Wenger, A F
Decisions about health promotion and illness prevention occur within a cultural context that is influenced by the contemporary context of community and family in addition to the ethnohistorical and language contexts, worldview and sociocultural factors of the particular culture and the available folk and professional health care resources. Using information about the health and care beliefs and values and health care decision making process in negotiating culturally congruent nursing and health care interventions is imperative, especially in a world with limited health care resources and an increasing demand for recognition of cultural diversity. This article uses data on health and health care decision-making from an ethnonursing study of the Old Order Amish to demonstrate the role of cultural context in health care practices and decision making. Leininger's cultural care theory and Hall's conceptualization of high context culture were used to investigate these phenomena. High context features of the Old Order Amish culture are used to explain how Amish are actively involved in decisions and actions taken to promote health and prevent and treat illness using a broad array of folk, alternative and professional services simultaneously. As nurses learn to involve clients in decisions and actions using the guiding principles of cultural care preservation, accommodation and repatterning they will provide culturally congruent care for Amish and other culture-specific groups.
Kaltoft, Mette Kjer; Dowie, Jack
’Evidence-based Health Care via Multi-Criteria Decision Analytic decision support: a Danish case study......’Evidence-based Health Care via Multi-Criteria Decision Analytic decision support: a Danish case study...
To examine the application of the decision tree approach to collaborative clinical decision-making in mental health care in the United Kingdom (UK). While this approach to decision-making has been examined in the acute care setting, there is little published evidence of its use in clinical decision-making within the mental health setting. The complexities of dual diagnosis (schizophrenia and substance misuse in this case example) and the varied viewpoints of different professionals often hamper the decision-making process. This paper highlights how the approach was used successfully as a multiprofessional collaborative approach to decision-making in the context of British community mental health care. A selective review of the relevant literature and a case study application of the decision tree framework. The process of applying the decision tree framework to clinical decision-making in mental health practice can be time consuming and client inclusion within the process is not always appropriate. The approach offers a method of assigning numerical values to support complex multiprofessional decision-making as well as considering underpinning literature to inform the final decision. Use of the decision tree offers a common framework that can assist professionals to examine the options available to them in depth, while considering the complex variables that influence decision-making in collaborative mental health practice. Use of the decision tree warrants further consideration in mental health care in terms of practice and education.
Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R
Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.
Westermann, G M A; Maurer, J M G
In the communication and interaction between doctor and patient in Western health care there has been a paradigm shift from the paternalistic approach to shared decision-making. To summarise the background situation, recent developments and the current level of shared decision-making in (youth) mental health care. We conducted a critical review of the literature relating to the methodology development, research and the use of counselling and decision-making in mental health care. The majority of patients, professionals and other stakeholders consider shared decision-making to be desirable and important for improving the quality and efficiency of care. Up till recently most research and studies have concentrated on helping patients to develop decision-making skills and on showing patients how and where to access information. At the moment more attention is being given to the development of skills and circumstances that will increase patients' interaction with care professionals and patients' emotional involvement in shared decision-making. In mental health for children and adolescents, more often than in adult mental health care, it has been customary to give more attention to these aspects of shared decision-making, particularly during counselling sessions that mark the transition from diagnosis to treatment. This emphasis has been apparent for a long time in textbooks, daily practice, methodology development and research in youth mental health care. Currently, a number of similar developments are taking place in adult mental health care. Although most health professionals support the policy of shared decision-making, the implementation of the policy in mental health care is still at an early stage. In practice, a number of obstacles still have to be surmounted. However, the experience gained with counselling and decision-making in (youth) mental health care may serve as an example to other sections of mental health care and play an important role in the further
Mehlman, M J; Durchslag, M R; Neuhauser, D
Recent interpretations of laws prohibiting discrimination against persons with disabilities indicate that these laws will play a greater role in health care decision making than previously anticipated. This article employs lessons from other areas of antidiscrimination law to examine these developments and to provide a framework for making health care decisions that are consistent with these new legal interpretations. This article addresses decisions in individual cases, treatment policies adopted by health care providers, and coverage programs of third-party payers, both public and private.
van Baal, Pieter; Morton, Alec; Severens, Johan L
Results of cost effectiveness analyses (CEA) studies are most useful for decision makers if they face only one constraint: the health care budget. However, in practice, decision makers wishing to use the results of CEA studies may face multiple resource constraints relating to, for instance, constraints in health care inputs such as a shortage of skilled labour. The presence of multiple resource constraints influences the decision rules of CEA and limits the usefulness of traditional CEA studies for decision makers. The goal of this paper is to illustrate how results of CEA can be interpreted and used in case a decision maker faces a health care input constraint. We set up a theoretical model describing the optimal allocation of the health care budget in the presence of a health care input constraint. Insights derived from that model were used to analyse a stylized example based on a decision about a surgical robot as well as a published cost effectiveness study on eye care services in Zambia. Our theoretical model shows that applying default decision rules in the presence of a health care input constraint leads to suboptimal decisions but that there are ways of preserving the traditional decision rules of CEA by reweighing different cost categories. The examples illustrate how such adjustments can be made, and makes clear that optimal decisions depend crucially on such adjustments. We conclude that it is possible to use the results of cost effectiveness studies in the presence of health care input constraints if results are properly adjusted. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Garcia, Christopher; Goodrich, Michael
Many regions in America are experiencing downward trends in the number of practicing physicians and the number of available physician hours, resulting in a worrisome decrease in the availability of health care services. Recent changes in American health care legislation may induce a rapid change in the demand for health care services, which in turn will result in a new supply-demand equilibrium . In this paper we develop a system dynamics model linking physician availability to health care demand and profitability. We use this model to explore scenarios based on different initial conditions and describe possible outcomes for a range of different policy decisions.
Empowering Health Care Decision-makers to Achieve Regional Needs for Tobacco Control in Latin America ... This project builds on earlier work on the development and validation of an economic model to estimate the social, economic, and health burden of tobacco, together with the expected impact of tax increases in ...
Mick, S S; Conrad, D A
A scheme to help health care managers make decisions regarding vertical integration (and deintegration) strategies and to alert health care managers to a more analytic view of vertical integration that may help avoid costly mistakes is presented. Central to the decision-making scheme is the comparison between the costs of purchasing goods and services from (and selling them to) other organizations and the costs of acquiring (and supplying) the same goods and services within one's own organization. Whether outside or inside an organizational boundary, these costs (called transaction costs) may be important in determining whether vertical integration is an appropriate organizational strategy (Williamson 1975).
Vahdat, Shaghayegh; Hamzehgardeshi, Leila; Hessam, Somayeh; Hamzehgardeshi, Zeinab
Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions. Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making. To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article. BASED ON THE REVIEW OF ARTICLES AND BOOKS, TOPICS WERE DIVIDED INTO SIX GENERAL CATEGORIES: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making. IN MOST STUDIES, FACTORS INFLUENCING PATIENT PARTICIPATION CONSISTED OF: factors associated with health care professionals such as doctor-patient relationship, recognition of patient's knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services.
Full Text Available Cancer Research UK has developed PROforma, a formal language for modelling clinical processes, along with associated tools for creating decision support, care planning, clinical workflow management and other applications. The PROforma method has been evaluated in a variety of settings: in primary health care (prescribing, referral of suspected cancer patients, genetic risk assessment and in specialist care of patients with breast cancer, leukaemia, HIV infection and other conditions. About nine years of experience have been gained with PROforma technologies. Seven trials of decision support applications have been published or are in preparation. Each of these has shown significant positive effects on a variety of measures of quality and/or outcomes of care. This paper reviews the evidence base for the clinical effectiveness of these PROforma applications, and previews the CREDO project _a multi-centre trial of a complex PROforma application for supporting integrated breast cancer care across primary and secondary care settings.
Walley, Paul; Silvester, Kate; Mountford, Shaun
The paper seeks to investigate decision-making processes within hospital improvement activity, to understand how performance measurement systems influence decisions and potentially lead to unsuccessful or unsustainable process changes. A longitudinal study over a 33-month period investigates key events, decisions and outcomes at one medium-sized hospital in the UK. Process improvement events are monitored using process control methods and by direct observation. The authors took a systems perspective of the health-care processes, ensuring that the impacts of decisions across the health-care supply chain were appropriately interpreted. The research uncovers the ways in which measurement systems disguise failed decisions and encourage managers to take a low-risk approach of "symptomatic relief" when trying to improve performance metrics. This prevents many managers from trying higher risk, sustainable process improvement changes. The behaviour of the health-care system is not understood by many managers and this leads to poor analysis of problem situations. Measurement using time-series methodologies, such as statistical process control are vital for a better understanding of the systems impact of changes. Senior managers must also be aware of the behavioural influence of similar performance measurement systems that discourage sustainable improvement. There is a risk that such experiences will tarnish the reputation of performance management as a discipline. Recommends process control measures as a way of creating an organization memory of how decisions affect performance--something that is currently lacking.
Sun, Xin; Faunce, Thomas
Decision-analytical modelling is widely used in health-care economic evaluations, especially in situations where evaluators lack clinical trial data, and in circumstances where such evaluations factor into reimbursement pricing decisions. This paper aims to improve the understanding and use of modelling techniques in this context, with particular emphasis on Markov modelling. We provide an overview, in this paper, of the principles and methodological details of decision-analytical modelling. We propose a common route for practicing modelling that accommodates any type of decision-analytical modelling techniques. We use the treatment of chronic hepatitis B as an example to indicate the process of development, presentation and analysis of the Markov model, and discuss the strengths, weaknesses and pitfalls of different approaches. Good practice of modelling requires careful planning, conduct and analysis of the model, and needs input from modellers and users.
Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab
A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff.
Dohan, Daniel; Garrett, Sarah B; Rendle, Katharine A; Halley, Meghan; Abramson, Corey
When making health care decisions, patients and consumers use data but also gather stories from family and friends. When advising patients, clinicians consult the medical evidence but also use professional judgment. These stories and judgments, as well as other forms of narrative, shape decision making but remain poorly understood. Furthermore, qualitative research methods to examine narrative are rarely included in health science research. We illustrate how narratives shape decision making and explain why it is difficult but necessary to integrate qualitative research on narrative into the health sciences. We draw on social-scientific insights on rigorous qualitative research and our ongoing studies of decision making by patients with cancer, and we describe new tools and approaches that link qualitative research findings with the predominantly quantitative health science scholarship. Finally, we highlight the benefits of more fully integrating qualitative research and narrative analysis into the medical evidence base and into evidence-based medical practice. Project HOPE—The People-to-People Health Foundation, Inc.
Full Text Available Abstract Background Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. Methods In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. Results The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Conclusions Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions.
Defechereux, Thierry; Paolucci, Francesco; Mirelman, Andrew; Youngkong, Sitaporn; Botten, Grete; Hagen, Terje P; Niessen, Louis W
Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions.
Forsberg, Helena Hvitfeldt; Aronsson, Håkan; Keller, Christina; Lindblad, Staffan
Simulation modeling is a way to test changes in a computerized environment to give ideas for improvements before implementation. This article reviews research literature on simulation modeling as support for health care decision making. The aim is to investigate the experience and potential value of such decision support and quality of articles retrieved. A literature search was conducted, and the selection criteria yielded 59 articles derived from diverse applications and methods. Most met the stated research-quality criteria. This review identified how simulation can facilitate decision making and that it may induce learning. Furthermore, simulation offers immediate feedback about proposed changes, allows analysis of scenarios, and promotes communication on building a shared system view and understanding of how a complex system works. However, only 14 of the 59 articles reported on implementation experiences, including how decision making was supported. On the basis of these articles, we proposed steps essential for the success of simulation projects, not just in the computer, but also in clinical reality. We also presented a novel concept combining simulation modeling with the established plan-do-study-act cycle for improvement. Future scientific inquiries concerning implementation, impact, and the value for health care management are needed to realize the full potential of simulation modeling.
Williams, Val; Boyle, Geraldine; Jepson, Marcus; Swift, Paul; Williamson, Toby; Heslop, Pauline
This paper reports on data collected in 2011 from a national study about the operation of the best interests principle, a key feature of the Mental Capacity Act (MCA) 2005 for England and Wales. The objective was to provide a picture of current professional practices in best interests decision-making. Four contrasting sample sites were selected, in which National Health Service trusts, social care and other organisations were recruited to participate. A multimethod design was followed, including an online survey with 385 participants, followed by qualitative research through a telephone survey of 68 participants, and face-to-face semi-structured interviews following up 25 best interests cases, with different perspectives on the process in 12 of those cases. The current paper reports only on the qualitative findings. The findings indicate that the MCA was successful in providing a structure for these practitioners, and that the five principles of the MCA were in general adhered to. A variety of perceived risks led to best interests processes being undertaken, and a typical scenario was for a period of hospitalisation or ill health to trigger a best interests decision process about a social care and or a life decision. The study supported previous research in finding the notion of capacity the most difficult aspect of the MCA, and it provides evidence of some specific capacity assessment practices, including problematic ones relating to 'insight'. Best interests decisions were often made by consensus, with practitioners taking on different roles within the process. Meetings played a key part, but other ways of involving people lacking capacity and significant others were also important. It was recommended that the issues highlighted in this research could be clarified further in the Code of Practice, or within risk guidance. © 2013 John Wiley & Sons Ltd.
Full Text Available Objective. To examine the opinions of a perinatal health team regarding decisions related to late termination of pregnancy and severely ill newborns. Materials and Methods. An anonymous questionnaire was administered to physicians, social workers, and nurses in perinatal care. Differences were evaluated using the chi square and Student’s t tests. Results. When considering severely ill fetuses and newborns, 82% and 93% of participants, respectively, opted for providing palliative care, whereas 18% considered feticide as an alter- native. Those who opted for palliative care aimed to diminish suffering and those who opted for intensive care intended to protect life or sanctity of life. There was poor knowledge about the laws that regulate these decisions. Conclusions. Although there is no consensus on what decisions should be taken with severely ill fetuses or neonates, most participants considered palliative care as the first option, but feticide or induced neonatal death was not ruled out.
Sabanović, Z; Masic, I
During the last decade the spreadsheets take very important place in many different kind of theoretical and practical applications. In recent years the PC-Windows Operating System allowed us to use and develop many sorts of specialised software packages, as well as expert packages, applicable in medicine. The relationship or communication between man and computer has been improved using new hardware configuration based on fast and intelligent processors, software modification and audio-visual technology. The facts mentioned above have instantly produced circumstances for more powerful spreadsheet software. According to powerful spreadsheet features we can utilise calculation and maximise HIGM requirement for our software configuration. The investigation within large area of Tuzla-Podrinje Kanton shows us that small number of people are using spreadsheet in medical application. Very small percentage of people have limited number of applications on calculation like, subtraction, addition, multiplication, division and percentage. They have often used spreadsheet as an integral part of the following software packages, EXCEL ver. 5.0 and very little Lotus 1-2-3 because Lotus is in these days behind. The aim of this paper is to highlight application of the spreadsheet USING EXCEL software package. Apart from simple calculation and graphic presentation in "DSS-Decision making support system" can be used for model simulation, generator configuration, management monitoring, support and decision making in health care.
Foo, Wei Ting; Zheng, Yiliang; Kwee, Ann K; Yang, Grace M; Krishna, Lalit
To explore the importance of factors influencing the end-of-life care decision making of health care professionals (HCPs) in Singapore. This cross-sectional survey encompassed facets of patient, family, and HCP-related care considerations. In total, 187 questionnaires were distributed to physicians and nurses and had a response rate of 78.6%. The respondents rated patients' wishes (96.6%), their clinical symptoms (93.9%), and patients' beliefs (91.1%) very high. In all, 94.6% of the HCPs would respect a competent patient's wishes over the family's wishes when goals conflict. However, 59.9% of HCPs would abide by the family's wishes when the patient loses capacity even if the patient's previously expressed wishes are known. End-of-life care decision making by HCPs appears largely patient centered, although familial determination still wields significant influence with implications for advance care planning.
Defechereux, T.; Paolucci, F.; Mirelman, A.; Youngkong, S.; Botten, G.; Hagen, T.P.; Niessen, L.W.
BACKGROUND: Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and
Osamor, Pauline; Grady, Christine
Women's decision-making autonomy has been poorly studied in most developing countries. The few existing studies suggest that it is closely linked to women's socio-demographic characteristics and the social settings in which they live. This study examined Nigerian women's perceived decision-making autonomy about their own health care using nationally representative data from the 2013 Nigerian Demographic and Health Survey. The study sample consisted of 27,135 women aged 15-49 years who lived with their husbands/partners. Responses to questions about who usually makes decisions about the respondent's health care were analysed. Factors associated with women's health care decision-making were investigated using logistic regression models. Only 6.2% of the women reported making their own decisions about health care. For most women (61.1%), this decision was made by their husband/partner alone and 32.7% reported joint decision-making with their husband/partner. Factors independently associated with decision-making by the woman included: geographical region, rural/urban residence, age, education, religion, wealth index, occupation, home ownership and husband's occupation. A strong association between women making their own health care decision was seen with region of residence (χ 2=3221.48, pwomen from the South West region were 8.3 times more likely to make their own health care decisions than women from the North West region. Factors that were significantly associated with joint health care decision-making were also significantly associated with decision-making by the woman alone. The study found that individual-level factors were significantly associated with Nigerian women's decision-making autonomy, as well as other factors, in particular geographic region. The findings provide an important perspective on women's health care decision-making autonomy in a developing country.
The population of older adults in the United States is growing in size and diversity, presenting challenges to health care providers and patients in the context of health care decision making (DM), including obtaining informed consent for treatment, advance care planning, and deliberations about end-of-life care options. Although existing…
Demi, A S
Too frequently a relative who is not emotionally close to the patient and who does not know the patient's desires related to health care is authorized to make decisions for the unconscious or incompetent patient, while a non-relative who is intimately involved with the patient and knows the patient's health care desires has no authority to make these decisions. Health care providers must too often stand by helplessly as disinterested or malevolent relatives make these decisions, while caring, competent non-relatives are shut out of the decision-making process. Planning for substitute decision-making can reduce stress and uncertainty for the patient, for the family and for health care providers.
Bartley, Emily J; Boissoneault, Jeff; Vargovich, Alison M; Wandner, Laura D; Hirsh, Adam T; Lok, Benjamin C; Heft, Marc W; Robinson, Michael E
Evidence suggests that patient characteristics such as sex, race, and age influence the pain management decisions of health care providers. Although this signifies that patient demographics may be important determinants of health care decisions, pain-related care also may be impacted by the personal characteristics of the health care practitioner. However, the extent to which health care provider characteristics affect pain management decisions is unclear, underscoring the need for further research in this area. A total of 154 health care providers (77 physicians, 77 dentists) viewed video vignettes of virtual human (VH) patients varying in sex, race, and age. Practitioners provided computerized ratings of VH patients' pain intensity and unpleasantness, and also reported their willingness to prescribe non-opioid and opioid analgesics for each patient. Practitioner sex, race, age, and duration of professional experience were included as predictors to determine their impact on pain management decisions. When assessing and treating pain, practitioner sex, race, age, and duration of experience were all significantly associated with pain management decisions. Further, the role of these characteristics differed across VH patient sex, race, and age. These findings suggest that pain assessment and treatment decisions may be impacted by the health care providers' demographic characteristics, effects which may contribute to pain management disparities. Future research is warranted to determine whether findings replicate in other health care disciplines and medical conditions, and identify other practitioner characteristics (e.g., culture) that may affect pain management decisions. Wiley Periodicals, Inc.
Goss, Claudia; Renzi, Cristina
In recent years there has been a growing recognition in Western healthcare systems of the importance of considering preferences of patients and the public in tailoring health services and treatment plans. The active collaboration between doctor and patient has recently been encouraged through the shared decision-making model. Aim of the present contribution is to describe the current state of patient and public participation in healthcare in Italy. First, we will briefly outline the organization of the Italian National Health Service; second, we will describe the governmental and institutional initiatives regarding participation; third, some examples of associations and initiatives promoting patient participation will be provided; forth, we will report on research projects on patient participation published in peer-reviewed journals; and finally, we will provide some examples on training activities promoting patient participation. The Italian National Health Plan and many regional and local health authorities in Italy explicitly recognize the importance of patient/citizen participation in healthcare decisions at the macro, meso and micro level of decision-making. However, application of a shared model is still at an early stage in Italy. The reported experiences have yielded positive results and have shown that particular attention should be dedicated to more disadvantaged subgroups of the population, involving patient organisations, enhancing patient/citizen knowledge and adopting approaches that take the specific context into account.
Osamor, Pauline E; Grady, Christine
Autonomy is considered essential for decision-making in a range of health care situations, from health care seeking and utilization to choosing among treatment options. Evidence suggests that women in developing or low-income countries often have limited autonomy and control over their health decisions. A review of the published empirical literature to identify definitions and methods used to measure women's autonomy in developing countries describe the relationship between women's autonomy and their health care decision-making, and identify sociodemographic factors that influence women's autonomy and decision-making regarding health care was carried out. An integrated literature review using two databases (PubMed and Scopus) was performed. Inclusion criteria were 1) publication in English; 2) original articles; 3) investigations on women's decision-making autonomy for health and health care utilization; and 4) developing country context. Seventeen articles met inclusion criteria, including eleven from South Asia, five from Africa, and one from Central Asia. Most studies used a definition of autonomy that included independence for women to make their own choices and decisions. Study methods differed in that many used study-specific measures, while others used a set of standardized questions from their countries' national health surveys. Most studies examined women's autonomy in the context of reproductive health, while neglecting other types of health care utilized by women. Several studies found that factors, including age, education, and income, affect women's health care decision-making autonomy. Gaps in existing literature regarding women's autonomy and health care utilization include gaps in the areas of health care that have been measured, the influence of sex roles and social support, and the use of qualitative studies to provide context and nuance.
Walsh, Anne M; Hamilton, Kyra; White, Katherine M; Hyde, Melissa K
The use of the internet to access information is rapidly increasing; however, the quality of health information provided on various online sites is questionable. We aimed to examine the underlying factors that guide parents' decisions to use online information to manage their child's health care, a behaviour which has not yet been explored systematically. Parents (N = 391) completed a questionnaire assessing the standard theory of planned behaviour (TPB) measures of attitude, subjective norm, perceived behavioural control (PBC), and intention as well as the underlying TPB belief-based items (i.e., behavioural, normative, and control beliefs) in addition to a measure of perceived risk and demographic variables. Two months later, consenting parents completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their use of online information to manage their child's health care during the previous 2 months. We found support for the TPB constructs of attitude, subjective norm, and PBC as well as the additional construct of perceived risk in predicting parents' intentions to use online information to manage their child's health care, with further support found for intentions, but not PBC, in predicting parents' behaviour. The results of the TPB belief-based analyses also revealed important information about the critical beliefs that guide parents' decisions to engage in this child health management behaviour. This theory-based investigation to understand parents' motivations and online information-seeking behaviour is key to developing recommendations and policies to guide more appropriate help-seeking actions among parents.
Somek, Mario; Hercigonja-Szekeres, Mira
The amount of stored data in health information systems can reach tera- and petabytes and application of specific algorithms in the field of data mining makes finding useful information suitable for making quality business decisions. A frequently used method for determining the rules of the relationship between attributes is the Association rule by applying Apriori algorithm. Lack of basic Apriori algorithm is derived from the slow work due to multiple scanned data sets. By examining the speed of generating the basic rules in relation to the improved Apriori algorithm by using software RapidMiner confirmed that the time required to generate rules for Improved algorithm is shorter, the rules are quickly generated particularly for large data sets, which is an advantage for making decisions.
Demeter, Sandor J
Health care providers (HCP) and clinical scientists (CS) are generally most comfortable using evidence-based rational decision-making models. They become very frustrated when policymakers make decisions that, on the surface, seem irrational and unreasonable. However, such decisions usually make sense when analysed properly. The goal of this paper to provide a basic theoretical understanding of major policy models, to illustrate which models are most prevalent in publicly funded health care systems, and to propose a policy analysis framework to better understand the elements that drive policy decision-making. The proposed policy framework will also assist HCP and CS achieve greater success with their own proposals.
This viewgraph presentation reviews the development of an Integrated Medical Model (IMM) decision support tool for in-flight crew health care safety. Clinical methods, resources, and case scenarios are also addressed.
Evans, Kevin; Robertson, Suzanne
This study explores a group of elderly women who were searching for physicians that were interested in providing negotiated health care options with particular interest in mutual decision making. The grounded theory approach was used to explore the health care interactions between the physicians and the elderly women (Strauss & Corbin, 1998).…
Woltmann, Emily M; Whitley, Rob
Most theoretical and empirical work regarding decision making in mental health suggests that mental health consumers have better outcomes when their preferences are integrated into quality of life decisions. A wealth of research, however, indicates that providers have difficulty predicting what their clients' priorities are. This study investigates consumer decision-making preferences and understanding of construction of decisions in community mental health. People living with severe mental illness being treated in the public mental health care system (N=16) participated in qualitative interviews regarding case management decision making as a part of a larger study investigating a decision support system to facilitate shared decision making. Interviews were transcribed, coded, and cross-case thematic analyses were conducted. Mental health consumers generally endorse a "shared" style of decision making. When asked what "shared" means, however, consumers describe a two-step process which first prioritizes autonomy, and if that is not possible, defers to case managers' judgment. Consumers also primarily focused on the relationship and affective components of decision making, rather than information-gathering or deliberating on options. Finally, when disagreements arose, consumers primarily indicated they handled them. Mental health consumers may have a different view of decision making than the literature on shared decision making suggests. Mental health consumers may consciously decide to at least verbally defer to their case managers, and remain silent about their preferences or wishes.
Legare, F.; Elwyn, G.; Fishbein, M.; Fremont, P.; Frosch, D.; Gagnon, M.P.; Kenny, D.A.; Labrecque, M.; Stacey, D.; St-Jacques, S.; Weijden, T.T. van der
ABSTRACT: BACKGROUND: There is considerable interest today in shared decision-making (SDM), defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal
Edwards, Ian; Richardson, Barbara
Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners' understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community.
Dowie, Jack; Kaltoft, Mette Kjer; Salkeld, Glenn
OBJECTIVE: To introduce a new online generic decision support system based on multicriteria decision analysis (MCDA), implemented in practical and user-friendly software (Annalisa©). BACKGROUND: All parties in health care lack a simple and generic way to picture and process the decisions to be made...... in pursuit of improved decision making and more informed choice within an overall philosophy of person- and patient-centred care. METHODS: The MCDA-based system generates patient-specific clinical guidance in the form of an opinion as to the merits of the alternative options in a decision, which are all......-off practicality (including resource constraints) with normative rigour and empirical complexity, in both their development and delivery, is emphasized. CONCLUSION: The MCDA-/Annalisa-based decision support system represents a prescriptive addition to the portfolio of decision-aiding tools available online...
Nüssler, Emil Karl; Eskildsen, Jacob Kjær; Håkonsson, Dorthe Døjbak
Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register...... of Gynecological Surgery we examine factors related to decisions to use mesh. Our results indicate that decisions to use mesh are not evidence based, and cannot be explained neither by FDA safety communications, nor by medical conditions usually assumed to predict its usage. Instead, decisions to use mesh...... are highly influenced by the geographical placement of surgeons. Therfore, decisions to use mesh are boundedly rationality, rather than rational....
Zydziūnaite, Vilma; Suominen, Tarja; Astedt-Kurki, Päivi; Lepaite, Daiva
The objective was to describe the research methods and research focuses on ethical dilemmas concerning decision-making within health care leadership. The search was conducted on Medline and PubMed databases (1998-2008). The systematic review included 21 selected articles. The ethical dilemmas concerning decision-making within health care leadership are related to three levels: institutional (particular organization), political and local interface (local governmental structure), and national (professional expertise and system). The terms that are used as adequate to the term of "ethical dilemma" are the following: "continuous balancing," "result of resource allocation," "gap between professional obligations and possibilities," "ethically controversial situation," "concern about interactions," "ethical difficulty," "outcome of medical choices," "concern about society access to health care resources," "ethically difficult/challenging situation," "(the consequence of) ethical concern/ethical issue." In qualitative studies, a semi-structured interview and qualitative content analysis are the most commonly applied methods; in quantitative studies, questionnaire surveys are employed. In the research literature, there is a lack of specification according to professional qualification of health care professionals concerning ethical dilemmas by decision-making within health care management/administration. The research on ethical dilemmas in health care leadership, management, and administration should integrate data about levels at which ethical dilemmas occur and investigate ethical dilemmas as complex phenomena because those are attached to decision-making and specific nuances of health care management/administration. In this article, the presented scientific problem requires extensive scientific discussions and research on ethical dilemmas concerning decision-making within health care leadership at various levels.
Full Text Available Till date, the medical decision-making process in Korea has followed the paternalist model, relying on the instructions of physicians. However, in recent years, shared decision making at the end-of-life between physicians and nurses is now emphasized in Korea. The purpose of this study was conducted to explore how health care professionals’ characteristics, attitude toward dignified dying, and moral sensitivity affect their shared medical decision making. The design was descriptive survey. This study was undertaken in two university hospitals in two metropolitan cities, South Korea. The participants were 344 nurses and 80 physicians who work at university hospitals selected by convenience sampling method. Data were collected from January 10 through March 20, 2014 using the Dignified Dying Scale, Moral Sensitivity Scale, and Shared Medical Decision-Making Scale. Shared medical decision making, attitude toward dignified dying, moral sensitivity, age, and working experience had a significant correlation with each other. The factors affecting shared medical decision making of Korean health care professionals were moral sensitivity and attitude toward dignified dying. These variables explained 22.4% of the shared medical decision making. Moral sensitivity and a positive attitude toward dignified dying should be promoted among health care professionals as a part of an educational program for shared medical decision making.
Bute, Jennifer J.; Petronio, Sandra; Torke, Alexia M.
This study explored the communicative experiences of surrogates who served as decision makers for patients who were unable to convey health information and choices about treatment options. Drawing on assumptions from communication privacy management theory (Petronio, 2002), 35 surrogates were interviewed to explore how they navigated the role of guardian of patients’ private health information while the patient was hospitalized. This research determined that surrogates are not only guardians and thereby co-owners of the patients’ private health information, they actually served in a “proxy ownership” role. Surrogates described obstacles to both obtaining and sharing private health information about the patient, suggesting that their rights as legitimate co-owners of the patients’ information were not fully acknowledged by the medical teams. Surrogates also described challenges in performing the proxy ownership role when they were not fully aware of the patient's wishes. Theoretical and practical implications of these challenges are discussed. PMID:25175060
Campbell-Crofts, Sandra Joan; Roden, Janet
Objectives This qualitative descriptive study explored the primary health care decisions of a group of 12 Australians in Stages 3B to 5 with chronic kidney disease in the preservation of kidney health. Methods Questioning within the qualitative interviews focused on gaining an understanding of the participants' perceptions of their kidney health and the decisions made as a consequence of their interaction within the Australian primary health care system. Results Participants were dependent on their General Practitioner to recognise their symptoms, make the correct diagnosis and authorise the correct referral for specialist nephrology care. Three pathways in this process were identified: 'easy'; 'difficult' and 'protracted'. Clinician failure to correctly attribute symptoms to chronic kidney disease influenced the 'difficult' pathway, while failure to adequately communicate kidney health status influenced the 'protracted' pathway. Use of the language of 'recovery', 'stability' and 'protection' held meaning to the participants in gaining an understanding of their kidney health. Discussion Identifying pathways to diagnosis and referral can raise awareness of the challenges kidney health consumers face in their participation within the primary health care arena. Using consumer meaningful language improves the capacity of these consumers to engage in their own primary health care agenda.
Newhouse, Joseph P; Garber, Alan M; Graham, Robin P; McCoy, Margaret A; Mancher, Michelle; Kibria, Ashna
... 2.7 trillion in 2011, or 17.9 percent of the national gross domestic product. Increasing costs strain budgets at all levels of government and threaten the solvency of Medicare, the nation's largest health insurer...
Stacey, Gemma; Felton, Anne; Morgan, Alastair; Stickley, Theo; Willis, Martin; Diamond, Bob; Houghton, Philip; Johnson, Beverley; Dumenya, John
Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients' care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.
Turner, Simon; Morris, Stephen; Sheringham, Jessica; Hudson, Emma; Fulop, Naomi J
A range of evidence informs healthcare decision-making, from formal research findings to 'soft intelligence' or local data, as well as practical experience or tacit knowledge. However, cultural and organisational factors often prevent the translation of such evidence into practice. Using a multi-level framework, this project will analyse how interactions between the evidence available and processes at the micro (individual/group) and meso (organisational/system) levels influence decisions to introduce or diffuse innovations in acute and primary care within the National Health Service in the UK. This study will use a mixed methods design, combining qualitative and quantitative methods, and involves four interdependent work streams: (1) rapid evidence synthesis of relevant literature with stakeholder feedback; (2) in-depth case studies of 'real-world' decision-making in acute and primary care; (3) a national survey and discrete choice experiment; and (4) development of guidance for decision-makers and evaluators to support the use of evidence in decision-making. This study will enhance the understanding of decision-makers' use of diverse forms of evidence. The findings will provide insights into how and why some evidence does inform decisions to introduce healthcare innovations, and why barriers persist in other cases. It will also quantify decision-makers' preferences, including the 'tipping point' of evidence needed to shift stakeholders' views. Practical guidance will be shared with healthcare decision-makers and evaluators on uses of evidence to enable the introduction and diffusion of innovation.
Enders, Sheila R; Paterniti, Debora A; Meyers, Frederick J
length. Findings were used to develop a handbook to assist low literacy populations in general, and female inmates in particular, to obtain appropriate medical care and treatment and to make advance care decisions regarding the end of life. Those who face chronic, potentially life-limiting illness cannot make meaningful decisions regarding medical care and treatment without having a basic foundation of health information. Acquiring knowledge and improving communication skills reduce stress and vulnerability, assuring individuals of some control over decision making.
Thokala, Praveen; Devlin, Nancy; Marsh, Kevin; Baltussen, Rob; Boysen, Meindert; Kalo, Zoltan; Longrenn, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Ijzerman, Maarten
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting, objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making and a set of techniques, known under the collective heading multiple criteria decision analysis (MCDA), are useful for this purpose. MCDA methods are widely used in other sectors, and recently there has been an increase in health care applications. In 2014, ISPOR established an MCDA Emerging Good Practices Task Force. It was charged with establishing a common definition for MCDA in health care decision making and developing good practice guidelines for conducting MCDA to aid health care decision making. This initial ISPOR MCDA task force report provides an introduction to MCDA - it defines MCDA; provides examples of its use in different kinds of decision making in health care (including benefit risk analysis, health technology assessment, resource allocation, portfolio decision analysis, shared patient clinician decision making and prioritizing patients' access to services); provides an overview of the principal methods of MCDA; and describes the key steps involved. Upon reviewing this report, readers should have a solid overview of MCDA methods and their potential for supporting health care decision making. Copyright © 2016. Published by Elsevier Inc.
Silva Layes, Elizabeth; Morales, Fernando; Leivas, Julio
Proper management of information is not only essential but also critical in any organization's decision making process. Data integration and spacial visualization are the key features of georeferencial systems, which bring support to decision making in epidemiology as well as sanitary planning.This paper shows the development of a georeferential system that interacts with the data provided by the Health Care System.Thereby allowing creation of viable methods which will help to improve patient care, treatments, and interventions through building space-time relationships.
Ksykiewicz-Dorota, Anna; Szczurak, Tamara
Contrary to family nurses, practice nurses employed in outpatient departments did not change their scope of duties very much compared to the period prior to the reform of health care. The study presented the current and expected scope of tasks, with the consideration of the area of independent decision making in ambulatory health care. The dependent variable was the scope of nursing practice, which was analysed by means of the following indicators: the scope of duties realized, scope of independence at work, scope of responsibility, possibilities of occupational development and making decisions concerning the methods of work, the competence to make decisions. The study covered a group of 90 nurses employed in public and non-public health care units in Białystok and its area, and was conducted with the use of a questionnaire form. It was observed that practice nurses expected changes with respect to competence, and consequently increased responsibility and adjustment of tasks according to their qualifications. Nurses from public units had less favourable conditions for widening their decision area. The analysis of the study material showed that the regular scope of duties and responsibility in one third of nurses in both groups did not cover occupational competence. In order to independently plan and make decisions, nurses must be trained and improve their knowledge. In the opinion of 80% of respondents from public units and 60% of those employed in non-public units, nurses do not have sufficient possibilities for post-graduate education according to the needs.
Shayo, Elizabeth H.; Norheim, Ole F.; Mboera, Leonard E. G.
challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. METHODS: The study was carried out in the Mbarali District...... of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. RESULTS......ABSTRACT: BACKGROUND: Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people's needs. In Tanzania, the policy of decentralization and the health sector reform place...
Dowie, Jack; Kaltoft, Mette Kjer; Salkeld, Glenn
OBJECTIVE: To introduce a new online generic decision support system based on multicriteria decision analysis (MCDA), implemented in practical and user-friendly software (Annalisa©). BACKGROUND: All parties in health care lack a simple and generic way to picture and process the decisions to be made...... scored and ranked. The scores for each option combine, in a simple expected value calculation, the best estimates available now for the performance of those options on patient-determined criteria, with the individual patient's preferences, expressed as importance weightings for those criteria. The survey......-off practicality (including resource constraints) with normative rigour and empirical complexity, in both their development and delivery, is emphasized. CONCLUSION: The MCDA-/Annalisa-based decision support system represents a prescriptive addition to the portfolio of decision-aiding tools available online...
Dowie, Jack; Kjer Kaltoft, Mette; Salkeld, Glenn; Cunich, Michelle
To introduce a new online generic decision support system based on multicriteria decision analysis (MCDA), implemented in practical and user-friendly software (Annalisa©). All parties in health care lack a simple and generic way to picture and process the decisions to be made in pursuit of improved decision making and more informed choice within an overall philosophy of person- and patient-centred care. The MCDA-based system generates patient-specific clinical guidance in the form of an opinion as to the merits of the alternative options in a decision, which are all scored and ranked. The scores for each option combine, in a simple expected value calculation, the best estimates available now for the performance of those options on patient-determined criteria, with the individual patient's preferences, expressed as importance weightings for those criteria. The survey software within which the Annalisa file is embedded (Elicia©) customizes and personalizes the presentation and inputs. Principles relevant to the development of such decision-specific MCDA-based aids are noted and comparisons with alternative implementations presented. The necessity to trade-off practicality (including resource constraints) with normative rigour and empirical complexity, in both their development and delivery, is emphasized. The MCDA-/Annalisa-based decision support system represents a prescriptive addition to the portfolio of decision-aiding tools available online to individuals and clinicians interested in pursuing shared decision making and informed choice within a commitment to transparency in relation to both the evidence and preference bases of decisions. Some empirical data establishing its usability are provided. © 2013 The Authors. Health Expectations published by John Wiley & Sons Ltd.
Adunlin, Georges; Diaby, Vakaramoko; Xiao, Hong
The use of Multi-Criteria Decision Analysis (MCDA) in health care has become common. However, the literature lacks systematic review trend analysis on the application of MCDA in health care. To systematically identify applications of MCDA to the areas of health care, and to report on publication trends. English language studies published from January 1, 1980 until October 1, 2013 were included. Electronic databases searches were supplemented by searching conference proceedings and relevant journals. Studies considered for inclusion were those using MCDA techniques within the areas of health care, and involving the participation of decision makers. A bibliometric analysis was undertaken to present the publication trends. A total of 66 citations met the inclusion criteria. An increase in publication trend occurred in the years 1990, 1997, 1999, 2005, 2008, and 2012. For the remaining years, the publication trend was either steady or declining. The trend shows that the number of publications reached its highest peak in 2012 (n = 9). Medical Decision Making was the dominant with the highest number published papers (n = 7). The majority of the studies were conducted in the US (n = 29). Medical Decision Making journal published the highest number of articles (n = 7). Analytic Hierarchy Process (n = 33) was the most used MCDA technique. Cancer was the most researched disease topic (n = 12). The most covered area of application was diagnosis and treatment (n = 26). The review shows that MCDA has been applied to a broad range of areas in the health care, with the use of a variety of methodological approaches. Further research is needed to develop practice guidelines for the appropriate application and reporting of MCDA methods. © 2014 John Wiley & Sons Ltd.
Wu, Wenchen Kenneth; Sause, Robert B; Zacker, Christopher
The extent to which the increased volume of available health-related quality of life (HRQOL) information and heightened education has increased the acceptance and use of HRQOL remains unclear. Likewise, the value of HRQOL information in the formulary decision-making process continues to be undefined. To investigate the perceptions and use of HRQOL by managed care decision-makers in the formulary development process. A mail survey was sent to a nationwide sample of 108 Academy of Managed Care Pharmacy (AMCP) members who were involved in formulary management. Survey candidates were identified according to their job titles listed in the 1999-2000 AMCP membership directory. The survey process began in May 2000 and ended in August 2000. The main outcome measures included (a) managed care formulary decision-makers' assessment of HRQOL as a treatment outcome, (b) the existing role and future use of HRQOL information in formulary decisions, and (c) the level of understanding of HRQOL concepts and the benefits attributable to favorable HRQOL results. A response rate of 51.9% was obtained. Most of the respondents (>70%) believed that patients consider HRQOL as an important treatment outcome. Fewer respondents (43%) felt that payers view HRQOL outcomes as an important quality indicator. Most respondents (95%) considered HRQOL data in making formulary decisions, and many (73%) believe that HRQOL outcomes will play a more important role in future formulary decisions. Respondents indicated a better understanding of disease-specific and generic HRQOL measurements than utility measurement and interpretation of results. A minority of respondents (34%) would be willing to pay a higher price for a product with better HRQOL outcomes. When asked which factors would lead to increased use of HRQOL information, respondents indicated that health care cost savings and increased productivity were considered important (77% and 65%, respectively). A drug product with better HRQOL outcomes
Marsh, Kevin; IJzerman, Maarten Joost; Thokala, Praveen; Baltussen, Rob; Boysen, Meindert; Kalo, Zoltan; Longrenn, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Devlin, Nancy
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making. A set of techniques, known under the collective heading
Thokala, Praveen; Devlin, Nancy; Marsh, Kevin; Baltussen, Rob; Boysen, Meindert; Kalo, Zoltan; Longrenn, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; IJzerman, Maarten Joost
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting, objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making and a set of techniques, known under the collective heading
Kurtzman, Ellen T; Greene, Jessica
This systematic review synthesizes what is known about the effective presentation of health care performance information for consumer decision making. Six databases were searched for articles published in English between September 2003 and April 2014. Experimental studies comparing consumers' responses to performance information when one or more presentation feature was altered were included. A thematic analysis was performed and practical guidelines derived. All 31 articles retained, the majority which tested responses to various presentations of health care cost and/or quality information, found that consumers better understand and make more informed choices when the information display is less complex. Simplification can be achieved by reducing the quantity of choices, displaying results in a positive direction, using non-technical language and evaluative elements, and situating results in common contexts. While findings do not offer a prescriptive design, this synthesis informs approaches to enhancing the presentation of health care performance information and areas that merit additional research. Guidelines derived from these results can be used to enhance health care performance reports for consumer decision making including using recognizable, evaluative graphics and customizable formats, limiting the amount of information presented, and testing presentation formats prior to use. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Eliacin, Johanne; Salyers, Michelle P; Kukla, Marina; Matthias, Marianne S
Although research has suggested that patients desire to participate in shared decision-making, recent studies show that most patients take a passive role in their treatment decisions. The discrepancy between patients' expressed desire and actual behaviors underscores the need to better understand how patients perceive shared decision-making and what factors influence their participation. To investigate patients' preferences and appraisals of their involvement in treatment decisions. Fifty-four qualitative interviews were conducted with veterans receiving outpatient mental health care at a U.S. Veterans Affairs Medical Center. Interviews were analyzed using thematic analysis. Participants outlined several factors that influence their preferences and involvement in treatment decisions. These include the patient-provider relationship, fear of being judged, perceived inadequacy, and a history of substance abuse. Patients' preferences and willingness to engage in shared decision-making fluctuate over time and are context dependent. A better understanding of these factors and a strong patient-provider relationship will facilitate better measurement and implementation of shared decision-making.
