WorldWideScience

Sample records for models requires careful

  1. Patient-centered care requires a patient-oriented workflow model.

    Science.gov (United States)

    Ozkaynak, Mustafa; Brennan, Patricia Flatley; Hanauer, David A; Johnson, Sharon; Aarts, Jos; Zheng, Kai; Haque, Saira N

    2013-06-01

    Effective design of health information technology (HIT) for patient-centered care requires consideration of workflow from the patient's perspective, termed 'patient-oriented workflow.' This approach organizes the building blocks of work around the patients who are moving through the care system. Patient-oriented workflow complements the more familiar clinician-oriented workflow approaches, and offers several advantages, including the ability to capture simultaneous, cooperative work, which is essential in care delivery. Patient-oriented workflow models can also provide an understanding of healthcare work taking place in various formal and informal health settings in an integrated manner. We present two cases demonstrating the potential value of patient-oriented workflow models. Significant theoretical, methodological, and practical challenges must be met to ensure adoption of patient-oriented workflow models. Patient-oriented workflow models define meaningful system boundaries and can lead to HIT implementations that are more consistent with cooperative work and its emergent features.

  2. Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model.

    Science.gov (United States)

    Schnelle, John F; Schroyer, L Dale; Saraf, Avantika A; Simmons, Sandra F

    2016-11-01

    Nursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. This study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. Minimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload

  3. Business Process Modelling is an Essential Part of a Requirements Analysis. Contribution of EFMI Primary Care Working Group.

    Science.gov (United States)

    de Lusignan, S; Krause, P; Michalakidis, G; Vicente, M Tristan; Thompson, S; McGilchrist, M; Sullivan, F; van Royen, P; Agreus, L; Desombre, T; Taweel, A; Delaney, B

    2012-01-01

    To perform a requirements analysis of the barriers to conducting research linking of primary care, genetic and cancer data. We extended our initial data-centric approach to include socio-cultural and business requirements. We created reference models of core data requirements common to most studies using unified modelling language (UML), dataflow diagrams (DFD) and business process modelling notation (BPMN). We conducted a stakeholder analysis and constructed DFD and UML diagrams for use cases based on simulated research studies. We used research output as a sensitivity analysis. Differences between the reference model and use cases identified study specific data requirements. The stakeholder analysis identified: tensions, changes in specification, some indifference from data providers and enthusiastic informaticians urging inclusion of socio-cultural context. We identified requirements to collect information at three levels: micro- data items, which need to be semantically interoperable, meso- the medical record and data extraction, and macro- the health system and socio-cultural issues. BPMN clarified complex business requirements among data providers and vendors; and additional geographical requirements for patients to be represented in both linked datasets. High quality research output was the norm for most repositories. Reference models provide high-level schemata of the core data requirements. However, business requirements' modelling identifies stakeholder issues and identifies what needs to be addressed to enable participation.

  4. Modelling health care processes for eliciting user requirements: a way to link a quality paradigm and clinical information system design.

    Science.gov (United States)

    Staccini, P; Joubert, M; Quaranta, J F; Fieschi, D; Fieschi, M

    2001-12-01

    Healthcare institutions are looking at ways to increase their efficiency by reducing costs while providing care services with a high level of safety. Thus, hospital information systems have to support quality improvement objectives. The elicitation of the requirements has to meet users' needs in relation to both the quality (efficacy, safety) and the monitoring of all health care activities (traceability). Information analysts need methods to conceptualise clinical information systems that provide actors with individual benefits and guide behavioural changes. A methodology is proposed to elicit and structure users' requirements using a process-oriented analysis, and it is applied to the blood transfusion process. An object-oriented data model of a process has been defined in order to organise the data dictionary. Although some aspects of activity, such as 'where', 'what else', and 'why' are poorly represented by the data model alone, this method of requirement elicitation fits the dynamic of data input for the process to be traced. A hierarchical representation of hospital activities has to be found for the processes to be interrelated, and for their characteristics to be shared, in order to avoid data redundancy and to fit the gathering of data with the provision of care.

  5. Specifying process requirements for holistic care.

    Science.gov (United States)

    Poulymenopoulou, M; Malamateniou, F; Vassilacopoulos, G

    2013-09-01

    Holistic (health and social) care aims at providing comprehensive care to the community, especially to elderly people and people with multiple illnesses. In turn, this requires using health and social care resources more efficiently through enhanced collaboration and coordination among the corresponding organizations and delivering care closer to patient needs and preferences. This paper takes a patient-centered, process view of holistic care delivery and focuses on requirements elicitation for supporting holistic care processes and enabling authorized users to access integrated patient information at the point of care when needed. To this end, an approach to holistic care process-support requirements elicitation is presented which is based on business process modeling and places particular emphasis on empowering collaboration, coordination and information sharing among health and social care organizations by actively involving users and by providing insights for alternative process designs. The approach provides a means for integrating diverse legacy applications in a process-oriented environment using a service-oriented architecture as an appropriate solution for supporting and automating holistic care processes. The approach is applied in the context of emergency medical care aiming at streamlining and providing support technology to cross-organizational health and social care processes to address global patient needs.

  6. The Epital Care Model

    DEFF Research Database (Denmark)

    Phanareth, Klaus; Vingtoft, Søren; Christensen, Anders Skovbo

    2017-01-01

    BACKGROUND: There is worldwide recognition that the future provision of health care requires a reorganization of provision of care, with increased empowerment and engagement of patients, along with skilled health professionals delivering services that are coordinated across sectors...... and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports...... the intentions of the World Health Organization (WHO) to have integrated people-centered care. OBJECTIVE: To design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care...

  7. Planning intensive care unit design using computer simulation modeling: optimizing integration of clinical, operational, and architectural requirements.

    Science.gov (United States)

    OʼHara, Susan

    2014-01-01

    Nurses have increasingly been regarded as critical members of the planning team as architects recognize their knowledge and value. But the nurses' role as knowledge experts can be expanded to leading efforts to integrate the clinical, operational, and architectural expertise through simulation modeling. Simulation modeling allows for the optimal merge of multifactorial data to understand the current state of the intensive care unit and predict future states. Nurses can champion the simulation modeling process and reap the benefits of a cost-effective way to test new designs, processes, staffing models, and future programming trends prior to implementation. Simulation modeling is an evidence-based planning approach, a standard, for integrating the sciences with real client data, to offer solutions for improving patient care.

  8. Towards elicitation of users requirements for hospital information system: from a care process modelling technique to a web based collaborative tool.

    OpenAIRE

    Staccini, Pascal M.; Joubert, Michel; Quaranta, Jean-Francois; Fieschi, Marius

    2002-01-01

    Growing attention is being given to the use of process modeling methodology for user requirements elicitation. In the analysis phase of hospital information systems, the usefulness of care-process models has been investigated to evaluate the conceptual applicability and practical understandability by clinical staff and members of users teams. Nevertheless, there still remains a gap between users and analysts in their mutual ability to share conceptual views and vocabulary, keeping the meaning...

  9. Requirements Engineering for a Pervasive Health Care System

    DEFF Research Database (Denmark)

    Jørgensen, Jens Bæk; Bossen, Claus

    2003-01-01

    We describe requirements engineering for a new pervasive health care system for hospitals in Denmark. The chosen requirements engineering approach composes iterative prototyping and explicit environment description in terms of workflow modelling. New work processes and their proposed computer...

  10. [Modeling the requirements on routine data of general practitioners from the health-care researcher's point of view with the help of unified modeling langauge (UML)].

