Kansas Data Access and Support Center — This database comprises 28 State agency boundaries and point of contact. The Kansas Geological Survey collected legal descriptions of the boundaries for various...
U.S. Department of Health & Human Services — A list of all Home Health Agencies that have been registered with Medicare. The list includes addresses, phone numbers, and quality measure ratings for each agency.
Neal W. Tamayo
As a consultant for a government agency, this paper will design recommendations and improvements for the agency’s public personnel administration. In order to do this, the consultant has to become familiar with the agency, its departments and also understand the key factors. The department chosen from the government for this paper is the Social Security Administration (Kestenbaum, 2014).
Chamberlain, Petra E.
The demographic data and model survey instruments used in a study of 444 Wisconsin administrators of schools, universities, hospitals, correction institutions, and governmental agencies are described. A taxonomy of 58 desired competencies grouped by (1) general management techniques, (2) personnel administration, (3) legal requirements, (4)…
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Statement of Organization, Functions and Delegations of Authority; Correction AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Notice; correction. SUMMARY: HRSA published a document in the Federal...
... Twitter Instagram RSS Subscribe Occupational Safety and Health Administration English | Spanish MENU OSHA English | Spanish Search A ... STATES DEPARTMENT OF LABOR Occupational Safety and Health Administration 200 Constitution Ave., NW, Washington, DC 20210 800- ...
David T. Karamanukyan
Full Text Available In this article the author focuses on the American system of administrative agencies, which are the fundamental pillar for the functioning of administrative justice of the country. A study of the conceptual and taxonomic unit of the current system of administrative agencies of the United States, with the help of comparative analysis of the advantages and disadvantages of legal and doctrinal definitions of the concept of “administrative agency” the author develops an authentic interpretation of the term
David T. Karamanukyan
In this article the author focuses on the American system of administrative agencies, which are the fundamental pillar for the functioning of administrative justice of the country. A study of the conceptual and taxonomic unit of the current system of administrative agencies of the United States, with the help of comparative analysis of the advantages and disadvantages of legal and doctrinal definitions of the concept of “administrative agency” the author develops an authentic interpretatio...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency..., Public Law 104-13), the Health Resources and Services Administration (HRSA) publishes periodic summaries... Administration (HRSA) plans to conduct a survey of the National Practitioner Data Bank and the Healthcare...
Juan Carlos Morón Urbina
Full Text Available Peruvian law has explicitly recognized regulatory powers to administrative agencies, which allows them to have a preponderant role in the production of rules in public procurement. Although these delegations of legislative authority are positively defined, distortions in the system of legal sources arise when agencies exceed delegated powers or when measures issued by administrative entities are mistaken for regulations. This paper aims to identify regulatory powers of Peruvian administrative agencies, as well as the regulatory measures they issue, and their relation with other sources of law.
Social Security Administration — The purpose of this agreement is for SSA to verify SSNs and other identifying information for the Department of Veterans Affairs, VHA. DVA will use the information...
... DEPARTMENT OF LABOR Occupational Safety and Health Administration [Docket No. OSHA-2010-0004] OSHA Listens: Occupational Safety and Health Administration Stakeholder Meeting AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Notice of public meeting. SUMMARY: The Occupational Safety...
Porter, Russell; Broussard, Amelia; Duckett, Todd
It is imperative for divinity and health administration programs to improve their level of ethics education for their graduates who work as health administration chaplains. With an initial presentation of the variation of ethical dilemmas presented in health care facilities covering social, organizational, and patient levels, we indicate the need…
... exemption, determining that a qualified expert panel does not meet the selection criteria, denying a request... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Informal conferences regarding agency administrative actions. 516.123 Section 516.123 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH...
One of the defining features of the capability approach (CA) to health, as developed in Venkatapuram's book Health Justice, is its aim to enable individual health agency. Furthermore, the CA to health hopes to provide a strong guideline for assessing the health-enabling content of social and political conditions. In this article, I employ the recent literature on the liberal concept of vulnerability to assess the CA. I distinguish two kinds of vulnerability. Considering circumstantial vulnerability, I argue that liberal accounts of vulnerability concerned with individual autonomy, align with the CA to health. Individuals should, as far as possible, be able to make health-enabling decisions about their lives, and their capability to do so should certainly not be hindered by public policy. The CA to health and a vulnerability-based analysis then work alongside to define moral responsibilities and designate those who hold them. Both approaches demand social policy to address circumstances that hinder individuals from taking health-enabling decisions. A background condition of vulnerability, on the other hand, even though it hampers the capability for health, does not warrant the strong moral claim proposed by the CA to health to define health as a meta-capability that should guide social policy. Nothing in our designing social policy could change the challenge to health agency when we deal with background conditions of vulnerability. © 2016 John Wiley & Sons Ltd.
Dousing the tension in the Niger delta through administrative agency: A programme evaluation of Niger delta development commission as an intervention regime. ... the study concludes that because of systemic constraints arising from the hegemonic interests of the dominant coalitions in the Nigerian Social formation, ...
Building Capacity for Complementary and Integrative Medicine Through a Large, Cross-Agency, Acupuncture Training Program: Lessons Learned from a Military Health System and Veterans Health Administration Joint Initiative Project.
Niemtzow, Richard; Baxter, John; Gallagher, Rollin M; Pock, Arnyce; Calabria, Kathryn; Drake, David; Galloway, Kevin; Walter, Joan; Petri, Richard; Piazza, Thomas; Burns, Stephen; Hofmann, Lew; Biery, John; Buckenmaier, Chester
Complementary and integrative medicine (CIM) use in the USA continues to expand, including within the Military Health System (MHS) and Veterans Health Administration (VHA). To mitigate the opioid crisis and provide additional non-pharmacological pain management options, a large cross-agency collaborative project sought to develop and implement a systems-wide curriculum, entitled Acupuncture Training Across Clinical Settings (ATACS). ATACS curriculum content and structure were created and refined over the course of the project in response to consultations with Subject Matter Experts and provider feedback. Course content was developed to be applicable to the MHS and VHA environments and training was open to many types of providers. Training included a 4-hr didactic and "hands on" clinical training program focused on a single auricular acupuncture protocol, Battlefield Acupuncture. Trainee learning and skills proficiency were evaluated by trainer-observation and written examination. Immediately following training, providers completed an evaluation survey on their ATACS experience. One month later, they were asked to complete another survey regarding their auricular acupuncture use and barriers to use. The present evaluation describes the ATACS curriculum, faculty and trainee characteristics, as well as trainee and program developer perspectives. Over the course of a 19-mo period, 2,712 providers completed the in-person, 4-hr didactic and hands-on clinical training session. Due to the increasing requests for training, additional ATACS faculty were trained. Overall, 113 providers were approved to be training faculty. Responses from the trainee surveys indicated high satisfaction with the ATACS training program and illuminated several challenges to using auricular acupuncture with patients. The most common reported barrier to using auricular acupuncture was the lack of obtaining privileges to administer auricular acupuncture within clinical practice. The ATACS program
U.S. Department of Health & Human Services — The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standard payment), and submitted charges organized by CMS Certification...
Jarrín, Olga; Flynn, Linda; Lake, Eileen T; Aiken, Linda H
An important goal of home health care is to assist patients to remain in community living arrangements. Yet home care often fails to prevent hospitalizations and to facilitate discharges to community living, thus putting patients at risk of additional health challenges and increasing care costs. To determine the relationship between home health agency work environments and agency-level rates of acute hospitalization and discharges to community living. Analysis of linked Center for Medicare and Medicaid Services Home Health Compare data and nurse survey data from 118 home health agencies. Robust regression models were used to estimate the effect of work environment ratings on between-agency variation in rates of acute hospitalization and community discharge. Home health agencies with good work environments had lower rates of acute hospitalizations and higher rates of patient discharges to community living arrangements compared with home health agencies with poor work environments. Improved work environments in home health agencies hold promise for optimizing patient outcomes and reducing use of expensive hospital and institutional care.
The Agency's health and safety measures as approved by the Board of Governors on 31 March 1960 in implementation of Articles III. A. 6 and XII of the Statute of the Agency are reproduced in this document for the information of all Members.
Health Resources Administration (DHEW/PHS), Bethesda, MD. Bureau of Health Manpower.
This guide to career possibilities in hospital and health administration describes some of the skills required of a health or hospital administrator--interpersonal skills and managerial abilities; and also some of the varied tasks that such an administrator performs. It provides biographical sketches of several health administrators which…
...] Food and Drug Administration Health Professional Organizations Conference AGENCY: Food and Drug... conference for representatives of Health Professional Organizations. Dr. Margaret Hamburg, Commissioner of... person attending, the name of the organization, address, and telephone number. There is no registration...
Clossey, Laurene; Rheinheimer, David
This research explores the impact of mental health agency culture on consumers' perceptions of agency support for their recovery. This study hypothesized that a constructive organizational culture must be present for consumers to perceive agency support for recovery. A sample of 12 mental health agencies in rural Pennsylvania participated in the research. Agency administrators completed an instrument called the recovery oriented service environment, which measured the number of recovery model program components offered by the agency. Consumers completed the recovery oriented services indicators, which taps into their perception of agency support for recovery. Direct service staff completed the organizational social context, which measured their agency's culture. Results showed that in this sample stronger consumer perceptions of agency support for recovery were correlated with higher ratings of agency constructive culture. The results suggest that agency culture is an important variable to target when implementing recovery model programming.
Full Text Available The public in general would have different ideas regarding "efficiency, effectiveness and productivity" because these concepts have apparently different meanings and purposes. Properly understood and utilized, however, these concepts can be useful tools for improving management in the public service.Employees, supervisors and administrators themselves would have different views of these concepts. Several variables affect the interrelationships between the three factors and it is quite difficult to tell whether or not an agency is really efficient, effective and productive.Intending to operationalize and provide measurements of these concepts in the Philippine setting, this study is a survey on efficiency, effectiveness and productivity of Philippine administrative agencies. Furthermore, insights into the relationships that exist among these three concepts have been obtained and the key variables affecting them identified.More specifically, this study is an examination of the effects of four structural variables – centralization, complexity, formalization and stratification – on efficiency, effectiveness and productivity.During the first phase of the research project, the research team examined organizational records as the basis for the preparation of schedules for study. Pre-tests were done during the first six months of research. Immediately after the formulation of the initial questionnaire, the development of the final questionnaire started. The first set was administered to supervisory personnel of selected units of the four agencies under study - the Department of Health (DOH, the Department of Local Government and Community Development (DLGCD, the Development Bank of the Philippines (DBP and the Government Service Insurance System (GSIS. These agencies were selected on the basis of the primary function of financing and service. The original plan was to have at least six representative agencies of the government for the survey, but due
Courtney, Karen L; Alexander, Gregory L; Pack, Beth; Bax, Heather; Adams-Leander, Shelia; Holcomb, Melissa
Building on work within public administration research, five categories of quality indicators are proposed for evaluating World Wide Web (web) sites belonging to state health professional agencies and associations. The five measures include: transparency, transactions, connectivity, personalization and usability. This project describes the construction of each quality indicator index and a calculation of quality scores. This project applies these methods to state Boards of Nursing and nursing association websites.
Dillon, Lindsey; Sellers, Christopher; Underhill, Vivian; Shapiro, Nicholas; Ohayon, Jennifer Liss; Sullivan, Marianne; Brown, Phil; Harrison, Jill; Wylie, Sara
We explore and contextualize changes at the Environmental Protection Agency (EPA) over the first 6 months of the Trump administration, arguing that its pro-business direction is enabling a form of regulatory capture. We draw on news articles, public documents, and a rapid response, multisited interview study of current and retired EPA employees to (1) document changes associated with the new administration, (2) contextualize and compare the current pro-business makeover with previous ones, and (3) publicly convey findings in a timely manner. The lengthy, combined experience of interviewees with previous Republican and Democratic administrations made them valuable analysts for assessing recent shifts at the Scott Pruitt-led EPA and the extent to which these shifts steer the EPA away from its stated mission to "protect human and environmental health." Considering the extent of its pro-business leanings in the absence of mitigating power from the legislative branch, we conclude that its regulatory capture has become likely-more so than at similar moments in the agency's 47-year history. The public and environmental health consequences of regulatory capture of the EPA will probably be severe and far-reaching.
... 7 Agriculture 1 2010-01-01 2010-01-01 false Administrator, Risk Management Agency and Manager... Secretary for Farm and Foreign Agricultural Services to the Administrator, Risk Management Agency, and... for the transaction of the business of the Federal Crop Insurance Corporation and the Risk Management...
... Requests: State Library Administrative Agencies Survey, FY 2014 AGENCY: Institute of Museum and Library..., collection of information. SUMMARY: The Institute of Museum and Library Service (``IMLS'') as part of its... information is necessary for the proper performance of the functions of the agency, including whether the...
U.S. Department of Health & Human Services — A list of VHA hospitals with behavioral health measure data. VHA reports data on a set of core performance measures for Hospital-Based Inpatient Psychiatric Services...
Zeltzer, Barry B; Kohn, Robert
This study examined the practices of home care agencies and home health nursing agencies in the management and treatment of homebound clients with behavioral problems, dementia, and undiagnosed mental illnesses. A survey was mailed to all 54 directors of agencies in Rhode Island in 2003; 53 responded, either by mail or telephone. Data indicated a lack of psychiatric services, a reluctance to address behavioral problems, and a failure to identify undiagnosed disorders. There was also a bias against accepting individuals with primary psychiatric disorders. Although the population of homebound elders with mental illness is increasing, their needs are not being met by these agencies.
... organizational orders, changed the name of ``Import Administration'' to ``Enforcement and Compliance..., Director, Office of Operations Support Enforcement & Compliance, Telephone: (202) 482-5194; Michele D..., through internal Department Organizational Orders 10-3 (effective September 18, 2013) and Department...
..., except that: (A) The State agency and an institution that is a school food authority must enter into a single permanent agreement for all child nutrition programs administered by the school food authority and..., to the end that no person may, on the grounds of race, color, national origin, sex, age, or...
... (VSO Access to VHA Electronic Health Records) Under OMB Review AGENCY: Veterans Health Administration... Electronic Health Records, VA Form 10- 0400. OMB Control Number: 2900-0710. Type of Review: Extension of a... power of attorney by veterans who have medical information recorded in VHA electronic health records...
... October 1, 2013, the Department of Commerce (Department), through internal department organizational... Administration in any document or other communication shall be deemed to be references to Enforcement and... internal Department Organizational Order 10-3 (effective September 18, 2013) and Department Organizational...
..., Office of Policy, Planning, Research, and Communication, Institute of Museum and Library Services, 1800 M... Requests: State Library Administrative Agencies Survey, FY 2011-2013 AGENCY: Institute of Museum and Library Services, The National Foundation for the Arts and the Humanities. ACTION: Notice, request for...
The European Medicines Agency (EMA) and the Committee for Advanced Therapies (CAT) are responsible for reviewing applications for marketing authorization for Advanced Therapy Medicinal Products (ATMP), which include (stem) cell-based medicines, for the ATMP classification and certification procedure, and to provide scientific advice to developers of ATMPs. The CAT, an expert committee dedicated to ATMPs, was established by the Regulation (EC) No 1394/2007 on Advanced Therapies. The CAT came into operation in January 2009. ATMPs are defined in this Regulation as gene therapy and cell therapy medicinal products, and tissue-engineered products. The US FDA's Center for Biologics Evaluation and Research is responsible for ensuring the safety, purity, potency and effectiveness of many biologically derived products, including blood intended for transfusion, blood components and derivatives, vaccines and allergenic extracts, and cell, tissue and gene therapy products for the prevention, diagnosis and treatment of human diseases, conditions or injury. Human cells or tissue intended for implantation, transplantation, infusion or transfer into a human recipient are regulated as human cells, tissues, and cellular and tissue-based products (HCT/Ps).
... funds will be used to achieve program objectives. (Approved by the Office of Management and Budget under... 7 Agriculture 4 2010-01-01 2010-01-01 false State provision of administrative funds to local... PROGRAM § 247.23 State provision of administrative funds to local agencies. (a) How much of the...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration National... Services Administration (HRSA), Parklawn Building (and via audio conference call), 5600 Fishers Lane, Room... and Services Administration, Parklawn Building, Room 13-64, 5600 Fishers Lane, Rockville, Maryland...
... Supplement will include: (1) Awareness and sources of information, (2) attitudes toward diet and physical... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0001] Agency Information Collection Activities; Proposed Collection; Comment Request; Health and Diet Survey...
Marshall, Amy; Powell, Norman; Pierce, Doris; Nolan, Ronnie; Fehringer, Elaine
Students, a large percentage with disabilities, are at high risk for poor post-secondary outcomes in state agency education programs. This mixed-methods study describes the understandings of student transitions in state agency education programs from the perspectives of youth and administrators. Results indicated that: transition is more narrowly defined within alternative education programs; key strengths of transition practice are present in nontraditional schools; and the coordination barriers within this fluid inter-agency transition system are most apparent in students' frequent inter-setting transitions between nontraditional and home schools.
Hahn, A D
Changes authorized by the Balanced Budget Act of 1997 have removed many of the payment benefits that motivated past home health agency acquisition activity and temporarily have slowed the rapid pace of acquisitions of home health agencies. The act required that Medicare's cost-based payment system be replaced with a prospective payment system (PPS) and established an interim payment system to provide a framework for home health agencies to make the transition to the PPS. As a consequence, realistic valuations of home health agencies will be determined primarily by cash flows, with consideration given to operational factors, such as quality of patient care, service territory, and information systems capabilities. The limitations imposed by the change in payment mechanism will cause acquisition interest to shift away from home health agencies with higher utilization and revenue expansion to agencies able to control costs and achieve operating leverage.
U.S. Department of Health & Human Services — This is a compilation of URLs, dataset names and general information about the Federal Assistance Award (CFDA) program name, the associated sub-agency and the types...
... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5724-N-02] Annual Factors for... Web site of the annual factors for determining the on-going administrative fee for housing agencies... Relay Service during business hours at 1-800-877-8337. SUPPLEMENTARY INFORMATION: The annual factors for...
... AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: In... to VA's OMB Desk Officer, OMB Human Resources and Housing Branch, New Executive Office Building, Room... benefit claim within 30 days prior to the fielding period. The sample will be stratified as follows: (1...
Liang, Zhixue; Wang, Shui
Collaboration among multiple travel agencies and with scenery administration bureaus is vital for small or medium sized travel companies to succeed in the fierce competition of the tourism industry; business processes such as regrouping individual travelers between different agencies prove to be difficult and unpleasant user experience; tourists want to be more informed and have more initiative. To address these issues, proposes an integrated tourism e-commerce platform for travel agencies and scenery administration bureaus as well as tourists to interact in a more smooth way; this platform is constructed upon J2EE framework, provides online collaboration & coordination for companies and information services (such as self-navigation using Google Map etc) for tourists. A running implementation of this platform has been put into real business for a small travel company.
Montreuil, Marjorie; Carnevale, Franco A
The capacity of children to act as agents is being increasingly recognized and has important implications for health research and practice. However, there are various discrepancies in how children's agency is defined in the literature. The aim of this analysis was to examine the concept of children's agency within the health-related literature, using Rodgers evolutionary method. The following questions were addressed: How did the concept of agency become associated with children in the health-related literature? What are the sociocultural and legal contexts that surround the concept of children's agency? What is the meaning of children's agency? Forty-five articles were included in the analysis. An inductive approach was used to identify the attributes of children's agency as well as the temporal, disciplinary, and paradigmatic trends in its conceptualization. The concept of children's agency first appeared in the health literature in the 1980s and was defined as an ability children could gradually develop. Later on, children's agency was used to refer to the capacity of all children to influence their own and others' health-care needs and is now increasingly used to refer to children as active agents who reflect on and construct their social worlds. © The Author(s) 2015.
Williams-Crowe, S M; Aultman, T V
A new era of health care reform places increasing pressure on public health leaders and agencies to participate in the public policy arena. Public health professionals have long been comfortable in providing the scientific knowledge base required in policy development. What has been more recent in its evolution, however, is recognition that they must also play an active role in leading and shaping the debate over policy. A profile of effective State legislative policy "entrepreneurs" and their strategies has been developed to assist health agencies in developing such a leadership position. Based on the experiences of State legislative liaison officers, specific strategies for dealing with State legislatures have been identified and are organized into five key areas--agency organization, staff skills, communications, negotiation, and active ongoing involvement. A public health agency must be organized effectively to participate in the legislative policy process. Typically, effective agencies centralize responsibility for policy activities and promote broad and coordinated participation throughout the organization. Playing a key role in the agency's political interventions, the legislative liaison office should be staffed with persons possessing excellent interpersonal skills and a high degree of technical competence. Of central importance to effective legislative policy entrepreneurship is the ability to communicate the agency's position clearly. This includes setting forward a focused policy agenda, documenting policy issues in a meaningful manner, and reaching legislators with the proper information. Once a matter is on the legislative agenda, the agency must be prepared to negotiate and build broad support for the measure. Finally, public health agencies must be active policy players. To take advantage of new opportunities for action, the public health (policy) leader must monitor the political environment continually.By working to anticipate and formulate
... and Research Centers Contact Us Share Protecting Children's Environmental Health Children are often more vulnerable to pollutants ... during development. Learn more about children's health, the environment, and what you can do. Basic Information Children ...
Taking into account their acquired experience, would not health agencies become the place where biomedical practices will be managed on an every day basis? Would in a near future these agencies have the role to interprete the principles of the bioethics law to adapt them to concrete issues?
Reed, Patricia D
After more than seven years of funding through The Centers for Disease Control and Prevention, local public health agencies have made inconsistent progress in fulfilling their Homeland Security objectives...
Davis, Mary V; Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon
We conducted case studies of 10 agencies that participated in early quality improvement efforts. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.
Crichton, Anne, Ed.; Neuhauser, Duncan, Ed.
The role of epidemiology in health administration is considered in 11 articles, and three course descriptions and a bibliography are provided. Titles and authors include the following: "The Need for Creative Managerial Epidemiology" (Gary L. Filerman); "The Growing Role of Epidemiology in Health Administration" (Maureen M.…
Cockerham, William C
This article utilizes the agency-structure debate as a framework for constructing a health lifestyle theory. No such theory currently exists, yet the need for one is underscored by the fact that many daily lifestyle practices involve considerations of health outcomes. An individualist paradigm has influenced concepts of health lifestyles in several disciplines, but this approach neglects the structural dimensions of such lifestyles and has limited applicability to the empirical world. The direction of this article is to present a theory of health lifestyles that includes considerations of both agency and structure, with an emphasis upon restoring structure to its appropriate position. The article begins by defining agency and structure, followed by presentation of a health lifestyle model and the theoretical and empirical studies that support it.
Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon
Objectives. We conducted case studies of 10 agencies that participated in early quality improvement efforts. Methods. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007–2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Results. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Conclusions. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies’ ability to create and sustain a quality improvement culture. PMID:24228680
The Law no.155 of 3 Dec. 2004(the latest revision, Law no.87 of 26 July 2005) is the law to define the objective, scope of activities, etc. of the independent administrative institution Japan Atomic Energy Agency. The agency is established under the atomic energy basic law to make comprehensive research and development associated with nuclear energy and establishment of nuclear fuel cycle and to contribute to promote research, development and utilization of it. The agency has its main office in Ibaraki prefecture and its capital is the amount of contributions by the government and persons other than the government. The officers are consisted of a president, an executive vice president, less than 7 executive directors and 2 auditors. The president is appointed by the Minister of Ministry of Education, Culture, Sports, Science and Technology with the consent of the atomic energy commission. The term of the president is from the day of the appointment to the end of midterm goal period and that of auditors is 2 years. Activities of the agency include basic and application research of nuclear energy, technical establishment of nuclear fuel cycle (R and D of Fast Breeder Reactor, nuclear fuel for FBR, reprocessing and treatment and disposal of HLW), promotion of application of R and D results of above areas, utilization sharing of facility and equipment, human resource development of nuclear energy field, collection, arrangement and dissemination of nuclear information and study and analysis requested by the government. (T. Tanaka)
The presence of social inequalities in health requires a multi-faceted intervention, focusing on the social determinants as well as the provision of care and prevention strategies. Regional health agencies have important levers at their disposal, as illustrated by the example of the Île-de-France region. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Full Text Available The incorporation of agencies into Colombia’s Administrative Structure has generated profound debates about the need to create administrative bodies that differ from traditional ones. Such incorporation is all the more problematic when these North American agencies are introduced without any real analysis of the local tradition and culture. The situation became more complicated as a consequence of the undisputed fact that the values and philosophies of the Public Administration Structure in Colombia are different from the predominant values in the United States. Hence, this paper provides a critical analysis of the institution and of its credulous and impulsive adoption of such instruments into our reality.
Madamala, Kusuma; Sellers, Katie; Beitsch, Leslie M; Pearsol, Jim; Jarris, Paul
There were 3 specific objectives of this study. The first objective was to examine the progress of state/territorial health assessment, health improvement planning, performance management, and quality improvement (QI) activities at state/territorial health agencies and compare findings to the 2007 findings when available. A second objective was to examine respondent interest and readiness for national voluntary accreditation. A final objective was to explore organizational factors (eg, leadership and capacity) that may influence QI or accreditation readiness. Cross-sectional study. State and Territorial Public Health Agencies. Survey respondents were organizational leaders at State and Territorial Public Health Agencies. Sixty-seven percent of respondents reported having a formal performance management process in place. Approximately 77% of respondents reported a QI process in place. Seventy-three percent of respondents agreed or strongly agreed that they would seek accreditation and 36% agreed or strongly agreed that they would seek accreditation in the first 2 years of the program. In terms of accreditation prerequisites, a strategic plan was most frequently developed, followed by a state/territorial health assessment and health improvement plan, respectively. Advancements in the practice and applied research of QI in state public health agencies are necessary steps for improving performance. In particular, strengthening the measurement of the QI construct is essential for meaningfully assessing current practice patterns and informing future programming and policy decisions. Continued QI training and technical assistance to agency staff and leadership is also critical. Accreditation may be the pivotal factor to strengthen both QI practice and research. Respondent interest in seeking accreditation may indicate the perceived value of accreditation to the agency.
Panteli, Dimitra; Zentner, Annette; Storz-Pfennig, Philipp; Busse, Reinhard
Gender as a social construct is a recognized health determinant. Because best practice in reporting health technology assessment (HTA) clearly specifies the need to appraise a technology's social impact within the target population, the extent to which gender issues are taken into account in HTA production is of interest, not only in light of equitable practices but also for reasons of effectiveness. The aim of this study is to provide a first assessment of the degree of gender sensitivity shown by HTA agencies around the world today. The Web sites of sixty HTA agencies were analyzed. The consideration of gender aspects was specifically looked for in each agency's general mission statement, its priority setting process, and its methodological approach. Additionally, specific gender-oriented initiatives not belonging to any of the aforementioned categories were identified. Of the sixty agencies, less than half mention a commitment to addressing the social implication of health technologies. Only fifteen institutions make information on their priority setting principles available on their Web sites and gender was an issue in two of those cases. Data on methodology were obtainable online from 18 agencies, two of which mentioned gender issues explicitly. Finally, gender-oriented initiatives were identified by thirteen agencies. A gender-sensitive approach is apparently rarely adopted in current HTA production. Exceptional practices and relevant tools do exist and could serve as examples to be promoted by international collaborative networks.
... DEPARTMENT OF LABOR Occupational Safety and Health Administration Preparations for the 23rd Session of the UN Sub-Committee of Experts on the Globally Harmonized System of Classification and...: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Notice of public meeting. SUMMARY: OSHA...
Zachik, Albert A; Naylor, Michael W; Klaehn, Robert L
Child and adolescent psychiatrists are in a unique position to provide administrative and clinical leadership to public agencies. In mental health, services for children and adolescents in early childhood, school, child welfare, and juvenile justice settings, transition-aged youth programs, workforce development, family and youth leadership programs, and use of Medicaid waivers for home- and community-based service system development are described. In child welfare, collaboration between an academic child psychiatry department and a state child welfare department is described. In developmental disabilities, the role of the child and adolescent psychiatrist administrator is described providing administrative leadership, clinical consultation, quality review, and oversight of health and behavioral health plans for persons with developmental disabilities.
Donald Trump's rhetoric and leadership are destroying the "culture of community" necessary for progress on health equity. His one-line promises to provide "quality health care at a fraction of the cost" smack of neoliberal nostrums that shifted ever more costs onto patients, thereby preventing many people from getting care. The dangers of Trump go far beyond health policy, however; Trump's presidency threatens the political and cultural institutions that make any good policy possible. Copyright © 2017 by Duke University Press.
Frohlich, Katherine L; Dunn, James R; McLaren, Lindsay; Shiell, Alan; Potvin, Louise; Hawe, Penelope; Dassa, Clément; Thurston, Wilfreda E
The increasing availability, use and limitations of administrative data for place-based population health research, and a lack of theory development, created the context for the current paper. We developed a heuristic to interrogate administrative data sets and to help us develop explanatory pathways for linking place and health. Guided by a worked example, we argue that some items in administrative data sets lend themselves to multiple theories, creating problems of inference owing to the implications of using inductive versus deductive reasoning during the research process, and that certain types of theories are privileged when used administrative data bases.
... Services Administration, HHS. ACTION: Correction of Burden Table. SUMMARY: The Health Resources and Services Administration published an Agency Information Collection document in the Federal Register of... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency...
... Services Administration, HHS. ACTION: Correction in Burden Table. SUMMARY: The Health Resources and Services Administration published an Agency Information Collection document in the Federal Register of... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency...
... Reduction Act AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Notice... DEPARTMENT OF LABOR Occupational Safety and Health Administration Agency Information Collection... or Todd Owen, Directorate of Standards and Guidance, Occupational Safety and Health Administration, U...
... Locators Find treatment facilities and programs in the United States or U.S. Territories for mental and substance use ... Health Information Technology HIV, AIDS, and Viral Hepatitis Homelessness and ... and Local Government Partnerships Suicide Prevention Trauma and ...
U.S. Department of Health & Human Services — A list of VHA hospitals with data on readmissions and deaths. These data show how often patients who are hospitalized for certain conditions experience serious...
Department of Veterans Affairs — At the Department of Veterans Affairs (VA), our most important mission is to provide the high quality health care and benefits Veterans have earned and deserve —...
Fleenor, C P; Weis, W L
In a recent study conducted by the authors, Seattle-area managers disclosed a high incidence of discrimination against smokers at the hiring point, and expressed strong preferences for further restrictions on smoking in the workplace. Surprisingly, of the six management groups represented in the study, only healthcare administrators were acquiescent toward the presumed rights of smokers as employees. This anomaly, as well as other insights drawn from the research, is discussed in the article. Reader explanations to the apparent contradiction presented here are invited.
Lucyk, Kelsey; Lu, Mingshan; Sajobi, Tolulope; Quan, Hude
Health decision-making requires evidence from high-quality data. As one example, the Discharge Abstract Database (DAD) compiles data from the majority of Canadian hospitals to form one of the most comprehensive and highly regarded administrative health databases available for health research, internationally. However, despite the success of this and other administrative health data resources, little is known about their history or the factors that have led to their success. The purpose of this paper is to provide an historical overview of Canadian administrative health data for health research to contribute to the institutional memory of this field. We conducted a qualitative content analysis of approximately 20 key sources to construct an historical narrative of administrative health data in Canada. Specifically, we searched for content related to key events, individuals, challenges, and successes in this field over time. In Canada, administrative health data for health research has developed in tangent with provincial research centres. Interestingly, the lessons learned from this history align with the original recommendations of the 1964 Royal Commission on Health Services: (1) standardization, and (2) centralization of data resources, that is (3) facilitated through governmental financial support. The overview history provided here illustrates the need for longstanding partnerships between government and academia, for classification, terminology and standardization are time-consuming and ever-evolving processes. This paper will be of interest to those who work with administrative health data, and also for countries that are looking to build or improve upon their use of administrative health data for decision-making.
With the immense economic growth and social development, China has gained worldwide attention. With the quick growth of industrialization, several international professionals are gaining interest in occupational management system and in the role of the Chinese Government in protecting the worker's health. The Law on Prevention and Control of Occupational Diseases and the Work Safety Law are the two most important laws in China, which highlight the responsibilities of the employer, employee, governmental agencies, authorized occupational health service agency, and other stakeholders. The State Council comprises two departments, namely, the State Administration on Work Safety (SAWS) and the National Health and Family Planning Commission (NHFPC), which are responsible for governing the occupational health work. A series of regulations and standards have been promulgated by the Chinese Government to encourage or instruct the employers to fulfill their responsibility; however, several issues persist related to occupational health work, including administrative, technological, and sociocultural aspects. At present, the Chinese Government wants to enhance the reform in both economic and administrative structures, and the adjustments for modifying and/or improving the occupational health regulatory system are expected. Notably, the occupational health work in China must be altered for better.
Gac, E J; Boerstler, H; Ruhnka, J C
The Socratic Method has long been recognized by the legal profession as an effective tool for promoting critical thinking and analysis in the law. This article describes ways the technique can be used in health administration education to help future administrators develop the "ethical rudder" they will need for effective leadership. An illustrative dialogue is provided.
... Administration, HHS. ACTION: Correction. SUMMARY: The Health Resources and Services Administration published an... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency... Services Administration (HRSA) under the Health Center Program as authorized under section 330 of the...
Markiewicz, Milissa; Moore, Jill; Foster, Johanna H; Berner, Maureen; Matthews, Gene; Wall, Aimee
Some states are considering restructuring local public health agencies (LPHAs) in hopes of achieving long-term efficiencies. North Carolina's experience operating different types of LPHAs, such as county health departments, district health departments, public health authorities, and consolidated human services agencies, can provide valuable information to policy makers in other states who are examining how best to organize their local public health system. To identify stakeholders' perceptions of the benefits and challenges associated with different types of LPHAs in North Carolina and to compare LPHA types on selected financial, workforce, and service delivery measures. Focus groups and key informant interviews were conducted to identify stakeholders' perceptions of different LPHA types. To compare LPHA types on finance, workforce, and service delivery measures, descriptive statistical analyses were performed on publicly available quantitative data. North Carolina. Current and former state and local public health practitioners, county commissioners, county managers, assistant managers, state legislators, and others. In addition to identifying stakeholders' perceptions of LPHA types, proportion of total expenditures by funding source, expenditures per capita by funding source, full-time equivalents per 1000 population, and percentage of 127 tracked services offered were calculated. Stakeholders reported benefits and challenges of all LPHA types. LPHA types differ with regard to source of funding, with county health departments and consolidated human services agencies receiving a greater percentage of their funding from county appropriations than districts and authorities, which receive a comparatively larger percentage from other revenues. Types of LPHAs are not entirely distinct from one another, and LPHAs of the same type can vary greatly from one another. However, stakeholders noted differences between LPHA types-particularly with regard to district health
Ochor, J O
The constraints facing health education include: the fragmentation and dispersal of health-educational services among different agencies and personnel; lack of policy guidelines; ineffectively organized and inefficiently managed health education systems; poor hierarchical status and inadequacy of resources. To resolve these constraints, national health education systems in health agencies should be developed on the basis of stipulated guidelines that could ensure their viability, efficiency and effectiveness. A study at the African Regional Health Education Centre, Ibadan, Nigeria, has yielded thirty synthesized guidelines. The "guidelines" were empirically tested as an evaluation tool by assessing the operational and organizational status of Oyo State Health Education Unit, Ibadan, Nigeria. These guidelines are adaptable to local conditions to enhance the re-organization, re-orientation and consolidation of health education in national health agencies.
Licht, Kenneth F.
The Occupational Safety and Health Act (1970) concerns private schools but does not directly affect the operations of public schools or colleges. The intent, however, is to have the States develop and administer their own health and safety programs. Administrators should, therefore, initiate a comprehensive, districtwide safety education and…
Spetz, Joanne; Burgess, James F; Phibbs, Ciaran S
The impact of health information technology (HIT) in hospitals is dependent in large part on how it is used by nurses. This study examines the impact of HIT on the quality of care in hospitals in the Veterans Health Administration (VA), focusing on nurse-sensitive outcomes from 1995 to 2005. Data were obtained from VA databases and original data collection. Fixed-effects Poisson regression was used, with the dependent variables measured using the Agency for Healthcare Research and Quality Inpatient Quality Indicators and Patient Safety Indicators software. Dummy variables indicated when each facility began and completed implementation of each type of HIT. Other explanatory variables included hospital volume, patient characteristics, nurse characteristics, and a quadratic time trend. The start of computerized patient record implementation was associated with significantly lower mortality for two diagnoses but significantly higher pressure ulcer rates, and full implementation was associated with significantly more hospital-acquired infections. The start of bar-code medication administration implementation was linked to significantly lower mortality for one diagnosis, but full implementation was not linked to any change in patient outcomes. The commencement of HIT implementation had mixed effects on patient outcomes, and the completion of implementation had little or no effect on outcomes. This longitudinal study provides little support for the perception of VA staff and leaders that HIT has improved mortality rates or nurse-sensitive patient outcomes. Future research should examine patient outcomes associated with specific care processes affected by HIT. Copyright © 2014 Elsevier Inc. All rights reserved.
Burgmair, Wolfgang; Weber, Matthias M
By 1850 the reformation of institutional psychiatric care in Bavaria was given the highest priority by monarchy and administration. Cooperating with experts, especially the psychiatrist Karl August von Solbrig, they provided for new asylums to be established throughout Bavaria in a surprisingly short period of time. It was, however, only at personal intervention of King Max II. that the administrative and financial difficulties which had existed since the beginning of the 19th century could be overcome. The planning of asylums done by each administrative district of Bavaria vividly reflects rivalry as well as cooperation between all governmental and professional agencies involved. Modernization of psychiatry was publicly justified by referring to scientism, the need for a more progressive restructuring of administration, and the paternalistic care of the monarchy, whereas, from an administrative point of view, aspects of psychiatric treatment, like what kind of asylum would be best, were rather insignificant. The structures established by means of the alliance between state administration and psychiatric care under the rule of King Max II. had a lasting effect on the further development of Bavaria.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency...: Workforce Recruitment in Health Resources and Services Administration (HRSA)--Funded Health Centers (OMB No...: Health Resources and Services Administration; HHS. ACTION: Notice. SUMMARY: In compliance with section...
... Intellectual and Developmental Disabilities; Agency Information Collection Activities; Proposed Collection; Comment Request; Financial Status Reporting Form for State Councils on Developmental Disabilities AGENCY... hours per Total burden respondents respondent response hours Financial Status Reporting Form for State...
A Comparison of the Audit and Accreditation Tools Used By The Health Care Financing Administration, The Texas Department of Insurance, and The National Committee on Quality Assurance: The Cost of Multi-Agency Oversight on Medicare+Choice Plans in Texas
Comparison of Oversight Models in Managed Care 1 Running Head: Comparison of Oversight Models in Managed Care A Comparison of the Audit and...TITLE AND SUBTITLE A Comparison of the Audit and Accreditation Tools Used By The Health Care Financing Administration, The Texas Department of...Comparison of Oversight Models in Managed Care 5 A Comparison of the Audit and Accreditation Tools Used By The Health Care Financing
Verdier, James; Barrett, Allison
This brief report describes some notable variations in how state Medicaid agencies administer and fund Medicaid mental health services. Hour-long telephone interviews were conducted with all state and District of Columbia Medicaid directors or their designees. Responses indicated that Medicaid and mental health agencies were located within the same umbrella agency in 28 states, potentially facilitating collaboration. The mental health agency provided funding for some Medicaid mental health services in 32 states, and counties provided such funding in 22 states. Medicaid agencies generally delegated more authority to state mental health agencies in states where some Medicaid funding came from mental health sources and also in states where both agencies were in the same umbrella agency. The increasing role of Medicaid in funding state mental health services, combined with new federal limits on Medicaid financing of these services, underscores the importance of interagency collaboration and better alignment of Medicaid and mental health responsibilities.
Pourshaban, Deena; Basurto-Dávila, Ricardo; Shih, Margaret
Workforce shortages have been identified as a priority for US public health agencies. Voluntary turnover results in loss of expertise and institutional knowledge as well as high costs to recruit and train replacement workers. To analyze patterns and predictors of voluntary turnover among public health workers. Descriptive analysis and linear probability regression models. Employees of state health agencies in the United States who participated in the Public Health Workforce Interests and Needs Survey (PH WINS). Intended retirement and voluntary departure; pay satisfaction; job satisfaction. Nearly 25% of workers reported plans to retire before 2020, and an additional 18% reported the intention to leave their current organization within 1 year. Four percent of staff are considering leaving their organization in the next year for a job at a different health department. There was significant heterogeneity by demographic, socioeconomic, and job characteristics. Areas such as administration/management, health education, health services, social services, and epidemiology may be particularly vulnerable to turnover. The strongest predictors of voluntary departure were pay and job satisfaction, which were associated with 9 (P salary levels, higher levels of education and longer work experience were associated with lower pay satisfaction, except for physicians, who were 11 percentage points (P = .02) more likely to be satisfied with their pay than employees with doctoral degrees. Several workplace characteristics related to relationships with supervisors, workplace environment, and employee motivation/morale were significantly associated with job satisfaction. Our findings suggest that public health agencies may face significant pressure from worker retirement and voluntary departures in coming years. Although retirement can be addressed through recruitment efforts, addressing other voluntary departures will require focusing on improving pay and job satisfaction.
... Reduction Act AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Notice... DEPARTMENT OF LABOR Occupational Safety and Health Administration Agency Information Collection..., PhD, MPH, Assistant Secretary of Labor for Occupational Safety and Health, directed the preparation...
Ricci, Karen; Lurie, Nicole; Stoto, Michael A; Wasserman, Jeffrey; Dausey, David J; Meade, Barbara; Diamond, Alexis; Molander, Roger C
... to evaluate the ability to receive and respond to case reports 24 hours a day, 7 days a week. We refined these tests by beta-testing them at 20 metropolitan area local public health agencies across the country over the course of 10 months. The contents of this manual will be of interest to public health professionals at the state and local l...
