... 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- ...
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...
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…
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…
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...
... 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...
... 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...
... 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...
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.…
... 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...
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.
... 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.
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.
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…
... 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...
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)
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.
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...
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.
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...
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.
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.
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.
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.
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.
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
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.
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
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…
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.
... 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…
...] 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...
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 ...
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.
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.
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 ...
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.
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.
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...
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
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
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...
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.
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
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.
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
... 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...
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.
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.
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.
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...
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...
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.
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.
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.
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.
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...
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.
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
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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).
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
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
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.
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.
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
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.
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.
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...
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...
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.
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
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...
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...
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.
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.
... 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
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
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
Fox, D M; Schaffer, D C
Since 1969 federal tax policy has permitted nonprofit hospitals to turn away indigent patients or to transfer them to public hospitals. The Internal Revenue Service made health policy, but its officials remain convinced that they were not making policy at all. Convinced that it was reasoning from legal principles, the Revenue Service accepted the hospital industry's view of the history and purpose of hospitals. The federal courts further obscured the problem. Moreover, the Revenue Service took no interest in the effects of its ruling on the services provided by tax-exempt hospitals until 1989. We describe these events and seek to explain them by linking the recent history of health policy to the assumptions that govern the making of tax policy. We conclude that the making of health policy by tax officials who are not accountable for it and who believe that they are not making policy at all is not in the public interest.
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.
Martynenko, A V
The article is dedicated to development of directions and specific functions of the health system bodies/institutions public relations (PR) activities. Priorities are set forth depending on the form of property thereof. A complex use of approaches toward carrying out of PR activities permits optimizing work both within the system itself and relations with the society as a whole.
Youens, David; Preen, David B; Harris, Mark N; Moorin, Rachael E
When information on changes in address or migration of people to or from a study jurisdiction is unavailable in longitudinal studies, issues relating to loss-to-follow-up and misclassification bias may result. This study investigated how estimations of associations between general practitioner (GP) contact and hospital use were affected by incomplete address and migration data. This was a retrospective population-based cohort study of Western Australians from 1990 to 2004. Linked administrative data including mortality records, hospital admissions, primary care and Electoral Roll records were used. Regularity of GP contact, based on the variance of the number of days between GP visits, was calculated for each person-year. Outcomes were the number and costs (A$2014) of diabetes-related hospital admissions in the following year. Models were estimated separately for cohorts where (i) postcode was ascertained at study commencement and held constant, and (ii) postcode and residency within Western Australia were updated with each change of address recorded on the Electoral Roll over the study period. Updating address data reduced total person-years by 11% and changed the distribution of covariates. Estimations of associations between patterns of GP contact and number of hospitalizations changed; the incidence rate ratios measuring the relationship with the most regular GP contact (baseline of those with interval (CI) 0.66-1.00] to 0.42 (95% CI 0.33-0.53) after updating postcode information. Impacts on cost models were smaller, though still statistically significant. Longitudinal studies using administrative data may report biased results if they ignore address changes and migration. Researchers should attempt to link to these data wherever possible, or choose study designs which these issues are less likely to affect. Custodians should be aware that such data can be vital to high quality research. © The Author 2017; all rights reserved. Published by Oxford University
Colomer Revuelta, C; Peiró Pérez, R
In scientific societies, as in other social fields, women's participation in decision making is lower than that of men. We describe the situation in SESPAS (Spanish Society of Public Health and Health Services Administration) where, despite representing a 40% of its members, very few women have been in positions in which decisions are taken or in those of professional recognition. The process of change implemented during recent years and some of the effects of the actions taken are presented. Making the existing inequalities known has generated debate and interest in the intervention. A gender and public health working group was set up. In the last two years more women have been promoted to more senior positions in SESPAS.
Dichter, Melissa E; Sorrentino, Anneliese; Bellamy, Scarlett; Medvedeva, Elina; Roberts, Christopher B; Iverson, Katherine M
Experience of intimate partner violence (IPV) can lead to mental health conditions, including anxiety, depression, and unhealthy substance use. Women seen in the Veterans Health Administration (VHA) face high rates of both IPV and mental health morbidity. This study aimed to identify associations between recent IPV experience and mental health diagnoses among women VHA patients. We examined medical records data for 8,888 female veteran and nonveteran VHA patients across 13 VHA facilities who were screened for past-year IPV between April, 2014 and April, 2016. Compared with women who screened negative for past-year IPV (IPV-), those who screened positive (IPV+; 8.7%) were more than twice as likely to have a mental health diagnosis, adjusted odds ratio (AOR) = 2.27, 95% confidence interval (CI) [1.95, 2.64]; or more than two mental health diagnoses, AOR = 2.29, 95% CI [1.93, 2.72]). Screening IPV+ was also associated with significantly higher odds of each type of mental health morbidity (AOR range = 1.85-3.19) except psychoses. Over half (53.5%) of the women who screened IPV+ had a mental health diagnosis, compared with fewer than one-third (32.6%) of those who screened IPV-. Each subtype of IPV (psychological, physical, and sexual violence) was significantly associated with having a mental health diagnosis (AOR range = 2.25-2.37) or comorbidity (AOR range = 2.17-2.78). Associations remained when adjusting for military sexual trauma and combat trauma among the veteran subsample. These findings highlight the mental health burden associated with past-year IPV among female VHA patients and underscore the need to address psychological and sexual IPV, in addition to physical violence. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
Bender, Miriam; Smith, Tyler C
Use of mental indication in health outcomes research is of growing interest to researchers. This study, as part of a larger research program, quantified agreement between administrative International Classification of Disease (ICD-9) coding for, and "gold standard" clinician documentation of, mental health issues (MHIs) in hospitalized heart failure (HF) patients to determine the validity of mental health administrative data for use in HF outcomes research. A 13% random sample (n = 504) was selected from all unique patients (n = 3,769) hospitalized with a primary HF diagnosis at 4 San Diego County community hospitals during 2009-2012. MHI was defined as ICD-9 discharge diagnostic coding 290-319. Records were audited for clinician documentation of MHI. A total of 43% (n = 216) had mental health clinician documentation; 33% (n = 164) had ICD-9 coding for MHI. ICD-9 code bundle 290-319 had 0.70 sensitivity, 0.97 specificity, and kappa 0.69 (95% confidence interval 0.61-0.79). More specific ICD-9 MHI code bundles had kappas ranging from 0.44 to 0.82 and sensitivities ranging from 42% to 82%. Agreement between ICD-9 coding and clinician documentation for a broadly defined MHI is substantial, and can validly "rule in" MHI for hospitalized patients with heart failure. More specific MHI code bundles had fair to almost perfect agreement, with a wide range of sensitivities for identifying patients with an MHI. Copyright © 2016 Elsevier Inc. All rights reserved.
EPA and the Occupational Safety and Health Administration (OSHA) share responsibility for prevention: OSHA has the Process Safety Management Standard to protect workers, and EPA the Risk Management Program to protect the general public and environment.
Whyte, A. A.
A survey of the internal and external reporting and recordkeeping procedures of these programs was conducted and the major problems associated with them are outlined. The impact of probable future requirements on existing information systems is evaluated. This report also presents the benefits of combining the safety and health information systems into one computerized system and recommendations for the development and scope of that system.
The person who demands a preliminary ruling concerning the temporary or permanent closing down of a nuclear installation, has to present prima facie evidence for being endangered by the operation of a certain installation. The general allegation that the installation is hazardous to his/her health is not sufficient. The applicant has to present prima facie evidence for being exposed to a radiation dose higher than the limit given in Sec. 45 Radiation Protection Ordinance. (CW).
The person who demands a preliminary ruling concerning the temporary or permanent closing down of a nuclaer installation, has to present prima facie evidence for being endangered by the operation of a certain installation. The general allegation that the installation is hazardous to his/her health is not sufficient. The applicant has to present prima facie evidence for being exposed to a radiation dose higher than the limit given in sec. 45 Radiation Protection Ordinance. (CW)
Porter Geoffrey; Urquhart Robin; Bu Jingyu; Kendell Cynthia; MacIntyre Maureen; Dewar Ron; Kephart George; Asada Yukiko; Grunfeld Eva
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...
Yoon, Gihyun; Petrakis, Ismene L; Rosenheck, Robert A
This study assesses medical and psychiatric comorbidities, service utilization, and psychotropic medication prescriptions in veterans with comorbid major depressive disorder (MDD) and alcohol use disorder (AUD) relative to veterans with MDD alone. Using cross-sectional administrative data (fiscal year [FY]2012: October 1, 2011-September 30, 2012) from the Veterans Health Administration (VHA), we identified veterans with a diagnosis of current (12-month) MDD nationally (N = 309,374), 18.8% of whom were also diagnosed with current (12-month) AUD. Veterans with both MDD and AUD were compared to those with MDD alone on sociodemographic characteristics, current (12-month) medical and psychiatric disorders, service utilization, and psychotropic prescriptions. We then used logistic regression analyses to calculate odds ratio and 95% confidence interval of characteristics that were independently different between the groups. Dually diagnosed veterans with MDD and AUD, relative to veterans with MDD alone, had a greater number of comorbid health conditions, such as liver disease, drug use disorders, and bipolar disorder as well as greater likelihood of homelessness and higher service utilization. Dually diagnosed veterans with MDD and AUD had more frequent medical and psychiatric comorbidities and more frequently had been homeless. These data suggest the importance of assessing the presence of comorbid medical/psychiatric disorders and potential homelessness in order to provide appropriately comprehensive treatment to dually diagnosed veterans with MDD and AUD and indicate a need to develop more effective treatments for combined disorders. © American Academy of Addiction Psychiatry.
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.
Mehta, Sanjay R; MacGruder, Cathy; Looney, David; Johns, Scott; Smith, Davey M
In response to a difference in pricing, the San Diego Veterans Administration Medical Center changed its tuberculin preparation from Tubersol to Aplisol in the fall of 2006. Following the change, an increased number of employee skin test conversions was noted. Employee tuberculin skin test converters from 2006 were screened with the QuantiFERON Gold (QFT-G) gamma interferon release assay. Those employees who tested negative by QFT-G were asked to repeat their skin test with both Tubersol and Aplisol tuberculin preparations. Of the new purified protein derivative converters, 12 of 14 returned for repeat testing with QFT-G, and the assay was negative for 83% (10/12), positive for 8% (1/12), and indeterminate for 8% (1/12) of the individuals. Nine of the individuals who were QFT-G negative agreed to repeat skin testing with both tuberculin preparations, and 7/8 (87.5%) demonstrated reactivity with the Aplisol preparation, while 0/8 (0%) reacted to the Tubersol preparation. A change from Tubersol to Aplisol resulted in elevated tuberculin skin test conversion rates that may be due to false-positive reactions. The differences in skin test reactivity between preparations support CDC guidelines that recommend that institutions should not change tuberculin preparations, as doing so may falsely increase the number of positive reactions.
Gazda, Nicholas P; Griffin, Emily; Hamrick, Kasey; Baskett, Jordan; Mellon, Meghan M; Eckel, Stephen F; Granko, Robert P
Purpose: The purpose of this article is to share experiences after the development of a health-system pharmacy administration residency with a MS degree and express the need for additional programs in nonacademic medical center health-system settings. Summary: Experiences with the development and implementation of a health-system pharmacy administration residency at a large community teaching hospital are described. Resident candidates benefit from collaborations with other health-systems through master's degree programs and visibility to leaders at your health-system. Programs benefit from building a pipeline of future pharmacy administrators and by leveraging the skills of residents to contribute to projects and department-wide initiatives. Tools to assist in the implementation of a new pharmacy administration program are also described and include rotation and preceptor development, marketing and recruiting, financial evaluation, and steps to prepare for accreditation. Conclusion: Health-system pharmacy administration residents provide the opportunity to build a pipeline of high-quality leaders, provide high-level project involvement, and produce a positive return on investment (ROI) for health-systems. These programs should be explored in academic and nonacademic-based health-systems.
Olga L. Zadvornaya
Full Text Available Purpose: to study and evaluate the motivational and psychological readiness of health managers to introduce and use tools and approaches to develop and improve professional performance in the context of the modernization of the health-care system, the growing need for highly skilled management skills.Based on proven methods of research, international experience and our own research, the authors proved the feasibility of using coaching as a technology of training on cycles of training, ensuring the formation and development of valuable personal qualities and professional competencies of the heads of medical organizations.Methods: in the present study, the following methods were used: systemic approach, content analysis, methods of social diagnosis (questionnaires, interviews, comparative analysis, method of expert evaluations, method of statistical processing of information.Results: reviewed and proposed approaches to use modern technology management training of health aimed at improving the efficiency of healthcare organizations.Conclusions and Relevance: heads of the medical organizations have a high level of motivation and psychological readiness for professional development, effectiveness of professional activity, to achieve the goals of the success of the activities of medical organizations in modern conditions.Coaching is one of the effective combining of different methods and techniques instrument affecting the results of the activities of individuals and the organization as a whole. In scientific research, devoted to increase of efficiency of activity of managerial staff in the healthcare, not defined methodological approaches to the use of coaching in professional development and improving professional activity of heads of medical organizations. Coaching in educational activities based on interdisciplinary scientific and practical achievements, the range of effective educational methodologies, techniques and approaches that can be
Li-Ting, Chang; Chung-Ho, Chen; Yi-Hsin, Yang; Pei-Shan, Ho
Oral cancer is a major global health problem. The complexity of histological prognosticators in oral cancer makes it difficult to compare the benefits of different treatment regimens. The Taiwanese National Health database provides an opportunity to assess correlations between outcome and treatment protocols and to compare the effects of different treatment regimens. However, the absence of indices of disease severity is a critical problem. The aim of this study was to ascertain how accurately we could assess the severity of oral cancer at the time of initial diagnosis on the basis of variables in a national database. In the cancer registry database of a medical center in Taiwan, we identified 1067 histologically confirmed cases of oral cancer (ICD9 codes 140, 141 and 143–145) that had been first diagnosed and subjected to initial treatment in this hospital. The clinical staging status was considered as the gold standard and we used concordance (C)-statistics to assess the model’s predictive performance. We added the predictors of treatment modality, cancer subsite, and age group to our models. Our final overall model included treatment regimen, site, age, and two interaction terms; namely, interactions between treatment regimen and age and those between treatment regimen, site, and age. In this model, the C-statistics were 0.82–0.84 in male subjects and 0.96–0.99 in female subjects. Of the models stratified by age, the model that considered treatment regimen and site had the highest C-statistics for the interaction term, this value being greater than 0.80 in male subjects and 0.9 in female subjects. In this study, we found that adjusting for sex, age at first diagnosis, oral cancer subsite, and therapy regimen provided the best indicator of severity of oral cancer. Our findings provide a method for assessing cancer severity when information about staging is not available from a national health-related database
Kawonga, Mary; Fonn, Sharon; Blaauw, Duane
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. 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 influence this exercise of authority. This cross-sectional survey involved interviews with 51 managers. We drew ideas from the concept of 'exercised decision-space' - traditionally used to measure local level managers' exercise of authority over health system functions following decentralisation. Our main outcome measure was the degree of exercised authority - classified as 'low', 'medium' or 'high' - over four M&E domains (HIV data collection, collation, analysis, and use). We applied ordinal logistic regression to assess whether actor type (horizontal or vertical) was predictive of a higher degree of exercised authority, independent of management capacity (training and experience), and M&E knowledge. Relative to vertical managers, horizontal managers had lower HIV M&E knowledge, were more likely to exercise a higher degree of authority over HIV data collation (OR 7.26; CI: 1.9, 27.4), and less likely to do so over HIV data use (OR 0.19; CI: 0.05, 0.84). A higher HIV M&E knowledge score was predictive of a higher exercised authority over HIV data use (OR 1.22; CI: 0.99, 1.49). There was no association between management capacity and degree of authority. This study demonstrates a HIV M&E model that is neither fully vertical nor integrated. The HIV M&E is characterised by horizontal managers producing HIV information while vertical managers use it. This may undermine policies to strengthen integrated health system planning and management under the leadership of horizontal managers.
Ford, James H.; Krahn, Dean; Wise, Meg; Oliver, Karen Anderson
Objective To examine how attributes affecting sustainability differ across VHA organizational components and by staff characteristics. Subjects Surveys of 870 change team members and 50 staff interviews within the VA’s Mental Health System Redesign initiative. Methods A one-way ANOVA with a Tukey post-hoc test examined differences in sustainability by VISN, job classification, and tenure from staff survey data of the Sustainability Index. Qualitative interviews used an iterative process to identify “a priori” and “in vivo” themes. A simple stepwise linear regression explored predictors of sustainability. Results Sustainability differed across VISN and staff tenure. Job classification differences existed for: 1) Benefits and Credibility of the change and 2) staff involvement and attitudes toward change. Sustainability barriers were: staff and institutional resistance, and non-supportive leadership. Facilitators were: commitment to veterans, strong leadership, and use of QI Tools. Sustainability predictors were outcomes tracking, regular reporting, and use of PDSA cycles. Conclusions Creating homogeneous implementation and sustainability processes across a national health system is difficult. Despite the VA’s best evidence-based implementation efforts, there was significant variance. Locally tailored interventions might better support sustainability than “one-size-fits all” approaches. Further research is needed to understand how participation in a QI collaborative affects sustainability. PMID:21971024
Maguire, E M; Bokhour, B G; Asch, S M; Wagner, T H; Gifford, A L; Gallagher, T H; Durfee, J M; Martinello, R A; Elwy, A R
We examined print, broadcast and social media reports about health care systems' disclosures of large scale adverse events to develop future effective messaging. Directed content analysis. We systematically searched four communication databases, YouTube and Really Simple Syndication (RSS) feeds relating to six disclosures of lapses in infection control practices in the Department of Veterans Affairs occurring between 2009 and 2012. We assessed these with a coding frame derived from effective crisis and risk communication models. We identified 148 unique media reports. Some components of effective communication (discussion of cause, reassurance, self-efficacy) were more present than others (apology, lessons learned). Media about 'promoting secrecy' and 'slow response' appeared in reports when time from event discovery to patient notification was over 75 days. Elected officials' quotes (n = 115) were often negative (83%). Hospital officials' comments (n = 165) were predominantly neutral (92%), and focused on information sharing. Health care systems should work to ensure that they develop clear messages focused on what is not well covered by the media, including authentic apologies, remedial actions taken, and shorten the timeframe between event identification and disclosure to patients. Published by Elsevier Ltd.
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 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 Radiation Control for Health and Safety Act of 1968. The report provides a summary of the operations of the Center in carrying out that responsibility for calendar year 1988. In reviewing the operations of the Center for Devices and Radiological Health as reported in the document, it should be kept in mind that the day-to-day administration of the Act is only part of the Center's function. Other responsibilities include the administration and enforcement of the 1976 Medical Device Amendments to the Federal Food, Drug, and Cosmetic Act (not covered in the report)
Patel, Thakor G; Pogach, Leonard M; Barth, Robert H
At the beginning of this decade, Healthy People 2010 issued a series of objectives to "reduce the incidence, morbidity, mortality and health care costs of chronic kidney disease." A necessary feature of any program to reduce the burden of kidney disease in the US population must include mechanisms to screen populations at risk and institute early the aspects of management, such as control of blood pressure, management of diabetes, and, in patients with advanced chronic kidney disease (CKD), preparation for dialysis therapy and proper vascular access management, that can retard CKD progression and improve long-term outcome. The Department of Veterans Affairs and the Veterans Health Administration is a broad-based national health care system that is almost uniquely situated to address these issues and has developed a number of effective approaches using evidence-based clinical practice guidelines, performance measures, innovative use of a robust electronic medical record system, and system oversight during the past decade. In this report, we describe the application of this systems approach to the prevention of CKD in veterans through the treatment of risk factors, identification of CKD in veterans, and oversight of predialysis and dialysis care. The lessons learned and applicability to the private sector are discussed.
Silva, Silvio Fernandes da; Souza, Nathan Mendes; Barreto, Jorge Otávio Maia
The scope of this article was to identify the boundaries of the autonomy of local administration in the context of the federal pact in the Brazilian Unified Health System and the importance and potential for promoting innovation, creativity and evidence-based decision-making by local governments. The methodology used was to ask questions that favored dialogue with the specific literature to identify the influence of centrally-formulated policies in spaces of local autonomy and then to identify strategies to foster innovation, creativity and the systematic use of evidence-based research in health policy implementation. A gradual reduction in municipal decision-making autonomy was detected due to increased financial commitment of the municipalities resulting from responsibilities assumed, albeit with the possibility of reverting this trend in the more recent context. Some determinants and challenges for the dissemination of innovative practices were analyzed and some relevant national and international experiences in this respect were presented. The conclusion drawn is that it is possible to make local decision-making more effective provided that initiatives are consolidated to promote this culture and the formulation and implementation of evidence-based health policies.
Jiwani, Aliya; Himmelstein, David; Woolhandler, Steffie; Kahn, James G
The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. BIR costs in the U.S. health care system totaled approximately $471 ($330 - $597) billion in 2012. This includes $70 ($54 - $76) billion in physician practices, $74 ($58 - $94) billion in hospitals, an estimated $94 ($47 - $141) billion in settings providing other health services and supplies, $198 ($154 - $233) billion in private insurers, and $35 ($17 - $52) billion in public insurers. Compared to simplified financing, $375
Kendall, Claire E; Younger, Jaime; Manuel, Douglas G; Hogg, William; Glazier, Richard H; Taljaard, Monica
Building on an existing theoretical shared primary care/specialist care framework to (1) develop a unique typology of care for people living with human immunodeficiency virus (HIV) in Ontario, (2) assess sensitivity of the typology by varying typology definitions, and (3) describe characteristics of typology categories. Retrospective population-based observational study from April 1, 2009, to March 31, 2012. A total of 13,480 eligible patients with HIV and receiving publicly funded health care in Ontario. We derived a typology of care by linking patients to usual family physicians and to HIV specialists with five possible patterns of care. Patient and physician characteristics and outpatient visits for HIV-related and non-HIV-related care were used to assess the robustness and characteristics of the typology. Five possible patterns of care were described as low engagement (8.6%), exclusively primary care (52.7%), family physician-dominated comanagement (10.0%), specialist-dominated comanagement (30.5%), and exclusively specialist care (5.2%). Sensitivity analyses demonstrated robustness of typology assignments. Visit patterns varied in ways that conform to typology assignments. We anticipate this typology can be used to assess the impact of care patterns on the quality of primary care for people living with HIV. Copyright © 2015 Elsevier Inc. All rights reserved.
Smith, Eric G; Austin, Karen L; Kim, Hyungjin Myra; Eisen, Susan V; Kilbourne, Amy M; Miller, Donald R; Zivin, Kara; Hannemann, Claire; Sauer, Brian C; Valenstein, Marcia
BackgroundThe mood stabilisers lithium and valproate might plausibly have differing associations with mortality because of differing effects on mental health and various physiological indicators.AimsTo assess associations between lithium, valproate and non-suicide mortality.MethodIntention-to-treat, propensity score-matched cohort study.ResultsLithium was associated with significantly reduced non-suicide mortality in the intent-to-treat cohort over 0-90 days (hazard ratio (HR) = 0.67, 95% CI 0.51-0.87) but not longer. In secondary analyses, a sizeable reduction in mortality was observed during active treatment with lithium across all time periods studied (for example 365-day HR = 0.62, 95% CI 0.45-0.84), but significantly increased risks were observed among patients discontinuing lithium by 180 days (HR = 1.54, 95% CI 1.01-2.37).ConclusionsPatients initiating lithium had lower non-suicide mortality over 0-90 days than patients initiating valproate and consistently lower non-suicide mortality among patients maintaining treatment, but elevated risk among patients discontinuing treatment by 180 days. Although residual confounding or selection effects cannot be excluded, this study suggests potential benefits to enhancing lithium treatment persistence and the monitoring of patients discontinuing lithium. There is a need for further research. © The Royal College of Psychiatrists 2015.
Hogan, Timothy; Martinez, Rachael; Evans, Charlesnika; Saban, Karen; Proescher, Eric; Steiner, Monica; Smith, Bridget
The polytraumatic nature of traumatic brain injury (TBI) makes diagnosis and treatment difficult. To (1) characterise information needs among Veterans Health Administration (VHA) polytrauma care team members engaged in the diagnosis and treatment of TBI; (2) identify sources used for TBI related information; and (3) identify barriers to accessing TBI related information. Cross-sectional online survey of 236 VHA polytrauma care team members. Most respondents (95.8%) keep at least somewhat current regarding TBI, but 31.5% need more knowledge on diagnosing TBI and 51.3% need more knowledge on treating TBI. Respondents use VHA affiliated sources for information, including local colleagues (81.7%), VHA offsite conferences/meetings (78.3%) and onsite VHA educational offerings (73.6%); however, limited time due to administrative responsibilities (50.9%), limited financial resources (50.4%) and patient care (50.4%) were prominent barriers. Medical librarians are in a unique position to develop information services, resources and other electronic tools that reflect the clinical context in which polytrauma care team members practice, and the different tasks they perform. Polytrauma care team members could benefit from additional information regarding the diagnosis and treatment of TBI. Addressing their information needs and supporting their information seeking requires a mulit-pronged approach to time and financial constraints. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
Bowman, Candice; Luck, Jeff; Gale, Randall C; Smith, Nina; York, Laura S; Asch, Steven
Disease severity, complexity, and patient burden highlight cancer care as a target for quality improvement (QI) interventions. The Veterans Health Administration (VHA) implemented a series of disease-specific online cancer care QI toolkits. To describe characteristics of the toolkits, target users, and VHA cancer care facilities that influenced toolkit access and use and assess whether such resources were beneficial for users. Deductive content analysis of detailed notes from 94 telephone interviews with individuals from 48 VHA facilities. We evaluated toolkit access and use across cancer types, participation in learning collaboratives, and affiliation with VHA cancer care facilities. The presence of champions was identified as a strong facilitator of toolkit use, and learning collaboratives were important for spreading information about toolkit availability. Identified barriers included lack of personnel and financial resources and complicated approval processes to support tool use. Online cancer care toolkits are well received across cancer specialties and provider types. Clinicians, administrators, and QI staff may benefit from the availability of toolkits as they become more reliant on rapid access to strategies that support comprehensive delivery of evidence-based care. Toolkits should be considered as a complement to other QI approaches.
Landrum, Mary Beth; Keating, Nancy L; Lamont, Elizabeth B; Bozeman, Samuel R; McNeil, Barbara J
Many studies have documented low rates of effective cancer therapies, particularly in older or minority populations. However, little is known about why effective therapies are underused in these populations. The authors examined medical records of 584 patients with cancer diagnosed or treated in Department of Veterans Affairs facilities to assess reasons for lack of 1) surgery for stage I/II nonsmall cell lung cancer, 2) surgery for stage I/II/III rectal cancer, 3) adjuvant radiation therapy for stage II/III rectal cancer, and 4) adjuvant chemotherapy for stage III colon cancer. They also assessed differences in reasons for underuse by patient age and race. Across the 4 guideline-recommended treatments, 92% to 99% of eligible patients were referred to the appropriate cancer specialist; however, therapy was recommended in only 74% to 92% of eligible cases. Poor health was cited in the medical record as the reason for lack of therapy in 15% to 61% of underuse cases; patient refusal explained 26% to 58% of underuse cases. African American patients were more likely to refuse surgery. Older patients were more likely to refuse treatments. Recommendation against therapy was a primary factor in underuse of effective therapies in older and sicker patients. Patients' refusal of therapy contributed to age and racial disparities in care. Improved data on the effectiveness of cancer therapies in community populations and interventions aimed at improved communication of known risks and benefits of therapy to cancer patients could be effective tools to reduce underuse and lingering disparities in care. Copyright © 2011 American Cancer Society.
Cookson, Richard; Laudicella, Mauro; Donni, Paolo Li
This study developed a method for measuring change in socio-economic equity in health care utilisation using small-area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving non-emergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1500 and combined with other small-area administrative data. Regression models of utilisation were used to examine year-on-year change in the small-area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003 to 2008) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006 to 2008) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small-area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall non-emergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement. Copyright © 2012 Elsevier Ltd. All rights reserved.
Bohnert, Kipling M; Ilgen, Mark A; Louzon, Samantha; McCarthy, John F; Katz, Ira R
Limited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care. A cohort study using national administrative health records. National VHA system, USA. All VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 (n = 4 863 086). The primary outcome of suicide mortality was assessed via FY 2006-2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004-2005 VHA National Patient Care Database (NPCD) records. In unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females [hazard ratios (HRs)] ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women]. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men (P suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder (P suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co-occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women. Published 2017. This article is a U.S. Government work and is in the public domain in the
Valenstein, Paul N; Wang, Edward; O'Donohue, Tom
The Veterans Health Administration (VA) operates the largest integrated laboratory network in the United States. To assess whether the unique characteristics of VA laboratories impact efficiency of operations, we compared the productivity of VA and non-VA facilities. Financial and activity data were prospectively collected from 124 VA and 131 non-VA laboratories enrolled in the College of American Pathologists Laboratory Management Index Program (LMIP) during 2002. In addition, secular trends in 5 productivity ratios were calculated for VA and non-VA laboratories enrolled in LMIP from 1997 through 2002. Veterans Health Administration and non-VA facilities did not differ significantly in size. Inpatients accounted for a lower percentage of testing at VA facilities than non-VA facilities (21.7% vs 37.3%; P benefits; P depreciation, and maintenance than their non-VA counterparts (all P <.001), resulting in lower overall cost per on-site test result (2.64 dollars vs 3.40 dollars; P <.001). Cost per referred (sent-out) test did not differ significantly between the 2 groups. Analysis of 6-year trends showed significant increases in both VA (P <.001) and non-VA (P =.02) labor productivity (on-site tests/total FTE). Expenses at VA laboratories for labor per test, consumables per test, overall expense per test, and overall laboratory expense per discharge decreased significantly during the 6-year period (P <.001), while in non-VA facilities the corresponding ratios showed no significant change. Overall productivity of VA laboratories is superior to that of non-VA facilities enrolled in LMIP. The principal advantages enjoyed by the VA are higher-than-average labor productivity (tests/FTE) and lower-than-average consumable expenses.