    Science.gov (United States)

    Kersting, M; Hauswaldt, J; Lingner, H

    2012-08-01

    Health-care research is, besides primary acquired study data, based on data from widely differing secondary sources. In order to link, compare and analyze data sources uniform models and methods are needed. This could be facilitated by a more structured description of requirements, models and methods of health-care research than those currently used. Suitable methods of presentation were sought in an approach to this target and the unified modeling language (UML) identified as a possible alternative. Using different tools 3 UML diagrams were created to represent some individual aspects of a scientific use file (SUF): A use case diagram as well as an activity and a class diagram. In the use case diagram we attempted to represent the general use cases of an SUF based on general practitioners routine data. Secondly a class diagram was constructed to visualize the contents and structure of a SUF. Thirdly an activity diagram was developed to graphically represent the concept of a general practitioner's episode of care. The creation of the UML diagrams was possible without any technical difficulties. Regarding the content the 3 diagrams must still be considered as prototypes. The use case diagram shows possible uses and users of an SUF, e. g. a research worker, industry but also the general practitioner who supplies the data. The class diagram reveals a general data structure that can serve information processes in practice and research. Besides aggregation, possibilities for specialization and generalization are essential elements of the class diagram that can be used meaningfully. The activity diagram for the schematic representation of a general practitioner's episode of care reveals the existence of multiple endpoints of an episode and the possibility to form relationships by means of episodes (diagnosis>therapy). The constructed diagrams are preliminary results and should be refined in future steps. Use case diagrams enable a rapid overview of the meaning and

  11. Models of care and delivery

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2014-01-01

    with community clinics for injecting drug-dependent persons is also being implemented. Shared care models require oversight to ensure that primary responsibility is defined for the persons overall health situation, for screening of co-morbidities, defining indication to treat comorbidities, prescription of non......Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good...... outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining...

  12. Towards elicitation of users requirements for hospital information system: from a care process modelling technique to a web based collaborative tool.

    Science.gov (United States)

    Staccini, Pascal M; Joubert, Michel; Quaranta, Jean-Francois; Fieschi, Marius

    2002-01-01

    Growing attention is being given to the use of process modeling methodology for user requirements elicitation. In the analysis phase of hospital information systems, the usefulness of care-process models has been investigated to evaluate the conceptual applicability and practical understandability by clinical staff and members of users teams. Nevertheless, there still remains a gap between users and analysts in their mutual ability to share conceptual views and vocabulary, keeping the meaning of clinical context while providing elements for analysis. One of the solutions for filling this gap is to consider the process model itself in the role of a hub as a centralized means of facilitating communication between team members. Starting with a robust and descriptive technique for process modeling called IDEF0/SADT, we refined the basic data model by extracting concepts from ISO 9000 process analysis and from enterprise ontology. We defined a web-based architecture to serve as a collaborative tool and implemented it using an object-oriented database. The prospects of such a tool are discussed notably regarding to its ability to generate data dictionaries and to be used as a navigation tool through the medium of hospital-wide documentation.

  13. Acute sports injuries requiring hospital care.

    OpenAIRE

    Sandelin, J

    1986-01-01

    The present investigation reports 138 consecutive patients injured in sports, who needed treatment as in-patients in a one year period. More injuries were sustained in soccer than in other sports. The lower extremity was the site of most injuries, fractures and dislocations being the most common type of injury. At follow-up 50% of the patients complained of discomfort. The average stay in hospital after a sports injury requiring hospital care was 6 days. In 52% of the patients the duration of...

  14. Radiation doses to neonates requiring intensive care

    International Nuclear Information System (INIS)

    Robinson, A.; Dellagrammaticas, H.D.

    1983-01-01

    Radiological investigations have become accepted as an important part of the range of facilities required to support severely ill newborn babies. Since the infants are so small, many of the examinations are virtually ''whole-body'' irradiations and it was thought that the total doses received might be appreciable. A group of such babies admitted to the Neonatal Intensive Care Unit in Sheffield over a six-month period have been studied. X-ray exposure factors used for each examination have been noted and total skin, gonad and bone marrow doses calculated, supplemented by measurements on phantoms. It is concluded that in most cases doses received are of the same order as those received over the same period from natural background radiation and probably less than those received from prenatal obstetric radiography, so that the additional risks from the diagnostic exposure are small. The highest doses are received in CT scans and barium examinations and it is recommended that the need for these should be carefully considered. (author)

  15. 32 CFR 732.16 - Emergency care requirements.

    Science.gov (United States)

    2010-07-01

    ... sepsis. (9) Any other obstetrical condition that, by definition, constitutes an emergency circumstance. ... 32 National Defense 5 2010-07-01 2010-07-01 false Emergency care requirements. 732.16 Section 732... MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.16 Emergency care requirements...

  16. Requirements Modeling with Agent Programming

    Science.gov (United States)

    Dasgupta, Aniruddha; Krishna, Aneesh; Ghose, Aditya K.

    Agent-oriented conceptual modeling notations are highly effective in representing requirements from an intentional stance and answering questions such as what goals exist, how key actors depend on each other, and what alternatives must be considered. In this chapter, we review an approach to executing i* models by translating these into set of interacting agents implemented in the CASO language and suggest how we can perform reasoning with requirements modeled (both functional and non-functional) using i* models. In this chapter we particularly incorporate deliberation into the agent design. This allows us to benefit from the complementary representational capabilities of the two frameworks.

  17. Successful chronic disease care for Aboriginal Australians requires cultural competence.

    Science.gov (United States)

    Liaw, Siaw Teng; Lau, Phyllis; Pyett, Priscilla; Furler, John; Burchill, Marlene; Rowley, Kevin; Kelaher, Margaret

    2011-06-01

    To review the literature to determine the attributes of culturally appropriate healthcare to inform the design of chronic disease management (CDM) models for Aboriginal patients in urban general practice. A comprehensive conceptual framework, drawing on the Access to Care, Pathway to Care, Chronic Care, Level of Connectedness, and Cultural Security, Cultural Competency and Cultural Respect models, was developed to define the search strategy, inclusion criteria and appraisal methods for the literature review. Selected papers were reviewed in detail if they examined a chronic disease intervention for an Aboriginal population and reported on its evaluation, impacts or outcomes. In the 173 papers examined, only 11 programs met the inclusion criteria. All were programs conducted in rural and remote Aboriginal community-controlled health services. Successful chronic disease care and interventions require adequate Aboriginal community engagement, utilising local knowledge, strong leadership, shared responsibilities, sustainable resources and integrated data and systems. These success factors fitted within the conceptual framework developed. Research and development of culturally appropriate CDM models concurrently in both urban and rural settings will enable more rigorous evaluation, leading to stronger evidence for best practice. A partnership of mainstream and Aboriginal-controlled health services is essential to successfully 'close the gap'. Findings will inform and guide the development, implementation and evaluation of culturally appropriate CDM in mainstream general practice and primary care. © 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia.

  18. CNA Training Requirements and Resident Care Outcomes in Nursing Homes.

    Science.gov (United States)

    Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy B; Yang, Bo Kyum; Han, Kihye

    2017-06-01

    To examine the relationship between certified nursing assistant (CNA) training requirements and resident outcomes in U.S. nursing homes (NHs). The number and type of training hours vary by state since many U.S. states have chosen to require additional hours over the federal minimums, presumably to keep pace with the increasing complexity of care. Yet little is known about the impact of the type and amount of training CNAs are required to have on resident outcomes. Compiled data on 2010 state regulatory requirements for CNA training (clinical, total initial training, in-service, ratio of clinical to didactic hours) were linked to 2010 resident outcomes data from 15,508 NHs. Outcomes included the following NH Compare Quality Indicators (QIs) (Minimum Data Set 3.0): pain, antipsychotic use, falls with injury, depression, weight loss and pressure ulcers. Facility-level QIs were regressed on training indicators using generalized linear models with the Huber-White correction, to account for clustering of NHs within states. Models were stratified by facility size and adjusted for case-mix, ownership status, percentage of Medicaid-certified beds and urban-rural status. A higher ratio of clinical to didactic hours was related to better resident outcomes. NHs in states requiring clinical training hours above federal minimums (i.e., >16hr) had significantly lower odds of adverse outcomes, particularly pain falls with injury, and depression. Total and in-service training hours also were related to outcomes. Additional training providing clinical experiences may aid in identifying residents at risk. This study provides empirical evidence supporting the importance of increased requirements for CNA training to improve quality of care. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Telehealth-based model of care redesign to facilitate local fitting and management of patients with a spinal fracture requiring a thoracic lumbar sacral orthosis in rural hospitals in New South Wales.