Hulshof, P.J.H.; Kortbeek, Nikky; Boucherie, Richardus J.; Hans, Elias W.
We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is
Osamor, Pauline E; Grady, Christine
Autonomy is considered essential for decision-making in a range of health care situations, from health care seeking and utilization to choosing among treatment options. Evidence suggests that women in developing or low-income countries often have limited autonomy and control over their health decisions. A review of the published empirical literature to identify definitions and methods used to measure women’s autonomy in developing countries describe the relationship between women’s autonomy and their health care decision-making, and identify sociodemographic factors that influence women’s autonomy and decision-making regarding health care was carried out. An integrated literature review using two databases (PubMed and Scopus) was performed. Inclusion criteria were 1) publication in English; 2) original articles; 3) investigations on women’s decision-making autonomy for health and health care utilization; and 4) developing country context. Seventeen articles met inclusion criteria, including eleven from South Asia, five from Africa, and one from Central Asia. Most studies used a definition of autonomy that included independence for women to make their own choices and decisions. Study methods differed in that many used study-specific measures, while others used a set of standardized questions from their countries’ national health surveys. Most studies examined women’s autonomy in the context of reproductive health, while neglecting other types of health care utilized by women. Several studies found that factors, including age, education, and income, affect women’s health care decision-making autonomy. Gaps in existing literature regarding women’s autonomy and health care utilization include gaps in the areas of health care that have been measured, the influence of sex roles and social support, and the use of qualitative studies to provide context and nuance. PMID:27354830
Villa, Lorenzo; Warholak, Terri L; Hines, Lisa E; Taylor, Ann M; Brown, Mary; Hurwitz, Jason; Brixner, Diana; Malone, Daniel C
Comparative effectiveness research (CER) is a helpful approach to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision makers about the most effective interventions. To (a) identify the factors necessary to increase the use of the Agency for Healthcare Research and Quality's (AHRQ) CER reviews in hospitals and managed care organizations; (b) assess current awareness and implementation of CER materials in these facilities and organizations; and (c) inform development of content for a workshop on CER. Pharmacy and therapeutics (PT) committee members and supportive personnel were recruited to participate in focus groups conducted at national health professional meetings. Prior to the sessions, each participant completed a prefocus group questionnaire evaluating the organization and process of the respondent's PT committee, as well as the respondent's role in the PT committee and awareness of AHRQ CER reports. Each session consisted of a focused discussion about CER and sources of evidence for PT monographs, and each participant completed a ballot to rank topics of importance for inclusion in a CER workshop for health care professionals involved in the PT process. Overarching themes were later identified using qualitative analysis of the transcripts of the focus group sessions. Thirty-nine (68%) pharmacists and 18 (32%) physicians involved in the PT process participated in 1 of 7 focus groups. Almost half of the participants had 6-15 years experience with the PT process. Participants represented health plans, hospitals, and health care systems. Two-thirds indicated they were aware of AHRQ's Effective Health Care Program's CER reviews, yet only 26% reported using the reviews in their organizations. The overarching themes reflected the need for timely and conclusive CER information; the role of the pharmacist as central to evidence synthesis for the PT process; and the need for educational programs
Zhu, Junhong; Rodgers, Sheila; Melia, Kath M
The aim of the study was to understand why nurses leave nursing practice in China by exploring the process from recruitment to final exit. This report examines the impact of safety and quality of health care on nursing career decision-making from the leavers' perspective. The nursing shortage in China is more serious than in most developed countries, but the loss of nurses through voluntarily leaving nursing practice has not attracted much attention. This qualitative study draws on a grounded theory approach. In-depth interviews with 19 nurses who have left nursing practice and were theoretically sampled from one provincial capital city in Mainland China. 'Loss of confidence in the safety and quality of health care' became one of the main categories from all leavers' accounts of their decision to leave nursing practice. It emerged from three themes 'Perceiving risk in clinical practice', 'Recognising organisational barriers to safety' and 'Failing to meet expectations of patients'. The findings indicate that the essential work value of nursing to the leavers is the safety and quality of care for their patients. When nurses perceived that they could not fulfil this essential work value in their nursing practice, some of them could not accept the compromise to their value of nursing and left voluntarily to get away from the physical and mental stress. However, some nurses had to stay and accept the limitations on the safety and quality of health care. The study suggests that well-qualified nurses voluntarily leaving nursing practice is a danger signal for patients and hospitals, and has caused deterioration in nursing morale for both current and potential nursing workforces. It suggests that safety and quality of health care could be improved when individual nurses are empowered to exercise nursing autonomy with organisational and managerial support. The priority retention strategies need to remove organisational barriers to the safety and quality of health care
Bradley, Eleanor; Green, Debra
A diagnosis of serious mental illness can impact on the whole family. Families informally provide significant amounts of care but are disproportionately at risk of carer burden when compared to those supporting people with other long-term conditions. Shared decision making (SDM) is an ethical model of health communication associated with positive health outcomes; however, there has been little research to evaluate how routinely family is invited to participate in SDM, or what this looks like in practice. This UK study aimed to better understand how the family caregivers of those diagnosed with SMI are currently involved in decision making, particularly decisions about treatment options including prescribed medication. Objectives were to Explore the extent to which family members wish to be involved in decisions about prescribed medication Determine how and when professionals engage family in these decisions Identify barriers and facilitators associated with the engagement of family in decisions about treatment. Open-ended questions were sent to professionals and family members to elicit written responses. Qualitative responses were analysed thematically. Themes included the definition of involvement and "rules of engagement." Staff members are gatekeepers for family involvement, and the process is not democratic. Family and staff ascribe practical, rather than recovery-oriented roles to family, with pre-occupation around notions of adherence. Staff members need support, training and education to apply SDM. Time to exchange information is vital but practically difficult. Negotiated teams, comprising of staff, service users, family, peers as applicable, with ascribed roles and responsibilities could support SDM. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
Full Text Available Abstract Background Patient and public involvement (PPI is framed as positive for individuals, the health system, public health, as well as for communities and society as a whole. We investigated whether preferences for PPI differed between two countries with Beveridge type health systems–Sweden and England. We measured willingness to be involved in individual treatment decisions and in decisions about the organization and provision of local health and social care services. Methods This was a comparative cross-sectional study of the general population’s preferences. Together, the two samples included 3125 respondents; 1625 in England and 1500 in Sweden. Country differences were analysed in a multinomial regression model controlling for gender, age and educational attainment. Results Overall, 68% of respondents wanted a passive patient role and 44% wanted to be involved in local decisions about organization and provision of services. In comparison with in Sweden, they were in England less likely to want a health professional such as a GP or consultant to make decisions about their treatment and also more likely to want to make their own decisions. They were also less likely to want to be involved in local service development decisions. An increased likelihood of wanting to be involved in organizational decision-making was associated with individuals wanting to make their own treatment decisions. Women were less likely to want health professionals to make decisions and more likely to want to be involved in organizational decisions. Conclusions An effective health system that ensures public health must integrate an effective approach to PPI both in individual treatment decisions and shaping local health and social care priorities. To be effective, involvement activities must take in to account the variation in the desire for involvement and the implications that this has for equity. More work is needed to understand the relationship between the
Fredriksson, Mio; Eriksson, Max; Tritter, Jonathan
Patient and public involvement (PPI) is framed as positive for individuals, the health system, public health, as well as for communities and society as a whole. We investigated whether preferences for PPI differed between two countries with Beveridge type health systems-Sweden and England. We measured willingness to be involved in individual treatment decisions and in decisions about the organization and provision of local health and social care services. This was a comparative cross-sectional study of the general population's preferences. Together, the two samples included 3125 respondents; 1625 in England and 1500 in Sweden. Country differences were analysed in a multinomial regression model controlling for gender, age and educational attainment. Overall, 68% of respondents wanted a passive patient role and 44% wanted to be involved in local decisions about organization and provision of services. In comparison with in Sweden, they were in England less likely to want a health professional such as a GP or consultant to make decisions about their treatment and also more likely to want to make their own decisions. They were also less likely to want to be involved in local service development decisions. An increased likelihood of wanting to be involved in organizational decision-making was associated with individuals wanting to make their own treatment decisions. Women were less likely to want health professionals to make decisions and more likely to want to be involved in organizational decisions. An effective health system that ensures public health must integrate an effective approach to PPI both in individual treatment decisions and shaping local health and social care priorities. To be effective, involvement activities must take in to account the variation in the desire for involvement and the implications that this has for equity. More work is needed to understand the relationship between the desire to be involved and actually being involved, but both appear
Slack, Philip; Rose, Anneka
This quality improvement project was inspired as an answer to a problem that many fellow psychiatric trainees had been struggling with while on-call covering the old age mental health hospital which includes a specialist dementia ward. The issue was that decisions around ceilings of care for patients were often not discussed or at least recorded in the electronic notes and as a result when reviewing deteriorating patients out of hours trainees would find themselves without any guidance on the treating medics opinion on what was in the best interests of the patient. This led to situations where unnecessary transfers to the acute hospital would occur overnight which could have been avoided with more consistent planning. Prior to initiating the changes it was recorded that nine out of 47 inpatients had documented decisions on ceiling of care of treatment in the consultant's ward round entries. Next policies from acute hospitals were reviewed, opinions were discussed in departmental meetings, and eventually there was agreed a change in procedure with the consultant on the dementia ward around resuscitation and ceiling of care status and consistent recording of this. Following the intervention there was seen an improvement in the recording of decisions around treatment and transfer of patients on the dementia ward of 80% (4/5) fully compliant with new criteria and then 71% (5/7) in successive cycles. Further communication both with relevant professionals on the old age ward and with the trainees on the on-call rota will be necessary to sustain any change but the centralised recording of resuscitation status and ceiling of care in the ward round entries have provided much more guidance than was previously available. In the future it may be possible to spread this policy throughout the entire old age mental health unit.
Goetghebeur, Mireille M; Wagner, Monika; Khoury, Hanane; Levitt, Randy J; Erickson, Lonny J; Rindress, Donna
Health care decision making is complex and requires efficient and explicit processes to ensure transparency and consistency of factors considered. To pilot an adaptable decision-making framework incorporating multicriteria decision analysis (MCDA) in health technology assessment (HTA) with a pan-Canadian group of policy and clinical decision makers and researchers appraising 10 medicines covering 6 therapeutic areas. An appraisal group was convened and participants were asked to express their individual perspectives, independently of the medicines, by assigning weights to each criterion of the MCDA core model: disease severity, size of population, current practice and unmet needs, intervention outcomes (efficacy, safety, patient reported), type of health benefit, economics, and quality of evidence. Participants then assigned performance scores for each medicine using available evidence synthesized in a "by-criterion" HTA report covering each of the MCDA CORE model criteria. MCDA estimates of perceived value were calculated by combining normalized weights and scores. Feedback on the approach was collected through structured discussion. Relative weights on criteria varied widely, reflecting the diverse perspectives of participants. Scores for each criterion provided a performance measure, highlighting strengths and weaknesses of each medicine. MCDA estimates of perceived value ranged from 0.42 to 0.64 across medicines, providing comprehensive measures incorporating a large spectrum of criteria. Participants reported that the framework provided an efficient approach to systematic consideration in a pragmatic format of the multiple elements guiding decision, including criteria and values (MCDA core model) and evidence (HTA "by-criterion" report). This proof-of-concept study demonstrated the usefulness of incorporating MCDA in HTA to support transparent and systematic appraisal of health care interventions. Further research is needed to advance MCDA-based approaches to
Upshur Ross EG
Full Text Available Abstract Background Concerns regarding the privacy of health information are escalating owing both to the growing use of information technology to store and exchange data and to the increasing demand on the part of patients to control the use of their medical records. The objective of this study was to evaluate the Health Care Information Directive (HCID, a recently-developed patient decision aid that aims to delineate the level of health information an individual is willing to share. Methods We convened a series of four focus group meetings with several communities in a large Canadian city. A total of 28 men and women participated, representing health care consumer advocates, urban professionals, senior citizens, and immigrants who speak English as a second language. Data were analysed using qualitative methods. Results Participants lacked substantial knowledge regarding the fate and uses of personal health information. They expressed mistrust concerning how their information will be used and protected. Several suggestions were made towards customizing the use of data according to specific needs rather than broad and full access to their charts. Furthermore, despite concern regarding the implementation of a tool like the HCID, participants were hopeful that a refined instrument could contribute to the improved regulation of health information. Conclusion This study indicated poor knowledge concerning the uses of personal health information, distrust concerning security provisions, and cautious support for a patient decision aid such as the HCID to improve control over health data.
Full Text Available Mihiretu Alemayehu, Mengistu Meskele School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Introduction: Millions of women have little health care decision making autonomy in many cultures and tribes. African women are often perceived to have little participation in health care decisions. However, little has been investigated to identify factors contributing to decision making autonomy. Hence, it is important to obtain information on the contributing factors of decision making autonomy and disparities across different socio-cultural contexts. Methodology: A cross-sectional study was conducted in Wolaita and Dawro zones, Southern Ethiopia from February to March 2015. A total of 967 women were selected through multi-stage sampling. A survey was administered face-to-face through an interview format. EpiData v22.214.171.124 and SPSS version 20 were used to enter and analyze data, respectively. Proportions and means were used to describe the study population. Variables with P-value <0.2 in bivariate analysis were selected for multivariable regression. Finally, variables with P-value <0.05 in multivariable logistic regressions were identified as independent predictors. Odds ratios along with confidence intervals were used to determine the presence of association. Result: It was determined that 58.4% of women have autonomy, while 40.9% of study participants’ health care decisions were made by their husbands. The husband’s education (adjusted odds ratio [AOR] =1.91 [1.10, 3.32], wealth index (AOR =0.62 [0.42, 0.92], age (AOR =2.42 [1.35, 4.32] and AOR =7 [3.45, 14.22], family size (AOR =0.53 [0.33, 0.85] and AOR =0.42 [0.23, 0.75], and occupation (AOR =1.66 [1.14, 2.41], were predictors of health care decision making autonomy. Conclusion: Even though every woman has the right to participate in her own health care decision making, more than two fifths of them have no role in making health care
Tarantino, M D; Ye, X; Bergstrom, F; Skorija, K; Luo, M P
Little is known about the impact of the recent US economic downturn and health care reform on patient, caregiver and health care provider (HCP) decision-making for haemophilia A. To explore the impact of the recent economic downturn and perceived impact of health care reform on haemophilia A treatment decisions from patient, caregiver and HCP perspectives. Patients/caregivers and HCPs completed a self-administered survey in 2011. Survey participants were asked about demographics, the impact of the recent economic downturn and health care reform provisions on their treatment decisions. Seventy three of the 134 (54%) patients/caregivers and 39 of 48 (81%) HCPs indicated that the economic downturn negatively impacted haemophilia care. Seventy of the 73 negatively impacted patients made financially related treatment modifications, including delaying/cancelling routine health care visit, skipping doses and/or skipping filling prescription. Treatment modifications made by HCPs included delaying elective surgery, switching from higher to lower priced product, switching from recombinant to plasma-derived products and delaying prophylaxis. Health care reform was generally perceived as positive. Due to the elimination of lifetime caps, 30 of 134 patients (22%) and 28 of 48 HCPs (58%) indicated that they will make treatment modifications by initiating prophylaxis or scheduling routine appointment/surgery sooner. Both patients/caregivers and HCPs reported that the economic downturn had a negative impact on haemophilia A treatment. Suboptimal treatment modifications were made due to the economic downturn. Health care reform, especially the elimination of lifetime caps, was perceived as positive for haemophilia A treatment and as a potential avenue for contributing to more optimal treatment behaviours. © 2012 Blackwell Publishing Ltd.
Full Text Available EAG Joosten1,2, GH de Weert3, T Sensky4, CPF van der Staak5, CAJ de Jong1,21Novadic-Kentron, Network for Addiction Treatment Services, Vught, the Netherlands; 2Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA, Nijmegen, the Netherlands; 3Julius Center for Health Sciences and Primary Health Care, UMC Utrecht, Utrecht, the Netherlands; 4Department of Psychological Medicine, Imperial College London, London, United Kingdom; 5Academic Centre for Social Sciences, Radboud University Nijmegen, Nijmegen, the NetherlandsBackground: In recent decades, shared decision-making (SDM models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to examine the effect of a shared decision-making intervention (SDMI for substance-dependent patients on patients’ and clinicians’ perceptions of therapeutic alliance.Methods: Clinicians were randomly assigned to SDMI or usual procedures to reach a treatment agreement. SDMI is a structured, manualized, 5-session procedure to facilitate treatment agreement and consists of five standardized sessions.Results: Patients’ perceptions of the therapeutic alliance were very favorable at start of treatment, and no differences were found between intervention groups. Clinicians’ scores on perceived helpfulness and on the overall therapeutic alliance were higher in the SDMI group than in the controls, after 8 weeks of treatment and at the end of treatment.Conclusion: The present study has shown that a specific intervention to enhance shared decision-making results in favorable changes in clinicians’ perceptions of the therapeutic alliance.Keywords: therapeutic alliance, helping alliance, shared decision-making, addiction, substance-dependence
Peterson, K Jean
Shared decision making (SDM) is a process integral to social work practice, one where the provider/professional and the consumer/patient discuss treatment alternatives based on patient values and life circumstances and make a shared decision about whether and how to proceed with treatment. Evidence-based medicine suggests that for many health conditions, having the choice of several effective treatment options is not uncommon. In these cases treatment should be based on what is best for the individual, since many factors influence an individual's treatment preference, including the psychological, social, cultural, and spiritual history she/he brings to the medical encounter; a history that has long been ignored in somatic health care. This article develops the argument that medical social workers possess the professional knowledge and skill base to provide decisional coaching, and implementing SDM in primary care settings. Of particular importance are the values that guide professional social work practice, including client self-determination, which is the basis of SDM, and the ability to maintain neutrality.
Ruohonen, Toni; Ennejmy, Mohammed
Making reliable and justified operational and strategic decisions is a really challenging task in the health care domain. So far, the decisions have been made based on the experience of managers and staff, or they are evaluated with traditional methods, using inadequate data. As a result of this kind of decision-making process, attempts to improve operations usually have failed or led to only local improvements. Health care organizations have a lot of operational data, in addition to clinical data, which is the key element for making reliable and justified decisions. However, it is progressively problematic to access it and make usage of it. In this paper we discuss about the possibilities how to exploit operational data in the most efficient way in the decision-making process. We'll share our future visions and propose a conceptual framework for automating the decision-making process.
Lobach, David; Sanders, Gillian D; Bright, Tiffani J; Wong, Anthony; Dhurjati, Ravi; Bristow, Erin; Bastian, Lori; Coeytaux, Remy; Samsa, Gregory; Hasselblad, Vic; Williams, John W; Wing, Liz; Musty, Michael; Kendrick, Amy S
To catalogue study designs used to assess the clinical effectiveness of CDSSs and KMSs, to identify features that impact the success of CDSSs/KMSs, to document the impact of CDSSs/KMSs on outcomes, and to identify knowledge types that can be integrated into CDSSs/KMSs. MEDLINE(®), CINAHL(®), PsycINFO(®), and Web of Science(®). We included studies published in English from January 1976 through December 2010. After screening titles and abstracts, full-text versions of articles were reviewed by two independent reviewers. Included articles were abstracted to evidence tables by two reviewers. Meta-analyses were performed for seven domains in which sufficient studies with common outcomes were included. We identified 15,176 articles, from which 323 articles describing 311 unique studies including 160 reports on 148 randomized control trials (RCTs) were selected for inclusion. RCTs comprised 47.5 percent of the comparative studies on CDSSs/KMSs. Both commercially and locally developed CDSSs effectively improved health care process measures related to performing preventive services (n = 25; OR 1.42, 95% confidence interval [CI] 1.27 to 1.58), ordering clinical studies (n = 20; OR 1.72, 95% CI 1.47 to 2.00), and prescribing therapies (n = 46; OR 1.57, 95% CI 1.35 to 1.82). Fourteen CDSS/KMS features were assessed for correlation with success of CDSSs/KMSs across all endpoints. Meta-analyses identified six new success features: Integration with charting or order entry system. Promotion of action rather than inaction. No need for additional clinician data entry. Justification of decision support via research evidence. Local user involvement. Provision of decision support results to patients as well as providers. Three previously identified success features were confirmed: Automatic provision of decision support as part of clinician workflow. Provision of decision support at time and location of decisionmaking. Provision of a recommendation, not just an assessment. Only 29
Haverkate, I; van der Wal, G
To describe the prevalence and some features of policies on medical decisions concerning the end of life (MDELs) in Dutch hospitals, nursing homes, and institutions for the mentally disabled. A cross-sectional descriptive postal survey of 558 Dutch health care institutions. All Dutch hospitals, nursing homes, and general institutions for the mentally disabled. Directors of patients care of the institutions. Respondents' reports on the existence of policies and guidelines on the following MDELs: euthanasia/assisted suicide (EAS), life-terminating acts without explicit request of the patient, refusal of treatment by patient, withholding or withdrawing treatment, symptom and pain control, and do-not-resuscitate (DNR) decisions. Of 558 health care institution managers, 86% responded. Most of the hospitals (69.2%) and nursing homes (73.9%) but only 16.3% of the institutions for the disabled had a written EAS policy. Nursing homes with a ban on EAS often had religious affiliations. In 37% of nursing homes, 15% of hospitals, and 15% of institutions for the disabled, the management had written policies on terminating life without request. Sixty percent of the hospitals, 35% of the nursing homes, and 17% of the institutions for the disabled had guidelines for one or more of four other distinct MDELs. Forty-five percent, 20%, and 8% of hospitals, nursing homes, and institutions of mentally disabled, respectively, had guidelines on DNR decisions. The management of 89% of the hospitals and 94% of the nursing homes communicated their policies on EAS to physicians and nurses in their institutions without being asked. Far fewer of these hospitals (3.9%) and nursing homes (30.5%) made their policies on EAS known to patients without being asked. This study indicates that an important step toward policy development on EAS has been made by Dutch hospitals and nursing homes. Particularly with respect to policies on such decisions as withholding or withdrawing treatment, symptom and
Nobre, F F; Trotta, L T; Gomes, L F
The objective of this paper is to present a multi-criteria decision making (MCDM) approach to support public health decision making that takes into consideration the fuzziness of the decision goals and the behavioural aspect of the decision maker. The approach is used to analyse the process of health technology procurement in a University Hospital in Rio de Janeiro, Brazil. The method, known as TODIM, relies on evaluating alternatives with a set of decision criteria assessed using an ordinal scale. Fuzziness in generating criteria scores and weights or conflicts caused by dealing with different viewpoints of a group of decision makers (DMs) are solved using fuzzy set aggregation rules. The results suggested that MCDM models, incorporating fuzzy set approaches, should form a set of tools for public health decision making analysis, particularly when there are polarized opinions and conflicting objectives from the DM group. Copyright 1999 John Wiley & Sons, Ltd.
Brogan, Andrew P; DeMuro, Carla; Barrett, Amy M; D'Alessio, Denise; Bal, Vasudha; Hogue, Susan L
Health authorities and payers increasingly recognize the importance of patient perspectives and patient-reported outcomes (PROs) in health care decision making. However, given the broad variety of PRO endpoints included in clinical programs and variations in the timing of PRO data collection and country-specific needs, the role of PRO data in reimbursement decisions requires characterization. To (a) determine the effect of PRO data on market access and reimbursement decisions for oncology products in multiple markets and (b) assess the effect of PRO data collected after clinical progression on payer decision making. A 3-part assessment (targeted literature review, qualitative one-on-one interviews, and online survey) was undertaken. Published literature was identified through searches in PubMed/MEDLINE and Embase. In addition, a targeted search was conducted of health technology assessment (HTA) agency websites in the United States, the United Kingdom, France, and Germany. Qualitative one-on-one interviews were conducted with 16 payers from the RTI Health Solutions global advisory panel in 14 markets (Australia, Brazil, France, Germany, Italy, South Korea, Netherlands, Poland, Spain, Sweden, Taiwan, Turkey, the United Kingdom, and the United States [n = 3]). Of the 200 payers and payer advisors from the global advisory panel invited to participate in the online survey, 20 respondents (China, France, Germany, Spain [n = 2], Taiwan, the United Kingdom, and the United States [n = 13]) completed the survey, and 6 respondents (Australia, South Korea, and the United States [n = 4]) partially completed the survey. Reviews of the literature and publicly available HTAs and reimbursement decisions suggested that HTA bodies and payers have varying experience with and confidence in PRO data. Payers participating in the survey indicated that PRO data may be especially influential in oncology compared with other therapeutic areas. Payers surveyed offered little differentiation
McKinlay, John; Piccolo, Rebecca; Marceau, Lisa
Decades of work on health disparities have culminated in identification of three contributors to variability in diagnosis and management of disease: (i) patient attributes; (ii) doctor's characteristics; and (iii) organizational factors. Understanding the relative influence of different contributors to variability in diagnosis and management of diabetes is important to improving quality and reducing disparities. This study was designed to examine the influence of patient, provider and organizational factors on the diagnosis and management of a major chronic disease - diabetes. A factorial experiment using video vignettes was conducted among n = 192 primary care doctors. Doctors were interviewed after viewing vignettes of (1) a 'patient' with symptoms strongly suggestive of diabetes and (2) an already diagnosed diabetes 'patient' with emerging peripheral neuropathy. A total of 60.9% of doctors identified diabetes as the correct diagnosis, with significant variations depending on the patients' race/ethnicity. Many doctors offered competing diagnoses with high levels of certainty. For the 'patient' with emerging peripheral neuropathy, 42.2% of doctors would do all essential components of a foot examination, while 21.9% would do none. That half of all diabetes in the United States remains undiagnosed is unsurprising given only 60.9% of doctors would diagnose it when the condition is strongly suggested, and nearly one-quarter suspecting diabetes would not order tests necessary to confirm it. The diagnosis of diabetes is significantly influenced by a patient's race/ethnicity, and clinical management (specifically for foot neuropathy) is influenced by patient socio-economic status (SES), doctor's gender and access to clinical guidelines. © 2012 John Wiley & Sons Ltd.
McKinlay, John; Piccolo, Rebecca; Marceau, Lisa
Rationale, Aims and Objectives Decades of work on health disparities have culminated in identification of three contributors to variability in diagnosis and management of disease: 1) patient attributes, 2) physician characteristics, and 3) organizational. Understanding the relative influence of different contributors to variability in diagnosis and management of diabetes is important to improving quality and reducing disparities. This study was designed to examine the influence of patient, provider, and organizational factors on the diagnosis and management of a major chronic disease: diabetes. Method A factorial experiment using video vignettes was conducted among n=192 primary care physicians. Physicians were interviewed after viewing vignettes of (1) a “patient” with symptoms strongly suggestive of diabetes and (2) an already diagnosed diabetes “patient” with emerging peripheral neuropathy. Results 60.9 percent of physicians identified diabetes as the correct diagnosis, with significant variations depending on the patients’ race/ethnicity. Many physicians offered competing diagnoses with high levels of certainty. For the “patient” with emerging peripheral neuropathy, 42.2 percent of physicians would do all essential components of a foot examination, while 21.9 percent would do none. Conclusions That half of all diabetes in the US remains undiagnosed is unsurprising given only 60.9 percent of physicians would diagnose it when the condition is strongly suggested, and nearly one quarter suspecting diabetes would not order tests necessary to confirm it. The diagnosis of diabetes is significantly influenced by a patient’s race/ethnicity and clinical management (specifically for foot neuropathy), is influenced by patient SES, physician gender, and access to clinical guidelines. PMID:23216876
Zizzo, Natalie; Bell, Emily; Lafontaine, Anne-Louise; Racine, Eric
Patient-centred care is a recommended model of care for Parkinson's disease (PD). It aims to provide care that is respectful and responsive to patient preferences, values and perspectives. Provision of patient-centred care should entail considering how patients want to be involved in their care. To understand the participation preferences of patients with PD from a patient-centred care clinic in health-care decision-making processes. Mixed-methods study with early-stage Parkinson's disease patients from a patient-centred care clinic. Study involved a modified Autonomy Preference Index survey (N=65) and qualitative, semi-structured in-depth interviews, analysed using thematic qualitative content analysis (N=20, purposefully selected from survey participants). Interviews examined (i) the patient preferences for involvement in health-care decision making; (ii) patient perspectives on the patient-physician relationship; and (iii) patient preferences for communication of information relevant to decision making. Preferences for participation in decision making varied between individuals and also within individuals depending on decision type, relational and contextual factors. Patients had high preferences for communication of information, but with acknowledged limits. The importance of communication in the patient-physician relationship was emphasized. Patient preferences for involvement in decision making are dynamic and support shared decision making. Relational autonomy corresponds to how patients envision their participation in decision making. Clinicians may need to assess patient preferences on an on-going basis. Our results highlight the complexities of decision-making processes. Improved understanding of individual preferences could enhance respect for persons and make for patient-centred care that is truly respectful of individual patients' wants, needs and values. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.
Iglesias, Cynthia P; Drummond, Michael F; Rovira, Joan
The use of economic evaluation studies (EE) in the decision-making process within the health-care system of nine Latin American (LA) and three European countries was investigated. The aim was to identify the opportunities, obstacles, and changes needed to facilitate the introduction of EE as a formal tool in health-care decision-making processes in LA. A comparative study was conducted based on existing literature and information provided through a questionnaire applied to decision makers in Argentina, Brazil, Colombia, Cuba, Mexico, Nicaragua, Peru, Portugal Spain, United Kingdom, Uruguay, and Venezuela. Systematic electronic searches of HEED, NHS EED, and LILACS were conducted to identify published economic evaluation studies in LA from 1982 onward. There is relatively little evidence of the conduct and use of EE within the health care systems in LA. Electronic searches retrieved 554 records; however, only 93 were EE. In the nine LA participating countries, broad allocation of health-care resources is primarily based on political criteria, historical records, geographical areas, and specific groups of patients and diseases. Public-health provision and inclusion of services in health-insurance package are responsibilities of the Ministry of Health. Decisions regarding the purchase of medicines are primarily made through public tenders, and mainly based on differences in clinical efficacy and the price of health technologies of interest. To expedite the process of incorporating EE as a formal tool to inform decision-making processes within the health-care systems in LA countries, two main conditions need to be fulfilled. First, adequate resources and skills need to be available to conduct EE of good quality. Second, decision-making procedures need to be modified to accommodate "evidence-based" approaches such as EE.
Air, Mary E; Grierson, Matthew J; Davenport, Kathleen L; Krabak, Brian J
To examine perceptual influences on dancers' health care-seeking decisions and whether dancers' beliefs correlate with actual use of provider services when they are injured. Secondary aims were to understand how dancers may select physicians and what they consider to be the most important features of the medical consultation. Prospective cohort study. University and conservatory dance departments. Forty American collegiate dancers. Before the start of the dance semester, all participants completed a retrospective survey that included baseline demographic data, dance experience, a dance-related injury (DRI) inventory, previous health care exposures, and perceptions regarding health care treatment providers. Data regarding new DRIs and health care exposures were then prospectively collected every 2 weeks for 6 months. A DRI was defined as any neuromusculoskeletal condition sustained as the result of dancing activity that caused a dancer to stop or modify his or her dancing for more than 3 consecutive days. Dancers perceived dance teachers to be first-line treatment providers (47.5%), followed by physical therapists (PTs; 30%). Physicians were ranked third (12.5%) and only marginally higher than a dance colleague (10%). The dancers expressed a strong preference for nonsurgical rather than surgical physicians (87.5% versus 5.0%), and among physicians, the majority of dancers preferred subspecialists (60%), namely nonsurgical sports medicine doctors and physiatrists. During the 6-month prospective data-collection period, 25 dancers (69.4%) sustained 55 unique injuries, with 22 dancers (88%) and 34 injuries (61.8%) undergoing evaluation. Only 17.7% of injuries were evaluated by a physician. Dancers showed greater incongruity between their preinjury perceptions and postinjury use of physicians than they did with PTs (P = .0002). Although dancers did not perceive physicians to be first-line treatment providers for DRIs, these perceptions about physicians were poorly
Full Text Available Abstract Background There is considerable interest today in shared decision-making (SDM, defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal is to bring together the resources and the expertise needed to develop an interdisciplinary and international research team on the implementation of SDM in clinical practice using a theory-based dyadic perspective. Methods Participants include researchers from Canada, US, UK, and Netherlands, representing medicine, nursing, psychology, community health and epidemiology. In order to develop a collaborative research network that takes advantage of the expertise of the team members, the following research activities are planned: 1 establish networking and on-going communication through internet-based forum, conference calls, and a bi-weekly e-bulletin; 2 hold a two-day workshop with two key experts (one in theoretical underpinnings of behavioral change, and a second in dyadic data analysis, and invite all investigators to present their views on the challenges related to the implementation of SDM in clinical practices; 3 conduct a secondary analyses of existing dyadic datasets to ensure that discussion among team members is grounded in empirical data; 4 build capacity with involvement of graduate students in the workshop and online forum; and 5 elaborate a position paper and an international multi-site study protocol. Discussion This study protocol aims to inform researchers, educators, and clinicians interested in improving their understanding of effective strategies to implement shared decision-making in clinical practice using a theory-based dyadic perspective.
Sadigh, Gelareh; Carlos, Ruth C; Krupinski, Elizabeth A; Meltzer, Carolyn C; Duszak, Richard
The purpose of this article is to review the literature on communicating transparency in health care pricing, both overall and specifically for medical imaging. Focus is also placed on the imperatives and initiatives that will increasingly impact radiologists and their patients. Most Americans seek transparency in health care pricing, yet such discussions occur in fewer than half of patient encounters. Although price transparency tools can help decrease health care spending, most are used infrequently and most lack information about quality. Given the high costs associated with many imaging services, radiologists should be aware of such initiatives to optimize patient engagement and informed shared decision making.
Lambin, Philippe; Roelofs, Erik; Reymen, Bart; Velazquez, Emmanuel Rios; Buijsen, Jeroen; Zegers, Catharina M L; Carvalho, Sara; Leijenaar, Ralph T H; Nalbantov, Georgi; Oberije, Cary; Scott Marshall, M; Hoebers, Frank; Troost, Esther G C; van Stiphout, Ruud G P M; van Elmpt, Wouter; van der Weijden, Trudy; Boersma, Liesbeth; Valentini, Vincenzo; Dekker, Andre
An overview of the Rapid Learning methodology, its results, and the potential impact on radiotherapy. Rapid Learning methodology is divided into four phases. In the data phase, diverse data are collected about past patients, treatments used, and outcomes. Innovative information technologies that support semantic interoperability enable distributed learning and data sharing without additional burden on health care professionals and without the need for data to leave the hospital. In the knowledge phase, prediction models are developed for new data and treatment outcomes by applying machine learning methods to data. In the application phase, this knowledge is applied in clinical practice via novel decision support systems or via extensions of existing models such as Tumour Control Probability models. In the evaluation phase, the predictability of treatment outcomes allows the new knowledge to be evaluated by comparing predicted and actual outcomes. Personalised or tailored cancer therapy ensures not only that patients receive an optimal treatment, but also that the right resources are being used for the right patients. Rapid Learning approaches combined with evidence based medicine are expected to improve the predictability of outcome and radiotherapy is the ideal field to study the value of Rapid Learning. The next step will be to include patient preferences in the decision making. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Riaño, David; Real, Francis; López-Vallverdú, Joan Albert; Campana, Fabio; Ercolani, Sara; Mecocci, Patrizia; Annicchiarico, Roberta; Caltagirone, Carlo
Chronically ill patients are complex health care cases that require the coordinated interaction of multiple professionals. A correct intervention of these sort of patients entails the accurate analysis of the conditions of each concrete patient and the adaptation of evidence-based standard intervention plans to these conditions. There are some other clinical circumstances such as wrong diagnoses, unobserved comorbidities, missing information, unobserved related diseases or prevention, whose detection depends on the capacities of deduction of the professionals involved. In this paper, we introduce an ontology for the care of chronically ill patients and implement two personalization processes and a decision support tool. The first personalization process adapts the contents of the ontology to the particularities observed in the health-care record of a given concrete patient, automatically providing a personalized ontology containing only the clinical information that is relevant for health-care professionals to manage that patient. The second personalization process uses the personalized ontology of a patient to automatically transform intervention plans describing health-care general treatments into individual intervention plans. For comorbid patients, this process concludes with the semi-automatic integration of several individual plans into a single personalized plan. Finally, the ontology is also used as the knowledge base of a decision support tool that helps health-care professionals to detect anomalous circumstances such as wrong diagnoses, unobserved comorbidities, missing information, unobserved related diseases, or preventive actions. Seven health-care centers participating in the K4CARE project, together with the group SAGESA and the Local Health System in the town of Pollenza have served as the validation platform for these two processes and tool. Health-care professionals participating in the evaluation agree about the average quality 84% (5.9/7.0) and
Full Text Available Anne Hogden,1 David Greenfield,1 Peter Nugus,1 Matthew C Kiernan21Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, 2Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia, Sydney, New South Wales, AustraliaBackground: The aim of this study was to explore clinician perspectives on patient decision-making in multidisciplinary care for amyotrophic lateral sclerosis (ALS, in an attempt to identify factors influencing decision-making.Methods: Thirty-two health professionals from two specialized multidisciplinary ALS clinics participated in individual and group interviews. Participants came from allied health, medical, and nursing backgrounds. Interviews were audio recorded, and the transcripts were analyzed thematically.Results: Respondents identified barriers and facilitators to optimal timing and quality of decision-making. Barriers related to the patient and the health system. Patient barriers included difficulties accepting the diagnosis, information sources, and the patient-carer relationship. System barriers were timing of diagnosis and symptom management services, access to ALS-specific resources, and interprofessional communication. Facilitators were teamwork approaches, supported by effective communication and evidence-based information.Conclusion: Patient-centered and collaborative decision-making is influenced by a range of factors that inhibit the delivery of optimal care. Decision-making relies on a fine balance between timing of information and service provision, and the readiness of patients to receive them. Health system restrictions impacted on optimal timing, and patients coming to terms with their condition. Clinicians valued proactive decision-making to prepare patients and families for inevitable change. The findings indicate disparity between patient choices and clinician perceptions of evidence, knowledge, and
Wahlert, Lance; Fiester, Autumn
This article addresses the timely and ethically problematic issue of surrogate decision-making rights for lesbian, gay, bisexual, and transgender (LGBT) patients and their families in the American health care system. Despite multiple pro-LGBT recommendations that have been released in recent years by the Obama administration, the Institute of Medicine, and the US Department of Health and Human Services, such initiatives, while laudable, also have unfortunately occasioned a "false sense of security" for many LGBT patients, their families, and their caregivers. In particular, new regulations on surrogate decision making merely invoke a sense of universal patient rights rather than actually generating them. Therefore, it is imperative that primary care physicians urge all LGBT patients to take proactive steps to protect themselves and their loved ones by naming proxy decision makers well before the crises that would necessitate such decisions.
This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting. Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives. This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives. This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.
Khan, Muhammad Waqas; Muehlschlegel, Susanne
Shared decision making is a collaborative decision-making process between health care providers and patients or their surrogates, taking into account the best scientific evidence available while considering the patient's values, goals, and preferences. Decision aids are tools enabling SDM. This article discusses shared decision making in general and in the intensive care unit in particular and facilitators and barriers for the creation and implementation of International Patient Decision Aids Standards Collaboration-compliant decision aids for the intensive care unit and neuro-intensive care unit. Copyright © 2017 Elsevier Inc. All rights reserved.
Marsh, Kevin; IJzerman, Maarten; Thokala, Praveen; Baltussen, Rob; Boysen, Meindert; Kaló, Zoltán; Lönngren, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Devlin, Nancy
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making. A set of techniques, known under the collective heading, multiple criteria decision analysis (MCDA), are useful for this purpose. In 2014, ISPOR established an Emerging Good Practices Task Force. The task force's first report defined MCDA, provided examples of its use in health care, described the key steps, and provided an overview of the principal methods of MCDA. This second task force report provides emerging good-practice guidance on the implementation of MCDA to support health care decisions. The report includes: a checklist to support the design, implementation and review of an MCDA; guidance to support the implementation of the checklist; the order in which the steps should be implemented; illustrates how to incorporate budget constraints into an MCDA; provides an overview of the skills and resources, including available software, required to implement MCDA; and future research directions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Elwyn, G.; Dehlendorf, C.; Epstein, R.M.; Marrin, K.; White, J.; Frosch, D.L.
Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific
Joynt, Gavin M; Lipman, Jeffrey; Hartog, Christiane; Guidet, Bertrand; Paruk, Fathima; Feldman, Charles; Kissoon, Niranjan; Sprung, Charles L
When terminal illness exists, it is common clinical practice worldwide to withhold (WH) or withdraw (WD) life-sustaining treatments. Systematic documentation of professional opinion and perceived practice similarities and differences may allow recommendations to be developed. Speakers from invited faculty of the World Federation of Societies of Intensive and Critical Care Medicine Congress that took place in Durban (2013), with an interest in ethics, were approached to participate in an ethics round table. Key domains of health care professional end-of-life decision making were defined, explored by discussion, and then questions related to current practice and opinion developed and subsequently answered by round-table participants to establish the presence or absence of agreement. Agreement was established for the desirability for early goal-of-care discussions and discussions between health care professionals to establish health care provider consensus and confirmation of the grounds for WH/WD, before holding formal WH/WD discussions with patients/surrogates. Nurse and other health care professional involvement were common in most but not all countries/regions. Principles and practical triggers for initiating discussions on WH/WD, such as multiorgan failure, predicted short-term survival, and predicted poor neurologic outcome, were identified. There was majority agreement for many but not all statements describing health care professional end-of-life decision making. Copyright © 2014 Elsevier Inc. All rights reserved.
Horner, V; Rautenbach, P; Mbananga, N; Mashamba, T; Kwinda, H
There are problems of quality in maternity services at primary health care level in South Africa. Many of these problems can be traced to non-adherence to the maternity care guidelines and lack of tools to support clinic staff and managers in their roles. The aim of this research was to investigate the utility of e-health (computerized) decision support systems at addressing the problem of compliance of health workers to the maternity care guidelines at primary health care in South Africa. At present there are no documented studies on e-health clinical decision support systems for primary health care in South Africa, though clinical decision support systems for primary health care are listed as part of the e-health strategy of the National Department of Health. An e-health decision support system named the Bacis (Basic Antenatal Care Information System) Program was developed, then implemented and evaluated at a primary health care clinic. The duration of the study was two years: this includes development, implementation and evaluation. There was an overall improvement in compliance from 85.1 % to 89.3%. This result was not statistically significant. However when results were stratified into specific categories, the Bacis Program showed statistically significant improvement in compliance over the checklist system in three out of nine important categories. These are compliance at booking, patients younger than 18 years and patients booking after week 20. Further, insights and experience were also gained on development and implementation of clinical information systems at resource strained environments such as primary health care in South Africa. These results, insights and experience are invaluable for the implementation of the proposed e-health strategy in South Africa.
Lee, Nam-Ju; Starren, Justin; Bakken, Suzanne
This paper explores user interface issues in the design and implementation of a personal digital assistant-based decision support system (PDA-DSS) in health care. An automated literature search found 15 studies addressing the main PDA user interface issues, which can be categorized as display, security, memory, Web browser, and communication.
Kim, Kyounghae; Heinze, Katherine; Xu, Jiayun; Kurtz, Melissa; Park, Hyunjeong; Foradori, Megan; Nolan, Marie T
The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.