Dausey, David J
... to evaluate the ability to receive and respond to case reports 24 hours a day, 7 days a week. We refined these tests by beta-testing them at 20 metropolitan area local public health agencies across the country over the course of 10 months. The contents of this manual will be of interest to public health professionals at the state and local l...
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Judicial review of the final agency order of an Administrative Law Judge in cases arising under section 274B. 68.57 Section 68.57 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) RULES OF PRACTICE AND PROCEDURE FOR ADMINISTRATIVE HEARINGS...
Bradecki, W. (Wyzszy Urzad Gorniczy, Katowice (Poland))
Discusses the visit of 2 representatives of the Mine Safety and Health Administration and the West Mining Company from the United States to Poland in November 1991. During the visit, occupational safety in underground coal mines in Upper Silesia was evaluated. Selected aspects of experience and organization schemes of the Mine Safety and Health Administration are evaluated from the point of view of their use in Poland to increase occupational safety in coal mining. The following aspects are discussed: Mine Safety and Health Administration and its budget (US$ 186 million), personnel (2,700), research institutes that specialize in mine safety (the National Institute of Occupational Safety and Health, Bureau of Mines), natural hazards associated with mining, mine safety in underground and surface coal mines in the USA in relation to number of coal miners and coal output, job safety analysis as a key to the success of the MSHA, increased hazards in small mines (Pennsylvania, West Virginia, Virginia and Kentucky), problems of drug addiction and alcoholism among coal miners.
Jones, V B; Taylor, L C
The question of the degree of technical versus managerial competence to be found in future graduates from health administration programs is not easily resolved. In the HIMSS 1988 survey of CIOs the attributes needed for success are listed in descending rank order as follows: leadership ability, vision/imagination, knowledge of hospital systems, business acumen, decisiveness, and technical competence. CIOs ranked technical competence as less important than other attributes associated with general management success. The expectations for attitudes, knowledge, and skills presented in this article support the greater importance of management abilities relative to pure technical competence. However, it is vital that an appropriate level of technical knowledge and skill be maintained to enable future alumni of health administration programs to function effectively as administrators. Depending on their role in a health care organization, greater or lesser technical knowledge may be needed. Those pursuing a career path toward CIO must, of necessity, have greater technical knowledge and skill. We have discussed necessary and expected attitudes, knowledge, and skills that will be needed by the generalist health administration graduate in the future. It will be important to develop and maintain an attitude that MIS is a strategic tool, that health care technology is a corporate asset, and that information is power. Graduates must recognize the necessity of maintaining and enhancing their knowledge and skills through continuing education. The knowledge base of MIS education should focus on determining information needs to support strategic goals, understanding of general systems theory, principles of systems analysis, design, implementation and maintenance, awareness and exposure to standard application software, and an awareness of external sources of data.(ABSTRACT TRUNCATED AT 250 WORDS)
Aarons, Gregory A; Wells, Rebecca S; Zagursky, Karen; Fettes, Danielle L; Palinkas, Lawrence A
We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies. Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable). Data analyses distilled statements into 14 factors or dimensions. Descriptive analyses suggest that perceptions of importance and changeability varied across stakeholder groups. Implementation of EBP is a complex process. Cross-system-level approaches are needed to bring divergent and convergent perspectives to light. Examples include agency and program directors facilitating EBP implementation by supporting staff, actively sharing information with policymakers and administrators about EBP effectiveness and fit with clients' needs and preferences, and helping clinicians to present and deliver EBPs and address consumer concerns.
Fihn, Stephan D; Francis, Joseph; Clancy, Carolyn; Nielson, Christopher; Nelson, Karin; Rumsfeld, John; Cullen, Theresa; Bates, Jack; Graham, Gail L
Health care has lagged behind other industries in its use of advanced analytics. The Veterans Health Administration (VHA) has three decades of experience collecting data about the veterans it serves nationwide through locally developed information systems that use a common electronic health record. In 2006 the VHA began to build its Corporate Data Warehouse, a repository for patient-level data aggregated from across the VHA's national health system. This article provides a high-level overview of the VHA's evolution toward "big data," defined as the rapid evolution of applying advanced tools and approaches to large, complex, and rapidly changing data sets. It illustrates how advanced analysis is already supporting the VHA's activities, which range from routine clinical care of individual patients--for example, monitoring medication administration and predicting risk of adverse outcomes--to evaluating a systemwide initiative to bring the principles of the patient-centered medical home to all veterans. The article also shares some of the challenges, concerns, insights, and responses that have emerged along the way, such as the need to smoothly integrate new functions into clinical workflow. While the VHA is unique in many ways, its experience may offer important insights for other health care systems nationwide as they venture into the realm of big data. Project HOPE—The People-to-People Health Foundation, Inc.
... EMPLOYEE OCCUPATIONAL SAFETY AND HEALTH PROGRAMS AND RELATED MATTERS Evaluation of Federal Occupational Safety and Health Programs § 1960.80 Secretary's evaluations of agency occupational safety and health... evaluating an agency's occupational safety and health program. To accomplish this, the Secretary shall...
The purpose of this research was to a) determine what assessment methods are being used in undergraduate health information administration programs to assess student learning and the usefulness of those methods, b) determine to what extent programs have incorporated good student learning assessment practices. Programs use a variety of assessment tools to measure student learning; the most useful include assessments by the professional practice supervisor, course tests, assignments, presentati...
..., whenever possible, provide advance notice to the Press Relations Staff (HFI-20), Office of Public Affairs... required by the presiding officer. If so, the Press Relations Staff will function as a liaison between the... public administrative proceedings. 10.206 Section 10.206 Food and Drugs FOOD AND DRUG ADMINISTRATION...
...), through internal department organizational orders, changed the name of ``Import Administration'' to... Administration in any document or other communication shall be deemed to be references to Enforcement and..., through internal Department Organizational Orders 10-3 (effective September 18, 2013) and Department...
Aiwanehi Barbara Ofuani
Full Text Available This study examines Business, Government and Society interrelationships. It eventually narrowed down to assessing the efficiency of government regulatory agencies, in fulfilling the role of government in protecting consumers from unscrupulous practices of businesses. The National Agency for Food and Drugs Administration and Control (NAFDAC was chosen for the study. Since the expectations of the consumers are paramount here, the stakeholder approach method was used for assessing the efficiency of NAFDAC. Literature and previous empirical studies on the topic were examined. For representativeness, data was collected utilizing the survey research design through Questionnaire distributed to 200 respondents in some areas of Lagos Mainland in Lagos state, using the convenience sampling method. 187 copies of the questionnaire representing 93.5% were returned and usable. Descriptive statistics was used to analyze the responses to questions regarding the efficiency of NAFDAC and a hypothesis tested using a one-sample T-test. The findings ran contrary to results from some previous studies. Instead, consumer awareness of the existence of NAFDAC as a regulatory agency and its functions were established, along with a high rate of consumer education. The assessment of its efficiency also showed a high rating. Recommendations were made that the study be replicated in other states of Nigeria and further studies carried out to evaluate its efficiency under previous and current directors for improvement purposes.
Shah, Jai L; Kapoor, Reena; Cole, Robert; Steiner, Jeanne L
Issues of mental health and employee health have risen to increasing prominence in recent years. However, there have been few explorations of the clinical and administrative challenges that these issues raise, particularly in settings that are themselves mental health workplaces. In order to identify and understand such challenges, a brief case of acute employee illness in a mental health workplace is described followed by a discussion of salient clinical, administrative, and organizational considerations. The case raises questions about medicolegal responsibilities and relationships between clinicians and patients in mental health settings, illuminates tensions between clinical staff and human resources processes, and draws attention to the need for illness prevention and mental health promotion initiatives in the workplace. Increased awareness of these issues, complications, and potential solutions would benefit clinicians, administrators, and mental health institutions.
Liss-Levinson, Rivka; Bharthapudi, Kiran; Leider, Jonathon P; Sellers, Katie
State health agencies play a critical role in protecting and promoting the health and well-being of the people they serve. To be effective, they must maintain a highly skilled, diverse workforce of sufficient size and with proper training. The goal of this study was to examine demographics, job and workplace environment characteristics, job satisfaction, and reasons for initially joining the public health workforce as predictors of an employee's intentions to leave an organization within the next year. This study used a cross-sectional design. Respondents were selected on the basis of a stratified sampling approach, with 5 geographic (paired Health and Human Services [HHS] regions) as the primary strata. Balanced repeated replication was used as a resampling method for variance estimation. A logistic regression model was used to examine the correlates of intentions to leave one's organization within the next year. The independent variables included several measures of satisfaction, perceptions about the workplace environment, initial reasons for joining public health, gender, age, education, salary, supervisory status, program area, and paired HHS region. The sample for this study consisted of 10,246 permanently employed state health agency central office employees who responded to the Public Health Workforce Interests and Needs Survey (PH WINS). Considering leaving one's organization within the next year. Being a person of color, living in the West (HHS regions 9 and 10), and shorter tenure in one's current position were all associated with higher odds of intentions to leave an organization within the next year. Conversely, greater employee engagement, organizational support, job satisfaction, organization satisfaction, and pay satisfaction were all significant predictors of lower intentions to leave one's organization within the next year. Results from this study suggest several variables related to demographics, job characteristics, workplace environment, and
... and complied with, and to evaluate the effectiveness of related internal controls. Contract administration functions for the resale stock merchandise contracts were segregated among the service centers, regions, and commissary stores...
Moore, James W.; Turner, Danielle C.; Corlett, Philip R.; Arana, Fernando S.; Morgan, Hannah L.; Absalom, Antony R.; Adapa, Ram; de Wit, Sanne; Everitt, Jessica C.; Gardner, Jenny M.; Pigott, Jennifer S.; Haggard, Patrick; Fletcher, Paul C.
Introduction. Aberrant experience of agency is characteristic of schizophrenia. An understanding of the neurobiological basis of such experience is therefore of considerable importance for developing successful models of the disease. We aimed to characterise the effects of ketamine, a drug model for
... injuries, child abuse, neglect, or maltreatment, and reduction of emergency room visits; (3) improvement in... Administration for Children and Families Agency Information Collection Activities: Proposed Collection: Public Comment Request AGENCY: Health Resources and Services Administration, HHS. Administration for Children and...
... safety and health. 1960.19 Section 1960.19 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... EMPLOYEE OCCUPATIONAL SAFETY AND HEALTH PROGRAMS AND RELATED MATTERS Standards § 1960.19 Other Federal agency standards affecting occupational safety and health. (a) Where employees of different agencies...
McDermott, D R; Little, M W
Based on responses from 52 hospital administrators, four areas of managerial concern have been addressed, including: (1) decision-making factors; (2) hospital service offerings: current and future; (3) marketing strategy and service priorities; and (4) health care industry challenges. Of the total respondents, 35 percent indicate a Director of Marketing has primary responsibility for making marketing-related decisions in their hospital, and 19 percent, a Vice-President of Marketing, thus demonstrating the increased priority of the marketing function. The continued importance of the physician being the primary market target is highlighted by 70 percent of the administrators feeling physician referrals will be more important regarding future admissions than in the past, compared to only two percent feeling the physicians' role will be less important. Of primary importance to patients selecting a hospital, as perceived by the administrators, are the physician's referral, the patient's previous experience, the hospital's reputation, and the courtesy of the staff. The clear majority of the conventional-care hospitals surveyed offer out-patient surgery, a hospital pharmacy, obstetrics/maternity care, and diabetic services. The future emphasis on expanding services is evidenced by some 50 percent of the hospital administrators indicating they either possibly or definitely plan to offer long-term nursing care, out-patient substance abuse programs, and cancer clinics by 1990. In addition, some one-third of the respondents are likely to expand their offerings to include wellness/fitness centers, in-patient substance abuse programs, remote or satellite primary care clinics, and diabetic services. Other areas having priority for future offerings include services geared specifically toward women and the elderly. Perceived as highest in priority by the administrators regarding how their hospital can achieve its goals in the next three years are market development strategies
Bogen handler om den praksis, vi kalder administration. Vi er i den offentlige sektor i Danmark hos kontorfolkene med deres sagsmapper, computere, telefoner,, lovsamlinger,, retningslinier og regneark. I bogen udfoldes en mangfoldighed af konkrete historier om det administrative arbejde fra...... forskellige områder i den offentlige sektor. Hensigten er at forstå den praksis og faglighed der knytter sig til det administrative arbejde...
Full Text Available A key indicator to evaluate the success of an organization is the degree of meeting specific civil project goals based on a predetermined schedule. Therefore, the main purpose of this paper is to evaluate the performance of governmental administration agencies based on realization of civil project goals. In this paper, the information published by the President Deputy of Strategic Planning and Control, that publishes an annual report of evaluation indicators for national civil development projects, are used to evaluate and prioritize the major and non-major governmental agencies. Also, the Gray Relational Analysis (GRA and the TOPSIS method are employed to analyze the data. The results indicate that using the GRA method, Supreme Council of Seminary and using the TOPSIS method, The Ministry of Labor and Social Affaires have gained the highest ranking.
Full Text Available The present study examines the role of public relations as a socio-economic tool of persuasion and educating taxpayers of their civic responsibility to honor fair tax obligations. We propose solutions for improving and restructuring the fiscal control management by diversifying and expanding the range of the instrument constant communication/ public relations and increasing their efficiency in the National Agency for Fiscal Administration, diversifying forms of public communication. The proposed work aims to fill a niche in tax audit work of taxpayers to be felt in practice equitable collection of taxes.
Fajardo-Ortiz, Guillermo; Ortiz-Montalvo, Armando
Historically, health services administration has been managed under a Taylorist, Fayolist, humanist and bureaucratic focus approach. However, today dynamic and competitive behaviors that require others approaches in management are developing. Because of the social, scientific and technological changes that are occurring, it is necessary to abandon hierarchical and authoritarian schemes, "up and down" lines, prescriptive rules and order line up must be left behind. Health services administration is an adapted complex system that is not proportional, neither predictable in direction or magnitude. A new proposal is to focus on the sciences of complexity, where the social factors, materials, economics, human and ethics coincide with order and disorder, reason and unreason, and in which we must accept that the phenomenon that emerges creates different organizing different structures from the addition or subtraction of components. There is distance in the process of cause and direct effect. The mirage from the sciences of complexity are trans-disciplinary and we have accepted this in others branches of knowledge, such as quantum physics, non-linear mathematics and cybernetics, so we have to accept the influence of entropy, non-entropy, attractors, the theory of chaos and fractals.
Yan, Yu-Hua; Yang, Chen-Wei; Fang, Shih-Chieh
The main purpose of this study was to investigate the agency problem presented by the global budget system followed by hospitals in Taiwan. In this study, we examine empirically the interaction between the principal: Bureau of National Health Insurance (BNHI) and agency: medical service providers (hospitals); we also describe actual medical service provider and hospital governance conditions from a agency theory perspective. This study identified a positive correlation between aversion to agency hazard (self-interest behavior, asymmetric information, and risk hedging) and agency problem risks (disregard of medical ethics, pursuit of extra-contract profit, disregard of professionalism, and cost orientation). Agency costs refer to BNHI auditing and monitoring expenditures used to prevent hospitals from deviating from NHI policy goals. This study also found agency costs negatively moderate the relationship between agency hazards and agency problems The main contribution of this study is its use of agency theory to clarify agency problems and several potential factors caused by the NHI system. This study also contributes to the field of health policy study by clarifying the nature and importance of agency problems in the health care sector. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Labor-Management Services Administration (DOL), Washington, DC.
Given the diversity of existing patterns of regulations and agencies, this directory is intended to be a guide to the administrative structure and functional responsibilities of the agencies within the various states for the conduct of public sector labor relations. It is not meant to be a statutory analysis nor does it deal with the extent of…
Wang, Yun; Spatz, Erica S; Tariq, Maliha; Angraal, Suveen; Krumholz, Harlan M
To evaluate home health agency quality performance. Observational study. Home health agencies. All Medicare-certified agencies with at least 6 months of data from 2011 to 2015. Twenty-two quality indicators, five patient survey indicators, and their composite scores. The study included 11,462 Medicare-certified home health agencies that served 92.4% of all ZIP codes nationwide, accounting for 315.2 million people. The mean composite scores were 409.1 ± 22.7 out of 500 with the patient survey indicators and 492.3 ± 21.7 out of 600 without the patient survey indicators. Home health agency performance on 27 quality indicators varied, with the coefficients of dispersion ranging from 4.9 to 62.8. Categorization of agencies into performance quartiles revealed that 3,179 (27.7%) were in the low-performing group (below 25th percentile) at least one time during the period from 2011-12 to 2014-15 and that 493 were in the low-performing group throughout the study period. Geographic variation in agency performance was observed. Agencies with longer Medicare-certified years were more likely to have high-performing scores; agencies providing partial services, with proprietary ownership, and those with long travel distances to reach patients had lower performance. Agencies serving low-income counties and counties with lower proportions of women and senior residences and greater proportions of Hispanic residents were more likely to attain lower performance scores. Home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance. Still, there is a need to improve the quality of care of all agencies. Many parts of the United States, particularly lower-income areas and areas with more Hispanic residents, are more likely to receive lower quality home health care. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.
the key issues facing health care providers in ... gral part of community-based health programmes ... health care services more accessible to everyone s. , .... health; villagers are often more willing to help meet the costs of services they value. 2.
White, A W
To provide seamless care for patients while the health care industry undergoes changes, an integrated health information system must be developed. This effort affects the roles and responsibilities of practitioners and educators in health information administration (HIA). The changes may affect job satisfaction of HIA educators as they prepare entry-level practitioners for emerging roles. A national survey of HIA faculty's job satisfaction used the JDI/JIG scales and a researcher-developed instrument. The survey asked what job, institutional, and individual factors were significantly related to overall job satisfaction, whether there is a relationship between organizational fit and overall job satisfaction, and whether HIA faculty were pursuing terminal degrees, and what incentives and impediments they found to do so. Response rate was 78%. These faculty were very satisfied with their jobs. Work, pay, supervision, and co-workers were significantly related to overall job satisfaction, with work and supervision accounting for 47% of the variance. Doctorally prepared faculty valued research more than did others, and tended to be in institutions perceived to value research. Although 79% reported that their institutions encouraged them to pursue advanced degrees, only 23.6% were pursuing doctorates. These findings may be useful in recruiting HIA practitioners into academia as well as for accreditation purposes.
Seligman, Jamie; Felder, Stephanie S; Robinson, Maryann E
The Substance Abuse and Mental Health Services Administration (SAMHSA) in the Department of Health and Human Services offers extensive disaster behavior health resources to assist disaster survivors in preparing for, responding to, and recovering from natural and manmade disasters. One of SAMHSA's most innovative resources is the SAMHSA Behavioral Health Disaster Response App (SAMHSA Disaster App). The SAMHSA Disaster App prepares behavioral health responders for any type of traumatic event by allowing them to access disaster-related materials and other key resources right on their phone, at the touch of a button. The SAMHSA Disaster App is available on iPhone, Android, and BlackBerry devices.
Reed, Patricia D
.... This thesis argues that several factors contribute to this lack of success, including funding structures and guidelines, the reluctance on the part of other responder agencies to include Public...
Matyssek, A K
Leadership includes two tasks within public administration: leading employees by creating healthy working conditions and being led by others. The basis of leading others in a healthy way means dealing with oneself in a healthy manner; this includes typical healthy behavior (i.e., physical activity, improved nutrition, not smoking), which allows for recovery by a good work-life balance and a sensitive dealing with one's own limits. Given these conditions of healthy self care, managers are able to act as role models and lead their employees in a healthy manner. Leading in a healthy manner means showing appreciation, being interested in the employees ("caring"), integrating them in decision-making, allowing transparency, improving the working atmosphere, and finally reducing stress and increasing resources. The latter includes social support, which decreases the danger of employees burning out. The article presents the concept of a 2-day training that is designed for managers in order to raise their awareness for duties related to health management in public administration.
Schult, Tamara M; Schmunk, Sandra K; Awosika, Ebi R
The aim of this study was to describe a comprehensive approach to decrease physical inactivity in the Veterans Health Administration (VHA) employee population. The approach included (1) initiatives to decrease physical inactivity in the workplace; (2) two operational surveys to assess system-wide service provision; and (3) two national employee surveys. From 2010 to 2012, 86 employee fitness centers were completed in VA medical centers. A grants program (2010 to 2015) funded smaller projects designed to decrease physical inactivity in the workplace. Projects involved the provision of equipment to decrease sedentary behaviors, including stability balls, treadmill and sit-to-stand desks, stairwell projects, and funding for on-site fitness classes, bicycle racks, and outdoor par courses and walking paths among others. A comprehensive approach to decrease physical inactivity in VHA employees was successful. Overall, self-reported, age-adjusted physical inactivity in VHA employees decreased from 25.3% in 2010 to 16.1% in 2015.
Full Text Available The term agency has been defined as a sense of responsibility for one’s life course, the belief that one is in control of one’s decisions and is responsible for their outcomes, and the confidence that one will be able to overcome obstacles that impede one’s progress along one’s chosen life course. Agency is an upper psychological structure which consists of self-esteem, purpose in life, self-efficacy (ego strength, and internal locus of control. Literature offers quite different explanations for agency concept. The reason of this situation may be the attribution of different meanings to the concept by psychologists and sociologists. When considering the agency literature in Turkey and other countries, it can be said that the number of studies on agency subject is lower than the number of studies on other psychosocial study subjects. Agency should be taken into consideration as a psychosocial variable in the studies to be made in Turkey.
Havnaer, Annika G; Greenberg, Paul B; Cockerham, Glenn C; Clark, Melissa A; Chomsky, Amy
To describe current cataract surgery practices within the United States Veterans Health Administration (VHA). Veterans Health Administration hospitals in the U.S. Retrospective data analysis. An initial e-mail containing a link to an anonymous 32-question survey of cataract surgery practices was sent to participants in May 2016. Two reminder e-mails were sent to nonresponders 1 week and 2 weeks after the initial survey was sent; the remaining nonresponders were called twice over a 2-week period. The data were analyzed using descriptive statistics. The response rate was 75% (67/89). Cataract surgeons routinely ordered preoperative testing in 29 (45%) of 65 sections and preoperative consultations in 26 (39%) of 66 sections. In 22 (33%) of 66 sections, cataract surgeons administered intracameral antibiotics. In 61 (92%) of 66 sections, cataract surgeons used toric intraocular lenses (IOLs). In 20 (30%) of 66 sections, cataract surgeons used multifocal IOLs. Cataract surgeons in 6 (9%) of 66 sections performed femtosecond laser-assisted cataract surgery. In 6 (9%) of 66 sections, cataract surgeons performed immediate sequential bilateral cataract surgery. Forty-nine (74%) ophthalmology chiefs reported a high level of satisfaction with Veterans Affairs ophthalmology. The survey results indicate that in cataract surgery in the VHA, routine preoperative testing is commonly performed and emerging practices, such as femtosecond laser-assisted cataract surgery and immediate sequential bilateral cataract surgery, have limited roles. The results of this survey could benchmark future trends in U.S. cataract surgery practices, especially in teaching hospital settings. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
The issues in imaging are the appropriate use of equipment and optimising the organisation of imaging facilities, through a pooling of medical resources. The Ministry responsible for health has confirmed its desire to increase the number of MRI devices in order to better address patient needs in compliance with best practices, especially in dealing with strokes and cancers. The primary need is to reinforce radiation protection, essentially with regard to children. The steps taken are designed to speed up the replacement of irradiating techniques. According to the SROS-PRS (regional health care organisation scheme - regional health care project), the ARS (regional health agencies) are required to mobilize all resources in order to meet the national objectives for improving access to imaging and reducing disparities in access and efficiency. It is up to the ARS to define the territorial distribution of supply, with appropriate gradation of imaging facilities, in particular to ensure a permanent supply of care. (author)
Bell, Robert A; McGlone, Matthew S; Dragojevic, Marko
When describing health threats, communicators can assign agency to the threat (e.g., "Hepatitis C has infected 4 million Americans") or to humans (e.g., "Four million Americans have contracted hepatitis C"). In an online experiment, the authors explored how assignment of agency affects perceptions of susceptibility and severity of a health threat, response efficacy, self-efficacy, fear arousal, and intentions to adopt health-protective recommendations. Participants were 719 individuals recruited through Mechanical Turk ( www.mturk.com ), a crowdsource labor market run by Amazon ( www.amazon.com ). The participants were assigned randomly to read 1 of 8 flyers defined by a 2×4 (Agency Assignment×Topic) factorial design. Each flyer examined 1 health threat (E. coli, necrotizing fasciitis, salmonella, or Carbapenem-resistant Klebsiella pneumoniae) and was written in language that emphasized bacterial or human agency. Perceived susceptibility and severity were highest when bacterial agency language was used. Response efficacy, self-efficacy, and fear arousal were not significantly affected by agency assignment. Participants reported stronger intentions to adopt recommendations when bacteria agency language was used, but this effect did not reach conventional standards of significance (p < .051). The authors concluded that health communicators can increase target audiences' perceptions of susceptibility and severity by assigning agency to the threat in question when devising health messages.
Nelson, Richard E; Hicken, Bret; Cai, Beilei; Dahal, Arati; West, Alan; Rupper, Randall
To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit. We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data's longitudinal nature, we used multivariable generalized estimating equation models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions. Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural patients compared to urban patients, and for those living 50-75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban-rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living reimbursement utilization slightly more than other patients. Our findings suggest an inverted U-shaped relationship between veterans' utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit. © 2013 National Rural Health Association.
Moran, Eileen A; Basa, Edesha; Gao, Jian; Woodmansee, Denni; Almenoff, Peter L; Hooker, Roderick S
This study assessed the 2014 clinical productivity of 5,959 physician assistants (PAs) and nurse practitioners (NPs) in the US Department of Veterans Affairs' Veterans Health Administration (VHA). Total work relative value units divided by the direct clinical full-time equivalent measured annual productivity, and correlated factors were examined using weighted analysis of variance. PAs and NPs in adult primary care roles were more productive than those in other specialties. Both providers were more productive in rural than in nonrural settings and less productive in teaching than nonteaching hospitals. Men were slightly more productive than women but age and years of VHA employment were not correlates of productivity. PAs were more productive when their scope of practice allowed significant autonomy; NP productivity was unaffected by supervisory requirements. PAs and NPs are an important component of the VHA provider workforce, and their productivity correlates with a number of factors. More organizational research is necessary to better understand the contributing roles PAs and NPs provide in a rapidly evolving, vertically integrated, national health delivery system.
Public Health Agency
This second corporate business plan explains the purpose of the PHA and focuses on health improvement, health protection and addressing health inequalities. The business plan is available to download below.
Castrucci, Brian C; Leider, Jonathon P; Liss-Levinson, Rivka; Sellers, Katie
Earnings have been shown to be a critical point in workforce recruitment and retention. However, little is known about how much governmental public health staff are paid across the United States. To characterize earnings among state health agency central office employees. A cross-sectional survey was conducted of state health agency central office employees in late 2014. The sampling approach was stratified by 5 (paired HHS) regions. Balanced repeated replication weights were used to correctly calculate variance estimates, given the complex sampling design. Descriptive and bivariate statistical comparisons were conducted. A linear regression model was used to examine correlates of earnings among full-time employees. A total of 9300 permanently employed, full-time state health agency central office staff who reported earnings information. Earnings are the main outcomes examined in this article. Central office staff earn between $55,000 and $65,000 on average annually. Ascending supervisory status, educational attainment, and tenure are all associated with greater earnings. Those employed in clinical and laboratory positions and public health science positions earn more than their colleagues in administrative positions. Disparities exist between men and women, with men earning more, all else being equal (P earnings levels, including disparities in earnings that persist after accounting for education and experience. Data from the survey can inform strategies to address earnings issues and help reduce disparities.
Elliott, Amanda; Davidson, Arthur; Lum, Flora; Chiang, Michael; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E.; Chou, Chiu-Fang
Purpose To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Methods We describe three currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Results Each of the three sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Conclusions Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. PMID:23158225
... Services of Residents § 415.204 Services of residents in skilled nursing facilities and home health... 42 Public Health 3 2010-10-01 2010-10-01 false Services of residents in skilled nursing facilities and home health agencies. 415.204 Section 415.204 Public Health CENTERS FOR MEDICARE & MEDICAID...
The participants discussed recruitment, training, rewards, retention, and roles of village health volunteers. This paper presents background data on village health volunteers in Malawi and elsewhere and reviews the key issues facing health care providers in working with village health volunteers. A copy of the workshop ...
Veenstra, Gerry; Burnett, Patrick John
Many health scholars find that Pierre Bourdieu's theory of practice leaves too little room for individual agency. We contend that, by virtue of its relational, field-theoretic underpinnings, the idea of leaving room for agency in Bourdieu's theory of practice is misguided. With agency manifested in interactions and social structures consisting of relations built upon relations, the stark distinction between agency and structure inherent to substantialist thinking is undermined, even dissolved, in a relational field-theoretic context. We also contend that, when treated as relationally bound phenomena, Bourdieu's notions of habitus, doxa, capital and field illuminate creative, adaptive and future-looking practices. We conclude by discussing difficulties inherent to implementing a relational theory of practice in health promotion and public health. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
....105 Administrative Personnel DEPARTMENT OF HEALTH AND HUMAN SERVICES SUPPLEMENTAL FINANCIAL DISCLOSURE REQUIREMENTS FOR EMPLOYEES OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES § 5502.105 Agency procedures. (a) The designated agency ethics official or, with the concurrence of the designated agency ethics official, each of...
Yuasa, Motoyuki; Yamaguchi, Yoshie; Imada, Mihoko
The Japan International Cooperation Agency (JICA) has focused its attention on appraising health development assistance projects and redirecting efforts towards health system strengthening. This study aimed to describe the type of project and targets of interest, and assess the contribution of JICA health-related projects to strengthening health systems worldwide. We collected a web-based Project Design Matrix (PDM) of 105 JICA projects implemented between January 2005 and December 2009. We developed an analytical matrix based on the World Health Organization (WHO) health system framework to examine the PDM data and thereby assess the projects' contributions to health system strengthening. The majority of JICA projects had prioritized workforce development, and improvements in governance and service delivery. Conversely, there was little assistance for finance or medical product development. The vast majority (87.6%) of JICA projects addressed public health issues, for example programs to improve maternal and child health, and the prevention and treatment of infectious diseases such as AIDS, tuberculosis and malaria. Nearly 90% of JICA technical healthcare assistance directly focused on improving governance as the most critical means of accomplishing its goals. Our study confirmed that JICA projects met the goals of bilateral cooperation by developing workforce capacity and governance. Nevertheless, our findings suggest that JICA assistance could be used to support financial aspects of healthcare systems, which is an area of increasing concern. We also showed that the analytical matrix methodology is an effective means of examining the component of health system strengthening to which the activity and output of a project contributes. This may help policy makers and practitioners focus future projects on priority areas.
Derickson, Ryan; Fishman, Jonathan; Osatuke, Katerine; Teclaw, Robert; Ramsel, Dee
In psychologically safe workplaces, employees feel comfortable taking interpersonal risks, such as pointing out errors. Previous research suggested that psychologically safe climate optimizes organizational outcomes. We evaluated psychological safety levels in Veterans Health Administration (VHA) hospitals and assessed their relationship to employee willingness of reporting medical errors. We conducted an ANOVA on psychological safety scores from a VHA employees census survey (n = 185,879), assessing variability of means across racial and supervisory levels. We examined organizational climate assessment interviews (n = 374) evaluating how many employees asserted willingness to report errors (or not) and their stated reasons. Finally, based on survey data, we identified 2 (psychologically safe versus unsafe) hospitals and compared their number of employees who would be willing/unwilling to report an error. Psychological safety increased with supervisory level (P hospital (71% would report, 13% would not) were less willing to report an error than at the psychologically safe hospital (91% would, 0% would not). A substantial minority would not report an error and were willing to admit so in a private interview setting. Their stated reasons as well as higher psychological safety means for supervisory employees both suggest power as an important determinant. Intentions to report were associated with psychological safety, strongly suggesting this climate aspect as instrumental to improving patient safety and reducing costs.
Stoskopf, C H; Xirasagar, S
This paper reviews gender issues in academe and presents findings of a limited survey of ACEHSA-accredited health administration graduate programs. The survey shows gender ratios adverse to women at the full, associate, and assistant professor levels. Men to women ratio among faculty was 1.98, among full-time faculty it was 2.24, and among tenured/tenure-track faculty it was 2.69, despite an excess of female students over male students in graduate programs, and despite equal proportions of women and men faculty holding doctoral degrees. Distribution by rank showed 48.5 percent full professors, 27.8 percent associate professors, and, 20.1 percent assistant professors among men, vs. 27.4 percent, 41.1 percent, and 31.5 percent respectively among women. In other academic fields similar gender ratios prevail, and many researchers have documented evidence of continuing gender inequities in tenure, promotion and salary, given comparable performance, despite the enactment of Title IX in 1972. Gender disparities are rooted in a complex web of gender-specific constraints interwoven with secular human capital and structural variables, and confounded by sexist discriminatory factors. In light of these issues, recommendations are made toward creating an equitable academic climate without compromising the ideal of meritocracy, through gender-sensitive initiatives and vigilance mechanisms to bring policies to fruition.
... conditions affecting employee safety and health, coordination of inspection functions is encouraged. ... HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) BASIC PROGRAM ELEMENTS FOR FEDERAL EMPLOYEE... shall be conducted by inspectors qualified to recognize and evaluate hazards of the working environment...
Rispel, Laetitia C; Angelides, George
Globally, insufficient information exists on the costs of nursing agencies, which are temporary employment service providers that supply nurses to health establishments and/or private individuals. The aim of the study was to determine the utilisation and direct costs of nursing agencies in the South African public health sector. A survey of all nine provincial health departments was conducted to determine utilisation and management of nursing agencies. The costs of nursing agencies were assumed to be equivalent to expenditure. Provincial health expenditure was obtained for five financial years (2005/6-2009/10) from the national Basic Accounting System database, and analysed using Microsoft Excel. Each of the 166,466 expenditure line items was coded. The total personnel and nursing agency expenditure was calculated for each financial year and for each province. Nursing agency expenditure as a percentage of the total personnel expenditure was then calculated. The nursing agency expenditure for South Africa is the total of all provincial expenditure. The 2009/10 annual government salary scales for different categories of nurses were used to calculate the number of permanent nurses who could have been employed in lieu of agency expenditure. All expenditure is expressed in South African rands (R; US$1 ∼ R7, 2010 prices). Only five provinces reported utilisation of nursing agencies, but all provinces showed agency expenditure. In the 2009/10 financial year, R1.49 billion (US$212.64 million) was spent on nursing agencies in the public health sector. In the same year, agency expenditure ranged from a low of R36.45 million (US$5.20 million) in Mpumalanga Province (mixed urban-rural) to a high of R356.43 million (US$50.92 million) in the Eastern Cape Province (mixed urban-rural). Agency expenditure as a percentage of personnel expenditure ranged from 0.96% in KwaZulu-Natal Province (mixed urban-rural) to 11.96% in the Northern Cape Province (rural). In that financial year
Maxey, Hannah L.; Randolph, Courtney; Gano, Laura; Kochhar, Komal
Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce. PMID:27218701
Vann, Timi S.; Venezia, Robert A.
The National Aeronautics and Space Administration (NASA), Earth Science Enterprise is engaged in applications of NASA Earth science and remote sensing technologies for public health. Efforts are focused on establishing partnerships with those agencies and organizations that have responsibility for protecting the Nation's Health. The program's goal is the integration of NASA's advanced data and technology for enhanced decision support in the areas of disease surveillance and environmental health. A focused applications program, based on understanding partner issues and requirements, has the potential to significantly contribute to more informed decision making in public health practice. This paper intends to provide background information on NASA's investment in public health and is a call for partnership with the larger practice community.
Hayes, Sara L; Mann, Mala K; Morgan, Fiona M; Kelly, Mark J; Weightman, Alison L
In many countries, national, regional and local inter- and intra-agency collaborations have been introduced to improve health outcomes. Evidence is needed on the effectiveness of locally developed partnerships which target changes in health outcomes and behaviours. To evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes in any population or age group. We searched the Cochrane Public Health Group Specialised Register, AMED, ASSIA, CENTRAL, CINAHL, DoPHER, EMBASE, ERIC, HMIC, IBSS, MEDLINE, MEDLINE In-Process, OpenGrey, PsycINFO, Rehabdata, Social Care Online, Social Services Abstracts, Sociological Abstracts, TRoPHI and Web of Science from 1966 through to January 2012. 'Snowballing' methods were used, including expert contact, citation tracking, website searching and reference list follow-up. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), controlled before-and-after studies (CBAs) and interrupted time series (ITS) where the study reported individual health outcomes arising from interagency collaboration between health and local government agencies compared to standard care. Studies were selected independently in duplicate, with no restriction on population subgroup or disease. Two authors independently conducted data extraction and assessed risk of bias for each study. Sixteen studies were identified (28,212 participants). Only two were considered to be at low risk of bias. Eleven studies contributed data to the meta-analyses but a narrative synthesis was undertaken for all 16 studies. Six studies examined mental health initiatives, of which one showed health benefit, four showed modest improvement in one or more of the outcomes measured but no clear overall health gain, and one showed no evidence of health gain. Four studies considered lifestyle improvements, of which one showed some limited short-term improvements, two failed to show health gains for the intervention
Visker, Joseph; Rhodes, Darson; Cox, Carol
Community Health Workers (CHWs) serve an indispensable but oftten misunderstood and unrecognized role in public health. These individuals constitute the frontline of health care in many communities and are relied upon to provide an assortment of services. Unfortunately, the full extent to which CHWs are utilized is unknown and there is little…
Mittermayer, Renato; Huić, Mirjana; Mestrović, Josipa
Avedis Donabedian defined the quality of care as the kind of care, which is expected to maximize an inclusive measure of patient welfare, after taking into account the balance of expected gains and losses associated with the process of care in all its segments. According to the World Medical Assembly, physicians and health care institutions have an ethical and professional obligation to strive for continuous quality improvement of services and patient safety with the ultimate goal to improve both individual patient outcomes as well as population health. Health technology assessment (HTA) is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner, with the aim to formulate safe and effective health policies that are patient focused and seek to achieve the highest value. The Agency for Quality and Accreditation in Health was established in 2007 as a legal, public, independent, nonprofit institution under the Act on Quality of Health Care. The Agency has three departments: Department of Quality and Education, Department of Accreditation, and Department of Development, Research, and Health Technology Assessment. According to the Act, the Agency should provide the procedure of granting, renewal and cancellation of accreditation of healthcare providers; proposing to the Minister, in cooperation with professional associations, the plan and program for healthcare quality assurance, improvement, promotion and monitoring; proposing the healthcare quality standards as well as the accreditation standards to the Minister; keeping a register of accreditations and providing a database related to accreditation, healthcare quality improvement, and education; providing education in the field of healthcare quality assurance, improvement and promotion; providing the HTA procedure and HTA database, supervising the healthcare insurance
... INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES Credits Against Tax § 1.42-13... Internal Revenue Service, the Agency, or the Agency and the affected taxpayer, should complete and file the... already been filed with the Service, the Agency, or the Agency and the affected taxpayer, should refile a...
Rebmann, Terri; Citarella, Barbara; Subramaniam, Divya S; Subramaniam, Dipti P
Adequate pandemic preparedness is imperative for home health agencies. A 23-item pandemic preparedness survey was administered to home health agencies in the spring of 2010. The Kruskal-Wallis (KW) test was used to evaluate the relationships between agency size and preparedness indicators. Significant findings were further analyzed by the Mann-Whitney (MW) U post hoc test. The response rate was 25% (526/2,119). Approximately one-third of respondents (30.4%; n = 131) reported experiencing trouble obtaining supplies during the 2009 H1N1 pandemic. Small agencies were significantly more likely (Krusal-Wallis [KW] = 9.2; P agency pandemic preparedness, including surge capacity and participation in disaster drills, that need to be addressed. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
Gómez, Eduardo J
Of recent interest is the capacity of international health agencies to adapt to changes in the global health environment and country needs. Yet, little is known about the potential benefits of using social science institutional theory, such as path dependency and institutional change theory, to explain why some international agencies, such as the WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria, fail to adapt, whereas others, such as the World Bank and UNAIDS, have. This article suggests that these institutional theories can help to better understand these differences in international agency adaptive capacity, while highlighting new areas of policy research and analysis.
Bunger, Alicia C; Doogan, Nathan J; Cao, Yiwen
Meeting the complex needs of youth with behavioral health problems requires a coordinated network of community-based agencies. Although fiscal scarcity or retrenchment can limit coordinated services, munificence can stimulate service delivery partnerships as agencies expand programs, hire staff, and spend more time coordinating services. This study examines the 2-year evolution of referral and staff expertise sharing networks in response to substantial new funding for services within a regional network of children's mental health organizations. Quantitative network survey data were collected from directors of 22 nonprofit organizations that receive funding from a county government-based behavioral health service fund. Both referral and staff expertise sharing networks changed over time, but results of a stochastic actor-oriented model of network dynamics suggest the nature of this change varies for these networks. Agencies with higher numbers of referral and staff expertise sharing partners tend to maintain these ties and/or develop new relationships over the 2 years. Agencies tend to refer to agencies they trust, but trust was not associated with staff expertise sharing ties. However, agencies maintain or form staff expertise sharing ties with referral partners, or with organizations that provide similar services. In addition, agencies tend to reciprocate staff expertise sharing, but not referrals. Findings suggest that during periods of resource munificence and service expansion, behavioral health organizations build service delivery partnerships in complex ways that build upon prior collaborative history and coordinate services among similar types of providers. Referral partnerships can pave the way for future information sharing relationships.
