriano, Camilla Costa

    2018-04-01

    This is a descriptive-exploratory study using a qualitative approach, conducted in ten municipalities in southern Brazil. Data were obtained by talking to 21 nurses from February to November 2012, through semi-structured interviews using questions to probe their health promotion practices. Data were analyzed through thematic analysis focused on health promotion concepts. We identified four themes about health promotion practices of family health nurses in Brazil: a) training of nurses for health promotion practice was weak; b) nurses formed health promotion groups around diseases and life stages; c) nurses formed groups to meet community needs; and d) nurses used health promotion techniques in group work. These family health nurses were somewhat aware of the importance of health promotion, and how to assist the population against various ailments using some health promotion strategies. The main weaknesses were the lack of understanding about health promotion concepts, and the difficulty of understanding the relevance of its practice, probably attributable to limitations in training. We conclude that primary care groups in Brazil's unified health system could do better in applying health promotion concepts in their practice.

  7. The Nordic maintenance care program

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  8. ACOG Committee Opinion No. 731: Group Prenatal Care.

    Science.gov (United States)

    2018-03-01

    Individual prenatal care is intended to prevent poor perinatal outcomes and provide education to women throughout pregnancy, childbirth, and the postpartum period through a series of one-on-one encounters between a woman and her obstetrician or other obstetric care provider. Concerns regarding increasing health care costs, health care provider availability, dissatisfaction with wait times, and the minimal opportunity for education and support associated with the individual care model have given rise to interest in alternative models of prenatal care. One alternative model, group prenatal care, may be beneficial or preferred for some practice settings and patient populations, although individual prenatal care remains standard practice. Group prenatal care models are designed to improve patient education and include opportunities for social support while maintaining the risk screening and physical assessment of individual prenatal care. Bringing patients with similar needs together for health care encounters increases the time available for the educational component of the encounter, improves efficiency, and reduces repetition. Evidence suggests patients have better prenatal knowledge, feel more ready for labor and delivery, are more satisfied with care in prenatal care groups, and initiate breastfeeding more often. There is no evidence that suggests that group prenatal care causes harm. Individual and group care models warrant additional study with a goal of demonstrating differences in outcomes and identifying populations that benefit most from specific care models.

  9. ACOG Committee Opinion No. 731 Summary: Group Prenatal Care.

    Science.gov (United States)

    2018-03-01

    Individual prenatal care is intended to prevent poor perinatal outcomes and provide education to women throughout pregnancy, childbirth, and the postpartum period through a series of one-on-one encounters between a woman and her obstetrician or other obstetric care provider. Concerns regarding increasing health care costs, health care provider availability, dissatisfaction with wait times, and the minimal opportunity for education and support associated with the individual care model have given rise to interest in alternative models of prenatal care. One alternative model, group prenatal care, may be beneficial or preferred for some practice settings and patient populations, although individual prenatal care remains standard practice. Group prenatal care models are designed to improve patient education and include opportunities for social support while maintaining the risk screening and physical assessment of individual prenatal care. Bringing patients with similar needs together for health care encounters increases the time available for the educational component of the encounter, improves efficiency, and reduces repetition. Evidence suggests patients have better prenatal knowledge, feel more ready for labor and delivery, are more satisfied with care in prenatal care groups, and initiate breastfeeding more often. There is no evidence that suggests that group prenatal care causes harm. Individual and group care models warrant additional study with a goal of demonstrating differences in outcomes and identifying populations that benefit most from specific care models.

  10. Effectiveness of the Lunch is in the Bag program on communication between the parent, child and child-care provider around fruits, vegetables and whole grain foods: A group-randomized controlled trial.

    Science.gov (United States)

    Sharma, Shreela V; Rashid, Tasnuva; Ranjit, Nalini; Byrd-Williams, Courtney; Chuang, Ru-Jye; Roberts-Gray, Cynthia; Briley, Margaret; Sweitzer, Sara; Hoelscher, Deanna M

    2015-12-01

    To evaluate the effectiveness of the parent- and early care education (ECE) center-based Lunch is in the Bag program on communication between parent, child, and their ECE center providers around fruits, vegetables and whole grain foods (FVWG). A total of n=30 ECE center; 577 parent-child dyads participated in this group-randomized controlled trial conducted from 2011 to 2013 in Texas (n=15 ECE center, 327 dyads intervention group; n=15 ECE center, 250 dyads comparison group). Parent-child and parent-ECE center provider communication was measured using a parent-reported survey administered at baseline and end of the five-week intervention period. Multilevel linear regression analysis was used to compare the pre-to-post intervention changes in the parent-child and parent-ECE center provider communication scales. Significance was set at pparent-child and parent-ECE center provider communication scores were low. There was a significant increase post-intervention in the parent-ECE center provider communication around vegetables (Adjusted β=0.78, 95%CI: 0.13, 1.43, p=0.002), and around fruit (Adjusted β=0.62, 95%CI: 0.04, 0.20, p=0.04) among the parents in the intervention group as compared to those in the comparison group. There were no significant intervention effects on parent-child communication. Lunch is in the Bag had significant positive effects on improving communication between the parents and ECE center providers around FVWG. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Chapter 7. Creating and Sustaining a Culture of Group Care

    Science.gov (United States)

    Ainsworth, Frank; Fulcher, Leon C.

    2006-01-01

    Group care centers are established to provide a range of living, learning, treatment, and supervisory opportunities for children and young people who, for a variety of reasons, need alternative, supplementary, or substitute care. It is important, therefore, that group care centres establish an organizational climate, ethos, or culture of caring…

  12. Gestational Weight Gain and Breastfeeding Outcomes in Group Prenatal Care.

    Science.gov (United States)

    Brumley, Jessica; Cain, M Ashley; Stern, Marilyn; Louis, Judette M

    2016-09-01

    This study sought to examine the differences in pregnancy outcomes with a focus on gestational weight gain for women attending group prenatal care compared to standard individual prenatal care. A matched case-control study was conducted including 65 women who chose group care and 130 women who chose standard individual care. Women were matched based on prepregnancy body mass index (BMI) category, eligibility for midwifery care, and age within 5 years. Women choosing group prenatal care and women choosing standard individual care had similar gestational weight gain, birth weight, gestational age at birth, and mode of birth. Women choosing group prenatal care did have a significantly higher rate of exclusive breastfeeding at 6 weeks postpartum (odds ratio [OR], 4.07; 95% confidence interval [CI], 1.81-9.15; P care. Group prenatal care participation resulted in equivalent gestational weight gain as well as pregnancy outcomes as compared to standard individual care. Breastfeeding rates were improved for women choosing group prenatal care. Randomized controlled trials are needed in order to eliminate selection bias. © 2016 by the American College of Nurse-Midwives.

  13. The patient perspective: utilizing focus groups to inform care coordination for high-risk medicaid populations.

    Science.gov (United States)

    Sheff, Alex; Park, Elyse R; Neagle, Mary; Oreskovic, Nicolas M

    2017-07-25

    Care coordination programs for high-risk, high-cost patients are a critical component of population health management. These programs aim to improve outcomes and reduce costs and have proliferated over the last decade. Some programs, originally designed for Medicare patients, are now transitioning to also serve Medicaid populations. However, there are still gaps in the understanding of what barriers to care Medicaid patients experience, and what supports will be most effective for providing them care coordination. We conducted two focus groups (n = 13) and thematic analyses to assess the outcomes drivers and programmatic preferences of Medicaid patients enrolled in a high-risk care coordination program at a major academic medical center in Boston, MA. Two focus groups identified areas where care coordination efforts were having a positive impact, as well as areas of unmet needs among the Medicaid population. Six themes emerged from the focus groups that clustered in three groupings: In the first group (1) enrollment in an existing medical care coordination programs, and (2) provider communication largely presented as positive accounts of assistance, and good relationships with providers, though participants also pointed to areas where these efforts fell short. In the second group (3) trauma histories, (4) mental health challenges, and (5) executive function difficulties all presented challenges faced by high-risk Medicaid patients that would likely require redress through additional programmatic supports. Finally, in the third group, (6) peer-to-peer support tendencies among patients suggested an untapped resource for care coordination programs. Programs aimed at high-risk Medicaid patients will want to consider programmatic adjustments to attend to patient needs in five areas: (1) provider connection/care coordination, (2) trauma, (3) mental health, (4) executive function/paperwork and coaching support, and (5) peer-to-peer support.

  14. The critical care air transport program.

    Science.gov (United States)

    Beninati, William; Meyer, Michael T; Carter, Todd E

    2008-07-01

    The critical care air transport team program is a component of the U.S. Air Force Aeromedical Evacuation system. A critical care air transport team consists of a critical care physician, critical care nurse, and respiratory therapist along with the supplies and equipment to operate a portable intensive care unit within a cargo aircraft. This capability was developed to support rapidly mobile surgical teams with high capability for damage control resuscitation and limited capacity for postresuscitation care. The critical care air transport team permits rapid evacuation of stabilizing casualties to a higher level of care. The aeromedical environment presents important challenges for the delivery of critical care. All equipment must be tested for safety and effectiveness in this environment before use in flight. The team members must integrate the current standards of care with the limitation imposed by stresses of flight on their patient. The critical care air transport team capability has been used successfully in a range of settings from transport within the United States, to disaster response, to support of casualties in combat.

  15. Expanding the Application of Group Interventions: Emergence of Groups in Health Care Settings

    Science.gov (United States)

    Drum, David; Becker, Martin Swanbrow; Hess, Elaine

    2011-01-01

    Changes in the health care arena and within the specialty of group work are contributing to the increased utilization of groups in health care settings. Psychoeducational, theme, and interpersonal therapy groups are highlighted for their contributions to treating challenging health conditions. An understanding of the evolution of these group…

  16. Exploring the Relationship between Global Quality and Group Engagement in Toddler Child Care Classrooms

    Science.gov (United States)

    Hooper, Alison; Hallam, Rena

    2017-01-01

    Toddlers' engagement with their social and physical environment is an important aspect of their experience in early care and education programs. The purpose of this research study was to examine how global quality relates to children's engagement in toddler child care classrooms. Additionally, this study explored how toddlers' group engagement…

  17. Association of Group Prenatal Care With Gestational Weight Gain.

    Science.gov (United States)

    Kominiarek, Michelle A; Crockett, Amy; Covington-Kolb, Sarah; Simon, Melissa; Grobman, William A

    2017-04-01

    To compare gestational weight gain among women in group prenatal care with that of women in individual prenatal care. In this retrospective cohort study, women who participated in group prenatal care from 2009 to 2015 and whose body mass indexes (BMIs) and gestational weight gain were recorded were matched with the next two women who had the same payer type, were within 2-kg/m prepregnancy BMI and 2-week gestational age at delivery, and had received individual prenatal care. Bivariate comparisons of demographics and antenatal complications were performed for women in group and individual prenatal care, and weight gain was categorized as "below," "met," or "exceeded" goals according to the 2009 Institute of Medicine guidelines. Logistic regression analysis estimated the association between excessive weight gain and model of care, with adjustment for confounders, stratified by BMI. Women in group prenatal care (n=2,117) were younger and more commonly non-Hispanic black, nulliparous, and without gestational diabetes (P≤.005 for all). Women in group prenatal care more commonly exceeded the weight gain goals (55% compared with 48%, Pprenatal care, compared with individual prenatal care, is associated with excessive gestational weight gain.

  18. Effects of Group Prenatal Care on Food Insecurity during Late Pregnancy and Early Postpartum.

    Science.gov (United States)

    Heberlein, Emily C; Frongillo, Edward A; Picklesimer, Amy H; Covington-Kolb, Sarah

    2016-05-01

    This study compared the effects of group to individual prenatal care in late pregnancy and early postpartum on (1) women's food security and (2) psychosocial outcomes among food-insecure women. We recruited 248 racially diverse, low-income, pregnant women receiving CenteringPregnancy™ group prenatal care (N = 124) or individual prenatal care (N = 124) to complete surveys in early pregnancy, late pregnancy, and early postpartum, with 84 % completing three surveys. Twenty-six percent of group and 31 % of individual care participants reported food insecurity in early pregnancy (p = 0.493). In multiple logistic regression models, women choosing group versus individual care were more likely to report food security in late pregnancy (0.85 vs. 0.66 average predicted probability, p care average predicted probability, p care average predicted probability, p = 0.052) in intention-to-treat models. Group participants were more likely to change perceptions on affording healthy foods and stretching food resources. Group compared to individual care participants with early pregnancy food insecurity demonstrated higher maternal-infant attachment scale scores (89.8 vs. 86.2 points for individual care, p = 0.032). Group prenatal care provides health education and the opportunity for women to share experiences and knowledge, which may improve food security through increasing confidence and skills in managing household food resources. Health sector interventions can complement food assistance programs in addressing food insecurity during pregnancy.

  19. Competition and rural primary care programs.

    Science.gov (United States)

    Ricketts, T C

    1990-04-01

    Rural primary care programs were established in areas where there was thought to be no competition for patients. However, evidence from site visits and surveys of a national sample of subsidized programs revealed a pattern of competitive responses by the clinics. In this study of 193 rural primary care programs, mail and telephone surveys produced uniform data on the organization, operation, finances, and utilization of a representative sample of clinics. The programs were found to compete in terms of: (1) price, (2) service mix, (3) staff availability, (4) structural accessibility, (5) outreach, and (6) targeting a segment of the market. The competitive strategies employed by the clinics had consequences that affected their productivity and financial stability. The strategies were related to the perceived missions of the programs, and depended heavily upon the degree of isolation of the program and the targeting of the services. The competitive strategy chosen by a particular program could not be predicted based on service area population and apparent competitors in the service area. The goals and objectives of the programs had more to do with their competitive responses than with market characteristics. Moreover, the chosen strategies may not meet the demands of those markets.

  20. Practices for caring in nursing: Brazilian research groups.

    Science.gov (United States)

    Erdmann, A L; de Andrade, S R; de Mello, A L Ferreira; Klock, P; do Nascimento, K C; Koerich, M Santos; Backes, D Stein

    2011-09-01

    The present study considers the production of knowledge and the interactions in the environment of research and their relationships in the system of caring in nursing and health. To elaborate a theoretical model of the organization of the practices used for caring, based on the experiences made by the research groups of administration and management in nursing, in Brazil. The study is based on grounded theory. Twelve leaders of research groups, working as professors in public universities in the south and the south-east of Brazil, distributed in sample groups, were interviewed. The core phenomenon 'research groups of administration and management in nursing: arrangements and interactions in the system of caring in nursing' was derived from the categories: conceptual bases and contexts of the research groups; experiencing interactions in the research groups; functionality of the research groups; and outputs of the research groups. The research groups are integrated in the system of caring in nursing. The activities of the Brazilian administration and management in nursing research groups are process oriented and in a process of constant renovation, socially relevant, operate in a complex scenario and contribute to the advancement of the organizations of the system of caring in nursing through strengthening the connection among academia, service and community. © 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.

  1. Computer Programming Languages for Health Care

    Science.gov (United States)

    O'Neill, Joseph T.

    1979-01-01

    This paper advocates the use of standard high level programming languages for medical computing. It recommends that U.S. Government agencies having health care missions implement coordinated policies that encourage the use of existing standard languages and the development of new ones, thereby enabling them and the medical computing community at large to share state-of-the-art application programs. Examples are based on a model that characterizes language and language translator influence upon the specification, development, test, evaluation, and transfer of application programs.

  2. The comparative effects of group prenatal care on psychosocial outcomes.

    Science.gov (United States)

    Heberlein, Emily C; Picklesimer, Amy H; Billings, Deborah L; Covington-Kolb, Sarah; Farber, Naomi; Frongillo, Edward A

    2016-04-01

    To compare the psychosocial outcomes of the CenteringPregnancy (CP) model of group prenatal care to individual prenatal care, we conducted a prospective cohort study of women who chose CP group (N = 124) or individual prenatal care (N = 124). Study participants completed the first survey at study recruitment (mean gestational age 12.5 weeks), with 89% completing the second survey (mean gestational age 32.7 weeks) and 84% completing the third survey (6 weeks' postpartum). Multiple linear regression models compared changes by prenatal care model in pregnancy-specific distress, prenatal planning-preparation and avoidance coping, perceived stress, affect and depressive symptoms, pregnancy-related empowerment, and postpartum maternal-infant attachment and maternal functioning. Using intention-to-treat models, group prenatal care participants demonstrated a 3.2 point greater increase (p prenatal planning-preparation coping strategies. While group participants did not demonstrate significantly greater positive outcomes in other measures, women who were at greater psychosocial risk benefitted from participation in group prenatal care. Among women reporting inadequate social support in early pregnancy, group participants demonstrated a 2.9 point greater decrease (p = 0.03) in pregnancy-specific distress in late pregnancy and 5.6 point higher mean maternal functioning scores postpartum (p = 0.03). Among women with high pregnancy-specific distress in early pregnancy, group participants had an 8.3 point greater increase (p prenatal planning-preparation coping strategies in late pregnancy and a 4.9 point greater decrease (p = 0.02) in postpartum depressive symptom scores. This study provides further evidence that group prenatal care positively impacts the psychosocial well-being of women with greater stress or lower personal coping resources. Large randomized studies are needed to establish conclusively the biological and psychosocial benefits of group

  3. Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy.

    Science.gov (United States)

    Hager, David R; Persaud, Rosemary A; Naseman, Ryan W; Choudhary, Kavish; Carter, Kristen E; Hansen, Amanda

    2017-05-01

    Background: While hospital beds continue to decline as patients previously treated as inpatients are stabilized in ambulatory settings, the number of critical care beds available in the United States continues to rise. Growth in pharmacy student graduation, postgraduate year 2 critical care (PGY2 CC) residency programs, and positions has also increased. There is a perception that the critical care trained pharmacist market is saturated, yet this has not been evaluated since the rise in pharmacy graduates and residency programs. Purpose: To describe the current perception of critical care residency program directors (CC RPDs) and directors of pharmacy (DOPs) on the critical care pharmacist job market and to evaluate critical care postresidency placement and anticipated changes in PGY2 CC programs. Methods: Two electronic surveys were distributed from October 2015 to November 2015 through Vizient/University HealthSystem Consortium, American Society of Health-System Pharmacists (ASHP), Society of Critical Care Medicine, and American College of Clinical Pharmacy listservs to target 2 groups of respondents: CC RPDs and DOPs. Questions were based on the ASHP Pharmacy Forecast and the Pharmacy Workforce Center's Aggregate Demand Index and were intended to identify perceptions of the critical care market of the 2 groups. Results: Of 116 CC RPDs, there were 66 respondents (56.9% response rate). Respondents have observed an increase in applicants; however, they do not anticipate increasing the number of positions in the next 5 years. The overall perception is that there is a balance in supply and demand in the critical care trained pharmacist market. A total of 82 DOPs responded to the survey. Turnover of critical care pharmacists within respondent organizations is expected to be low. Although a majority of DOPs plan to expand residency training positions, only 9% expect to increase positions in critical care PGY2 training. Overall, DOP respondents indicated a balance of

  4. Consumer-sponsored prepaid group practice: restructuring the health care system.

    Science.gov (United States)

    Warden, G L

    1984-01-01

    The traditional separation of health care delivery and financing systems is breaking down as various new types of health care facilities are established and as payment continues to be a major concern. Group Health Cooperative of Puget Sound (GHC) was organized as a prepaid group practice system responsive to consumers. Costs, methods of payment and delivery of care are interrelated and are all influenced by consumer ownership. GHC has been refining its benefit programs since 1945. Strategies for controlling use and costs focus on improved provider management and on flexibility. This article explains how the structure of GHC benefits the consumer.

  5. Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.

    Science.gov (United States)

    Povar, Gail J; Blumen, Helen; Daniel, John; Daub, Suzanne; Evans, Lois; Holm, Richard P; Levkovich, Natalie; McCarter, Alice O; Sabin, James; Snyder, Lois; Sulmasy, Daniel; Vaughan, Peter; Wellikson, Laurence D; Campbell, Amy

    2004-07-20

    Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.

  6. Crisis Group Fellowship Program | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The fellowship will not be of an academic nature, but rather a working one. Two fellows from MENA and one from West Africa will be hired to work for two years in the field with Crisis Group at the analyst level. Over the course of ... Faleh A. Jabar. It is with great sadness that we announce the sudden passing of Dr Faleh A.

  7. City Kids in the Wilderness: A Pilot-Test of Outward Bound for Foster Care Group Home Youth.

    Science.gov (United States)

    Fischer, Robert L.; Attah, E. B.

    2001-01-01

    A study examined perceptions of a 7-day Outward Bound program among 23 urban youths, foster parents, and foster care workers from group homes in Atlanta (Georgia). Foster parents reported improved self-esteem and behavior among the teens, but foster care workers reported worse behavior. Negative program impressions lessened among male youths but…

  8. Delinquency and Crime Prevention: Overview of Research Comparing Treatment Foster Care and Group Care

    Science.gov (United States)

    Osei, Gershon K.; Gorey, Kevin M.; Jozefowicz, Debra M. Hernandez

    2016-01-01

    Background: Evidence of treatment foster care (TFC) and group care's (GC) potential to prevent delinquency and crime has been developing. Objectives: We clarified the state of comparative knowledge with a historical overview. Then we explored the hypothesis that smaller, probably better resourced group homes with smaller staff/resident ratios have…

  9. Head Start’s Impact is Contingent on Alternative Type of Care in Comparison Group

    Science.gov (United States)

    Brooks-Gunn, Jeanne; Waldfogel, Jane

    2014-01-01

    Using data (n = 3,790 with 2,119 in the 3-year-old cohort and 1,671 in the 4-year-old cohort) from 353 Head Start centers in the Head Start Impact Study, the only large-scale randomized experiment in Head Start history, this paper examined the impact of Head Start on children’s cognitive and parent-reported social-behavioral outcomes through first grade contingent on the child care arrangements used by children who were randomly assigned to the control group (i.e., parental care, relative/non-relative care, another Head Start program, or other center-based care). A principal score matching approach was adopted to identify children assigned to Head Start who were similar to children in the control group with a specific care arrangement. Overall, the results showed that the effects of Head Start varied substantially contingent on the alternative child care arrangements. Compared to children in parental care and relative/non-relative care, Head Start participants generally had better cognitive and parent-reported behavioral development, with some benefits of Head Start persisting through first grade; in contrast, few differences were found between Head Start and other center-based care. The results have implications regarding the children for whom Head Start is most beneficial as well as how well Head Start compares to other center-based programs. PMID:25329552

  10. 76 FR 34541 - Child and Adult Care Food Program Improving Management and Program Integrity

    Science.gov (United States)

    2011-06-13

    ... 7 CFR Parts 210, 215, 220 et al. Child and Adult Care Food Program Improving Management and Program..., 220, 225, and 226 RIN 0584-AC24 Child and Adult Care Food Program Improving Management and Program... management and integrity in the Child and Adult Care Food Program (CACFP), at 67 FR 43447 (June 27, 2002) and...

  11. Medication errors in home care: a qualitative focus group study.

    Science.gov (United States)

    Berland, Astrid; Bentsen, Signe Berit

    2017-11-01

    To explore registered nurses' experiences of medication errors and patient safety in home care. The focus of care for older patients has shifted from institutional care towards a model of home care. Medication errors are common in this situation and can result in patient morbidity and mortality. An exploratory qualitative design with focus group interviews was used. Four focus group interviews were conducted with 20 registered nurses in home care. The data were analysed using content analysis. Five categories were identified as follows: lack of information, lack of competence, reporting medication errors, trade name products vs. generic name products, and improving routines. Medication errors occur frequently in home care and can threaten the safety of patients. Insufficient exchange of information and poor communication between the specialist and home-care health services, and between general practitioners and healthcare workers can lead to medication errors. A lack of competence in healthcare workers can also lead to medication errors. To prevent these, it is important that there should be up-to-date information and communication between healthcare workers during the transfer of patients from specialist to home care. Ensuring competence among healthcare workers with regard to medication is also important. In addition, there should be openness and accurate reporting of medication errors, as well as in setting routines for the preparation, alteration and administration of medicines. To prevent medication errors in home care, up-to-date information and communication between healthcare workers is important when patients are transferred from specialist to home care. It is also important to ensure adequate competence with regard to medication, and that there should be openness when medication errors occur, as well as in setting routines for the preparation, alteration and administration of medications. © 2017 John Wiley & Sons Ltd.

  12. 76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative

    Science.gov (United States)

    2011-10-03

    ...] Medicare Program; Comprehensive Primary Care Initiative AGENCY: Centers for Medicare & Medicaid Services... organizations to participate in the Comprehensive Primary Care initiative (CPC), a multipayer model designed to... the Comprehensive Primary Care initiative or the application process. SUPPLEMENTARY INFORMATION: I...

  13. Improving insomnia in primary care patients: A randomized controlled trial of nurse-led group treatment.

    Science.gov (United States)

    Sandlund, Christina; Hetta, Jerker; Nilsson, Gunnar H; Ekstedt, Mirjam; Westman, Jeanette

    2017-07-01

    Insomnia is a common health problem, and most people who seek help for insomnia consult primary care. In primary care, insomnia treatment typically consists of hypnotic drugs, although cognitive behavioral therapy for insomnia is the recommended treatment. However, such treatment is currently available to few primary care patients. To evaluate the effects of a group treatment program for insomnia led by nurses in primary care. were the Insomnia Severity Index, a 2-week sleep diary, and a questionnaire on frequency of hypnotic drug use. A randomized controlled trial with pre- and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group. Routine primary health care; 7 primary care centers in Stockholm, Sweden. Patients consulting primary care for insomnia were assessed for eligibility. To be included, patients had to have insomnia disorder and be 18 years or older. Patients were excluded if they if they worked night shifts or had severe untreated somatic and/or mental illness, bipolar disorder, or untreated sleep disorder other than insomnia. One-hundred and sixty-five patients 20 to 90 years were included. Most were women, and many had co-existing somatic and/or mental health problems. The post-treatment dropout rate was 20%. The intervention was a nurse-led group treatment for insomnia based on the techniques of cognitive behavioral therapy for insomnia. The nurses had 2days of training in how to deliver the program. Ninety patients were randomized to the intervention and 75 to the control group (treatment as usual). Data from 82 in the intervention and 71 in the control group were analyzed in accordance with intention-to-treat principles. Fifty-four of the 72 in the intervention group who participated in the group treatment program were followed up after 1year. Mean Insomnia Severity Index score decreased significantly from 18.4 to 10.7 after group treatment but remained unchanged after treatment as usual (17.0 to 16.6). The effect

  14. Diabetes quality management in Dutch care groups and outpatient clinics: a cross-sectional study.

    Science.gov (United States)

    Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E H M

    2014-08-07

    In recent years, most Dutch general practitioners started working under the umbrella of diabetes care groups, responsible for the organisation and coordination of diabetes care. The quality management of these new organisations receives growing interest, although its association with quality of diabetes care is yet unclear. The best way to measure quality management is unknown and it has not yet been studied at the level of outpatient clinics or care groups. We aimed to assess quality management of type 2 diabetes care in care groups and outpatient clinics. Quality management was measured with online questionnaires, containing six domains (see below). They were divided into 28 subdomains, with 59 (care groups) and 57 (outpatient clinics) questions respectively. The mean score of the domains reflects the overall score (0-100%) of an organisation. Two quality managers of all Dutch care groups and outpatient clinics were invited to fill out the questionnaire.Sixty care groups (response rate 61.9%) showed a mean score of 59.6% (CI 57.1-62.1%). The average score in 52 outpatient clinics (response rate 50.0%) was 61.9% (CI 57.5-66.8%).Mean scores on the six domains for care groups and outpatient clinics respectively were: 'organisation of care' 71.9% (CI 68.8-74.9%), 76.8% (CI 72.8-80.7%); 'multidisciplinary teamwork' 67.1% (CI 62.4-71.9%), 71.5% (CI 65.3-77.8%); 'patient centeredness' 46.7% (CI 42.6-50.7%), 62.5% (CI 57.7-67.2%); 'performance management' 63.3% (CI 61.2-65.3%), 50.9% (CI 44.2-57.5%); 'quality improvement policy' 52.6% (CI 49.2-56.1%), 50.9% (CI 44.6-57.3%); and 'management strategies' 56.0% (CI 51.4-60.7%), 59.0% (CI 52.8-65.2%). On subdomains, care groups scored highest on 'care program' (83.3%) and 'measured outcomes' (98.3%) and lowest on 'patient safety' (15.1%) and 'patient involvement' (17.7%). Outpatient clinics scored high on the presence of a 'diabetic foot team' (81.6%) and the support in 'self-management' (81.0%) and low on 'patient

  15. Caring for the Karen. A newly arrived refugee group.

    Science.gov (United States)

    Power, David V; Moody, Emily; Trussell, Kristi; O'Fallon, Ann; Chute, Sara; Kyaw, Merdin; Letts, James; Mamo, Blain

    2010-04-01

    Since 2004, Minnesota has seen an influx of refugees from Burma. Many of these newcomers came from the Karen state and spent time in refugee camps in Thailand before resettling in the United States. To better understand the health needs of this population, the authors of this article conducted chart reviews at a St. Paul family medicine clinic that serves a number of Karen refugees and reviewed formal data from the Minnesota Department of Health's Refugee Health Program. Here, they briefly describe this community, the cultural issues that could affect health care providers' ability to care for Karen patients, and the health concerns of these refugees.

  16. Staff Group Unanimity in the Care of Juveniles in Institutional Treatment: Routines, Rituals, and Relationships

    Science.gov (United States)

    Ahonen, Lia; Degner, Jurgen

    2013-01-01

    One prerequisite for effective institutional care is that staff agree on how to deliver treatment and have a unified view of how to achieve change--in other words, to have staff group unanimity (SGU). This study used the Correctional Program Assessment Inventory (CPAI) 2000, interviews with key staff, and observations of daily activities to…

  17. Group Use and Other Aspects of Programmed Instruction. Final Report.

    Science.gov (United States)

    Crist, Robert L.

    The use of group approval as a social reinforcer and related methods in group presentation of programed instruction were investigated in a series of studies. The efficacy of programed instructional materials is frequently limited by their inability to command and maintain adequate attention and motivation. To consider social reinforcement effects…

  18. Professional groups driving change toward patient-centred care

    DEFF Research Database (Denmark)

    Burau, Viola; Carstensen, Kathrine; Lou, Stina

    2017-01-01

    BACKGROUND: Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to implement new health policies more effectively. Our aim...... was to analyse the role and capacity of health professions in driving organisational change in interprofessional working and patient-centred care. METHODS: A case study of the introduction of interprofessional, early discharge teams in stroke rehabilitation in Denmark was conducted with focus on day......-to-day coordination of care tasks and the professional groups' interests and strategies. The study included 5 stroke teams and 17 interviews with different health professionals conducted in 2015. RESULTS: Professional groups expressed highly positive professional interest in reorganised stroke rehabilitation...

  19. Perceptions about prenatal care: views of urban vulnerable groups

    Directory of Open Access Journals (Sweden)

    Hatcher Barbara

    2002-11-01

    Full Text Available Abstract Background In the United States, infant mortality rates remain more than twice as high for African Americans as compared to other racial groups. Lack of adherence to prenatal care schedules in vulnerable, hard to reach, urban, poor women is associated with high infant mortality, particularly for women who abuse substances, are homeless, or live in communities having high poverty and high infant mortality. This issue is of concern to the women, their partners, and members of their communities. Because they are not part of the system, these womens' views are often not included in other studies. Methods This qualitative study used focus groups with four distinct categories of people, to collect observations about prenatal care from various perspectives. The 169 subjects included homeless women; women with current or history of substance abuse; significant others of homeless women; and residents of a community with high infant mortality and poverty indices, and low incidence of adequate prenatal care. A process of coding and recoding using Ethnograph and counting ensured reliability and validity of the process of theme identification. Results Barriers and motivators to prenatal care were identified in focus groups. Pervasive issues identified were drug lifestyle, negative attitudes of health care providers and staff, and non-inclusion of male partners in the prenatal experience. Conclusions Designing prenatal care relevant to vulnerable women in urban communities takes creativity, thoughtfulness, and sensitivity. System changes recommended include increased attention to substance abuse treatment/prenatal care interaction, focus on provider/staff attitudes, and commitment to inclusion of male partners.

  20. Diabetes quality management in care groups and outpatient clinics

    NARCIS (Netherlands)

    Campmans-Kuijpers, M.J.E.

    2015-01-01

    This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with

  1. Auditing an intensive care unit recycling program.

    Science.gov (United States)

    Kubicki, Mark A; McGain, Forbes; O'Shea, Catherine J; Bates, Samantha

    2015-06-01

    The provision of health care has significant direct environmental effects such as energy and water use and waste production, and indirect effects, including manufacturing and transport of drugs and equipment. Recycling of hospital waste is one strategy to reduce waste disposed of as landfill, preserve resources, reduce greenhouse gas emissions, and potentially remain fiscally responsible. We began an intensive care unit recycling program, because a significant proportion of ICU waste was known to be recyclable. To determine the weight and proportion of ICU waste recycled, the proportion of incorrect waste disposal (including infectious waste contamination), the opportunity for further recycling and the financial effects of the recycling program. We weighed all waste and recyclables from an 11-bed ICU in an Australian metropolitan hospital for 7 non-consecutive days. As part of routine care, ICU waste was separated into general, infectious and recycling streams. Recycling streams were paper and cardboard, three plastics streams (polypropylene, mixed plastics and polyvinylchloride [PVC]) and commingled waste (steel, aluminium and some plastics). ICU waste from the waste and recycling bins was sorted into those five recycling streams, general waste and infectious waste. After sorting, the waste was weighed and examined. Recycling was classified as achieved (actual), potential and total. Potential recycling was defined as being acceptable to hospital protocol and local recycling programs. Direct and indirect financial costs, excluding labour, were examined. During the 7-day period, the total ICU waste was 505 kg: general waste, 222 kg (44%); infectious waste, 138 kg (27%); potentially recyclable waste, 145 kg (28%). Of the potentially recyclable waste, 70 kg (49%) was actually recycled (14% of the total ICU waste). In the infectious waste bins, 82% was truly infectious. There was no infectious contamination of the recycling streams. The PVC waste was 37% contaminated

  2. Day Care: A Program in Search of a Policy.

    Science.gov (United States)

    Bikales, Gerda

    This report examines current issues relating to day care and challenges many of the policy assumptions that underlie a major public program of subsidized day care for children. A historical perspective of day care is presented and various types of day care are described. The costs and benefits of day care are examined and the relation of day care…

  3. Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

    NARCIS (Netherlands)

    Bastiaanssen, I.L.W.; Delsing, M.J.M.H.; Geijsen, L.; Kroes, G.; Veerman, J.W.; Engels, R.C.M.E.

    2014-01-01

    The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children. The aim of the current study was to observe the pedagogical interventions of group care

  4. Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

    Science.gov (United States)

    Bastiaanssen, Inge L. W.; Delsing, Marc J. M. H.; Geijsen, Luuk; Kroes, Gert; Veerman, Jan W.; Engels, Rutger C. M. E.

    2014-01-01

    Background: The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children. Objective: The aim of the current study was to observe the pedagogical interventions of group care workers within residential…

  5. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care.

    Science.gov (United States)

    Goodwin, N

    2001-01-01

    This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital) services and also, potentially, social care. This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

  6. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2001-03-01

    Full Text Available Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

  7. Creating and Maintaining a Wellness Environment in Child Care Centers Participating in the Child and Adult Care Food Program

    Science.gov (United States)

    Lofton, Kristi L.; Carr, Deborah H.

    2010-01-01

    Purpose/Objectives: This study identifies issues associated with creating and maintaining a wellness environment in child care centers (CCCs) participating in the Child and Adult Care Food Program (CACFP). Methods: Structured interviews and focus groups were conducted with CCC professionals and state agency personnel to develop a survey to assess…

  8. 75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

    Science.gov (United States)

    2010-11-03

    ...] Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting AGENCY: Centers for Medicare... guidance and ask questions about the upcoming Community-based Care Transitions Program. The meeting is open... conference will also provide an overview of the Community-based Care Transitions Program (CCTP) and provide...

  9. Critical Care Nurses' Reasons for Poor Attendance at a Continuous Professional Development Program.

    Science.gov (United States)

    Viljoen, Myra; Coetzee, Isabel; Heyns, Tanya

    2016-12-01

    Society demands competent and safe health care, which obligates professionals to deliver quality patient care using current knowledge and skills. Participation in continuous professional development programs is a way to ensure quality nursing care. Despite the importance of continuous professional development, however, critical care nurse practitioners' attendance rates at these programs is low. To explore critical care nurses' reasons for their unsatisfactory attendance at a continuous professional development program. A nominal group technique was used as a consensus method to involve the critical care nurses and provide them the opportunity to reflect on their experiences and challenges related to the current continuous professional development program for the critical care units. Participants were 14 critical care nurses from 3 critical care units in 1 private hospital. The consensus was that the central theme relating to the unsatisfactory attendance at the continuous professional development program was attitude. In order of importance, the 4 contributing priorities influencing attitude were communication, continuous professional development, time constraints, and financial implications. Attitude relating to attending a continuous professional development program can be changed if critical care nurses are aware of the program's importance and are involved in the planning and implementation of a program that focuses on the nurses' individual learning needs. ©2016 American Association of Critical-Care Nurses.

  10. The Costs of Critical Care Telemedicine Programs

    Science.gov (United States)

    Falk, Derik M.; Bonello, Robert S.; Kahn, Jeremy M.; Perencevich, Eli; Cram, Peter

    2013-01-01

    Background: Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals. Methods: We conducted a systematic review of studies published between January 1, 1990, and July 1, 2011, reporting costs of tele-ICUs. Studies were summarized, and key cost data were abstracted. We then obtained the costs of implementing a tele-ICU in a network of seven VHA hospitals and report these costs in light of the existing literature. Results: Our systematic review identified eight studies reporting tele-ICU costs. These studies suggested combined implementation and first year of operation costs for a tele-ICU of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient. VHA data suggested a cost for implementation and first year of operation of $70,000 to $87,000 per ICU-bed, depending on the depreciation methods applied. Conclusions: The cost of tele-ICU implementation is substantial, and the impact of these programs on hospital costs or profits is unclear. Until additional data become available, clinicians and administrators should carefully weigh the clinical and economic aspects of tele-ICUs when considering investing in this technology. PMID:22797291

  11. Space Station Freedom Environmental Health Care Program

    Science.gov (United States)

    Richard, Elizabeth E.; Russo, Dane M.

    1992-01-01

    The paper discusses the environmental planning and monitoring aspects of the Space Station Freedom (SSF) Environmental Health Care Program, which encompasses all phases of the SSF assembly and operation from the first element entry at MB-6 through the Permanent Manned Capability and beyond. Environmental planning involves the definition of acceptability limits and monitoring requirements for the radiation dose barothermal parameters and potential contaminants in the SSF air and water and on internal surfaces. Inflight monitoring will be implemented through the Environmental Health System, which consists of five subsystems: Microbiology, Toxicology, Water Quality, Radiation, and Barothermal Physiology. In addition to the environmental data interpretation and analysis conducted after each mission, the new data will be compared to archived data for statistical and long-term trend analysis and determination of risk exposures. Results of these analyses will be used to modify the acceptability limits and monitoring requirements for the future.

  12. Parent Group Training Programs in Juvenile Courts: A National Survey

    Science.gov (United States)

    Windell, James O.; Windell, Ellen A.

    1977-01-01

    This survey of juvenile courts across the country indicates that only one of five courts have a parent group program and few use procedures reported in the growing literature relating to changing the behavior of agressive children. (Author)

  13. Evaluation of a Research Mentorship Program in Community Care

    Science.gov (United States)

    Ploeg, Jenny; de Witt, Lorna; Hutchison, Brian; Hayward, Lynda; Grayson, Kim

    2008-01-01

    This article describes the results of a qualitative case study evaluating a research mentorship program in community care settings in Ontario, Canada. The purpose of the program was to build evaluation and research capacity among staff of community care agencies through a mentorship program. Data were collected through in-depth, semi-structured…

  14. Careful cheating: People cheat groups rather than individuals

    Directory of Open Access Journals (Sweden)

    Amitay eAmir

    2016-03-01

    Full Text Available Cheating for material gain is a destructive phenomenon in any society. We examine the extent to which people care about the victims of their unethical behavior—be they a group of people or an individual—and whether they are sensitive to the degree of harm or cost that they cause to these victims. The results of three studies suggest that when a group (rather than a single individual is the victim of one’s behavior, the incidence of cheating increases only if the harm to the group is presented in global terms—such that the cheating might be justified by the relatively minor harm caused to each individual in the group (Study #1 and #3. However, when the harm or cost to each individual in the group is made explicit, the tendency to cheat the group is no longer apparent and the tendency to cheat increases when the harm caused is minor—regardless of whether the victim is an individual or a group of people (Study #2. Individual differences in rational and intuitive thinking appear to play different roles in the decision to cheat different type of opponents: individual opponents seem to trigger the subject’s intuitive thinking which restrains the urge to cheat, whereas groups of opponents seem to trigger the subject’s rational mode of thinking which encourage cheating.

  15. Careful Cheating: People Cheat Groups Rather than Individuals.

    Science.gov (United States)

    Amir, Amitai; Kogut, Tehila; Bereby-Meyer, Yoella

    2016-01-01

    Cheating for material gain is a destructive phenomenon in any society. We examine the extent to which people care about the victims of their unethical behavior-be they a group of people or an individual-and whether they are sensitive to the degree of harm or cost that they cause to these victims. The results of three studies suggest that when a group (rather than a single individual) is the victim of one's behavior, the incidence of cheating increases only if the harm to the group is presented in global terms-such that the cheating might be justified by the relatively minor harm caused to each individual in the group (Studies #1 and #3). However, when the harm or cost to each individual in the group is made explicit, the tendency to cheat the group is no longer apparent and the tendency to cheat increases when the harm caused is minor-regardless of whether the victim is an individual or a group of people (Study #2). Individual differences in rational and intuitive thinking appear to play different roles in the decision to cheat different type of opponents: individual opponents seem to trigger the subject's intuitive thinking which restrains the urge to cheat, whereas groups of opponents seem to trigger the subject's rational mode of thinking which encourage cheating.

  16. Supporting Family Carers Through Telephone-Mediated Group Programs: Opportunities For Gerontological Social Workers.

    Science.gov (United States)

    Shanley, Chris

    2008-01-01

    Telephone-mediated group programs are an important but under-utilized medium for reaching frail or disabled older persons' family carers who are in need of support. The primary purpose and style of group programs can range across a broad spectrum–encompassing educational, supportive and therapeutic types. Gerontological social workers are the members of the multidisciplinary care team whose training, experience and supervision makes them most suitable for facilitating this broad range of group types. Drawing on the experience of training a number of group facilitators, this article provides suggestions for social workers contemplating the use of telephone-mediated groups and highlights groupwork skills peculiar to conducting group programs via the telephone.

  17. Simplified tools for measuring retention in care in antiretroviral treatment program in Ethiopia: cohort and current retention in care.

    Science.gov (United States)

    Assefa, Yibeltal; Worku, Alemayehu; Wouters, Edwin; Koole, Olivier; Haile Mariam, Damen; Van Damme, Wim

    2012-01-01

    Patient retention in care is a critical challenge for antiretroviral treatment programs. This is mainly because retention in care is related to adherence to treatment and patient survival. It is therefore imperative that health facilities and programs measure patient retention in care. However, the currently available tools, such as Kaplan Meier, for measuring retention in care have a lot of practical limitations. The objective of this study was to develop simplified tools for measuring retention in care. Retrospective cohort data were collected from patient registers in nine health facilities in Ethiopia. Retention in care was the primary outcome for the study. Tools were developed to measure "current retention" in care during a specific period of time for a specific "ART-age group" and "cohort retention" in care among patients who were followed for the last "Y" number of years on ART. "Probability of retention" based on the tool for "cohort retention" in care was compared with "probability of retention" based on Kaplan Meier. We found that the new tools enable to measure "current retention" and "cohort retention" in care. We also found that the tools were easy to use and did not require advanced statistical skills. Both "current retention" and "cohort retention" are lower among patients in the first two "ART-age groups" and "ART-age cohorts" than in subsequent "ART-age groups" and "ART-age cohorts". The "probability of retention" based on the new tools were found to be similar to the "probability of retention" based on Kaplan Meier. The simplified tools for "current retention" and "cohort retention" will enable practitioners and program managers to measure and monitor rates of retention in care easily and appropriately. We therefore recommend that health facilities and programs start to use these tools in their efforts to improve retention in care and patient outcomes.

  18. Simplified tools for measuring retention in care in antiretroviral treatment program in Ethiopia: cohort and current retention in care.

    Directory of Open Access Journals (Sweden)

    Yibeltal Assefa

    Full Text Available INTRODUCTION: Patient retention in care is a critical challenge for antiretroviral treatment programs. This is mainly because retention in care is related to adherence to treatment and patient survival. It is therefore imperative that health facilities and programs measure patient retention in care. However, the currently available tools, such as Kaplan Meier, for measuring retention in care have a lot of practical limitations. The objective of this study was to develop simplified tools for measuring retention in care. METHODS: Retrospective cohort data were collected from patient registers in nine health facilities in Ethiopia. Retention in care was the primary outcome for the study. Tools were developed to measure "current retention" in care during a specific period of time for a specific "ART-age group" and "cohort retention" in care among patients who were followed for the last "Y" number of years on ART. "Probability of retention" based on the tool for "cohort retention" in care was compared with "probability of retention" based on Kaplan Meier. RESULTS: We found that the new tools enable to measure "current retention" and "cohort retention" in care. We also found that the tools were easy to use and did not require advanced statistical skills. Both "current retention" and "cohort retention" are lower among patients in the first two "ART-age groups" and "ART-age cohorts" than in subsequent "ART-age groups" and "ART-age cohorts". The "probability of retention" based on the new tools were found to be similar to the "probability of retention" based on Kaplan Meier. CONCLUSION: The simplified tools for "current retention" and "cohort retention" will enable practitioners and program managers to measure and monitor rates of retention in care easily and appropriately. We therefore recommend that health facilities and programs start to use these tools in their efforts to improve retention in care and patient outcomes.

  19. The Development of a Program Engagement Theory for Group Offending Behavior Programs.

    Science.gov (United States)

    Holdsworth, Emma; Bowen, Erica; Brown, Sarah; Howat, Douglas

    2017-10-01

    Offender engagement in group offending behavior programs is poorly understood and under-theorized. In addition, there is no research on facilitators' engagement. This article presents the first ever theory to address this gap. A Program Engagement Theory (PET) was derived from a constructivist grounded theory analysis that accounts for both facilitators' and offenders' engagement in group offending behavior programs (GOBPs). Interviews and session observations were used to collect data from 23 program facilitators and 28 offenders (group members). The analysis revealed that group members' engagement involved shared identities and moving on as a group. In turn, this was dependent on facilitators personalising treatment frameworks and establishing a hook to help group members move on. The PET emphasizes the importance of considering change during treatment as a process rather than simply a program outcome. Solution-focused (SF) programs were more conducive to engagement and the change process than offence-focused programs.

  20. Neurolinguistic Programming in the Context of Group Counseling.

    Science.gov (United States)

    Childers, John H. Jr.; Saltmarsh, Robert E.

    1986-01-01

    Describes neurolinguistic programming (NLP) in the context of group counseling. NLP is a model of communication that focuses on verbal and nonverbal patterns of behaviors as well as on the structures and processes of human subjectivity. Five stages of group development are described, and specific NLP techniques appropriate to the various stages…

  1. The Performance Enhancement Group Program: Integrating Sport Psychology and Rehabilitation

    Science.gov (United States)

    Granito, Vincent J.; Hogan, Jeffery B.; Varnum, Lisa K.

    1995-01-01

    In an effort to improve the psychological health of the athlete who has sustained an injury, the Performance Enhancement Group program for injured athletes was created. This paper will offer a model for the Performance Enhancement Group program as a way to: 1) support the athlete, both mentally and physically; 2) deal with the demands of rehabilitation; and 3) facilitate the adjustments the athlete has to make while being out of the competitive arena. The program consists of responsibilities for professionals in sport psychology (ie, assessment/orientation, support, education, individual counseling, and evaluation) and athletic training (ie, organization/administration, recruitment and screening, support, application of techniques, and program compliance). The paper will emphasize that the success of the program is dependent on collaboration between professionals at all levels. PMID:16558357

  2. The significance of ethics reflection groups in mental health care: a focus group study among health care professionals.