Full Text Available OBJECTIVES: To explore the "how" and "why" of care decision making by frontline providers of maternal and newborn services in the Greater Accra region of Ghana and determine appropriate interventions needed to support its quality and related maternal and neonatal outcomes. METHODS: A cross sectional and descriptive mixed method study involving a desk review of maternal and newborn care protocols and guidelines availability, focus group discussions and administration of a structured questionnaire and observational checklist to frontline providers of maternal and newborn care. RESULTS: Tacit knowledge or 'mind lines' was an important primary approach to care decision making. When available, protocols and guidelines were used as decision making aids, especially when they were simple handy tools and in situations where providers were not sure what their next step in management had to be. Expert opinion and peer consultation were also used through face to face discussions, phone calls, text messages, and occasional emails depending on the urgency and communication medium access. Health system constraints such as availability of staff, essential medicines, supplies and equipment; management issues (including leadership and interpersonal relations among staff, and barriers to referral were important influences in decision making. Frontline health providers welcomed the idea of interventions to support clinical decision making and made several proposals towards the development of such an intervention. They felt such an intervention ought to be multi-faceted to impact the multiple influences simultaneously. Effective interventions would also need to address immediate challenges as well as more long-term challenges influencing decision-making. CONCLUSION: Supporting frontline worker clinical decision making for maternal and newborn services is an important but neglected aspect of improved quality of care towards attainment of MDG 4 & 5. A multi
Truglio-Londrigan, Marie; Slyer, Jason T; Singleton, Joanne K; Worral, Priscilla
The objective of this review is to identify and synthesize the best available evidence related to the meaningfulness of internal and external influences on shared-decision making for adult patients and health care providers in all health care settings.The specific questions to be answered are: BACKGROUND: Patient-centered care is emphasized in today's healthcare arena. This emphasis is seen in the works of the International Alliance of Patients' Organizations (IAOP) who describe patient-centered healthcare as care that is aimed at addressing the needs and preferences of patients. The IAOP presents five principles which are foundational to the achievement of patient-centered healthcare: respect, choice, policy, access and support, as well as information. These five principles are further described as:Within the description of these five principles the idea of shared decision-making is clearly evident.The concept of shared decision-making began to appear in the literature in the 1990s. It is defined as a "process jointly shared by patients and their health care provider. It aims at helping patients play an active role in decisions concerning their health, which is the ultimate goal of patient-centered care." The details of the shared decision-making process are complex and consist of a series of steps including:Three overall representative decision-making models are noted in contemporary literature. These three models include: paternalistic, informed decision-making, and shared decision-making. The paternalistic model is an autocratic style of decision-making where the healthcare provider carries out the care from the perspective of knowing what is best for the patient and therefore makes all decisions. The informed decision-making model takes place as the information needed to make decisions is conveyed to the patient and the patient makes the decisions without the healthcare provider involvement. Finally, the shared decision-making model is representative of a
Trosman, Julia R; Weldon, Christine B; Douglas, Michael P; Deverka, Patricia A; Watkins, John B; Phillips, Kathryn A
New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations. We interviewed representatives from 10 private payers and 6 provider institutions involved in implementing the ACO model (i.e., ACOs) to understand changes, challenges, and facilitators of decision making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs' decision making in terms of achieving a balance between the components of the Triple Aim-improving care experience, improving population health, and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs' decisions and ACOs' insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients' interest in personalized medicine. As new payment models evolve, payers, ACOs, and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous, and transparent approaches to decision making on medical innovations. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Shayo Elizabeth H
Full Text Available Abstract Background Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people’s needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual’s opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. Methods The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. Results The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Conclusions Existing challenges related to individuals’ influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all
Background Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people’s needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual’s opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. Methods The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. Results The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Conclusions Existing challenges related to individuals’ influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in
Jolles, M P; Wells, R
Many children in contact with child welfare agencies do not receive needed health services. These agencies have used participatory decision making (PDM) practices as a way to increase families' use of recommended services. However, we lack evidence of whether caregiver participation in PDM increases children's use of health services. This study uses a national sample of children involved with child welfare to compare their health service use between those children serve through a PDM practice and those who did not experience it. Cross-sectional analyses using the 2009-2010 National Survey of Child and Adolescent Well-Being. Propensity score analysis accounted for observed selection bias. PDM practice was measured as whether the caregiver was included in decision-making during service planning meetings. Health service use was measured as child's receipt of any primary or mental health care services in the past year. Primary health care need was measured using standardized measures and caseworker report. The sample was comprised of children ages 2-17 with primary or mental health needs in contact with a child welfare agency. In the unmatched sample of 1,358 children, 14% were served through a PDM service practice, and 12% had a primary health care and 37% a mental health need. Families served through PDM were also reported by caseworkers as more cooperative during the child welfare investigation, and with fewer reports of domestic violence and agency re-referrals (P child use of primary health services. Inclusion of caregivers in decision making may not be sufficient to overcome barriers to children's mental health service use. © 2016 John Wiley & Sons Ltd.
Al-Shorbaji, Najeeb; Borycki, Elizabeth M; Kimura, Michio; Lehmann, Christoph U; Lorenzi, Nancy M; Moura, Lincoln A; Winter, Alfred
This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Representation of People's Decisions in Health Information Systems: A Complementary Approach for Understanding Health Care Systems and Population Health" written by Fernan Gonzalez Bernaldo de Quiros, Adriana Ruth Dawidowski, and Silvana Figar. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the paper of de Quiros, Dawidowski, and Figar. In subsequent issues the discussion can continue through letters to the editor.
DeSalvo, Robert J.; And Others
An elective case study course involving graduate students from various health profession disciplines from two universities was developed to provide a forum for health care teams to discuss the philosophical and functional impact of situations and their alternative solutions. The nonclinical, administratively-oriented problem situations stressed…
Moving toward holistic wellness, empowerment and self-determination for Indigenous peoples in Canada: Can traditional Indigenous health care practices increase ownership over health and health care decisions?
Auger, Monique; Howell, Teresa; Gomes, Tonya
This study aimed to understand the role that traditional Indigenous health care practices can play in increasing individual-level self-determination over health care and improving health outcomes for urban Indigenous peoples in Canada. This project took place in Vancouver, British Columbia and included the creation and delivery of holistic workshops to engage community members (n = 35) in learning about aspects of traditional health care practices. Short-term and intermediate outcomes were discussed through two gatherings involving focus groups and surveys. Data were transcribed, reviewed, thematically analyzed, and presented to the working group for validation. When participants compared their experiences with traditional health care to western health care, they described barriers to care that they had experienced in accessing medical doctors (e.g., racism, mistrust), as well as the benefits of traditional healing (e.g., based on relationships, holistic approach). All participants also noted that they had increased ownership over their choices around, and access to, health care, inclusive of both western and traditional options. They stressed that increased access to traditional health care is crucial within urban settings. Self-determination within Indigenous urban communities, and on a smaller scale, ownership for individuals, is a key determinant of health for Indigenous individuals and communities; this was made clear through the analysis of the research findings and is also supported within the literature. This research also demonstrates that access to traditional healing can enhance ownership for community members. These findings emphasize that there is a continued and growing need for support to aid urban Indigenous peoples in accessing traditional health care supports.
Canally, Culum; Doherty, Sean; Doran, Diane M; Goubran, Rafik A
The growing need to gain efficiencies within a home care setting has prompted home care practitioners to focus on health informatics to address the needs of an aging clientele. The remote and heterogeneous nature of the home care environment necessitates the use of non-intrusive client monitoring and a portable, point-of-care graphical user interface. Using a grounded theory approach, this article examines the simulated use of a graphical user interface by practitioners in a home care setting to explore the salient features of monitoring the activity of home care clients. The results demonstrate the need for simple, interactive displays that can provide large amounts of geographical and temporal data relating to patient activity. Additional emerging themes from interviews indicate that home care professionals would use a graphical user interface of this type for patient education and goal setting as well as to assist in the decision-making process of home care practitioners. © The Author(s) 2014.
Lee, Chang Won; Kwak, N K
This paper deals with strategic enterprise resource planning (ERP) in a health-care system using a multicriteria decision-making (MCDM) model. The model is developed and analyzed on the basis of the data obtained from a leading patient-oriented provider of health-care services in Korea. Goal criteria and priorities are identified and established via the analytic hierarchy process (AHP). Goal programming (GP) is utilized to derive satisfying solutions for designing, evaluating, and implementing an ERP. The model results are evaluated and sensitivity analyses are conducted in an effort to enhance the model applicability. The case study provides management with valuable insights for planning and controlling health-care activities and services.
Hogden A; Greenfield D; Nugus P; Kiernan MC
Anne Hogden,1 David Greenfield,1 Peter Nugus,1 Matthew C Kiernan21Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, 2Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia, Sydney, New South Wales, AustraliaBackground: The aim of this study was to explore clinician perspectives on patient decision-making in multidisciplinary care for amyotrophic lateral sclerosis (ALS), in an attempt ...
Butler, Ashley M
There is growing emphasis on shared decision making (SDM) to promote family participation in care and improve the quality of child mental health care. Yet, little is known about the relationship of SDM with parental perceptions of child mental health treatment or child mental health functioning. The objectives of this preliminary study were to examine (a) the frequency of perceived SDM with providers among minority parents of children referred to colocated mental health care in a primary care clinic, (b) associations between parent-reported SDM and mental health treatment stigma and child mental health impairment, and (c) differences in SDM among parents of children with various levels of mental health problem severity. Participants were 36 Latino and African American parents of children (ages 2-7 years) who were referred to colocated mental health care for externalizing mental health problems (disruptive, hyperactive, and aggressive behaviors). Parents completed questions assessing their perceptions of SDM with providers, child mental health treatment stigma, child mental health severity, and level of child mental health impairment. Descriptive statistics demonstrated the majority of the sample reported frequent SDM with providers. Correlation coefficients indicated higher SDM was associated with lower stigma regarding mental health treatment and lower parent-perceived child mental health impairment. Analysis of variance showed no significant difference in SDM among parents of children with different parent-reported levels of child mental health severity. Future research should examine the potential of SDM for addressing child mental health treatment stigma and impairment among minority families.
Grim, Katarina; Rosenberg, David; Svedberg, Petra; Schön, Ulla-Karin
Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.
Full Text Available The objective of this Health Technology Assessment (HTA methods report was to examine and to assess decision analysis (DA as a method to transfer and adapt international scientific evidence in HTA to the German health care context. Furthermore, we sought to develop a systematic framework to facilitate the selection, transfer, adaptation, and synthesis of these data in German HTA projects. In this report, we review and summarise the concepts and methods of DA; present potential areas of applications, and provide a basis for the critical assessment of decision-analytic studies. The two main methods of DA, decision trees and Markov models, as well as various approaches to sensitivity analyses are described. Examples of typical situations for the use of DA in scientific evidence transfer are described, and a list of main health care domains and parameters in evidence transfer is presented. Finally, we developed a framework to transfer and apply international evidence to the national health care context. The strengths and limitations of the decision-analytic approach are critically examined. In summary, this HTA report describes different situations, in which decision-analytic models can be useful, and demonstrates the utility of DA in transferring and applying international evidence to the national health care context. We developed a systematic instrument to transfer international evidence to the context of other countries and successfully applied this instrument in two German HTA projects. The use of this instrument is recommended in further HTA projects dealing with the application of international evidence to the German health care context. The use of decision-analytic models to transfer international evidence is endorsed. However, the limitations of DA should be clearly stated discussed transparently in all HTA reports.
Gallegos, Tom; Mrgudic, Kate
Sees health care decision making posing variety of complex issues for individuals, families, and providers. Describes Health Decisions Community Council (HDCC), community-based bioethics committee established to offer noninstitutional forum for discussion of health care dilemmas. Notes that social work skills and values for autonomy and…
Catibusić, Sulejman; Hadzagić-Catibusić, Feriha; Zubcević, Smail
Growth in role of data warehousing as strategic information for decision makers is significant. Many health institutions have data warehouse implementations in process of development or even in production. This article was made with intention to improve general understanding of data warehousing requirements form the point of view of end-users, and information system as well. For that reason, in this document advantages and arguments for implementation, techniques and methods of data warehousing, data warehouse foundation and exploration of information as final product of data warehousing process have been described.
Padgett, Kath; Rhodes, Christine; Lumb, Maureen; Morris, Penny; Sherwin, Sue; Symons, Jools; Tate, Joannie; Townend, Ken
Involving service users and carers in decisions about their health care is a key feature of health-care practice. Professional health and social care students need to develop skills and attributes to best enable this to happen. The aims were to explore service user and carer perceptions of behaviours, attributes and context required to enable shared decision making; to compare these perceptions to those of students and academic staff with a view to utilizing the findings to inform the development of student assessment tools. A mixed methods approach was used including action learning groups (ALG) and an iterative process alongside a modified Delphi survey. The ALGs were from an existing service user and carer network. The survey was sent to sixty students, sixty academics and 30 service users from 16 different professional disciplines, spanning four Universities in England. The collaborative enquiry process and survey identified general agreement that being open and honest, listening, showing respect, giving time and being up to date were important. The qualitative findings identified that individual interpretation was a key factor. An unexpected result was an insight into possible insecurities of students. The findings indicate that distilling rich qualitative information into a format for student assessment tools could be problematic as the individual context could be lost, it is therefore proposed that the information could be better used as a learning rather than assessment tool. Several of those involved identified how they valued the process and found it beneficial. © 2012 John Wiley & Sons Ltd.
Alie, R E
In this second lesson of a five-part WMU/AHRA magazine course on ethics, Dr. Alie tackles an interesting concept--group-think. According to the author, this tendency occurs when cohesive groups lose their ability to critically evaluate alternatives in problem solving. Since groups such as committees or task forces frequently resolve issues and make policy in health care organizations, warning signs of this phenomenon are detailed as well as suggestions to help avoid the problem.
Pieter Van Herck
Full Text Available CONTEXT: Health care technological evolution through new drugs, implants and other interventions is a key driver of healthcare spending. Policy makers are currently challenged to strengthen the evidence for and cost-effectiveness of reimbursement decisions, while not reducing the capacity for real innovations. This article examines six cases of reimbursement decision making at the national health insurance authority in Belgium, with outcomes that were contested from an evidence-based perspective in scientific or public media. METHODS: In depth interviews with key stakeholders based on the adapted framework of Davies allowed us to identify the relative impact of clinical and health economic evidence; experience, expertise & judgment; financial impact & resources; values, ideology & political beliefs; habit & tradition; lobbyists & pressure groups; pragmatics & contingencies; media attention; and adoption from other payers & countries. FINDINGS: Evidence was not the sole criterion on which reimbursement decisions were based. Across six equivocal cases numerous other criteria were perceived to influence reimbursement policy. These included other considerations that stakeholders deemed crucial in this area, such as taking into account the cost to the patient, and managing crisis scenarios. However, negative impacts were also reported, in the form of bypassing regular procedures unnecessarily, dominance of an opinion leader, using information selectively, and influential conflicts of interest. CONCLUSIONS: 'Evidence' and 'negotiation' are both essential inputs of reimbursement policy. Yet, purposely selected equivocal cases in Belgium provide a rich source to learn from and to improve the interaction between both. We formulated policy recommendations to reconcile the impact of all factors identified. A more systematic approach to reimburse new care may be one of many instruments to resolve the budgetary crisis in health care in other countries as
Van Herck, Pieter; Annemans, Lieven; Sermeus, Walter; Ramaekers, Dirk
Context Health care technological evolution through new drugs, implants and other interventions is a key driver of healthcare spending. Policy makers are currently challenged to strengthen the evidence for and cost-effectiveness of reimbursement decisions, while not reducing the capacity for real innovations. This article examines six cases of reimbursement decision making at the national health insurance authority in Belgium, with outcomes that were contested from an evidence-based perspective in scientific or public media. Methods In depth interviews with key stakeholders based on the adapted framework of Davies allowed us to identify the relative impact of clinical and health economic evidence; experience, expertise & judgment; financial impact & resources; values, ideology & political beliefs; habit & tradition; lobbyists & pressure groups; pragmatics & contingencies; media attention; and adoption from other payers & countries. Findings Evidence was not the sole criterion on which reimbursement decisions were based. Across six equivocal cases numerous other criteria were perceived to influence reimbursement policy. These included other considerations that stakeholders deemed crucial in this area, such as taking into account the cost to the patient, and managing crisis scenarios. However, negative impacts were also reported, in the form of bypassing regular procedures unnecessarily, dominance of an opinion leader, using information selectively, and influential conflicts of interest. Conclusions ‘Evidence’ and ‘negotiation’ are both essential inputs of reimbursement policy. Yet, purposely selected equivocal cases in Belgium provide a rich source to learn from and to improve the interaction between both. We formulated policy recommendations to reconcile the impact of all factors identified. A more systematic approach to reimburse new care may be one of many instruments to resolve the budgetary crisis in health care in other countries as well, by separating
What Influences Patients' Decisions When Choosing a Health Care Provider? : Measuring Preferences of Patients with Knee Arthrosis, Chronic Depression, or Alzheimer's Disease, Using Discrete Choice Experiments
A.S. Groenewoud (Stef); N.J.A. van Exel (Job); A. Bobinac (Ana); M. Berg (Marc); R. Huijsman (Robbert); E.A. Stolk (Elly)
textabstractObjective: To investigate what influences patients' health care decisions and what the implications are for the provision of information on the quality of health care providers to patients. Data Sources/Study Setting: Dutch patient samples between November 2006 and February 2007. Study
Ubachs-Moust, Josy; Houtepen, Rob; Van der Weijden, Trudy; ter Meulen, Ruud; Vos, Rein
This article deals with the issue of public trust in decisions made by individual physicians, concerning older people, as perceived by various key professionals. While trust is a basic element in our health care service, it is at the same time a difficult phenomenon to conceptualize. This article tries to contribute to a better understanding of what trust in medical practice entails and what are the necessary conditions for a society to put trust in the medical profession. The focus is on care for older people under the condition of scarcity in health care resources. Our study has a qualitative design consisting of semi-structured in-depth interviews with 24 key professionals focusing on decision-makers and those in line of professionally organizing or influencing the decision-making process. We found roughly three categories of trust: distrust; trust; and qualified trust. In each category we found different reasons to give or withhold trust and different views on how far the discretionary power of doctors should go. We recommend promoting trust by addressing the criteria or limits brought forward in the qualified trust category. The preconditions as identified in the qualified trust section provide the boundaries and marking points between which physicians have to move regarding the care for older people. The qualifications provide us insight in where and how to invest in trust under these and under different circumstances. An important conclusion is that trust is never finished: trust needs to be gained and negotiated in a continuous process of action and interaction.
Chen, Chia-Ching; Yamada, Tetsuji; Nakashima, Taeko; Chiu, I-Ming
The purposes of this study are: (1) to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC) service use; (2) to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3) to investigate health outcome disparity based on substitutability. The methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR), which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly. There exists a complement relationship between the informal home care (IHC) and community-based FHC services, and the elasticity's ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH) services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services. Policy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.
Full Text Available ObjectivesThe purposes of this study are: (1 to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC service use; (2 to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3 to investigate health outcome disparity based on substitutability.Methodology and dataThe methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR, which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly.ResultsThere exists a complement relationship between the informal home care (IHC and community-based FHC services, and the elasticity’s ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services.ConclusionPolicy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.
Liu, Hu-Chen [School of Management, Hefei University of Technology, Hefei 230009 (China); Department of Industrial Engineering and Management, Tokyo Institute of Technology, Tokyo 152-8552 (Japan); Wu, Jing [Department of Public Management, Tongji University, Shanghai 200092 (China); Li, Ping, E-mail: email@example.com [Shanghai Pudong New Area Zhoupu Hospital, No. 135 Guanyue Road, Shanghai 201318 (China); East Hospital Affiliated to Tongji University, No. 150 Jimo Road, Shanghai 200120 (China)
Highlights: • Propose a VIKOR-based fuzzy MCDM technique for evaluating HCW disposal methods. • Linguistic variables are used to assess the ratings and weights for the criteria. • The OWA operator is utilized to aggregate individual opinions of decision makers. • A case study is given to illustrate the procedure of the proposed framework. - Abstract: Nowadays selection of the appropriate treatment method in health-care waste (HCW) management has become a challenge task for the municipal authorities especially in developing countries. Assessment of HCW disposal alternatives can be regarded as a complicated multi-criteria decision making (MCDM) problem which requires consideration of multiple alternative solutions and conflicting tangible and intangible criteria. The objective of this paper is to present a new MCDM technique based on fuzzy set theory and VIKOR method for evaluating HCW disposal methods. Linguistic variables are used by decision makers to assess the ratings and weights for the established criteria. The ordered weighted averaging (OWA) operator is utilized to aggregate individual opinions of decision makers into a group assessment. The computational procedure of the proposed framework is illustrated through a case study in Shanghai, one of the largest cities of China. The HCW treatment alternatives considered in this study include “incineration”, “steam sterilization”, “microwave” and “landfill”. The results obtained using the proposed approach are analyzed in a comparative way.
Couet, N.; Desroches, S.; Robitaille, H.; Vaillancourt, H.; Leblanc, A.; Turcotte, S.; Elwyn, G.; Legare, F.
BACKGROUND: We have no clear overview of the extent to which health-care providers involve patients in the decision-making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this. OBJECTIVE: To systematically review studies
Hulshof, P.J.H.; Kortbeek, Nikky; Boucherie, Richardus J.; Hans, Elias W.; Bakker, P.J.M
We provide a comprehensive overview of the typical decisions to be made in resource capacity planning and control in health care, and a structured review of relevant articles from the field of Operations Research and Management Sciences (OR/MS) for each planning decision. The contribution of this
Farrelly, Simone; Lester, Helen; Rose, Diana; Birchwood, Max; Marshall, Max; Waheed, Waquas; Henderson, R Claire; Szmukler, George; Thornicroft, Graham
Despite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear. Sharing decisions in mental health care may be especially complex. Fluctuations in service user capacity and significant power differences are particular barriers. We trialled a form of facilitated SDM that aimed to generate patients' treatment preferences in advance of a possible relapse. The 'Joint Crisis Plan' (JCP) intervention was trialled in four mental health trusts in England between 2008 and 2011. This qualitative study used grounded theory methods to analyse focus group and interview data to understand how stakeholders perceived the intervention and the barriers to SDM in the form of a JCP. Fifty service users with psychotic disorders and 45 clinicians participated in focus groups or interviews between February 2010 and November 2011. Results suggested four barriers to clinician engagement in the JCP: (i) ambivalence about care planning; (ii) perceptions that they were 'already doing SDM'; (iii) concerns regarding the clinical 'appropriateness of service users' choices'; and (iv) limited 'availability of service users' choices'. Service users reported barriers to SDM in routine practice, most of which were addressed by the JCP process. Barriers identified by clinicians led to their lack of constructive engagement in the process, undermining the service users' experience. Future work requires interventions targeted at the engagement of clinicians addressing their concerns about SDM. Particular strategies include organizational investment in implementation of service users' choices and directly training clinicians in SDM communication processes. © 2015 John Wiley & Sons Ltd.
Laamanen, Ritva; Simonsen-Rehn, Nina; Suominen, Sakari; Øvretveit, John; Brommels, Mats
To explore outsourcing of primary health care (PHC) services in four municipalities in Finland with varying amounts and types of outsourcing: a Southern municipality (SM) which contracted all PHC services to a not-for-profit voluntary organization, and Eastern (EM), South-Western (SWM) and Western (WM) municipalities which had contracted out only a few services to profit or public organizations. A mail survey to all municipality politicians (response rate 52%, N=101) in 2004. Data were analyzed using cross-tabulations, Spearman correlation and linear regression analyses. Politicians were willing to outsource PHC services only partially, and many problems relating to outsourcing were reported. Politicians in all municipalities were least likely to outsource preventive services. A multiple linear regression model showed that reported preference to outsource in EM and in SWM was lower than in SM, and also lower among politicians from "leftist" political parties than "rightist" political parties. Perceived difficulties in local health policy issues were related to reduced preference to outsource. The model explained 27% of the variance of the inclination to outsource PHC services. The findings highlight how important it is to take into account local health policy issues when assessing service-provision models.
Andersen, Rikke Sand; Vedsted, Peter; Olesen, Frede; Bro, Flemming; Søndergaard, Jens
The absence of a more significant improvement in cancer survival in countries such as the UK and Denmark may be partly rooted in delayed care-seeking among cancer patients. Past research on patient delay has mainly focused on patient characteristics (e.g. sociodemographic and psychological factors and symptom recognition) as causes of delayed care-seeking, while few studies have examined how the organizational structure of health care systems may influence patients' reflections on seeking care. The aim of this study was to explore this relationship. The analysis presented is based on semi-structured interviews with 30 cancer patients and their families. The article raises two hypotheses on the relationship between structural elements of a health care system and people's reflections on seeking health care: (1) Gatekeeping introduces an asymmetrical relationship between the patient and the GP which potentially results in self-restricting care-seeking, (2) Continuity in the doctor-patient relationship may negatively influence patient reflections on access to health care, as the focus shifts from the medical issues of the consultation to reflections on how to properly interact with the GP and the system in which she/he is situated. It is concluded that these hypotheses form a sound basis for further primary care research on how the organizational structure of health care systems influences patient reflections on access to medical care.
Bülbül, S; Sürücü, M; Karavaizoğlu, C; Eke, M
In the terminal stages of neuro-metabolic diseases, parents can begin to experience a sense of loss even before the child dies, and might accept death prematurely. A 2.5-year-old female patient with Sandoff Disease (diagnosed at 9 months of age), and a 17-month-old male Krabbe patient (diagnosed at 5 months of age) were admitted to the hospital with hypernatraemic dehydration and bronchopneumonia, respectively, within 10 days of each other. Both patients developed respiratory arrest short after admission and were supported with mechanical ventilation. Both families gave written consent to end life support, but their wishes could not be accepted according to Turkish law. Specialists are expected to communicate well with families and give continuous care while respecting the opinions of patients' families on the timing of the withdrawal of life support. However, ethical and legal regulations on the conduct of health care professionals in these circumstances are unclear in Turkey and should be developed rapidly. © 2014 John Wiley & Sons Ltd.
Liu, Hu-Chen; Wu, Jing; Li, Ping
Nowadays selection of the appropriate treatment method in health-care waste (HCW) management has become a challenge task for the municipal authorities especially in developing countries. Assessment of HCW disposal alternatives can be regarded as a complicated multi-criteria decision making (MCDM) problem which requires consideration of multiple alternative solutions and conflicting tangible and intangible criteria. The objective of this paper is to present a new MCDM technique based on fuzzy set theory and VIKOR method for evaluating HCW disposal methods. Linguistic variables are used by decision makers to assess the ratings and weights for the established criteria. The ordered weighted averaging (OWA) operator is utilized to aggregate individual opinions of decision makers into a group assessment. The computational procedure of the proposed framework is illustrated through a case study in Shanghai, one of the largest cities of China. The HCW treatment alternatives considered in this study include "incineration", "steam sterilization", "microwave" and "landfill". The results obtained using the proposed approach are analyzed in a comparative way. Copyright © 2013. Published by Elsevier Ltd.
Full Text Available Abstract Background The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability. Methods Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Örebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed. Results Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases. Conclusion The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.
Ksykiewicz-Dorota, Anna; Kamińska, Beata
Until recently, corrective medicine and narrowly-understood prophylaxis have remained the focus of attention of health care staff. Various factors influenced the modification of current health activities. Providers of medical services, especially those engaged in PHC should react to the change in the concept of health care by expanding the present services offered. According to the WHO concept, dealing with healthy people is not a waste of time. Therefore, an attempt was undertaken to discover whether in the practice of environmental/family nurses, tasks were proposed to patients in the area of health promotion and prophylaxis. The studies covered 110 environmental/family nurses from the Bialystok Region. The material obtained in two groups of health care units--public and non-public--was then compared. Significant statistical differences with respect to 'very frequent' realization of health promotion programmes were observed between nurses employed in public health care units and those from non-public units. These programmes most often concerned breast feeding, and care of mother and child. In the area of prophylaxis, however, both groups undertook a 'very small' scope of actions on behalf of environment protection and prevention of three of the health problems recognized: prevention of faulty posture, dental caries and counteracting accidents, injuries and poisonings. Prophylactic tasks concerning cardiovascular system diseases, cancer, addictions and contagious diseases were more often realized.
Health Literacy and Health-Care Engagement as Predictors of Shared Decision-Making Among Adult Information Seekers in the USA: a Secondary Data Analysis of the Health Information National Trends Survey.
Wigfall, Lisa T; Tanner, Andrea H
The objective of this study is to examine the relationship between health literacy, health-care engagement, and shared decision-making (SDM). We analyzed Health Information National Trends Survey 4 (cycle 3) data for 1604 information seekers who had one or more non-emergency room health-care visits in the previous year. SDM was more than two times higher among adults who "always" versus "usually/sometimes/never" take health information to doctor visits (OR = 2.54; 95 % CI 1.19-5.43). There was a twofold increase in SDM among adults who were "completely/very confident" versus "somewhat/a little/not confident" about finding health information (OR = 2.03; 95 % CI 1.37-3.02). Differences in SDM between adults who understood health information and those who had difficulty understanding health information were not statistically significant (OR = 1.39; 95 % CI 0.93-2.07). A Healthy People 2020 goal is to increase SDM. Previous research has suggested that SDM may improve health outcomes across the continuum of care. Only about half of adults report always being involved in health-care decisions. Even more alarming is the fact that SDM has not increased from 2003 to 2013. Our findings suggest that increasing health literacy has the potential to increase health-care engagement and subsequently increase SDM. Effective intervention strategies are needed to improve health literacy and promote health-care engagement.
Hussain, Jamilla A; Flemming, Kate; Murtagh, Fliss E M; Johnson, Miriam J
To ensure that decisions to start and stop dialysis in ESRD are shared, the factors that affect patients and health care professionals in making such decisions must be understood. This systematic review sought to explore how and why different factors mediate the choices about dialysis treatment. MEDLINE, Embase, CINAHL, and PsychINFO were searched for qualitative studies of factors that affect patients' or health care professionals' decisions to commence or withdraw from dialysis. A thematic synthesis was conducted. Of 494 articles screened, 12 studies (conducted from 1985 to 2014) were included. These involved 206 patients (most receiving hemodialysis) and 64 health care professionals (age ranges: patients, 26-93 years; professionals, 26-61 years). For commencing dialysis, patients based their choice on "gut instinct," as well as deliberating over the effect of treatment on quality of life and survival. How individuals coped with decision-making was influential: Some tried to take control of the problem of progressive renal failure, whereas others focused on controlling their emotions. Health care professionals weighed biomedical factors and were led by an instinct to prolong life. Both patients and health care professionals described feeling powerless. With regard to dialysis withdrawal, only after prolonged periods on dialysis were the realities of life on dialysis fully appreciated and past choices questioned. By this stage, however, patients were physically dependent on treatment. As was seen with commencing dialysis, individuals coped with treatment withdrawal in a problem- or emotion-controlling way. Families struggled to differentiate between choosing versus allowing death. Health care teams avoided and queried discussions regarding dialysis withdrawal. Patients, however, missed the dialogue they experienced during predialysis education. Decision-making in ESRD is complex and dynamic and evolves over time and toward death. The factors at work are
Orlando, Lori A; Hauser, Elizabeth R; Christianson, Carol; Powell, Karen P; Buchanan, Adam H; Chesnut, Blair; Agbaje, Astrid B; Henrich, Vincent C; Ginsburg, Geoffrey
The CDC's Family History Public Health Initiative encourages adoption and increase awareness of family health history. To meet these goals and develop a personalized medicine implementation science research agenda, the Genomedical Connection is using an implementation research (T3 research) framework to develop and integrate a self-administered computerized family history system with built-in decision support into 2 primary care clinics in North Carolina. The family health history system collects a three generation family history on 48 conditions and provides decision support (pedigree and tabular family history, provider recommendation report and patient summary report) for 4 pilot conditions: breast cancer, ovarian cancer, colon cancer, and thrombosis. All adult English-speaking, non-adopted, patients scheduled for well-visits are invited to complete the family health system prior to their appointment. Decision support documents are entered into the medical record and available to provider's prior to the appointment. In order to optimize integration, components were piloted by stakeholders prior to and during implementation. Primary outcomes are change in appropriate testing for hereditary thrombophilia and screening for breast cancer, colon cancer, and ovarian cancer one year after study enrollment. Secondary outcomes include implementation measures related to the benefits and burdens of the family health system and its impact on clinic workflow, patients' risk perception, and intention to change health related behaviors. Outcomes are assessed through chart review, patient surveys at baseline and follow-up, and provider surveys. Clinical validity of the decision support is calculated by comparing its recommendations to those made by a genetic counselor reviewing the same pedigree; and clinical utility is demonstrated through reclassification rates and changes in appropriate screening (the primary outcome). This study integrates a computerized family health
This chapter gives an educational overview of: * The difference between informal and formal ontologies * The primary objectives of ontology design, re-use, extensibility, and interoperability * How formal ontologies can be used to map terminologies and classification systems * How formal ontologies improve semantic interoperability * The relationship between a well-formed ontology and the development of intelligent decision support.
The aim of this paper is to identify the best possible health care waste management option in the West Black Sea Region by taking into account economic, social, environmental, and technical aspects in the concept of multi-criteria decision analysis. In the scope of this research, three different health care waste management scenarios that consist of different technology alternatives were developed and compared using a decision-making computer software, called Right Choice, by identifying various criteria, measuring them, and ranking their relative importance from the point of key stakeholders. The results of the study show that the decentralized autoclave technology option coupled with the disposal through land-filling with energy recovery has potential to be an optimum option for health care waste management system, and an efficient health care waste segregation scheme should be given more attention by the authorities in the region. Furthermore, the discussion of the results points out multidisciplinary approach and the equilibrium between social, environmental, economic, and technical criteria. The methodology used in this research was developed in order to enable the decision makers to gain an increased perception of a decision problem. In general, the results and remarks of this study can be used as a basis of future planning and anticipation of needs for investment in the area of health care waste management in the region and also in developing countries that are dealing with the similar waste management problems.
Lauriks, Steve; de Wit, Matty A S; Buster, Marcel C A; Fassaert, Thijs J L; van Wifferen, Ron; Klazinga, Niek S
The current study set out to develop a decision support tool based on the Self-Sufficiency Matrix (Dutch version; SSM-D) for the clinical decision to allocate homeless people to the public mental health care system at the central access point of public mental health care in Amsterdam, The Netherlands. Logistic regression and receiver operating characteristic-curve analyses were used to model professional decisions and establish four decision categories based on SSM-D scores from half of the research population (Total n = 612). The model and decision categories were found to be accurate and reliable in predicting professional decisions in the second half of the population. Results indicate that the decision support tool based on the SSM-D is useful and feasible. The method to develop the SSM-D as a decision support tool could be applied to decision-making processes in other systems and services where the SSM-D has been implemented, to further increase the utility of the instrument.
Full Text Available With rising healthcare costs comes an increasing demand for evidence-informed resource allocation using economic evaluations worldwide. Furthermore, standardization of costing and reporting methods both at international and national levels are imperative to make economic evaluations a valid tool for decision-making. The aim of this review is to assess the availability and consistency of costing evidence that could be used for decision-making in Austria. It describes systematically the current economic evaluation and costing studies landscape focusing on the applied costing methods and their reporting standards. Findings are discussed in terms of their likely impacts on evidence-based decision-making and potential suggestions for areas of development.A systematic literature review of English and German language peer-reviewed as well as grey literature (2004-2015 was conducted to identify Austrian economic analyses. The databases MEDLINE, EMBASE, SSCI, EconLit, NHS EED and Scopus were searched. Publication and study characteristics, costing methods, reporting standards and valuation sources were systematically synthesised and assessed.A total of 93 studies were included. 87% were journal articles, 13% were reports. 41% of all studies were full economic evaluations, mostly cost-effectiveness analyses. Based on relevant standards the most commonly observed limitations were that 60% of the studies did not clearly state an analytical perspective, 25% of the studies did not provide the year of costing, 27% did not comprehensively list all valuation sources, and 38% did not report all applied unit costs.There are substantial inconsistencies in the costing methods and reporting standards in economic analyses in Austria, which may contribute to a low acceptance and lack of interest in economic evaluation-informed decision making. To improve comparability and quality of future studies, national costing guidelines should be updated with more specific
Mayer, Susanne; Kiss, Noemi; Łaszewska, Agata; Simon, Judit
With rising healthcare costs comes an increasing demand for evidence-informed resource allocation using economic evaluations worldwide. Furthermore, standardization of costing and reporting methods both at international and national levels are imperative to make economic evaluations a valid tool for decision-making. The aim of this review is to assess the availability and consistency of costing evidence that could be used for decision-making in Austria. It describes systematically the current economic evaluation and costing studies landscape focusing on the applied costing methods and their reporting standards. Findings are discussed in terms of their likely impacts on evidence-based decision-making and potential suggestions for areas of development. A systematic literature review of English and German language peer-reviewed as well as grey literature (2004-2015) was conducted to identify Austrian economic analyses. The databases MEDLINE, EMBASE, SSCI, EconLit, NHS EED and Scopus were searched. Publication and study characteristics, costing methods, reporting standards and valuation sources were systematically synthesised and assessed. A total of 93 studies were included. 87% were journal articles, 13% were reports. 41% of all studies were full economic evaluations, mostly cost-effectiveness analyses. Based on relevant standards the most commonly observed limitations were that 60% of the studies did not clearly state an analytical perspective, 25% of the studies did not provide the year of costing, 27% did not comprehensively list all valuation sources, and 38% did not report all applied unit costs. There are substantial inconsistencies in the costing methods and reporting standards in economic analyses in Austria, which may contribute to a low acceptance and lack of interest in economic evaluation-informed decision making. To improve comparability and quality of future studies, national costing guidelines should be updated with more specific methodological
Jarzembski, W B
Today, health care engineering management is merely a concept of dreamers, with most engineering decisions in health care being made by nonengineers. It is the purpose of this paper to present a rationale for an integrated hospital engineering group, and to acquaint the clinical engineer with some of the salient features of management concepts. Included are general management concepts, organization, personnel management, and hospital engineering systems.
Full Text Available Jennifer H Lofland,1 Phaedra T Johnson,2 Mike P Ingham,3 Sarah C Rosemas,2 John C White,2 Lorie Ellis3 1Janssen Global Commercial Strategic Organization – Immunology, Raritan, NJ, 2Health Economics and Outcomes Research, Optum Inc., Eden Prairie, MN, 3Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA Background: Shared decision-making (SDM, a process whereby physicians and patients collaborate to select interventions, is not well understood for biologic treatment of autoimmune conditions. Methods: This was a cross-sectional survey of adults initiating treatment for Crohn’s disease or ulcerative colitis (inflammatory bowel disease, IBD or psoriatic arthritis or rheumatoid arthritis (RAPA. Survey data were linked to administrative claims for 6 months before (baseline and after (follow-up therapy initiation. Measures included the Shared Decision Making Questionnaire, Patient Activation Measure (PAM, Morisky Medication Adherence Scale (MMAS, general health, and treatment satisfaction. Claims-based Quan–Charlson comorbidity scores, persistence, medication possession ratio (MPR, and health care costs were examined. Patients were compared by participation (SDM and nonparticipation (non-SDM in SDM. Results: Among 453 respondents, 357 were eligible, and 306 patients (204 RAPA and 102 IBD were included in all analyses. Overall (n=357, SDM participants (n=120 were more often females (75.0% vs 62.5%, P=0.018, had lower health status (48.0 vs 55.4, P=0.005, and higher Quan–Charlson scores (1.0 vs 0.7, P=0.035 than non-SDM (n=237 participants. Lower MMAS scores (SDM 0.17 vs non-SDM 0.41; P<0.05 indicated greater likelihood of adherence; SDM participants also reported higher satisfaction with medication and had greater activation (PAM SDM vs non-SDM 66.9 vs 61.6; P<0.001. Mean MPR did not differ, but persistence was longer among SDM participants (111.2 days vs 102.2 days for non-SDM; P=0.029. Costs did not
Saronga, Happiness Pius; Dalaba, Maxwell Ayindenaba; Dong, Hengjin; Leshabari, Melkizedeck; Sauerborn, Rainer; Sukums, Felix; Blank, Antje; Kaltschmidt, Jens; Loukanova, Svetla
Poor quality of care is among the causes of high maternal and newborn disease burden in Tanzania. Potential reason for poor quality of care is the existence of a "know-do gap" where by health workers do not perform to the best of their knowledge. An electronic clinical decision support system (CDSS) for maternal health care was piloted in six rural primary health centers of Tanzania to improve performance of health workers by facilitating adherence to World Health Organization (WHO) guidelines and ultimately improve quality of maternal health care. This study aimed at assessing the cost of installing and operating the system in the health centers. This retrospective study was conducted in Lindi, Tanzania. Costs incurred by the project were analyzed using Ingredients approach. These costs broadly included vehicle, computers, furniture, facility, CDSS software, transport, personnel, training, supplies and communication. These were grouped into installation and operation cost; recurrent and capital cost; and fixed and variable cost. We assessed the CDSS in terms of its financial and economic cost implications. We also conducted a sensitivity analysis on the estimations. Total financial cost of CDSS intervention amounted to 185,927.78 USD. 77% of these costs were incurred in the installation phase and included all the activities in preparation for the actual operation of the system for client care. Generally, training made the largest share of costs (33% of total cost and more than half of the recurrent cost) followed by CDSS software- 32% of total cost. There was a difference of 31.4% between the economic and financial costs. 92.5% of economic costs were fixed costs consisting of inputs whose costs do not vary with the volume of activity within a given range. Economic cost per CDSS contact was 52.7 USD but sensitive to discount rate, asset useful life and input cost variations. Our study presents financial and economic cost estimates of installing and operating an
Alladin, Waseem J.
Introduces a nine-dimensional ethnomedical model. Sickness conception, well-being criteria, and recognition of health need were ranked as the three most important dimensions. Offers suggestions for integrating the ethnomedical approach into transcultural counseling using a brief case example. (JPS)
Pasman, H.R.W.; Wolf, de JT; Hesselink, B.A.M.; Heide, van der A.; Wal, van der G.; Maas, van der P.J.; Philipsen, B.D.
OBJECTIVES: To describe the existence of policy statements on euthanasia and physician-assisted suicide (EAS) and practice guidelines for all medical end-of-life decisions in Dutch health care institutions in 2005, whether the existence of practice guidelines is related to characteristics of
What Influences Patients' Decisions When Choosing a Health Care Provider? Measuring Preferences of Patients with Knee Arthrosis, Chronic Depression, or Alzheimer's Disease, Using Discrete Choice Experiments.
Groenewoud, Stef; Van Exel, N Job A; Bobinac, Ana; Berg, Marc; Huijsman, Robbert; Stolk, Elly A
To investigate what influences patients' health care decisions and what the implications are for the provision of information on the quality of health care providers to patients. Dutch patient samples between November 2006 and February 2007. Discrete choice experiments were conducted in three patient groups to explore what influences choice for health care providers. Data were obtained from 616 patients with knee arthrosis, 368 patients with chronic depression, and 421 representatives of patients with Alzheimer's disease. The three patients groups chose health care providers on a different basis. The most valued attributes were effectiveness and safety (knee arthrosis); continuity of care and relationship with the therapist (chronic depression); and expertise (Alzheimer's disease). Preferences differed between subgroups, mainly in relation to patients' choice profiles, severity of disease, and some background characteristics. This study showed that there is substantial room for (quality) information about health care providers in patients' decision processes. This information should be tailor-made, targeting specific patient segments, because different actors and factors play a part in their search and selection process. © Health Research and Educational Trust.
Boissoneault, Jeff; Mundt, Jennifer M; Bartley, Emily J; Wandner, Laura D; Hirsh, Adam T; Robinson, Michael E
Disparities in health care associated with patients' gender, race, and age are well documented. Previous studies using virtual human (VH) technology have demonstrated that provider characteristics may play an important role in pain management decisions. However, these studies have largely emphasized group differences. The aims of this study were to examine dentists' and physicians' use of VH characteristics when making clinical judgments (i.e., cue use) and to identify provider characteristics associated with the magnitude of the impact of these cues (β-weights). Providers (N=152; 76 physicians, 76 dentists) viewed video vignettes of VH patients varying in gender (male/female), race (white/black), and age (younger/older). Participants rated VH patients' pain intensity and unpleasantness and then rated their own likelihood of administering non-opioid and opioid analgesics. Compared to physicians, dentists had significantly lower β-weights associated with VH age cues for all ratings (p0.69). These effects varied by provider race and gender. For pain intensity, professional differences were present only among non-white providers. White providers had greater β-weights than non-white providers for pain unpleasantness but only among men. Provider differences regarding the use of VH age cues in non-opioid analgesic administration were present among all providers except non-white males. These findings highlight the interaction of patient and provider factors in driving clinical decision making. Although profession was related to use of VH age cues in pain-related clinical judgments, this relationship was modified by providers' personal characteristics. Additional research is needed to understand what aspects of professional training or practice may account for differences between physicians and dentists and what forms of continuing education may help to mitigate the disparities.