    Science.gov (United States)

    Gallagher, Ryan; Giles, Michelle; Morison, Jane; Henderson, Judith

    2018-03-23

    To develop and implement a telehealth-based model of care for spinal fractures requiring management with thoracic lumbar sacral orthoses that eliminates the need for transfer to a metropolitan tertiary referral hospital. Pre-post design observational study evaluating model of care implementation. Rural referral hospitals in a large NSW region covering metropolitan, rural and remote hospitals. Patients presenting with a thoracic or lumbar spine fracture requiring thoracic lumbar sacral orthoses management and rural clinicians caring for them. Number of patients managed in rural hospitals without transfer to a metropolitan tertiary referral hospital; length of stay and related cost efficiencies; clinicians' perceived skills, knowledge and confidence levels. Model of care was implemented with clinical and system governance processes; and educational workshops across eight rural hospitals. A total of 81 patients managed in rural hospitals under this model between July 2013 and June 2016 without transfer were included in this study. Mean length of stay reduced from nine to four days. Hospital transfers were eliminated from the patient journey, totalling 24 324 km. Workshops were attended by 71 clinicians from nine rural hospitals and survey findings indicated a significant increase in staff knowledge, skill and confidence post education. Cost efficiencies were gained by eliminating 162 inter-hospital transfers and 405 patient bed days. This model has streamlined patient journeys and reduced transfers and travel, enabling rural clinicians to provide specialised services in local communities and facilitating timely evidence-based care in local communities without any adverse events. © 2018 National Rural Health Alliance Ltd.

  20. Cancer Survivorship Care: Person Centered Care in a Multidisciplinary Shared Care Model

    Directory of Open Access Journals (Sweden)

    Jacqueline Loonen

    2018-01-01

    Full Text Available Survivors of childhood and adult-onset cancer are at lifelong risk for the development of late effects of treatment that can lead to serious morbidity and premature mortality. Regular long-term follow-up aiming for prevention, early detection and intervention of late effects can preserve or improve health. The heterogeneous and often serious character of late effects emphasizes the need for specialized cancer survivorship care clinics. Multidisciplinary cancer survivorship care requires a coordinated and well integrated health care environment for risk based screening and intervention. In addition survivors engagement and adherence to the recommendations are also important elements. We developed an innovative model for integrated care for cancer survivors, the “Personalized Cancer Survivorship Care Model”, that is being used in our clinic. This model comprises 1. Personalized follow-up care according to the principles of Person Centered Care, aiming to empower survivors and to support self management, and 2. Organization according to a multidisciplinary and risk based approach. The concept of person centered care is based on three components: initiating, integrating and safeguarding the partnership with the patient. This model has been developed as a universal model of care that will work for all cancer survivors in different health care systems. It could be used for studies to improve self efficacy and the cost-effectiveness of cancer survivorship care.

  1. Health care professionals' perspectives on the requirements ...

    African Journals Online (AJOL)

    ... a roll-out plan; leadership; and supporting and reinforcing structures such as: resources, communicating, education and development regarding the best practice, and the organisational structure. The requirements were identified at four different levels: individual level (e.g. the nurse and medical specialists), management ...

  2. Requirements for reflection in the critical care environment

    Directory of Open Access Journals (Sweden)

    Celia J. Filmalter

    2015-03-01

    Full Text Available Background: Reflection is recognised as an important method for practice development. The importance of reflection is well documented in the literature, but the requirements for reflection remain unclear. Objectives: To explore and describe the requirements for reflection in the critical care environment as viewed by educators of qualified critical care nurses. Method: A focus group interview was conducted to explore and describe the views of educators of qualified critical care nurses regarding requirements for reflection in the critical care environment. Results: The themes that emerged from the focus group were buy-in from stakeholders –management, facilitators and critical care nurses, and the need to create an environment where reflection can occur. Conclusion: Critical care nurses should be allowed time to reflect on their practice and be supported by peers as well as a facilitator in a non-intimidating way to promote emancipatorypractice development.

  3. Costs of health care across primary care models in Ontario.

    Science.gov (United States)

    Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

    2017-08-01

    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

  4. Developing Integrated Care: Towards a development model for integrated care

    NARCIS (Netherlands)

    M.M.N. Minkman (Mirella)

    2012-01-01

    textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated

  5. 42 CFR 409.43 - Plan of care requirements.

    Science.gov (United States)

    2010-10-01

    ...) Changes to the plan of care signature requirements. Any changes in the plan must be signed and dated by a...) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same... skilled nursing, physical therapy, speech-language pathology services, or occupational therapy visit in a...

  6. Caring about caring: developing a model to implement compassionate relationship centred care in an older people care setting.

    Science.gov (United States)

    Dewar, Belinda; Nolan, Mike

    2013-09-01

    This study actively involved older people, staff and relatives in agreeing a definition of compassionate relationship-centred care and identifying strategies to promote such care in acute hospital settings for older people. It was a major component of a three year programme (the Leadership in Compassionate Care Programme, LCCP) seeking to integrate compassionate care across practice and educational environments. Compassionate caring and promoting dignity are key priorities for policy, practice and research worldwide, being central to the quality of care for patients and families, and job satisfaction for staff. Therapeutic relationships are essential to achieving excellence in care but little is known about how to develop and sustain such relationships in a culture that increasingly focuses on throughput and rapid turnover. The study used appreciative inquiry and a range of methods including participant observation, interviews, story telling and group discussions to actively engage older people, relatives and staff. A process of immersion crystallization was used to analyze data with staff as co-analysts. The study adds considerably to the conceptualization of compassionate, relationship-centred care and provides a model to aid staff deliver such care in practice, based on 'appreciative caring conversations' that enable all parties to gain two forms of 'person and relational knowledge' about 'who people are and what matters to them' and 'how people feel about their experience'. Such knowledge enables staff, patients and carers to 'work together to shape the way things are done'. The study generated a model called the 7 'C's that captures in detail the factors necessary to promote 'appreciative caring conversations'. The study demonstrates that engaging in 'appreciative caring conversations' promotes compassionate, relationship-centred care but that these conversations involve practitioners taking risks. Such 'relational practices' must therefore be valued and

  7. Data requirements for integrated near field models

    International Nuclear Information System (INIS)

    Wilems, R.E.; Pearson, F.J. Jr.; Faust, C.R.; Brecher, A.

    1981-01-01

    The coupled nature of the various processes in the near field require that integrated models be employed to assess long term performance of the waste package and repository. The nature of the integrated near field models being compiled under the SCEPTER program are discussed. The interfaces between these near field models and far field models are described. Finally, near field data requirements are outlined in sufficient detail to indicate overall programmatic guidance for data gathering activities

  8. Costs of health care across primary care models in Ontario

    OpenAIRE

    Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

    2017-01-01

    Background 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. Methods Utilization data for a one year period was measured using administrative databases for a 1...