    Science.gov (United States)

    Hem, Marit Helene; Molewijk, Bert; Gjerberg, Elisabeth; Lillemoen, Lillian; Pedersen, Reidar

    2018-06-05

    Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of 'bricolage' which means our approach was inductive. Most participants report positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices.

  3. Modernizing dermatology interest groups in medical school: Certificate programs.

    Science.gov (United States)

    Wang, Jordan V; Korta, Dorota Z; Keller, Matthew

    2017-11-15

    This commentary addresses the increasingly competitive nature of applying to dermatology residency programs and how both interest groups in medical schools and their dermatology departments can help to better prepare applicants. As previous literature argued that dermatology has been underemphasized in medical school curricula, we propose five fundamental options that interest groups can implement in order to offer increased exposure to our field in medical training. Furthermore, with therecent trend of many schools conferring certificates in various specialized concentrations, we also discuss interest groups pioneering certificate-grantingprograms in dermatology competency. The pros and cons of having a recognized certificate program in dermatology are presented.

  4. Disease Management, Case Management, Care Management, and Care Coordination: A Framework and a Brief Manual for Care Programs and Staff.

    Science.gov (United States)

    Ahmed, Osman I

    2016-01-01

    With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.

  5. Using focus groups and social marketing to strengthen promotion of group prenatal care.

    Science.gov (United States)

    Vonderheid, Susan C; Carrie, S Klima; Norr, Kathleen F; Grady, Mary Alice; Westdahl, Claire M

    2013-01-01

    Centering Pregnancy, an innovative group model of prenatal care, shows promise to reduce persistent adverse maternal-infant outcomes and contain costs. Because this innovation requires systemwide change, clinics reported needing support enrolling women into groups and obtaining organizational buy-in. This study used the 3-step social marketing communication strategy to help clinic staff identify key customers and customer-specific barriers to adopting or supporting Centering Pregnancy. They developed targeted information to reduce barriers and built skills in communicating with different customers through role-playing. Findings provide practical information for others to use this communication strategy to improve implementation of Centering Pregnancy.

  6. Teaching Group Processes through Multiple Group Leadership Opportunities in a Masters Level Counselor Education Program

    Science.gov (United States)

    Bourgeois, Marc B.; Winters, Ryan C.; Esters, Irvin E.

    2016-01-01

    Utilizing an experiential component in group work training is a prominent feature in Counselor Education programs. Although numerous models have been proposed, the vast majority offer limited explanations of incorporating the number of hours of group participation and observation recommended by the Professional Standards for the Training of Group…

  7. What influences success in family medicine maternity care education programs?

    Science.gov (United States)

    Biringer, Anne; Forte, Milena; Tobin, Anastasia; Shaw, Elizabeth; Tannenbaum, David

    2018-01-01

    Abstract Objective To ascertain how program leaders in family medicine characterize success in family medicine maternity care education and determine which factors influence the success of training programs. Design Qualitative research using semistructured telephone interviews. Setting Purposive sample of 6 family medicine programs from 5 Canadian provinces. Participants Eighteen departmental leaders and program directors. METHODS Semistructured telephone interviews were conducted with program leaders in family medicine maternity care. Departmental leaders identified maternity care programs deemed to be “successful.” Interviews were audiorecorded and transcribed verbatim. Team members conducted thematic analysis. Main findings Participants considered their education programs to be successful in family medicine maternity care if residents achieved competency in intrapartum care, if graduates planned to include intrapartum care in their practices, and if their education programs were able to recruit and retain family medicine maternity care faculty. Five key factors were deemed to be critical to a program’s success in family medicine maternity care: adequate clinical exposure, the presence of strong family medicine role models, a family medicine–friendly hospital environment, support for the education program from multiple sources, and a dedicated and supportive community of family medicine maternity care providers. Conclusion Training programs wishing to achieve greater success in family medicine maternity care education should employ a multifaceted strategy that considers all 5 of the interdependent factors uncovered in our research. By paying particular attention to the informal processes that connect these factors, program leaders can preserve the possibility that family medicine residents will graduate with the competence and confidence to practise full-scope maternity care. PMID:29760273

  8. Experiencing maternity care: the care received and perceptions of women from different ethnic groups

    Science.gov (United States)

    2013-01-01

    Background According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women. Methods Secondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women’s experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity. Results A total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff. Conclusion Women in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern. PMID

  9. Experiencing maternity care: the care received and perceptions of women from different ethnic groups.

    Science.gov (United States)

    Henderson, Jane; Gao, Haiyan; Redshaw, Maggie

    2013-10-22

    According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women. Secondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women's experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity. A total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff. Women in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern.

  10. Advancing Care Within an Adult Mental Health Day Hospital: Program Re-Design and Evaluation.

    Science.gov (United States)

    Taube-Schiff, Marlene; Mehak, Adrienne; Marangos, Sandy; Kalim, Anastasia; Ungar, Thomas

    2017-11-13

    Day hospital mental health programs provide alternate care to individuals of high acuity that do not require an inpatient psychiatric stay. Ensuring provision of best practice within these programs is essential for patient stabilization and recovery. However, there is scant literature to review when creating such a program. This paper provides an overview of the steps an acute care hospital took when designing and implementing new programming within a day hospital program. Qualitative data was collected following initial program rollout. This data helped to inform the ongoing modification of groups offered, group scheduling and content, as well as ensuring patient satisfaction and adequate skill delivery during the rollout period and beyond. The goal of this paper is to inform health service delivery for other programs when attempting to build or re-design a day hospital program.

  11. Interprofessional collaboration regarding patients' care plans in primary care: a focus group study into influential factors.

    Science.gov (United States)

    van Dongen, Jerôme Jean Jacques; Lenzen, Stephanie Anna; van Bokhoven, Marloes Amantia; Daniëls, Ramon; van der Weijden, Trudy; Beurskens, Anna

    2016-05-28

    The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding interprofessional collaboration related to care plan development in primary care. A qualitative study, including four semi-structured focus group interviews (n = 4). In total, a heterogeneous group of experts (n = 16) and health care professionals (n = 15) participated. Participants discussed viewpoints, barriers, and facilitators regarding interprofessional collaboration related to care plan development. The data were analysed by means of inductive content analysis. The findings show a variety of factors influencing the interprofessional collaboration in developing a care plan. Factors can be divided into 5 key categories: (1) patient-related factors: active role, self-management, goals and wishes, membership of the team; (2) professional-related factors: individual competences, domain thinking, motivation; (3) interpersonal factors: language differences, knowing each other, trust and respect, and motivation; (4) organisational factors: structure, composition, time, shared vision, leadership and administrative support; and (5) external factors: education, culture, hierarchy, domain thinking, law and regulations, finance, technology and ICT. Improving interprofessional collaboration regarding care plan development calls for an integral approach including patient- and professional related factors, interpersonal, organisational, and external factors. Further, the leader of the team seems to play a key role in watching the patient perspective, organising and coordinating interprofessional collaborations, and guiding the team through developments. The results of this study can be used as input for developing tools and interventions targeted at executing and improving interprofessional

  12. Exploring Group Composition among Young, Urban Women of Color in Prenatal Care: Implications for Satisfaction, Engagement, and Group Attendance.

    Science.gov (United States)

    Earnshaw, Valerie A; Rosenthal, Lisa; Cunningham, Shayna D; Kershaw, Trace; Lewis, Jessica; Rising, Sharon Schindler; Stasko, Emily; Tobin, Jonathan; Ickovics, Jeannette R

    2016-01-01

    Group models of prenatal care continue to grow in popularity. However, little is known about how group composition (similarity or diversity between members of groups) relates to care-related outcomes. The current investigation aimed to explore associations between prenatal care group composition with patient satisfaction, engagement, and group attendance among young, urban women of color. Data were drawn from two studies conducted in New Haven and Atlanta (2001-2004; n = 557) and New York City (2008-2011; n = 375) designed to evaluate group prenatal care among young, urban women of color. Women aged 14 to 25 were assigned to group prenatal care and completed surveys during their second and third trimesters of pregnancy. Group attendance was recorded. Data were merged and analyzed guided by the Group Actor-Partner Interdependence Model using multilevel regression. Analyses explored composition in terms of age, race, ethnicity, and language. Women in groups with others more diverse in age reported greater patient engagement and, in turn, attended more group sessions, b(se) = -0.01(0.01); p = .04. The composition of prenatal care groups seems to be associated with young women's engagement in care, ultimately relating to the number of group prenatal care sessions they attend. Creating groups diverse in age may be particularly beneficial for young, urban women of color, who have unique pregnancy needs and experiences. Future research is needed to test the generalizability of these exploratory findings. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  13. GRUCAL, a computer program for calculating macroscopic group constants

    International Nuclear Information System (INIS)

    Woll, D.

    1975-06-01

    Nuclear reactor calculations require material- and composition-dependent, energy averaged nuclear data to describe the interaction of neutrons with individual isotopes in material compositions of reactor zones. The code GRUCAL calculates these macroscopic group constants for given compositions from the material-dependent data of the group constant library GRUBA. The instructions for calculating group constants are not fixed in the program, but will be read at the actual execution time from a separate instruction file. This allows to accomodate GRUCAL to various problems or different group constant concepts. (orig.) [de

  14. Employer Child Care Resources: A Guide to Developing Effective Child Care Programs and Policies.

    Science.gov (United States)

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

    Increasing numbers of employers are responding to employee child care needs by revising their benefit packages, work schedules, and recruitment plans to include child care options. This guide details ways to develop effective child care programs and policies. Section 1 of the guide describes employees' growing child care needs and employers'…

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

    Science.gov (United States)

    Martini, Gilbert R., Jr.

    1991-01-01

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

  16. Qualitative findings from focus group discussions on hand hygiene compliance among health care workers in Vietnam.

    Science.gov (United States)

    Salmon, Sharon; McLaws, Mary-Louise

    2015-10-01

    It is accepted by hospital clinical governance that every clinician's "duty of care" includes hand hygiene, yet globally, health care workers (HCWs) continue to struggle with compliance. Focus group discussions were conducted to explore HCWs' barriers to hand hygiene in Vietnam. Twelve focus group discussions were conducted with HCWs from 6 public hospitals across Hanoi, Vietnam. Discussions included participants' experiences with and perceptions concerning hand hygiene. Tape recordings were transcribed verbatim and then translated into English. Thematic analysis was conducted by 2 investigators. Expressed frustration with high workload, limited access to hand hygiene solutions, and complicated guidelines that are difficult to interpret in overcrowded settings were considered by participants to be bona fide reasons for noncompliance. No participant acknowledged hand hygiene as a duty of care practice for her or his patients. Justification for noncompliance was the observation that visitors did not perform hand hygiene. HCWs did acknowledge a personal duty of care when hand hygiene was perceived to benefit her or his own health, and then neither workload or environmental challenges influenced compliance. Limited resources in Vietnam are amplified by overcrowded conditions and dual bed occupancy. Yet without a systematic systemic duty of care to patient safety, changes to guidelines and resources might not immediately improve compliance. Thus, introducing routine hand hygiene must start with education programs focusing on duty of care. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Development of a Proactive Care Program (U-CARE) to Preserve Physical Functioning of Frail Older People in Primary Care

    NARCIS (Netherlands)

    Bleijenberg, N.; Ten Dam, V.H.; Drubbel, I.; Numans, M.E.; De Wit, N.J.; Schuurmans, M.J.

    2013-01-01

    Purpose: Care for older patients in primary care is currently reactive, fragmented, and time consuming. An innovative structured and proactive primary care program (U-CARE) has been developed to preserve physical functioning and enhance quality of life of frail older people. This study describes in

  18. A social comparison theory analysis of group composition and efficacy of cancer support group programs.

    Science.gov (United States)

    Carmack Taylor, Cindy L; Kulik, James; Badr, Hoda; Smith, Murray; Basen-Engquist, Karen; Penedo, Frank; Gritz, Ellen R

    2007-07-01

    Group-based psychosocial programs provide an effective forum for improving mood and social support for cancer patients. Because some studies show more benefit for patients with initially high psychosocial distress, and little or no benefit for patients with initially low distress, support programs may better address patient needs by only including distressed patients. However, distressed patients may benefit particularly from the presence of nondistressed patients who model effective coping, an idea many researchers and extensions of social comparison theory support. We present a theoretical analysis, based on a social comparison perspective, of how group composition (heterogeneous group of distressed and nondistressed patients versus homogeneous group of distressed patients) may affect the efficacy of cancer support programs. We propose that a heterogeneous group allows distressed patients maximal opportunity for the various social comparison activities they are likely to prefer; a homogeneous group does not. Though the presence of nondistressed patients in a heterogeneous group potentially benefits distressed patients, the benefits for nondistressed patients are unclear. For nondistressed patients, heterogeneous groups may provide limited opportunities for preferred social comparison activity and may create the possibility for no benefit or even negative effects on quality of life. We also discuss ethical issues with enrolling nondistressed patients whose presence may help others, but whose likelihood of personal benefit is questionable.

  19. Working Together to Connect Care: a metropolitan tertiary emergency department and community care program.

    Science.gov (United States)

    Harcourt, Debra; McDonald, Clancy; Cartlidge-Gann, Leonie; Burke, John

    2017-03-02

    Objective Frequent attendance by people to an emergency department (ED) is a global concern. A collaborative partnership between an ED and the primary and community healthcare sectors has the potential to improve care for the person who frequently attends the ED. The aims of the Working Together to Connect Care program are to decrease the number of presentations by providing focused community support and to integrate all healthcare services with the goal of achieving positive, patient-centred and directed outcomes. Methods A retrospective analysis of ED data for 2014 and 2015 was used to ascertain the characteristics of the potential program cohort. The definition used to identify a 'frequent attendee' was more than four presentations to an ED in 1 month. This analysis was used to develop the processes now known as the Working Together to Connect Care program. This program includes participant identification by applying the definition, flagging of potential participants in the ED IT system, case review and referral to community services by ED staff, case conferencing facilitated within the ED and individualised, patient centred case management provided by government and non-government community services. Results Two months after the date of commencement of the Working Together to Connect Care program there are 31 active participants in the program: 10 are on the Mental Health pathway, and one is on the No Consent pathway. On average there are three people recruited to the program every week. The establishment of a new program for supporting frequent attendees of an ED has had its challenges. Identifying systems that support people in their community has been an early positive outcome of this project. Conclusion It is expected that data regarding the number of ED presentations, potential fiscal savings and client outcomes will be available in 2017. What is known about the topic? Frequent attendance at EDs is a global issue and although the number of 'super users' is

  20. The implementation evaluation of primary care groups of practice: a focus on organizational identity

    Directory of Open Access Journals (Sweden)

    Pozzebon Marlei

    2010-02-01

    Full Text Available Abstract Background Since 2002 the Health Ministry of Québec (Canada has been implementing a primary care organizational innovation called 'family medicine groups'. This is occurring in a political context in which the reorganization of primary care is considered necessary to improve health care system performance. More specifically, the purpose of this reform has been to overcome systemic deficiencies in terms of accessibility and continuity of care. This paper examines the first years of implementation of the family medicine group program, with a focus on the emergence of the organizational identity of one of the pilot groups located in the urban area of Montreal. Methods An in-depth longitudinal case study was conducted over two and a half years. Face to face individual interviews with key informants from the family medicine group under study were conducted over the research period considered. Data was gathered throuhg observations and documentary analysis. The data was analyzed using temporal bracketing and Fairclough's three-dimensional critical discourse analytical techniques. Results Three different phases were identified over the period under study. During the first phase, which corresponded to the official start-up of the family medicine group program, new resources and staff were only available at the end of the period, and no changes occurred in medical practices. Power struggles between physicians and nurses characterized the second phase, resulting in a very difficult integration of advanced nurse practitioners into the group. Indeed, the last phase was portrayed by initial collaborative practices associated with a sensegiving process prompted by a new family medicine group director. Conclusions The creation of a primary care team is a very challenging process that goes beyond the normative policy definitions of who is on the team or what the team has to do. To fulfil expectations of quality improvement through team-based care

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

    Science.gov (United States)

    Jarrott, Shannon E; Gigliotti, Christina M

    2010-12-01

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

  2. International Piping Integrity Research Group (IPIRG) Program. Final report

    International Nuclear Information System (INIS)

    Wilkowski, G.; Schmidt, R.; Scott, P.

    1997-06-01

    This is the final report of the International Piping Integrity Research Group (IPIRG) Program. The IPIRG Program was an international group program managed by the U.S. Nuclear Regulatory Commission and funded by a consortium of organizations from nine nations: Canada, France, Italy, Japan, Sweden, Switzerland, Taiwan, the United Kingdom, and the United States. The program objective was to develop data needed to verify engineering methods for assessing the integrity of circumferentially-cracked nuclear power plant piping. The primary focus was an experimental task that investigated the behavior of circumferentially flawed piping systems subjected to high-rate loadings typical of seismic events. To accomplish these objectives a pipe system fabricated as an expansion loop with over 30 meters of 16-inch diameter pipe and five long radius elbows was constructed. Five dynamic, cyclic, flawed piping experiments were conducted using this facility. This report: (1) provides background information on leak-before-break and flaw evaluation procedures for piping, (2) summarizes technical results of the program, (3) gives a relatively detailed assessment of the results from the pipe fracture experiments and complementary analyses, and (4) summarizes advances in the state-of-the-art of pipe fracture technology resulting from the IPIRG program

  3. International Piping Integrity Research Group (IPIRG) Program. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Wilkowski, G.; Schmidt, R.; Scott, P. [and others

    1997-06-01

    This is the final report of the International Piping Integrity Research Group (IPIRG) Program. The IPIRG Program was an international group program managed by the U.S. Nuclear Regulatory Commission and funded by a consortium of organizations from nine nations: Canada, France, Italy, Japan, Sweden, Switzerland, Taiwan, the United Kingdom, and the United States. The program objective was to develop data needed to verify engineering methods for assessing the integrity of circumferentially-cracked nuclear power plant piping. The primary focus was an experimental task that investigated the behavior of circumferentially flawed piping systems subjected to high-rate loadings typical of seismic events. To accomplish these objectives a pipe system fabricated as an expansion loop with over 30 meters of 16-inch diameter pipe and five long radius elbows was constructed. Five dynamic, cyclic, flawed piping experiments were conducted using this facility. This report: (1) provides background information on leak-before-break and flaw evaluation procedures for piping, (2) summarizes technical results of the program, (3) gives a relatively detailed assessment of the results from the pipe fracture experiments and complementary analyses, and (4) summarizes advances in the state-of-the-art of pipe fracture technology resulting from the IPIRG program.

  4. ArtBreak: A Creative Group Counseling Program for Children

    Science.gov (United States)

    Ziff, Katherine; Pierce, Lori; Johanson, Susan; King, Margaret

    2012-01-01

    This article describes the pilot of a school-based creative group-counseling program for children called ArtBreak, a choice-based studio art experience based on the restorative possibilities of art making delineated in the expressive therapies continuum (ETC; Kagin & Lusebrink, 1978). The ETC features a developmental hierarchy in relation to how…

  5. Structure of NCI Cooperative Groups Program Prior to NCTN

    Science.gov (United States)

    Learn how the National Cancer Institute’s Cooperative Groups Program was structured prior to its being replaced by NCI’s National Clinical Trials Network (NCTN). The NCTN gives funds and other support to cancer research organizations to conduct cancer clinical trials.

  6. Crisis Group Fellowship Program | CRDI - Centre de recherches ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    In much of the Middle East and North Africa (MENA) and West Africa, there is a dearth of research, training and employment opportunities in the social sciences, particularly in the area of research and policy analysis on local conflicts. The Crisis Group has long considered establishing a fellowship program in order to train a ...

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

    Directory of Open Access Journals (Sweden)

    Akhilesh S Pathipati

    2016-07-01

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

  8. Implementing the Namaste Care Program for residents with advanced dementia: exploring the perceptions of families and staff in UK care homes.

    Science.gov (United States)

    Stacpoole, Min; Hockley, Jo; Thompsell, Amanda; Simard, Joyce; Volicer, Ladislav

    2017-10-01

    Increasing numbers of older people with advanced dementia are cared for in care homes. No cure is available, so research focused on improving quality of life and quality of care for people with dementia is needed to support them to live and die well. The Namaste Care programme is a multi-dimensional care program with sensory, psycho-social and spiritual components intended to enhance quality of life and quality of care for people with advanced dementia. The aim of the study was to establish whether the Namaste Care program can be implemented in UK care homes; and what effect Namaste Care has on the quality of life of residents with advanced dementia, their families and staff. This article explores the qualitative findings of the study, reporting the effect of the programme on the families of people with advanced dementia and care home staff, and presenting their perceptions of change in care. An organisational action research methodology was used. Focus groups and interviews were undertaken pre/post implementation of the Namaste Care program. The researcher kept a reflective diary recording data on the process of change. A comments book was available to staff and relatives in each care home. Data was analysed thematically within each care home and then across all care homes. Six care homes were recruited in south London: one withdrew before the study was underway. Of the five remaining care homes, four achieved a full Namaste Care program. One care home did not achieve the full program during the study, and another discontinued Namaste Care when the study ended. Every home experienced management disruption during the study. Namaste Care challenged normal routinised care for older people with advanced dementia. The characteristics of care uncovered before Namaste was implemented were: chaos and confusion, rushing around, lack of trust, and rewarding care. After the programme was implemented these perceptions were transformed, and themes of calmness, reaching out to

  9. ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore.

    Science.gov (United States)

    Mittal, Chikul; Lee, Hsien Chieh Daniel; Goh, Kiat Sern; Lau, Cheng Kiang Adrian; Tay, Leeanna; Siau, Chuin; Loh, Yik Hin; Goh, Teck Kheng Edward; Sandi, Chit Lwin; Lee, Chien Earn

    2018-05-30

    To test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital. The ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program. Clinical outcome data on consecutive hip fracture patients seen in 12 months pre-intervention were then compared with the post-intervention group. Both pre- and post-intervention groups were followed up across the continuum of care for a period of 12 months. VC patients showed significant improvement in median time to surgery (97 to 50.5 h), as well as proportion of patients operated within 48 h from hospital admission (48% from 18.8%) as compared to baseline pre-intervention data. These patients also had significant reduction (p value based care for hip fracture patients at Changi General Hospital. This has also reflected successful change management and interdisciplinary collaboration within the organization through the program. There is potential for testing this methodology as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system.

  10. A program of symptom management for improving self-care for patients with HIV/AIDS.

    Science.gov (United States)

    Chiou, Piao-Yi; Kuo, Benjamin Ing-Tiau; Chen, Yi-Ming; Wu, Shiow-Ing; Lin, Li-Chan

    2004-09-01

    The purpose of this study was to investigate the effect of a symptom management program on self-care of medication side effects among AIDS/HIV-positive patients. Sixty-seven patients from a sexually transmitted disease control center, a medical center, and a Catholic AIDS support group in Taipei were randomly assigned to three groups: one-on-one teaching, group teaching, and a control group. All subjects in each teaching group attended a 60- or 90-minute program on highly active antiretroviral therapy (HAART) side effect self-care education and skill training once per week for 3 weeks; subjects also underwent counseling by telephone. A medication side effect self-care knowledge questionnaire, Rosenberg's Self-Esteem Scale (RSES), and unscheduled hospital visits were used to evaluate the effectiveness of the symptom management program. The results revealed there were significant differences in mean difference of knowledge and unscheduled hospital visits between baseline and post-testing at 3 months for symptom management in the two groups. The mean difference of the self-esteem scale was not significant between the two groups. In summary, the symptom management program effectively increased the ability of AIDS/HIV-positive patients to self-care for medication side effects. We recommend that this program be applied in the clinical nursing practice.

  11. What constitutes an excellent allied health care professional? A multidisciplinary focus group study

    Directory of Open Access Journals (Sweden)

    Paans W

    2013-09-01

    excellence, focus group, health care, honors programs, multidisciplinary care

  12. AN INTEGRATIVE GROUP PSYCHOTHERAPY PROGRAM FOR CHILDREN. THE WIZARDING SCHOOL

    Directory of Open Access Journals (Sweden)

    Oana Maria Popescu

    2012-02-01

    Full Text Available One of the most important tendencies in child psychotherapy is the integration of various psychotherapeutic approaches and technical interventions belonging to different orientations. Based on the Harry Potter stories, the „Wizarding School” structured group therapy program is a 12-step integratively oriented program applicable in personal development, individual and group therapy for children aged 6 to 13 (at present being adapted for adult psychotherapy. The program takes place within a fairy tale, being therefore a type of informal hypnotic trance. The interventions are drawn from the lessons described in Harry Potter’s story at Hogwarts, based on the fundamental principles of child psychotherapy and including elements of play therapy, art therapy, hypnotherapy, cognitive- behavioural therapy, transactional analysis, supportive therapy, family therapy and person centred therapy. From a theoretical point of view the program is based on elements from a number of psychotherapeutic approaches, the main concept being that we need to create a therapeutic myth that is acceptable to a child. The program is not suitable for children with structural deficits, who have difficulties in making the difference between fantasy and reality.

  13. Focus group testing for the vehicle scrappage program : final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-03-15

    Canada's national vehicle scrappage program was designed to reduce greenhouse gas (GHG) and smog-forming emissions by removing personal vehicles with model years of 1995 and older from Canadian road systems. The program will also promote sustainable transportation alternatives and recycling programs to prevent the release of other toxic substances into the environment. Incentives designed to encourage Canadians to scrap older vehicles may include cash incentives and rebates towards the purchase of a new vehicle, free transit passes, and other options designed to support sustainable transportation. This paper discussed a research program conducted to assess target audience responses to the programs and its proposed incentives. The survey was conducted with a series of 20 focus groups located in major cities across Canada. Sessions were comprised of between 6 to 10 participants from lower-income and higher-income households. All groups responded negatively to both the overall policy as well as to specific program elements. The study showed that most participants were not aware that older vehicles emit significantly higher levels of harmful emissions. The research audience did not understand distinctions between smog-producing emissions and GHG emissions. Participants also believed that personal vehicles had a minor negative impact on the environment compared to trucks, industry, and vehicle fleets. Participants felt a sense of pride in the ways in which they had maintained their older vehicles, and also perceived them as safer than newer vehicles. It was concluded that many participants were resistant to facts presented to them about older vehicles, and felt that the incentives were insufficient to trigger action. The effectiveness of advertising materials designed to promote the program was also assessed. 3 tabs., 9 figs.

  14. Changes in Postacute Care in the Medicare Shared Savings Program.

    Science.gov (United States)

    McWilliams, J Michael; Gilstrap, Lauren G; Stevenson, David G; Chernew, Michael E; Huskamp, Haiden A; Grabowski, David C

    2017-04-01

    Postacute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit postacute care spending has implications for the importance and design of other payment models that include postacute care. To assess changes in postacute care spending and use of postacute care associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred. With the use of fee-for-service Medicare claims from a random 20% sample of beneficiaries with 25 544 650 patient-years, 8 395 426 hospital admissions, and 1 595 352 stays in skilled nursing facilities (SNFs) from January 1, 2009, to December 31, 2014, difference-in-difference comparisons of beneficiaries served by ACOs with beneficiaries served by local non-ACO health care professionals (control group) were performed before vs after entry into the MSSP. Differential changes were estimated separately for cohorts of ACOs entering the MSSP in 2012, 2013, and 2014. Patient attribution to an ACO in the MSSP. Postacute spending, discharge to a facility, length of SNF stays, readmissions, use of highly rated SNFs, and mortality, adjusted for patient characteristics. For the 2012 cohort of 114 ACOs, participation in the MSSP was associated with an overall reduction in postacute spending (differential change in 2014 for ACOs vs control group, -$106 per beneficiary [95% CI, -$176 to -$35], or -9.0% of the precontract unadjusted mean of $1172; P = .003) that was driven by differential reductions in acute inpatient care, discharges to facilities rather than home (-0.6 percentage points [95% CI, -1.1 to 0.0], or -2.7% of the unadjusted precontract mean of 22.6%; P = .03), and length of SNF stays (-0.60 days per stay [95% CI, -0.99 to -0.22], or -2.2% of the precontract unadjusted mean of 27.07 days; P = .002). Reductions in use of SNFs and length of stay were largely due to within-hospital or

  15. Exploring Parental and Staff Perceptions of the Family-Integrated Care Model: A Qualitative Focus Group Study.

    Science.gov (United States)

    Broom, Margaret; Parsons, Georgia; Carlisle, Hazel; Kecskes, Zsuzsoka; Thibeau, Shelley

    2017-12-01

    Family-integrated care (FICare) is an innovative model of care developed at Mount Sinai Hospital, Canada, to better integrate parents into the team caring for their infant in the neonatal intensive care unit (NICU). The effects of FICare on neonatal outcomes and parental anxiety were assessed in an international multicenter randomized trial. As an Australian regional level 3 NICU that was randomized to the intervention group, we aimed to explore parent and staff perceptions of the FICare program in our dual occupancy NICU. This qualitative study took place in a level 3 NICU with 5 parent participants and 8 staff participants, using a post implementation review design. Parents and staff perceptions of FICare were explored through focus group methodology. Thematic content analysis was done on focus group transcripts. Parents and staff perceived the FICare program to have had a positive impact on parental confidence and role attainment and thought that FICare improved parent-to-parent and parent-to-staff communication. Staff reported that nurses working with families in the program performed less hands-on care and spent more time educating and supporting parents. FICare may change current NICU practice through integrating and accepting parents as active members of the infant's care team. In addition, nurse's roles may transition from bedside carer to care coordinator, educating and supporting parents during their journey through the NICU. Further research is needed to assess the long-term impact of FICare on neonates, parents, and staff.

  16. Evaluation of a caring education program for Taiwanese nursing students: a quasi-experiment with before and after comparison.

    Science.gov (United States)

    Wu, Li-Min; Chin, Chi-Chun; Chen, Chung-Hey

    2009-11-01

    Caring is an essential component in nursing curricula. However, how caring can be accomplished effectively has rarely been taught to nursing students. To examine acceptability and preliminary efficacy of a caring education program for nursing students in Taiwan. Students were recruited to participate in a pre-post-test quasi-experimental study. Students self-selected into a control group (n=33) or an experimental group (n=35). The experimental group registered for a 13-week caring education program based on Watson's 10 creative factors through multiple teaching strategies. The Caring Behaviors Assessment (CBA) was used to collect data at weeks 1 and 13. Content analysis was used to reach the main descriptions of caring education from an experimental group of nursing students. The experimental group reported a significantly higher score of caring behaviors after participating in the education program (t=3.4, p=.00). The score of each CBA subscale in the experimental group was significantly enhanced from week 1 to week 13, except in the existential/phenomenological/spiritual dimension. Qualitative results supported that a caring education could help nursing students by building caring behaviors which could be adapted to clinical situations. The findings support the credibility of caring-focused teaching strategies and such focused caring programs are acceptable and show efficacy for nursing students.

  17. 07051 Working Group Outcomes -- Programming Paradigms for the Web: Web Programming and Web Services

    OpenAIRE

    Hull, Richard; Thiemann, Peter; Wadler, Philip

    2007-01-01

    Participants in the seminar broke into groups on ``Patterns and Paradigms'' for web programming, ``Web Services,'' ``Data on the Web,'' ``Software Engineering'' and ``Security.'' Here we give the raw notes recorded during these sessions.

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

    Directory of Open Access Journals (Sweden)

    Seekles Wike

    2009-06-01

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

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

    Science.gov (United States)

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

    2013-03-01

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

  20. Development of a Chronic Care Ostomy Self Management Program

    Science.gov (United States)

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

    2012-01-01

    Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self Management Program, which was informed by (1) evidence on published quality of life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies. PMID:23104143

  1. Effectiveness of Group Cognitive Behavioral Therapy for Insomnia (CBT-I) in a Primary Care Setting.

    Science.gov (United States)

    Davidson, Judith R; Dawson, Samantha; Krsmanovic, Adrijana

    2017-05-02

    Primary care is where many patients with insomnia first ask for professional help. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia. Although CBT-I's efficacy is well established, its effectiveness in real-life primary care has seldom been investigated. We examined the effectiveness of CBT-I as routinely delivered in a Canadian primary care setting. The patients were 70 women and 11 men (mean age = 57.0 years, SD = 12.3); 83% had medical comorbidity. For the first 81 patients who took the six-session group program we compared initial and postprogram sleep diaries, sleep medication use, Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS), and visits to the family physician. Sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, and ISI scores improved significantly (p 7). Wait-list data from 42 patients showed minimal sleep and mood improvements with the passage of time. Number of visits to the family physician six months postprogram decreased, although not significantly (p = .108). The CBT-I program was associated with improvement on all sleep and mood measures. Effect sizes were similar to, or larger than, those found in randomized controlled trials, demonstrating the real-world effectiveness of CBT-I in an interdisciplinary primary care setting.

  2. Leader Behaviors, Group Cohesion, and Participation in a Walking Group Program.

    Science.gov (United States)

    Izumi, Betty T; Schulz, Amy J; Mentz, Graciela; Israel, Barbara A; Sand, Sharon L; Reyes, Angela G; Hoston, Bernadine; Richardson, Dawn; Gamboa, Cindy; Rowe, Zachary; Diaz, Goya

    2015-07-01

    Less than half of all U.S. adults meet the 2008 Physical Activity Guidelines. Leader behaviors and group cohesion have been associated with increased participation or adherence in sports team and exercise class settings. Physical activity interventions in community settings that encompass these factors may enhance intervention adherence. The purpose of this study is to examine the impact of Community Health Promoter leader behaviors and group cohesion on participation in a walking group intervention among racially/ethnically diverse adults in low to moderate-income communities in Detroit, Michigan. Data for the current study were drawn from the Walk Your Heart to Health (WYHH) data set. WYHH was a multisite cluster RCT with a lagged intervention and outcome measurements at baseline and 4, 8, and 32 weeks. Pooled survey data from both intervention arms were used for the current study. Data were analyzed between August 2013 and October 2014. A total of 603 non-Hispanic black, non-Hispanic white, and Hispanic adults across five cohorts that began the 32-week WYHH intervention between March 2009 and October 2011. The intervention was a 32-week walking group program hosted by community- and faith-based organizations and facilitated by Community Health Promoters. Walking groups met three times per week for 90 minutes per session. To promote participation in or adherence to WYHH, Community Health Promoters used evidence-based strategies to facilitate group cohesion. Group members assumed increasing leadership responsibility for facilitating sessions over time. Participation in WYHH as measured by consistency of attendance. Community Health Promoter leader behaviors were positively associated with participation in WYHH. Social but not task cohesion was significantly associated with consistent participation. Social cohesion may mediate the relationship between leader behaviors and walking group participation. Providing leaders with training to build socially cohesive groups

  3. A Mentoring Program in Environmental Science for Underrepresented Groups

    Science.gov (United States)

    Stevens, L.; Rizzo, D. M.

    2009-12-01

    We developed a four-year program, combining educational and career support and research activities, to recruit and retain students from underrepresented groups in environmental sciences. Specifically, the program: ○ Assigns each student a faculty or graduate student mentor with whom the student conducts research activities. ○ Includes a weekly group meeting for team building and to review professional development and academic topics, such as time management and research ethics. ○ Requires students to make multiple formal presentations of their research proposals and results. ○ Provides scholarships and stipends for both the academic year and to engage students in summer research. The program seeks to achieve several goals including: ● Enhance academic performance. ● Encourage continued study in environmental science. ● Facilitate students completing their studies at UVM. ● Increase students’ interest in pursuing science careers. ● Create a more welcoming academic environment. To assess progress toward achievement of these goals, we conducted individual structured interviews with participating undergraduate students, graduate students, and faculty members at two points in time. First, interviews were conducted in the fall of 2007 after two years, and again in spring 2009, after four years. An independent research consultant, Dr. Livingston, conducted the interviews. In 2009, over the course of three days, the interviews included three graduate student and two faculty mentors, and six of the seven undergraduate students. Of the six students, three were juniors and three were graduating seniors. Results of the 2009 interviews echoed those of 2007. Both students and their mentors are quite satisfied with the program. The student presentations, weekly meetings, mentoring relationships, and summer research experiences all get high ratings from program participants. Students give high praise to their mentors and the program directors for providing

  4. Critical Care Organizations: Building and Integrating Academic Programs.

    Science.gov (United States)

    Moore, Jason E; Oropello, John M; Stoltzfus, Daniel; Masur, Henry; Coopersmith, Craig M; Nates, Joseph; Doig, Christopher; Christman, John; Hite, R Duncan; Angus, Derek C; Pastores, Stephen M; Kvetan, Vladimir

    2018-04-01

    Academic medical centers in North America are expanding their missions from the traditional triad of patient care, research, and education to include the broader issue of healthcare delivery improvement. In recent years, integrated Critical Care Organizations have developed within academic centers to better meet the challenges of this broadening mission. The goal of this article was to provide interested administrators and intensivists with the proper resources, lines of communication, and organizational approach to accomplish integration and Critical Care Organization formation effectively. The Academic Critical Care Organization Building section workgroup of the taskforce established regular monthly conference calls to reach consensus on the development of a toolkit utilizing methods proven to advance the development of their own academic Critical Care Organizations. Relevant medical literature was reviewed by literature search. Materials from federal agencies and other national organizations were accessed through the Internet. The Society of Critical Care Medicine convened a taskforce entitled "Academic Leaders in Critical Care Medicine" on February 22, 2016 at the 45th Critical Care Congress using the expertise of successful leaders of advanced governance Critical Care Organizations in North America to develop a toolkit for advancing Critical Care Organizations. Key elements of an academic Critical Care Organization are outlined. The vital missions of multidisciplinary patient care, safety, and quality are linked to the research, education, and professional development missions that enhance the value of such organizations. Core features, benefits, barriers, and recommendations for integration of academic programs within Critical Care Organizations are described. Selected readings and resources to successfully implement the recommendations are provided. Communication with medical school and hospital leadership is discussed. We present the rationale for critical

  5. 78 FR 36449 - State Long-Term Care Ombudsman Program

    Science.gov (United States)

    2013-06-18

    ...-term care ombudsmen at every level have reported to AoA that they have found some provisions of the Act... to residents' care and quality of life at the local, state and national levels. Begun in 1972 as a... policies so long as those policies do not conflict with Ombudsman program law and policy). Therefore, AoA...

  6. Creating a successful culturally sensitive home care program.

    Science.gov (United States)

    Blanter, R; Page, P M

    1995-12-01

    Providing quality home care services to immigrants requires an integrated, holistic approach that genuinely addresses language and cultural differences. One home care agency in Massachusetts developed a team-oriented, culturally sensitive outreach program that ensures non-English-speaking patients the same level of service that the general population receives.

  7. Doctoral Programs Need Changes to Attract and Retain Underrepresented Groups

    Science.gov (United States)

    Bernard, R. E.; Mayfield, K. K.

    2017-12-01

    Geoscience is currently recognized as the least diverse of all STEM fields. While attention typically focuses on K-12 and undergraduate populations, the extreme lack of diversity among graduate students, and doctoral students in particular, should be examined and addressed. In 2016, members of underrepresented minority (URM) groups made up only 6% of those graduating with geoscience PhDs. In all STEM fields, only 48% of Hispanic/Latino and 38% of Black/African American doctoral studies had earned doctorates within 7 years, with 36% of members of these groups leaving the program entirely. Recent studies suggest that these high attrition rates can be attributed, in part, to a mismatch between motivations of URM members and PhD-granting institutions while students are pursuing scientific education and careers. Traditional STEM doctoral programs do not offer, facilitate, or incentivize substantial opportunities to integrate social justice issues, community involvement, and altruism—factors which have been found to be of more importance to these populations than to male members of well-represented groups. URM members are also less likely to be interested in purely academic research careers, so doctoral programs may be failing to attract (and failing to prepare) diverse populations by not offering experiences beyond typical research and TA duties. In this presentation, trends in motivation and persistence among URM students in STEM will be discussed, in addition to highlighting education and outreach activities that can be successfully incorporated for a more fulfilling, balanced, attractive, and preparatory education experience. Specific activities undertaken and recommended by the presenter in her PhD experience include the following: a federal research internship, a state government policy internship, a formal partnership with a local K-12 teacher though a former NSF GK-12 program, a two-week education workshop aboard a scientific research drillship, and attending a

  8. Home-based intermediate care program vs hospitalization

    Science.gov (United States)

    Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael

    2008-01-01

    OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs. PMID:18208958

  9. The NASA Goddard Group's Source Monitoring Database and Program

    Science.gov (United States)

    Gipson, John; Le Bail, Karine; Ma, Chopo

    2014-12-01

    Beginning in 2003, the Goddard VLBI group developed a program to purposefully monitor when sources were observed and to increase the observations of ``under-observed'' sources. The heart of the program consists of a MySQL database that keeps track of, on a session-by-session basis: the number of observations that are scheduled for a source, the number of observations that are successfully correlated, and the number of observations that are used in a session. In addition, there is a table that contains the target number of successful sessions over the last twelve months. Initially this table just contained two categories. Sources in the geodetic catalog had a target of 12 sessions/year; the remaining ICRF-1 defining sources had a target of two sessions/year. All other sources did not have a specific target. As the program evolved, different kinds of sources with different observing targets were added. During the scheduling process, the scheduler has the option of automatically selecting N sources which have not met their target. We discuss the history and present some results of this successful program.

  10. A Predoctoral Program in Dental Care for the Developmentally Disabled.

    Science.gov (United States)

    Ferguson, Fred S.; And Others

    1990-01-01

    In 1980, the State University of New York at Stony Brook began a program, integrated into the program of children's dentistry, to train students in care for the developmentally disabled. Management of developmentally disabled patients is provided over three years, and represents an extension of pediatric behavior management. (MSE)

  11. Quality of diabetes care in Dutch care groups: no differences between diabetes patients with and without co-morbidity

    Directory of Open Access Journals (Sweden)

    Simone R de Bruin

    2013-12-01

    Full Text Available Objective: To evaluate the relationship between presence and nature of co-morbidity and quality of care for diabetes patients enrolled in diabetes disease management programmes provided by care groups.Methods: We performed an observational study within eight Dutch diabetes care groups. Data from patient record systems of care groups and patient questionnaires were used to determine quality of care. Quality of care was measured as provision of the recommended diabetes care, patients’ achievement of recommended clinical outcomes and patients’ perception of coordination and integration of care.Results: 527 diabetes patients without and 1187 diabetes patients with co-morbidity were included. Of the co-morbid patients, 7.8% had concordant co-morbid conditions only, 63.8% had discordant co-morbid diseases only and 28.4% had both types of conditions. Hardly any differences were observed between patients with and without co-morbidity in terms of provided care, achievement of clinical outcomes and perceived coordination and integration of care.Conclusions: Our study implies that care groups are able to provide similar quality of diabetes care for diabetes patients with and without co-morbidity. Considering the expected developments regarding additional disease management programmes in care groups, it is of importance to monitor quality of care, including patient experiences, for all chronic diseases. It will then become clear whether accountable provider-led organisations such as care groups are able to ensure quality of care for the increasing number of patients with multiple chronic conditions.

  12. Research program of the Neutrino Research Group. Year 2004

    International Nuclear Information System (INIS)

    2004-01-01

    For the last two decades, neutrino physics has been producing major discoveries including neutrino oscillations. These results gave clear confirmation that active neutrinos oscillate and therefore have mass with three different mass states. This is a very important result showing that the Minimal Standard Model is incomplete and requires an extension which is not yet known. The neutrino research field is very broad and active, at the frontier of today's particle physics. The creation of a Neutrino Research Group (GDR) was proposed in 2004 with the aim of gathering CEA and CNRS research teams working on Neutrino Physics on experimental or theoretical level. This document presents the Research program of the Neutrino Research Group which is divided into 5 working groups with the following activities: 1 - Determination of neutrino parameters; 2 - Physics beyond the standard model; 3 - Neutrinos in the universe; 4 - Accelerators, detection means, R and D and valorisation; 5 - Common tools to all working groups. The research group participating laboratories and teams are listed at the end of the document

  13. Innovation in Rehabilitation Services and Clinical Programs for Health Care

    Directory of Open Access Journals (Sweden)

    Asghar Dadkhah

    2014-06-01

    Full Text Available Rehabilitation program is a critical piece of clinical care strategy in order to accelerate healing and improve quality of life to the fullest extent possible. An innovated program should have 3 inspiring concepts: Seek inspire and Advance. Seeking and evaluating is a breakthrough technology, innovative methodology and emerging trend in the healthcare industry. The program should inspire clinicians to critically evaluate and implement the highest standards of care. Also an innovated program should advance clinical program development to maximize opportunities for first to market positioning and community partnerships. The scope of program can be from psycho-rehabilitation to predictor in addiction (1-3, Cognitive and motor rehabilitation researchers are quite concerned about system wide biases that may impair development of innovative rehabilitation techniques. In this issue ....

  14. Importance of patient centred care for various patient groups.

    NARCIS (Netherlands)

    Rademakers, J.J.D.J.M.; Delnoij, D.M.J.; Boer, D. de

    2010-01-01

    Background: Though patient centred care is a somewhat ‘fuzzy’ concept, in general it is considered as something to strive for. However, preliminary evidence suggests that the importance of elements of patient-centred care (PCC), such as communication, information and shared decision making, may vary

  15. Michigan's Physician Group Incentive Program offers a regional model for incremental 'fee for value' payment reform.

    Science.gov (United States)

    Share, David A; Mason, Margaret H

    2012-09-01

    Blue Cross Blue Shield of Michigan partnered with providers across the state to create an innovative, "fee for value" physician incentive program that would deliver high-quality, efficient care. The Physician Group Incentive Program rewards physician organizations-formal groups of physicians and practices that can accept incentive payments on behalf of their members-based on the number of quality and utilization measures they adopt, such as generic drug dispensing rates, and on their performance on these measures across their patient populations. Physicians also receive payments for implementing a range of patient-centered medical home capabilities, such as patient registries, and they receive higher fees for office visits for incorporating these capabilities into routine practice while also improving performance. Taken together, the incentive dollars, fee increases, and care management payments amount to a potential increase in reimbursement of 40 percent or more from Blue Cross Blue Shield of Michigan for practices designated as high-performing patient-centered medical homes. At the same time, we estimate that implementing the patient-centered medical home capabilities was associated with $155 million in lower medical costs in program year 2011 for Blue Cross Blue Shield of Michigan members. We intend to devote a higher percentage of reimbursement over time to communities of caregivers that offer high-value, system-based care, and a lower percentage of reimbursement to individual physicians on a service-specific basis.

  16. PROGRAM OF PALLIATIVE CANCER CARE – OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Iva Slánská

    2013-01-01

    Full Text Available Introduction: Annually more than 27,000 persons die of cancer in the Czech Republic and the overall incidence of malignancies is still increasing. These data shows the need for affordable and good follow-up care especially for patients without any cancer treatment due to irreversible progression of tumor. Currently the outpatient palliative cancer care gets more into the forefront. Prerequisite for a well working outpatient palliative care is cooperation with general practitioners and home health care agencies. The purpose of the so called program of palliative cancer care is to guide a patient in palliative cancer care and to improve the cooperation among health care providers. Methods: During the period from January 2008 to October 2010 we evaluated in patient without any oncology treatment due to irreversible progression of tumor. Results: In palliative outpatient clinic we treated 446 patients, 119 of them received home care services with average length of 27.8 days. 77 patients died at home, 51 in health facilities and 41 in inpatient hospice care. Conclusion: We present pilot study focusing on outpatient palliative cancer care which shows the real benefit from early indication of palliative cancer care. This type of care allows patients to stay as long as possible at home among their close relatives.

  17. Participation in preventive care programs: individual determinants, social interactions and program design.

    OpenAIRE

    Bouckaert, Nicolas

    2014-01-01

    This doctoral research focuses on existing medical preventive care programs. Because of externalities (e.g. in the prevention of communicable diseases) or the program cost-benefit ratio, preventive care programs require high participation rates. In the United States, the Centers for Disease Control and Prevention have set clear participation objectives – next to quality targets – which are measured and evaluated over time (National Center for Health Statistics, 2012). For example, the 2010 pa...