Bélanger, Emmanuelle; Rodríguez, Charo; Groleau, Danielle; Légaré, France; MacDonald, Mary Ellen; Marchand, Robert
The participation of patients in making decisions about their care is especially important towards the end of life because palliative care decisions involve extensive uncertainty and are heavily influenced by personal values. Yet, there is a scarcity of studies directly observing clinical interactions between palliative patients and their health care providers. In this study, we aimed to understand how patient participation in palliative care decisions is constructed through discourse in a community hospital-based palliative care team. This qualitative study combined ethnographic observations of a palliative care team with discourse analysis. Eighteen palliative care patients with cancer diagnoses, six family physicians, and two nurses were involved in the study. Multiple interactions were observed between each patient and health care providers over the course of 1 year, for a total of 101 consultations, 24 of which were audio-recorded. The analysis consisted in looking for the interpretive repertoires (i.e., familiar lines of argument used to justify actions) that were used to justify patient participation in decision-making during clinical interactions, as well as exploring their implications for decision roles and end-of-life care. Patients and their health care providers seldom addressed their decision-making roles explicitly. Rather, they constructed patient participation in palliative care decisions in a covert manner. Four interpretive repertoires were used to justify patient participation: (1) exposing uncertainty, (2) co-constructing patient preferences, (3) affirming patient autonomy, and finally (4) upholding the authority of health care providers. The results demonstrate how patients and health care providers used these arguments to negotiate their respective roles in decision-making. In conclusion, patients and health care providers used a variety of interpretive repertoires to covertly negotiate their roles in decision-making, and to legitimize
Full Text Available The participation of patients in making decisions about their care is especially important towards the end of life because palliative care decisions involve extensive uncertainty and are heavily influenced by personal values. Yet, there is a scarcity of studies directly observing clinical interactions between palliative patients and their health care providers. In this study, we aimed to understand how patient participation in palliative care decisions is constructed through discourse in a community hospital-based palliative care team. This qualitative study combined ethnographic observations of a palliative care team with discourse analysis. Eighteen palliative care patients with cancer diagnoses, six family physicians, and two nurses were involved in the study. Multiple interactions were observed between each patient and health care providers over the course of 1 year, for a total of 101 consultations, 24 of which were audio-recorded. The analysis consisted in looking for the interpretive repertoires (i.e., familiar lines of argument used to justify actions that were used to justify patient participation in decision-making during clinical interactions, as well as exploring their implications for decision roles and end-of-life care. Patients and their health care providers seldom addressed their decision-making roles explicitly. Rather, they constructed patient participation in palliative care decisions in a covert manner. Four interpretive repertoires were used to justify patient participation: (1 exposing uncertainty, (2 co-constructing patient preferences, (3 affirming patient autonomy, and finally (4 upholding the authority of health care providers. The results demonstrate how patients and health care providers used these arguments to negotiate their respective roles in decision-making. In conclusion, patients and health care providers used a variety of interpretive repertoires to covertly negotiate their roles in decision-making, and to
Novakovic, Tanja; Martin, Antony P; Parker, Mark; Ferrario, Alessandra; Vukovic, Simo; Łanda, Krzysztof; Duba, Jaroslav; Dankó, Dávid; Kotsopoulos, Nikolaos; Godman, Brian; Ristic, Jelena; Stefanovic, Danka; Tesic, Danka
The Pharmacoeconomics Section of the Pharmaceutical Association of Serbia organised a one day international conference on the value of innovation in decision-making in health care in Central and Eastern Europe. The focus of the conference was on reimbursement decisions for medicines using health technology assessment and the use of managed entry agreements (MEAs). The objectives of this conference were firstly to discuss the challenges and opportunities with the use of MEAs in Central and Eastern European countries; secondly the role of patient registries especially with outcome based schemes, and finally new approaches to improve accessibility to new medicines including better managing their entry.
Chambers, Duncan; Wilson, Paul M; Thompson, Carl A; Hanbury, Andria; Farley, Katherine; Light, Kate
Context: Barriers to the use of systematic reviews by policymakers may be overcome by resources that adapt and present the findings in formats more directly tailored to their needs. We performed a systematic scoping review to identify such knowledge-translation resources and evaluations of them. Methods: Resources were eligible for inclusion in this study if they were based exclusively or primarily on systematic reviews and were aimed at health care policymakers at the national or local level. Resources were identified by screening the websites of health technology assessment agencies and systematic review producers, supplemented by an email survey. Electronic databases and proceedings of the Cochrane Colloquium and HTA International were searched as well for published and unpublished evaluations of knowledge-translation resources. Resources were classified as summaries, overviews, or policy briefs using a previously published classification. Findings: Twenty knowledge-translation resources were identified, of which eleven were classified as summaries, six as overviews, and three as policy briefs. Resources added value to systematic reviews by, for example, evaluating their methodological quality or assessing the reliability of their conclusions or their generalizability to particular settings. The literature search found four published evaluation studies of knowledge-translation resources, and the screening of abstracts and contact with authors found three more unpublished studies. The majority of studies reported on the perceived usefulness of the service, although there were some examples of review-based resources being used to assist actual decision making. Conclusions: Systematic review producers provide a variety of resources to help policymakers, of which focused summaries are the most common. More evaluations of these resources are required to ensure users’ needs are being met, to demonstrate their impact, and to justify their funding. PMID:21418315
Couët, Nicolas; Desroches, Sophie; Robitaille, Hubert; Vaillancourt, Hugues; Leblanc, Annie; Turcotte, Stéphane; Elwyn, Glyn; Légaré, France
We have no clear overview of the extent to which health-care providers involve patients in the decision-making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this. To systematically review studies that used the OPTION instrument to observe the extent to which health-care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation. We conducted online literature searches in multiple databases (2001-12) and gathered further data through networking. (i) OPTION scores as reported outcomes and (ii) health-care providers and patients as study participants. For analysis, we only included studies using the revised scale. Extracted data included: (i) study and participant characteristics and (ii) OPTION outcomes (scores, statistical associations and reported psychometric results). We also assessed the quality of OPTION outcomes reporting. We found 33 eligible studies, 29 of which used the revised scale. Overall, we found low levels of patient-involving behaviours: in cases where no intervention was used to implement shared decision making (SDM), the mean OPTION score was 23 ± 14 (0-100 scale). When assessed, the variables most consistently associated with higher OPTION scores were interventions to implement SDM (n = 8/9) and duration of consultations (n = 8/15). Whatever the clinical context, few health-care providers consistently attempt to facilitate patient involvement, and even fewer adjust care to patient preferences. However, both SDM interventions and longer consultations could improve this. © 2013 John Wiley & Sons Ltd.
Kazandjian, Vahé A; Lipitz-Snyderman, Allison
To discuss the usefulness of health care information technology (HIT) in assisting care providers minimize uncertainty while simultaneously increasing efficiency of the care provided. An ongoing study of HIT, performance measurement (clinical and production efficiency) and their implications to the payment for care represents the design of this study. Since 2006, all Maryland hospitals have embarked on a multi-faceted study of performance measures and HIT adoption surveys, which will shape the health care payment model in Maryland, the last of the all-payor states, in 2011. This paper focuses on the HIT component of the Maryland care payment initiative. While the payment model is still under review and discussion, 'appropriateness' of care has been discussed as an important dimension of measurement. Within this dimension, the 'uncertainty' concept has been identified as associated with variation in care practices. Hence, the methods of this paper define how HIT can assist care providers in addressing the concept of uncertainty, and then provides findings from the first HIT survey in Maryland to infer the readiness of Maryland hospital in addressing uncertainty of care in part through the use of HIT. Maryland hospitals show noteworthy variation in their adoption and use of HIT. While computerized, electronic patient records are not commonly used among and across Maryland hospitals, many of the uses of HIT internally in each hospital could significantly assist in better communication about better practices to minimize uncertainty of care and enhance the efficiency of its production. © 2010 Blackwell Publishing Ltd.
Rajić Nataša N.
Full Text Available The Law on the Right to Health Care of Children and Pregnant Women was challenged before the Constitutional Court of Serbia in the part which relating to the obligation of providing specified medical data to the Republic Fund for Health Insurance. The evaluation was requested in relation to Article 42 of the Constitution of the Republic of Serbia as well as in relation to Article 8 of the European Convention on Human Rights and Fundamental Freedoms. The availability of specified health information as a condition of exercising the right to health care of separated categories of the population was considered in the context of alleged violation of the right to protection of personal data and the right to respect for private and family life. In other words, the question which was opened was a matter of collision of two rights that have different legal nature: the right to health care and the right to protection of personal data. The paper analyzes the decisions of the Constitutional Court on the conformity of the disputed provisions with Constitution and ratified international treaty, while the purpose of the analysis pointing to problematic places in the decision as well as the relevant constitutional issues in the decision-making procedure that have not been opened.
Full Text Available Chiara Marzorati,1,2 Gabriella Pravettoni2,3 1Foundations of the Life Sciences, Bioethics and Cognitive Science, European School of Molecular Medicine (SEMM, 2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, 3Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy Abstract: In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of “value” is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on “value” and new paradigms such as patient-centered system (PCS, patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care. Keywords: health care system, value, value-based medicine, patient empowerment, clinical decision
McNabb, Marion; Chukwu, Emeka; Ojo, Oluwayemisi; Shekhar, Navendu; Gill, Christopher J; Salami, Habeeb; Jega, Farouk
Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre. Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care. Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (peducation. These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.
Bosl, William; Mandel, Joshua; Jonikas, Magdalena; Ramoni, Rachel Badovinac; Kohane, Isaac S; Mandl, Kenneth D
Non-adherence to prescribed medications is a serious health problem in the United States, costing an estimated $100 billion per year. While poor adherence should be addressable with point of care health information technology, integrating new solutions with existing electronic health records (EHR) systems require customization within each organization, which is difficult because of the monolithic software design of most EHR products. The objective of this study was to create a published algorithm for predicting medication adherence problems easily accessible at the point of care through a Web application that runs on the Substitutable Medical Apps, Reusuable Technologies (SMART) platform. The SMART platform is an emerging framework that enables EHR systems to behave as "iPhone like platforms" by exhibiting an application programming interface for easy addition and deletion of third party apps. The app is presented as a point of care solution to monitoring medication adherence as well as a sufficiently general, modular application that may serve as an example and template for other SMART apps. The widely used, open source Django framework was used together with the SMART platform to create the interoperable components of this app. Django uses Python as its core programming language. This allows statistical and mathematical modules to be created from a large array of Python numerical libraries and assembled together with the core app to create flexible and sophisticated EHR functionality. Algorithms that predict individual adherence are derived from a retrospective study of dispensed medication claims from a large private insurance plan. Patients' prescription fill information is accessed through the SMART framework and the embedded algorithms compute adherence information, including predicted adherence one year after the first prescription fill. Open source graphing software is used to display patient medication information and the results of statistical prediction
Teerawattananon, Yot; Russell, Steve
This paper presents qualitative findings from an assessment of the acceptability of using economic evaluation among policy actors in Thailand. Using cost-utility data from two economic analyses a hypothetical case scenario was created in which policy actors had to choose between two competing interventions to include in a public health benefit package. The two competing interventions, laparoscopic cholecystectomy (LC) for gallbladder disease versus renal dialysis for chronic renal disease, were selected because they highlighted conflicting criteria influencing the allocation of healthcare resources. Semi-structured interviews were conducted with 36 policy actors who play a major role in resource allocation decisions within the Thai healthcare system. These included 14 policy makers at the national level, five hospital directors, ten health professionals and seven academics. Twenty six out of 36 (72%) respondents were not convinced by the presentation of economic evaluation findings and chose not to support the inclusion of a proven cost-effective intervention (LC) in the benefit package due to ethical, institutional and political considerations. There were only six respondents, including three policy makers at national level, one hospital director, one health professional and one academic, (6/36, 17%) whose decisions were influenced by economic evaluation evidence. This paper illustrates limitations of using economic evaluation information in decision making priorities of health care, perceived by different policy actors. It demonstrates that the concept of maximising health utility fails to recognise other important societal values in making health resource allocation decisions.
López, Marta Manovel; López, Miguel Maldonado; de la Torre Díez, Isabel; Jimeno, José Carlos Pastor; López-Coronado, Miguel
Decision support systems (DSS) are increasingly demanded due that diagnosis is one of the main activities that physicians accomplish every day. This fact seems critical when primary care physicians deal with uncommon problems belonging to specialized areas. The main objective of this paper is the development and user evaluation of a mobile DSS for iOS named OphthalDSS. This app has as purpose helping in anterior segment ocular diseases' diagnosis, besides offering educative content about ophthalmic diseases to users. For the deployment of this work, firstly it has been used the Apple IDE, Xcode, to develop the OphthalDSS mobile application using Objective-C as programming language. The core of the decision support system implemented by OphthalDSS is a decision tree developed by expert ophthalmologists. In order to evaluate the Quality of Experience (QoE) of primary care physicians after having tried the OphthalDSS app, a written inquiry based on the Likert scale was used. A total of 50 physicians answered to it, after trying the app during 1 month in their medical consultation. OphthalDSS is capable of helping to make diagnoses of diseases related to the anterior segment of the eye. Other features of OphthalDSS are a guide of each disease and an educational section. A 70% of the physicians answered in the survey that OphthalDSS performs in the way that they expected, and a 95% assures their trust in the reliability of the clinical information. Moreover, a 75% of them think that the decision system has a proper performance. Most of the primary care physicians agree with that OphthalDSS does the function that they expected, it is a user-friendly and the contents and structure are adequate. We can conclude that OphthalDSS is a practical tool but physicians require extra content that makes it a really useful one.
Coombs, Maureen A; Parker, Roses; de Vries, Kay
Background: Increasing importance is being placed on the coordination of services at the end of life. Aim: To describe decision-making processes that influence transitions in care when approaching the end of life. Design: Qualitative study using field observations and longitudinal semi-structured interviews. Setting/participants: Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and P...
Full Text Available Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre.Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care.Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001, out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education.These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.
Harris, Claire; Allen, Kelly; Waller, Cara; Brooke, Vanessa
This is the third in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Leaders in a large Australian health service planned to establish an organisation-wide, systematic, integrated, evidence-based approach to disinvestment. In order to introduce new systems and processes for disinvestment into existing decision-making infrastructure, we aimed to understand where, how and by whom resource allocation decisions were made, implemented and evaluated. We also sought the knowledge and experience of staff regarding previous disinvestment activities. Structured interviews, workshops and document analysis were used to collect information from multiple sources in an environmental scan of decision-making systems and processes. Findings were synthesised using a theoretical framework. Sixty-eight respondents participated in interviews and workshops. Eight components in the process of resource allocation were identified: Governance, Administration, Stakeholder engagement, Resources, Decision-making, Implementation, Evaluation and, where appropriate, Reinvestment of savings. Elements of structure and practice for each component are described and a new framework was developed to capture the relationships between them. A range of decision-makers, decision-making settings, type and scope of decisions, criteria used, and strengths, weaknesses, barriers and enablers are outlined. The term 'disinvestment' was not used in health service decision-making. Previous projects that involved removal, reduction or restriction of current practices were driven by quality and safety issues, evidence-based practice or a need to find resource savings and not by initiatives where the primary aim was to disinvest. Measuring resource savings is difficult, in some situations impossible. Savings are often only theoretical as resources released may be utilised immediately by patients waiting for beds, clinic
The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.
Griva, Konstadina; Li, Zhi Hui; Lai, Alden Yuanhong; Choong, Meng Chan; Foo, Marjorie Wai Yin
This study explored the factors influencing decision-making about dialysis modality, integrating the perspectives of patients, their families, and health care professionals within an Asian population. The study further sought to understand the low penetration rate of peritoneal dialysis (PD) in Singapore. ♢ A sample of 59 participants comprising pre-dialysis patients, dialysis patients, caregivers, and health care professionals (HCPs) participated in semi-structured interviews to explore the decision-making process and their views about various dialysis modalities. Data were thematically analyzed using NVivo9 (QSR International, Doncaster, Australia) to explore barriers to and facilitators of various dialysis modalities and decisional support needs. ♢ Fear of infection, daily commitment to PD, and misperceptions of PD emerged as barriers to PD. Side effects, distance to dialysis centers, and fear of needling and pain were barriers to hemodialysis (HD). The experiences of other patients, communicated informally or opportunistically, influenced the preferences and choices of patients and family members for a dialysis modality. Patients and families value input from HCPs and yet express strong needs to discuss subjective experiences of life on dialysis (PD or HD) with other patients before making a decision about dialysis modality. ♢ Pre-dialysis education should expand its focus on the family as the unit of care and should provide opportunities for interaction with dialysis patients and for peer-led learning. Barriers to PD, especially misperceptions and misunderstandings, can be targeted to improve PD uptake.
Griva, Konstadina; Li, Zhi Hui; Lai, Alden Yuanhong; Choong, Meng Chan; Foo, Marjorie Wai Yin
♦ Objectives: This study explored the factors influencing decision-making about dialysis modality, integrating the perspectives of patients, their families, and health care professionals within an Asian population. The study further sought to understand the low penetration rate of peritoneal dialysis (PD) in Singapore. ♦ Methods: A sample of 59 participants comprising pre-dialysis patients, dialysis patients, caregivers, and health care professionals (HCPs) participated in semi-structured interviews to explore the decision-making process and their views about various dialysis modalities. Data were thematically analyzed using NVivo9 (QSR International, Doncaster, Australia) to explore barriers to and facilitators of various dialysis modalities and decisional support needs. ♦ Results: Fear of infection, daily commitment to PD, and misperceptions of PD emerged as barriers to PD. Side effects, distance to dialysis centers, and fear of needling and pain were barriers to hemodialysis (HD). The experiences of other patients, communicated informally or opportunistically, influenced the preferences and choices of patients and family members for a dialysis modality. Patients and families value input from HCPs and yet express strong needs to discuss subjective experiences of life on dialysis (PD or HD) with other patients before making a decision about dialysis modality. ♦ Conclusions: Pre-dialysis education should expand its focus on the family as the unit of care and should provide opportunities for interaction with dialysis patients and for peer-led learning. Barriers to PD, especially misperceptions and misunderstandings, can be targeted to improve PD uptake. PMID:23123668
Hay Simon I
Full Text Available Abstract Background Most Ministries of Health across Africa invest substantial resources in some form of health management information system (HMIS to coordinate the routine acquisition and compilation of monthly treatment and attendance records from health facilities nationwide. Despite the expense of these systems, poor data coverage means they are rarely, if ever, used to generate reliable evidence for decision makers. One critical weakness across Africa is the current lack of capacity to effectively monitor patterns of service use through time so that the impacts of changes in policy or service delivery can be evaluated. Here, we present a new approach that, for the first time, allows national changes in health service use during a time of major health policy change to be tracked reliably using imperfect data from a national HMIS. Methods Monthly attendance records were obtained from the Kenyan HMIS for 1 271 government-run and 402 faith-based outpatient facilities nationwide between 1996 and 2004. A space-time geostatistical model was used to compensate for the large proportion of missing records caused by non-reporting health facilities, allowing robust estimation of monthly and annual use of services by outpatients during this period. Results We were able to reconstruct robust time series of mean levels of outpatient utilisation of health facilities at the national level and for all six major provinces in Kenya. These plots revealed reliably for the first time a period of steady nationwide decline in the use of health facilities in Kenya between 1996 and 2002, followed by a dramatic increase from 2003. This pattern was consistent across different causes of attendance and was observed independently in each province. Conclusion The methodological approach presented can compensate for missing records in health information systems to provide robust estimates of national patterns of outpatient service use. This represents the first such use of
Full Text Available Véronique LapaigeCanadian Health Services Research Foundation Fellow; PRO-ACTIVE Research Program (Participatory and Evaluative Research Program to Optimize Workplace Management: Application of Knowledge, Transfer of Expertise, Innovative Interventions, Training Transformational Leaders Pavillon Ferdinand-Vandry, CIFSS (Centre intégré de formation en sciences de la santé, Laval University, Quebec City, Quebec Canada Abstract: In the globalized knowledge economy, the challenge of translating knowledge into policy and practice is universal. At the dawn of the 21st century, the clinicians, leaders, and managers of health care organizations are increasingly required to bridge the research-practice gap. A shift from moving evidence to solving problems is due. However, despite a vast literature on the burgeoning field of knowledge translation research, the “evidence-based” issue remains for many health care professionals a day-to-day debate leading to unresolved questions. On one hand, many clinicians still resist to the implementation of evidence-based clinical practice, asking themselves why their current practice should be changed or expanded. On the other hand, many leaders and managers of health care organizations are searching how to keep pace with the demand of actionable knowledge. For example, they are wondering: (a if managerial and policy innovations are subjected to the same evidentiary standards as clinical innovations, and (b how they can adapt the scope of evidence-based medicine to the culture, context, and content of health policy and management. This paper focuses on evidence-based health care management within the context of contemporary globalization. In this paper, our heuristic hypothesis is that decision-making process related changes within clinical/managerial/policy environments must be given a socio-historical backdrop. We argue that the relationship between research on the transfer of knowledge and its uptake by
Armontrout, James; Gitlin, David; Gutheil, Thomas
Previous research in the area of medical decision-making capacity has demonstrated relatively poor agreement between experienced evaluators in "gray area" cases. We performed a survey to determine the level of agreement about gray area decision-making capacity case scenarios within and between individuals of different professional backgrounds. Participants received a survey consisting of 3 complicated decision-making capacity vignettes with an accompanying "yes/no" question regarding capacity and a certainty scale for each vignette. Participants were identified from mailing lists of professional organizations and local hospitals. We received responses from psychiatry trainees, consultation-liaison psychiatrists, forensic psychiatrists, and lawyers with experience in health care law. Results were analyzed using SPSS. Across the 3 vignettes, the percentage agreeing that the individual described had capacity to refuse medical treatment ranged between 35% and 40% for trainees, 33% and 67% for consult psychiatrists, 41% and 76% for forensic psychiatrists, and 40% and 83% for health care lawyers. Only question 2 reached significance between-group differences (Pearson χ(2) = 11.473, p opinions on capacity. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
Tang, D H; Warholak, T L; Hines, L E; Hurwitz, J; Brown, M; Taylor, A M; Brixner, D; Malone, D C
Comparative effectiveness research (CER) is a constellation of research methods designed to improve health care decision making. Educational programs that improve health care decision makers' CER knowledge and awareness may ultimately lead to more cost-effective use of health care resources. This study was conducted to evaluate changes in CER knowledge, attitudes, and ability among Pharmacy and Therapeutics (P&T) Committee members and support staff after attending a tailored educational program. Physicians and pharmacists from two professional societies and the Indian Health Service who participated in the P&T process were invited via email to participate in this study. Participants completed a questionnaire, designed specifically for this study, prior to and following the 4-hour live, educational program on CER to determine the impact on their related knowledge, attitudes, and ability to use CER in decision-making. Rasch analysis was used to assess validity and reliability of subsections of the questionnaire and regression analysis was used to assess programmatic impact on CER knowledge, attitude, and ability. One hundred and forty of the 199 participants completed both the pre- and post-CER session questionnaires (response rate = 70.4%). Most participants (>75%) correctly answered eight of the ten knowledge items after attending the educational session. More than 60% of the respondents had a positive attitude toward CER both before and after the program. Compared to baseline (pretest), participants reported significant improvements in their perceived ability to use CER after attending the session in these areas: using CER reviews, knowledge of CER methods, identifying problems with randomized controlled trials, identifying threats to validity, understanding of evidence synthesis approaches, and evaluating the quality of CER (all P values < 0.001). The questionnaire demonstrated acceptable reliability and validity evidence (limited evidence of construct under
Jackson, Leigh; Goldsmith, Lesley; Skirton, Heather
Direct-to-consumer (DTC) genetic tests are available online, but there is little practical guidance for health professionals and consumers concerning their use. Work to produce such guidance was initially informed by three systematic reviews assessing the evidence on views and experiences of users and health professionals and policies of professional and bioethics organizations. The evidence suggested that consumers' motivations include general curiosity, improving their general health, ascertaining the risk of a particular condition or planning for future children. However, health professionals and bioethics organizations expressed concerns about potential harms resulting from these tests. Using this evidence, we constructed a list of topics to be included in proposed guidelines. Using an expert group technique, we aimed to develop guidance for (i) potential consumers and (ii) health professionals approached by patients considering or having undertaken such tests. We considered it important to involve a wide range of participants with relevant experience. Accordingly, researchers and clinicians based in four countries were invited to a 2-day workshop in August 2012. Following an iterative process, we decided to produce clinically relevant and pragmatic guidance in the form of a decision support tool for use in primary care. By utilizing both the relevant literature and the experience of the expert group, we identified seven key underlying reasons that might prompt individuals to consider DTC testing. We considered primary care physicians as the most likely health professionals from whom individuals would seek advice. Based on the outcomes of the workshop, we developed a decision support tool encompassing varied clinical scenarios. Health professionals and patients are guided through a pathway that includes relevant actions and information on the appropriateness of the test. This tool will be freely accessible to health professionals and patients online. © The
Harris, Claire; Allen, Kelly; Waller, Cara; Dyer, Tim; Brooke, Vanessa; Garrubba, Marie; Melder, Angela; Voutier, Catherine; Gust, Anthony; Farjou, Dina
This is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately. Literature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes. Surveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed. Health service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research
Artells, Juan José; Peiró, Salvador; Meneu, Ricard
To identify difficulties, obstacles and limitations to establish an organizational structure devoted to the evaluation of healthcare technologies for incorporation, maintenance or removal from the services portfolio of the Spanish National Health System (sNHS). Panel of 14 experts, structured according to processes adapted from brainstorming, nominal group, and Rand consensus method techniques. The panel proposed 77 items as potential obstacles to the establishment of an official and independent "agency" able to inform on sNHS healthcare benefits funding or selective disinvestment. These items were focused on: 1) lack of political motivation to introduce the cost-effectiveness analysis from the state and regional governments and lack of independence and transparency of the evaluation processes, 2) the tension between a decentralized health system and evaluation activities with significant scale economies, 3) technical difficulties of the evaluation processes, including their ability to influence decision making and 4) social and professional refusal to the exclusion of healthcare benefits when it is perceived as indiscriminate. Although there is a different number and type of obstacles for developing the capacity of the sNHS to include or exclude healthcare benefits based on the evaluation of their effectiveness and efficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field.
vaccine for their children. journal of. COMMUNITY HEALTH. & PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26(2) 46-58. Correspondence to: Ijadunola M.Y. Department of Community Health, Faculty of Clinical Sciences,. College of Health Sciences, Obafemi Awolowo University,.
Cancer Survivorship Care Plan Utilization and Impact on Clinical Decision-Making at Point-of-Care Visits with Primary Care: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.
Donohue, SarahMaria; Haine, James E; Li, Zhanhai; Feldstein, David A; Micek, Mark; Trowbridge, Elizabeth R; Kamnetz, Sandra A; Sosman, James M; Wilke, Lee G; Sesto, Mary E; Tevaarwerk, Amye J
Every cancer survivor and his/her primary care provider should receive an individualized survivorship care plan (SCP) following curative treatment. Little is known regarding point-of-care utilization at primary care visits. We assessed SCP utilization in the clinical context of primary care visits. Primary care physicians and advanced practice providers (APPs) who had seen survivors following provision of an SCP were identified. Eligible primary care physicians and APPs were sent an online survey, evaluating SCP utilization and influence on decision-making at the point-of-care, accompanied by copies of the survivor's SCP and the clinic note. Eighty-eight primary care physicians and APPs were surveyed November 2016, with 40 (45%) responding. Most respondents (60%) reported discussing cancer or related issues during the visit. Information needed included treatment (66%) and follow-up visits, and the cancer team was responsible for (58%) vs primary care (58%). Respondents acquired this information by asking the patient (79%), checking oncology notes (75%), the SCP (17%), or online resources (8%). Barriers to SCP use included being unaware of the SCP (73%), difficulty locating it (30%), and finding needed information faster via another mechanism (15%). Despite largely not using the SCP for the visit (90%), most respondents (61%) believed one would be quite or very helpful for future visits. Most primary care visits included discussion of cancer or cancer-related issues. SCPs may provide the information necessary to deliver optimal survivor care but efforts are needed to reduce barriers and design SCPs for primary care use.
Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter
The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precis......, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation...
Boivin, Antoine; Lehoux, Pascale; Burgers, Jako; Grol, Richard
In the past 50 years, individual patient involvement at the clinical consultation level has received considerable attention. More recently, patients and the public have increasingly been involved in collective decisions concerning the improvement of health care and policymaking. However, rigorous evaluation guiding the development and implementation of effective public involvement interventions is lacking. This article describes those key ingredients likely to affect public members' ability to deliberate productively with professionals and influence collective health care choices. We conducted a trial process evaluation of public involvement in setting priorities for health care improvement. In all, 172 participants (including 83 patients and public members and 89 professionals) from 6 Health and Social Services Centers in Canada participated in the trial. We video-recorded 14 one-day meetings, and 2 nonparticipant observers took structured notes. Using qualitative analysis, we show how public members influenced health care improvement priorities. Legitimacy, credibility, and power explain the variations in the public members' influence. Their credibility was supported by their personal experience as patients and caregivers, the provision of a structured preparation meeting, and access to population-based data from their community. Legitimacy was fostered by the recruitment of a balanced group of participants and by the public members' opportunities to draw from one another's experience. The combination of small-group deliberations, wider public consultation, and a moderation style focused on effective group process helped level out the power differences between professionals and the public. The engagement of key stakeholders in the intervention design and implementation helped build policy support for public involvement. A number of interacting active ingredients structure and foster the public's legitimacy, credibility, and power. By paying greater attention to
Kaltoft, Mette Kjer; Dowie, Jack; Turner, Robin
is to arrive at the necessary compromise between an individualised public policy (using each individual's preferences) and a deindividualised policy (using mean population preferences) in a more rigorous and transparent way. We show how cluster analysis can be combined with multi-criteria decision analysis...... (MCDA) to facilitate progression from variable-centred to person-centred public health, albeit at a subgroup level. Methods: Cluster analysis encompasses various techniques designed to detect patterns in the characteristics of individuals to establish the basis for policy decisions targeted at subgroups....... The statistical quality of the cluster solutions produced was established and the results subjected to descriptive interpretation. Being interested in practical policy significance, the mean importance weights for each cluster were entered into a MCDA of the policy decision of whether or not to have a prostate...
COMMUNITY HEALTH. & PRIMARY HEALTH CARE. KEYWORDS ABSTRACT. Correspondence to: Journal of Community Medicine and Primary Health Care. 26 (2) 1-6. Facility User's Preference between the Free and the Bamako. Initiative (Drug Revolving Fund-Based) Health Services in Iwajowa Local Government, Oyo ...
Sockolow, P S; Weiner, J P; Bowles, K H; Abbott, P; Lehmann, H P
Provide evidence-based advise to "Program of All-inclusive Care for the Elderly" (PACE) decision makers considering implementing an electronic health record (EHR) system, drawing on the results of a mixed methods study to examine: (1) the diffusion of an EHR among clinicians documenting direct patient care in a PACE day care site, (2) the impact of the use of the EHR on the satisfaction levels of clinicians, and (3) the impact of the use of the EHR on patient functional outcomes. Embedded mixed methods design with a post-test design quantitative experiment and concurrent qualitative component. Quantitative methods included: (1) the EHR audit log used to determine the frequency and timing during the week of clinicians' usage of the system; (2) a 22-item clinician satisfaction survey; and (3) a 16-item patient functional outcome questionnaire related to locomotion, mobility, personal hygiene, dressing, feeding as well the use of adaptive devices. Qualitative methods included observations and open-ended, semi-structured follow-up interviews. Qualitative data was merged with the quantitative data by comparing the findings along themes. The setting was a PACE utilizing an EHR in Philadelphia: PACE manages the care of nursing-home eligible members to enable them to avoid nursing home admission and reside in their homes. Participants were 39 clinicians on the multi-disciplinary teams caring for the elders and 338 PACE members. Clinicians did not use the system as intended, which may help to explain why the benefits related to clinical processes and patient outcomes as expected for an EHR were not reflected in the results. Clinicians were satisfied with the EHR, although there was a non-significant decline between 11 and 17 months post implementation of the EHR. There was no significant difference in patient functional outcome the two time periods. However, the sample size of 48 was too small to allow any conclusive statements to be made. Interpretation of findings
Carter, M.W.; Hans, Elias W.; Kolisch, R.
Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully
In the globalized knowledge economy, the challenge of translating knowledge into policy and practice is universal. At the dawn of the 21st century, the clinicians, leaders, and managers of health care organizations are increasingly required to bridge the research-practice gap. A shift from moving evidence to solving problems is due. However, despite a vast literature on the burgeoning field of knowledge translation research, the "evidence-based" issue remains for many health care professionals a day-to-day debate leading to unresolved questions. On one hand, many clinicians still resist to the implementation of evidence-based clinical practice, asking themselves why their current practice should be changed or expanded. On the other hand, many leaders and managers of health care organizations are searching how to keep pace with the demand of actionable knowledge. For example, they are wondering: (a) if managerial and policy innovations are subjected to the same evidentiary standards as clinical innovations, and (b) how they can adapt the scope of evidence-based medicine to the culture, context, and content of health policy and management. This paper focuses on evidence-based health care management within the context of contemporary globalization. In this paper, our heuristic hypothesis is that decision-making process related changes within clinical/managerial/policy environments must be given a socio-historical backdrop. We argue that the relationship between research on the transfer of knowledge and its uptake by clinical, managerial and policy target audiences has undergone a shift, resulting in increasing pressures in health care for intense researcher-practitioner collaboration and the development of "integrative KT platforms" at the crossroads of different fields (the field of knowledge management and the field of knowledge translation). The objectives of this paper are: (a) to provide an answer to the questions that health professionals ask most frequently
In the globalized knowledge economy, the challenge of translating knowledge into policy and practice is universal. At the dawn of the 21st century, the clinicians, leaders, and managers of health care organizations are increasingly required to bridge the research-practice gap. A shift from moving evidence to solving problems is due. However, despite a vast literature on the burgeoning field of knowledge translation research, the “evidence-based” issue remains for many health care professionals a day-to-day debate leading to unresolved questions. On one hand, many clinicians still resist to the implementation of evidence-based clinical practice, asking themselves why their current practice should be changed or expanded. On the other hand, many leaders and managers of health care organizations are searching how to keep pace with the demand of actionable knowledge. For example, they are wondering: (a) if managerial and policy innovations are subjected to the same evidentiary standards as clinical innovations, and (b) how they can adapt the scope of evidence-based medicine to the culture, context, and content of health policy and management. This paper focuses on evidence-based health care management within the context of contemporary globalization. In this paper, our heuristic hypothesis is that decision-making process related changes within clinical/managerial/policy environments must be given a socio-historical backdrop. We argue that the relationship between research on the transfer of knowledge and its uptake by clinical, managerial and policy target audiences has undergone a shift, resulting in increasing pressures in health care for intense researcher-practitioner collaboration and the development of “integrative KT platforms” at the crossroads of different fields (the field of knowledge management and the field of knowledge translation). The objectives of this paper are: (a) to provide an answer to the questions that health professionals ask most
González, Carolina; López, Diego M; Blobel, Bernd
Decision-making is a crucial task for decision makers in healthcare, especially because decisions have to be made quickly, accurately and under uncertainty. Taking into account the importance of providing quality decisions, offering assistance in this complex process has been one of the main challenges of Artificial Intelligence throughout history. Decision Support Systems (DSS) have gained popularity in the medical field for their efficacy to assist decision-making. In this sense, many DSS have been developed, but only few of them consider processing and analysis of information contained in electronic health records, in order to identify individual or population health risk factors. This paper deals with Intelligent Decision Support Systems that are integrated into Electronic Health Records Systems (EHRS) or Public Health Information Systems (PHIS). It provides comprehensive support for a wide range of decisions with the purpose of improving quality of care delivered to patients or public health planning, respectively.
healthcare providers in south-east Nigerian. Malaria. National population commission and ORC Macro. Journal.2009;8:22. 6. Amaghionyeodiwe LA. Determinants of the. 15. World Health Organisation. The African choice of health care provider in Nigeria. Health malaria report 2003. Available at. Care Management Science.
... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Vacation health care URL of this page: //medlineplus.gov/ency/article/001937.htm Vacation health care To use the ...
This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.
Ethgen, O; Tellier, V; Sedrine, W B; De Maeseneer, J; Gosset, C; Reginster, J-Y
The objective was to quantify the outcome of osteoporosis (OP) in terms of health-related quality of life (HR-QOL) and cost of ambulatory care and to look at the association between these two outcomes variables. A cross-sectional health survey of 4800 Belgian individuals over the age of 45 years was used. Individuals having reported OP were retrieved and for each of them, at least two matched individuals for age, sex, residency location, and health insurance status were identified. All individuals were assessed with the SF-36. The two major health insurance providers furnished cost value for ambulatory care. HR-QOL and cost data were compared between the OP group and control group. Beta-coefficients from linear regression were calculated to give information on the relative importance of the association between each SF-36 dimensions and cost of ambulatory care. Of 4796 individuals appropriately surveyed, 221 (4.8%) reported OP. The control group included 651 individuals. The OP group experienced impaired HR-QOL compared to their matched counterparts, all the difference in mean or median SF-36 scores being significant at the level of P vitality dimensions played the most important role in the determination of cost (beta = -0.28, P vitality can play an important role in the determination of cost. Conclusively, they should not be neglected in future management of OP.
Bulger, R J
As prefigured in the Greek tragedy Antigone, one of the primary conflicts in contemporary health care is that between humane concern for the individual and concern for society at large and administrative rules. The computerization of the health care system and development of large data bases will create new forms of this conflict that will challenge the self-definition of health care and health care professionals.
Shaw, Chloe; Stokoe, Elizabeth; Gallagher, Katie; Aladangady, Narendra; Marlow, Neil
The article analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision-making were used by doctors: 'making recommendations' and 'providing options'. Different trajectories for parental involvement in decision-making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. 'Making recommendations' led to misalignment and reduced opportunities for questions and collaboration; 'providing options' led to an aligned approach with opportunities for questions and fuller participation in the decision-making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidance. A Virtual Abstract of this paper can be accessed at: https://www.youtube.com/watch?v=MyuymxDNupk&feature=youtu.be. © 2016 Foundation for the Sociology of Health & Illness.
Full Text Available Abstract Background Developments in information technology promise to revolutionise the delivery of health care by providing access to data in a timely and efficient way. Information technology also raises several important concerns about the confidentiality and privacy of health data. New and existing legislation in Europe and North America may make access to patient level data difficult with consequent impact on research and health surveillance. Although research is being conducted on technical solutions to protect the privacy of personal health information, there is very little research on ways to improve individuals power over their health information. This paper proposes a health care information directive, analogous to an advance directive, to facilitate choices regarding health information disclosure. Results and Discussion A health care information directive is described which creates a decision matrix that combines the ethical appropriateness of the use of personal health information with the sensitivity of the data. It creates a range of possibilities with in which individuals can choose to contribute health information with or without consent, or not to contribute information at all. Conclusion The health care information directive may increase individuals understanding of the uses of health information and increase their willingness to contribute certain kinds of health information. Further refinement and evaluation of the directive is required.
debut (20.8%), 40.8% had multiple sexual partners, 23.3% had sex under the influence of alcohol while. 34.2% didn't use ... PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26(2) 97-106. KEYWORDS. Risky sexual behaviour, young people, ..... 2010;15(1): Art. #505[cited consistent with ...
Up to 11 (7.2%) respondents in the non-BI LGA were not satisfied with the drug services in the health centers, compared ... improvement in primary health care services,. 8 ..... Naves J O, Silver LD. Evaluation of pharmaceutical assistance in public primary care in Brasilia, Brazil. Rev. Saude Publica. 2005; 39(2): 223-30. 21.
Brown, Judith Belle; French, Reta; McCulloch, Amy; Clendinning, Eric
Abstract Objective To explore the knowledge and perceptions of fourth-year medical students regarding the new models of primary health care (PHC) and to ascertain whether that knowledge influenced their decisions to pursue careers in family medicine. Design Qualitative study using semistructured interviews. Setting The Schulich School of Medicine and Dentistry at The University of Western Ontario in London. Participants Fourth-year medical students graduating in 2009 who indicated family medicine as a possible career choice on their Canadian Residency Matching Service applications. Methods Eleven semistructured interviews were conducted between January and April of 2009. Data were analyzed using an iterative and interpretive approach. The analysis strategy of immersion and crystallization assisted in synthesizing the data to provide a comprehensive view of key themes and overarching concepts. Main findings Four key themes were identified: the level of students’ knowledge regarding PHC models varied; the knowledge was generally obtained from practical experiences rather than classroom learning; students could identify both advantages and disadvantages of working within the new PHC models; and although students regarded the new PHC models positively, these models did not influence their decisions to pursue careers in family medicine. Conclusion Knowledge of the new PHC models varies among fourth-year students, indicating a need for improved education strategies in the years before clinical training. Being able to identify advantages and disadvantages of the PHC models was not enough to influence participants’ choice of specialty. Educators and health care policy makers need to determine the best methods to promote and facilitate knowledge transfer about these PHC models. PMID:22518904
Barfoed, Benedicte Marie Lind
Objectives We aim to present new knowledge about different perspectives of health care professionals’ risk perceptions and clinical decision making. Furthermore, we intend to discuss differences between professional and personal risk perceptions and the impact on decisions in terms of both short...... and long-term outcomes. Background Insight into healthcare professionals’ perception of risk is a cornerstone for understanding their strategies for practising preventive care. The way people perceive risk can be seen as part of a general personality trait influenced by a mixture of individual...... considerations and the specific context. Most research has been focused on understanding of the concepts of risk. However healthcare professionals’ risk perception and personal attitudes also affect their clinical decision-making and risk communication. The differences between health care professionals’ personal...
Younger, David S
China has recently emerged as an important global partner. However, like other developing nations, China has experienced dramatic demographic and epidemiologic changes in the past few decades. Population discontent with the health care system has led to major reforms. China's distinctive health care system, including its unique history, vast infrastructure, the speed of health reform, and economic capacity to make important advances in health care, nonetheless, has incomplete insurance coverage for urban and rural dwellers, uneven access, mixed quality of health care, increasing costs, and risk of catastrophic health expenditures. Copyright © 2016 Elsevier Inc. All rights reserved.
Younger, David S
Although a stated right for all Indians, equal access to health care in India is impeded by socioeconomic barriers. With its 3-tier system of public health care centers in villages, district hospitals, and tertiary care hospitals, government expenditure in India is inordinately low, with a disproportionate emphasis on private health spending. Accordingly, the poorest receive a minority of the available subsidies, whereas the richest obtain more than a third, fostering a divide in health care infrastructure across the rich and poor in urban and rural settings. This paradigm has implications for domestic Indian public health and global public health. Copyright © 2016 Elsevier Inc. All rights reserved.