General Accounting Office, Washington, DC. Div. of Human Resources.
This report concerns the Health Care Financing Administration's (HCFA) contracting with Utilization and Quality Control Peer Review Organizations (PROs) as a means of monitoring the medical necessity and quality of in-hospital care provided to Medicare beneficiaries. Findings from a HCFA survey of PROs in California, Florida, and Georgia are used…
Chinyeaka Justine Igbokwe-Ibeto
Full Text Available Public Over the years, the efficiency and effectiveness of Nigeria’s public sector has been a subject of debate. However, in recent time, the organizational performance and service delivery of National Agency for Food, Drug Administration and Control (NAFDAC have been a success story. Within the framework of New Public Management (NPM theory, the study investigates the secrete behind the degree of success achieved by NAFDAC with the aim of recommending such to other public sector organizations in Nigeria which has over the year’s demonstrated lack of zeal for service delivery. The study relied heavily on primary and secondary data. Yamani’s formula for sample size determination was used to select a sample of 133 employees from NAFDAC Lagos office out of a total of 200. Weighted mean and chi-square statistical tools was used to determine the independence or otherwise of the variables under investigation. It is the position of the study that NPM has enhanced NAFDAC’s performance and service delivery. It concludes that since the traditional public administration theories has failed to deliver the much needed public goods and services, it is therefore imperative to reinvent Nigeria’s public sector in line with (NPM international best practices so as to reposition the Nigerian public sector for the challenges of a modern and rapidly changing world. However, while change is desirable, we feel there is need to exercise caution on account of the peculiar nature and character of the Nigerian state and society. Reinventing the country’s public sector should progress slowly and wisely.
Bonham, Caroline A; Sommerfeld, David; Willging, Cathleen; Aarons, Gregory A
Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities.
Caroline A. Bonham
Full Text Available Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38 supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities.
Aziz, Muhammad Abdul; Adnan, Muhammad; Khan, Amir Hasan; Sufyan, Muhammad; Khan, Shahid Niaz
In remote areas, medicinal plants have an imperative role in curing various livestock's ailments. In Pakistan, people residing in remote areas including South Waziristan Agency and Bajaur Agency depend on traditional herbal remedies for treating their domestic animals. Medicinal plants are an important part of the medical system in these Agencies. The prime goal of the current study is to explore the ethnoveterinary practices in the two regions and discuss cross-cultural consensus on the use of medicinal plants. In this study, we have given detailed description on the ethnoveterinary usage of certain medicinal plants and their recipes. Moreover, we have also elaborated the ethnoveterinary potential of certain plants in relation to their ethnomedicinal, pharmacological and phytochemicals reports. Fieldwork comprised of two fields surveys conducted at South Waziristan Agency and Bajaur Agency. A total of 75 informants from South Waziristan Agency and 80 informants from Bajaur Agency were interviewed with the help of semi-structured questionnaires. Use reports (URs) were recorded for all the documented taxa. Data were quantitatively analyzed by using informant consensus factor (F ic ) index in order to find out information homogeneity provided by the informants. To analyze the cross-cultural consensus, the recorded data were tabulated as well as shown by Venn diagram. Overall, 94 medicinal plant taxa were recorded in the comparative analysis. Out of these, most of the plants species (72 species) were used at Bajaur Agency than South Waziristan Agency (37 species). Cross-cultural analysis showed that only 15 medicinal plants were used in common by the indigenous communities in both Agencies, which indicates a low interregional consensus with regard to the ethnoveterinary practices of medicinal plants. Apiaceae was the dominant family in both regions by representing maximum number of plant species (11 species). Gastro intestinal complexities were common in both regions
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency Information Collection Activities: Proposed Collection: Comment Request Periodically, the Health Resources and... Resources and Services Administration (HRSA), Bureau of Clinician Recruitment and Service (BCRS) places...
... Services Administration and Centers for Disease Control and Prevention I hereby delegate to the Administrator, Health Resources and Services Administration (HRSA), and the Director, Centers for Disease Control and Prevention (CDC), with authority to redelegate, the authority vested in the Secretary of the...
Wright, Tim; Hyner, Gerald C.
Administrators of older adult-centered facilities must identify barriers to the planning and implementation of health promotion programs. In this qualitative research those barriers were identified through in-depth interviews with administrators of older adult-centered facilities. As identified by administrators, the predominant barriers to the…
Beatty, Kate E; Erwin, Paul Campbell; Brownson, Ross C; Meit, Michael; Fey, James
Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Cross-sectional study using secondary data from the 2013 National Association of County & City Health Officials (NACCHO) National Profile of Local Health Departments Study (Profile Study). United States. LHDs (n = 490) that responded to the 2013 NACCHO Profile Survey. LHDs decision to seek PHAB accreditation. Significantly more accreditation-seeking LHDs were located in urban areas (87.0%) than in micropolition (8.9%) or rural areas (4.1%) (P < .001). LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs (RLHDs). LHDs that had completed an agency-wide strategic plan were 8.5 times (95% CI, 4.0-17.9), LHDs with a local board of health were 3.3 times (95% CI, 1.5-7.0), and LHDs governed by their state health department were 12.9 times (95% CI, 3.3-50.0) more likely to seek accreditation. The most commonly cited barrier was time and effort required for accreditation application exceeded benefits (73.5%). The strongest predictor for seeking PHAB accreditation was serving an urban jurisdiction. Micropolitan LHDs were more likely to seek accreditation than smaller RLHDs, which are typically understaffed and underfunded. Major barriers identified by the RLHDs included fees being too high and the time and effort needed for accreditation exceeded their perceived benefits. RLHDs will need additional financial and technical support to achieve accreditation. Even with additional funds, clear messaging of the benefits of accreditation
Northwest Regional Educational Lab., Portland, OR.
This annotated bibliography lists curriculum materials for health occupations education which were produced by Federal agencies and are appropriate for these subject matter areas: (1) dentistry, (2) medical laboratory technology, (3) nursing, (4) rehabilitation, (5) radiology, (6) opthalmology, (7) environmental health, and (8) mental health…
U.S. Department of Health & Human Services — A list of VHA hospitals with inpatient experience of care survey data. The VA SHEP uses the same questions as the Hospital Consumer Assessment of Health Providers...
Harvard Law Review, 1976
Implications of the Occupational Safety and Health Act of 1970 are described in two cases: Brennan v. Occupational Safety and Health Review Commission (Underhill Construction Corp.), and Anning-Johnson Co. v. United States Occupational Safety and Health Review Commission. (LBH)
Management of health institutions, like many other endeavours, is regulated by law. There is therefore the need for health managers to familiarise themselves with the laws affecting their institutions. The health manager must know the functions, powers and limitations of different statutory or established organs within his ...
... Health Systems Agencies of Applications Under Section 1625 of the Public Health Service Act Appendix to..., App. Appendix to Subpart G of Part 124—Interim Procedures and Criteria for Review by Health Systems... section 1625 of the Act, health systems agencies shall use the procedures and criteria stated below. A...
Bhattacharya, Sanmitra; Srinivasan, Padmini; Polgreen, Philip
It is becoming increasingly common for individuals and organizations to use social media platforms such as Facebook. These are being used for a wide variety of purposes including disseminating, discussing and seeking health related information. U.S. Federal health agencies are leveraging these platforms to 'engage' social media users to read, spread, promote and encourage health related discussions. However, different agencies and their communications get varying levels of engagement. In this study we use statistical models to identify factors that associate with engagement. We analyze over 45,000 Facebook posts from 72 Facebook accounts belonging to 24 health agencies. Account usage, user activity, sentiment and content of these posts are studied. We use the hurdle regression model to identify factors associated with the level of engagement and Cox proportional hazards model to identify factors associated with duration of engagement. In our analysis we find that agencies and accounts vary widely in their usage of social media and activity they generate. Statistical analysis shows, for instance, that Facebook posts with more visual cues such as photos or videos or those which express positive sentiment generate more engagement. We further find that posts on certain topics such as occupation or organizations negatively affect the duration of engagement. We present the first comprehensive analyses of engagement with U.S. Federal health agencies on Facebook. In addition, we briefly compare and contrast findings from this study to our earlier study with similar focus but on Twitter to show the robustness of our methods.
Iwami, Michiyo; Petchey, Roland
In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies.
Isett, Kimberley Roussin; Laugesen, Miriam J; Cloud, David H
To ascertain any lessons learned about how public health reforms undertaken in New York City during the Bloomberg Administration were shepherded through the public policy and administration gauntlet. The question is, how feasible is this approach and would it work outside of New York City? Using a theoretically grounded case study approach, 3 initiatives were examined that were proposed and/or implemented during a 10-year period of the Mayoralty of Michael Bloomberg (2002-2011): transfats restrictions, clean bus transportation policies, and a sugar-sweetened beverages tax (as a counterfactual). The investigation began by performing a comprehensive public documents search and was followed with interviews of 27 individuals involved in the selected policy initiatives. Interviews were coded in Nvivo using an iterative, grounded methodology. Using a theoretical lens, the case study illustrates that the multifaceted role of leadership was not confined to the executives in the City or the Agency. Instead, leadership extended to other administrative officials within the agency and the Board of Health. Second, New York City used reorganization and coordinative mechanisms strategically to ensure achievement of their goals. This included creation of new departments/bureaus and coordinating structures across the City. Evidence of the explicit use of incentives, as initially anticipated from the theoretical framework, was not found. While some aspects of this case study are unique to the context of New York City, 2 approaches used in New York City are feasible for other jurisdictions: harnessing the full scope and breadth of authority of the agency and its associated boards and commissions, and remobilizing existing workforce to explicitly focus on and coordinate targeted policies for issues of concern. Questions for further consideration are posed at the conclusion of the article.
Gross, Nathan; Peek-Asa, Corinne; Nocera, Maryalice; Casteel, Carri
Workplace violence in the home health industry is a growing concern, but little is known about the content of existing workplace violence prevention programs. The authors present the methods for this study that examined workplace violence prevention programs in a sample of 40 California home health and hospice agencies. Data was collected through surveys that were completed by the branch managers of participating facilities. Programs were scored in six different areas, including general workplace violence prevention components; management commitment and employee involvement; worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation. The results and discussion sections consider these six areas and the important gaps that were found in existing programs. For example, although most agencies offered workplace violence training, not every worker performing patient care was required to receive the training. Similarly, not all programs were written or reviewed and updated regularly. Few program differences were observed between agency characteristics, but nonetheless several striking gaps were found.
Scammon, D; Kennard, L
Perceptions of consumers, health care administrators, and physicians regarding health care providers are analyzed. Ratings on 26 dimensions of health care services were obtained from members of the three participant groups using measures of image and satisfaction of both physicians in general, and of specific physicians. Discriminant analysis reveals significantly different perceptions of the health care system among the three groups of respondents. These differences suggest some changes in health care administration which could lead to increased consumer satisfaction and competitive advantages for physicians and health care institutions.
The Food and Drug Administration through its National Center for Devices and Radiological Health, is responsible for the day-to-day administration of the Radiation Control for Health and Safety Act. This report covers the detailed operation of the Agency in carrying out that responsibility for calendar year 1983. There are nine equipment performance or regulatory standards (television receivers, cold-cathode gas discharge tubes, microwave ovens, diagnostic x-ray systems, cabinet x-ray systems, laser products, ultrasonic therapy products, mercury vapor lamps, and sunlamp products) now in effect
Occupational Safety and Health Administration, Washington, DC.
The manual guides an instructor in conducting a training course for first-line supervisors to familiarize them with six aspects relating to the Occupational Safety and Health Act of 1970: (1) requirements of the Act, (2) compliance with its standards, (3) identification of health and safety hazards, (4) correction of adverse conditions, (5) record…
Gilman, Stuart C; Chokshi, Dave A; Bowen, Judith L; Rugen, Kathryn Wirtz; Cox, Malcolm
Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care.
Samel W. Ririhena
Full Text Available Abstract Reforms are demands to improve services especially health services to the community in Merauke. The purpose of writing is to analyze the theory of agency in order to verify the health care bureaucracy reformas Merauke district which includes reform of the bureaucracy adverse selection and moral hazard. This study used a qualitative approach and data collection is done by using interviews and intervieuw based on interactive model of Milles and Huberman. The results showed that the reform of health care bureaucracy in Merauke not running optimally and the problem of adverse selection and moral hazard is still happening in the agency relationship between the Department of Health and the Health Center.
Tarride, J E; Harrington, K; Balfour, R; Simpson, P; Foord, L; Anderson, L; Lakey, W
To evaluate the My Health Matters! (MHM) program, a multifaceted workplace intervention relying on education and awareness, early detection and disease management with a focus on risk factors for metabolic syndrome. The MHM program was offered to 2,000 public servants working in more than 30 worksites in British Columbia, Canada. The MHM program included a health risk assessment combined with an opportunity to attend an on-site screening and face-to-face call back visits and related on-site educational programs. Clinical and economic outcomes were collected over time in this one-year prospective study coupled with administrative and survey data. Forty three per cent of employees (N=857) completed the online HRA and 23 per cent (N=447) attended the initial clinical visit with the nurse. Risk factors for metabolic syndrome were identified in more than half of those attending the clinical visit. The number of risk factors significantly decreased by 15 per cent over six months (N=141). The cost per employee completing the HRA was $205 while the cost per employee attending the initial clinical visit was $394. Eighty-two per cent of employees would recommend the program to other employers. This study supports that workplace interventions are feasible, sustainable and valued by employees. As such, this study provides a new framework for implementing and evaluating workplace interventions focussing on metabolic disorders.
U.S. Department of Health & Human Services — A list of VHA hospitals with timely and effective care (process of care) measure data. VHA collects this information through a Quality Improvement Organization...
Jan 18, 2011 ... state of complete physical, mental and social well-being, not merely the ... School health education programme aims at developing optimum physical, ... school personnel, counseling pupils, parents and others concerning ...
Powell, Thomas; Perron, Brian Edward
Self-help groups benefit clients by linking them to people who have "been there" and are successfully coping with their situations. Mental health/substance use agencies can increase access to evidence-based benefits of self-help groups by engaging them in organizational exchanges. Organizational theories are used to frame beneficial exchanges with self-help groups. Adaptational theory is used to frame exchanges with self-help groups and various service agency subunits, e.g., board, practitioner, and client units. Institutional theory is used to frame joint agency/self-help initiatives to promote community acceptance of self-help groups, which in turn may enhance the credibility of the professional agency.
Ebie, J C
The paper discusses the present machinery for the administration of health care facilities in the Midwestern State of Nigeria and makes suggestions for improvement. The multiplicity of autonomous authorities involved in the running of health care facilities and the compartmentalization of health care into 'preventive' aspects (managed by the State Ministry of Health and Local Authorities) and 'curative' aspects (managed by the State Hospitals Management Board) are seen as the main disadvantages of the present system. A new administrative set-up is suggested, the highlights of which include the creation of a number of Area Health Boards that will have responsibility for all State Government and Local Authority health care facilities in their respective geographically defined areas of jurisdiction (this will abolish the artificial division between the administrations of 'preventive' and 'curative' aspects of health care), more professional divisions in the state Ministry of Health (which will retain responsibility on behalf of government for policy matters and the provision of health care facilities) than at the moment, a State Health Service Commission and A State Health Advisory Committee. It is important for doctors and other personnel in the health care field to know something about the administrative machinery of the health care delivery system in which they work. Apart from doctors who are trained in certain postgraduate fields, most other doctors do not appear to have any formal training in or early exposure to medical administration and yet, some of them get called upon during their career to undertake administrative duties at a very high level. This paper describes the present system of administration of health care facilities in the Midwestern State and offers suggestions for consideration for improvement. It is a well known fact that the administration of health care facilities in the Midwestern State has improved considerably in recent years. The
Norwood, Connor W; Maxey, Hannah L; Randolph, Courtney; Gano, Laura; Kochhar, Komal
Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.
Alwon, Floyd J.
Guidelines are suggested whereby mental health agency administrators can promote organizational growth and avoid dangers during an agency crisis. Emphasis is placed on the administrator's comprehension of leadership styles and task organization. Typical staff reactions to agency crises are described. (Author/DB)
Electronic reporting of laboratory results to public health agencies can improve public health surveillance for reportable diseases and conditions by making reporting more timely and complete. Since 2010, CDC has provided funding to 57 state, local, and territorial health departments through the Epidemiology and Laboratory Capacity for Infectious Diseases cooperative agreement to assist with improving electronic laboratory reporting (ELR) from clinical and public health laboratories to public health agencies. As part of this agreement, CDC and state and large local health departments are collaborating to monitor ELR implementation in the United States by developing data from each jurisdiction regarding total reporting laboratories, laboratories sending ELR by disease category and message format, and the number of ELR laboratory reports compared with the total number of laboratory reports. At the end of July 2013, 54 of the 57 jurisdictions were receiving at least some laboratory reports through ELR, and approximately 62% of 20 million laboratory reports were being received electronically, compared with 54% in 2012. Continued progress will require collaboration between clinical laboratories, laboratory information management system (LIMS) vendors, and public health agencies.
Full Text Available Abstract Background Colorectal cancer (CRC is the third most commonly diagnosed cancer in Canada and accounts for 11.9% of all cancer-related mortality. Fortunately, previous studies have provided evidence of improved outcomes from access to timely and appropriate health services along the disease trajectory in CRC. As a result, the CIHR/CCNS Team in Access to Colorectal Cancer Services in Nova Scotia (Team ACCESS was created to build colorectal cancer (CRC research capacity in Nova Scotia (NS and to study access to and quality of CRC services along the entire continuum of cancer care. Objectives The objectives of this paper are to: 1 provide a detailed description of the methodologies employed across the various studies being conducted by Team ACCESS; 2 demonstrate how administrative health data can be used to evaluate access and quality in CRC services; and 3 provide an example of an interdisciplinary team approach to addressing health service delivery issues. Methods All patients diagnosed with CRC in NS between 2001 and 2005 were identified through the Nova Scotia Cancer Registry (NSCR and staged using the Collaborative Stage Data Collection System. Using administrative databases that were linked at the patient level, Team ACCESS created a retrospective longitudinal cohort with comprehensive demographic, clinical, and healthcare utilization data. These data were used to examine access to and quality of CRC services in NS, as well as factors affecting access to and quality of care, at various transition points along the continuum of care. Team ACCESS has also implemented integrated knowledge translation strategies targeting policy- and decision- makers. Discussion The development of Team ACCESS represents a unique approach to CRC research. We anticipate that the skills, tools, and knowledge generated from our work will also advance the study of other cancer disease sites in NS. Given the increasing prevalence of cancer, and with national and
Porter, Geoffrey; Urquhart, Robin; Bu, Jingyu; Kendell, Cynthia; Macintyre, Maureen; Dewar, Ron; Kephart, George; Asada, Yukiko; Grunfeld, Eva
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in Canada and accounts for 11.9% of all cancer-related mortality. Fortunately, previous studies have provided evidence of improved outcomes from access to timely and appropriate health services along the disease trajectory in CRC. As a result, the CIHR/CCNS Team in Access to Colorectal Cancer Services in Nova Scotia (Team ACCESS) was created to build colorectal cancer (CRC) research capacity in Nova Scotia (NS) and to study access to and quality of CRC services along the entire continuum of cancer care. The objectives of this paper are to: 1) provide a detailed description of the methodologies employed across the various studies being conducted by Team ACCESS; 2) demonstrate how administrative health data can be used to evaluate access and quality in CRC services; and 3) provide an example of an interdisciplinary team approach to addressing health service delivery issues. All patients diagnosed with CRC in NS between 2001 and 2005 were identified through the Nova Scotia Cancer Registry (NSCR) and staged using the Collaborative Stage Data Collection System. Using administrative databases that were linked at the patient level, Team ACCESS created a retrospective longitudinal cohort with comprehensive demographic, clinical, and healthcare utilization data. These data were used to examine access to and quality of CRC services in NS, as well as factors affecting access to and quality of care, at various transition points along the continuum of care. Team ACCESS has also implemented integrated knowledge translation strategies targeting policy- and decision- makers. The development of Team ACCESS represents a unique approach to CRC research. We anticipate that the skills, tools, and knowledge generated from our work will also advance the study of other cancer disease sites in NS. Given the increasing prevalence of cancer, and with national and provincial funding agencies promoting collaborative research
Chesser, Amy K.; Keene Woods, Nikki; Wipperman, Jennifer; Wilson, Rachel; Dong, Frank
Low health literacy is associated with poor health outcomes. Research is needed to understand the mechanisms and pathways of its effects. Computer-based assessment tools may improve efficiency and cost-effectiveness of health literacy research. The objective of this preliminary study was to assess if administration of the Short Test of Functional…
... for Mine Safety and Health Administration employees. The rules in this section apply to employees of... Mine Safety and Health Act. Example: A mine inspector who was a former employee of mining company X... Secretary of labor for Mine Safety and Health or the Assistant Secretary's designee may grant an employee a...
Scheidt, S D
Although women have made many strides in the area of leadership, stereotypes still exist that limit their power. Traditional concepts of femininity have not typically been associated with strength and competence. This article describes an inpatient unit at San Francisco General Hospital, University of California, San Francisco, which is led by a group of women. The unit houses a women-focused treatment team specializing in treating women who have serious mental illness with histories of severe trauma, including poverty and violence. The article describes the challenges and rewards available to women leaders in this type of setting. Four areas of women's leadership are explored: the stereotypes women have about each other as leaders, the expectations and biases of staff and trainees, the projections of patients onto women leaders, and women's leadership in relation to department administration. Strategies for addressing biases in these areas and developing women's leadership conclude the article.
Bates, P W
The author discusses the concept of a legal 'contract' and gives many examples of its application in hospitals and health settings. He describes the main features of a contract and gives special attention to personnel and clinical ramifications and to the role of agents in making contracts on behalf of hospitals.
... Part D grantees' level of participation in state-sponsored initiatives for the development of health... provide outpatient or ambulatory family-centered primary medical care for women, infants, children, and... from denying coverage to children with pre-existing conditions such as HIV/AIDS, cancelling coverage...
McRae, J A
This article outlines three methods of mental health marketing--formal, intermediary, and interactive. It discusses advantages and disadvantages of each method. These approaches are particularly good for public, non-profit agencies and individuals in contacting the private sector. The need for flexibility and marketing mix is emphasized.
The role of health agencies in the field of biomedicine does not appear today anymore as a question of systemic approach but much more as a question of implementing the bioethical principles acknowledged in the legislation and by the different stake-holders of the biomedical techniques.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Health Center Program AGENCY: Health Resources and Services Administration, HHS. ACTION: Notice of Noncompetitive... Improvement Project (CIP) from Saint Vincent's Catholic Medical Centers (SVCMC) of New York, current grantee...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Health Center Program AGENCY: Health Resources and Services Administration, HHS. ACTION: Notice of Noncompetitive... for Services (IDS) and a portion of the Capital Improvement Project (CIP) from Saint Vincent's...
Association of Univ. Programs in Health Administration, Washington, DC.
This report, prepared by the Association of University Programs in Hospital Administration (AUPHA), presents recommendations for increasing the representation of minorities in hospital and health-care administration careers on a nationwide basis. A short-term objective is to increase the representation of minorities in graduate degree programs…
There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.
On March 26, 2012, Occupational Safety and Health Administration (OSHA) modified its HCS to conform to the United Nations’ (UN) Globally Harmonized System of Classification and Labeling of Chemicals (GHS), to improve consistency and quality of information.
medical condition caused by it. Explain conditions, such as traumatic bursitis, traumatic neuritis, traumatic myositis , or traumatic synovitis, by... histopathologic findings have a direct bearing on diagnosis and treatment (AR 40-31/BUMEDINST 6510.2F/AFR 160-55). In such cases, the attending physician...Armed Forces Institute of Pathology and Armed Forces Histopathology Centers AR 40–35 Preventive Dentistry AR 40–48 Nonphysician Health Care Providers
... conditions are met: (a) The negotiated price is fair and reasonable; (b) A document of agreement signifying acceptance of the arrangements with terms and conditions is filed with the participating agency by the TSP...
and how best to deal with ** !285 0 it. Since these alternative futures are built conceptually V with tools which are at once both analytical and...what follows. Management Improvements In this area, FAA-- o Completed the conceptual and functional design of an up-graded FAA-wide uniform...it seeks is a stable relationship with agency labor organizations within a framwork which will not interfere with the agency’s accomplishment of its
Laetitia C. Rispel
Full Text Available Background: Worldwide, there is an increased reliance on casual staff in the health sector. Recent policy attention in South Africa has focused on the interrelated challenges of agency nursing and moonlighting in the health sector. Objective: This paper examines the potential health system consequences of agency nursing and moonlighting among South African nurses. Methods: During 2010, a cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses providing clinical care completed a self-administered questionnaire after giving informed consent. The questionnaire obtained information on socio-demographics, involvement in agency nursing and moonlighting, and self-reported indicators of potential health system consequences of agency nursing and moonlighting. A weighted analysis was done using STATA® 13. Results: In the survey, 40.7% of nurses reported moonlighting or working for an agency in the preceding year. Of all participants, 51.5% reported feeling too tired to work, 11.5% paid less attention to nursing work on duty, and 10.9% took sick leave when not actually sick in the preceding year. Among the moonlighters, 11.9% had taken vacation leave to do agency work or moonlighting, and 9.8% reported conflicting schedules between their primary and secondary jobs. In the bivariate analysis, moonlighting nurses were significantly more likely than non-moonlighters to take sick leave when not sick (p=0.011 and to pay less attention to nursing work on duty (p=0.035. However, in a multiple logistic regression analysis, the differences between moonlighters and non-moonlighters did not remain statistically significant after adjusting for other socio-demographic variables. Conclusion: Although moonlighting did not emerge as a statistically significant predictor, the reported health system consequences are serious. A combination of strong nursing leadership, effective management, and consultation with and
Mroz, Tracy M; Meadow, Ann; Colantuoni, Elizabeth; Leff, Bruce; Wolff, Jennifer L
To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely. Retrospective analysis. Home health agencies. Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009. Not applicable. Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge. Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13-1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88-.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77-.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18-1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10-1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70-.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03-1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07-1.28). As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation. Copyright © 2017
... Services Administration publishes summaries of proposed data collection projects for public comment... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency Information Collection Activities: Proposed Collection; Comment Request In compliance with the requirements of...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency... Resources and Services Administration (HRSA) publishes abstracts of information collection requests under... Act of 1995: Proposed Project: Children's Hospital Graduate Medical Education (CHGME) Payment Program...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency... Services Administration (HRSA) publishes periodic summaries of proposed projects being developed for...: Children's Hospital Graduate Medical Education Payment Program (CHGME PP) Annual Report (OMB No. 0915-0313...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Agency...: Mother and Infant Home Visiting Program Evaluation. (MIHOPE): Site Recruitment. OMB No.: New Collection. Description: The Administration for Children and Families (ACF) and Health Resources and Services...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency... Resources and Services Administration (HRSA) publishes abstracts of information collection requests under... individuals for attendance at accredited schools of nursing. The Bureau of Clinician Recruitment and Service...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency... Resources and Services Administration (HRSA) publishes abstracts of information collection requests under... Act of 1995: Proposed Project: The Division of Independent Review Grant Reviewer Recruitment Form (OMB...
... organizational orders, changed the name of ``Import Administration'' to ``Enforcement and Compliance... Administration in any document or other communication shall be deemed to be references to Enforcement and..., through internal Department Organizational Orders 10-3 (effective September 18, 2013) and Department...
Risso-Gill, Isabelle; McKee, Martin; Coker, Richard; Piot, Peter; Legido-Quigley, Helena
Myanmar has undergone a remarkable political transformation in the last 2 years, with its leadership voluntarily transitioning from an isolated military regime to a quasi-civilian government intent on re-engaging with the international community. Decades of underinvestment have left the country underdeveloped with a fragile health system and poor health outcomes. International aid agencies have found engagement with the Myanmar government difficult but this is changing rapidly and it is opportune to consider how Myanmar can engage with the global health system strengthening (HSS) agenda. Nineteen semi-structured, face-to-face interviews were conducted with representatives from international agencies working in Myanmar to capture their perspectives on HSS following political reform. They explored their perceptions of HSS and the opportunities for implementation. Participants reported challenges in engaging with government, reflecting the disharmony between actors, economic sanctions and barriers to service delivery due to health system weaknesses and bureaucracy. Weaknesses included human resources, data and medical products/infrastructure and logistical challenges. Agencies had mixed views of health system finance and governance, identifying problems and also some positive aspects. There is little consensus on how HSS should be approached in Myanmar, but much interest in collaborating to achieve it. Despite myriad challenges and concerns, participants were generally positive about the recent political changes, and remain optimistic as they engage in HSS activities with the government.
Marta M. Jankowska
Full Text Available Background: Social and environmental factors are increasingly recognized for their ability to influence health outcomes at both individual and neighborhood scales in the developing urban world. Yet issues of spatial heterogeneity in these complex environments may obscure unique elements of neighborhood life that may be protective or harmful to human health. Resident perceptions of neighborhood effects on health may help to fill gaps in our interpretation of household survey results and better inform how to plan and execute neighborhood-level health interventions. Objective: We evaluate differences in housing and socioeconomic indicators and health, environment, and neighborhood perceptions derived from the analysis of a household survey and a series of focus groups in Accra, Ghana. We then explore how neighborhood perceptions can inform survey results and ultimately neighborhood-level health interventions. Design: Eleven focus groups were conducted across a socioeconomically stratified sample of neighborhoods in Accra, Ghana. General inductive themes from the focus groups were analyzed in tandem with data collected in a 2009 household survey of 2,814 women. In-depth vignettes expand upon the three most salient emergent themes. Results: Household and socioeconomic characteristics derived from the focus groups corroborated findings from the survey data. Focus group and survey results diverged for three complex health issues: malaria, health-care access, and sense of personal agency in promoting good health. Conclusion: Three vignettes reflecting community views about malaria, health-care access, and sense of personal agency in promoting good health highlight the challenges facing community health interventions in Accra and exemplify how qualitatively derived neighborhood-level health effects can help shape health interventions.
Silva, Keila Silene de Brito E; Bezerra, Adriana Falangola Benjamin; Sousa, Islândia Maria Carvalho de; Gonçalves, Rogério Fabiano
Considering the importance of Brazil's Information System on Public Health Budgets (SIOPS) as a tool for planning, management, and social control of public expenditures in health, this article aimed to evaluate the relationship between the regularity of data entry into the SIOPS and knowledge and use of the system by municipal health administrators in Pernambuco State, Brazil. Ten municipalities were selected from the State's five meso-regions, five of which entered information into the system and five only on an irregular basis. Semi-structured interviews were performed with the municipal health secretaries. Analysis of the data showed that command of information technology and knowledge of the System do not affect the regularity of data entry, as a function of the distance between the Municipal Health Secretariat administrators and the SIOPS, such that the data are normally entered by outsourced services. Thus, the resulting information has not been fully explored by systems administrators as a management tool.
Garcia, Hector A.; McGeary, Cindy A.; McGeary, Donald D.; Finley, Erin P.; Peterson, Alan L.
The purpose of this study was to conduct the first assessment of burnout among Veterans Health Administration (VHA) mental health clinicians providing evidence-based posttraumatic stress disorder (PTSD) care. This study consisted of 138 participants and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.2). Recruitment was directed through VHA PTSD Clinical Teams (PCT) throughout the United States based on a nationwide mailing list of PCT Clinic Directors. Participants completed an electronic survey that assessed demographics, organizational work factors, absenteeism, and burnout (assessed through the Maslach Burnout Inventory-General Survey, MBI-GS). Twelve percent of the sample reported low Professional Efficacy, 50% reported high levels of Exhaustion, and 47% reported high levels of Cynicism as determined by the MBI-GS cut-off scores. Only workplace characteristics were significantly associated with provider scores on all 3 scales. Exhaustion and Cynicism were most impacted by perceptions of organizational politics/bureaucracy, increased clinical workload and control over how work is done. Organizational factors were also significantly associated with provider absenteeism and intent to leave his/her job. Findings suggest that providers in VHA specialty PTSD care settings may benefit from programs or supports aimed at preventing and/or ameliorating burnout. PMID:24564443
Jeffery, Ryan M.; Dickinson, Laura; Ng, Nicholas D.; DeGeorge, Lindsey M.; Nable, Jose V.
Opioid abuse is a growing and significant public health concern in the United States. Naloxone is an opioid antagonist that can rapidly reverse the respiratory depression associated with opioid toxicity. Georgetown University's collegiate-based emergency medical services (EMS) agency recently adopted a protocol, allowing providers to administer…
Dekkers, Ilona A.; Roos, Rick; Molen, Aart J. van der
The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) earlier this year recommended to suspend some marketing authorisations for Gadolinium Containing Contrast Agents (GCCAs) based on linear chelators due to the potential risk of gadolinium retention in the human body. These recommendations have recently been re-evaluated by EMA's Committee for Medicinal Products for Human Use (CHMP), and confirmed the final opinion of the European Medicines Agency. This editorial provides an overview of the available GCCAs and summarises the recent evidence of gadolinium retention. Moreover, a critical appraisal of the strengths and limitations of the scientific evidence currently available on gadolinium retention is given. (orig.)
Makkar, Steve R.; Haynes, Abby; Williamson, Anna; Redman, Sally
There are calls for policymakers to make greater use of research when formulating policies. Therefore, it is important that policy organisations have a range of tools and systems to support their staff in using research in their work. The aim of the present study was to measure the extent to which a range of tools and systems to support research use were available within six Australian agencies with a role in health policy, and examine whether this was related to the extent of engagement with, and use of research in policymaking by their staff. The presence of relevant systems and tools was assessed via a structured interview called ORACLe which is conducted with a senior executive from the agency. To measure research use, four policymakers from each agency undertook a structured interview called SAGE, which assesses and scores the extent to which policymakers engaged with (i.e., searched for, appraised, and generated) research, and used research in the development of a specific policy document. The results showed that all agencies had at least a moderate range of tools and systems in place, in particular policy development processes; resources to access and use research (such as journals, databases, libraries, and access to research experts); processes to generate new research; and mechanisms to establish relationships with researchers. Agencies were less likely, however, to provide research training for staff and leaders, or to have evidence-based processes for evaluating existing policies. For the majority of agencies, the availability of tools and systems was related to the extent to which policymakers engaged with, and used research when developing policy documents. However, some agencies did not display this relationship, suggesting that other factors, namely the organisation’s culture towards research use, must also be considered. PMID:29513669
Makkar, Steve R; Haynes, Abby; Williamson, Anna; Redman, Sally
There are calls for policymakers to make greater use of research when formulating policies. Therefore, it is important that policy organisations have a range of tools and systems to support their staff in using research in their work. The aim of the present study was to measure the extent to which a range of tools and systems to support research use were available within six Australian agencies with a role in health policy, and examine whether this was related to the extent of engagement with, and use of research in policymaking by their staff. The presence of relevant systems and tools was assessed via a structured interview called ORACLe which is conducted with a senior executive from the agency. To measure research use, four policymakers from each agency undertook a structured interview called SAGE, which assesses and scores the extent to which policymakers engaged with (i.e., searched for, appraised, and generated) research, and used research in the development of a specific policy document. The results showed that all agencies had at least a moderate range of tools and systems in place, in particular policy development processes; resources to access and use research (such as journals, databases, libraries, and access to research experts); processes to generate new research; and mechanisms to establish relationships with researchers. Agencies were less likely, however, to provide research training for staff and leaders, or to have evidence-based processes for evaluating existing policies. For the majority of agencies, the availability of tools and systems was related to the extent to which policymakers engaged with, and used research when developing policy documents. However, some agencies did not display this relationship, suggesting that other factors, namely the organisation's culture towards research use, must also be considered.
Moreira, Elka Maltez de Miranda; Costa, Ediná Alves
The Brazilian National Health Surveillance Agency (Anvisa) is supervised by the Ministry of Health by means of a management contract, a performance evaluation tool. This case study was aimed at describing and analyzing Anvisa's performance evaluation model based on the agency's institutional purpose, according to the following analytical categories: the management contract formalization, evaluation tools, evaluators and institutional performance. Semi-structured interviews and document analysis revealed that Anvisa signed only one management contract with the Ministry of Health in 1999, updated by four additive terms. The Collegiate Board of Directors and the Advisory Center for Strategic Management play the role of Anvisa's internal evaluators and an Assessing Committee, comprising the Ministry of Health, constitutes its external evaluator. Three phases were identified in the evaluation model: the structuring of the new management model (1999-2000), legitimation regarding the productive segment (2001-2004) and widespread legitimation (2005). The best performance was presented in 2000 (86.05%) and the worst in 2004 (40.00%). The evaluation model was shown to have contributed little towards the agency's institutional purpose and the effectiveness measurement of the implemented actions.
The Secretary of Health, Education, and Welfare is required, Subpart 3, Section 2, Part F of Title III of the Public Health Service Act; 42 USC et seq. (Public Law 90-602), to submit an annual report to the President for transmittal to the Congress on or before April 1 on the adminstration of the Radiation Control for Health and Safety Act. The detailed information required to be included in the report is outlined in Section 360D of Public Law 90-602. The Food and Drug Administration, through its Bureau of Radiological Health, has been delegated the authority for the day-to-day administration of the Act. This report covers the detailed operation of the Agency in carrying out that responsibility for calendar year 1974
Grabenbauer, L; Fraser, R; McClay, J; Woelfl, N; Thompson, C B; Cambell, J; Windle, J
Less than 20% of hospitals in the US have an electronic health record (EHR). In this qualitative study, we examine the perspectives of both academic and private physicians and administrators as stakeholders, and their alignment, to explore their perspectives on the use of technology in the clinical environment. Focus groups were conducted with 74 participants who were asked a series of open-ended questions. Grounded theory was used to analyze the transcribed data and build convergent themes. The relevance and importance of themes was constructed by examining frequency, convergence, and intensity. A model was proposed that represents the interactions between themes. Six major themes emerged, which include the impact of EHR systems on workflow, patient care, communication, research/outcomes/billing, education/learning, and institutional culture. Academic and private physicians were confident of the future benefits of EHR systems, yet cautious about the current implementations of EHR, and its impact on interactions with other members of the healthcare team and with patients, and the amount of time necessary to use EHR's. Private physicians differed on education and were uneasy about the steep learning curve necessary for use of new systems. In contrast to physicians, university and hospital administrators are optimistic, and value the availability of data for use in reporting. The results of our study indicate that both private and academic physicians concur on the need for features that maintain and enhance the relationship with the patient and the healthcare team. Resistance to adoption is related to insufficient functionality and its potential negative impact on patient care. Integration of data collection into clinical workflows must consider the unexpected costs of data acquisition.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention The Centers for Disease Control (CDC)/Health Resources and Services Administration (HRSA) Advisory Committee on HIV, Viral... announcements of meetings and other committee management activities, for both the Centers for Disease Control...
This study focused on the clinical workflow evolutions when implementing the health information technology (HIT). The study especially emphasized on administrating medication when the electronic health record (EHR) systems were adopted at rural healthcare facilities. Mixed-mode research methods, such as survey, observation, and focus group, were…
Godbey, Frank W.; Hatch, Loren L.
Designed as an aid for establishing and strengthening occupational safety and health programs on college and university campuses, this administrator guide is divided into four chapters. The first chapter defines and gives background information on the Occupational Safety and Health Act (OSHA). In addition, it presents a discussion of what the OSHA…
John R. Myers; David Elton Fosbroke
The Occupational Safety and Health Administration (OSHA) has established safety and health regulations for the logging industry. These new regulations move beyond the prior OSHA pulpwood harvesting standard by including sawtimber harvesting operations. Because logging is a major tool used by forest managers to meet silvicultural goals, managers must be aware of what...
... Grain Reserve Program, a producer may request to rotate or exchange new crop grain for the original crop... is impossible for FmHA or its successor agency under Public Law 103-354 or CCC to have a first lien...
Hagenaars, L.L.; Klazinga, N.S.; Muller, M.; Morgan, D.J.; Jeurissen, P.P.T.
INTRODUCTION: Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending
Hagenaars, Luc L.; Klazinga, Niek S.; Mueller, Michael; Morgan, David J.; Jeurissen, Patrick P. T.
Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between
Zhou, Xiaoyuan; Mao, Zhengzhong; Rechel, Bernd; Liu, Chaojie; Jiang, Jialin; Zhang, Yinying
Since 2003, China has experimented in some of the country's counties with the private administration of the New Cooperative Medical Scheme (NCMS), a publicly subsidized health insurance scheme for rural populations. Our study compared the effectiveness and efficiency of private vs public administration in four counties in one of China's most affluent provinces in the initial stage of the NCMS's implementation. The study was undertaken in Ningbo city of Zhejiang province. Out of 10 counties in Ningbo, two counties with private administration for the NCMS (Beilun and Ninghai) were compared with two others counties with public administration (Zhenhai and Fenghua), using the following indicators: (1) proportion of enrollees who were compensated for inpatient care; (2) average reimbursement-expense ratio per episode of inpatient care; (3) overall administration cost; (4) enrollee satisfaction. Data from 2004 to 2006 were collected from the local health authorities, hospitals and the contracted insurance companies, supplemented by a randomized household questionnaire survey covering 176 households and 479 household members. In our sample counties, private administration of the NCMS neither reduced transaction costs, nor improved the benefits of enrollees. Enrollees covered by the publicly administered NCMS were more likely to be satisfied with the insurance scheme than those covered by the privately administered NCMS. Experience in the selected counties suggests that private administration of the NCMS did not deliver the hoped-for results. We conclude that caution needs to be exercised in extending private administration of the NCMS.