Kukla, Marina; McGuire, Alan B; Strasburger, Amy M; Belanger, Elizabeth; Bakken, Shana K
Veterans Health Administration vocational services assist veterans with mental illness to acquire jobs; one major component of these services is job development. The purpose of this study was to characterize the nature of effective job development practices and to examine perceptions and intensity of job development services. A national mixed-methods online survey of 233 Veterans Health Administration vocational providers collected data regarding frequency of employer contacts, perceptions of job development ease/difficulty, and effective job development practices when dealing with employers. Qualitative responses elucidating effective practices were analyzed using content analysis. Vocational providers had a modest number of job development employer contacts across 2 weeks (M = 11.0, SD = 10.6) and fewer were face-to-face (M = 7.6, SD = 8.4). Over 70% of participants perceived job development to be difficult. Six major themes emerged regarding effective job development practices with employers: using an employer-focused approach; utilizing a targeted marketing strategy; engaging in preparation and follow-up; going about the employer interaction with genuineness, resilience, and a strong interpersonal orientation; serving as an advocate for veterans and educator of employers; utilizing specific employer-tailored strategies, such as arranging a one-on-one meeting with a decision maker and touring the business, individualizing a prescripted sales pitch, connecting on a personal level, and engaging in ongoing communication to solidify the working relationship. Respondents highlight several potentially effective job development strategies; tools and resources may be developed around these strategies to bolster job development implementation and allow opportunities for fruitful employer interactions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Mittaine-Marzac, Benedicte; De Stampa, Matthieu; Bagaragaza, Emmanuel; Ankri, Joël; Aegerter, Philippe
Despite the demonstrated feasibility and policies to enable more to receive chemotherapy at home, in a few countries, parenteral chemotherapy administration at home remains currently marginal. Of note, findings of different studies on health outcomes and resources utilisation vary, leading to conflicting results. This protocol outlines a systematic review that seeks to synthesise and critically appraise the current state of evidence on the comparison between home setting and hospital setting for parenteral chemotherapy administration within the same high standards of clinical care. This protocol has been prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols approach. Electronic searches will be conducted on bibliographic databases selected from the earliest available data through 15 November 2017 published in French and English languages. Additional potential papers in the selected studies and grey literature will be also included in the review. The review will include all types of studies exploring patients receiving anticancer drugs for injection at home compared with patients receiving the drugs in a hospital setting, and will assess at least one of the following criteria: patients' health outcomes, patients' or caregivers' satisfaction, resource utilisation with cost savings, and incentives and/or barriers of each admission setting according to patients' and relatives' points of view. Two reviewers will independently screen studies and extract relevant data from the included studies. Methodological quality of studies will be assessed using the 'Quality Assessment Tool for Quantitative Studies' developed by the Effective Public Health Practice Project tool, in addition to the Consolidated Health Economic Evaluation Reporting Standards statement for economic studies. As the review is focused on the analysis of secondary data, it does not require ethics approval. The results of the study will be disseminated through
Wright, Brad; OʼShea, Amy M J; Glasgow, Justin M; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary
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 and enrollment files, American Hospital Association Survey, and Area Health Resource File. We used these data to estimate linear regression models of hospitals' observation stay rates as a function of hospital, patient, and local health system characteristics, while controlling for time trends and Veterans Integrated Service Network level fixed effects.We found that observation stay rates are inversely related to hospital bed size and that hospitals with a greater proportion of younger or rural patients have higher observation stay rates. Observation stay rates were nearly 15 percentage points higher in 2012 than 2005.Although we identify several characteristics associated with variation in VHA hospital observation stay rates, many factors remain unmeasured.
Inobaya, Marianette T; Chau, Thao N; Ng, Shu-Kay; MacDougall, Colin; Olveda, Remigio M; Tallo, Veronica L; Landicho, Jhoys M; Malacad, Carol M; Aligato, Mila F; Guevarra, Jerric R; Ross, Allen G
Schistosomiasis control is centred on preventive chemotherapy through mass drug administration (MDA). However, endemic countries continue to struggle to attain target coverage rates and patient compliance. In the Philippines, barangay health workers (BHWs) play a vital role in the coordination of MDA, acting as advocates, implementers, and educators. The aim of this study was to determine whether BHW knowledge and attitudes towards schistosomiasis and MDA is sufficient and correlated with resident knowledge and drug compliance. A cross-sectional survey was conducted in 2015 among 2186 residents and 224 BHWs in the province of Northern Samar, the Philippines using a structured survey questionnaire. BHWs showed good familiarity on how schistosomiasis is acquired and diagnosed. Nevertheless, both BHWs and residents had poor awareness of the signs and symptoms of schistosomiasis, disease prevention, and treatment options. There was no correlation between the knowledge scores of the BHWs and the residents (r=0.080, p=0.722). Kruskal-Wallis analysis revealed significant differences in BHW knowledge scores between the low (3.29, 95% confidence interval 3.16-3.36), moderate (3.61, 95% confidence interval 3.49-3.69), and high (4.05, 95% confidence interval 3.77-4.13) compliance village groups (p=0.002), with the high compliance areas having the highest mean knowledge scores. This study highlights the importance of community health workers in obtaining the World Health Organization drug coverage rate of 75% and improving compliance with MDA in the community. Investing in the education of community health workers with appropriate disease-specific training is crucial if disease elimination is ultimately to be achieved. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Bukowski, Leigh A; Blosnich, John; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Gordon, Adam J
Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.
Mooney, C; Farrier, D
Kangaroo Valley is a drinking water supply catchment for Kangaroo Valley village, parts of the Southern Highlands and Sydney. It is also a popular recreation area both for swimming and canoeing. Land use has traditionally been dominated by dairy farming but there has been significant and continuing development of land for hobby farms and rural residential subdivision. Dairy industry restructuring has affected the viability of some farms in the Valley and created additional pressure for subdivision. River health is a function of flows, water quality, riparian vegetation, geomorphology and aquatic habitat and riverine biota. River flows in the Kangaroo River are affected by water extraction and storage for urban water supply and extraction by commercial irrigators and riparian land holders which have a significant impact at low flows. Current water quality often does not meet ANZECC Guidelines for primary contact and recreation and the river is a poor source of raw drinking water. Key sources of contaminants are wastewater runoff from agriculture, and poorly performing on-site sewage management systems. Riparian vegetation, which is critical to the maintenance of in-stream ecosystems suffers from uncontrolled stock access and weed infestation. The management of land use and resulting diffuse pollution sources is critical to the long term health of the river. The Healthy Rivers Commission of New South Wales Independent Inquiry into the Shoalhaven River System Final Report July, 1999 found that the longer term protection of the health of the Kangaroo River is contingent upon achievement of patterns of land use that have regard to land capability and also to the capability of the river to withstand the impacts of inappropriate or poorly managed land uses. This micro case study of Kangaroo Valley examines the complex legal and administrative arrangements with particular reference to the management of diffuse pollution for river health. In the past, diffuse pollution has
Miller, Laura J; Ghadiali, Nafisa Y
This pilot study aims to ascertain the prevalence of self-reported premenstrual, perinatal, and perimenopausal influences on mental health, and of gynecologic conditions that could interact with psychiatric conditions, among women veterans receiving psychiatric care within a Veterans Administration (VA) Women's Health Clinic (WHC). Participants included all women veterans (N=68) who received psychiatric evaluations within a VA WHC over a 5-month period. This setting encompasses colocated and coordinated primary care, gynecologic and mental health services. Evaluations included a Women's Mental Health Questionnaire, a psychiatric interview, and medical record review. Deidentified data were extracted from a clinical data repository for this descriptive study. High proportions of study participants reported that their emotional problems intensified premenstrually (42.6%), during pregnancy (33.3%), in the postpartum period (33.3%), or during perimenopause (18.2%). Unintended pregnancy (70.0% of pregnancies) and pregnancy loss (63.5% of women who had been pregnant) were prominent sex-linked stressors. Dyspareunia (22.1% of participants) and pelvic pain (17.6% of participants) were frequent comorbidities. Among women veterans receiving psychiatric care within a VA WHC, there are high rates of self-reported premenstrual, perinatal, and perimenopausal influences on mental health. This population also has substantial comorbidity of psychiatric disorders with dyspareunia and pelvic pain. This underscores the importance of recognizing and addressing women veterans' sex-specific care needs, including interactions among reproductive cycle phases, gynecologic pain, and psychiatric symptoms. The findings support the need for greater awareness of the sex-specific mental health needs of women veterans, and for more definitive studies to further characterize these needs.
Full Text Available 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 influence this exercise of authority. Methods: This cross-sectional survey involved interviews with 51 managers. We drew ideas from the concept of ‘exercised decision-space’ – traditionally used to measure local level managers’ exercise of authority over health system functions following decentralisation. Our main outcome measure was the degree of exercised authority – classified as ‘low’, ‘medium’ or ‘high’ – over four M&E domains (HIV data collection, collation, analysis, and use. We applied ordinal logistic regression to assess whether actor type (horizontal or vertical was predictive of a higher degree of exercised authority, independent of management capacity (training and experience, and M&E knowledge. Results: Relative to vertical managers, horizontal managers had lower HIV M&E knowledge, were more likely to exercise a higher degree of authority over HIV data collation (OR 7.26; CI: 1.9, 27.4, and less likely to do so over HIV data use (OR 0.19; CI: 0.05, 0.84. A higher HIV M&E knowledge score was predictive of a higher exercised authority over HIV data use (OR 1.22; CI: 0.99, 1.49. There was no association between management capacity and degree of authority. Conclusions: This study demonstrates a HIV M&E model that is neither fully vertical nor integrated. The HIV M&E is characterised by horizontal managers producing HIV information while vertical managers use it. This may undermine policies to strengthen integrated health system
Weiner, Bryan J; Haynes-Maslow, Lindsey; Kahwati, Leila C; Kinsinger, Linda S; Campbell, Marci K
One-third of US veterans receiving care at Veterans Health Administration (VHA) medical facilities are obese and, therefore, at higher risk for developing multiple chronic diseases. To address this problem, the VHA designed and nationally disseminated an evidence-based weight-management program (MOVE!). The objective of this study was to examine the organizational factors that aided or inhibited the implementation of MOVE! in 10 VHA medical facilities. Using a multiple, holistic case study design, we conducted 68 interviews with medical center program coordinators, physicians formally appointed as program champions, managers directly responsible for overseeing the program, clinicians from the program's multidisciplinary team, and primary care physicians identified by program coordinators as local opinion leaders. Qualitative data analysis involved coding, memorandum writing, and construction of data displays. Organizational readiness for change and having an innovation champion were most consistently the 2 factors associated with MOVE! implementation. Other organizational factors, such as management support and resource availability, were barriers to implementation or exerted mixed effects on implementation. Barriers did not prevent facilities from implementing MOVE! However, they were obstacles that had to be overcome, worked around, or accepted as limits on the program's scope or scale. Policy-directed implementation of clinical weight-management programs in health care facilities is challenging, especially when no new resources are available. Instituting powerful, mutually reinforcing organizational policies and practices may be necessary for consistent, high-quality implementation.
Ribesse, Nathalie; Bossyns, Paul; Marchal, Bruno; Karemere, Hermes; Burman, Christopher J; Macq, Jean
In the field of development cooperation, interest in systems thinking and complex systems theories as a methodological approach is increasingly recognised. And so it is in health systems research, which informs health development aid interventions. However, practical applications remain scarce to date. The objective of this article is to contribute to the body of knowledge by presenting the tools inspired by systems thinking and complexity theories and methodological lessons learned from their application. These tools were used in a case study. Detailed results of this study are in process for publication in additional articles. Applying a complexity 'lens', the subject of the case study is the role of long-term international technical assistance in supporting health administration reform at the provincial level in the Democratic Republic of Congo. The Methods section presents the guiding principles of systems thinking and complex systems, their relevance and implication for the subject under study, and the existing tools associated with those theories which inspired us in the design of the data collection and analysis process. The tools and their application processes are presented in the results section, and followed in the discussion section by the critical analysis of their innovative potential and emergent challenges. The overall methodology provides a coherent whole, each tool bringing a different and complementary perspective on the system.
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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
We Need Action on Social Determinants of Health - but Do We Want It, too? Comment on "Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities".
de Leeuw, Evelyne
Recently a number of calls have been made to mobilise the arsenal of political science insights to investigate - and point to improvements in - the social determinants of health (SDH), and health equity. Recently, in this journal, such a rallying appeal was made for the field of public administration. This commentary argues that, although scholarly potential should justifiably be redirected to resolve these critical issues for humanity, a key ingredient in taking action may have been neglected. This factor is 'community.' Community health has been a standard element of the public health and health promotion, even political, repertoire for decades now. But this commentary claims that communities are insufficiently charged, equipped or appreciated to play the role that scholarship attributes (or occasionally avoids to identify) to them. Community is too important to not fully engage and understand. Rhetorical tools and inquiries can support their quintessential role. © 2016 by Kerman University of Medical Sciences.
We Need Action on Social Determinants of Health – but Do We Want It, too? Comment on “Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities”
Evelyne de Leeuw
Full Text Available Recently a number of calls have been made to mobilise the arsenal of political science insights to investigate – and point to improvements in – the social determinants of health (SDH, and health equity. Recently, in this journal, such a rallying appeal was made for the field of public administration. This commentary argues that, although scholarly potential should justifiably be redirected to resolve these critical issues for humanity, a key ingredient in taking action may have been neglected. This factor is ‘community.’ Community health has been a standard element of the public health and health promotion, even political, repertoire for decades now. But this commentary claims that communities are insufficiently charged, equipped or appreciated to play the role that scholarship attributes (or occasionally avoids to identify to them. Community is too important to not fully engage and understand. Rhetorical tools and inquiries can support their quintessential role.
Arout, Caroline A; Sofuoglu, Mehmet; Bastian, Lori A; Rosenheck, Robert A
Fibromyalgia is a poorly understood, chronically disabling pain syndrome. While research has focused on its clinical presentation and treatment, less is known about fibromyalgia's clinical epidemiology in real-world healthcare systems. Gender differences have been difficult to study because relatively few males are diagnosed with fibromyalgia. Veterans Health Administration (VHA) patients diagnosed with fibromyalgia nationwide in FY 2012 were compared to Veterans with other pain diagnoses on sociodemographic characteristics, medical and psychiatric diagnoses, health service use, and opioid and psychotropic prescription fills. Additional analyses compared characteristics of men and women diagnosed with fibromyalgia. Risk ratios and Cohen's d were used for bivariate comparisons, followed by logistic regression analyses to identify independent factors associated with a diagnosis of fibromyalgia in the VHA. Altogether, 77,087 of 2,216,621 Veterans with pain diagnoses (3.48%) were diagnosed with fibromyalgia. They were more likely to be female, younger than patients with other pain conditions, more likely to have multiple psychiatric comorbidities and other types of pain, and used more medical outpatient services. Women diagnosed with fibromyalgia were younger and more likely to have headaches, connective tissue diseases (CTD), and psychiatric comorbidities, while men had more comorbid medical conditions. In this large, predominantly older male sample of Veterans with pain diagnoses, those with fibromyalgia were far more likely to be women. Gender comparisons showed women with fibromyalgia were more likely to be diagnosed with psychiatric disorders and CTD, while males were more likely to be diagnosed with medical conditions. Fibromyalgia shows a striking, gender-dependent picture of multimorbidity, which should be considered in treatment.
Taleo, Fasihah; Taleo, George; Graves, Patricia M; Wood, Peter; Kim, Sung Hye; Ozaki, Masayo; Joseph, Hayley; Chu, Brian; Pavluck, Alex; Yajima, Aya; Melrose, Wayne; Ichimori, Kazuyo; Capuano, Corinne
Vanuatu was formerly highly endemic for lymphatic filariasis (LF), caused by Wuchereria bancrofti and transmitted by Anopheles mosquitoes. After a baseline survey showing 4.8% antigen prevalence in 1998, the country conducted nationwide (in one implementation unit) annual mass drug administration (MDA) with albendazole and diethylcarbamazine citrate from 2000 to 2004 and achieved prevalence of 0.2% by 2006 in a representative nationwide cluster survey among all age groups. Post MDA surveillance was conducted from 2006 to 2012. After MDA, the country was divided for surveillance into three evaluation units (EUs) formed by grouping provinces according to baseline prevalence: EU1: Torba, Sanma and Malampa; EU2: Penama; EU3: Shefa and Tafea. The study compiled all past data and information on surveys in Vanuatu from the country programme. This paper reviews the surveillance activities done after stopping MDA to validate the interruption of transmission and elimination of LF as a public health problem. Post-MDA surveillance consisting of at least three transmission assessment surveys (TAS) in each of the three EUs was conducted between 2006 and 2012. Sentinel and spot check surveys identified a few villages with persistent high prevalence; all antigen positive cases in these sites were treated and additional targeted MDA conducted for 3 years in 13 villages in one area of concern. All three EUs passed all TAS in 2007, 2010 and 2012 respectively, with no positives found except in EU2 (Penama province) in 2012 when 2 children tested positive for circulating filariasis antigen. Assessment of the burden of chronic filariasis morbidity found 95 cases in 2003 and 32 remaining cases in 2007, all aged over 60 years. Vanuatu has achieved validation of elimination of LF as a public health problem. Post-validation surveillance is still recommended especially in formerly highly endemic areas.
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
Shay, Kenneth; Hyduke, Barbara; Burris, James F
The leaders of Geriatrics and Extended Care (GEC) in the Veterans Health Administration (VHA) undertook a strategic planning process that led to approval in 2009 of a multidisciplinary, evidence-guided strategic plan. This article reviews the four goals contained in that plan and describes VHA's progress in addressing them. The goals included transforming the healthcare system to a veteran-centric approach, achieving universal access to a panel of services, ensuring that the Veterans Affair's (VA) healthcare workforce was adequately prepared to manage the needs of the growing elderly veteran population, and integrating continuous improvement into all care enhancements. There has been substantial progress in addressing all four goals. All VHA health care has undergone an extensive transformation to patient-centered care, has enriched the services it can offer caregivers of dependent veterans, and has instituted models to better integrate VA and non-VA cares and services. A range of successful models of geriatric care described in the professional literature has been adapted to VA environments to gauge suitability for broader implementation. An executive-level task force developed a three-pronged approach for enhancing the VA's geriatric workforce. The VHA's performance measurement approaches increasingly include incentives to enhance the quality of management of vulnerable elderly adults in primary care. The GEC strategic plan was intended to serve as a road map for keeping VHA aligned with an ambitious but important long-term vision for GEC services. Although no discrete set of resources was appropriated for fulfillment of the plan's recommendations, this initial report reflects substantial progress in addressing most of its goals. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
Macpherson, Eleanor E; Adams, Emily R; Bockarie, Moses J; Hollingsworth, T Deirdre; Kelly-Hope, Louise A; Lehane, Mike; Kovacic, Vanja; Harrison, Robert A; Paine, Mark Ji; Reimer, Lisa J; Torr, Stephen J
Achieving the 2020 goals for Neglected Tropical Diseases (NTDs) requires scale-up of Mass Drug Administration (MDA) which will require long-term commitment of national and global financing partners, strengthening national capacity and, at the community level, systems to monitor and evaluate activities and impact. For some settings and diseases, MDA is not appropriate and alternative interventions are required. Operational research is necessary to identify how existing MDA networks can deliver this more complex range of interventions equitably. The final stages of the different global programmes to eliminate NTDs require eliminating foci of transmission which are likely to persist in complex and remote rural settings. Operational research is required to identify how current tools and practices might be adapted to locate and eliminate these hard-to-reach foci. Chronic disabilities caused by NTDs will persist after transmission of pathogens ceases. Development and delivery of sustainable services to reduce the NTD-related disability is an urgent public health priority. LSTM and its partners are world leaders in developing and delivering interventions to control vector-borne NTDs and malaria, particularly in hard-to-reach settings in Africa. Our experience, partnerships and research capacity allows us to serve as a hub for developing, supporting, monitoring and evaluating global programmes to eliminate NTDs.
Monteith, Lindsey L; Bahraini, Nazanin H; Matarazzo, Bridget B; Gerber, Holly R; Soberay, Kelly A; Forster, Jeri E
No studies have examined whether military sexual trauma, as measured and defined within the Veterans Health Administration (VHA), is associated with suicidal ideation among Veterans in VHA care, when taking prior suicide attempts into account. Research regarding the role of gender in this association is also limited. The present study examined: (1) whether military sexual trauma was associated with the presence of past-week suicidal ideation among 354 Veterans in VHA (310 men, 44 women); (2) whether gender moderated the association between military sexual trauma and suicidal ideation. Information regarding military sexual trauma, suicidal ideation, suicide attempt, and psychiatric diagnoses was obtained from self-report instruments and medical records. Adjusting for age, gender, combat, posttraumatic stress disorder, depressive disorders, negative affect, and lifetime suicide attempt, Veterans with military sexual trauma were significantly more likely to report suicidal ideation, compared to Veterans without military sexual trauma. Furthermore, the association between military sexual trauma and suicidal ideation was stronger for men compared to women. These results contribute to a growing literature identifying military sexual trauma as a risk factor for suicidal thoughts and behaviors among Veterans in VHA care and emphasize the importance of screening for suicidal ideation among survivors of military sexual trauma. Published by Elsevier Ireland Ltd.
Copeland, Laurel A; Sako, Edward Y; Zeber, John E; Pugh, Mary Jo; Wang, Chen-Pin; MacCarthy, Andrea A; Restrepo, Marcos I; Mortensen, Eric M; Lawrence, Valerie A
To estimate 1-year mortality risk associated with preoperative serious mental illness (SMI) as defined by the Veterans Health Administration (schizophrenia, bipolar disorder, posttraumatic stress disorder [PTSD], major depression) following nonambulatory cardiac or vascular surgical procedures compared to patients without SMI. Cardiac/vascular operations were selected because patients with SMI are known to be at elevated risk of cardiovascular disease. Retrospective analysis of system-wide data from electronic medical records of patients undergoing nonambulatory surgery (inpatient or day-of-surgery admission) October 2005-September 2009 with 1-year follow-up (N=55,864; 99% male; operations (64%; 23% died), coronary artery bypass graft (26%; 10% died) or other cardiac operations (11%; 15%-18% died). Fourteen percent of patients with PTSD died, 20% without SMI and 24% with schizophrenia, with other groups intermediate. In multivariable stratified models, SMI was associated with increased mortality only for patients with bipolar disorder following cardiac operations. Bipolar disorder and PTSD were negatively associated with death following vascular operations. SMI is not consistently associated with postoperative mortality in covariate-adjusted analyses. Published by Elsevier Inc.
Zubkoff, Lisa; Neily, Julia; Mills, Peter D; Borzecki, Ann; Shin, Marlena; Lynn, Marilyn M; Gunnar, William; Rosen, Amy
The Institute for Healthcare Improvement (IHI) Virtual Breakthrough Series (VBTS) process was used in an eight-month (June 2011-January 2012) quality improvement (QI) project to improve care related to reducing postoperative respiratory failure. The VBTS collaborative drew on Patient Safety Indicator 11: Postoperative Respiratory Failure Rate to guide changes in care at the bedside. Sixteen Veterans Health Administration hospitals, each representing a regional Veterans Integrated Service Network, participated in the QI project. During the prework phase (initial two months), hospitals formed multidisciplinary teams, selected measures related to their goals, and collected baseline data. The six-month action phase included group conference calls in which the faculty presented clinical background on the topic, discussed evidence-based processes of care, and/or presented content regarding reducing postoperative respiratory failure. During a final, six-month continuous improvement and spread phase, teams were to continue implementing changes as part of their usual processes. The six most commonly reported interventions to reduce postoperative respiratory failure focused on improving incentive spirometer use, documenting implementation of targeted interventions, oral care, standardized orders, early ambulation, and provider education. A few teams reported reduced ICU readmissions for respiratory failure. The VBTS collaborative helped teams implement process changes to help reduce postoperative respiratory complications. Teams reported initial success at implementing site-specific improvements using real-time data. The VBTS model shows promise for knowledge sharing and efficient multifacility improvement efforts, although long-term sustainability and testing in these and other settings need to be examined.
Burgess, James F; Shwartz, Michael; Stolzmann, Kelly; Sullivan, Jennifer L
To examine the relationship between cost and quality in Veterans Health Administration (VA) nursing homes (called Community Living Centers, CLCs) using longitudinal data. One hundred and thirty CLCs over 13 quarters (from FY2009 to FY2012) were studied. Costs, resident days, and resident severity (RUGs score) were obtained from the VA Managerial Cost Accounting System. Clinical quality measures were obtained from the Minimum Data Set, and resident-centered care (RCC) was measured using the Artifacts of Culture Change Tool. We used a generalized estimating equation model with facilities included as fixed effects to examine the relationship between total cost and quality after controlling for resident days and severity. The model included linear and squared terms for all independent variables and interactions with resident days. With the exception of RCC, all other variables had a statistically significant relationship with total costs. For most poorer performing smaller facilities (lower size quartile), improvements in quality were associated with higher costs. For most larger facilities, improvements in quality were associated with lower costs. The relationship between cost and quality depends on facility size and current level of performance. © Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
Frakt, Austin B; Pizer, Steven D; Hendricks, Ann M
Medicare and the Veterans Health Administration (VA) both finance large outpatient prescription drug programs, though in very different ways. In the ongoing debate on how to control Medicare spending, some suggest that Medicare should negotiate directly with drug manufacturers, as the VA does. In this article we relate the role of interest groups to policy differences between Medicare and the VA and, in doing so, explain why such a large change to the Medicare drug program is unlikely. We argue that key policy differences are attributable to stable differences in interest group involvement. While this stability makes major changes in Medicare unlikely, it suggests the possibility of leveraging VA drug purchasing to achieve savings in Medicare. This could be done through a VA-administered drug-only benefit for Medicare-enrolled veterans. Such a partnership could incorporate key elements of both programs: capacity to accept large numbers of enrollees (like Medicare) and leverage to negotiate prescription drug prices (like the VA). Moreover, it could be implemented at no cost to the VA while achieving savings for Medicare and beneficiaries.
Kim, Hyungjin Myra; Smith, Eric G; Stano, Claire M; Ganoczy, Dara; Zivin, Kara; Walters, Heather; Valenstein, Marcia
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"). Three random samples of patients were selected, each stratified by geographic region, gender, and year of cohort entry, from a VHA depression treatment cohort from April 1, 1999 to September 30, 2004. The first sample was selected from patients who died by suicide, the second from patients who remained alive on the date of death of suicide cases, and the third from patients with a new start of a commonly used antidepressant medication. Four variables were assessed using administrative codes in the year prior to the index date: suicide attempt, alcohol abuse/dependence, drug abuse/dependence and tobacco use. Specificity was high (≥ 90%) for all four administrative codes, regardless of the sample. Sensitivity was ≤75% and was particularly low for suicide attempt (≤ 17%). Positive predictive values for alcohol dependence/abuse and tobacco use were high, but barely better than flipping a coin for illicit drug abuse/dependence. Sensitivity differed across the three samples, but was highest in the suicide death sample. Administrative data-based diagnoses among VHA records have high specificity, but low sensitivity. The accuracy level varies by different diagnosis and by different patient subgroup.
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
Lavoue, J; Friesen, M C; Burstyn, I
Inspectors from the US Occupational Safety and Health Administration (OSHA) have been collecting industrial hygiene samples since 1972 to verify compliance with Permissible Exposure Limits. Starting in 1979, these measurements were computerized into the Integrated Management Information System (IMIS). In 2010, a dataset of over 1 million personal sample results analysed at OSHA's central laboratory in Salt Lake City [Chemical Exposure Health Data (CEHD)], only partially overlapping the IMIS database, was placed into public domain via the internet. We undertook this study to inform potential users about the relationship between this newly available OSHA data and IMIS and to offer insight about the opportunities and challenges associated with the use of OSHA measurement data for occupational exposure assessment. We conducted a literature review of previous uses of IMIS in occupational health research and performed a descriptive analysis of the data recently made available and compared them to the IMIS database for lead, the most frequently sampled agent. The literature review yielded 29 studies reporting use of IMIS data, but none using the CEHD data. Most studies focused on a single contaminant, with silica and lead being most frequently analysed. Sixteen studies addressed potential bias in IMIS, mostly by examining the association between exposure levels and ancillary information. Although no biases of appreciable magnitude were consistently reported across studies and agents, these assessments may have been obscured by selective under-reporting of non-detectable measurements. The CEHD data comprised 1 450 836 records from 1984 to 2009, not counting analytical blanks and erroneous records. Seventy eight agents with >1000 personal samples yielded 1 037 367 records. Unlike IMIS, which contain administrative information (company size, job description), ancillary information in the CEHD data is mostly analytical. When the IMIS and CEHD measurements of lead were merged
Jaglal, Susan B; Guilcher, Sara J T; Hawker, Gillian; Lou, Wendy; Salbach, Nancy M; Manno, Michael; Zwarenstein, Merrick
Internationally, chronic disease self-management programs (CDSMPs) have been widely promoted with the assumption that confident, knowledgeable patients practicing self-management behavior will experience improved health and utilize fewer healthcare resources. However, there is a paucity of published data supporting this claim and the majority of the evidence is based on self-report. We used a retrospective cohort study using linked administrative health data. Data from 104 tele-CDSMP participants from 13 rural and remote communities in the province of Ontario, Canada were linked to administrative databases containing emergency department (ED) and physician visits and hospitalizations. Patterns of health care utilization prior to and after participation in the tele-CDSMP were compared. Poisson Generalized Estimating Equations regression was used to examine the impact of the tele-CDSMP on health care utilization after adjusting for covariates. There were no differences in patterns of health care utilization before and after participating in the tele-CDSMP. Among participants ≤ 66 years, however, there was a 34% increase in physician visits in the 12 months following the program (OR = 1.34, 95% CI 1.11-1.61) and a trend for decreased ED visits in those >66 years (OR = 0.59, 95% CI 0.33-1.06). This is the first study to examine health care use following participation in the CDSMP in a Canadian population and to use administrative data to measure health care utilization. Similar to other studies that used self-report measures to evaluate health care use we found no differences in health care utilization before and after participation in the CDSMP. Future research needs to confirm our findings and examine the impact of the CDSMP on health care utilization in different age groups to help to determine whether these interventions are more effective with select population groups.
Britton, Peter C; Bohnert, Kipling M; Ilgen, Mark A; Kane, Cathleen; Stephens, Brady; Pigeon, Wilfred R
The purpose of this study was to calculate suicide rates and identify correlates of risk in the year following discharge from acute Veterans Health Administration psychiatric inpatient units among male veterans discharged from 2005 to 2010 (fiscal years). Suicide rates and standardized mortality ratios were calculated. Descriptive analyses were used to describe suicides and non-suicides and provide base rates for interpretation, and unadjusted and adjusted proportional hazard models were used to identify correlates of suicide. From 2005 to 2010, 929 male veterans died by suicide in the year after discharge and the suicide rate was 297/100,000 person-years (py). The suicide rate significantly increased from 234/100,000 py (95% CI = 193-282) in 2005 to 340/100,000 py (95% CI = 292-393) in 2008, after which it plateaued. Living in a rural setting, HR (95% CI) = 1.20 (1.05, 1.36), and being diagnosed with a mood disorder such as major depression, HR (95% CI) = 1.60 (1.36, 1.87), or other anxiety disorder, HR (95% CI) = 1.52 (1.24, 1.87), were associated with increased risk for suicide. Among male veterans, the suicide rate in the year after discharge from acute psychiatric hospitalization increased from 2005 to 2008, after which it plateaued. Prevention efforts should target psychiatrically hospitalized veterans who live in rural settings and/or are diagnosed with mood or other anxiety disorders.
Neily, Julia; Chomsky, Amy; Orcutt, James; Paull, Douglas E; Mills, Peter D; Gilbert, Christina; Hemphill, Robin R; Gunnar, William
The study goals were to examine wrong intraocular lens (IOL) implant adverse events in the Veterans Health Administration (VHA), identify root causes and contributing factors, and describe system changes that have been implemented to address this challenge. This study represents collaboration between the VHA's National Center for Patient Safety (NCPS) and the National Surgery Office (NSO). This report includes 45 wrong IOL implant surgery adverse events reported to established VHA NCPS and NSO databases between July 1, 2006, and June 31, 2014. There are approximately 50,000 eye implant procedures performed each year in the VHA. Wrong IOL implant surgery adverse events are reported by VHA facilities to the NCPS and the NSO. Two authors (A.C. and J.N.) coded the reports for event type (wrong lens or expired lens) and identified the primary contributing factor (coefficient κ = 0.837). A descriptive analysis was conducted, which included the reported yearly event rate. The main outcome measure was the reported wrong IOL implant surgery adverse events. There were 45 reported wrong IOL implant surgery adverse events. Between 2011 and June 30, 2014, there was a significant downward trend (P = 0.02, R = 99.7%) at a pace of -0.08 (per 10,000 cases) every year. The most frequently coded primary contributing factor was incomplete preprocedure time-out (n = 12) followed by failure to perform double check of preprocedural calculations based upon original data and implant read-back at the time the surgical eye implant was performed (n = 10). Preventing wrong IOL implant adverse events requires diligence beyond performance of the preprocedural time-out. In 2013, the VHA has modified policy to ensure double check of preprocedural calculations and implant read-back with positive impact. Continued analysis of contributing human factors and improved surgical team communication are warranted.