  18. Public dental health care program for persons with disability

    DEFF Research Database (Denmark)

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

    2005-01-01

    The objectives of the study were (1) to describe the organization and content of the Danish public oral health care program for persons with disability, and (2) to analyse possible variations in relation to the goals and requirements set by the health authorities. Data were collected by means......) payment of service, (4) providers of oral health care, (5) special training of staff, 6) dental services delivered, (7) ethical issues, and (8) patient rights. Less than one-third of persons estimated by the health authorities were enrolled in the program. On average, 0.4% of the municipal population...... of knowledge of oral health and oral health care for persons with disability were barriers to equal access to the program. Preventive dental services were the most frequent services delivered, although relatively few oral hygienists were involved in the program. Special training was most frequent in large...

  19. The Effects of Staff Training on the Types of Interactions Observed at Two Group Homes for Foster Care Children

    Science.gov (United States)

    Crosland, Kimberly A.; Dunlap, Glen; Sager, Wayne; Neff, Bryon; Wilcox, Catherine; Blanco, Alfredo; Giddings, Tamela

    2008-01-01

    Objectives: An extensive literature base exists for behavioral parent training; however, few studies have focused on training direct care staff at group home and residential facilities for children. This study was conducted to determine whether a behavioral staff training program consisting of classroom training and in-home feedback would improve…

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

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-04-01

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

  1. Development of a hospital-based care coordination program for children with special health care needs.

    Science.gov (United States)

    Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten

    2013-01-01

    A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  2. Psychosocial and psychoeducational group program for main caregiver of mentally sick in early phase of schizophrenia

    Directory of Open Access Journals (Sweden)

    Estíbaliz Amaro Martín

    2012-03-01

    Full Text Available Deinstitutionalization processes in recent times have led to a new age in relations between family and mental health professionals. Care professionals were replaced, after the psychiatric reform, for care carried out by the family without the knowledge, information and skills to assume these functions. This is the situation of many families of patients with schizophrenia.Disabling features of schizophrenia usually cause depends on their families, who take care with the consequent impact on their lives. Psychosocial interventions assessing their work and want to build an alliance with them by giving them skills and coping mechanisms to reduce adverse family atmosphere, anticipate and solve problems and reduce the expressions of anger and guilt keeping appropiate expectations. However, these actions must be enforced by providing main caregivers with the skills that enable them to gain control, this is the main target of psychoeducational programs.Today there are many people in favour of such interventions in the early stages of schizophrenia. However, it is no clear how far development of these programs is supported by evidence of effectiveness. So it has proposed a psychosocial and psychoeducational program aimed at main caregivers of patients with schizophrenia in early stages. This program will be led by a psychiatric nurse in collaboration with other professionals in the interdisciplinary team; psychiatrist, clinical psychologist and social worker. It has developed clinical trial with a control group who will receive the gide for families, caregivers and people affected, "Cómo afrontar la esquizofrenia," and an experimental group will receive, in addition to the guide, the group intervention sessions.

  3. Exploring workplace violence among home care workers in a consumer-driven home health care program.

    Science.gov (United States)

    Nakaishi, Lindsay; Moss, Helen; Weinstein, Marc; Perrin, Nancy; Rose, Linda; Anger, W Kent; Hanson, Ginger C; Christian, Mervyn; Glass, Nancy

    2013-10-01

    Nominal research has examined sexual harassment and workplace violence against home care workers within consumer-driven home care models such as those offered in Oregon. This study examined home care workers' experiences of violence while providing care to consumer employers, the patients who hire and manage home care workers. Focus groups and interviews were conducted in Oregon with 83 home care workers, 99 Oregon Department of Human Services (DHS) employees, and 11 consumer employers. Home care workers reported incidents of workplace physical violence (44%), psychological abuse (65%), sexual harassment (41%), and sexual violence (14%). Further, three themes were identified that may increase the risk of workplace violence: (1) real and perceived barriers to reporting violence; (2) tolerance of violence; and (3) limited training to prevent violence. To ensure worker safety while maintaining quality care, safety policies and training for consumer employers, state DHS employees, and home care workers must be developed. Copyright 2013, SLACK Incorporated.

  4. "In Our Corner": A Qualitative Descriptive Study of Patient Engagement in a Community-Based Care Coordination Program.

    Science.gov (United States)

    Sefcik, Justine S; Petrovsky, Darina; Streur, Megan; Toles, Mark; O'Connor, Melissa; Ulrich, Connie M; Marcantonio, Sherry; Coburn, Ken; Naylor, Mary D; Moriarty, Helene

    2018-03-01

    The purpose of this study was to explore participants' experience in the Health Quality Partners (HQP) Care Coordination Program that contributed to their continued engagement. Older adults with multiple chronic conditions often have limited engagement in health care services and face fragmented health care delivery. This can lead to increased risk for disability, mortality, poor quality of life, and increased health care utilization. A qualitative descriptive design with two focus groups was conducted with a total of 20 older adults enrolled in HQP's Care Coordination Program. Conventional content analysis was the analytical technique. The overarching theme resulting from the analysis was "in our corner," with subthemes "opportunities to learn and socialize" and "dedicated nurses," suggesting that these are the primary contributing factors to engagement in HQP's Care Coordination Program. Study findings suggest that nurses play an integral role in patient engagement among older adults enrolled in a care coordination program.

  5. Oral health care knowledge and practices of a group of deaf adolescents in Lagos, Nigeria.

    Science.gov (United States)

    Oredugba, Folakemi A

    2004-01-01

    This study sought to determine the oral health care knowledge and practices of a group of deaf adolescents in Lagos. The study involved 50 students of Wesley School 1 for the Deaf, Lagos (26 males and 24 females, aged 10-19 years, mean 13.3 +/- 2.8). Information about previous dental care, oral hygiene, and snacking habits were obtained through a questionnaire and sign language by the teachers. Only 12 percent of pupils had received dental care. Eight percent and 72 percent, respectively, gave correct answers to causes of tooth decay and bleeding gums. Ninety-four percent brushed their teeth once daily, with no significant sex difference (P > .05). Reported dental problems include bleeding gums (36%), tooth discoloration, and tooth decay. The majority of pupils (60%) preferred biscuits and soft drinks as snacks. More than 90 percent were willing to have a dental check-up. The oral health knowledge and practices of this group of children will improve through a controlled school-based oral health education program.

  6. Day Care Legal Handbook: Legal Aspects of Organizing and Operating Day Care Programs.

    Science.gov (United States)

    Aikman, William F.

    This guide for providers of day care services presents information on business regulations and other legal considerations affecting for-profit and not-for-profit day care programs. Three basic topics covered are: (1) choosing the type of organization (sole proprietorship, partnership or corporation), (2) forming the organization, and (3) operating…

  7. Wiisokotaatiwin: development and evaluation of a community-based palliative care program in Naotkamegwanning First Nation.

    Science.gov (United States)

    Nadin, Shevaun; Crow, Maxine; Prince, Holly; Kelley, Mary Lou

    2018-04-01

    Approximately 474 000 Indigenous people live in 617 First Nations communities across Canada; 125 of those communities are located in Ontario, primarily in rural and remote areas. Common rural health challenges, including for palliative care, involve quality and access. The need for culturally relevant palliative care programs in First Nations communities is urgent because the population is aging with a high burden of chronic and terminal disease. Because local palliative care is lacking, most First Nations people now leave their culture, family and community to receive care in distant hospitals or long-term care homes. Due to jurisdictional issues, a policy gap exists where neither federal nor provincial governments takes responsibility for funding palliative care in First Nations communities. Further, no Canadian program models existed for how different levels of government can collaborate to fund and deliver palliative care in First Nations communities. This article describes an innovative, community-based palliative care program (Wiisokotaatiwin) developed in rural Naotkamegwanning, and presents the results of a process evaluation of its pilot implementation. The evaluation aimed to (i) document the program's pilot implementation, (ii) assess progress toward intended program outcomes and (iii) assess the perceived value of the program. The Wiisokotaatiwin Program was developed and implemented over 5 years using participatory action research (http://www.eolfn.lakeheadu.ca). A mixed-method evaluation approach was adopted. Descriptive data were extracted from program documents (eg client registration forms). Client tracking forms documented service provision data for a 4-month sample period. Quantitative and qualitative data were collected through client and family member questionnaires (n=7) and healthcare provider questionnaires (n=22). A focus group was conducted with the program leadership team responsible for program development. Quantitative data were

  8. Summary of the Nevada Applied Ecology Group and correlative programs

    International Nuclear Information System (INIS)

    Friesen, H.N.

    1992-10-01

    This summary document presents results in a broad context; it is not limited to findings of the Nevada Applied Ecology Group. This book is organized to present the findings of the Nevada Applied Ecology Group and correlative programs in accordance with the originally stated objectives of the Nevada Applied Ecology Group. This plan, in essence, traces plutonium from its injection into the environment to movement in the ecosystem to development of cleanup techniques. Information on other radionuclides was also obtained and will be presented briefly. Chapter 1 presents a brief description of the ecological setting of the Test Range Complex. The results of investigations for plutonium distribution are presented in Chapter 2 for the area surrounding the Test Range Complex and in Chapter 3 for on-site locations. Chapters 4 and 5 present the results of investigations concerned with concentrations and movement, respectively, of plutonium in the ecosystem of the Test Range Complex, and Chapter 6 summarizes the potential hazard from this plutonium. Development of techniques for cleanup and treatment is presented in Chapter 7, and the inventory of radionuclides other than plutonium is presented briefly in Chapter 8

  9. Disease-Specific Care: Spine Surgery Program Development.

    Science.gov (United States)

    Koerner, Katie; Franker, Lauren; Douglas, Barbara; Medero, Edgardo; Bromeland, Jennifer

    2017-10-01

    Minimal literature exists describing the process for development of a Joint Commission comprehensive spine surgery program within a community hospital health system. Components of a comprehensive program include structured communication across care settings, preoperative education, quality outcomes tracking, and patient follow-up. Organizations obtaining disease-specific certification must have clear knowledge of the planning, time, and overall commitment, essential to developing a successful program. Health systems benefit from disease-specific certification because of their commitment to a higher standard of service. Certification standards establish a framework for organizational structure and management and provide institutions a competitive edge in the marketplace. A framework for the development of a spine surgery program is described to help guide organizations seeking disease-specific certification. In developing a comprehensive program, it is critical to define the program's mission and vision, identify key stakeholders, implement clinical practice guidelines, and evaluate program outcomes.

  10. Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital.

    Directory of Open Access Journals (Sweden)

    Fatma Karapinar-Çarkıt

    Full Text Available To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective.A controlled clinical trial was performed at the Internal Medicine department of a general teaching hospital. All admitted patients using at least one prescription drug were included. The COACH program consisted of medication reconciliation, patient counselling at discharge, and communication to healthcare providers in primary care. The primary outcome was the proportion of patients with an unplanned rehospitalisation within three months after discharge. Also, the number of quality-adjusted life-years (QALYs was assessed. Cost data were collected using cost diaries. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios between the groups was estimated by bootstrapping.In the COACH program, 168 patients were included and in usual care 151 patients. There was no significant difference in the proportion of patients with unplanned rehospitalisations (mean difference 0.17%, 95% CI -8.85;8.51, and in QALYs (mean difference -0.0085, 95% CI -0.0170;0.0001. Total costs for the COACH program were non-significantly lower than usual care (-€1160, 95% CI -3168;847. Cost-effectiveness planes showed that the program was not cost-effective compared with usual care for unplanned rehospitalisations and QALYs gained.The COACH program was not cost-effective in comparison with usual care. Future studies should focus on high risk patients and include other outcomes (e.g. adverse drug events as this may increase the chances of a cost-effective intervention. Dutch trial register NTR1519.

  11. Physicians' fees and public medical care programs.

    Science.gov (United States)

    Lee, R H; Hadley, J

    1981-01-01

    In this article we develop and estimate a model of physicians' pricing that explicitly incorporates the effects of Medicare and Medicaid demand subsidies. Our analysis is based on a multiperiod model in which physicians are monopolistic competitors supplying services to several markets. The implications of the model are tested using data derived from claims submitted by a cohort of 1,200 California physicians during the years 1972-1975. We conclude that the demand for physician's services is relatively elastic; that increases in the local supply of physicians reduce prices somewhat; that physicians respond strategically to attempts to control prices through the customary-prevailing-reasonable system; and that price controls limit the rate of increase in physicians' prices. The analysis identifies a family of policies that recognize the monopsony power of public programs and may change the cost-access trade-off. PMID:7021479

  12. Exploring the Group Prenatal Care Model: A Critical Review of the Literature

    Science.gov (United States)

    Thielen, Kathleen

    2012-01-01

    Few studies have compared perinatal outcomes between individual prenatal care and group prenatal care. A critical review of research articles that were published between 1998 and 2009 and involved participants of individual and group prenatal care was conducted. Two middle range theories, Pender’s health promotion model and Swanson’s theory of caring, were blended to enhance conceptualization of the relationship between pregnant women and the group prenatal care model. Among the 17 research studies that met inclusion criteria for this critical review, five examined gestational age and birth weight with researchers reporting longer gestations and higher birth weights in infants born to mothers participating in group prenatal care, especially in the preterm birth population. Current evidence demonstrates that nurse educators and leaders should promote group prenatal care as a potential method of improving perinatal outcomes within the pregnant population. PMID:23997549

  13. Molecular and Clinical Based Cardiovascular Care Program

    Science.gov (United States)

    2010-11-01

    activity. Although few participants reported a strict vegan dietary pattern following completion of the CADRe Study, dietary fiber and average fruit and...44.9 94.8 44.6 % study goal Diet (specified vegan 91.9 9.8 89.5 14.1 diet elements), % study goal Stress management 70.0 26.8 57.9 37.0...prospective, cohort lifestyle intervention study ( vegan diet, exercise, stress management, group support). We determined baseline (0.731 ± 0.151 mm) and 1

  14. The manager's role in marketing. The Health Care Group.

    Science.gov (United States)

    1991-06-01

    With the impending reductions in physician reimbursements, the key to a practice's ongoing vitality will be its ability to increase volume and gain greater market share. Traditionally, most doctors have relied on word-of-mouth referrals from current patients and physicians to bring in new patients. In today's health care environment, however, this approach to practice building is not enough to assure growth.

  15. Chapter 9. Managing Occupational Stress for Group Care Personnel

    Science.gov (United States)

    Mattingly, Martha A.

    2006-01-01

    Traditional clinical professions, as well as the emerging child and youth care profession, have focused primarily on the welfare of identified clients. While the personal and professional well-being of practitioners has long been addressed in the training and supervision of human service workers, serious efforts to identify problems confronting…

  16. Medication safety programs in primary care: a scoping review.

    Science.gov (United States)

    Khalil, Hanan; Shahid, Monica; Roughead, Libby

    2017-10-01

    Medication safety plays an essential role in all healthcare organizations; improving this area is paramount to quality and safety of any wider healthcare program. While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated, no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliation or computerized physician order entry. This scoping review sought to map the current medication safety programs used in primary care. The current scoping review sought to examine the characteristics of medication safety programs in the primary care setting and to map evidence on the outcome measures used to assess the effectiveness of medication safety programs in improving patient safety. The current review considered participants of any age and any condition using care obtained from any primary care services. We considered studies that focussed on the characteristics of medication safety programs and the outcome measures used to measure the effectiveness of these programs on patient safety in the primary care setting. The context of this review was primary care settings, primary healthcare organizations, general practitioner clinics, outpatient clinics and any other clinics that do not classify patients as inpatients. We considered all quantitative studied published in English. A three-step search strategy was utilized in this review. Data were extracted from the included studies to address the review question. The data extracted included type of medication safety program, author, country of origin, aims and purpose of the study, study population, method, comparator, context, main findings and outcome

  17. Qualitative focus group study investigating experiences of accessing and engaging with social care services: perspectives of carers from diverse ethnic groups caring for stroke survivors.

    Science.gov (United States)

    Greenwood, Nan; Holley, Jess; Ellmers, Theresa; Mein, Gill; Cloud, Geoffrey

    2016-01-29

    Informal carers, often family members, play a vital role in supporting stroke survivors with post-stroke disability. As populations age, numbers of carers overall and those from minority ethnic groups in particular, are rising. Carers from all ethnic groups, but especially those from black and minority ethnic groups frequently fail to access support services, making understanding their experiences important. The study therefore explored the experiences of carers of stroke survivors aged 45+ years from 5 ethnic groups in accessing and receiving social care services after hospital discharge. This qualitative study used 7 recorded focus groups with informal carers of stroke survivors. Data were analysed thematically focusing on similarities and differences between ethnic groups. Carers were recruited from voluntary sector organisations supporting carers, stroke survivors and black and minority ethnic groups in the UK. 41 carers from 5 ethnic groups (Asian Indian, Asian Pakistani, black African, black Caribbean, white British) participated in the focus groups. Several interconnected themes were identified including: the service gap between hospital discharge and home; carers as the best person to care and cultural aspects of caring and using services. Many themes were common to all the included ethnic groups but some related to specific groups. Across ethnic groups there were many similarities in the experiences of people caring for stroke survivors with complex, long-term care needs. Accessing services demands effort and persistence on carers' part. If carers believe services are unsatisfactory or that they, rather than formal services, should be providing support for stroke survivors, they are unlikely to persist in their efforts. Cultural and language differences add to the challenges black and minority ethnic group carers face. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Glycemic control, compliance, and satisfaction for diabetic gravidas in centering group care.

    Science.gov (United States)

    Parikh, Laura I; Jelin, Angie C; Iqbal, Sara N; Belna, Sarah L; Fries, Melissa H; Patel, Misbah; Desale, Sameer; Ramsey, Patrick S

    2017-05-01

    To determine if diabetic gravidas enrolled in Centering® group care have improved glycemic control compared to those attending standard prenatal care. To compare compliance and patient satisfaction between the groups. We conducted a prospective cohort study of diabetics enrolled in centering group care from October 2013 to December 2015. Glycemic control, compliance and patient satisfaction (five-point Likert scale) were evaluated. Student's t-test, Chi-Square and mixed effects model were used to compare outcomes. We compared 20 patients in centering to 28 standard prenatal care controls. Mean fasting blood sugar was lower with centering group care (91.0 versus 105.5 mg/dL, p =0.017). There was no difference in change in fasting blood sugar over time between the two groups (p = 0.458). The percentage of time patients brought their blood glucose logs did not differ between the centering group and standard prenatal care (70.7 versus 73.9%, p = 0.973). Women in centering group care had better patient satisfaction scores for "ability to be seen by a physician" (5 versus 4, p = 0.041) and "time in waiting room" (5 versus 4, p =0.001). Fasting blood sugar was lower for patients in centering group care. Change in blood sugar over time did not differ between groups. Diabetic gravidas enrolled in centering group care report improved patient satisfaction.

  19. 75 FR 26945 - International Education Programs Service-Fulbright-Hays Group Projects Abroad Program

    Science.gov (United States)

    2010-05-13

    .... Schools and/or departments of education have a role to play in creating greater exposure since they are... DEPARTMENT OF EDUCATION International Education Programs Service--Fulbright-Hays Group Projects... Postsecondary Education, Department of Education. ACTION: Notice of proposed priorities. SUMMARY: The Assistant...

  20. Qualitative Comparison of Women's Perspectives on the Functions and Benefits of Group and Individual Prenatal Care.

    Science.gov (United States)

    Heberlein, Emily C; Picklesimer, Amy H; Billings, Deborah L; Covington-Kolb, Sarah; Farber, Naomi; Frongillo, Edward A

    2016-01-01

    Women's definitions and experiences of the functions and benefits of their routine prenatal care are largely absent from research and public discourse on prenatal care outcomes. This qualitative study aimed to develop a framework of women's prenatal care experiences by comparing the experiences of women in individual and group prenatal care. We conducted serial qualitative interviews with racially diverse low-income women receiving individual prenatal care (n = 14) or group prenatal care (n = 15) through pregnancy and the early postpartum period. We completed 42 second-trimester, 48 third-trimester, and 44 postpartum interviews. Using grounded theory, the semistructured interviews were coded for themes, and the themes were integrated into an explanatory framework of prenatal care functions and benefits. Individual and group participants described similar benefits in 3 prenatal care functions: confirming health, preventing and monitoring medical complications, and building supportive provider relationships. For the fourth function, educating and preparing, group care participants experienced more benefits and different benefits. The benefits for group participants were enhanced by the supportive group environment. Group participants described greater positive influences on stress, confidence, knowledge, motivation, informed decision making, and health care engagement. Whereas pregnant women want to maximize their probability of having a healthy newborn, other prenatal care outcomes are also important: reducing pregnancy-related stress; developing confidence and knowledge for improving health; preparing for labor, birth, and newborn care; and having supportive relationships. Group prenatal care may be more effective in attaining these outcomes. Achieving these outcomes is increasingly relevant in health care systems prioritizing woman-centered care and improved birth outcomes. How to achieve them should be part of policy development and research. © 2016 by the

  1. Congenital toxoplasmosis and prenatal care state programs

    Science.gov (United States)

    2014-01-01

    Background Control programs have been executed in an attempt to reduce vertical transmission and the severity of congenital infection in regions with a high incidence of toxoplasmosis in pregnant women. We aimed to evaluate whether treatment of pregnant women with spiramycin associated with a lack of monitoring for toxoplasmosis seroconversion affects the prognosis of patients. Methods We performed a prospective cohort study with 246 newborns (NB) at risk for congenital toxoplasmosis in Goiânia (Brazil) between October 2003 and October 2011. We analyzed the efficacy of maternal treatment with spiramycin. Results A total of 40.7% (66/162) of the neonates were born seriously infected. Vertical transmission associated with reactivation during pregnancy occurred in 5.5% (9/162) of the NB, with one showing severe infection (systemic). The presence of specific immunoglobulins (fetal IgM and NB IgA) suggested the worst prognosis. Treatment of pregnant women by spiramycin resulted in reduced vertical transmission. When infected pregnant women did not undergo proper treatment, the risk of severe infection (neural-optical) in NB was significantly increased. Fetal IgM was associated with ocular impairment in 48.0% (12/25) of the fetuses and neonatal IgA-specific was related to the neuro-ophthalmologic and systemic forms of the disease. When acute toxoplasmosis was identified in the postpartum period, a lack of monitoring of seronegative pregnant women resulted in a higher risk of severe congenital infection. Conclusion Treatment of pregnant women with spiramycin reduces the possibility of transmission of infection to the fetus. However, a lack of proper treatment is associated with the onset of the neural-optical form of congenital infection. Primary preventive measures should be increased for all pregnant women during the prenatal period and secondary prophylaxis through surveillance of seroconversion in seronegative pregnant woman should be introduced to reduce the

  2. The Cambia Sojourns Scholars Leadership Program: Conversations with Emerging Leaders in Palliative Care.

    Science.gov (United States)

    Cruz-Oliver, Dulce M; Bernacki, Rachelle; Cooper, Zara; Grudzen, Corita; Izumi, Seiko; Lafond, Deborah; Lam, Daniel; LeBlanc, Thomas W; Tjia, Jennifer; Walter, Jennifer

    2017-08-01

    There is a pressing workforce shortage and leadership scarcity in palliative care to adequately meet the demands of individuals with serious illness and their families. To address this gap, the Cambia Health Foundation launched its Sojourns Scholars Leadership Program in 2014, an initiative designed to identify, cultivate, and advance the next generation of palliative care leaders. This report intends to summarize the second cohort of Sojourns Scholars' projects and their reflection on their leadership needs. This report summarizes the second cohort of sojourns scholars' project and their reflection on leadership needs. After providing a written reflection on their own projects, the second cohort participated in a group interview (fireside chat) to elicit their perspectives on barriers and facilitators in providing palliative care, issues facing leadership in palliative care in the United States, and lessons from personal and professional growth as leaders in palliative care. They analyzed the transcript of the group interview using qualitative content analysis methodology. Three themes emerged from descriptions of the scholars' project experience: challenges in palliative care practice, leadership strategies in palliative care, and three lessons learned to be a leader were identified. Challenges included perceptions of palliative care, payment and policy, and workforce development. Educating and collaborating with other clinicians and influencing policy change are important strategies used to advance palliative care. Time management, leading team effort, and inspiring others are important skills that promote effectiveness as a leader. Emerging leaders have a unique view of conceptualizing contemporary palliative care and shaping the future. Providing comprehensive, coordinated care that is high quality, patient and family centered, and readily available depends on strong leadership in palliative care. The Cambia Scholars Program represents a unique opportunity.

  3. International piping integrity research group (IPIRG) program final report

    International Nuclear Information System (INIS)

    Schmidt, R.; Wilkowski, G.; Scott, P.; Olsen, R.; Marschall, C.; Vieth, P.; Paul, D.

    1992-04-01

    This is the final report of the International Piping Integrity Research Group (IPIRG) Programme. The IPIRG Programme was an international group programme managed by the U.S. Nuclear Regulatory Commission and funded by a consortium of organizations from nine nations: Canada, France, Italy, Japan, Sweden, Switzerland, Taiwan, the United Kingdom, and the United states. The objective of the programme was to develop data needed to verify engineering methods for assessing the integrity of nuclear power plant piping that contains circumferential defects. The primary focus was an experimental task that investigated the behaviour of circumferentially flawed piping and piping systems to high-rate loading typical of seismic events. To accomplish these objectives a unique pipe loop test facility was designed and constructed. The pipe system was an expansion loop with over 30 m of 406-mm diameter pipe and five long radius elbows. Five experiments on flawed piping were conducted to failure in this facility with dynamic excitation. The report: provides background information on leak-before-break and flaw evaluation procedures in piping; summarizes the technical results of the programme; gives a relatively detailed assessment of the results from the various pipe fracture experiments and complementary analyses; and, summarizes the advances in the state-of-the-art of pipe fracture technology resulting from the IPIRG Program

  4. Group Psychological Therapy in Obstetric Fistula Care: A ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Keywords: Obstetric fistula, mental ill health, Group Psychotherapy, South Sudan. Résumé. L'objectif de cette étude est de déterminer l'impact du groupe thérapie psychologique (GPT) sur la ... This conflict led to destruction of many social.

  5. Quality Care through Multi-Age Grouping of Children.

    Science.gov (United States)

    Prendergast, Leo

    2002-01-01

    Asserts that multi-age grouping in early childhood settings can and does work. Addresses four main hurdles to successful implementation: (1) laws and regulations that act as barriers; (2) health concerns; (3) overcoming educational values that conflict with those of the age-grouped classroom; and (4) staff misunderstanding of multi-age grouping…

  6. The intersection of everyday life and group prenatal care for women in two urban clinics.

    Science.gov (United States)

    Novick, Gina; Sadler, Lois S; Knafl, Kathleen A; Groce, Nora Ellen; Kennedy, Holly Powell

    2012-05-01

    Women from vulnerable populations encounter challenging circumstances that generate stress and may adversely affect their health. Group prenatal care (GPNC) incorporates features that address social stressors, and has been demonstrated to improve pregnancy outcomes and prenatal care experiences. In this qualitative study, we describe the complex circumstances in the lives of women receiving care in two urban clinics and how GPNC attenuated them. Stressors included problems with transportation and child care, demanding jobs, poverty, homelessness, difficult relationships with partners, limited family support, and frustrating health care experiences. Receiving prenatal care in groups allowed women to strengthen relationships with significant others, gain social support, and develop meaningful relationships with group leaders. By eliminating waits and providing the opportunity to participate in care, GPNC also offered sanctuary from frustrations encountered in receiving individual care. Reducing such stressors may help improve pregnancy outcomes; however, more evidence is needed on mechanisms underlying these effects.

  7. Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study

    Science.gov (United States)

    2013-01-01

    Background Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. Methods/design This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. Discussion This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries

  8. Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review.

    Science.gov (United States)

    de Bruin, Simone R; Versnel, Nathalie; Lemmens, Lidwien C; Molema, Claudia C M; Schellevis, François G; Nijpels, Giel; Baan, Caroline A

    2012-10-01

    To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers. Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden. Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with multiple chronic conditions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain.

    Science.gov (United States)

    van der Roer, Nicole; van Tulder, Maurits; van Mechelen, Willem; de Vet, Henrica

    2008-02-15

    Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks. To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with nonspecific chronic low back pain. The intensive group training protocol combines exercise therapy, back school, and behavioral principles. Two studies found a significant reduction in absenteeism for a graded activity program in occupational health care. This program has not yet been evaluated in a primary care physiotherapy setting. Participating physical therapists in primary care recruited 114 patients with chronic nonspecific low back pain. Eligible patients were randomized to either the protocol group or the guideline group. Outcome measures included functional status (Roland Morris Disability Questionnaire), pain intensity (11-point numerical rating scale), general perceived effect and quality of life (EuroQol-5D). Cost data were measured with cost diaries and included direct and indirect costs related to low back pain. After 52 weeks, the direct health care costs were significantly higher for patients in the protocol group, largely due to the costs of the intervention. The mean difference in total costs amounted to [Euro sign] 233 (95% confidence interval: [Euro sign] -2.185; [Euro sign] 2.764). The cost-effectiveness planes indicated no significant differences in cost effectiveness between the 2 groups. The results of this economic evaluation showed no difference in total costs between the protocol group and the guideline group. The differences in effects were small and not statistically significant. At present, national implementation of the protocol is not recommended.

  10. Medicaid program; health care-related taxes. Final rule.

    Science.gov (United States)

    2009-06-30

    This rule finalizes our proposal to delay enforcement of certain clarifications regarding standards for determining hold harmless arrangements in the final rule entitled, "Medicaid Program; Health Care-Related Taxes" from the expiration of a Congressional moratorium on enforcement from July 1, 2009 to June 30, 2010.

  11. Promoting Healthy Pregnancies Through Perinatal Groups: A Comparison of CenteringPregnancy® Group Prenatal Care and Childbirth Education Classes

    OpenAIRE

    Walker, Deborah S.; Worrell, Renee

    2008-01-01

    CenteringPregnancy® group prenatal care is growing in popularity and has commonalities with childbirth education classes. In order for leaders of childbirth education classes to best serve their clients' needs, it is important to be aware of new, emerging models of prenatal care such as CenteringPregnancy. This article provides an overview of CenteringPregnancy and similarities and differences between CenteringPregnancy and childbirth education classes. Providers of prenatal education, whethe...

  12. Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers.

    Science.gov (United States)

    Hermes, Eric; Burrone, Laura; Perez, Elliottnell; Martino, Steve; Rowe, Michael

    2018-05-18

    Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop

  13. A mobility program for an inpatient acute care medical unit.

    Science.gov (United States)

    Wood, Winnie; Tschannen, Dana; Trotsky, Alyssa; Grunawalt, Julie; Adams, Danyell; Chang, Robert; Kendziora, Sandra; Diccion-MacDonald, Stephanie

    2014-10-01

    For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

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

    Directory of Open Access Journals (Sweden)

    Ali Akbar Vaezi

    2011-03-01

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

  15. Interprofessional collaboration regarding patients' care plans in primary care : a focus group study into influential factors

    NARCIS (Netherlands)

    Stephanie Anna Lenzen; Trudy van der Weijden; Anna Beurskens; Marloes Amantia van Bokhoven; Ramon Daniëls; Jerôme Jean Jacques van Dongen

    2016-01-01

    Background: The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding

  16. Interprofessional collaboration regarding patients' care plans in primary care: a focus group study into influential factors

    NARCIS (Netherlands)

    Dongen, J.J. van; Lenzen, S.A.; Bokhoven, M.A. van; Daniels, R.; Weijden, T.T. van der; Beurskens, A.

    2016-01-01

    BACKGROUND: The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding

  17. Designing an Elderly Assistance Program Based-on Home Care

    Science.gov (United States)

    Umusya'adah, L.; Juwaedah, A.; Jubaedah, Y.; Ratnasusanti, H.; Puspita, R. H.

    2018-02-01

    PKH (Program Keluarga Harapan) is a program of Indonesia’s Government through the ministry of social directorate to accelerate the poverty reduction and the achievement of Millennium Development Goals (MDGs) target as well as the policies development in social protection and social welfare domain or commonly referred to as Indonesian Conditional Cash Transfer (CCT) Program. This research is motivated that existing participants of the family expectation program (PKH) that already exist in Sumedang, Indoensia, especially in the South Sumedang on the social welfare components is only limited to the health checking, while for assisting the elderly based Home Care program there has been no structured and systematic, where as the elderly still need assistance, especially from the family and community environment. This study uses a method of Research and Development with Model Addie which include analysis, design, development, implementation and evaluation. Participants in this study using purposive sampling, where selected families of PKH who provide active assistance to the elderly with 82 participants. The program is designed consists of program components: objectives, goals, forms of assistance, organizing institutions and implementing the program, besides, program modules include assisting the elderly. Form of assistance the elderly cover physical, social, mental and spiritual. Recommended for families and companions PKH, the program can be implemented to meet the various needs of the elderly. For the elderly should introspect, especially in the health and follow the advice recommended by related parties

  18. Determinants of Private Long-Term Care Insurance Purchase in Response to the Partnership Program.

    Science.gov (United States)

    Lin, Haizhen; Prince, Jeffrey T

    2016-04-01

    To assess three possible determinants of individuals' response in their private insurance purchases to the availability of the Partnership for Long-Term Care (PLTC) insurance program: bequest motives, financial literacy, and program awareness. The health and retirement study (HRS) merged with data on states' implementation of the PLTC program. Individual-level decision on private long-term care insurance is regressed on whether the PLTC program is being implemented for a given state-year, asset dummies, policy determinant variable, two-way and three-way interactions of these variables, and other controls, using fixed effects panel regression. Analysis used a sample between 50 and 69 years of age from 2002 to 2010, resulting in 12,695 unique individuals with a total of 39,151 observations. We find mild evidence that intent to bequest influences individual purchase of insurance. We also find that program awareness is necessary for response, while financial literacy notably increases responsiveness. Increasing response to the PLTC program among the middle class (the stated target group) requires increased efforts to create awareness of the program's existence and increased education about the program's benefits, and more generally, about long-term care risks and needs. © Health Research and Educational Trust.

  19. The Influence of Group Versus Individual Prenatal Care on Phase of Labor at Hospital Admission.

    Science.gov (United States)

    Tilden, Ellen L; Emeis, Cathy L; Caughey, Aaron B; Weinstein, Sarah R; Futernick, Sarah B; Lee, Christopher S

    2016-07-01

    Group prenatal care, an alternate model of prenatal care delivery, has been associated with various improved perinatal outcomes in comparison to standard, individual prenatal care. One important maternity care process measure that has not been explored among women who receive group prenatal care versus standard prenatal care is the phase of labor (latent vs active) at hospital admission. A retrospective case-control study was conducted comparing 150 women who selected group prenatal care with certified nurse-midwives (CNMs) versus 225 women who chose standard prenatal care with CNMs. Analyses performed included descriptive statistics to compare groups and multivariate regression to evaluate the contribution of key covariates potentially influencing outcomes. Propensity scores were calculated and included in regression models. Women within this sample who received group prenatal care were more likely to be in active labor (≥ 4 cm of cervical dilatation) at hospital admission (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.03-2.99; P = .049) and were admitted to the hospital with significantly greater cervical dilatation (mean [standard deviation, SD] 5.7 [2.5] cm vs. 5.1 [2.3] cm, P = .005) compared with women who received standard prenatal care, controlling for potential confounding variables and propensity for group versus individual care selection. Group prenatal care may be an effective and safe intervention for decreasing latent labor hospital admission among low-risk women. Neither group prenatal care nor active labor hospital admission was associated with increased morbidity. © 2016 by the American College of Nurse-Midwives.

  20. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study.

    Science.gov (United States)

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, Bert

    2015-08-21

    Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model was used to study the relationship between context factors, mechanisms and outcomes. Dutch integrated care involves care groups, bundled payments, patient involvement, health professional cooperation and task substitution, evidence-based care protocols and a shared clinical information system. Community involvement is not (yet) part of Dutch integrated care. Barriers to the implementation of integrated care included insufficient integration between the patient databases, decreased earnings for some health professionals, patients' insufficient medical and policy-making expertise, resistance by general practitioner assistants due to perceived competition, too much care provided by practice nurses instead of general practitioners and the funding system incentivising the provision of care exactly as described in the care protocols. Facilitators included performance monitoring via the care chain information system, increased earnings for some health professionals, increased focus on self-management, innovators in primary and secondary care, diabetes nurses acting as integrators and financial incentives for guideline adherence. Economic and political context and health IT-related barriers were discussed as the most problematic areas of integrated care implementation. The implementation of integrated care led to improved communication and cooperation but also to insufficient and unnecessary care provision and deteriorated preconditions for person-centred care. Dutch integrated diabetes care is still a

  1. Palliative care for cancer patients in a primary health care setting:Bereaved relatives' experience, a qualitative group interview study

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde

    2008-01-01

    care setting to explore barriers and facilitators for delivery of good palliative home care. Methods: Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results: Three main categories of experience were identified: 1) The health professionals' management, where...

  2. Therapeutic Residential Care for Children and Youth : A Consensus Statement of the International Work Group on Therapeutic Residential Care

    NARCIS (Netherlands)

    Whittaker, James K.; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James P.; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laura; Daly, Daniel L.; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek T.; Holden, Martha J.; James, Sigrid; Kendrick, Andrew; Knorth, Erik J.; Lausten, Mette; Lyons, John S.; Martin, Eduardo; McDermid, Samantha; McNamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari M.; Small, Richard W.; Thoburn, June; Thompson, Ronald; Zeira, Anat

    While the focus of this consensus statement and the review volume that preceded it (Whittaker, Del Valle, & Holmes, 2014) is on therapeutic residential care (TRC), a specialized form of group care, we view our work as supportive of a much wider effort internationally concerned with the quality of

  3. Time providing care outside visits in a home-based primary care program.

    Science.gov (United States)

    Pedowitz, Elizabeth J; Ornstein, Katherine A; Farber, Jeffrey; DeCherrie, Linda V

    2014-06-01

    To assess how much time physicians in a large home-based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time and patient and provider-related factors that may contribute to that time were considered. Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included length of interaction, mode, nature, and with whom the interaction was for 3 weeks. MSVD, an academic home-visit program in Manhattan, New York. All primary care physicians (PCPs) in MSVD (n = 14) agreed to participate. Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Data on 1,151 interactions for 537 patients were collected. An average 8.2 h/wk was spent providing nonhome visit care for a full-time provider. Using the most conservative estimates, 3.6 h/wk was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found between patients with and without dementia, new and established patients, and primary-panel and covered patients. Home-based primary care providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  4. The Family Startup Program: study protocol for a randomized controlled trial of a universal group-based parenting support program.

    Science.gov (United States)

    Trillingsgaard, Tea; Maimburg, Rikke Damkjær; Simonsen, Marianne

    2015-04-21

    Inadequate parenting is an important public health problem with possible severe and long-term consequences related to child development. We have solid theoretical and political arguments in favor of efforts enhancing the quality of the early family environment in the population at large. However, little is known about effect of universal approaches to parenting support during the transition to parenthood. This protocol describes an experimental evaluation of group based parenting support, the Family Startup Program (FSP), currently implemented large scale in Denmark. Participants will be approximately 2500 pregnant women and partners. Inclusion criteria are parental age above 18 and the mother expecting first child. Families are recruited when attending routine pregnancy scans provided as a part of the publicly available prenatal care program at Aarhus University Hospital, Skejby. Families are randomized within four geographically defined strata to one of two conditions a) participation in FSP or b) Treatment As Usual (TAU). FSP aims to prepare new families for their roles as parents and enhance parental access to informal sources of support, i.e. social network and community resources. The program consists of twelve group sessions, with nine families in each group, continuing from pregnancy until the child is 15 months old. TAU is the publicly available pre- and postnatal care available to families in both conditions. Analyses will employ survey data, administrative data from health visitors, and administrative register based data from Statistics Denmark. All data sources will be linked via the unique Danish Civil Registration Register (CPR) identifier. Data will be obtained at four time points, during pregnancy, when the child is nine months, 18 months and seven years. The primary study outcome is measured by the Parenting Sense of Competence scale (PSOC) J Clin Child Psychol 18:167-75, 1989. Other outcomes include parenting and couple relationship quality

  5. An art therapy group for bereaved youth in hospice care.

    Science.gov (United States)

    McIntyre, B B

    1990-09-01

    Through art, music, and drama children can creatively express the feelings of sadness and anger that occur when a family member dies. In so doing, they can often avoid later difficulties resulting from unresolved emotions. Hospices may want to develop an art therapy group to facilitate this process with clients and their families.

  6. Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program.

    Science.gov (United States)

    Walus, Ashley N; Woloschuk, Donna M M

    2017-01-01

    Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research

  7. A challenging job: Physical and sexual violence towards group workers in youth residential care.

    NARCIS (Netherlands)

    Alink, L.R.A.; Euser, S.; Bakermans-Kranenburg, M.J.; van IJzendoorn, M.H.

    2014-01-01

    Background: Residential or group care social workers appear to be at increased risk for experiencing physical violence at work. However, little is known about sexual harassment in addition to physical victimization of social workers in youth residential or group care. Objective: We investigated the

  8. A Challenging Job: Physical and Sexual Violence towards Group Workers in Youth Residential Care

    Science.gov (United States)

    Alink, Lenneke R. A.; Euser, Saskia; Bakermans-Kranenburg, Marian J.; van IJzendoorn, Marinus H.

    2014-01-01

    Background: Residential or group care social workers appear to be at increased risk for experiencing physical violence at work. However, little is known about "sexual harassment" in addition to physical victimization of social workers in "youth" residential or group care. Objective We investigated the prevalence of physical and…

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

    Science.gov (United States)

    Khouri, Rawda

    2011-01-01

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

  10. A Strength Training Program for Primary Care Patients, Central Pennsylvania, 2012

    Science.gov (United States)

    Patel, Vijay A.; Kraschnewski, Jennifer L.; Rovniak, Liza S.; Messina, Dino A.; Stuckey, Heather L.; Curry, William J.; Chuang, Cynthia H.; Sherwood, Lisa L.; Hess, Stacy L.

    2014-01-01

    Introduction Primary care providers can recommend strength training programs to use “Exercise as Medicine,” yet few studies have examined the interest of primary care patients in these programs. Methods We conducted a cross-sectional survey of primary care patients in central Pennsylvania. Interest in participating in free group-based strength training and weight control programs was assessed, in addition to patient demographics, medical history, and quality of life. Results Among 414 patients, most (61.0%) were aged 54 or older, and 64.0% were female. More patients were interested in a strength training program (55.3%) than in a weight control program (45.4%). Nearly three-quarters (72.8%) of those reporting 10 or more days of poor physical health were interested in a strength training program compared with 49.5% of those reporting no days of poor physical health. After adjusting for potential confounders, those reporting poorer physical health had 2.7 greater odds (95% confidence interval, 1.4–5.1) of being interested in a strength training program compared with those reporting better physical health. Patients with hypertension, diabetes, or high cholesterol were not more interested in a strength training program than those without these conditions. Conclusion Primary care practices may consider offering or referring patients to community-based strength training programs. This study observed high levels of interest in these widely available programs. Practices may also consider screening and referring those with poorer physical health, as they may be the most interested and have the most to gain from participating. PMID:24967829

  11. A culture of education: Enhancing school performance of youth living in residential group care in Ontario.

    Science.gov (United States)

    Gharabaghi, Kiaras

    2011-01-01

    This article presents a synthesis of what is known about the educational experiences of youth living in residential group care based on a literature review that highlights both the experiences of the youth themselves and the operational context of residential group care in Ontario as it pertains to educational performance. The author argues that there is little emphasis on education within the residential group care sector in Ontario that could translate into more productive educational experiences for youth. The article then provides a framework for developing a culture of education for residential group care that can be acted upon expeditiously. Enhancing the educational performance of young people living in group care will require a cultural approach that provides for daily and pervasive education supports and encouragement, and aims to enhance the lived experience of young people pursuant to their education.

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

    Science.gov (United States)

    2010-10-01

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

  13. Self-Care and Self-Help Groups for the Elderly: A Directory.

    Science.gov (United States)

    National Inst. on Aging (DHHS/PHS), Bethesda, MD.

    This document notes that, as health care costs continue to rise, the elderly are monitoring themselves as a means of cost containment, and as a way of enhancing their sense of well-being and their ability to lead active lives. It points out that more and more organizations are sponsoring health programs that promote the concept of self-care and…

  14. The affordable care ACT on loyalty programs for federal beneficiaries.

    Science.gov (United States)

    Piacentino, Justin J; Williams, Karl G

    2014-02-01

    To discuss changes in the law that allow community pharmacy loyalty programs to include and offer incentives to Medicare and Medicaid beneficiaries. The retailer rewards exception of the Patient Protection and Affordable Care Act of 2010 and its change to the definition of remuneration in the civil monetary penalties of the Anti-Kickback Statute now allow incentives to be earned on federal benefit tied prescription out-of-pocket costs. The criteria required to design a compliant loyalty program are discussed. Community pharmacies can now include Medicare and Medicaid beneficiaries in compliant customer loyalty programs, where allowed by state law. There is a need for research directly on the influence of loyalty programs and nominal incentives on adherence.

  15. Parents' experiences and perceptions of group-based antenatal care in four clinics in Sweden.

    Science.gov (United States)

    Andersson, Ewa; Christensson, Kyllike; Hildingsson, Ingegerd

    2012-08-01

    group-based antenatal care consists of six to nine two-hour sessions in which information is shared and discussed during the first hour and individual examinations are conducted during the second hour. Groups generally consist of six to eight pregnant women. Parent education is built into the programme, which originated in the United States and was introduced in Sweden at the beginning of the year of 2000. to investigate parents' experiences of group antenatal care in four different clinics in Sweden. a qualitative study was conducted using content analysis five group interviews and eleven individual interviews with parents who experienced group-based antenatal care. An interview guide was used. the study was set in four antenatal clinics that had offered group-based antenatal care for at least one year. The clinics were located in three different areas of Sweden. the participants were women and their partners who had experienced group-based antenatal care during pregnancy. Other criteria for participation were mastery of the Swedish language and having followed the care programme. three themes emerged, 'The care-combining individual physical needs with preparation for parenthood, refers to the context, organisation, and content of care'. Group antenatal care with inbuilt parent education was appreciated, but respondents reported that they felt unprepared for the first few weeks after birth. Their medical needs (for physical assessment and screening) were, however, fulfilled. The theme, 'The group-a composed recipient of care', showed the participants role and experience. The role could be passive or active in groups or described as sharers. Groups helped parents normalise their symptoms. The theme, 'The midwife-a controlling professional', showed midwives are ignorant of gender issues but, for their medical knowledge, viewed as respectable professionals. in the four clinics studied, group-based antenatal care appeared to meet parents' needs for physical assessment

  16. Study of the outcome of suicide attempts: characteristics of hospitalization in a psychiatric ward group, critical care center group, and non-hospitalized group

    Directory of Open Access Journals (Sweden)

    Kemuyama Nobuo

    2010-01-01

    Full Text Available Abstract Background The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group. Methods The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC", "hospitalization in the psychiatry ward (HIPW", or "non-hospitalization (NH", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome. Results The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS, general health performance (GAS, psychiatric symptoms (BPRS, and life events (LCU, while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care. Conclusion There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a

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

    Directory of Open Access Journals (Sweden)

    Abdullah M Al-Wahbi

    2010-10-01

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

  18. The pipeline training program in maternal and child health: interdisciplinary preparation of undergraduate students from underrepresented groups.

    Science.gov (United States)

    Pizur-Barnekow, Kris; Rhyner, Paula M; Lund, Shelley

    2010-05-01

    The Preparing Academically Successful Students in Maternal and Child Health (MCH PASS) training program provided financial support and specialized training to occupational therapy (OT) and speech-language pathology (SLP) undergraduate students from underrepresented groups in maternal and child health. The project assisted undergraduate trainees to matriculate into graduate programs in their respective fields and facilitated application into long-term maternal and child health training programs. Sixteen trainees (8 OT and 8 SLP) participated in an undergraduate training program with an emphasis on interdisciplinary teaming, family mentoring, leadership development, public health and population-based research. Instruction occurred in community and classroom settings through didactic instruction and small group discussions. Fifteen of the trainees applied to and were accepted in graduate programs in their respective fields. Two trainees applied to a long-term MCH training program. Students reported increased knowledge about programs that serve women and children, the effects of poverty on health, interdisciplinary teaming and the daily routines of families who have a child with a special health care need. The MCH PASS program provided a unique opportunity for undergraduate students in OT and SLP to learn about public health with an emphasis on maternal and child health. The specialized preparation enabled students to understand better the health concerns of underserved families whose children have special health care needs.

  19. Teaching a Model of Social Skills Training to Child Care Workers at a Group Home for Adolescents, for Improvement of Treatment Planning.

    Science.gov (United States)

    Gramling, Lyle T.