Deatsch-Kratochvil, Amanda N; Pascual, Thomas Neil; Kesner, Adam; Rosenblatt, Eduardo; Chhem, Rethy K
Global health has been an issue of seemingly low political importance in comparison with issues that have direct bearing on countries' national security. Recently, health has experienced a "political revolution" or a rise in political importance. Today, we face substantial global health challenges, from the spread of infectious disease, gaps in basic maternal and child health care, to the globalization of cancer. A recent estimate states that the "overall lifetime risk of developing cancer (both sexes) is expected to rise from more than one in three to one in two by 2015." These issues pose significant threats to international health security. To successfully combat these grave challenges, the international community must embrace and engage in global health diplomacy, defined by scholars Thomas Novotny and Vicanne Adams as a political activity aimed at improving global health, while at the same time maintaining and strengthening international relations. The IAEA (International Atomic Energy Agency) is an international organization with a unique mandate to "accelerate and enlarge the contribution of atomic energy to peace, health, and prosperity throughout the world." This article discusses global health diplomacy, reviews the IAEA's program activities in human health by focusing on radiation medicine and cancer, and the peaceful applications of atomic energy within the context of global health diplomacy. Copyright © 2013 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.
Jung, Jeah Kyoungrae; Wu, Bingxiao; Kim, Hyunjee; Polsky, Daniel
We examine consumers' use of publicized quality information in Medicare home health care markets, where consumer cost sharing and travel costs are absent. We report two findings. First, agencies with high quality scores are more likely to be preferred by consumers after the introduction of a public reporting program than before. Second, consumers' use of publicized quality information differs by patient group. Community-based patients have slightly larger responses to public reporting than hospital-discharged patients. Patients with functional limitations at the start of their care, at least among hospital-discharged patients, have a larger response to the reported functional outcome measure than those without functional limitations. In all cases of significant marginal effects, magnitudes are small. We conclude that the current public reporting approach is unlikely to have critical impacts on home health agency choice. Identifying and releasing quality information that is meaningful to consumers may help increase consumers' use of public reports. © The Author(s) 2015.
Few sociologists dissent from the notion that the mid- to late 1970s witnessed a shift in capitalism's modus operandi . Its association with a rapid increase of social and material inequality is beyond dispute. This article opens with a brief summation of contemporary British trends in economic inequalities, and finds an echo of these trends in health inequalities. It is suggested that the sociology of health inequalities in Britain lacks an analysis of agency, and that such an analysis is crucial. A case is made that the recent critical realist contribution of Margaret Archer on 'internal conversations' lends itself to an understanding of agency that is salient here. The article develops her typology of internal conversations to present characterizations of the 'focused autonomous reflexives' whose mind-sets are causally efficacious for producing and reproducing inequalities, and the 'dedicated meta-reflexives' whose casts of mind might yet predispose them to mobilize resistance to inequalities.
Yip, A M; Kephart, G; Rockwood, K
The Canadian Study of Health and Aging (CSHA) was a cohort study that included 528 Nova Scotian community-dwelling participants. Linkage of CSHA and provincial Medical Services Insurance (MSI) data enabled examination of health care utilization in this subsample. This article discusses methodological and ethical issues of database linkage and explores variation in the use of health services by demographic variables and health status. Utilization over 24 months following baseline was extracted from MSI's physician claims, hospital discharge abstracts, and Pharmacare claims databases. Twenty-nine subjects refused consent for access to their MSI file; health card numbers for three others could not be retrieved. A significant difference in healthcare use by age and self-rated health was revealed. Linkage of population-based data with provincial administrative health care databases has the potential to guide health care planning and resource allocation. This process must include steps to ensure protection of confidentiality. Standard practices for linkage consent and routine follow-up should be adopted. The Canadian Study of Health and Aging (CSHA) began in 1991-92 to explore dementia, frailty, and adverse health outcomes (Canadian Study of Health and Aging Working Group, 1994). The original CSHA proposal included linkage to provincial administrative health care databases by the individual CSHA study centers to enhance information on health care utilization and outcomes of study participants. In Nova Scotia, the Medical Services Insurance (MSI) administration, which drew the sampling frame for the original CSHA, did not retain the list of corresponding health card numbers. Furthermore, consent for this access was not asked of participants at the time of the first interview. The objectives of this study reported here were to examine the feasibility and ethical considerations of linking data from the CSHA to MSI utilization data, and to explore variation in health
Lehoux, Pascale; Miller, Fiona A.; Daudelin, Geneviève; Denis, Jean-Louis
Background: New technologies constitute an important cost-driver in healthcare, but the dynamics that lead to their emergence remains poorly understood from a health policy standpoint. The goal of this paper is to clarify how entrepreneurs, investors, and regulatory agencies influence the value of emerging health technologies. Methods: Our 5-year qualitative research program examined the processes through which new health technologies were envisioned, financed, developed and commercialized by entrepreneurial clinical teams operating in Quebec’s (Canada) publicly funded healthcare system. Results: Entrepreneurs have a direct influence over a new technology’s value proposition, but investors actively transform this value. Investors support a technology that can find a market, no matter its intrinsic value for clinical practice or healthcare systems. Regulatory agencies reinforce the "double" value of a new technology—as a health intervention and as an economic commodity—and provide economic worth to the venture that is bringing the technology to market. Conclusion: Policy-oriented initiatives such as early health technology assessment (HTA) and coverage with evidence may provide technology developers with useful input regarding the decisions they make at an early stage. But to foster technologies that bring more value to healthcare systems, policy-makers must actively support the consideration of health policy issues in innovation policy. PMID:28949463
Jacobs Julie A
Full Text Available Abstract Background While increasing attention is placed on using evidence-based decision making (EBDM to improve public health, there is little research assessing the current EBDM capacity of the public health workforce. Public health agencies serve a wide range of populations with varying levels of resources. Our survey tool allows an individual agency to collect data that reflects its unique workforce. Methods Health department leaders and academic researchers collaboratively developed and conducted cross-sectional surveys in Kansas and Mississippi (USA to assess EBDM capacity. Surveys were delivered to state- and local-level practitioners and community partners working in chronic disease control and prevention. The core component of the surveys was adopted from a previously tested instrument and measured gaps (importance versus availability in competencies for EBDM in chronic disease. Other survey questions addressed expectations and incentives for using EBDM, self-efficacy in three EBDM skills, and estimates of EBDM within the agency. Results In both states, participants identified communication with policymakers, use of economic evaluation, and translation of research to practice as top competency gaps. Self-efficacy in developing evidence-based chronic disease control programs was lower than in finding or using data. Public health practitioners estimated that approximately two-thirds of programs in their agency were evidence-based. Mississippi participants indicated that health department leaders' expectations for the use of EBDM was approximately twice that of co-workers' expectations and that the use of EBDM could be increased with training and leadership prioritization. Conclusions The assessment of EBDM capacity in Kansas and Mississippi built upon previous nationwide findings to identify top gaps in core competencies for EBDM in chronic disease and to estimate a percentage of programs in U.S. health departments that are evidence
In Part II of a three-part series, the financial, technological and legislative issues of a hospital-based home health-agency are discussed. Beginning a home healthcare service requires intensive research to answer key environmental and operational questions--need, competition, financial projections, initial start-up costs and the impact of delayed depreciation. Assessments involving technology, staffing, legislative and regulatory issues can help project service volume, productivity and cost-control.
Collins, Sara R; Nuzum, Rachel; Rustgi, Sheila D; Mika, Stephanie; Schoen, Cathy; Davis, Karen
The United States leads all industrialized countries in the share of national health care expenditures devoted to insurance administration. The U.S. share is over 30 percent greater than Germany's and more than three times that of Japan. This issue brief examines the sources of administrative costs and describes how a private-public approach to health care reform--with the central feature of a national insurance exchange (largely replacing the present individual and small-group markets)--could substantially lower such costs. In three variations on that approach, estimated administrative costs would fall from 12.7 percent of claims to an average of 9.4 percent. Savings--as much as $265 billion over 2010-2020--would be realized through less marketing and underwriting, reduced costs of claims administration, less time spent negotiating provider payment rates, and fewer or standardized commissions to insurance brokers.
Sorin Adrian Ciupitu
Full Text Available Modernization of the fiscal administration was necessary for the growth of consumers' trust in this institution. This trust can be won only when the population, who pays taxes and fees in this country, will remark that an institution as ANAF spends less every year regarding tax collection and cuts tax evasion. Both natural persons and legal entities desire to see transparency regarding income administration, service development and simplification of the means to file fiscal statements. The services offered to tax payers have to be of high quality and professionalism with equal and indiscriminate treatment.
The purpose of this study was to examine the potential of a High School Health Science Career Academy to support African American students' science career trajectories. I used three key theoretical tools---critical science agency (Basu, 2007; Calabrese Barton & Tan, 2008), power (Nespor, 1994), and cultural production (Carlone, 2004; Eisenhart & Finkel, 1998) to highlight the intersections between the career trajectory implied by the Academy (its curriculum, classroom activities, and clinical experiences) and the students' pursued career trajectories. Data was collected over five months and included individual student interviews, group interviews, parent and administrator interviews, field notes from a culminating medical course and clinical internship, and Academy recruitment documents. The results of this study suggest that participants pursued a health science career for altruistic purposes and the Academy was a resource they drew upon to do so. However, the meanings of science and science person implied by the Academy hindered the possibility for many participants' to advance their science career trajectories. While the Academy promised to expose students to a variety of high-status health care roles, they were funneled into feminine, entry-level positions. This study adds to previous underrepresentation literature by contextualizing how identity-related factors influence African American students' career attainment.
Many public policy programs fail to translate ambitious headlines to on-the-ground action. The reasons for this are many and varied, but for public administration and management scholars a large part of the gap between ambition and achievement is the challenge associated with the operation of the machinery of government itself, and how it relates to the other parties that it relies on to fulfill these outcomes. In their article, Carey and Friel set out key reasons why public health scholars should seek to better understand important ideas in public administration. In commenting on their contribution, I draw out two critical questions that are raised by this discussion: (i) what are boundaries and what forms do they take? and (ii) why work across boundaries? Expanding on these key questions extends the points made by Carey and Friel on the importance of understanding public administration and will better place public health scholars and practitioners to realise health outcomes. PMID:27694672
Saari, Chelsey K
The Kent County Health Department (KCHD) was accredited by the Public Health Accreditation Board (PHAB) in September 2014. Although Michigan has had a state-level accreditation process for local health departments since the late 1990s, the PHAB accreditation process presented a unique opportunity for KCHD to build on successes achieved through state accreditation and enhance performance in all areas of KCHD programs, services, and operations. PHAB's standards, measures, and peer-review process provided a standardized and structured way to identify meaningful opportunities for improvement and to plan and implement strategies for enhanced performance and established a platform for being recognized nationally as a high-performing local health department. The current case report highlights the way in which KCHD has developed and implemented its strategic plan to guide efforts aimed at addressing gaps identified through the accreditation process and to drive overall improvement within our agency.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-0345] Food and Drug Administration/National Institutes of Health/ National Science Foundation Public Workshop... public workshop; request for comments. SUMMARY: The Food and Drug Administration (FDA) is announcing its...
Ikeda, Chiseko; Saeki, Kazuko; Hirano, Michiyo
Stress assessments are due to be conducted in December 2015. It is expected that there will be an increase in the number of private health agencies that provide stress assessment services and mental health care. This study aimed to clarify the current situation of and the factors related to stress assessments conducted by nurses in occupational health agencies. Nurses working full time were randomly selected from 60 organizations that were members of the National Federation of Industrial Health Organization. Self-administered questionnaires were sent out between November 2013 and January 2014. The questionnaire included the personal attributes of the participants, training programs, job contents, and how practical mental health care, including stress assessment, is. The study was approved by the ethics committees in the respective organizations. Out of the 162 questionnaires that were distributed, 89 (54.9%) were returned and 85 (53.1%) were valid for analysis. Stress assessments were conducted by 38.8% of the participants. With reference to their confidence in conducting stress assessments, "confidence and" 70.6%, respectively. The groups that conducted and did not conduct the stress assessments did not show any differences in the findings or other attributes. Further, the implementation of stress assessment was not associated with occupational health nurse (OHN) training, education, position, age, years of experience, attendance of lectures on mental health, etc. However, the confidence in conducting the assessment was related to age when dealing with cases on confidence stress assessment consultation in follow-up to the implementation of screening, such as stress, persons at high risk, and so on. Approximately 40% of the nurses were already conducting stress assessments, but most of them conducted such assessments about once a year and were not deeply involved in them. Approximately 70% of the nurses were confident in implementing stress assessments. Further
Lucenko, Barbara A; Sharkova, Irina V; Huber, Alice; Jemelka, Ron; Mancuso, David
This study aimed to measure the relative contribution of adverse experiences to adolescent behavioral health problems using administrative data. Specifically, we sought to understand the predictive value of adverse experiences on the presence of mental health and substance abuse problems for youth receiving publicly funded social and health services. Medicaid claims and other service records were analyzed for 125,123 youth age 12-17 and their biological parents. Measures from administrative records reflected presence of parental domestic violence, mental illness, substance abuse, criminal justice involvement, child abuse and/or neglect, homelessness, and death of a biological parent. Mental health and substance abuse status of adolescents were analyzed as functions of adverse experiences and other youth characteristics using logistic regression. In multivariate analyses, all predictors except parental domestic violence were statistically significant for substance abuse; parental death, parental mental illness, child abuse or neglect and homelessness were statistically significant for mental illness. Odds ratios for child abuse/neglect were particularly high in both models. The ability to identify risks during childhood using administrative data suggests the potential to target prevention and early intervention efforts for children with specific family risk factors who are at increased risk for developing behavioral health problems during adolescence. This study illustrates the utility of administrative data in understanding adverse experiences on children and the advantages and disadvantages of this approach. Copyright © 2015 Elsevier Ltd. All rights reserved.
Kisely, Steve; Pais, Joanne
The Australian Government has provided $20 million to establish the Population Health Research Network (PHRN), with representation from all States and Territories to facilitate population health research through data linkage. Health LinQ is part of the Queensland node involving four Queensland universities, Queensland Health and the Australian e-Health Research Centre. This paper reviews the potential for using administrative databases to study the mental health experience of Indigenous Queenslanders. Researchers can define cohorts for study within the administrative data or link them to their own data. Robust protocols preserve confidentiality so that researchers only receive anonymized data. Indigenous status can be defined either through place of residence or through the recording of Indigenous status in datasets such as the Queensland Hospital Admitted Patient Data Collection. Available data include hospital morbidity, mental health data and mortality. Indigenous status is correctly identified in about 89% of cases with variation by definition used. Administrative data provide researchers and decision makers with accessible, cost-effective information without the intrusion and cost of additional data collection. These techniques are especially useful in studying regional, rural and remote populations where access may be difficult.
West, Robert M; House, Allan O; Keen, Justin; Ward, Vicky L
This article investigates network governance in the context of health and wellbeing services in England, focussing on relationships between managers in a range of services. There are three aims, namely to investigate, (i) the configurations of networks, (ii) the stability of network relationships over time and, (iii) the balance between formal and informal ties that underpin inter-agency relationships. Latent position cluster network models were used to characterise relationships. Managers were asked two questions, both designed to characterise informal relationships. The resulting networks differed substantially from one another in membership. Managers described networks of relationships that spanned organisational boundaries, and that changed substantially over time. The findings suggest that inter-agency co-ordination depends more on informal than on formal relationships. Copyright © 2015 Elsevier Ltd. All rights reserved.
Mathes, Tim; Jacobs, Esther; Morfeld, Jana-Carina; Pieper, Dawid
The number of Health Technology Assessment (HTA) agencies increases. One component of HTAs are economic aspects. To incorporate economic aspects commonly economic evaluations are performed. A convergence of recommendations for methods of health economic evaluations between international HTA agencies would facilitate the adaption of results to different settings and avoid unnecessary expense. A first step in this direction is a detailed analysis of existing similarities and differences in recommendations to identify potential for harmonization. The objective is to provide an overview and comparison of the methodological recommendations of international HTA agencies for economic evaluations. The webpages of 127 international HTA agencies were searched for guidelines containing recommendations on methods for the preparation of economic evaluations. Additionally, the HTA agencies were requested information on methods for economic evaluations. Recommendations of the included guidelines were extracted in standardized tables according to 13 methodological aspects. All process steps were performed independently by two reviewers. Finally 25 publications of 14 HTA agencies were included in the analysis. Methods for economic evaluations vary widely. The greatest accordance could be found for the type of analysis and comparator. Cost-utility-analyses or cost-effectiveness-analyses are recommended. The comparator should continuously be usual care. Again the greatest differences were shown in the recommendations on the measurement/sources of effects, discounting and in the analysis of sensitivity. The main difference regarding effects is the focus either on efficacy or effectiveness. Recommended discounting rates range from 1.5%-5% for effects and 3%-5% for costs whereby it is mostly recommended to use the same rate for costs and effects. With respect to the analysis of sensitivity the main difference is that oftentimes the probabilistic or deterministic approach is recommended
Horner, Elizabeth Mokyr; Cullen, Mark R
Is retirement good or bad for health? Disentangling causality is difficult. Much of the previous quasi-experimental research on the effect of health on retirement used self-reported health and relied upon discontinuities in public retirement incentives across Europe. The current study investigated the effect of retirement on health by exploiting discontinuities in private retirement incentives to test the effect of retirement on health using a quasi-experimental study design. Secondary data (1997-2009) on a cohort of male manufacturing workers in a United States setting. Health status was determined using claims data from private insurance and Medicare. Analyses used employer-based administrative and claims data and claim data from Medicare. Widely used selection on observables models overstate the negative impact of retirement due to the endogeneity of the decision to retire. In addition, health status as measured by administrative claims data provide some advantages over the more commonly used survey items. Using an instrument and administrative health records, we find null to positive effects from retirement on all fronts, with a possible exception of increased risk for diabetes. This study provides evidence that retirement is not detrimental and may be beneficial to health for a sample of manufacturing workers. In addition, it supports previous research indicating that quasi-experimental methodologies are necessary to evaluate the relationship between retirement and health, as any selection on observable model will overstate the negative relationship of retirement on health. Further, it provides a model for how such research could be implemented in countries like the United States that do not have a strong public pension program. Finally, it demonstrates that such research need-not rely upon survey data, which has certain shortcomings and is not always available for homogenous samples.
Gómez, Eduardo J
This article proposes an approach to comparing and assessing the adaptive capacity of multilateral health agencies in meeting country and individual healthcare needs. Most studies comparing multilateral health agencies have failed to clearly propose a method for conducting agency comparisons. This study conducted a qualitative case study methodological approach, such that secondary and primary case study literature was used to conduct case study comparisons of multilateral health agencies. Through the proposed Sequential Comparative Analysis (SCA), the author found a more effective way to justify the selection of cases, compare and assess organizational transformative capacity, and to learn from agency success in policy sustainability processes. To more affectively understand and explain why some multilateral health agencies are more capable of adapting to country and individual healthcare needs, SCA provides a methodological approach that may help to better understand why these agencies are so different and what we can learn from successful reform processes. As funding challenges continue to hamper these agencies' adaptive capacity, learning from each other will become increasingly important.
Hu, Hengrui; Allen, Peg; Yan, Yan; Reis, Rodrigo S; Jacob, Rebekah R; Brownson, Ross C
Use of research evidence in public health decision making can be affected by organizational supports. Study objectives are to identify patterns of organizational supports and explore associations with research evidence use for job tasks among public health practitioners. In this longitudinal study, we used latent class analysis to identify organizational support patterns, followed by mixed logistic regression analysis to quantify associations with research evidence use. The setting included 12 state public health department chronic disease prevention units and their external partnering organizations involved in chronic disease prevention. Chronic disease prevention staff from 12 US state public health departments and partnering organizations completed self-report surveys at 2 time points, in 2014 and 2016 (N = 872). Latent class analysis was employed to identify subgroups of survey participants with distinct patterns of perceived organizational supports. Two classify-analyze approaches (maximum probability assignment and multiple pseudo-class draws) were used in 2017 to investigate the association between latent class membership and research evidence use. The optimal model identified 4 latent classes, labeled as "unsupportive workplace," "low agency leadership support," "high agency leadership support," and "supportive workplace." With maximum probability assignment, participants in "high agency leadership support" (odds ratio = 2.08; 95% CI, 1.35-3.23) and "supportive workplace" (odds ratio = 1.74; 95% CI, 1.10-2.74) were more likely to use research evidence in job tasks than "unsupportive workplace." The multiple pseudo-class draws produced comparable results with odds ratio = 2.09 (95% CI, 1.31-3.30) for "high agency leadership support" and odds ratio = 1.74 (95% CI, 1.07-2.82) for "supportive workplace." Findings suggest that leadership support may be a crucial element of organizational supports to encourage research evidence use. Organizational supports such
Kelly, E.; Stoye, G.; Vera-Hernández, M.
© 2016 The Authors. Fiscal Studies published by John Wiley & Sons Ltd. on behalf of Institute for Fiscal StudiesHealth spending per capita in England has almost doubled since 1997, yet relatively little is known about how that spending is distributed across the population. This paper uses administrative National Health Service (NHS) hospital records to examine key features of public hospital spending in England. We describe how costs vary across the life cycle, and the concentration of spendi...
Kelly, Elaine; Stoye, George; Vera-Hernández, Marcos
Health spending per capita in England has more than doubled since 1997, yet relatively little is known about how that spending is distributed across the population. This paper uses administrative National Health Service (NHS) hospital records to examine key features of public hospital spending in England. We describe how costs vary across the lifecycle, and the concentration of spending among people and over time. We find that costs per person start to increase after age 50 and escalate after...
Full Text Available This paper draws from interviews with 21 young New Zealanders, ages 16-24, to examine how health apps shape young people’s experiences of themselves as agentive subjects in relation to their physical and mental wellbeing. Focusing on the intended and unintended effects of health apps, I examine how digital care technologies recast the spatiality and temporality of healthcare, enabling new ways of constituting and tracking health, expanding possibilities of interactive exchanges with others, and redistributing a sense of agency and control. In many ways, the forms of self-governance that health apps engender are no different from other moves to promote increased self-responsibility that are cultivated as part of advanced liberalism. However, I argue that by collapsing the spatial and temporal relations of technology use, health apps not only heighten opportunities for adopting self-responsibility, but also, as many young people attest, promote the feeling that there is no escaping from them. The result is that for many young people having a sense of control and responsibility over their health comes to be calibrated against not only the inherent inter-sociality of care (i.e. young people’s desires to both give and receive care to and from others, but also the health and fitness “demands” seemingly made upon them by technology itself.
Shi, L; Samuels, M E; Glover, S
Based on a 1994 national survey of Community and Migrant Health Center (C/MHC) administrators, this study draws a profile of C/MHC administrators in terms of their personal and work characteristics, as well as their values and beliefs regarding successful C/MHC attributes and important managerial practices. Further, the study compares C/MHC administrators with different educational preparation in terms of their personal and work characteristics, values and beliefs, as well as their perceived deficiencies. The study results indicate that critical factors in C/MHC success, in order of ranked importance, were good organizational leadership, organization's value to community and efficiency. Successful managerial characteristics, in order of ranked importance, were vision for the future of organization, honesty/integrity and open to new possibilities. Administrators with more advanced degrees expressed less deficiencies and those with no college degree showed greatest deficiency on five of eight measures.
Citty, Sandra W; Kamel, Amir; Garvan, Cynthia; Marlowe, Lee; Westhoff, Lynn
Malnutrition in hospitalized patients is a major cause for hospital re-admission, pressure ulcers and increased hospital costs. Methods to improve the administration and documentation of nutritional supplements for hospitalized patients are needed to improve patient care, outcomes and resource utilization. Staff at a medium-sized academic health science center hospital in the southeastern United States noted that nutritional supplements ordered for patients at high risk for malnutrition were not offered or administered to patients in a standardized manner and/or not documented clearly in the electronic health record as per prescription. This paper reports on a process improvement project that redesigned the ordering, administration and documentation process of oral nutritional supplements in the electronic health record. By adding nutritional products to the medication order sets and adding an electronic nutrition administration record (ENAR) tab, the multidisciplinary team sought to standardize nutritional supplement ordering, documentation and administration at prescribed intervals. This process improvement project used a triangulated approach to evaluating pre- and post-process change including: medical record reviews, patient interviews, and nutrition formula room log reports. Staff education and training was carried out prior to initiation of the system changes. This process change resulted in an average decrease in the return of unused nutritional formula from 76% returned at baseline to 54% post-process change. The process change resulted in 100% of nutritional supplement orders having documentation about nutritional medication administration and/or reason for non-administration. Documentation in the ENAR showed that 41% of ONS orders were given and 59% were not given. Significantly more patients reported being offered the ONS product (p=0.0001) after process redesign and more patients (5% before ENAR and 86% after ENAR reported being offered the correct
P. Alison Paprica
Members of general public were generally supportive of research based on linked administrative health data but with conditions, particularly when the possibility of private sector research was discussed. Notably, and citing security concerns, focus group participants preferred models that had a limited number of individuals or organizations accessing data.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-N-0001... include an update on the FDA Safety and Innovation Act (Pub. L. 112-144) and an overview of FDA's Network... liaison between FDA Centers and the public on matters that involve medical product safety and also acts as...
Salm, M.; Schunk, D.
We use administrative German data to examine the role of physical and mental health conditions in explaining developmental gaps between children whose parents have different educational levels. Specifically, we employ sibling fixed effect models to estimate the effect of a comprehensive list of
Carey, Gemma; Friel, Sharon
Many of the societal level factors that affect health - the 'social determinants of health (SDH)' - exist outside the health sector, across diverse portfolios of government, and other major institutions including non-governmental organisations (NGOs) and the private sector. This has created growing interest in how to create and implement public policies which will drive better and fairer health outcomes. While designing policies that can improve the SDH is critical, so too is ensuring they are appropriately administered and implemented. In this paper, we draw attention to an important area for future public health consideration - how policies are managed and implemented through complex administrative layers of 'the state.' Implementation gaps have long been a concern of public administration scholarship. To precipitate further work in this area, in this paper, we provide an overview of the scholarly field of public administration and highlight its role in helping to understand better the challenges and opportunities for implementing policies and programs to improve health equity. © 2015 by Kerman University of Medical Sciences.
... annually from approximately 25 application holders. FDA professionals familiar with Dear Health Care... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-D-0319] Draft Guidance for Industry and Food and Drug Administration Staff on Dear Health Care Provider Letters...
Honoré, Peggy A; Stefanak, Matthew; Dessens, Scott
A turnaround describes an organization's ability to recover from successive periods of decline. Current and projected declines in US economic conditions continue to place local public health departments at risk of fiscal exigency. This examination focused on turnaround methodologies used by a local public health department to reverse successive periods of operational and financial declines. Illustrations are provided on the value added by implementing financial ratio and trend analysis in addition to using evidence-based private sector turnaround strategies of retrenchment, repositioning, and reorganization. Evidence has shown how the financial analysis and strategies aided in identifying operational weakness and set in motion corrective measures. The Public Health Uniform Data System is introduced along with a list of standards offered for mainstreaming these and other routine stewardship practices to diagnose, predict, and prevent agency declines.
The author, being a former senior medical officer and currently a consultant of the Nuclear Medicine Section, the Division of Human Health, the Department of Nuclear Sciences and Applications, the International Atomic Energy Agency (IAEA) to standardize the isotope and radiation technologies for health and medical care and transfer them to the IAEA member states to address their health issues, participated in an international cooperation project to survey the current situation of the health and medical care in Viet Nam and exchange opinions with the World Health Organization Western Pacific Regional Office Viet Nam Office and the Viet Nam Health Department coordinated by the Japan Public Health Association from 10th to 15th January 2016 and perceived efforts made and action plans for the health and medical care in Viet Nam by the international organizations of the IAEA and the World Health Organization (WHO). IAEA has verified various isotopes and radiation technologies up to now in the international field of health and medical care and has being offered them to the member states under the sustainable frame work of technical co-operation. However, the activity in the health and medical care field of IAEA is hardly recognized by the public health professionals in Japan. In order to attain the objective to improve and maintain human health under the umbrella of the United Nations system, the peaceful use of nuclear technology has been promoted in the field of non-electric applications of nuclear energy including human health and medical care by the IAEA. There are several discrepancies seen with the field and tactics of health and medical care between the IAEA and the WHO. In terms of measures to fight NCDs which should be an urgent issue in most of the member states, a comprehensive approach is often needed beyond the capability of IAEA as isotopes and radiation technologies. The IAEA should strive to solve issues on human health and medical care maintaining much
Elliott, Amanda F; Davidson, Arthur; Lum, Flora; Chiang, Michael F; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E; Chou, Chiu-Fang
To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Perspective, comparing systems. We describe 3 currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Each of the 3 sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. Copyright © 2012 Elsevier Inc. All rights reserved.
Mokyr Horner, Elizabeth; Cullen, Mark R
Researchers investigating health outcomes for populations over age 65 can utilize Medicare claims data, but these data include no direct information about individuals' health prior to age 65 and are not typically linkable to files containing data on exposures and behaviors during their worklives. The current paper is a proof-of-concept, of merging employers' administrative data and private, employment-based health claims with Medicare data. Characteristics of the linked data, including sensitivity and specificity, are evaluated with an eye toward potential uses of such linked data. This paper uses a sample of former manufacturing workers from an industrial cohort as a test case. The dataset created by this integration could be useful to research in areas such as social epidemiology and occupational health. Medicare and employment administrative data were linked for a large cohort of manufacturing workers (employed at some point during 1996-2008) who transitioned onto Medicare between 2001-2009. Data on work-life health, including biometric indicators, were used to predict health at age 65 and to investigate the concordance of employment-based insurance claims with subsequent Medicare insurance claims. Chronic diseases were found to have relatively high levels of concordance between employment-based private insurance and subsequent Medicare insurance. Information about patient health prior to receipt of Medicare, including biometric indicators, were found to predict health at age 65. Combining these data allows for evaluation of continuous health trajectories, as well as modeling later-life health as a function of work-life behaviors and exposures. It also provides a potential endpoint for occupational health research. This is the first harmonization of its kind, providing a proof-of-concept. The dataset created by this integration could be useful for research in areas such as social epidemiology and occupational health.
Pink, G H; Coyte, P C
The curricula of graduate health administration programs have, historically, not articulated the theoretical links between health economics and health finance, although an understanding of these links could enhance comprehension of both disciplines. We provide a pedagogical approach that can be used to clarify these interconnections. It compares the standard neoclassical microeconomic concept of the hospital with the financial concept of the hospital, for the purpose of relating the optimal output decision in microeconomic theory to the optimal investment decision in financial theory. This approach can be taught in an advanced course in either economics or finance.
Lee, Wan-Ju; Lee, Todd A; Pickard, Alan Simon; Shoaibi, Azadeh; Schumock, Glen T
The validity of algorithms used to identify health outcomes in claims-based and administrative data is critical to the reliability of findings from observational studies. The traditional approach to algorithm validation, using medical charts, is expensive and time-consuming. An alternative method is to link the claims data to an external, electronic data source that contains information allowing confirmation of the event of interest. In this paper, we describe this external linkage validation method and delineate important considerations to assess the feasibility and appropriateness of validating health outcomes using this approach. This framework can help investigators decide whether to pursue an external linkage validation method for identifying health outcomes in administrative/claims data.
U.S. Environmental Protection Agency — The EPA Administrative Enforcement Dockets database contains the electronic dockets for administrative penalty cases filed by EPA Regions and Headquarters. Visitors...
Davi Monteiro Diniz
Full Text Available The Brazilian Federal Constitution of 1988 establishes the autonomy of Brazilian universities. Moreover, it commands that the universities should not disassociate their activities in teaching, research and extension. This paper considers whether the current administrative law allows the Brazilian public federal universities to accomplish these goals. Departing from the legal approach of these federal universities as executive (administrative agencies, this paper analyzes the main effects of such legal status on the capacity of federal universities to fulfill their academic mission, revealing a persistent gap between the constitutional prescriptions and the administrative law concerning Brazilian federal universities. It concludes that such legislative discrepancy is clearly detrimental to the constitutional order.
PennState Geisinger Health System, Hershey, Pa., conducted an extensive ad agency search after its inception in 1997. The integrated health care delivery system needed to introduce its brand to an audience that was confused by the wide array of available health care options. BVK/McDonald, Milwaukee, the agency selected, has created a branding campaign that revolves around the tag-line "The power of health." PennState Geisinger will tabulate the results of BVK/McDonald's multi-million dollar campaign in 2000; at that time it will know whether its selection committee chose wisely.
Blacksher, Erika; Lovasi, Gina S
Built environment characteristics have been linked to health outcomes and health disparities. However, the effects of an environment on behavior may depend on human perception, interpretation, motivation, and other forms of human agency. We draw on epidemiological and ethical concepts to articulate a critique of research on the built environment and physical activity. We identify problematic assumptions and enumerate both scientific and ethical reasons to incorporate subjective perspectives and public engagement strategies into built environment research and interventions. We maintain that taking agency seriously is essential to the pursuit of health equity and the broader demands of social justice in public health, an important consideration as studies of the built environment and physical activity increasingly focus on socially disadvantaged communities. Attention to how people understand their environment and navigate competing demands can improve the scientific value of ongoing efforts to promote active living and health, while also better fulfilling our ethical obligations to the individuals and communities whose health we strive to protect. Copyright © 2011 Elsevier Ltd. All rights reserved.
... Surveillance for a New Generation of U.S. Veterans) Under OMB Review AGENCY: Veterans Benefits Administration... a New Generation of U.S. Veterans Survey. OMB Control Number: OMB Control No. 2900-0722. Type of... Human Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, DC 20503 (202...
Sellers, Katie; Leider, Jonathon P; Harper, Elizabeth; Castrucci, Brian C; Bharthapudi, Kiran; Liss-Levinson, Rivka; Jarris, Paul E; Hunter, Edward L
Public health practitioners, policy makers, and researchers alike have called for more data on individual worker's perceptions about workplace environment, job satisfaction, and training needs for a quarter of a century. The Public Health Workforce Interests and Needs Survey (PH WINS) was created to answer that call. Characterize key components of the public health workforce, including demographics, workplace environment, perceptions about national trends, and perceived training needs. A nationally representative survey of central office employees at state health agencies (SHAs) was conducted in 2014. Approximately 25,000 e-mail invitations to a Web-based survey were sent out to public health staff in 37 states, based on a stratified sampling approach. Balanced repeated replication weights were used to account for the complex sampling design. A total of 10,246 permanently employed SHA central office employees participated in PH WINS (46% response rate). Perceptions about training needs; workplace environment and job satisfaction; national initiatives and trends; and demographics. Although the majority of staff said they were somewhat or very satisfied with their job (79%; 95% confidence interval [CI], 78-80), as well as their organization (65%; 95% CI, 64-66), more than 42% (95% CI, 41-43) were considering leaving their organization in the next year or retiring before 2020; 4% of those were considering leaving for another job elsewhere in governmental public health. The majority of public health staff at SHA central offices are female (72%; 95% CI, 71-73), non-Hispanic white (70%; 95% CI, 69-71), and older than 40 years (73%; 95% CI, 72-74). The greatest training needs include influencing policy development, preparing a budget, and training related to the social determinants of health. PH WINS represents the first nationally representative survey of SHA employees. It holds significant potential to help answer previously unaddressed questions in public health
Blangiardi, F; Ferrera, G; Cilia, S; Aprile, E
Cancer screening is a secondary prevention program that permits early diagnosis of neoplasias and precancerous lesions are in order to diminish mortality and morbidity for certain types of tumors (breast, colon-rectal, and cervical). In 2010, the Ragusa Provincial Health Agency began screening for colon-rectal cancer in an experimental phase that initially involved only the municipality of Ragusa but that was then extended to other municipalities of the province. Although the organizing model suffered from many managerial problems including lack of human resources and tools, there was good collaboration and involvement of the public health/hygiene offices and the general practitioners and volunteer associations. This type of networking was useful in that adhesion to screening was well above that expected. Another winning aspect of the project resulted in clear and pertinent communication to the population.
This study aims to determine whether the Taiwanese government's implementation of new health care payment reforms (the National Health Insurance with fee-for-service (NHI-FFS) and global budget (NHI-GB)) has resulted in better cost containment. Also, the question arises under the agency theory whether the monitoring system is effective in reducing the risk of information asymmetry. This study uses panel data analysis with fixed effects model to investigate changes in cost containment at Taipei municipal hospitals before and after adopting reforms from 1989 to 2004. The results show that the monitoring system does not reduce information asymmetry to improve cost containment under the NHI-FFS. In addition, after adopting the NHI-GB system, health care costs are controlled based on an improved monitoring system in the policymaker's point of view. This may suggest that the NHI's fee-for-services system actually causes health care resource waste. The GB may solve the problems of controlling health care costs only on the macro side.
Galnares-Cordero, Lorea; Gutiérrez-Ibarluzea, Iñaki
The aim of this study was to analyze the information needs of Spanish health technology assessment (HTA) agencies and units to facilitate access to the resources they require to substantiate their reports. A questionnaire was designed and distributed among HTA bodies to ascertain the actual situation of subscriptions to information resources and what information specialists from these bodies considered would be the ideal subscription situation. Their information needs were then studied, and the resources that best met these needs were put forward. Following this definition, a subscriptions policy was adopted with suppliers and publishers. The survey showed that HTA bodies share a minimum of core subscriptions that includes open sources (MEDLINE, DARE) and sources that the government subscribes to for the health community (ISI Web of Science, Cochrane Library Plus). There was no common approach to determining which databases to subscribe to (UpToDate, EMBASE, Ovid EBMR, CINAHL, or ECRI). After identifying the information needs, a list of resources was proposed that would best cover these needs and, of these, subscription to the following was proposed: Scopus, Ovid EBMR, Clinical Evidence, DynaMed, ECRI, and Hayes. There are differences in the way that HTA agencies and units access the different resources of biomedical information. Combined subscription to several resources for documentation services was suggested as a way of resolving these differences.
Jackson, Andrew L
Abstract Background Geographical health inequalities are naturally described by the variation in health outcomes between areas (e.g. mortality rates). However, comparisons made between countries are hampered by our lack of understanding of the effect of the size of administrative units, and in particular the modifiable areal unit problem. Our objective was to assess how differences in geographic and administrative units used for disseminating data affect the description of health inequalities. Methods Retrospective study of standard populations and deaths aggregated by administrative regions within 20 European countries, 1990-1991. Estimated populations and deaths in males aged 0-64 were in 5 year age bands. Poisson multilevel modelling was conducted of deaths as standardised mortality ratios. The variation between regions within countries was tested for relationships with the mean region population size and the unequal distribution of populations within each country measured using Gini coefficients. Results There is evidence that countries whose regions vary more in population size show greater variation and hence greater apparent inequalities in mortality counts. The Gini coefficient, measuring inequalities in population size, ranged from 0.1 to 0.5 between countries; an increase of 0.1 was accompanied by a 12-14% increase in the standard deviation of the mortality rates between regions within a country. Conclusions Apparently differing health inequalities between two countries may be due to differences in geographical structure per se, rather than having any underlying epidemiological cause. Inequalities may be inherently greater in countries whose regions are more unequally populated.
Tustin, Aaron W; Jones, Alison; Lopez, Gaylord P; Ketcham, Glenn R; Hodgson, Michael J
In the United States, regional poison centers frequently receive calls about toxic workplace exposures. Most poison centers do not share call details routinely with governmental regulatory agencies. Worker health and safety could be enhanced if regulators such as the Occupational Safety and Health Administration (OSHA) had the ability to investigate these events and prevent similar incidents. With this goal in mind, the Georgia Poison Center (GPC) began referring occupational exposures to OSHA in July 2014. GPC began collecting additional employer details when handling occupational exposure calls. When workers granted permission, GPC forwarded call details to the OSHA Regional Office in Atlanta. These referrals enabled OSHA to initiate several investigations. We also analyzed all occupational exposures reported to GPC during the study period to characterize the events, detect violations of OSHA reporting requirements, and identify hazardous scenarios that could form the basis for future OSHA rulemaking or guidance. GPC was informed about 953 occupational exposures between 1 July, 2014 and 7 January, 2016. Workers were exposed to 217 unique substances, and 70.3% of victims received treatment in a healthcare facility. Hydrogen sulfide was responsible for the largest number of severe clinical effects. GPC obtained permission to refer 89 (9.3%) calls to OSHA. As a result of these referrals, OSHA conducted 39 investigations and cited 15 employers for "serious" violations. OSHA forwarded several other referrals to other regulatory agencies when OSHA did not have jurisdiction. At least one employer failed to comply with OSHA's new rule that mandates reporting of all work-related hospitalizations. This collaboration increased OSHA's awareness of dangerous job tasks including hydrofluoric acid exposure among auto detailers and carbon monoxide poisoning with indoor use of gasoline-powered tools. Collaboration with the GPC generated a useful source of referrals to OSHA. OSHA
Hagenaars, Luc L; Klazinga, Niek S; Mueller, Michael; Morgan, David J; Jeurissen, Patrick P T
Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. We used OECD data, which include health system governance and financing-related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). We find that governance and financing-related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross-country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single-payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. These differences can partially be explained because multi-payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems. Copyright © 2017 John Wiley & Sons, Ltd.