Chavez, Laura J; Williams, Emily C; Lapham, Gwen T; Rubinsky, Anna D; Kivlahan, Daniel R; Bradley, Katharine A
Brief alcohol interventions are recommended for primary care patients who screen positive for alcohol misuse, but implementation is challenging. The U.S. Veterans Health Administration (Veterans Affairs [VA]) implemented brief interventions for patients with alcohol misuse in 2008, and rates of brief interventions documented in the electronic medical record increased from 24% to 78% (2008-2011). This study examined whether an independent measure of brief interventions-patient-reported alcohol-related advice-also increased among VA outpatients who screened positive for alcohol misuse on a mailed survey. This retrospective cross-sectional study included VA outpatient respondents to the VA's Survey of Healthcare Experiences of Patients (SHEP; 2007-2011) who reported past-year alcohol use and answered a question about alcohol-related advice. Alcohol-related advice was defined as a report of past-year advice from a VA clinician to abstain from or reduce drinking. The adjusted prevalence of alcoholrelated advice among patients who screened positive for alcohol misuse (SHEP AUDIT-C ≥ 5) was estimated for each year. Among patients with alcohol misuse (n = 61,843), the adjusted prevalence of alcohol-related advice increased from 40.4% (95% CI [39.3%, 41.5%]) in 2007 to 55.5% (95% CI [53.3%, 57.8%]) in 2011. Rates of alcoholrelated advice increased significantly each year except the last. The VA's efforts to implement brief interventions were associated with increased patient-reported alcohol-related advice over time, with a majority of patients with alcohol misuse reporting its receipt. Other systems considering similar approaches to implementation may benefit from collecting patient-reported measures of brief interventions for an additional perspective on implementation.
Omedo, Martin; Ogutu, Michael; Awiti, Alphonce; Musuva, Rosemary; Muchiri, Geoffrey; Montgomery, Susan P; Secor, W Evan; Mwinzi, Pauline
Compliance with mass drug administration (MDA) can be affected by rumors and mistrust about the drug. Communication campaigns are an effective way to influence attitudes and health behaviors in diverse public health contexts, but there is very little documentation about experiences using health communications in schistosomiasis control programs. A qualitative study was conducted with community health workers (CHWs) as informants to explore the effect of a health communication campaign on their experiences during subsequent praziquantel MDA for schistosomiasis. Discussions were audio-recorded, transcribed verbatim, translated into English where applicable, and analyzed thematically using ATLAS.ti software. According to the CHWs, exposure to mass media messages improved awareness of the MDA, which in turn, led to better treatment compliance. Our findings suggest that communication campaigns influence health behaviors and create awareness of schistosomiasis control interventions, which may ultimately improve praziquantel MDA. © The American Society of Tropical Medicine and Hygiene.
... its approved HIT planning advance planning document and health information technology implementation... and expenses of Medicaid provider health information technology adoption and operation. 495.364... SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY...
Full Text Available Valentina Perrone, Diego Sangiorgi, Stefano Buda, Luca Degli Esposti Clicon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy Aim: The objectives of this study were to: 1 analyze the drug utilization pattern among adult psoriasis patients who were newly prescribed with topical medication; and 2 assess their adherence to topical therapy and the possibility of switching to other strategies in the treatment process. Methods: An observational retrospective analysis was conducted based on administrative databases of two Italian local health units. All adult subjects who were diagnosed with psoriasis or who were newly prescribed for topical medication with at least one prescription between January 1, 2010, and December 31, 2014, were screened. Only patients who were “non-occasional users of topical drugs” (if they had at least two prescriptions of topical drugs in a time space of 2 years were considered for the first and second objectives in the analysis. The date of the first prescription of topical agents was identified as the index date (ID, which was then followed for all time available from ID (follow-up period. The adherence to therapy was assessed on the basis of cycles of treatment covered in the 6 months before the end of the follow-up period. The mean health care costs in patients who switched to disease-modifying antirheumatic drugs (DMARDs or biologics after the ID were evaluated. Results: A total of 17,860 patients with psoriasis who were newly prescribed for topical medication were identified. A total of 2,477 were identified as “non-occasional users of topical drugs”, of whom 70.2% had a prescription for a topical fixed combination regimen at ID. Around 19% adhered to their medication, whereas 6% switched to other options of psoriasis treatment. Multivariable logistic regression model shows that patients on fixed combination treatment were less likely to be non-adherent to treatment and less likely to switch to
Michael A. Grasso
Full Text Available Introduction: The purpose of the study was to measure national prescribing patterns for hydrocodone/acetaminophen among veterans seeking emergency medical care, and to see if patterns have changed since this medication became a Schedule II controlled substance. Methods: We conducted a retrospective cohort study of emergency department (ED visits within the Veterans Health Administration (VA between January 2009 and June 2015. We looked at demographics, comorbidities, utilization measures, diagnoses, and prescriptions. Results: During the study period, 1,709,545 individuals participated in 6,270,742 ED visits and received 471,221 prescriptions for hydrocodone/acetaminophen (7.5% of all visits. The most common diagnosis associated with a prescription was back pain. Prescriptions peaked at 80,776 in 2011 (8.7% of visits, and declined to 35,031 (5.6% during the first half of 2015 (r=‒0.99, p<0.001. The percentage of hydrocodone/acetaminophen prescriptions limited to 12 pills increased from 22% (13,949 in 2009 to 31% (11,026 in the first half of 2015. A prescription was more likely written for patients with a pain score≥7 (OR 3.199, CI [3.192‒3.205], a musculoskeletal (OR 1.622, CI [1.615‒1.630] or soft tissue (OR 1.656, CI [1.649‒1.664] diagnosis, and those below the first quartile for total ED visits (OR 1.282, CI [1.271‒1.293] and total outpatient ICD 9 codes (OR 1.843, CI [1.833‒1.853]. Conclusion: Hydrocodone/acetaminophen is the most frequently prescribed ED medication in the VA. The rate of prescribing has decreased since 2011, with the rate of decline remaining unchanged after it was classified as a Schedule II controlled substance. The proportion of prescriptions falling within designated guidelines has increased but is not at goal. [West J Emerg Med. 2016;17(4:396-403.
Randall, Stephen B; Pories, Walter J; Pearson, Amy; Drake, Daniel J
Mobilization of morbidly obese patients poses significant physical challenges to healthcare providers. The purpose of this study was to examine the staff injuries associated with the patient handling of the obese, to describe a process for identifying injuries associated with their mobilization, and to report on the need for safer bariatric patient handling. We performed our study at a 761-bed, level 1 trauma center affiliated with a U.S. medical school. The hospital's Occupational Safety and Health Administration (OSHA) 300 log was expanded to the "E-OSHA 300 log" to specifically identify injuries the staff attributed to bariatric patient handling. The 2007 E-OSHA 300 log was analyzed to identify and describe the frequency, severity, and nature of bariatric versus nonbariatric patient handling injuries. The analyses revealed that during 2007, although patients with a body mass index of > or =35 kg/m(2) constituted patient population, 29.8% of staff injuries related to patient handling were linked to working with a bariatric patient. Bariatric patient handling accounted for 27.9% of all lost workdays and 37.2% of all restricted workdays associated with patient handling. Registered nurses and nursing assistants accounted for 80% of the injuries related to bariatric patient handling. Turning and repositioning the patient in bed accounted for 31% of the injuries incurred. The E-OSHA 300 log narratives revealed that staff injuries associated with obese and nonobese patient handling were usually performed using biomechanics and not equipment. Manual mobilization of morbidly obese patients increases the risk of caregiver injury. A tracking indicator on the OSHA 300 logs for staff injury linked to a bariatric patient would provide the ability to compare obese and nonobese patient handling injuries. The E-OSHA 300 log provides a method to identify the frequency, severity, and nature of caregiver injury during mobilization of the obese. Understanding the heightened risk of
Full Text Available 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 random samples of patients were selected, each stratified by geographic region, gender, and year of cohort entry, from a VHA depression treatment cohort from April 1, 1999 to September 30, 2004. The first sample was selected from patients who died by suicide, the second from patients who remained alive on the date of death of suicide cases, and the third from patients with a new start of a commonly used antidepressant medication. Four variables were assessed using administrative codes in the year prior to the index date: suicide attempt, alcohol abuse/dependence, drug abuse/dependence and tobacco use. Results Specificity was high (≥ 90% for all four administrative codes, regardless of the sample. Sensitivity was ≤75% and was particularly low for suicide attempt (≤ 17%. Positive predictive values for alcohol dependence/abuse and tobacco use were high, but barely better than flipping a coin for illicit drug abuse/dependence. Sensitivity differed across the three samples, but was highest in the suicide death sample. Conclusions Administrative data-based diagnoses among VHA records have high specificity, but low sensitivity. The accuracy level varies by different diagnosis and by different patient subgroup.
Wertenberger, Sydney; Chapman, Kathleen M; Wright-Brown, Salena
The Department of Veterans Health Administration Office of Nursing Service has embarked on a multiyear transformational process, an example of which is the development of an organization-wide nursing handbook. The development of this handbook offered the opportunity to improve collaboration, redefine expectations and behavior, as well as prepare for the future of Nursing within the Veterans Health Administration. The lessons learned from this process have revolved around the themes of leadership skills for managing high-level change often in a virtual environment; constant collaboration; that the practice of nursing will continue to evolve on the basis of new evidence, technology, customer expectations, and resources; and that the process to accomplish this goal is powerful.
Min, Jungwon; Tan, Zhengqi; Abadie, Laurie; Townsend, Scott; Xue, Hong; Wang, Youfa
To examine the effects of the National Aeronautics and Space Administration Mission-X: Train Like an Astronaut program (MX) on children's health-related knowledge and behaviors of a sample of US participants. A nonexperimental pilot intervention study in 5 cities with a pre-post comparison of children's health-related knowledge and behaviors in the United States in 2014 and 2015. Children (n = 409) with a mean age (standard deviation) of 10.1 (1.7) years. Children answered pre- and postintervention questionnaires. We measured the differences in children's health knowledge on nutrition and physical fitness and behaviors on diet and physical activity as scores. A 6-week web- and school-based intervention for a healthier lifestyle by introducing physical fitness and science activities based on actual astronaut training under a teacher's supervision. Nonparametric analysis and logistic regression models. Participants significantly improved both of their health behaviors on physical activity ( P < .001) and diet ( P = .06) and their health knowledge regarding nutrition ( P < .001) and physical fitness ( P < .001) after the intervention. The improvement in children's behaviors ( P < .001), knowledge ( P < .001), and the total score ( P < .001) after intervention did not significantly vary by sex or age, after adjusting for year of participation and state of residency. The MX seems effective in improving health behaviors and health knowledge of participating children, which may serve as a model for sustainable global child health promotion program. Further research is needed to test its long-term effects on child health.
... shall be the same as those published in part 6 of this title with respect to safety and health... with the Assistant Secretary of Labor for Occupational Safety and Health who shall publish a notice in... enforcement of safety and health standards. 1926.4 Section 1926.4 Labor Regulations Relating to Labor...
Veterans Health Administration Office of Nursing Services exploration of positive patient care synergies fueled by consumer demand: care coordination, advanced clinic access, and patient self-management.
Wertenberger, Sydney; Yerardi, Ruth; Drake, Audrey C; Parlier, Renee
The consumers who utilize the Veterans Health Administration healthcare system are older, and most are learning to live with chronic diseases. Their desires and needs have driven changes within the Veterans Health Administration. Through patient satisfaction initiatives and other feedback sources, consumers have made it clear that they do not want to wait for their care, they want a say in what care is provided to them, and they want to remain as independent as possible. Two interdisciplinary processes/models of healthcare are being implemented on the national level to address these issues: advanced clinic access and care coordination. These programs have a synergistic relationship and are integrated with patient self-management initiatives. Positive outcomes of these programs also meet the needs of our staff. As these new processes and programs are implemented nationwide, skills of both patients and nursing staff who provide their care need to be enhanced to meet the challenges of providing nursing care now and into the 21st century. Veterans Health Administration Office of Nursing Services Strategic Planning Work Group is defining and implementing processes/programs to ensure nurses have the knowledge, information, and skills to meet these patient care demands at all levels within the organization.
A fast-paced, example-based guide to learning how to administrate, monitor, and optimize Apache Solr.""Administrating Solr"" is for developers and Solr administrators who have a basic knowledge of Solr and who are looking for ways to keep their Solr server healthy and well maintained. A basic working knowledge of Apache Lucene is recommended, but this is not mandatory.
Hewitt, Kimberly Kappler; Weckstein, Daniel K.
One of the biggest obstacles to overcome in creating and sustaining an administrative professional learning community (PLC) is time. Administrators are constantly deluged by the tyranny of the urgent. It is a Herculean task to carve out time for PLCs, but it is imperative to do so. In this article, the authors describe how an administrative PLC…
I examine whether individuals respond to monetary incentives to detect latent medical conditions. The effect is identified by a policy that deemed diabetes associated with herbicide exposure a compensable disability under the Veterans Benefits Administration's Disability Compensation program. Since a diagnosis is a requisite for benefit…
Korolenko, V V; Dykun, O P; Isayenko, R M; Remennyk, O I; Avramenko, T P; Stepanenko, V I; Petrova, K I; Volosovets, O P; Lazoryshynets, V V
The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular
Département des Ressources humaines
Administrative Circular N° 2 (Rev. 2) - May 2004 Guidelines and procedures concerning recruitment and probation period of staff members This circular has been revised. It cancels and replaces Administrative Circular N° 2 (Rev. 1) - March 2000. Administrative Circular N° 9 (Rev. 3) - May 2004 Staff members contracts This circular has been revised. It cancels and replaces Administrative Circular N° 9 (Rev. 2) - March 2000. Administrative Circular N° 26 (Rev. 4) - May 2004 Procedure governing the career evolution of staff members This circular has also been revised. It Administrative Circulars Administrative Circular N° 26 (Rev. 3) - December 2001 and brings up to date the French version (Rev. 4) published on the HR Department Web site in January 2004. Operational Circular N° 7 - May 2004 Work from home This circular has been drawn up. Operational Circular N° 8 - May 2004 Dealing with alcohol-related problems...
Hrynzovskyi, Anatolii M; Holovanova, Irina A; Omelchuk, Sergei T; Kuzminska, Olena V; Hrynzovska, Anastasia A; Karlova, Olena O; Kondratiuk, Vitalii Ye
Introduction: The public health system modernization history is based upon the progress in state country administration and administration of healthcare within the sectorwide approach. The WHO European Bureau pays much attention to the National Health Service systems development while implementing their basic policies. The Ukrainian state health service management was founded basing on the regulatory field of the Russian Empire, using the European healthcare promotion experience. Aim: of the article is the analysis of the regulatory field of police and amenity authorities of the Russian Empire and Ukraine within the medical and social service in the 18th-19th centuries. Materials and methods: The structure of the article corresponds to the problem city and chronology principles, using the following methods and techniques of scientific learning: the systemic, historic, regulatory comparative, logical and structural-functional analysis of the studied medical-legal phenomena. The study sources are the scientific publications, collections of laws and executive orders of the Russian Empire and Ukraine in the 18th-19th centuries. Review: As a result of the performed work it can be determined were the main directions of the police competence in late 18th- early 19th centuries. Conclusion: Preserving health, treatment of the ill and injured, management of medical and social service of those in need, holding various preventive activities and supporting safe environment and regulating the safety of food were the main directions of the police competence in late 18th- early 19th centuries.
Orr, Justine; Smith, Mark; Burchill, Charles; Katz, Alan; Fransoo, Randy
Using the Manitoba Centre for Health Policy as an example, this commentary discusses how even small investments in population health data can create a multitude of research benefits. The authors highlight that through infrastructure development such as acquiring databases, facilitating access to data and developing data management practices, new, innovative research can be achieved at relatively low cost.
Reijneveld, S.A.; Stronks, K.
Background. Surveys among the general population are an important method for collecting epidemiological data on health and utilization of health care in that population. Selective non-response may affect the validity of these data. This study examines the impact of response bias on estimates of
Le Pogam, Marie-Annick; Quantin, Catherine; Reich, Oliver; Tuppin, Philippe; Fagot-Campagna, Anne; Paccaud, Fred; Peytremann-Bridevaux, Isabelle; Burnand, Bernard
Frail older people with multiple interacting conditions, polypharmacy, and complex care needs are particularly exposed to health care-related adverse events. Among these, anticoagulant-related thromboembolic and hemorrhagic events are particularly frequent and serious in older inpatients. The growing use of anticoagulants in this population and their substantial risk of toxicity and inefficacy have therefore become an important patient safety and public health concern worldwide. Anticoagulant-related adverse events and the quality of anticoagulation management should thus be routinely assessed to improve patient safety in vulnerable older inpatients. This project aims to develop and validate a set of outcome and process indicators based on linked administrative health data (ie, insurance claims data linked to hospital discharge data) assessing older inpatient safety related to anticoagulation in both Switzerland and France, and enabling comparisons across time and among hospitals, health territories, and countries. Geriatric patient safety indicators (GPSIs) will assess anticoagulant-related adverse events. Geriatric quality indicators (GQIs) will evaluate the management of anticoagulants for the prevention and treatment of arterial or venous thromboembolism in older inpatients. GPSIs will measure cumulative incidences of thromboembolic and bleeding adverse events based on hospital discharge data linked to insurance claims data. Using linked administrative health data will improve GPSI risk adjustment on patients' conditions that are present at admission and will capture in-hospital and postdischarge adverse events. GQIs will estimate the proportion of index hospital stays resulting in recommended anticoagulation at discharge and up to various time frames based on the same electronic health data. The GPSI and GQI development and validation process will comprise 6 stages: (1) selection and specification of candidate indicators, (2) definition of administrative data
Langton, Julia M; Blanch, Bianca; Drew, Anna K; Haas, Marion; Ingham, Jane M; Pearson, Sallie-Anne
There has been an increase in observational studies using health administrative data to examine the nature, quality, and costs of care at life's end, particularly in cancer care. To synthesize retrospective observational studies on resource utilization and/or costs at the end of life in cancer patients. We also examine the methods and outcomes of studies assessing the quality of end-of-life care. A systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) methodology. We searched MEDLINE, Embase, CINAHL, and York Centre for Research and Dissemination (1990-2011). Independent reviewers screened abstracts of 14,424 articles, and 835 full-text manuscripts were further reviewed. Inclusion criteria were English-language; at least one resource utilization or cost outcome in adult cancer decedents with solid tumors; outcomes derived from health administrative data; and an exclusive end-of-life focus. We reviewed 78 studies examining end-of-life care in over 3.7 million cancer decedents; 33 were published since 2008. We observed exponential increases in service use and costs as death approached; hospital services being the main cost driver. Palliative services were relatively underutilized and associated with lower expenditures than hospital-based care. The 15 studies using quality indicators demonstrated that up to 38% of patients receive chemotherapy or life-sustaining treatments in the last month of life and up to 66% do not receive hospice/palliative services. Observational studies using health administrative data have the potential to drive evidence-based palliative care practice and policy. Further development of quality care markers will enhance benchmarking activities across health care jurisdictions, providers, and patient populations. © The Author(s) 2014.
Kirkeskov, Lilli; Kristiansen, Eva; Bøggild, Henrik
Kirkeskov L, Kristiansen E, Bøggild H, von Platen-Hallermund F, Sckerl H, Carlsen A, Larsen MJ, Poulsen S. The association between fluoride in drinking water and dental caries in Danish children. Linking data from health registers, environmental registers and administrative registers. Community...... Dent Oral Epidemiol 2010. (c) 2010 John Wiley & Sons A/S Abstract - Objectives: To study the association between fluoride concentration in drinking water and dental caries in Danish children. Methods: The study linked registry data on fluoride concentration in drinking water over a 10-year period...... with data on dental caries from the Danish National Board of Health database on child dental health for 5-year-old children born in 1989 and 1999, and for 15-year-old children born in 1979 and 1989. The number of children included in the cohorts varied between 41.000 and 48.000. Logistic regression was used...
Through the example of a Danish reform of educational plans in early childhood education, the paper critically addresses administrative educational reforms promoting accountability, visibility and documentation. Drawing on Foucaultian perspectives, the relation between knowledge and governing...... of administrative technology, tracing how the humanistic values of education embed and are embedded within ‘the professional nursery teacher' as an object and subject of administrative practice. Rather than undermining the humanistic potential of education, it is argued that the technology of accounting...
While flu vaccination rates are inching up among health care workers, there is still room for improvement. The Centers for Disease Control and Prevention reports that slightly more than 75% of health care workers received the flu vaccination during the 2013-14 season--an increase of roughly 3% over the 2012-13 season. However, some hospitals have been able to achieve vaccination rates in excess of 99%. The apparent key to these efforts is a firm mandate that all personnel receive a flu shot as a condition of employment. There is always pushback to such policies, but hospitals report that most personnel eventually come around. While flu vaccination rates are on the increase among health, care personnel, data from the Centers for Medicare and Medicaid Services (CMS) note that rates vary widely from state to state. For example, the vaccination rate for health care workers in New Jersey stood at just 62% last year. In contrast, more than 95% of health care workers in Maryland received the shot during the 2013-14 flu season. Both Loyola University Medical Center and Henry Ford Hospital have been able to boost flu vaccination rates among their health care workers to more than 99% with the implementation of policies that require flu shots as a condition of employment. Experts say successful flu vaccination campaigns require strong administration buy-in and physician leadership.
Bekker, Marleen P.M.; Putters, Kim; Grinten, Tom E.D. van der
Like any policy-relevant research, HIA faces the risk of not being used by decisions-makers. This article addresses the questions: 'How do policy decisions come about?' and 'How does this affect HIA?' Current literature in political-administrative sciences identifies three ways for decision-making: rational, incremental and mixed model. These models define the relationship between the policy process at stake and the HIA. In incremental or mixed model decision-making, use of HIA evidence by policy-makers is heavily dependent on their values in the context, which may result in conceptual utilization or may extend to strategic utilization. In rational decision-making, HIA provides information independent from the context, which results in instrumental utilization. HIA practitioners need to optimise utilization and produce an appropriate HIA by mapping the policy process. They can do this by asking the questions 'What? How? Who? and What context? and by maintaining continuous communication with the decision-makers. An appropriate HIA is policy-, time- and place-specific: reflecting the decision-making of the policy at stake. Furthermore, HIA concerns two policy fields with two different contexts and, in some cases, two different decision-making models. The administrative requirements for an appropriate HIA need further exploration
Sayer, Nina A; Rosen, Craig S; Bernardy, Nancy C; Cook, Joan M; Orazem, Robert J; Chard, Kathleen M; Mohr, David C; Kehle-Forbes, Shannon M; Eftekhari, Afsoon; Crowley, Jill; Ruzek, Josef I; Smith, Brandy N; Schnurr, Paula P
Evidence-based psychotherapies for PTSD are often underused. The objective of this mixed-method study was to identify organizational and clinic factors that promote high levels of reach of evidence-based psychotherapies for PTSD 10 years into their dissemination throughout the Veterans Health Administration. We conducted 96 individual interviews with staff from ten outpatient PTSD teams at nine sites that differed in reach of evidence-based psychotherapies for PTSD. Major themes associated with reach included clinic mission, clinic leader and staff engagement, clinic operations, staff perceptions, and the practice environment. Strategies to improve reach of evidence-based psychotherapies should attend to organizational and team-level factors.
Masoudi, F A; Ordin, D L; Delaney, R J; Krumholz, H M; Havranek, E P
This is the second in a series describing Health Care Financing Administration (HCFA) initiatives to improve care for Medicare beneficiaries with heart failure. The first article outlined the history of HCFA quality-improvement projects and current initiatives to improve care in six priority areas: heart failure, acute myocardial infarction, stroke, pneumonia, diabetes, and breast cancer. This article details the objectives and design of the Medicare National Heart Failure Quality Improvement Project (NHF), which has as its goal the improvement of inpatient heart failure care. (c)2000 by CHF, Inc.
Jaff, Jennifer C; Arnold, Janis; Bousvaros, Athos
In addition to their physical challenges, children and adolescents with inflammatory bowel disease (IBD) living in the United States face a number of administrative and regulatory hurdles that affect their quality of life. This article, written by a physician, attorney/patient advocate, and social worker, discusses a number of these challenges and describes how the provider can help his or her patient overcome them. Specifically, the article discusses 4 areas in detail: appeals of denials of coverage from insurance companies and third party payors; assisting children with IBD with classroom and school accommodations; assisting uninsured children in obtaining Social Security benefits; and aiding a parent to care for their child using the Family and Medical Leave Act. Although this article has a pediatric focus, adults have similar advocacy needs. Case examples and sample letters to third-party payors, schools, and employers are included in this article.
... research discoveries into approved diagnostics and therapies as well as promote science to enhance the... that regulatory considerations form an increasing component of biomedical research planning, and that... dramatic breakthroughs occurring in biomedical research discovery, new public health challenges on the rise...
This article explores the central role of the National Institutes of Health (NIH) in developing and promoting biostatistics in American biomedical research between the late 1940s and the late 1960s. During this period, the NIH invested in the training of both intramural and extramural biostatisticians and was considered the single largest user of biostatisticians in the country. In addition to helping meet the scientific needs of NIH investigators, this article argues that biostatisticians played a critical role in aligning NIH-funded scientific endeavors with new public administration mandates and policies. In particular, it argues that the changing expectations of federal oversight and management played a central, though largely unrecognized, role in the growing presence of biostatistics at the NIH and in American health and biomedical research during the 1960s.
Risikko, Tanja; Remes, Jouko; Hassi, Juhani
Cold is a typical environmental risk factor in outdoor work in northern regions. It should be taken into account in a company's occupational safety, health and quality systems. A development process for improving cold risk management at the Finnish Maritime Administration (FMA) was carried out by FMA and external experts. FMA was to implement it. Three years after the development phase, the outcomes and implementation were evaluated. The study shows increased awareness about cold work and few concrete improvements. Concrete improvements in occupational safety and health practices could be seen in the pilot group. However, organization-wide implementation was insufficient, the main reasons being no organization-wide practices, unclear process ownership, no resources and a major reorganization process. The study shows a clear need for expertise supporting implementation. The study also presents a matrix for analyzing the process.
Himmelstein, David U; Woolhandler, Steffie; Wolfe, Sidney M
This report provides nationwide and state-specific estimates of U.S. health care administration spending and potential savings in 2003 were the United States to institute a Canadian-style national health insurance system. The United States wastes more on health care bureaucracy than it would cost to provide health care to all its uninsured. Administrative expenses will consume at least dollar 399.4 billion of a total health expenditure of dollar 1,660.5 billion in 2003. Streamlining administrative overhead to Canadian levels would save approximately dollar 286.0 billion in 2003, dollar 6,940 for each of the 41.2 million Americans who were uninsured as of 2001. This is substantially more than would be needed to provide full insurance coverage. The cost of excess health bureaucracy in individual states is equally striking. For example, Massachusetts, with 560,000 uninsured state residents, could save about dollar 8,556 million in 2003 (dollar 16,453 per uninsured resident of that state) if it streamlined administration to Canadian levels. New Mexico, with 373,000 uninsured, could save dollar 1,500 million on health bureaucracy (dollar 4,022 per uninsured resident). Only a single-payer national health insurance system could garner these massive administrative savings, allowing universal coverage without any increase in total health spending. Because incremental reforms necessarily preserve the current fragmented and duplicative payment structure, they cannot achieve significant bureaucratic savings.
Degli Esposti L
Full Text Available Luca Degli Esposti,1 Stefania Saragoni,1 Stefano Buda,1 Alessandra Sturani,2 Ezio Degli Esposti11CliCon Srl, Health, Economics and Outcomes Research, Ravenna, Italy; 2Nephrology and Dialysis Unit, Santa Maria delle Croci Hospital, Ravenna, ItalyBackground: Diabetes is one of the most prevalent chronic diseases, and its prevalence is predicted to increase in the next two decades. Diabetes imposes a staggering financial burden on the health care system, so information about the costs and experiences of collecting and reporting quality measures of data is vital for practices deciding whether to adopt quality improvements or monitor existing initiatives. The aim of this study was to quantify the association between health care costs and level of glycemic control in patients with type 2 diabetes using clinical and administrative databases.Methods: A retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Patients were subdivided according to their glycated hemoglobin level. Multivariate analyses were used to control for differences in potential confounding factors, including age, gender, Charlson comorbidity index, presence of dyslipidemia, hypertension, or cardiovascular disease, and degree of adherence with antidiabetic drugs among the study groups.Results: Of the total population of 700,000 subjects, 31,022 were identified as being diabetic (4.4% of the entire population. Of these, 21,586 met the study inclusion criteria. In total, 31.5% of patients had very poor glycemic control and 25.7% had excellent control. Over 2 years, the mean diabetes-related cost per person was: €1291.56 in patients with excellent control; €1545.99 in those with good control; €1584.07 in those with fair control; €1839.42 in those with poor control; and €1894.80 in those with very poor control. After adjustment, compared with the group having excellent control, the estimated excess cost
Al Qahtani S
Full Text Available Saad Al QahtaniKing Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaIntroduction: Mentoring has been defined as a process whereby the mentor guides the mentee in personal or professional development. Few mentoring programs are available to prepare the qualified and scientifically trained administrators required to manage the rapidly expanding national health services in the Kingdom of Saudi Arabia. We wanted to measure the attitude and knowledge of the students of the Master’s Program in Health and Hospital Administration toward mentoring.Materials and methods: This is a cross-sectional survey, design study, conducted at King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. The participants were students enrolled in the master’s program. The dimensions of the questionnaire were demographics, knowledge about mentoring, understanding of mentoring, perception toward mentoring, attitude toward mentoring, experience with mentoring, and the need of mentoring. A Likert scale was used to measure responses.Results: Among 120 students, the response rate was 85%. In the domain of attitude toward mentoring, 92% of the respondents stated that mentoring is an effective method of developing their potential. The mean age was 30±4 years, 75.5% were female, 36% had finished at least two semesters, and 92% expressed a strong need for mentoring in the master program.Conclusion: Mentorship is considered an important underutilized educational tool, which has great potential if implemented properly. Our university masters’ students demonstrated a need for mentoring that we believe is a good platform to plan future development of mentorship programs.Keywords: mentor, student knowledge, higher education
Military service and other socioecological factors influencing weight and health behavior change in overweight and obese Veterans: a qualitative study to inform intervention development within primary care at the United States Veterans Health Administration
Jay, Melanie; Mateo, Katrina F.; Squires, Allison P.; Kalet, Adina L.; Sherman, Scott E.
Background Obesity affects 37?% of patients at Veterans Health Administration (VHA) medical centers. The VHA offers an intensive weight management program (MOVE!) but less than 10?% of eligible patients ever attend. However, VHA patients see their primary care provider about 3.6 times per year, supporting the development of primary care-based weight management interventions. To address gaps in the literature regarding Veterans? experiences with weight management and determine whether and how ...