  9. Mediating Informal Care Online: Findings from an Extensive Requirements Analysis

    Directory of Open Access Journals (Sweden)

    Christiane Moser

    2015-05-01

    Full Text Available Organizing and satisfying the increasing demand for social and informal care for older adults is an important topic. We aim at building a peer-to-peer exchange platform that empowers older adults to benefit from receiving support for daily activities and reciprocally offering support to others. In situated interviews and within a survey we investigated the requirements and needs of 246 older adults with mild impairments. Additionally, we conducted an interpretative role analysis of older adults’ collaborative care processes (i.e., support exchange practices in order to identify social roles and understand the inherent expectations towards the execution of support. We will describe our target group in the form of personas and different social roles, as well as user requirements for establishing a successful peer-to-peer collaboration. We also consider our finding from the perspective of social capital theory that allows us to describe in our requirements how relationships provide valuable social resources (i.e., social capital for informal and social care.

  10. Achieving Value in Primary Care: The Primary Care Value Model.

    Science.gov (United States)

    Rollow, William; Cucchiara, Peter

    2016-03-01

    The patient-centered medical home (PCMH) model provides a compelling vision for primary care transformation, but studies of its impact have used insufficiently patient-centered metrics with inconsistent results. We propose a framework for defining patient-centered value and a new model for value-based primary care transformation: the primary care value model (PCVM). We advocate for use of patient-centered value when measuring the impact of primary care transformation, recognition, and performance-based payment; for financial support and research and development to better define primary care value-creating activities and their implementation; and for use of the model to support primary care organizations in transformation. © 2016 Annals of Family Medicine, Inc.

  11. A Requirements Analysis Model Based on QFD

    Institute of Scientific and Technical Information of China (English)

    TANG Zhi-wei; Nelson K.H.Tang

    2004-01-01

    The enterprise resource planning (ERP) system has emerged to offer an integrated IT solution and more and more enterprises are increasing by adopting this system and regarding it as an important innovation. However, there is already evidence of high failure risks in ERP project implementation, one major reason is poor analysis of the requirements for system implementation. In this paper, the importance of requirements analysis for ERP project implementation is highlighted, and a requirements analysis model by applying quality function deployment (QFD) is presented, which will support to conduct requirements analysis for ERP project.

  12. Modeling and Testing Legacy Data Consistency Requirements

    DEFF Research Database (Denmark)

    Nytun, J. P.; Jensen, Christian Søndergaard

    2003-01-01

    An increasing number of data sources are available on the Internet, many of which offer semantically overlapping data, but based on different schemas, or models. While it is often of interest to integrate such data sources, the lack of consistency among them makes this integration difficult....... This paper addresses the need for new techniques that enable the modeling and consistency checking for legacy data sources. Specifically, the paper contributes to the development of a framework that enables consistency testing of data coming from different types of data sources. The vehicle is UML and its...... accompanying XMI. The paper presents techniques for modeling consistency requirements using OCL and other UML modeling elements: it studies how models that describe the required consistencies among instances of legacy models can be designed in standard UML tools that support XMI. The paper also considers...

  13. Collaborative deliberation: a model for patient care.

    Science.gov (United States)

    Elwyn, Glyn; Lloyd, Amy; May, Carl; van der Weijden, Trudy; Stiggelbout, Anne; Edwards, Adrian; Frosch, Dominick L; Rapley, Tim; Barr, Paul; Walsh, Thom; Grande, Stuart W; Montori, Victor; Epstein, Ronald

    2014-11-01

    Existing theoretical work in decision making and behavior change has focused on how individuals arrive at decisions or form intentions. Less attention has been given to theorizing the requirements that might be necessary for individuals to work collaboratively to address difficult decisions, consider new alternatives, or change behaviors. The goal of this work was to develop, as a forerunner to a middle range theory, a conceptual model that considers the process of supporting patients to consider alternative health care options, in collaboration with clinicians, and others. Theory building among researchers with experience and expertise in clinician-patient communication, using an iterative cycle of discussions. We developed a model composed of five inter-related propositions that serve as a foundation for clinical communication processes that honor the ethical principles of respecting individual agency, autonomy, and an empathic approach to practice. We named the model 'collaborative deliberation.' The propositions describe: (1) constructive interpersonal engagement, (2) recognition of alternative actions, (3) comparative learning, (4) preference construction and elicitation, and (5) preference integration. We believe the model underpins multiple suggested approaches to clinical practice that take the form of patient centered care, motivational interviewing, goal setting, action planning, and shared decision making. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Virtual Models of Long-Term Care

    Science.gov (United States)

    Phenice, Lillian A.; Griffore, Robert J.

    2012-01-01

    Nursing homes, assisted living facilities and home-care organizations, use web sites to describe their services to potential consumers. This virtual ethnographic study developed models representing how potential consumers may understand this information using data from web sites of 69 long-term-care providers. The content of long-term-care web…

  15. A fuzzy model for exploiting customer requirements

    Directory of Open Access Journals (Sweden)

    Zahra Javadirad

    2016-09-01

    Full Text Available Nowadays, Quality function deployment (QFD is one of the total quality management tools, where customers’ views and requirements are perceived and using various techniques improves the production requirements and operations. The QFD department, after identification and analysis of the competitors, takes customers’ feedbacks to meet the customers’ demands for the products compared with the competitors. In this study, a comprehensive model for assessing the importance of the customer requirements in the products or services for an organization is proposed. The proposed study uses linguistic variables, as a more comprehensive approach, to increase the precision of the expression evaluations. The importance of these requirements specifies the strengths and weaknesses of the organization in meeting the requirements relative to competitors. The results of these experiments show that the proposed method performs better than the other methods.

  16. A SUSTAINABLE HEALTH CARE SYSTEM REQUIRES MANAGEMENT TRANSFORMATION

    Directory of Open Access Journals (Sweden)

    Kanellopoulos Dimitros

    2011-12-01

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

  17. Diabetes care: model for the future of primary care.

    Science.gov (United States)

    Posey, L Michael; Tanzi, Maria G

    2010-01-01

    To review relevant trends threatening primary care and the evidence supporting use of nonphysicians in primary and chronic care of patients with diabetes. Current medical and pharmacy literature as selected by authors. The care needed by patients with diabetes does not fit well into our current medical model for primary care, and an adequate supply of physicians is not likely to be available for primary care roles in coming years. Patients with diabetes who are placed on evidence-based regimens, are educated about their disease, are coached in ways that motivate them to lose weight and adopt other therapeutic lifestyle changes, and are adhering to and persisting with therapy will soon have improved clinical parameters. These quickly translate into fewer hospitalizations and emergency department visits. A growing body of literature supports the use of pharmacists and other nonphysicians in meeting the needs of patients with diabetes. Pharmacists should join nurse practitioners, specially trained nurses, and physician assistants as integral members of the health care team in providing care to patients with diabetes and, by logical extension, other chronic conditions. Demand for primary care is likely to outstrip the available supply of generalist physicians in the coming years. In addition to nurse practitioners and physician assistants, pharmacists should be considered for key roles in future interdisciplinary teams that triage and provide direct care to patients, including those with diabetes and other chronic conditions.