García Gómez, Montserrat; Alonso Urreta, Iciar; Antón Tomey, Carlos; Bosque Peralta, Isabel; García-Gutierrez, María Jesús; Luna Lacarta, Francisco José; Martínez Arguisuelas, Nieves; Mena Marín, María Luisa; Vázquez Cortizo, Margarita
The current structure of the Spanish State of Autonomies is characterized by institutional pluralism and the autonomy of the different public administrations. In this context, the principle of coordination is fundamental for the cohesion of the system, but experience shows that its implementation is difficult. This paper examines the set of actions carried out by the administrations in relation to an occupational and public health problem raised in March 2016. The Public Health General Direction of Aragon's Government was informed of a possible use of brake linings with asbestos to manufacture axles for agricultural machinery by a Company from Zaragoza; the collaboration from Aragon's Institute of Occupational Safety and Health, the Industry Department and the Labour and Social Security Inspectorate were asked; the joint action of these administrations detected the use of several models of brake linings with a content of 2-5% of Chrysotile. The brake linings came from a Chinese company. The axles nated are sold in several Spanish Autonomous Communities. A national alert was activated by the SIRIPQ (System of Rapid Exchange of Information on Chemical Products) which is coordinated by the Ministry of Health, Social Services and Equality. Several measures were taken including: ceasing the work with the brake linings, the replacement of brake linings with asbestos, the immobilization of brake linings in the company by application of the REACH Reglament, etc. This case shows that the cooperation and co-responsibility of public administrations from different territorial, sectoral and competence areas allows improving the occupational risks prevention and the public health.
Full Text Available The research objective is rational (optimal time management in studying the course modules on Advanced Training of Health Care Administrators. Materials and methods. We conducted expert survey of 73 healthcare administrators from medical organizations of Saratov region. Branch-and-bound method was used for rescheduling the educational program. Results. Both direct and inverse problems have been solved. The direct one refers to time distribution for each module of the advanced Training of Healthcare Administrators course so that the total score is maximum and each module is marked not lower than "satisfactory". The inverse one resulted in achieving minimal time characteristics for varieties of average score. Conclusion. The offered approach allows to solve problems of managing time given for education.
Schroll, Jeppe Bennekou; Abdel-Sattar, Maher; Bero, Lisa
OBJECTIVES: To compare the accessibility, comprehensiveness, and usefulness of data available from the European Medicines Agency (EMA) and the Food and Drug Administration (FDA) drug reports. STUDY DESIGN AND SETTING: This is a cross-sectional study. All new molecular drugs approved between January...... 1, 2011 and December 31, 2012 from the FDA and EMA Web sites were eligible. RESULTS: We included 27 drug reports. Most were searchable, but the FDA table of contents did not match the file's page numbers. Several FDA documents must be searched compared with a single EMA document, but the FDA reports...... contain more summary data on harms. Detailed information about harms was reported for 93% of the FDA reports (25 of 27 reports) and 26% of the EMA reports (7 of 27 reports). The reports contained information about trial methodology but did not include trial registry IDs or investigator names. All reports...
Jönsson, Kristina; Phoummalaysith, Bounfeng; Wahlström, Rolf; Tomson, Göran
During the last 20 years Lao People's Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective implementation by contextualizing the policy evolution over time and by focusing particularly on the National Drug Policy and the Health Care Law. Special attention is given to the role of research in policymaking. The analysis was guided by the conceptual framework of policy context, process, content and actors, combined with an institutional perspective, and showed that effective implementation of a health policy is highly dependent on both structures and agency of those involved in the policy process. The National Drug Policy was formulated and adopted in a short period of time in a resource-scarce setting, but with dedicated policy entrepreneurs and support of concerned international collaborators. Timely introduction of operational health systems research played a crucial role to support the implementation, as well as the subsequent revision of the policy. The development of the Health Care Law took several years and once adopted, the implementation was delayed by institutional legacies and issues concerning the choice of institutional design and financing, despite strong support of the law among the policymakers. Among many factors, timing of the implementation appeared to be of crucial importance, in combination with strong leadership. These two examples show that more research, that problematizes the complex policy environment in combination with improved communication between researchers and policymakers, is necessary to inform about measures for effective implementation. A way forward can be to strengthen the domestic research capacity and the international research collaboration regionally as well as globally. Published by Oxford University Press
... DEPARTMENT OF LABOR Occupational Safety and Health Administration Maritime Advisory Committee for Occupational Safety and Health (MACOSH) AGENCY: Occupational Safety and Health Administration (OSHA), Labor... Maritime Advisory Committee for Occupational Safety and Health. The Committee will better enable OSHA to...
... DEPARTMENT OF LABOR Occupational Safety and Health Administration Maritime Advisory Committee for Occupational Safety and Health (MACOSH) AGENCY: Occupational Safety and Health Administration (OSHA), Labor... for Occupational Safety and Health (MACOSH or Committee) was established under Section 7 of the...
Hatala, Jeffrey J; Fields, Tina T
Obesity rates in the southern US states are higher than in other states. Historically, large-scale community-based interventions in the United States have not proven successful. With local public health agencies (LPHAs) tasked with prevention, their role in obesity prevention is important, yet little research exists regarding what predicts the participation of LPHAs. Cross-sectional data from the 2008 National Association of City and County Health Officials profile study and two public health conceptual frameworks were used to assess structural and environmental predictors of LPHA participation in obesity prevention. The predictors were compared between southern and nonsouthern states. Univariate and weighted logistic regressions were performed. Analysis revealed that more LPHAs in southern states were engaged in nearly all of the 10 essential public health functions related to obesity prevention compared with nonsouthern states. Presence of community-based organizations and staffing levels were the only significant variables in two of the six logistic regression models. This study provides insights into the success rates of the obesity prevention efforts of LPHAs in southern and nonsouthern states. Future research is needed to understand why and how certain structural elements and any additional factors influence LPHA participation in obesity prevention.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency...: Workforce Recruitment in Health Resources and Services Administration (HRSA)--Funded Health Centers (OMB No... States Code, as amended by the Paperwork Reduction Act of 1995, Pub. L. 104-13), the Health Resources and...
Rebmann, Terri; Wang, Jing; Swick, Zachary; Reddick, David; delRosario, John Leon
Only limited data are available on US business continuity activities related to biologic events. A questionnaire was administered to human resource professionals during May-July 2011 to assess business continuity related to biologic events, incentives businesses are providing to maximize worker surge capacity, and seasonal influenza vaccination policy. Linear regressions were used to describe factors associated with higher business continuity and pandemic preparedness scores. The χ(2) and Fisher exact tests compared health care versus non-health care businesses on preparedness indicators. Possible business continuity and pandemic preparedness scores ranged from 0.5 to 27 and 0 to 15, with average resulting scores among participants at 13.2 and 7.3, respectively. Determinants of business continuity and pandemic preparedness were (1) business size (larger businesses were more prepared), (2) type of business (health care more prepared), (3) having human resource professional as company disaster planning committee member, and (4) risk perception of a pandemic in the next year. Most businesses (63.3%, n = 298) encourage staff influenza vaccination; 2.1% (n = 10) mandate it. Only 10% of businesses (11.0%, n = 52) provide employee incentives, and fewer than half (41.0%, n = 193) stockpile personal protective equipment. Despite the recent H1N1 pandemic, many US businesses lack adequate pandemic plans. It is critical that businesses of all sizes and types become better prepared for a biologic event. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
Borkowski, Nancy; Gordon, Jean; Rushing, John
This paper describes the development and implementation of an undergraduate health administration program for nontraditional students at a Hispanic serving institution. The program had to meet the needs of a diverse, adult student population, the local community, and the future leadership requirements of the healthcare industry. As such, the program was designed as a "bridge" for full-time employed healthcare licensed professionals seeking to complete a baccalaureate degree and obtain positions in the healthcare management field. It answered the call of the local community to strengthen partnerships between business and education by offering the program at healthcare employer worksites. Furthermore, the program addressed three needs of the healthcare industry: (1) the recognized shortage of future healthcare leaders, (2) the under-representation of minorities in the industry, and (3) proposed changes in health administration programs' curricula to focus on competencies in the areas of communication skills, decision making, ethical leadership, and self-development.
Revere, Debra; Calhoun, Rebecca; Baseman, Janet; Oberle, Mark
Communication technologies that enable bi-directional/two-way communications and cell phone texting (SMS) between public health agencies and their stakeholders may improve public health surveillance, ensure targeted distribution of alerts to hard-to-reach populations, reduce mortality and morbidity in an emergency, and enable a crucial feedback loop between public health agencies and the communities they serve. Building on prior work regarding health care provider preferences for receiving one-way public health communications by email, fax or SMS, we conducted a formative, exploratory study to understand how a bi-directional system and the incorporation of SMS in that system might be used as a strategy to send and receive messages between public health agencies and community-based organizations which serve vulnerable populations, health care providers, and public health workers. Our research question: Under what conditions and/or situations might public health agencies utilize bi-directional and/or SMS messaging for disseminating time-sensitive public health information (alerts, advisories, updates, etc.) to their stakeholders? A mixed methods (qualitative and quantitative) study was conducted between April and July 2014. Data collection included a survey distributed to health care providers and semi-structured interviews with providers, community- and government-based organization leaders and directors, and public health agency internal workforce staff. Survey respondents and interviewees were asked about their exposure to public health messages, how these messages are received and how the information in these messages are handled, and in what situations (for example, a local vs. a national event, a pandemic or emergency vs. a health update) a bi-directional and/or SMS messaging system might improve communications between public health agencies and their stakeholder group. Interview and survey data were qualitatively analyzed. Thematic codes were quantitized into
Costa, Jose Felipe Riani; Portela, Margareth Crisóstomo
The design and deployment of complex technologies like the electronic health record (EHR) involve technical, personal, social, and organizational issues. The Brazilian public and private scenario includes different local and regional initiatives for implementation of the electronic health record. The Brazilian Ministry of Health also has a proposal to develop a national EHR. The current study aimed to provide a comprehensive view of perceptions by health system administrators, professionals, and users concerning their experiences with the electronic health record and their opinions of the possibility of developing a national EHR. This qualitative study involved 28 semi-structured interviews. The results revealed both the diversity of factors that can influence the implementation of an electronic health record and the existence of convergences and aspects that tend to be valued differently according to the different points of view. Key aspects include discussions on the electronic health record's attributes and it impact on healthcare, especially in the case of local electronic health records, concerns over costs and confidentiality and privacy pertaining to electronic health records in general, and the possible implications of centralized versus decentralized data storage in the case of a national EHR. The interviews clearly showed the need to establish more effective communication among the various stakeholders, and that the different perspectives should be considered when drafting and deploying an EHR at the local, regional, and national levels.
VAMC VA Medical Center VBA Veterans Benefits Administration VFW Veterans of Foreign War of the United States VHA Veterans Health...System, August 26, 2014, accessed August 27, 2014, http://www.va.gov/oig/pubs/VAOIG-14-02603-267.pdf. 2 Sloan D. Gibson, “Remarks of Acting Secretary...Sloan D. Gibson During VFW Annual Convention” (address at the 115th VFW Annual Meeting, St. Louis, MO, July 22, 2014), accessed July 27, 2014, http
... on the sources of L. monocytogenes contamination, the effects of individual manufacturing and/or... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-N-1182] Draft Joint Food and Drug Administration/Health Canada Quantitative Assessment of the Risk of...
... (Living Will and Durable Power of Attorney for Health Care) Under OMB Review AGENCY: Department of... INFORMATION Title: Living Will and Durable Power of Attorney for Health Care, VA Form 10-0137. OMB Control... about his or her medical treat and to record specific instructions about their treatment preferences in...
Resnick, Beth; Kass, Nancy; Sellers, Katie; Young, Jessica; Bernet, Patrick; Jarris, Paul
Objectives. We examined critical budget and priority criteria for state health agencies to identify likely decision-making factors, pressures, and opportunities in times of austerity. Methods. We have presented findings from a 2-stage, mixed-methods study with state public health leaders regarding public health budget- and priority-setting processes. In stage 1, we conducted hour-long interviews in 2011 with 45 health agency executive and division or bureau leaders from 6 states. Stage 2 was an online survey of 207 executive and division or bureau leaders from all state health agencies (66% response rate). Results. Respondents identified 5 key criteria: whether a program was viewed as “mission critical,” the seriousness of the consequences of not funding the program, financing considerations, external directives and mandates, and the magnitude of the problem the program addressed. Conclusions. We have presented empirical findings on criteria used in state health agency budgetary decision-making. These criteria suggested a focus and interest on core public health and the largest public health problems with the most serious ramifications. PMID:24825212
Gill, Stephen; Benatar, Solomon R
Ilona Kickbusch's thought provoking editorial is criticized in this commentary, partly because she fails to refer to previous critical work on the global conditions and policies that sustain inequality, poverty, poor health and damage to the biosphere and, as a result, she misreads global power and elides consideration of the fundamental historical structures of political and material power that shape agency in global health governance. We also doubt that global health can be improved through structures and processes of multilateralism that are premised on the continued reproduction of the ecologically myopic and socially unsustainable market civilization model of capitalist development that currently prevails in the world economy. This model drives net financial flows from poor to rich countries and from the poor to the affluent and super wealthy individuals. By contrast, we suggest that significant progress in global health requires a profound and socially just restructuring of global power, greater global solidarity and the "development of sustainability." © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The Occupational Safety and Health Act of 1970 (OSHAct) declared that every worker is entitled to safe and healthful working conditions, and that employers are responsible for work being free from all recognized hazards. Thirty-eight years after these assurances, however, it is difficult to find anyone who believes the promise of the OSHAct has been met. The persistence of preventable, life-threatening hazards at work is a failure to keep a national promise. I review the history of the Occupational Safety and Health Administration and propose measures to better ensure that those who go to work every day return home safe and sound. These measures fall into 6 areas: leverage and accountability, safety and health systems, employee rights, equal protection, framing, and infrastructure.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency... entry. These systems must be multi-agency and be comprised of the key public and private agencies that... family outcome indicators and provide a theory of change, or rationale, on how a specific ECCS activity...
McClellan, Sean R; Snowden, Lonnie
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.
Perrault, Evan K; Inderstrodt-Stephens, Jill; Hintz, Elizabeth A
With funding for public health initiatives declining, creating measurable objectives that are focused on tracking and changing population outcomes (i.e., knowledge, attitudes, or behaviors), instead of those that are focused on health agencies' own outputs (e.g., promoting services, developing communication messages) have seen a renewed focus. This study analyzed 4094 objectives from the Community Health Improvement Plans (CHIPs) of 280 local PHAB-accredited and non-accredited public health agencies across the United States. Results revealed that accredited agencies were no more successful at creating outcomes-focused objectives (35% of those coded) compared to non-accredited agencies (33% of those coded; Z = 1.35, p = .18). The majority of objectives were focused on outputs (accredited: 61.2%; non-accredited: 63.3%; Z = 0.72, p = .47). Outcomes-focused objectives primarily sought to change behaviors (accredited: 85.43%; non-accredited: 80.6%), followed by changes in knowledge (accredited: 9.75%; non-accredited: 10.8%) and attitudes (accredited: 1.6%; non-accredited: 5.1%). Non-accredited agencies had more double-barreled objectives (49.9%) compared to accredited agencies (32%; Z = 11.43, p < .001). The authors recommend that accreditation procedures place a renewed focus on ensuring that public health agencies strive to achieve outcomes. It is also advocated that public health agencies work with interdisciplinary teams of Health Communicators who can help them develop procedures to effectively and efficiently measure outcomes of knowledge and attitudes that are influential drivers of behavioral changes.
Lessard, Laura; Trotter, Mary
Introduction Changes in food availability in worksites can result in changes in eating behavior and weight status. Nemours Health and Prevention Services, in conjunction with partners in Delaware, conducted a 6-month pilot program to assess the feasibility and impact of requiring that 75% of the items in vending machines in 3 state agency buildings have healthful items. Methods We collected process evaluation data from October 2011 through April 2012 by taking weekly photographs of all machines to record the number of healthful items available. Outcomes were measured through sales reports designed to enumerate changes in number and type of items sold and overall profit from each building. Results We found challenges in fully implementing the 75% goal. In one of the 3 buildings, all machines were compliant within 7 weeks; in another, full compliance did not occur until week 19. Despite these challenges, the number of items sold in each machine was comparable to numbers from the previous year. Total profits from each building varied across the 3 sites and during the pilot. One building had a 51% increase in profits in January 2012 compared with profits averaged for January 2011 and January 2010. In contrast, monthly profit at another building fluctuated from an increase of 6% to a loss of 30%. Conclusion Overall, our results suggest that collaborative efforts can result in a feasible intervention with little negative influence on profits. PMID:25144678
Varela-Lema, Leonor; Atienza-Merino, Gerardo; López-García, Marisa
This study was carried out to develop an explicit health priority setting methodology to support decision-making regarding the technologies to be assessed for inclusion in the National Health Service service portfolio. The primary objective is to identify and analyse the criteria, approaches and conceptual frameworks used for national/international priority setting. An exhaustive review of the literature was carried out. For this purpose, a search of the main biomedical databases was performed and assessment agency websites were reviewed, among other sources. In general terms, it was found that there are no standardised criteria for priority setting, although some consensus and common trends have been identified regarding key elements (criteria, models and strategies, key actors, etc.). Globally, 8 key domains were identified: 1) need for intervention; 2) health outcomes; 3) type of benefit of the intervention; 4) economic consequences; 5) existing knowledge on the intervention/quality of and uncertainties regarding the evidence; 6) implementation and complexity of the intervention/feasibility; 7) priority, justice and ethics; and 8) overall context. The review provides a thorough analysis of the relevant issues and offers key recommendations regarding considerations for developing a national prioritisation framework. Findings are envisioned to be useful for different public organisations that are aiming to establish healthcare priorities. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
Barbosa, Ana de Oliveira; Costa, Ediná Alves
The term sanitary safety (SS) appeared in the international debate mainly due to the emerging sanitary crisis, although its meaning has remained obscure. This paper aims to analyze the concept of SS brought into the Brazilian sanitary surveillance upon the creation of the National Health Surveillance Agency. An exploratory case study was undertaken with technical data analysis and semi-structured interviews with informants who had taken part in the process of formulating the body's institutional design. The following categories were analyzed: incorporation of the SS term into the institutional mission, the SS concept and SS mechanisms. The SS concept was analyzed in both institutional and technical discursive dimensions. The former elicits the sense of strategy, a reliable relationship and legitimacy whereas the latter shows the sense of an acceptable risk-benefit relationship from the perspective of individual and collective health protection and promotion. The SS concept was found to encompass health-related products, technologies and services, especially those designed for medical diagnosis and treatment, but environmental issues received little mention. The scope of the SS concept was shown to be widening to include the surveillance of hospital infection, drugs and blood.
A series of administrative initiatives undertaken by the Carter Administration in response to public concerns about harmful effects of exposures to ionizing radiation in various settings has been abandoned by the Reagan Administration. The decision to discard the Radiation Policy Council, the coordinating agency established in 1980, leaves the federal government with no overall focus or overall budget for radiation research and protection activities. The line agencies with direct radiation responsibilities, including the Department of Energy, Nuclear Regulatory Commission, Department of Defense, Food and Drug Administration's Bureau of Radiological health, and Department of Labor, continue with somewhat contradictory and uncoordinated programs
Urata, Janelle Y; Couch, Elizabeth T; Walsh, Margaret M; Rowe, Dorothy J
Purpose: To explore the knowledge, attitudes, and practices of supervising nurse administrators (SNAs) regarding the oral care provided to long-term care facility (LTCF) residents and the role of dental professionals in those facilities. Methods: The investigators of this study partnered with the National Association of Nursing Administrators to send this cross-sectional study consisting of a 35-item electronic survey to its members whose email addresses were in their database. Online software tabulated responses and calculated frequencies (percentages) of responses for each survey item. Results: Of the 2,359 potential participants, 171 (n=171) completed the survey for a 7% response rate. Only 25% of the respondents were familiar with the expertise of dental hygienists (DHs), however once informed, the majority were interested in having DHs perform oral health staff trainings, oral screenings, and dental referrals and initiate fluoride varnish programs. Most respondents correctly answered the oral health-related knowledge items, understood that oral health is important to general health, but reported that the LTCF residents' oral health was only "good" or "fair." Fewer than half, (48%) of the SNAs were "very satisfied" with the quality of oral care provided to the residents. While more than half reported that they had no dentist on staff or on-site dental equipment, 77% reported that they would consider on-site mobile oral care services. Oral health training for staff was provided primarily by registered nurses, however only 32% reported including identification of dental caries as part of the in-service training. Conclusion: This exploratory study lays the foundation for more extensive research investigating various strategies to improve the oral health of LTCF residents, including increased collaboration between DHs and SNAs. Copyright © 2018 The American Dental Hygienists’ Association.
Ellis, Randall P; Fiebig, Denzil G; Johar, Meliyanni; Jones, Glenn; Savage, Elizabeth
Explaining individual, regional, and provider variation in health care spending is of enormous value to policymakers but is often hampered by the lack of individual level detail in universal public health systems because budgeted spending is often not attributable to specific individuals. Even rarer is self-reported survey information that helps explain this variation in large samples. In this paper, we link a cross-sectional survey of 267 188 Australians age 45 and over to a panel dataset of annual healthcare costs calculated from several years of hospital, medical and pharmaceutical records. We use this data to distinguish between cost variations due to health shocks and those that are intrinsic (fixed) to an individual over three years. We find that high fixed expenditures are positively associated with age, especially older males, poor health, obesity, smoking, cancer, stroke and heart conditions. Being foreign born, speaking a foreign language at home and low income are more strongly associated with higher time-varying expenditures, suggesting greater exposure to adverse health shocks. Copyright © 2013 John Wiley & Sons, Ltd.
Mangelsdorff, A David; Rogers, Jody; Finstuen, Kenn; Pryor, Rene
The purpose of this research is to assess the impact of an educational program on the Military Health System on some of the evidence-based educational outcomes for the Individual (student) and the Society (all Army Medical Treatment Facilities). The U.S. Army-Baylor University HCA program provides a unique opportunity to assess the impact of an educational program on the Military Health System (MHS). Since the majority of the graduate students are military officers who serve in military medical treatment facilities (MTFs), tracking their career progression allows assessing the value added of the U.S. Army-Baylor University HCA experience from 1951 to 2001 (n = 2234). The context of Society outcomes includes all the Army MTFs where U.S. Army-Baylor University HCA graduates execute their leadership skills. During the time from 1994 to 2001, all of the Army MTFs in the MHS (n = 38) were examined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). In a similar but shorter time frame (1997-2001), DoD patient satisfaction assessments were conducted. The Individual outcomes (career advancement, increase in status, higher professional association membership) demonstrate that the selection criteria used for program admission appear to be successful. The Society outcomes showed higher JCAHO scores and satisfied consumers in Army facilities with Baylor graduates as the Deputy Commander for Administration (DCA). Continued internal program assessments (curriculum reviews) and external reviews (Accrediting Commission on Education for Health Services Administration accreditations of 5 years in 1987, 8 years in 1993 and 7 years in 2001, and 7 ACHE student chapter awards) attest to the strengths of the U.S. Army-Baylor University HCA program. Educating the MHS shareholders (patients, beneficiaries, professional and support staff, senior leaders) and leveraging technology to. share best practices for all administrators (including non-Baylor graduates) will
Schmalzried, Hans D; Fallon, L Fleming
Major funding cuts have occurred throughout the United States public health system during the past several years. Funding for local public health agency (LPHA) services and programs is obtained through a patchwork of sources that vary both within and among states. Even though local city and county sources provide a significant proportion of funding for LPHAs, information available in the literature about these revenues is sparse and is not clearly described. This study focused on a single specific revenue stream included in the local sources (local city and county) category: funds voted on directly by the public. The primary purpose of this study was to examine whether this type of funding source provided fiscal advantages for LPHAs. Specifically, we wanted to see how sensitive levy votes were to changing general economic conditions. A questionnaire to collect LPHA levy data was developed, approved, and mailed to county boards of elections in Ohio (n = 88). Elections officials were asked to provide voting results for all LPHA levy ballot attempts since 1994 regardless of outcome. In the study period (1994 through 2011), 250 LPHA property tax levies were placed on election ballots in Ohio. LPHAs were successful in 155 (62.0%) and unsuccessful in 95 (38.0%) attempts. Over the 18-year period, the most noteworthy outcome was a 94.6% pass rate for renewal levies. Our study demonstrated that voter-approved tax levies provide some fiscal advantages for LPHAs: higher per capita revenues than those who have to rely on other sources of income and predictable revenue streams. This translates into more funds being available for public health programs and services. Property tax levies allow citizens to make direct investments in their local health departments.
Finlay, Andrea K; Stimmel, Matthew; Blue-Howells, Jessica; Rosenthal, Joel; McGuire, Jim; Binswanger, Ingrid; Smelson, David; Harris, Alex H S; Frayne, Susan M; Bowe, Tom; Timko, Christine
The Veterans Health Administration (VA) Health Care for Reentry Veterans (HCRV) program links veterans exiting prison with treatment. Among veterans served by HCRV, national VA clinical data were used to describe contact with VA health care, and mental health and substance use disorder diagnoses and treatment use. Of veterans seen for an HCRV outreach visit, 56 % had contact with VA health care. Prevalence of mental health disorders was 57 %; of whom 77 % entered mental health treatment within a month of diagnosis. Prevalence of substance use disorders was 49 %; of whom 37 % entered substance use disorder treatment within a month of diagnosis. For veterans exiting prison, increasing access to VA health care, especially for rural veterans, and for substance use disorder treatment, are important quality improvement targets.
Widman, Amy; Hochberg, Francine A
This commentary responds to the essay by Elliott, Narayan, and Nasmith wherein they propose that the federal government may preclude plaintiffs with medically inflicted injuries from bringing state common-law tort claims against those whose negligence caused their injury. The administrative system championed by Elliott and other proponents is a radical departure from the current civil justice system. Specifically, we argue that the administrative health courts, as proposed, violate the commerce clause, the spending clause, the Seventh Amendment, and separation of powers principles. The commentary concludes that such a system is fatally flawed and cannot withstand constitutional scrutiny. Moreover, we are not persuaded that Congress will be able to ground such a radical constitutional restructuring in any sound public policy, as the majority of studies do not evidence Elliott, Narayan, and Nasmith's presumption that the civil justice system has failed in the medical malpractice context.
Pracht, Etienne E; Bass, Elizabeth
This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable. © 2011 National Association for Healthcare Quality.
Yang, Yuhui; Zhang, Hui; Yan, Biao; Zhang, Tianyu; Gao, Ying; Shi, Yonghui; Le, Guowei
This study aims to investigate the health effects of long-term dietary oxidized tyrosine (O-Tyr) and its main product (dityrosine) administration on mice metabolism. Mice received daily intragastric administration of either O-Tyr (320 μg/kg body weight), dityrosine (Dityr, 320 μg/kg body weight), or saline for consecutive 6 weeks. Urine and plasma samples were analyzed by NMR-based metabolomics strategies. Body weight, clinical chemistry, oxidative damage indexes, and histopathological data were obtained as complementary information. O-Tyr and Dityr exposure changed many systemic metabolic processes, including reduced choline bioavailability, led to fat accumulation in liver, induced hepatic injury, and renal dysfunction, resulted in changes in gut microbiota functions, elevated risk factor for cardiovascular disease, altered amino acid metabolism, induced oxidative stress responses, and inhibited energy metabolism. These findings implied that it is absolutely essential to reduce the generation of oxidation protein products in food system through improving modern food processing methods.
Sprague, Courtenay; Woollett, Nataly; Parpart, Jane; Hatcher, Abigail M; Sommers, Theresa; Brown, Shelley; Black, Vivian
While violence against women is a recognised global health problem, women's agency in marginalised settings is poorly understood, particularly in relation to health systems. We explored agency as a practical and theoretical construct through qualitative research among 20 nurses with direct or indirect experiences of intimate partner violence (IPV) in Johannesburg. Interviews conducted from August 2013 to March 2014 generated rich descriptions from respondents in five health facilities. Nurses' self-reported IPV matched national prevalence of 24-31%. Findings revealed the way in which agency is enacted by nurses, allowing them the economic means to leave abusive partnerships, yet disabling them from agency and health promotion in their workplace. At the same time, nurses expanded agentic possibilities for patients by enabling a national response to IPV within South African health clinics - one that is largely undocumented. We posit that nurses can serve as important agentic actors in public health systems in low- and middle-income country settings by assisting patients to address IPV, even in the absence of targeted training and guidelines. To ensure the health and well-being of women experiencing IPV, nurses should be supported by the health sector to respond skilfully to patients and to safely process their own experiences of violence.
Dunn, Edward J; Mills, Peter D; Neily, Julia; Crittenden, Michael D; Carmack, Amy L; Bagian, James P
Communication failure, a leading source of adverse events in health care, was involved in approximately 75% of more than 7,000 root cause analysis reports to the Department of Veterans Affairs (VA) National Center for Patient Safety (NCPS). The VA NCPS Medical Team Training (MTT) program, which is based on aviation principles of crew resource management (CRM), is intended to improve outcomes of patient care by enhancing communication between health care professionals. Unique features of MTT include a full-day interactive learning session (facilitated entirely by clinical peers in a health care context), administration of pre-and postintervention safety attitudes questionnaires, and follow-up semistructured interviews with reports of program activities and lessons learned. Examples of projects in these facilities include intensive care unit (ICU) teams' patient-centered multidisciplinary rounds, surgical teams' preoperative briefings and debriefings, an entire operating room (OR) unit's adoption of "Rules of Conduct" for expected staff behavior, and an ICU team's use of the model for daily administrative briefings. An MTT program based on applied CRM principles was successfully developed and implemented in 43 VA medical centers from September 2003 to May 2007.
Hyde, Justeen K; Shortell, Stephen M
This systematic review provides a synthesis of the growing field of public health systems research related to the structure and organization of state and local governmental public health agencies. It includes an overview of research examining the influence of organizational characteristics on public health performance and health status and a summary of the strengths and gaps of the literature to date. Data were retrieved through an iterative process, beginning with key word searches in three publication databases (PubMed, JSTOR, Web of Science). Gray literature was searched through the use of Google Scholar™. Targeted searches on websites and key authors were also performed. Documents underwent an initial and secondary screening; they were retained if they contained information about local or state public health structure, organization, governance, and financing. 77 articles met the study criteria. Public health services are delivered by a mix of local, state, and tribal governmental and nongovernmental agencies and delivered through centralized (28%); decentralized (37%); or combined authority (35%). The majority of studies focused on organizational characteristics that are associated with public health performance based on the 10 Essential Public Health Services framework. Population size of jurisdiction served (>50,000); structure of authority (decentralized and mixed); per capita spending at the local level; some partnerships (academic, health services); and leadership of agency directors have been found to be related to public health performance. Fewer studies examined the relationship between organizational characteristics and health outcomes. Improvements in health outcomes are associated with an increase in local health department expenditures, FTEs per capita, and location of health department within local networks. Public health systems in the U.S. face a number of critical challenges, including limited organizational capacity and financial resources
Guerrero, Erick G; Heslin, Kevin C; Chang, Evelyn; Fenwick, Karissa; Yano, Elizabeth
This study explored the role of organizational factors in the ability of Veterans Health Administration (VHA) clinics to implement colocated mental health care in primary care settings (PC-MH). The study used data from the VHA Clinical Practice Organizational Survey collected in 2007 from 225 clinic administrators across the United States. Clinic degree of implementation of PC-MH was the dependent variable, whereas independent variables included policies and procedures, organizational context, and leaders' perceptions of barriers to change. Pearson bivariate correlations and multivariable linear regression were used to test hypotheses. Results show that depression care training for primary care providers and clinics' flexibility and participation were both positively correlated with implementation of PC-MH. However, after accounting for other factors, regressions show that only training primary care providers in depression care was marginally associated with degree of implementation of PC-MH (p = 0.051). Given the importance of this topic for implementing integrated care as part of health care reform, these null findings underscore the need to improve theory and testing of more proximal measures of colocation in future work.
... 42 Public Health 4 2010-10-01 2010-10-01 false Organization for administration. 431.11 Section 431... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Single State Agency § 431.11 Organization for administration. (a) Basis and purpose. This section, based on section 1902(a...
Full Text Available Amac: It is important to learn how the people perceive their environment to promote health and to improve their perspectives. This study is aimed to determine the behaviors of smoking, physical activity, stres management and healthy eating of the administrative hospital staff and evaluate their perspectives about hospital environment. Gerec ve Yontem: The universe of the study was the administrative staffs working at a hospital. The questionnarie developed by the researchers .were used to collect data. The official permission was taken from hospital management, and the verbal permission was from the staff. Bulgular: The mean age of the participants was 34.4±7.43 and the mean year of working in this hospital was 10.7±7.1 years. The most common nutritional habit seen among all staff was drinking excess amount of tea, coffee, coke. Among the participants, 51.8% of the participants did not do any physical activity. The people interviewed in the study pointed out that the most given information among all topics was tobacco control (36.7%. Hospital staff declared the first desired expectations for their workplace as having a seperate place to rest, professional support on communication skills, professional support on stress management. The least expectation declared by the staff was "removing salt from the table". Sonuc: It is found that the hospital administrative staff interviewed in our study did not have enough awareness about health promoting behaviors and their accessibility to health promoting environment. The interventions should be developed to improve institutional policies, environmental infrastructure and also the level of awareness of staff. [TAF Prev Med Bull 2012; 11(6.000: 707-716
Full Text Available ConBased on the program “Yo quiero, yo puedo… mejorar mi salud y ejercer mis derechos” [I want to, I can…improve my health and exercise my rights], a pilot model was designed and implemented in three States of Mexico. This model aims to change nutrition and hygiene behaviors in the inhabitants of marginalized communities, through knowledge and psychosocial skills development facilitating personal agency and intrinsic empowerment. Evaluation of the program showed an effect on knowledge, assertive communication, personal agency and gender equity among the personnel in charge of the warehouses that provide the rural stores, and on knowledge, assertive communication, decision making and personal agency in the target population. Life skills training, knowledge and personal agency promotion enhance opportunities for poverty reduction.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency.... L. 104-13), the Health Resources and Services Administration (HRSA) publishes periodic summaries of... and Human Services' (HHS) priority policies to improve health care delivery. Some of these priorities...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency... Health Resources and Services Administration (HRSA), Bureau of Clinician Recruitment and Service (BCRS... States Code, as amended by the Paperwork Reduction Act of 1995, Pub. L. 104-13), the Health Resources and...
Department of Health (Ireland)
The Irish Government in March 2008 set a target to identify measure and reduce the Administrative Burden (AB) of domestic regulation for businesses by 25% by the end of 2012 – on foot of a European Council invitation to all member states in March 2007. As part of a cross-Government process led by the Business Regulation Unit of the Department of Jobs, Enterprise and Innovation (DJEI), the Department of Health carried out a measurement exercise in 2012 on the main Information Obligations...
Zabin, L S
Several ideologies of the present Administration appear to converge as they impinge upon family planning--themes which are not restricted to reproductive health but which interact in ways particularly threatening to its achievements of the last decade. Most of these ideologies are clear, articulated objectives of the present government such as overall budget reduction and the return of budgetary control to the states. Others are responsive to the influence of the so called "moral mojority." Essentially, the federal government can affect family planning delivery through 4 different routes: through the allocation of funds; through specific legislation; and through regulation or organizational structure (areas in the hands of the executive branch alone). There have been recent and prime examples of all 4 routes, all directed at weakening the federal family planning program which has grown steadily stronger with bipartisan support in the last decades. Major sources of family planning support are reviewed in order to indicate the areas of change or of serious risk to the field. By retaining the categorical funding of Title 10 (half of the federal money in the family planning field has, for some years, come through Title 10 of the Public Health Service Act) in 1981, Congress reasserted the importance it places upon fertility regualtion against Administration pressure to block-grant. Despite an approximately 23% cut, this funding remains the single best hope for the field in these tight money times. In the language of the House Budget Committee report, Congress expressed its intention that an emphasis upon family planning be retained in the Maternal and Child Health block grant. It is no surprise that under the pressure of funding cuts that intention has not been honored. An upsurge in the use of Medicaid funding by family planning providers has increased the proportion of family planning funds from this source. In Title 20 of the Social Security Act (Social Services) it
Beder, Joan; Postiglione, Paul
For the social worker in the Veterans Health Administration (VA) System, numerous challenges are faced and met while serving the nation's Veterans. As part of the multidisciplinary team, social workers perform a variety of tasks and function in diverse roles. The qualitative survey research reported in this article sought to detail what social workers identified about the impact and rewards of their work and what they saw as the challenges and frustrations. In addition the social workers were asked to clarify their role with the patient and the family. Intervention strategies used in the course of the social workers interaction with the Veterans was also ascertained.
... organizations; and other stakeholders to reach out, engender trust, reduce stigma, and encourage our Nation's... are experiencing mental health crises and provide confident and trustworthy counseling. To be... Collection: Emergency Submission for OMB Review; Comment Request AGENCY: Veterans Health Administration...
Goldberg, P; Landre, M F; David, S; Goldberg, M; Dassa, S; Marne, M J
A cross-sectional epidemiological survey was conducted among prison staff in France to investigate the relationships between working conditions and health. The sample included men and women 20 to 64 years old belonging to all categories of prison personnel: prison guards, administrative staff, socioeducational workers, technicians, health care workers, and managers (n = 4587, response rate 45.7%). A mailed self-administered questionnaire was used to assess sociodemographic characteristics, working conditions, and physical and mental disorders. Multiple logistic regression analyses were conducted to determine the effects of working conditions and social relationships on health of prison staff. However, the results reported here only concern 17 health disorders: body mass index, sick leave, medication use, accidents, digestive disorders, lower extremities and back disorders, hypertension, hemorrhoids, arthritis, skin disorders, urinary infections, chronic bronchitis, cholesterol, gastric ulcer, respiratory infections, ocular disorders. The living non professional conditions mostly associated with health disorders were financial difficulties (OR: 1.9 for digestive disorders, 1.8 for gastric ulcer, 1.7 for medication use) and irregularity of meals (OR = 1.5 for digestive disorders, and hypertension). In the occupational environment, the factors most associated with health disorders are seniority (OR = 4.2 for arthritis, 2.3 for cholesterol) and constraints (OR = 1.7 for lower extremities disorders). In spite of some limits associated to this kind of study, relationships between occupational and non occupational factors and physical health conditions were observed; the results also pointed out the protective role of the social relationships for health conditions.
Shahsavari, Hooman; Nasrabadi, Alireza Nikbakht; Almasian, Mohammad; Heydari, Heshmatolah; Hazini, Abdolrahim
Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task. The purpose of this study was to explore the administrative aspects of the delivery of home health care services. This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method. 23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories. Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.
Montesano, Vicki L; Sivec, Harry J; Munetz, Mark R; Pelton, Jeremy R; Turkington, Douglas
The purpose of this article is twofold: (a) to describe the adaptation of an evidence-based practice and, (b) using a dissemination framework, to describe the process of implementing the practice at a community mental health agency. The authors describe the training concept and dissemination framework of implementing an emerging practice: high-yield cognitive behavioral techniques for psychosis, which is rooted in cognitive behavioral therapy. Thirteen case managers who represented teams from across the agency delivered the adapted practice at a community mental health agency. Implementation required buy in from all stakeholders, communication across disciplines, persistence, and flexibility. It appears that the use of a dissemination framework that is grounded in the literature, yet flexible, eases the process of implementing an adapted practice. Further research focusing on the effectiveness of this approach, along with the impact of implementing a full spectrum of cognitive behavioral therapy services for individuals with persistent psychotic symptoms, based on cognitive behavioral therapy principles, is indicated.
Gase, Lauren N; Gomez, Louis M; Kuo, Tony; Glenn, Beth A; Inkelas, Moira; Ponce, Ninez A
School climate is an integral part of a comprehensive approach to improving the well-being of students; however, little is known about the relationships between its different domains and measures. We examined the relationships between student, staff, and administrative measures of school climate to understand the extent to which they were related to each other and student outcomes. The sample included 33,572 secondary school students from 121 schools in Los Angeles County during the 2014-2015 academic year. A multilevel regression model was constructed to examine the association between the domains and measures of school climate and 5 outcomes of student well-being: depressive symptoms or suicidal ideation, tobacco use, alcohol use, marijuana use, and grades. Student, staff, and administrative measures of school climate were weakly correlated. Strong associations were found between student outcomes and student reports of engagement and safety, while school staff reports and administrative measures of school climate showed limited associations with student outcomes. As schools seek to measure and implement interventions aimed at improving school climate, consideration should be given to grounding these efforts in a multidimensional conceptualization of climate that values student perspectives and includes elements of both engagement and safety. © 2017, American School Health Association.
Mendeloff, J M; Kagey, B T
Investigations of fatalities by the Occupational Safety and Health Administration (OSHA) provide the most detailed available information about traumatic workplace deaths that are potentially related to violations of existing safety standards. Comparison of the number of such deaths investigated by OSHA from 1977 to 1986 with the comparable category of deaths reported to the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses indicates that the overall magnitudes have been roughly similar. The OSHA data contain more information than other sources and are especially valuable for analyses of fatalities at smaller workplaces. The OSHA data show that death rates decline sharply with establishment size; the inverted "U" pattern for lost workday injury rates is absent. Because accident investigations are conducted as part of an administrative system, the OSHA data can be influenced by changes in administrative policies. Changes over time in the percent of fatalities in which violations of OSHA standards were cited have clearly been influenced by changes in OSHA citation policy and thus do not provide a valid measure of the rate of violation-caused deaths. Realization of the epidemiological value of this data source depends upon a commitment from OSHA to maintain consistency in investigating accidents and to improve its data collection methods.
Lewis, Robert K
On 29 December 1970, the Occupational Safety and Health Act of 1970 established the Occupational Safety and Health Administration (OSHA). This article on OSHA, Title 29, Part 1910.1096 Ionizing Radiation standard was written to increase awareness of the employer, the workforce, state and federal governments, and those in the radon industry who perform radon testing and radon mitigation of the existence of these regulations, particularly the radon relevant aspect of the regulations. This review paper was also written to try to explain what can sometimes be complicated regulations. As the author works within the Radon Division of the Pennsylvania Department of Environmental Protection, Bureau of Radiation Protection, the exclusive focus of the article is on radon. The 1910.1096 standard obviously covers many other aspects of radiation and radiation safety in the work place.