Anchala, Raghupathy; Di Angelantonio, Emanuele; Prabhakaran, Dorairaj; Franco, Oscar H
Hypertension remains the top global cause of disease burden. Decision support systems (DSS) could provide an adequate and cost-effective means to improve the management of hypertension at a primary health care (PHC) level in a developing country, nevertheless evidence on this regard is rather limited. Development of DSS software was based on an algorithmic approach for (a) evaluation of a hypertensive patient, (b) risk stratification (c) drug management and (d) lifestyle interventions, based on Indian guidelines for hypertension II (2007). The beta testing of DSS software involved a feedback from the end users of the system on the contents of the user interface. Software validation and piloting was done in field, wherein the virtual recommendations and advice given by the DSS were compared with two independent experts (government doctors from the non-participating PHC centers). The overall percent agreement between the DSS and independent experts among 60 hypertensives on drug management was 85% (95% CI: 83.61-85.25). The kappa statistic for overall agreement for drug management was 0.659 (95% CI: 0.457-0.862) indicating a substantial degree of agreement beyond chance at an alpha fixed at 0.05 with 80% power. Receiver operator curve (ROC) showed a good accuracy for the DSS, wherein, the area under curve (AUC) was 0.848 (95% CI: 0.741-0.948). Sensitivity and specificity of the DSS were 83.33 and 85.71% respectively when compared with independent experts. A point of care, pilot tested and validated DSS for management of hypertension has been developed in a resource constrained low and middle income setting and could contribute to improved management of hypertension at a primary health care level.
Remsburg, Darren W; Galligan, David T; Ferguson, James D
To use decision and sensitivity analysis to examine the delivery of health care on US dairy farms as measured by correction of left displaced abomasum (LDA). 5 journal articles evaluating outcomes from veterinarian- or herd personnel-delivered correction of LDA via laparotomy or a roll-and-toggle procedure. Economic analysis. A decision tree was constructed on the basis of published outcome data for correction of LDAs performed by veterinarians and herd personnel. Sensitivity of the model to changing input assumptions was evaluated via an indifference curve and tornado graph. Decision tree analysis revealed that correction of an LDA provided by herd personnel had an expected economic advantage of $76, compared with correction provided by a veterinarian. Sensitivity of this analysis to variations in inputs indicated that changes of 2 input levels would shift the advantage to veterinarian-provided correction: a reduction (from 0.74 to 0.62) in the probability of success for correction provided by herd personnel or an increase (from 0.78 to 0.87) in the probability of success for correction provided by a veterinarian. In this model, LDA correction by herd personnel had a significant economic advantage, compared with veterinarian-provided correction. Continued absorption of traditional veterinary tasks by unlicensed herd personnel may threaten the veterinarian-client-patient relationship (VCPR), which could have profound economic and regulatory impacts. Food animal veterinarians need to evaluate their business model to ensure they continue to provide relevant, sustainable services to their clients within the context of a valid VCPR.
... Caregivers Questions to Ask about Advanced Cancer Research Managing Cancer Care Finding Health Care Services Costs & Medical ... Feelings Planning for Advanced Cancer Advanced Cancer & Caregivers Managing Cancer Care Finding Health Care Services Managing Costs ...
Cobden, David S; Niessen, Louis W; Barr, Charles E; Rutten, Frans F H; Redekop, W Ken
Type 2 diabetes (T2D) treatment involves complex interactions between biological, psychological, and behavioral factors of care, requiring multifaceted efforts in clinical practice and disease management to reduce health and economic burdens. We aimed to quantify correlations among these factors and characterize their level of inclusion in economic analyses that are part of informed medical decision-making. A comprehensive, stepwise systematic literature review was performed on published articles dated 1993 to 2008 using medical subject heading and keyword searches in electronic reference libraries. Data were collected using standardized techniques and were analyzed descriptively. A total of 97 articles fulfilling all inclusion criteria were reviewed, including 16 on economic models (17% of articles). Most studies were retrospective (41 of 97; 42%) and from managed care perspectives (66%). Oral antidiabetic drugs were a central focus, appearing in 83% of studies. Patient behaviors, particularly medication adherence and persistence in real-world settings, are well researched (n=65) and may influence diabetes outcomes, cardiovascular risk, mortality rates, and treatment-specific resource use (e.g., hospitalizations) and costs (costs in T2D. Enhancing their inclusion in pharmacoeconomic modeling, notably the influence on clinical effectiveness of variation in self-management between treatments, should ultimately lead to more accurate estimates of comparative cost-effectiveness, and thereby improve value-based resource allocation and patient access to appropriate therapy.
... medicines or supplements that you are taking WHY PREVENTIVE HEALTH CARE IS IMPORTANT Even if you feel ... want to schedule a visit . Another part of preventive health is learning to recognize changes in your ...
Klecun, Ela; Lichtner, Valentina; Cornford, Tony
This paper explores notions of e-Literacy (otherwise IT literacy or digital literacy) in health care. It proposes a multi-dimensional definition of e-Literacy in health care and provides suggestions for policy makers and managers as to how e-Literacy might be accounted for in their decisions.
Politi, Mary C; Kuzemchak, Marie D; Liu, Jingxia; Barker, Abigail R; Peters, Ellen; Ubel, Peter A; Kaphingst, Kimberly A; McBride, Timothy; Kreuter, Matthew W; Shacham, Enbal; Philpott, Sydney E
Since the Affordable Care Act was passed, more than 12 million individuals have enrolled in the health insurance marketplace. Without support, many struggle to make an informed plan choice that meets their health and financial needs. We designed and evaluated a decision aid, Show Me My Health Plans (SMHP), that provides education, preference assessment, and an annual out-of-pocket cost calculator with plan recommendations produced by a tailored, risk-adjusted algorithm incorporating age, gender, and health status. We evaluated whether SMHP compared to HealthCare.gov improved health insurance decision quality and the match between plan choice, needs, and preferences among 328 Missourians enrolling in the marketplace. Participants who used SMHP had higher health insurance knowledge (LS-Mean = 78 vs. 62; P < 0.001), decision self-efficacy (LS-Mean = 83 vs. 75; P < 0.002), confidence in their choice (LS-Mean = 3.5 vs. 2.9; P < 0.001), and improved health insurance literacy (odds ratio = 2.52, P <0.001) compared to participants using HealthCare.gov. Those using SMHP were 10.3 times more likely to select a silver- or gold-tier plan (P < 0.0001). SMHP can improve health insurance decision quality and the odds that consumers select an insurance plan with coverage likely needed to meet their health needs. This study represents a unique context through which to apply principles of decision support to improve health insurance choices.
Rothman, Brian; Leonard, Joan C; Vigoda, Michael M
The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data
Early detection and treatment of these morbidities could prevent deterioration. The aim of the survey was to determine and compare the prevalence of ..... interventions. Increasing the detection rate of mental morbidity in the community is fundamental. The inclusion of mental health care as a component of primary health ...
large extent can reduce financial barriers to options; including government budgetary health care access ..... managers and demand-side factors, such as. International Health Conference. New adverse selection in ... patients in the scheme, and patient demand for. Information Centre. 1995. insured services. Many previous ...
Institute of Medicine; Roundtable on Value and Science-Driven Health Care
"The Institute of Medicine's Roundtable on Value & Science-Driven Health Care held a workshop, titled Partnering with Patients to Drive Shared Decisions, Better Value, and Care Improvement, on February 25 and 26, 2013...
... map [a-z] More VA More VA Health Health Care Information A-Z Health Topic Finder My Health ... General QUICK LIST Apply for Benefits Apply for Health Care Prescriptions My Health e Vet eBenefits Life Insurance ...
Durocher, Evelyne; Chung, Ryoa; Rochon, Christiane; Hunt, Matthew
Vulnerability is a central concept in humanitarian aid. Discussions of vulnerability in disaster response literature and guidelines for humanitarian aid range from considerations of a universal human vulnerability, to more nuanced examinations of how particular characteristics render individuals more or less at risk. Despite its frequent use, there is a lack of clarity about how vulnerability is conceptualized and how it informs operational priorities in humanitarian assistance. Guided by interpretive description methodology, we draw on the feminist taxonomy of vulnerability presented by Mackenzie, Rogers and Dodds (2014) to examine perspectives of 24 expatriate and Haitian decision-makers and health professionals interviewed between May 2012 and March 2013. The analysis explores concepts of vulnerability and equity in relation to the humanitarian response following the 2010 earthquake in Haiti. Participants' conceptualizations of vulnerability included consideration for inherent vulnerabilities related to individual characteristics (e.g. being a woman or disabled) and situational vulnerabilities related to particular circumstances such as having less access to health care resources or basic necessities. Participants recognized that vulnerabilities could be exacerbated by socio-political structures but felt ill-equipped to address these. The use of the taxonomy and a set of questions inspired by Hurst's (2008) approach to identifying and reducing vulnerability can guide the analysis of varied sources of vulnerability and open discussions about how and by whom vulnerabilities should be addressed in humanitarian responses. More research is required to inform how humanitarian responders could balance addressing acute vulnerability with consideration of systemic and pre-existing circumstances that underlie much of the vulnerability experienced following an acute disaster.
Chung, Ryoa; Rochon, Christiane; Hunt, Matthew
Vulnerability is a central concept in humanitarian aid. Discussions of vulnerability in disaster response literature and guidelines for humanitarian aid range from considerations of a universal human vulnerability, to more nuanced examinations of how particular characteristics render individuals more or less at risk. Despite its frequent use, there is a lack of clarity about how vulnerability is conceptualized and how it informs operational priorities in humanitarian assistance. Guided by interpretive description methodology, we draw on the feminist taxonomy of vulnerability presented by Mackenzie, Rogers and Dodds (2014) to examine perspectives of 24 expatriate and Haitian decision-makers and health professionals interviewed between May 2012 and March 2013. The analysis explores concepts of vulnerability and equity in relation to the humanitarian response following the 2010 earthquake in Haiti. Participants’ conceptualizations of vulnerability included consideration for inherent vulnerabilities related to individual characteristics (e.g. being a woman or disabled) and situational vulnerabilities related to particular circumstances such as having less access to health care resources or basic necessities. Participants recognized that vulnerabilities could be exacerbated by socio-political structures but felt ill-equipped to address these. The use of the taxonomy and a set of questions inspired by Hurst’s (2008) approach to identifying and reducing vulnerability can guide the analysis of varied sources of vulnerability and open discussions about how and by whom vulnerabilities should be addressed in humanitarian responses. More research is required to inform how humanitarian responders could balance addressing acute vulnerability with consideration of systemic and pre-existing circumstances that underlie much of the vulnerability experienced following an acute disaster. PMID:27617037
Matos, Ana Raquel
This article explores the controversial decision made by the Ministry of Health to restructure the perinatal emergency services in Portugal in 2006. Particular emphasis is given to the protests held across the country against, the actors involved, and the arguments put forward for and against the measure, in an attempt to understand the forms of knowledge and experiences brought to the discussion about the issues raised by the decision, and how different forms of knowledge are reconciled under a democratic process. In addition, this article explores the importance of citizen participation, including that which emerges from conflicting relations, in the formulation of health policies.
Escher, Monica; Nendaz, Mathieu; Ricou, Bara
Palliative care patients have limited prospects of survival and the benefit of intensive care is uncertain. To make a decision there are considerations other than survival probabilities. Patients should receive appropriate care and be spared suffering. End of life in the intensive care unit has an impact on families, who may develop psychological problems or complicated grief. End of life care can be a source of conflicts and cause burnout in health providers. Finally, intensive care is an expensive resource, which must be fairly allocated. In these complex situations, patient preferences help make a decision. However, they have often not been discussed with the physicians. General practitioners have a role to play by promoting advance care planning with their patients.
Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda
ABSTRACT: BACKGROUND: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four indicators of health care were...... assessed: Compliance with current guidelines on initiation of 1) combination antiretroviral therapy (cART), 2) chemoprophylaxis, 3) frequency of laboratory monitoring, and 4) virological response to cART (proportion of patients with HIV-RNA 90% of time on cART). RESULTS: 7097 Euro...... to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East and Argentina (adjusted OR 0.16[95%CI 0.11-0.23, p HIV health care utilization...
Full Text Available BackgroundAboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD. Despite the importance of absolute cardiovascular risk assessment (CVRA as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions. We also examine the proportion with elevated risk and follow-up actions recorded.MethodsWe undertook cross-sectional analysis of 2,052 client records from 97 PHC centers to assess CVRA in Indigenous adults aged ≥20 years with no recorded chronic disease diagnosis (2012–2014. Multilevel regression was used to quantify the variation in CVRA attributable to health center and client level factors. The main outcome measure was the proportion of eligible adults who had CVRA recorded. Secondary outcomes were the proportion of clients with elevated risk that had follow-up actions recorded.ResultsApproximately 23% (n = 478 of eligible clients had documented CVRA. Almost all assessments (99% were conducted in the Northern Territory. Within this jurisdiction, there was wide variation between centers in the proportion of clients with documented CVRA (median 38%; range 0–86%. Regression analysis showed health center factors accounted for 48% of the variation. Centers with integrated clinical decision support systems were more likely to document CVRA (OR 21.1; 95% CI 5.4–82.4; p < 0.001. Eleven percent (n = 53 of clients were found with moderate/high CVD risk, of whom almost one-third were under 35 years (n = 16. Documentation of follow-up varied with respect to the targeted risk factor
In the globalized knowledge economy, the challenge of translating knowledge into policy and practice is universal. At the dawn of the 21st century, the clinicians, leaders, and managers of health care organizations are increasingly required to bridge the research-practice gap. A shift from moving evidence to solving problems is due. However, despite a vast literature on the burgeoning field of knowledge translation research, the ?evidence-based? issue remains for many health care professional...
Bowman, Darcia Harris
The Broad Acres clinic is one of 1,500 school-based health centers nationwide that bring a wide range of medical, nutritional, and mental-health care to millions of students and their families. The centers provide an important safety net for children and adolescents--particularly the more than 10 million today who lack health insurance, according…
The liberalization of health care in the course of three decades of ‘reform and opening up’ has given people in rural China access to a diverse range of treatment options, but the health care system has also been marred by accusations of price hikes, fake pharmaceuticals, and medical malpractice...... roads to healing. The recent introduction of new rural cooperative medicine in the township represents an attempt to bring the state back in and address popular concern with the cost and quality of health care. While superficially reminiscent of the traditional socialist system, this new state attempt...
9192,861 6141,372 KEN65.3 ORL ANS $30.77T $35.14 134.44 635.77 62,409,314 62,285,479 1696I NEWOR*1 NN54.35 637.50 S40.99 542.55 56,480,605 164.&24,20...u.Aabulatory Care BA medical Car* BAA j7nternalCMedicine BAD Alegy Clinic SAC Cardiology Clinic &At Diabetic Clinic % mAJ Endocrinology Nypetensiofi...ACCOUNT NAME N VISIT COST SA MEDICAL CARE 104 53.14 8AA INTERNAL MEDICINE 95 $69.81 SAS ALLERGY 23 $16.70 SAC CARDIOLOGY 23 $44.61 SAE DIABETIC 10
2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, Nigeria. 1. 2. Adam V.Y , Iseh A.E. ABSTRACT. Introduction. The level of accurate knowledge adolescents have about HIV/AIDS, is important to enhance effective preventive actions, which ultimately result in a decrease in the incidence of ...
Enterobacter spp. 1. 0.6. Table V: Proportion of Respondent that enter the Ward with Handheld Device. Table VI: Proportion of Respondent that Disinfect Phones and what they Disinfect with. Table VII: Hand Hygiene Practices. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 27, NO 1, MARCH ...
globally, (Ischaemic heart diseases, Convention on Tobacco Control (FCTC), which. 5 cerebrovascular diseases, lower ... tract infections, chronic obstructive than 86% of the world's population. Tobacco pulmonary diseases ... and delivery of smoking cessation services among health care workers in Abuja. A cross sectional ...
Hollnagel, E.; Braithwaite, J.; Wears, R. L.
Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean...... production, and high reliability. This has on the whole been met with limited success because health care as a non-trivial and multifaceted system differs significantly from most traditional industries. In order to allow health care systems to perform as expected and required, it is necessary to have...... engineering's unique approach emphasises the usefulness of performance variability, and that successes and failures have the same aetiology. This book contains contributions from acknowledged international experts in health care, organisational studies and patient safety, as well as resilience engineering...
Borel, M; Veber, B; Villette-Baron, K; Hariri, S; Dureuil, B; Hervé, C
Decision-making bringing to an admission or not in intensive care is complex. The aim of this study is to analyze with an ethical point of view the making decision process leading to the refusal and its consequences. It is proposed a setting in prospect through the principles of beneficence, non-maleficience, respect for autonomy, justice, and the Leonetti law. Prospective study in surgical reanimation at the University Hospital of Rouen over 9 months (November 2007-September 2008). Systematic collection for each non-admitted patient of the general characters, the methods of decision making, immediate becoming and within 48 h Constitution of two groups: patients for whom an admission in intensive care could be an unreasonable situation of obstinacy, and patients for whom an admission in reanimation would not be about unreasonable if it occurred. One hundred and fifty situations were analyzed. The potentially unreasonable character of an admission does not involve necessarily a refusal of care in intensive care. The question of the lack of place and equity in the access to the care is real but relative according to the typology of the patients. The research of the respect of the autonomy of the patient is difficult but could be facilitated. The Leonetti law does not appear to be able to be a framework with the situation of refusal of care in intensive care. It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.
Eibner, Christine; Girosi, Federico; Miller, Amalia; Cordova, Amado; McGlynn, Elizabeth A; Pace, Nicholas M; Price, Carter C; Vardavas, Raffaele; Gresenz, Carole Roan
The Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (ACA) changes the regulatory environment within which health insurance policies on the small-group market are bought and sold. New regulations include rate bands that limit premium price variation, risk-adjustment policies that will transfer funds from low-actuarial-risk to high-actuarial-risk plans, and requirements that plans include "essential health benefits." While the new regulations will be applied to all non-grandfathered fully insured policies purchased by businesses with 100 or fewer workers, self-insured plans are exempt from these regulations. As a result, some firms may have a stronger incentive to offer self-insured plans after the ACA takes full effect. In this article we identify factors that influence employers' decisions to self-insure and estimate how the ACA will influence self-insurance rates. We also consider the implications of higher self-insurance rates for adverse selection in the non-self-insured small-group market and whether enrollees in self-insured plans receive different benefits than enrollees in fully-insured plans. Results are based on data analysis, literature review, findings from discussions with stakeholders, and microsimulation analysis using the COMPARE model. Overall, we find little evidence that self-insured plans differ systematically from fully insured plans in terms of benefit generosity, price, or claims denial rates. Stakeholders expressed significant concern about adverse selection in the health insurance exchanges due to regulatory exemptions for self-insured plans. However, our microsimulation analysis predicts a sizable increase in self-insurance only if comprehensive stop-loss policies become widely available after the ACA takes full effect and the expected cost of self-insuring with stop-loss is comparable to the cost of being fully insured in a market without rating regulations.
Thompson, Michael; Cutler, Charles M
One of the contributing factors to both the increase in health care costs and the backlash to managed care was the lack of consumer awareness of the cost of health care service, the effect of health care costs on profits and wages, and the need to engage consumers more actively as consumers in health care decisions. This article reviews the birth of the health care consumerism movement and identifies gaps in health care consumerism today. The authors reveal some of the keys to building a sustainable health care consumerism framework, which involves enlisting consumers as well as other stakeholders.
Oliveira, Beatriz Rosana Gonçalves de; Collet, Neusa; Viera, Cláudia Silveira
This study aims to reflect on humanization in health care, recovering the history of understanding about mankind, the human and humanity, until humanization in humanity and health. We discuss the national humanization program in hospital care and reflect on this proposal and on the issue of humanization in Brazilian health care nowadays. Communication is indispensable to establish humanization, as well as technical and material conditions. Both users and health professionals need to be heard, building a network of dialogues to think and promote singular humanization actions. For this process to take effect, there is a need to involve the whole that makes up the health service. This group involves different professionals, such as managers, public policy makers, professional councils and education institutions.
Youngkong, S.; Baltussen, R.M.; Tantivess, S.; Mohara, A.; Teerawattananon, Y.
OBJECTIVES: Considering rising health expenditure on the one hand and increasing public expectations on the other hand, there is a need for explicit health care rationing to secure public acceptance of coverage decisions of health interventions. The National Health Security Office, the institute
Hallgren, Jenny; Ernsth Bravell, Marie; Dahl Aslan, Anna K; Josephson, Iréne
The purpose of this study was to explore how older people experience and perceive decisions to seek hospital care while receiving home health care. Twenty-two Swedish older persons were interviewed about their experiences of decision to seek hospital while receiving home health care. The interviews were analyzed using qualitative content analysis. The findings consist of one interpretative theme describing an overall confidence in hospital staff to deliver both medical and psychosocial health care, In Hospital We Trust, with three underlying categories: Superior Health Care, People's Worries, and Biomedical Needs. Findings indicate a need for establishing confidence and ensuring sufficient qualifications, both medical and psychological, in home health care staff to meet the needs of older people. Understanding older peoples' arguments for seeking hospital care may have implications for how home care staff address individuals' perceived needs. Fulfillment of perceived health needs may reduce avoidable hospitalizations and consequently improve quality of life. Copyright © 2015 Elsevier Inc. All rights reserved.
Bakker, D.H. de; Zwaanswijk, M.; Zantinge, E.M.; Verhaak, P.F.M.
One of the goals of the current health care reform in the Netherlands is to strengthen demand orientation. Community based primary health care provision should be tuned to local demand. Information on local demand is missing, however. Research goal is to provide local decision makers (patient
This paper presents a short discussion of essential concepts in primary health care based on the Alma Ata Declaration of 1978 and a brief description of the Philippine Ministry of Health primary health program. The phrase primary health care implies that PHC is a package of goods to be delivered to people, whereas in fact it is an approach to health care which emphasizes community involvement and participation in health development. Community participation is too often taken to mean that communities should participate in programs designed, implemented, and run by health professionals. PHC however requires that health programs be designed, implemented, run by, and belong to the people of the community. External agencies and health professionals must find ways of becoming involved and participating in the community's programs. A thorough reorientation of health professionals, particularly doctors and nurses, away from technology and toward the ideals and wisdom of the people is needed if PHC is to succeed. PHC should provide the bridge between technological knowledge and indigenous wisdom. The national government is embarking on a nationwide PHC program, with structures being organized at national, regional, provincial, municipal, and barangay levels for PHC. The higher organizational levels are intended to ensure access to their available resources to complement resources at the lower levels, especially at the critical barangay level. Because over 70% of the national population lives in rural areas, the national government's effort through the Ministry of Health will stress rural needs and approaches. Different approaches will be needed for poor urban communities, and the Manila Health Department may be able to provide leadership for developing the new ideas needed to tailor health development programs to Filipino urban communities.
Weel, C. van; Schers, H.J.; Timmermans, A.
This article analyzes Dutch experiences of health care reform--in particular in primary care--with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and
Jacobsen, Christian Bøtcher; Andersen, Lotte Bøgh; Serritzlew, Søren
An important task in governing health services is to control costs. The literatures on both costcontainment and supplier induced demand focus on the effects of economic incentives on health care costs, but insights from these literatures have never been integrated. This paper asks how economic cost...... containment measures affect the utilization of health services, and how these measures interact with the number of patients per provider. Based on very valid register data, this is investigated for 9.556 Danish physiotherapists between 2001 and 2008. We find that higher (relative) fees for a given service...... make health professionals provide more of this service to each patient, but that lower user payment (unexpectedly) does not necessarily mean higher total cost or a stronger association between the number of patients per supplier and the health care utilization. This implies that incentives...
and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicaid is a federal and...living care. “Medicine has been slow to confront the very changes that it has been responsible for – or to apply the knowledge we already have about how...challenge to the nation. Challenges of the Industry As already outlined, a number of challenges confront the U.S. health care industry. Below are six
Marušič, Dorjan; Prevolnik Rupel, Valentina
In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.
Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.
Vivian, Lauraine; Marais, Adele; McLaughlin, Sean; Falkenstein, Sandra; Argent, Andrew
To assess the care-giving practices of health-care practitioners in the paediatric intensive care unit (PICU) through their qualitative insights, reflections and experience in participatory action research. Qualitative research in the form of 'participatory action research' was used to gather data from three sources within the unit: focus groups within disciplines, observations within the PICU, and semi-structured interviews. All staff members were active collaborators and equal stakeholders in the decision-making process, research and feedback. The paediatric intensive care unit (PICU) of the Red Cross War Memorial Children's Hospital (RCWMCH). All staff members from various disciplines working in the PICU. Staff members described problems with respect to relationships, trust and decision-making within care-giving practices. The study qualitatively describes how poor communication amongst staff members in respect of relationships and decision-making impacted on trust and how this tended to compromise care-giving practices in the PICU. The data suggested that this was more evident in informal rather than formal clinical decision-making procedures. The strength of the study was that the participatory action design in the research allowed staff members to address the very dynamics that they themselves cited as problematic.
Chrimes, Dillon; Kitos, Nicole R; Kushniruk, Andre; Mann, Devin M
Usability testing can be used to evaluate human-computer interaction (HCI) and communication in shared decision making (SDM) for patient-provider behavioral change and behavioral contracting. Traditional evaluations of usability using scripted or mock patient scenarios with think-aloud protocol analysis provide a way to identify HCI issues. In this paper we describe the application of these methods in the evaluation of the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) tool, and test the usability of the tool to support the ADAPT framework for integrated care counseling of pre-diabetes. The think-aloud protocol analysis typically does not provide an assessment of how patient-provider interactions are effected in "live" clinical workflow or whether a tool is successful. Therefore, "Near-live" clinical simulations involving applied simulation methods were used to compliment the think-aloud results. This complementary usability technique was used to test the end-user HCI and tool performance by more closely mimicking the clinical workflow and capturing interaction sequences along with assessing the functionality of computer module prototypes on clinician workflow. We expected this method to further complement and provide different usability findings as compared to think-aloud analysis. Together, this mixed method evaluation provided comprehensive and realistic feedback for iterative refinement of the ADAPT system prior to implementation. The study employed two phases of testing of a new interactive ADAPT tool that embedded an evidence-based shared goal setting component into primary care workflow for dealing with pre-diabetes counseling within a commercial physician office electronic health record (EHR). Phase I applied usability testing that involved "think-aloud" protocol analysis of eight primary care providers interacting with several scripted clinical scenarios. Phase II used "near-live" clinical simulations of five providers interacting with standardized
Full Text Available Process Nursing Care (PAE is a systematic tool that facilitates the scientificity of care in community practice nurse, the application of scientific method in community practice, allows nursing to provide care in logical, systematic and comprehensive reassessing interventions to achieve the proposed results. It began with the valuation of Marjory Gordon Functional Patterns and then at the stage of diagnosis and planning North American Nursing Diagnosis Association (NANDA, Nursing Interventions Classification (NIC and Nursing Outcomes Classification (NOC is interrelate. It is a descriptive and prospective study. Diagnosis was made by applying the instruments measuring scale of the socio-demographic characteristics, symptom questionnaire for early detection of mental disorders in the community and appreciation for functional patterns. The PAE includes more frequent diagnoses, criteria outcomes, indicators, interventions and activities to manage community issues. alteration was evidenced in patterns: Adaptation and Stress Tolerance, Self-perception-Self-concept-, Role-Relationships, sleep and rest and Perception and Health Management. A standardized NANDA-NIC-NOC can provide inter care holistic care from the perspective of community mental health with a degree of scientific nature that frames the professional work projecting the individual, family and community care.
... Program SNF Requirements of Participation SNF Value-Based Purchasing (SNF VBP) Survey and Regulatory Therapy Services Workforce ... out, stay informed and spread. Looking for more information reguarding Prefered Provider Program Quality Care Book Store ... Nursing Home Administrator | Benedictine Health System US - MO - St. Louis, Qualifications Required: Bachelor’s degree ...
... Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Related MedlinePlus Health Topics Home Care Services Browse the Encyclopedia A.D.A.M., ...
Vrangbæk, Karsten; Byrkjeflot, Haldor
adjustment of such frameworks. In this article we present a framework for analyzing accountability within health care. The paper makes use of the concept of "accountability regime" to signify the combination of different accountability forms, directions and functions at any given point in time. We show...
Bisantz, Ann M; Fairbanks, Rollin J
Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...
Chaudry, Ajay; Henly, Julia; Meyers, Marcia
This working paper is one in a series of projects initiated by the Administration for Children and Families (ACF) to improve knowledge for child care researchers and policy makers about parental child care decision making. In this paper, the authors identify three distinct conceptual frameworks for understanding child care decisions--a rational…
Lavoie, Josée G; Kaufert, Joseph; Browne, Annette J; O'Neil, John D
Accessing cancer treatment requires First Nation peoples living in rural and remote communities to either commute to care, or to relocate to an urban centre for the length or part of the treatment. While Canadians living in rural and remote communities must often make difficult decisions following a cancer diagnosis, such decisions are further complicated by the unique policy and socio-historical contexts affecting many First Nation peoples in Canada. These contexts often intersect with negative healthcare experiences which can be related to jurisdictional confusion encountered when seeking care. Given the rising incidence of cancer within First Nation populations, there is a growing potential for negative health outcomes. The analysis presented in this paper focuses on the experience of First Nation peoples' access to cancer care in the province of Manitoba. We analyzed policy documents and government websites; interviewed individuals who have experienced relocation (N = 5), family members (N = 8), healthcare providers and administrators (N = 15). Although the healthcare providers (social workers, physicians, nurses, patient navigators, and administrators) we interviewed wanted to assist patients and their families, the focus of care remained informed by patients' clinical reality, without recognition of the context which impacts and constrains access to cancer care services. Contrasting and converging narratives identify barriers to early diagnosis, poor coordination of care across jurisdictions and logistic complexities that result in fatigue and undermine adherence. Providers and decision-makers who were aware of this broader context were not empowered to address system's limitations. We argue that a whole system's approach is required in order to address these limitations.
Knerr, Sarah; Wernli, Karen J; Leppig, Kathleen; Ehrlich, Kelly; Graham, Amanda L; Farrell, David; Evans, Chalanda; Luta, George; Schwartz, Marc D; O'Neill, Suzanne C
Mammographic breast density is one of the strongest risk factors for breast cancer after age and family history. Mandatory breast density disclosure policies are increasing nationally without clear guidance on how to communicate density status to women. Coupling density disclosure with personalized risk counseling and decision support through a web-based tool may be an effective way to allow women to make informed, values-consistent risk management decisions without increasing distress. This paper describes the design and methods of Engaged, a prospective, randomized controlled trial examining the effect of online personalized risk counseling and decision support on risk management decisions in women with dense breasts and increased breast cancer risk. The trial is embedded in a large integrated health care system in the Pacific Northwest. A total of 1250 female health plan members aged 40-69 with a recent negative screening mammogram who are at increased risk for interval cancer based on their 5-year breast cancer risk and BI-RADS® breast density will be randomly assigned to access either a personalized web-based counseling and decision support tool or standard educational content. Primary outcomes will be assessed using electronic health record data (i.e., chemoprevention and breast MRI utilization) and telephone surveys (i.e., distress) at baseline, six weeks, and twelve months. Engaged will provide evidence about whether a web-based personalized risk counseling and decision support tool is an effective method for communicating with women about breast density and risk management. An effective intervention could be disseminated with minimal clinical burden to align with density disclosure mandates. Clinical Trials Registration Number:NCT03029286. Copyright © 2017 Elsevier Inc. All rights reserved.
On May 14, 2013, Angelina Jolie disclosed she carries BRCA1, which means she has an 87% risk of developing breast cancer during her lifetime. Jolie decided to undergo a preventative bilateral mastectomy (PBM), reducing her risk to 5%. The purpose of this study was to analyze the type of information individuals are exposed to when using the Internet to search health information regarding Jolie's decision. Qualitative content analysis revealed four main themes--information about genetics, information about a PBM, information about health care, and information about Jolie's gender identity. Broadly, the identified websites mention Jolie's high risk for developing cancer due to the genetic mutation BRCA1, describe a PBM occasionally noting reasons why she had this surgery and providing alternatives to the surgery, discuss issues related to health care services, costs, and insurances about Jolie's health decision, and portray Jolie as a sexual icon, a partner to Brad Pitt, a mother of six children, and an inspirational humanitarian. The websites also depict Jolie's health decision in positive, negative, and/or both ways. Discussion centers on how this actress' health decision impacts the public.
Boisvert, Isabelle; Clemesha, Jennifer; Lundmark, Erik; Crome, Erica; Barr, Caitlin; McMahon, Catherine M.
Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of ...
Kaltoft, Mette Kjer; Nielsen, Jesper Bo; Salkeld, Glenn
of the effects of different actions and interventions on their health, including those implying contact with health care services. We see their research as primarily carried out in order to make better decisions for themselves, but they can offer to contribute the results to the wider population. We see...... to increased user involvement, though somewhat more aligned with the former. METHODS: Our online decision support tools, delivered directly to the person in the community and openly accessible, are to be seen as research resources. They will take the form of interactive decision aids for a variety of specific...
Macdonald, Marilyn; Lang, Ariella; MacDonald, Jo-Anne
The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health care providers, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be…
Huízar-Hernández, Víctor; Arredondo, Armando; Caballero, Marta; Castro-Ríos, Angélica; Flores-Hernández, Sergio; Pérez-Padilla, Rogelio; Reyes-Morales, Hortensia
The aim of the study was to analyze, using a decision analysis approach, the probability of severity of illness due to delayed utilization of health services and inappropriate hospital medical treatment during the 2009 AH1N1 influenza epidemic in Mexico. Patients with influenza AH1N1 confirmed by the polymerase chain reaction (PCR) test from two hospitals in Mexico City, were included. Path methodology based upon literature and validated by clinical experts was followed. The probability for severe illness originated from delayed utilization of health services, delayed prescription of neuraminidase inhibitors (NAIs) and inappropriate use of antibiotics was assessed. Ninety-nine patients were analyzed, and 16% developed severe illness. Most patients received NAIs and 85.9% received antibiotics. Inappropriate use of antibiotics was observed in 70.7% of cases. Early utilization of services increased the likelihood of non-severe illness (cumulative probability CP = 0.56). The major cumulative probability for severe illness was observed when prescription of NAIs was delayed (CP = 0.19). Delayed prescription of NAIs and irrational use of antibiotics are critical decisions for unfavorable outcomes in patients suffering influenza AH1N1. Copyright © 2017 IMSS. Published by Elsevier Inc. All rights reserved.
Tinetti, Mary E; Esterson, Jessica; Ferris, Rosie; Posner, Philip; Blaum, Caroline S
Older adults with multiple conditions receive care that is often fragmented, burdensome, and of unclear benefit. An advisory group of patients, caregivers, clinicians, health system engineers, health care system leaders, payers, and others identified three modifiable contributors to this fragmented, burdensome care: decision making and care focused on diseases, not patients; inadequate delineation of roles and responsibilities and accountability among clinicians; and lack of attention to what matters to patients and caregivers (ie, their health outcome goals and care preferences). The advisory group identified patient priority-directed care as a feasible, sustainable approach to addressing these modifiable factors. Copyright © 2016 Elsevier Inc. All rights reserved.
Maternal and neonatal deaths and morbidity still pose an enormous challenge for health authorities in Ghana, a lower middle income country. Despite massive investments in maternal and neonatal health and special attention through Millennium Development Goals (MDG) 4
Chowdhury, Tanvir Turin; Hemmelgarn, Brenda
Health-care systems require reliable information on which to base health-care planning and make decisions, as well as to evaluate their policy impact. Administrative data provide important information about health services use, expenditures, clinical outcomes, and may be used to assess quality of care. With increased digitalization and accessibility of administrative databases, these data are more readily available for health service research purposes, aiding evidence-based decision-making. This chapter discusses the utility of administrative data for population-based studies of health and health care.
Chin, Jean Lau; Yee, Barbara W K; Banks, Martha E
As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.
Implementing an evidence-based computerized decision support system linked to electronic health records to improve care for cancer patients: the ONCO-CODES study protocol for a randomized controlled trial.
Moja, Lorenzo; Passardi, Alessandro; Capobussi, Matteo; Banzi, Rita; Ruggiero, Francesca; Kwag, Koren; Liberati, Elisa Giulia; Mangia, Massimo; Kunnamo, Ilkka; Cinquini, Michela; Vespignani, Roberto; Colamartini, Americo; Di Iorio, Valentina; Massa, Ilaria; González-Lorenzo, Marien; Bertizzolo, Lorenzo; Nyberg, Peter; Grimshaw, Jeremy; Bonovas, Stefanos; Nanni, Oriana
Computerized decision support systems (CDSSs) are computer programs that provide doctors with person-specific, actionable recommendations, or management options that are intelligently filtered or presented at appropriate times to enhance health care. CDSSs might be integrated with patient electronic health records (EHRs) and evidence-based knowledge. The Computerized DEcision Support in ONCOlogy (ONCO-CODES) trial is a pragmatic, parallel group, randomized controlled study with 1:1 allocation ratio. The trial is designed to evaluate the effectiveness on clinical practice and quality of care of a multi-specialty collection of patient-specific reminders generated by a CDSS in the IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) hospital. We hypothesize that the intervention can increase clinician adherence to guidelines and, eventually, improve the quality of care offered to cancer patients. The primary outcome is the rate at which the issues reported by the reminders are resolved, aggregating specialty and primary care reminders. We will include all the patients admitted to hospital services. All analyses will follow the intention-to-treat principle. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in cancer hospitals, thereby informing healthcare policy about the potential role of CDSS use. Furthermore, the study will inform whether CDSS may facilitate the integration of primary care in cancer settings, known to be usually limited. The increasing use of and familiarity with advanced technology among new generations of physicians may support integrated approaches to be tested in pragmatic studies determining the optimal interface between primary and oncology care. ClinicalTrials.gov, NCT02645357.
Aabenhus, Mette Morre; Schriver, Michael; Kallestrup, Per
Global health interventions often focus on specific diseases, thus forming vertical programmes. Studies show that vertical programmes perform poorly, which underlines the need for a horizontal basis: universal community-based primary health care, which improves health equity and outcomes. The diagonal approach supports an integrated patient-centered health-care system. The ''15% by 2015''-initiative suggests that vertical programmes invest 15% of their budgets in strengthening integrated primary health care. Strategies depend on local context.
Van Bewer, Vanessa
To analyze the concept of transdisciplinarity and provide an enhanced definition of transdisciplinarity in health care. The term transdisciplinarity is increasingly prevalent in health care research and has been identified as important to improving the effectiveness and efficiency in health care. However, the term continues to be misappropriated and poorly understood by researchers and clinicians alike which hinders its potential use and impact. Walker and Avant's (2005) method of concept analysis was used as a framework for the study of the concept. The databases PubMed, CINAHL, Academic Search Premier, PsycInfo and ERIC were used searching the terms transdisciplinarity, transdisciplinary, interdisciplinary and interdisciplinarity. Transdisciplinarity in health care involves transcending of disciplinary boundaries, a sharing of knowledge, skills and decision-making, a focus on real-world problems and the inclusion of multiple stakeholders including patients, their families and their communities. An enhanced definition of transdisciplinarity in health care emerged from this concept analysis that may provide clarity and direction for health care providers. Nurses, and other health care providers, can look to this definition to understand transdisciplinary health care teams as opposed to multidisciplinary, and interdisciplinary ones. © 2017 Wiley Periodicals, Inc.
Vissers, J M
Modelling-based health care management ought to become just as popular as evidence based medicine. Making managerial decisions based on evidence by modelling efforts is certainly a step forward. Examples can be given of many successful applications in different areas of decision making: disease process modelling, screening and prevention policy development, resource allocation, waiting lists and waiting times, patient scheduling. Also examples can be given which would have benefited by prior modelling, for example adverse effects of health care system reform decisions. This contribution aims at giving an overview of health care management modelling areas, and observations from a European perspective on developing successful health care management models. The overview is created by presenting different reference frameworks for mapping health care management modelling applications. We report a development from an almost arbitrary list of applications used for bibliographic purposes (scheduling, simulation, queueing, etc.) towards frameworks that focus on the process of delivery. The advantage of mapping modelling applications in this way is that we are able to position contributions within a reference framework with a focus on processes, with the patient process at the top. The acceptance of process-orientation as a basis for modelling has consequences for the way models are developed. Close cooperation between modeller and manager and a profound insight into the dynamics of the modelling area concerned are important requirements for developing successful models. This is illustrated for waiting lists as an area of modelling.
Korfmacher, Katrina Smith; Aviles, Katia; Cummings, B J; Daniell, William; Erdmann, Jared; Garrison, Valerie
Health impact assessments (HIA) promote the consideration of health in a wide range of public decisions. Although each HIA is different, common pathways, evidence bases, and strategies for community engagement tend to emerge in certain sectors, such as urban redevelopment, natural resource extraction, or transportation planning. To date, a limited number of HIAs have been conducted on decisions affecting water resources and waterfronts. This review presents four recent HIAs of water-related decisions in the United States and Puerto Rico. Although the four cases are topically and geographically diverse, several common themes emerged from the consideration of health in water-related decisions. Water resource decisions are characterized by multiple competing uses, inter-institutional and inter-jurisdictional complexity, scientific uncertainty, long time scales for environmental change, diverse cultural and historical human values, and tradeoffs between private use and public access. These four case studies reveal challenges and opportunities of examining waterfront decisions through a "health lens". This review analyzes these cases, common themes, and lessons learned for the future practice of HIA in the waterfront zone and beyond.
Woltmann, Emily M; Wilkniss, Sandra M; Teachout, Alexandra; McHugo, Gregory J; Drake, Robert E
Involvement of community mental health consumers in mental health decision making has been consistently associated with improvements in health outcomes. Electronic decision support systems (EDSSs) that support both consumer and provider decision making may be a sustainable way to improve dyadic communication in a field with approximately 50% workforce turnover per year. This study examined the feasibility of such a system and investigated proximal outcomes of the system's performance. A cluster randomized design was used to evaluate an EDSS at three urban community mental health sites. Case managers (N=20) were randomly assigned to the EDSS-supported planning group or to the usual care planning group. Consumers (N=80) were assigned to the same group as their case managers. User satisfaction with the care planning process was assessed for consumers and case managers (possible scores range from 1 to 5, with higher summary scores indicating more satisfaction). Recall of the care plan was assessed for consumers. Linear regression with adjustment for grouping by worker was used to assess satisfaction scores. A Wilcoxon rank-sum test was used to examine knowledge of the care plan. Compared with case managers in the control group, those in the intervention group were significantly more satisfied with the care planning process (mean ± SD score=4.0 ± .5 versus 3.3 ± .5; adjusted p=.01). Compared with consumers in the control group, those in the intervention group had significantly greater recall of their care plans three days after the planning session (mean proportion of plan goals recalled=75% ± 28% versus 57% ± 32%; p=.02). There were no differences between the clients in the intervention and control groups regarding satisfaction. This study demonstrated that clients can build their own care plans and negotiate and revise them with their case managers using an EDSS.
@hotmail.com, A.Ehigiegba@shell.com. KEYWORDS. Volunteer,. Obio Cottage. Hospital,. Participants,. Nigeria journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care.
... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Types of health care providers URL of this page: //medlineplus.gov/ency/article/001933.htm Types of health care providers To ...
... medlineplus.gov/ency/patientinstructions/000878.htm Understanding your health care costs To use the sharing features on this ... This is the payment you make for certain health care provider visits and prescriptions. It is a set ...
Fadope, Cece Modupe; And Others
A series of articles that examine environmental health and discuss health care reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for health care professionals who want to address…
Yang, Zhou; Gilleskie, Donna B.; Norton, Edward C.
Prescription drug coverage creates a change in medical care consumption, beyond standard moral hazard, arising both from the differential cost-sharing and the relative effectiveness of different types of care. We model the dynamic supplemental health insurance decisions of Medicare beneficiaries, their medical care demand, and subsequent health…
Mohan, Deepika; Angus, Derek C
Despite concerted efforts to improve the quality of care provided in the intensive care unit, inconsistency continues to characterize physician decision making. The resulting variations in care compromise outcomes and impose unnecessary decisional regret on clinicians and patients alike. Critical care is not the only arena where decisions fail to conform to the dictates of logic. Behavioral psychology uses scientific methods to analyze the influence of social, cognitive, and emotional factors on decisions. The overarching hypothesis underlying this "thought outside the box" is that the application of behavioral psychology to physician decision making in the intensive care unit will demonstrate the existence of cognitive biases associated with classic intensive care unit decisions; provide insight into novel strategies to train intensive care unit clinicians to better use data; and improve the quality of decision making in the intensive care unit as characterized by more consistent, patient-centered decisions with reduced decisional regret and work-related stress experienced by physicians.