  18. Multidisciplinary Care Models for Patients With Psoriatic Arthritis.

    Science.gov (United States)

    Queiro, Rubén; Coto, Pablo; Rodríguez, Jesús; Notario, Jaume; Navío Marco, Teresa; de la Cueva, Pablo; Pujol Busquets, Manel; García Font, Mercè; Joven, Beatriz; Rivera, Raquel; Alvarez Vega, Jose Luis; Chaves Álvarez, Antonio Javier; Sánchez Parera, Ricardo; Ruiz Carrascosa, Jose Carlos; Rodríguez Martínez, Fernando José; Pardo Sánchez, José; Feced Olmos, Carlos; Pujol, Conrad; Galindez, Eva; Pérez Barrio, Silvia; Urruticoechea Arana, Ana; Hergueta, Mercedes; Luelmo, Jesús; Gratacós, Jordi

    To describe (structure, processes) of the multidisciplinary care models in psoriatic arthritis (PsA) in Spain, as well as barriers and facilitators of their implementation. A qualitative study was performed following structured interviews with 24 professionals (12 rheumatologists, 12 dermatologists who provide multidisciplinary care for patients with PsA). We collected data related to the hospital, department, population and multidisciplinary care model (type, physical and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision- making, research and education, clinical sessions, development and planning of the model, advantages and disadvantages of the model, barriers and facilitators in the implementation of the model. The models characteristics are described. We analyzed 12 multidisciplinary care models in PsA, with at least 1-2 years of experience, and 3 subtypes of models, face-to-face, parallel, and preferential circuit. All are adapted to the hospital and professionals characteristics. A proper implementation planning is essential. The involvement and empathy between professionals and an access and well-defined referral criteria are important facilitators in the implementation of a model. The management of agendas and data collection to measure the multidisciplinary care models health outcomes are the main barriers. There are different multidisciplinary care models in PsA that can improve patient outcomes, system efficiency and collaboration between specialists. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  19. Modeling requirements for in situ vitrification

    International Nuclear Information System (INIS)

    MacKinnon, R.J.; Mecham, D.C.; Hagrman, D.L.; Johnson, R.W.; Murray, P.E.; Slater, C.E.; Marwil, E.S.; Weaver, R.A.; Argyle, M.D.

    1991-11-01

    This document outlines the requirements for the model being developed at the INEL which will provide analytical support for the ISV technology assessment program. The model includes representations of the electric potential field, thermal transport with melting, gas and particulate release, vapor migration, off-gas combustion and process chemistry. The modeling objectives are to (1) help determine the safety of the process by assessing the air and surrounding soil radionuclide and chemical pollution hazards, the nuclear criticality hazard, and the explosion and fire hazards, (2) help determine the suitability of the ISV process for stabilizing the buried wastes involved, and (3) help design laboratory and field tests and interpret results therefrom

  20. Mayo Clinic Care Network: A Collaborative Health Care Model.

    Science.gov (United States)

    Wald, John T; Lowery-Schrandt, Sherri; Hayes, David L; Kotsenas, Amy L

    2018-01-01

    By leveraging its experience and expertise as a consultative clinical partner, the Mayo Clinic developed an innovative, scalable care model to accomplish several strategic goals: (1) create and sustain high-value relationships that benefit patients and providers, (2) foster relationships with like-minded partners to act as a strategy against the development of narrow health care networks, and (3) increase national and international brand awareness of Mayo Clinic. The result was the Mayo Clinic Care Network. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  1. 25 CFR 20.507 - What requirements must foster care providers meet?

    Science.gov (United States)

    2010-04-01

    ... ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.507 What requirements must foster care providers meet? If a child needs foster care, the social services worker must select care that... contain an approved current home study. (c) An off-reservation foster home, or residential care facility...

  2. Health care professionals' perspectives on the requirements facilitating the roll-out of kangaroo mother care in South Africa

    Directory of Open Access Journals (Sweden)

    Wilma ten Ham

    2016-10-01

    Purpose of the research: To explore and describe the perspectives of health professionals on the requirements for the rolling-out process of KMC as a best practice in South Africa. Methodology: Twelve semi-structured individual interviews were conducted in 2012 with health professionals from various South African healthcare levels, involved in the implementation and the rolling-out process of kangaroo mother care. Content analysis were guided in terms of the four requirements for roll-out of best practices, identified in Edwards and Grinspun's Evidence Informed Model of Care. Results: The requirements for the successful rollout of best practices mentioned by the participants in this study concur with the requirements of Edwards and Grinspun: personal alignment and protocol/policy alignment with the best practice; a roll-out plan; leadership; and supporting and reinforcing structures such as: resources, communicating, education and development regarding the best practice, and the organisational structure. The requirements were identified at four different levels: individual level (e.g. the nurse and medical specialists, management level (of the hospital, provincial level and national level.

  3. Do assisted-reproduction twin pregnancies require additional antenatal care?

    Science.gov (United States)

    Jauniaux, E; Ben-Ami, I; Maymon, R

    2013-02-01

    Iatrogenic twinning has become the main side-effect assisted reproduction treatment. We have evaluated the evidence for additional care that assisted-reproduction twins may require compared with spontaneous twins. Misacarriages are increased in women with tubal problems and after specific treatments. Assisted-reproduction twin pregnancies complicated by a vanishing twin after 8 weeks have an increased risk of preterm delivery and of low and very low birthweight compared with singleton assisted-reproduction pregnancies. Monozygotic twin pregnancies occur at a higher rate after assisted reproduction treatment and are associated with a higher risk of perinatal complications. The incidence of placenta praevia and vasa praevia is increased in assisted-reproduction twin pregnancies. Large cohort studies do not indicate a higher rate of fetal congenital malformations in assisted-reproduction twins. Overall, assisted-reproduction twins in healthy women assisted-reproduction twins is only increased in women with a pre-existing medical condition such as hypertensive disorders and diabetes and most of these risks can be avoided with single-embryo transfer. Following the birth of the first IVF baby, rumours started to spread in both the medical literature and the media about the long-term health effects for children born following assisted reproduction treatment. However, after more than 30 years, the most common complications associated with IVF treatment remain indirect and technical such as the failure of treatment and ovarian hyperstimulation. Iatrogenic twinning has become the main side-effect of assisted reproduction treatment and the increasing number of twin pregnancies, in particular in older women, has generated numerous debates on the need for additional healthcare provision. In this review, we have evaluated the evidence for additional care that assisted-conception twin pregnancies may require compared with spontaneous twin pregnancies. Twin pregnancies are

  4. 32 CFR 732.17 - Nonemergency care requirements.

    Science.gov (United States)

    2010-07-01

    ... her leave address or travel to the most accessible USMTF or USTF with capability for maternity care... approval of nonemergency care (medical, dental, or maternity) from non-Federal sources to the adjudication... information addressee on each letter of authorization. (c) Maternity care. (1) Pregnant active duty members...

  5. An Employee-Centered Care Model Responds to the Triple Aim: Improving Employee Health.

    Science.gov (United States)

    Fox, Kelly; McCorkle, Ruth

    2018-01-01

    Health care expenditures, patient satisfaction, and timely access to care will remain problematic if dramatic changes in health care delivery models are not developed and implemented. To combat this challenge, a Triple Aim approach is essential; Innovation in payment and health care delivery models is required. Using the Donabedian framework of structure, process, and outcome, this article describes a nurse-led employee-centered care model designed to improve consumers' health care experiences, improve employee health, and increase access to care while reducing health care costs for employees, age 18 and older, in a corporate environment.

  6. Modeling of Food and Nutrition Surveillance in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Santuzza Arreguy Silva VITORINO

    Full Text Available ABSTRACT Objective: To describe the modeling stages of food and nutrition surveillance in the Primary Health Care of the Unified Health Care System, considering its activities, objectives, and goals Methods: Document analysis and semi-structured interviews were used for identifying the components, describe the intervention, and identify potential assessment users. Results: The results include identification of the objectives and goals of the intervention, the required inputs, activities, and expected effects. The intervention was then modeled based on these data. The use of the theoretical logic model optimizes times, resources, definition of the indicators that require monitoring, and the aspects that require assessment, identifying more clearly the contribution of the intervention to the results Conclusion: Modeling enabled the description of food and nutrition surveillance based on its components and may guide the development of viable plans to monitor food and nutrition surveillance actions so that modeling can be established as a local intersectoral planning instrument.