Serfaty, A; Baron, S; Crenn-Hebert, C; Barry, Y; Tala, S
The uses of medical administrative data (MAD/BDMA) emerged in perinatal health following the work on regionalization of very pre-term birth. They have become more numerous since the late 2000s. The objective of this article is to take stock of the existing work carried out within the REDSIAM-perinatality group, on MAD/BDMA and their uses for the period of "birth". The studied MADs are the Hospital Discharge Data (PMSI) and the French national health database (SNIIRAM). The material includes knowledge shared by the members of the REDSIAM-perinatality group, scientific references and gray literature. Our exploratory study shows that the uses of MAD in perinatal health are diversified at the local, regional and national levels. The works and publications, increasing, take the form of public access of processed data. Collective thinking makes it possible to move from a localized use to an institution, a network or several, to a national use and an inscription in public authorities' responses. In 2015/2016, two institutional sites provide access to data on maternal and child health: Data.Drees and ATIH ScanSanté. MAD/BDMA uses are multiple: epidemiological use (count of births by gestational age, weight in particular; perinatal indicators), quality of care, planning (maternity activities, regionalization of care). There is an increasing interest among stakeholders, producers and/or operators of MAD/BDMA (decision-makers, professionals or researchers). The BDMA, including the PMSI and the SNIIRAM, are used and relevant in Perinatal health with the rise of health networks, the territorialisation of health, in an increased demand for quality of care. Their use will increase the reliability of the data collected and an inscription in the validation studies, more and more numerous in the field of BDMA. The algorithms need to be more finely compiled, validated and enhanced. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Southmayd, Emily A; De Souza, Mary Jane
Bone growth, development, and remodeling are modulated by numerous circulating hormones. Throughout the lifespan, the extent to which each of the hormones impacts bone differs. Understanding the independent and combined impact of these hormones on controlling bone remodeling allows for the development of more informed decision making regarding pharmacology, specifically the use of hormonal medication, at all ages. Endocrine control of bone health in women is largely dictated by the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis and the hypothalamic-pituitary-ovarian (HPO) axis. Growth hormone, secreted from the pituitary gland, stimulates cells in almost every tissue to secrete IGF-1, although the majority of circulating IGF-1 is produced hepatically. Indeed, systemic IGF-1 concentrations have been found to be correlated with bone mineral density (BMD) in both pre- and post-menopausal women and is often used as a marker of bone formation. Sex steroids produced by the ovaries, namely estradiol, mediate bone resorption through binding to estrogen receptors on osteoclasts and osteoblasts. Specifically, by increasing osteoclast apoptosis and decreasing osteoblast apoptosis, adequate estrogen levels prevent excessive bone resorption, which helps to explain the rapid decline in bone mass that occurs with the menopausal decrease in estrogen production. Though there are documented correlations between endogenous estrogen concentrations and GH/IGF-1 dynamics, this relationship changes across the lifespan as sex-steroid dynamics fluctuate and, possibly, as tissue responsiveness to GH stimulation decreases. Aside from the known role of endogenous sex steroids on bone health, the impact of exogenous estrogen administration is of interest, as exogenous formulations further modulate GH and IGF-1 production. However, the effect and extent of GH and IGF-1 modulation seems to be largely dependent on age at administration and route of administration. Specifically
Full Text Available Kai-Uwe Kern,1 Janice England,2 Andrea Roth-Daniek,3 Till Wagner3 1Institute for Pain Medicine/Pain Practice, Wiesbaden, Germany; 2Pain Medicine and Anaesthesia, The Christie National Health Service Foundation Trust, Manchester, UK; 3Pain Therapy and Palliative Care Department, Medizinisches Zentrum Städteregion Aachen, Aachen, Germany Abstract: Neuropathic pain is difficult to treat and can have a severe effect on quality of life. The capsaicin 8% patch is a novel treatment option that directly targets the source of peripheral neuropathic pain. It can provide pain relief for up to 12 weeks in patients with peripheral neuropathic pain. Treatment with the capsaicin 8% patch follows a clearly defined procedure, and patch application must be carried out by a physician or a health care professional under the supervision of a physician. Nonetheless, in our experience, nurses often take the lead role in capsaicin 8% patch application without the involvement of a physician. We believe that the nurse's key role is of benefit to the patients, as he or she may be better placed, because of time constraints and patient relationships, to support the patient through the application procedure than a physician. Moreover, a number of frequently prescribed drugs, including botulinum toxin and infliximab, can be administered by health care professionals without the requirement for physician supervision. Here we argue that current guidance should be amended to remove the requirement for physician supervision during application of the capsaicin 8% patch. Keywords: capsaicin, neuropathic pain, topical, health care professional, physician, nurse
Full Text Available This paper reports upon findings of a series of semi-structured interviews with students, academics and administrative staff from a health care faculty in a UK Higher Education Institution (HEI. Exploring their experiences of mapping to the EU DIGCOMP Digital Competence Framework, a hermeneutic lens enables a more nuanced approach to attitudes towards Digital Competence (DC. One of the eight lifelong learning key-competences required for managers, doctors, nurses and other health-related professionals, DC is crucial to professional development. Defined by 14 themes, the findings express the participants’ experiences, knowledge and level of comprehension of the subject. Our findings indicate students are conflating digital social media skills with their skills for the workplace, resulting in over-confidence; academics raising concerns about work/private life balance offered by the affordances of handheld devices; administrative staff that are far more confident and managing a range of technology’s effectively. The research further reveals that the DIGICOMP framework is applicable as a generic framework for professional practice.
Kelly, Megan M; Reilly, Erin; Quiñones, Timothy; Desai, Nitigna; Rosenheck, Robert
Long acting intramuscular (IM) naltrexone is an effective treatment for opioid use disorder (OUD), but rates and correlates of its use have not been studied. National administrative from the Veterans Health Administration (VHA) from Fiscal Year 2012 identified only 16 VHA facilities that prescribed IM naltrexone to 5 or more veterans diagnosed with OUD. Data from these facilities were used to identify sociodemographic, diagnostic, and service use characteristics, including use of psychotropic medication, that were characteristic of veterans who filled prescriptions for IM naltrexone. This was in comparison to users of opiate agonist treatments (methadone or buprenorphine) or veterans with no pharmacologic treatment for OUD. Comparisons were made using both bi-variate analyses and multivariable logistic regression. Only 179 of 16,402 veterans with OUD (1%) at these 16 facilities filled a prescription for IM naltrexone and only 256 of 99,394 (0.26%) nationally. These veterans were characterized by past homelessness, co-morbid alcohol use disorder, multiple psychiatric disorders, and a greater likelihood of psychiatric hospitalization, as well as mental health outpatient and antidepressant medication use. IM naltrexone is rarely used for OUD and is primarily used for patients with multiple co-morbidities, especially alcohol use disorder and serious mental illness. The use of this treatment illustrates many of the principles identified by the emerging focus on multi-morbidity as a critical feature of clinical practice. Copyright © 2017. Published by Elsevier B.V.
Nielsen, Elof Nellemann; Rehr, Preben René
En undervisningsbog der henvender sig til administrationsbacheloruddannelsen. Kapitlerne er inddelt efter modulerne på uddannelsen og indeholder derfor elementer af administration, forvaltning, økonomistyring, innovation, samfundsvidenskabelige metoder og politisk styrede organisationer.......En undervisningsbog der henvender sig til administrationsbacheloruddannelsen. Kapitlerne er inddelt efter modulerne på uddannelsen og indeholder derfor elementer af administration, forvaltning, økonomistyring, innovation, samfundsvidenskabelige metoder og politisk styrede organisationer....
SAT Administrator is the Information System for Nuclear Power Plant Personnel Training Program Design. It supports the design of training programs in the following phases: job analysis; task analysis; competency analysis; task competency association; definition of learning objectives to competencies; training program design; definition of test items. The general structure of the database and management software supports application of the SAT Administrator in any nuclear power installation
Dallo, Florence J; Ruterbusch, Julie J; Kirma, Joseph David; Schwartz, Kendra; Fakhouri, Monty
The objectives of this study were to estimate and compare the prevalence of heart disease, cancer, chronic lower respiratory disease, stroke, Alzheimer's, diabetes, nephrosis, flu/pneumonia, hypertension, and atherosclerosis between Arab Americans and whites attending a large, metropolitan hospital system. The sample included 68,047 patients, 18 years of age or older, who visited the hospital during 2012. Demographic and disease variables were electronically abstracted. Demographic characteristics were compared between Arab Americans and whites using Chi square tests. Sex specific, age-adjusted prevalence ratios (PR) and 95 % confidence intervals were estimated for these two groups using a log-binomial regression model. Compared to white men, Arab American men had a higher prevalence of diabetes (PR 1.40, 95 % CI 1.29-1.52) and hypertension (PR 1.07, 95 % CI 1.04-1.10), and a lower prevalence of chronic lower respiratory disease (PR 0.74, 95 % CI 0.66-0.83). Compared to white women, Arab American women had a higher prevalence of chronic lower respiratory disease (PR 1.12, 95 % CI 1.01-1.25), diabetes (PR 1.49, 95 % CI 1.38-1.60), influenza/pneumonia (PR 1.26, 95 % CI 1.05-1.51) and hypertension (PR 1.04, 95 % CI 1.01-1.08). This study supports previous findings that health disparities exist for Arab Americans, who are classified as "white" in health statistics. Standard inclusion of Arab American as a separate ethnicity category will aid researchers in assessing the health care needs of this growing minority community.
Goffman, Rachel M; Harris, Shannon L; May, Jerrold H; Milicevic, Aleksandra S; Monte, Robert J; Myaskovsky, Larissa; Rodriguez, Keri L; Tjader, Youxu C; Vargas, Dominic L
Missed appointments reduce the efficiency of the health care system and negatively impact access to care for all patients. Identifying patients at risk for missing an appointment could help health care systems and providers better target interventions to reduce patient no-shows. Our aim was to develop and test a predictive model that identifies patients that have a high probability of missing their outpatient appointments. Demographic information, appointment characteristics, and attendance history were drawn from the existing data sets from four Veterans Affairs health care facilities within six separate service areas. Past attendance behavior was modeled using an empirical Markov model based on up to 10 previous appointments. Using logistic regression, we developed 24 unique predictive models. We implemented the models and tested an intervention strategy using live reminder calls placed 24, 48, and 72 hours ahead of time. The pilot study targeted 1,754 high-risk patients, whose probability of missing an appointment was predicted to be at least 0.2. Our results indicate that three variables were consistently related to a patient's no-show probability in all 24 models: past attendance behavior, the age of the appointment, and having multiple appointments scheduled on that day. After the intervention was implemented, the no-show rate in the pilot group was reduced from the expected value of 35% to 12.16% (p value < 0.0001). The predictive model accurately identified patients who were more likely to miss their appointments. Applying the model in practice enables clinics to apply more intensive intervention measures to high-risk patients. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
Frankline Augustin; Louis Rubino; Donghai Wei
Research hospitals/academic medical centers have a threefold mission of patient care, research and education. The meaning of education is to train students with both clinical and administrative personnel in order to better suit themselves in the health care industry. Health administration programs are proliferating in China and the United States due to the influence of their recent health reform movements. In China, health administration programs are staffed with faculty from clinical medicine and management, mostly from their university afifliated medical centers. However, health administration program faculty in the United States have a diverse set of industry backgrounds and bring an invaluable wealth of experience into the classroom. The authors provide a literature background on the often-followed paths that a person in the U.S. might take while pursuing a full time teaching career in higher education. A health administration faculty typology has been well developed, and concentrating on the following professional roles: a healthcare operator, an academic/educational administrator, a consultant, a clinician and a researcher. Thus, the authors discuss anecdotal data that they have collected on the perceived positives and negatives associated for each type. The authors conclude with providing recommendations to both Chinese and American programs to produce a more collegial and collaborative academic environment.
Röttger, Julia; Blümel, Miriam; Linder, Roland; Busse, Reinhard
Health system responsiveness is an important aspect of health systems performance. The concept of responsiveness relates to the interpersonal and contextual aspects of health care. While disease management programs (DMPs) aim to improve the quality of health care (e.g. by improving the coordination of care), it has not been analyzed yet whether these programs improve the perceived health system responsiveness. Our study aims to close this gap by analyzing the differences in the perceived health system responsiveness between DMP-participants and non-participants. We used linked survey- and administrative claims data from 7037 patients with coronary heart disease in Germany. Of those, 5082 were enrolled and 1955 were not enrolled in the DMP. Responsiveness was assessed with an adapted version of the WHO responsiveness questionnaire in a postal survey in 2013. The survey covered 9 dimensions of responsiveness and included 17 items for each, GP and specialist care. Each item had five answer categories (very good - very bad). We handled missing values in the covariates by multiple imputation and applied propensity score matching (PSM) to control for differences between the two groups (DMP/non-DMP). We used Wilcoxon-signed-rank and McNemar test to analyze differences regarding the reported responsiveness. The PSM led to a matched and well balanced sample of 1921 pairs. Overall, DMP-participants rated the responsiveness of care more positive. The main difference was found for the coordination of care at the GP, with 62.0% of 1703 non-participants reporting a "good" or "very good" experience, compared to 69.1% of 1703 participants (p < 0.001). The results of our study indicate an overall high responsiveness for CHD-care, as well for DMP-participants as for non-participants. Yet, the results also clearly indicate that there is still a need to improve the coordination of care. Copyright © 2017 Elsevier Ltd. All rights reserved.
Carter, Marion W; Gavin, Loretta; Zapata, Lauren B; Bornstein, Marta; Mautone-Smith, Nancy; Moskosky, Susan B
This study aims to describe aspects of the scope and quality of family planning services provided by US publicly funded health centers before the release of relevant federal recommendations. Using nationally representative survey data (N=1615), we describe four aspects of service delivery: family planning services provided, contraceptive methods provided onsite, written contraceptive counseling protocols and youth-friendly services. We created a count index for each issue and used multivariable ordered logistic regression to identify health center characteristics associated with scoring higher on each. Half of the sample received Title X funding and about a third each were a community health center or health department clinic. The vast majority reported frequently providing contraceptive services (89%) and STD services (87%) for women in the past 3 months. Service provision to males was substantially lower except for STD screening. A total of 63% and 48% of health centers provided hormonal IUDs and implants onsite in the past 3 months, respectively. Forty percent of health centers included all five recommended contraceptive counseling practices in written protocols. Of youth-friendly services, active promotion of confidential services was among the most commonly reported (83%); offering weekend/evening hours was among the least (42%). In multivariable analyses, receiving Title X funding, having larger volumes of family planning clients and being a Planned Parenthood clinic were associated with higher scores on most indices. Many services were consistent with the recommendations for providing quality family planning services, but there was room for improvement across domains and health centers types. As assessed in this paper, the scope and quality of these family planning services was relatively high, particularly among Planned Parenthood clinics and Title X-funded centers. However, results point to important areas for improvement. Future studies should assess
Wenk, Manuel; Van Aken, Hugo; Zarbock, Alexander
In October 2016, the World Health Organization (WHO) published recommendations for preventing surgical site infections (SSIs). Among those measures is a recommendation to administer oxygen at an inspired fraction of 80% intra- and postoperatively for up to 6 hours. SSIs have been identified as a global health problem, and the WHO should be commended for their efforts. However, this recommendation focuses only on the patient's "wound," ignores other organ systems potentially affected by hyperoxia, and may ultimately worsen patient outcomes.The WHO advances a "strong recommendation" for the use of a high inspired oxygen fraction even though the quality of evidence is only moderate. However, achieving this goal by disregarding other potentially lethal complications seems inappropriate, particularly in light of the weak evidence underpinning the use of high fractions of oxygen to prevent SSI. Use of such a strategy thus should be intensely discussed by anesthesiologists and perioperative physicians.Normovolemia, normotension, normoglycemia, normothermia, and normoventilation can clearly be safely applied to most patients in most clinical scenarios. But the liberal application of hyperoxemia intraoperatively and up to 6 hours postoperatively, as suggested by the WHO, is questionable from the viewpoint of anesthesia and perioperative medicine, and its effects will be discussed in this article.
Hassett, Michael J; Uno, Hajime; Cronin, Angel M; Carroll, Nikki M; Hornbrook, Mark C; Ritzwoller, Debra
Recurrent cancer is common, costly, and lethal, yet we know little about it in community-based populations. Electronic health records and tumor registries contain vast amounts of data regarding community-based patients, but usually lack recurrence status. Existing algorithms that use structured data to detect recurrence have limitations. We developed algorithms to detect the presence and timing of recurrence after definitive therapy for stages I-III lung and colorectal cancer using 2 data sources that contain a widely available type of structured data (claims or electronic health record encounters) linked to gold-standard recurrence status: Medicare claims linked to the Cancer Care Outcomes Research and Surveillance study, and the Cancer Research Network Virtual Data Warehouse linked to registry data. Twelve potential indicators of recurrence were used to develop separate models for each cancer in each data source. Detection models maximized area under the ROC curve (AUC); timing models minimized average absolute error. Algorithms were compared by cancer type/data source, and contrasted with an existing binary detection rule. Detection model AUCs (>0.92) exceeded existing prediction rules. Timing models yielded absolute prediction errors that were small relative to follow-up time (differences by cancer type and dataset challenged efforts to create 1 common algorithm for all scenarios. Valid and reliable detection of recurrence using big data is feasible. These tools will enable extensive, novel research on quality, effectiveness, and outcomes for lung and colorectal cancer patients and those who develop recurrence.
Sada, Yvonne; Hou, Jason; Richardson, Peter; El-Serag, Hashem; Davila, Jessica
Accurate identification of hepatocellular cancer (HCC) cases from automated data is needed for efficient and valid quality improvement initiatives and research. We validated HCC International Classification of Diseases, 9th Revision (ICD-9) codes, and evaluated whether natural language processing by the Automated Retrieval Console (ARC) for document classification improves HCC identification. We identified a cohort of patients with ICD-9 codes for HCC during 2005-2010 from Veterans Affairs administrative data. Pathology and radiology reports were reviewed to confirm HCC. The positive predictive value (PPV), sensitivity, and specificity of ICD-9 codes were calculated. A split validation study of pathology and radiology reports was performed to develop and validate ARC algorithms. Reports were manually classified as diagnostic of HCC or not. ARC generated document classification algorithms using the Clinical Text Analysis and Knowledge Extraction System. ARC performance was compared with manual classification. PPV, sensitivity, and specificity of ARC were calculated. A total of 1138 patients with HCC were identified by ICD-9 codes. On the basis of manual review, 773 had HCC. The HCC ICD-9 code algorithm had a PPV of 0.67, sensitivity of 0.95, and specificity of 0.93. For a random subset of 619 patients, we identified 471 pathology reports for 323 patients and 943 radiology reports for 557 patients. The pathology ARC algorithm had PPV of 0.96, sensitivity of 0.96, and specificity of 0.97. The radiology ARC algorithm had PPV of 0.75, sensitivity of 0.94, and specificity of 0.68. A combined approach of ICD-9 codes and natural language processing of pathology and radiology reports improves HCC case identification in automated data.
Koo, Kevin; Gormley, E Ann
Prompted by patients' changing perceptions of transvaginal mesh, this study examines how mesh has been reported in the news following the 2011 US Food and Drug Administration (FDA) updated notification about the use of mesh in the treatment of pelvic organ prolapse. Two national newspaper databases were queried for articles discussing transvaginal mesh published within 3 years of the FDA announcement. Content analysis included headline subjects, mesh-related complications, quoted sources, and the FDA recommendations. To determine whether more widely read sources publish higher quality reporting, a subgroup analysis was conducted based on newspaper circulation. Ninety-five articles met inclusion criteria. Mesh-related litigation was the most common headline subject (36 articles, 38%), and 54% of all articles referenced legal action. Fifty-seven articles (60%) cited at least one mesh-related complication. Only 18 articles (19%) quoted surgeons who use transvaginal mesh. For the FDA update, 40% of articles that first reported the announcement accurately specified that it applies to mesh for prolapse, not incontinence. This ambiguity persisted: half of all articles cited the warning, but only 23% distinguished between prolapse and incontinence. Higher newspaper circulation did not significantly improve the quality of reporting about the content or context of the FDA's recommendations. Despite frequent media coverage of transvaginal mesh and its complications since 2011, very few news sources that cited the FDA warning distinguished between prolapse and incontinence. Given prevalent reporting of mesh-related litigation, the findings raise concern about how patients perceive the safety and efficacy of transvaginal mesh, regardless of indication. Neurourol. Urodynam. 36:329-332, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
We developed population segments designed to account for patient complexity and primary health care needs; as such, segments provide more information than traditional indices of morbidity burden based on counts of chronic conditions. These segments will be used to report information on the quality of primary care. We plan to include conduct validation studies using additional variables (e.g, socio-economic factors, level of vulnerability from patient surveys so that segments more accurately represent the level of complexity and patients’ primary health care needs.
Degli Esposti, Luca; Saragoni, Stefania; Buda, Stefano; Sturani, Alessandra; Degli Esposti, Ezio
Diabetes is one of the most prevalent chronic diseases, and its prevalence is predicted to increase in the next two decades. Diabetes imposes a staggering financial burden on the health care system, so information about the costs and experiences of collecting and reporting quality measures of data is vital for practices deciding whether to adopt quality improvements or monitor existing initiatives. The aim of this study was to quantify the association between health care costs and level of glycemic control in patients with type 2 diabetes using clinical and administrative databases. A retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Patients were subdivided according to their glycated hemoglobin level. Multivariate analyses were used to control for differences in potential confounding factors, including age, gender, Charlson comorbidity index, presence of dyslipidemia, hypertension, or cardiovascular disease, and degree of adherence with antidiabetic drugs among the study groups. Of the total population of 700,000 subjects, 31,022 were identified as being diabetic (4.4% of the entire population). Of these, 21,586 met the study inclusion criteria. In total, 31.5% of patients had very poor glycemic control and 25.7% had excellent control. Over 2 years, the mean diabetes-related cost per person was: €1291.56 in patients with excellent control; €1545.99 in those with good control; €1584.07 in those with fair control; €1839.42 in those with poor control; and €1894.80 in those with very poor control. After adjustment, compared with the group having excellent control, the estimated excess cost per person associated with the groups with good control, fair control, poor control, and very poor control was €219.28, €264.65, €513.18, and €564.79, respectively. Many patients showed suboptimal glycemic control. Lower levels of glycated hemoglobin were associated with lower diabetes
Purported risk or harm reduction through product design change of cigarettes has occurred in three phases in the U.S. The first phase from the 1940s to the early 1960s included a gradual rise in filtered cigarettes. The second phase, which began in the early 1960s in response to the landmark 1964 U.S. Surgeon General's report that linked smoking with lung cancer and other diseases, included the introduction of purportedly low tar and nicotine cigarettes. Subsequent research found that both filters and low tar and nicotine cigarettes were ineffective approaches to reducing health risks associated with smoking. Despite this, these product design changes were used in tobacco industry marketing campaigns to allay consumer health concerns and stabilize tobacco markets and sales. Since 2004, a new risk or harm reduction phase has occurred with the backing by Philip Morris as well as major U.S. health groups of U.S. Food and Drug Administration legislation that would require disclosure of tobacco ingredients, ban misleading health claims, prohibit or reduce harmful ingredients, and require prior approval of tobacco design, performance changes, and modified risk tobacco products. However, current scientific literature indicates that there is no scientific consensus and little evidence on what tobacco ingredients are linked to particular morbidities and mortalities and at what levels. This will allow the tobacco industry to implicitly or explicitly claim their products are "safer." Instead, health advocates should advocate for scientifically proven policy measures such as smoke free public places or higher tobacco taxes that control and reduce tobacco markets and consumption.
Essential learning tools for continuing medical education for physicians, geneticists, nurses, allied health professionals, mental health professionals, business administration professionals, and reproductive endocrinology and infertility (REI) fellows: the Midwest Reproductive Symposium International.
Collins, Gretchen G; Jeelani, Roohi; Beltsos, Angeline; Kearns, William G
Essential learning tools for continuing medical education are a challenge in today's rapidly evolving field of reproductive medicine. The Midwest Reproductive Symposium International (MRSi) is a yearly conference held in Chicago, IL. The conference is targeted toward physicians, geneticists, nurses, allied health professionals, mental health professionals, business administration professionals, and reproductive endocrinology and infertility (REI) fellows engaged in the practice of reproductive medicine. In addition to the scientific conference agenda, there are specific sessions for nurses, mental health professionals, and REI fellows. Unique to the MRSi conference, there is also a separate "Business Minds" session to provide education on business acumen as it is an important element to running a department, division, or private clinic.
Landes, Sara J; Rodriguez, Allison L; Smith, Brandy N; Matthieu, Monica M; Trent, Lindsay R; Kemp, Janet; Thompson, Caitlin
National implementation of evidence-based psychotherapies (EBPs) in the Veterans Health Administration (VHA) provides important lessons on the barriers and facilitators to implementation in a large healthcare system. Little is known about barriers and facilitators to the implementation of a complex EBP for emotional and behavioral dysregulation-dialectical behavioral therapy (DBT). The purpose of this study was to understand VHA clinicians' experiences with barriers, facilitators, and benefits from implementing DBT into routine care. This national program evaluation survey measured site characteristics of VHA sites (N = 59) that had implemented DBT. DBT was most often implemented in general mental health outpatient clinics. While 42% of sites offered all four modes of DBT, skills group was the most frequently implemented mode. Fifty-nine percent of sites offered phone coaching in any form, yet only 11% of those offered it all the time. Providers were often provided little to no time to support implementation of DBT. Barriers that were difficult to overcome were related to phone coaching outside of business hours. Facilitators to implementation included staff interest and expertise. Perceived benefits included increased hope and functioning for clients, greater self-efficacy and compassion for providers, and ability to treat unique symptoms for clinics. There was considerable variability in the capacity to address implementation barriers among sites implementing DBT in VHA routine care. Mental health policy makers should note the barriers and facilitators reported here, with specific attention to phone coaching barriers.
Full Text Available Context: Caregivers of sick children have to be careful with medicine dosing and giving medicines to a reluctant child can be challenging. Aim: To assess the knowledge, attitude, and practices of caregivers regarding pediatric medicine administration and health literacy allied to this task. Settings and Design: This cross-sectional study was carried out on outpatient and inpatient basis in the pediatrics department of a teaching hospital over 6 months. Subjects and Methods: Data regarding sociodemographic profile of patient and caregiver, idea regarding pediatric dosage forms, dosing of medicines, and medication errors during administration were recorded from 377 caregivers. Reconstitution of dry powder and measurement of 5 mL liquid medicine using measuring cup of the medicine phial was demonstrated by the caregivers. Statistical Analysis: Association assessed by point biserial correlation and Spearman's rank correlation. Results: Majority of the primary caregivers surveyed were young, educated, homemaker mothers. Liquid medicines were used maximally (88.9%. Majority (87.3% of the caregivers used standardized dosing instruments to measure liquids and reconstitution (85.9%, and teaspoon measurement task (91% was performed satisfactorily by most. Some potentially wrong practices (e.g., adding medicine to milk, redilution of reconstituted medicine, and storing beyond the recommended period were recorded. Medication errors were reported by 44.5% caregivers, significantly more in the outpatient setting. Although the statistical correlation was weak, the chance of medication error was less, and the precision of measurement was better with increasing education of the caregiver. Conclusions: Physicians need to be aware of the limitations of knowledge and the possibility of wrong administration practices among caregivers of children. Remedial measures in this regard can reduce the risk of medication errors.
Sinyavskaya, Liliya; Matteau, Alexis; Johnson, Sarasa; Durand, Madeleine
Algorithms to define current exposure to warfarin using administrative data may be imprecise. Study objectives were to characterize dispensation patterns, to measure gaps between expected and observed refill dates for warfarin and direct oral anticoagulants (DOACs). Retrospective cohort study using administrative health care databases of the Régie de l'assurance-maladie du Québec. We identified every dispensation of warfarin, dabigatran, rivaroxaban, or apixaban for patients with AF initiating oral anticoagulants between 2010 and 2015. For each dispensation, we extracted date and duration. Refill gaps were calculated as difference between expected and observed dates of successive dispensation. Refill gaps were summarized using descriptive statistics. To account for repeated observations nested within patients and to assess the components of variance of refill gaps, we used unconditional multilevel linear models. We identified 61 516 new users. Majority were prescribed warfarin (60.3%), followed by rivaroxaban (16.4%), dabigatran (14.5%), apixaban (8.8%). Most frequent recorded duration of dispensation was 7 days, suggesting use of pharmacist-prepared weekly pillboxes. The average refill gap from multilevel model was higher for warfarin (9.28 days, 95%CI:8.97-9.59) compared with DOACs (apixaban 3.08 days, 95%CI: 2.96-3.20, dabigatran 3.70, 95%CI: 3.56-3.84, rivaroxaban 3.15, 95%CI: 3.03-3.27). The variance of refill gaps was greater among warfarin users than among DOAC users. Greater refill gaps for warfarin may reflect inadequate capture of the period covered by the number of dispensed pills recorded in administrative data. A time-dependent definition of exposure using dispensation data would lead to greater misclassification of warfarin than DOACs use. Copyright © 2018 John Wiley & Sons, Ltd.
Implementing Health in All Policies - Time and Ideas Matter Too! Comment on "Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities".
Carey and Friel suggest that we turn to knowledge developed in the field of public administration, especially new public governance, to better understand the process of implementing health in all policies (HiAP). In this commentary, I claim that theories from the policy studies bring a broader view of the policy process, complementary to that of new public governance. Drawing on the policy studies, I argue that time and ideas matter to HiAP implementation, alongside with interests and institutions. Implementing HiAP is a complex process considering that it requires the involvement and coordination of several policy sectors, each with their own interests, institutions and ideas about the policy. Understanding who are the actors involved from the various policy sectors concerned, what context they evolve in, but also how they own and frame the policy problem (ideas), and how this has changed over time, is crucial for those involved in HiAP implementation so that they can relate to and work together with actors from other policy sectors. © 2016 by Kerman University of Medical Sciences.
Implementing Health in All Policies – Time and Ideas Matter Too!; Comment on “Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities”
Full Text Available Carey and Friel suggest that we turn to knowledge developed in the field of public administration, especially new public governance, to better understand the process of implementing health in all policies (HiAP. In this commentary, I claim that theories from the policy studies bring a broader view of the policy process, complementary to that of new public governance. Drawing on the policy studies, I argue that time and ideas matter to HiAP implementation, alongside with interests and institutions. Implementing HiAP is a complex process considering that it requires the involvement and coordination of several policy sectors, each with their own interests, institutions and ideas about the policy. Understanding who are the actors involved from the various policy sectors concerned, what context they evolve in, but also how they own and frame the policy problem (ideas, and how this has changed over time, is crucial for those involved in HiAP implementation so that they can relate to and work together with actors from other policy sectors.
N° 21 - August 2003 Special leave This circular has been amended. Copies of this circular are available in the Divisional Secretariats. In addition, administrative and operational circulars, as well as the lists of those in force, are available for consultation on the Web at: http://cern.ch/hr-div/internal/admin_services/admincirc/listadmincirc.asp Human Resources Division Tel. 74128
The Internet and electronic commerce (e-commerce) generate lots of data. Data must be stored, organized, and managed. Database administrators, or DBAs, work with database software to find ways to do this. They identify user needs, set up computer databases, and test systems. They ensure that systems perform as they should and add people to the…
Grayson, Katherine, Ed.
When it comes to Administrative IT solutions and processes, best practices range across the spectrum. Enterprise resource planning (ERP), student information systems (SIS), and tech support are prominent and continuing areas of focus. But widespread change can also be accomplished via the implementation of campuswide document imaging and sharing,…
Mull, Hillary J; Borzecki, Ann M; Loveland, Susan; Hickson, Kathleen; Chen, Qi; MacDonald, Sally; Shin, Marlena H; Cevasco, Marisa; Itani, Kamal M F; Rosen, Amy K
The Patient Safety Indicators (PSIs) use administrative data to screen for select adverse events (AEs). In this study, VA Surgical Quality Improvement Program (VASQIP) chart review data were used as the gold standard to measure the criterion validity of 5 surgical PSIs. Independent chart review was also used to determine reasons for PSI errors. The sensitivity, specificity, and positive predictive value of PSI software version 4.1a were calculated among Veterans Health Administration hospitalizations (2003-2007) reviewed by VASQIP (n = 268,771). Nurses re-reviewed a sample of hospitalizations for which PSI and VASQIP AE detection disagreed. Sensitivities ranged from 31% to 68%, specificities from 99.1% to 99.8%, and positive predictive values from 31% to 72%. Reviewers found that coding errors accounted for some PSI-VASQIP disagreement; some disagreement was also the result of differences in AE definitions. These results suggest that the PSIs have moderate criterion validity; however, some surgical PSIs detect different AEs than VASQIP. Future research should explore using both methods to evaluate surgical quality. Published by Elsevier Inc.