    This practicum study implemented a training program in the teaching of social skills for 4 child care workers at a group home for 12 adolescents having moderate to severe emotional and behavioral problems. The inservice training program involved teaching concepts, techniques, and social skills terminology during the first four sessions, with…

  20. Taking Care of You: Body, Mind, Spirit--A Unique Stress Management Program That Improves Lifestyle Behaviors

    Science.gov (United States)

    Vetter-Smith, Molly; Massey, Vera; Rellergert, Linda; Wissmann, Mary

    2014-01-01

    Taking Care of You: Body, Mind, Spirit is a multi-session group program developed by University of Missouri Extension that provides a unique and practical approach to helping adults better managing their stress and bounce back from life's challenges while improving lifestyle behaviors. The program combines mindfulness and a variety of other…

  1. The effectiveness of a group psycho-educational program on family caregiver burden of patients with mental disorders

    Directory of Open Access Journals (Sweden)

    Navidian Ali

    2012-08-01

    Full Text Available Abstract Background Brief family intervention may have a positive impact on family caregivers for patients with mental disorders. We assessed the effectiveness of a group psycho-educational program on family caregivers for patients with schizophrenia and mood disorders. Methods This randomized controlled trial was performed on 100 caregivers for patients with mental disorders attending the Isfahan Behavioral Sciences Research Center (IBSRC, in Isfahan, Iran. One hundred family caregivers of patients with schizophrenia (n = 50 and mood disorders (n = 50 were selected and assigned randomly to either a psycho-educational group intervention or routine care in each diagnosis category. The caregivers were followed for 3 months. Caregiver burden was assessed using the Zarit Burden Interview Results The mean scores of the Zarit caregiver burden decreased significantly for the group that participated in the psycho-educational program, while scores in the control group did not change significantly. Conclusions This group intervention program was effective to reduce the caregiver burden for both categories of mental disorders in the Iranian population. This group intervention program may improve the quality of life of patients and caregivers by improving the standards of care giving. Trial registration RCT registration number: IRCT138804272200N

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

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

    2013-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

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

  4. A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations.

    Science.gov (United States)

    Morganti, Kristy Gonzalez; Lovejoy, Susan; Beckjord, Ellen Burke; Haviland, Amelia M; Haas, Ann C; Farley, Donna O

    2014-01-01

    This study evaluated how the Perfecting Patient Care (PPC) University, a quality improvement (QI) training program for health care leaders and clinicians, affected the ability of organizations to improve the health care they provide. This training program teaches improvement methods based on Lean concepts and principles of the Toyota Production System and is offered in several formats. A retrospective evaluation was performed that gathered data on training, other process factors, and outcomes after staff completed the PPC training. A majority of respondents reported gaining QI competencies and cultural achievements from the training. Organizations had high average scores for the success measures of "outcomes improved" and "sustainable monitoring" but lower scores for diffusion of QI efforts. Total training dosage was significantly associated with the measures of QI success. This evaluation provides evidence that organizations gained the PPC competencies and cultural achievements and that training dosage is a driver of QI success.

  5. Core competencies for shared decision making training programs: insights from an international, interdisciplinary working group.

    Science.gov (United States)

    Légaré, France; Moumjid-Ferdjaoui, Nora; Drolet, Renée; Stacey, Dawn; Härter, Martin; Bastian, Hilda; Beaulieu, Marie-Dominique; Borduas, Francine; Charles, Cathy; Coulter, Angela; Desroches, Sophie; Friedrich, Gwendolyn; Gafni, Amiram; Graham, Ian D; Labrecque, Michel; LeBlanc, Annie; Légaré, Jean; Politi, Mary; Sargeant, Joan; Thomson, Richard

    2013-01-01

    Shared decision making is now making inroads in health care professionals' continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but existing programs vary widely in their theoretical foundations, length, and content. An international, interdisciplinary group of 25 individuals met in 2012 to discuss theoretical approaches to making health-related decisions, compare notes on existing programs, take stock of stakeholders concerns, and deliberate on core competencies. This article summarizes the results of those discussions. Some participants believed that existing models already provide a sufficient conceptual basis for developing and implementing shared decision making competency-based training programs on a wide scale. Others argued that this would be premature as there is still no consensus on the definition of shared decision making or sufficient evidence to recommend specific competencies for implementing shared decision making. However, all participants agreed that there were 2 broad types of competencies that clinicians need for implementing shared decision making: relational competencies and risk communication competencies. Further multidisciplinary research could broaden and deepen our understanding of core competencies for shared decision making training. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  6. Changing the health care system: a professional education program for Hispanic leaders in California.

    Science.gov (United States)

    Greenwald, H P; DeVries, R A; Dickstein, D A

    2001-01-01

    This article reports characteristics and evaluation findings on a program aimed at promoting change in California's health care system by training minority managers and policy specialists. Between 1990 and 1992, 30 Hispanic college graduates enrolled in the University of Southern California's Hispanic Leadership Program. Funded in part by the W. K. Kellogg Foundation, this program led to award of the Master of Health Administration degree and involved students in a series of community workshops. Evaluation took place via alumni surveys and focus groups. Although four individuals failed to complete the program, nearly all others entered careers potentially leading to positions of influence in health care delivery. Graduates indicated that they possessed most of the skills they considered necessary to help improve services to Hispanic people. All had taken concrete action toward this objective. Experience with the program has provided lessons valuable for conducting efforts of this kind, the principal one being that success requires substantial human and material resources. Long-term follow-up will be necessary to assess the program's ultimate impact on California's health care system.

  7. Primary care provider perceptions of intake transition records and shared care with outpatient cardiac rehabilitation programs

    Directory of Open Access Journals (Sweden)

    Jamnik Veronica

    2011-09-01

    Full Text Available Abstract Background While it is recommended that records are kept between primary care providers (PCPs and specialists during patient transitions from hospital to community care, this communication is not currently standardized. We aimed to assess the transmission of cardiac rehabilitation (CR program intake transition records to PCPs and to explore PCPs' needs in communication with CR programs and for intake transition record content. Method 144 PCPs of consenting enrollees from 8 regional and urban Ontario CR programs participated in this cross-sectional study. Intake transition records were tracked from the CR program to the PCP's office. Sixty-six PCPs participated in structured telephone interviews. Results Sixty-eight (47.6% PCPs received a CR intake transition record. Fifty-eight (87.9% PCPs desired intake transition records, with most wanting it transmitted via fax (n = 52, 78.8%. On a 5-point Likert scale, PCPs strongly agreed that the CR transition record met their needs for providing patient care (4.32 ± 0.61, with 48 (76.2% reporting that it improved their management of patients' cardiac risk. PCPs rated the following elements as most important to include in an intake transition record: clinical status (4.67 ± 0.64, exercise test results (4.61 ± 0.52, and the proposed patient care plan (4.59 ± 0.71. Conclusions Less than half of intake transition records are reaching PCPs, revealing a large gap in continuity of patient care. PCP responses should be used to develop an evidence-based intake transition record, and procedures should be implemented to ensure high-quality transitional care.

  8. [An Integrative Review of Home Care Service for Pregnant Women, Mothers, Infants, and Toddlers in Vulnerable Group].

    Science.gov (United States)

    Kim, Dasom; Lee, Insook

    2017-10-01

    This study was intended to integrate the evidence of home care service intervention for mothers and children in vulnerable groups through an integrative literature review. We searched the MEDLINE (PubMED), EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, DBpia databases. The quality of the articles was assessed by one doctoral researcher and verified by one professor of community health nursing who had participated in the systematic review of literature. A framework was developed to identify the intervention patterns in the selected papers and categorize various elements. The extracted intervention elements were grouped into potential themes, which were verified by assessors on whether they clearly reflected the interventions in the papers. Among 878 searched papers, we selected 16 papers after excluding literature that does not satisfy the selection criteria and quality evaluation. The intervention elements of 16 selected papers were categorized into six themes. The extracted intervention elements were divided into the themes of Patient-specific/Situation-specific care planning and intervention, Emphasis on self care competency, Intense home visit by developmental milestone, Reinforcing and modeling mother-child attachment, Communication and interaction across the intervention, Linkage with community resource and multidisciplinary approach. As a result of the analysis of proper interventions of home care services for mothers and children in vulnerable groups, it was found that it is necessary to consider indispensable intervention elements that can standardize the quality of home care services, and conduct studies on developing intervention programs based on the elements. © 2017 Korean Society of Nursing Science

  9. Workplace Violence Training Programs for Health Care Workers: An Analysis of Program Elements.

    Science.gov (United States)

    Arbury, Sheila; Hodgson, Michael; Zankowski, Donna; Lipscomb, Jane

    2017-06-01

    Commercial workplace violence (WPV) prevention training programs differ in their approach to violence prevention and the content they present. This study reviews 12 such programs using criteria developed from training topics in the Occupational Safety and Health Administration's (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and a review of the WPV literature. None of the training programs addressed all the review criteria. The most significant gap in content was the lack of attention to facility-specific risk assessment and policies. To fill this gap, health care facilities should supplement purchased training programs with specific training in organizational policies and procedures, emergency action plans, communication, facility risk assessment, and employee post-incident debriefing and monitoring. Critical to success is a dedicated program manager who understands risk assessment, facility clinical operations, and program management and evaluation.

  10. The Effect of the Educational Program on Iranian Fathers’ Involvement in Infant care: A Randomized Clinical Trial Study

    Directory of Open Access Journals (Sweden)

    Maryam Bagheri

    2015-11-01

    Full Text Available Introduction With the increase in women's employment and change in attitudes towards father’s role in family, father involvement in infant care can indirectly influence the physical health and well being of infant and mother. Materials and Methods This randomized clinical trial was performed on 150 qualified pregnant women and husbands. During the 35-37 weeks of pregnancy, fathers in fathers’ training group and couples in couples’ training group, participated in two training sessions of healthy infant caring. Fathers in control group received no training and mothers in all three groups received the routine pregnancy training and care. At the end of 4 and 8 weeks after birth, the involvement rate of fathers in infant care questioners were completed by mothers in all three groups. Then, the data were analyzed using Analysis of variance (ANOVA and SPSS software.  Results The total amount of involvement was calculated 55.77 for the fourth weekand 62.64 for the eigth week. The average of total involvement rate and three dimensions of direct father-child interaction, accessibility and responsibility and providing financial resources in two training groups comparing with that in control group, indicated a significant difference (p≤0.05. Conclusion Training the fathers regarding the infant care led to an increase in the fathers’ involvement dimensions in infant care. Thus, paternal training of this educational program should be considered in pregnancy care programs.

  11. [Effects of a Mobile Web-based Pregnancy Health Care Educational Program for Mothers at an Advanced Maternal Age].

    Science.gov (United States)

    Wang, Hee Jung; Kim, Il Ok

    2015-06-01

    This study was conducted to develop a mobile web-based pregnancy health care educational program for mothers who were at an advanced maternal age (AMA) and to verify the effects of the program on pregnancy health care. This program was developed using a web-based teaching-learning system design model and composed of 10 subject areas. This research was a quasi-experimental study using a non-equivalent control group pretest-posttest time serial design and data were collected from April 2 to May 3, 2014. To verify the effects of the program, it was used for 2 weeks with 30 AMA mothers (experimental group). For the control group, a classroom education booklet for pregnant women used with 31 AMA mothers. The experimental group having participated in program had statistically significantly higher scores for knowledge (t=3.76, pcare, compared to the control group. The results of the program indicate that a Mobile web-based pregnancy health care educational program is effective in meeting the needs of AMA mothers and can be used as the prenatal educational program for AMA mothers and is appropriate as an educational media for theses mothers.

  12. Comparing Homeless Persons’ Care Experiences in Tailored Versus Nontailored Primary Care Programs

    Science.gov (United States)

    Holt, Cheryl L.; Steward, Jocelyn L.; Jones, Richard N.; Roth, David L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa W.; Austin, Erika L.; Henry, Stephen Randal; Kay Johnson, N.; Shanette Granstaff, U.; O’Connell, James J.; Golden, Joya F.; Young, Alexander S.; Davis, Lori L.; Pollio, David E.

    2013-01-01

    Objectives. We compared homeless patients’ experiences of care in health care organizations that differed in their degree of primary care design service tailoring. Methods. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the “Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Results. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient–clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient–clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results. Conclusions. Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness. PMID:24148052

  13. Examining courtesy stigma among foreign health care workers caring for persons with Alzheimer's disease: A focus group study.

    Science.gov (United States)

    Werner, Perla; Hess, Adi

    2016-01-01

    Studies have shown that courtesy stigma is common among informal caregivers of persons with Alzheimer's disease. Guided by attribution theory and using focus group methodology, we examined this topic among 12 foreign health care workers. Findings revealed that stigma is noticeable in the everyday reality of foreign workers caring for persons with dementia and that its management is shaped by beliefs and knowledge about the disease in their original countries, and by knowledge gained as caregivers. Greater understanding of stigma among foreign workers is crucial for advancing knowledge in the area and for improving the care provided to persons with Alzheimer's disease.

  14. [Cancer nursing care education programs: the effectiveness of different teaching methods].

    Science.gov (United States)

    Cheng, Yun-Ju; Kao, Yu-Hsiu

    2012-10-01

    In-service education affects the quality of cancer care directly. Using classroom teaching to deliver in-service education is often ineffective due to participants' large workload and shift requirements. This study evaluated the learning effectiveness of different teaching methods in the dimensions of knowledge, attitude, and learning satisfaction. This study used a quasi-experimental study design. Participants were cancer ward nurses working at one medical center in northern Taiwan. Participants were divided into an experimental group and control group. The experimental group took an e-learning course and the control group took a standard classroom course using the same basic course material. Researchers evaluated the learning efficacy of each group using a questionnaire based on the quality of cancer nursing care learning effectiveness scale. All participants answered the questionnaire once before and once after completing the course. (1) Post-test "knowledge" scores for both groups were significantly higher than pre-test scores for both groups. Post-test "attitude" scores were significantly higher for the control group, while the experimental group reported no significant change. (2) after a covariance analysis of the pre-test scores for both groups, the post-test score for the experimental group was significantly lower than the control group in the knowledge dimension. Post-test scores did not differ significantly from pre-test scores for either group in the attitude dimension. (3) Post-test satisfaction scores between the two groups did not differ significantly with regard to teaching methods. The e-learning method, however, was demonstrated as more flexible than the classroom teaching method. Study results demonstrate the importance of employing a variety of teaching methods to instruct clinical nursing staff. We suggest that both classroom teaching and e-learning instruction methods be used to enhance the quality of cancer nursing care education programs. We

  15. [Effectiveness of a mindfulness program in primary care professionals].

    Science.gov (United States)

    Martín Asuero, Andrés; Rodríguez Blanco, Teresa; Pujol-Ribera, Enriqueta; Berenguera, Anna; Moix Queraltó, Jenny

    2013-01-01

    To determine the long-term effects of a mindfulness program on burnout, mood states, empathy, and mindfulness in primary care professionals. A repeated measures before-after study was performed in 87 participants working in primary care. The variables evaluated were scores of the Burnout Inventory (Maslach), mood states (Profile of Mood States [POMS]), empathy (Jefferson Scale of Physician Empathy [JSPE]) and mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), adherence to the intervention, and changes in attitudes. Evaluations were performed at baseline, at 8 weeks, and at 6 and 12 months. The intervention lasted for 1 year and consisted of two training phases, an intensive first phase lasting 28 hours, spread over 8 weeks, and a second, maintenance phase of 25 hours spread over 10 months. The effect of the intervention was assessed through observed change, standardized response mean (SRM), and linear mixed-effects models on repeated measures. The scores of all the scales improved significantly during the follow-up compared with baseline scores. The greatest differences were obtained at 12 months, especially in the the FFMQ (SRM: 1.4), followed by the POMS (SRM: 0,8). The greatest improvement in the maintenance phase was found in the difference between consecutive scores. The only scale that showed major changes in all phases was the FFMQ scale. At the end of the intervention, 89% of participants practiced the exercises of the program on their own and 94% reported improvements in self-care and greater professionalism. A psychoeducational program based on mindfulness reduces burnout and improves mood states, empathy, and mindfulness, while encouraging better self-care. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  16. Pediatric Critical Care Telemedicine Program: A Single Institution Review.

    Science.gov (United States)

    Hernandez, Maria; Hojman, Nayla; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S; Litman, Rebecca; Marcin, James P

    2016-01-01

    Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care. We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided. During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%). This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.

  17. Funding intensive care - approaches in systems using diagnosis-related groups.

    OpenAIRE

    Ettelt, S; Nolte, E

    2010-01-01

    This report reviews approaches to funding intensive care in health systems that use activitybased payment mechanisms based on diagnosis-related groups (DRGs) to reimburse hospital care. The report aims to inform the current debate about options for funding intensive care services for adults, children and newborns in England. Funding mechanisms reviewed here include those in Australia (Victoria), Denmark, France, Germany, Italy, Spain, Sweden and the United States (Medicare). Approaches to org...

  18. The programmed nursing care for lower extremity deep venous thrombus patients receiving interventional thrombolysis: its effect on living quality

    International Nuclear Information System (INIS)

    Qiao Cuiyun; Wang Zhujun; Lan Guiyun; Liang Zhiqiang; Shi Yonmin

    2011-01-01

    Objective: Tu study the effect of comprehensive programmed nursing intervention on the living quality in patients with lower extremity deep venous thrombus who receive interventional thrombolysis therapy. Methods: A total of 60 patients receiving interventional thrombolysis due to lower extremity deep venous thrombus were randomly and equally divided into two groups. Patients in study group (n=30) was treated with comprehensive programmed nursing intervention in addition to the conventional therapy and routine nursing care, while patients in control group (n=30) was treated with the conventional therapy and routine nursing care only. The conventional therapy and routine nursing care included the nursing assessment before the operation, observation of the vital signs and the cooperation psychological care during the operation, the performance of medication according to the doctor's orders after the operation, etc. The comprehensive programmed nursing intervention included the nursing assessment of the patient before operation and the scientifically making of the nursing plan, which mainly referred to the cognitive behavior, the psychological care and the health education. They were systematically carried out during the perioperative period. One month after discharge the patients were asked to pay a return visit. The living quality was evaluated with relevant standards, and the results were compared between the two groups. Results: The score of living quality in the study group was significantly higher than that in the control group (P<0.01). Conclusion: The comprehensive programmed nursing intervention can significantly improve the living quality of lower extremity deep venous thrombosis patients who receive interventional thrombolysis therapy. (authors)

  19. Characteristics of physical activity programs in the Brazilian primary health care system

    Directory of Open Access Journals (Sweden)

    Grace Angélica de Oliveira Gomes

    2014-10-01

    Full Text Available 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 reported having a physical activity intervention program, the most common involving walking groups. Most of the activities were performed in the morning, once or twice a week, and in sessions of 30 minutes or more. Physical education professionals were primarily responsible for directing the activities. Interventions occurred in the health unit itself or in adjacent community spaces. In general, these characteristics were similar between units with or without NASF, but varied substantially across regions. These findings will guide future physical activity policies and programs within primary care in Brazil.

  20. Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care.

    Science.gov (United States)

    Closa, Conxita; Mas, Miquel À; Santaeugènia, Sebastià J; Inzitari, Marco; Ribera, Aida; Gallofré, Miquel

    2017-09-01

    To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Quasi-experimental longitudinal study. An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  1. Steam-Generator Integrity Program/Steam-Generator Group Project

    International Nuclear Information System (INIS)

    1982-10-01

    The Steam Generator Integrity Program (SGIP) is a comprehensive effort addressing issues of nondestructive test (NDT) reliability, inservice inspection (ISI) requirements, and tube plugging criteria for PWR steam generators. In addition, the program has interactive research tasks relating primary side decontamination, secondary side cleaning, and proposed repair techniques to nondestructive inspectability and primary system integrity. The program has acquired a service degraded PWR steam generator for research purposes. This past year a research facility, the Steam Generator Examination Facility (SGEF), specifically designed for nondestructive and destructive examination tasks of the SGIP was completed. The Surry generator previously transported to the Hanford Reservation was then inserted into the SGEF. Nondestructive characterization of the generator from both primary and secondary sides has been initiated. Decontamination of the channelhead cold leg side was conducted. Radioactive field maps were established in the steam generator, at the generator surface and in the SGEF

  2. Helping While Learning: A Skilled Group Helper Training Program.

    Science.gov (United States)

    Smaby, Marlowe H.; Tamminen, Armas W.

    1983-01-01

    Describes a developmental group training workshop for training experienced counselors to do group counseling. Discusses stages of training including exploration, understanding, and action, which can help counselors learn helping skills for counseling that can often transfer to their own interpersonal lives and interactions with others. (JAC)

  3. Understanding the value added to clinical care by educational activities. Value of Education Research Group.

    Science.gov (United States)

    Ogrinc, G S; Headrick, L A; Boex, J R

    1999-10-01

    In an era of competition in health care delivery, those who pay for care are interested in supporting primarily those activities that add value to the clinical enterprise. The authors report on their 1998 project to develop a conceptual model for assessing the value added to clinical care by educational activities. Through interviews, nine key stakeholders in patient care identified five ways in which education might add value to clinical care: education can foster higher-quality care, improve work satisfaction of clinicians, have trainees provide direct clinical services, improve recruitment and retention of clinicians, and contribute to the future of health care. With this as a base, an expert panel of 13 clinical educators and investigators defined six perspectives from which the value of education in clinical care might be studied: the perspectives of health-care-oriented organizations, clinician-teachers, patients, education organizations, learners, and the community. The panel adapted an existing model to create the "Education Compass" to portray education's effects on clinical care, and developed a new set of definitions and research questions for each of the four major aspects of the model (clinical, functional, satisfaction, and cost). Working groups next drafted proposals to address empirically those questions, which were critiqued at a national conference on the topic of education's value in clinical care. The next step is to use the methods developed in this project to empirically assess the value added by educational activities to clinical care.

  4. Evaluation of a training program to assist care staff to better recognize and manage depression among palliative care patients and their families.

    Science.gov (United States)

    McCabe, Marita R P; Goldhammer, Denisa; Mellor, David; Hallford, David; Davison, Tanya

    2012-01-01

    This study was designed to evaluate the effectiveness of a training program to improve the knowledge, attitudes, and self-efficacy of palliative care staff and thus enable them to better detect and manage depression among palliative care patients and their families. Participants were 90 professional carers who completed a four-session training program. Knowledge, attitudes, self-efficacy, and barriers to working with depressed patients were assessed preintervention, post-intervention, and at a three-month follow-up. The results demonstrated that compared to the control group, the intervention group had improved in all of these areas. Improvements were maintained at the three-month follow-up in all areas except attitudes. The results of this study indicate the importance of training in managing depression among palliative care staff. Booster sessions will likely be needed to ensure that training program gains are maintained.

  5. The identification and measurement of quality dimensions in health care: focus group interview results.

    Science.gov (United States)

    Jun, M; Peterson, R T; Zsidisin, G A

    1998-01-01

    The identification and measurement of service quality are critical factors that are responsible for customer satisfaction. This article identifies 11 attributes that define quality of care and patient satisfaction and reveals various gaps among the patient, physician, and administrator groups in the perceived importance of those dimensions. Managerial implications for patient-focused health care are discussed.

  6. Effectiveness of an Internet-based learning program on venous leg ulcer nursing care in home health care--study protocol.

    Science.gov (United States)

    Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta

    2015-10-01

    To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care (eVLU) in home health care. The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care. Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups. During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014. Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300. © 2015 John Wiley & Sons Ltd.

  7. The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee.

    Science.gov (United States)

    Anderson, D R; Whitmer, R W; Goetzel, R Z; Ozminkowski, R J; Dunn, R L; Wasserman, J; Serxner, S

    2000-01-01

    To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.

  8. Health Care Professionals' Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study.

    Science.gov (United States)

    Milberg, Anna; Torres, Sandra; Ågård, Pernilla

    2016-01-01

    The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals' understandings of cross-cultural interaction during end-of-life care. Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis. The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, 'unusual' emotional and pain expressions, the expectation that these patients' families would be 'different' and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting "the unknown". In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients. The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as "the unknown" since they anticipate a variety of challenges

  9. Health Care Professionals’ Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study

    Science.gov (United States)

    Torres, Sandra; Ågård, Pernilla

    2016-01-01

    Objective The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals’ understandings of cross-cultural interaction during end-of-life care. Methods Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis. Results The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, ‘unusual’ emotional and pain expressions, the expectation that these patients’ families would be ‘different’ and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting “the unknown”. In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients. Conclusions The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as

  10. Health Care Professionals' Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study.

    Directory of Open Access Journals (Sweden)

    Anna Milberg

    Full Text Available The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals' understandings of cross-cultural interaction during end-of-life care.Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis.The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, 'unusual' emotional and pain expressions, the expectation that these patients' families would be 'different' and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting "the unknown". In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients.The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as "the unknown" since they anticipate a variety

  11. 76 FR 67801 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

    Science.gov (United States)

    2011-11-02

    ... Furnished by Non-Physician Practitioners in the Assignment Process c. Assignment of Beneficiaries to ACOs... Insurance Program CMP Civil Monetary Penalties CMS Centers for Medicare & Medicaid Services CNM Certified... the current payment system by rewarding providers for delivering high quality, efficient clinical care...

  12. Urology Group Compensation and Ancillary Service Models in an Era of Value-based Care.

    Science.gov (United States)

    Shore, Neal D; Jacoby, Dana

    2016-01-01

    Changes involving the health care economic landscape have affected physicians' workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non-physician- owned multispecialty enterprises, for both outpatient and inpatient services. The looming and dramatic shift from volume- to value-based health care compensation will assuredly affect urology group compensation arrangements and productivity formulae. For groups that can implement change rapidly, efficiently, and harmoniously, there will be opportunities to achieve the Triple Aim goals of the Patient Protection and Affordable Care Act, while maintaining a successful medical-financial practice. In summary, implementing new payment algorithms alongside comprehensive care coordination will assist urology groups in addressing the health economic cost and quality challenges that have been historically encountered with fee-for-service systems. Urology group leadership and stakeholders will need to adjust internal processes, methods of care coordination, cultural dependency, and organizational structures in order to create better systems of care and management. In response, ancillary services and patient throughput will need to evolve in order to adequately align quality measurement and reporting systems across provider footprints and patient populations.

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

    Directory of Open Access Journals (Sweden)

    Keenum Michael

    2006-08-01

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

  14. 76 FR 21372 - Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions...

    Science.gov (United States)

    2011-04-15

    ...] Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions Program... interested parties of an opportunity to apply to participate in the Medicare Community-based Care Transitions.... 111-148, enacted on March 23, 2010) (Affordable Care Act) authorized the Medicare Community-based Care...

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

    Science.gov (United States)

    California Childcare Health Program, 2011

    2011-01-01

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

  16. 32 CFR 199.16 - Supplemental Health Care Program for active duty members.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 2 2010-07-01 2010-07-01 false Supplemental Health Care Program for active duty... (CHAMPUS) § 199.16 Supplemental Health Care Program for active duty members. (a) Purpose and applicability... the supplemental health care program for active duty members of the uniformed services, the provision...

  17. [Gait, balance and independence rehabilitation program in elderly adults in a primary care unit].

    Science.gov (United States)

    Espinosa-Cuervo, Gisela; López-Roldán, Verónica Miriam; Escobar-Rodríguez, David Alvaro; Conde-Embarcadero, Margarita; Trejo-León, Gerardo; González-Carmona, Beatriz

    2013-01-01

    to evaluate the effect of a supervised rehabilitation program to improve gait, balance and independence in elderly patients attending a family medicine unit. we conducted a quasi-experimental study over a period of four weeks in a group of 72 patients older than 65 years. a supervised program regarding the risk factors for falling, and balance, gait, coordination and oculovestibular system, the modalities to be done two or three times a week in the primary care unit or at home. An analysis of both tests was performed by "up and go," Tinetti scale and the Katz index. "intention to treat" and "by protocol." mean age was 72 ± 5 years, 67.8% were female and 81.9% of the patients completed the program. A significant clinical improvement with statistical level were evident for gait and balance (p = 0.001), independence showed only clinical improvement (p = 0.083). The efficacy for periodicity (two or three times/week) and performance place showed same clinical improvement and statistical level for gait and balance (p = 0.001 to 0.003) and independence showed only clinical improvement (p = 0.317 to 0.991). an integral rehabilitation program improved gait, balance and clinical independence significantly. The supervised program is applicable and can be reproduced at primary care unit or home for geriatric care and preventive actions.

  18. Effectiveness of a group-based self-management program for people with chronic fatigue syndrome: a randomized controlled trial.

    Science.gov (United States)

    Pinxsterhuis, Irma; Sandvik, Leiv; Strand, Elin Bolle; Bautz-Holter, Erik; Sveen, Unni

    2017-01-01

    To evaluate the effectiveness of a group-based self-management program for people with chronic fatigue syndrome. A randomized controlled trial. Four mid-sized towns in southern Norway and two suburbs of Oslo. A total of 137 adults with chronic fatigue syndrome. A self-management program including eight biweekly meetings of 2.5 hours duration. The control group received usual care. Primary outcome measure: Medical Outcomes Study-Short Form-36 physical functioning subscale. Fatigue severity scale, self-efficacy scale, physical and mental component summary of the Short Form-36, and the illness cognition questionnaire (acceptance subscale). Assessments were performed at baseline, and at six-month and one-year follow-ups. At the six-month follow-up, a significant difference between the two groups was found concerning fatigue severity ( p = 0.039) in favor of the control group, and concerning self-efficacy in favor of the intervention group ( p = 0.039). These significant differences were not sustained at the one-year follow-up. No significant differences were found between the groups concerning physical functioning, acceptance, and health status at any of the measure points. The drop-out rate was 13.9% and the median number of sessions attended was seven (out of eight). The evaluated self-management program did not have any sustained effect, as compared with receiving usual care.

  19. Impact of a Novel Cost-Saving Pharmacy Program on Pregabalin Use and Health Care Costs.

    Science.gov (United States)

    Martin, Carolyn; Odell, Kevin; Cappelleri, Joseph C; Bancroft, Tim; Halpern, Rachel; Sadosky, Alesia

    2016-02-01

    Pharmacy cost-saving programs often aim to reduce costs for members and payers by encouraging use of lower-tier or generic medications and lower-cost sales channels. In 2010, a national U.S. health plan began a novel pharmacy program directed at reducing pharmacy expenditures for targeted medications, including pregabalin. The program provided multiple options to avoid higher cost sharing: use mail order pharmacy or switch to a lower-cost alternative medication via mail order or retail. Members who did not choose any option eventually paid the full retail cost of pregabalin. To evaluate the impact of the pharmacy program on pregabalin and alternative medication use, health care costs, and health care utilization. This retrospective analysis of claims data included adult commercial health plan members with a retail claim for pregabalin in the first 13 months of the pharmacy program (identification [ID] period: February 1, 2010-February 28, 2011). Members whose benefit plan included the pharmacy program were assigned to the program cohort; all others were assigned to the nonprogram cohort. The program cohort index date was the first retail pregabalin claim during the ID period and after the program start; the nonprogram cohort index date was the first retail pregabalin claim during the ID period. All members were continuously enrolled for 12 months pre- and post-index and had at least 1 inpatient claim or ≥ 2 ambulatory visit claims for a pregabalin-indicated condition. Cohorts were propensity score matched (PSM) 1:1 with logistic regression on demographic and pre-index characteristics, including mail order and pregabalin use, comorbidity, health care costs, and health care utilization. Pregabalin, gabapentin and other alternative medication use, health care costs, and health care utilization were measured. The program cohort was also divided into 2 groups: members who changed to gabapentin post-index and those who did not. A difference-in-differences (Di

  20. Randomised active programs on healthcare workers' flu vaccination in geriatric health care settings in France: the VESTA study.

    Science.gov (United States)

    Rothan-Tondeur, M; Filali-Zegzouti, Y; Golmard, J-L; De Wazieres, B; Piette, F; Carrat, F; Lejeune, B; Gavazzi, G

    2011-02-01

    Because of a lack of efficacy of influenza vaccination in elderly population, there are still numerous outbreaks in geriatric health care settings. The health care workers (HCW) flu vaccination is known to get herd immunity and decrease the impact of influenza in elderly population living in geriatric health care settings. However, the rates of vaccinated HCWs are still low in France. The French Geriatric Infection Risk Institute (ORIG) performed the VESTA study, a three-phase multicentre to identify factors limiting vaccination in HCWs, and to develop and implement active programs promoting HCWs influenza vaccination. To implement multicenter programs to enhance HCW influenza vaccination. It was a cluster randomised interventional studies. 43 geriatric health care settings (GHCSs), long term care and rehabilitation care settings in France. 1814 Health care workers from 20 GHCSs in the interventional group and 2,435 health care workers in 23 GHCSs in the control group. After the failure of a first educational program giving scientific information and. tested during the 2005-06 flu season in 43 HCSs, a second program was designed with the help of marketing experts, one year after Program 1. The objectives were to involve HCWs in the creation of "safety zones", and to give personal satisfaction. Program 2 was tested during the 2006-07 season. 20 of the 24 HCSs from the Program 1 cluster were included in the Program 2 cluster (1,814 HCWs), and 16 of the 19 HCSs from the Control 1 cluster, plus 7 new HCSs with interest in participating, were included in the Control 2 cluster (23 HCSs; 2,435 HCWs). The efficacy of each program was assessed by calculating and comparing the percentage of vaccinated HCWs, from all HCSs taken together, in the program and control clusters. Program 1 failed to increase the HCW vaccination coverage rate (VCR) (Program 1: 34%; Control 1: 32%; p > 0.05),). Program 2 increased the VCR in HCWs (Program 2: 44%; Control 2: 27%; Chi2 test, p active

  1. Experts' perspectives on SwissDRG: Second class care for vulnerable patient groups?

    Science.gov (United States)

    Leu, A; Wepf, H; Elger, B; Wangmo, T

    2018-03-14

    On the 1st of January 2012, Switzerland introduced the diagnosis-related group hospital tariff structure (SwissDRG). It was recognised that healthcare provided to the most vulnerable patient groups would be a challenge for the new SwissDRG. Coincident with the implementation of SwissDRG, we explored hospital experts' perceptions of which patient groups are vulnerable under the SwissDRG system, what has changed for this group, as well as solutions to ensure adequate access to health care for them. We interviewed 43 experts from 40 Swiss hospitals. Participating experts named several vulnerable patient groups who share some common characteristics. These hospital experts were concerned about the patient groups that are not financially profitable and questioned the practicability of the current regulation. At the same time, they highlighted the complexity associated with caring for this group under the new SwissDRG and reported measures at the macro, meso, and micro levels to protect vulnerable patient groups from negative effects. To curb negative outcomes for vulnerable patient groups after the introduction of the SwissDRG, the Swiss legislation has introduced various instruments including the acute and transitional care (ATC) measures. We conclude that ATC measures do not produce the expected effect the legislators had hoped for. More health data is needed to identify situations where vulnerable patient groups are more susceptible to inadequate health care access in Switzerland. Copyright © 2018 Elsevier B.V. All rights reserved.

  2. Development and evaluation of a self care program on breastfeeding in Japan: A quasi-experimental study

    Directory of Open Access Journals (Sweden)

    Awano Masayo

    2010-08-01

    Full Text Available Abstract Background Although the importance of breastfeeding is well known in Japan, in recent years less than 50% of mothers were fully breastfeeding at one month after birth. The purpose of this study was to develop a self-care program for breastfeeding aimed at increasing mothers' breastfeeding confidence and to evaluate its effectiveness. Methods A quasi-experimental pretest-posttest design was conducted in Japan. The intervention, a breastfeeding self-care program, was created to improve mothers' self-efficacy for breastfeeding. This Breastfeeding Self-Care Program included: information on the advantages and basics of breastfeeding, a breastfeeding checklist to evaluate breastfeeding by mothers and midwives, and a pamphlet and audiovisual materials on breastfeeding. Mothers received this program during their postpartum hospital stay. A convenience sample of 117 primiparous women was recruited at two clinical sites from October 2007 to March 2008. The intervention group (n = 55, who gave birth in three odd-numbered months, received standard care and the Breastfeeding Self-Care Program while the control group (n = 62 gave birth in three even numbered months and received standard breastfeeding care. To evaluate the effectiveness of the Breastfeeding Self-Care Program, breastfeeding self-efficacy and breastfeeding rate were measured early postpartum, before the intervention, and after the intervention at one month postpartum. The study used the Japanese version of The Breastfeeding Self-Efficacy Scale Short Form (BSES-SF to measure self-efficacy. Results The BSES-SF score of the intervention group rose significantly from 34.8 at early postpartum to 49.9 at one month after birth (p Conclusion Results indicate that the Breastfeeding Self-Care Program increased mothers' self-efficacy for breastfeeding and had a positive effect on the continuation of breastfeeding. Trial Registration Number UMIN000003517

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

    Directory of Open Access Journals (Sweden)

    Warmington K

    2015-08-01

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

  4. Moving on in life after intensive care--partners' experience of group communication.

    Science.gov (United States)

    Ahlberg, Mona; Bäckman, Carl; Jones, Christina; Walther, Sten; Hollman Frisman, Gunilla

    2015-09-01

    Partners have a burdensome time during and after their partners' intensive care period. They may appear to be coping well outwardly but inside feel vulnerable and lost. Evaluated interventions for partners on this aspect are limited. The aim of this study was to describe the experience of participating in group communication with other partners of former intensive care patients. The study has a descriptive intervention-based design where group communication for partners of former, surviving intensive care unit (ICU) patients was evaluated. A strategic selection was made of adult partners to former adult intensive care patients (n = 15), 5 men and 10 women, aged 37-89 years. Two group communication sessions lasting 2 h were held at monthly intervals with three to five partners. The partners later wrote, in a notebook, about their feelings of participating in group communications. To deepen the understanding of the impact of the sessions, six of the partners were interviewed. Content analysis was used to analyse the notebooks and the interviews. Three categories were identified: (1) Emotional impact, the partners felt togetherness and experienced worries and gratitude, (2) Confirmation, consciousness through insight and reflection and (3) The meeting design, group constellation and recommendation to participate in group communication. Partners of an intensive care patient are on a journey, constantly trying to adapt to the new situation and find new strategies to ever-changing circumstances. Group communications contributed to togetherness and confirmation. To share experiences with others is one way for partners to be able to move forward in life. Group communication with other patients' partners eases the process of going through the burden of being a partner to an intensive care patient. Group communications needs to be further developed and evaluated to obtain consensus and evidence for the best practice. © 2015 British Association of Critical Care Nurses.

  5. Health Care Access and Use Among Low-Income Children on Subsidized Insurance Programs in California.

    OpenAIRE

    Christopher Trenholm; Anna Saltzman; Shanna Shulman; Michael Cousineau; Dana Hughes

    2008-01-01

    This paper summarizes the CaliforniaKids and Healthy Kids programs—county-based insurance programs in California for low-income children. The study examined features of both programs, use of basic health care services by the children enrolled, and typical experiences accessing inpatient and other high-cost care. Children enrolled in the two programs made substantial use of outpatient health care, despite important variation in program features. The study concludes with recommendations on ho...

  6. Integrating interdisciplinary pain management into primary care: development and implementation of a novel clinical program.

    Science.gov (United States)

    Dorflinger, Lindsey M; Ruser, Christopher; Sellinger, John; Edens, Ellen L; Kerns, Robert D; Becker, William C

    2014-12-01

    The aims of this study were to develop and implement an interdisciplinary pain program integrated in primary care to address stakeholder-identified gaps. Program development and evaluation project utilizing a Plan-Do-Study-Act (PDSA) approach to address the identified problem of insufficient pain management resources within primary care. A large Healthcare System within the Veterans Health Administration, consisting of two academically affiliated medical centers and six community-based outpatients clinics. An interprofessional group of stakeholders participated in a Rapid Process Improvement Workshop (RPIW), a consensus-building process to identify systems-level gaps and feasible solutions and obtain buy-in. Changes were implemented in 2012, and in a 1-year follow-up, we examined indicators of engagement in specialty and multimodal pain care services as well as patient and provider satisfaction. In response to identified barriers, RPIW participants proposed and outlined two readily implementable, interdisciplinary clinics embedded within primary care: 1) the Integrated Pain Clinic, providing in-depth assessment and triage to targeted resources; and 2) the Opioid Reassessment Clinic, providing assessment and structured monitoring of patients with evidence of safety, efficacy, or misuse problems with opioids. Implementation of these programs led to higher rates of engagement in specialty and multimodal pain care services; patients and providers reported satisfaction with these services. Our PDSA cycle engaged an interprofessional group of stakeholders that recommended introduction of new systems-based interventions to better integrate pain resources into primary care to address reported barriers. Early data suggest improved outcomes; examination of additional outcomes is planned. Wiley Periodicals, Inc.

  7. Schistosomiasis Sustained Control Program in Ethnic Groups Around Ninefescha (Eastern Senegal).

    Science.gov (United States)

    N'Diaye, Monique; Dioukhane, Elhadji M; Ndao, Babacar; Diedhiou, Kemo; Diawara, Lamine; Talla, Idrissa; Vernet, Charlotte; Bessin, François; Barbier, Dominique; Dewavrin, Patrick; Klotz, Francis; Georges, Pierre

    2016-09-07

    Schistosomiasis is the second most significant parasitic disease in children in several African countries. For this purpose, the "Programme National de Lutte contre les Bilharzioses" (PNLB) was developed in partnership with the World Health Organization (WHO) to control this disease in Senegal. However, geographic isolation of Bedik ethnic groups challenged implementation of the key elements of the schistosomiasis program in eastern Senegal, and therefore, a hospital was established in Ninefescha to improve access to health care as well as laboratory support for this population. The program we have implemented from 2008 in partnership with the PNLB/WHO involved campaigns to 1) evaluate schistosomiasis prevalence in children of 53 villages around Ninefescha hospital, 2) perform a mass drug administration following the protocol established by the PNLB in school-aged children, 3) monitor annual prevalence, 4) implement health education campaigns, and 5) oversee the building of latrines. This campaign led to a drop in schistosomiasis prevalence but highlighted that sustainable schistosomiasis control by praziquantel treatment, awareness of the use of latrines, and inhabitants' voluntary commitment to the program are crucial to improve Schistosoma elimination. Moreover, this study revealed that preschool-aged children, for whom praziquantel was not recommended until 2014 in Senegal, constituted a significant reservoir for the parasite. © The American Society of Tropical Medicine and Hygiene.

  8. Parent and adolescent effects of a universal group program for the parenting of adolescents.

    Science.gov (United States)

    Chu, Joanna Ting Wai; Bullen, Pat; Farruggia, Susan P; Dittman, Cassandra K; Sanders, Matthew R

    2015-05-01

    There is growing support for the large-scale implementation of parenting programs for the prevention of child behavior disorders and child maltreatment in younger children. However, there is only limited evidence on the efficacy of parenting programs in modifying risk and protective factors relating to adolescent behavior problems. This study examined the efficacy of Group Teen Triple P (GTTP), an eight-session parenting program specifically designed for parents of young adolescents. Seventy-two families with adolescents aged between 12 and 15 years were randomly assigned to either GTTP (n = 35) or a care as usual (CAU) control condition (n = 37). Compared to CAU parents, parents who received GTTP reported significant improvements in parenting practices, parenting confidence, the quality of family relationships, and fewer adolescent problem behaviors at post-intervention. Several of the parent-reported effects were corroborated by reports from adolescents, including decreases in parent-adolescent conflict and increases in parental monitoring. Adolescents whose parents participated in GTTP also reported significantly fewer behavioral problems than adolescents in the CAU condition. Many of these improvements were maintained at 6-month follow-up.

  9. The impact of team-based primary care on health care services utilization and costs: Quebec's family medicine groups.

    Science.gov (United States)

    Strumpf, Erin; Ammi, Mehdi; Diop, Mamadou; Fiset-Laniel, Julie; Tousignant, Pierre

    2017-09-01

    We investigate the effects on health care costs and utilization of team-based primary care delivery: Quebec's Family Medicine Groups (FMGs). FMGs include extended hours, patient enrolment and multidisciplinary teams, but they maintain the same remuneration scheme (fee-for-service) as outside FMGs. In contrast to previous studies, we examine the impacts of organizational changes in primary care settings in the absence of changes to provider payment and outside integrated care systems. We built a panel of administrative data of the population of elderly and chronically ill patients, characterizing all individuals as FMG enrollees or not. Participation in FMGs is voluntary and we address potential selection bias by matching on GP propensity scores, using inverse probability of treatment weights at the patient level, and then estimating difference-in-differences models. We also use appropriate modelling strategies to account for the distributions of health care cost and utilization data. We find that FMGs significantly decrease patients' health care services utilization and costs in outpatient settings relative to patients not in FMGs. The number of primary care visits decreased by 11% per patient per year among FMG enrolees and specialist visits declined by 6%. The declines in costs were of roughly equal magnitude. We found no evidence of an effect on hospitalizations, their associated costs, or the costs of ED visits. These results provide support for the idea that primary care organizational reforms can have impacts on the health care system in the absence of changes to physician payment mechanisms. The extent to which the decline in GP visits represents substitution with other primary care providers warrants further investigation. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  10. Differences between early and late involvement of palliative home care in oncology care: A focus group study with palliative home care teams.

    Science.gov (United States)

    Dhollander, Naomi; Deliens, Luc; Van Belle, Simon; De Vleminck, Aline; Pardon, Koen

    2018-05-01

    To date, no randomised controlled trials on the integration of specialised palliative home care into oncology care have been identified. Information on whether existing models of integrated care are applicable to the home care system and how working procedures and skills of the palliative care teams might require adaptation is missing. To gain insight into differences between early and late involvement and the effect on existing working procedures and skills as perceived by palliative home care teams. Qualitative study - focus group interviews. Six palliative home care teams in Flanders, Belgium. Participants included physicians, nurses and psychologists. Differences were found concerning (1) reasons for initiation, (2) planning of care process, (3) focus on future goals versus problems, (4) opportunity to provide holistic care, (5) empowerment of patients and (6) empowerment of professional caregivers. A shift from a medical approach to a more holistic approach is the most noticeable. Being involved earlier also results in a more structured follow-up and in empowering the patient to be part of the decision-making process. Early involvement creates the need for transmural collaboration, which leads to the teams taking on more supporting and coordinating tasks. Being involved earlier leads to different tasks and working procedures and to the need for transmural collaboration. Future research might focus on the development of an intervention model for the early integration of palliative home care into oncology care. To develop this model, components of existing models might need to be adapted or extended.

  11. [Perspective of informal caregivers on home care. Qualitative study with a computer program].

    Science.gov (United States)

    Prieto Rodríguez, M Angeles; Gil García, Eugenia; Heierle Valero, Cristina; Frías Osuna, Antonio

    2002-01-01

    A hot debate exists in our country as to the models of home care which must be developed. This study is aimed at ascertaining how the family caregivers of terminal cancer patients, of the elderly suffering from dementia and of individuals having undergone major operations in outpatient surgery programs rate the quality of the home care provided. A phenomenological type qualitative study based on discussion groups (9), triangular groups (5) and in-depth interviews (22). This study was conducted in Andalusia throughout the 1999-2000 period. The subjects of the study were the main caregivers of patients provided with home care through the healthcare centers. The information must be analyzed by means of a Nudist-4 software-aided content analysis. The analysis variables were those of the Servqual model. For the caregivers of cancer patients, the most important aspects of the quality of the home care provided were the Response Capacity and Accessibility. This analysis revealed that the patients suffered pain but the pain was not controlled. Negative aspects hindering accessibility were the lack of home care coverage outside of regular working hours, the difficulty of getting in touch by phone, the length of time it takes for someone to come and the visits solely on request. The caregivers of patients having undergone major outpatient surgery want Security and Reliability. They complain of the short length of time within which the patients are released from the hospital and of the home care provided by the health care center. The caregivers of the elderly with dementia place top priority on being provided with the materials they need to take care of these patients. Caregivers' and patients' expectations differ, depending on health problems, therefore, the type of home care provided should vary, according to the health problems involved. It is necessary to develop a flexible model, capable of adapting to different patient needs and the diverse circumstances that affect

  12. Is there a survival benefit within a German primary care-based disease management program?

    Science.gov (United States)

    Miksch, Antje; Laux, Gunter; Ose, Dominik; Joos, Stefanie; Campbell, Stephen; Riens, Burgi; Szecsenyi, Joachim

    2010-01-01

    To compare the mortality rate of patients with type 2 diabetes who were enrolled in the German diabetes disease management program (DMP) with the mortality rate of those who were not enrolled. This observational study was part of the ELSID study (Evaluation of a Large Scale Implementation of disease management programs) in Germany. Participants had type 2 diabetes and were either enrolled or not enrolled in the DMP. The DMP provides systems-based, multifaceted, and patient-centered interventions. To reduce imbalances between the groups, a matched sample was created using sex, age, retirement status, federal state, pharmacy-based cost groups, and diagnostic-cost groups as matching criteria. Cox proportional hazards regression model and the Kaplan-Meier method were used to assess overall mortality. The observation period was 3 years beginning on January 1, 2006. A total of 11,079 patients were included in the analysis. As of January 1, 2006, 2300 patients were enrolled in the DMP and 8779 were receiving routine care. There were 1927 matched pairs of patients in the DMP group and the non-DMP group. The overall mortality rate was 11.3% in the DMP and 14.4% in the non-DMP group (log-rank test P German diabetes DMP and reduced mortality. This reduced mortality cannot be attributed directly to the DMP. However, further research should evaluate whether a primary care-based DMP contributes to increased life expectancy in patients with diabetes.