Iverson, Katherine M; Huang, Kristin; Wells, Stephanie Y; Wright, Jason D; Gerber, Megan R; Wiltsey-Stirman, Shannon
Intimate partner violence (IPV) is a significant health issue faced by women veterans, but little is known about their preferences for IPV-related care. Five focus groups were conducted with 24 women Veterans Health Administration (VHA) patients with and without a lifetime history of IPV to understand their attitudes and preferences regarding IPV screening and responses within VHA. Women veterans wanted disclosure options, follow-up support, transparency in documentation, and VHA and community resources. They supported routine screening for IPV and articulated preferences for procedural aspects of screening. Women suggested that these procedures could be provided most effectively when delivered with sensitivity and connectedness. Findings can inform the development of IPV screening and response programs within VHA and other healthcare settings. © 2014 Wiley Periodicals, Inc.
Hudak, R P; Brooke, P P; Finstuen, K; Riley, P
This research identifies the most important domains in health care administration (HCA) from now to the year 2000 and differentiates job skill, knowledge, and ability requirements necessary for successful management. Fellows of the American College of Healthcare Executives from about half of the United States responded to two iterations of a Delphi mail inquiry. Fellows identified 102 issues that were content-analyzed into nine domains by an HCA expert panel. Domains, in order of ranked importance, were cost/finance, leadership, professional staff interactions, health care delivery concepts, accessibility, ethics, quality/risk management, technology, and marketing. In the second Delphi iteration, Fellows reviewed domain results and rated job requirements on required job importance. Results indicated that while a business orientation is needed for organizational survival, an equal emphasis on person-oriented skills, knowledge, and abilities is required.
Boden, L I; Hall, J A; Levenstein, C; Punnett, L
In a study conducted to determine if the existence of a joint labor-management health and safety committee (HSC) was correlated with either the number of Occupational Safety and Health Administration (OSHA) complaints or hazardousness, as measured by OSHA serious citations, virtually no effect could be detected in a sample of 127 Massachusetts manufacturing firms. At a sample of 13 firms, interviews of HSC members were conducted. Committee attributes and perceptions about committee effectiveness were compared with the number of OSHA complaints and serious citations. There were fewer complaints and fewer serious citations at firms with HSCs that were perceived as effective. Results of the study suggest that the objective attributes of the committee may be less important to its success than the commitment of management and labor to solving workplace safety problems.
Mooney, C; Farrier, D
fallen through the gaps in legislation and its administration. Although water pollution legislation is broad enough to embrace diffuse pollution, in practice the Environment Protection Authority has focused on regulating point sources. Water legislation has traditionally been concerned with issues of water quantity rather than water quality. Legislation which allows agency intervention in relation to land degradation has grown from soil conservation roots, neglecting the flow-on effects upon water quality. Under the land use planning system existing land uses are protected from new regulatory requirements. A number of recent developments in NSW law and its administration have set the scene for addressing this past neglect. Water planning provisions in the Water Management Act 2000 have the potential to enable community based Water Management Committees to move away from a narrow focus on water quantity to the broader issues of river health, including water quality. Improved management of on-site sewage management systems is expected as a result of the Local Government (Approvals) Amendment (Sewage Management Regulation) 1998. A draft Regional Environmental Plan prepared for the Sydney Catchment Authority aims to improve the assessment of new development in terms of its impact on drinking water quality. It also moves away from an exclusive concern with controlling new development towards grappling with existing uses. Proposed amendments to the Environmental Planning and Assessment Act, 1979 as detailed in the White Paper, Plan First (2001) include the integration of imperatives derived from catchment strategies and water management plans into local land use plans.
May, Joy L.
The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences…
Riippa, Iiris; Kahilakoski, Olli-Pekka; Linna, Miika; Hietala, Minni
Interventions aimed at improving chronic care typically consist of multiple interconnected parts, all of which are essential to the effect of the intervention. Limited attention has been paid to the use of routine clinical and administrative data in the evolution of these complex interventions. The purpose of this study is to examine the feasibility of routinely collected data when evaluating complex interventions and to demonstrate how a theory-based, realist approach to evaluation may increase the feasibility of routine data. We present a case study of evaluating a complex intervention, namely, the chronic care model (CCM), in Finnish primary health care. Issues typically faced when evaluating the effects of a complex intervention on health outcomes and resource use are identified by using routine data in a natural setting, and we apply context-mechanism-outcome (CMO) approach from the realist evaluation paradigm to improve the feasibility of using routine data in evaluating complex interventions. From an experimentalist approach that dominates the medical literature, routine data collected from a single centre offered a poor starting point for evaluating complex interventions. However, the CMO approach offered tools for identifying indicators needed to evaluate complex interventions. Applying the CMO approach can aid in a typical evaluation setting encountered by primary care managers: one in which the intervention is complex, the primary data source is routinely collected clinical and administrative data from a single centre, and in which randomization of patients into two research arms is too resource consuming to arrange. © 2014 John Wiley & Sons, Ltd.
... Condition of participation: Administrative management. The clinic or rehabilitation agency has an effective... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Administrative management. 485.709 Section 485.709 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...
Lacking a coordinated effort in utilizing data and tracking program outcomes, one agency developed a Quality Management (QM) division to facilitate and manage more effective data use. To support this process, the agency sought to develop a collective, agency-wide understanding and investment in improving and measuring client outcomes. Similarly, the agency also focused efforts on creating a culture of transparency and accountability, with goals of improving service, increasing agency integrity, meeting regulatory compliance, and engaging in effective risk management. Operationalizing the QM initiative involved developing procedures, systems, and guidelines that would facilitate the generation of reliable and accurate data that could be used to inform program change and decision-making. This case study describes this agency's experience in successfully creating and implementing a QM initiative aimed at engaging in greater knowledge sharing. Copyright © Taylor & Francis Group, LLC
Pace, Romina; Peters, Tricia; Rahme, Elham; Dasgupta, Kaberi
Health administrative data are frequently used for hypertension surveillance. The aim of this systematic review was to determine the sensitivity and specificity of the commonly used hypertension case definition of 2 physician outpatient claims within a 2-year period or 1 hospital discharge abstract record. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE (from 1946) and EMBASE (from 1947) for relevant studies through September 2016 (keywords: "hypertension," "administrative databases," "validation studies"). Data with standardized forms and assessed quality using Quality Assessment of Diagnostic Accuracy Studies criteria were reviewed by 2 reviewers. Pooled sensitivity and specificity were estimated using a generalized linear-model approach to random-effects bivariate regression meta-analysis. The search strategy identified 1732 abstracts, among which 3 articles were deemed relevant. One of the articles incorporated 2 studies with differing reference standards and study populations; thus, we considered each separately. The quality scores of the retained studies ranged from 10-12 of a maximum 14. The sensitivity of the definition investigated to identify hypertension using administrative health databases was 71.2% (95% confidence interval [CI], 68.3-73.7) and the specificity was 94.5% (95% CI, 93.2-95.6) when compared with surveys or medical records. The 2 physician outpatient claims within a 2-year period or 1 hospital discharge abstract record hypertension case definition accurately classifies individuals as hypertensive in approximately 70% of cases and correctly identifies persons as nonhypertensive in approximately 95% of cases. This is likely sufficiently sensitive and specific for most research and surveillance purposes. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
Ring, Joseph; Tupin, Edward; Elder, Deirdre; Hiatt, Jerry; Sheetz, Michael; Kirner, Nancy; Little, Craig
The Health Physics Society (HPS) provided comment to the U.S. Environmental Protection Agency (EPA) on options to consider when developing an action plan for President Trump's Executive Order to evaluate regulations for repeal, replacement, or modification. The HPS recommended that the EPA reconsider their adherence to the linear no-threshold (LNT) model for radiation risk calculations and improve several documents by better addressing uncertainties in low-dose, low dose-rate (LDDR) radiation exposure environments. The authors point out that use of the LNT model near background levels cannot provide reliable risk projections, use of the LNT model and collective-dose calculations in some EPA documents is inconsistent with the recommendations of international organizations, and some EPA documents have not been exposed to the public comment rule-making process. To assist in establishing a better scientific basis for the risks of low dose rate and low dose radiation exposure, the EPA should continue to support the "Million Worker Study," led by the National Council on Radiation Protection and Measurement.
This article explores some core findings from a qualitative investigation of parents' experiences of their child's treatment in an adolescent mental health service in Sydney, Australia. In particular, the research question was, "How does parents' involvement in the child/adolescent's treatment influence their perception of how they can be helpful in their child's recovery?" The theme of parent hope emerged from the broad qualitative exploration of parent's experience of their involvement in their adolescent's intensive treatment program. A purposive sample of 14 sets of parents participated, being interviewed at admission, discharge, and 6 months following their adolescent's discharge. A continuum of high, moderate, and low levels of hope were evident in this parent sample 6 months after their treatment involvement. The strongly emergent theme was the relationship between parents' hope and agency/self-efficacy. Parents who remained more passive in expecting expert helpers to fix their child experienced reduced hope months after finishing the program. When parents positively changed their interaction with their child, they felt a more sustained hopefulness. These findings generate the hypothesis that if parents are actively involved in changing themselves as part of their child's treatment, they experience increased hope and effectiveness in contributing to their child's recovery.
Gong, Fang; Xu, Jun; Fujishiro, Kaori; Takeuchi, David T
The relationship between human agency and health is an important yet under-researched topic. This study uses a life course perspective to examine how human agency (measured by voluntariness, migratory reasons, and planning) and timing (measured by age at immigration) affect mental health outcomes among Asian immigrants in the United States. Data from the National Latino and Asian American Study showed that Asian immigrants (n=1491) with multiple strong reasons to migrate were less likely to suffer from mental health problems (i.e., psychological distress and psychiatric disorders in the past 12 months) than those without clear goals. Moreover, Asian immigrants with adequate migratory planning had lower levels of distress and lower rates of 12-month psychiatric disorders than those with poorly planned migration. Compared with migrants of the youngest age category (six or younger), those who migrated during preteen and adolescent years without clear goals had higher levels of psychological distress, and those who migrated during adulthood (25 years or older) were less likely to suffer from recent depressive disorders (with the exception of those migrating for life-improving goals). Furthermore, we found that well-planned migration lowered acculturative stress, and multiple strong reasons for migration buffered the negative effect of acculturative stress upon mental health. Findings from this study advance research on immigrant health from the life course perspective by highlighting the effects of exercising human agency during the pre-migration stage upon post-migration mental health. Copyright © 2011 Elsevier Ltd. All rights reserved.
Stordalen, Gunhild A.; Rocklöv, Joacim; Nilsson, Maria; Byass, Peter
Background Despite considerable global attention to the issues of climate change, relatively little priority has been given to the likely effects on human health of current and future changes in the global climate. We identify three major societal determinants that influence the impact of climate change on human health, namely the application of scholarship and knowledge; economic and commercial considerations; and actions of governments and global agencies. Discussion The three major areas are each discussed in terms of the ways in which they facilitate and frustrate attempts to protect human health from the effects of climate change. Academia still pays very little attention to the effects of climate on health in poorer countries. Enterprise is starting to recognise that healthy commerce depends on healthy people, and so climate change presents long-term threats if it compromises health. Governments and international agencies are very active, but often face immovable vested interests in other sectors. Overall, there tends to be too little interaction between the three areas, and this means that potential synergies and co-benefits are not always realised. Conclusion More attention from academia, enterprise, and international agencies needs to be given to the potential threats the climate change presents to human health. However, there needs to also be much closer collaboration between all three areas in order to capitalise on possible synergies that can be achieved between them. PMID:23653920
Schwartz, Miriam E; Welsh, Deborah E; Paull, Douglas E; Knowles, Regina S; DeLeeuw, Lori D; Hemphill, Robin R; Essen, Keith E; Sculli, Gary L
Communication failure is a significant source of adverse events in health care and a leading root cause of sentinel events reported to the Joint Commission. The Veterans Health Administration National Center for Patient Safety established Clinical Team Training (CTT) as a comprehensive program to enhance patient safety and to improve communication and teamwork among health care professionals. CTT is based on techniques used in aviation's Crew Resource Management (CRM) training. The aviation industry has reached a significant safety record in large part related to the culture change generated by CRM and sustained by its recurrent implementation. This article focuses on the improvement of communication, teamwork, and patient safety by utilizing a standardized, CRM-based, interprofessional, immersive training in diverse clinical areas. The Teamwork and Safety Climate Questionnaire was used to evaluate safety climate before and after CTT. The scores for all of the 27 questions on the questionnaire showed an increase from baseline to 12 months, and 11 of those increases were statistically significant. A recurrent training is recommended to maintain the positive outcomes. CTT enhances patient safety and reduces risk of patient harm by improving teamwork and facilitating clear, concise, specific and timely communication among health care professionals. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.
Mossé, Philippe; Maury, Caroline; Daumerie, Nicolas; Roelandt, Jean-Luc
The new mental health care policy, which has been set up in France, involves a change of paradigm, which has been going on since the 2000s: the emphasis is shifting from psychiatry to mental health care. This shift mainly concerns the knowledge about mental health is produced and circulates among an increasingly large number of bodies. Mainly grounded on actor interview analysis, official reports and blueprints, this study shows that the results of this process are numerous. They include the development of ambulatory care and strong moves towards decentralization. More data and knowledge are therefore to be shared in this more complex system. However, the French State, in the form of the central administration, is taking advantage of this move and is still contributing significantly to the definition and implementation of the new policy. On the other hand, the new governance dynamic is not leading to standardization of medical practices, as the mental health field remains highly heterogeneous. Copyright © 2012 John Wiley & Sons, Ltd.
... DEPARTMENT OF TRANSPORTATION Federal Highway Administration Notice of Final Federal Agency Action on Proposed Transportation Project in Illinois and Indiana AGENCY: Federal Highway Administration...., Acting Division Administrator, Federal Highway Administration, 3250 Executive Park Drive, Springfield...
Al-Modallal, Hanan; Hamaideh, Shaher; Mudallal, Rula
This study aimed at investigating differences in mental health problems between attendees of governmental and United Nations Relief and Works Agency for Palestine Refugees health care centers in Jordan. Further, predictors of mental health problems based on women's demographic profile were investigated. A convenience sample of 620 women attending governmental and United Nations Relief and Works Agency for Palestine Refugees health care centers in Jordan was recruited for this purpose. Independent samples t-tests were used to identify differences in mental health, and multiple linear regression was implemented to identify significant predictors of women's mental health problems. Results indicated an absence of significant differences in mental health problems between attendees of the two types of health care centers. Further, among the demographic indicators that were tested, income, spousal violence, and general health were the predictors of at least three different mental health problems in women. This study highlights opportunities for health professionals to decrease women's propensity for mental health problems by addressing these factors when treating women attending primary care centers in different Jordanian towns, villages, and refugee camps.
Kawonga, Mary; Fonn, Sharon; Blaauw, Duane
Background: In light of an increasing global focus on health system strengthening and integration of vertical programmes within health systems, methods and tools are required to examine whether general health service managers exercise administrative authority over vertical programmes. Objective: To measure the extent to which general health service (horizontal) managers, exercise authority over the HIV programme’s monitoring and evaluation (M&E) function, and to explore factors that may i...
From Headline to Hard Grind: The Importance of Understanding Public Administration in Achieving Health OutcomesComment on "Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities".
Many public policy programs fail to translate ambitious headlines to on-the-ground action. The reasons for this are many and varied, but for public administration and management scholars a large part of the gap between ambition and achievement is the challenge associated with the operation of the machinery of government itself, and how it relates to the other parties that it relies on to fulfill these outcomes. In their article, Carey and Friel set out key reasons why public health scholars should seek to better understand important ideas in public administration. In commenting on their contribution, I draw out two critical questions that are raised by this discussion: (i) what are boundaries and what forms do they take? and (ii) why work across boundaries? Expanding on these key questions extends the points made by Carey and Friel on the importance of understanding public administration and will better place public health scholars and practitioners to realise health outcomes. © 2016 by Kerman University of Medical Sciences.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-N-0001] Food and Drug Administration/Xavier University Global Medical Device Conference AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public conference. SUMMARY: The Food and Drug Administration (FDA...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-0001] Food and Drug Administration/Xavier University Global Medical Device Conference AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public conference. SUMMARY: The Food and Drug Administration (FDA...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-N-0001] Food and Drug Administration/Xavier University Global Medical Device Conference AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public conference. SUMMARY: The Food and Drug Administration (FDA...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Chapter I [Docket No. FDA-2013-N-0365] Establishment of a Public Docket for Administrative Detention Under the Food and Drug Administration Safety and Innovation Act AGENCY: Food and Drug Administration, HHS. ACTION: Establishment of...
Omer-Salim, Amal; Suri, Shobha; Dadhich, Jai Prakash; Faridi, Mohammad Moonis Akbar; Olsson, Pia
Women's agency, or intentional actions, in combining breastfeeding and employment is significant for health and labour productivity. Previous research in India showed that mothers use various collaborative strategies to ensure a "good enough" combination of breastfeeding and employment. Bandura's theoretical agency constructs previously applied in various realms could facilitate the exploration of agency in an Indian context. To explore manifestations of agency in combining breastfeeding and employment amongst Indian health workers using Bandura's theoretical constructs of agency and women's experiences. Qualitative semi-structured interviews were conducted with ten women employees within the governmental health sector in New Delhi, India. Both deductive and inductive qualitative content analyses were used. Bandura's features and modes of agency revealed that intentionality is underpinned by knowledge, forethought means being prepared, self-reactiveness includes collaboration and that self-reflectiveness gives perspective. Women's interviews revealed four approaches to agency entitled: 'All within my stride or the knowledgeable navigator'; 'Much harder than expected, but ok overall'; This is a very lonely job'; and 'Out of my control'. Agency features and their elements are complex, dynamic and involve family members. Bandura's theoretical agency constructs are partially useful in this context, but additional social practice constructs of family structure and relationship quality are needed for better correspondence with women's experiences of agency. The variation in individual approaches to agency has implications for supportive health and workplace services. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
... DEPARTMENT OF LABOR Occupational Safety and Health Administration [Docket No. OSHA-2010-0032] 29 CFR Parts 1910 and 1926 Interpretation of OSHA's Provisions for Feasible Administrative or Engineering Controls of Occupational Noise AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION...
Angel, Jacqueline L; Berlinger, Nancy
Health and social welfare policy proposals put forth by the Trump administration and Republican-controlled Congress could have huge impacts on low-income groups. This paper focuses on older Hispanics, with an emphasis on the Mexican-origin population who form the largest Hispanic subgroup. A demographic portrait is presented that indicates that Mexican-origin individuals have less wealth and lower incomes than do non-Hispanic Whites. Given rising health care costs, lower use of nursing homes, and greater propensity to live with grown children, prevailing economic disadvantage has serious consequences for this population. More restrictive immigration policies aimed at limiting family reunification could have intergenerational caregiving consequences. In addition, because of labor-force disadvantages, low-income Mexican-origin adults are less likely to have private insurance compared to non-Hispanic Whites as they approach retirement. Consequently, Mexican-origin older adults tend to rely on Medicaid when eligible; in contrast, late-life migrants-who do not qualify for federally funded benefits for at least five years-and unauthorized migrants-who are excluded from federally funded benefits-have extremely limited access to safety net provisions. The potential effects of proposed cutbacks in health care financing on older Hispanics are discussed.
Merlin, Tracy; Tamblyn, David; Ellery, Benjamin
A mapping exercise was undertaken to determine how HTA is being described and conducted across the International Network of Agencies for Health Technology Assessment (INAHTA), with the aim of harmonizing terminologies and approaches. Three progressive surveys were undertaken. In 2010, INAHTA agencies were asked to provide details on all of their HTA products. In 2013, additional information was sought on key methodological characteristics of five of the most common HTA product types. Subsequently, final agreement was sought on three proposed product types. Forty-five HTA agencies responded to at least one of the surveys. In 2010, twenty-one agencies reported publishing over seventy named HTA products. Core domains associated with full HTA reports were reported by a third of agencies but were labeled differently, so products were classified according to product type (n = 17). Agencies producing short, tailored products increased between 2010 and 2013, with the publication of rapid reviews doubling from 33 percent to 66 percent. In 2013, half of the agencies adapted their common HTA products from documents produced by other agencies. A consensus (>70 percent) was achieved on definitions for HTA reports, mini-HTAs, and rapid reviews. The product label for an HTA is not always indicative of its content. Terminology has, therefore, been agreed to make explicit the trade-off between rigor and timeliness in three common HTA product types. An INAHTA Product Type (IPT) Mark has been created to identify each of these. It is hoped this will further facilitate HTA adaptation between agencies and reduce duplication of effort.
Acheampong, Franklin; Tetteh, Ashalley Raymond; Anto, Berko Panyin
This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana. This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients' medication charts, and identified errors were clarified with staff for possible causes. Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding "lack of drug availability" fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems. This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.
.... EIA's petroleum marketing survey forms collect volumetric and price information needed for determining... DEPARTMENT OF ENERGY Energy Information Administration Agency Information Collection Extension AGENCY: U.S. Energy Information Administration (EIA), Department of Energy. ACTION: Agency Information...
Bailey, Michael; Birchall, Alan; Etherington, George; Wilkins, Bernard; Bishop, Louise; Fraser, Graham; Gross, Roger; Maguire, Helen; Evans, Barry; Shaw, Karen
Mr. Alexander Litvinenko died on 23 November 2006, having allegedly been poisoned with polonium- 210 ( 210 Po) a few weeks earlier. The police investigation identified a number of contaminated locations, including parts of several hotels, restaurants, offices and transport. An extensive programme of individual monitoring of potentially exposed persons was rapidly initiated, based on urine sampling. Methods used for low-level measurement of 210 Po in environmental samples were adapted. The Health Protection Agency set a Reporting Level of 30 mBq d -1 , results above which indicated likely intake of 210 Po from the incident. At each location, risk assessments were undertaken to identify persons with significant risk of contamination with 210 Po. These individuals were invited to provide samples, not only to enable a direct assessment to be made of their own exposures, but also to inform decisions on whether others connected with the location should provide samples, or whether they could be reassured. Urine samples from 753 people were processed: about 500 during the first month. Of these, 139 measurements were above the Reporting Level, assessed doses for 36 were in the range ≥ 1 mSv and <6 mSv, and 17 were ≥ 6 mSv, with the highest at about 100 mSv. Many of the hotel guests were overseas visitors. An Overseas Advice Team was set up to encourage authorities abroad to adopt similar strategies. Overall, 664 persons from 52 countries and territories were identified. For 176, results of urine measurements were provided to the Overseas Advice Team, of which 13 were above the Reporting Level. Assessed doses for eight of these were <1 mSv, and the other five were in the range ≥ 1 mSv and <6 mSv. (author)
Chanteur, J.; Pellerin, P.
Apart from safety and quality requirements the organisation of nuclear medicine services, or more generally of installations where non-sealed radioactive sources are used, is governed by profitability and efficiency criteria. In view of the high price of products and apparatus the equipment must be based on a rationalisation of options guiding the organisation arrangements as a whole. The following items are dealt with in succession: various categories of installations; general planning of equipment; equipment regulations based on a major requirement, the confinement of contamination sources; working rules examined with respect to the systematics adopted by the International Health Physics Commission and referred in turn to the protection of the patient and that of the surroundings practical observations concerning administrative and technical questions [fr
Hartmann, Christine W; Meterko, Mark; Rosen, Amy K; Shibei Zhao; Shokeen, Priti; Singer, Sara; Gaba, David M
Improving safety climate could enhance patient safety, yet little evidence exists regarding the relationship between hospital characteristics and safety climate. This study assessed the relationship between hospitals' organizational culture and safety climate in Veterans Health Administration (VA) hospitals nationally. Data were collected from a sample of employees in a stratified random sample of 30 VA hospitals over a 6-month period (response rate = 50%; n = 4,625). The Patient Safety Climate in Healthcare Organizations (PSCHO) and the Zammuto and Krakower surveys were used to measure safety climate and organizational culture, respectively. Higher levels of safety climate were significantly associated with higher levels of group and entrepreneurial cultures, while lower levels of safety climate were associated with higher levels of hierarchical culture. Hospitals could use these results to design specific interventions aimed at improving safety climate.
Hopkins, J W
The WHO smallpox eradication campaign represents perhaps the best example of a successful international health administration. In the 1st year of the campaign (1967), the guiding strategy was to vaccinate people en masse over a 2-3 year period in countries where smallpox was epidemic thereby conquering the disease. In Western Nigeria where 90% of the population had been vaccinated, a smallpox outbreak occurred in a religious sect resisting vaccinations and a delay in delivery of supplies forced a change in strategy. Campaign staff learned to rapidly isolate infected persons and swiftly vaccinate the uninfected in an outbreak area in order to break the transmission of smallpox, even where 1/2 the population had been vaccinated. Technological advancements also contributed to the campaign's success. For example, the jet injector vaccinated 1000 people/hour with efficient, reliable, mass produced potent, stable freeze dried vaccines (often produced in target countries) or the less costly and virtually maintenance free bifurcated needle was used. The most significant contribution to the success of the campaign, however, was the flexible mode of management adopted by the campaign staff at WHO which provided an appropriate environment for organizational learning and innovation. Although management was open and flexible, the campaign did depend on careful planning and setting of goals, continual assessment, and rapid response to field requests for assistance or advice. Trends in the incidence of smallpox was chosen as the indicator of success as opposed to the number of vaccinations. The campaign demonstrated the need for cultural adaptations as it operated in each country and region. This evaluation of the success of the smallpox campaign presents conclusions that serve as guidelines to the organization and administration of international programs designed to solve other health problems.
Amerine, Lindsey B Poppe; Granko, Robert P; Savage, Scott W; Daniels, Rowell; Eckel, Stephen F
The experience of health-system pharmacy administration (HSPA) residents in a longitudinal human resource (HR) management program is described. The subsequent benefits to the residents, department, and profession are also discussed. Postgraduate year 2 HSPA residents at an academic medical center desired more responsibility for managing an operational area. To this end, a program was created in which these residents directly manage a small group of pharmacy technicians and report to a clinical manager or assistant director with oversight responsibility. These "resident managers" are responsible, under the direction of the area's clinical manager, for the personnel, schedule, time and attendance, and HR activities of the area. Resident managers have led and sustained operational improvement projects in their areas. In addition to providing learning experiences to residents, the HSPA residency program has also improved the operations of the areas in which these residents work. Benefits to the residents include conducting annual performance evaluations for employees with whom they have a relationship as it is a task every administrator completes. Resident managers at UNC have consistently stated that this longitudinal HR experience is one of the most rewarding and most challenging experiences offered in the two-year HSPA residency. The involvement of HSPA residents in longitudinal management responsibilities furthers residents' leadership success by providing trained managers who are ready to immerse themselves into practice postresidency, having employee engagement and HR skills as well as experiences with leading operational improvements. A longitudinal HR management experience was successfully incorporated into an HSPA residency combined Master of Science degree program. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
Swindell, Paul; Doyle, Jon; Roach, Dennis
The Federal Aviation Administration (FAA) started a research program in structural health monitoring (SHM) in 2011. The program's goal was to understand the technical gaps of implementing SHM on commercial aircraft and the potential effects on FAA regulations and guidance. The program evolved into a demonstration program consisting of a team from Sandia National Labs Airworthiness Assurance NDI Center (AANC), the Boeing Corporation, Delta Air Lines, Structural Monitoring Systems (SMS), Anodyne Electronics Manufacturing Corp (AEM) and the FAA. This paper will discuss the program from the selection of the inspection problem, the SHM system (Comparative Vacuum Monitoring-CVM) that was selected as the inspection solution and the testing completed to provide sufficient data to gain the first approved use of an SHM system for routine maintenance on commercial US aircraft.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Centers for Disease Control and Prevention/Health Resources and Services Administration (CDC/HRSA) Advisory Committee... and other committee management activities, for both the Centers for Disease Control and Prevention and...
Lydia Stewart Ferreira
Full Text Available The health tribunal process is assumed to be neutral and allow for the tribunal’s focus to be on the parties’ legal arguments. This study quantitatively examined approximately 400 decisions over a five-year period to determine whether or not health tribunal hearings are neutral or whether the hearing process itself affects the tribunal’s decision independent of the parties’ legal arguments. Certain tribunal procedures affected tribunal decisions independent of legal arguments. This novel quantitative research matrix, which analysed cases over a five year time period, identified trends which are overlooked in traditional legal analysis of judicial review. Il est présumé que le processus d’audience du tribunal de la santé est neutre et permet au tribunal de se concentrer sur les arguments juridiques des parties. Cette étude porte sur l’analyse quantitative d’environ 400 décisions et s’est étendue sur une période de cinq années; elle visait à déterminer si les audiences du tribunal de la santé sont neutres ou non, ou si le processus d’audience même influence les décisions du tribunal indépendamment des arguments juridiques des parties. Cette nouvelle matrice de données quantitatives, qui a analysé des causes sur une période de cinq années, a permis de constater des tendances qui sont mises de côté dans les analyses juridiques traditionnelles du processus de contrôle judiciaire.
...) Assignment of a Control Number Under the Paperwork Reduction Act AGENCY: Occupational Safety and Health... DEPARTMENT OF LABOR Occupational Safety and Health Administration [Docket No. OSHA-2010-0033.... SUMMARY: The Occupational Safety and Health Administration (OSHA) is announcing that OMB approved the...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency.... L. 104-13), the Health Resources and Services Administration (HRSA) publishes periodic summaries of... Medicare Improvements for Patients and Providers Act of 2008, Public Law 110-275, is to support...
Cleary, Paul D; Meterko, Mark; Wright, Steven M; Zaslavsky, Alan M
Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information. Consequently some hospitals, especially those treating particularly complex patients, have been concerned that standard adjustment methods do not adequately reflect the challenges of treating their patients. To compare scores for different types of hospitals after making adjustments using only survey-reported patient characteristics and using more complete clinical and hospital information. We used clinical and survey data from a national sample of 1858 veterans hospitalized for an initial acute myocardial infarction (AMI) in a Department of Veterans Affairs (VA) medical center during fiscal years 2003 and 2004. We used VA administrative data to characterize hospitals. The survey asked patients about their experiences with hospital care. The clinical data included 14 measures abstracted from medical records that are predictive of survival after an AMI. Comparisons of scores across hospitals adjusted only for patient-reported health status and sociodemographic characteristics were similar to those that also adjusted for patient clinical characteristics; the Spearman rank-order correlations between the 2 sets of adjusted scores were >0.97 across 9 dimensions of inpatient experience. This study did not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics.
Walker, Patricia Hinton; Pock, Arnyce; Ling, Catherine G; Kwon, Kyung Nancy; Vaughan, Megan
Battlefield acupuncture is a unique auricular acupuncture procedure which is being used in a number of military medical facilities throughout the Department of Defense (DoD). It has been used with anecdotal published positive impact with warriors experiencing polytrauma, post-traumatic stress disorder, and traumatic brain injury. It has also been effectively used to treat warriors with muscle and back pain from carrying heavy combat equipment in austere environments. This article highlights the history within the DoD related to the need for nonpharmacologic/opioid pain management across the continuum of care from combat situations, during evacuation, and throughout recovery and rehabilitation. The article describes the history of auricular acupuncture and details implementation procedures. Training is necessary and partially funded through DoD and Veteran's Administration (VA) internal Joint Incentive Funds grants between the DoD and the VA for multidisciplinary teams as part of a larger initiative related to the recommendations from the DoD Army Surgeon General's Pain Management Task Force. Finally, Uniformed Services University of the Health Sciences School of Medicine and Graduate School of Nursing faculty members present how this interdisciplinary training is currently being integrated into both schools for physicians and advanced practice nurses at the Uniformed Services University of the Health Sciences. Current and future research challenges and progress related to the use of acupuncture are also presented. Published by Elsevier Inc.
Full Text Available The speech of female health professionals who work in public residences is analyzed in this writing, a work which most of them choose as their vocation, from a perspective in public employment and personal cares. The crisis has destroyed positions, social rights, made precarious the employment done in all the environments and especially in the Administration, the outsourcing of work is started, the increasing of flexibility of the labor conditions, the instability… Everything worsens particularly the conditions of the public health professionals. The question arisen is: where are the labor stability, the vocation and working in a position each one has been trained for? The labor conditions worsen, making employment and positions more precarious. The statistics reflect there is less unemployment when there is more training; but there are many university people who work in a position different to the one they have been trained for. A group of discussion composed by six people with a university degree in Nursing and Auxiliary Nursing Care, who work in public residences for elderly people, has been created to focus on this work, out of the labor place.
Peng, Mingkai; Li, Bing; Southern, Danielle A; Eastwood, Cathy A; Quan, Hude
Hospital administrative health data create separate records for each hospital stay of patients. Treating a hospital transfer as a readmission could lead to biased results in health service research. This is a cross-sectional study. We used the hospital discharge abstract database in 2013 from Alberta, Canada. Transfer cases were defined by transfer institution code and were used as the reference standard. Four time gaps between 2 hospitalizations (6, 9, 12, and 24 h) and 2 day gaps between hospitalizations [same day (up to 24 h), ≤1 d (up to 48 h)] were used to identify transfer cases. We compared the sensitivity and positive predictive value (PPV) of 6 definitions across different categories of sex, age, and location of residence. Readmission rates within 30 days were compared after episodes of care were defined at the different time gaps. Among the 6 definitions, sensitivity ranged from 93.3% to 98.7% and PPV ranged from 86.4% to 96%. The time gap of 9 hours had the optimal balance of sensitivity and PPV. The time gaps of same day (up to 24 h) and 9 hours had comparable 30-day readmission rates as the transfer indicator after defining episode of care. We recommend the use of a time gap of 9 hours between 2 hospitalizations to define hospital transfer in inpatient databases. When admission or discharge time is not available in the database, a time gap of same day (up to 24 h) can be used to define hospital transfer.
Lucyk, Kelsey; Tang, Karen; Quan, Hude
Administrative health data are increasingly used for research and surveillance to inform decision-making because of its large sample sizes, geographic coverage, comprehensivity, and possibility for longitudinal follow-up. Within Canadian provinces, individuals are assigned unique personal health numbers that allow for linkage of administrative health records in that jurisdiction. It is therefore necessary to ensure that these data are of high quality, and that chart information is accurately coded to meet this end. Our objective is to explore the potential barriers that exist for high quality data coding through qualitative inquiry into the roles and responsibilities of medical chart coders. We conducted semi-structured interviews with 28 medical chart coders from Alberta, Canada. We used thematic analysis and open-coded each transcript to understand the process of administrative health data generation and identify barriers to its quality. The process of generating administrative health data is highly complex and involves a diverse workforce. As such, there are multiple points in this process that introduce challenges for high quality data. For coders, the main barriers to data quality occurred around chart documentation, variability in the interpretation of chart information, and high quota expectations. This study illustrates the complex nature of barriers to high quality coding, in the context of administrative data generation. The findings from this study may be of use to data users, researchers, and decision-makers who wish to better understand the limitations of their data or pursue interventions to improve data quality.
Kohr, J M; Strack, R W; Newton-Ward, M; Cooke, C H
To investigate the use of planning models and social marketing planning principles within a state's central public health agency as a means for informing improved planning practices. Qualitative semi-structured interviews were conducted with 30 key programme planners in selected division branches, and a quantitative survey was distributed to 63 individuals responsible for programme planning in 12 programme-related branches. Employees who have an appreciation of and support for structured programme planning and social marketing may be considered the 'low hanging fruit' or 'early adopters'. On the other hand, employees that do not support or understand either of the two concepts have other barriers to using social marketing when planning programmes. A framework describing the observed factors involved in programme planning on an individual, interpersonal and organizational level is presented. Understanding the individual and structural barriers and facilitators of structured programme planning and social marketing is critical to increase the planning capacity within public health agencies.
Jolley, Rachel J; Jetté, Nathalie; Sawka, Keri Jo; Diep, Lucy; Goliath, Jade; Roberts, Derek J; Yipp, Bryan G; Doig, Christopher J
Objective Administrative health data are important for health services and outcomes research. We optimised and validated in intensive care unit (ICU) patients an International Classification of Disease (ICD)-coded case definition for sepsis, and compared this with an existing definition. We also assessed the definition's performance in non-ICU (ward) patients. Setting and participants All adults (aged ≥18 years) admitted to a multisystem ICU with general medicosurgical ICU care from one of three tertiary care centres in the Calgary region in Alberta, Canada, between 1 January 2009 and 31 December 2012 were included. Research design Patient medical records were randomly selected and linked to the discharge abstract database. In ICU patients, we validated the Canadian Institute for Health Information (CIHI) ICD-10-CA (Canadian Revision)-coded definition for sepsis and severe sepsis against a reference standard medical chart review, and optimised this algorithm through examination of other conditions apparent in sepsis. Measures Sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results Sepsis was present in 604 of 1001 ICU patients (60.4%). The CIHI ICD-10-CA-coded definition for sepsis had Sn (46.4%), Sp (98.7%), PPV (98.2%) and NPV (54.7%); and for severe sepsis had Sn (47.2%), Sp (97.5%), PPV (95.3%) and NPV (63.2%). The optimised ICD-coded algorithm for sepsis increased Sn by 25.5% and NPV by 11.9% with slightly lowered Sp (85.4%) and PPV (88.2%). For severe sepsis both Sn (65.1%) and NPV (70.1%) increased, while Sp (88.2%) and PPV (85.6%) decreased slightly. Conclusions This study demonstrates that sepsis is highly undercoded in administrative data, thus under-ascertaining the true incidence of sepsis. The optimised ICD-coded definition has a higher validity with higher Sn and should be preferentially considered if used for surveillance purposes. PMID:26700284
Schmitz, Susan; Radcliff, Tiffany A; Chu, Karen; Smith, Robert E; Dobalian, Aram
The US Veterans Health Administration's Disaster Emergency Medical Personnel System (DEMPS) is a team of employee disaster response volunteers who provide clinical and non-clinical staffing assistance when local systems are overwhelmed. This study evaluated attitudes and recommendations of the DEMPS program to understand the impact of multi-modal training on volunteer perceptions. DEMPS volunteers completed an electronic survey in 2012 (n=2120). Three training modes were evaluated: online, field exercise, and face-to-face. Measures included: "Training Satisfaction," "Attitudes about Training," "Continued Engagement in DEMPS." Data were analyzed using χ2 and logistic regression. Open-ended questions were evaluated in a manner consistent with grounded theory methodology. Most respondents participated in DEMPS training (80%). Volunteers with multi-modal training who completed all 3 modes (14%) were significantly more likely to have positive attitudes about training, plan to continue as volunteers, and would recommend DEMPS to others (P-valuevolunteer engagement. A blended learning environment using multi-modal training methods, could enhance satisfaction and attitudes and possibly encourage continued engagement in DEMPS or similar programs. DEMPS training program modifications in 2015 expanded this blended learning approach through new interactive online learning opportunities. (Disaster Med Public Health Preparedness. 2018; page 1 of 8).
The labeling of the Avanti polyurethane condom selling in 10 Western states makes misleading claims about protection from pregnancy and sexually transmitted diseases (STDs) according to officials at the US Food and Drug Administration (FDA). Avanti is sold in a foil package printed with the claim that it is effective against pregnancy, HIV, and STDs. However, polyurethane condoms have not undergone clinical efficacy testing for contraception or STDs, according to officials. The manufacturer of the condom refuted this allegation, stating that latex condoms have the same claims on them. In early 1995 the FDA met with the manufacturer and other companies developing plastic condoms, and concluded that these condoms could not make such claims, nor any claims about slippage and breakage rates. Despite warnings in 1993 to the manufacturer of Avanti about labeling restrictions, the company printed pregnancy and STD efficacy claims on the boxes and individual packages. The FDA later worked out a compromise with the firm in which only the boxes had to be reprinted with the generic label. The FDA had to weigh the risk of the public health cost of delaying sale of the condom, which is the first impermeable condom proven safe for people with latex allergies. In 1991 the FDA was defining standards for clinical testing and labeling of polyurethane condoms under congressional mandate, but the manufacturer of Avanti began mass production based on a preliminary approval determining that the condom was equivalent to latex condoms already on the market. 7000 Avanti condoms were subsequently tested in five countries, but these user tests did not compare Avanti to latex condoms and did not test for pregnancy and STD protection. Test results submitted to the FDA by the company indicated that, although Avanti is more than 1/3 less elastic than latex condoms, it did not break more frequently in an in-use study involving 187 couples.
The Superfund Amendments and Reauthorization Act (SARA) of 1986 greatly expanded the health authority of the Comprehensive Environmental Response, Compensation, and Liability Act. One of the federal agencies most affected by SARA is the Agency for Toxic Substances and Disease Registry (ATSDR) of the U.S. Public Health Service. Among other responsibilities, ATSDR was mandated to conduct health assessments within strict time frames for each site on or proposed for the U.S. Environmental Protection Agency's National Priorities List. The author will review ATSDR's efforts to address this new statutory mandate, especially for federal facilities, and will focus on different conceptual frameworks for implementing the health assessment program
Iwin Leenen; Georgina García Rodríguez; Susan Pick Steiner
ConBased on the program “Yo quiero, yo puedo… mejorar mi salud y ejercer mis derechos” [I want to, I can…improve my health and exercise my rights], a pilot model was designed and implemented in three States of Mexico. This model aims to change nutrition and hygiene behaviors in the inhabitants of marginalized communities, through knowledge and psychosocial skills development facilitating personal agency and intrinsic empowerment. Evaluation of the program showed an effect on knowledge, assert...