... 42 Public Health 2 2010-10-01 2010-10-01 false Administration. 403.512 Section 403.512 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... Administration. (a) General. Administration of grants will be in accordance with the provisions of this subpart...
Medicaid program; Medicaid Management Information Systems; conditions of approval and reapproval and procedures for reduction of federal financial participation--Health Care Financing Administration. Proposed rule.
This proposal adds to regulations new conditions and procedures for initial approval and for reapproval of Medicaid Management Information Systems (MMIS) to update the regulations to reflect additional requirements added by section 901 of the Mental Health Systems Act of 1980 (Pub. L. 96-398). The proposal specifies procedures for reducing the level of Federal financial participation in a State's administrative expenditures when a State fails to meet the conditions for initial operation, initial approval or reapproval of an MMIS. It also proposes procedures with respect to waivers of the conditions of approval and reapproval and to appeals of adverse decisions. These provisions are intended to improve States' MMIS, and to ensure efficient system operations, and to detect cases of fraud, waste, and abuse effectively.
White, Michelle K; Maher, Stephen M; Rizio, Avery A; Bjorner, Jakob B
Patient-reported outcome (PRO) measures originally developed for paper administration are increasingly being administered electronically in clinical trials and other health research studies. Three published meta-analyses of measurement equivalence among paper and electronic modes aggregated findings across hundreds of PROs, but there has not been a similar meta-analysis that addresses a single PRO, partly because there are not enough published measurement equivalence studies using the same PRO. Because the SF-36 (R) Health Survey (SF-36) is a widely used PRO, the aim of this study was to conduct a meta-analysis of measurement equivalence studies of this survey. A literature search of several medical databases used search terms for variations of "SF-36" or "SF-12" and "equivalence" in the title or abstract of English language publications. The eight scale scores and two summary measures of the SF-36 and SF-12 were transformed to norm-based scores (NBS) using developer guidelines. A threshold of within ± 2 NBS points was set as the margin of equivalence. Comprehensive meta-analysis software was used. Twenty-five studies were included in the meta-analysis. Results indicated that mean differences across domains and summary scores ranged from 0.01 to 0.39 while estimates of agreement ranged from 0.76 to 0.91, all well within the equivalence threshold. Moderator analyses showed that time between administration, survey language, and type of electronic device did not influence equivalence. The results of the meta-analysis support equivalence of paper-based and electronic versions of the SF-36 and SF-12 across a variety of disease populations, countries, and electronic modes.
Seaman, Karla L; Sanfilippo, Frank M; Roughead, Elizabeth E; Bulsara, Max K; Kemp-Casey, Anna; Bulsara, Caroline; Watts, Gerald F; Preen, David
Across the world, health systems are adopting approaches to manage rising healthcare costs. One common strategy is a medication copayments scheme where consumers make a contribution (copayment) towards the cost of their dispensed medicines, with remaining costs subsidised by the health insurance service, which in Australia is the Federal Government.In Australia, copayments have tended to increase in proportion to inflation, but in January 2005, the copayment increased substantially more than inflation. Results from aggregated dispensing data showed that this increase led to a significant decrease in the use of several medicines. The aim of this study is to determine the demographic and clinical characteristics of individuals ceasing or reducing statin medication use following the January 2005 Pharmaceutical Benefit Scheme (PBS) copayment increase and the effects on their health outcomes. This whole-of-population study comprises a series of retrospective, observational investigations using linked administrative health data on a cohort of West Australians (WA) who had at least one statin dispensed between 1 May 2002 and 30 June 2010. Individual-level data on the use of pharmaceuticals, general practitioner (GP) visits, hospitalisations and death are used.This study will identify patients who were stable users of statin medication in 2004 with follow-up commencing from 2005 onwards. Subgroups determined by change in adherence levels of statin medication from 2004 to 2005 will be classified as continuation, reduction or cessation of statin therapy and explored for differences in health outcomes and health service utilisation after the 2005 copayment change. Ethics approvals have been obtained from the Western Australian Department of Health (#2007/33), University of Western Australia (RA/4/1/1775) and University of Notre Dame (0 14 167F). Outputs from the findings will be published in peer reviewed journals designed for a policy audience and presented at state
Aluise, J J; Schmitz, C C; Bland, C J; McArtor, R E
To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education is now available, which addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies, and references provide health care educators with a model for developing administrative skills programs for academic physicians and other health care professionals. The continuing success of the academic medical center as a responsive health care system may depend on the degree to which academic physicians and their colleagues in other fields gain sophistication in self-management and organizational administration. Health care educators can apply the competencies and instructional strategies offered in this article to administrative development programs for physicians and other health professionals in their institutions.
Pearson-Stuttard, Jonathan; Kypridemos, Chris; Collins, Brendan; Mozaffarian, Dariush; Huang, Yue; Bandosz, Piotr; Capewell, Simon; Whitsel, Laurie; Wilde, Parke; O'Flaherty, Martin; Micha, Renata
Sodium consumption is a modifiable risk factor for higher blood pressure (BP) and cardiovascular disease (CVD). The US Food and Drug Administration (FDA) has proposed voluntary sodium reduction goals targeting processed and commercially prepared foods. We aimed to quantify the potential health and economic impact of this policy. We used a microsimulation approach of a close-to-reality synthetic population (US IMPACT Food Policy Model) to estimate CVD deaths and cases prevented or postponed, quality-adjusted life years (QALYs), and cost-effectiveness from 2017 to 2036 of 3 scenarios: (1) optimal, 100% compliance with 10-year reformulation targets; (2) modest, 50% compliance with 10-year reformulation targets; and (3) pessimistic, 100% compliance with 2-year reformulation targets, but with no further progress. We used the National Health and Nutrition Examination Survey and high-quality meta-analyses to inform model inputs. Costs included government costs to administer and monitor the policy, industry reformulation costs, and CVD-related healthcare, productivity, and informal care costs. Between 2017 and 2036, the optimal reformulation scenario achieving the FDA sodium reduction targets could prevent approximately 450,000 CVD cases (95% uncertainty interval: 240,000 to 740,000), gain approximately 2.1 million discounted QALYs (1.7 million to 2.4 million), and produce discounted cost savings (health savings minus policy costs) of approximately $41 billion ($14 billion to $81 billion). In the modest and pessimistic scenarios, health gains would be 1.1 million and 0.7 million QALYS, with savings of $19 billion and $12 billion, respectively. All the scenarios were estimated with more than 80% probability to be cost-effective (incremental cost/QALY cost-saving by 2031. Limitations include evaluating only diseases mediated through BP, while decreasing sodium consumption could have beneficial effects upon other health burdens such as gastric cancer. Further, the effect
Colombo, Lara; Zito, Margherita; Ghislieri, Chiara
In recent years, the interest in the well-being at work has grown considerably, also considering the latest law directives. Several scholars have devoted particular attention to the topic of the work-to-family influence and of social supports, as elements able to affect the perceived well-being. The well-being in health care has to consider the particular nature of work and the relevant relational dimensions that require special attention for the emotional side. The research was promoted by the Committee for Equal Opportunities of a public health organization in the North-West Italy. Referring to the job demands-resources theoretical model, this study investigated the role of organizational and family supports, work-to-family spillover (positive and negative) and family workload as possible determinants of job satisfaction, intended as an indicator of psychological well-being at work. Respondents to the questionnaire are 541 (55% of the total employees), their average age is 43 and they are mostly women (80%). Data analysis showed the central role of supervisors supports, of the co-workers supports and, to a lesser extent, the role of the work-to-family spillover in influencing job satisfaction. Moreover, significant differences between medical and administrative staff were detected. The centrality of supports, especially those of supervisors in determining job satisfaction, is in line with studies indicating that a supportive leadership and a family-friendly culture can facilitate the arise of positive outcomes for both workers and organizations.
Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use.
Nelson, Karin M; Helfrich, Christian; Sun, Haili; Hebert, Paul L; Liu, Chuan-Fen; Dolan, Emily; Taylor, Leslie; Wong, Edwin; Maynard, Charles; Hernandez, Susan E; Sanders, William; Randall, Ian; Curtis, Idamay; Schectman, Gordon; Stark, Richard; Fihn, Stephan D
In 2010, the Veterans Health Administration (VHA) began implementing the patient-centered medical home (PCMH) model. The Patient Aligned Care Team (PACT) initiative aims to improve health outcomes through team-based care, improved access, and care management. To track progress and evaluate outcomes at all VHA primary care clinics, we developed and validated a method to assess PCMH implementation. To create an index that measures the extent of PCMH implementation, describe variation in implementation, and examine the association between the implementation index and key outcomes. We conducted an observational study using data on more than 5.6 million veterans who received care at 913 VHA hospital-based and community-based primary care clinics and 5404 primary care staff from (1) VHA clinical and administrative databases, (2) a national patient survey administered to a weighted random sample of veterans who received outpatient care from June 1 to December 31, 2012, and (3) a survey of all VHA primary care staff in June 2012. Composite scores were constructed for 8 core domains of PACT: access, continuity, care coordination, comprehensiveness, self-management support, patient-centered care and communication, shared decision making, and team-based care. Patient satisfaction, rates of hospitalization and emergency department use, quality of care, and staff burnout. Fifty-three items were included in the PACT Implementation Progress Index (Pi2). Compared with the 87 clinics in the lowest decile of the Pi2, the 77 sites in the top decile exhibited significantly higher patient satisfaction (9.33 vs 7.53; P hospitalization rates for ambulatory care-sensitive conditions (4.42 vs 3.68 quarterly admissions for veterans 65 years or older per 1000 patients; P < .001), and lower emergency department use (188 vs 245 visits per 1000 patients; P < .001). The extent of PCMH implementation, as measured by the Pi2, was highly associated with important outcomes for both
Stallmann, C; Swart, E; Robra, B-P; March, S
We analysed the degree and impact of consent bias in the prospective study 'leben in der Arbeit (lidA)' after linking primary interview data with claims data from German statutory health insurance funds as well as with administrative data provided by the German Federal Employment Agency. Prospective cohort study. Within two study waves (2011, 2014) primary data were collected based on computer-assisted personal interviews. During interview informed consent to data linkage was obtained. We used binary logistic regression analyses with participants' consent for record linkage as the dependent variable calculating odds ratios (ORs) and 95% confidence intervals (95% CIs) for independent variables. Several sociodemographic, socio-economic and work-related factors were modelled as potential determinants of consent. A total of 4244 participants took part in both waves. After excluding invalid consent, 4178 participants were included in the analysis. About 3918 (93.8%) of these participants gave their consent to link their primary data with data from at least one source. Within regression analyses only moderate bias was found due to region of residence, apprenticeship, professional affiliations, income and number of diseases. Participants from former West Germany were less likely to have their study data linked with both data sources (OR 0.63 [95% CI 0.42-0.96]) than those from the former East Germany. Participants with no information on income were more likely to refuse consent to both data sources compared to the reference group (net income: under EUR 1000; OR 0.15 [95% CI 0.08-0.30]). Respondents with two (OR 1.37 [95% CI 1.06-1.77]) or three and more diseases (OR 1.30 [95% CI 1.02-1.66]) diagnosed by a doctor agreed more frequently to linking both data sources than participants without disease. There is just a small proportion of variance in consenting explained by the models (R 2 : 0.063-0.085). Also, only small changes of factors' prevalence were observed in
Organization of accident medical service in emergency situations in the system of Federal administration board for medical-biological and emergency problems at the Ministry of public health and medical industry of Russia
Federal Administration Board for medical-biological problems at the Ministry of Public Health and Medical Industry of Russia, in accordance with the entrusted functions, provides medical-sanitary service for the workers of the branches of industry with especially dangerous labour conditions. For these purpose, there is functioning in its system a network of therapeutic-prophylactic, sanitary, scientific-research, educational and other establishments. A high degree of accident danger of the attended industrial plants determines the state policy of organizations and administrations as well as scientific-practical establishments of the Federal Administration Board in respect of elaboration and introduction of a complex of measures which would enable to guarantee the safe functioning of the plants. All sub-administration establishments have the necessary structures, settle the questions of liquidation of medical-sanitary after-effects of accidents at the attended plants, and are regarded to be the organizations of specialized emergency medical aid of the Federal Administration Board
Full Text Available Administrative contracts are a special type of contract where usually one of the contracting parties is a public law body and which is concluded for the performance of public service and the realization of a public interest. They go a long way since its inception to its eventual final acceptance of all the legal systems. One of the enduring characteristics of this type of contract is their disquised or unnoticed existence. This is why only monitoring their development may lead to a complete understanding of the importance and essence of this institution as well as the need for its complete legal regulation.
Administrative contracts are a special type of contract where usually one of the contracting parties is a public law body and which is concluded for the performance of public service and the realization of a public interest. They go a long way since its inception to its eventual final acceptance of all the legal systems. One of the enduring characteristics of this type of contract is their disquised or unnoticed existence. This is why only monitoring their development may lead to a complete u...
Santana-Davila, Rafael; Devisetty, Kiran; Szabo, Aniko; Sparapani, Rodney; Arce-Lara, Carlos; Gore, Elizabeth M; Moran, Amy; Williams, Christina D; Kelley, Michael J; Whittle, Jeffrey
The optimal chemotherapy regimen to use with radiotherapy in stage III non-small-cell lung cancer is unknown. Here, we compare the outcome of patents treated within the Veterans Health Administration with either etoposide-cisplatin (EP) or carboplatin-paclitaxel (CP). We identified patients treated with EP and CP with concurrent radiotherapy from 2001 to 2010. Survival rates were compared using Cox proportional hazards regression models with adjustments for confounding provided by propensity score methods and an instrumental variables analysis. Comorbidities and treatment complications were identified through administrative data. A total of 1,842 patients were included; EP was used in 27% (n = 499). Treatment with EP was not associated with a survival advantage in a Cox proportional hazards model (hazard ratio [HR], 0.97; 95% CI, 0.85 to 1.10), a propensity score matched cohort (HR, 1.07; 95% CI, 0.91 to 1.24), or a propensity score adjusted model (HR, 0.97; 95% CI, 0.85 to 1.10). In an instrumental variables analysis, there was no survival advantage for patients treated in centers where EP was used more than 50% of the time as compared with centers where EP was used in less than 10% of the patients (HR, 1.07; 95% CI, 0.90 to 1.26). Patients treated with EP, compared with patients treated with CP, had more hospitalizations (2.4 v 1.7 hospitalizations, respectively; P kidney disease/dehydration (30.5% v 21.2%, respectively; P patients treated with EP versus CP had similar overall survival, but EP was associated with increased morbidity. © 2014 by American Society of Clinical Oncology.
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 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 Radiation Control for Health and Safety Act of 1968. The report provides a summary of the operations of the Center in carrying out that responsibility for calendar year 1990. In reviewing the operations of the Center for Devices and Radiological Health as reported in the document, it should be kept in mind that the day-to-day administration of the Act is only part of the Center's function. Other responsibilities include the administration and enforcement of the 1976 Medical Device Amendments to the Federal Food, Drug, and Cosmetic Act (not covered in the report). Manufacturers of electronic products are required by 21 CFR 1002.20 to report accidental radiation occurrences to the Center for Devices and Radiological Health. The Center no longer maintains a Radiation Incidents Registry, since accidental radiation occurrences are reported through the Device Experience Network (DEN) and through the requirements of the Medical Device Reporting (MDR) Regulations
NIOSH (National Institute for Occupational Safety and Health) testimony to Department of Labor on the Mine Safety and Health Administration proposed rule: ionizing radiation standards for metal and nonmetal mines, August 13, 1987 by R. Niemeier
Recommendations were offered for protecting workers against the health effects of ionizing radiation in metal and nonmetal mines. Available data demonstrating such health effects was reviewed and evidence supporting the technical feasibility of reducing the current Mine Safety and Health Administration (MSHA) standard was presented. Five recent studies indicated a significant increase in lung cancer rates associated with radon progeny exposure in underground mines. Additional studies indicated an exposure/response relationship in uranium miners. The influence of smoking on the association between radon progeny exposure and lung cancer was cited. Evidence has indicated that exposure to radon progeny carries a potential risk of developing occupationally induced lung cancer. Risk-assessment data supported the conclusion that miners with the same characteristics as the United States Public Health Service uranium miners cohort and who accrue a cumulative occupational exposure of 120 working level months, would have a lung cancer excess lifetime risk of about 35 to 40 lung cancer deaths per 1000 exposed miners. Modern mining methods using dilution ventilation as well as bulkheading and backfilling techniques make it possible to achieve substantial reductions in the cumulative exposure to radon progeny. Information was provided on sampling strategy, control technology, ventilation systems, respirators, and medical surveillance programs
Full Text Available In Italy, advance health care directives are a subject of considerable debate in both legal theory and practice. This debate focuses in partic- ular not only on the appropriateness of approving ad hoc statutory reg- ulations but also on the extent to which similar advance indications of a person’s wishes are applicable under the existing legal system, albeit in the absence of a law regulating them. The authors of this paper con- sider, in particular, guidelines relating to the possible use of the mech- anism of support administration (amministrazione di sostegno (Law No. 6/2004 as a procedure to be used for the legal recognition of advance health care directives, particularly in the light of the legal pro- vision for the possible designation in advance of a support administra- tor by a beneficiary in anticipation of an eventual situation of incapac- ity. This underlines how the concept of health does not only exist in the abstract, but must be measured in relation to the particular patient in the particular situation and how beneficence and respect for auton- omy are both essential elements in the choices aimed at promoting the health and the wellbeing of its citizens.
Division des ressources humaines
N° 2 (Rev. 1) - March 2000Guidelines and procedures concerning recruitment and probation period of staff membersN° 9 (Rev. 2) - March 2000Staff members contractsN° 16 (Rev. 2) - January 2000TrainingN° 30 (Rev. 1) - January 2000Indemnities and reimbursements upon taking up appointment and termination of contractN° 32 - February 2000Principles and procedures governing complaints of harassmentThese circular have been amended (No 2, N° 9, N° 16 and N° 30) or drawn up (N° 32).Copies are available in the Divisional Secretariats.Note:\tAdministrative and operational circulars, as well as the lists of those in force, are available for consultation in the server SRV4_Home in the Appletalk zone NOVELL (as GUEST or using your Novell username and password), volume PE Division Data Disk.The Word files are available in the folder COM, folder Public, folder ADM.CIRC.docHuman Resources DivisionTel. 74128
A Sophisticated Architecture Is Indeed Necessary for the Implementation of Health in All Policies but not Enough Comment on "Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities".
In this commentary, I argue that beyond a sophisticated supportive architecture to facilitate implementation of actions on the social determinants of health (SDOH) and health inequities, the Health in All Policies (HiAP) project faces two main barriers: lack of awareness within policy networks on the social determinants of population health, and a tendency of health actors to neglect investing in other sectors' complex problems. © 2016 by Kerman University of Medical Sciences.
Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications.
Rac, Goran; Younger, Austin; Clemens, James Q; Kobashi, Kathleen; Khan, Aqsa; Nitti, Victor; Jacobs, Ilana; Lemack, Gary E; Brown, Elizabeth T; Dmochowski, Roger; MacLachlan, Lara; Mourtzinos, Arthur; Ginsberg, David; Koski, Michelle; Rames, Ross; Rovner, Eric S
To investigate the possible effects of the Food and Drug Administration (FDA) Public Health Notifications in 2008 and 2011 regarding surgical trends in transvaginal mesh (TVM) placement for stress urinary incontinence (SUI) and related mesh revision surgery in Female Pelvic Medicine & Reconstructive Surgery (FPMRS) practice in tertiary care academic medical centers in the United States. Surgical volume for procedures performed primarily by FPMRS surgeons at eight academic institutions across the US was collected using Current Procedural Terminology (CPT) codes for stress urinary incontinence repair and revision surgeries from 2007 to 2013. SAS statistical software was used to assess for trends in the data. There was a decrease in the use of synthetic mesh sling for the treatment of SUI at academic tertiary care centers over the past 7 years; however, this was not statistically significant. While the total number of surgical interventions for SUI remained stable, there was an increase in the utilization of autologous fascia pubovaginal slings (AFPVS). The number of mesh sling revision surgeries, including urethrolysis and removal or revision of slings, increased almost three-fold at these centers. These observed trends suggest a possible effect of the FDA Public Health Notifications regarding TVM on surgical practice for SUI in academic centers, even though they did not specifically warn against the use of synthetic mesh for this indication. Indications for surgery, complications, and outcomes were not evaluated during this retrospective study. However, such data may provide alternative insights into reasons for the observed trends. Neurourol. Urodynam. 36:1155-1160, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Increased Severe Trauma Patient Volume is Associated With Survival Benefit and Reduced Total Health Care Costs: A Retrospective Observational Study Using a Japanese Nationwide Administrative Database.
Endo, Akira; Shiraishi, Atsushi; Fushimi, Kiyohide; Murata, Kiyoshi; Otomo, Yasuhiro
The aim of this study was to evaluate the associations of severe trauma patient volume with survival benefit and health care costs. The effect of trauma patient volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. We conducted a retrospective observational study, including trauma patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma patient volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for patient severity and hospital characteristics. A total of 116,329 patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest volume categories compared with the reference category [94.2% in the highest volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. Hospitals with high volumes of severe trauma patients were significantly associated with a survival benefit and lower total cost per admission.
Mazzali, Cristina; Duca, Piergiorgio
Health research based on administrative data and the availability of regional or national administrative databases has been increasing in recent years. We will discuss the general characteristics of administrative data and specific aspects of their use for health research purposes, indicating their advantages and disadvantages. Some fields of application will be discussed and described through examples.
U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) has compiled a summary of overall Medicare Administrative Contractor (MAC) performance information as measured...
Zubkoff, Lisa; Neily, Julia; King, Beth J; Dellefield, Mary Ellen; Krein, Sarah; Young-Xu, Yinong; Boar, Shoshana; Mills, Peter D
In 2014 the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help VHA facilities prevent hospital-acquired conditions: catheter-associated urinary tract infection (CAUTI) and hospital-acquired pressure ulcers (HAPUs). During the prework phase, participating facilities assembled a multidisciplinary team, assessed their current system for CAUTI or HAPU prevention, and examined baseline data to set improvement aims. The action phase consisted of educational conference calls, coaching, and monthly team reports. Learning was conducted via phone, web-based options, and e-mail. The CAUTI bundle focused on four key principles: (1) avoidance of indwelling urinary catheters, (2) proper insertion technique, (3) proper catheter maintenance, and (4) timely removal of the indwelling catheter. The HAPU bundle focused on assessment and inspection, pressure-relieving surfaces, turning and repositioning, incontinence management, and nutrition/hydration assessment and intervention. For the 18 participating units, the mean aggregated CAUTI rate decreased from 2.37 during the prework phase to 1.06 per 1,000 catheter-days during the action (implementation) phase (p model for implementing a virtual model for improvement. Copyright 2016 The Joint Commission.
Hertel, Moritz; Schmidt-Westhausen, Andrea Maria; Strietzel, Frank-Peter
In order to identify oral candidiasis patients being at risk of carrying potentially drug-resistant Candida, the aim of the study was to detect local, systemic, demographic, and health-related factors influencing (I) yeast spectrum composition and (II) antifungal administration frequency. Additionally, the aim was to investigate (III) species shift occurrence. Data from 798 patients (496 females, 302 males; mean age 59.7) with oral candidiasis diagnosed based on positive clinical and microbial findings (species identification and CFU count) between 2006 and 2011 were retrospectively analyzed using Pearson's chi(2) test and regression analysis. Among 958 isolates, Candida albicans was the most frequently detected (76.8 %). Also, species intrinsically resistant to azoles were frequently isolated (15.8 and 17.7 % of isolates and patients). (I) Infections only caused by C. albicans were significantly associated with the use of inhalation steroids (p = 0.001) and antibiotics (p = 0.04), super-infection of lichen planus (p = 0.002), and the absence of removable dentures (p oral candidiasis remains C. albicans. Nevertheless, therapeutic problems may be caused by the frequent presence of species intrinsically resistant to azoles, especially in patients wearing dentures.
Do associations between employee self-reported organizational assessments and attitudinal outcomes change over time? An analysis of four Veterans Health Administration surveys using structural equation modelling.
Das, Sonali; Chen, Ming-Hui; Warren, Nicholas; Hodgson, Michael
This paper evaluates relationships between healthcare employees' perceptions of three hospital organizational constructs (Leadership, Support and Resources), and their assessment of two employee-related outcomes (employee satisfaction and retention) and two patient-related outcomes (patient satisfaction and quality of care). Using four all-employee surveys conducted by the Veterans Health Administration in the United States between 1997 and 2006, we examine the strength of these relationships and their changes over time. Exposure and outcome measures are employee-assessed in all the surveys. Because it can accommodate both latent and measured variables into the model, Structural Equation Modelling (SEM) is used to capture and quantify the relationship structure. The aim of the project is to identify possible intervention foci. The analyses revealed that employee-related outcomes are improved by increases in Leadership and Support, and, not surprisingly, the outcome variable of employee satisfaction reduced turnover intention. The employee assessed patient-related outcomes of satisfaction and quality of care were most improved by increases in Resources. Results also indicate that the three organizational constructs and the web of associations characterized by SEM underwent changes over the study period, perhaps in relation to changes in VHA policy emphases, changes in survey wording and other possible unmeasured factors. Copyright © 2010 John Wiley & Sons, Ltd.
Full Text Available Abstract Background While many randomised controlled trials have been conducted on multivitamins, to our knowledge no qualitative research exploring the subjective experience of taking a multivitamin during a clinical trial has been reported. Methods Semi-structured and open-ended written questions were incorporated into a 16-week double-blind, randomised, placebo-controlled, parallel groups trial of once-daily multivitamin administration. At the final study visit (week 16, three open-ended questions were posed to elucidate any positive, negative or unusual experiences from taking either the multivitamin or matched placebo. Qualitative thematic analysis was undertaken by researchers who were blind as to treatment condition of participants, and triangulation (independent analysis from three researchers was employed to ensure methodological rigour. Participant’s experiences were categorised as “positive” or “negative” and a Chi Square analysis was then applied to each of the experiential themes, to compare experiences between the multivitamin and placebo groups, (subdividing the groups by gender. Usual experiences were categorised and discussed separately. Results Of the 182 participants enrolled, 116 completed the study and qualitative data were available from 114 participants. Thematic analysis revealed significant effects in favour of the multivitamin over placebo for participants experiencing increased energy levels (p=.022 and enhanced mood (p=.027. The beneficial effect on energy levels was particularly evident among female participants. A trend was found for participants reporting better sleep in the multivitamin over placebo. The multivitamin and placebo groups did not significantly differ in perceived positive or negative effects in areas relating to other aspects of mental function or physical health. No significant negative effects were revealed, although there was a non-significant trend for more people in the multivitamin
Huang, Allen R; Redpath, Calum J; van Walraven, Carl
Cholinesterase inhibitors are used to treat the symptoms of dementia and can theoretically cause bradycardia. Previous studies suggest that patients taking these medications have an increased risk of undergoing pacemaker insertion. Since these drugs have a marginal impact on patient outcomes, it might be preferable to change drug treatment rather than implant a pacemaker. This population-based study determined the association of people with dementia exposed to cholinesterase inhibitor medication and pacemaker insertion. We used data from the Ontario health administrative databases from January 1, 1993 to June 30, 2012. We included all community-dwelling seniors who had a code for dementia and were exposed to cholinesterase inhibitors (donezepil, galantamine, and rivastigmine) and/or drugs used to treat co-morbidities of hypertension, diabetes, depression and hypothyroidism. We controlled for exposure to anti-arrhythmic drugs. Observation started at first exposure to any medication and continued until the earliest of pacemaker insertion, death, or end of study. 2,353,909 people were included with 96,000 (4.1%) undergoing pacemaker insertion during the observation period. Case-control analysis showed that pacemaker patients were less likely to be coded with dementia (unadjusted OR 0.42 [95%CI 0.41-0.42]) or exposed to cholinesterase inhibitors (unadjusted OR 0.39 [95%CI 0.37-0.41]). That Cohort analysis showed patients with dementia taking cholinesterase inhibitors had a decreased risk of pacemaker insertion (unadj-HR 0.58 [0.55-0.61]). Adjustment for patient age, sex, and other medications did not notably change results, as did restricting the analysis to incident users. Patients taking cholinesterase inhibitors rarely undergo, and have a significantly reduced risk of, cardiac pacemaker insertion.
Rosen, Amy K; Loveland, Susan A; Romano, Patrick S; Itani, Kamal M F; Silber, Jeffrey H; Even-Shoshan, Orit O; Halenar, Michael J; Teng, Yun; Zhu, Jingsan; Volpp, Kevin G
Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of patient safety indicators (PSIs) changed after these reforms. Observational study of patients admitted to Veterans Health Administration (VA) (N = 826,047) and Medicare (N = 13,367,273) acute-care hospitals from July 1, 2000 to June 30, 2005. We examined changes in patient safety events in more versus less teaching-intensive hospitals before (2000-2003) and after (2003-2005) duty hour reform, using conditional logistic regression, adjusting for patient age, gender, comorbidities, secular trends, baseline severity, and hospital site. Ten PSIs were aggregated into 3 composite measures based on factor analyses: "Continuity of Care," "Technical Care," and "Other" composites. Continuity of Care composite rates showed no significant changes postreform in hospitals of different teaching intensity in either VA or Medicare. In the VA, there were no significant changes postreform for the technical care composite. In Medicare, the odds of a Technical Care PSI event in more versus less teaching-intensive hospitals in postreform year 1 were 1.12 (95% CI; 1.01-1.25); there were no significant relative changes in postreform year 2. Other composite rates increased in VA in postreform year 2 in more versus less teaching-intensive hospitals (odds ratio, 1.63; 95% CI; 1.10-2.41), but not in Medicare in either postreform year. Duty hour reform had no systematic impact on PSI rates. In the few cases where there were statistically significant increases in the relative odds of developing a PSI, the magnitude of the absolute increases were too small to be clinically meaningful.
Frangipane di Regalbono, Antonio; Di Cesare, Angela; Traversa, Donato; Simonato, Giulia; Poser, Helen; Danesi, Patrizia; Furnari, Carmelo; Russi, Ilaria; Raele, Donato Antonio; Crisi, Paolo; Pampurini, Fabrizio; Pietrobelli, Mario
The present study evaluated the microfilaricidal efficacy of a single application of the spot-on containing imidacloprid 10%/moxidectin 2.5% (Advocate(®), Bayer Animal Health) in dogs naturally infected either by Dirofilaria immitis or Dirofilaria repens. Dogs living in north-eastern and central-southern Italy, endemic for D. immitis and D. repens respectively, were randomly screened. Sixteen animals, eight infected with D. immitis and eight with D. repens, and fulfilling inclusion criteria were enrolled. Dogs infected with D. immitis received an adulticide treatment prior to the study and Advocate(®) 3 weeks after. The animals were divided in blocks of two (1:1, T1:T2) animals each, where Day 0 (D0) had an interval of 15days to compare T2 vs. T1 dogs during the first fortnight of examination (i.e. T2 dogs acted as control animals at each examination). At baseline (Days -15 and 0 for T2 and T1 dogs, respectively) the animals had a range of microfilaraemia of 180-99.700mff/ml (D. immitis) and 60-750 mff/ml (D. repens). All animals received a topical administration of Advocate(®) at D0 and were examined for microfilariae with microscopic and molecular tests at D15, D30, D60 and D90. All animals scored negative for mff at the first control post-treatment and throughout the study, with the exception of two D. immitis- infected animals that had a 2 mff/ml count at D15, and then become negative from Day 30 onwards. No adverse events were observed. The present study demonstrates the safety and the high microfilaricidal efficacy (99.97% and 100% for D. immitis and D. repens, respectively) of a single dose of moxidectin contained in Advocate(®) in naturally infected dogs. Copyright © 2016 Elsevier B.V. All rights reserved.