  13. Social Media as a Platform for Information About Diabetes Foot Care: A Study of Facebook Groups.

    Science.gov (United States)

    Abedin, Tasnima; Al Mamun, Mohammad; Lasker, Mohammad A A; Ahmed, Syed Walid; Shommu, Nusrat; Rumana, Nahid; Turin, Tanvir C

    2017-02-01

    Diabetes is one of the most challenging chronic health conditions in the current era. Diabetes-related foot problems need proper patient education, and social media could a play role to disseminate proper information. A systematic search was performed on Facebook groups using the key words "diabetes foot care", "diabetes foot", "diabetes foot management" and "podiatric care". The search resulted in 57 groups and detailed activity information was collected from those groups. Usefulness of each relevant post was determined. Regression analysis was performed to explore the factors associated with the level of usefulness of diabetes foot care-related Facebook groups. Our search resulted in a total of 16 eligible diabetes foot care-related Facebook groups with a total of 103 eligible posts. The average number of group members for the selected groups were 265.75 with an interquartile range of 3.5-107.75. Of the total 103 timeline posts, 45.6% posts were categorized as useful, while the remaining posts were not useful. Top mentioned diabetes foot care practice was "Checking feet daily". Multivariable logistic regression analysis showed that the level of usefulness of diabetes foot care-related Facebook groups were significantly associated with the type of posts and no association was found with presence of "likes" and presence of comment. Facebook being a widely used social networking system, patient welfare organizations, doctors, nurses and podiatrists could use this platform to provide support to educating diabetes patients and their caregivers by disseminating useful and authentic knowledge and information related to diabetes foot care. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  14. GPs' perspectives on preventive care for older people: a focus group study.

    Science.gov (United States)

    Drewes, Yvonne M; Koenen, Julia M; de Ruijter, Wouter; van Dijk-van Dijk, D J Annemarie; van der Weele, Gerda M; Middelkoop, Barend J C; Reis, Ria; Assendelft, Willem J J; Gussekloo, Jacobijn

    2012-11-01

    Preventive care traditionally aims to prevent diseases or injuries. For older people, different aims of prevention, such as maintenance of independence and wellbeing, are increasingly important. To explore GPs' perspectives on preventive care for older people. Qualitative study comprising six focus groups with GPs in the Netherlands. The focus-group discussions with 37 GPs were analysed using the framework analysis method. Whether or not to implement preventive care for older people depends on the patient's individual level of vitality, as perceived by the GP. For older people with a high level of vitality, GPs confine their role to standardised disease-oriented prevention on a patient's request; when the vitality levels in older people fall, the scope of preventive care shifts from prevention of disease to prevention of functional decline. For older, vulnerable people, GPs expect most benefit from a proactive, individualised approach, enabling them to live as independently as possible. Based on these perspectives, a conceptual model for preventive care was developed, which describes GPs' different perspectives toward older people who are vulnerable and those with high levels of vitality. It focuses on five main dimensions: aim of care (prevention of disease versus prevention of functional decline), concept of care (disease model versus functional model), initiator (older persons themselves versus GP), target groups (people with requests versus specified risk groups), and content of preventive care (mainly cardiovascular risk management versus functional decline). GPs' perspectives on preventive care are determined by their perception of the level of vitality of their older patients. Preventive care for older people with high levels of vitality may consist of a standardised disease-oriented approach; those who are vulnerable will need an individualised approach to prevent functional decline.

  15. The Case for Mixed-Age Grouping in Early Childhood Education Programs.

    Science.gov (United States)

    Katz, Lilian G.; And Others

    The seven brief chapters of this paper advocate mixed-age grouping in schools and child care centers. Discussion defines mixed-age grouping and examines some limitations of single-age grouping. Research findings on social and cognitive aspects of mixed-age grouping are reviewed. Social aspects are discussed by considering in turn the following…

  16. Capacity for Cancer Care Delivery Research in National Cancer Institute Community Oncology Research Program Community Practices: Availability of Radiology and Primary Care Research Partners.

    Science.gov (United States)

    Carlos, Ruth C; Sicks, JoRean D; Chang, George J; Lyss, Alan P; Stewart, Teresa L; Sung, Lillian; Weaver, Kathryn E

    2017-12-01

    Cancer care spans the spectrum from screening and diagnosis through therapy and into survivorship. Delivering appropriate care requires patient transitions across multiple specialties, such as primary care, radiology, and oncology. From the program's inception, the National Cancer Institute Community Oncology Research Program (NCORP) sites were tasked with conducting cancer care delivery research (CCDR) that evaluates structural, organizational, and social factors, including care transitions that determine patient outcomes. The aim of this study is to describe the capacity of the NCORP to conduct multidisciplinary CCDR that includes radiology and primary care practices. The NCORP includes 34 community and 12 minority and underserved community sites. The Landscape Capacity Assessment was conducted in 2015 across these 46 sites, composed of the 401 components and subcomponents designated to conduct CCDR. Each respondent had the opportunity to designate an operational practice group, defined as a group of components and subcomponents with common care practices and resources. The primary outcomes were the proportion of adult oncology practice groups with affiliated radiology and primary care practices. The secondary outcomes were the proportion of those affiliated radiology and primary care groups that participate in research. Eighty-seven percent of components and subcomponents responded to at least some portion of the assessment, representing 230 practice groups. Analyzing the 201 adult oncology practice groups, 85% had affiliated radiologists, 69% of whom participate in research. Seventy-nine percent had affiliated primary care practitioners, 31% of whom participate in research. Institutional size, multidisciplinary group practice, and ownership by large regional or multistate health systems was associated with research participation by affiliated radiology and primary care groups. Research participation by these affiliated specialists was not significantly

  17. Career ladder program for registered nurses in ambulatory care.

    Science.gov (United States)

    Nelson, Joan; Sassaman, Becky; Phillips, Alison

    2008-01-01

    RN ladder programs are designed to inspire and reward clinical excellence. Kaiser Permanente Colorado's (KPCO) career ladder program emerged as a result of a labor-management partnership. Career ladder point assignments are reflective of the organization's priorities and values. KPCO's career ladder point tool awards RNs for formal and continuing education, professional presentations, organizational experience and experience as an RN, certifications and active professional memberships, leadership activities, research and publications, and nursing-related volunteer work. Participation in the RN career ladder requires that the nurse achieve a self-determined, manager-approved, measurable goal that will improve patient care. Career ladder nurses at KPCO were significantly more involved in leadership and interdisciplinary activities, quality improvement projects, and preceptorship.

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

    Science.gov (United States)

    Burton, Elissa; Lewin, Gill; Clemson, Lindy; Boldy, Duncan

    2013-01-01

    Restorative home care services are short-term and aimed at maximizing a person's ability to live independently. They are multidimensional and often include an exercise program to improve strength, mobility, and balance. The aim of this study was to determine whether a lifestyle exercise program would be undertaken more often and result in greater functional gains than the current structured exercise program delivered as part of a restorative home care service for older adults. A pragmatic randomized controlled trial was conducted in an organization with an established restorative home care service. Individuals who were to have an exercise program as part of their service were randomized to receive either a lifestyle and functional exercise program called LiFE (as this was a new program, the intervention) or the structured exercise program currently being used in the service (control). Exercise data collected by the individuals throughout and pre and post intervention testing was used to measure balance, strength, mobility, falls efficacy, vitality, function, and disability. There was no difference between the groups in the amounts of exercise undertaken during the 8-week intervention period. Outcome measurement indicated that the LiFE program was as effective, and on 40% of the measures, more effective, than the structured exercise program. Organizations delivering restorative home care services that include an exercise component should consider whether LiFE rather than the exercise program they are currently using could help their clients achieve better outcomes.

  19. 76 FR 69693 - Tolerance Crop Grouping Program III

    Science.gov (United States)

    2011-11-09

    ... Parl. ex Sudw., P. pinea L.; Pistachio, Pistacia vera L.; Sapucaia nut, Lecythis zabucaja Aubl... the current taxonomic name. Pistachio was previously rejected as a member of Tree Nuts Crop Group 14, because there were concerns that the unsealed husks or shells surrounding pistachio nuts would expose the...

  20. Pile group program for full material modeling and progressive failure.

    Science.gov (United States)

    2008-12-01

    Strain wedge (SW) model formulation has been used, in previous work, to evaluate the response of a single pile or a group of piles (including its : pile cap) in layered soils to lateral loading. The SW model approach provides appropriate prediction f...

  1. The Weight Management Dietetics Practice Group collecting outcomes mentoring program

    Science.gov (United States)

    The is a newsletter article for the Academy of Nutrition and Dietetics (AND), Weight Management Dietetics Practice Group (WM DPG). The article presents the ‘Collecting Outcomes Mentoring Program’ for 2017 that is managed by the Research Section of the WM DPG. Dietitians in the WM DGP are provided wi...

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

    Directory of Open Access Journals (Sweden)

    Lewin G

    2016-06-01

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

  3. Attractiveness of working in home care: An online focus group study among nurses.

    Science.gov (United States)

    De Groot, Kim; Maurits, Erica E M; Francke, Anneke L

    2018-01-01

    Many western countries are experiencing a substantial shortage of home-care nurses due to the increasing numbers of care-dependent people living at home. In-depth knowledge is needed about what home-care nurses find attractive about their work in order to make recommendations for the recruitment and retention of home-care nursing staff. The aims of this explorative, qualitative study were to gain in-depth knowledge about which aspects home-care nurses find attractive about their work and to explore whether these aspects vary for home-care nurses with different levels of education. Discussions were conducted with six online focus groups in 2016 with a total of 38 Dutch home-care nurses. The transcripts were analysed using the principles of thematic analysis. The findings showed that home-care nurses find it attractive that they are a "linchpin", in the sense of being the leading professional and with the patient as the centre of care. Home-care nurses also find having autonomy attractive: autonomy over decision-making about care, freedom in work scheduling and working in a self-directed team. Variety in patient situations and activities also makes their work attractive. Home-care nurses with a bachelor's degree did not differ much in what they found attractive aspects from those with an associate degree (a nursing qualification after completing senior secondary vocational education). It is concluded that autonomy, variety and being a "linchpin" are the attractive aspects of working in home care. To help recruit and retain home-care nursing staff, these attractive aspects should be emphasised in nursing education and practice, in recruitment programmes and in publicity material. © 2017 John Wiley & Sons Ltd.

  4. Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program.

    Science.gov (United States)

    Lawn, Sharon; Zabeen, Sara; Smith, David; Wilson, Ellen; Miller, Cathie; Battersby, Malcolm; Masman, Kevin

    2017-08-24

    Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health's Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P=0.037) and complex needs (Pmanage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia's health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self

  5. Evaluation of a program to improve diabetes care through intensified care management activities and diabetes medication copayment reduction.

    Science.gov (United States)

    Kogut, Stephen J; Johnson, Scott; Higgins, Tara; Quilliam, Brian

    2012-05-01

    Medication copayment reduction can be integrated with disease management programs to incentivize patient engagement in chronic care management. While disease management programs in diabetes have been evaluated across a range of settings and designs, less is known regarding the effectiveness of copayment reduction as a component of disease management. To evaluate the short-term results of a diabetes-focused disease management program that included copayment reduction, care coordination, and patient goal setting, focusing on rates of evidence-based care processes and all-cause pharmacy and health care costs. Blue Cross Blue Shield of Rhode Island offered large employer groups the opportunity to participate in a diabetes disease management initiative that featured reduced copayments (from $7/$25/$40 for generic, tier 2, and tier 3 drugs, respectively, to $0 for generic and $0-$2 for brand drugs) for diabetes-related medications. In return for the copayment reduction, participants agreed to the following: (a) participate in care coordination with a case manager, (b) have an annual physical examination, (c) have a hemoglobin A1c blood test at least twice annually, and (d) have a low-density lipoprotein cholesterol (LDL-C) test at least once annually. Patients received personalized support provided by a registered nurse and dietician, disease-related education provided by nurses, and intensified case management services, including working with a health coach to establish healthy behavioral change goals. All study subjects were aged 18 years or older and had at least 1 ICD-9-CM code for diabetes and at least 1 claim for an antidiabetic drug during a 12-month measurement period, which was each subject's most recent 12-month period of continuous enrollment from January 1, 2008, through May 31, 2010. Administrative claims data were used to determine the percentage of intervention (participating) and nonintervention (nonparticipating) subjects from among all of the plan

  6. From home deliveries to health care facilities: establishing a traditional birth attendant referral program in Kenya.

    Science.gov (United States)

    Tomedi, Angelo; Stroud, Sophia R; Maya, Tania Ruiz; Plaman, Christopher R; Mwanthi, Mutuku A

    2015-07-16

    To assess the effectiveness of a traditional birth attendant (TBA) referral program on increasing the number of deliveries overseen by skilled birth attendants (SBA) in rural Kenyan health facilities before and after the implementation of a free maternity care policy. In a rural region of Kenya, TBAs were recruited to educate pregnant women about the importance of delivering in healthcare facilities and were offered a stipend for every pregnant woman whom they brought to the healthcare facility. We evaluated the percentage of prenatal care (PNC) patients who delivered at the intervention site compared with the percentage of PNC patients who delivered at rural control facilities, before and after the referral program was implemented, and before and after the Kenya government implemented a policy of free maternity care. The window period of the study was from July of 2011 through September 2013, with a TBA referral intervention conducted from March to September 2013. The absolute increases from the pre-intervention period to the TBA referral intervention period in SBA deliveries were 5.7 and 24.0% in the control and intervention groups, respectively (p facility significantly increased compared to control health facilities when TBAs educated women about the need to deliver with a SBA and when TBAs received a stipend for bringing women to local health facilities to deliver. Furthermore, this TBA referral program proved to be far more effective in the target region of Kenya than a policy change to provide free obstetric care.

  7. Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care.

    Science.gov (United States)

    Lemak, Christy Harris; Nahra, Tammie A; Cohen, Genna R; Erb, Natalie D; Paustian, Michael L; Share, David; Hirth, Richard A

    2015-04-01

    As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. Project HOPE—The People-to-People Health Foundation, Inc.

  8. Building Children's Sense of Community in a Day Care Centre through Small Groups in Play

    Science.gov (United States)

    Koivula, Merja; Hännikäinen, Maritta

    2017-01-01

    This study examines the process through which children build a sense of community in small groups in a day care centre. The study asks the following: how does children's sense of community develop, and what are its key features? Data were collected by applying ethnographic methods in a group of three- to five-year-old children over eleven months.…

  9. The importance of patient-centered care for various patient groups.

    NARCIS (Netherlands)

    Boer, D. de; Delnoij, D.; Rademakers, J.

    2013-01-01

    Objectives: To assess differences in the importance ascribed to patient-centered care between various patient groups and demographic groups. Methods: Survey data collected using questionnaires were analyzed for patients that underwent hip or knee surgery (n=214), patients suffering from rheumatoid

  10. Development Trends in the Fields of Education and Care for Vulnerable Groups in Slovenia

    Science.gov (United States)

    Kobolt, Alenka; Pavel, Jana Rapus

    2010-01-01

    This paper presents the main developments in education and care for vulnerable groups of children and youth in Slovenia over the past twenty years. It describes the education system and provides an overview of the development of social pedagogy as a discipline and the practice of working with some groups of vulnerable young people. The trends can…

  11. The primary care diagnosis of dementia in Europe: an analysis using multidisciplinary, multinational expert groups.

    NARCIS (Netherlands)

    Lepeleire, J. De; Wind, A.W.; Iliffe, S.; Moniz-Cook, E.; Wilcock, J.; Gonzalez, V.M.; Derksen, E.W.C.; Gianelli, M.V.; Vernooy-Dassen, M.J.F.J.

    2008-01-01

    OBJECTIVES: To explore the extent of variation in the detection of dementia in primary care across Europe, and the potential for the development of European guidelines. METHOD: A mixture of focus group and adapted nominal group methods involving 23 experts of different disciplines and from eight

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

    Directory of Open Access Journals (Sweden)

    Mohammad Abbasinia

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Khouri RI

    2011-06-01

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

  14. Building positive self-image in adolescents in foster care: the use of role models in an interactive group approach.

    Science.gov (United States)

    Yancey, A K

    1998-01-01

    In a previous article (Yancey, 1992), the literature on identity development in individuals from socially devalued racial and ethnic groups was summarized. It was postulated that the social maladaptation of adolescents in residential group foster care is reflective of identity disturbances created by the negative images of African-Americans and Latinos perpetuated by the dominant society and unfiltered by optimal parental racial/ethnic socialization. The present article describes the development of a pilot preventive mental health intervention, the PRIDE (Personal and Racial/ethnic Identity Development and Enhancement) program, designed to provide components of parenting that are necessary for promoting positive self-image in ethnically marginalized adolescents and that are typically lacking in the group foster care milieu. PRIDE utilizes successful, ethnically relevant role models in interactive group sessions to create a significant cognitive and emotional experience for teens. While the utility of role modeling for at-risk youth is widely accepted, there is little research on the packaging, delivery, and influence of this intervention modality. This study demonstrates the feasibility of a "hybrid" role-modeling approach (intermediate in intensity of exposure and cost between one-to-one mentoring and career-day programs). Implications for further research on this type of intervention are discussed.

  15. [Treatment of eating disorders during hospitalization: presentation of a hospital intensive care program in pediatric age].

    Science.gov (United States)

    D'Argenio, L; Zaccagnino, M; Donati, C; Perini, A; Fazzi, E

    2013-04-01

    The aim of this study was to present a hospital intensive care program for patients affected by a severe eating disorders, with a significant loss of weight (BMI110 bpm or inability to sustain core body temperature), abnormal laboratory data, especially electrolyte imbalance and refusal to take food and fluids. In our study we reported 2 year follow-up of 16 patients treated with the hospital intensive care program between 2007 and 2008 in our department. The proposed program was proved an efficient method in a critical phase of the alimentary behavior disorders. It was possible for all the patients to avoid alternative feeding techniques (enteral or parenteral) and to obtain a correct alimentation with a satisfactory improvement of clinical conditions. Eight patients (50%) fully recovered. 5 patients (31.25%) had a significant improvement reaching a BMI>18.5 and one of them had a regular menstrual cycle, too. However in this group of patients a strict modality to alimentation and concern about weight and physical appearance remain. In 3 patients (18.5%) the BMI is still low and amenorrhea persists. The hospital intensive care program, inspired by the cognitive-behavioral model, through a food rehabilitation and a psychotherapeutic and psychoeducational help, lets the patients and their family understand and modify the dysfunctional patterns, experimenting a right modality to approach alimentation, with a satisfactory improvement in clinical conditions.

  16. 76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2011-07-26

    ... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012 Correction In notice document 2011-18257 appearin...

  17. Effectiveness of a quality-improvement program in improving management of primary care practices

    Science.gov (United States)

    Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

    2011-01-01

    Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the

  18. Risk transfer formula for individual and small group markets under the Affordable Care Act.

    Science.gov (United States)

    Pope, Gregory C; Bachofer, Henry; Pearlman, Andrew; Kautter, John; Hunter, Elizabeth; Miller, Daniel; Keenan, Patricia

    2014-01-01

    The Affordable Care Act provides for a program of risk adjustment in the individual and small group health insurance markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula. This article is the third of three in this issue of the Medicare & Medicaid Research Review that describe the ACA risk adjustment methodology and focuses on the risk transfer formula. In our first companion article, we discussed the key issues and choices in developing the methodology. In our second companion paper, we described the risk adjustment model that is used to calculate risk scores. In this article we present the risk transfer formula. We first describe how the plan risk score is combined with factors for the plan allowable premium rating, actuarial value, induced demand, geographic cost, and the statewide average premium in a formula that calculates transfers among plans. We then show how each plan factor is determined, as well as how the factors relate to each other in the risk transfer formula. The goal of risk transfers is to offset the effects of risk selection on plan costs while preserving premium differences due to factors such as actuarial value differences. Illustrative numerical simulations show the risk transfer formula operating as anticipated in hypothetical scenarios.

  19. Can community care workers deliver a falls prevention exercise program? A feasibility study

    Directory of Open Access Journals (Sweden)

    Burton E

    2018-03-01

    Full Text Available Elissa Burton,1 Gill Lewin,2 Hilary O’Connell,3 Mark Petrich,4,5 Eileen Boyle,1 Keith D Hill1 1School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; 2School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; 3Independent Living Centre Western Australia, Perth, Western Australia, Australia; 4Western Australian Department of Health, Perth, Western Australia, Australia; 5School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia Background: Almost half of older people receiving community care fall each year and this rate has not improved in the last decade. Falls prevention programs targeted at this group are uncommon, and expensively delivered by university trained allied health professionals. Purpose: To investigate the feasibility of community care workers delivering a falls prevention exercise program to older clients, at low or medium risk of falling, as part of an existing service provision. Patients and methods: Community care workers from 10 community care organizations participated in the training for, and delivery to their clients of, an 8-week evidence-based falls prevention exercise program. Community care workers included assessment staff (responsible for identifying the need for community care services through completing an assessment and support workers (responsible for providing support in the home. Clients were surveyed anonymously at the completion of the intervention and workers participated in a semi-structured interview. Results: Twenty-five community care workers participated in the study. The falls prevention program was delivered to 29 clients, with an average age of 82.7 (SD: 8.72 years and consisting of 65.5% female. The intervention was delivered safely with no adverse events recorded, and the eligibility and assessment tools

  20. [The Articulator of Primary Health Care Program: an innovative proposal for qualification of Primary Health Care].

    Science.gov (United States)

    Doricci, Giovanna Cabral; Guanaes-Lorenzi, Carla; Pereira, Maria José Bistafa

    2017-06-01

    In 2009, the Secretary of State for Health of Sao Paulo created a Program with a view to qualify the primary care in the state. This proposal includes a new job function, namely the articulator of primary care. Due to the scarcity of information about the practice of these new professionals in the scientific literature, this article seeks to analyze how articulators interpret their function and how they describe their daily routines. Thirteen articulators were interviewed. The interviews were duly analyzed by qualitative delineation. The results describe three themes: 1)Roles of the articulator: technical communicator and political advisor; 2) Activities performed to comply with the expected roles, examples being diagnosis of the municipalities, negotiation of proposals, participation in meetings, visits to municipalities; and 3) Challenges of the role, which are configured as challenges to the health reform process, examples being the lack of physical and human resources, activities of professionals in the medical-centered model, among others. The conclusion drawn is that the Program has great potential to provide input for the development and enhancement of Primary Care. Nevertheless, there are a series of challenges to be overcome, namely challenges to the context per se.

  1. Investing in CenteringPregnancy™ Group Prenatal Care Reduces Newborn Hospitalization Costs.

    Science.gov (United States)

    Crockett, Amy; Heberlein, Emily C; Glasscock, Leah; Covington-Kolb, Sarah; Shea, Karen; Khan, Imtiaz A

    CenteringPregnancy™ group prenatal care is an innovative model with promising evidence of reducing preterm birth. The outpatient costs of offering CenteringPregnancy pose barriers to model adoption. Enhanced provider reimbursement for group prenatal care may improve birth outcomes and generate newborn hospitalization cost savings for insurers. To investigate potential cost savings for investment in CenteringPregnancy, we evaluated the impact on newborn hospital admission costs of a pilot incentive project, where BlueChoice Health Plan South Carolina Medicaid managed care organization paid an obstetric practice offering CenteringPregnancy $175 for each patient who participated in at least five group prenatal care sessions. Using a one to many case-control matching without replacement, each CenteringPregnancy participant was matched retrospectively on propensity score, age, race, and clinical risk factors with five individual care participants. We estimated the odds of newborn hospital admission type (neonatal intensive care unit [NICU] or well-baby admission) for matched CenteringPregnancy and individual care cohorts with four or more visits using multivariate logistic regression. Cost savings were calculated using mean costs per admission type at the delivery hospital. Of the CenteringPregnancy newborns, 3.5% had a NICU admission compared with 12.0% of individual care newborns (p Investing in CenteringPregnancy for 85 patients ($14,875) led to an estimated net savings for the managed care organization of $67,293 in NICU costs. CenteringPregnancy may reduce costs through fewer NICU admissions. Enhanced reimbursement from payers to obstetric practices supporting CenteringPregnancy sustainability may improve birth outcomes and reduce associated NICU costs. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  2. Differential in Utilization of Maternal Care Services in Empowered Action Group States, India (1990-2006

    Directory of Open Access Journals (Sweden)

    Jeetendra Yadav

    2016-03-01

    Full Text Available Background: Low use of maternal care services is one of the reasons why child mortality and maternal mortality is still considerably high in India. Most maternal deaths are preventable if mothers receive essential health care before, during, and after childbirth. In India, the eight socioeconomically backward states referred to as the Empowered Action Group (EAG states; lag behind in the demographic transition and low utilization of maternal health care services. Addressing the maternity care needs of women may have considerable ramifications for achieving the Millennium Development Goal (MDG – 5.Aims & Objectives:  To explore the prevalence, trends and factors associated with the utilization of maternal care services in Empowered Action Group States, India (1990-2006.Material Methods: Data from three rounds of the round of the Demographic and Health Survey (DHS, known as the National Family Health Survey (NFHS of India were analyzed. Bivariate and multivariate-pooled logistic regression model were applied to examine the utilization of the maternal and child health care trends over time.Result: The results from analysis indicate that the full ANC and skilled birth attendant (SBA has increased from 17% and 20% to 25% and35% respectively during the last one and half decade (1990-2006.Conclusion: Various socioeconomic and demographic factors are associated with the utilization of maternal care services in EAG states, India. Promoting the use of family planning, female education, targeting vulnerable groups such as poor, illiterate, high parity women, involving media and grass root level workers and collaboration between community leaders and health care system could be some important policy level interventions to address the unmet need of maternal and child health care services among women. The study concludes that much of these differentials are social constructs that can be reduced by prioritizing the needs of the disadvantaged and adopting

  3. Differential in Utilization of Maternal Care Services in Empowered Action Group States, India (1990-2006

    Directory of Open Access Journals (Sweden)

    Jeetendra Yadav

    2016-03-01

    Full Text Available Background: Low use of maternal care services is one of the reasons why child mortality and maternal mortality is still considerably high in India. Most maternal deaths are preventable if mothers receive essential health care before, during, and after childbirth. In India, the eight socioeconomically backward states referred to as the Empowered Action Group (EAG states; lag behind in the demographic transition and low utilization of maternal health care services. Addressing the maternity care needs of women may have considerable ramifications for achieving the Millennium Development Goal (MDG – 5. Aims & Objectives:  To explore the prevalence, trends and factors associated with the utilization of maternal care services in Empowered Action Group States, India (1990-2006. Material Methods: Data from three rounds of the round of the Demographic and Health Survey (DHS, known as the National Family Health Survey (NFHS of India were analyzed. Bivariate and multivariate-pooled logistic regression model were applied to examine the utilization of the maternal and child health care trends over time. Result: The results from analysis indicate that the full ANC and skilled birth attendant (SBA has increased from 17% and 20% to 25% and35% respectively during the last one and half decade (1990-2006. Conclusion: Various socioeconomic and demographic factors are associated with the utilization of maternal care services in EAG states, India. Promoting the use of family planning, female education, targeting vulnerable groups such as poor, illiterate, high parity women, involving media and grass root level workers and collaboration between community leaders and health care system could be some important policy level interventions to address the unmet need of maternal and child health care services among women. The study concludes that much of these differentials are social constructs that can be reduced by prioritizing the needs of the disadvantaged and

  4. Systematic review: barriers and facilitators for minority ethnic groups accessing urgent and prehospital care

    OpenAIRE

    Phung, Viet-Hai; Windle, Karen; Asghar, Zahid; Ortega, Marishona; Essam, Nadya; Barot, Mukesh; Kai, Joe; Johnson, Mark; Siriwardena, A. Niroshan

    2014-01-01

    Background Research addressing inequalities has focussed predominantly on primary and acute care. We aimed to identify barriers or facilitators to people from minority ethnic groups accessing prehospital care and to explore the causes and consequences of any differences in delivery. Methodology We conducted a systematic literature review and narrative synthesis. Electronic searches from 2003 through to 2013 identified studies; systematic reviews, randomised controlled trials, quasi-...

  5. Care of preterm infants: programs of research and their relationship to developmental science.

    Science.gov (United States)

    Holditch-Davis, Diane; Black, Beth Perry

    2003-01-01

    The purpose of this review was to examine the topics covered in current programs of nursing research on the care of the preterm infant and to determine the extent to which this research is informed by developmental science. A researcher was considered to have a current program of research if he or she had at least five publications published since 1990 and was the first author on at least three of them. The infants in a study could be any age from birth throughout childhood; studies focusing on parenting, nursing, or other populations of infants were not included. Seventeen nurse researchers had current programs of research in this area. These programs had four themes. Those of Becker, Evans, Pridham, Shiao, and Zahr focused on infant responses to the neonatal intensive care unit (NICU) environment and treatments. Franck, Johnston, and Stevens focused on pain management. Harrison, Ludington-Hoe, and White-Traut's research focused on infant stimulation. Holditch-Davis, McCain, McGrath, Medoff-Cooper, Schraeder, and Youngblut studied infant behavior and development. These research programs had many strengths, including strong interdisciplinary focus and clinical relevance. However, additional emphasis is needed on the care of the critically ill infant. Also, despite the fact that the preterm infant's neurological system develops rapidly over the first year, only three of these researchers used a developmental science perspective. Only research on infant behavior and development focused on the developmental changes that the infants were experiencing. Most of the studies were longitudinal, but many did not use statistics appropriate for identifying stability and change over time. The response of individual infants and the broader ecological context as evidenced by factors such as gender, ethnic group, culture, and intergenerational effects were rarely examined. Thus research on the care of preterm infants could be expanded if the developmental science perspective

  6. Pilot evaluation of a group therapy program for children bereaved by suicide.

    Science.gov (United States)

    Daigle, Marc S; Labelle, Réal J

    2012-01-01

    Thousands of children are bereaved each year by suicide, yet there exists very little literature specifically on the psychological care, programs, and interventions available to help them. (1) To build and validate theoretical models for the Group Therapy Program for Children Bereaved by Suicide (PCBS); (2) to test these models in a preliminary evaluation. In the first part, we built theoretical models, which were then validated by scientists and clinicians. In the second part, the sessions of the PCBS were observed and rated. The participating children were tested pre- and postprogram. Positive changes were observed in the participating children in terms of basic safety, realistic understanding and useful knowledge, inappropriate behaviors, physical and psychological symptoms, child-parent and child-child communication, capacity for social and affective reinvestment, actualization of new models of self and the world, self-esteem, awareness and use of tools, cognitive, verbal, written and drawing abilities, cognitive dissonance, ambivalence, antagonism, and isolation. The changes reported in the bereaved children show that the PCBS has some efficacy.

  7. End-of-Life Care for People With Cancer From Ethnic Minority Groups: A Systematic Review.

    Science.gov (United States)

    LoPresti, Melissa A; Dement, Fritz; Gold, Heather T

    2016-04-01

    Ethnic/racial minorities encounter disparities in healthcare, which may carry into end-of-life (EOL) care. Advanced cancer, highly prevalent and morbid, presents with worsening symptoms, heightening the need for supportive and EOL care. To conduct a systematic review examining ethnic/racial disparities in EOL care for cancer patients. We searched four electronic databases for all original research examining EOL care use, preferences, and beliefs for cancer patients from ethnic/racial minority groups. Twenty-five studies were included: 20 quantitative and five qualitative. All had a full-text English language article and focused on the ethnic/racial minority groups of African Americans, Hispanics Americans, or Asian Americans. Key themes included EOL decision making processes, family involvement, provider communication, religion and spirituality, and patient preferences. Hospice was the most studied EOL care, and was most used among Whites, followed by use among Hispanics, and least used by African and Asian Americans. African Americans perceived a greater need for hospice, yet more frequently had inadequate knowledge. African Americans preferred aggressive treatment, yet EOL care provided was often inconsistent with preferences. Hispanics and African Americans less often documented advance care plans, citing religious coping and spirituality as factors. EOL care differences among ethnic/racial minority cancer patients were found in the processes, preferences, and beliefs regarding their care. Further steps are needed to explore the exact causes of differences, yet possible explanations include religious or cultural differences, caregiver respect for patient autonomy, access barriers, and knowledge of EOL care options. © The Author(s) 2014.

  8. Association of mandated language access programming and quality of care provided by mental health agencies.

    Science.gov (United States)

    McClellan, Sean R; Snowden, Lonnie

    2015-01-01

    This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP). In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years. On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days. This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

  9. Support groups for children in alternate care: a largely untapped therapeutic resource.

    Science.gov (United States)

    Mellor, D; Storer, S

    1995-01-01

    Children in alternate care often have adjustment problems that manifest in various aspects of their lives. Individual therapy is often assumed to be the desired intervention, but resources seldom permit one-to-one therapy for these disturbances. The authors argue that groupwork should be considered as a possible treatment of choice. Not only is it likely to be more economical than individual therapy, it has the inherent advantage of telling children in care that they are not alone, and that other children have similar experiences and feelings. It also allows them to develop their own support network. Such groups appear to have been underutilized in work with children in out-of-home care. This article describes such a group and its outcome. Various techniques were developed to achieve specified aims. The techniques appeared to be successful. Further work on such groups and more specific evaluation is called for.

  10. Culture-specific programs for children and adults from minority groups who have asthma.

    Science.gov (United States)

    McCallum, Gabrielle B; Morris, Peter S; Brown, Ngiare; Chang, Anne B

    2017-08-22

    studies ranged from very low to low. For our primary outcome (asthma exacerbations during follow-up), the quality of evidence was low for all outcomes. In adults, use of a culture-specific programme, compared to generic programmes or usual care did not significantly reduce the number of participants from two studies with 294 participants for: exacerbations with one or more exacerbations during follow-up (odds ratio (OR) 0.80, 95% confidence interval (CI) 0.50 to 1.26), hospitalisations over 12 months (OR 0.83, 95% CI 0.31 to 2.22) and exacerbations requiring oral corticosteroids (OR 0.97, 95% CI 0.55 to 1.73). However, use of a culture-specific programme, improved asthma quality of life scores in 280 adults from two studies (mean difference (MD) 0.26, 95% CI 0.17 to 0.36) (although the MD was less then the minimal important difference for the score). In children, use of a culture-specific programme was superior to generic programmes or usual care in reducing severe asthma exacerbations requiring hospitalisation in two studies with 305 children (rate ratio 0.48, 95% CI 0.24 to 0.95), asthma control in one study with 62 children and QoL in three studies with 213 children, but not for the number of exacerbations during follow-up (OR 1.55, 95% CI 0.66 to 3.66) or the number of exacerbations (MD 0.18, 95% CI -0.25 to 0.62) among 100 children from two studies. The available evidence showed that culture-specific education programmes for adults and children from minority groups are likely effective in improving asthma-related outcomes. This review was limited by few studies and evidence of very low to low quality. Not all asthma-related outcomes improved with culture-specific programs for both adults and children. Nevertheless, while modified culture-specific education programs are usually more time intensive, the findings of this review suggest using culture-specific asthma education programmes for children and adults from minority groups. However, more robust RCTs are needed to

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

    Directory of Open Access Journals (Sweden)

    Fitri Haryanti

    2014-12-01

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

  12. Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

    NARCIS (Netherlands)

    Karapinar-Çarkıt, Fatma; van der Knaap, Ronald; Bouhannouch, Fatiha; Borgsteede, Sander D; Janssen, Marjo J A; Siegert, Carl E H; Egberts, Toine C G; van den Bemt, Patricia M L A; van Wier, Marieke F; Bosmans, Judith E

    2017-01-01

    BACKGROUND: To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective. METHODS: A

  13. Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

    NARCIS (Netherlands)

    F. Karapinar-Çarkit (Fatma); R. van der Knaap (Ronald); Bouhannouch, F. (Fatiha); S.D. Borgsteede (Sander); M.J.A. Janssen (Marjo); Siegert, C.E.H. (Carl E. H.); T.C.G. Egberts (Toine C.G.); P.M.L.A. van den Bemt (Patricia); M.F. van Wier (Marieke); J.E. Bosmans (Judith)

    2017-01-01

    textabstractBackground To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective.

  14. 75 FR 72682 - Health Care Eligibility Under the Secretarial Designee Program and Related Special Authorities

    Science.gov (United States)

    2010-11-26

    ... members not in a present duty status. This authority includes payment for health care services in private... 0790-AI52 Health Care Eligibility Under the Secretarial Designee Program and Related Special... assigns responsibilities for health care eligibility under the Secretarial Designee Program. It also...

  15. Attitudes of older adults in a group-based exercise program towards a blended intervention; a focus-group study.

    Directory of Open Access Journals (Sweden)

    Sumit Mehra

    2016-11-01

    Full Text Available Ageing is associated with a decline in daily functioning and mobility. A physically active life and physical exercise can minimize the decline of daily functioning and improve the physical-, psychological- and social functioning of older adults. Despite several advantages of group-based exercise programs, older adults participating in such interventions often do not meet the frequency, intensity or duration of exercises needed to gain health benefits. An exercise program that combines the advantages of group-based exercises led by an instructor with tailored home-based exercises can increase the effectiveness. Technology can assist in delivering a personalized program. The aim of the study was to determine the susceptibility of older adults currently participating in a nationwide group-based exercise program to such a blended exercise program. Eight focus-groups were held with adults of 55 years of age or older. Two researchers coded independently the remarks of the 30 participants that were included in the analysis according to the three key concepts of the Self Determination Theory: autonomy, competence and relatedness. The results show that maintaining self-reliance and keeping in touch with others were the main motives to participate in the weekly group-based exercises. Participants recognized benefits of doing additional home-based exercises, but had concerns regarding guidance, safety and motivation. Furthermore, some participants strongly rejected the idea to use technology to support them in doing exercises at home, but the majority was open to it. Insights are discussed how these findings can help design novel interventions that can increase the wellbeing of older adults and preserve an independent living.

  16. Group long-term care insurance: decision-making factors and implications for financing long-term care.

    Science.gov (United States)

    Stum, Marlene S

    2008-01-01

    This study proposes and tests a systemic family decision-making framework to understand group long-term care insurance (LTCI) enrollment decisions. A random sample of public employees who were offered group LTCI as a workplace benefit were examined. Findings reveal very good predictive efficacy for the overall conceptual framework with a pseudo R2 value of .687, and reinforced the contributions of factors within the family system. Enrollees were more likely to have discussed the decision with others, used information sources, and had prior experience when compared to non-enrollees. Perceived health status, financial knowledge, attitudes regarding the role of private insurance, risk taking, and coverage features were additional factors related to enrollment decisions. The findings help to inform policymakers about the potential of LTCI as one strategy for financing long-term care.

  17. Comparing a telephone- and a group-delivered diabetes prevention program

    DEFF Research Database (Denmark)

    S, Lim; Dunbar, James; Versace, Vin

    2017-01-01

    Aims To explore the acceptability of a telephone- or a group-delivered diabetes prevention program for women with previous gestational diabetes and to compare the characteristics associated with program engagement. Methods Postpartum women participated in a lifestyle modification program delivere...

  18. Cost and utilisation of hospital based delivery care in Empowered Action Group (EAG) states of India.

    Science.gov (United States)

    Mohanty, Sanjay K; Srivastava, Akanksha

    2013-10-01

    Large scale investment in the National Rural Health Mission is expected to increase the utilization and reduce the cost of maternal care in public health centres in India. The objective of this paper is to examine recent trends in the utilization and cost of hospital based delivery care in the Empowered Action Group (EAG) states of India. The unit data from the District Level Household Survey 3, 2007-2008 is used in the analyses. The coverage and the cost of hospital based delivery at constant price is analyzed for five consecutive years preceding the survey. Descriptive and multivariate analyses are used to understand the socio-economic differentials in cost and utilization of delivery care. During 2004-2008, the utilization of delivery care from public health centres has increased in all the eight EAG states. Adjusting for inflation, the household cost of delivery care has declined for the poor, less educated and in public health centres in the EAG states. The cost of delivery care in private health centres has not shown any significant changes across the states. Results of the multivariate analyses suggest that time, state, place of residence, economic status; educational attainment and delivery characteristics of mother are significant predictors of hospital based delivery care in India. The study demonstrates the utility of public spending on health care and provides a thrust to the ongoing debate on universal health coverage in India.

  19. Palliative care experiences of adult cancer patients from ethnocultural groups: a qualitative systematic review protocol.

    Science.gov (United States)

    Busolo, David; Woodgate, Roberta

    2015-01-01

    The objective of this review is to synthesize the best available evidence on palliative care experiences of adult cancer patients from ethnocultural groups.More specifically, this systematic review seeks to answer the following questions:1. What are the palliative care experiences of adult cancer patients from diverse ethnocultural groups?2. What meanings do adult patients with cancer from diverse ethnocultural groups assign to their experiences with palliative care? Globally, over 20.4 million people need palliative care services annually. The majority of these people (19 million) are adults, with 34% of them being patients diagnosed with cancer. With the current increase in the aging population, especially in developed countries, the number of adults requiring palliative care is expected to rise. Furthermore, how palliative care is offered and received continues to be shaped by culture and ethnicity. Likewise, culture and ethnicity influence how palliative care patients experience diseases like cancer, and seek and utilize palliative care services. Also, healthcare providers sometimes find it challenging to address the palliative care needs of patients from different ethnocultural groups. Sometimes these challenges are believed to be due to cultural incompetence of the care provider. When palliative care patients and their providers differ in their perception of care needs and how to address them, negative palliative care experiences are likely to ensue. Therefore, as the demand for palliative care increases, and ethnocultural factors continue to affect palliation, it is important to gain a better understanding of palliative care experiences of patients from different ethnocultural groups.The terms culture and ethnicity have been defined and used differently in literature which sometimes lead to confusion. Ethnicity has been defined as distinctive shared origins or social backgrounds and traditions of a group of people that are maintained between generations and

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

    Science.gov (United States)

    Bulduk, Serap; Usta, Esra; Dinçer, Yeliz

    2017-06-01

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

  1. [The impact of patient identification on an integrated program of palliative care in Basque Country].

    Science.gov (United States)

    Larrañaga, Igor; Millas, Jesús; Soto-Gordoa, Myriam; Arrospide, Arantzazu; San Vicente, Ricardo; Irizar, Marisa; Lanzeta, Itziar; Mar, Javier

    2017-12-05

    Evaluate the process and the economic impact of an integrated palliative care program. Comparative cross-sectional study. Integrated Healthcare Organizations of Alto Deba and Goierri Alto-Urola, Basque Country. Patients dead due to oncologic and non-oncologic causes in 2012 (control group) and 2015 (intervention group) liable to need palliative care according to McNamara criteria. Identification as palliative patients in primary care, use of common clinical pathways in primary and secondary care and arrange training courses for health professionals. Change in the resource use profile of patients in their last 3 months. Propensity score by genetic matching method was used to avoid non-randomization bias. The groups were compared by univariate analysis and the relationships between variables were analysed by logistic regressions and generalized linear models. One thousand and twenty-three patients were identified in 2012 and 1,142 patients in 2015. In 2015 doubled the probability of being identify as palliative patient in deaths due to oncologic (19-33%) and non-oncologic causes (7-16%). Prescriptions of opiates rise (25-68%) and deaths in hospital remained stable. Contacts per patient with primary care and home hospitalization increased, while contacts with hospital admissions decreased. Cost per patient rise 26%. The integrated palliative care model increased the identification of the target population. Relationships between variables showed that the identification had a positive impact on prescription of opiates, death outside the hospital and extension to non-oncologic diseases. Although the identification decreased admissions in hospital, costs per patient had a slight increase due to home hospitalizations. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  2. Newborn access and care in a health attention program

    Directory of Open Access Journals (Sweden)

    Poliana Remundini de Lima

    2016-03-01

    Full Text Available A cross-sectional study aimed to describe the access and integrality of attention to children before one year old, born between January of 2010 and December of 2012 in a Brazilian city, in a newborn attention program. From the 24.560 children, 55.0% were users of the Unified Health System (SUS; 10.1% children presented low weight at birth; 6,332 (46.9% children received BCG vaccine at the nursing consultation day; 13,590 (79.5% children had neonatal screening being less than seven days old; 17,035 (69.4% children were vaccinated for Hepatitis B at birth. Within SUS users, 68% of children went to nursing consultation at their first week of life and, 37.8% went to a medical consultation being 10 days old. The study presents information of care after birth at the primary healthcare as potential instrument to coordinate assistance to this clientele.