The Agency's regional activities towards the promotion of radioimmunoassay (RIA) in human health were initiated in 1986 and today reach almost 50 countries in three regions, namely Africa, East Asia and the Pacific and Latin America. In addition to regional activities, the Agency's TC programme has included a large number of radioimmunoassay-related projects in the human health sector in many of its developing Member States. During the period 1986-1995, the Agency approved over 50 national and seven regional projects in topics related to RIA in human health. Total allotments for all of these projects amount to over $9 million, and by the end of August 1995, expenditures had reached almost $7 million. The evaluation was conducted on the basis of an in-depth study of the programme at Headquarters; of questionnaires that were sent to national co-ordinators in all participating countries; and of short visits to four selected countries, one each in Asia and in Latin America, and two in Africa. Both the responses to the questionnaires - the return rate for which was 71% - and the discussions held during the field missions provided an adequate basis for the evaluation. 1 fig., 8 tabs
Andradas, Elena; Blasco, Juan-Antonio; Valentín, Beatriz; López-Pedraza, María-José; Gracia, Francisco-Javier
The aim of this study was to explore the needs and requirements of decision makers in our regional healthcare system for health technology assessment (HTA) products to support portfolio development planning for a new HTA agency in Madrid, Spain. A Delphi study was conducted during 2003. Questionnaires were developed based on a review of products and services offered by other agency members of the International Network of Agencies for Health Technology Assessment, and included preference and prioritization questions to evaluate twenty-two different products and services. The initial Delphi panel involved eighty-seven experts from twenty-one public hospitals, eleven primary healthcare centers, six private hospitals, and eight departments of the Regional Ministry of Health of the Community of Madrid. The global participation rate was 83.9 percent. Ten of the twenty-two possible products were rated of high interest by more than 80 percent of respondents. Important differences in preferences and priorities were detected across different settings. Public hospitals and primary healthcare centers shared a more "micro" perspective, preferring classic technology-centered HTA products, whereas private hospitals and Ministry representatives demanded more "macro" products and services such as organizational model and information system assessments. The high participation rate supports the representativeness of the results for our regional context. The strategic development of an HTA portfolio based on decision makers' needs and requirements as identified in this type of exercise should help achieve a better impact on policy development and decision making.
Piovesan, Márcia Franke; Labra, Maria Eliana
This article examines the decision-making process that led to the creation of the Brazilian National Health Surveillance Agency (ANVISA) in 1999. The authors begin by discussing the history of the Agency's predecessor, the Health Surveillance Secretariat, and the need for its modernization to adjust the quality of the products under its control to domestic and international demands. From the theoretical perspective of neo-institutionalism, the article goes on to analyze the social and political context surrounding the debate on the proposed alternatives to adjust Health Surveillance to new rules in line with such requirements, focusing especially on the formulation of the new policy, the decision-making arena, and the actors with specific interests in the sector. The research drew on extensive documentary and media material, plus interviews with key actors. The article concludes that a determinant factor for the creation of ANVISA was the favorable domestic political context, fostering a positive correlation of forces that (in an extremely short timeframe, 1998-1999) allowed the creation of the first regulatory agency in the social policies area in Brazil.
Nambudiri, Vinod E; Landrum, Mary Beth; Lamont, Elizabeth B; McNeil, Barbara J; Bozeman, Samuel R; Freedland, Stephen J; Keating, Nancy L
To examine the variation in prostate cancer treatment in the Veterans Health Administration (VHA)--a national, integrated delivery system. We also compared the care for older men in the VHA with that in fee-for-service Medicare. We used data from the Veterans Affairs Central Cancer Registry linked with administrative data and Surveillance, Epidemiology, and End Results-Medicare data to identify men with local or regional prostate cancer diagnosed during 2001 to 2004. We used multinomial logistic and hierarchical regression models to examine the patient, tumor, and facility characteristics associated with treatment in the VHA and, among older patients, used propensity score methods to compare primary therapy between the VHA and fee-for-service Medicare. The rates of radical prostatectomy and radiotherapy varied substantially across VHA facilities. Among the VHA patients, older age, black race/ethnicity, and greater comorbidity were associated with receiving neither radical prostatectomy nor radiotherapy. Facilities with more black patients with prostate cancer had lower rates of radical prostatectomy, and those with less availability of external beam radiotherapy had lower radiotherapy rates. The adjusted rates of radiotherapy (39.7% vs 52.0%) and radical prostatectomy (12.1% vs 15.8%) were lower and the rates of receiving neither treatment greater (48.2% vs 32.2%) in the VHA versus fee-for-service Medicare (P < .001). In the VHA, the treatment rates varied substantially across facilities, and black men received less aggressive prostate cancer treatment than white men, suggesting factors other than patient preferences influence the treatment decisions. Also, primary prostate cancer therapy for older men is less aggressive in the VHA than in fee-for-service Medicare. Copyright Â© 2012 Elsevier Inc. All rights reserved.
Gradus, Jaimie L; Leatherman, Sarah; Curreri, Andrew; Myers, Lisa G; Ferguson, Ryan; Miller, Matthew
Epidemiologic studies have reported substance abuse and posttraumatic stress disorder (PTSD) diagnoses as risk factors for suicide among Veterans Health Administration (VHA) patients. Research on risk factors for suicide may not generalize to our understanding of non-fatal intentional self-harm (ISH), given the evidence that these outcomes have unique risk factors. The aims of this study were to examine (1) gender-stratified rates of non-fatal ISH in VHA patients with alcohol abuse/dependence, drug abuse/dependence, and PTSD and (2) gender-stratified interaction between alcohol abuse and dependence and drug abuse and dependence and PTSD in predicting non-fatal ISH. Participants include all VHA care users who received a PTSD diagnosis in Massachusetts from 2000 to 2008 (n=16,004) and an age- and gender-matched comparison group (n=52,502). Data were obtained from the VHA administrative registries. We found evidence of stronger interactions between substance abuse diagnoses and PTSD in predicting non-fatal ISH for females than for males. The interaction contrast (IC) for alcohol abuse and dependence and PTSD in predicting non-fatal ISH among female VHA patients was 62.35/100,000 person-years; for male VHA patients the comparable IC was 21.49/100,000 person-years. For female VHA patients the IC for drug abuse and dependence and PTSD predicting ISH was 256.33/100,000 person-years; no interaction was observed for male VHA patients. This study contributes to the scant literature on gender differences in substance abuse and PTSD among VHA patients. The findings highlight comorbid diagnoses as particularly important risk factors for non-fatal ISH among female VHA patients. Published by Elsevier B.V.
Oliva, Elizabeth M; Trafton, Jodie A; Harris, Alex H S; Gordon, Adam J
Opioid agonist therapy (OAT) through addiction specialty clinic settings (clinic-based OAT) using methadone or buprenorphine or office-based settings using buprenorphine (office-based OAT) is an evidence-based treatment for opioid dependence. The low number of clinic-based OATs available to veterans (N = 53) presents a barrier to OAT access; thus, the expansion in office-based OAT has been encouraged. To examine trends in office-based OAT utilization over time and whether availability of office-based OAT improved the proportion of veterans with opioid use disorders treated with OAT. We examined Veterans Health Administration (VHA) administrative data for evidence of buprenorphine prescribing and clinic-based OAT clinic stops from October 2003 through September 2010 [fiscal years (FY) 2004-2010]. The number of patients receiving buprenorphine increased from 300 at 27 facilities in FY2004 to 6147 at 118 facilities in FY2010. During this time, the number of patients diagnosed with an opioid use disorder increased by 45%; however, the proportion of opioid use disorder patients receiving OAT remained relatively stable, ranging from 25% to 27%. Office-based OAT utilization and the number of opioid use disorder veterans treated with OAT are increasing at the same rate over time, suggesting that office-based OAT is being used to meet the growing need for OAT care. Although office-based OAT is increasingly being used within the VHA and may be one way the VHA is keeping up with the demand for OAT, more research is needed to understand how to engage a greater proportion of opioid use disorder patients in treatment.
Ajrouche, Aya; Estellat, Candice; De Rycke, Yann; Tubach, Florence
Administrative databases are increasingly being used in cancer observational studies. Identifying incident cancer in these databases is crucial. This study aimed to develop algorithms to estimate cancer incidence by using health administrative databases and to examine the accuracy of the algorithms in terms of national cancer incidence rates estimated from registries. We identified a cohort of 463 033 participants on 1 January 2012 in the Echantillon Généraliste des Bénéficiaires (EGB; a representative sample of the French healthcare insurance system). The EGB contains data on long-term chronic disease (LTD) status, reimbursed outpatient treatments and procedures, and hospitalizations (including discharge diagnoses, and costly medical procedures and drugs). After excluding cases of prevalent cancer, we applied 15 algorithms to estimate the cancer incidence rates separately for men and women in 2012 and compared them to the national cancer incidence rates estimated from French registries by indirect age and sex standardization. The most accurate algorithm for men combined information from LTD status, outpatient anticancer drugs, radiotherapy sessions and primary or related discharge diagnosis of cancer, although it underestimated the cancer incidence (standardized incidence ratio (SIR) 0.85 [0.80-0.90]). For women, the best algorithm used the same definition of the algorithm for men but restricted hospital discharge to only primary or related diagnosis with an additional inpatient procedure or drug reimbursement related to cancer and gave comparable estimates to those from registries (SIR 1.00 [0.94-1.06]). The algorithms proposed could be used for cancer incidence monitoring and for future etiological cancer studies involving French healthcare databases. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
Rodwell, John; Demir, Defne; Parris, Melissa; Steane, Peter; Noblet, Andrew
Investigations of workplace bullying in health care settings have tended to focus on nurses or other clinical staff. However, the organizational and power structures enabling bullying in health care are present for all employees, including administrative staff. : The purpose of this study was to specifically focus on health care administration staff and examine the prevalence and consequences of workplace bullying in this occupational group. A cross-sectional study was conducted based on questionnaire data from health care administration staff who work across facilities within a medium to large health care organization in Australia. The questionnaire included measures of bullying, negative affectivity (NA), job satisfaction, organizational commitment, well-being, and psychological distress. The three hypotheses of the study were that (a) workplace bullying will be linked to negative employee outcomes, (b) individual differences on demographic factors will have an impact on these outcomes, and (c) individual differences in NA will be a significant covariate in the analyses. The hypotheses were tested using t tests and analyses of covariances. A total of 150 health care administration staff completed the questionnaire (76% response rate). Significant main effects were found for workplace bullying, with lower organizational commitment and well-being with the effect on commitment remaining over and above NA. Main effects were found for age on job satisfaction and for employment type on psychological distress. A significant interaction between bullying and employment type for psychological distress was also observed. Negative affectivity was a significant covariate for all analyses of covariance. The applications of these results include the need to consider the occupations receiving attention in health care to include administration employees, that bullying is present across health care occupations, and that some employees, particularly part-time staff, may need to be
Foster, Angel M; Evans, Dabney P; Garcia, Melissa; Knaster, Sarah; Krause, Sandra; McGinn, Therese; Rich, Sarah; Shah, Meera; Tappis, Hannah; Wheeler, Erin
Since the 1990s, the Inter-agency field manual on reproductive health in humanitarian settings (IAFM) has provided authoritative guidance on reproductive health service provision during different phases of complex humanitarian emergencies. In 2018, the Inter-Agency Working Group on Reproductive Health in Crises will release a new edition of this global resource. In this article, we describe the collaborative and inter-sectoral revision process and highlight major changes in the 2018 IAFM. Key revisions to the manual include repositioning unintended pregnancy prevention within and explicitly incorporating safe abortion care into the Minimum Initial Service Package (MISP) chapter, which outlines a set of priority activities to be implemented at the outset of a humanitarian crisis; stronger guidance on the transition from the MISP to comprehensive sexual and reproductive health services; and the addition of a logistics chapter. In addition, the IAFM now places greater and more consistent emphasis on human rights principles and obligations, gender-based violence, and the linkages between maternal and newborn health, and incorporates a diverse range of field examples. We conclude this article with an outline of plans for releasing the 2018 IAFM and facilitating uptake by those working in refugee, crisis, conflict, and emergency settings.
Clarissa Sampaio Silva
Full Text Available This article deals with the need for the Public Administration rescue his decision spaces in relation to the realization of the right to health, as opposed to excessive judicialization. Based on doctrinal and legislative research seeks to demonstrate that the consensuality, new aspects of administrative action, has importance for the development, under the Public Health System, scientific medical consensus, which recommended observance in statements of the National Justice Council . The increase of social participation in the adoption of those guidelines and the opening of institutional dialogue to discuss certain cases can reduce recourse to the courts.
Full Text Available Abstract Background The increased use and adoption of Electronic Health Records (EHR causes a tremendous growth in digital information useful for clinicians, researchers and many other operational purposes. However, this information is rich in Protected Health Information (PHI, which severely restricts its access and possible uses. A number of investigators have developed methods for automatically de-identifying EHR documents by removing PHI, as specified in the Health Insurance Portability and Accountability Act “Safe Harbor” method. This study focuses on the evaluation of existing automated text de-identification methods and tools, as applied to Veterans Health Administration (VHA clinical documents, to assess which methods perform better with each category of PHI found in our clinical notes; and when new methods are needed to improve performance. Methods We installed and evaluated five text de-identification systems “out-of-the-box” using a corpus of VHA clinical documents. The systems based on machine learning methods were trained with the 2006 i2b2 de-identification corpora and evaluated with our VHA corpus, and also evaluated with a ten-fold cross-validation experiment using our VHA corpus. We counted exact, partial, and fully contained matches with reference annotations, considering each PHI type separately, or only one unique ‘PHI’ category. Performance of the systems was assessed using recall (equivalent to sensitivity and precision (equivalent to positive predictive value metrics, as well as the F2-measure. Results Overall, systems based on rules and pattern matching achieved better recall, and precision was always better with systems based on machine learning approaches. The highest “out-of-the-box” F2-measure was 67% for partial matches; the best precision and recall were 95% and 78%, respectively. Finally, the ten-fold cross validation experiment allowed for an increase of the F2-measure to 79% with partial matches
Clydette L Powell
Full Text Available For many years, and before the term “FBO” was used for faith-based organizations, the United States Agency for International Development (USAID has supported the work of FBOs in global health and development. The Agency has long recognized the impact of FBOs within that development space, because these organizations are often well positioned to reach the hard-to-reach and to go the last mile because of their strong ties to the community. Moreover, FBOs deliver a substantial percentage of the health services in some developing countries. Faith partners, whether Catholic, Protestant, Buddhist, Hindu, Muslim, or other, have an important role to play as implementers in global health and to support global efforts towards achieving the Millennium Development Goals (MDGs in health. In addition, partnerships at national and international levels are key to the success of US Presidential Initiatives in the developing world, such as President’s Emergency Plan for AIDS Relief (PEPFAR and President’s Malaria Initiative (PMI. FBOs also have an important voice in policy and strategy formulation. Among other international donors, USAID support has been of great importance to the work of FBOs, thereby helping host nations to achieve goals in ending preventable child and maternal deaths, improving communicable disease control and prevention, and by supporting the construction and renovation of hospitals and health facilities where service delivery is most needed. The development literature is replete with examples of the work of FBOs made possible through access to resources. This paper focuses on some of the work supported by USAID in global health initiatives in order to reach complementary goals and achieve significant public health advances. Given the vastness of the topic, not all the global health initiatives involving FBOs supported by USAID are included here; the reader is encouraged to access the USAID website and USAID implementing partners for
Schult, Tamara M; Mohr, David C; Osatuke, Katerine
The goals of this paper were twofold: (a) To provide a population overview of burnout profiles by occupation in a large, health care sector employee population and (b) to investigate how burnout profiles relate to self-reported health behaviours, chronic conditions, and absenteeism. Burnout profiles were considered by 5 main occupational groups (physicians, nurses, other clinical, administrative, and wage grade [trade, craft, and labor workers]) in survey respondents (n = 86,257 employees). Logistic regression analyses were conducted to examine how burnout profiles were associated with health controlling for gender, age, race, ethnicity, and occupational group. Employees in the "Frustrated/Burning Up" and "Withdrawing/Burned Out" profiles, respectively, had significantly increased odds of anxiety (OR = 2.17; 99% CI [2.04, 2.31]; OR = 2.21; 99% CI [2.05, 2.38]), depression (OR = 2.06; 99% CI [1.93, 2.20]; OR = 2.20; 99% CI [2.04, 2.38]), sleep disorders (OR = 1.98; 99% CI [1.85, 2.12]; OR = 1.97; 99% CI [1.81, 2.13]), low back disease (OR = 1.60; 99% CI [1.50, 1.71]; OR = 1.58; 99% CI [1.47, 1.70]), physical inactivity (OR = 1.49; 99% CI [1.38, 1.60]; OR = 1.68; 99% CI [1.54, 1.83]), and 5 or more days away from work (OR = 1.74; 99% CI [1.65, 1.85]; OR = 2.15; 99% CI [2.01, 2.30]). Burnout is related to the health of employees. Burnout profiles offer a way to assess patterns of burnout by occupational group and may help customize future interventions. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
Davies Elizabeth A
Full Text Available Abstract Background Little is known about how to use patient feedback to improve experiences of health care. The Veterans Health Administration (VA conducts regular patient surveys that have indicated improved care experiences over the past decade. The goal of this study was to assess factors that were barriers to, or promoters of, efforts to improve care experiences in VA facilities. Methods We conducted case studies at two VA facilities, one with stable high scores on inpatient reports of emotional support between 2002 and 2006, and one with stable low scores over the same period. A semi-structured interview was used to gather information from staff who worked with patient survey data at the study facilities. Data were analyzed using a previously developed qualitative framework describing organizational, professional and data-related barriers and promoters to data use. Results Respondents reported more promoters than barriers to using survey data, and particularly support for improvement efforts. Themes included developing patient-centered cultures, quality improvement structures such as regular data review, and training staff in patient-centered behaviors. The influence of incentives, the role of nursing leadership, and triangulating survey data with other data on patients' views also emerged as important. It was easier to collect data on current organization and practice than those in the past and this made it difficult to deduce which factors might influence differing facility performance. Conclusions Interviews with VA staff provided promising examples of how systematic processes for using survey data can be implemented as part of wider quality improvement efforts. However, prospective studies are needed to identify the most effective strategies for using patient feedback to improve specific aspects of patient-centered care.
Larney, Sarah; Bohnert, Amy S B; Ganoczy, Dara; Ilgen, Mark A; Hickman, Matthew; Blow, Fred C; Degenhardt, Louisa
The population of people with opioid use disorders (OUD) is aging. There has been little research on the effects of aging on mortality rates and causes of death in this group. We aimed to compare mortality in older (≥ 50 years of age) adults with OUD to that in younger (OUD and older adults with no history of OUD. We also examined risk factors for specific causes of death in older adults with OUD. Using data from the Veteran's Health Administration National Patient Care Database (2000-2011), we compared all-cause and cause-specific mortality rates in older adults with OUD to those in younger adults with OUD and older adults without OUD. We then generated a Cox regression model with specific causes of death treated as competing risks. Older adults with OUD were more likely to die from any cause than younger adults with OUD. The drug-related mortality rate did not decline with age. HIV-related and liver-related deaths were higher among older OUD compared to same-age peers without OUD. There were very few clinically important predictors of specific causes of death. Considerable drug-related mortality in people with OUD suggests a need for greater access to overdose prevention and opioid substitution therapy across the lifespan. Elevated risk of liver-related death in older adults may be addressed through antiviral therapy for hepatitis C virus infection. There is an urgent need to explore models of care that address the complex health needs of older adults with OUD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Ross, Joseph S.; Arling, Greg; Ofner, Susan; Roumie, Christianne L.; Keyhani, Salomeh; Williams, Linda S.; Ordin, Diana L.; Bravata, Dawn M.
Background Quality of care delivered in the inpatient and ambulatory settings may be correlated within an integrated health system such as the Veterans Health Administration (VHA). We examined the correlation between stroke care quality at hospital discharge and within 6 months post-discharge. Methods Cross-sectional hospital-level correlation analyses of chart-abstracted data for 3467 veterans discharged alive after an acute ischemic stroke from 108 VHA medical centers and 2380 veterans with post-discharge follow-up within 6 months, in fiscal year 2007. Four risk-standardized processes of care represented discharge care quality: prescription of anti-thrombotic and anti-lipidemic therapy, anti-coagulation for atrial fibrillation, and tobacco cessation counseling, along with a composite measure of defect-free care. Five risk-standardized intermediate outcomes represented post-discharge care quality: achievement of blood pressure, low-density lipoprotein (LDL), international normalized ratio (INR), and glycosylated hemoglobin target levels, and delivery of appropriate treatment for post-stroke depression, along with a composite measure of achieved outcomes. Results Median risk-standardized composite rate of defect-free care at discharge was 79%. Median risk-standardized post-discharge rates of achieving goal were 56% for blood pressure, 36% for LDL, 41% for INR, 40% for glycosylated hemoglobin, and 39% for depression management and the median risk-standardized composite six-month outcome rate was 44%. The hospital composite rate of defect-free care at discharge was correlated with meeting the LDL goal (r=0.31; p=0.007) and depression management (r=0.27; p=0.03) goal, but was not correlated with blood pressure, INR, or glycosylated hemoglobin goals, nor with the composite measure of achieved post-discharge outcomes (p-values >0.15). Conclusions Hospital discharge care quality was not consistently correlated with ambulatory care quality. PMID:21719771
Chan, Wing Cheuk; Papaconstantinou, Dean; Lee, Mildred; Telfer, Kendra; Jo, Emmanuel; Drury, Paul L; Tobias, Martin
To validate the New Zealand Ministry of Health (MoH) Virtual Diabetes Register (VDR) using longitudinal laboratory results and to develop an improved algorithm for estimating diabetes prevalence at a population level. The assigned diabetes status of individuals based on the 2014 version of the MoH VDR is compared to the diabetes status based on the laboratory results stored in the Auckland regional laboratory result repository (TestSafe) using the New Zealand diabetes diagnostic criteria. The existing VDR algorithm is refined by reviewing the sensitivity and positive predictive value of the each of the VDR algorithm rules individually and as a combination. The diabetes prevalence estimate based on the original 2014 MoH VDR was 17% higher (n = 108,505) than the corresponding TestSafe prevalence estimate (n = 92,707). Compared to the diabetes prevalence based on TestSafe, the original VDR has a sensitivity of 89%, specificity of 96%, positive predictive value of 76% and negative predictive value of 98%. The modified VDR algorithm has improved the positive predictive value by 6.1% and the specificity by 1.4% with modest reductions in sensitivity of 2.2% and negative predictive value of 0.3%. At an aggregated level the overall diabetes prevalence estimated by the modified VDR is 5.7% higher than the corresponding estimate based on TestSafe. The Ministry of Health Virtual Diabetes Register algorithm has been refined to provide a more accurate diabetes prevalence estimate at a population level. The comparison highlights the potential value of a national population long term condition register constructed from both laboratory results and administrative data. Copyright © 2018 Elsevier B.V. All rights reserved.
Robertson M Clare
Full Text Available Abstract Background Estimating costs is essential to the economic analysis of health care programs. Health care costs are often captured from administrative databases or by patient report. Administrative records only provide a partial representation of health care costs and have additional limitations. Patient-completed questionnaires may allow a broader representation of health care costs; however the validity and feasibility of such methods have not been firmly established. This study was conducted to assess the validity and feasibility of using a patient-completed questionnaire to capture health care use and costs for patients with osteoarthritis, and to compare the research costs of the data-capture methods. Methods We designed a patient questionnaire and applied it in a clinical trial. We captured equivalent data from four administrative databases. We evaluated aspects of the questionnaire's validity using sensitivity and specificity, Lin's concordance correlation coefficient (ρc, and Bland-Altman comparisons. Results The questionnaire's response rate was 89%. Acceptable sensitivity and specificity levels were found for all types of health care use. The numbers of visits and the majority of medications reported by patients were in agreement with the database-derived estimates (ρc > 0.40. Total cost estimates from the questionnaire agreed with those from the databases. Patient-reported co-payments agreed with administrative records with respect to GP office transactions, but not pharmaceutical co-payments. Research costs for the questionnaire-based method were less than one-third of the costs for the databases method. Conclusion A patient-completed questionnaire is feasible for capturing health care use and costs for patients with osteoarthritis, and data collected using it mostly agree with administrative databases. Caution should be exercised when applying unit costs and collecting co-payment data.
... surety bonds; Prohibition on FFP. (a) Definitions. As used in this section, unless the context indicates... to furnish timely confirmation of the issuance of, and the validity and accuracy of information... to the face amount of the bond; or (iii) For other good cause. (3) The Medicaid agency must specify...
and Results Act (GPRA) was passed, requiring all federal agencies to engage in strategic planning and nudging them towards comprehensive strategic...involves the social- psychological process of sense making that leads to negotiations. This stage is when the individual partner organizations...expectations through informal bargaining and informal sense making Commitments For future action through formal legal contract or psychological contract
... and public health and ensuring adequate privacy and security of health information. The intent of the RHITND Program is to support the adoption and use of electronic health records (EHR) in coordination with... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency...
... privacy and security of health information. The intent of RHITND is to support the adoption and use of electronic health records (EHR) in coordination with the ongoing HHS activities related to the Health... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency...
... Program AGENCY: Health Resources and Services Administration, HHS ACTION: Notice of Noncompetitive Replacement Award to Regional Health Care Affiliates. SUMMARY: The Health Resources and Services Administration (HRSA) will be transferring Health Center Program (section 330 of the Public Health Service Act...
Heget, Jeffrey R; Bagian, James P; Lee, Caryl Z; Gosbee, John W
In 1998 the Veterans Health Administration (VHA) created the National Center for Patient Safety (NCPS) to lead the effort to reduce adverse events and close calls systemwide. NCPS's aim is to foster a culture of safety in the Department of Veterans Affairs (VA) by developing and providing patient safety programs and delivering standardized tools, methods, and initiatives to the 163 VA facilities. To create a system-oriented approach to patient safety, NCPS looked for models in fields such as aviation, nuclear power, human factors, and safety engineering. Core concepts included a non-punitive approach to patient safety activities that emphasizes systems-based learning, the active seeking out of close calls, which are viewed as opportunities for learning and investigation, and the use of interdisciplinary teams to investigate close calls and adverse events through a root cause analysis (RCA) process. Participation by VA facilities and networks was voluntary. NCPS has always aimed to develop a program that would be applicable both within the VA and beyond. NCPS's full patient safety program was tested and implemented throughout the VA system from November 1999 to August 2000. Program components included an RCA system for use by caregivers at the front line, a system for the aggregate review of RCA results, information systems software, alerts and advisories, and cognitive acids. Following program implementation, NCPS saw a 900-fold increase in reporting of close calls of high-priority events, reflecting the level of commitment to the program by VHA leaders and staff.
Kleitman, Naomi; Rao, Mahendra S; Owens, David F
Recently, the U.S. Food and Drug Administration (FDA), the U.S. National Institutes of Health, and the stem cell research community have collaborated on a series of workshops that address moving pluripotent stem cell therapies into the clinic. The first two workshops in the series focused on preclinical science, and a third, future workshop will focus on clinical trials. This summary addresses major points from both of the recent preclinically focused meetings. When entering into a therapeutics developmental program based on pluripotent cells, investigators must make decisions at the very early stages that will have major ramifications during later phases of development. Presentations and discussions from both invited participants and FDA staff described the need to characterize and document the quality, variability, and suitability of the cells and commercial reagents used at every translational stage. This requires consideration of future regulatory requirements, ranging from donor eligibility of the original source material to the late-stage manufacturing protocols. Federal, industrial, and academic participants agreed that planning backward is the best way to anticipate what evidence will be needed to justify human testing of novel therapeutics and to eliminate wasted efforts.
Zalkind, D; Malec, B
A national survey of alumni of AUPHA programs from the classes of 1983, 1984, and 1985 was undertaken to assess their experiences in management information systems education, both formally and on the job. The survey covered 38 AUPHA graduate member programs and resulted in 1,181 responses. Over 40 percent of the alumni indicated that they had had an introductory management information systems (MIS) course in a health administration program. Since graduation, almost 90 percent have had some significant on-the-job involvement with computers, computer-generated information, or MIS. More than one-third of the respondents felt that their MIS course work did not adequately prepare them for what was expected on the job. Alumni stressed that microcomputer software applications, such as spreadsheets and data bases, are important areas for student hands-on experiences. When asked the importance of certain areas to be included in a required introductory MIS course, the alumni also recommended spreadsheet analysis and design, report writing and data presentation, and other management areas. Additional comments suggested more access to personal computers (PCs), more relevance in the curriculum to the "real world," and the importance of MIS to the career paths of alumni. Faculty suggestions from a 1984-85 survey are compared with alumni responses in order to identify curricular changes needed. Recommendations are outlined for consideration.
Weeks, James L
The Mine Safety and Health Administration (MSHA) proposes to issue citations for non-compliance with the exposure limit for respirable coal mine dust when measured exposure exceeds the exposure limit with a "high degree of confidence." This criterion threshold value (CTV) is derived from the sampling and analytical error of the measurement method. This policy is based on a combination of statistical and legal reasoning: the one-tailed 95% confidence limit of the sampling method, the apparent principle of due process and a standard of proof analogous to "beyond a reasonable doubt." This policy raises the effective exposure limit, it is contrary to the precautionary principle, it is not a fair sharing of the burden of uncertainty, and it employs an inappropriate standard of proof. Its own advisory committee and NIOSH have advised against this policy. For longwall mining sections, it results in a failure to issue citations for approximately 36% of the measured values that exceed the statutory exposure limit. Citations for non-compliance with the respirable dust standard should be issued for any measure exposure that exceeds the exposure limit.
Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A
This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation. © The Author(s) 2014.
Albert, Mathieu; Laberge, Suzanne
The idea of interdisciplinarity has been taken up by academic and governmental organisations around the world and enacted through science policies, funding programs and higher education institutions. In Canada, interdisciplinarity led to a major transformation in health research funding. In 2000, the federal government closed the Medical Research Council (MRC) and created the Canadian Institutes of Health Research (CIHR). From the outset, CIHR's vision and goals were innovative, as it sought to include the social sciences within its purview alongside more traditional health research sectors. The extent to which it has been successful in this endeavour, however, remains unknown. The aim of our study was to examine how CIHR's intentions to foster inclusiveness and cooperation across disciplines were implemented in the agency's own organisational structure. We focused on social scientists' representation on committees and among decision-makers between 2000 and 2015, one of the key mandates of CIHR being to include the social sciences within its remit and support research in this area. We examined the composition of the Governing Council, the Institute Scientific Directors, the Chairs of the College of Reviewers, and two International Review Panels invited by CIHR. We targeted these committees and decision-makers since they hold the power to influence the field of Canadian health research through the decisions they make. Our findings show that, while CIHR was created with the mandate to support the entire spectrum of health-related research-including the social sciences-this call for inclusiveness has not yet been materialized in the agency's organisational structure. Social scientists, as well as researchers from neighbouring disciplines such as social epidemiology, health promotion and the humanities, are still confined to low levels of representation within CIHR's highest echelons. This imbalance limits social scientists' input into health research in Canada and
Full Text Available Abstract Background There is increasing interest in the contribution of the quality of nursing care to patient outcomes. Due to different casemix and risk profiles, algorithms for administrative health data that identify nursing-sensitive outcomes in adult hospitalised patients may not be applicable to paediatric patients. The study purpose was to test adult algorithms in a paediatric hospital population and make amendments to increase the accuracy of identification of hospital acquired events. The study also aimed to determine whether the use of linked hospital records improved the likelihood of correctly identifying patient outcomes as nursing sensitive rather than being related to their pre-morbid conditions. Methods Using algorithms developed by Needleman et al. (2001, proportions and rates of records that identified nursing-sensitive outcomes for pressure ulcers, pneumonia and surgical wound infections were determined from administrative hospitalisation data for all paediatric patients discharged from a tertiary paediatric hospital in Western Australia between July 1999 and June 2009. The effects of changes to inclusion and exclusion criteria for each algorithm on the calculated proportion or rate in the paediatric population were explored. Linked records were used to identify comorbid conditions that increased nursing-sensitive outcome risk. Rates were calculated using algorithms revised for paediatric patients. Results Linked records of 129,719 hospital separations for 79,016 children were analysed. Identification of comorbid conditions was enhanced through access to prior and/or subsequent hospitalisation records (43% of children with pressure ulcers had a form of paralysis recorded only on a previous admission. Readmissions with a surgical wound infection were identified for 103 (4.8/1,000 surgical separations using linked data. After amendment of each algorithm for paediatric patients, rates of pressure ulcers and pneumonia reduced by
Wilson, Sally; Bremner, Alexandra P; Hauck, Yvonne; Finn, Judith
There is increasing interest in the contribution of the quality of nursing care to patient outcomes. Due to different casemix and risk profiles, algorithms for administrative health data that identify nursing-sensitive outcomes in adult hospitalised patients may not be applicable to paediatric patients. The study purpose was to test adult algorithms in a paediatric hospital population and make amendments to increase the accuracy of identification of hospital acquired events. The study also aimed to determine whether the use of linked hospital records improved the likelihood of correctly identifying patient outcomes as nursing sensitive rather than being related to their pre-morbid conditions. Using algorithms developed by Needleman et al. (2001), proportions and rates of records that identified nursing-sensitive outcomes for pressure ulcers, pneumonia and surgical wound infections were determined from administrative hospitalisation data for all paediatric patients discharged from a tertiary paediatric hospital in Western Australia between July 1999 and June 2009. The effects of changes to inclusion and exclusion criteria for each algorithm on the calculated proportion or rate in the paediatric population were explored. Linked records were used to identify comorbid conditions that increased nursing-sensitive outcome risk. Rates were calculated using algorithms revised for paediatric patients. Linked records of 129,719 hospital separations for 79,016 children were analysed. Identification of comorbid conditions was enhanced through access to prior and/or subsequent hospitalisation records (43% of children with pressure ulcers had a form of paralysis recorded only on a previous admission). Readmissions with a surgical wound infection were identified for 103 (4.8/1,000) surgical separations using linked data. After amendment of each algorithm for paediatric patients, rates of pressure ulcers and pneumonia reduced by 53% and 15% (from 1.3 to 0.6 and from 9.1 to 7.7 per
... communications as they allow for an in-depth understanding of individuals' attitudes, beliefs, motivations, and... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0067... Product Communications, as Used by the Food and Drug Administration AGENCY: Food and Drug Administration...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-0297...; Prevention of Salmonella Enteritidis in Shell Eggs During Production--Recordkeeping and Registration AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0157...: Fast Track Drug Development Programs: Designation, Development, and Application Review AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing...
research on child care environmental health issues, identify key state and regional healthy child care organizations for partnerships, and see how other states are addressing child care environmental health issues.
The Patient Protection and Affordable Care Act creates new incentives and builds on existing wellness program policies to promote employer wellness programs and encourage opportunities to support healthier workplaces. The proposed rules are promulgated by the Department of Health and Human Services (HHS), the Department of Labor, and the Treasury Department, and seek to encourage appropriately designed, consumer-protective wellness programs in group health coverage. This legislative landscape raises significant federalism concerns insofar as it largely shifts the responsibility for administration of health incentive programs to the states. Little attention has been paid to the shifting "administrative burden" that would thereby ensue. This paper will address the distribution of power in the American federal system vis-à-vis subnational counterparts in the wake of rampant, recent health care reform efforts. This paper will therefore explore the willingness of the national government to delegate policymaking responsibility to state governments in the context of an important aspect of healthcare reform. This, in turn, can be used to assess the distribution of powers between governmental levels--a subject that has received little systematic inquiry to date. Finally, this paper will explore the degree of administrative burden shifting that may likely occur as a result of these changes in health reform and what potential impacts it may have on individual health.
Goldsbury David E
Full Text Available Abstract Background Monitoring treatment patterns is crucial to improving cancer patient care. Our aim was to determine the accuracy of linked routinely collected administrative health data for monitoring colorectal and lung cancer care in New South Wales (NSW, Australia. Methods Colorectal and lung cancer cases diagnosed in NSW between 2000 and 2002 were identified from the NSW Central Cancer Registry (CCR and linked to their hospital discharge records in the NSW Admitted Patient Data Collection (APDC. These records were then linked to data from two relevant population-based patterns of care surveys. The main outcome measures were the sensitivity and specificity of data from the CCR and APDC for disease staging, investigative procedures, curative surgery, chemotherapy, radiotherapy, and selected comorbidities. Results Data for 2917 colorectal and 1580 lung cancer cases were analysed. Unknown disease stage was more common for lung cancer in the administrative data (18% than in the survey (2%. Colonoscopies were captured reasonably accurately in the administrative data compared with the surveys (82% and 79% respectively; 91% sensitivity, 53% specificity but all other colorectal or lung cancer diagnostic procedures were under-enumerated. Ninety-one percent of colorectal cancer cases had potentially curative surgery recorded in the administrative data compared to 95% in the survey (96% sensitivity, 92% specificity, with similar accuracy for lung cancer (16% and 17%; 92% sensitivity, 99% specificity. Chemotherapy (~40% sensitivity and radiotherapy (sensitivity≤30% were vastly under-enumerated in the administrative data. The only comorbidity that was recorded reasonably accurately in the administrative data was diabetes. Conclusions Linked routinely collected administrative health data provided reasonably accurate information on potentially curative surgical treatment, colonoscopies and comorbidities such as diabetes. Other diagnostic procedures
Democratic Society White House Leadership Development Program (WHLD) Harvard Kennedy School (HKS)–Senior Executive Fellows Program George......Nurse Leaders: An Exploration of Current Nurse Leadership Development in the Veterans Health Administration 5a. CONTRACT NUMBER 5b. GRANT NUMBER
Vildósola, H; Colichón, A; Bardales, F; Serván, J C
A seroepidemiological assessment for Hepatitis B was performed in 199 workers, apparently healthy, of Hospital de Apoyo Iquitos of them were health care workers (representing 29.96% of health workers) and 42 were administrative personnel (22.82% of hospital's administrative personnel). We evaluated the HBsAg and anti-HBc IgG total by the microelisa technique. The total prevalence of HBsAg carriers was 3.36% and 20.1% of the anti-HBc; in the health group the 3.89% had HBsAg and the 16.88% anti-HBc, while the administrative group presented 2.38% of HBsAg and 26.19% the anti-HBc. There was no significative statistical difference between both groups. There was not either in the presence of the different studied epidemiological variables. We presume that it can exist a common epidemilogical factor which would conditioned a similarity of risk for infection in the health personnel as well the administrative personnel and even in the general population. If this find in other Amazon cities is confirmed, we could conclude that this represents a epidemilogical characteristic of the intermediate endemicity urban areas.
... between clinical depression, alterations in physical functioning, and the levels of circulating... (Prevalence and Clinical Course of Depression Among Patients With Heart Failure) Activity Under OMB Review AGENCY: Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: In...
... Patient Satisfaction Survey); Activities under OMB Review AGENCY: Veterans Health Administration...- 0764 (Dental Patient Satisfaction Survey)'' in any correspondence. FOR FURTHER INFORMATION CONTACT...-0764 (Dental Patient Satisfaction Survey)'' in any correspondence).'' SUPPLEMENTARY INFORMATION: Title...
Strudwick, Gillian; Clark, Carrie; McBride, Brittany; Sakal, Moshe; Kalia, Kamini
Barcode medication administration systems have been implemented in a number of healthcare settings in an effort to decrease medication errors. To use the technology, nurses are required to login to an electronic health record, scan a medication and a form of patient identification to ensure that these correspond correctly with the ordered medications prior to medication administration. In acute care settings, patient wristbands have been traditionally used as a form of identification; however, past research has suggested that this method of identification may not be preferred in inpatient mental health settings. If barcode medication administration technology is to be effectively used in this context, healthcare organizations need to understand patient preferences with regards to identification methods. The purpose of this study was to elicit patient perceptions of barcode medication administration identification practices in inpatient mental health settings. Insights gathered can be used to determine patient-centered preferences of identifying patients using barcode medication administration technology. Using a qualitative descriptive approach, fifty-two (n=52) inpatient interviews were completed by a Peer Support Worker using a semi-structured interview guide over a period of two months. Interviews were conducted in a number of inpatient mental health areas including forensic, youth, geriatric, acute, and rehabilitation services. An interprofessional team, inclusive of a Peer Support Worker, completed a thematic analysis of the interview data. Six themes emerged as a result of the inductive data analysis. These included: management of information, privacy and security, stigma, relationships, safety and comfort, and negative associations with the technology. Patients also indicated that they would like a choice in the type of identification method used during barcode medication administration. As well, suggestions were made for how barcode medication
Meireles, Manuel; Scarpi, Marinho Jorge
Investigations in the field of the learning competence that investigate the impact of the acquisition of new individual competence of those responsible for ophthalmologic clinics, by means of a MBA Administration in Health course, on the organizational modernity of ophthalmologic clinics. Survey using questionnaires applied to students and former students of the course and to managers of ophthalmologic clinics not linked to the course (n=30 each one). The analysis was made by means of statistical methods: r of Pearson and Q of Yule; Student's t test, sum of series test, median test and U test of Mann-Whitney. Linear and positive correlation was observed between excellency of MBA Administration in Health and the development of the veteran students' capacities (rho correlation of Spearman at the level of 0.01); there is a significant difference (0.0364, by the Mann-Whitney test), between veteran students and freshmen regarding the need to extend the individual capacities provided by the MBA Administration in Health course, to the other operational employees of the ophthalmologic clinics; and there is a significant difference (0.0057, for the Mann-Whitney test), among veteran students of the MBA Administration in Health course and freshmen regarding the importance of the organizational modernity for the ophthalmologic clinics. The obtained results are consistent, in a general way, with the proposed model: MBA Administration's excellence in Health contributes significantly to the organizational modernity, to the development of competence of the veteran students, and, also in substantial way to the perception of organizational hiatuses.