Henshall, Chris; Schuller, Tara
Identifying treatments that offer value and value for money is becoming increasingly important, with interest in how health technology assessment (HTA) and decision makers can take appropriate account of what is of value to patients and to society, and in the relationship between innovation and assessments of value. This study summarizes points from an Health Technology Assessment International (HTAi) Policy Forum discussion, drawing on presentations, discussions among attendees, and background papers. Various perspectives on value were considered; most place patient health at the core of value. Wider elements of value comprise other benefits for: patients; caregivers; the health and social care systems; and society. Most decision-making systems seek to take account of similar elements of value, although they are assessed and combined in different ways. Judgment in decisions remains important and cannot be replaced by mathematical approaches. There was discussion of the value of innovation and of the effects of value assessments on innovation. Discussion also included moving toward "progressive health system decision making," an ongoing process whereby evidence-based decisions on use would be made at various stages in the technology lifecycle. Five actions are identified: (i) development of a general framework for the definition and assessment of value; development by HTA/coverage bodies and regulators of (ii) disease-specific guidance and (iii) further joint scientific advice for industry on demonstrating value; (iv) development of a framework for progressive licensing, usage, and reimbursement; and (v) promoting work to better adapt HTA, coverage, and procurement approaches to medical devices.
religious acts of the prehistoric era to empirical-rational decisions of the Egyptian civilization, to modern day evidence-based medicine. Evidence-based medicine requires that clinical decisions and health policies on the prevention, diagnosis and ...
Stevens, Gabrielle; Thompson, Rachel; Watson, Bernadette; Miller, Yvette D
Participation in decision-making, supported by comprehensive and quality information provision, is increasingly emphasised as a priority for women in maternity care. Patient decision aids are tools that can offer women greater access to information and guidance to participate in maternity care decision-making. Relative to their evaluation in controlled settings, the implementation of patient decision aids in routine maternity care has received little attention and our understanding of which approaches may be effective is limited. This paper critically discusses the application of patient decision aids in routine maternity care and explores viable solutions for promoting their successful uptake. A range of patient decision aids have been developed for use within maternity care, and controlled trials have highlighted their positive impact on the decision-making process for women. Nevertheless, evidence of successful patient decision aid implementation in real world health care settings is lacking due to practical and ideological barriers that exist. Patient-directed social marketing campaigns are a relatively novel approach to patient decision aid delivery that may facilitate their adoption in maternity care, at least in the short-term, by overcoming common implementation barriers. Social marketing may also be particularly well suited to maternity care, given the unique characteristics of this health context. The potential of social marketing campaigns to facilitate patient decision aid adoption in maternity care highlights the need for pragmatic trials to evaluate their effectiveness. Identifying which sub-groups of women are more or less likely to respond to these strategies will further direct implementation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Story, William T.; Burgard, Sarah A.
This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service use focus on women’s reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands’ involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized. PMID:23068556
The Family Dental Health Care Service is a new approach that includes efforts to serve oral and dental patients that focuses on maintenance, improvement and protection. This oral and dental health approach uses basic dentistry science and technology. The vision of the Family Dental Health Care Service is the family independences in the effort of dental health maintenance and to achieve the highest oral and dental health degree as possible through family dentist care that is efficient, effecti...
Schieber, G J; Puollier, J P
Trends in health are reviewed for the member countries of the Organization for Economic Cooperation and Development (OECD) covering the following: the basic difficulties inherent in international comparative studies; the absolute levels of health expenditures in 1984; the levels and rates of growth of the health share in the gross domestic product (GDP) and the public share of total health expenditures; the elasticities of real health expenditures to real GDP for the 1960-75, 1975-84, and 1960-84 time periods; growth in health expenditures for the largest 7 OECD countries in terms of growth in population, health prices, health care prices in excess of overall prices, and utilization/intensity of services per person. International comparisons are a problem due to differences in defining the boundaries of the health sector, the heterogeneity of data, and methodological problems arising from comparing different economic, demographic, cultural, and institutional structures. The most difficult problem in international comparisons of health expenditures is lack of appropriate measures of health outcome. Exhibit 1 contains per capita health expenditures denominated in US dollars based on GDP purchasing power parities for 21 OECD countries for 1984. Per capita health expenditures ranged from less than $500 in Greece, Portugal, and Spain to over $1400 in Sweden and the US, with an OECD average of $871. After adjusting for price level differences, there still appears to be a greater than 3-fold difference in the "volume" of services consumed across the OECD countries. To determine if per capita health expenditures are related to a country's wealth as measured by its per capita GDP, the relationship between per capita health expenditures and per capita GDP for the 21 countries were examined for 1984. The data points and the "best fitting" trend line indicate a statistically significant relationship in which each $100 difference in per capita GDP is associated with a $10
Part II of Health Care Engineering begins with statistics on the occurrence of medical errors and adverse events, and includes some technological solutions. A chapter on electronic medical records follows. The knowledge management process divided into four steps is described; this includes a discussion on data acquisition, storage, and retrieval. The next two chapters discuss the other three steps of the knowledge management process (knowledge discovery, knowledge translation, knowledge integration and sharing). The last chapter briefly discusses usability studies and clinical trials.This two-
Bakker, D.H. de; Zwaanswijk, M.; Zantinge, E.M.; Verhaak, P.F.M.
One of the goals of the current health care reform in the Netherlands is to strengthen demand orientation. Community based primary health care provision should be tuned to local demand. Information on local demand is missing, however. Research goal is to provide local decision makers (patient organizations, insurers, providers) with a tool to analyse local demand, thus creating a basis for an informed discussion. Methods: Known sociodemographic characteristics of local areas on age, gender, h...
... Adult Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap ... Centers Hospice Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare ...
Lee, Karen; Burnett, Emma; Morrison, Kenny; Ricketts, Ian
Observational and survey methods have limitations in measuring hand hygiene behavior. The ability of a personal digital assistant to anonymously gather data at the point of decision making could potentially address these. Participants were provided with a personal digital assistant to be used for three 2-hour periods and asked to rate influential factors of the Health Belief Model (HBM). Participants were also required to enter what they thought they should do and what they actually did. A total of 741 hand hygiene opportunities was recorded. All HBM constructs were higher for hand hygiene opportunities where there was compliance versus noncompliance, with a significant difference for patient pressure, my risk, perceived benefits, perceived seriousness, and availability of good facilities. Only 20% of doctors, 28% of nurses, and 66% of physiotherapists always did what they thought they should. There was no correlation between self-reported and actual compliance. The HBM appeared to be a useful theoretical framework. Surprisingly, participants rated their compliance as high despite having recorded instances where they did not do what they thought they should do. This suggests that staff may have a different definition of compliance than strict observation of the guidelines. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
Client Satisfaction with Antenatal Care Services in Primary Health Care. Centres in Sabon Gari Local Government Area, Kaduna State Nigeria. journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. 1. 1. 1. M.B Sufiyan , A.A Umar , A. Shugaba . 1Department of Community Medicine, Ahmadu Bello University, ...
Bossuyt, N; Van Casteren, V; Goderis, G; Wens, J; Moreels, S; Vanthomme, K; De Clercq, E
We assessed the impact of a nation-wide ambulatory care complex intervention (the "care trajectory program") on quality of care in Belgium. We used the three-step public health triangulation method described in this paper and data from four different data sources: a national reimbursement database, an electronic patient record-based general practitioner network, the Belgian general practitioner sentinel network, and a new national registry for care trajectory patients. By applying our method and using the available evidence, we identified key findings that have been accepted by experts and stakeholders. We also produced timely recommendations for the decision-making process, four years after the start of the care trajectory program.
Petrochuk, M A; Javalgi, R G
Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.
Huy Ming Lim
Full Text Available The Institute of Medicine’s (IOM 2001 landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, identified patient-centeredness as one of the fundamental attributes of quality health care, alongside safety, effectiveness, timeliness, efficiency, and equity. The IOM defined patient-centeredness as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” This concept of patient-centered care represents a paradigm shift from the traditional disease-oriented and physician-centered care, grounding health care in the subjective experience of illness and the needs and preferences of individual patients rather than the evaluation and treatment of diseases which emphasizes on leveraging clinical expertise and evidence derived from population-based studies. Regrettably, despite the ubiquitous talk about patient-centered care in modern health care, shared decision-making and effective physician-patient communication—the two cruxes of patient-centered care—are yet to become the norms. Strategies to promote and enhance shared decision-making and effective communication between clinicians and patients should be rigorously implemented to establish a health care system that truly values patients as individuals and turn the rhetoric of patient-centered care into reality.
Kon, Alexander A.; Davidson, Judy E.; Morrison, Wynne; Danis, Marion; White, Douglas B.
Objectives Shared decision-making (SDM) is endorsed by critical care organizations, however there remains confusion about what SDM is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define SDM, recommend when SDM should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. Methods The American College of Critical Care Medicine (ACCM) and American Thoracic Society (ATS) Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of ACCM and ATS were included in the statement. Main Results Six recommendations were endorsed: 1) Definition: Shared decision-making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. 2) Clinicians should engage in a SDM process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their “default” approach a SDM process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Conclusions Patient and surrogate preferences for decision-making roles regarding value
Health care workers are exposed to many job hazards. These can include Infections Needle injuries Back injuries ... prevention practices. They can reduce your risk of health problems. Use protective equipment, follow infection control guidelines, ...
Bélanger, Emmanuelle; Rodríguez, Charo; Groleau, Danielle; Légaré, France; Macdonald, Mary Ellen; Marchand, Robert
Conversations about end-of-life care remain challenging for health care providers. The tendency to delay conversations about care options represents a barrier that impedes the ability of terminally-ill patients to participate in decision-making. Family physicians with a palliative care practice are often responsible for discussing end-of-life care preferences with patients, yet there is a paucity of research directly observing these interactions. In this study, we sought to explore how patients and family physicians initiated decision-making conversations in the context of a community hospital-based palliative care service. This qualitative study combined discourse analysis with ethnographic methods. The field research lasted one year, and data were generated through participant observation and audio-recordings of consultations. A total of 101 consultations were observed longitudinally between 18 patients, 6 family physicians and 2 pivot nurses. Data analysis consisted in exploring the different types of discourses initiating decision-making conversations and how these discourses were affected by the organizational context in which they took place. The organization of care had an impact on decision-making conversations. The timing and origin of referrals to palliative care shaped whether patients were still able to participate in decision-making, and the decisions that remained to be made. The type of decisions to be made also shaped how conversations were initiated. Family physicians introduced decision-making conversations about issues needing immediate attention, such as symptom management, by directly addressing or eliciting patients' complaints. When decisions involved discussing impending death, decision-making conversations were initiated either indirectly, by prompting the patients to express their understanding of the disease and its progression, or directly, by providing a justification for broaching a difficult topic. Decision-making conversations and
Schenker, Yael; Arnold, Robert M; London, Alex John
Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly.
Cawsey, Alison J.; Webber, Bonnie L.; Jones, Ray B.
Abstract Good communication is vital in health care, both among health care professionals, and between health care professionals and their patients. And well-written documents, describing and/or explaining the information in structured databases may be easier to comprehend, more edifying, and even more convincing than the structured data, even when presented in tabular or graphic form. Documents may be automatically generated from structured data, using techniques from the field of natural language generation. These techniques are concerned with how the content, organization and language used in a document can be dynamically selected, depending on the audience and context. They have been used to generate health education materials, explanations and critiques in decision support systems, and medical reports and progress notes. PMID:9391935
Holzhausen, Ylva; Maaz, Asja; Cianciolo, Anna T; Ten Cate, Olle; Peters, Harm
In medical contexts around the world, supervising physicians continuously decide what degree of supervision to apply as trainees carry out professional activities. Although the implications for patients can be far-reaching, little is known about how these entrustment decisions are formed. The concept of 'Entrustable Professional Activities' has initiated interest and valuable research on factors that may influence the entrustment decision process.The aim of the current article is to link models of entrustment developed in the fields of occupational and organizational psychology and military psychology to medical education studies that have explored the factors influencing physicians' entrustment decisions. We provide a conceptual framework of the entrustment decision-making process, which we suggest will contribute to the understanding of how supervising physicians arrive at the decision to entrust a medical trainee with a professional activity.
G. Alan Tarr
Full Text Available President Barack Obama proposed a major overhaul of the American healthsystem, and in 2010 the U.S. Congress enacted his proposal, the PatientProtection and Affordable Care Act. Opponents of the Act challenged itsconstitutionality in federal court, claiming that it exceeds the powers grantedto the federal government under the Commerce Clause and the NecessaryProper Clause of the federal Constitution. Some courts have upheldthe law, but others have agreed with the critics, in particular ruling thatthe provision requiring citizens to buy health insurance is unconstitutional.Eventually the U.S. Supreme Court will rule on the issue. This article tracesthe controversy, surveys the interpretation of pertinent constitutional provisionsin past cases, analyzes the constitutional arguments presented byproponents and opponents of the Act, and concludes that the Act is constitutional.
Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.
Tracy, Jane; McDonald, Rachael
Background: Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care.…
Groen-van de Ven, Leontine; Smits, Carolien; Oldewarris, Karen; Span, Marijke; Jukema, Jan; Eefsting, Jan; Vernooij-Dassen, Myrra
This prospective multiperspective study provides insight into the decision trajectories of people with dementia by studying the decisions made and related key events. This study includes three waves of interviews, conducted between July 2010 and July 2012, with 113 purposefully selected respondents (people with beginning to advanced stages of dementia and their informal and professional caregivers) completed in 12 months (285 interviews). Our multilayered qualitative analysis consists of content analysis, timeline methods, and constant comparison. Four decision themes emerged-managing daily life, arranging support, community living, and preparing for the future. Eight key events delineate the decision trajectories of people with dementia. Decisions and key events differ between people with dementia living alone and living with a caregiver. Our study clarifies that decisions relate not only to the disease but to living with the dementia. Individual differences in decision content and sequence may effect shared decision-making and advance care planning.
Port Harcourt. ... Journal of Community Medicine and Primary Health Care. 25 (2) 53-58. KEYWORDS. Healer shopping,. Discharge Against. Medical Advice,. Non- communicable diseases, epidemiological transition, Port.
Busanello, Josefine; Lunardi Filho, Wilson Danilo; Kerber, Nalú Pereira da Costa; Lunardi, Valéria Lerch; dos Santos, Silvana Sidnei
This is an integrative review that aims to identify the contribution of nursing care for woman's participation in the decision process of the pregnancy and puerperal cycle, as described in Brazilian scientific publications. The scientific productions were retrieved in May, 2010, from the Virtual Library of Health (Biblioteca Virtual em Saúde) database. From the eight articles reviewed, two themes stood out: Contributions of nursing care to the woman's participation in the decision process of the pregnancy and puerperal cycle; and Limitations of nursing care to the woman's participation in the decision process of the pregnancy and puerperal cycle. The following review supports the production of knowledge in nursing, by identifying a gap in what nurses know and do about this issue, as shown by the lack of nursing researches that concern, specifically, the participation of the woman in the decision process during the pregnancy and puerperal cycle and the possible contributions of nursing care to ensure women of this right.
Raúl A Borracci
preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8% answered the form completely. A trend to trust only in the doctor's knowledge to obtain information (81.7%, in wanting to know the options of treatment and express one's point of view (85.9%, and to involve the family in the decisions (63.2% was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (OR: 0.64, giving less freedom to family involvement (OR: 1.31. People with a lower social and economical level claim fewer options (OR: 0.48 and gave less family participation (OR = 1.79. Natives from other South American countries had a minor tendency to demand for options and express their thoughts (OR: 0.60; and the ones with lower education level trusted less in the doctor's knowledge (OR: 1.81, demanded fewer options (OR: 0.45 and chose not to know the severity of the disease (OR: 0.56. The analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patient's autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.
1Department of Paediatrics and Child Health, Faculty of Clinical Sciences, College of Health Sciences,. Obafemi Awolowo ... Younger parents less than 35years, parents with lower educational attainments and low .... staffing, availability of immunization consumables was estimated using the Computer Programme for.
financing are critical issues that continue to bother health policy makers. .... Ethical approval. Ethical approval was obtained from the. Health Research Ethics Committee of the Delta. State University Teaching Hospital, Oghara and informed written (and or verbal) ... Teachers/Religious Leaders. Indifferent. 85. 24.3%. 117.
Background: Quarry industry has become a major means of livelihood in Ebonyi state, but insufficient data exists on their operations and use of control measures like dust mask, with no serious attempt at comprehensive health education. The study sought to assess the effect of health education on the perception and ...
mania) and anxiety disorders (General anxiety, agoraphobia, social phobia, obsessive-compulsive disorder and post traumatic stress disorder). Conclusion: Findings suggest that there is need to consider mental and psychological care of clients with HIV/AIDS to minimise the prevalence of psychiatric disorder among HIV ...
Methodology. A cross-sectional survey of patients at the antiretroviral clinic of the Federal Medical Centre,. Makurdi, Nigeria, was conducted between June and August 2008. An adapted version of the RAND. Patient Satisfaction Questionnaire Long Form was used to assess seven dimensions of care: general satisfaction ...
This guide provides a framework for study circles to use in discussing the health care crisis in the United States. The guide begins with a background section that gives an overview of the health care crisis; then it presents a two-part framework for discussion. Part 1 focuses on the ethical issues that underlie any policy decisions. It points out…
Jones, W. L.
Space age health care delivery is being delivered to both NASA astronauts and employees with primary emphasis on preventive medicine. The program relies heavily on comprehensive health physical exams, health education, screening programs and physical fitness programs. Medical data from the program is stored in a computer bank so epidemiological significance can be established and better procedures can be obtained. Besides health care delivery to the NASA population, NASA is working with HEW on a telemedicine project STARPAHC, applying space technology to provide health care delivery to remotely located populations.
Patel, Vimla L.; Zhang, Jiajie; Yoskowitz, Nicole A.; Green, Robert; Sayan, Osman R.
The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers. PMID:18343731
Abbasgholizadeh Rahimi, Samira; Menear, Matthew; Robitaille, Hubert; Légaré, France
Mobile health (mHealth) applications intended to support shared decision making in diagnostic and treatment decisions are increasingly available. In this paper, we discuss some recent studies on mHealth applications with relevance to shared decision making. We discuss the potential advantages and disadvantages of using mHealth in shared decision making in various contexts, and suggest some directions for future research in this quickly expanding field.
Newth, Christopher John L; Khemani, Robinder G; Jouvet, Philippe A; Sward, Katherine A
Respiratory support is required in most children in the pediatric intensive care unit. Decision-support tools (paper or electronic) have been shown to improve the quality of medical care, reduce errors, and improve outcomes. Computers can assist clinicians by standardizing descriptors and procedures, consistently performing calculations, incorporating complex rules with patient data, and capturing relevant data. This article discusses computer decision-support tools to assist clinicians in making flexible but consistent, evidence-based decisions for equivalent patient states. Copyright © 2017 Elsevier Inc. All rights reserved.
Merlino, James I; Raman, Ananth
The Cleveland Clinic has long had a reputation for medical excellence. But in 2009 the CEO acknowledged that patients did not think much of their experience there and decided to act. Since then the Clinic has leaped to the top tier of patient-satisfaction surveys, and it now draws hospital executives from around the world who want to study its practices. The Clinic's journey also holds Lessons for organizations outside health care that must suddenly compete by creating a superior customer experience. The authors, one of whom was critical to steering the hospital's transformation, detail the processes that allowed the Clinic to excel at patient satisfaction without jeopardizing its traditional strengths. Hospital leaders: Publicized the problem internally. Seeing the hospital's dismal service scores shocked employees into recognizing that serious flaws existed. Worked to understand patients' needs. Management commissioned studies to get at the root causes of dissatisfaction. Made everyone a caregiver. An enterprisewide program trained everyone, from physicians to janitors, to put the patient first. Increased employee engagement. The Clinic instituted a "caregiver celebration" program and redoubled other motivational efforts. Established new processes. For example, any patient, for any reason, can now make a same-day appointment with a single call. Set patients' expectations. Printed and online materials educate patients about their stays--before they're admitted. Operating a truly patient-centered organization, the authors conclude, isn't a program; it's a way of life.
Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.
Full Text Available The Family Dental Health Care Service is a new approach that includes efforts to serve oral and dental patients that focuses on maintenance, improvement and protection. This oral and dental health approach uses basic dentistry science and technology. The vision of the Family Dental Health Care Service is the family independences in the effort of dental health maintenance and to achieve the highest oral and dental health degree as possible through family dentist care that is efficient, effective, fair, evenly distributed, safe and has a good quality. To support this effort, the Ministry of Health has issued Health Care Policy and Implementation Guideline as well as the licensing standard for family dentist practice.
Full Text Available In developed countries, nowadays we live in a networked society: a society of information, knowledge and services (Castells, 1996, with strong specificities in the Health field (Bourret, 2003, Silber, 2003. The World Health Organization (WHO has outlined the importance of information for improving health for all. However, financial resources remain limited. Health costs represent 11% of GNP in France, Germany, Switzerland and Canada, 14% in the USA, and 7.5% in Spain and the United Kingdom. Governments, local powers, health or insurance organizations therefore face difficult choices in terms of opportunities and priorities, and for that they need specific and valuable data. Firstly, this paper provide a comprehensive overview of our networked society and the appointment of ICT (Information and Communication Technologies and Health (in other words e-Health in a perspective of needs and uses at the micro, meso, and macro levels. We point out the main challenges of development of Nationwide Health Information Network both in the US, UK and France. Then we analyze the main issues about data for Decision Making in Networked Health: coordination and evaluation. In the last sections, we use an Information System perspective to investigate the three interoperability layers (micro, meso and macro. We analyze the requirements and challenges to design an interoperability global architecture which supports different kinds of interactions; then we focus on the harmonization efforts provided at several levels. Finally, we identify common methodological and engineering issues.
Lown, Beth A; Chen, Lin H; Han, Pauline V; Jentes, Emily S; Wilson, Mary E; Benoit, Christine M; Avery, Karen A; Ooi, Winnie; Hamer, Davidson H; Barnett, Elizabeth D
Yellow fever (YF), a potentially fatal mosquito-borne infection, is preventable with a live-attenuated vaccine, rarely associated with severe adverse events. We surveyed travelers to assess their reasons for pre-travel medical consultation, information they considered important regarding YF disease and vaccination, whether they recalled receiving this information, and whether they were involved in vaccine decision-making. Travelers aged 18 years and older were surveyed at three Boston-area travel clinics. Only those making YF vaccination decisions were included for analyses. Of 831 travelers surveyed, 589 (70%) indicated making a YF vaccination decision. Travel medicine providers recommended YF vaccination to 537 (91%) of 589 travelers; 92% of these 537 received vaccine. Among 101 travelers aged 60 years and older, 9% declined the vaccine; among those younger than 60 years, 4% declined the vaccine (p = 0.06). Of 589 travelers, most agreed they needed to understand destination-specific YF risks (82%) and vaccine risks (88%), and were involved in YF vaccine decisions (87%). Less than half recalled discussing their concerns about YF vaccine with the provider (42%) or what risks and benefits mattered most to them (32%). Most participants sought YF disease and vaccine risk information and wanted to be involved in decision-making; however, fewer than half recalled discussing their opinions or concerns about YF vaccine. Providers need effective risk communication skills and the ability to elicit and respond to travelers' concerns to help them make informed, shared decisions. © 2014 International Society of Travel Medicine.
McDavid, Lolita M
Children in foster care need more from health providers than routine well-child care. The changes in legislation that were designed to prevent children from languishing in foster care also necessitate a plan that works with the child, the biological family, and the foster family in ensuring the best outcome for the child. This approach acknowledges that most foster children will return to the biological family. Recent research on the effect of adverse childhood experiences across all socioeconomic categories points to the need for specifically designed, focused, and coordinated health and mental health services for children in foster care. Copyright © 2015 Elsevier Inc. All rights reserved.
Nautical tourism is one of the developing branches of tourism in Europe. It differs from other forms of tourism. Conditions under which nautical tourists live are similar to those of seamen employed on vessels in costal shipping. The health care for nautical tourists should be organized according to the principles of health care for crews of merchant ships engaged in constal shipping.
communicable diseases such as hypertension and transitions currently experienced in Sub-Saharan. 96. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. KEYWORDS journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. Journal of Community Medicine ...
This editorial reviews areas of health care reform including managed health care, diagnosis-related groups, and the Resource-Based Relative Value Scale for physician services. Relevance of such reforms to people with developmental disabilities is considered. Much needed insurance reform is not thought to be likely, however. (DB)
PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26 (1) 21-29. KEYWORDS. Household, expenditure,. Treatment, presumptive malaria,. Gimba ... A cross-sectional descriptive study conducted during community diagnosis posting of final year medical students of. Ahmadu Bello University ...
Full Text Available Anne Hogden,1 David Greenfield,1 Peter Nugus,1 Matthew C Kiernan21Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, 2Prince of Wales Clinical School, University of New South Wales and Neuroscience Research Australia, Sydney, NSW, AustraliaPurpose: Family carers of patients with amyotrophic lateral sclerosis (ALS are presumed to have frequent involvement in decision-making for symptom management and quality of life. To better understand and improve decision-making, we investigated the range and extent of carer participation in decision-making. By focusing on the perspectives of ALS support carers, the study aimed to explore carer participation in decision-making, to identify carer roles, and determine the facilitators and barriers to carer participation in decision-making for ALS multidisciplinary care.Participants and methods: An exploratory, in-depth study was conducted with eight carers of ALS patients from two specialized ALS multidisciplinary clinics. Carers participated in semi-structured interviews that were audio recorded and transcribed then coded and analyzed for emergent themes.Results: Carers made a significant contribution to ALS decision-making. Their roles were: promoting the patient voice, promoting patient health literacy, and providing emotional support and logistical assistance. Facilitators of carer participation in decision-making were perceived to be: health professional endorsement of patients' decision-making style; access to credible information sources; evidence-based information from the ALS clinic, ALS support association, and health practitioners; supportive relationships with family and friends; spiritual faith; ease of contact with ALS services; and availability of physical and practical support for carers. Barriers to carer participation included: changes to patient communication and cognition; conflict between respect for patients' independence and
Ettema, Jehan Frans; Kudahl, Anne Braad; Sørensen, Jan Tind
Animal health economics deals with quantifying the economic effects of animal disease, decision support tools in animal health management and further analysis of the management's impact at animal, herd or national level. Scientists from The Netherlands, France and Sweden have since 1988 organised...... informal workshops to exchange their knowledge and expertise in this field of science. This report contains the summary of the presentations given by 12 PhD students and 2 senior scientists of the Animal Health Economics workshops which was held on the 9th and 10th of November, 2006 at the Research Centre...... Foulum in Denmark. Different disciplines and approaches within Animal Health Economics are dealt with by the different scientists and the report contains a variety of novel results and projects. The resulting discussion is summarized in the report....
Doctors must frequently make decisions during medical treatment, whether in an acute care facility, such as an Intensive Care Unit (ICU), or in an operating room. These decisions rely on a various information sources, such as the patient's medical history, preoperative images, and general medical knowledge. Decision support systems can assist by facilitating access to this information when and where it is needed. This paper presents some research eorts that address the integration of information with clinical practice. The example systems include a clinical decision support system (CDSS) for pediatric traumatic brain injury, an augmented reality head- mounted display for neurosurgery, and an augmented reality telerobotic system for minimally-invasive surgery. While these are dierent systems and applications, they share the common theme of providing information to support clinical decisions and actions, whether the actions are performed with the surgeon's own hands or with robotic assistance.
Akishita, Masahiro; Ishii, Shinya; Kojima, Taro; Kozaki, Koichi; Kuzuya, Masafumi; Arai, Hidenori; Arai, Hiroyuki; Eto, Masato; Takahashi, Ryutaro; Endo, Hidetoshi; Horie, Shigeo; Ezawa, Kazuhiko; Kawai, Shuji; Takehisa, Yozo; Mikami, Hiroshi; Takegawa, Shogo; Morita, Akira; Kamata, Minoru; Ouchi, Yasuyoshi; Toba, Kenji
Physicians are uncertain about what medical services should be provided to older and/or disabled patients. Better understanding of health outcome prioritization among health care providers and recipients may help the process of decision- and policy-making. For this purpose, surveys were conducted on priorities of health care outcomes for the elderly. Survey research. Four groups of health care providers and four groups of health care recipients. A total of 2512 health care providers and 4277 recipients. Questionnaires were sent to more than 8000 health care providers and more than 9000 health care recipients: geriatricians, physicians who commonly see older patients or work in long term care facilities, staff members and participants in adult day care, patients in outpatient geriatric clinics, family members of patients with dementia, and community-dwelling older adults. The questionnaire asked the subjects to rank 12 measures of health care outcomes. The mean response rate was 49%. All health care provider groups considered "improvement of quality of life" the most important. In contrast, in health care recipient groups, "effective treatment of illness," "improvement of physical function," and "reduction of carer burden" were given high priority, whereas "improvement of quality of life" was perceived as less important. All the groups, including health care providers and recipients, ranked "reduction of mortality" the least important, followed by "avoiding institutional care." Stratification analysis showed that the results did not differ by sex, nursing care level, or the existence of relatives who required nursing care, whereas age slightly influenced the order of high-ranked measures. Priorities of health care services and their differences between providers and recipients should be taken into account in the health care of older patients and the design of health care policies and research. Copyright © 2013 American Medical Directors Association, Inc. Published
Layse Kelle Silva
Full Text Available Objective. To determine ethical implications for nursing practice at the point of decision making by nursing professors in practice area. Methodology. A qualitative method was adopted, with use of semistructured interviews with sixteen nursing professors who delivered care at a teaching hospital in Salvador, Bahia, from May to June 2011. The methodological reference used was the discourse of the collective subject (DCS by Lefévre and Lefévre. Results. In response to DCSs, the following subjects appeared: "Ethics is fundamental and of vital importance in the decision making process," "searching for knowledge and research to identify problems and solutions, including alternatives and support for decisions," and "to act in the best way." Conclusion. Professors who provide education about patient care also delivered care. They have the responsibility to consider the ethical implications of decision making because they stimulate fundamental reflection and could positively influence future nursing professionals.
Beatty, Rebecca M.
Survey responses from 71 health professionals, benchmarking data from 8 hospitals, continuing education program evaluations, and focus groups with nursing, allied health, and primary care providers indicated a need for professional continuing education on women's health issues. Primary topic needs were identified. The data formed the basis for…
Miles, Stephen H.; And Others
A discussion of the role of academic health centers in health care reform efforts looks at the following issues: balancing academic objectivity and social advocacy; managing sometimes divergent interests of centers, faculty, and society; and the challenge to develop infrastructure support for reform. Academic health centers' participation in…
Friesen-Storms, Jolanda H H M; Bours, Gerrie J J W; van der Weijden, Trudy; Beurskens, Anna J H M
In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient's values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient's values. The shared decision-making model seems to be helpful in the integration of the individual patient's values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient's willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making—integrated with evidence-based practice—can facilitate the shared decision-making process. We conclude that nurses as well as other
Patients with far-advanced disease are often vulnerable and anxious and the doctor, care team, patient and family may face difficult decisions regarding care. It is important that the doctor bases his/her practice on sound ethical principles, based on the four prima facie principles of autonomy, beneficence, non-malefi-.
May 1, 2012 ... Results: The findings reveal different modes money was made available for payment for health services. On the whole, about 98% of payment was through out-of pocket spending (user-charges) with most respondents using their own money. Although this financing method shown to be associated with ...
2Department of Community Health, University of Benin Teaching Hospital, Benin City, Edo State. 1. 2. 2. Awunor N.S , Omuemu V.O , Adam V.Y. ABSTRACT. Introduction. A nation's disease control effort is often as good as the surveillance and notification system put in place, which would help to generate the much needed ...
living on each square inch of the phone. This study determined the prevalence of micro-organisms on the mobile phones of health workers and their role as a source of hospital acquired infection. The study utilised a cross-sectional design. A total of one hundred and eighty swabs were collected from the mobile phones of ...
child deaths among under-fives were due to. Childhood immunization is an effective public. VPDs, this represents 17% of global total. 1 health initiative aimed at reducing the burden mortality in children under five years of age. of vaccine preventable diseases (VPDs) and. To achieve the Millennium Developmental.
Oct 7, 2011 ... These factors include poor environmental and personal hygiene, poverty, malnutrition, unsafe water supply and ... The environment farmers live in, their standard of living and nutrition are very important to their health. ..... Globalization of food system: JOURNAL OF COMMUNITY MEDICINE AND PRIMARY ...
instruments were pretested self-administered questionnaire and observational checklist. The data generated were analyzed using .... The observational checklist (OBL) was used to. Kwara State was carried from April to ..... supervision of health workers by middle cadre Central Zonal Office). Report on Routine immunization ...
Further studies on this subject are recommended. Employees' Assessment of Leadership in a Tertiary. Hospital in South-South Nigeria. Adeleye O. A, Aduh U. Department of Community Health, .... National Institute of Standards and Technology, (where it is trying to go in the future)”; “my senior were originally designed for ...
Leanza, Francesco; Hauser, Diane
Teens are avid users of new technologies and social media. Nearly 95% of US adolescents are online at least occasionally. Health care professionals and organizations that work with teens should identify online health information that is both accurate and teen friendly. Early studies indicate that some of the new health technology tools are acceptable to teens, particularly texting, computer-based psychosocial screening, and online interventions. Technology is being used to provide sexual health education, medication reminders for contraception, and information on locally available health care services. This article reviews early and emerging studies of technology use to promote teen health. Copyright © 2014 Elsevier Inc. All rights reserved.
Mold, James W; Hamm, Robert; Scheid, Dewey
Evidence-based medicine and goal-directed, patient-centered health care seem, at times, like parallel universes, though, at a conceptual level, they are perfectly compatible. Part of the problem is that many of the kinds of information required for decision making in primary care are often unavailable or difficult to find. Several case examples are used to illustrate this problem, and reasons and solutions are suggested. The goal-directed health care model could be helpful for directing the search for evidence that is relevant to the decisions that patients and their primary care physicians must make on a regular basis.
Miles, S H; Lurie, N; Fisher, E S; Haugen, D
There is increasing support for the proposition that academic health centers have a duty to accept broad responsibility for the health of their communities. The Health of the Public program has proposed that centers become directly involved in the social-political process as advocates for reform of the health care system. Such engagement raises important issues about the roles and responsibilities of centers and their faculties. To address these issues, the authors draw upon the available literature and their experiences in recent health care reform efforts in Minnesota and Vermont in which academic health center faculty participated. The authors discuss (1) the problematic balance between academic objectivity and social advocacy that faculty must attempt when they engage in the health care reform process; (2) the management of the sometimes divergent interests of academic health centers, some of their faculty, and society (including giving faculty permission to engage in reform efforts and developing a tacit understanding that distinguishes faculty positions on reform issues from the center's position on such issues); and (3) the challenge for centers to develop infrastructure support for health reform activities. The authors maintain that academic health centers' participation in the process of health care reform helps them fulfill the trust of the public that they are obligated to and ultimately depend on.
Saarni, Samuli I; Hofmann, Bjørn; Lampe, Kristian; Lühmann, Dagmar; Mäkelä, Marjukka; Velasco-Garrido, Marcial; Autti-Rämö, Ilona
Health technology assessment (HTA) is the multidisciplinary study of the implications of the development, diffusion and use of health technologies. It supports health-policy decisions by providing a joint knowledge base for decision-makers. To increase its policy relevance, HTA tries to extend beyond effectiveness and costs to also considering the social, organizational and ethical implications of technologies. However, a commonly accepted method for analysing the ethical aspects of health technologies is lacking. This paper describes a model for ethical analysis of health technology that is easy and flexible to use in different organizational settings and cultures. The model is part of the EUnetHTA project, which focuses on the transferability of HTAs between countries. The EUnetHTA ethics model is based on the insight that the whole HTA process is value laden. It is not sufficient to only analyse the ethical consequences of a technology, but also the ethical issues of the whole HTA process must be considered. Selection of assessment topics, methods and outcomes is essentially a value-laden decision. Health technologies may challenge moral or cultural values and beliefs, and their implementation may also have significant impact on people other than the patient. These are essential considerations for health policy. The ethics model is structured around key ethical questions rather than philosophical theories, to be applicable to different cultures and usable by non-philosophers. Integrating ethical considerations into HTA can improve the relevance of technology assessments for health care and health policy in both developed and developing countries.
Full Text Available The question to be addressed in this paper is : How can the ethics of justice and the ethics of care be used complementary to each other in ethical decision making within the health care team? Various arguments are presented that justify the reasons that the ethics of justice and the ethics of care should be used complementary to each other for effective ethical decision making within the health care team. The objective is to explore and describe the compatibility of the ethics of justice and the ethics of care from two perspectives: firstly an analysis of the characteristics of the two ethical theories, and secondly the scientific-philosophical viewpoints of these theories. The two theories are incompatible when viewed from these perspectives. For a probable solution to this incompatibility arguments are presented from the perspectives of reflection and virtue-based ethics.
Swota Alissa H
Full Text Available Abstract Background Communication may affect perceptions of fair process for intensive care unit bed allocation decisions through its impact on the publicity condition of accountability for reasonableness. Methods We performed a qualitative case study to describe participant perceptions of the communication of bed allocation decisions in an 18-bed university affiliated, medical-surgical critical care unit at Sunnybrook and Women's College Health Sciences Centre. Interviewed participants were 3 critical care physicians, 4 clinical fellows in critical care, 4 resource nurses, 4 "end-users" (physicians who commonly referred patients to the unit, and 3 members of the administrative staff. Median bed occupancy during the study period (Jan-April 2003 was 18/18; daily admissions and discharges (median were 3. We evaluated our description using the ethical framework "accountability for reasonableness" (A4R to identify opportunities for improvement. Results The critical care physician, resource nurse, critical care fellow and end-users (trauma team leader, surgeons, neurosurgeons, anesthesiologists functioned independently in unofficial "parallel tracks" of bed allocation decision-making; this conflicted with the official designation of the critical care physician as the sole authority. Communication between key decision-makers was indirect and could exclude those affected by the decisions; notably, family members. Participants perceived a lack of publicity for bed allocation rationales. Conclusion The publicity condition should be improved for critical care bed allocation decisions. Decision-making in the "parallel tracks" we describe might be unavoidable within usual constraints of time, urgency and demand. Formal guidelines for direct communication between key participants in such circumstances would help to improve the fairness of these decisions.
García-Altés, Anna; Argimon, Josep M
Improving the quality and transparency of governmental healthcare decision-making has an impact on the health of the population through policies, organisational management and clinical practice. Moreover, the comparison between healthcare centres and the transparent feedback of results to professionals and to the wider public contribute directly to improved results. The "Results Centre" of the Catalan healthcare system measures and disseminates the results achieved by the different healthcare centres in order to facilitate a shared decision-making process, thereby enhancing the quality of healthcare provided to the population of Catalonia (Spain). This is a pioneering initiative in Spain and is aligned with the most advanced countries in terms of policies of transparency and accountability. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
Miller, Jesse J; Morris, Peter; Files, D Clark; Gower, Emily; Young, Michael
Family members of critically ill patients in the intensive care unit face significant morbidity. It may be the decision-making process that plays a significant role in the psychological morbidity associated with being a surrogate in the ICU. We hypothesize that family members facing end-of-life decisions will have more decisional conflict and decisional regret than those facing non-end-of-life decisions. We enrolled a sample of adult patients and their surrogates in a tertiary care, academic medical intensive care unit. We queried the surrogates regarding decisions they had made on behalf of the patient and assessed decision conflict. We then contacted the family member again to assess decision regret. Forty (95%) of 42 surrogates were able to identify at least 1 decision they had made on behalf of the patient. End-of-life decisions (defined as do not resuscitate [DNR]/do not intubate [DNI] or continuation of life support) accounted for 19 of 40 decisions (47.5%). Overall, the average Decision Conflict Scale (DCS) score was 21.9 of 100 (range 0-100, with 0 being little decisional conflict and 100 being great decisional conflict). The average DCS score for families facing end-of-life decisions was 25.5 compared with 18.7 for all other decisions. Those facing end-of-life decisions scored higher on the uncertainty subscale (subset of DCS questions that indicates level of certainty regarding decision) with a mean score of 43.4 compared with all other decisions with a mean score of 27.0. Overall, very few surrogates experienced decisional regret with an average DRS score of 13.4 of 100. Nearly all surrogates enrolled were faced with decision-making responsibilities on behalf of his or her critically ill family member. In our small pilot study, we found more decisional conflict in those surrogates facing end-of-life decisions, specifically on the subset of questions dealing with uncertainty. Surrogates report low levels of decisional regret. Copyright © 2015 Elsevier
Background Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. Summary In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the
Hogden, Anne; Greenfield, David; Nugus, Peter; Kiernan, Matthew C
Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS . The aim was to examine the question: how can decision making that is both effective and patient-centred be enacted in ALS multidisciplinary care? Fifty-four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi-structured interviews. Interviews were transcribed, coded and analysed thematically. Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision-making process; patient-centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non-specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: 'Participant Engagement'; 'Option Information'; 'Option Deliberation'; and 'Decision Implementation'. Effective and patient-centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient-centred decision making, by incorporating patients' cyclic decision-making patterns and facilitating carer inclusion in decision processes. The model captures the complexities of patient-centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment. © 2013 John Wiley & Sons Ltd.
Full Text Available Health Impact Assessment is defined as ‘the combination of procedures, methods and tools through which it is possible to evaluate a policy, a program or a development plan concerning possible effects on public health and their distribution in the general population’. In a constructive debate this definition points out some interesting observations: - health is not the result of health policies alone, but it is often defined by the attention given to it in other contexts; - health is however the result of policies and it therefore must deserve the attention of Decision Makers; - health must not be taken into consideration without taking into account an evaluation of its distribution and its determinants within a population. Particular attention must therefore be paid into inequalities; - following the Council of the European Union recent conclusions on Health in All Policies we have to consider that everyday environments such as day-care centers, schools,workplaces,neighborhoods and the commute between them have significant effects on health and that health, in turn, has an effect on the economy by enabling active and productive participation in working life. In the past 20 years huge progress has been achieved in the epidemiological contest to define risks. Nowadays, it is known that a low cultural level lowers the capacity to respond to prevention, that elevated pollution levels do represent a health risk, and that the scarce social relationships that elderly people have in our society have strong consequences on their health and their quality of life.
Nouraei Motlagh, Soraya; Sabermahani, Asma; Hadian, Mohammad; Lari, Mohsen Asadi; Mahdavi, Mohamad Reza Vaez; Abolghasem Gorji, Hassan
Successful health system planning and management is dependent on well informed decisions, so having complete knowledge about medical services' utilization is essential for resource allocation and health plans. The main goal of this study is identification of factors effecting inpatient and outpatient services utilization in public and private sectors. This study encompasses all regions of Tehran in 2011 and uses Urban HEART questionnaires. This population-based survey included 34700 households with 118000 individuals in Tehran. For determining the most important factors affected on health services consumption, logit model was applied. Regarding to the finding, the most important factors affected on utilization were age, income level and deciles, job status, household dimension and insurance coverage. The main point was the negative relationship between health care utilization and education but it had a positive relationship with private health care utilization. Moreover suffering from chronic disease was the most important variable in health care utilization. According to the mentioned results and the fact that access has effect on health services utilization, policy makers should try to eliminate financial access barriers of households and individuals. This may be done with identification of households with more than 65 or smaller than 5 years old, people in low income deciles or with chronic illness. According to age effect on health services usage and aging population of Iran, results of this study show more importance of attention to aged population needs in future years.