  3. A randomised controlled trial of caseload midwifery care: M@NGO (Midwives @ New Group practice Options

    Directory of Open Access Journals (Sweden)

    Tracy Sally K

    2011-10-01

    Full Text Available Abstract Background Australia has an enviable record of safety for women in childbirth. There is nevertheless growing concern at the increasing level of intervention and consequent morbidity amongst childbearing women. Not only do interventions impact on the cost of services, they carry with them the potential for serious morbidities for mother and infant. Models of midwifery have proliferated in an attempt to offer women less fragmented hospital care. One of these models that is gaining widespread consumer, disciplinary and political support is caseload midwifery care. Caseload midwives manage the care of approximately 35-40 a year within a small Midwifery Group Practice (usually 4-6 midwives who plan their on call and leave within the Group Practice. We propose to compare the outcomes and costs of caseload midwifery care compared to standard or routine hospital care through a randomised controlled trial. Methods/design A two-arm RCT design will be used. Women will be recruited from tertiary women's hospitals in Sydney and Brisbane, Australia. Women allocated to the caseload intervention will receive care from a named caseload midwife within a Midwifery Group Practice. Control women will be allocated to standard or routine hospital care. Women allocated to standard care will receive their care from hospital rostered midwives, public hospital obstetric care and community based general medical practitioner care. All midwives will collaborate with obstetricians and other health professionals as necessary according to the woman's needs. Discussion Data will be collected at recruitment, 36 weeks antenatally, six weeks and six months postpartum by web based or postal survey. With 750 women or more in each of the intervention and control arms the study is powered (based on 80% power; alpha 0.05 to detect a difference in caesarean section rates of 29.4 to 22.9%; instrumental birth rates from 11.0% to 6.8%; and rates of admission to neonatal intensive

  4. A randomised controlled trial of caseload midwifery care: M@NGO (Midwives @ New Group practice Options).

    Science.gov (United States)

    Tracy, Sally K; Hartz, Donna; Hall, Bev; Allen, Jyai; Forti, Amanda; Lainchbury, Anne; White, Jan; Welsh, Alec; Tracy, Mark; Kildea, Sue

    2011-10-26

    Australia has an enviable record of safety for women in childbirth. There is nevertheless growing concern at the increasing level of intervention and consequent morbidity amongst childbearing women. Not only do interventions impact on the cost of services, they carry with them the potential for serious morbidities for mother and infant.Models of midwifery have proliferated in an attempt to offer women less fragmented hospital care. One of these models that is gaining widespread consumer, disciplinary and political support is caseload midwifery care. Caseload midwives manage the care of approximately 35-40 a year within a small Midwifery Group Practice (usually 4-6 midwives who plan their on call and leave within the Group Practice.) We propose to compare the outcomes and costs of caseload midwifery care compared to standard or routine hospital care through a randomised controlled trial. A two-arm RCT design will be used. Women will be recruited from tertiary women's hospitals in Sydney and Brisbane, Australia. Women allocated to the caseload intervention will receive care from a named caseload midwife within a Midwifery Group Practice. Control women will be allocated to standard or routine hospital care. Women allocated to standard care will receive their care from hospital rostered midwives, public hospital obstetric care and community based general medical practitioner care. All midwives will collaborate with obstetricians and other health professionals as necessary according to the woman's needs. Data will be collected at recruitment, 36 weeks antenatally, six weeks and six months postpartum by web based or postal survey. With 750 women or more in each of the intervention and control arms the study is powered (based on 80% power; alpha 0.05) to detect a difference in caesarean section rates of 29.4 to 22.9%; instrumental birth rates from 11.0% to 6.8%; and rates of admission to neonatal intensive care of all neonates from 9.9% to 5.8% (requires 721 in each arm

  5. Hanford site guide for preparing and maintaining generator group pollution prevention program documentation

    International Nuclear Information System (INIS)

    1995-12-01

    This manual provides the necessary guidance to contractor generator groups for developing and maintaining documentation of their pollution prevention (P2) program activities. Preparation of program documentation will demonstrate compliance with contractor and U.S. Department of Energy (DOE) requirements, as well as state and federal regulations. Contractor waste generator groups are no longer required to prepare and update facility waste minimization plans. Developing and maintaining program documentation replace this requirement

  6. Health care as perceived by persons with inflammatory bowel disease - a focus group study.

    Science.gov (United States)

    Lesnovska, Katarina Pihl; Hollman Frisman, Gunilla; Hjortswang, Henrik; Hjelm, Katarina; Börjeson, Sussanne

    2017-11-01

    The aim of this study was to explore the perceptions of health care among persons living with inflammatory bowel disease. The quality of care plays an important role in the life of persons with a chronic disease. To define what persons with inflammatory bowel disease perceive as high-quality care, greater focus must be placed on the individual's own perspective of living with the condition. A qualitative exploratory study was conducted based on focus groups. Five focus groups were conducted with adult persons living with inflammatory bowel disease, 14 men and 12 women aged 19-76 years. The interviews were performed between January-June 2014. The perceptions of health care from the perspective of persons living with inflammatory bowel disease were summarised in two categories: 'professional attitudes of healthcare staff' and 'structure of the healthcare organisation'. Persons with inflammatory bowel disease want to be encountered with respect, experience trust and obtain information at the right time. They also expect shared decision-making, communication and to encounter competent healthcare professionals. Furthermore, the expectations on and perceptions of the structure of the healthcare organisation comprise access to care, accommodation, continuity of care, as well as the pros and cons of specialised care. The findings show the importance of establishing a respectful and trusting relationship, facilitating healthcare staff and persons with inflammatory bowel disease to work as a team in fulfilling individual care needs - but there is room for improvement in terms of quality of care. A person-centred approach, which places the individual and her/his family at the centre, considering them experts on their own health and enabling them to collaborate with healthcare staff, seems important to reach a high-quality healthcare organisation for patients with Inflammatory bowel disease. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

  7. End-of-Life Care for Blood Cancers: A Series of Focus Groups With Hematologic Oncologists

    Science.gov (United States)

    Odejide, Oreofe O.; Salas Coronado, Diana Y.; Watts, Corey D.; Wright, Alexi A.; Abel, Gregory A.

    2014-01-01

    Purpose: Hematologic cancers are associated with aggressive cancer-directed care near death and underuse of hospice and palliative care services. We sought to explore hematologic oncologists' perspectives and decision-making processes regarding end-of-life (EOL) care. Methods: Between September 2013 and January 2014, 20 hematologic oncologists from the Dana-Farber/Harvard Cancer Center participated in four focus groups regarding EOL care for leukemia, lymphoma, multiple myeloma, and hematopoietic stem-cell transplantation. Focus groups employed a semistructured format with case vignettes and open-ended questions and were followed by thematic analysis. Results: Many participants felt that identifying the EOL phase for patients with hematologic cancers was challenging as a result of the continuing potential for cure with advanced disease and the often rapid pace of decline near death. This difficulty was reported to result in later initiation of EOL care. Barriers to high-quality EOL care were also reported to be multifactorial, including unrealistic expectations from both physicians and patients, long-term patient-physician relationships resulting in difficulty conducting EOL discussions, and inadequacy of existing home-based EOL services. Participants also expressed concern that some EOL quality measures developed for solid tumors may be unacceptable for patients with blood cancers given their unique needs at the EOL (eg, palliative transfusions). Conclusion: Our analysis suggests that hematologic oncologists need better clinical markers for when to initiate EOL care. In addition, current quality measures may be inappropriate for identifying overly aggressive care for patients with blood cancers. Further research is needed to develop effective interventions to improve EOL care for this patient population. PMID:25294393

  8. Impact of a quality improvement program on care and outcomes for children with asthma.

    Science.gov (United States)

    Homer, Charles J; Forbes, Peter; Horvitz, Lisa; Peterson, Laura E; Wypij, David; Heinrich, Patricia

    2005-05-01

    To test a quality improvement intervention, a learning collaborative based on the Institute for Healthcare Improvement's Breakthrough Series methodology, specifically intended to improve care and outcomes for patients with childhood asthma. Randomized trial in primary care practices. Practices in greater Boston, Mass, and greater Detroit, Mich. Forty-three practices, with 13 878 pediatric patients with asthma, randomized to intervention and control groups. Intervention Participation in a learning collaborative project based on the Breakthrough Series methodology of continuous quality improvement. Change from baseline in the proportion of children with persistent asthma who received appropriate medication therapy for asthma, and in the proportion of children whose parent received a written management plan for their child's asthma, as determined by telephone interviews with parents of 631 children. After adjusting for state, practice size, child age, sex, and within-practice clustering, no overall effect of the intervention was found. This methodologically rigorous assessment of a widely used quality improvement technique did not demonstrate a significant effect on processes or outcomes of care for children with asthma. Potential deficiencies in program implementation, project duration, sample selection, and data sources preclude making the general inference that this type of improvement program is ineffective. Additional rigorous studies should be undertaken under more optimal settings to assess the efficacy of this method for improving care.

  9. 75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

    Science.gov (United States)

    2010-06-08

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration on Aging Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title VI Native American Programs Purpose of Notice: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act Medicare...

  10. [Impact of an informative intervention on the colorectal cancer screening program in primary care professionals].

    Science.gov (United States)

    Benito-Aracil, Llúcia; Binefa-Rodriguez, Gemma; Milà-Diaz, Núria; Lluch-Canut, M Teresa; Puig-Llobet, Montse; Garcia-Martinez, Montse

    2015-01-01

    To evaluate the impact of an intervention in primary care professionals on their current knowledge about colorectal cancer screening, subsequent surveillance recommendations and referral strategies. Cluster randomized controlled trial. Primary Care Centers in L'Hospitalet de Llobregat (Barcelona). Primary Care Professionals (doctors and nurses). Training session in six of the 12 centers (randomly selected) about the colorrectal cancer screening program, and three emails with key messages. Professionals and centers characteristics and two contextual variables; involvement of professionals in the screening program; information about colorectal cancer knowledge, risk factors, screening procedures, surveillance recommendations and referral strategies. The total score mean on the first questionnaire was 8.07 (1.38) and the second 8.31 (1.39). No statistically significant differences between the intervention and control groups were found, however, in 9 out of 11 questions the percentage of correct responses was increased in the intervention group, mostly related to the surveillance after the diagnostic examination. The intervention improves the percentage of correct answers, especially in those in which worst score obtained in the first questionnaire. This study shows that professionals are familiar with colorectal cancer screening, but there's a need to maintain frequent communication in order to keep up to date the information related to the colorectal cancer screening. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Andrés Felipe Ardila Rodríguez

    2016-06-01

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

  12. Well Baby Group Care: Evaluation of a Promising Intervention for Primary Obesity Prevention in Toddlers.

    Science.gov (United States)

    Machuca, Hildred; Arevalo, Sandra; Hackley, Barbara; Applebaum, Jo; Mishkin, Arielle; Heo, Moonseong; Shapiro, Alan

    2016-06-01

    Nationally, approximately 24% of preschool children are overweight or obese, with low-income communities disproportionately affected. Few interventions to prevent obesity in children at greatest risk have demonstrated positive results. Therefore, we evaluated the effectiveness of a novel group well-child care intervention for primary obesity prevention at age 2 years. Well Baby Group (WBG) is an alternative to traditional well-child care offered at a federally qualified health center in the South Bronx. Facilitated by a pediatrician and nutritionist, WBG fosters positive dietary behaviors, responsive parenting and feeding practices, and peer support during the first 18 months of life. Multivariable logistic regression was conducted to test the effect of WBG on rates of overweight/obesity at 2 years (BMI-for-age ≥85th percentile) using a nonrandomized comparison group of children receiving traditional care at our center over the same period. Characteristics of mothers and infants were comparable between intervention (n = 47) and comparison (n = 140) groups. Children enrolled in WBG were significantly less likely to be overweight/obese at 2 years than children receiving traditional well-child care (2.1% vs. 15.0%; OR 0.12; 95% CI 0.02-0.94; p = 0.02). In multivariable regression analysis, WBG remained a significant independent protective factor (OR 0.12; 95% CI 0.02-0.93; p = 0.04), adjusting for birthweight and parity. WBG, a replicable model integrated into primary care visits, affords a unique opportunity to intervene consistently and early, providing families in at-risk communities with increased provider time, intensive education, and ongoing support. Further study of group well-child care for primary obesity prevention is warranted to confirm the effectiveness of the model.

  13. Disease management programs in type 2 diabetes: quality of care.

    Science.gov (United States)

    Berthold, Heiner K; Bestehorn, Kurt P; Jannowitz, Christina; Krone, Wilhelm; Gouni-Berthold, Ioanna

    2011-06-01

    To determine whether disease management programs (DMPs) for type 2 diabetes mellitus (T2DM) can improve some processes of care and intermediate outcomes. Two cross-sectional registries of patients with T2DM were used for data extraction before (previous cohort) and after (recent cohort) introduction of DMPs in Germany (N = 78,110). In the recent cohort, 15,293 patients were treated within the DMPs and 9791 were not. Processes of care, medications, and intermediate outcomes (achievement of treatment targets for low-density lipoprotein [LDL] cholesterol, blood pressure, and glycosylated hemoglobin [A1C]) were analyzed using multi- variable, multilevel logistic regression, adjusting for patient case-mix and physician-level clustering to derive odds ratios and 95% confidence intervals (CIs). Availability of structured diabetes education and of lipid, blood pressure, and A1C measurements increased over time. In DMP patients, availability was significantly higher for blood pressure and A1C but not for lipid measurements. Prescription of angiotensin-converting enzyme inhibitors, oral antidiabetic drugs, and insulin increased over time and was more common in DMP patients. Statin prescription increased over time but was not influenced by DMP status. Intermediate outcomes improved over time, but DMPs had no influence on intermediate outcomes except for reaching LDL cholesterol targets (odds ratio 1.12 [95% CI 1.06, 1.19] in favor of DMPs). While there may be some unmeasured confounding, our data suggest that improvement in processes of care by DMPs, as implemented in Germany, only partially translates into improvement of intermediate outcomes.

  14. The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial.

    Science.gov (United States)

    Jeon, Yun-Hee; Simpson, Judy M; Chenoweth, Lynn; Cunich, Michelle; Kendig, Hal

    2013-10-25

    A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care--CLiAC) was developed to improve managers' leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster

  15. Development and Evaluation of Care Programs for the Delirium Management in Patients after Coronary Artery Bypass Graft Surgery (CABG

    Directory of Open Access Journals (Sweden)

    Safoora Fallahpoor

    2016-07-01

    Full Text Available Delirium is one of the common problems of cognitive impairment after coronary artery bypass graft surgery (CABG that its prevention, timely detection, and treatment require a care and management program to be controlled. The present research has studied a care program for the management of delirium in patients after coronary artery bypass graft surgery. This research was performed by action research methodology during a fivestage cycle in two groups of 50 persons (without interference and with intervention. In both groups, the patients were evaluated every 8 hours by CAM-ICU tool in hours (6, 14 and 22 for the occurrence of delirium after surgery until they were in Intensive Care Unit (ICU. In the intervention group, the developed program was implemented in three areas of delirium management before, during, and after the surgery. Then, the collected information was analyzed in two groups using descriptive and analytical statistics in SPSS 20 software. Delirium was observed at least once in 68% of patients without the intervention and 38% of patients with intervention after surgery. The ratio of delirium incidence was significantly lower in the intervention group (P<0.05. In addition, the total number of delirium in ICU was significantly lower for patients in the intervention group (P<0.05.The developed program for reducing the incidence of delirium in hospitalized patients after coronary artery bypass graft surgery (CABG was confirmed. This means that its applying will lead to a reduction in delirium.

  16. A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial.

    Science.gov (United States)

    Rojas, Graciela; Guajardo, Viviana; Martínez, Pablo; Castro, Ariel; Fritsch, Rosemarie; Moessner, Markus; Bauer, Stephanie

    2018-04-30

    In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management

  17. 75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2010-10-01

    ...; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective...

  18. 77 FR 4908 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-02-01

    ... Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal... 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...

  19. 77 FR 65495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-10-29

    ... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates...

  20. 75 FR 34614 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Science.gov (United States)

    2010-06-17

    ... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and Rate Year 2010 Rates... Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long-Term Care...

  1. 78 FR 15882 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-03-13

    ... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals...

  2. OPERATIVE GROUP: EDUCATIONAL PRACTICE AS AN EXPRESSION FOR SELF-CARE IN DIABETES MELLITUS TYPE 2

    Directory of Open Access Journals (Sweden)

    Mariana Almeida Maia

    2013-12-01

    Full Text Available The goal is to understand the views of users with type 2 diabetes about their participation in the operating groups and the impact of self-care practices. This is a qualitative descriptive- exploratory held in three basic health units of the sanitary district east of Belo Horizonte and involved the participation of 18 users in 2011. The speeches of the users were analyzed based on content analysis, identifying the categories: exchange of experience, education for self- care, assessment of user participation in the operative groups, Feelings and links between professionals and users. It was noted that the operational groups provided the construction of knowledge through listening, reflection and questioning of reality where the user identified the importance of knowledge about diet, physical activity and treatment. We found that health actions implemented through the operational groups encourage users to think about your lifestyle, characterized as a tool in health education from the perspective of promotion, prevention and control.

  3. Diabetes education through group classes leads to better care and outcomes than individual counselling in adults: a population-based cohort study.

    Science.gov (United States)

    Hwee, Jeremiah; Cauch-Dudek, Karen; Victor, J Charles; Ng, Ryan; Shah, Baiju R

    2014-05-09

    Self-management education, supported by multidisciplinary health care teams, is essential for optimal diabetes management. We sought to determine whether acute diabetes complications or quality of care differed for patients in routine clinical care when their self-management education was delivered through group diabetes education classes versus individual counselling. With the use of population-level administrative and primary data, all diabetic patients in Ontario who attended a self-management education program in 2006 were identified and grouped according to whether they attended group classes (n=12,234), individual counselling (n=55,761) or a mixture of both (n=9,829). Acute complications and quality of care in the following year were compared among groups. Compared with those attending individual counselling, patients who attended group classes were less likely to have emergency department visits for hypo/hyperglycemia (odds ratio 0.54, 95% confidence interval [CI]: 0.42-0.68), hypo/hyperglycemia hospitalizations (OR 0.49, CI: 0.32-0.75) or foot ulcers/cellulitis (OR 0.64, CI: 0.50-0.81). They were more likely to have adequate HbA1c testing (OR 1.10, CI: 1.05-1.15) and lipid testing (OR 1.25, CI: 1.19-1.32), and were more likely to receive statins (OR 1.22, CI: 1.07-1.39). Group self-management education was associated with fewer acute complications and some improvements in processes of care. Group sessions can offer care to more patients with reduced human resource requirements. With increased pressure to find efficiencies in health care delivery, group diabetes education may provide an opportunity to deliver less resource-intensive care that simultaneously improves patient care.

  4. Managing the conflict between individual needs and group interests--ethical leadership in health care organizations.

    Science.gov (United States)

    Shale, Suzanne

    2008-03-01

    This paper derives from a grounded theory study of how Medical Directors working within the UK National Health Service manage the moral quandaries that they encounter as leaders of health care organizations. The reason health care organizations exist is to provide better care for individuals through providing shared resources for groups of people. This creates a paradox at the heart of health care organization, because serving the interests of groups sometimes runs counter to serving the needs of individuals. The paradox presents ethical dilemmas at every level of the organization, from the boardroom to the bedside. Medical Directors experience these organizational ethical dilemmas most acutely by virtue of their position in the organization. As doctors, their professional ethic obliges them to put the interests of individual patients first. As executive directors, their role is to help secure the delivery of services that meet the needs of the whole patient population. What should they do when the interests of groups of patients, and of individual patients, appear to conflict? The first task of an ethical healthcare organization is to secure the trust of patients, and two examples of medical ethical leadership are discussed against this background. These examples suggest that conflict between individual and population needs is integral to health care organization, so dilemmas addressed at one level of the organization inevitably re-emerge in altered form at other levels. Finally, analysis of the ethical activity that Medical Directors have described affords insight into the interpersonal components of ethical skill and knowledge.

  5. Medical care of hepatitis B among Asian American populations: perspectives from three provider groups.

    Science.gov (United States)

    Hwang, Jessica P; Roundtree, Aimee K; Engebretson, Joan C; Suarez-Almazor, Maria E

    2010-03-01

    Physicians can play a significant role in helping to decrease the hepatitis B virus (HBV) burden among Asian Americans. Few studies have described knowledge and practice patterns in the medical community among different provider types regarding HBV and liver cancer. Our study explores the HBV beliefs, attitudes and practice patterns of medical providers serving Asian American communities. We conducted three focus groups with primary care providers, liver specialists, and other providers predominantly serving Asian American community. We asked about practices and barriers to appropriate medical care and outreach. We moderated three focus groups with 23 participants, 18 of whom completed and returned demographic surveys. Twelve were of Asian ethnicity and 13 spoke English as a second language. Only eight screened at least half of their patients, most (72%) using the hepatitis B surface antigen test. We used grounded theory methods to analyze focus group transcripts. Participants frequently discussed cultural and financial barriers to hepatitis care. They admitted reluctance to screen for HBV because patients might be unwilling or unable to afford treatment. Cultural differences were discussed most by primary care providers; best methods of outreach were discussed most by liver specialists; and alternative medicine was discussed most by acupuncturists and other providers. More resources are needed to lower financial barriers complicating HBV care and encourage providing guideline-recommended screenings. Other providers can help promote HBV screening and increase community and cultural awareness.

  6. Study protocol: translating and implementing psychosocial interventions in aged home care the lifestyle engagement activity program (LEAP) for life

    Science.gov (United States)

    2013-01-01

    Background Tailored psychosocial activity-based interventions have been shown to improve mood, behaviour and quality of life for nursing home residents. Occupational therapist delivered activity programs have shown benefits when delivered in home care settings for people with dementia. The primary aim of this study is to evaluate the effect of LEAP (Lifestyle Engagement Activity Program) for Life, a training and practice change program on the engagement of home care clients by care workers. Secondary aims are to evaluate the impact of the program on changes in client mood and behaviour. Methods/design The 12 month LEAP program has three components: 1) engaging site management and care staff in the program; 2) employing a LEAP champion one day a week to support program activities; 3) delivering an evidence-based training program to care staff. Specifically, case managers will be trained and supported to set meaningful social or recreational goals with clients and incorporate these into care plans. Care workers will be trained in and encouraged to practise good communication, promote client independence and choice, and tailor meaningful activities using Montessori principles, reminiscence, music, physical activity and play. LEAP Champions will be given information about theories of organisational change and trained in interpersonal skills required for their role. LEAP will be evaluated in five home care sites including two that service ethnic minority groups. A quasi experimental design will be used with evaluation data collected four times: 6-months prior to program commencement; at the start of the program; and then after 6 and 12 months. Mixed effect models will enable comparison of change in outcomes for the periods before and during the program. The primary outcome measure is client engagement. Secondary outcomes for clients are satisfaction with care, dysphoria/depression, loneliness, apathy and agitation; and work satisfaction for care workers. A process

  7. The SMILES program: a group program for children with mentally ill parents or siblings.

    Science.gov (United States)

    Pitman, Erica; Matthey, Stephen

    2004-07-01

    The Simplifying Mental Illness + Life Enhancement Skills program, for children with a mentally ill parent or sibling, is a 3-day program that aims to increase children's knowledge of mental illness and to better equip them with life skills considered beneficial for coping in their family. Self-report data from 25 children who attended 3 of these programs, in Canada and Australia, indicate that these aims were achieved. Their parents also report benefits for their children.

  8. Cognitive systems at the point of care: The CREDO program.

    Science.gov (United States)

    Fox, John

    2017-04-01

    CREDO is a framework for understanding human expertise and for designing and deploying systems that support cognitive tasks like situation and risk assessment, decision-making, therapy planning and workflow management. The framework has evolved through an extensive program of research on human decision-making and clinical practice. It draws on concepts from cognitive science, and has contributed new results to cognitive theory and understanding of human expertise and knowledge-based AI. These results are exploited in a suite of technologies for designing, implementing and deploying clinical services, early versions of which were reported by Das et al. (1997) [9] and Fox and Das (2000) [26]. A practical outcome of the CREDO program is a technology stack, a key element of which is an agent specification language (PROforma: Sutton and Fox (2003) [55]) which has proved to be a versatile tool for designing point of care applications in many clinical specialties and settings. Since software became available for implementing and deploying PROforma applications many kinds of services have been successfully built and trialed, some of which are in large-scale routine use. This retrospective describes the foundations of the CREDO model, summarizes the main theoretical, technical and clinical contributions, and discusses benefits of the cognitive approach. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  9. 76 FR 66931 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

    Science.gov (United States)

    2011-10-28

    ...] Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center for... Services (CMS). This two-day training session is the third and final Accelerated Development Learning... the quality of care for beneficiaries. Through Accelerated Development Learning Sessions (ADLS), the...

  10. A chronic care ostomy self-management program for cancer survivors.

    Science.gov (United States)

    Krouse, Robert S; Grant, Marcia; McCorkle, Ruth; Wendel, Christopher S; Cobb, Martha D; Tallman, Nancy J; Ercolano, Elizabeth; Sun, Virginia; Hibbard, Judith H; Hornbrook, Mark C

    2016-05-01

    Individuals with ostomies experience extensive changes in health-related quality of life (HRQOL) and daily routine. Patients and families are typically forced to use trial and error to improve self-management. This is a longitudinal one-group design pilot study of a five-session ostomy self-care curriculum based on the Chronic Care Model to improve HRQOL and self-management for cancer survivors with ostomies. Participants were surveyed to evaluate each session. Multiple instruments were administered to examine outcomes at baseline, post-intervention, and at 6-month follow-up (Patient Activation Measure, self-efficacy, Hospital Anxiety and Depression Scale, Ways of Coping, Group Health Association of America Satisfaction with ostomy care survey, and the City of Hope Quality of Life Ostomy). Changes from pre-intervention to post-intervention and pre-intervention to follow-up were evaluated with paired t-tests. Text responses were coded and evaluated for important themes and recommendations. Thirty-eight subjects participated in the study. Most had a history of rectal cancer (60.5%) or bladder cancer (28.9%). Participants rated the overall program high (4.4-4.8 on 5-point scale). Text feedback indicated that participants enjoyed the group forums, wanted more participants, and more hands-on training. Scores on multiple surveys were shown to be improved and sustained, including patient activation (p = 0.0004), self-efficacy (p = 0.006), total HRQOL (p = 0.01), physical well-being (p = 0.005), and social well-being (p = 0.002). Survivor anxiety was significantly reduced by follow-up (p = 0.047). This self-management ostomy program can help cancer survivors with ostomies adapt to their stoma. Initiating this program in the community setting would be beneficial to many cancer survivors. Copyright © 2016 John Wiley & Sons, Ltd.

  11. Why Are Half of Women Interested in Participating in Group Prenatal Care?

    Science.gov (United States)

    McDonald, Sarah D; Sword, Wendy; Eryuzlu, Leyla N; Neupane, Binod; Beyene, Joseph; Biringer, Anne B

    2016-01-01

    To determine the likelihood of participating in group prenatal care (GPC) and associated factors among low-risk women receiving traditional prenatal care from obstetricians, family physicians or midwives, and to determine factors associated with likelihood of participating. Prior to completing a self-administered questionnaire, a 2-min compiled video of GPC was shown to pregnant women receiving traditional prenatal care. Data were collected on opinions of current prenatal care, GPC, and demographics. Biologically plausible variables with a p value ≤0.20 were entered in the multivariable logistic regression model and those with a p value care provider (aOR 1.67, 95% CI 1.12-2.44), and valued woman-centeredness ("fairly important" aOR 2.81, 95% CI 1.77-4.49; "very important" aOR 4.10, 95% CI 2.45-6.88). Women placed high importance on learning components of GPC. The majority would prefer to be with similar women, especially in age. About two-thirds would prefer to have support persons attend GPC and over half would be comfortable with male partners. Approximately half of women receiving traditional prenatal care were interested in participating in GPC. Our findings will hopefully assist providers interested in optimizing satisfaction with traditional prenatal care and GPC by identifying important elements of each, and thus help engage women to consider GPC.

  12. Parental care in a polygynous group of bat-eared foxes, Otocyon ...

    African Journals Online (AJOL)

    This study reports the first recorded instance of polygyny and communal nursing in Otocyon m. megalotis. The polygynous group, which was studied in the Kalahari Desert, consisted of a male, two lactating females and a litter of five pups. New aspects of parental care that were observed include the bringing of food items to ...

  13. Transformation Education: A Vehicle for Structuring Group Care Organizations to Increase Service Quality and Effectiveness

    Science.gov (United States)

    Ross, Andrew L.

    2007-01-01

    Transformation Education, an organizational philosophy and operating system, is designed to increase service quality and effectiveness of group care through aligning its organizational structure with its purpose. This alignment is achieved through creating a culture designed to dispense transformation rather than treatment. The author presents how…

  14. Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support.

    Science.gov (United States)

    Campmans-Kuijpers, Marjo J; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E

    2015-02-01

    To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P quality management score (P = 0.001). Of the 44 participating outpatient clinics, 28 completed the study. Their total score changed from 65.7% (CI 60.3-71.1%) to 67.3% (CI 62.9-71.7%; P = 0.30). Only the results in the domain multidisciplinary teamwork improved (P = 0.001). Measuring quality management and providing feedback and a benchmark improves the level of quality management in care groups but not in outpatient clinics. The questionnaires might also be a useful asset for other diabetes care groups, such as Accountable Care Organizations. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  15. Group discussions with the health care team--a method of improving care of hypertension in general practice.

    Science.gov (United States)

    Adorian, D; Silverberg, D S; Tomer, D; Wamosher, Z

    1990-06-01

    A management-by-objective approach was used by the health care administration of the Kupat Holim Sick Fund to improve care of hypertension in 20 family practices in the city of Ashdod in central Israel. The doctor-nurse teams in these clinics met jointly on a regular basis with a physician-instructor, reviewed the results of their care of hypertension and discussed ways of improving it. Over a seven-year period, until 1988, the percentage of the population treated increased from 4.0% to 9.2% and percentage of treated patients who had diastolic pressure of 100 mmHg or more fell from 29.6% to 13.4%. Dropout rate ranged from 2.3% to 3.1% per year over the whole period. In 20 other practices in the Ashdod area in 1988 used for comparison, only 5.9% of the population was treated and the per cent treated was less than Ashdod for all age groups above 30. Dropout rate was higher, averaging 9.8% per year, and the percentage of patients with diastolic pressures of 100 mmHg or more was higher (18.1%). Thus the use of regular discussions with feedback to the health care team was associated with better detection, treatment and follow-up of hypertension.

  16. Interagency task force on the health effects of ionizing radiation: report of the work group on care and benefits

    International Nuclear Information System (INIS)

    1979-06-01

    The report examines existing systems for providing care and benefits to persons who may have been injured by radiation exposure and recommends additional guidelines for handling radiation-related claims. The benefits systems examined are Veterans' benefits, Federal Employees Compensation Act, Longshoremen's and Harbor Workers' Compensation Act, State Workers' Compensation programs, Government and private 'back-up' program, Social Security Disability Insurance (Medicare), Supplemental Security Income (Medicaid), private health insurance, government hospitals, and remedies available under the judicial system. The report recommends that the Federal Government develop guidelines to determine the likelihood of a causal relationship between a person's illness and his exposure to radiation; that Federal compensation programs and State programs develop criteria for deciding radiation exposure claims, based on those guidelines; that a national registry of radiation workers be established to maintain individual radiation exposure records; and that the Federal Government annually compile compensation claims based on radiation exposure. Appendixes list those groups of people most likely to be exposed to radiation, and the benefits available under the various compensation programs listed above

  17. The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial

    Science.gov (United States)

    2013-01-01

    Background A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Methods Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be

  18. Peer monitoring, social ties and moral hazard in group lending programs : Evidence from Eritrea

    NARCIS (Netherlands)

    Hermes, N; Lensink, R; Mehrteab, HT

    In this paper, we investigate the impact of monitoring and social ties on moral hazard behavior within group lending programs. Our study is based on data from an extensive questionnaire held in Eritrea among participants of 102 groups. We separately analyze the impact of group leaders and other

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

    Directory of Open Access Journals (Sweden)

    Burton E

    2013-12-01

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

  20. New Pathways for Primary Care: An Update on Primary Care Programs From the Innovation Center at CMS

    Science.gov (United States)

    Baron, Richard J.

    2012-01-01

    Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide. PMID:22412007

  1. Building social participation with a support group users: challenges of care qualification in a Psychosocial Care Center (CAPS

    Directory of Open Access Journals (Sweden)

    Vitor Corrêa Detomini

    2015-09-01

    Full Text Available The literature points out a lack of studies describing practical experiences approaching the role of social participation, even though, the subject Brazilian Health System (SUS as a principle is valued by theoretical-conceptual works. The lack of studies is especially observed in mental health care services, where the existing studies focus on the users’ management engagement as part of psychosocial rehabilitation. Thus, this article introduces an experience developed in a Center for Psycho-Social Attention (CAPS, in the state of Mato Grosso do Sul, aiming to address the issue of social participation in care qualification, in accordance to legislation and technical standards. Thisstudy focused on two types of sources. 1 Internship Final Report of a Psycology Student including 54 sessions of a support group, 2 technical and legal documents concerning the SUS and the National Mental Health Policy and Humanization. The service aspects were analyzed through technical and legislative foundations - focusing the needs and claims on group discussions, classified as structure and process, used to assess the health care quality. Most concerns were listed on normative Ordinances and Regulations. Achieving social participation was not an institutional premise and, among the main difficulties was the medical/outpatient centered model and the representation of “crazy”/”CAPS users” as incapable. It requires: i integration of “clinic” and “politics”; ii intensification of interdisciplinary and psychological care; iii respect the citizenship of mental health users, and, finally, iv that the collective participation spaces do not exhaust themselves. Therefore, the collective participation spaces need practical recommendations in order to improve the structures and work processes and meet the users’ needs.

  2. The efficacy of a short education program and a short physiotherapy program for treating low back pain in primary care: a cluster randomized trial.

    Science.gov (United States)

    Albaladejo, Celia; Kovacs, Francisco M; Royuela, Ana; del Pino, Rafael; Zamora, Javier

    2010-03-01

    Cluster randomized clinical trial. To assess the efficacy of a short education program and short physiotherapy program for treating low back pain (LBP) in primary care. There is sparse evidence on the effectiveness of education and physiotherapy programs that are short enough to be feasible in primary care. Sixty-nine primary care physicians were randomly assigned to 3 groups and recruited 348 patients consulting for LBP; 265 (79.8%) were chronic. All patients received usual care, were given a booklet and received a consistent 15 minutes group talk on health education, which focused on healthy nutrition habits in the control group, and on active management for LBP in the "education" and "education + physiotherapy" groups. Additionally, in the "education + physiotherapy" group, patients were given a second booklet and a 15-minute group talk on postural hygiene, and 4 one-hour physiotherapy sessions of exercise and stretching which they were encouraged to keep practicing at home. The main outcome measure was improvement of LBP-related disability at 6 months. Patients' assessment and data analyses were blinded. During the 6-month follow-up period, improvement in the "control" group was negligible. Additional improvement in the "education" and "education + physiotherapy" groups was found for disability (2.0 and 2.2 Roland Morris Questionnaire points, respectively), LBP (1.8 and 2.10 Visual Analogue Scale points), referred pain (1.3 and 1.6 Visual Analogue Scale points), catastrophizing (1.6 and 1.8 Coping Strategies Questionnaire points), physical quality of life (2.9 and 2.9 SF-12 points), and mental quality of life (3.7 and 5.1 SF-12 points). The addition of a short education program on active management to usual care in primary care leads to small but consistent improvements in disability, pain, and quality of life. The addition of a short physiotherapy program composed of education on postural hygiene and exercise intended to be continued at home, increases those

  3. The impact of a proactive chronic care management program on hospital admission rates in a German health insurance society.

    Science.gov (United States)

    Hamar, Brent; Wells, Aaron; Gandy, William; Haaf, Andreas; Coberley, Carter; Pope, James E; Rula, Elizabeth Y

    2010-12-01

    Hospital admissions are the source of significant health care expenses, although a large proportion of these admissions can be avoided through proper management of chronic disease. In the present study, we evaluate the impact of a proactive chronic care management program for members of a German insurance society who suffer from chronic disease. Specifically, we tested the impact of nurse-delivered care calls on hospital admission rates. Study participants were insured individuals with coronary artery disease, heart failure, diabetes, or chronic obstructive pulmonary disease who consented to participate in the chronic care management program. Intervention (n  = 17,319) and Comparison (n  = 5668) groups were defined based on records of participating (or not participating) in telephonic interactions. Changes in admission rates were calculated from the year prior to (Base) and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, the admission rate in the Intervention group decreased by 6.2% compared with a 14.9% increase in the Comparison group (P  management care calls can help reduce hospital admissions among German health insurance members with chronic disease.

  4. What influences success in family medicine maternity care education programs? Qualitative exploration.

    Science.gov (United States)

    Biringer, Anne; Forte, Milena; Tobin, Anastasia; Shaw, Elizabeth; Tannenbaum, David

    2018-05-01

    To ascertain how program leaders in family medicine characterize success in family medicine maternity care education and determine which factors influence the success of training programs. Qualitative research using semistructured telephone interviews. Purposive sample of 6 family medicine programs from 5 Canadian provinces. Eighteen departmental leaders and program directors. Semistructured telephone interviews were conducted with program leaders in family medicine maternity care. Departmental leaders identified maternity care programs deemed to be "successful." Interviews were audiorecorded and transcribed verbatim. Team members conducted thematic analysis. Participants considered their education programs to be successful in family medicine maternity care if residents achieved competency in intrapartum care, if graduates planned to include intrapartum care in their practices, and if their education programs were able to recruit and retain family medicine maternity care faculty. Five key factors were deemed to be critical to a program's success in family medicine maternity care: adequate clinical exposure, the presence of strong family medicine role models, a family medicine-friendly hospital environment, support for the education program from multiple sources, and a dedicated and supportive community of family medicine maternity care providers. Training programs wishing to achieve greater success in family medicine maternity care education should employ a multifaceted strategy that considers all 5 of the interdependent factors uncovered in our research. By paying particular attention to the informal processes that connect these factors, program leaders can preserve the possibility that family medicine residents will graduate with the competence and confidence to practise full-scope maternity care. Copyright© the College of Family Physicians of Canada.

  5. Midwives' perceptions of women's preferences related to midwifery care in Germany: A focus group study.

    Science.gov (United States)

    Lohmann, Susanne; Mattern, Elke; Ayerle, Gertrud M

    2018-06-01

    To explore how midwives perceive patient preferences related to midwifery care in Germany. This qualitative study, which was part of a larger study, used a hermeneutic-interpretive approach and involved focus group interviews with midwives. Data collection and analysis were done in a conjoined fashion between April 2015 and September 2016. Four focus group interviews were conducted in four different federal states of Germany. The sample of 20 qualified midwives was heterogeneous with regards to age, educational level, professional experience, type of midwifery care provided, and setting (employed, caseload, education) in which they provided services. Three main themes were identified: Strengths and limitations of midwives' present professional profile (midwives' area of responsibility, range of services, and competency); lack of midwives and midwifery services; women's experiences of conflict in interprofessional care. Each main theme is broken down into several aspects of content. Many women are not aware of the scope of professional knowledge and expertise of midwives. Moreover, the poor delineation of midwives' and obstetricians' areas of competency in Germany's hospitals seems to be disadvantageous for the women. Midwives feel that due to context implications they cannot live up to the quality of midwifery care they aspire to. Lack of midwives results in midwives being overwhelmed, women underserved, and both disappointed. On the one hand, new models of midwifery/maternity care need to be developed to solve some of the existing problems; on the other hand, new forms of interprofessional cooperation and management of transition of care points are required. Overall it is important that changes are implemented in such a way that women are enabled, and welcome, to clearly state their preferences for midwifery and maternity care. Particularly in Germany, tertiary education of midwives is needed to broaden their expertise and place them on an equal footing with

  6. The Effect of Group Counseling Program on 8th Grade Students’ Assertiveness Levels

    Directory of Open Access Journals (Sweden)

    İsmail SEÇER

    2014-06-01

    Full Text Available This study is conducted to determine the effects of group counseling program on elementary school 8th grade students’ assertiveness skills. Study group was formed of 100 students getting educated in Erzurum Kültür Elementary School in 2011-2012 education years. RAE-Rathus Assertiveness Schedule was applied on this group to gather data. 30 students getting lower scores from the inventory have been randomly divided into experimental and control groups. Each group is formed of 15 students. Group counseling program has been carried out for 8 weeks on the experimental group to improve the students’ assertiveness skills. Single-way and two-way analysis of covariance (ANCOVA has been used in the analysis of the data. The data is analyzed with SPSS 19.00. The results of the study show that assertiveness skills of the students who participate in the group counseling program has increased significantly compared to the control group and to the preexperimental circumstances. Besides, it is determined that the change observed in the experimental group has been occurred separately from the age and socio-economic level variables, and it is determined with the monitoring test applied after four months that this affect is continued. According to this result, it can be said that the applied group counseling program is an effective means to improve the assertiveness skills of elementary school students

  7. [The Positionality of Caring Action: Small Group Dialogue in a Course on Nursing Ethics].

    Science.gov (United States)

    Chiang, Hsien-Hsien

    2016-12-01

    The content of nursing-ethics education has typically focused on the external standards of caring behavior and neglected the relationship between the ethical attitudes and internal experiences of caregivers. To explore the embodied experience in order to define the positionality of caring action, which is necessary to enrich the content of nursing ethics through small-group-learning-based dialogue. The researcher, as a participant observer, teaches a course on nursing ethics. Reflective analysis was used to analyze the data from the process of small group learning, a reflective group of faculty members, and 30 reflective journals submitted by 10 students. The results identified three items that were related to the positionality of caring action: the attitudes of belief, including the choice to belief and deep understanding; articulating the value system, including exploring affectivity and positionality; and cultivating the self through self-dialogues and dialogues with others. The attitudes of belief promote trust in interpersonal relationships. Articulating the value system deepens the meaning of caring. Cultivating the self may facilitate the ethical self.

  8. Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation.

    Science.gov (United States)

    Kim, Hyun-Soo; Lee, Moo-Sik; Hong, Jee-Young

    2016-01-01

    The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide. Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization. The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size. It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation.

  9. The emotional intelligence of a group of critical-care nurses in South Africa

    Directory of Open Access Journals (Sweden)

    Amanda Towell

    2013-11-01

    Full Text Available Critical-care nurses often look after three or more critically-ill patients during a shift. The workload and emotional stress can lead to disharmony between the nurse’s body, mind and spirit. Nurses with a high emotional intelligence have less emotional exhaustion and psychosomatic symptoms; they enjoy better emotional health; gain more satisfaction from their actions (both at work and at home; and have improved relationships with colleagues at work. The question arises: what is the emotional intelligence of critical-care nurses? A quantitative survey was conducted. The target population was registered nurses working in critical-care units who attended the Critical Care Congress 2009 (N = 380. Data were collected with the use of the Trait Emotional Intelligence Short Form and analysed using the Statistical Package for the Social Sciences software. The sample (n= 220 was mainly a mature, female and professionally-experienced group of registered nurses. They held a variety of job descriptions within various critical-care units. Statistics indicated that the standard deviations were small and no aberrant aspects such as demographics skewed the findings. The conclusion was made that registered nurses who are older and that have more experience in critical care appear to have a higher range of emotional intelligence.

  10. A weekend program model for faculty development with primary care physicians.

    Science.gov (United States)

    Gjerde, Craig L; Kokotailo, Patricia; Olson, Curtis A; Hla, Khin Mae

    2004-01-01

    Medical teachers are expected to be proficient at teaching students and residents about the changing health care system. The University of Wisconsin established a faculty development fellowship program to better prepare clinical teachers in family medicine, general pediatrics, and general internal medicine. This paper describes our fellowship program, presents data on program accomplishments, and discusses what we have learned. We developed a year-long series of five weekend workshops. A core group of faculty provided 2- to 4- hour sessions on topics including evidence-based medicine, physician leadership, advocacy, doctor-patient communication, quality, technology tools, and teaching skills. Evaluation data were used to shape the program, make improvements, and assess impact. Fellows self-assessed their ability to perform skills at the beginning and ending of the year; paired t tests were used to compare these changes. Attendance and program completion rates were more than 94% for the 84 fellows taught over 6 years. Individual sessions and the overall program were well-rated by fellows. Participants reported improvements in targeted skills; statistical analyses confirmed many significant pre-post improvements. To obtain high ratings, faculty must apply adult learning and active learning principles; lectures were not well tolerated. Initial technology skills were often low; computer labs needed many helpers. Participants needed extensive faculty support on their projects. It facilitated coordination and learning to have a core group of fellowship faculty who did most of the teaching. Graduates have become enthusiastic recruiters for new fellows. Our 5-weekend program has proven to be an effective faculty development model.

  11. CLINICAL AND PHARMACOECONOMIC REASONABILITY OF USING PROBIOTIC ENTEROCOCCUS STRAIN FOR THE COMPLEX DEVELOPMENTAL CARE PROGRAM FOR PREMATURE INFANTS

    Directory of Open Access Journals (Sweden)

    N. V. Gonchar

    2015-01-01

    Full Text Available Introduction. Possibilities of using probiotic enterococci in premature neonates undergoing inpatient antibacterial therapy remains understudied. The article is aimed at analyzing clinical and pharmacoeconomic reasonability of using probiotic Enterococcus faecium L3 strain in premature infants with very low body weight in the framework of complex inpatient developmental care. Patients and methods. 55 children randomized into 2 groups were observed: the control group (n = 26 was undergoing standard developmental care program, the primary group (n = 29 was introduced liquid probiotic Enterococcus faecium L3 strain (titer — 108 CFU/ml or more (0.5 ml TID for 14 days after attaining the enteral feeding volume of 5.0 ml. Results. Analysis of the clinical symptoms characteristic of non-smooth course of developmental care over premature infants helped to reveal higher frequency of infectious complications in the control group children than in the primary group (14 [53.8%] vs. 6 [20.7%]; p < 0.05. Acute food intolerance was observed less frequently in the primary group than in the control group (6 [20.7%] vs. 10 [38.5%], p > 0.05. The primary group's children featured significant decrease in the frequency of monocytosis, positive changes of intestinal microbiotic composition (increase in the amount of bifidum bacteria, lactobacilli, enterococci, decrease in the amount of Clostridium difficile and antibiotic-resistant clinical Klebsiella pneumoniae strains. Conclusion. Favorable outcome of developmental care over premature infants (absence of infectious complications was less expensive in the primary group's children.

  12. [The construction of care by the health team and the caretaker within a home-care program for bedridden patients in Porto Alegre (RS, Brazil)].

    Science.gov (United States)

    de Almeida Freitas, Ivani Bueno; Meneghel, Stela Nazareth; Selli, Lucilda

    2011-01-01

    The main objective of this case study was to understand the construction of care in the Homecare Program for Bedridden Patients (PADA) of a basic health unit (UBS) in Porto Alegre, RS. Data were obtained from 13 caretaker groups in the UBS, and participating observation recorded in field diary in the patient's homes. An analysis of the discourse practices was performed inspired in Foucault's discourse concepts speeches and in studies on ethics and self-care. In the groups, the caretaker occupied a space that we metaphorically called the Delphic Oracle, a place for acceptance, listening and support. Hearing the dialogues that took place between the team and the caretakers made us face the contradiction present in the institutional discourse, which both stimulates self-care, and imposes rules, duties, tasks. Care as a citizenship right opposite to care as submission and subjugation created tension inside the group several times. Foucault's notion of care comprises a synthesis of the exercise of a person over his- or herself, making him or her better as a human being and, at the same time, capacitating him or her to become a better citizen.

  13. The Value Proposition of Prevention: The Impacts of Pure North S’Energy Foundation’s Preventive Care Program on Acute Care Utilization in Alberta

    Directory of Open Access Journals (Sweden)

    J.C. Herbert Emery

    2016-04-01

    and the number of visits for ambulatory care reduced by 14 per cent over a control group matched for age, sex and postal code, who did not participate in the Pure North program. In the second year after joining the program, hospital admissions dropped by 32 per cent for participants aged 55 and over. If these effects could be achieved in the population of Albertans aged 55 to 75, the hospital bed nights freed up per year would be equivalent to adding the acute care bed capacity of the Foothills Medical Centre in Calgary. These figures translate into significant cost differences. The average cost of hospitals, ambulatory care and visits to general practitioners in the year prior to joining Pure North’s program came to $1,320 per individual. Cost reductions in annual health-care utilization among participants ranged from $294 (22 per cent per person who joined the program to $600 (45 per cent per person who stayed in the program for at least a year. Two years into the program, a participant could expect to avoid $276 in hospitalization and emergency room costs. The Pure North program is a cost-effective model for preventive health services, resulting in better health and labour productivity for individuals, and considerable savings in public money for the health-care system. Every dollar spent on a participant who stays with the program for at least a year represents a $2.36 benefit in the avoidance of hospitalization and ambulatory care, as well as gains in personal health and productivity. The public health-care system must shift its focus to preventive care if it wants to realize cost savings, efficiency and improved health for Albertans, rather than waiting to treat people until after they become ill with chronic diseases. Pure North offers an important model to help the public system understand how to make that transition to a prevention-oriented mindset.

  14. The Impact of a Primary Care Education Program Regarding Cancer Survivorship Care Plans: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.

    Science.gov (United States)

    Donohue, SarahMaria; Haine, James E; Li, Zhanhai; Trowbridge, Elizabeth R; Kamnetz, Sandra A; Feldstein, David A; Sosman, James M; Wilke, Lee G; Sesto, Mary E; Tevaarwerk, Amye J

    2017-09-20

    Survivorship care plans (SCPs) have been recommended as tools to improve care coordination and outcomes for cancer survivors. SCPs are increasingly being provided to survivors and their primary care providers. However, most primary care providers remain unaware of SCPs, limiting their potential benefit. Best practices for educating primary care providers regarding SCP existence and content are needed. We developed an education program to inform primary care providers of the existence, content, and potential uses for SCPs. The education program consisted of a 15-min presentation highlighting SCP basics presented at mandatory primary care faculty meetings. An anonymous survey was electronically administered via email (n = 287 addresses) to evaluate experience with and basic knowledge of SCPs pre- and post-education. A total of 101 primary care advanced practice providers (APPs) and physicians (35% response rate) completed the baseline survey with only 23% reporting prior receipt of a SCP. Only 9% could identify the SCP location within the electronic health record (EHR). Following the education program, primary care physicians and APPs demonstrated a significant improvement in SCP knowledge, including improvement in their ability to locate one within the EHR (9 vs 59%, p educational program containing information about SCP existence, content, and location in the EHR increased primary care physician and APP knowledge in these areas, which are prerequisites for using SCP in clinical practice.