Full Text Available During December 2013, the first locally transmitted chikungunya virus (CHIKV infections in the Americas were reported in the Caribbean. Although CHIKV infection is rarely fatal, risk for severe disease increases with age and medical comorbidities. Herein we describe characteristics of Veterans Health Administration (VHA patients with CHIKV infection and, among those with infections diagnosed in Puerto Rico, investigated risk factors for hospitalization.We queried VHA's national electronic medical records to identify patients with CHIKV testing during 2014. Demographics, clinical history, laboratory results, and outcomes were abstracted. We investigated risk factors for hospitalization among patients with laboratory-confirmed CHIKV infection in Puerto Rico.We identified 180 laboratory-confirmed CHIKV infections; 148 (82.2% were diagnosed in Puerto Rico, and 32 (17.8% were diagnosed among returning travelers elsewhere in the United States. In Puerto Rico, where more patients were hospitalized (55.4% versus 20.0% and died (4.1% versus 0%, risk for hospitalization increased with age (relative risk [RR]/each 10-year increase, 1.19; 95% confidence interval [CI], 1.06-1.32 and, adjusted for age, increased among patients with congestive heart failure (RR, 1.58; 95% CI, 1.25-1.99, chronic kidney disease (RR, 1.52; 95% CI, 1.19-1.94, diabetes mellitus (RR, 1.39; 95% CI, 1.06-1.84, or chronic lung disease (RR, 1.37; 95% CI, 1.03-1.82.CHIKV infection is an emerging problem among Veterans residing in or visiting areas with CHIKV transmission. Although overall mortality rates are low, clinicians in affected areas should be aware that older patients and patients with comorbidities may be at increased risk for severe disease.
Weems, Shelley; Heller, Pamela; Fenton, Susan H
The Veterans Health Administration (VHA) of the US Department of Veterans Affairs has been preparing for the October 1, 2015, conversion to the International Classification of Diseases, Tenth Revision, Clinical Modification and Procedural Coding System (ICD-10-CM/PCS) for more than four years. The VHA's Office of Informatics and Analytics ICD-10 Program Management Office established an ICD-10 Learning Lab to explore expected operational challenges. This study was conducted to determine the effects of the classification system conversion on coding productivity. ICD codes are integral to VHA business processes and are used for purposes such as clinical studies, performance measurement, workload capture, cost determination, Veterans Equitable Resource Allocation (VERA) determination, morbidity and mortality classification, indexing of hospital records by disease and operations, data storage and retrieval, research purposes, and reimbursement. The data collection for this study occurred in multiple VHA sites across several months using standardized methods. It is commonly accepted that coding productivity will decrease with the implementation of ICD-10-CM/PCS. The findings of this study suggest that the decrease will be more significant for inpatient coding productivity (64.5 percent productivity decrease) than for ambulatory care coding productivity (6.7 percent productivity decrease). This study reveals the following important points regarding ICD-10-CM/PCS coding productivity: 1. Ambulatory care ICD-10-CM coding productivity is not expected to decrease as significantly as inpatient ICD-10-CM/PCS coding productivity. 2. Coder training and type of record (inpatient versus outpatient) affect coding productivity. 3. Inpatient coding productivity is decreased when a procedure requiring ICD-10-PCS coding is present. It is highly recommended that organizations perform their own analyses to determine the effects of ICD-10-CM/PCS implementation on coding productivity.
True, Gala; Stewart, Greg L; Lampman, Michelle; Pelak, Mary; Solimeo, Samantha L
The patient-centered medical home (PCMH) relies on a team approach to patient care. For organizations engaged in transitioning to a PCMH model, identifying and providing the resources needed to promote team functioning is essential. To describe team-level resources required to support PCMH team functioning within the Veterans Health Administration (VHA), and provide insight into how the presence or absence of these resources facilitates or impedes within-team delegation. Semi-structured interviews with members of pilot teams engaged in PCMH implementation in 77 primary care clinics serving over 300,000 patients across two VHA regions covering the Mid-Atlantic and Midwest United States. A purposive sample of 101 core members of pilot teams, including 32 primary care providers, 42 registered nurse care managers, 15 clinical associates, and 12 clerical associates. Investigators from two evaluation sites interviewed frontline primary care staff separately, and then collaborated on joint analysis of parallel data to develop a broad, comprehensive understanding of global themes impacting team functioning and within-team delegation. We describe four themes key to understanding how resources at the team level supported ability of primary care staff to work as effective, engaged teams. Team-based task delegation was facilitated by demarcated boundaries and collective identity; shared goals and sense of purpose; mature and open communication characterized by psychological safety; and ongoing, intentional role negotiation. Our findings provide a framework for organizations to identify assets already in place to support team functioning, as well as areas in need of improvement. For teams struggling to make practice changes, our results indicate key areas where they may benefit from future support. In addition, this research sheds light on how variation in medical home implementation and outcomes may be associated with variation in team-based task delegation.
Ozierański, Piotr; Löblová, Olga; Nicholls, Natalia; Csanádi, Marcell; Kaló, Zoltán; McKee, Martin; King, Lawrence
Transparency is recognised to be a key underpinning of the work of health technology assessment (HTA) agencies, yet it has only recently become a subject of systematic inquiry. We contribute to this research field by considering the Polish Agency for Health Technology Assessment (AHTAPol). We situate the AHTAPol in a broader context by comparing it with the National Institute for Health and Care Excellence (NICE) in England. To this end, we analyse all 332 assessment reports, called verification analyses, that the AHTAPol issued from 2012 to 2015, and a stratified sample of 22 Evidence Review Group reports published by NICE in the same period. Overall, by increasingly presenting its key conclusions in assessment reports, the AHTAPol has reached the transparency standards set out by NICE in transparency of HTA outputs. The AHTAPol is more transparent than NICE in certain aspects of the HTA process, such as providing rationales for redacting assessment reports and providing summaries of expert opinions. Nevertheless, it is less transparent in other areas of the HTA process, such as including information on expert conflicts of interest. Our findings have important implications for understanding HTA in Poland and more broadly. We use them to formulate recommendations for policymakers.
[Health promotion effectiveness: developing and testing a system for routine evaluation in health education, workplace health promotion and setting approach supplied by the German statutory health insurance agencies].
Kliche, T; Riemann, K; Bockermann, C; Niederbühl, K; Wanek, V; Koch, U
The aim of the study was to develop and test a routine evaluation system for all health promotion and education activities funded by the German statutory health insurance companies. The system aims at measuring both individual health effects and the complex organisational effects of setting projects. Measurement instruments were developed synoptically and tested in three field tests (2003-2008). In order to assess the impact of individual health training, 212 courses of the health insurance companies were evaluated. To assess the setting approach, 56 schools participating in a health-promotion project were included, and for workplace health-promotion 6 projects of different health insurance companies were included. The research design was an observational study. Instead of control groups, individual data were compared to reference values for gender- and age-matched groups from national health surveys. The studies consisted of baseline and final assessment (T1/T2), complemented by a follow-up (T3), all adapted to the time of intervention (i. e., 3-24 months for T1/T2 and 3-18 months for T2/T3). The evaluation system provides multilevel-measurement based upon validated questionnaires for health-related structures and processes in institutions, and for the participating individual's subjective health, health problems, health-related quality of life, workplace and institutional satisfaction. Controlling for central confounders is also possible (input and dosage, age, gender, educational background). Thus, short but valid measurement instruments of high usability are available to evaluate the effectiveness of prevention, health promotion and education. © Georg Thieme Verlag KG Stuttgart · New York.
This article examines social and health care professionals' views, based on their encounters with both victims and perpetrators, on the division of responsibility in the process of ending intimate partner violence. Applying discourse analysis to focus group discussions with a total of 45 professionals on solutions to the problem, several positions of responsible agency in which professionals place themselves and their clients are identified. The results suggest that one key to understanding the complexities involved in violence intervention lies in a more adequate theorization of the temporal and intersubjective dimensions of the process of assigning responsibility for the problem. © The Author(s) 2015.
Höer, Ariane; Schiffhorst, Guido; Zimmermann, Anne; Fischaleck, Johann; Gehrmann, Luise; Ahrens, Henrik; Carl, Gunther; Sigel, Karl-Otto; Osowski, Ulrike; Klein, Maria; Bleß, Hans-Holger
Healthcare-utilization data for multiple sclerosis (MS) are scarce in Germany. The Purpose of the study was to analyse administrative prevalence of MS, medication use and type of specialists involved in MS treatment in the outpatient setting in Bavaria. Pseudonymized claims data from Bavarian Statutory Health Insurance (SHI)-accredited physicians were used. Administrative prevalence of MS was defined as having ≥1 MS diagnosis (International Classification of Diseases, 10th edition, code G35) documented by a neurologist or psychiatrist, or ≥1 prescription for disease-modifying drugs (DMDs)). The administrative prevalence calculated for Bavaria was projected to Germany. DMD prescription and involvement of different specialities in health care service for MS patients was analysed. Administrative prevalence of MS in Bavaria increased from 0.123% to 0.175% of insured persons between 2005 and 2009; when projected, this yielded ~102,000-143,000 patients with MS in the German population. The percentage of patients receiving ≥1 DMD prescription increased from 45.5% to 50.5%. Patients with MS were mainly treated by neurologists in the ambulatory care setting. These results provide important information on the administrative prevalence of MS in Bavaria and on healthcare provision for patients, which is relevant for resource planning in the healthcare sector.
.... To determine the status of computer security within VHA, we (1) evaluated information system general controls at the VA Maryland Health Cafe System, the New Mexico VA Health Care System, and the VA North Texas Health Care System and (2...
Scott, Kerry; George, Asha S; Harvey, Steven A; Mondal, Shinjini; Patel, Gupteswar; Sheikh, Kabir
Participatory health initiatives ideally support progressive social change and stronger collective agency for marginalized groups. However, this empowering potential is often limited by inequalities within communities and between communities and outside actors (i.e. government officials, policymakers). We examined how the participatory initiative of Village Health, Sanitation, and Nutrition Committees (VHSNCs) can enable and hinder the renegotiation of power in rural north India. Over 18 months, we conducted 74 interviews and 18 focus groups with VHSNC members (including female community health workers and local government officials), non-VHSNC community members, NGO staff, and higher-level functionaries. We observed 54 VHSNC-related events (such as trainings and meetings). Initial thematic network analysis supported further examination of power relations, gendered "social spaces," and the "discourses of responsibility" that affected collective agency. VHSNCs supported some re-negotiation of intra-community inequalities, for example by enabling some women to speak in front of men and perform assertive public roles. However, the extent to which these new gender dynamics transformed relations beyond the VHSNC was limited. Furthermore, inequalities between the community and outside stakeholders were re-entrenched through a "discourse of responsibility": The comparatively powerful outside stakeholders emphasized community responsibility for improving health without acknowledging or correcting barriers to effective VHSNC action. In response, some community members blamed peers for not taking up this responsibility, reinforcing a negative collective identity where participation was futile because no one would work for the greater good. Others resisted this discourse, arguing that the VHSNC alone was not responsible for taking action: Government must also intervene. This counter-narrative also positioned VHSNC participation as futile. Interventions to strengthen
... Information Technology Network Development Grant AGENCY: Health Resources and Services Administration (HRSA...-competitive replacement award under the Rural Health Information Technology Network Development Grant (RHITND... relinquishing its fiduciary responsibilities for the Rural Health Information Technology Network Development...
... Tots Public-Private Partnership AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0005; FDA 225-09-0014] Memorandum of Understanding Between the Food and Drug Administration and the...
... Dependence; Public Hearing; Extension of Comment Period AGENCY: Food and Drug Administration, HHS. ACTION: Notification of public hearing; Extension of comment period. SUMMARY: The Food and Drug Administration (FDA) is... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Part 15 [Docket No...
... AGENCY: Food and Drug Administration, HHS. ACTION: Notification of public meeting. SUMMARY: The Food and Drug Administration (FDA) is providing public meeting registration information for two FSMA related... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Parts 1, 16, 106, 110...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2009-D-0495] Draft Guidance for Industry and Food and Drug Administration Staff; Medical Devices; Neurological and Physical Medicine Device Guidance Documents; Availability AGENCY: Food and Drug Administration, HHS. ACTION...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-D-0635] Guidance for Industry and Food and Drug Administration Staff; Section 905(j) Reports: Demonstrating Substantial Equivalence for Tobacco Products; Availability AGENCY: Food and Drug Administration, HHS. ACTION...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-D-0530] Draft Guidance for Industry and Food and Drug Administration Staff; Mobile Medical Applications; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-D-0514] Draft Guidance for Industry and Food and Drug Administration Staff; Procedures for Handling Section 522 Postmarket Surveillance Studies; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2009-D-0010] Guidance for Industry and Food and Drug Administration Staff: Investigational Device Exemption Guidance for Retinal Prostheses; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2007-D-0076] (formerly Docket No. 2007D-0387) Guidance for Industry and Food and Drug Administration Staff; In Vitro Diagnostic Studies--Frequently Asked Questions; Availability AGENCY: Food and Drug Administration, HHS...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-D-0395] Draft Guidance for Industry and Food and Drug Administration Staff; Recommendations for Premarket Notifications for Lamotrigine and Zonisamide Assays; Availability AGENCY: Food and Drug Administration, HHS...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-1161] Draft Guidance for Industry and Food and Drug Administration Staff; Design Considerations for Devices Intended for Home Use; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-D-0168] Draft Guidance for Industry and Food and Drug Administration Staff: Recommendations for Labeling Medical...; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0002] Industry Exchange Workshop on Food and Drug Administration Drug and Device Requirements; Public Workshop AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public workshop. SUMMARY: The Food and Drug...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0002] 2011 Parenteral Drug Association/Food and Drug Administration Glass Quality Conference; Public Conference AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public conference. SUMMARY: The Food...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-0001] Society of Clinical Research Associates-Food and Drug Administration: Food and Drug Administration Clinical Trial Requirements, Regulations, Compliance, and Good Clinical Practice AGENCY: Food and Drug...
Wright, Brad; O'Shea, Amy M.J.; Glasgow, Justin M.; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary
Abstract Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals. The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals. Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient...
The Secretary of Health and Human Services is required by Subpart 3, Part F of Title III of the Public Health Service Act; 42 USC 263b et seq. (Public Law 90-602) to submit an annual report to the President for transmittal to the Congress on or before April 1 on the administration of the Radiation Control for Health and Safety Act. The detailed information required to be included in the report is outlined in Section 360D of the Public Health Service Act. The Food and Drug Administration, through its Center for Devices and Radiological Health, is responsible for the day-to-day administration of the Act. The report covers the detailed operation of the Agency in carrying out that responsibility for calendar year 1984. Manufacturers of electronic products are required by 21 CFR 1002.20 to report accidental radiation occurrences to the CDRH, FDA. During the calendar year 1984, the Radiation Incidents Registry received 11 reports alleging injury involving 235 persons
Kash, Bita A; Spaulding, Aaron; Gamm, Larry; Johnson, Christopher E
The dimensions of absorptive capacity (ACAP) are defined, and the importance of ACAP is established in the management literature, but the concept has not been applied to health care organizations attempting to implement multiple strategic initiatives. The aim of this study was to test the utility of ACAP by analyzing health care administrators' experiences with multiple strategic initiatives within two health systems. Results are drawn from administrators' assessments of multiple initiatives within two health systems using in-depth personal interviews with a total of 61 health care administrators. Data analysis was performed following deductive qualitative analysis guidelines. Interview transcripts were coded based on the four dimensions of ACAP: acquiring, assimilating, internalizing/transforming, and exploiting knowledge. Furthermore, we link results related to utilization of management resources, including number of key personnel involved and time consumption, to dimensions of ACAP. Participants' description of multiple strategic change initiatives confirmed the importance of the four ACAP dimensions. ACAP can be a useful framework to assess organizational capacity with respect to the organization's ability to concurrently implement multiple strategic initiatives. This capacity specifically revolves around human capital requirements from upper management based on the initiatives' location or stage within the ACAP framework. Strategic change initiatives in health care can be usefully viewed from an ACAP perspective. There is a tendency for those strategic initiatives ranking higher in priority and time consumption to reflect more advanced dimensions of ACAP (assimilate and transform), whereas few initiatives were identified in the ACAP "exploit" dimension. This may suggest that health care leaders tend to no longer identify as strategic initiatives those innovations that have moved to the exploitation stage or that less attention is given to the exploitation
..., and prevention of physical and mental diseases and other impairments; (2) assist states and their... Health Effects; presentation on NCEH/ ATSDR Internal Clearance and External Peer Review Policies and...
... centers advance the preventive and primary medical/health care home model of coordinated, comprehensive... services. More than 1,200 health centers operate nearly 9,000 service delivery sites that provide care in... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency...
...) Program is to promote diversity among health profession students and practitioners by providing funds to...), physician assistants, dental hygiene, and mental and behavioral health. Each school will determine the... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency...
..., dental hygiene, and mental and behavioral health. Each school will determine the eligibility of students... is to promote diversity among health profession students and practitioners by providing funds to... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency... States Code, as amended by the Paperwork Reduction Act of 1995, Pub. L. 104-13), the Health Resources and... The National Health Service Corps (NHSC) of the Bureau of Clinician Recruitment and Service (BCRS...
National Aeronautics and Space Administration — Public data set for NASA Agency Intellectual Property (IP). The distribution contains both Patent information as well as General Release of Open Source Software.
... Information Technology Implementation AGENCY: Health Resources and Services Administration, HHS. ACTION... advance information technology resources of the Tennessee's medically underserved communities, TPCA has... advancement and effective use of Health Information Technology. These advancements will result in measurable...
... Information Technology Implementation AGENCY: Health Resources and Services Administration (HRSA), Department... effective use of Health Information Technology (HIT). SUPPLEMENTARY INFORMATION: Former Grantee of Record... advance information technology resources of Virginia's medically underserved communities, HCHC has...
Borges, Fabiano Tonaco; Garbin, Cléa Adas Saliba; Siqueira, Carlos Eduardo; Garbin, Artênio José Ísper; Rocha, Najara Barbosa da; Lolli, Luíz Fernando; Moimaz, Suzely Adas Saliba
The scope of this study was to discuss the administrative sustainability of Brazil's Vocational Health Schools (ETSUS) based on the principle of teaching and service integration, which brings a new dimension to healthcare work as yet unregulated by Brazilian public administration. It was a qualitative study using case study methodology. The research involved a semi-structured questionnaire given to ETSUS managers addressing institutional, administrative, and work management aspects. The sample was composed of 6 ETSUS that belong to the Network of Vocational Health Schools (RET-SUS). The ETSUS showed centralized planning and management, and decentralized implementation of their core activities. The majority did not have administrative autonomy and relied heavily on funding from the federal government. According to ETSUS managers, the lack of regulation of teaching activities by civil servants weakens the management of ETSUS. The ETSUS have managerial problems related to teaching-service integration, which has to be regulated in order to guarantee the sustainability of these schools and avoid conflicts with Brazilian legislation.
Marcon, G; Gardini, F; Voltan, G P
The laws for the reform of the Italian National Health Service (502, 517) show marked bureaucratic and administrative patterns. The aim of these laws seems to be mainly a tight control of the health expenses instead of an improvement of health care. This choice is confirmed by the selection of indicators (DRG's) more fit for reimbursement rather than for quality assurance in health care. Moreover, these indicators are only a poor expression of the real medical status of the patients. The reform of the British NHS appears very similar to the Italian reform, mainly for the empowerment of managers to detriment of health professionals and of health care quality. The reforms designed with the collaboration of health workers may be more useful than the reforms based mainly upon bureaucratic principles. Only with this collaboration the double target of the reduction of health related costs and of the maintenance of an acceptable quality may be achieved. The professional associations and the academic world must be involved in the political and organisational choices related with health care, mainly in the fields of the setting of organisational standards and of the training of actual and future doctors. The model proposed is that of internal medicine as an example of the ideal set of skills useful for a mixed clinical and organisational task. The internists, used to the solution of complex clinical problems, may be the ideal candidates for the role of clinical managers.
Martin, Krystle; Ham, Elke; Hilton, Zoe
To describe the documentation of pro re nata (PRN) medication for anxiety, and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process. The ability to accurately document patients' symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e.g., De Marinis, Piredda, Pascarella et al., 2009) and considerable information missing (e.g., Marinis et al., 2010). Additionally, the administration of PRN medication has consistently been noted to be poorly documented (e.g., Baker, Lovell, & Harris, 2008). The project was a mixed method, two-phase study that collected data from two sites. In phase 1, nursing documentation of PRN medication administrations was reviewed in patient charts; phase 2 included verbal reports from staff about this practice. Nurses using EHR documented more information than those using paper charts, including the reason for PRN administration, who initiated the administration, and effectiveness. There were some differences between written and verbal reports, including whether potential side effects were explained to patients prior to PRN administration. We continue the calls for attention to be paid to improving the quality of nursing documentation. Our results support the shift to using EHR, yet not relying on this method completely to ensure comprehensiveness of documentation. Efforts to address the quality of documentation, particularly for PRN administration, are needed. This could be done through training, using structured report templates, and switching to electronic databases. This article is protected by copyright. All rights reserved. This article is
... electronic data interchange (EDI). Through the use of electronic funds transfers (EFT) for health care claim... care transactions results in higher use of EDI by health care providers.\\8\\ We expect usage of EFT and...
Wozney, Lori; Newton, Amanda S; Gehring, Nicole D; Bennett, Kathryn; Huguet, Anna; Hartling, Lisa; Dyson, Michele P; McGrath, Patrick
The use of technology such as computers, tablets, and smartphones to improve access to and the delivery of mental health care (eMental Health care) is growing worldwide. However, despite the rapidly expanding evidence base demonstrating the efficacy of eMental Health care, its implementation in clinical practice and health care systems remains fragmented. To date, no peer-reviewed, key-informant studies have reported on the perspectives of decision-makers concerned with whether and how to implement eMental Health care. From September to November 2015, we conducted 31 interviews with key informants responsible for leadership, policy, research, and/ or information technology in organizations influential in the adoption of technology for eMental Health care. Deductive and inductive thematic analyses of transcripts were conducted using the Behavior Change Wheel as an organizing framework. Frequency and intensity effect sizes were calculated for emerging themes to further explore patterns within the data. Key informant responses (n = 31) representing 6 developed countries and multiple organizations showed consensus on common factors impacting implementation: individual and organizational capacities (e.g., computer literacy skills [patients and providers], knowledge gaps about cyber security, limited knowledge of available services); motivational drivers of technology-based care (e.g., extending care, data analytics); and opportunities for health systems to advance eMental Health care implementation (e.g., intersectoral research, rapid testing cycles, sustainable funding). Frequency effect sizes showed strong associations between implementation and credibility, knowledge, workflow, patient empowerment, electronic medical record (EMR) integration, sustained funding and intersectoral networks. Intensity effect sizes showed the highest concentration of statements (>10% of all comments) related to funding, credibility, knowledge gaps, and patient empowerment. This study
highly-competitive military system. Academic probation is imposed on any now student who did not have an undergraduate grade point average (GPA) of...DF), and depersonalization intensity (DI). This suggests that students with higher GRE scores exhibited a lower degree of feelings related to these...characteristics, and the levels of stress during the US Army - Baylor University Graduate Program in Health Care Administration. The students were administered
.... Specifically, a thorough knowledge of the language, terminology, and acronyms is fundamental to understanding today s health care delivery processes both in the civilian sector and the military health system...
Lin, E.; Balogh, R.; Cobigo, V.; Ouellette-Kuntz, H.; Wilton, A. S.; Lunsky, Y.
Background: Individuals with intellectual and developmental disabilities (IDD) experience high rates of physical and mental health problems; yet their health care is often inadequate. Information about their characteristics and health services needs is critical for planning efficient and equitable services. A logical source of such information is…
Tseng, Phillip; Kaplan, Robert S; Richman, Barak D; Shah, Mahek A; Schulman, Kevin A
Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of
Kim Hyungjin; Smith Eric G; Stano Claire M; Ganoczy Dara; Zivin Kara; Walters Heather; Valenstein Marcia
Abstract Background Observational research frequently uses administrative codes for mental health or substance use diagnoses and for important behaviours such as suicide attempts. We sought to validate codes (International Classification of Diseases, 9th edition, clinical modification diagnostic and E-codes) entered in Veterans Health Administration administrative data for patients with depression versus a gold standard of electronic medical record text ("chart notation"). Methods Three rando...
..., Department of Health and Human Services and Department of Agriculture; Memorandum of Understanding Regarding... Memorandum of Understanding (MOU). The MOU will support and encourage cooperation and communication between... Department of Human Services (HHS) and the U.S. Department of Agriculture (USDA). HHS's Centers for Disease...
..., diagnosis, treatment, control, and prevention of physical and mental diseases and other impairments; (2... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention (CDC) Board of.... L. 92-463), the Centers for Disease Control and Prevention (CDC), announces the following meeting of...
Stickel, Sue A.; Callaway, Yvonne L.; Compton, Emily A.
Women have historically served as members of the armed forces and today the numbers of women are increasing and their roles are expanding. Increasingly women are experiencing combat related mental health concerns as well as issues unique to serving within a military culture. Licensed Professional Counselors (LPCs) will be eligible for jobs as…
The U.S. Environmental Protection Agency’s (U.S. EPA) mission is to protect human health and the environment. Those not familiar with U.S. EPA’s mission often do not realize that U.S. EPA is a public health agency. In this presentation, Dr. Danelle Lobdell will provid...
Gase, Lauren N.; Gomez, Louis M.; Kuo, Tony; Glenn, Beth A.; Inkelas, Moira; Ponce, Ninez A.
Background: School climate is an integral part of a comprehensive approach to improving the well-being of students; however, little is known about the relationships between its different domains and measures. We examined the relationships between student, staff, and administrative measures of school climate to understand the extent to which they…
Rigby, J M; Backman, A M
Marketing has a bad reputation among Canadian health managers, even though marketing solutions may address many of their problems. This article provides an overview of current understandings of marketing and how they may be applied to health care situations. Marketing should be considered an ongoing process. This is particularly helpful if we understand the root task of health managers as creating and promoting exchanges--with governments, physicians, nurses, other health workers and client groups. Exchanges that are desirable to the health care community will more likely occur if the true costs and benefits of health services are analyzed, understood and imaginatively communicated. The public constantly evaluates the health system. Constant evaluation implies a need for marketing directed internally at staff and those within the health system, and externally at constituents outside the system. Properly understood and practiced, marketing can be part of the innovative solutions health care managers develop and apply as they deal with the difficult challenges facing them in Canada's current health care environment.
Tayyebeh Asadi Malek Abadi
Full Text Available Background and Objective: Education is one of the strategic actions for human resources development. The purpose of education is improvement in functional outcomes and the knowledge, skills and attitude of staff. Appropriateness of organizational training and needs of employees predisposes improvement in potential capacity of employees and effectiveness and improvement of the performance of employees. The Purpose of this study was to explore the educational needs assessment of health educator teachers of Kouhdasht city from the perspective of administrators and themselves health educators.Materials and Methods: In this descriptive-applied study all health educator teachers and administrators in high schools (primary and secondary in Koohdasht, Lorestan, Iran participated. The sample size consisted of 70 subjects (26 men and 44 women. Data were collected through the questionnaire that was based on Likert scale. Through task analysis, knowledge, skills and attitude of educators were extracted and examined validity and reliability of the questionnaire proved to be satisfactory. Descriptive methods, one sample T-test, independent T-test, Friedman test and analysis of variance were used for analysis.Results: Prioritize educational needs of health educator teachers from the perspective of themselves were life skills education, sex education (to girls/boys and common infectious diseases in adolescents. From the perspective of school administrators, these priorities were Knowledge of pharmaceutical information and their side effects, methods of prevention of drug abuse among adolescents and life skills education.Conclusion: Results of study showed significant differences between the existing and desired level of knowledge, skill and attitude of health educator teachers. Consideration the educational needs of employees and their involvement in the assessment process will be helpful.
Tuohy, Carolyn Hughes
Current ideas about the role of the state include an enthusiasm for mechanisms of "indirect" or "third-party" governance. The health care arena, in which models of indirect governance have a long history, is an important test bed for these ideas. Classically, the arena was marked by trust-based, principal-agent relationships established to overcome information gaps. Over time (and to different degrees across nations), emphasis shifted to contractual relationships assuming relatively well-informed actors and then to performance monitoring and information sharing within complex and loosely coupled networks. In this latest stage, there is a risk that some important features of democratic leadership, and of decision making in the health care arena, will be eclipsed. Accountability mechanisms must clearly locate responsibility for actions and must allow for the exercise of professional judgment.
Barlow, S E; Dietz, W H
The development of recommendations for physicians, nurse practitioners, and nutritionists to guide the evaluation and treatment of overweight children and adolescents. The Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services convened a committee of pediatric obesity experts to develop the recommendations. The Committee recommended that children with a body mass index (BMI) greater than or equal to the 85th percentile with complications of obesity or with a BMI greater than or equal to the 95th percentile, with or without complications, undergo evaluation and possible treatment. Clinicians should be aware of signs of the rare exogenous causes of obesity, including genetic syndromes, endocrinologic diseases, and psychologic disorders. They should screen for complications of obesity, including hypertension, dyslipidemias, orthopedic disorders, sleep disorders, gall bladder disease, and insulin resistance. Conditions that indicate consultation with a pediatric obesity specialist include pseudotumor cerebri, obesity-related sleep disorders, orthopedic problems, massive obesity, and obesity in children younger than 2 years of age. Recommendations for treatment evaluation included an assessment of patient and family readiness to engage in a weight-management program and a focused assessment of diet and physical activity habits. The primary goal of obesity therapy should be healthy eating and activity. The use of weight maintenance versus weight loss to achieve weight goals depends on each patient's age, baseline BMI percentile, and presence of medical complications. The Committee recommended treatment that begins early, involves the family, and institutes permanent changes in a stepwise manner. Parenting skills are the foundation for successful intervention that puts in place gradual, targeted increases in activity and targeted reductions in high-fat, high-calorie foods. Ongoing support for families
Specialists in social medicine and the organization of health services, in particular those in leading functions, are the most important persons who master the argumentation and justification of optimal relations of proposed innovations from the aspect of improving the health status of the population and from the aspect of national economy, ensuring expedient investment into the system of health services and early return of these investments. These leading workers must have exceptional abilities as regards management and organization and moreover be able to stimulate collaborators to creative work, ensure their effective cooperation, team work and consequential integration at the level of different health and economic facilities entrusted to them.
Mulvaney-Day, Norah E; Womack, Catherine A; Oddo, Vanessa M
Understanding the relationship between obesity and fast food consumption encompasses a broad range of individual level and environmental factors. One theoretical approach, the health capability framework, focuses on the complex set of conditions allowing individuals to be healthy. This qualitative study aimed to identify factors that influence individual level health agency with respect to healthy eating choices in uniformly constrained environments (e.g., fast food restaurants). We used an inductive qualitative research design to develop an interview guide, conduct open-ended interviews with a purposive sample of 14 student fast food workers (aged 18-25), and analyze the data. Data analysis was conducted iteratively during the study with multiple coders to identify themes. Emergent themes included environmental influences on eating behaviors (time, cost, restaurant policies, social networks) and internal psychological factors (feelings associated with hunger, food knowledge versus food preparation know-how, reaction to physical experiences, perceptions of food options, delayed gratification, and radical subjectivity). A localized, embedded approach to analyzing the factors driving the obesity epidemic is needed. Addressing contextual interactions between internal psychological and external environmental factors responds to social justice and public health concerns, and may yield more relevant and effective interventions for vulnerable communities. Copyright © 2012 Elsevier Ltd. All rights reserved.
Durbeck, D. C.; Heinzelmann, F.; Schacter, J.; Haskell, W. L.; Payne, G. H.; Moxley, R. T., III; Nemiroff, M.; Limoncelli, D. D.; Arnoldi, L. B.; Fox, S. M., III
An exercise program was initiated in a federal agency to assess the feasibility of such a program, and to identify the factors that influenced joining, adherence to, and effectiveness of the program. The program was utilized by 237 of the 998 eligible federal employees; mean attendance rate was 1.3 days/week. Those who volunteered perceived a need for increased physical activity, believed they had sufficient time to participate and derived subjective as well as objective benefits. Significant improvements were found in heart rate response to the standard exercise test, body weight, skinfold measurements and triglyceride levels.
... encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp... reported by hospitals: (1) prevention; (2) diagnosis; (3) treatment; and (4) management. Table 1 summarizes... care claims--Dental. ASC X12 837 P Health care claims-- Professional. ASC X12 837 I Health care claims...
Gase, Lauren Nichol; Gomez, Louis M.; Kuo, Tony; Glenn, Beth A.; Inkelas, Moira; Ponce, Ninez A.
BACKGROUND School climate is an integral part of a comprehensive approach to improving the wellbeing of students; however, little is known about the relationships between its different domains and measures. This study examined the relationships between student, staff, and administrative measures of school climate in order to understand the extent to which they were related to each other and student outcomes. METHODS The sample included 33,572 secondary school students from 121 schools in Los Angeles County during the 2014–2015 academic year. A multilevel regression model was constructed to examine the association between the domains and measures of school climate and five outcomes of student wellbeing: depressive symptoms or suicidal ideation, tobacco use, alcohol use, marijuana use, and grades. RESULTS Student, staff, and administrative measures of school climate were weakly correlated. Strong associations were found between student outcomes and student reports of engagement and safety, while school staff reports and administrative measures of school climate showed limited associations with student outcomes. CONCLUSIONS As schools seek to measure and implement interventions aimed at improving school climate, consideration should be given to grounding these efforts in a multi-dimensional conceptualization of climate that values student perspectives and includes elements of both engagement and safety. PMID:28382671
Facco, Simona; Finiguerra, Ivana; Fuggetta, Leornardo; Garrino, Lorenza; Di Monte, Valerio
The Service of Health Professions of this facility (TO2 of Turin) aimed during the 2010 to devise/develop a new evaluation tool for the new employees , trying to fit them with the profiles set up the previous year. The conceptual model of reference for the construction of working drafts of the grids was inspired by the special insert edition of "L'infermiere" in 2007, a literature review was carried out and a number of internal meeting within 6 of the Service of health Professions were set up. A working group were set up - 93 people - as well as indicators were developed to monitor and implementation of the instruments. Once the drafts of the standard tools were made, working groups started to improve the tools provided under the supervision of a tutor. Finally half way through an evaluation was carried out using a questionnaire. The new template leads a number of problems which were later sorted out also with the support of tutors.
... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0712] Agency Information Collection (Nation-Wide Customer Satisfaction Surveys) Activities Under OMB Review AGENCY: Veterans Health Administration... ``OMB Control No. 2900-0712.'' SUPPLEMENTARY INFORMATION: Title: Nation-wide Customer Satisfaction...
... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0712] Agency Information Collection (Nation-wide Customer Satisfaction Surveys) Activities Under OMB Review AGENCY: Veterans Health Administration... ``OMB Control No. 2900-0712.'' SUPPLEMENTARY INFORMATION: Title: Nation-wide Customer Satisfaction...
... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0208] Agency Information Collection (Architect--Engineer Fee Proposal) Activity Under OMB Review AGENCY: Veterans Health Administration... . Please refer to ``OMB Control No. 2900-0208.'' SUPPLEMENTARY INFORMATION: Titles: a. Architect--Engineer...
Full Text Available Ilona Kickbusch’s thought provoking editorial is criticized in this commentary, partly because she fails to refer to previous critical work on the global conditions and policies that sustain inequality, poverty, poor health and damage to the biosphere and, as a result, she misreads global power and elides consideration of the fundamental historical structures of political and material power that shape agency in global health governance. We also doubt that global health can be improved through structures and processes of multilateralism that are premised on the continued reproduction of the ecologically myopic and socially unsustainable market civilization model of capitalist development that currently prevails in the world economy. This model drives net financial flows from poor to rich countries and from the poor to the affluent and super wealthy individuals. By contrast, we suggest that significant progress in global health requires a profound and socially just restructuring of global power, greater global solidarity and the “development of sustainability.”
Schuhmacher, A; Bafundo, K W; Islam, K M S; Aupperle, H; Glaser, R; Schoon, H A; Gropp, J M
The pleuromutilin antibiotic tiamulin (TIA) is known to produce a variety of negative interactive effects when it is administered in combination with several anticoccidial ionophores. A 35-d growth study was performed in cages to evaluate the compatibility of TIA when it was administered concurrently with the poly-ether ionophore anticoccidial semduramicin (SEM). Tiamulin and SEM, both alone and in combination, were administered to 10 replicates of female broilers arranged in a completely randomized block design. Tiamulin was administered in drinking water (250 mg of TIA/kg of water) from d 15 through 19 of the study, whereas SEM was incorporated in feed (25 mg/kg) from placement to the conclusion of the test. Water consumption was determined during the period of concurrent administration of the drugs and weekly measurements of feed intake and bird performance were recorded. In addition, hematocrit, blood cell counts, serum protein, albumin, glucose, uric acid, electrolytes, and activities of several enzymes were determined from blood samples taken at d 35. Results indicated that simultaneous administration of TIA and SEM during the third week of the trial reduced water and feed intake resulting in a temporary growth depression. Feed efficiency was transiently affected during the period of coadministration. However, during the fourth week of the test, negative effects in body weight were not observed for any treatment and feed conversion improved for birds concurrently receiving TIA + SEM. By the termination of the experiment, no adverse effects were observed in final performance for any treatment. Histopathological and hematological parameters were unaffected by treatment at d 35 of the test. These results demonstrated that simultaneous administration of TIA and SEM produced only temporary impairments of water and feed consumption that transiently influenced performance. Neither mortality nor long-term effects on performance variables occurred in broilers.
Shan, Linghan; Wu, Qunhong; Liu, Chaojie; Li, Ye; Cui, Yu; Liang, Zi; Hao, Yanhua; Liang, Libo; Ning, Ning; Ding, Ding; Pan, Qingxia; Han, Liyuan
China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that insurance programmes bring to members
... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Agency Information Collection Activities: Requests for Comments; Clearance of Renewed Approval of Information Collection: Operations Specifications AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice and request for comments...
Twigg, Judyth L
In keeping with the introduction of market-oriented reforms since the collapse of the Soviet Union, Russia's health care system has undergone a series of sweeping changes since 1992. These reforms, intended to overhaul socialized methods of health care financing and delivery and to replace them with a structure of competitive incentives to improve efficiency and quality of care, have met with mixed levels of implementation and results. This article probes some of the sources of support for and resistance to change in Russia's system of health care financing and delivery. It does so through a national survey of two key groups of participants in that system: head doctors in Russian clinics and hospitals, and the heads of the regional-level quasi-governmental medical insurance Funds. The survey results demonstrate that, on the whole, both head doctors and health insurance Fund directors claim to support the recent health care system reforms, although the latter's support is consistently statistically significantly stronger than that of the former. In addition, the insurance Fund directors' responses to the survey questions tend consistently to fall in the shape of a standard bell curve around the average responses, with a small number of respondents more in agreement with the survey statements than average, and a similarly small number of respondents less so. By contrast, the head doctors, along a wide variety of reform measures, split into two camps: one that strongly favors the marketization of health care, and one that would prefer a return to Soviet-style socialized medicine. The survey results show remarkable national consistency, with no variance according to the respondents' geographic location, regional population levels or other demographic or health characteristics, age of respondents, or size of health facility represented. These findings demonstrate the emergence of well-defined bureaucratic and political constituencies, their composition mixed depending
...; Establishment of a Public Docket AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is establishing a public docket for information pertaining to FDA's... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-N-1090...
... Administration and the International Anesthesia Research Society for the Safety of Key Inhaled and Intravenous Drugs in Pediatrics Public-Private Partnership AGENCY: Food and Drug Administration, HHS. ACTION: Notice... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-N-0004...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-D-0189] Guidance for Industry and Food and Drug Administration Staff; Class II Special Controls Guidance Document: Low Level Laser System for Aesthetic Use; Availability AGENCY: Food and Drug Administration, HHS...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2008-D-0275] Guidance for Industry and Food and Drug Administration Staff; Class II Special Controls Guidance Document: Full-Field Digital Mammography System; Availability AGENCY: Food and Drug Administration, HHS. [[Page...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-D-0028] Guidance for Industry and Food and Drug Administration Staff; Class II Special Controls Guidance Document: Ovarian Adnexal Mass Assessment Score Test System; Availability AGENCY: Food and Drug Administration, HHS...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-D-0645] Guidance for Industry and Food and Drug Administration Staff; Class II Special Controls Guidance Document: Contact Cooling System for Aesthetic Use; Availability AGENCY: Food and Drug Administration, HHS. ACTION...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2006-D-0094] Guidance for Industry and Food and Drug Administration Staff; Class II Special Controls Guidance Document: Topical Oxygen Chamber for Extremities; Availability AGENCY: Food and Drug Administration, HHS. ACTION...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-0524] Guidance for Industry and Food and Drug Administration Staff; Acceptance and Filing Reviews for Premarket Approval Applications; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-D-0500] Guidance for Industry and Food and Drug Administration Staff; Class II Special Controls Guidance Document: Focused Ultrasound Stimulator System for Aesthetic Use; Availability AGENCY: Food and Drug Administration...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-0524] Draft Guidance for Industry and Food and Drug Administration Staff; Acceptance and Filing Review for Premarket Approval Applications; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2007-D-0367] Guidance for Industry and Food and Drug Administration Staff; Impact-Resistant Lenses: Questions and Answers; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-0384] Draft Guidance for Industry and Food and Drug Administration Staff; Pediatric Information for X-Ray Imaging Device Premarket Notifications; Availability AGENCY: Food and Drug Administration, HHS. ACTION...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-D-0215] Draft Guidance for Industry and Food and Drug Administration Staff on In Vitro Companion Diagnostic Devices; Extension of Comment Period AGENCY: Food and Drug Administration, HHS. ACTION: Notice; extension...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-1056] Guidance for Industry and Food and Drug Administration Staff; eCopy Program for Medical Device Submissions; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-1056] Draft Guidance for Industry and Food and Drug Administration Staff; eCopy Program for Medical Device Submissions; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-D-0847] Draft Guidance for Industry and Food and Drug Administration Staff on Humanitarian Use Device Designations; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and...