Rolls, Joanne; Keahey, David
The purpose of this study was to assess the number of Health Resources and Services Administration Expansion of Physician Assistant Training (EPAT)-funded physician assistant (PA) programs planning to maintain class size at expanded levels after grant funds expire and to report proposed financing methods. The 5-year EPAT grant expired in 2015, and the effect of this funding on creating a durable expansion of PA training seats has not yet been investigated. The study used an anonymous, 9-question, Web-based survey sent to the program directors at each of the PA programs that received EPAT funding. Data were analyzed in Excel and using SAS statistical analysis software for both simple percentages and for Fisher's exact test. The survey response rate was 81.48%. Eighty-two percent of responding programs indicated that they planned to maintain all expanded positions. Fourteen percent will revert to their previous student class size, and 4% will maintain a portion of the expanded positions. A majority of the 18 programs (66%) maintaining all EPAT seats will be funded by tuition pass-through, and one program (6%) will increase tuition. There was no statistical association between the program type and the decision to maintain expanded positions (P = .820). This study demonstrates that the one-time EPAT PA grant funding opportunity created a durable expansion in PA training seats. Future research should focus on the effectiveness of the program in increasing the number of graduates choosing to practice in primary care and the durability of expansion several years after funding expiration.
Neily, Julia; Mills, Peter D; Lee, Pamela; Carney, Brian; West, Priscilla; Percarpio, Katherine; Mazzia, Lisa; Paull, Douglas E; Bagian, James P
Communication is problematic in healthcare. The Veterans Health Administration is implementing Medical Team Training. The authors describe results of the first 32 of 130 sites to undergo the programme. This report is unique; it provides aggregate results of a crew resource-management programme for numerous facilities. Facilities were taught medical team training and implemented briefings, debriefings and other projects. The authors coached teams through consultative phone interviews over a year. Implementation teams self-reported implementation and rated programme impact: 1='no impact' and 5='significant impact.' We used logistic regression to examine implementation of briefing/debriefing. Ninety-seven per cent of facilities implemented briefings and debriefings, and all implemented an additional project. As of the final interview, 73% of OR and 67% of ICU implementation teams self-reported and rated staff impact 4-5. Eighty-six per cent of OR and 82% of ICU implementation teams self-reported and rated patient impact 4-5. Improved teamwork was reported by 84% of OR and 75% of ICU implementation teams. Efficiency improvements were reported by 94% of OR implementation teams. Almost all facilities (97%) reported a success story or avoiding an undesirable event. Sites with lower volume were more likely to conduct briefings/debriefings in all cases for all surgical services (p=0.03). Sites are implementing the programme with a positive impact on patients and staff, and improving teamwork, efficiency and safety. A unique feature of the programme is that implementation was facilitated through follow-up support. This may have contributed to the early success of the programme.
Bulzacchelli, Maria T; Vernick, Jon S; Webster, Daniel W; Lees, Peter S J
To evaluate the impact of the United States' federal Occupational Safety and Health Administration's control of hazardous energy (lockout/tagout) standard on rates of machinery-related fatal occupational injury. The standard, which took effect in 1990, requires employers in certain industries to establish an energy control program and sets minimum criteria for energy control procedures, training, inspections, and hardware. An interrupted time-series design was used to determine the standard's effect on fatality rates. Machinery-related fatalities, obtained from the National Traumatic Occupational Fatalities surveillance system for 1980 through 2001, were used as a proxy for lockout/tagout-related fatalities. Linear regression was used to control for changes in demographic and economic factors. The average annual crude rate of machinery-related fatalities in manufacturing changed little from 1980 to 1989, but declined by 4.59% per year from 1990 to 2001. However, when controlling for demographic and economic factors, the regression model estimate of the standard's effect is a small, non-significant increase of 0.05 deaths per 100 000 production worker full-time equivalents (95% CI -0.14 to 0.25). When fatality rates in comparison groups that should not have been affected by the standard are incorporated into the analysis, there is still no significant change in the rate of machinery-related fatalities in manufacturing. There is no evidence that the lockout/tagout standard decreased fatality rates relative to other trends in occupational safety over the study period. A possible explanation is voluntary use of lockout/tagout by some employers before introduction of the standard and low compliance by other employers after.
Bulzacchelli, Maria T; Vernick, Jon S; Webster, Daniel W; Lees, Peter S J
Objective To evaluate the impact of the United States' federal Occupational Safety and Health Administration's control of hazardous energy (lockout/tagout) standard on rates of machinery‐related fatal occupational injury. The standard, which took effect in 1990, requires employers in certain industries to establish an energy control program and sets minimum criteria for energy control procedures, training, inspections, and hardware. Design An interrupted time‐series design was used to determine the standard's effect on fatality rates. Machinery‐related fatalities, obtained from the National Traumatic Occupational Fatalities surveillance system for 1980 through 2001, were used as a proxy for lockout/tagout‐related fatalities. Linear regression was used to control for changes in demographic and economic factors. Results The average annual crude rate of machinery‐related fatalities in manufacturing changed little from 1980 to 1989, but declined by 4.59% per year from 1990 to 2001. However, when controlling for demographic and economic factors, the regression model estimate of the standard's effect is a small, non‐significant increase of 0.05 deaths per 100 000 production worker full‐time equivalents (95% CI −0.14 to 0.25). When fatality rates in comparison groups that should not have been affected by the standard are incorporated into the analysis, there is still no significant change in the rate of machinery‐related fatalities in manufacturing. Conclusions There is no evidence that the lockout/tagout standard decreased fatality rates relative to other trends in occupational safety over the study period. A possible explanation is voluntary use of lockout/tagout by some employers before introduction of the standard and low compliance by other employers after. PMID:17916891
Schonberger, Robert B; Dai, Feng; Brandt, Cynthia; Burg, Matthew M
Among a national cohort of surgical patients, the authors analyzed the association between medical follow-up during the first postsurgical year and survival during the second postsurgical year. Retrospective cohort study. US Veterans Hospitals. The study included adults who received surgical care in any Veterans Health Administration facility from 2006 to 2011 who were discharged within 10 days of surgery and who survived for at least 1 year postoperatively. None. The association between the receipt of nonsurgical ambulatory medical care during the first postoperative year and the hazard of death during postsurgical year 2 was measured. Among 236,200 veterans, 93.2% received a nonsurgical medical follow-up visit in postsurgical year 1; of those, 5.1% died during postsurgical year 2. This compares with 9.4% year-2 mortality among patients lacking year-1 medical follow-up (p<0.0001). After adjustment for confounders, medical follow-up in postoperative year 1 again was associated with a significantly lower hazard of death in postoperative year 2 (hazard ratio 0.71; 95% confidence interval 0.66-0.78). Sensitivity analyses examining patient subgroups stratified by procedural specialty demonstrated comparable findings. The results were robust under a variety of simulated scenarios of unmeasured confounding. Within a national cohort of US veterans who presented for surgery, those who received nonsurgical ambulatory follow-up during the first postoperative year demonstrated lower all-cause mortality in the subsequent postoperative year than those who did not receive the same type of follow-up care. Interventions focused on postoperative care coordination of outpatient medical follow-up may have the potential to improve long-term postoperative survival. Copyright © 2016. Published by Elsevier Inc.
Harris, Alex H S; Brown, Randall; Dawes, Michael; Dieperink, Eric; Myrick, Donald Hugh; Gerould, Heather; Wagner, Todd H; Wisdom, Jennifer P; Hagedorn, Hildi J
Over 16 million Americans meet diagnostic criteria for alcohol use disorder (AUD), but only 7.8% of them receive formal treatment each year. Safe and effective pharmacological treatments for AUD exist; however, they are rarely prescribed. Therefore, we developed and pilot tested a multifaceted implementation intervention to improve consideration and receipt of effective pharmacologic treatments for AUD, focusing on primary care settings where patients have the most frequent contact with healthcare systems. The intervention included training of local providers to serve as champions and a website for primary care providers that included educational materials, a case-finding dashboard, and contact information for local and national clinical experts. We also mailed patients educational material about treatment options. The intervention was implemented at three large facilities of the Veterans Health Administration (VHA). An interrupted time series design, analyzed with segmented logistic regression, was used to evaluate the intervention's effects. The odds of a patient with AUD receiving one of the AUD medications was increasing throughout the pre-implementation period, and the rate of change (slope) increased significantly in the implementation period. Translating these numbers into percentages, at baseline 2.9% of patients filled a prescription for an AUD medication within 30days of a primary care visit. This increased to 3.8% by the end of the pre-implementation period (increasing 0.037% per month), and increased to 5.2% by the end of the implementation period (increasing 0.142% per month). However, the intervention effect was not significant when control sites were added, suggesting that improvement may have been driven by secular trends rather than solely by this intervention. Although the intervention was feasible, it was not effective. Continued analysis of process and implementation data including qualitative interviews with key stakeholders, may elucidate the
... 42 Public Health 5 2010-10-01 2010-10-01 false Administration. 483.75 Section 483.75 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS... Care Facilities § 483.75 Administration. A facility must be administered in a manner that enables it to...
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
Full Text Available Abstract Background The economical impact of absenteeism and reduced productivity due to acute infectious respiratory and gastrointestinal disease is normally not in the focus of surveillance systems and may therefore be underestimated. However, large community studies in Europe and USA have shown that communicable diseases have a great impact on morbidity and lead to millions of lost days at work, school and university each year. Hand disinfection is acknowledged as key element for infection control, but its effect in open, work place settings is unclear. Methods Our study involved a prospective, controlled, intervention-control group design to assess the epidemiological and economical impact of alcohol-based hand disinfectants use at work place. Volunteers in public administrations in the municipality of the city of Greifswald were randomized in two groups. Participants in the intervention group were provided with alcoholic hand disinfection, the control group was unchanged. Respiratory and gastrointestinal symptoms and days of work were recorded based on a monthly questionnaire over one year. On the whole, 1230 person months were evaluated. Results Hand disinfection reduced the number of episodes of illness for the majority of the registered symptoms. This effect became statistically significant for common cold (OR = 0.35 [0.17 - 0.71], p = 0.003, fever (OR = 0.38 [0.14-0.99], p = 0.035 and coughing (OR = 0.45 [0.22 - 0.91], p = 0.02. Participants in the intervention group reported less days ill for most symptoms assessed, e.g. colds (2.07 vs. 2.78%, p = 0.008, fever (0.25 vs. 0.31%, p = 0.037 and cough (1.85 vs. 2.00%, p = 0.024. For diarrhoea, the odds ratio for being absent became statistically significant too (0.11 (CI 0.01 - 0.93. Conclusion Hand disinfection can easily be introduced and maintained outside clinical settings as part of the daily hand hygiene. Therefore it appears as an interesting, cost-efficient method within the scope
Shimada, Stephanie L; Petrakis, Beth Ann; Rothendler, James A; Zirkle, Maryan; Zhao, Shibei; Feng, Hua; Fix, Gemmae M; Ozkaynak, Mustafa; Martin, Tracey; Johnson, Sharon A; Tulu, Bengisu; Gordon, Howard S; Simon, Steven R; Woods, Susan S
We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities. We coded 1000 threads of SM communication sampled from 40 primary care teams. Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients. Medication renewals and refills (47.2%), scheduling requests (17.6%), medication issues (12.9%), and health issues (12.7%) were the most common patient-initiated requests, followed by referrals (7.0%), administrative issues (6.5%), test results (5.4%), test issues (5.2%), informing messages (4.9%), comments about the patient portal or SM (4.1%), appreciation (3.9%), self-reported data (2.8%), life issues (1.5%), and complaints (1.5%). Very few messages were clinically urgent (0.7%) or contained other potentially challenging content. Message threads were mostly short (2.7 messages), comprising an average of 1.35 discrete content types. A substantial proportion of issues (24.2%) did not show any evidence of being resolved through SM. Time to response and extent of resolution via SM varied by message content. Proactive SM use by teams varied, but was most often for test results (32.7%), medication-related issues (21.8%), medication renewals (16.4%), or scheduling issues (18.2%). The majority of messages were transactional and initiated by patients or caregivers. Not all content categories were fully addressed over SM. Further education and training for both patients and clinical teams could improve the quality and efficiency of SM communication. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.
Hübner, Nils-Olaf; Hübner, Claudia; Wodny, Michael; Kampf, Günter; Kramer, Axel
The economical impact of absenteeism and reduced productivity due to acute infectious respiratory and gastrointestinal disease is normally not in the focus of surveillance systems and may therefore be underestimated. However, large community studies in Europe and USA have shown that communicable diseases have a great impact on morbidity and lead to millions of lost days at work, school and university each year. Hand disinfection is acknowledged as key element for infection control, but its effect in open, work place settings is unclear. Our study involved a prospective, controlled, intervention-control group design to assess the epidemiological and economical impact of alcohol-based hand disinfectants use at work place. Volunteers in public administrations in the municipality of the city of Greifswald were randomized in two groups. Participants in the intervention group were provided with alcoholic hand disinfection, the control group was unchanged. Respiratory and gastrointestinal symptoms and days of work were recorded based on a monthly questionnaire over one year. On the whole, 1230 person months were evaluated. Hand disinfection reduced the number of episodes of illness for the majority of the registered symptoms. This effect became statistically significant for common cold (OR = 0.35 [0.17 - 0.71], p = 0.003), fever (OR = 0.38 [0.14-0.99], p = 0.035) and coughing (OR = 0.45 [0.22 - 0.91], p = 0.02). Participants in the intervention group reported less days ill for most symptoms assessed, e.g. colds (2.07 vs. 2.78%, p = 0.008), fever (0.25 vs. 0.31%, p = 0.037) and cough (1.85 vs. 2.00%, p = 0.024). For diarrhoea, the odds ratio for being absent became statistically significant too (0.11 (CI 0.01 - 0.93). Hand disinfection can easily be introduced and maintained outside clinical settings as part of the daily hand hygiene. Therefore it appears as an interesting, cost-efficient method within the scope of company health support programmes. ISRCTN96340690.
Muhwezi, Wilson Winstons; Katahoire, Anne Ruhweza; Banura, Cecily; Mugooda, Herbert; Kwesiga, Doris; Bastien, Sheri; Klepp, Knut-Inge
Evidence suggests that in spite of some adolescents being sexually active, many parents do not discuss sex-related issues with them due to lack of age-appropriate respectful vocabulary and skills. The likelihood of parent-adolescent communication improving sexual and reproductive health outcomes appears plausible. The desire to understand parent-adolescent communication and how to improve it for promotion of healthy sexual behaviours inspired this research. The paper is meant to describe perceptions of adolescents, parents and school administrators about parent-adolescent communication on sexual issues; describe the content of such communication and identify factors that influence this communication. The study was done among two urban and two rural secondary school students in their second year of education. Data were collected from 11 focus group discussions and 10 key Informants Interviews. Data management, analysis and interpretation followed thematic analysis principles. Illuminating verbatim quotations are used to illustrate findings. Parental warmth and acceptability of children was perceived by parents to be foundational for a healthy adolescent- parent communication. Perceptions of adolescents tended to point to more open and frequent communication with mothers than fathers and to cordial relationships with mothers. Fathers were perceived by adolescents to be strict, intimidating, unapproachable and unavailable. While adolescents tended to generally discuss sexual issues with mothers, male adolescents communicated less with anyone on sex, relationships and condoms. Much of the parent-adolescent communication was perceived to focus on sexually transmitted infections and body changes. Discussions of sex and dating with adolescents were perceived to be rare. Common triggers of sexuality discussions with female adolescents were; onset of menstruation and perceived abortion in the neighbourhood. Discussion with male adolescents, if it occurred was perceived to
Full Text Available Objetivo: Describir las desigualdades de género en las posiciones de liderazgo y de reconocimiento científico en la Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS, la Sociedad Española de Epidemiología (SEE y la Asociación de Economía de la Salud (AES, de 2000 a 2009. Métodos: Estudio descriptivo de la distribución por sexo de juntas directivas, comités científicos, comité organizador y moderadores de mesa de congresos de la SESPAS, la SEE y la AES, así como del comité editorial de Gaceta Sanitaria, de los editoriales de la revista, y de editores del Informe SESPAS. Resultados: En el periodo 2000-2009, en la SESPAS se produjo un ligero aumento de participación de las mujeres, la SEE cuenta con más paridad de género, y la AES tiene una baja representación de mujeres. Conclusiones: La persistencia de desigualdades de género en las sociedades profesionales de salud pública requiere seguir analizando sus causas, así como promover acciones que permitan cambiar la presente situación.Objective: To describe gender inequalities in positions of leadership and scientific recognition in activities carried out by the Spanish Public Health and Health Administration Society (SESPAS, the Spanish Epidemiology Society (SEE and the Health Economics Association (AES for 2000-2009. Methods: We performed a descriptive study of the gender distribution of the boards of directors, scientific and conference organization committees and chairpersons of the SESPAS, SEE and AES. The gender distribution of the editorial board of Gaceta Sanitaria, and of the authors of editorials published in the journal, as well as that of the editors of SESPAS Reports, was also analyzed. Results: Between 2000 and 2009, there was a slight increase in women's participation in the SESPAS and there was greater gender parity in the SEE. However, representation of women in the AES was low. Conclusions: The causes of gender inequalities in public
Conradsen, Inger Marie; Gøtze, Michael
Administrative Appeals, review, administrative tribunals, ombudsman, alternative dispute resolution......Administrative Appeals, review, administrative tribunals, ombudsman, alternative dispute resolution...
Jaqueline Resende Candido Mello
Full Text Available Purpose – The present study deals with self-administrations in supplementary health and analyzes to what extent sectoral regulation has observed the specific culture of the regulated business. In order to do so, it presents a historical and cultural contextualization of the self-administrations and the normative of the sector, in addition to analogy with the closed private pension entities. Methodology/approach/design – It is based on the theory of autopoiesis and Teubner's Regulatory Trilemma, which are informed in the initial sections. Next, analysis of norms affected to self-administrations in supplementary health and a comparative approach in relation to closed private pension entities. Findings – To the extent that the legal system and the social system regulated are not coherent with each other, since they are not observed, regulatory action can fail. In the case of self-administrations, regulatory action may disintegrate this system if it does not observe its distinct nature and, consequently, does not preserve the culture of the business.
Chami, Goylette F.; Kontoleon, Andreas A.; Bulte, Erwin; Fenwick, Alan; Kabatereine, Narcis B.; Tukahebwa, Edridah M.; Dunne, David W.
Over 1.9 billion individuals require preventive chemotherapy through mass drug administration (MDA). Community-directed MDA relies on volunteer community medicine distributors (CMDs) and their achievement of high coverage and compliance. Yet, it is unknown if village social networks influence
Chami, Goylette F.; Kontoleon, Andreas A.; Bulte, Erwin; Fenwick, Alan; Kabatereine, Narcis B.; Tukahebwa, Edridah M.; Dunne, David W.
Over 1.9 billion individuals require preventive chemotherapy through mass drug administration (MDA). Community-directed MDA relies on volunteer community medicine distributors (CMDs) and their achievement of high coverage and compliance. Yet, it is unknown if village social networks influence
Buckley, Elizabeth S; Sullivan, Tom; Farshid, Gelareh; Hiller, Janet E; Roder, David M
Stratification of women with screen-detected ductal carcinoma in situ (DCIS) by risk of subsequent invasive breast cancer (IBC) could assist treatment planning and selection of surveillance protocols that accord with risk. We assessed the utility of routinely collected administrative data for stratifying by IBC risk following DCIS detection in a population-based screening programme to inform ongoing surveillance protocols. A retrospective cohort design was used, employing linked data from the South Australian breast screening programme and cancer registry. Women entered the study at screening commencement and were followed until IBC diagnosis, death or end of the study period (1 December 2010), whichever came first. Routinely collected administrative data were analyzed to identify predictors of invasive breast cancer. Proportional hazards regression confirmed that the DCIS cohort had an elevated risk of IBC after adjustment for relevant confounders (HR = 4.0 (95% CL 3.4, 4.8)), which accorded with previous study results. Within the DCIS cohort, conservative breast surgery and earlier year of screening commencement were both predictive of an elevated invasive breast cancer risk. These linked cancer registry and administrative data gave plausible estimates of IBC risk following DCIS diagnosis, but were limited in coverage of key items for further risk stratification. It is important that the research utility of administrative datasets is maximized in their design phase in collaboration with researchers. © 2016 John Wiley & Sons, Ltd.
Training for Better Management: Avante Zambézia, PEPFAR and Improving the Quality of Administrative Services Comment on "Implementation of a Health Management Mentoring Program: Year-1 Evaluation of Its Impact on Health System Strengthening in Zambézia Province, Mozambique".
Schwarcz, Sandra K; Rutherford, George W; Horvath, Hacsi
The United States President's Emergency Plan for AIDS Relief (PEPFAR) emphasizes health systems strengthening as a cornerstone of programmatic success. Health systems strengthening, among other things, includes effective capacity building for clinical care, administrative management and public health practice. Avante Zambézia is a district-level in-service training program for administrative staff. It is associated with improved accounting practices and human resources and transportation management but not monitoring and evaluation. We discuss other examples of successful administrative training programs that vary in the proportion of time that is spent learning on the job and the proportion of time spent in classrooms. We suggest that these programs be more rigorously evaluated so that lessons learned can be generalized to other countries and regions. © 2015 by Kerman University of Medical Sciences.
Training for Better Management: Avante Zambézia, PEPFAR and Improving the Quality of Administrative Services; Comment on “Implementation of a Health Management Mentoring Program: Year-1 Evaluation of Its Impact on Health System Strengthening in Zambézia Province, Mozambique”
Sandra K. Schwarcz
Full Text Available The United States President’s Emergency Plan for AIDS Relief (PEPFAR emphasizes health systems strengthening as a cornerstone of programmatic success. Health systems strengthening, among other things, includes effective capacity building for clinical care, administrative management and public health practice. Avante Zambéziais a district-level in-service training program for administrative staff. It is associated with improved accounting practices and human resources and transportation management but not monitoring and evaluation. We discuss other examples of successful administrative training programs that vary in the proportion of time that is spent learning on the job and the proportion of time spent in classrooms. We suggest that these programs be more rigorously evaluated so that lessons learned can be generalized to other countries and regions.
Administrative requirements for radiographs are found in many segments of the United States health care system. This document presents an FDA radiation recommendation on administratively required dental x-ray examinations. In general, such examinations are not requested to further the patient's dental health, but rather as a means of monitoring claims. However, the administrative use of radiographs that have been taken in the normal course of patient care is usually appropriate, as long as the patient's right to privacy is respected
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
Military service and other socioecological factors influencing weight and health behavior change in overweight and obese Veterans: a qualitative study to inform intervention development within primary care at the United States Veterans Health Administration.
Jay, Melanie; Mateo, Katrina F; Squires, Allison P; Kalet, Adina L; Sherman, Scott E
Obesity affects 37 % of patients at Veterans Health Administration (VHA) medical centers. The VHA offers an intensive weight management program (MOVE!) but less than 10 % of eligible patients ever attend. However, VHA patients see their primary care provider about 3.6 times per year, supporting the development of primary care-based weight management interventions. To address gaps in the literature regarding Veterans' experiences with weight management and determine whether and how to develop a primary care-based weight management intervention to both improve obesity counseling and increase attendance to MOVE!, we conducted a qualitative study to assess: 1) Veterans' personal experiences with healthy weight-related behavior change (including barriers and facilitators to behavior change and experiences with primary care providers, staff, and the MOVE! program), and 2) potential new approaches to improve weight management within primary care at the VHA including goal setting and technology. Overweight/obese VHA patients (aged 18-75, BMI greater than 30 or greater than 25 with at least 1 co-morbidity) were recruited for focus group sessions stratified by gender, MOVE! referral, and attendance. Each session was facilitated by a trained moderator, audio-recorded, and professionally transcribed. Using an iterative coding approach, two coders separately reviewed and coded transcripts, and met frequently to negotiate codes and synthesize emerging themes. Of 161 eligible patients, 54 attended one of 6 focus groups (2 female, 4 male, 9-11 participants per session): 63 % were male, 46 % identified as African-American, 32 % White/Caucasian, 74 % were college-educated or higher, and 61 % reported having attended MOVE!. We identified two major themes: Impact of Military Service and Promotion and Sustainability of Healthy Behaviors. After service in a highly structured military environment, Veterans had difficulty maintaining weight on their own. They perceived physical
Jones, David K; Gusmano, Michael K; Nadash, Pamela; Miller, Edward Alan
The ACA has survived multiple existential threats in the legislative and judicial branches, including dozens of congressional attempts at repeal and two major Supreme Court cases. Even as it seems that the ACA is here to stay, what the law accomplishes is far from settled. The Trump administration is using executive powers to weaken the law, in many cases using the same powers that President Obama used to strengthen the effects of the reform. States have responded by seeking flexibility to pursue reforms, such as work requirements, that could not pass Congress and that were not allowed by the Obama administration. There is no indication that the ACA is imploding as President Trump has predicted and seems to desire, although these changes have a real and substantial impact on the lives of many Americans, including the near-elderly in unique ways.
Comnmunity Health Nursing (1) Nurse Anesthetists (2) Inhalation Therapy IPPB Treatments Humidity Aerosol Chest Physiotherapy Arterial Blood Samples OB...Continuing Health (12) Psychiatric Intensive Care Unit (13) Post-Traumatic Stress Unit (14) Geriatric C. Outpatient Program - Mental Hygiene Clinic 3...Service consists.of a large professional staff of Registered Nurses, Licensed Practical Nurses, Nurse Instructors, Geriatric Consultant Nurse and a
Cardoso, Christopher; Kingdon, Danielle; Ellenbogen, Mark A
A large body of research has examined the acute effects of intranasal oxytocin administration on social cognition and stress-regulation. While progress has been made with respect to understanding the effect of oxytocin administration on social cognition in clinical populations (e.g. autism, schizophrenia), less is known about its impact on the functioning of the hypothalamic-pituitary-adrenal (HPA) axis among individuals with a mental disorder. We conducted a meta-analysis on the acute effect of intranasal oxytocin administration on the cortisol response to laboratory tasks. The search yielded eighteen studies employing a randomized, placebo-controlled design (k=18, N=675). Random-effects models and moderator analyses were performed using the metafor package for the statistical program R. The overall effect size estimate was modest and not statistically significant (Hedges g=-0.151, p=0.11) with moderate heterogeneity in this effect across studies (I(2)=31%). Controlling for baseline differences in cortisol concentrations, moderation analyses revealed that this effect was larger in response to challenging laboratory tasks that produced a robust stimulation of the HPA-axis (Hedges g=-0.433, 95% CI[-0.841, -0.025]), and in clinical populations relative to healthy controls (Hedges g=-0.742, 95% CI[-1.405, -0.078]). Overall, oxytocin administration showed greater attenuation of the cortisol response to laboratory tasks that strongly activated the HPA-axis, relative to tasks that did not. The effect was more robust among clinical populations, suggesting possible increased sensitivity to oxytocin among those with a clinical diagnosis and concomitant social difficulties. These data support the view that oxytocin may play an important role in HPA dysfunction associated with psychopathology. Copyright © 2014 Elsevier Ltd. All rights reserved.
Department of Veterans Affairs — The Administrative Data Repository (ADR) was established to provide support for the administrative data elements relative to multiple categories of a person entity...
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...
Millennium Challenge Corporation — The Millennium Challenge Account-Philippines' (MCA-P) implementation of the Revenue Administration Reform Project (RARP) is expected to improve tax administration,...
Full Text Available The International Health Regulations (IHR (2005 require World Health Organization Member States to notify events fulfilling two of four criteria: (1 serious public health impact; (2 unusual or unexpected event; (3 significant risk of international spread; or (4 significant risk of international travel or trade restrictions.1 In-flight transmission of infections like severe acute respiratory syndrome is well documented.2 With the enormous amount of air travel today, the risk of increasing in-flight transmission and subsequent international spread of infections are increasing. Prompt notification and information sharing under the IHR mechanism is critical for effective contact tracing and prompt control measures. We report on a case of in-flight exposure to an infection with significant public health risks that was successfully resolved using IHR (2005 guidelines.
Full Text Available The article considers the review of approaches for the creation of a new social paradigm in the health care system management based on the principles of humanism. The paradigms are based on responsible partnership and person-oriented approach. Major principles of the paradigm’s creation are given in details, as well as their expected impact on implementing reforms in the health care management of Ukraine.
Full Text Available An administrative contract is the will between a public authority either a person empowe¬red by it, and one or more natural or legal persons, whether private or public, pursuing the realization of a public interest and to which a special scheme of administrative law applies. The typology of administrative contracts is very varied, depending on the evolution of the society’s needs. Thus, they are currently included in the category of administrative contracts: concession contracts and public procurement contracts, contracts for the use of public goods, public management contracts, public-private partnership contracts, public lending contracts and constitutive documents of the associative structures of public authorities.
To understand the constant increase in administration, we need a new approach to the administration. For many years, the administration has intensified as a closed science, associated only with economics, law and political science. However, this approach did not bring anything good, because almost nothing in the administration has improved. Therefore, it is necessary to connect the administration with the natural sciences which give the best description of the world around us. Because of this...
Rosner, David; Markowitz, Gerald
The Occupational Safety and Health Act of 1970 and the Workers Right to Know laws later in that decade were signature moments in the history of occupational safety and health. We have examined how and why industry leaders came to accept that it was the obligation of business to provide information about the dangers to health of the materials that workers encountered. Informing workers about the hazards of the job had plagued labor-management relations and fed labor disputes, strikes, and even pitched battles during the turn of the century decades. Industry's rhetorical embrace of the responsibility to inform was part of its argument that government regulation of the workplace was not necessary because private corporations were doing it.
Brownell, Marni D; Nickel, Nathan C; Enns, Jennifer E; Chartier, Mariette; Campbell, Rhonda; Phillips-Beck, Wanda; Chateau, Dan; Burland, Elaine; Santos, Rob; Katz, Alan
First Nations people are descendants of Canada's original inhabitants. In consequence of historical and ongoing structural injustices, many First Nations families struggle with challenging living conditions, including high rates of poverty, poor housing conditions, mental illness and social isolation. These risk factors impede caregivers' abilities to meet their children's basic physical and psychosocial needs. Home visiting programmes were developed to support child developmental health in families facing parenting challenges. However, whether home visiting is an effective intervention for First Nations families has not been examined. We are evaluating two home visiting programmes in Manitoba, Canada, to determine whether they promote nurturing family environments for First Nations children. This research builds on new and established relationships among academic researchers, government decision-makers and First Nations stakeholders. We will link health, education and social services data from the Manitoba Population Research Data Repository to data from two home visiting programmes in Manitoba. Logistic regression modelling will be used to assess whether programme participation is associated with improved child developmental health, better connections between families and social services, reduced instances of child maltreatment and being taken into out-of-home care by child welfare and reduced inequities for First Nations families. Non-participating individuals with similar sociodemographic characteristics will serve as comparators. We will use an interrupted time series approach to test for differences in outcomes before and after programme implementation and a propensity score analysis to compare differences between participants and non-participants. Approvals were granted by the Health Information Research Governance Committee of the First Nations Health and Social Secretariat of Manitoba and the University of Manitoba Health Research Ethics Board. Our
When scientific researches are being published one should consider carefully the different possible influences which may change the results. These influences may be of two kinds: Non-Causal explanations, and Casual explanations. Researchers may arrive at their results and not have considered all the causative explanations. Occams's Razor is the basic rule by which most reasonable explanations are chosen. A statistical result and an appropriate simple theory to explain it, is not sufficient to prove causative effect. In many cases though, the media and public tend to accept a statistically significant result as if it was a proven cause and effect relation. There are several conditional demands called Bradford Hill criteria of which epidemiological data and results are only one, the more results arrived by using the Bradford Hill criteria, the better chances exist that the examined variable is the cause for the effect. Finally, there is a gap between a proven causal factor for disease or the harmful effects of treatment and a "clear cut" health policy. There are several intermediate powerful influences which are involved in the process of stating a new health policy. These influences include among others, the involvement of decision makers, political influences and civil service professionals. As an example three different issues of a well proven clinical research will be presented. The research of Rofecoxib = "Vioxx" cardiac effects, the research of Hormonal Replacement Treatment health effects on post menopausal women and the last of Health risks presented by mobile phone use. Although the results of those researches were proven to be statistically significant, Health Policy in each case is different and less clear. Health Policy is not based solely on figures and statistical results, but rather on a far wider and more complex influences and judgment.