  7. Modeling Health Care Expenditures and Use.

    Science.gov (United States)

    Deb, Partha; Norton, Edward C

    2018-04-01

    Health care expenditures and use are challenging to model because these dependent variables typically have distributions that are skewed with a large mass at zero. In this article, we describe estimation and interpretation of the effects of a natural experiment using two classes of nonlinear statistical models: one for health care expenditures and the other for counts of health care use. We extend prior analyses to test the effect of the ACA's young adult expansion on three different outcomes: total health care expenditures, office-based visits, and emergency department visits. Modeling the outcomes with a two-part or hurdle model, instead of a single-equation model, reveals that the ACA policy increased the number of office-based visits but decreased emergency department visits and overall spending.

  8. The Gold Coast Integrated Care Model

    Directory of Open Access Journals (Sweden)

    Martin Connor

    2016-07-01

    Full Text Available This article outlines the development of the Australian Gold Coast Integrated Care Model based on the elements identified in contemporary research literature as essential for successful integration of care between primary care, and acute hospital services. The objectives of the model are to proactively manage high risk patients with complex and chronic conditions in collaboration with General Practitioners to ultimately reduce presentations to the health service emergency department, improve the capacity of specialist outpatients, and decrease planned and unplanned admission rates. Central to the model is a shared care record which is maintained and accessed by staff in the Coordination Centre. We provide a process map outlining the care protocols from initial assessment to care of the patient presenting for emergency care. The model is being evaluated over a pilot three year proof of concept phase to determine economic and process perspectives. If found to be cost-effective, acceptable to patients and professionals and as good as or better than usual care in terms of outcomes, the strategic intent is to scale the programme beyond the local health service.

  9. Developing rural palliative care: validating a conceptual model.

    Science.gov (United States)

    Kelley, Mary Lou; Williams, Allison; DeMiglio, Lily; Mettam, Hilary

    2011-01-01

    The purpose of this research was to validate a conceptual model for developing palliative care in rural communities. This model articulates how local rural healthcare providers develop palliative care services according to four sequential phases. The model has roots in concepts of community capacity development, evolves from collaborative, generalist rural practice, and utilizes existing health services infrastructure. It addresses how rural providers manage challenges, specifically those related to: lack of resources, minimal community understanding of palliative care, health professionals' resistance, the bureaucracy of the health system, and the obstacles of providing services in rural environments. Seven semi-structured focus groups were conducted with interdisciplinary health providers in 7 rural communities in two Canadian provinces. Using a constant comparative analysis approach, focus group data were analyzed by examining participants' statements in relation to the model and comparing emerging themes in the development of rural palliative care to the elements of the model. The data validated the conceptual model as the model was able to theoretically predict and explain the experiences of the 7 rural communities that participated in the study. New emerging themes from the data elaborated existing elements in the model and informed the requirement for minor revisions. The model was validated and slightly revised, as suggested by the data. The model was confirmed as being a useful theoretical tool for conceptualizing the development of rural palliative care that is applicable in diverse rural communities.

  10. A Requirement Engineering Framework for Electronic Data Sharing of Health Care Data Between Organizations

    Science.gov (United States)

    Liu, Xia; Peyton, Liam; Kuziemsky, Craig

    Health care is increasingly provided to citizens by a network of collaboration that includes multiple providers and locations. Typically, that collaboration is on an ad-hoc basis via phone calls, faxes, and paper based documentation. Internet and wireless technologies provide an opportunity to improve this situation via electronic data sharing. These new technologies make possible new ways of working and collaboration but it can be difficult for health care organizations to understand how to use the new technologies while still ensuring that their policies and objectives are being met. It is also important to have a systematic approach to validate that e-health processes deliver the performance improvements that are expected. Using a case study of a palliative care patient receiving home care from a team of collaborating health organizations, we introduce a framework based on requirements engineering. Key concerns and objectives are identified and modeled (privacy, security, quality of care, and timeliness of service). And, then, proposed business processes which use new technologies are modeled in terms of these concerns and objectives to assess their impact and ensure that electronic data sharing is well regulated.

  11. BDA special care case mix model.

    Science.gov (United States)

    Bateman, P; Arnold, C; Brown, R; Foster, L V; Greening, S; Monaghan, N; Zoitopoulos, L

    2010-04-10

    Routine dental care provided in special care dentistry is complicated by patient specific factors which increase the time taken and costs of treatment. The BDA have developed and conducted a field trial of a case mix tool to measure this complexity. For each episode of care the case mix tool assesses the following on a four point scale: 'ability to communicate', 'ability to cooperate', 'medical status', 'oral risk factors', 'access to oral care' and 'legal and ethical barriers to care'. The tool is reported to be easy to use and captures sufficient detail to discriminate between types of service and special care dentistry provided. It offers potential as a simple to use and clinically relevant source of performance management and commissioning data. This paper describes the model, demonstrates how it is currently being used, and considers future developments in its use.

  12. Human resources requirements for diabetic patients healthcare in primary care clinics of the Mexican Institute of Social Security

    Directory of Open Access Journals (Sweden)

    Svetlana V Doubova

    2013-11-01

    Full Text Available Objective. To estimate the requirements of human resources (HR of two models of care for diabetes patients: conventional and specific, also called DiabetIMSS, which are provided in primary care clinics of the Mexican Institute of Social Security (IMSS. Materials and methods. An evaluative research was conducted. An expert group identified the HR activities and time required to provide healthcare consistent with the best clinical practices for diabetic patients. HR were estimated by using the evidence-based adjusted service target approach for health workforce planning; then, comparisons between existing and estimated HRs were made. Results. To provide healthcare in accordance with the patients’ metabolic control, the conventional model required increasing the number of family doctors (1.2 times nutritionists (4.2 times and social workers (4.1 times. The DiabetIMSS model requires greater increase than the conventional model. Conclusions. Increasing HR is required to provide evidence-based healthcare to diabetes patients.

  13. Understanding Business Models in Health Care.

    Science.gov (United States)

    Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

    2016-05-01

    The increasing focus on the costs of care is forcing health care organizations to critically look at their basic set of processes and activities, to determine what type of value they can deliver. A business model describes the resources, processes, and cost assumptions that an organization makes that will lead to the delivery of a unique value proposition to a customer. As health care organizations are beginning to transform their structure in preparation for a value-based delivery system, understanding business model theory can help in the redesign process.

  14. Simulation modeling for the health care manager.

    Science.gov (United States)

    Kennedy, Michael H

    2009-01-01

    This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

  15. ISLAMIC CARING MODEL ON INCREASE PATIENT SATISFACTION

    Directory of Open Access Journals (Sweden)

    Muh. Abdurrouf

    2017-04-01

    Full Text Available Introduction: Patient satisfaction was important aspect that must be considered by health service providers, patients who were not satisfied will leave the hospital and be a competitor's customers so be able caused a decrease in sales of products/services and in turn could reduce and even loss of profit, therefore, the hospital must provided the best service so that it could increase patient satisfaction. The purpose of this study was to exams the effect of Islamic caring model on increase patient satisfaction.. Method: This study was used pre-experimental design, the respondents were 31 patients in the treatment group assigned Islamic caring and 31 patients with a kontrol group that were not given Islamic caring Inpatient Surgical Sultan Agung Islamic Hospital Semarang by using consecutive sampling techniques, patient satisfaction data collected through questionnaires and analyzed with Mann-Whitney test, as for finding out the Islamic caring for patient satisfaction were analyzed with spearmen's rho test. Result: The results showed that there was a significant influence of Islamic caring for perceived disconfirmation (p=0,000 there was a perceived disconfirmation influence on patient satisfaction significantly (p=0,000, there was a significant influence of Islamic caring for patient satisfaction in the treatment group with a kontrol group (p=0.001. Discussion: Discussion of this study was Islamic caring model effect on the increase perceived disconfirmation and patient satisfaction, Perceived disconfirmation effect on patient satisfaction, patient satisfaction who given Islamic caring was increase, patients given Islamic caring had higher satisfaction levels than patients who not given Islamic caring. Suggestions put forward based on the results of the study of Islamic caring model could be applied in Sultan Agung Islamic Hospital as a model of nursing care, Islamic caring behavior can be learned and improved through training and commitment and

  16. Myasthenic crisis patients who require intensive care unit management.

    Science.gov (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto

    2012-09-01

    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care. Copyright © 2012 Wiley Periodicals, Inc.