Full Text Available The online environment has opened new opportunities for consumers of health services, both in terms of the need for information on identified health problem and the possibilities of solving them and choosing the desired health service, resulting in a significant impact on decision of the consumer of health services. The consumers of health services use the internet to get information on identified health problems both before consulting a health service or its buying decision, because of their desire to be informed when acquiring health service, and its subsequent purchase to verify the correctness of service received. In this context, the health care provider cannot create and promote his own desires and beliefs if he wants to be the top choice of the consumers of health services. This paper aims to analyze the impact of the online environment on the decisions of the consumer of health services. The study was conducted on a sample of 223 patients admitted to two public hospitals in Oradea. The patients were given a questionnaire with 20 items, which mainly focused on: information sources, accessing sites with medical content, the moment of accessing the site, verification of information and information from the online influence on their behavior. From the analysis it appears that the information sought by patients online are general, fewer patients frequently access sites of medical institutions, health care facilities or health blogs and forums. The decisions of the Consumers of health care services are influenced to a lesser extent by the information from the online environment, the decisive role in terms of making a decision represent the information received from the doctor. Finally, for the consumer of health care services is difficult to choose because, to some extent even if the needs are becoming increasingly difficult to satisfy a substrate remains related to the personality and mentality of each, of the personal factors regarding
health care and reproductive health. It plays a major role in reducing maternal and neonatal morbidity. Access to family planning also has the and mortality. It confers important health and potential to control population growth and in the development benefits to individuals, families, long run reduce green house gas emission ...
activities in the health centres ( Table 2) The study showed that community health extension workers were responsible for ... development goals for mothers and children as distant as it was 40 years ago when primary health care strategy was adopted for ... Most of them were very experienced, 50% of. The study (Table II) ...
Full Text Available The paper deals with conscientious objection in health care, addressing the problems of scope, verification and limitation of such refusal, paying attention to ideological agendas hidden behind the right of conscience where the claimed refusal can cause harm or where such a claim is an attempt to impose certain moral values on society or an excuse for not providing health care. The nature of conscientious objection will be investigated and an ethical analysis of conscientious objection will be conducted. Finally some suggestions for health care policy will be proposed.
U.S. Department of Health & Human Services — A list of all Home Health Agencies that have been registered with Medicare. The list includes addresses, phone numbers, and quality measure ratings for each agency.
Jensen, Hanne Irene
Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...... (135) from 10 ICUs in the Region of Southern Denmark. Additionally the survey included primary physicians (146) from two regional ICUs. Subproject 4. Audit: Three interdisciplinary audits with the participation of 8 primary care physicians, 9 intensivists, and 12 nurses were conducted. Form and profit...... be interdisciplinary, but the literature shows that this is not always the case. Research on end-of-life issues in Danish ICUs is limited. Aim The aims of this thesis were to • Examine Danish practices regarding end-of-life decisions in the ICU. • Examine the opinions of nurses and physicians who work in Danish ICUs...
... Sloane PD, Warshaw GA, et al, eds. Ham's Primary Care Geriatrics: A Case-Based Approach . 6th ed. ... Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, ...
Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost
Torbica, Aleksandra; De Allegri, Manuela; Belemsaga, Danielle; Medina-Lara, Antonieta; Ridde, Valery
Several countries in sub-Saharan Africa have implemented policies to remove or reduce user fees. Our aim was to identify criteria guiding such decisions among national policy entrepreneurs, those who link up problem definition, solution development and political processes. We administered a best-worst scaling (BWS) experiment to 89 policy entrepreneurs, asking them to identify the most and the least important criteria on a series of predefined sets. Sets were compiled using a Balance Incomplete Block Design which generated random combinations of all 11 criteria included in the experiment. In turn, those had emerged from a prior set of focus group discussions organized among policy entrepreneurs. Ordered logit models were used to investigate the value of single criteria as well as heterogeneity of preferences. Political commitment was identified as the most important criterion guiding policy decisions on user fee abolition or reduction to the overall sample, but particularly so for more experienced respondents aged over 50 years. International pressure and donor money were identified as least important while equity and institutional capacity were deemed of relatively little importance. Respondents more involved in advising on policy than on formulating policy rated economic issues such as financial sustainability and cost-effectiveness as less important. It is feasible to apply BWS experiments in low-income countries, although whether the technique can be adjusted to elicit preferences among non-literate respondents in these settings is unclear. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Veerkamp, J S J; van Amerongen, W E; Blanksma, N G; Krikken, J B; Lansen, P C; Merkus, T J M; Olderaan, F J; Parree, J W F; Stel, G
In this article the principles of child oral health care in the Netherlands and the consequences of cariological principals of oral health care delivery to children are described. First of all the age of the child plays a very significant role in decisions concerning prevention and restoration. In addition, the combination of a positive attitude on the part of the dentist and a pain-free treatment can prevent fear of treatment and avoidance behaviour of the children. In the treatment of carious lesions, moreover, the oral health care provider should consider to what extent the problem is related to behaviour and fits in the multi-factorial caries model. Restorative treatments should be considered as supporting prevention, reducing caries activity and eliminating the effects of neglected oral health care. Prevention has to be seen as an essential element of the treatment model and it should start early from the standpoint of habit formation and the rapid demineralization process in the deciduous dentition which results from failed preventive care.
Full Text Available Health care organizations have to develop a sustainable path for creating public value by seeking legitimacy for building and maintaining public trust with patients as social and economic institutions creating value and sustaining both health and wealth for people and communities within society. Health care organizations having at disposal decreasing resources and meeting increasing demands of citizens are following an unsustainable path. Designing sustainable health care systems and organizations is emerging as a strategic goal for developing the wealth of people and communities over time. Building sustainable organizations relies on valuing human resources, designing efficient and effective processes, using technology for better managing the relationships within and outside organizations. Sustainable health care organizations tend to rediscover the importance of human resource management and policies for effectively improving communication with patients and building trust-based relationships. While processes of accreditation contribute to legitimizing effectiveness and quality of health care services and efficient processes, introducing and using new information and communication technologies (ICTs and informatics helps communication leading to restore trust-based relationships between health care institutions and patients for value creation within society.
Campbell, Robert James
This article introduces health care managers to the theories and philosophies of John Kotter and William Bridges, 2 leaders in the evolving field of change management. For Kotter, change has both an emotional and situational component, and methods for managing each are expressed in his 8-step model (developing urgency, building a guiding team, creating a vision, communicating for buy-in, enabling action, creating short-term wins, don't let up, and making it stick). Bridges deals with change at a more granular, individual level, suggesting that change within a health care organization means that individuals must transition from one identity to a new identity when they are involved in a process of change. According to Bridges, transitions occur in 3 steps: endings, the neutral zone, and beginnings. The major steps and important concepts within the models of each are addressed, and examples are provided to demonstrate how health care managers can actualize the models within their health care organizations.
Brown, Edwina A; Bekker, Hilary L; Davison, Sara N; Koffman, Jonathan; Schell, Jane O
Historic migration and the ever-increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. Because health care beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision making at the end of life. The principles of truth telling and patient autonomy are embedded in the framework of Anglo-American medical ethics. In contrast, in many parts of the world, the cultural norm is protection of the patient from the truth, decision making by the family, and a tradition of familial piety, where it is dishonorable not to do as much as possible for parents. The challenge for health care professionals is to understand how culture has enormous potential to influence patients' responses to medical issues, such as healing and suffering, as well as the physician-patient relationship. Our paper provides a framework of communication strategies that enhance crosscultural competency within nephrology teams. Shared decision making also enables clinicians to be culturally competent communicators by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient's specific health characteristics and values when choosing health care. The development of decision aids to include cultural awareness could avoid conflict proactively, more productively address it when it occurs, and enable decision making within the framework of the patient and family cultural beliefs. Copyright © 2016 by the American Society of Nephrology.
Bekker, Hilary L.; Davison, Sara N.; Koffman, Jonathan; Schell, Jane O.
Historic migration and the ever–increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. Because health care beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision making at the end of life. The principles of truth telling and patient autonomy are embedded in the framework of Anglo–American medical ethics. In contrast, in many parts of the world, the cultural norm is protection of the patient from the truth, decision making by the family, and a tradition of familial piety, where it is dishonorable not to do as much as possible for parents. The challenge for health care professionals is to understand how culture has enormous potential to influence patients’ responses to medical issues, such as healing and suffering, as well as the physician-patient relationship. Our paper provides a framework of communication strategies that enhance crosscultural competency within nephrology teams. Shared decision making also enables clinicians to be culturally competent communicators by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient’s specific health characteristics and values when choosing health care. The development of decision aids to include cultural awareness could avoid conflict proactively, more productively address it when it occurs, and enable decision making within the framework of the patient and family cultural beliefs. PMID:27510456
Dunn, Michael C.; Clare, Isabel C. H.; Holland, Anthony J.
In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. PMID:18240026
Browning, Annette M
Critical care nurses are often faced with working with families during the end-of-life care of a loved one. Often there is indecisiveness in family members of critically ill patients when faced with making these difficult decisions. The purpose of this manuscript is to describe origins of indecisiveness in family members of critically ill patients who are faced with end-of-life care decisions. Strategies to empower family members during this crucial time are also discussed.
Goodrich, David E.; Kilbourne, Amy M.; Nord, Kristina M.; Bauer, Mark S.
Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims under healthcare reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components. PMID:23881714
Thapa, Amit; Kc, Bidur; Shakya, Bikram
Financial limitations and the scarcity of technological knowledge are a major hurdle to good communication platforms, data storage, and dissemination of medical knowledge in developing countries. Out of necessity we used free-to-use apps in our practice. We studied the applicability and cost effective aspect of a systematic use of these apps in neurosurgery. We designed the Free-to-use apps in neurosurgery (FAN) module in 4 phases at Kathmandu Medical College Teaching Hospital over the last 3 years. We used free apps like Viber, Dropbox, Skype, and VLC media player on 3G and Wi-Fi network. Users were trained in ethics and measures to ensure confidentiality and privacy of patient-related data. Endpoints studied were feasibility, reliability, cost effectiveness, and overall satisfaction of the users. In the FAN module, the Viber app was used to send pictures of digital images via smartphones within 30 minutes, enabling quick decisions by the consultants. Dropbox not only helped store images but also helped quick verification of discharge summaries as early as 15 minutes increasing overall efficiency. With Skype, consultants could be contacted even when they were abroad, and with the use of FAN they remain updated of their patients. By the use of Skype and VLC media player, 2 operative live workshops from abroad were transmitted live with good visual and audio reception, allowing question-and-answer sessions with the faculties. User satisfaction was more than 90%. The FAN module helped in quick reliable decision making, allowing for instantaneous communication and storing data and exchange of knowledge across countries. Copyright © 2016 Elsevier Inc. All rights reserved.
JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. INTRODUCTION disability from complications of pregnancy and. 1 child birth. MI in birth preparedness is. Birth preparedness by a couple ensures that indispensible in rural communities where patriarchy appropriate care ...
Jonsson, E.; Banta, H.D.
Health care in Sweden is a public sector responsibility and equity in access to care is quite important. The Swedish system is organized into several levels, with the Federation of County Councils at the top, and with regional, county, and local levels. In theory, the four hospital tiers developed
Sherertz, R J; Bassetti, S.; Bassetti-Wyss, B.
Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site infection by airborne dispersal. Outbreaks have been associated with skin colonization or viral upper respiratory tract infection in a phenomenon of airborne dispersal of Staphylococcus aureus called the "cloud" phenomenon. This review summarizes the data supporting the e...
Marasović Šušnjara, Ivana
Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.
Full Text Available Brian Ondiege, Malcolm Clarke Department of Computer Science, College of Engineering, Design and Physical Sciences, Brunel University London, UK Abstract: With the rapid advances in the capabilities of telehealth devices and their increasing connection to the Internet, security is becoming an issue of major concern. Therefore, the perceptions of the health care professionals regarding security are of interest, as the patients trust them to make informed decisions on issues concerning their privacy, data, and health. Eight health care professionals were interviewed to determine their perceptions and knowledge of security in health care. The research further examines one specific aspect of security which is considered of significant concern: the authenticity of a device being from the actual manufacturer and not a counterfeit. This research proposes device registration together with digital signatures and one-time passwords to address the issue of counterfeit remote patient-monitoring devices and identify and authenticate the user of the device. Keywords: telehealth security, health care professionals’ perception, personal health device, authentication
Hersh, Lauren; Salzman, Brooke; Snyderman, Danielle
Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks, and assessing for comprehension. Additionally, printed information should be written at or below a fifth- to sixth-grade reading level. Visual aids, graphs, or pictures can enhance patient understanding, as can more concrete presentation of numerical information.
Rimmer, E M
The Canadian health care system has developed very differently from that of its neighbour, the United States of America. It has a publicly financed and administered universal insurance plan which provides good access to high quality medicine, free at the point of delivery. Increasing costs, however, mean that painful political decisions on health will have to be made. Experiments with alternative means of financing primary health care provision and the Canadian approach to postgraduate educat...
Tai-Seale, M.; Elwyn, G.; Wilson, C.J.; Stults, C.; Dillon, E.C.; Li, M.; Chuang, J.; Meehan, A.; Frosch, D.L.
Patient-provider communication and shared decision making are essential for primary care delivery and are vital contributors to patient experience and health outcomes. To alleviate communication shortfalls, we designed a novel, multidimensional intervention aimed at nudging both patients and primary
Longo, Daniel R
The proliferation of health care consumer reports (also known as "consumer guides," "report cards," and "performance reports") designed to assist consumers in making more informed health care decisions makes it vital to understand the perspective of employers who provide the vast majority of health insurance to the working population regarding the use of these reports. There is little empirical evidence on how consumer reports are used by employers to make health care purchasing decisions. This study fills that gap by surveying 154 businesses in Boone County, Missouri, regarding their evaluation of a consumer guide. The majority of employers surveyed indicate that the report will not have a direct effect on their health care purchasing decisions. However, they indicate that the reports are "positive and worthwhile" and their responses reflect a favorable view of the health care organization that developed and disseminated the report. Additionally, findings indicate that employers generally prefer consumer reports as a means to compare local health care institutions, rather than reviewing national averages to locate the same information. Report developers should take precautions to determine the intent of such reports, as they may not achieve the objective of changing employers' health care purchasing behavior.
Stacey, Dawn; Hill, Sophie; McCaffery, Kirsten; Boland, Laura; Lewis, Krystina B; Horvat, Lidia
Basic health literacy is required for making health decisions. The aim of this chapter is to discuss the use of shared decision making interventions for supporting patient involvement in making health decisions. The chapter provides a definition of shared decision making and discusses the link between shared decision making and the three levels of health literacy: functional, communicative/interactive, and critical. The Interprofessional Shared Decision Making Model is used to identify the various players involved: the patient, the family/surrogate/significant others, decision coach, and health care professionals. When patients are involved in shared decision making, they have better health outcomes, better healthcare experiences, and likely lower costs. Yet, their degree of involvement is influenced by their level of health literacy. Interventions to facilitate shared decision making are patient decision aids, decision coaching, and question prompt lists. Patient decision aids have been shown to improve knowledge, accurate risk perceptions, and chosen options congruent with patients' values. Decision coaching improves knowledge and patient satisfaction. Question prompts also improve satisfaction. When shared decision making interventions have been evaluated with patients presumed to have lower health literacy, they appeared to be more beneficial to disadvantaged groups compared to those with higher literacy or better socioeconomic status. However, special attention needs to be applied when designing these interventions for populations with lower literacy. Two case exemplars are provided to illustrate the design and choice of interventions to better support patients with varying levels of health literacy. Despite evidence indicating these interventions are effective for involving patients in shared decision making, few are used in routine clinical practice. To increase their uptake, implementation strategies need to overcome barriers interfering with their use
Simms, Mark D.; Freundlich, Madelyn; Battistelli, Ellen S.; Kaufman, Neal D.
Describes the essential features of a health care system that can meet the special needs of children in out-of-home care. Discusses some of the major recent changes brought about by welfare and health care reform. Notes that it remains to be seen whether the quality of services will improve as a result of these reforms. (Author)
Goeree, Ron; Diaby, Vakaramoko
In a climate of escalating demands for new health care services and significant constraints on new resources, the disciplines of health economics and health technology assessment (HTA) have increasingly been turned to as explicit evidence-based frameworks to help make tough health care access and reimbursement decisions. Health economics is the discipline of economics concerned with the efficient allocation of health care resources, essentially trying to maximize health benefits to society contingent upon available resources. HTA is a broader field drawing upon several disciplines, but which relies heavily upon the tools of health economics and economic evaluation. Traditionally, health economics and economic evaluation have been widely used at the political (macro) and local (meso) decision-making levels, and have progressively had an important role even at informing individual clinical decisions (micro level). The aim of this paper is to introduce readers to health economics and discuss its relevance to frontline clinicians. Particularly, the content of the paper will facilitate clinicians' understanding of the link between economics and their medical practice, and how clinical decision-making reflects on health care resource allocation. Copyright © 2013 Elsevier Ltd. All rights reserved.
... Control Preventing infections can help the respiratory home care patient stay as healthy as possible. Hand-washing is the single most important thing for patients and caregivers to perform on a routine basis. Use a liquid soap and lots of warm running water. Work up a good lather and scrub for at ...
Easterly, C.E.; Jones, T.D.
Development efforts since the late 1970s have resulted in a generalized method for ranking health hazards. This method provides the basis for a wide range of applications where decisions are needed for allocating resources on the basis of health risk considerations. It has been used for more than a decade to solve real problems, and it is supported by 23 publications in the open literature. The diversity of this generalized methodology allows us to provide support in a great number of problem areas. we give four examples in this manuscript: the relative toxicities of petroleum mixtures; a method to derive Emergency Response Planning Guides; an estimate of the possible carcinogenic potency of tungsten, an alternative material to depleted uranium for heavy armor penetrators; and an approach to low dose extrapolation. Our experience suggests that many more applications of the original concept and variations on it can be of utility in military situations. Some potentially fruitful areas may be in the: development of a health-risk-ranking system for alternative solutions to manufacturing, waste management, and remediation; provision of a basis for identifying levels of hazardous agents which are below health concerns, or which should be of concern; development of a framework for evaluating chemicals and radioactive materials on the same basis, and in the development of a battery of in vitro bioassays which could take the place of long-term whole animal tests.
Grazier, Kyle L; Metzler, Bridget
Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.
O'Hara, Rachel; Johnson, Maxine; Siriwardena, A Niroshan; Weyman, Andrew; Turner, Janette; Shaw, Deborah; Mortimer, Peter; Newman, Chris; Hirst, Enid; Storey, Matthew; Mason, Suzanne; Quinn, Tom; Shewan, Jane
Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterized by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service to identify areas of risk associated with decisions about patient care. The aim of this study was to explore systemic influences on decision making by paramedics relating to care transitions to identify potential risk factors. An exploratory multi-method qualitative study was conducted in three English National Health Service (NHS) Ambulance Service Trusts, focusing on decision making by paramedic and specialist paramedic staff. Researchers observed 57 staff across 34 shifts. Ten staff completed digital diaries and three focus groups were conducted with 21 staff. Nine types of decision were identified, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. Seven overarching systemic influences and risk factors potentially influencing decision making were identified: demand; performance priorities; access to care options; risk tolerance; training and development; communication and feedback and resources. Use of multiple methods provided a consistent picture of key systemic influences and potential risk factors. The study highlighted the increased complexity of paramedic decisions and multi-level system influences that may exacerbate risk. The findings have implications at the level of individual NHS Ambulance Service Trusts (e.g. ensuring an appropriately skilled workforce to manage diverse patient needs and reduce emergency department conveyance) and at the wider prehospital emergency care system level (e.g. ensuring access to appropriate patient care options as alternatives to the emergency department). © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Flagg, Robin Louise
AbstractGovernor Decision-making: Expansion of Medicaid under the Affordable Care ActByRobin FlaggDoctor of Philosophy in Health Services and Policy AnalysisUniversity of California, BerkeleyProfessor Ann C. Keller, ChairThis is a study of factors that influence gubernatorial decision making. In particular, I ask why some governors decided to expand Medicaid under the Accountable Care Act (ACA) while others opted against it. Governors, like all chief executives, are subject to cross-pressur...
... in medical offices or in the dialysis unit. Nephrology Nurse Nephrology nurses are licensed, registered nurses who ... nutritional intake to ensure the patient's optimal health. Nephrology Social Worker Most nephrology social workers have a ...
Brooks, Laura Anne; Manias, Elizabeth; Nicholson, Patricia
Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. ©2017 American Association of Critical-Care Nurses.
Véronique LapaigeCanadian Health Services Research Foundation Fellow; PRO-ACTIVE Research Program (Participatory and Evaluative Research Program to Optimize Workplace Management: Application of Knowledge, Transfer of Expertise, Innovative Interventions, Training Transformational Leaders) Pavillon Ferdinand-Vandry, CIFSS (Centre intégré de formation en sciences de la santé), Laval University, Quebec City, Quebec Canada Abstract: In the globalized kno...
Jirawattanapisal, Thidaporn; Kingkaew, Pritaporn; Lee, Tae-Jin; Yang, Ming-Chin
To review the use of evidence in the market approval process, reimbursement, and price control mechanisms for medicines and medical devices in Thailand, South Korea, and Taiwan. Documentary reviews supplemented by interviews with senior policymakers of relevant public health authorities. Drug regulatory authorities play a vital role in the market authorization process by considering evidence on safety, efficacy and quality for new medicines, and bio-equivalence for new generic products of previously patented medicines. For the formulation of the reimbursement list, all three cases applied evidence on cost-effectiveness, to various degrees, with clear institutional structure, capacity, and functions. Only Thailand has specified an explicit benchmark on cost-effectiveness for inclusion in the reimbursement list. For price control, all have established mechanisms and processes for price negotiation. These mechanisms apply evidence on cost structure and relative prices in other countries to ensure affordable prices, especially with the patented drug industry. Thailand's universal insurance schemes use a capitation payment model which proves effective in implicit price control. To increase access to essential medicines that have patents on and high price, Thailand applied Trade-Related Aspects of Intellectual Property flexibilities; "government use of patent," for public noncommercial purposes to seven essential drugs in 2006 to 2008. Rapidly increasing health expenditure and universal health insurance systems have created greater requirement for proof of "value for money" in the approval and funding of new medical technologies. All settings have established clear mechanisms to apply appropriate evidence in the processes of market approval, reimbursement, and pricing control.
Buchanan, Larry M.
It is widely recognized throughout the health care industry that the United States leads the world in health care spending per capita. However, the chilling dose of reality for American health care consumers is that for all of their spending, the World Health Organization ranks the country's health care system 37th in overall performance--right…
... Living Listen Español Text Size Email Print Share Mental Health Care: Who's Who Page Content Article Body Psychiatrist: ... degree in psychology, counseling or a related field. Mental Health Counselor: Master’s degree and several years of supervised ...
the children didnot receive BCG vaccine while spiritual homes was the pattern in 6.9 households. 22.9% did not receive measles vaccine. A total of 63 under-five deaths were reported in 53. Table VI shows the health-seeking behaviour of. 6. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL.
This podcast will educate health care providers on diagnosing babesiosis and providing patients at risk with tick bite prevention messages. Created: 4/25/2012 by Center for Global Health, Division of Parasitic Diseases and Malaria. Date Released: 4/25/2012.
Zuchowski, Jessica L; Chrystal, Joya G; Hamilton, Alison B; Patton, Elizabeth W; Zephyrin, Laurie C; Yano, Elizabeth M; Cordasco, Kristina M
Veterans concurrently using both Veterans Affairs (VA) and community providers and facilities have increased coordination needs related to bridging their care across health care settings. Women Veterans commonly require a combination of VA and community care if they have women-specific specialty care needs, such as gynecologic malignancies. We assessed VA women's health providers' and administrators' perceptions of coordination challenges for Veterans' gynecologic cancer care, and potential approaches for addressing these challenges. We carried out semistructured qualitative interviews with field-based key informants (VA gynecologists, women's health medical directors, and other staff directly involved in women's health care coordination) at 15 VA facilities. Transcripts were summarized in a template to capture key points. Themes were identified and iteratively revised (inductively/deductively) via a collaborative decision-making process utilizing matrices to compare content across interviews. Key informants (n=23) noted that services for patients with gynecologic cancers are provided through a combination of VA and community care with wide variation in care arrangements by facility. Care coordination challenges included care fragmentation, lack of role clarity and care tracking, and difficulties associated with VA and community provider communication, patient communication, patient records exchange, and authorizations. Care coordination roles suggested for addressing challenges included: care tracker, provider point-of-contact, patient liaison, and records administrator. Experiences in coordinating care for women Veterans with gynecologic malignancies receiving concurrent VA and community cancer care reveal challenges inherent in delivering care across health care systems, as well as potential approaches for addressing them.
de Soárez, Patrícia Coelho; Soares, Marta Oliveira; Novaes, Hillegonda Maria Dutilh
Most economic evaluations that participate in decision-making processes for incorporation and financing of technologies of health systems use decision models to assess the costs and benefits of the compared strategies...
Full Text Available Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.
Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC) practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.
stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet.
Duncan, Edward; Best, Catherine; Hagen, Suzanne
One person in every four will suffer from a diagnosable mental health condition during their life course. Such conditions can have a devastating impact on the lives of the individual, their family and society. Increasingly partnership models of mental health care have been advocated and enshrined in international healthcare policy. Shared decision making is one such partnership approach. Shared decision making is a form of patient-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This is advocated on the basis that patients have a right to self-determination and also in the expectation that it will increase treatment adherence. To assess the effects of provider-, consumer- or carer-directed shared decision making interventions for people of all ages with mental health conditions, on a range of outcomes including: patient satisfaction, clinical outcomes, and health service outcomes. We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2008, Issue 4), MEDLINE (1950 to November 2008), EMBASE (1980 to November 2008), PsycINFO (1967 to November 2008), CINAHL (1982 to November 2008), British Nursing Index and Archive (1985 to November 2008) and SIGLE (1890 to September 2005 (database end date)). We also searched online trial registers and the bibliographies of relevant papers, and contacted authors of included studies. Randomised controlled trials (RCTs), quasi-randomised controlled trials (q-RCTs), controlled before-and-after studies (CBAs); and interrupted time series (ITS) studies of interventions to increase shared decision making in people with mental health conditions (by DSM or ICD-10 criteria). Data on recruitment methods, eligibility criteria, sample characteristics, interventions, outcome measures, participant flow and outcome data from each study were extracted by one author and checked by another. Data are presented in a narrative
Svendsen, Gunnar Lind Haase; Jensen, Marit Vatn
This literature study focuses on possible links between access to health services and migration in rural areas. Why do people move to or from rural areas or why do they stay? What determines where people settle? And, in this context, do local health care services play an important or minor role......, or no role at all? First, the paper reports on key findings from rural migration studies, in order to shed light on two migration trends: urbanization and counter-urbanization. Then we take a closer look on settlement preferences in rural areas, including the impact of health care facilities. Finally, we end...
Sands, D Z; Wald, J S
Address current topics in consumer health informatics. Literature review. Current health care delivery systems need to be more effective in the management of chronic conditions as the population turns older and experiences escalating chronic illness that threatens to consume more health care resources than countries can afford. Most health care systems are positioned poorly to accommodate this. Meanwhile, the availability of ever more powerful and cheaper information and communication technology, both for professionals and consumers, has raised the capacity to gather and process information, communicate more effectively, and monitor the quality of care processes. Adapting health care systems to serve current and future needs requires new streams of data to enable better self-management, improve shared decision making, and provide more virtual care. Changes in reimbursement for health care services, increased adoption of relevant technologies, patient engagement, and calls for data transparency raise the importance of patient-generated health information, remote monitoring, non-visit based care, and other innovative care approaches that foster more frequent contact with patients and better management of chronic conditions.
Ethical decisions in endof- life care. D Norval, E Gwyther. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...
Kahan, B R; Goodstadt, M S
This research inquiry used qualitative and quantitative methods to examine how key decision makers from Saskatchewan health districts and Saskatchewan Health understand the determinants of health. The inquiry was based on the premise that key decision makers' understanding of the determinants of health, and the consensus regarding these understandings, hinder or facilitate dialogue, choice of effective strategies, and achievement of health promotion goals. Interviews indicated variation in perspective and emphasis regarding how key decision makers understand the determinants of health. A survey of key decision makers found: 1) inconsistencies in respondents' understanding of the determinants of health, particularly between stated beliefs and priorities for actions; and 2) that the degree of consensus among decision makers was higher for stated beliefs and lower for choices of action. Results indicate a need for clarification and consensus-building processes concerning the determinants of health, as well as for clear policies that foster consistency between beliefs and actions and minimize inappropriate or undesirable differences in interpretations.
Borel, Marie; Veber, Benoit; Villette-Baron, Karen; Hariri, S.; Dureuil, Bertrand; Hervé, Christian
International audience; It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.
Badır, Aysel; Topçu, İbrahim; Türkmen, Emine; Göktepe, Nilgün; Miral, Mukaddes; Ersoy, Nermin; Akın, Esra
Life-sustaining treatments are increasingly used in intensive care units (ICUs) for EOL care, but the decision to use these may cause ethical issues. The aim of this study was to investigate the views and practices of critical care nurses in Turkey on the end-of-life (EOL) care. This was a cross-sectional study. The research was conducted in 32 second- and third-level ICUs of 19 Ministry of Health research hospitals in Turkey. The Views of European Nurses in Intensive Care on EOL Care tool was used for data collection. The total sample size was 602. While half of the nurses stated that the withholding and withdrawal of life support were ethically different decisions, 40% felt both decisions were unethical. The expected quality of life as viewed by the patient, the medical team, the family and the nursing team (90·4%, 85·4%, and 83·4%, respectively) was an important factor in EOL decision making. The majority of the nurses (75·7%) were not directly involved in the EOL decision making and 78·4% of nurses were committed to family involvement in EOL decisions. When withdrawing treatment, 87·2% of ICU nurses agreed that the patient and family members should perform their final religious and spiritual duties. Further results showed that after withdrawing treatment, a majority of nurses (86%) agreed to continue pressure sore prevention, effective pain relief (85·5%), nutritional support (77·6%) and hydration (64·8%). Almost half (48·2%) indicated that keeping the patients in the ICU was unnecessary. ICU nurses expressed a range of experiences and practices regarding EOL care. ICU nurses should be more involved in the decision-making process about EOL care. Due to their unique relationship with patients, nurses should be involved in EOL care decision making; however, patients, families or nurses are not often involved in the decision-making process in Turkey. © 2015 British Association of Critical Care Nurses.
Fukui, Sadaaki; Salyers, Michelle P; Matthias, Marianne S; Collins, Linda; Thompson, John; Coffman, Melinda; Torrey, William C
The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock's Informed Decision Making Scale (Braddock et al. 1997, 1999, 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was "exploration of consumer preference," with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM.
Sortsø, Camilla; Lauridsen, Jørgen; Emneus, Martha
Understanding socioeconomic inequalities in health care is critical for achieving health equity. The aim of this paper is threefold: 1) to quantify inequality in diabetes health care service utilization; 2) to understand determinants of these inequalities in relation to socio...... differences in inequality estimates. While income, alike other measures of labor market attachment, to a certain extent is explained by morbidity and thus endogenous, education is more decisive for patients' ability to take advantage of the more specialized services provided in a universal health care system....
van Weert, J.C.M.; van Munster, B.C.; Sanders, R.; Spijker, R.; Hooft, L.; Jansen, J.
Background Decision aids have been overall successful in improving the quality of health decision making. However, it is unclear whether the impact of the results of using decision aids also apply to older people (aged 65+). We sought to systematically review randomized controlled trials (RCTs) and
Van Weert, Julia C M; Van Munster, Barbara C.; Sanders, Remco; Spijker, René; Hooft, Lotty; Jansen, Jesse
Background: Decision aids have been overall successful in improving the quality of health decision making. However, it is unclear whether the impact of the results of using decision aids also apply to older people (aged 65+). We sought to systematically review randomized controlled trials (RCTs) and
van Weert, Julia C. M.; van Munster, Barbara C.; Sanders, Remco; Spijker, Rene; Hooft, Lotty; Jansen, Jesse
Background: Decision aids have been overall successful in improving the quality of health decision making. However, it is unclear whether the impact of the results of using decision aids also apply to older people (aged 65+). We sought to systematically review randomized controlled trials (RCTs) and
National Environmental Education & Training Foundation, 2012
This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on…
Araújo, Patricia Sodré; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair
To characterize the activities of clinical nature developed by pharmacists in basic health units and their participation in educational activities aiming at health promotion. This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional and exploratory study, of evaluative nature, consisting of a survey of information in a representative sample of cities, stratified by the Brazilian regions that constitute domains of study, and a subsample of primary health care services. The interviewed pharmacists (n=285) were responsible for the delivery of medicines and were interviewed in person with the use of a script. The characterization of the activities of clinical nature was based on information from pharmacists who declared to perform them, and on participation in educational activities aiming at health promotion, according to information from all pharmacists. The results are presented in frequency and their 95% confidence intervals. From the interviewed subjects, 21.3% said they perform activities of clinical nature. Of these, more than 80% considered them very important; the majority does not dispose of specific places to perform them, which hinders privacy and confidentiality in these activities. The main denominations were "pharmaceutical guidance" and "pharmaceutical care." The registration of activities is mainly made in the users' medical records, computerized system, and in a specific document filed at the pharmacy, impairing the circulation of information among professionals. Most pharmacists performed these activities mainly along with physicians and nurses; 24.7% rarely participated in meetings with the health team, and 19.7% have never participated. Activities of clinical nature performed by pharmacists in Brazil are still incipient. The difficulties found point out
Garvelink, Mirjam M; Emond, Julie; Menear, Matthew; Brière, Nathalie; Freitas, Adriana; Boland, Laura; Perez, Maria Margarita Becerra; Blair, Louisa; Stacey, Dawn; Légaré, France
For the elderly to get the care and services they need, they may need to make the difficult decision about staying in their home or moving to another home. Many other people may be involved in their care too (friends, family and healthcare providers), and can support them in making the decision. We asked informal caregivers of elderly people to help us develop a decision guide to support them and their loved ones in making this decision. This guide will be used by health providers in home care who are trained to help people make decisions. The guide is in French and English. To design and test this decision guide we involved elderly people, their caregivers and health administrators. We first asked them what they needed for making the decision, and then designed a first version of the guide. Then we asked them to look at it and give feedback, which was used to make the final version. We then used scientific criteria to check its content and the language used. The final decision guide was acceptable to the caregivers, their elderly loved ones, and the health administrators. The guide is currently being evaluated in a large research project with home care teams in the province of Quebec. Background As they grow older, many elderly people are faced with the difficult and preference-sensitive decision about staying in their home or moving to a residence better adapted to their evolving care needs. We aimed to develop an English and French decision aid (DA) for elderly people facing this decision, and to involve end-users in all phases of the development process. Methods A three-cycle design with involvement of end-users in Quebec. End-users were elderly people (n = 4) caregivers of the elderly (n = 5), health administrators involved in home-care service delivery or policy (n = 6) and an interprofessional research team (n = 19). Cycle 1: Decisional needs assessment and development of the first prototype based on existing tools and input from end
Halfon, Neal; And Others
Outlines access to health care for children in out-of-home care under current law, reviews how health care access for these children would be affected by President Clinton's health care reform initiative, and proposes additional measures that could be considered to improve access and service coordination for children in the child welfare system.…
Youngkong, Sitaporn; Baltussen, Rob; Tantivess, Sripen; Mohara, Adun; Teerawattananon, Yot
Considering rising health expenditure on the one hand and increasing public expectations on the other hand, there is a need for explicit health care rationing to secure public acceptance of coverage decisions of health interventions. The National Health Security Office, the institute managing the Universal Coverage Scheme in Thailand, recently called for more rational, transparent, and fair decisions on the public reimbursement of health interventions. This article describes the application of multicriteria decision analysis (MCDA) to guide the coverage decisions on including health interventions in the Universal Coverage Scheme health benefit package in the period 2009-2010. We described the MCDA priority-setting process through participatory observation and evaluated the rational, transparency, and fairness of the priority-setting process against the accountability for reasonableness framework. The MCDA was applied in four steps: 1) 17 interventions were nominated for assessment; 2) nine interventions were selected for further quantitative assessment on the basis of the following criteria: size of population affected by disease, severity of disease, effectiveness of health intervention, variation in practice, economic impact on household expenditure, and equity and social implications; 3) these interventions were then assessed in terms of cost-effectiveness and budget impact; and 4) decision makers qualitatively appraised, deliberated, and reached consensus on which interventions should be adopted in the package. This project was carried out in a real-world context and has considerably contributed to the rational, transparent, and fair priority-setting process through the application of MCDA. Although the present project has applied MCDA in the Thai context, MCDA is adaptable to other settings. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Background: Decisions concerning the implementation of health programs are usually made on the basis of descriptive assessment. There are only few attempts to review whether returns from investment on these programs worth the effort. Objectives: To analyze and evaluate the cost-effectiveness of health care ...
Young, D W
Many Western European countries are moving toward privatization of their health care systems. The United States' health care system, since it is almost entirely privatized, is therefore worthy of study. Doing so raises several questions. How is privatization being managed in the US? How could its management be improved? What management lessons must be kept in mind if it is to be used effectively? What potential pitfalls should European countries consider as they move toward greater privatization? With operating costs, European countries must avoid the mistakes that have led to dramatic increases in annual health care costs in the US, simultaneous with reductions in access and quality. Doing so requires designing systems that promote hospital behavior consistent with a country's health objectives. With capital costs, an approach must be designed that allows policy-makers to work closely with both managers and physicians in order to make strategically sound choices about access and quality. Such an approach will require physicians to incorporate their clinical judgments into community standards of care, and to adopt a regional (rather than an institutional or personal) perspective in the determination of any incremental capital expenditures. By making regulation proactive and strategic, rather than punitive, health policymakers in Western Europe can achieve the best privatization has to offer without feeling the sting of its unintended consequences. In so doing they can help to move their health systems toward achieving the multiple and illusive goals of access, quality and reasonable cost.
Zhou, Wengang; Satheesh, P
This book presents research on emerging computational intelligence techniques and tools, with a particular focus on new trends and applications in health care. Healthcare is a multi-faceted domain, which incorporates advanced decision-making, remote monitoring, healthcare logistics, operational excellence and modern information systems. In recent years, the use of computational intelligence methods to address the scale and the complexity of the problems in healthcare has been investigated. This book discusses various computational intelligence methods that are implemented in applications in different areas of healthcare. It includes contributions by practitioners, technology developers and solution providers.
telemonitoring . In emergency cases where immediate medical treatment is the issue, recent studies conclude that early and specialized pre-hospital patient ...Lama, J Vila: “Intelligent Telemonitoring of Critical Care Patients ”, IEEE EMB Mag, Vol 18, No 4, pp 80-88, Jul/Aug 1999.  Strode S, Gustke S...Abstract- In this study we present a multipurpose health care telemedicine system, which can be used for emergency or patient monitoring cases
This podcast is based on the November, 2010 CDC Vital Signs report which indicates that more than one in four adults 18-64 years old (about 50 million) report being uninsured for at least part of the past 12 months, and focuses on the growing number of middle-income adults and those with a chronic illness or disability who have no health insurance. Created: 11/9/2010 by Centers for Disease Control and Prevention (CDC). Date Released: 11/9/2010.
Sahoo, Sanjeeb K
Nanomedicine: Emerging Field of Nanotechnology to Human HealthNanomedicines: Impacts in Ocular Delivery and TargetingImmuno-Nanosystems to CNS Pathologies: State of the Art PEGylated Zinc Protoporphyrin: A Micelle-Forming Polymeric Drug for Cancer TherapyORMOSIL Nanoparticles: Nanomedicine Approach for Drug/Gene Delivery to the BrainMagnetic Nanoparticles: A Versatile System for Therapeutic and Imaging SystemNanobiotechnology: A New Generation of Biomedicine Application of Nanotechnology-Based Drug Delivery and Targeting to LungsAptamers and Nanomedicine in C
The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.
... Management Education & Events Advocacy For Patients About ACOG Good Health Before Pregnancy: Preconception Care Home For Patients Search ... Pregnancy: Preconception Care FAQ056, April 2017 PDF Format Good Health Before Pregnancy: Preconception Care Pregnancy What is a ...
Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special ... for and what to ask will help you choose an organization that provides safe, quality care, treatment ...
Pfaff, H; Pförtner, T-K
Social inequalities in health and health care services represent issues of major concern. Findings in this area reveal inequalities in health and health care indicating disadvantages for individuals with a low socioeconomic background. Although the health care system plays a marginal role in the explanation of inequalities in health, health services research can be an important part in the development of equal health opportunities. The current article describes the causal associations between social inequalities, health inequalities and the health care service. Health services research can make a contribution to increasing equal opportunities in health and health care service. Against this background, we discuss the existing potential and need of research in the area of health services. © Georg Thieme Verlag KG Stuttgart · New York.
Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio
OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949
Heller, Kathryn Wolff; Avant, Mary Jane Thompson
Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…
This is an empirical study of 7 communities among the O-kun Yoruba of Ijumu, Kogi State, Nigeria. The general objective of the study was to investigate the prioritizing pattern of the various Primary Health Care services (PHC) in the study area. Data for the study were generated mainly through multi-stage sampling ...
Full Text Available Slovenia, like most countries of the modern world, spends toomuch on its public health care and supplies too little public healthcare services for the government, economists, politicians, and citizensto be happy. The many reforms of the public health care, e.g.in Slovenia, seem to be inefficient, one after the other, in solvingthis problem. Reforms have been conceived with a too poor considerationof the law of the requisite holism in decision preparation,decisions making and decision implementation. The articletackles procedure of implementation of reforms as inventions aresupposed to become innovations in the public health care organizationand management, rather than reforms’ content. Combinationof the absorption capacity, innovation promotion and diffusion issuggested for the requisite holism of implementation.
Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre
The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues...... through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries...... of prevention and public health? What role do citizen-doctors of chiropractic have in organizing community action on health-related matters? How can our future chiropractic graduates become socially responsible agents of change?...
Health programs are shaped by the decisions made in budget processes, so how budget-makers view health programs is an important part of making health policy. Budgeting in any country involves its own policy community, with key players including budgeting professionals and political authorities. This article reviews the typical pressures on and attitudes of these actors when they address health policy choices. The worldview of budget professionals includes attitudes that are congenial to particular policy perspectives, such as the desire to select packages of programs that maximize population health. The pressures on political authorities, however, are very different: most importantly, public demand for health care services is stronger than for virtually any other government activity. The norms and procedures of budgeting also tend to discourage adoption of some of the more enthusiastically promoted health policy reforms. Therefore talk about rationalizing systems is not matched by action; and action is better explained by the need to minimize blame. The budget-maker's perspective provides insight about key controversies in healthcare policy such as decentralization, competition, health service systems as opposed to health insurance systems, and dedicated vs. general revenue finance. It also explains the frequency of various "gaming" behaviors. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Barnes, Andrew J; Hanoch, Yaniv; Rice, Thomas; Long, Sharon K
Health insurance is among the most important financial and health-related decisions that people make. Choosing a health insurance plan that offers sufficient risk protection is difficult, in part because total expected health care costs are not transparent. This study examines the effect of providing total costs estimates on health insurance decisions using a series of hypothetical choice experiments given to 7,648 individuals responding to the fall 2015 Health Reform Monitoring Survey. Participants were given two health scenarios presented in random order asking which of three insurance plans would best meet their needs. Half received total estimated costs, which increased the probability of choosing a cost-minimizing plan by 3.0 to 10.6 percentage points, depending on the scenario ( p < .01). With many consumers choosing or failing to switch out of plans that offer insufficient coverage, incorporating insights on consumer decision making with personalized information to estimate costs can improve the quality of health insurance choices.
Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey
The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the
Frank, S R
The author believes that interactive media (the Internet and the World Wide Web) and associated applications used to access those media (portals, browsers, specialized Web-based applications) will result in a substantial, positive, and measurable impact on medical care faster than any previous information technology or communications tool. Acknowledging the dynamic environment, the author classifies "pure" digital health care companies into three business service areas: content, connectivity, and commerce. Companies offering these services are attempting to tap into a host of different markets within the health care industry including providers, payers, pharmaceutical and medical products companies, employers, distributors, and consumers. As the fastest growing medium in history, and given the unique nature of health care information and the tremendous demand for content among industry professionals and consumers, the Internet offers a more robust and targeted direct marketing opportunity than traditional media. From the medical consumer's standpoint (i.e., the patient) the author sees the Internet as performing five critical functions: (1) Disseminate information, (2) Aid informed decision making, (3) Promote health, (4) Provide a means for information exchange and support--the community concept, and (5) Increase self-care and manage demand for health services, lowering direct medical costs. The author firmly submits the Web will provide overall benefits to the health care economy as health information consumers manage their own health problems that might not directly benefit from an encounter with a health professional. Marrying the Internet to other interactive technologies, including voice recognition systems and telephone-based triage lines among others, holds the promise of reducing unnecessary medical services.
McGarry, Brian E; Tempkin-Greener, Helena; Grabowski, David C; Chapman, Benjamin P; Li, Yue
To determine the impact of consumer decision-making abilities on making a long-term care insurance (LTCi) purchasing decision that is consistent with normative economic predictions regarding policy ownership. Using data from the Health and Retirement Study, multivariate analyses are implemented to estimate the effect of decision-making ability factors on owning LTCi. Stratified multivariate analyses are used to examine the effect of decision-making abilities on the likelihood of adhering to economic predictions of LTCi ownership. In the full sample, better cognitive capacity was found to significantly increase the odds of ownership. When the sample was stratified based on expected LTCi ownership status, cognitive capacity was positively associated with ownership among those predicted to own and negatively associated with ownership among those predicted not to own who could likely afford a policy. Consumer decision-making abilities, specifically cognitive capacity, are an important determinant of LTCi decision outcomes. Deficits in this ability may prevent individuals from successfully preparing for future long-term care expenses. Policy makers should consider changes that reduce the cognitive burden of this choice, including the standardization of the LTCi market, the provision of consumer decision aids, and alternatives to voluntary and private insuring mechanisms.
Addresses the crisis in health care, considering costs, lack of access, and system ineffectiveness. Reviews "Setting Relationships Right," the Catholic Health Association's proposal for health care reform. Advocates educators' awareness of children's health needs and health care reform issues and support for the Every Fifth Child Act of…
Rosenberg, David; Schön, Ulla-Karin; Nyholm, Maria; Grim, Katarina; Svedberg, Petra
Despite the potential impact of shared decision making on users satisfaction with care and quality in health care decisions, there is a lack of knowledge and skills regarding how to work with shared decision making among health care providers. The aim of this study was to evaluate the psychometric properties of three instruments that measure varied dimensions of shared decision making, based on self-reports by clients, in a Swedish community mental health context. The study sample consisted of 121 clients with experience of community mental health care, and involved in a wide range of decisions regarding both social support and treatment. The questionnaires were examined for face and content validity, internal consistency, test-retest reliability and construct validity. The instruments displayed good face and content validity, satisfactory internal consistency and a moderate to good level of stability in test-retest reliability with fair to moderate construct correlations, in a sample of clients with serious mental illness and experience of community mental health services in Sweden. The questionnaires are considered to be relevant to the decision making process, user-friendly and appropriate in a Swedish community mental health care context. They functioned well in settings where non-medical decisions, regarding social and support services, are the primary focus. The use of instruments that measure various dimensions of the self-reported experience of clients, can be a key factor in developing knowledge of how best to implement shared decision making in mental health services.
Mafe, Cecilia; Menyah, Effie; Nkere, Munachi
Health care management and leadership education is an important gap in the undergraduate medical curriculum. Lack of training promotes poor decision making and may lead to inadequate health services, adversely affecting patients. We propose an integrated approach to health care management and leadership education at undergraduate level, to enable doctors to be effective leaders and manage resources appropriately and to ultimately improve patient care.
... AFFAIRS Proposed Information Collection (Living Will and Durable Power of Attorney for Health Care... information needed to record patient's specific instructions about health care decisions in the event he or... Power of Attorney for Health Care, VA Form 10-0137. OMB Control Number: 2900-0556. Type of Review...
Full Text Available Evidence-based health care informs clinicians of choices regarding the most effective care based on the best available research evidence. However, concepts or instruments of evidence-based medicine are still fragmented for most clinicians. Substantial gaps between evidence and clinical practice remain. A knowledge translation roadmap may help clinicians to improve the quality of care by integration of various concepts in evidence-based health care. Improving research transparency and accuracy, conducting an updated systematic review, and shared decision making are the key points to diminish the gaps between research and practice.
Savage, Brittany; Foli, Karen J; Edwards, Nancy E; Abrahamson, Kathleen
The Hispanic older adult population's rapid growth calls for an awareness of values that can affect the rendering and receipt of care. Familism, or familismo, a traditional Hispanic value, places importance of family over the self and can potentially affect health care perceptions and practices for Hispanic older adults. The current article discusses familism, which is upheld by some Hispanic older adults, and the potential for underuse of health care services. The traditional feminine role, marianismo, and masculine role, machismo, are considered, as well as implications for how decision making may be made by family members rather than the patient. Clinical implications for the provision of health care to Hispanic older adults are provided, along with the importance of considering acculturation and ethnic heterogeneity. Health care management strategies that reflect recognition and respect of familism, yet emphasize optimization of adherence and self-care, are described. Copyright 2016, SLACK Incorporated.
Le Var, Rita M. H.
Nurses and health care professionals must be prepared for transcultural health care because society is becoming increasingly multicultural and current health services are not meeting the needs of minority ethnic groups in Britain. (SK)
Shah, Koonal K; Cookson, Richard; Culyer, Anthony J; Littlejohns, Peter
The National Institute for Health and Clinical Excellence (NICE) routinely publishes details of the evidence and reasoning underpinning its recommendations, including its social value judgements (SVJs). To date, however, NICE's SVJs relating to equity in the distribution of health and health care have been less specific and systematic than those relating to cost-effectiveness in the pursuit of improved total population health. NICE takes a pragmatic, case-based approach to developing its principles of SVJ, drawing on the cumulative experience of its advisory bodies in making decisions that command respect among its broad range of stakeholders. This paper aims to describe the SVJs about equity in health and health care that NICE has hitherto used to guide its decision making. To do this, we review both the general SVJs reported in NICE guidance on methodology and the case-specific SVJs reported in NICE guidance about particular health care technologies and public health interventions.
Hagihara, Akihito; Tarumi, Kimio
Although findings of an association between physician communicative behaviors and the quality of health care have accumulated, the relationship between physician explanatory behaviors and negligent care has not been examined. The purpose of the study is to explore the association between physicians' explanatory behaviors and judges' decisions in lawsuits on negligent care. We analyzed the decisions made by 10 of the 47 district courts in Japan between 1986 and 1998. We employed two types of linear model to examine the association between physician explanatory behaviors and findings of medical negligence. The quality of a physician's explanatory behaviors, together with listening and talking to the patient or family, was related to decreased probability of a court decision of negligent care. However, explaining and listening to patients or their families were also related to the increased level of compensation. The results imply that physician's explanatory behaviors accompanied by explaining and listening to patients or their families markedly reduces the risk of a negligent care decision. However, more detailed communication of the facts about a case was associated with an increased level of compensation in the context of cases filed for medical negligence.
Development of a Decision Aid for Cardiopulmonary Resuscitation Involving Intensive Care Unit Patients' and Health Professionals' Participation Using User-Centered Design and a Wiki Platform for Rapid Prototyping: A Research Protocol.
Plaisance, Ariane; Witteman, Holly O; Heyland, Daren Keith; Ebell, Mark H; Dupuis, Audrey; Lavoie-Bérard, Carole-Anne; Légaré, France; Archambault, Patrick Michel
Cardiopulmonary resuscitation (CPR) is an intervention used in cases of cardiac arrest to revive patients whose heart has stopped. Because cardiac arrest can have potentially devastating outcomes such as severe neurological deficits even if CPR is performed, patients must be involved in determining in advance if they want CPR in the case of an unexpected arrest. Shared decision making (SDM) facilitates discussions about goals of care regarding CPR in intensive care units (ICUs). Patient decision aids (DAs) are proven to support the implementation of SDM. Many patient DAs about CPR exist, but they are not universally implemented in ICUs in part due to lack of context and cultural adaptation. Adaptation to local context is an important phase of implementing any type of knowledge tool such as patient DAs. User-centered design supported by a wiki platform to perform rapid prototyping has previously been successful in creating knowledge tools adapted to the needs of patients and health professionals (eg, asthma action plans). This project aims to explore how user-centered design and a wiki platform can support the adaptation of an existing DA for CPR to the local context. The primary objective is to use an existing DA about CPR to create a wiki-based DA that is adapted to the context of a single ICU and tailorable to individual patient's risk factors while employing user-centered design. The secondary objective is to document the use of a wiki platform for the adaptation of patient DAs. This study will be conducted in a mixed surgical and medical ICU at Hôtel-Dieu de Lévis, Quebec, Canada. We plan to involve all 5 intensivists and recruit at least 20 alert and oriented patients admitted to the ICU and their family members if available. In the first phase of this study, we will observe 3 weeks of daily interactions between patients, families, intensivists, and other allied health professionals. We will specifically observe 5 dyads of attending intensivists and alert
Willberg, A; Heger, R
This paper reports in detail on a project of Integrated Health Care in cardiology at Potsdam, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.
Wagner, H C; Fleming, D; Mangold, W G; LaForge, R W
Building relationships with patients is critical to the success of many health care organizations. The authors profile the relationship marketing program for a hospital's cardiac center and discuss the key strategic aspects that account for its success: a focus on a specific hospital service, an integrated marketing communication strategy, a specially designed database, and the continuous tracking of results.
Centres in Sabon Gari Local Government Area, Kaduna State Nigeria. journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. 1. 1. 1. M.B Sufiyan , A.A Umar , A. Shugaba . 1Department of Community Medicine, Ahmadu Bello University, Zaria. KEYWORDS. Assessment,. Client satisfaction, ANC,. PHC centers.
Handelsman, L; Speiser, M; Maltz, A; Kirpalani, S
Bankruptcy is an event that is often considered a business' worst nightmare. Debt, lawyers, and the U.S. government can lead to the eventual destruction of a business. This article shows how declaring bankruptcy can be a helpful instrument in continuing a successful venture in the health care marketplace.
Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi
In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...
Somasundaram, D. J.; van de Put, W. A.
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization. PMID:10212521
Somasundaram, D. J.; van de Put, W. A.
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization.
Connor, L R
Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management.
to eat together and lying on the same bed with ocular have far reaching implications in terms of cancers patients. management, prognosis and mortality of ocular cancer. Such individuals may not access available. Further analysis indicates that respondents'. 3,9 education, gender and marital status have no health care ...
This paper reports in detail on a project of Integrated Health Care in cardiology at Nuremberg, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.
Improving skilled attendants at birth: Experience in a primary health care facility in Rivers State, South-South Nigeria. 1. 2. Ordinioha B. , Seiyefa B. 1Community Medicine Department, University of Port Harcourt Teaching Hospital, Port Harcourt. 2Department of Family Medicine, Niger Delta University Teaching Hospital, ...
Artiklen har fokus på undervisning, planlægning, udvikling og evaluering af et internationalt tværfagligt valgfag Intercultural Health Care and Welfare, der udbydes på Det Sundhedsfaglige og Teknologiske Fakultet på Professionshøjskolen Metropol. Ifølge den tysk-amerikanske professor Iris Varner og...
Ralf M. Jendyk
Discussion: As decision making in medical care is an essential part of a physicians׳ daily routine and has tremendous impact on all parties involved, the results stress the need for addressing the different care settings as an influencing factor in undergraduate and continuing medical education.
Informal care is non-financed care outside the realm of formal healthcare, which represents an increasing challenge for aging societies. Informal care has frequently been neglected in health economic analyses, while in recent years its coverage has increased considerably in the international scientific literature. This review summarizes the methodology of the health-economic assessment of informal care, including the objective and subjective metrics of caregiver burden, its financial and non-financial valuation and practical applications, with special emphasis on the introduction of care-related quality of life instruments (e.g. Care Related Quality of Life - CarerQoL instrument). Care-related quality of life is a different entity from health-related quality of life, the two cannot be combined, so their joint evaluation requires multi-criteria decision analysis methods. Therefore, it is important to determine the societal preferences of care-related quality of life versus health-related quality of life, and map the relationship of care-related quality of life with time. The local validation of tools measuring care-related quality of life, its more widespread practical application and the analysis of its effect on decision making are also important part of the future research agenda. Orv Hetil. 2017; 158(35): 1363-1372.
Nursing care relations require an ethical decision, for an identified problem or a dilemma. To solve these requires a search for good solutions, respecting involved people and their rights. Care decision may come across situations where two rights of the person can oppose each other. Starting from the concept that there are no absolute rights, nurses take over, as their duty, the search for the best ethical resolution conciliating both, in each particular situation. As a reply to this problem, we shall analyze the principle of practical agreementfor the conflict resolution of the persons'rights and assume for ourselves to plan the best solutions for the dilemmatic situations in the nursing profession. Along with the reflection around this principle, we shall approach some examples that will help to clarify those ideas.
Neff, Bryan D
Evolutionary ecologists are attempting to explain how parents make behavioural decisions about how much care to provide to their young. Theory predicts that when genetic relatedness to young is decreased by cuckoldry, for example, parents should reduce their care in favour of alternative broods that provide greater reproductive success. Experimental manipulation of perceived paternity has been used to test the theory, but such studies have generated mixed results. Some manipulations can fail to alter a parent's perceived paternity, whereas others may directly affect parental behaviour when, for instance, the manipulation involves capturing the parent. No study has demonstrated parental care adjustment in a manner uncomplicated by experimental design or life history correlates. Here I test the theory using the fact that nest-tending parental male bluegill sunfish (Lepomis macrochirus) can assess their paternity using both the visual presence of parasitic cuckolder males during spawning, and olfactory cues released by newly hatched eggs. By manipulating both types of cues I show that parental males dynamically adjust their parental care, favouring broods that are apparently most closely related. These results confirm the importance of genetic relatedness in parental care decision-making.
U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...
Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical sc...
Astbury, Ruth; Shepherd, Ashley; Cheyne, Helen
To explore the processes that support shared decision-making when health visitors and parents are creating plans to improve the well-being of babies and children. Worldwide, there is a focus on promoting children's well-being to enhance the population health. Within the United Kingdom, health visitors have a key responsibility for working in partnership with parents to support this agenda. Despite evidence that the application of 'shared decision-making' frameworks can increase patient participation, improve patient satisfaction and improve health outcomes, there is limited research linking shared decision-making with health visitor practice. A qualitative, descriptive study. The study was undertaken in two phases: in Phase 1, data were collected by audio recording two health visitor-parent decision-making conversations, in the absence of the researcher, where decisions around planning for a baby or child were being made as part of usual care, and then the participants' experiences were sought through individual questionnaires. In Phase 2, semistructured interviews were conducted with nine health visitors and nine parents in relation to their recent experiences of planning care. Evidence of supportive processes included having a shared understanding around the issue needing to be addressed; being able to identify interventions that were accessible for the family; engaging in decision-making through deep, meaningful conversations using sensitive and responsive approaches; and establishing positive relationships between health visitors and parents, significant others within the family and other professionals. Despite evidence of strong, trusting relationships between parents and health visitors, there were times when shared decision-making was unable to take place due to the absence of supportive processes. Health visitors are aware that planning interventions with parents can be complex. These findings indicate the value of using a shared decision-making framework
Thokala, Praveen; Duenas, Alejandra
Multicriteria decision analysis (MCDA) has been suggested by some researchers as a method to capture the benefits beyond quality adjusted life-years in a transparent and consistent manner. The objectives of this article were to analyze the possible application of MCDA approaches in health technology assessment and to describe their relative advantages and disadvantages. This article begins with an introduction to the most common types of MCDA models and a critical review of state-of-the-art methods for incorporating multiple criteria in health technology assessment. An overview of MCDA is provided and is compared against the current UK National Institute for Health and Clinical Excellence health technology appraisal process. A generic MCDA modeling approach is described, and the different MCDA modeling approaches are applied to a hypothetical case study. A comparison of the different MCDA approaches is provided, and the generic issues that need consideration before the application of MCDA in health technology assessment are examined. There are general practical issues that might arise from using an MCDA approach, and it is suggested that appropriate care be taken to ensure the success of MCDA techniques in the appraisal process. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Moore, Jennifer E; Titler, Marita G; Kane Low, Lisa; Dalton, Vanessa K; Sampselle, Carolyn M
In response to the passage of the Affordable Care Act in the United States, clinicians and researchers are critically evaluating methods to engage patients in implementing evidence-based care to improve health outcomes. However, most models on implementation only target clinicians or health systems as the adopters of evidence. Patients are largely ignored in these models. A new implementation model that captures the complex but important role of patients in the uptake of evidence may be a critical missing link. Through a process of theory evaluation and development, we explore patient-centered concepts (patient activation and shared decision making) within an implementation model by mapping qualitative data from an elective induction of labor study to assess the model's ability to capture these key concepts. The process demonstrated that a new, patient-centered model for implementation is needed. In response, the Evidence Informed Decision Making through Engagement Model is presented. We conclude that, by fully integrating women into an implementation model, outcomes that are important to both the clinician and patient will improve. In the interest of providing evidence-based care to women during pregnancy and childbirth, it is essential that care is patient centered. The inclusion of concepts discussed in this article has the potential to extend beyond maternity care and influence other clinical areas. Utilizing the newly developed Evidence Informed Decision Making through Engagement Model provides a framework for utilizing evidence and translating it into practice while acknowledging the important role that women have in the process. Published by Elsevier Inc.
Robinson, James C
The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations.
Owoo, Nkechi S.; Lambon-Quayefio, Monica P.
The study explores the importance of social influence and the availability of health insurance on maternal care utilization in Ghana through the use of antenatal care services. A number of studies have found that access to health insurance plays a critical role in women?s decision to utilize antenatal care services. However, little is known about the role that social forces play in this decision. This study uses village-level data from the 2008 Ghana Demographic and Health Survey to investiga...
Kern, T; Kohnen, T
Although many health care reforms have been enacted in the last few years in Germany, many of the key points in the current social health care system have been retained from former times. All those introductions for an effective health care system from the last 150 years beginning with mandatory guild membership via Bismarck's social laws to the modern health care systems in Germany with the current problems of financing the heavy burden in the German budget are reported. Data and facts on the current health care system are provided. In the following two articles of this series ambulatory and inpatient treatment in the light of economic aspects of health care are reported.
Kreng, Victor B; Yang, Chi-Tien
An ideal resource allocation in health care should ensure most people to access equal health care services while needed. Not only social welfare economists but also health policy makers concern with rational distribution of health care resources. Taiwan implemented a National Health Insurance (NHI) program in 1995, to reduce financial barriers for all residents with a universal health care system. Horizontal equity, an explicit goal of the NHI system, is to guarantee equal opportunity of access to health care. Accordingly, this study, utilizing cross-sectional data, proposes a multi-criteria decision-making approach with grey incidence analysis to measure horizontal equity of health care resource allocation of the NHI in Taiwan. From the findings of this empirical study, most resources are allocated in North Taiwan resulting in geographical disparity due to unbalanced health care resource allocation. And the large-scale hospitals are mostly congregated only at metropolitan regions; therefore, the access to health care services for patients in rural areas is still limited. Finally, the NHI in Taiwan is a single-payer for all hospitals, in which payment for health care suppliers can be adopted as an efficient strategy to induce the disparity of resource allocation and to redistribute national health care resource. Crown Copyright © 2010. Published by Elsevier Ireland Ltd. All rights reserved.
Health care technology has become an increasingly visible issue in many countries, primarily because of the rising costs of health care. In addition, many questions concerning quality of care are being raised. Health care technology assessment has been seen as an aid in addressing questions
Boisvert, Isabelle; Clemesha, Jennifer; Lundmark, Erik; Crome, Erica; Barr, Caitlin; McMahon, Catherine M
Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices.
Wright, Adam; Sittig, Dean F
In this paper, we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. The SANDS architecture for decision support has several significant advantages over other architectures for clinical decision support. The most salient of these are:
Develop a Prototype Personal Health Record Application (PHR-A) that Captures Information About Daily Living Important for Diabetes and Provides Decision Support with Actionable Advice for Diabetes Self Care
testing your blood sugar or taking your medications.There are also surveys that ask what you believe about diabetes and how your mood has been. When you...Diary, Activity Diary, and Medications Log to see how those components of diabetes self-care affect your blood sugar . As with the other tabs, the Blood...Living Important for Diabetes and Provides Decision Support with Actionable Advice for Diabetes Self Care”. PRINCIPAL INVESTIGATOR: Dr. Stephanie Fonda
The emergence of the Internet made health information, which previously was almost exclusively available to health professionals, accessible to the general public. Access to health information on the Internet is likely to affect individuals' health care related decisions. The aim of this analysis is to determine how health information that people obtain from the Internet affects their demand for health care. I use a novel data set, the U.S. Health Information National Trends Survey (2003-07), to answer this question. The causal variable of interest is a binary variable that indicates whether or not an individual has recently searched for health information on the Internet. Health care utilization is measured by an individual's number of visits to a health professional in the past 12 months. An individual's decision to use the Internet to search for health information is likely to be correlated to other variables that can also affect his/her demand for health care. To separate the effect of Internet health information from other confounding variables, I control for a number of individual characteristics and use the instrumental variable estimation method. As an instrument for Internet health information, I use U.S. state telecommunication regulations that are shown to affect the supply of Internet services. I find that searching for health information on the Internet has a positive, relatively large, and statistically significant effect on an individual's demand for health care. This effect is larger for the individuals who search for health information online more frequently and people who have health care coverage. Among cancer patients, the effect of Internet health information seeking on health professional visits varies by how long ago they were diagnosed with cancer. Thus, the Internet is found to be a complement to formal health care rather than a substitute for health professional services. Copyright © 2012 Elsevier Ltd. All rights reserved.
Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in health care practices raise several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in health care practices as replacements of human care. I analyse them as demands for felt care, good care, private care, and real care. I argue that although these objections cannot stand as good reasons for a general and a priori rejection of AI assistive technolog...
... html To Your Health: NLM update Transcript Four health care challenges : 10/10/2017 To use the sharing ... to follow up on weekly topics. The U.S. health care delivery system needs to address four challenges in ...
Public health, prevention, health education and health promotion are inseparable from the concepts of information and communication. Information should respond as much as possible to the needs of professionals, decision-makers, and consumers who are more and more concerned and conscious of its importance in light of "information overload", various dissemination channels and the multiplicity of its sources. There are numerous issues at stake ranging from comprehension, to the validation of health information, health education, health promotion, prevention, decision-making, as well as issues related to knowledge and power. Irrespective of the type of choice to be made, the need for information, knowledge, and know-how is inseparable from that of other tools or regulatory measures required for decision-making. Information is the same as competence, epidemiological and population data, health data, scientific opinion, and expert conferences--all are needed to assist in decision-making. Based on the principle of precaution, information must increasingly take into account the rejection of a society which often reasons on the basis of a presumption of zero-risk, in an idealistic manner, and which also excludes the possibility of new risks. The consumer positions himself as the regulator of decisions, specifically those with regard to the notion of acceptable level of risk. All of the actors involved in the health system are or become at one moment or another public health decision-makers. Their decision might be based either on an analytical approach, or on an intuitive approach. Although the act of decision-making is the least visible part of public health policy, it is certainly the driving force. This process should integrate the perspective of all of the relevant players, including consumers, who are currently situated more and more frequently at the heart of the health system. Public health decision-making is conducted as a function of political, strategic and
Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings: results from a cluster randomized trial.
Anchala, Raghupathy; Kaptoge, Stephen; Pant, Hira; Di Angelantonio, Emanuele; Franco, Oscar H; Prabhakaran, D
Randomized control trials from the developed world report that clinical decision support systems (DSS) could provide an effective means to improve the management of hypertension (HTN). However, evidence from developing countries in this regard is rather limited, and there is a need to assess the impact of a clinical DSS on managing HTN in primary health care center (PHC) settings. We performed a cluster randomized trial to test the effectiveness and cost-effectiveness of a clinical DSS among Indian adult hypertensive patients (between 35 and 64 years of age), wherein 16 PHC clusters from a district of Telangana state, India, were randomized to receive either a DSS or a chart-based support (CBS) system. Each intervention arm had 8 PHC clusters, with a mean of 102 hypertensive patients per cluster (n=845 in DSS and 783 in CBS groups). Mean change in systolic blood pressure (SBP) from baseline to 12 months was the primary endpoint. The mean difference in SBP change from baseline between the DSS and CBS at the 12th month of follow-up, adjusted for age, sex, height, waist, body mass index, alcohol consumption, vegetable intake, pickle intake, and baseline differences in blood pressure, was -6.59 mm Hg (95% confidence interval: -12.18 to -1.42; P=0.021). The cost-effective ratio for CBS and DSS groups was $96.01 and $36.57 per mm of SBP reduction, respectively. Clinical DSS are effective and cost-effective in the management of HTN in resource-constrained PHC settings. http://www.ctri.nic.in. Unique identifier: CTRI/2012/03/002476. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
van den Berg, Michael J; Kringos, Dionne S; Marks, Lisanne K; Klazinga, Niek S
In 2006, the first edition of a monitoring tool for the performance of the Dutch health care system was released: the Dutch Health Care Performance Report (DHCPR). The Netherlands was among the first countries in the world developing such a comprehensive tool for reporting performance on quality, access, and affordability of health care. The tool contains 125 performance indicators; the choice for specific indicators resulted from a dialogue between researchers and policy makers. In the 'policy cycle', the DHCPR can rationally be placed between evaluation (accountability) and agenda-setting (for strategic decision making). In this paper, we reflect on important lessons learned after seven years of health care system performance assessment. These lessons entail the importance of a good conceptual framework for health system performance assessment, the importance of repeated measurement, the strength of combining multiple perspectives (e.g., patient, professional, objective, subjective) on the same issue, the importance of a central role for the patients' perspective in performance assessment, how to deal with the absence of data in relevant domains, the value of international benchmarking and the continuous exchange between researchers and policy makers.
Full Text Available The world population reached 7 billion in 2012, which is 6 billion more than in 1800. This remarkable population growth is the result of several factors like advances in the medical, technological and public health systems resulting in the control and treatment of communicable diseases, the control of pandemics, the end of large-scale wars, improvements in living conditions and the revolutions in the field of agriculture. Because of all these factors, there has been a considerable improvement in the life expectancy of human beings. There is also an alarming reduction in fertility rates. The combination of declining fertility rate and augmented life expectancies has led to a change in the demographics of the population with the strata of older individuals growing faster than the younger individuals. The aging of populations is poised to become the next global public health challenge. Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanization, modernization, globalization, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic non-infective conditions. Health systems need to find effective strategies to extend health care and to respond to the needs of older adults. This review highlights the pathophysiology of aging, biological and physiological changes, impact of aging on health, epidemiological transitions, multi-morbidity in elderly and challenges for health care system.
Kortteisto, Tiina; Komulainen, Jorma; Mäkelä, Marjukka; Kunnamo, Ilkka; Kaila, Minna
Health information technology, particularly electronic decision support systems, can reduce the existing gap between evidence-based knowledge and health care practice but professionals have to accept and use this information. Evidence is scant on which features influence the use of computer-based clinical decision support (eCDS) in primary care and how different professional groups experience it. Our aim was to describe specific reasons for using or not using eCDS among primary care professionals. The setting was a Finnish primary health care organization with 48 professionals receiving patient-specific guidance at the point of care. Multiple data (focus groups, questionnaire and spontaneous feedback) were analyzed using deductive content analysis and descriptive statistics. The content of the guidance is a significant feature of the primary care professional's intention to use eCDS. The decisive reason for using or not using the eCDS is its perceived usefulness. Functional characteristics such as speed and ease of use are important but alone these are not enough. Specific information technology, professional, patient and environment features can help or hinder the use. Primary care professionals have to perceive eCDS guidance useful for their work before they use it.
Crall, James J
National and state-level evidence has documented ongoing disparities in children's health and utilization of oral health care services, prompting a re-examination of factors associated with poor oral health and low use of oral health services. These efforts have yielded a wide array of proposals for improving children's oral health and oral health care delivery. This paper offers a perspective on the current context of efforts to improve children's oral health and oral health care delivery.
Martinho, Maria Júlia Costa Marques; Martins, Maria Manuela Ferreira Pereira da Silva; Angelo, Margareth
Decision making is an area of health research that has gained importance both for the partnership models of care that give prominence to the patient and family, either by growing concern about quality and customer satisfaction with the care provided. So we decided to make the cultural adaptation and to evaluate the psychometric properties of the Portuguese version "The Satisfaction with Decision Scale" de Holmes-Rovner (1996), which aims to assess satisfaction with the decisions taken in health. The sample consisted of 521 nursing students the School of Nursing of Porto. The results of reliability tests show good internal consistency for the total items (Alpha Cronbach = 0.88). The psychometric study allows us to state that the Portuguese version of "The Satisfaction with Decision Scale", we call "Escala da Satisfação com a Decisão em Saúde", is an instrument comparable with the original in terms of validity and reliability.
care reform legislation—the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA...Estimated Costs for Compliance Patient Protection and Affordable Care Act (PPACA) and Health Care and Education Reconciliation Act of 2010 (HCERA...including inpatient hospitals, home health agencies, nursing homes, hospice providers, psychiatric hospitals, long-term care hospitals, inpatient
According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…
Spector, Richard A
This article explores the development of jurisprudence interpreting application of the Employee Retirement Income Security Act of 1974 to patient care denials by managed care. It identifies quality-of-care protections for patient care under present federal law. If an insurance company utilization review denies care based on patient-specific reasoning, then the patient may have recourse against the utilization review on the basis of a state law claim of malpractice grounded in medical decision-making by the insurance company.
López-Manning, Mauricio; García-Díaz, Rocío
In 2010 Mexican health authorities enacted an antibiotic sale, prescription, and dispensation bill that increased the presence of a new kind of ambulatory care provider, the doctors adjacent to private pharmacies (DAPPs). To analyze how DAPPs' presence in the Mexican ambulatory care market has modified health care seekers' behavior following a two-stage health care provider selection decision process. The first stage focuses on individuals' propensity to captivity to the health care system structure before 2010. The second stage analyzes individuals' medical provider selection in a health system including DAPPs. This two-stage process analysis allowed us not only to show the determinants of each part in the decision process but also to understand the overall picture of DAPPs' impact in both the Mexican health care system and health care seekers, taking into account conditions such as the origins, evolution, and context of this new provider. We used data from individuals (N = 97,549) participating in the Mexican National Survey of Health and Nutrition in 2012. We found that DAPPs have become not only a widely accepted but also a preferred option among the Mexican ambulatory care providers that follow no specific income-level population user group (in spite of its original low-income population target). Our results showed DAPPs as an urban and rapidly expanded phenomenon, presumably keeping the growing pace of new communities and adapting to demographic changes. Individuals opt for DAPPs when they look for health care: in a nearby provider, for either the most recent or common ailments, and in an urban setting; regardless of most socioeconomic background. The relevance of location and accessibility variables in our study provides evidence of the role taken by this provider in the Mexican health care system. Copyright © 2017. Published by Elsevier Inc.
Sim, Livvi Li Wei; Ban, Kenneth Hon Kim; Tan, Tin Wee; Sethi, Sunil Kumar; Loh, Tze Ping
Management of complex chronic diseases such as diabetes requires the assimilation and interpretation of multiple laboratory test results. Traditional electronic health records tend to display laboratory results in a piecemeal and segregated fashion. This makes the assembly and interpretation of results related to diabetes care challenging. We developed a diabetes-specific clinical decision support system (Diabetes Dashboard) interface for displaying glycemic, lipid and renal function results,...
Bayer, R; Callahan, D; Caplan, A L; Jennings, B
The demands of equity and efficiency require a program of universal health insurance in the United States through which all workers will be provided by their employers with health insurance for themselves and their dependents, unemployment will no longer result in the loss of health insurance protection, and federal standards for Medicaid eligibility will be instituted. Issues raised by the assessment of insurance coverage and establishment of uniform standards are discussed within the context of the ethical foundations of medical necessity, schemes for sharing the burden of cost, and the conflict between technological advances and the limitation of resources. Cost containment measures now most prominently on the public agenda represent an unfortunate trend toward exacerbating inequalities by making the patient the main cost container. Moral priority must be given to remedying the patterns of inequality that characterize the American health care system.
Ito, Yuki; Shiraishi, Eriko; Kato, Atsuko; Haino, Takayuki; Sugimoto, Kouhei; Okamoto, Aikou; Suzuki, Nao
To identify the utility and issues associated with the use of decision trees in oncofertility patient care in Japan. A total of 35 women who had been diagnosed with cancer, but had not begun anticancer treatment, were enrolled. We applied the oncofertility decision tree for women published by Gardino et al. to counsel a consecutive series of women on fertility preservation (FP) options following cancer diagnosis. Percentage of women who decided to undergo oocyte retrieval for embryo cryopreservation and the expected live-birth rate for these patients were calculated using the following equation: expected live-birth rate = pregnancy rate at each age per embryo transfer × (1 - miscarriage rate) × No. of cryopreserved embryos. Oocyte retrieval was performed for 17 patients (48.6%; mean ± standard deviation [SD] age, 36.35 ± 3.82 years). The mean ± SD number of cryopreserved embryos was 5.29 ± 4.63. The expected live-birth rate was 0.66. The expected live-birth rate with FP indicated that one in three oncofertility patients would not expect to have a live birth following oocyte retrieval and embryo cryopreservation. While the decision trees were useful as decision-making tools for women contemplating FP, in the context of the current restrictions on oocyte donation and the extremely small number of adoptions in Japan, the remaining options for fertility after cancer are limited. In order for cancer survivors to feel secure in their decisions, the decision tree may need to be adapted simultaneously with improvements to the social environment, such as greater support for adoption.
Kihlgren, Annica; Svensson, Fredrik; Lövbrand, Conny; Gifford, Mervyn; Adolfsson, Annsofie
This study is part of a larger project called ViSam and includes testing of a decision support system developed and adapted for older people on the basis of M (R) ETTS (Rapid Emergency Triage and Treatment System). The system is designed to allow municipal nurses to determine the optimal level of care for older people whose health has deteriorated. This new system will allow more structured assessment, the patient should receive optimal care and improved data transmission to the next caregiver. This study has an explanatory approach, commencing with quantitative data collection phase followed by qualitative data arising from focus group discussions over the RNs professional experience using the Decision Support system. Focus group discussions were performed to complement the quantitative data to get a more holistic view of the decision support system. Using elements of the decision support system (vital parameters for saturation, pain and affected general health) together with the nurses' decision showed that 94 % of the older persons referred to hospital were ultimately hospitalized. Nurses felt that they worked more systematically, communicated more effectively with others and felt more professional when using the decision support system. The results of this study showed that, with the help of a decision support system, the correct patients are sent to the Emergency Department from municipal home care. Unnecessary referrals of older patients that might lead to poorer health, decreased well-being and confusion can thus be avoided. Using the decision support system means that healthcare co-workers (nurses, ambulance/emergency department/district doctor/SOS alarm) begin to communicate more optimally. There is increased understanding leading to the risk of misinterpretation being reduced and the relationship between healthcare co-workers is improved. However, the decision support system requires more extensive testing in order to enhance the evidence base relating
Trenchs Sáinz De La Maza, V; Cambra Lasaosa, F J; Palomeque Rico, A; Balcells Ramírez, J; Seriñá Ramírez, C; Hermana Tezanos Mf, M feminine T
Introduction Termination of artificial life-support in critically-ill patients without chance of recovery or with severe damage is frequent in the intensive care unit (UCI). Patients and methodsWe studied the present situation concerning the withdrawal of life support in Spain using data collected over 10 years in referral hospitals with pediatric ICUs. Forty-nine patients were included, of which 43 had chronic diseases.ResultsThe most frequent causes of admission to the pediatric ICU in this type of patiens was respiratory failure followed by cardiovascular surgery. The family seemed to be a key element when taking a decision although in a few cases the medical team acted paternalistically. The most common ways of limiting life-support were withholding or withdrawing some treatments (mainly mechanical ventilation and vasoactive drugs) and implementing do-not-resuscitate orders. Sedation and suitable pain management were widely used in terminal care. After the decision to limit life-support was made, six patients were discharged from the pediatric ICU. ConclusionsAlthough each case should be treated individually, because of the wide variation found in the limitation of life-support, we suggest the need for common guidelines that could help the decision-making process.
Hearns, Glen; Klein, Michael C; Trousdale, William; Ulrich, Catherine; Butcher, David; Miewald, Christiana; Lindstrom, Ronald; Eftekhary, Sahba; Rosinski, Jessica; Gómez-Ramírez, Oralia; Procyk, Andrea
Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH
Business school curricula have traditionally emphasized functional skills for people who will work in functional departments and general management skills for people who will organize interdepartmental work. Recently, some business schools have begun to develop programs that teach cross-functional work and team skills to functional specialists. Students educated in such programs will be well prepared to meet the new challenges that health care organizations will face.
Ritrovato, Matteo; Faggiano, Francesco C; Tedesco, Giorgia; Derrico, Pietro
This article outlines the Decision-Oriented Health Technology Assessment: a new implementation of the European network for Health Technology Assessment Core Model, integrating the multicriteria decision-making analysis by using the analytic hierarchy process to introduce a standardized methodological approach as a valued and shared tool to support health care decision making within a hospital. Following the Core Model as guidance (European network for Health Technology Assessment. HTA core model for medical and surgical interventions. Available from: http://www.eunethta.eu/outputs/hta-core-model-medical-and-surgical-interventions-10r. [Accessed May 27, 2014]), it is possible to apply the analytic hierarchy process to break down a problem into its constituent parts and identify priorities (i.e., assigning a weight to each part) in a hierarchical structure. Thus, it quantitatively compares the importance of multiple criteria in assessing health technologies and how the alternative technologies perform in satisfying these criteria. The verbal ratings are translated into a quantitative form by using the Saaty scale (Saaty TL. Decision making with the analytic hierarchy process. Int J Serv Sci 2008;1:83-98). An eigenvectors analysis is used for deriving the weights' systems (i.e., local and global weights' system) that reflect the importance assigned to the criteria and the priorities related to the performance of the alternative technologies. Compared with the Core Model, this methodological approach supplies a more timely as well as contextualized evidence for a specific technology, making it possible to obtain data that are more relevant and easier to interpret, and therefore more useful for decision makers to make investment choices with greater awareness. We reached the conclusion that although there may be scope for improvement, this implementation is a step forward toward the goal of building a "solid bridge" between the scientific evidence and the final decision
Anne E M Brabers
Full Text Available Patients vary in their preferences towards involvement in medical decision-making. Previous research, however, gives no clear explanation for this observed variation in their involvement. One possible explanation might be health literacy. Health literacy refers to personal characteristics and social resources needed for people to access, understand and use information to make decisions about their health. This study aimed to examine the relationship between health literacy and self-reported patient involvement. With respect to health literacy, we focused on those competences relevant for medical decision-making. We hypothesized that people with higher health literacy report that they are more involved in medical decision-making. A structured questionnaire was sent to members of the Dutch Health Care Consumer Panel in May 2015 (response 46%, N = 974. Health literacy was measured using five scales of the Health Literacy Questionnaire. A regression model was used to estimate the relationship between health literacy and self-reported involvement. In general, our results did not show a relationship between health literacy and self-reported involvement. We did find a positive significant association between the health literacy scale appraisal of health information and self-reported involvement. Our hypothesis was partly confirmed. The results from this study suggest that higher order competences, that is to say critical health literacy, in particular, are important in reporting involvement in medical decision-making. Future research is recommended to unravel further the relationship between health literacy and patient involvement in order to gain insight into whether health literacy might be an asset to enhance patient participation in medical decision-making.
Brabers, Anne E M; Rademakers, Jany J D J M; Groenewegen, Peter P; van Dijk, Liset; de Jong, Judith D
Patients vary in their preferences towards involvement in medical decision-making. Previous research, however, gives no clear explanation for this observed variation in their involvement. One possible explanation might be health literacy. Health literacy refers to personal characteristics and social resources needed for people to access, understand and use information to make decisions about their health. This study aimed to examine the relationship between health literacy and self-reported patient involvement. With respect to health literacy, we focused on those competences relevant for medical decision-making. We hypothesized that people with higher health literacy report that they are more involved in medical decision-making. A structured questionnaire was sent to members of the Dutch Health Care Consumer Panel in May 2015 (response 46%, N = 974). Health literacy was measured using five scales of the Health Literacy Questionnaire. A regression model was used to estimate the relationship between health literacy and self-reported involvement. In general, our results did not show a relationship between health literacy and self-reported involvement. We did find a positive significant association between the health literacy scale appraisal of health information and self-reported involvement. Our hypothesis was partly confirmed. The results from this study suggest that higher order competences, that is to say critical health literacy, in particular, are important in reporting involvement in medical decision-making. Future research is recommended to unravel further the relationship between health literacy and patient involvement in order to gain insight into whether health literacy might be an asset to enhance patient participation in medical decision-making.
The five leading issues identified, in order of importance, were 1. The need for treatment outcome and efficacy data. 2. The need for changes in clinical and academic preparation of entry-level practitioners. 3. The lack of inclusion or use of services for communication and related disorders in public and private health care programs. 4. The need for greater professional autonomy within the health care system. 5. The need to improve services to underserved populations with communication and related disorders. This report was forwarded to key National Office staff and appropriate ASHA boards, councils, and committees for the purposes of determining its feasibility and developing a national plan for action. The feasibility and action plan will detail completed, ongoing and future activities of the Association related to each issue, recommendation, and strategy. Periodic review of the actions taken and progress achieved will be monitored by the Executive Board, other appropriate boards and councils, and designated National Office staff. The plan represents a progressive view of needed change for the professions of speech-language pathology and audiology within the context of the broader health care delivery system.
Strasser, Roger; Kam, Sophia M; Regalado, Sophie M
Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status. Nowhere is the worldwide shortage of health professionals more pronounced than in rural areas of developing countries. Sub-Saharan Africa (SSA) includes a disproportionately large number of developing countries; therefore, this article explores SSA in depth as an example. Using the conceptual framework of access to primary health care, sustainable rural health service models, rural health workforce supply, and policy implications, this article presents a review of the academic and gray literature as the basis for recommendations designed to achieve greater health equity. An alternative international standard for health professional education is recommended. Decision makers should draw upon the expertise of communities to identify community-specific health priorities and should build capacity to enable the recruitment and training of local students from underserviced areas to deliver quality health care in rural community settings.
Lindly, Olivia J; Geldhof, G John; Acock, Alan C; Sakuma, Kari-Lyn K; Zuckerman, Katharine E; Thorburn, Sheryl
Family-centered care (FCC), including shared decision making (SDM), has become increasingly emphasized in pediatric health care delivery. Past studies using national surveys have used different FCC measurement approaches without determining their validity. We, therefore, sought to develop an FCC measurement model with Medical Expenditure Panel Survey (MEPS) items previously used to assess FCC or SDM; and to determine temporal associations of FCC with unmet health care need. Four longitudinal MEPS data files (2007-2011) were combined. The study sample included 15,764 US children aged 0 to 17 years. Eight items assessed FCC, and 5 items assessed unmet health care need. We performed exploratory factor analyses to develop an FCC measurement model and fit a cross-lagged structural equation model to determine temporal associations between FCC and unmet health care need. Results supported a 2-factor FCC model including family-provider communication and SDM. The family-provider communication factor was indicated by items reflecting general communication between the child's doctor and family. The SDM factor was indicated by items reflecting decision-making about the child's health care. Adjusted cross-lagged structural equation model results showed family-provider communication and SDM were associated with a reduced likelihood of unmet health care need the following year. Unmet health care need was not significantly associated with family-provider communication or SDM the subsequent year. Study results support differentiating between family-provider communication and SDM as interrelated aspects of FCC in future pediatric health care quality measurement and improvement. Family-provider communication and SDM may reduce the likelihood of unmet health care need the following year among US children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.