  15. Preliminary Effectiveness and Sustainability of Group Aerobic Exercise Program in Patients with Schizophrenia.

    Science.gov (United States)

    Yoon, Sol; Ryu, Je-Kwang; Kim, Chan-Hyung; Chang, Jhin-Goo; Lee, Hwa-Bock; Kim, Do-Hoon; Roh, Daeyoung

    2016-09-01

    The objective of this study was to examine the feasibility and sustained effect of a group aerobic exercise program in patients with schizophrenia. Twenty-four schizophrenic patients participated in a group-based individually tailored 90-minute outdoor cycling session per week for 3 months with intervention to enhance motivation. Physical health was evaluated by anthropometric measures, cardiorespiratory (CR) fitness, and blood tests. Mental health was assessed on self-esteem, interpersonal relationship, quality of life, and global function. Attrition rate for the exercise program was 8.3%. Exercise program significantly increased participant's self-esteem, positive relationship, global function, and quality of life. CR fitness significantly improved after 3 months. At the 9-month follow-up, 6 months after program completion, only in interpersonal relationship change the improved effects were maintained. These findings support the feasibility of group aerobic exercise program with high level of adherence and its long-term benefits in positive relationship change.

  16. The "take a nurse to lunch" program. A unique focus group improves and promotes food services.

    Science.gov (United States)

    1998-10-01

    Dan Booth is the director of hospitality services for MaineGeneral Health. For this 450-bed health care organization, he directs six departments, which include environmental services, food and nutrition, security, laundry services, telecommunications, and transportation. In this article he describes how his Take a Nurse to Lunch program operates, what its benefits are, and how it was implemented.

  17. Drug utilization research in primary health care as exemplified by physicians' quality assessment groups.

    Science.gov (United States)

    von Ferber, L; Luciano, A; Köster, I; Krappweis, J

    1992-11-01

    Drugs in primary health care are often prescribed for nonrational reasons. Drug utilization research investigates the prescription of drugs with an eye to medical, social and economic causes and consequences of the prescribed drug's utilization. The results of this research show distinct differences in drug utilization in different age groups and between men and women. Indication and dosage appear irrational from a textbook point of view. This indicates nonpharmacological causes of drug utilization. To advice successfully changes for the better quality assessment groups of primary health care physicians get information about their established behavior by analysis of their prescriptions. The discussion and the comparisons in the group allow them to recognize their irrational prescribing and the social, psychological and economic reasons behind it. Guidelines for treatment are worked out which take into account the primary health care physician's situation. After a year with 6 meetings of the quality assessment groups the education process is evaluated by another drug utilization analysis on the basis of the physicians prescription. The evaluation shows a remarkable improvement of quality and cost effectiveness of the drug therapy of the participating physicians.

  18. [Team cohesiveness: opinions of a group of primary health care professionals from Salamanca].

    Science.gov (United States)

    González, F J; de Cabo, A; Morán, M J; Manzano, J M

    1993-04-01

    To assess the view of a group of Primary care professionals on their level of perception of group cohesiveness in their teams' work dynamic. A descriptive and sectional study. Four urban health centres in Salamanca with a recognised teaching activity. Both health professionals and those outside the Health Service, working in Primary Care, who had been members of their teams for more than a year (N = 90). Descriptive statistics and "Chi squared" tests were employed. 72%. A high level of agreement on the need for team work (95.23%). They perceived their group cohesiveness as being very low (84.21% affirmed that they encounter problems of cohesiveness). The main statements concerning this lack of cohesiveness were: "lack of common objectives" (25.5%), "intolerance between workers" (20.13%), "work not shared" (19.46%) and "the taking of decisions individually" (19.44%). The main causes given were: lack of support from Management (23.74%) and too little training for team work (21.58%). There is a high degree of conviction that the team work model is the most efficacious way of developing Primary Care. However in three of the four teams questioned, there were serious problems preventing the teams' reaching an adequate level of group cohesiveness.

  19. Pawtucket R.I. Group Selected for EPA Environmental Workforce Development and Job Training Program Grant

    Science.gov (United States)

    Groundwork Rhode Island, a Pawtucket-based organization, was one of 17 groups selected today by the U.S. Environmental Protection Agency (EPA) to share $3.3 million to operate environmental job training programs for local citizens.

  20. Assessing the satisfaction and burden within an academic animal care and use program.

    Science.gov (United States)

    Norton, John N; Reynolds, Randall P; Chan, Cliburn; Valdivia, Raphael H; Staats, Herman F

    2017-09-01

    Although animal research requires adherence to various regulations and standards, the manner in which compliance is maintained and the degree of additional constraints varies between institutions. Regulatory burden, particularly if institutionally imposed, has become a concern for institutions as increased regulatory expectations result in decreased resources available for research efforts. Faculty, research staff, and support staff engaged in animal research were surveyed to determine what institutional animal care and use committee (IACUC) processes were considered burdensome, the perceived value of some suggested modifications, and satisfaction with the IACUC administrative office and the animal resource unit. Although the results revealed overwhelming satisfaction with the IACUC administrative office and the animal resource unit, several IACUC processes were deemed burdensome, and therefore there would be value in modifying IACUC processes. When comparing the value of modifying IACUC processes, different groups within the animal care and use program (ACUP) tended to have different responses on many of the topics. This survey identified several perceived burdensome IACUC processes that would likely benefit individuals if modified. In today's environment of shrinking budgets for biomedical research, minimizing regulatory burden-particularly unnecessary, self-imposed burden-in the ACUP is particularly important to ensure that costs, time, and effort are appropriate to achieve animal welfare and quality of research endeavors.-Norton, J. N., Reynolds, R. P., Chan, C., Valdivia, R. H., Staats, H. F. Assessing the satisfaction and burden within an academic animal care and use program. © FASEB.

  1. The impact of group prenatal care on pregnancy and postpartum weight trajectories.

    Science.gov (United States)

    Magriples, Urania; Boynton, Marcella H; Kershaw, Trace S; Lewis, Jessica; Rising, Sharon Schindler; Tobin, Jonathan N; Epel, Elissa; Ickovics, Jeannette R

    2015-11-01

    The objective of the study was to investigate whether group prenatal care (Centering Pregnancy Plus [CP+]) has an impact on pregnancy weight gain and postpartum weight loss trajectories and to determine whether prenatal depression and distress might moderate these trajectories. This was a secondary analysis of a cluster-randomized trial of CP+ in 14 Community Health Centers and hospitals in New York City. Participants were pregnant women aged 14-21 years (n = 984). Medical record review and 4 structured interviews were conducted: in the second and third trimesters and 6 and 12 months postpartum. Longitudinal mixed modeling was utilized to evaluate the weight change trajectories in the control and intervention groups. Prenatal distress and depression were also assessed to examine their impact on weight change. There were no significant differences between the intervention and control groups in baseline demographics. Thirty-five percent of the participants were overweight or obese, and more than 50% had excessive weight gain by Institute of Medicine standards. CP+ was associated with improved weight trajectories compared with controls (P prenatal care gained less weight during pregnancy and lost more weight postpartum. This effect was sustained among women who were categorized as obese based on prepregnancy body mass index (P Prenatal depression and distress were significantly associated with higher antepartum weight gain and postpartum weight retention. Women with the highest levels of depression and prenatal distress exhibited the greatest positive impact of group prenatal care on weight trajectories during pregnancy and through 12 months postpartum. Group prenatal care has a significant impact on weight gain trajectories in pregnancy and postpartum. The intervention also appeared to mitigate the effects of depression and prenatal distress on antepartum weight gain and postpartum weight retention. Targeted efforts are needed during and after pregnancy to improve

  2. The Effectiveness of a Body Image Group Counselling Program on Adolescent Girls in High School

    Directory of Open Access Journals (Sweden)

    Çiğdem Keven-Akliman

    2017-04-01

    Full Text Available The aim of this study was to investigate the effect of a body image group counselling program on adolescent girls in the context of Positive Psychology and Positive Psychotherapy. The sample set consisted of 22 female students, 11 in the experimental group and the other 11 in the control group, and they are all in the 9th grade and have negative body images. Research was conducted based on a pattern of a pre-test, post-test and follow-up test with control and experimental groups. A Body Image Scale, Body Image Coping Strategies Inventory and Program Evaluation Form were used as data collection tools. The positive body image group counselling program was conducted on the experimental group for ten sessions. The Wilcoxon sign rank test, Mann-Whitney U test and repeated-measure of analysis of variance (ANOVA were used for data analysis. According to the results, the program was statistically significant. Additionally, the results revealed statistically significant increases in positive body images and coping strategies in the intervention group when compared with the control group. The program may be used to increase positive body image.

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

    Directory of Open Access Journals (Sweden)

    Vernooij-Dassen Myrra JFJ

    2011-05-01

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

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

    Science.gov (United States)

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

    2012-06-01

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

  5. Reliability of an Interactive Computer Program for Advance Care Planning

    Science.gov (United States)

    Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

    2012-01-01

    Abstract Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83–0.95, and 0.86–0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830

  6. Listening to Women: Focus group discussions of what women want from postnatal care

    Directory of Open Access Journals (Sweden)

    WA Butchart

    1999-09-01

    Full Text Available Postpartum care is an essential part of the experience of childbirth and parenthood. This study explores what women want from postnatal care. Three focus groups, using a semi-structured format, were conducted. A total of 12 mothers, up to six weeks postpartum, participated in the study, which was conducted in two clinics in the Western Cape Metropole. Data was transcribed from taped sessions and analysed using Burnard’s (1991 model of “thematic content analysis” . Seven major categories were identified: Information, Support, Organisation of services, Attitudes of the health team, Contact with other mothers, Practical assistance and Other services. Listening to women is an essential element in the provision of flexible and responsive postnatal care that meets the felt needs of women and families.

  7. The Relationships among Group Size, Participation, and Performance of Programming Language Learning Supported with Online Forums

    Science.gov (United States)

    Shaw, Ruey-Shiang

    2013-01-01

    This study examined the relationships among group size, participation, and learning performance factors when learning a programming language in a computer-supported collaborative learning (CSCL) context. An online forum was used as the CSCL environment for learning the Microsoft ASP.NET programming language. The collaborative-learning experiment…

  8. AEL Career Decision-Making Program. Worker Trait Group File Content Notebook.

    Science.gov (United States)

    Appalachia Educational Lab., Charleston, WV.

    The Career Information System File is utilized in the organization and management procedures of the Career Information System (CIS) component of the Career Decision-Making (CDM) Program developed by Appalachia Educational Laboratory. (See CE 019 229 for an overview of the total CDM Program.) The twelve career areas and worker trait groups used to…

  9. 78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2013-07-26

    ...This notice announces the annual adjustments to the national average payment rates for meals and snacks served in child care centers, outside-school-hours care centers, at-risk afterschool care centers, and adult day care centers; the food service payment rates for meals and snacks served in day care homes; and the administrative reimbursement rates for sponsoring organizations of day care homes, to reflect changes in the Consumer Price Index. Further adjustments are made to these rates to reflect the higher costs of providing meals in the States of Alaska and Hawaii. The adjustments contained in this notice are made on an annual basis each July, as required by the laws and regulations governing the Child and Adult Care Food Program.

  10. Point of care testing of phospholipase A2 group IIA for serological diagnosis of rheumatoid arthritis

    Science.gov (United States)

    Liu, Nathan J.; Chapman, Robert; Lin, Yiyang; Mmesi, Jonas; Bentham, Andrew; Tyreman, Matthew; Abraham, Sonya; Stevens, Molly M.

    2016-02-01

    Secretory phospholipase A2 group IIA (sPLA2-IIA) was examined as a point of care marker for determining disease activity in rheumatoid (RA) and psoriatic (PsA) arthritis. Serum concentration and activity of sPLA2-IIA were measured using in-house antibodies and a novel point of care lateral flow device assay in patients diagnosed with varying severities of RA (n = 30) and PsA (n = 25) and found to correlate strongly with C-reactive protein (CRP). Levels of all markers were elevated in patients with active RA over those with inactive RA as well as both active and inactive PsA, indicating that sPLA2-IIA can be used as an analogue to CRP for RA diagnosis at point of care.Secretory phospholipase A2 group IIA (sPLA2-IIA) was examined as a point of care marker for determining disease activity in rheumatoid (RA) and psoriatic (PsA) arthritis. Serum concentration and activity of sPLA2-IIA were measured using in-house antibodies and a novel point of care lateral flow device assay in patients diagnosed with varying severities of RA (n = 30) and PsA (n = 25) and found to correlate strongly with C-reactive protein (CRP). Levels of all markers were elevated in patients with active RA over those with inactive RA as well as both active and inactive PsA, indicating that sPLA2-IIA can be used as an analogue to CRP for RA diagnosis at point of care. Electronic supplementary information (ESI) available. See DOI: 10.1039/c5nr08423g

  11. LDA-Based Unified Topic Modeling for Similar TV User Grouping and TV Program Recommendation.

    Science.gov (United States)

    Pyo, Shinjee; Kim, Eunhui; Kim, Munchurl

    2015-08-01

    Social TV is a social media service via TV and social networks through which TV users exchange their experiences about TV programs that they are viewing. For social TV service, two technical aspects are envisioned: grouping of similar TV users to create social TV communities and recommending TV programs based on group and personal interests for personalizing TV. In this paper, we propose a unified topic model based on grouping of similar TV users and recommending TV programs as a social TV service. The proposed unified topic model employs two latent Dirichlet allocation (LDA) models. One is a topic model of TV users, and the other is a topic model of the description words for viewed TV programs. The two LDA models are then integrated via a topic proportion parameter for TV programs, which enforces the grouping of similar TV users and associated description words for watched TV programs at the same time in a unified topic modeling framework. The unified model identifies the semantic relation between TV user groups and TV program description word groups so that more meaningful TV program recommendations can be made. The unified topic model also overcomes an item ramp-up problem such that new TV programs can be reliably recommended to TV users. Furthermore, from the topic model of TV users, TV users with similar tastes can be grouped as topics, which can then be recommended as social TV communities. To verify our proposed method of unified topic-modeling-based TV user grouping and TV program recommendation for social TV services, in our experiments, we used real TV viewing history data and electronic program guide data from a seven-month period collected by a TV poll agency. The experimental results show that the proposed unified topic model yields an average 81.4% precision for 50 topics in TV program recommendation and its performance is an average of 6.5% higher than that of the topic model of TV users only. For TV user prediction with new TV programs, the average

  12. Staff Food-Related Behaviors and Children's Tastes of Food Groups during Lunch at Child Care in Oklahoma.

    Science.gov (United States)

    Anundson, Katherine; Sisson, Susan B; Anderson, Michael; Horm, Diane; Soto, Jill; Hoffman, Leah

    2017-10-04

    Young children should consume a variety of nutrient-dense foods to support growth, while limiting added fat and sugar. A majority of children between the ages of 3 and 5 years attend child care in the United States, which makes this environment and the child-care staff influential at meals. The aim was to determine the association between best-practice food-related behaviors and young children's tastes of fruit, vegetable, low-fat dairy, and high-fat/high-sugar foods at child care. This was a cross-sectional study. A community-based study with 201 children ages 3 to 5 years from 25 early care and education centers, including 11 tribally affiliated centers and two Head Start programs across Oklahoma. Data collection occurred from fall 2011 to spring 2014. Classroom observations used the Environmental Policy Assessment Observation tool to measure the staff behaviors and environment. Staff behavior was compared at three different levels: the composite score of staff nutrition behavior, each constituent staff behavior, and staff behaviors grouped into broader feeding behaviors. Tasted food was measured through the Dietary Observation in Child Care method. The children's meals were categorized into the following food groups: fruit, vegetable, low-fat dairy, fried vegetable, fried meat, high-fat meat, and high-fat/high-sugar food. Descriptive statistics were calculated for relevant variables. Relationships between the constituent staff behaviors and food groups that children tasted were compared using multilevel mixed-model analysis. The mean number of tasted fruit or vegetable items was higher and the mean number of tasted high-fat/high-sugar food items was lower when staff: 1) determined fullness before plate removal when less than half of food was eaten, 2) ate with the children, 3) and talked about healthy food. The utilization of the three staff behaviors and their association with higher mean tastes of nutrient-dense items and lower mean tastes of high

  13. Self-reported reasons for hand hygiene in 3 groups of health care workers.

    Science.gov (United States)

    McLaughlin, Anne Collins; Walsh, Fran

    2012-09-01

    The hands of health care workers continue to be the main vector for nosocomial infection in hospitals. The purpose of the current research was to capture the health beliefs and self-reported behaviors of US health care workers to better understand why workers avoid hand hygiene and what prompts them to wash. An online survey of health care workers assessed their reasons for washing their hands, reasons for not washing, and what cues prompted the decision to wash or not wash in a variety of locations. The findings were that hand hygiene could be cued by an external situation but tended to be motivated internally. Hand hygiene was avoided because of situational barriers. The reasons for performing hand hygiene can be situated in the internally motivated Theory of Planned Behavior; however, the reasons for not performing hand hygiene tend to be situational and affected by the environment. The results may be used to design programs, products, and systems that promote appropriate hand hygiene practices. Principles for design of these programs and products are provided. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  14. A program for calculating group constants on the basis of libraries of evaluated neutron data

    International Nuclear Information System (INIS)

    Sinitsa, V.V.

    1987-01-01

    The GRUKON program is designed for processing libraries of evaluated neutron data into group and fine-group (having some 300 groups) microscopic constants. In structure it is a package of applications programs with three basic components: a monitor, a command language and a library of functional modules. The first operative version of the package was restricted to obtaining mid-group non-block cross-sections from evaluated neutron data libraries in the ENDF/B format. This was then used to process other libraries. In the next two versions, cross-section table conversion modules and self-shielding factor calculation modules, respectively, were added to the functions already in the package. Currently, a fourth version of the GRUKON applications program package, for calculation of sub-group parameters, is under preparation. (author)

  15. A new quality assurance package for hospital palliative care teams: the Trent Hospice Audit Group model.

    Science.gov (United States)

    Hunt, J; Keeley, V L; Cobb, M; Ahmedzai, S H

    2004-07-19

    Cancer patients in hospitals are increasingly cared for jointly by palliative care teams, as well as oncologists and surgeons. There has been a considerable growth in the number and range of hospital palliative care teams (HPCTs) in the United Kingdom. HPCTs can include specialist doctors and nurses, social workers, chaplains, allied health professionals and pharmacists. Some teams work closely with existing cancer multidisciplinary teams (MDTs) while others are less well integrated. Quality assurance and clinical governance requirements have an impact on the monitoring of such teams, but so far there is no standardised way of measuring the amount and quality of HPCTs' workload. Trent Hospice Audit Group (THAG) is a multiprofessional research group, which has been developing standards and audit tools for palliative care since the 1990s. These follow a format of structure-process-outcome for standards and measures. We describe a collaborative programme of work with HPCTs that has led to a new set of standards and audit tools. Nine HPCTs participated in three rounds of consultation, piloting and modification of standard statements and tools. The final pack of HPCT quality assurance tools covers: policies and documentation; medical notes review; questionnaires for ward-based staff. The tools measure the HPCT workload and casemix; the views of ward-based staff on the supportive role of the HPCT and the effectiveness of HPCT education programmes, particularly in changing practice. The THAG HPCT quality assurance pack is now available for use in cancer peer review.

  16. Mandatory Nap Times and Group Napping Patterns in Child Care: An Observational Study.

    Science.gov (United States)

    Staton, Sally L; Smith, Simon S; Hurst, Cameron; Pattinson, Cassandra L; Thorpe, Karen J

    2017-01-01

    Policy provision for naps is typical in child care settings, but there is variability in the practices employed. One practice that might modify children's early sleep patterns is the allocation of a mandatory nap time in which all children are required to lie on their beds without alternate activity permitted. There is currently limited evidence of the effects of such practices on children's napping patterns. This study examined the association between duration of mandatory nap times and group-level napping patterns in child care settings. Observations were undertaken in a community sample of 113 preschool rooms with a scheduled nap time (N = 2,114 children). Results showed that 83.5% of child care settings implemented a mandatory nap time (range = 15-145 min) while 14.2% provided alternate activities for children throughout the nap time period. Overall, 31% of children napped during nap times. Compared to rooms with ≤ 30 min of mandatory nap time, rooms with 31-60 min and > 60 min of mandatory nap time had a two-and-a-half and fourfold increase, respectively, in the proportion of children napping. Nap onset latency did not significantly differ across groups. Among preschool children, exposure to longer mandatory nap times in child care may increase incidence of napping.

  17. Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program.

    Science.gov (United States)

    Hewitt, Jennifer; Refshauge, Kathryn M; Goodall, Stephen; Henwood, Timothy; Clemson, Lindy

    2014-01-01

    Falls are common among older adults. It is reported that approximately 60% of residents of aged care facilities fall each year. This is a major cause of morbidity and mortality, and a significant burden for health care providers and the health system. Among community dwelling older adults, exercise appears to be an effective countermeasure, but data are limited and inconsistent among studies in residents of aged care communities. This trial has been designed to evaluate whether the SUNBEAM program (Strength and Balance Exercise in Aged Care) reduces falls in residents of aged care facilities. Is the program more effective and cost-effective than usual care for the prevention of falls? Single-blinded, two group, cluster randomized trial. 300 residents, living in 20 aged care facilities. Progressive resistance and balance training under the guidance of a physiotherapist for 6 months, then facility-guided maintenance training for 6 months. Usual care. Number of falls, number of fallers, quality of life, mobility, balance, fear of falling, cognitive well-being, resource use, and cost-effectiveness. Measurements will be taken at baseline, 6 months, and 12 months. The number of falls will be analyzed using a Poisson mixed model. A logistic mixed model will be used to analyze the number of residents who fall during the study period. Intention-to-treat analysis will be used. This study addresses a significant shortcoming in aged care research, and has potential to impact upon a substantial health care problem. Outcomes will be used to inform care providers, and guide health care policies.

  18. What Peer Mentoring Adds to Already Good Patient Care: Implementing the Carpeta Roja Peer Mentoring Program in a Well-Resourced Health Care System.

    Science.gov (United States)

    Knox, Lyndee; Huff, Jessica; Graham, Deborah; Henry, Michelle; Bracho, America; Henderson, Cynthia; Emsermann, Caroline

    2015-08-01

    The purpose of this study was to evaluate the impact of a peer support program on the health outcomes of patients already receiving well-organized, comprehensive diabetes care. We used a mixed-methods, nonrandomized, control-group design to evaluate the impact of a peer-mentoring program on the health outcomes and self-management behaviors of adults with type 2 diabetes in 15 primary care practices in San Antonio. Propensity score analysis, t-tests, and multivariable repeated analyses were used to evaluate impact. Qualitative interviews were conducted with 15 participants in the intervention group and analyzed using a grounded theory approach. Both intervention and control groups showed significant improvement on all health indicators from baseline to 6-month follow-up (Ppeer mentoring to already well-organized comprehensive diabetes care does not improve outcomes. However, findings suggest that the impact of the program extends to members of the participants' families, which is an intriguing finding that deserves further study. © 2015 Annals of Family Medicine, Inc.

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

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

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

  20. Comparing Costs of Telephone versus Face-to-Face Extended Care Programs for the Management of Obesity in Rural Settings

    Science.gov (United States)

    Radcliff, Tiffany A.; Bobroff, Linda B.; Lutes, Lesley D.; Durning, Patricia E.; Daniels, Michael J.; Limacher, Marian C.; Janicke, David M.; Martin, A. Daniel; Perri, Michael G.

    2012-01-01

    Background A major challenge following successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge may be exacerbated in rural areas with limited local support resources. Objective This study describes and compares program costs and cost-effectiveness for 12-month extended care lifestyle maintenance programs following an initial 6-month weight loss program. Design A 1-year prospective controlled randomized clinical trial. Participants/Setting The study included 215 female participants age 50 or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003, to May 31, 2007. Intervention The intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly-assigned to a 12-month extended care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). Main Outcome Measures Program delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. Statistical Analyses Performed Non-parametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. Results Median weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared to individual telephone counseling ($268 per participant) and

  1. An Exploratory Study of the Impacts of an Employer-Supported Child Care Program

    Science.gov (United States)

    Morrissey, Taryn W.; Warner, Mildred E.

    2011-01-01

    Although employer-sponsored child care programs have become more common, there is little empirical research on whether these programs affect employees' satisfaction with child care or their work-life balance, and if effects vary across employee characteristics. In this exploratory study, we administered a survey to employees with children at one…

  2. 76 FR 50540 - Pilot Program of Enhanced Contract Care Authority for Veterans in Highly Rural Areas

    Science.gov (United States)

    2011-08-15

    ... contracts in order to arrange for the provision of care through the pilot program. See Public Law 110- 387... DEPARTMENT OF VETERANS AFFAIRS Pilot Program of Enhanced Contract Care Authority for Veterans in... Veterans Affairs (VA) is implementing Sec. 403 of Public Law (Pub. L.) 110-387, ``Veterans' Mental Health...

  3. Geriatric Foot Care: A Model Educational Program for Mid-Level Practitioners.

    Science.gov (United States)

    Suggs, Patricia K.; Krissak, Ruth; Caruso, Frank; Teasdall, Robert

    2002-01-01

    An educational program on geriatric foot care was completed by 59 nurse practitioners, 12 physicians' assistants, and 1 physician. The 3 1/2 day program included interactive sessions, observation, and hands-on patient care. Posttest results and 6-month follow-up showed significant knowledge increases and incorporation of learning into practice.…

  4. 76 FR 34712 - Medicare Program; Pioneer Accountable Care Organization Model; Extension of the Submission...

    Science.gov (United States)

    2011-06-14

    ... stakeholders to develop initiatives to test innovative payment and service delivery models to reduce program...] Medicare Program; Pioneer Accountable Care Organization Model; Extension of the Submission Deadlines for... of the Pioneer Accountable Care Organization Model letters of intent to June 30, 2011 and the...

  5. 77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-10-17

    ... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates..., 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for...

  6. Foot Problems in a Group of Patients with Rheumatoid Arthritis: An Unmet Need for Foot Care

    OpenAIRE

    Borman, Pinar; Ayhan, Figen; Tuncay, Figen; Sahin, Mehtap

    2012-01-01

    Objectives: The aim of this study was to evaluate the foot involvement in a group of RA patients in regard to symptoms, type and frequency of deformities, location, radiological changes, and foot care. Patients and Methods: A randomized selected 100 rheumatoid arthritis (RA) patients were recruited to the study. Data about foot symptoms, duration and location of foot pain, pain intensity, access to services related to foot, treatment, orthoses and assistive devices, and usefulness of therapie...

  7. School Functioning of a Particularly Vulnerable Group: Children and Young People in Residential Child Care

    Directory of Open Access Journals (Sweden)

    Carla González-García

    2017-07-01

    Full Text Available A large proportion of the children and young people in residential child care in Spain are there as a consequence of abuse and neglect in their birth families. Research has shown that these types of adverse circumstances in childhood are risk factors for emotional and behavioral problems, as well as difficulties in adapting to different contexts. School achievement is related to this and represents one of the most affected areas. Children in residential child care exhibit extremely poor performance and difficulties in school functioning which affects their transition to adulthood and into the labor market. The main aim of this study is to describe the school functioning of a sample of 1,216 children aged between 8 and 18 living in residential child care in Spain. The specific needs of children with intellectual disability and unaccompanied migrant children were also analyzed. Relationships with other variables such as gender, age, mental health needs, and other risk factors were also explored. In order to analyze school functioning in this vulnerable group, the sample was divided into different groups depending on school level and educational needs. In the vast majority of cases, children were in primary or compulsory secondary education (up to age 16, this group included a significant proportion of cases in special education centers. The rest of the sample were in vocational training or post-compulsory secondary school. Results have important implications for the design of socio-educative intervention strategies in both education and child care systems in order to promote better school achievement and better educational qualifications in this vulnerable group.

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

    Directory of Open Access Journals (Sweden)

    M R Rajagopal

    2014-01-01

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

  9. Evaluation of new indigenous "point-of-care" ABO and Rh grouping device.

    Science.gov (United States)

    Tiwari, Aseem Kumar; Setya, Divya; Aggarwal, Geet; Arora, Dinesh; Dara, Ravi C; Ratan, Ankita; Bhardwaj, Gunjan; Acharya, Devi Prasad

    2018-01-01

    Erycard 2.0 is a "point-of-care" device that is primarily being used for patient blood grouping before transfusion. Erycard 2.0 was compared with conventional slide technology for accuracy and time taken for ABO and Rh forward grouping result with column agglutination technology (CAT) being the gold standard. Erycard 2.0 as a device was also evaluated for its stability under different storage conditions and stability of result till 48 h. In addition, grouping of hemolyzed samples was also tested with Erycard 2.0. Ease of use of Erycard 2.0 was evaluated with a survey among paramedical staff. Erycard 2.0 demonstrated 100% concordance with CAT as compared with slide technique (98.9%). Mean time taken per test by Erycard 2.0 and slide technique was 5.13 min and 1.7 min, respectively. After pretesting storage under different temperature and humidity conditions, Erycard 2.0 did not show any deviation from the result. The result did not change even after 48 h of testing and storage under room temperature. 100% concordance was recorded between pre- and post-hemolyzed blood grouping. Ease of use survey revealed that Erycard 2.0 was more acceptable to paramedical staff for its simplicity, objectivity, and performance than conventional slide technique. Erycard 2.0 can be used as "point-of-care" device for blood donor screening for ABO and Rh blood group and can possibly replace conventional slide technique.

  10. 75 FR 18138 - Health Care Eligibility Under the Secretarial Designee Program and Related Special Authorities

    Science.gov (United States)

    2010-04-09

    ... Component members not in a present duty status. This authority includes payment for health care services in... 0790-AI52] Health Care Eligibility Under the Secretarial Designee Program and Related Special... establish policies and assign responsibilities for health care eligibility under the Secretarial Designee...

  11. Care coordination in bone health screening between individual behaviors and health care services among Korean-American women across three age groups

    OpenAIRE

    Young-Shin Lee

    2017-01-01

    Integrated continuous care is important to prevent and treat brittle bone status in the aging process; however, minority groups often have limited access to health services. The purpose of this study was to identify the care coordination among women’s perceptions about their bone health, information from health care providers, and the results of Bone Mineral Density (BMD) tests across three age groups. The study was a cross-sectional comparative design. A total of 63 Korean American women com...

  12. Design choices made by target users for a pay-for-performance program in primary care: an action research approach

    Directory of Open Access Journals (Sweden)

    Kirschner Kirsten

    2012-03-01

    Full Text Available Abstract Background International interest in pay-for-performance (P4P initiatives to improve quality of health care is growing. Current programs vary in the methods of performance measurement, appraisal and reimbursement. One may assume that involvement of health care professionals in the goal setting and methods of quality measurement and subsequent payment schemes may enhance their commitment to and motivation for P4P programs and therefore the impact of these programs. We developed a P4P program in which the target users were involved in decisions about the P4P methods. Methods For the development of the P4P program a framework was used which distinguished three main components: performance measurement, appraisal and reimbursement. Based on this framework design choices were discussed in two panels of target users using an adapted Delphi procedure. The target users were 65 general practices and two health insurance companies in the South of the Netherlands. Results Performance measurement was linked to the Dutch accreditation program based on three domains (clinical care, practice management and patient experience. The general practice was chosen as unit of assessment. Relative standards were set at the 25th percentile of group performance. The incentive for clinical care was set twice as high as the one for practice management and patient experience. Quality scores were to be calculated separately for all three domains, and for both the quality level and the improvement of performance. The incentive for quality level was set thrice as high as the one for the improvement of performance. For reimbursement, quality scores were divided into seven levels. A practice with a quality score in the lowest group was not supposed to receive a bonus. The additional payment grew proportionally for each extra group. The bonus aimed at was on average 5% to 10% of the practice income. Conclusions Designing a P4P program for primary care with involvement of

  13. Design choices made by target users for a pay-for-performance program in primary care: an action research approach

    Science.gov (United States)

    2012-01-01

    Background International interest in pay-for-performance (P4P) initiatives to improve quality of health care is growing. Current programs vary in the methods of performance measurement, appraisal and reimbursement. One may assume that involvement of health care professionals in the goal setting and methods of quality measurement and subsequent payment schemes may enhance their commitment to and motivation for P4P programs and therefore the impact of these programs. We developed a P4P program in which the target users were involved in decisions about the P4P methods. Methods For the development of the P4P program a framework was used which distinguished three main components: performance measurement, appraisal and reimbursement. Based on this framework design choices were discussed in two panels of target users using an adapted Delphi procedure. The target users were 65 general practices and two health insurance companies in the South of the Netherlands. Results Performance measurement was linked to the Dutch accreditation program based on three domains (clinical care, practice management and patient experience). The general practice was chosen as unit of assessment. Relative standards were set at the 25th percentile of group performance. The incentive for clinical care was set twice as high as the one for practice management and patient experience. Quality scores were to be calculated separately for all three domains, and for both the quality level and the improvement of performance. The incentive for quality level was set thrice as high as the one for the improvement of performance. For reimbursement, quality scores were divided into seven levels. A practice with a quality score in the lowest group was not supposed to receive a bonus. The additional payment grew proportionally for each extra group. The bonus aimed at was on average 5% to 10% of the practice income. Conclusions Designing a P4P program for primary care with involvement of the target users gave us an

  14. Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality.

    Science.gov (United States)

    Jeon, Yun-Hee; Simpson, Judy M; Li, Zhicheng; Cunich, Michelle M; Thomas, Tamsin H; Chenoweth, Lynn; Kendig, Hal L

    2015-07-01

    To evaluate the effectiveness of a leadership and management program in aged care. Double-blind cluster randomized controlled trial. Twelve residential and community-aged care sites in Australia. All care staff employed for 6 months or longer at the aged care sites were invited to participate in the surveys at 3 time points: baseline (time 1), 9 months from baseline (time 2), and 9 months after completion of time 2 (time 3) from 2011 to 2013. At each time point, at least 500 care staff completed a survey. At baseline (N = 503) the largest age group was 45 to 54 years (37%), and the majority of care staff were born in Australia (70%), spoke English (94%), and had at least completed secondary education (57%). A 12-month Clinical Leadership in Aged Care (CLiAC) program for middle managers, which aimed to further develop their leadership and management skills in creating positive workplace relationships and in enabling person-centered, evidence-based care. The primary outcomes were care staff ratings of the work environment, care quality and safety, and staff turnover rates. Secondary outcomes were care staff's intention to leave their employer and profession, workplace stress, job satisfaction, and cost-effectiveness of implementing the program. Absenteeism was excluded due to difficulty in obtaining reliable data. Managers' self-rated knowledge and skills in leadership and management are not included in this article, which focuses on care staff perceptions only. At 6 months after its completion, the CLiAC program was effective in improving care staff's perception of management support [mean difference 0.61, 95% confidence interval (CI) 0.04-1.18; P = .04]. Compared with the control sites, care staff at the intervention sites perceived their managers' leadership styles as more transformational (mean difference 0.30, 95% CI 0.09-0.51; P = .005), transactional (mean difference 0.22, 95% CI 0.05-0.39; P = .01), and less passive avoidant (mean difference 0.30, 95% CI 0

  15. Annual Coded Wire Tag Program; Oregon Missing Production Groups, 1994 Annual Report.

    Energy Technology Data Exchange (ETDEWEB)

    Garrison, Robert L.; Isaac, Dennis L.; Lewis, Mark A.

    1994-12-01

    The goal of this program is to develop the ability to estimate hatchery production survival values and evaluate effectiveness of Oregon hatcheries. To accomplish this goal. We are tagging missing production groups within hatcheries to assure each production group is identifiable to allow future evaluation upon recovery of tag data.

  16. Use of Self-Management with the CW-FIT Group Contingency Program

    Science.gov (United States)

    Kamps, Debra; Conklin, Carl; Wills, Howard

    2015-01-01

    The purpose of the study was to determine the effects of self-management as a tier two enhancement to the group contingency intervention, Class-Wide Function-related Intervention Teams Program (CW-FIT). Two classrooms, first and fourth grade, and two students in each of the classrooms participated in the intervention. The group contingency…

  17. Modeling and evaluating evidence-based continuing education program in nursing home dementia care (MEDCED)--training of care home staff to reduce use of restraint in care home residents with dementia. A cluster randomized controlled trial.

    Science.gov (United States)

    Testad, Ingelin; Mekki, Tone Elin; Førland, Oddvar; Øye, Christine; Tveit, Eva Marie; Jacobsen, Frode; Kirkevold, Øyvind

    2016-01-01

    The aim of this study was to evaluate the effectiveness of a tailored 7-month training intervention "Trust Before Restraint," in reducing use of restraint, agitation, and antipsychotic medications in care home residents with dementia. This is a single-blind cluster randomized controlled trial in 24 care homes within the Western Norway Regional Health Authority 2011-2013. From 24 care homes, 274 residents were included in the study, with 118 in the intervention group and 156 in the control group. Use of restraint was significantly reduced in both the intervention group and the control group despite unexpected low baseline, with a tendency to a greater reduction in the control group. There was a significant reduction in Cohen-Mansfield Agitation Inventory score in both the intervention group and the follow-up group with a slightly higher reduction in the control group, although this did not reach significance and a small nonsignificant increase in use of antipsychotics (14.1-17.7%) and antidepressants (35.9-38.4%) in both groups. This study reports on the statistically significant reduction in use of restraint in care homes, both prior and during the 7-month intervention periods, in both intervention and control groups. When interpreted within the context of the current climate of educational initiatives to reduce restraint and a greater focus on the importance of person-centered care, the study also highlights the potential success achieved with national training programs for care staff and should be further evaluated to inform future training initiatives both in Norway and internationally. Copyright © 2015 John Wiley & Sons, Ltd.

  18. LGBTQ Youth and Young Adult Perspectives on a Culturally Tailored Group Smoking Cessation Program.

    Science.gov (United States)

    Baskerville, Neill Bruce; Shuh, Alanna; Wong-Francq, Katy; Dash, Darly; Abramowicz, Aneta

    2017-08-01

    The prevalence of smoking among LGBTQ youth and young adults (YYAs) is much higher than that of non-LGBTQ young people. The current study explored LGBTQ YYA perceptions of a culturally tailored group smoking cessation counselling program, along with how the intervention could be improved. We conducted focus groups (n = 24) with 204 LGBTQ YYAs in Toronto and Ottawa, Canada. Open-ended questions focused on their feelings, likes and dislikes, concerns and additional ideas for a culturally tailored group cessation counselling intervention. Focus group transcripts were coded thematically and analyzed. Overall, YYAs were ambivalent towards the concept of a culturally tailored, group cessation counselling program. Although several participants were attracted to the LGBTQ friendly and social benefits of such a program (eg, good support system), many also had concerns. Particularly, the possibility that other group members might trigger them to smoke was a frequently stated issue. Focus group members also noted lack of motivation to attend the group, and that the group program may be inaccessible depending on where and when the program was offered. Several suggestions were made as to how to ameliorate the expressed issues related to inaccessibility or lack of attractiveness. This study is among the first to gain the perspectives of LGBTQ YYAs on culturally tailored group cessation strategies in Canada. We identified components of group cessation programs that are both favored and not favored among LGBTQ YYAs, as well as suggestions as to how to make group cessation programs more appealing. This study is particularly relevant as smoking cessation programs are one of the most commonly offered and published cessation interventions for the LGBTQ community, yet little is understood in terms of preferences of LGBTQ YYA smokers. Given the disparity in the prevalence of smoking among LGBTQ young people compared to their non-LGBTQ peers, research on effective intervention strategies

  19. Differential effects of professional leaders on health care teams in chronic disease management groups.

    Science.gov (United States)

    Wholey, Douglas R; Disch, Joanne; White, Katie M; Powell, Adam; Rector, Thomas S; Sahay, Anju; Heidenreich, Paul A

    2014-01-01

    Leadership by health care professionals is likely to vary because of differences in the social contexts within which they are situated, socialization processes and societal expectations, education and training, and the way their professions define and operationalize key concepts such as teamwork, collaboration, and partnership. This research examines the effect of the nurse and physician leaders on interdependence and encounter preparedness in chronic disease management practice groups. The aim of this study was to examine the effect of complementary leadership by nurses and physicians involved in jointly producing a health care service on care team functioning. The design is a retrospective observational study based on survey data. The unit of analysis is heart failure care groups in U.S. Veterans Health Administration medical centers. Survey and administrative data were collected in 2009 from 68 Veterans Health Administration medical centers. Key variables include nurse and physician leadership, interdependence, psychological safety, coordination, and encounter preparedness. Reliability and validity of survey measures were assessed with exploratory factor analysis and Cronbach alphas. Multivariate analyses tested hypotheses. Professional leadership by nurses and physicians is related to encounter preparedness by different paths. Nurse leadership is associated with greater team interdependence, and interdependence is positively associated with respect. Physician leadership is positively associated with greater psychological safety, respect, and shared goals but is not associated with interdependence. Respect is associated with involvement in learning activities, and shared goals are associated with coordination. Coordination and involvement in learning activities are positively associated with encounter preparedness. By focusing on increasing interdependence and a constructive climate, nurse and physician leaders have the opportunity to increase care coordination

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

    Directory of Open Access Journals (Sweden)

    Van Royen Paul

    2009-08-01

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

  1. Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation

    Directory of Open Access Journals (Sweden)

    Hyun-Soo Kim

    2016-01-01

    Full Text Available Objectives: The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide. Methods: Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization. Results: The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size. Conclusions: It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation.

  2. The effectiveness of a cardiometabolic prevention program in general practices offering integrated care programs including a patient tailored lifestyle treatment.

    NARCIS (Netherlands)

    Hollander, M.; Eppink, L.; Nielen, M.; Badenbroek, I.; Stol, D.; Schellevis, F.; Wit, N. de

    2016-01-01

    Background & Aim: Selective cardio-metabolic prevention programs (CMP) may be especially effective in well-organized practices. We studied the effect of a CMP program in the academic primary care practices of the Julius Health Centers (JHC) that offer integrated cardiovascular disease management

  3. A mixed-methods evaluation of a multidisciplinary point of care ultrasound program.

    Science.gov (United States)

    Smith, Andrew; Parsons, Michael; Renouf, Tia; Boyd, Sarah; Rogers, Peter

    2018-04-24

    Point of Care Ultrasound (PoCUS) is well established within emergency medicine, however, the availability of formal training for other clinical disciplines is limited. Memorial University has established a cost-efficient, multidisciplinary PoCUS training program focusing on training residents' discipline-specific ultrasound skills. This study evaluates the skills, knowledge, and attitudes of residents who participated in the program. Analysis was conducted using a mixed-methods, sequential exploratory approach. Initially, a focus group of seven first year residents was conducted to generate themes that were used to guide development of a survey administered to residents over a two-year period. Thirty residents responded to the survey (response rate 63.8%) with 53.3% meeting the training requirements for focused assessment using sonography in trauma, 43.3% for pleural effusion, 40.0% for aortic aneurysms, and 40.0% for cardiac scans. Early pregnancy assessment was the skill of least interest with 46.6% not interested. Over half the residents (53.6%) agreed or strongly agreed that a multidisciplinary program met their needs while 21.4% disagreed. The focus group found the multidisciplinary approach adequate. A single PoCUS curriculum has been shown to meet the needs and expectations of a majority of residents from multiple disciplines. It can enhance collaboration and bridge gaps between increasingly compartmentalized practices of medicine.

  4. Rapid point-of-care CD4 testing at mobile HIV testing sites to increase linkage to care: an evaluation of a pilot program in South Africa.

    Science.gov (United States)

    Larson, Bruce A; Schnippel, Kathryn; Ndibongo, Buyiswa; Xulu, Thembisile; Brennan, Alana; Long, Lawrence; Fox, Matthew P; Rosen, Sydney

    2012-10-01

    A mobile HIV counseling and testing (HCT) program around Johannesburg piloted the integration of point-of-care (POC) CD4 testing, using the Pima analyzer, to improve linkages to HIV care. We report results from this pilot program for patients testing positive (n = 508) from May to October 2010. We analyzed 3 primary outcomes: assignment to testing group (offered POC CD4 or not), successful follow-up (by telephone), and completed the referral visit for HIV care within 8 weeks after HIV testing if successfully followed up. Proportions for each outcome were calculated, and relative risks were estimated using a modified Poisson approach. Three hundred eleven patients were offered the POC CD4 test, and 197 patients were not offered the test. No differences in patient characteristics were observed between the 2 groups. Approximately 62.7% of patients were successfully followed up 8 weeks after HIV testing, with no differences observed between testing groups. Among those followed up, 54.4% reported completing their referral visit. Patients offered the POC CD4 test were more likely to complete the referral visit for further HIV care (relative risk 1.25, 95% confidence interval: 1.00 to 1.57). In this mobile HCT setting, patients offered POC CD4 testing as part of the HCT services were more likely to visit a referral clinic after testing, suggesting that rapid CD4 testing technology may improve linkage to HIV care. Future research can evaluate options for adjusting HCT services if POC CD4 testing was included permanently and the cost-effectiveness of the POC CD4 testing compared with other approaches for improving linkage of care.

  5. Comparison of Cardiovascular Risk Screening Methods and Mortality Data among Hungarian Primary Care Population: Preliminary Results of the First Government-Financed Managed Care Program.

    Science.gov (United States)

    Móczár, Csaba; Rurik, Imre

    2015-09-01

    Besides participation in the primary prevention, screening as secondary prevention is an important requirement for primary care services. The effect of this work is influenced by the characteristics of individual primary care practices and doctors' screening habits, as well as by the regulation of screening processes and available financial resources. Between 1999 and 2009, a managed care program was introduced and carried out in Hungary, financed by the government. This financial support and motivation gave the opportunity to increase the number of screenings. 4,462 patients of 40 primary care practices were screened on the basis of SCORE risk assessment. The results of the screening were compared on the basis of two groups of patients, namely: those who had been pre-screened (pre-screening method) for known risk factors in their medical history (smoking, BMI, age, family cardiovascular history), and those randomly screened. The authors also compared the mortality data of participating primary care practices with the regional and national data. The average score was significantly higher in the pre-screened group of patients, regardless of whether the risk factors were considered one by one or in combination. Mortality was significantly lower in the participating primary practices than had been expected on the basis of the national mortality data. This government-financed program was a big step forward to establish a proper screening method within Hungarian primary care. Performing cardiovascular screening of a selected target group is presumably more appropriate than screening within a randomly selected population. Both methods resulted in a visible improvement in regional mortality data, though it is very likely that with pre-screening a more cost-effective selection for screening may be obtained.

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

    Science.gov (United States)

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

    2014-12-01

    Increasing concerns about quality of care and workforce shortages have motivated health care organizations and educational institutions to partner to create career ladders for frontline health care workers. Career ladders reward workers for gains in skills and knowledge and may reduce the costs associated with turnover, improve patient care, and/or address projected shortages of certain nursing and allied health professions. This study examines partnerships between health care and educational organizations in the United States during the design and implementation of career ladder training programs for low-skill workers in health care settings, referred to as frontline health care workers. Mixed methods data from 291 frontline health care workers and 347 key informants (e.g., administrators, instructors, managers) collected between 2007 and 2010 were analyzed using both regression and fuzzy-set qualitative comparative analysis (QCA). Results suggest that different combinations of partner characteristics, including having an education leader, employer leader, frontline management support, partnership history, community need, and educational policies, were necessary for high worker career self-efficacy and program satisfaction. Whether a worker received a wage increase, however, was primarily dependent on leadership within the health care organization, including having an employer leader and employer implementation policies. Findings suggest that strong partnerships between health care and educational organizations can contribute to the successful implementation of career ladder programs, but workers' ability to earn monetary rewards for program participation depends on the strength of leadership support within the health care organization. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Prenatal and Postpartum Care Disparities in a Large Medicaid Program.

    Science.gov (United States)

    Parekh, Natasha; Jarlenski, Marian; Kelley, David

    2018-03-01

    Objectives Pennsylvania's maternal mortality, infant mortality, and preterm birth rates rank 24th, 35th, and 25th in the country, and are higher among racial and ethnic minorities. Provision of prenatal and postpartum care represents one way to improve these outcomes. We assessed the extent of disparities in the provision and timeliness of prenatal and postpartum care for women enrolled in Pennsylvania Medicaid. Methods We performed a cross-sectional evaluation of representative samples of women who delivered live births from November 2011 to 2015. Our outcomes were three binary effectiveness-of-care measures: prenatal care timeliness, frequency of prenatal care, and postpartum care timeliness. Pennsylvania's Managed Care Organizations (MCOs) were required to submit these outcomes to the state after reviewing administrative and medical records through a standardized, validated sampling process. We assessed for differences in outcomes by race, ethnicity, region, year, and MCO using logistic regression. Results We analyzed data for 12,228 women who were 49% White, 31% Black/African American, 4% Asian, and 15% Hispanic/Latina. Compared to Black/African American women, white and Asian women had higher odds of prenatal and postpartum care. Hispanic/Latina women had higher frequency of prenatal care than non-Hispanic women. Pennsylvania's Southeast had lower prenatal care and Northwest had lower postpartum care than other regions. Prenatal care significantly decreased in 2014 and increased in 2015. We observed differences between MCOs, and as MCO performance diminished, racial disparities within each plan widened. We explored hypotheses for observed disparities in secondary analyses. Conclusions for Practice Our data demonstrate that interventions should address disparities by race, region, and MCO in equity-promoting measures.