  17. Nurse management skills required at an emergency care unit

    OpenAIRE

    Montezeli, Juliana Helena; Peres, Aida Maris; Bernardino, Elizabeth

    2013-01-01

    Objective: To identify the management skills needed for this professional at an emergency care unit. Method: An exploratory descriptive qualitative study conducted with eight nurses in which semi-structured interviews with nonparticipating systematic observation were conducted; the data was processed by content analysis. Results: The categories which emerged from the content analysis served as a list of management skills necessary to their work at the emergency care unit: leadership, decision...

  18. A Web-Based Model for Diabetes Education and Decision Support for the Home Care Nurse

    OpenAIRE

    Hill, Michelle; Kirby, Judy

    1998-01-01

    Diabetes education for the home care population requires expert knowledge to be available at the point-of-care, the patient's home. This poster displays a model for Web-based diabetes education and decision support for the home care nurse. The system utilizes the line of reasoning (LOR) model to organize and represent expert decision-making thought processes.

  19. We are not alone: international learning for professionals caring for children requiring palliative care.

    Science.gov (United States)

    Price, Jayne; Quinn, Karen; McNeilly, Patricia; Heywood, Melissa

    2015-06-01

    Educational opportunities for professionals working with children requiring palliative care are central to future development within the specialty across countries. International educational initiatives involving a range of professionals are important for learning with and from others working within the field. To explore the experiences and value to students from participating in an international online discussion forum. This article examines one such initiative; the use of an international asynchronous discussion forum with students in Melbourne, Australia and Belfast, UK who work with children and families. The innovation is examined and student perspectives of the forum's value are presented. Students endorsed the value of the forum, identifying three main areas of learning: differences across locations within countries, respecting different views and being open, and need for continued learning within children's palliative care. The overarching theme 'we are not alone' supported the idea that participation in the international discussion forum enabled students to see a broader perspective. Ideas for future developments of similar forums are also explored.

  20. ACO model should encourage efficient care delivery.

    Science.gov (United States)

    Toussaint, John; Krueger, David; Shortell, Stephen M; Milstein, Arnold; Cutler, David M

    2015-09-01

    The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Health care management modelling: a process perspective

    NARCIS (Netherlands)

    Vissers, J.M.H.

    1998-01-01

    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

  2. The unique requirements of primary health care in Southern Africa

    Directory of Open Access Journals (Sweden)

    D. P. Knobel

    1986-03-01

    Full Text Available The critical need for primary health care in Southern Africa with special reference to the demands of the heterogenous population is measured against the background of the declaration of Alma Ata at the WHO/UNICEF conference in 1978. In particular the provision of primary health care to the Third World communities of the RSA as an essential part of the security power base of the State is underlined and it is analised in terms of how shortcomings in this service can be exploited in a subversive revolutionary onslaught.

  3. Implementation strategies for collaborative primary care-mental health models.

    Science.gov (United States)

    Franx, Gerdien; Dixon, Lisa; Wensing, Michel; Pincus, Harold

    2013-09-01

    Extensive research exists that collaborative primary care-mental health models can improve care and outcomes for patients. These programs are currently being implemented throughout the United States and beyond. The purpose of this study is to review the literature and to generate an overview of strategies currently used to implement such models in daily practice. Six overlapping strategies to implement collaborative primary care-mental health models were described in 18 selected studies. We identified interactive educational strategies, quality improvement change processes, technological support tools, stakeholder engagement in the design and execution of implementation plans, organizational changes in terms of expanding the task of nurses and financial strategies such as additional collaboration fees and pay for performance incentives. Considering the overwhelming evidence about the effectiveness of primary care-mental health models, there is a lack of good studies focusing on their implementation strategies. In practice, these strategies are multifaceted and locally defined, as a result of intensive and required stakeholder engagement. Although many barriers still exist, the implementation of collaborative models could have a chance to succeed in the United States, where new service delivery and payment models, such as the Patient-Centered Medical Home, the Health Home and the Accountable Care Organization, are being promoted.

  4. Data requirements for speaker independent acoustic models

    CSIR Research Space (South Africa)

    Badenhorst, JAC

    2008-11-01

    Full Text Available When developing speech recognition systems in resource-constrained environments, careful design of the training corpus can play an important role in compensating for data scarcity. One of the factors to consider relates to the speaker composition...

  5. Health care managers' views on and approaches to implementing models for improving care processes.

    Science.gov (United States)

    Andreasson, Jörgen; Eriksson, Andrea; Dellve, Lotta

    2016-03-01

    To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes. In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome. In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory. 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work. Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management. © 2015 John Wiley & Sons Ltd.

  6. Dental Education Required for the Changing Health Care Environment.

    Science.gov (United States)

    Fontana, Margherita; González-Cabezas, Carlos; de Peralta, Tracy; Johnsen, David C

    2017-08-01

    To be able to meet the demands for care in 2040, dental graduates will need to address challenges resulting from the rapidly changing health care environment with knowledge and sets of skills to build on current standards and adapt to the future. The purposes of this article are to 1) analyze key challenges likely to evolve considerably between now and 2040 that will impact dental education and practice and 2) propose several sets of skills and educational outcomes necessary to address these challenges. The challenges discussed include changes in prevalence of oral diseases, dental practice patterns, materials and technologies, integrated medical-dental care, role of electronic health records, cultural competence, integrated curricula, interprofessional education, specialty-general balance, and web/cloud-based collaborations. To meet these challenges, the dental graduate will need skills such as core knowledge in basic and clinical dentistry, technical proficiency, critical thinking skills for lifelong learning, ethical and professional values, ability to manage a practice, social responsibility, and ability to function in a collegial intra- and interprofessional setting. Beyond the skills of the individual dentist will be the need for leadership in academia and the practice community. Academic and professional leaders will need to engage key constituencies to develop strategic directions and agendas with all parties pointed toward high standards for individual patients and the public at large. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

  7. 42 CFR 409.31 - Level of care requirement.

    Science.gov (United States)

    2010-10-01

    ... services means services that: (1) Are ordered by a physician; (2) Require the skills of technical or professional personnel such as registered nurses, licensed practical (vocational) nurses, physical therapists...

  8. Gamified Requirements Engineering: Model and Experimentation

    NARCIS (Netherlands)

    Lombriser, Philipp; Dalpiaz, Fabiano; Lucassen, Garm; Brinkkemper, Sjaak

    2016-01-01

    [Context & Motivation] Engaging stakeholders in requirements engineering (RE) influences the quality of the requirements and ultimately of the system to-be. Unfortunately, stakeholder engagement is often insufficient, leading to too few, low-quality requirements. [Question/problem] We aim to

  9. Access to care for patients with insulin-requiring diabetes in developing countries

    DEFF Research Database (Denmark)

    Beran, David; Yudkin, John S; de Courten, Maximilian

    2005-01-01

    The objective of this study was to assess the barriers to care for patients with insulin-requiring diabetes in Mozambique and Zambia.......The objective of this study was to assess the barriers to care for patients with insulin-requiring diabetes in Mozambique and Zambia....

  10. Understanding the health care utilization of children who require medical technology: A descriptive study of children who require tracheostomies.