Full Text Available The activity of administrative bodies includes big numbers of various acts and actions, through which the will of public administration is formed. The will of public administration bodies, expressed in administrative individual and normative acts, in administrative contracts and real acts, finds its reflection in the Constitution, laws and other provisions of legal character. All this activity is not inerrant and therefore, it is not uncontrollable. The supervision of executive activity is subject to political control of administrative acts through authorities designated for this purpose, as well as internal control and the judicial control. The institution of judicial control of administrative acts and actions appears as very important and widely treated in the legal doctrine. The protection of constitutional and legal rights of private persons is accomplished by subjecting administrative activity both to internal administrative control, as well as to the judicial control in accordance with legal provisions. The judicial control of administrative acts represents a constitutional guarantee for citizens to protect their rights through public and fair trial by an independent and impartial court. In this way, the Constitution empowers the common administrative court that invalidates an action or administrative act, but not all administrative acts may be subject to administrative dispute, with the exception of cases against which the administrative conflict cannot be carried out (negative enumeration.
Kirkeskov, Lilli; Kristiansen, Eva; Bøggild, Henrik
with data on dental caries from the Danish National Board of Health database on child dental health for 5-year-old children born in 1989 and 1999, and for 15-year-old children born in 1979 and 1989. The number of children included in the cohorts varied between 41.000 and 48.000. Logistic regression was used...... if analysis was limited to children residing in the same place during the entire study period. Conclusions: The study confirmed previous findings of an inverse relation between fluoride concentration in the drinking water and dental caries in children. This correlation was found in spite of the extensive use...
The importance of strict administrative procedures in the daily work is being demonstrated by commenting on events that occured in the operation of German nuclear power plants. The procedure for working in an area of the plant (pressurized medium, high-radioactive level, explosive of flammable mediums), where special measures for safe working have to be taken, is discussed in detail. The administrative problems during refuelling time are further on mentioned, especially the problems connected with administering more than 1,000 people with respect to health protection and sabotage protection. Some general comments on the influences from external causes (authorities, courts, etc.) are given. (orig./ORU) [de
de Man-van Ginkel, Janneke M.; Hafsteinsdottir, Thora; Lindeman, Eline; Burger, Huibert; Grobbee, Diederick; Schuurmans, Marieke
Background and Purpose-The early detection of poststroke depression is essential for optimizing recovery after stroke. A prospective study was conducted to investigate the diagnostic value of the 9-item and the 2-item Patient Health Questionnaire (PHQ-9, PHQ-2). Methods-One hundred seventy-one
The Relationship Between the Educational Background and Managerial Experience of Senior Navy Medical Service Corps Executives (Health Care Administrators) and their Perceived Current and Required Management Capabilities.
practitioner-based assessment of baccalaureate-level skills and knowledge needs ranked interpersonal skills, knowledge of the health care sector , and...OdM ctr and predicted onviroamsma nasional and world imawrelated military, economico political. scientific, and social factors. Designed for 0.5S016
Logtenberg, Susan J.; Kleefstra, Nanne; Houweling, Sebastiaan T.; Groenier, Klaas H.; Gans, Reinold O.; Bilo, Henk J.
OBJECTIVE - To investigate the effects of continuous intraperitoneal insulin infusion (CIPII) compared with subcutaneous insulin on health-related quality of life (HRQOL) and treatment satisfaction, and to perform a cost analysis in type 1 diabetes. RESEARCH DESIGN AND METHODS - We used an
Jørgensen, Tine Rikke; Emborg, Charlotte; Dahlen, Karianne; Bøgelund, Mette; Carlborg, Andreas
Agitation episodes are common among patients with schizophrenia or bipolar disorder. Oral and intramuscular administration methods are commonly used in pharmacological treatment of acute agitation. Recently, an innovative inhalation product with loxapine(Adasuve®)has become available for treatment of acute agitation episodes associated with bipolar disorder or schizophrenia. The objective for the present study was to investigate the impact of the pharmacological treatment's administration methods on the health-related quality of life (HRQoL) in patients with bipolar disorder or schizophrenia in Denmark and Sweden using a time trade-off (TTO) approach. The TTO methodology was used to examine the HRQoL impact of administration method of pharmacological treatment of acute agitation. Data were collected via an internet-based survey, using an existing panel of respondents with schizophrenia or bipolar disorder. Respondents considered living with schizophrenia/ bipolar disorder, having one yearly agitation episode treated with inhaler better than living with the same conditions and receiving treatment with tablet or injection. The utility value was 0.762 for inhalable treatment, 0.707 for injection and 0.734 for tablet treatment. Patients' preference for treatment delivery options showed that inhalation was associated with a significant utility gain when compared to injection or tablets. Inhalable loxapine may be a new tool for control of agitation episodes for strengthening the patient provider alliance when taking patient's preference for delivery method into consideration.
Grimmelikhuijsen, Stephan; Jilke, Sebastian; Olsen, Asmus Leth
on theories and methods from psychology and related fields and point to research in public administration that could benefit from further integration. An analysis of public administration topics through a psychological lens can be useful to confirm, add nuance to, or extend classical public administration...... theories. As such, behavioral public administration complements traditional public administration. Furthermore, it could be a two-way street for psychologists who want to test the external validity of their theories in a political-administrative setting. Finally, four principles are proposed to narrow......Behavioral public administration is the analysis of public administration from the micro-level perspective of individual behavior and attitudes by drawing on insights from psychology on the behavior of individuals and groups. The authors discuss how scholars in public administration currently draw...
Liana Teodora PASCARIU
Full Text Available Article examines whether all contracts of public persons are administrative contracts; in other words, if the administration may conclude contracts that, according to their legal nature, are not administrative. If we start from the definition of administrative contracts as it appears in Law no. 554/2004, these include contracts by public authorities which concern the enhancement of public property execution of works of public interest, public services, public procurement and other administrative contracts provided by special laws and subject to the jurisdiction of the administrative courts.
This document amends OSHA's regulations to reflect the Assistant Secretary's decision granting final approval to the Nevada State plan. As a result of this affirmative determination under section 18(e) of the Occupational Safety and Health Act of 1970, Federal OSHA's standards and enforcement authority no longer apply to occupational safety and health issues covered by the Nevada plan, and authority for Federal concurrent jurisdiction is relinquished. Federal enforcement jurisdiction is retained over any private sector maritime employment, private sector employers on Indian land, and any contractors or subcontractors on any Federal establishment where the land is exclusive Federal jurisdiction. Federal jurisdiction remains in effect with respect to Federal government employers and employees. Federal OSHA will also retain authority for coverage of the United States Postal Service (USPS), including USPS employees, contract employees, and contractor-operated facilities engaged in USPS mail operations.
Eccleston, R.C.; Barnett, M.H.
The report provides a brief overview of the FDA's major regulatory and voluntary efforts in the area of radiation control, and examines the impact of the Agency's programs to eliminate unproductive radiation exposure to the American consumer. It concludes with a summary of present and future concerns about newly emerging radiation-emitting products and uses, and the potential public health problems which they may engender
Optimization of health-care organization and perceived improvement of patient comfort by switching from intra-venous BU four-times-daily infusions to a once-daily administration scheme in adult hematopoietic stem cell recipients.
Xhaard, A; Rzepecki, P; Valcarcel, D; Santarone, S; Fürst, S; Serrano, D; De Angelis, G; Krüger, W; Scheid, C
Previous studies have shown an equivalent pharmacokinetic profile between four-times-daily (4QD) and once-daily (QD) administration of intra-venous (IV) BU, without increased toxicity. We assess the impact of a switch in IV BU from a 4QD to a QD schedule, in terms of health-care organization, staff working conditions, quality of care dispensed and perceived patient comfort. Clinicians, nurses and pharmacists from nine allogeneic transplantation units in five European countries were interviewed face to face. Overall perception of QD versus 4QD BU was very positive. Both administration schemes were evaluated to be equally efficaciousZ. QD BU was perceived to be safer and more convenient. Clinicians and nurses perceived that patient comfort was improved, due to fewer complications associated with repeated infusions, and avoiding night infusions associated with stress, anxiety and decreased quality of sleep. Switching from 4QD to QD BU had a significant impact on health-care organization, with a better integration in the overall management and usual timelines in the pharmacies and transplantation units. Time spent to prepare and administer BU was significantly reduced, leading to potential financial savings that merit further assessment and would be of particular interest in the current economic climate.
Factors associated with failure to correct the international normalised ratio following fresh frozen plasma administration among patients treated for warfarin-related major bleeding. An analysis of electronic health records.
Menzin, J; White, L A; Friedman, M; Nichols, C; Menzin, J; Hoesche, J; Bergman, G E; Jones, C
This study assessed the frequency and factors associated with failure to correct international normalised ratio (INR) in patients administered fresh frozen plasma (FFP) for warfarin-related major bleeding. This retrospective database analysis used electronic health records from an integrated health system. Patients who received FFP between 01/01/2004 and 01/31/2010, and who met the following criteria were selected: major haemorrhage diagnosis the day before to the day after initial FFP administration; INR ≥2 on the day before or the day of FFP and another INR result available; warfarin prescription within 90 days. INR correction (defined as INR ≤1.3) was evaluated at the last available test up to one day following FFP. A total of 414 patients met selection criteria (mean age 75 years, 53% male, mean Charlson score 2.5). Patients presented with gastrointestinal bleeding (58%), intracranial haemorrhage (38%) and other bleed types (4%). The INR of 67% of patients remained uncorrected at the last available test up to one day following receipt of FFP. In logistic regression analysis, the INR of patients who were older, those with a Charlson score of 4 or greater, and those with non-ICH bleeds (odds ratio vs. intracranial bleeding 0.48; 95% confidence interval 0.31-0.76) were more likely to remain uncorrected within one day following FFP administration. In an alternative definition of correction, (INR ≤1.5), 39% of patients' INRs remained uncorrected. For a substantial proportion of patients, the INRs remain inadequately or uncorrected following FFP administration, with estimates varying depending on the INR threshold used.
Domnich, Alexander; Panatto, Donatella; Signori, Alessio; Bragazzi, Nicola Luigi; Cristina, Maria Luisa; Amicizia, Daniela; Gasparini, Roberto
Health knowledge and literacy are among the main determinants of health. Assessment of these issues via Web-based surveys is growing continuously. Research has suggested that approximately one-fifth of respondents submit cribbed answers, or cheat, on factual knowledge items, which may lead to measurement error. However, little is known about methods of discouraging cheating in Web-based surveys on health knowledge. This study aimed at exploring the usefulness of imposing a survey time limit to prevent help-seeking and cheating. On the basis of sample size estimation, 94 undergraduate students were randomly assigned in a 1:1 ratio to complete a Web-based survey on nutrition knowledge, with or without a time limit of 15 minutes (30 seconds per item); the topic of nutrition was chosen because of its particular relevance to public health. The questionnaire consisted of two parts. The first was the validated consumer-oriented nutrition knowledge scale (CoNKS) consisting of 20 true/false items; the second was an ad hoc questionnaire (AHQ) containing 10 questions that would be very difficult for people without health care qualifications to answer correctly. It therefore aimed at measuring cribbing and not nutrition knowledge. AHQ items were somewhat encyclopedic and amenable to Web searching, while CoNKS items had more complex wording, so that simple copying/pasting of a question in a search string would not produce an immediate correct answer. A total of 72 of the 94 subjects started the survey. Dropout rates were similar in both groups (11%, 4/35 and 14%, 5/37 in the untimed and timed groups, respectively). Most participants completed the survey from portable devices, such as mobile phones and tablets. To complete the survey, participants in the untimed group took a median 2.3 minutes longer than those in the timed group; the effect size was small (Cohen's r=.29). Subjects in the untimed group scored significantly higher on CoNKS (mean difference of 1.2 points, P=.008
... program, administrative and management aspects of the HMO. (3) At a minimum, management by an executive... Administration and management. (a) General requirements. Each HMO must have administrative and managerial... 42 Public Health 3 2010-10-01 2010-10-01 false Administration and management. 417.124 Section 417...
Full Text Available ... OMSs) are trained in all aspects of anesthesia administration. Following dental school, they complete at least four ... complications and emergencies that may arise during the administration of anesthesia. Before your surgery, your OMS will ...
... OMSs) are trained in all aspects of anesthesia administration. Following dental school, they complete at least four ... complications and emergencies that may arise during the administration of anesthesia. Before your surgery, your OMS will ...
... de informacin confidencial --> DEA NEWS The Drug Enforcement Administration and Discovery Education name grand winner of Operation ... JUN 15 (Washington) The United States Drug Enforcement Administration, DEA Educational Foundation and Discovery Education awarded Porter ...
An easy-to-follow Apache Hadoop administrator's guide filled with practical screenshots and explanations for each step and configuration. This book is great for administrators interested in setting up and managing a large Hadoop cluster. If you are an administrator, or want to be an administrator, and you are ready to build and maintain a production-level cluster running CDH5, then this book is for you.
Richman, Barbara T.
President Ronald Reagan recently said he intended to nominate James Montgomery Beggs as NASA Administrator and John V. Byrne as NOAA Administrator. These two positions are key scientific posts that have been vacant since the start of the Reagan administration on January 20. The President also said he intends to nominate Hans Mark as NASA Deputy Administrator. At press time, Reagan had not designated his nominee for the director of the Office of Science and Technology Policy.
U.S. Department of Health & Human Services — Decisions issued by Administrative Law Judges of the Departmental Appeals Board's Civil Remedies Division concerning fraud and abuse determinations by the Office of...
Pradhan, Jalandhar; Dwivedi, Rinshu
Reproductive and Child Health (RCH) financing is a key area of focus which can lead towards an overall empowerment of women through financial inclusion. The major objectives of this paper are: first; to examine the socio-economic differentials in Out of Pocket Expenditure (OOPE) on delivery care, second; to look into the role of insurance coverage, third; to analyse various sources of financing, and fourth; to measure the adjusted effect of various covariates on the level of OOPE. Data were extracted from the National Sample Survey Organisations (NSSO), 71st round "Key indicators of social consumption in India, Health" conducted by the GoI during January to June 2014. Multivariate Generalised Linear Regression Model (GLRM) has been used to analyse the various covariates of OOPE on maternity care. Multivariate analysis has demonstrated a significant association between socioeconomic status of women and the level of OOPE on delivery care. Level of education, urban residence, higher caste and social group affiliation, strong economic conditions, and use of private facilities for the child birth among the mothers were a significant predictor of the expenditure on maternity care. Despite various efforts by the central and state governments to reduce financial burden, still a large number of households are paying a significant amount from their own pockets. There is an immediate need to re-look in the aspects of insurance coverage and high level of OOPE in delivery care. Copyright © 2016 Elsevier B.V. All rights reserved.
Aluise, J J; Scmitz, C C; Bland, C J; McArtor, R E
To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education now exists that addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies and references provide the academic physician with guidelines for expanding their professional expertise to include organizational and management skills. The continuing success of the academic medical center as a responsive health care system may depend upon the degree to which academic physicians gain sophistication in self-management and organizational administration.
Bourdillon, P.J.; Godfrey, B.E.; O'Brien, R.
A brief history is given of the evolution of a system to approve the licensing of doctors and dentists to use radioactive medicinal products in man. Currently, the Administration of Radioactive Substances Advisory Committee (ARSAC) is appointed by UK Health Ministers to advise them on the granting, renewal, suspension, revocation and variation of certificates. The type of information requested on the application form for a certificate is outlined. (UK)
Min, Jungwon; Kim, Gilsook; Lim, Hyunjung; Carvajal, Nubia A; Lloyd, Charles W; Wang, Youfa
Effective and sustainable intervention programs are needed to promote physical activity (PA) in children. To adapt the NASA Mission X: Train Like an Astronaut program for use with South Korean children, and to evaluate its feasibility and effectiveness for promoting children's physical fitness. Children 5 years old ( n = 212) and their parents were recruited from three kindergartens in three cities to participate in a 6-week intervention program in fall 2014. We assessed the children's PA and related changes, and parental changes in attitude and beliefs, after participation in the intervention. Girls reported less PA than boys (40.7 vs. 59.0, p X program was feasible and effective in promoting PA in kindergarteners, and also improved their parents' attitude and beliefs about children's PA in South Korea. This study provided a model for promoting childhood health through child care and educational settings.
Lillie, Sarah E; Fu, Steven S; Fabbrini, Angela E; Rice, Kathryn L; Clothier, Barbara; Nelson, David B; Doro, Elizabeth A; Moughrabieh, M Anas; Partin, Melissa R
The National Lung Screening Trial recently reported that annual low-dose computed tomography screening is associated with decreased lung cancer mortality in high-risk smokers. This study sought to identify the factors patients consider important in making lung cancer screening (LCS) decisions, and explore variations by patient characteristics and LCS participation. This observational survey study evaluated the Minneapolis VA LCS Clinical Demonstration Project in which LCS-eligible Veterans (N=1388) were randomized to either Direct LCS Invitation (mailed with decision aid, N=926) or Usual Care (provider referral, N=462). We surveyed participants three months post-randomization (response rate 44%) and report the proportion of respondents rating eight decision-making factors (benefits, harms, and neutral factors) as important by condition, patient characteristics, and LCS completion. Overall, the most important factor was personal risk of lung cancer and the least important factor was health risks from LCS. The reported importance varied by patient characteristics, including smoking status, health status, and education level. Overall, the potential harms of LCS were reported less important than the benefits or the neutral decision-making factors. Exposure to Direct LCS Invitation (with decision aid) increased Veterans' attention to specific decision-making factors; compared to Usual Care respondents, a larger proportion of Direct LCS Invitation respondents rated the chance of false-positive results, LCS knowledge, LCS convenience, and anxiety as important. Those completing LCS considered screening harms less important, with the exception of incidental findings. Decision tools influence Veterans' perceptions about LCS decision-making factors. As the factors important to LCS decision making vary by patient characteristics, targeted materials for specific subgroups may be warranted. Attention should be paid to how LCS incidental findings are communicated. Published by
Faseleh Jahromi, Mohammad; Shokryazdan, Parisa; Idrus, Zulkifli; Ebrahimi, Rohollah; Liang, Juan Boo
Palm kernel cake (PKC) is the main byproduct from the palm oil industry in several tropical countries that contains considerable amounts of oligosaccharide. We earlier demonstrated beneficial prebiotic effects of oligosaccharides extract of PKC (OligoPKC) in starter and finisher broiler birds. This study was envisaged to elucidate the effects of in ovo and/or oral administration of the OligoPKC on prenatal and post-hatched broiler chicks. A total of 140 broiler (Cobb500) eggs were randomly divided into two groups (n = 70 each), and on day 12 of incubation, eggs in one group received in ovo injection of 0.1 mL (containing 20 mg) of OligoPKC, while those in the other group received 0.1 mL of saline (placebo) solution. Of these in ovo placebo or OligoPKC injected eggs, after hatching, six chicks from each group were sampled for day-one analysis, while 48 chicks from each group were randomly allocated to two dietary regimes involving either no feeding or feeding of OligoPKC through basal diet for a 14 days experiment forming the experimental groups as: (i) saline-injected (Control, C), (ii) OligoPKC-injected (PREBovo), (iii) saline-injected, but fed 1% OligoPKC (PREBd), and (iv) OligoPKC-injected and also 1% OligoPKC (PREBovo+d). In ovo injection of prebiotic OligoPKC had no effect on body weight and serum immunoglobulins concentrations of day old chicks, except for IgG, which was increased significantly (P C and PREBovo), but lesser influenced by in ovo OligoPKC injection. Irrespective of its prior in ovo exposure, chicks fed OligoPKC diets had lower population of pathogenic bacteria. Overall serum immunoglobulin status of birds was improved by feeding of OligoPKC but in ovo OligoPKC injection had minor effect on that. In most cases, in ovo OligoPKC injection and feeding of OligoPKC reduced the expression of nutrient transporters in the intestine and improved antioxidant capacity of liver and serum. It is concluded that in ovo injection of OligoPKC increased Ig
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
Full Text Available Background. In African settings, where there is a high disease burden, there is a need to improve the science of documenting and analysing accurate information regarding medicine exposures in women immediately before and during pregnancy to assess the extent of use and safety in pregnant women and their unborn children.Objectives. To compare evidence of medicine use during pregnancy, as documented in paper-based clinical records (maternity case records (MCRs against electronic health information resources (Provincial Health Data Centre (PHDC and assess the level of concordance between the two as part of baseline investigations before piloting a provincial pregnancy exposure registry and birth defect surveillance system. The PHDC consolidates electronic clinical and pharmacy data.Methods. A folder review of completed pregnancies between November 2013 and January 2016 was conducted on randomly selected MCRs from midwife-run obstetric units and a secondary maternity hospital in Cape Town, South Africa. Medication exposures in the MCR were captured and compared with a customised PHDC data extract. The type and timing of drug exposures were compared. Total exposures were compiled from all data sources.Results. Two hundred and six MCRs from three facilities were sampled: 83 women had documented antiretroviral therapy (ART exposure; all but 1 (1% had been recorded in the PHDC extract. There was no evidence of ART use in the MCRs of 4 (5% cases, despite evidence in the PHDC. There were imprecise drug names in the MCRs of 14 (17% ART patients, discordant dates of onset between the MCRs and PHDC extracts in 10/83 (12% and inaccurate medicine names and incorrect dates in 1 (1% case each. Nine of 10 (90% women who were administered antituberculosis medication were recorded in the PHDC extract. Ten of 21 (48% isoniazid preventive therapy treatments appeared in the MCRs and PHDC; 9 (42% in the PHDC only and 2 (10% in the MCRs only. Half (n=18/36 of all
Profissionais administrativos na gestão do Sistema Único de Saúde: a divisão social do trabalho Administrative professionals in the management of the Unified Health System: the social division of labor
Francini Lube Guizard
Full Text Available O artigo analisa a inserção dos profissionais administrativos de nível médio nos serviços de saúde, visando problematizar sua atuação nas estruturas e relações de poder que conformam tais instituições. São apresentados dados relativos à compreensão desses trabalhadores sobre o papel que desempenham e as relações que vislumbram entre seu processo de trabalho e a gestão do Sistema Único de Saúde. O estudo foi desenvolvido em uma região de saúde do município do Rio de Janeiro, por meio do mapeamento dos processos de trabalho administrativos de nível médio nas diferentes instituições públicas de saúde desse território. Foram realizadas 44 entrevistas semiestruturadas, abrangendo os diferentes processos identificados. Os resultados indicam que a hierarquização do processo decisório está associada à desvalorização desses profissionais, que se percebem como meros executores das definições traçadas pelos níveis hierárquicos superiores. Concluímos que a racionalidade administrativa instrumental permanece hegemônica no território. Esses aspectos levam à reflexão sobre as possibilidades de avançar a consolidação do SUS sem a adesão dos atores sociais implicados em sua construção cotidiana, dentre os quais destacamos os agentes administrativos em seu papel estratégico nos processos de gestão.Abstract The article analyzes the insertion of mid-level administrative professionals in health services aiming at discussing the roles they play in the power structures and relations that make up such institutions. Data are presented concerning the workers' understanding of their roles and the relations they envision between their work processes and the management of the Unified Health System. The study was carried out in a health region of the city of Rio de Janeiro, and involved mapping the middle-level administrative work processes at the different public health institutions in this territory. In total, 44 semi
Millennium Challenge Corporation — Michigan State University was assigned to design the impact evaluation (IE) of the Land Administration Reform Project (LARP) funded under the Millennium Challenge...
P. Williamson, Ian; Enemark, Stig; Wallace, Judy
This paper introduces basic land administration theory and highlights four key concepts that are fundamental to understanding modern land administration systems - firstly the land management paradigm and its influence on the land administration framework, secondly the role that the cadastre plays...... in contributing to sustainable development, thirdly the changing nature of ownership and the role of land markets, and lastly a land management vision that promotes land administration in support of sustainable development and spatial enablement of society. We present here the first part of the paper. The second...
Social Security Administration — Contains SSA Security Reports that allow Information Security Officers (ISOs) to access, review and take appropriate action based on the information contained in the...
The Veterans Administration Information Resource Center provides database and informatics experts, customer service, expert advice, information products, and web technology to VA researchers and others.
Department of Veterans Affairs — ADR provides an authoritative data store for shared administrative, demographic, enrollment, and eligibility information which is managed as a corporate asset. This...
Allen-Ramey, Felicia C; Bukstein, Don; Luskin, Allan; Sajjan, Shiva G; Markson, Leona E
To compare asthma-related health care resource utilization among a matched cohort of asthma patients using inhaled corticosteroids (ICSs) plus either montelukast (MON) or salmeterol (SAL) as combination therapy for asthma, during a time prior to the availability of fixed-dose combinations of ICS/SAL. A retrospective analysis using the PHARMetrics patient-centric claims database was conducted for the period preceding the market introduction of combination fluticasone-SAL in September 2000. Patients had to meet the following criteria for inclusion in the study: they had to be between the ages of 4 and 55 years; they had to have been continuously enrolled for 2 years; they had to have initiated ICS/MON or ICS/SAL therapy between July 1, 1998, and June 30, 1999; and they had to have had either (a) a diagnosis of asthma (based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes of 493.xx) for 2 outpatient visits, 1 or more emergency department (ED) visits, or 1 or more hospitalizations within 1 year or (b) pharmacy claim records that contained a National Drug Code for an antiasthma medication (betaagonist, theophylline, ICS, cromolyn, or leukotriene) 2 or more times within 1 year. ICS/MON and ICS/SAL patients were matched 1 to 1 on age and propensity score. Outcomes included asthma-related hopitalizations and ED visits with ICD-9-CM codes of 493.xx, and oral corticosteroid (OCS) fills and short-acting beta-agonist (SABA) fills. Multivariate regression analyses were performed. Subgroup analyses based on sequential or concurrent initiation of combination therapy were also conducted. A total of 1,216 patients were matched (ICS/MON = 608; ICS/SAL= 608). Decreased odds of ED visits and/or hospitalizations were observed with ICS/MON (adjusted odds ratio [OR] = 0.58; 95% confidence interval [CI], 0.35- 0.98) versus ICS/SAL. The odds of postindex OCS fills were not different for ICS/MON and ICS/SAL patients (adjusted OR = 1.04; 95
P. Williamson, Ian; Enemark, Stig; Wallace, Judy
This paper introduces basic land administration theory and highlights four key concepts that are fundamental to understanding modern land administration systems. Readers may recall the first part of the paper in October issue of Coordinates. Here is the concluding part that focuses on the changing...
and the theoretical issues in relation to administrative legislation are discussed followed ..... that “laws properly so called” must be distinguished from morals and other ..... 44 William Wade, (1988), Administrative Law (Oxford University Press), p. .... 66 Rule 320, Rules of procedure and conduct of business in the Lok Sabha.
If you are a Linux administrator who is looking to gain knowledge that differentiates yourself from the crowd, then this is the book for you. Beginners who have a keen interest to learn more about Linux administration will also progress quickly with this resourceful learning guide.
Borelli, Frank L.
Presents ten guidelines for human relations skills that can help elevate the practice of student personnel administration to an art form. Administrators need to develop and perfect leadership skills including respect for individual differences, consistency, listening skills, instinct, being a role model, and establishment of realistic performance…
Discussion of the trends towards more uses of postmodern analysis within the discipline of public administration, particularly in the USA......Discussion of the trends towards more uses of postmodern analysis within the discipline of public administration, particularly in the USA...
Search the Division of Finance site DOF State of Alaska Finance Home Content Area Accounting Charge Cards Division of Finance is to provide accounting, payroll, and travel services for State government Top Department of Administration logo Alaska Department of Administration Division of Finance Search
Written in a cookbook format with practical recipes this book helps you to perform various administrative tasks using Webmin and enables you to perform common jobs more efficiently.This book is perfect for System administrators who want to learn more advanced concepts of Webmin and how it can help to set up a server for development, testing or deployment.
Using Harm-Based Weights for the AHRQ Patient Safety for Selected Indicators Composite (PSI-90): Does It Affect Assessment of Hospital Performance and Financial Penalties in Veterans Health Administration Hospitals?
Chen, Qi; Rosen, Amy K; Borzecki, Ann; Shwartz, Michael
To assess whether hospital profiles for public reporting and pay-for-performance, measured by the Agency for Healthcare Research and Quality (AHRQ) Patient Safety for Selected Indicators (PSI-90) composite measure, were affected by using the recently developed harm-based weights. Retrospective analysis of 2012-2014 data from the Veterans Health Administration (VA). The AHRQ PSI software (v5.0) was applied to obtain the original volume-based PSI-90 scores for 132 acute-care hospitals. We constructed a modified PSI-90 using the harm-based weights developed by AHRQ. We compared hospital profiles for public reporting and pay-for-performance between these two PSI-90s and assessed patterns in these changes. The volume-based and the harm-based PSI-90s were strongly correlated (r = 0.67, p hospitals changed categorization), but it had a much larger impact on pay-for-performance (e.g., 15 percent of hospitals would have faced different financial penalties under the Medicare Hospital-Acquired Condition Reduction Program). Because of changes in weights of specific PSIs, hospital profile changes occurred systematically. Use of the harm-based weights in PSI-90 has the potential to significantly change payments under pay-for-performance programs. Policy makers should carefully develop transition plans for guiding hospitals through changes in any quality metrics used for pay-for-performance. © Health Research and Educational Trust.
Land administration systems are the operational tool for conceptualizing rights, restrictions and responsibilities (RRRs) in land. Each of the rights, restrictions and responsibilities encompasses a human rights dimension that relates to the overall national land policies and should be unfolded...... as more than just rhetoric. This paper attempts to analyse the aspects of human rights in relation to land administration systems with a special focus on developing countries struggling to build adequate systems for governing the rights, restrictions and responsibilities in land. Human rights....... This relates to national political arrangements and standards for good governance and land administration systems are highly instrumental in this regard. This paper introduces the relation between land administration and human rights. It is argued that human rights and land administration are closely linked...
Schmaling, Karen B; Linton, John C
Academic psychologists' backgrounds may prepare them for many aspects of academic administration such as: understanding and working with people; prioritizing others' needs and institutional needs; and managing projects and budgets, e.g., for research grants or training programs. Contemporary academic health centers also may provide opportunities for psychologists to serve in academic health administration. This article encourages psychologists to consider preparing for and seeking administrative and higher-level leadership roles. Six psychologists serving diverse administrative roles-from vice chairs in medical school departments to presidents of universities with academic health centers-reflected on: their paths to administration; their preparation for administrative roles; and the commonalities and differences between the work and skills sets of psychologist health service providers and the work and skill sets required for higher level administrative and leadership roles.
... HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CERTIFICATION OF OPIOID TREATMENT PROGRAMS Procedures for... Withdrawal of Approval of an Accreditation Body § 8.34 Court review of final administrative action...
by @dtsamil Defense Technology Security Administration Mission, Culture, and History Executive Official seal of Defense Technology Security Administration Official seal of Defense Technology Security Administration OFFICE of the SECRETARY of DEFENSE Defense Technology Security Administration
What factors contribute to positive early childhood health and development in Australian Aboriginal children? Protocol for a population-based cohort study using linked administrative data (The Seeding Success Study)
Falster, Kathleen; Jorm, Louisa; Eades, Sandra; Lynch, John; Banks, Emily; Brownell, Marni; Craven, Rhonda; Einarsdóttir, Kristjana; Randall, Deborah
Introduction Australian Aboriginal children are more likely than non-Aboriginal children to have developmental vulnerability at school entry that tracks through to poorer literacy and numeracy outcomes and multiple social and health disadvantages in later life. Empirical evidence identifying the key drivers of positive early childhood development in Aboriginal children, and supportive features of local communities and early childhood service provision, are lacking. Methods and analysis The study population will be identified via linkage of Australian Early Development Census data to perinatal and birth registration data sets. It will include an almost complete population of children who started their first year of full-time school in New South Wales (NSW), Australia, in 2009 and 2012. Early childhood health and development trajectories for these children will be constructed via linkage to a range of administrative data sets relating to birth outcomes, congenital conditions, hospital admissions, emergency department presentations, receipt of ambulatory mental healthcare services, use of general practitioner services, contact with child protection and out-of-home care services, receipt of income assistance and fact of death. Using multilevel modelling techniques, we will quantify the contributions of individual-level and area-level factors to variation in early childhood development outcomes in Aboriginal and non-Aboriginal children. Additionally, we will evaluate the impact of two government programmes that aim to address early childhood disadvantage, the NSW Aboriginal Maternal and Infant Health Service and the Brighter Futures Program. These evaluations will use propensity score matching methods and multilevel modelling. Ethics and dissemination Ethical approval has been obtained for this study. Dissemination mechanisms include engagement of stakeholders (including representatives from Aboriginal community controlled organisations, policy agencies, service
Stanton Cynthia K
Full Text Available Abstract Background Hemorrhage is the leading direct cause of maternal death globally. While oxytocin is the drug of choice for postpartum hemorrhage prevention, its use has generally been limited to health facilities. This trial assesses the effectiveness, safety, and feasibility of expanding the use of prophylactic intramuscular oxytocin to peripheral health care providers at home births in four predominantly rural districts in central Ghana. Methods This study is designed as a community-based cluster-randomized trial in which Community Health Officers are randomized to provide (or not provide an injection of oxytocin 10 IU via the UnijectTM injection system within one minute of delivery of the baby to women who request their presence at home at the onset of labor. The primary aim is to determine if administration of prophylactic oxytocin via Uniject™ by this cadre will reduce the risk of postpartum hemorrhage by 50 % relative to deliveries which do not receive the prophylactic intervention. Postpartum hemorrhage is examined under three sequential definitions: 1 blood loss ≥500 ml (BL; 2 treatment for bleeding (TX and/or BL; 3 hospital referral for bleeding and/or TX and/or BL. Secondary outcomes address safety and feasibility of the intervention and include adverse maternal and fetal outcomes and logistical concerns regarding assistance at home births and the storage and handling of oxytocin, respectively. Discussion Results from this trial will build evidence for the effectiveness of expanding the delivery of this established prophylactic intervention to peripheral settings. Complementary data on safety and logistical issues related to this intervention will assist policymakers in low-income countries in selecting both the best uterotonic and service delivery strategy for postpartum hemorrhage prevention. Results of this trial are expected in mid-2013. The trial is registered at ClinicalTrials.gov: NCT01108289.
What factors contribute to positive early childhood health and development in Australian Aboriginal children? Protocol for a population-based cohort study using linked administrative data (The Seeding Success Study).
Falster, Kathleen; Jorm, Louisa; Eades, Sandra; Lynch, John; Banks, Emily; Brownell, Marni; Craven, Rhonda; Einarsdóttir, Kristjana; Randall, Deborah
Australian Aboriginal children are more likely than non-Aboriginal children to have developmental vulnerability at school entry that tracks through to poorer literacy and numeracy outcomes and multiple social and health disadvantages in later life. Empirical evidence identifying the key drivers of positive early childhood development in Aboriginal children, and supportive features of local communities and early childhood service provision, are lacking. The study population will be identified via linkage of Australian Early Development Census data to perinatal and birth registration data sets. It will include an almost complete population of children who started their first year of full-time school in New South Wales (NSW), Australia, in 2009 and 2012. Early childhood health and development trajectories for these children will be constructed via linkage to a range of administrative data sets relating to birth outcomes, congenital conditions, hospital admissions, emergency department presentations, receipt of ambulatory mental healthcare services, use of general practitioner services, contact with child protection and out-of-home care services, receipt of income assistance and fact of death. Using multilevel modelling techniques, we will quantify the contributions of individual-level and area-level factors to variation in early childhood development outcomes in Aboriginal and non-Aboriginal children. Additionally, we will evaluate the impact of two government programmes that aim to address early childhood disadvantage, the NSW Aboriginal Maternal and Infant Health Service and the Brighter Futures Program. These evaluations will use propensity score matching methods and multilevel modelling. Ethical approval has been obtained for this study. Dissemination mechanisms include engagement of stakeholders (including representatives from Aboriginal community controlled organisations, policy agencies, service providers) through a reference group, and writing of summary
Stanton, Cynthia K; Newton, Samuel; Mullany, Luke C; Cofie, Patience; Agyemang, Charlotte Tawiah; Adiibokah, Edward; Darcy, Niamh; Khan, Sadaf; Levisay, Alice; Gyapong, John; Armbruster, Deborah; Owusu-Agyei, Seth
Hemorrhage is the leading direct cause of maternal death globally. While oxytocin is the drug of choice for postpartum hemorrhage prevention, its use has generally been limited to health facilities. This trial assesses the effectiveness, safety, and feasibility of expanding the use of prophylactic intramuscular oxytocin to peripheral health care providers at home births in four predominantly rural districts in central Ghana. This study is designed as a community-based cluster-randomized trial in which Community Health Officers are randomized to provide (or not provide) an injection of oxytocin 10 IU via the Uniject™ injection system within one minute of delivery of the baby to women who request their presence at home at the onset of labor. The primary aim is to determine if administration of prophylactic oxytocin via Uniject™ by this cadre will reduce the risk of postpartum hemorrhage by 50 % relative to deliveries which do not receive the prophylactic intervention. Postpartum hemorrhage is examined under three sequential definitions: 1) blood loss ≥500 ml (BL); 2) treatment for bleeding (TX) and/or BL; 3) hospital referral for bleeding and/or TX and/or BL. Secondary outcomes address safety and feasibility of the intervention and include adverse maternal and fetal outcomes and logistical concerns regarding assistance at home births and the storage and handling of oxytocin, respectively. Results from this trial will build evidence for the effectiveness of expanding the delivery of this established prophylactic intervention to peripheral settings. Complementary data on safety and logistical issues related to this intervention will assist policymakers in low-income countries in selecting both the best uterotonic and service delivery strategy for postpartum hemorrhage prevention. Results of this trial are expected in mid-2013. The trial is registered at ClinicalTrials.gov: NCT01108289.
Full Text Available The role played by the administrative apparatus through the Department of Administrative Services in the Government policy Vargas is the object put in debate. Analyzes the theme from the the investigation of patrimonial, authoritarian and inefficient context which marks the formation and development of administrative bureaucracy, the tenders of professionalization and efficiency brought by the administrative reforms of the 1930s and 1940s with the contrast of the limitations of the import of the Weberian model in the Brazilian context and analysis of the establishment of the New State DASP and their assignments. Search the work demonstrate the control position he held directly and through the State Departments in the Brazilian Public Administration ensuring centralized and developmental policy of the government. For this is adopted as the research method of approach structuralism in order to identify the deconstruction of the phenomenon - of administrative reforms - in the superficial perception - the proposed impersonality and efficiency as the best way of achieving the public interest - its invariant structure - the search for the adequacy of the administrative apparatus and bureaucracy for pursuit of political ends pursued by the Government.
CSU-FDA (Colorado State Univ.-Food and Drug Administration) Collaborative Radiological Health Laboratory. Annual report - 1982: health effects of prenatal and postnatal whole-body exposure to ionizing radiation in the beagle dog
The Collaborative Radiological Health Laboratory was established in 1962 by the U.S. Public Health Service and Colorado State University for the purpose of determining in a carefully controlled animal experiment the life-time hazards associated with prenatal and early postnatal exposure to ionizing radiation. The CRHL study is designed to provide information that will facilitate the evaluation of risks to human beings from medical exposure during early development. The study is a long-term (lifespan) study of a moderately large and long-lived mammal exposed at one of several times during development to a relatively small and discrete dose of external radiation. Ages at irradiation selected for comparison reflect the primary concern with medical exposures during the development period. This annual report summarizes the current status of the study for the reporting period of January 1 through December 31, 1982
Maternal and institutional characteristics associated with the administration of prophylactic antibiotics for caesarean section: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health.
Morisaki, N; Ganchimeg, T; Ota, E; Vogel, J P; Souza, J P; Mori, R; Gülmezoglu, A M
To illustrate the variability in the use of antibiotic prophylaxis for caesarean section, and its effect on the prevention of postoperative infections. Secondary analysis of a cross-sectional study. Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Three hundred and fifty-nine health facilities with the capacity to perform caesarean section. Descriptive analysis and effect estimates using multilevel logistic regression. Coverage of antibiotic prophylaxis for caesarean section. A total of 89 121 caesarean sections were performed in 332 of the 359 facilities included in the survey; 87% under prophylactic antibiotic coverage. Thirty five facilities provided 0-49% coverage and 77 facilities provided 50-89% coverage. Institutional coverage of prophylactic antibiotics varied greatly within most countries, and was related to guideline use and the practice of clinical audits, but not to the size, location of the institution or development index of the country. Mothers with complications, such as HIV infection, anaemia, or pre-eclampsia/eclampsia, were more likely to receive antibiotic prophylaxis. At the same time, mothers undergoing caesarean birth prior to labour and those with indication for scheduled deliveries were also more likely to receive antibiotic prophylaxis, despite their lower risk of infection, compared with mothers undergoing emergency caesarean section. Coverage of antibiotic prophylaxis for caesarean birth may be related to the perception of the importance of guidelines and clinical audits in the facility. There may also be a tendency to use antibiotics when caesarean section has been scheduled and antibiotic prophylaxis is already included in the routine clinical protocol. This study may act as a signal to re-evaluate institutional practices as a way to identify areas where improvement is possible. © 2014 RCOG The World Health Organization retains copyright and all other rights in
We can all be Linux experts, provided we invest the time in learning the craft of Linux administration. Pro Linux System Administration makes it easy for small to medium--sized businesses to enter the world of zero--cost software running on Linux and covers all the distros you might want to use, including Red Hat, Ubuntu, Debian, and CentOS. Authors, and systems infrastructure experts James Turnbull, Peter Lieverdink, and Dennis Matotek take a layered, component--based approach to open source business systems, while training system administrators as the builders of business infrastructure. If
Eduardo Hernando Nieto
Full Text Available To what extent does studying jurisdictional politics need the knowledge of different administrative theories in general and the science of public administration in particular? This small text proposes such reflection and comes to the conclusion that it is impossible to propose a new approximation to this topic without considering the administrative theory, for that the specialists and thinkers will get more with the contact of this discipline from what it is called a multidisciplinary approach.
Current developments in atomic energy, and the administrative problems to which they give rise, were surveyed in a seminar on 'Atomic Energy for Atomic Energy Administrators' held at IAEA headquarters from 30 September to 4 October 1963. The ground covered included protection against radiation, isotopes and radiation sources, research reactors, nuclear power, legal matters, technical and scientific administration, the role of the universities, and the Agency's part in assistance to developing countries. The possibilities and limitations of radioisotope production from research reactors were discussed by Dr. G. B. Cook, of the Division of Research and Laboratories, IAEA in this paper.
Current developments in atomic energy, and the administrative problems to which they give rise, were surveyed in a seminar on 'Atomic Energy for Atomic Energy Administrators' held at IAEA headquarters from 30 September to 4 October 1963. The ground covered included protection against radiation, isotopes and radiation sources, research reactors, nuclear power, legal matters, technical and scientific administration, the role of the universities, and the Agency's part in assistance to developing countries. The possibilities and limitations of radioisotope production from research reactors were discussed by Dr. G. B. Cook, of the Division of Research and Laboratories, IAEA in this paper.
Administrative Circular N° 19 (Rev. 3) - April 2003 Subsistence indemnity - Other expenses necessarily incurred in the course of duty travelAdministrative Circular N° 25 (Rev. 2) - April 2003 Shift work - Special provisions for the Fire and Rescue Service - These circulars have been revised. Human Resources Division Tel. 74128Copies of these circulars are available in the Divisional Secretariats. In addition, administrative and operational circulars, as well as the lists of those in force, are available for consultation on the Web at: http://humanresources.web.cern.ch/humanresources/internal/admin_services/admincirc/listadmincirc.asp
ADMINISTRATIVE CIRCULAR NO. 23 (REV. 2) – SPECIAL WORKING HOURS Administrative Circular No. 23 (Rev. 2) entitled "Special working hours", approved following discussion in the Standing Concertation Committee on 9 December 2008, will be available on the intranet site of the Human Resources Department as from 19 December 2008: http://cern.ch/hr-docs/admincirc/admincirc.asp It cancels and replaces Administrative Circular No. 23 (Rev. 1) entitled "Stand-by duty" of April 1988. A "Frequently Asked Questions" information document on special working hours will also be available on this site. Paper copies of this circular will shortly be available in Departmental Secretariats. Human Resources Department Tel. 78003
ADMINISTRATIVE CIRCULAR NO. 23 (REV. 2) – SPECIAL WORKING HOURS Administrative Circular No. 23 (Rev. 2) entitled "Special working hours", approved following discussion in the Standing Concertation Committee meeting of 9 December 2008, will be available on the intranet site of the Human Resources Department as from 19 December 2008: http://cern.ch/hr-docs/admincirc/admincirc.asp It cancels and replaces Administrative Circular No. 23 (Rev. 1) entitled "Stand-by duty" of April 1988. A "Frequently Asked Questions" information document on special working hours will also be available on this site. Paper copies of this circular will shortly be available in departmental secretariats. Human Resources Department Tel. 78003
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2009-N-0247] Food and Drug Administration Transparency Initiative: Draft Proposals for Public Comment to Increase...: Food and Drug Administration, HHS. [[Page 61367
Full Text Available ... Anesthesia Evaluation Part V Broad Access to Care, Patient Safety and Comfort Oral and maxillofacial surgeons (OMSs) are trained in all aspects of anesthesia administration. Following dental ... evaluate patients for anesthesia, deliver the anesthetic and monitor post- ...
... content Official website of the Department of Homeland Security Transportation Security Administration A - Z Index Blog What Can I ... Search form Search the Site Main menu Travel Security Screening Special Procedures TSA Pre✓® Passenger Support Travel ...
Full Text Available ... OMSs) are trained in all aspects of anesthesia administration. Following dental school, they complete at least four years of training in a hospital-based surgical residency program alongside medical residents in ...
enabling of land administration systems managing tenure, valuation, planning, and development will allow the information generated by these activities to be much more useful. Also, the services available to private and public sectors and to community organisations should commensurably improve. Knowledge....... In other words: Good governance and sustainable development is not attainable without sound land administration or - more broadly – sound land management. The paper presents a land management vision that incorporates the benefits of ICT enabled land administration functions. The idea is that spatial...... the communication between administrative systems and also establish more reliable data due to the use the original data instead of copies. In Denmark, such governmental guidelines for a service-oriented ITarchitecture in support of e-government are recently adopted. Finally, the paper presents the role of FIG...
are not restricted to the administrative practices, but are part of education and its humanistic legacy as well. As such, the administrative demand of documentation becomes possible and recognisable through its reproductive elements. Elements that are constituted in a transformative conjunction in which......Abstract Through the example of a Danish reform of educational plans in early childhood education, this paper analyses the emergence of a new pedagogical desire related to administrative educational reforms promoting accountability, visibility and documentation. Two arguments are made: first......, it is argued that the changes in administrative practices during the last decade constitute a transformation, but also a reproduction of relations between knowledge and governing that goes back to the big expansion of the welfare state. Second, it is argued that these relations between knowledge and governing...
Article denouncing the supposed impartiality of signatories of a report released by the Union of Concerned Scientists (UCS), which accused the Bush administration of systemically suborning objective science to a political agenda (1 page).
... 42 Public Health 2 2010-10-01 2010-10-01 false Administrative review of CMS determinations. 403... Certification Program: General Provisions § 403.248 Administrative review of CMS determinations. (a) This section provides for administrative review if CMS determines— (1) Not to certify a policy; or (2) That a...
... 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...
... 42 Public Health 4 2010-10-01 2010-10-01 false UR responsibilities of administrative staff. 456... administrative staff. The UR plan must describe— (a) The UR support responsibilities of the ICF's administrative staff; and (b) Procedures used by the staff for taking needed corrective action. UR Plan: Informational...
A step-by-step guide to learn how to set up security on Linux servers by taking SELinux policies into your own hands.Linux administrators will enjoy the various SELinux features that this book covers and the approach used to guide the admin into understanding how SELinux works. The book assumes that you have basic knowledge in Linux administration, especially Linux permission and user management.
This book is a practical, hands-on guide, taking the reader from the basics of using Cassandra though to the installation and the running.Learning Cassandra for Administrators is for administrators who manage a large deployment of Cassandra clusters, and support engineers who would like to install the monitoring tools and who are also in charge of making sure the cluster stays the same, ensuring that the service is always up and running.
Grider, D.A.; Sturdivant, M.H.
In nonnuclear business, administrative procedures bring to mind such mundane topics as filing correspondence and scheduling vacation time. In the nuclear industry, on the other hand, administrative procedures play a vital role in assuring the safe operation of a facility. For some time now, industry focus has been on improving technical procedures. Significant efforts are under way to produce technical procedure requires that a validated technical, regulatory, and administrative basis be developed and that the technical process be established for each procedure. Producing usable technical procedures requires that procedure presentation be engineered to the same human factors principles used in control room design. The vital safety role of administrative procedures requires that they be just as sound, just a rigorously formulated, and documented as technical procedures. Procedure programs at the Tennessee Valley Authority and at Boston Edison's Pilgrim Station demonstrate that human factors engineering techniques can be applied effectively to technical procedures. With a few modifications, those same techniques can be used to produce more effective administrative procedures. Efforts are under way at the US Department of Energy Nuclear Weapons Complex and at some utilities (Boston Edison, for instance) to apply human factors engineering to administrative procedures: The techniques being adapted include the following
Office of Personnel Management — The Health Claims Data Warehouse (HCDW) will receive and analyze health claims data to support management and administrative purposes. The Federal Employee Health...
Kirkpatrick, Samuel A.
The politics of education has been ignored in educational administration programs; it has been not enough taught in American programs for educational administrators and not enough emphasized in discussions of administrative roles. Administration increasingly includes political as well as rational decisions. Thus, administrators need a unified…
... 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...
Full Text Available ... mouth and gums to improve function, appearance and oral health. Click here to find out more. Facial Cosmetic ... mouth and gums to improve function, appearance and oral health. Click here to find out more. Facial Cosmetic ...
Full Text Available ... and gums to improve function, appearance and oral health. Click here to find out more. Facial Cosmetic ... and gums to improve function, appearance and oral health. Click here to find out more. Facial Cosmetic ...
If you're an experienced system administrator looking to acquire Linux skills, or a seasoned Linux user facing a new challenge, Linux System Administration offers practical knowledge for managing a complete range of Linux systems and servers. The book summarizes the steps you need to build everything from standalone SOHO hubs, web servers, and LAN servers to load-balanced clusters and servers consolidated through virtualization. Along the way, you'll learn about all of the tools you need to set up and maintain these working environments. Linux is now a standard corporate platform with user
As time goes on, system administrators are presented with increasingly complicated challenges. In the early days, a team of engineers might have had to look after one or two systems. These days, one engineer can administer hundreds or thousands of systems. System administrators are gradually replacing their tools with more advanced and flexible ones. One of the choices is Python. Structurally, Python is a modern, high-level language with a very clean syntax. Python comes with many built-in libraries that can make automation tasks easier. It also has extensive set of third-party libraries and a
Archer, Charles J.; Megerian, Mark G.; Ratterman, Joseph D.; Smith, Brian E.
Computer hardware fault administration carried out in a parallel computer, where the parallel computer includes a plurality of compute nodes. The compute nodes are coupled for data communications by at least two independent data communications networks, where each data communications network includes data communications links connected to the compute nodes. Typical embodiments carry out hardware fault administration by identifying a location of a defective link in the first data communications network of the parallel computer and routing communications data around the defective link through the second data communications network of the parallel computer.
If you're familiar with JIRA for issue tracking, bug tracking, and other uses, you know it can sometimes be tricky to set up and manage. In this concise book, software toolsmith Matt Doar clarifies some of the more confusing aspects by answering difficult and frequently asked questions about JIRA administration. Practical JIRA Administration shows you how JIRA is intended to be used, making it an ideal supplement to the extensive documentation already available. The book's chapters are loosely connected, so you can go straight to the information that best serves your needs. Understand the di
Management of international rivers and their basins is the focus of the Centre for Comparative Studies on (International) River Basin Administration, recently established at Delft University of Technology in the Netherlands. Water pollution, sludge, and conflicting interests in the use of water in upstream and downstream parts of a river basin will be addressed by studying groundwater and consumption of water in the whole catchment area of a river.Important aspects of river management are administrative and policy aspects. The Centre will focus on policy, law, planning, and organization, including transboundary cooperation, posing standards, integrated environmental planning on regional scale and environmental impact assessments.
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
Discusses Max Weber's importance in Greenfield's work, particularly in Greenfield and Ribbins'"Greenfield on Educational Administration" (1993). In concentrating on human actors' subjective understanding, Greenfield was a faithful Weberian. However, he deviated from Weber by disavowing structural explanations of social and organizational…
Végh, Gyöngyi; Gribnau, Hans
There is no doubt that tax administration is a complex matter. It is institutionalised by a governance framework which is strongly influenced by legal traditions, state governance approaches, historical developments, and norms and values of society. While there are many common aspects of national
MSc. Arjeta Hallunovi
Full Text Available The goal of this study is to deal with some ethical causes in the public administration, that aim the avoidance of negative phenomenon’s as theft, corruption, etc. In this direction, the debates about ethics are becoming more and more a global tendency, as an implement through which would be found the way to get out of the crisis. The success in the reforms of the public administrations in major part depends, on the public functionaries and their willingness to make fundamental changes in the way they work. In this direction, the State should strengthen and modernize the public service, should realize an employment system, which should reflect more the merits on its service. For this reason, the government’s attempts should be concentrated on the construction of a positive image for the state and its administration as professional objective, which is oriented to the services. Being aware for the practical restrictions of this study, we firstly chose to concentrate on the local public administrations ethics. The study will be focused on the practical comparative analysis of the city of Shkodra and Durres by the realization of a questionnaire by each of these municipalities and the Agency of Legalization and Urbanization of Informal Zones (ALUIZNI in Shkodra.
The objectives of a hospital are to improve patient care, while the objectives of a hospital library are to improve services to the staff which will support their efforts. This handbook dealing with hospital administration is designed to aid the librarian in either implementing a hospital library, or improving services in an existing medical…
IT departments everywhere will be integrating Macs and Mac OS X into their IT infrastructure and this book will tell them how to do it. It will serve as an authoritative, useful and frequently referenced book on Mac OS X administration.
On the recommendation of the Standing Concertation Committee, the Director-General has approved the amounts used for the reimbursements mentioned in Administrative Circular No. 12 as follows: The figures, effective from 1 September 2006, are: Paragraph 8a: 17 Swiss francs Paragraph 9a: 682 Swiss francs Paragraph 9b: 34 Swiss francs Human Resources Department Tel. 79257/72862
Moore, Thomas R.
Expands Henri Fayol's definition of the administrative process to include a humanistic approach involving planning, organizing, implementing, controlling, evaluating, and satisfying functions. This empirical definition differs from some theoretical approaches by looking beyond resource consumption to consider ecological effects on the environment…
Manzo, Kathleen Kennedy
Cellphone-savvy students have created instructional and disciplinary challenges for educators for years. But the recent emergence of "sexting" by adolescents over their mobile phones caught many school administrators off guard, and the practice is prompting efforts around the country to craft policy responses. Students' sharing of nude or…
Dekker, M.A.C.; Etalle, S.; Jonker, W.; Petkovic, M.
Flexibility of management is an important requisite for access control systems as it allows users to adapt the access control system in accordance with practical requirements. This paper builds on earlier work where we defined administrative policies for a general class of RBAC models. We present a
... 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...
Galganski, Carol J
As part of Phase I of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association, this study identifies the core literature cited in nursing administration and the indexing services that provide access to the core journals. The results of this study will assist librarians and end users searching for information related to this nursing discipline, as well as database producers who might consider adding specific titles to their indexing services. Using the common methodology described in the overview article, five source journals for nursing administration were identified and selected for citation analysis over a three-year period, 1996 to 1998, to identify the most frequently cited titles according to Bradford's Law of Scattering. From this core of most productive journal titles, the bibliographic databases that provide the best access to these titles were identified. Results reveal that nursing administration literature relies most heavily on journal articles and on those titles identified as core nursing administrative titles. When the indexing coverage of nine services is compared, PubMed/MEDLINE and CINAHL provide the most comprehensive coverage of this nursing discipline. No one indexing service adequately covers this nursing discipline. Researchers needing comprehensive coverage in this area must search more than one database to effectively research their projects. While PubMed/MEDLINE and CINAHL provide more coverage for this discipline than the other indexing services, none is sufficiently broad in scope to provide indexing of nursing, health care management, and medical literature in a single file. Nurse administrators using the literature to research current work issues need to review not only the nursing titles covered by CINAHL but should also include the major weekly medical titles, core titles in health care administration, and general business sources if they wish to
An operations-partnered evaluation of care redesign for high-risk patients in the Veterans Health Administration (VHA): Study protocol for the PACT Intensive Management (PIM) randomized quality improvement evaluation.
Chang, Evelyn T; Zulman, Donna M; Asch, Steven M; Stockdale, Susan E; Yoon, Jean; Ong, Michael K; Lee, Martin; Simon, Alissa; Atkins, David; Schectman, Gordon; Kirsh, Susan R; Rubenstein, Lisa V
Patient-centered medical homes have made great strides providing comprehensive care for patients with chronic conditions, but may not provide sufficient support for patients at highest risk for acute care use. To address this, the Veterans Health Administration (VHA) initiated a five-site demonstration project to evaluate the effectiveness of augmenting the VA's Patient Aligned Care Team (PACT) medical home with PACT Intensive Management (PIM) teams for Veterans at highest risk for hospitalization. Researchers partnered with VHA leadership to design a mixed-methods prospective multi-site evaluation that met leadership's desire for a rigorous evaluation conducted as quality improvement rather than research. We conducted a randomized QI evaluation and assigned high-risk patients to participate in PIM and compared them with high-risk Veterans receiving usual care through PACT. The summative evaluation examines whether PIM: 1) decreases VHA emergency department and hospital use; 2) increases satisfaction with VHA care; 3) decreases provider burnout; and 4) generates positive returns on investment. The formative evaluation aims to support improved care for high-risk patients at demonstration sites and to inform future initiatives for high-risk patients. The evaluation was reviewed by representatives from the VHA Office of Research and Development and the Office of Research Oversight and met criteria for quality improvement. VHA aims to function as a learning organization by rapidly implementing and rigorously testing QI innovations prior to final program or policy development. We observed challenges and opportunities in designing an evaluation consistent with QI standards and operations priorities, while also maintaining scientific rigor. This trial was retrospectively registered at ClinicalTrials.gov on April 3, 2017: NCT03100526. Protocol v1, FY14-17. Copyright © 2018 Elsevier Inc. All rights reserved.
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 433 State Fiscal Administration CFR Correction 0 In Title 42 of the Code of Federal Regulations, Parts 430 to 481, revised as of October 1, 2012, on page 98, in Sec. 433.50, paragraphs (a)(1)(i) and (a)(1)(ii...
The Health Insurance Portability and Accessibility Act (HIPAA) was signed into law in 1996. Although focused on information technology issues, HIPAA will ultimately impact day-to-day operations at multiple levels within any clinical setting. Optometrists must begin to familiarize themselves with HIPAA in order to prepare themselves to practice in a technology-enriched environment. Title II of HIPAA, entitled "Administration Simplification," is intended to reduce the costs and administrative burden of healthcare by standardizing the electronic transmission of administrative and financial transactions. The Department of Health and Human Services is expected to publish the final rules and regulations that will govern HIPAA's implementation this year. The rules and regulations will cover three key aspects of healthcare delivery: electronic data interchange (EDI), security and privacy. EDI will standardize the format for healthcare transactions. Health plans must accept and respond to all transactions in the EDI format. Security refers to policies and procedures that protect the accuracy and integrity of information and limit access. Privacy focuses on how the information is used and disclosure of identifiable health information. Security and privacy regulations apply to all information that is maintained and transmitted in a digital format and require administrative, physical, and technical safeguards. HIPAA will force the healthcare industry to adopt an e-commerce paradigm and provide opportunities to improve patient care processes. Optometrists should take advantage of the opportunity to develop more efficient and profitable practices.
... toxic to microorganisms, e.g., antibiotics), or analogous products at any stage of production, shipment... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Administrative terminology. 101.2 Section 101.2 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF...
Francisco Santana de Souza
Full Text Available This work aims to analyze the essential tools for the management of the ICMS (Value-Added Tax on Sales and Services. It was developed a calculation procedure of this tax which permits to demonstrate the importance of correctly perform fiscal and accounting entries. In order to demonstrate this calculation procedure, it was used Financial Mathematics concepts of simple interest and simple trade discount together with article 33, 1989 of ICMS Law of the State of São Paulo. It was concluded that it is essential to have a precise ICMS tributary administration, in order to firstly avoid contentious administrative tributary which would imply additional and unnecessary costs to the organization and secondly to use tax evasion correctly in order to avoid excessive taxes payment. Thus, the appropriate use of both instruments will reflect into a positive cash flow for the organization.
Lee, Christopher Jon; The ATLAS collaboration; Bogdanchikov, Alexander; Ballestrero, Sergio; Contescu, Alexandru Cristian; Dubrov, Sergei; Fazio, Daniel; Korol, Aleksandr; Scannicchio, Diana; Twomey, Matthew Shaun; Voronkov, Artem
The ATLAS Trigger and Data Acquisition (TDAQ) system is responsible for the online processing of live data, streaming from the ATLAS experiment at the Large Hadron Collider (LHC) at CERN. The online farm is composed of ̃3000 servers, processing the data readout from ̃100 million detector channels through multiple trigger levels. During the two years of the first Long Shutdown (LS1) there has been a tremendous amount of work done by the ATLAS TDAQ System Administrators, implementing numerous new software applications, upgrading the OS and the hardware, changing some design philosophies and exploiting the High Level Trigger farm with different purposes. During the data taking only critical security updates are applied and broken hardware is replaced to ensure a stable operational environment. The LS1 provided an excellent opportunity to look into new technologies and applications that would help to improve and streamline the daily tasks of not only the System Administrators, but also of the scientists who wil...
Melo, M R; Fávero, N; Trevizan, M A; Hayashida, M
The objective of the present study was to investigate hospital administrator's expectations about the administrative role played by nurses, utilizing functions proposed by the Neoclassical Theory of Administration: planning, organization, direction, and control as theoretical references. An instrument established in TREVIZAN (1989) was applied to 11 hospital administrators. The results showed they expect the four functions to be done by nurses. Therefore, the interaction between nurses and hospital administrators is critical to improve the patient's assistance.
If you are an experienced system administrator and know how to manage servers and set up web environments but now want to explore Moodle, this book is perfect for you. You'll get to grips with the basics and learn to manage Moodle quickly, focusing on essential tasks. Having prior knowledge of virtual learning environments would be beneficial, but is not mandatory to make the most of this book.