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

    Directory of Open Access Journals (Sweden)

    Takahashi PY

    2014-07-01

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

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

    Science.gov (United States)

    Essary, Alison C; Wade, Nathaniel L

    2016-01-01

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

  10. The influence of personal and group racism on entry into prenatal care among African American women.

    Science.gov (United States)

    Slaughter-Acey, Jaime C; Caldwell, Cleopatra H; Misra, Dawn P

    2013-01-01

    Racism has been hypothesized as a barrier to accessing health care. No quantitative study has directly assessed its influence on women's initiation of prenatal care (PNC). We examined the relationship between PNC entry and experiences of personal and group racism among low-income, African-American (AA) women. We also examined whether the use of denial of racism as a coping mechanism was associated with a delay in accessing PNC. Using a prospective/retrospective cohort design we collected data from 872 AA women (prenatally, n = 484; postpartum, n = 388). Multinomial logistic regression was used to assess the relationship between the overall denial of racism index and PNC initiation. PNC entry was not associated with personal experiences of racism (p = .33); it was significantly associated with group experiences (p racism experienced by other AAs was a barrier to early PNC among low-income, AA women. Delayed access to PNC may be rooted in the avoidance of racialized experiences among less empowered women when faced with discrimination. Our findings have important implication for the engagement of AA women into the PNC delivery system and the health care system postpartum. Copyright © 2013 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  11. Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions.

    Science.gov (United States)

    Isenberg, Sarina R; Lu, Chunhua; McQuade, John; Chan, Kelvin K W; Gill, Natasha; Cardamone, Michael; Torto, Deirdre; Langbaum, Terry; Razzak, Rab; Smith, Thomas J

    2017-05-01

    Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014. This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%. The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (-25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings. The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.

  12. A pilot videoconference group stress management program in cancer survivors: lessons learned.

    Science.gov (United States)

    Zhou, Eric S; Partridge, Ann H; Blackmon, Jaime E; Morgan, Evan; Recklitis, Christopher J

    2016-01-01

    Cancer is a challenging experience and there is evidence that psychosocial interventions are effective at improving adjustment following treatment. At our cancer center, 14 cancer survivors (breast, prostate and blood cancers) completed a four-session cognitive-behavioral stress program. The first session was delivered at the survivor's local cancer center, where they were provided with a loaner tablet. The three subsequent sessions were delivered through group-based videoconference on the tablet. Session content was supplemented with a tailored ebook, designed specifically for this program. Participants provided feedback about the program as well as a standardized measure of perceived stress. Despite evidence that psychosocial programs are effective, there are significant barriers to dissemination, particularly for those residing in rural areas who do not live near academic medical centers where such programming is more readily available. Our experiences delivering a group-based videoconference program in cancer survivors are described, including positives and challenges associated with its design and implementation. Study participants enrolled from across four different US states, and the majority reported at least a 30-minute commute to their cancer center. This travel burden played a meaningful role in their desire to participate in our videoconference-based program. Although participants reported that session content was well suited to addressing stress management concerns, and session facilitators were able to effectively teach program techniques (eg progressive muscle relaxation, cognitive-reframing) and that the program was helpful overall, only modest improvements in perceived stress were seen. Participants noted challenges of the delivery including feeling disconnected from others, difficulty focusing, technical problems, and a desire for a longer program. Thus, although the novel delivery of a group-based, psychosocial program using tablet

  13. The Effect of a Personalized Dementia Care Intervention for Caregivers From Australian Minority Groups.

    Science.gov (United States)

    Xiao, Lily Dongxia; De Bellis, Anita; Kyriazopoulos, Helena; Draper, Brian; Ullah, Shahid

    2016-02-01

    Most caregiver interventions in a multicultural society are designed to target caregivers from the mainstream culture and exclude those who are unable to speak English. This study addressed the gap by testing the hypothesis that personalized caregiver support provided by a team led by a care coordinator of the person with dementia would improve competence for caregivers from minority groups in managing dementia. A randomised controlled trial was utilised to test the hypothesis. Sixty-one family caregivers from 10 minority groups completed the trial. Outcome variables were measured prior to the intervention, at 6 and 12 months after the commencement of trial. A linear mixed effect model was used to estimate the effectiveness of the intervention. The intervention group showed a significant increase in the caregivers' sense of competence and mental components of quality of life. There were no significant differences in the caregivers' physical components of quality of life. © The Author(s) 2015.

  14. Strong Military Families Program: A Multifamily Group Approach to Strengthening Family Resilience

    Science.gov (United States)

    Rosenblum, Kate; Muzik, Maria; Waddell, Rachel; Thompson, Stephanie; Rosenberg, Lauren; Masini, Gabriella; Smith, Karen

    2015-01-01

    Military families frequently display remarkable resilience in the face of significant challenges, and yet deployment and parental separation are significant stressors for parents, particularly those with infants and young children. The Strong Military Families preventive intervention is a multifamily parenting and self-care skills group that aims…

  15. Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

    Science.gov (United States)

    Wallace, Cara L

    2016-08-01

    This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.

  16. Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group.

    Science.gov (United States)

    Ma, Irene W Y; Arishenkoff, Shane; Wiseman, Jeffrey; Desy, Janeve; Ailon, Jonathan; Martin, Leslie; Otremba, Mirek; Halman, Samantha; Willemot, Patrick; Blouw, Marcus

    2017-09-01

    Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs. We recommend four POCUS applications for the core PGY 1-3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4-5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.

  17. [Do gatekeeping programs increase equality of health care in Germany? A comparison of the health care situation of participants and nonparticipants].

    Science.gov (United States)

    Schnitzer, S; Balke, K; Walter, A; Litschel, A; Kuhlmey, A

    2011-08-01

    This article compares the health care situation of participants in programs of general practitioner-centered health care (gatekeeping) in Germany (participants) with that of statutory health insurance holders who are not participating in such programs (nonparticipants). Because a key objective of the general practitioner model is to reduce the number of visits to specialists, the article also examines factors influencing frequent utilization of specialists in both groups. The analysis draws on a survey conducted by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, 2010) based on a sample representative of the German population. In this context, 5,232 holders of statutory health insurance aged between 18 and 79 years were interviewed on health care policy issues. The results show that regulating the utilization of specialists through the gatekeeping function of general practitioners succeeds in facilitating similar utilization rates across educational levels, between cities and towns, and between men and women. Thus, gatekeeping programs contribute to the reduction of health care inequalities.

  18. Parental Decision Making about Technology and Quality in Child Care Programs

    Science.gov (United States)

    Rose, Katherine K.; Vittrup, Brigitte; Leveridge, Tinney

    2013-01-01

    Background: This study investigated parental decision making about non-parental child care programs based on the technological and quality components of the program, both child-focused and parent-focused. Child-focused variables related to children's access to technology such as computers, educational television programming, and the internet.…

  19. Security, Dignity, Caring Relationships, and Meaningful Work: Needs Motivating Participation in a Job-Training Program

    Science.gov (United States)

    Ayers, David F.; Miller-Dyce, Cherrel; Carlone, David

    2008-01-01

    Researchers asked 17 participants in a job-training program to describe their personal struggles following an economic restructuring. Examined through a critical theoretical lens, findings indicate that the learners enrolled in the program to reclaim security, dignity, meaningful work, and caring relationships. Program planners at community…

  20. Impact of the Group Lifestyle Balance (GLB) Program on Diabetes Prevention in the Military Health System

    Science.gov (United States)

    2016-05-20

    program completers and changes in metabolic surrogates of disease prevalence. Conditions of interest were prediabetes , obesity, and metabolic...syndrome. Adults~ 1 Byrs with a BMI ~ 25 kg/m2, prediabetes , or metabolic syndrome (metS) were primary care provider and self-referred to GLB. Classes...prevalence: prediabetes 90.6%, obesity 56.1 %, and metabolic syndrome 33.3%. Change from baseline was compared at the end of 12 weeks. Overall, 52% of all

  1. Complications and Outcome of Pregnancy in Extremes of Reproductive Age Groups: Experience at Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Manju Lata Verma

    2016-09-01

    Full Text Available Background Pregnant women of extremes of reproductive age group at both ends ( 35 years age comprise high risk groups. Pregnant women up to 35 years get many complications like diabetes, spontaneous abortion, hypertensive disorders, autosomal trisomies, increased newborn and maternal morbidity and mortality and cesarean sections. Pregnancies of 35 year age group and to compare both the groups. Methods This retrospective study was done at department of obstetrics and gynaecology, Chatrapati Shahuji Maharaj Medical University, Lucknow, from January 2010 to December 2010. Data were collected from institutional logbook and various complications and outcome were studied. Statistical analyses were carried out by using the statistical package for SPSS-15. Results Present study showed that the definite increased risk of preeclampsia, eclampsia, obstetric cholestasis, twin gestation, anemia, preterm labor, premature rupture of membranes, intrauterine fetal growth restriction, and intrauterine fetal death in adolescent pregnancies and increased risk of eclampsia, diabetes, and cesarean sections in advanced age pregnancies. Conclusions Both adolescent and advanced age groups are high risk pregnancy groups so for best reproductive outcome, pregnancies at these ages should be very carefully supervised with both good maternal and fetal surveillance to achieve best maternal and fetal results.

  2. The Expanding Role of Managed Care in the Medicaid Program

    Science.gov (United States)

    Caswell, Kyle J.; Long, Sharon K.

    2015-01-01

    States increasingly use managed care for Medicaid enrollees, yet evidence of its impact on health care outcomes is mixed. This research studies county-level Medicaid managed care (MMC) penetration and health care outcomes among nonelderly disabled and nondisabled enrollees. Results for nondisabled adults show that increased penetration is associated with increased probability of an emergency department visit, difficulty seeing a specialist, and unmet need for prescription drugs, and is not associated with reduced expenditures. We find no association between penetration and health care outcomes for disabled adults. This suggests that the primary gains from MMC may be administrative simplicity and budget predictability for states rather than reduced expenditures or improved access for individuals. PMID:25882616

  3. College students’ perceptions of a caring climate in group physical activity classes

    Directory of Open Access Journals (Sweden)

    Newland Aubrey

    2017-02-01

    Full Text Available Study aim: Research suggests that physical activity rates decline sharply after high school. The pattern of activity or inactivity during college tends to persist into adulthood. A critical need exists for examination of strategies to engage college-age students in physical activity habits. One way to do this is through physical activity courses offered in colleges. This study examines the relationship between perceptions of a caring psychological climate and group connectedness, enjoyment, and attitudes toward classmates and the instructor in group physical activity courses. Material and methods: Participants were 174 students (107 males and 67 females; Mage = 21.71 enrolled in exercise, martial arts, and sports courses at a large university in the Mountain West. Results: Perceptions of a caring climate were significantly related to enhanced feelings of group connectedness, heightened enjoyment, and more positive attitudes toward classmates and instructor. Discussion: These findings suggest that a strategy to foster engagement in physical activity courses on campus is to train instructors to value, support, and welcome students.

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

    Directory of Open Access Journals (Sweden)

    Cantón Sonia

    2010-07-01

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

  5. Group program procedure for machining seal rings of steam turbines on digital computer controlled machines

    International Nuclear Information System (INIS)

    Glukhikh, V.K.; Skvortsov, S.B.; Sidorov, V.A.

    1982-01-01

    Developed is a group program procedure for turning machining of seal rings, including the use of new progressive high-accuracy equipment, universal device for securing of all nomenclature of treated seal rings, necessary cutting tools and program control of the process of treatment. Introduction of a new technological process permitted to improve the quality of treated seal rings; to reduce the labour consumption in 30...40% [ru

  6. Provision of Oral Health Care to Children under Seven Covered by Bolsa Família Program. Is This a Reality?

    Science.gov (United States)

    Petrola, Krishna Andréia Feitosa; Bezerra, Ítalo Barroso; de Menezes, Érico Alexandro Vasconcelos; Calvasina, Paola; Saintrain, Maria Vieira de Lima; Pimentel G F Vieira-Meyer, Anya

    2016-01-01

    Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Família Program, the Brazilian conditional cash transfer program (Bolsa Família Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Família Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Família Program health conditionalities (Bolsa Família Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Família Program. A pretested questionnaire included sociodemographic, Bolsa Família Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Família Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Família Program because they felt it was beyond their responsibilities. Nearly all Bolsa Família Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Família Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Família Program. Children in the routine care setting were more often referred

  7. Barriers to care and service needs among chronically homeless persons in a housing first program.

    Science.gov (United States)

    Parker, R David; Albrecht, Helmut A

    2012-01-01

    In 2010, more than 600,000 people in the United States experienced homelessness. Efficient and cost-effective housing methods that reduce homelessness need to be implemented. Housing Ready programs are the standard method that often has set requirements including earned income and sobriety, among others. These programs enable a subset of the homeless to become housed. However, chronically homeless persons, who use the most resources, are often not successful at enrollment or maintaining enrollment. Housing First (H1) is a method focusing on chronically homeless persons. Housing First places a client in housing and provides services after stabilization. This article assessed differences between chronically homeless persons in a H1 program and chronically homeless persons who are not in H1. A case-control study imbedded within a homeless service program collected sociodemographic and service variables, including access and barriers to care. Although the sample was 100% native English speaking, 22% of homeless persons reported that their providers do not speak their same language. All (100%) of participants had a disabling condition under HUD guidelines, but only 17.78% of homeless controls reported having a disabling condition. There were no differences on housing status based on income, gender, race, or age. The lack of differences between these groups indicates that a H1 program can be a clear derivation from the more common Housing Ready programs that have specific requirements for participation. Provider communication may negatively impact an individual's ability to transition from homelessness. Furthermore, chronically homeless persons not in intensive case management are less likely to understand the eligibility requirements for housing and, therefore, self-disqualify because of this lack of knowledge. Intentional communication and education for chronically homeless persons are 2 examples where case managers could improve the ability of the chronically homeless

  8. Multifamily group treatment in a program for patients with first-episode psychosis

    DEFF Research Database (Denmark)

    Fjell, Anne; Bloch Thorsen, Gerd Ragna; Friis, Svein

    2007-01-01

    Psychoeducational multifamily group treatment based on the McFarlane model was implemented for adult patients experiencing a first episode of psychosis and for the families of 301 patients. Patients were participants in a research project in Norway and Denmark. Of 301 patients 246 were invited...... to participate and 147 agreed. Patients' reluctance to participate increased with age. Most had to wait between six and 12 months until a sufficient number was gathered to start a group. Treatment was well received by patients and families. Care should be taken to prevent a long delay before group commencement...... at this stressful period in the lives of patients and families....

  9. GRUCAL: a program system for the calculation of macroscopic group constants

    International Nuclear Information System (INIS)

    Woll, D.

    1984-01-01

    Nuclear reactor calculations require material- and composition-dependent, energy-averaged neutron physical data in order to decribe the interaction between neutrons and isotopes. The multigroup cross section code GRUCAL calculates these macroscopic group constants for given material compositions from the material-dependent data of the group constant library GRUBA. The instructions for calculating group constants are not fixed in the program, but are read in from an instruction file. This makes it possible to adapt GRUCAL to various problems or different group constant concepts

  10. Process evaluation of a stepped-care program to prevent depression in primary care: patients' and practice nurses' experiences.

    Science.gov (United States)

    Pols, Alide D; Schipper, Karen; Overkamp, Debbie; van Dijk, Susan E; Bosmans, Judith E; van Marwijk, Harm W J; Adriaanse, Marcel C; van Tulder, Maurits W

    2017-02-23

    motivated to participate in scientific research rather than their intrinsic need to improve depressive symptoms. Additionally, various practice nurses preferred offering individually based therapy over pre-determined interventions in a protocolled sequence and somatic practice nurses expressed a lack of competence to recognise and treat mental health problems. This study demonstrates both the benefits and unique demands of programs such as Step-Dep. The appointed facilitators and barriers could guide the development of future studies aiming to prevent depression in similar patient groups.

  11. The Effect of Group Counseling on Physiological Aspect of Self-care and HbA1C Level of Patients with Diabetes Type II

    Directory of Open Access Journals (Sweden)

    Seyedreza Mazlom

    2015-06-01

    Full Text Available Background: The most important underlying cause of death in diabetic patients is poor self-care. The effect of education on self-care promotion has been widely investigated; however, the advisory role and impact of the treatment team have been scarcely investigated.  Aim: Determining the effect of group counseling on the psychological aspect of self-care and level of glycosylated hemoglobin in the patients with diabetes type II. Methods: In a randomized clinical trial, 73 patients with type II diabetes mellitus, who had been referred to Parsian Diabetes clinic of Mashhad in 2014, were divided into two groups of intervention and control. The group counseling program was performed in five 1.5-hour sessions with 3-day intervals, and each groups consisted of 8 to 10 people. The content of the meetings was problems in nutrition, exercise, diabetes mellitus disease, diabetes-related mental health problems, diabetes medications, and self-control of blood glucose. Researcher-made diabetes care questionnaire was filled and HbA1c test was measured before and two months after the intervention. Data were analyzed by SPSS version 11.5 using paired sample and independent t-tests. Results: In this study,27.3 percent of the subjects were male and 72.7 were female with the mean age of 49.1 ± 8.3. The scores of physiological aspect of self-care and HbA1C of the diabetic patients before the intervention was not significantly different between the groups; but in the post-intervention phase, the self-care in intervention group (49.1±5.8 significantly increased compared to the control group (31.8±12.2 (p

  12. The emotional intelligence of a group of critical-care nurses in South Africa

    Directory of Open Access Journals (Sweden)

    Amanda Towell

    2013-11-01

    Full Text Available Critical-care nurses often look after three or more critically-ill patients during a shift. The workload and emotional stress can lead to disharmony between the nurse’s body, mind and spirit. Nurses with a high emotional intelligence have less emotional exhaustion and psychosomatic symptoms; they enjoy better emotional health; gain more satisfaction from their actions (both at work and at home; and have improved relationships with colleagues at work. The question arises: what is the emotional intelligence of critical-care nurses? A quantitative survey was conducted. The target population was registered nurses working in critical-care units who attended the Critical Care Congress 2009 (N = 380. Data were collected with the use of the Trait Emotional Intelligence Short Form and analysed using the Statistical Package for the Social Sciences software. The sample (n = 220 was mainly a mature, female and professionally-experienced group of registered nurses. They held a variety of job descriptions within various critical-care units. Statistics indicated that the standard deviations were small and no aberrant aspects such as demographics skewed the findings. The conclusion was made that registered nurses who are older and that have more experience in critical care appear to have a higher range of emotional intelligence. Kritiekesorg-verpleegkundiges verpleeg dikwels drie of meer pasiënte wat kritiek siek is, tydens een skof. Die werkslading kan tot emosionele spanning ly wat ’n wanbalans tussen die liggaam, siel en gees van die verpleegkundiges laat ontstaan. Verpleekundiges met ’n hoë emosionele intelligensie ondervind minder emosionele uitbranding en psigosomatiese symptome. Hulle toon ’n beter emosionele gesondheid, ervaar meer werks- en tuisbevrediging en het beter verhoudings met hulle kollegas. The vraag wat ontstaan is ‘wat is die emosionel intelligensie van kritieksorg-verpleegkundiges?’ Die toeganglike populasie (N = 380 was

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

    Directory of Open Access Journals (Sweden)

    L M G Steuten

    2008-12-01

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

  14. Evaluation of a multi-site program designed to strengthen relational bonds for siblings separated by foster care.

    Science.gov (United States)

    Waid, Jeffrey; Wojciak, Armeda Stevenson

    2017-10-01

    Sibling relationships in foster care settings have received increased attention in recent years. Despite growing evidence regarding the protective potential of sibling relationships for youth in care, some sibling groups continue to experience foster care related separation, and few programs exist to address the needs of these youth. This study describes and evaluates Camp To Belong, a multi-site program designed to provide short-term reunification to separated sibling groups through a week-long summer camp experience. Using a pre-test post-test survey design, this paper examines changes in youth ratings of sibling conflict and sibling support across camps located in six geographically distinct regions of the United States. The effects of youth age, number of prior camp exposures, and camp location were tested using multilevel modeling procedures. Findings suggest that participation in Camp To Belong may reduce sibling conflict, and improvements in sibling support are noted for youth who have had prior exposure to the camp's programming. Camp-level variance in the sibling support outcome highlight the complex nature of relationships for siblings separated by foster care, and suggest the need for additional research. Lessons learned from this multi-site evaluation and future directions are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. An Analysis of the Child and Adult Care Food Programs in Child Care Centers

    National Research Council Canada - National Science Library

    Kapur, Kanika

    1999-01-01

    ...) that provides healthy meals and snacks in child and adult day care facilities. This report uses the Cost, Quality and Child Outcomes study to analyze the characteristics of three types of child care centers: (1...

  16. Use of a student support group to reduce student stress in a nurse anesthesia program.

    Science.gov (United States)

    Kless, J R

    1989-02-01

    Stress in nurse anesthesia programs may be excessive at times, especially in new students. While some degree of stress is necessary to motivate learning, excessive or prolonged stress can interfere with the normal learning process, thereby prolonging a student's clinical and academic progress. In the extreme, excessive stress may even preclude a student's successful completion of the educational program. Active faculty intervention through a student support group is advocated as a method for controlling stress levels and facilitating student learning. The positive effects of such intervention also increase the overall productivity of a program and better prepare nurse anesthesia students for their future careers.

  17. Hanford Site guide for preparing and maintaining generator group pollution prevention program documentation

    International Nuclear Information System (INIS)

    Place, B.G.

    1998-01-01

    This document provides guidance to generator groups for preparing and maintaining documentation of Pollution Prevention Waste Minimization (P2/WMin) Program activities. The guidance is one of a hierarchical series that includes the Hanford Site Waste Minimization and Pollution Prevention Awareness Program Plan (DOE-RL, 1998a) and Prime contractor implementation plans describing programs required by Resource Conservation and Recovery Act of 1976 (RCRA) 3002(b) and 3005(h) (RCRA and EPA, 1994). Documentation guidance for the following five P2/WMin elements are discussed: Fiscal Year (FY) Goals; Budget and Staffing; Waste Minimization (WMin) Assessments (WMAs); Quarterly Pollution Prevention (P2) Reporting WMin Certification

  18. Hanford Site Guide for Preparing and Maintaining Fenerator Group Pollution Prevention Program Documentation

    International Nuclear Information System (INIS)

    PLACE, B.G.

    1999-01-01

    This document provides guidance to generator groups for preparing and maintaining documentation of Pollution Prevention/Waste Minimization (P2/WMin) Program activities. The guidance is one of a hierarchical series that includes the Hanford Site Waste Minimization and Pollution Prevention Awareness Program Plan (DOE-RL, 1998a) and Prime Contractor implementation plans describing programs required by Resource Conservation and Recovery Act of 1976 (RCRA) 3002(b) and (300501) (RCRA and EPA, 1994). Documentation guidance for the following five P2/WMin elements are discussed: Fiscal Year (FY) Goals; Budget and Staffing; Waste Minimization (WMinn ) Assessments (WMAs); Pollution Prevention (P2) Reporting; WMin Certification

  19. Monitoring Resource Utilization in a Health Care Coordination Program.

    Science.gov (United States)

    Popejoy, Lori L; Jaddoo, Julie; Sherman, Jan; Howk, Christopher; Nguyen, Raymond; Parker, Jerry C

    2015-01-01

    This initial article describes the development of a health care coordination intervention and documentation system designed using the Agency for Healthcare Research and Quality (AHRQ) Care Coordination Atlas framework for Centers for Medicare & Medicaid-funded innovation project, Leveraging Information Technology to Guide High-Tech, High-Touch Care (LIGHT). The study occurred at an academic medical center that serves 114 counties. Twenty-five registered nurse care managers (NCMs) were hired to work with 137 providers in 10 family community and internal medicine clinics. Patients were allocated into one of the four tiers on the basis of their chronic medical conditions and health care utilization. Using a documentation system on the basis of the AHRQ domains developed for this study, time and touch data were calculated for 8,593 Medicare, Medicaid, or dual-eligible patients. We discovered through the touch and time analysis that the majority of health care coordination activity occurred in the AHRQ domains of communication, assess needs and goals, and facilitate transitions, accounting for 79% of the NCM time and 61% of the touches. As expected, increasing tier levels resulted in increased use of NCM resources. Tier 3 accounted for roughly 16% of the patients and received 159 minutes/member (33% of total minutes), and Tier 4 accounted for 4% of patients and received 316 minutes/member (17% of all minutes). In contrast Tier 2, which did not require routine touches per protocol, had 5,507 patients (64%), and those patients received 5,246 hours of health care coordination, or 57 minutes/member, and took 48% of NCM time. 1. The AHRQ Care Coordination Atlas offered a systematic way to build a documentation system that allowed for the extraction of data that was used to calculate the amount of time and the number of touches that NCMs delivered per member. 2. Using a framework to systematically guide the work of health care coordination helped NCMs to think strategically

  20. Assessing the efficacy of advancing underrepresented minority groups through AGU's Student Programs

    Science.gov (United States)

    Marasco, L.; Hurtado, C.; Gottschall, H.; Meisenhelder, K.; Hankin, E. R.; Harwell, D. E.

    2017-12-01

    The American Geophysical Union (AGU) strives to cultivate a diverse and inclusive organization that uses its position to build the global talent pool in Earth and space science. To cultivate a diverse talent pool, AGU must also foster a diverse student member population. The two largest AGU programs serving students are the Outstanding Student Paper Award (OSPA) and the Student Grants programs. OSPA allows students to practice their presentation skills and receive valuable feedback from experienced scientists. Over 3,000 students participated in OSPA at Fall Meeting 2016. The Student Grants program includes a suite of 14 travel and research grant opportunities. Over 2,000 students applied for grant opportunities in 2016 and 246 grants and fellowships were awarded. The OSPA and Student Grants programs also engage non-student members through volunteering opportunities for program roles, such as OSPA judge or grant reviewer. This presentation will look at the temporal participation trends of underrepresented minority groups in AGU's OSPA and Student Grants programs. The participation of underrepresented minority groups will also be compared before and after the implementation of policy changes to the Student Grants program in 2012.

  1. Efektifitas Penerapan Program Penanganan Turnover Karyawan Staf Manajemen PT. BEHAESTEX Group

    Directory of Open Access Journals (Sweden)

    Ratna Juita

    2015-12-01

    Full Text Available The purpose of this research are to recognize turnover management program implementation effectiveness of management staffs of PT. BEHAESTEX Group and know the causes aspect the employee who leave out then program that given is the target precise. This research used qualitative method with qualitative descriptive research type. Information digging by in depth interview, observation, and documentation taken from HRD data. Research subjects as 18 respondents obtained from staff employee who already terminated from PT. BEHAESTEX Group since 2010 until 2012 and represented each department. The result of the research indicates that effective turnover management program only one program that is employee training. While three other programs that are induction and orientation, coaching and counseling, building and brainstorming ineffective. The causes are the aim does not appropriate, human resources development qualification as program implementer is lack of competence and inconsistency program implementation. Beside found that the causes aspect which result employee terminated could be classified with work term under two years namely unable to adjustment with corporate culture, high idealism and accepted as civil servant. While work term over two years the causes are injustice pay, superior mind pattern still departmental and career stage is unobvious.

  2. Study to validate the outcome goal, competencies and educational objectives for use in intensive care orientation programs.

    Science.gov (United States)

    Boyle, M; Butcher, R; Kenney, C

    1998-03-01

    Intensive care orientation programs have become an accepted component of intensive care education. To date, however, there have been no Australian-based standards defining the appropriate level of competence to be attained upon completion of orientation. The aim of this study was to validate a set of aims, competencies and educational objectives that could form the basis of intensive care orientation and which would ensure an outcome standard of safe and effective practice. An initial document containing a statement of the desired outcome goal, six competency statements and 182 educational objectives was developed through a review of the orientation programs developed by the investigators. The Delphi technique was used to gain consensus among 13 nurses recognised for their expertise in intensive care education. The expert group rated the acceptability of each of the study items and provided suggestions for objectives to be included. An approval rating of 80 per cent was required to retain each of the study items, with the document refined through three Delphi rounds. The final document contains a validated statement of outcome goal, competencies and educational objectives for intensive care orientation programs.

  3. Implementing the first regional hospice palliative care program in Ontario: the Champlain region as a case study.

    Science.gov (United States)

    Pereira, José; Contant, Jocelyne; Barton, Gwen; Klinger, Christopher

    2016-07-26

    Regionalization promotes planning and coordination of services across settings and providers to meet population needs. Despite the potential advantages of regionalization, no regional hospice palliative care program existed in Ontario, Canada, as of 2010. This paper describes the process and early results of the development of the first regional hospice palliative care program in Ontario. The various activities and processes undertaken and the formal agreements, policies and documents are described. A participative approach, started in April 2009, was used. It brought together over 26 health service providers, including residential hospices, a palliative care unit, community and hospital specialist consultation teams, hospitals, community health and social service agencies (including nursing), individual health professionals, volunteers, patients and families. An extensive stakeholder and community vetting process was undertaken that included work groups (to explore key areas such as home care, the hospital sector, hospice and palliative care unit beds, provision of care in rural settings, e-health and education), a steering committee and input from over 320 individuals via e-mail and town-halls. A Transitional Leadership Group was elected to steer the implementation of the Regional Program over the summer of 2010. This group established the by-laws and details regarding the governance structure of the Regional Program, including its role, responsibilities, reporting structures and initial performance indicators that the Local Health Integration Network (LHIN) approved. The Regional Program was formally established in November 2010 with a competency-based Board of 14 elected members to oversee the program. Early work involved establishing standards and performance indicators for the different sectors and settings in the region, and identifying key clinical needs such as the establishment of more residential hospice capacity in Ottawa and a rural framework to ensure

  4. Personalized Primary Care for Older People: An evaluation of a multicomponent nurse-led care program

    NARCIS (Netherlands)

    Bleijenberg, N.

    2013-01-01

    Providing optimal care for the increasing number of frail older people with complex care needs is a major challenge in primary care. The current approach is reactive and does not meet the needs of older patients, resulting in unnecessary loss of daily functioning, suboptimal quality of life and high

  5. Improved Outcomes for Hispanic Women with Gestational Diabetes Using the Centering Pregnancy© Group Prenatal Care Model.

    Science.gov (United States)

    Schellinger, Megan M; Abernathy, Mary Pell; Amerman, Barbara; May, Carissa; Foxlow, Leslie A; Carter, Amy L; Barbour, Kelli; Luebbehusen, Erin; Ayo, Katherine; Bastawros, Dina; Rose, Rebecca S; Haas, David M

    2017-02-01

    Objective To determine the impact of Centering Pregnancy © -based group prenatal care for Hispanic gravid diabetics on pregnancy outcomes and postpartum follow-up care compared to those receiving traditional prenatal care. Methods A cohort study was performed including 460 women diagnosed with gestational diabetes mellitus (GDM) who received traditional or Centering Pregnancy © prenatal care. The primary outcome measured was completion of postpartum glucose tolerance testing. Secondary outcomes included postpartum visit attendance, birth outcomes, breastfeeding, and initiation of a family planning method. Results 203 women received Centering Pregnancy © group prenatal care and 257 received traditional individual prenatal care. Women receiving Centering Pregnancy © prenatal care were more likely to complete postpartum glucose tolerance testing than those receiving traditional prenatal care, (83.6 vs. 60.7 %, respectively; p prenatal care (30.2 vs. 42.1 %; p = 0.009), and were less likely to undergo inductions of labor (34.5 vs. 46.2 %; p = 0.014). When only Hispanic women were compared, women in the Centering group continued to have higher rates of breastfeeding and completion of postpartum diabetes screening. Conclusion for Practice Hispanic women with GDM who participate in Centering Pregnancy © group prenatal care may have improved outcomes.

  6. The Effect of Barkley's family-oriented program on the burden of care on families of children with attention deficit-hyperactive disorder

    Directory of Open Access Journals (Sweden)

    Sharifeh Mousavi

    2017-01-01

    Full Text Available Background: Attention deficit-hyperactive disorder (ADHD is the most common behavioral disorders during childhood whose treatment is greatly dependent on families; therefore, families of such children should improve their relation with them so that they could enjoy their lives. Hence, this study was conducted to evaluate the effect of Barkley's family-oriented program on the burden of care on such families. Materials and Methods: This clinical trial was conducted among 64 family care givers for children with ADHD. By simple sampling, samples passing the inclusion criteria were selected and randomly allocated into two groups of control and intervention. The intervention group received Barkley's family education program through 9 sessions; the control group participated in 3 group sessions and expressed their problems and experiences. Data were collected and analyzed using the Zarit Burden Interview. Results: Burden of care was gradually reduced through the study in the intervention group, however, the mean score of burden of care did not have a significant reduction in the control group. Conclusions: Because Barkley's family-oriented program was able to reduce the burden of care in families of children with ADHD, it is recommended to develop similar programs and evaluate them through various studies.

  7. Clinical outcomes of an early intervention program for preschool children with Autism Spectrum Disorder in a community group setting.

    Science.gov (United States)

    Eapen, Valsamma; Crnčec, Rudi; Walter, Amelia

    2013-01-07

    Available evidence indicates that early intervention programs, such as the Early Start Denver Model (ESDM), can positively affect key outcomes for children with Autism Spectrum Disorder (ASD). However, programs involving resource intensive one-to-one clinical intervention are not readily available or deliverable in the community, resulting in many children with ASD missing out on evidence-based intervention during their early and most critical preschool years. This study evaluated the effectiveness of the ESDM for preschool-aged children with ASD using a predominantly group-based intervention in a community child care setting. Participants were 26 children (21 male) with ASD with a mean age of 49.6 months. The ESDM, a comprehensive early intervention program that integrates applied behaviour analysis with developmental and relationship-based approaches, was delivered by trained therapists during the child's attendance at a child care centre for preschool-aged children with ASD. Children received 15-20 hours of group-based, and one hour of one-to-one, ESDM intervention per week. The average intervention period was ten months. Outcome measures were administered pre- and post-intervention, and comprised a developmental assessment - the Mullen Scales of Early Learning (MSEL); and two parent-report questionnaires - the Social Communication Questionnaire (SCQ) and Vineland Adaptive Behaviours Scales-Second Edition (VABS-II). Statistically significant post-intervention improvements were found in children's performance on the visual reception, receptive language and expressive language domains of the MSEL in addition to their overall intellectual functioning, as assessed by standardised developmental quotients. Parents reported significant increases in their child's receptive communication and motor skills on the VABS-II, and a significant decrease in autism-specific features on the SCQ. These effects were of around medium size, and appeared to be in excess of what may

  8. German diabetes management programs improve quality of care and curb costs.

    Science.gov (United States)

    Stock, Stephanie; Drabik, Anna; Büscher, Guido; Graf, Christian; Ullrich, Walter; Gerber, Andreas; Lauterbach, Karl W; Lüngen, Markus

    2010-12-01

    This paper reports the results of a large-scale analysis of a nationwide disease management program in Germany for patients with diabetes mellitus. The German program differs markedly from "classic" disease management in the United States. Although it combines important hallmarks of vendor-based disease management and the Chronic Care Model, the German program is based in primary care practices and carried out by physicians, and it draws on their personal relationships with patients to promote adherence to treatment goals and self-management. After four years of follow-up, overall mortality for patients and drug and hospital costs were all significantly lower for patients who participated in the program compared to other insured patients with similar health profiles who were not in the program. These results suggest that the German disease management program is a successful strategy for improving chronic illness care.

  9. Experiences with recruitment of marginalized groups in a Danish health promotion program

    DEFF Research Database (Denmark)

    Rasmussen, Marianne; Poulsen, Eva Kanstrup; Rytter, Anne Stoffersen

    2016-01-01

    neighborhoods across Denmark between 2010 and 2014. The aim of this study was to understand how recruitment approaches could promote participation in health programs within deprived neighborhoods to reach marginalized groups. METHOD: Documents from all 12 of the included municipalities were collected to conduct......BACKGROUND: Studies have found that marginalized groups living in deprived neighborhoods are less likely to participate in health programs compared to the majority of society. This study evaluates recruitment approaches conducted during a national government-funded project in 12 deprived...... have developed evaluations related to recruitment, and only three evaluations provided a description of which marginalized groups were recruited. Challenges related to recruitment consist of difficulties involving the target group, including general distrust, language barriers and a lack of ability...

  10. Development of a Temperature Programmed Identification Technique to Characterize the Organic Sulphur Functional Groups in Coal

    Directory of Open Access Journals (Sweden)

    Moinuddin Ghauri

    2017-06-01

    Full Text Available The Temperature Programmed Reduction (TPR technique is employed for the characterisation of various organic sulphur functional groups in coal. The TPR technique is modified into the Temperature Programmed Identification technique to investigate whether this method can detect various functional groups corresponding to their reduction temperatures. Ollerton, Harworth, Silverdale, Prince of Wales coal and Mequinenza lignite were chosen for this study. High pressure oxydesulphurisation of the coal samples was also done. The characterization of various organic sulphur functional groups present in untreated and treated coal by the TPR method and later by the TPI method confirmed that these methods can identify the organic sulphur groups in coal and that the results based on total sulphur are comparable with those provided by standard analytical techniques. The analysis of the untreated and treated coal samples showed that the structural changes in the organic sulphur matrix due to a reaction can be determined.

  11. Neurocritical care education during neurology residency: AAN survey of US program directors.

    Science.gov (United States)

    Sheth, K N; Drogan, O; Manno, E; Geocadin, R G; Ziai, W

    2012-05-29

    Limited information is available regarding the current state of neurocritical care education for neurology residents. The goal of our survey was to assess the need and current state of neurocritical care training for neurology residents. A survey instrument was developed and, with the support of the American Academy of Neurology, distributed to residency program directors of 132 accredited neurology programs in the United States in 2011. A response rate of 74% (98 of 132) was achieved. A dedicated neuroscience intensive care unit (neuro-ICU) existed in 64%. Fifty-six percent of residency programs offer a dedicated rotation in the neuro-ICU, lasting 4 weeks on average. Where available, the neuro-ICU rotation was required in the vast majority (91%) of programs. Neurology residents' exposure to the fundamental principles of neurocritical care was obtained through a variety of mechanisms. Of program directors, 37% indicated that residents would be interested in performing away rotations in a neuro-ICU. From 2005 to 2010, the number of programs sending at least one resident into a neuro-ICU fellowship increased from 14% to 35%. Despite the expansion of neurocritical care, large proportions of US neurology residents have limited exposure to a neuro-ICU and neurointensivists. Formal training in the principles of neurocritical care may be highly variable. The results of this survey suggest a charge to address the variability of resident education and to develop standardized curricula in neurocritical care for neurology residents.

  12. Reducing legal fees in medical group practices. The role of health care alternative dispute resolution.

    Science.gov (United States)

    Joseph, D M

    1995-01-01

    Conflict is a growth industry, particularly in an increasingly complex health care system. Litigation is the most common, and most costly, method of settling health care disputes. Highly adversarial, the process of litigation often generates as much, if not more, hostility than the original dispute. In addition, satisfaction with the outcome is very low. The challenge that has arisen is to manage the conflicts so that the underlying needs and interests of all the parties can best be met. Often the techniques and processes of alternative dispute resolution (ADR) can be successfully used in resolving these sorts of conflicts quickly, cheaply and with greater satisfaction for all parties. Various applications of ADR are currently being used or tested in a variety of health care disputes in the United States and Canada. Tremendous success has been achieved in mediating medical malpractice claims, medical staff disputes, economic credentialing conflicts, insurer relations issues and denial of coverage disputes. Professional relations and departmental staff disputes, partnership and employee conflicts, and organizational disputes within clinics, HMOs and large group practices have all been found particularly amenable to ADR. These are all situations in which everyone benefits from quick, non-hostile resolutions and on-going relationships can continue.

  13. Children of mentally ill parents—a pilot study of a group intervention program

    OpenAIRE

    Christiansen, Hanna; Anding, Jana; Schrott, Bastian; Röhrle, Bernd

    2015-01-01

    Objective: The transgenerational transmission of mental disorders is one of the most prominent risk factors for the development of psychological disorders. Children of mentally ill parents are a vulnerable high risk group with overall impaired development and high rates of psychological disorders. To date there are only a few evidence based intervention programs for this group overall and hardly any in Germany. We translated the evidence based Family Talk Intervention by Beardslee (2009) and ...

  14. Investing in organisational culture: nursing students' experience of organisational learning culture in aged care settings following a program of cultural development.

    Science.gov (United States)

    Grealish, Laurie; Henderson, Amanda

    2016-10-01

    Concerns around organisational learning culture limit nursing student placements in aged care settings to first year experiences. Determine the impact of an extended staff capacity building program on students' experiences of the organisational learning culture in the aged care setting. Pre and post-test design. A convenience sample of first, second and third year Bachelor of Nursing students attending placements at three residential aged care facilities completed the Clinical Learning Organisational Culture Survey. Responses between the group that attended placement before the program (n = 17/44; RR 38%) and the group that attended following the program (n = 33/72; RR 45%) were compared. Improvements were noted in the areas of recognition, accomplishment, and influence, with decreases in dissatisfaction. Organisational investment in building staff capacity can produce a positive learning culture. The aged care sector offers a rich learning experience for students when staff capacity to support learning is developed.

  15. Effects of individual and group exercise programs on pain, balance, mobility and perceived benefits in rheumatoid arthritis with pain and foot deformities.

    Science.gov (United States)

    do Carmo, Carolina Mendes; Almeida da Rocha, Bruna; Tanaka, Clarice

    2017-11-01

    [Purpose] To verify the effects of individual and group exercise programs on pain, balance, mobility and perceived benefits of rheumatoid arthritis patients (RA) with pain and foot deformities. [Subjects and Methods] Thirty patients with RA pain and foot deformity were allocated into two groups: G1: individual exercise program and G2: group exercise program. The variables analyzed were Numerical Rating Scale (NRS) for pain, Berg Balance Scale (BBS) for balance, Timed Up & Go Test (TUG) and Functional Reach (FR) for mobility, and Foot Health Status Questionnaire (FHSQ-Br) for perceived benefits. Both exercise programs consisted of functional rehabilitation exercises and self-care guidance aimed at reducing pain and improving balance and mobility. Intragroup comparisons of variables between A1 (pre-intervention) and A2 (post-intervention) were performed. [Results] Patients in both groups were similar in A1 (pre-intervention) in all the variables analyzed. Comparison between A1 and A2 for each variable showed improvement for G1 in the NRS, BBS, FR, TUG and in four out of ten domains of FHSQ-Br. G2 showed improvement in the NRS, BBS and eight out of ten domains of FHSQ-Br. [Conclusion] Both individual and group programs revealed benefits for patients with RA, however, group exercise programs showed better perception of benefits.

  16. Abortion-care education in Japanese nurse practitioner and midwifery programs: a national survey.

    Science.gov (United States)

    Mizuno, Maki

    2014-01-01

    While various reports have been published concerning ethical dilemmas in nursing and midwifery, and while many nurses and midwives struggle with the conflict between personal feelings raised by abortion and the duties of their position, few studies investigate the extent and conditions of abortion-care education for registered nurses (RNs) and certified nurse-midwives (CNMs) in Japan. To describe Japanese abortion-care education programs and to investigate program directors' or other relevant persons' perceptions of abortion-care education. Descriptive study was used to determine the extent of abortion-care education programs and the respondents' perceptions of abortion-care education. All 228 Japanese nursing and/or midwifery schools were invited to participate in the study. The response rate was 33.8% (n=77). Response rate varied by program type: 18.4% (n=45) for nursing programs and 29.0% (n=32) for midwifery programs. A confidential survey requesting information about curricular coverage of ten reproductive health topics related to abortion was mailed to program directors. The results show that the majority of CNM and RN programs surveyed offer didactic exposure to instruction in family planning and contraception, emergency contraception, legal considerations, and possible medical complications. However, few programs offer clinical exposure to all 10 topics. Of the respondents, 36% reported that lack of time and the low priority given to abortion-care education were issues of curriculum priority. As for educational materials, few textbooks or guidebooks exist on abortion care in Japan, and most educators use general nursing textbooks to cover this topic. Regardless of interest in or intention to provide abortion services as part of their practice, all providers of abortion-care education need to be knowledgeable about the full range of reproductive health options, including family planning and abortion, and to be able to convey this information to clients

  17. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups : A case study

    NARCIS (Netherlands)

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, H.J.M.

    2015-01-01

    Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two

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

    Science.gov (United States)

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

    2010-03-01

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

  19. Redefining diagnosis-related groups (DRGs) for palliative care - a cross-sectional study in two German centres.

    Science.gov (United States)

    Vogl, Matthias; Schildmann, Eva; Leidl, Reiner; Hodiamont, Farina; Kalies, Helen; Maier, Bernd Oliver; Schlemmer, Marcus; Roller, Susanne; Bausewein, Claudia

    2018-04-05

    Hospital costs and cost drivers in palliative care are poorly analysed. It remains unknown whether current German Diagnosis-Related Groups, mainly relying on main diagnosis or procedure, reproduce costs adequately. The aim of this study was therefore to analyse costs and reimbursement for inpatient palliative care and to identify relevant cost drivers. Two-center, standardised micro-costing approach with patient-level cost calculations and analysis of the reimbursement situation for patients receiving palliative care at two German hospitals (7/2012-12/2013). Data were analysed for the total group receiving hospital care covering, but not exclusively, palliative care (group A) and the subgroup receiving palliative care only (group B). Patient and care characteristics predictive of inpatient costs of palliative care were derived by generalised linear models and investigated by classification and regression tree analysis. Between 7/2012 and 12/2013, 2151 patients received care in the two hospitals including, but not exclusively, on the PCUs (group A). In 2013, 784 patients received care on the two PCUs only (group B). Mean total costs per case were € 7392 (SD 7897) (group A) and € 5763 (SD 3664) (group B), mean total reimbursement per case € 5155 (SD 6347) (group A) and € 4278 (SD 2194) (group B). For group A/B on the ward, 58%/67% of the overall costs and 48%/53%, 65%/82% and 64%/72% of costs for nursing, physicians and infrastructure were reimbursed, respectively. Main diagnosis did not significantly influence costs. However, duration of palliative care and total length of stay were (related to the cost calculation method) identified as significant cost drivers. Related to the cost calculation method, total length of stay and duration of palliative care were identified as significant cost drivers. In contrast, main diagnosis did not reflect costs. In addition, results show that reimbursement within the German Diagnosis-Related Groups system does not

  20. "It is our exercise family": experiences of ethnic older adults in a group-based exercise program.

    Science.gov (United States)

    Chiang, Kuan-Chun; Seman, Leslie; Belza, Basia; Tsai, Jenny Hsin-Chun

    2008-01-01

    Enhance Fitness (EF) (formerly the Lifetime Fitness Program) is an evidence-based community exercise program for older adults. From 1998 to 2005, participation of ethnic older adults increased significantly. However, little research is available about what ethnic older adults want or need to continue participation in exercise programs. The purpose of this study was to examine how physical environment, social environment, and individual biology and behavior influence adherence to exercise for ethnic older adults participating in EF. Six focus groups were conducted with 52 older adults participating in EF. Facilitators asked questions about factors that helped participants continue exercising in EF. Interviews were audiotaped and transcribed. Transcripts were systematically reviewed using content analysis. Focus group participants were Chinese (n = 21, 40%), African American (n = 18, 35%), white (n = 10, 19%), and Japanese (n = 3, 6%). Mean (SD) age was 76 years (7.4). Participants had, on average, participated in EF for 44 months (SD = 37.8). Results revealed four themes related to adherence. First, environmental factors that promoted adherence were location of the classes, transportation, weather, and the facility. Second, design of the exercise program that encouraged adherence included exercise content and type of delivery. Third, social support factors that encouraged adherence were the socializing and support between class participants and support from family, health care providers, and the class instructors. Finally, individual factors that encouraged adherence were personality traits and feelings, past physical activity experience, health benefits, and mental stimulation. Findings from this study suggest strategies for developing community-based physical activity programs for older adults from ethnically diverse communities.