    Science.gov (United States)

    Spratling, Regena

    2017-04-01

    Children who require medical technology have complex chronic illnesses. This medical technology, including ventilators, oximeters, tracheostomy tubes, and feeding tubes, allows children and their families to live at home; however, the management of the children's care by informal caregivers is complex with the need for intensive, specialized care. The purpose of this study was to examine the sociodemographic and clinical characteristics that affect health care utilization in a population of children who require medical technology. A retrospective electronic health record (EHR) review was completed on the EHR records on 171 children who require medical technology, specifically tracheostomies, at an outpatient technology dependent pulmonary clinic over a three year period (January 2010-December 2012). Descriptive statistics were used to analyze sociodemographic and clinical characteristics, including medical diagnoses, and emergency department (ED) visits and hospitalizations. Of the 171 children requiring medical technology studied, there were numerous medical diagnoses (n=791), 99% had chronic illnesses affecting two or more body systems, and 88% required two or more technologies, including a tracheostomy and a feeding tube. In addition, 91% of the children had at least one ED visit or hospitalization and were treated in the ED approximately three times over the three year period. The findings from this study noted an increased utilization of health care by these children, and identified common symptoms and medical technologies for which caregivers may need interventions, focusing on education in managing symptoms and medical technology prior to presentation to the ED or hospital. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Implementing Outcome Measures Within an Enhanced Palliative Care Day Care Model.

    LENUS (Irish Health Repository)

    Kilonzo, Isae

    2015-04-23

    Specialist palliative care day care (SPDC) units provide an array of services to patients and their families and can increase continuity of care between inpatient and homecare settings. A multidisciplinary teamwork approach is emphasized, and different models of day care exist. Depending on the emphasis of care, the models can be social, medical, therapeutic, or mixed. We describe our experience of introducing an enhanced therapeutic specialist day care model and using both patient- and carer-rated tools to monitor patient outcomes.

  12. 40 CFR 258.61 - Post-closure care requirements.

    Science.gov (United States)

    2010-07-01

    ... the final cover; (2) Maintaining and operating the leachate collection system in accordance with the...) Maintaining and operating the gas monitoring system in accordance with the requirements of § 258.23. (b) The... stop managing leachate if the owner or operator demonstrates that leachate no longer poses a threat to...

  13. Health care professionals' perspectives on the requirements facilitating the roll-out of kangaroo mother care in South Africa

    Directory of Open Access Journals (Sweden)

    Wilma ten Ham

    2016-12-01

    Conclusion: Although certain requirements, such as personal alignment and reinforcing structures can be used in the roll-out of best practices, further research is desirable to promote fuller understanding of how to devise and apply the requirements in the wider adoption of best practices in South African health care settings.

  14. From requirements to Java in a snap model-driven requirements engineering in practice

    CERN Document Server

    Smialek, Michal

    2015-01-01

    This book provides a coherent methodology for Model-Driven Requirements Engineering which stresses the systematic treatment of requirements within the realm of modelling and model transformations. The underlying basic assumption is that detailed requirements models are used as first-class artefacts playing a direct role in constructing software. To this end, the book presents the Requirements Specification Language (RSL) that allows precision and formality, which eventually permits automation of the process of turning requirements into a working system by applying model transformations and co

  15. Modeling uncertainty in requirements engineering decision support

    Science.gov (United States)

    Feather, Martin S.; Maynard-Zhang, Pedrito; Kiper, James D.

    2005-01-01

    One inherent characteristic of requrements engineering is a lack of certainty during this early phase of a project. Nevertheless, decisions about requirements must be made in spite of this uncertainty. Here we describe the context in which we are exploring this, and some initial work to support elicitation of uncertain requirements, and to deal with the combination of such information from multiple stakeholders.

  16. A goal-oriented requirements modelling language for enterprise architecture

    NARCIS (Netherlands)

    Quartel, Dick; Engelsman, W.; Jonkers, Henk; van Sinderen, Marten J.

    2009-01-01

    Methods for enterprise architecture, such as TOGAF, acknowledge the importance of requirements engineering in the development of enterprise architectures. Modelling support is needed to specify, document, communicate and reason about goals and requirements. Current modelling techniques for

  17. Therapeutic Plasma Exchange in Critically Ill Children Requiring Intensive Care.

    Science.gov (United States)

    Cortina, Gerard; McRae, Rosemary; Chiletti, Roberto; Butt, Warwick

    2018-02-01

    To characterize the clinical indications, procedural safety, and outcome of critically ill children requiring therapeutic plasma exchange. Retrospective observational study based on a prospective registry. Tertiary and quaternary referral 30-bed PICU. Forty-eight critically ill children who received therapeutic plasma exchange during an 8-year period (2007-2014) were included in the study. Therapeutic plasma exchange. A total of 48 patients underwent 244 therapeutic plasma exchange sessions. Of those, therapeutic plasma exchange was performed as sole procedure in 193 (79%), in combination with continuous renal replacement therapy in 40 (16.4%) and additional extracorporeal membrane oxygenation in 11 (4.6%) sessions. The most common admission diagnoses were hematologic disorders (30%), solid organ transplantation (20%), neurologic disorders (20%), and rheumatologic disorders (15%). Complications associated with the procedure occurred in 50 (21.2%) therapeutic plasma exchange sessions. Overall, patient survival from ICU was 82%. Although patients requiring therapeutic plasma exchange alone (n = 31; 64%) had a survival rate of 97%, those with additional continuous renal replacement therapy (n = 13; 27%) and extracorporeal membrane oxygenation (n = 4; 8%) had survival rates of 69% and 50%, respectively. Factors associated with increased mortality were lower Pediatric Index of Mortality 2 score, need for mechanical ventilation, higher number of failed organs, and longer ICU stay. Our results indicate that, in specialized centers, therapeutic plasma exchange can be performed relatively safely in critically ill children, alone or in combination with continuous renal replacement therapy and extracorporeal membrane oxygenation. Outcome in children requiring therapeutic plasma exchange alone is excellent. However, survival decreases with the number of failed organs and the need for continuous renal replacement therapy and extracorporeal membrane oxygenation.

  18. Game Maturity Model for Health Care.

    Science.gov (United States)

    de Boer, Jan C; Adriani, Paul; van Houwelingen, Jan Willem; Geerts, A

    2016-04-01

    This article introduces the Game Maturity Model for the healthcare industry as an extension to the general Game Maturity Model and describes the usage by two case studies of applied health games. The Game Maturity Model for healthcare provides a practical and value-adding method to assess existing games and to determine strategic considerations for application of applied health games. Our forecast is that within 5 years the use and development of applied games will have a role in our daily lives and the way we organize health care that will be similar to the role social media has today.

  19. Multiple sclerosis care: an integrated disease-management model.

    Science.gov (United States)

    Burks, J

    1998-04-01

    A disease-management model must be integrated, comprehensive, individual patient focused and outcome driven. In addition to high quality care, the successful model must reduce variations in care and costs. MS specialists need to be intimately involved in the long-term care of MS patients, while not neglecting primary care issues. A nurse care manager is the "glue" between the managed care company, health care providers and the patient/family. Disease management focuses on education and prevention, and can be cost effective as well as patient specific. To implement a successful program, managed care companies and health care providers must work together.

  20. Health Care Efficiencies: Consolidation and Alternative Models vs. Health Care and Antitrust Regulation - Irreconcilable Differences?

    Science.gov (United States)

    King, Michael W

    2017-11-01

    Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation. Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments. While debate rages on Capitol Hill over "repeal and replace," only limited attention has been directed toward reforming the current "fee-for-service" model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act ("ACA") 3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for

  1. Islamic Caring Model on Increase Patient Satisfaction

    OpenAIRE

    Abdurrouf, Muh; Nursalam, Nursalam; Purwaningsih, Purwaningsih

    2013-01-01

    Introduction: Patient satisfaction was important aspect that must be considered by health service providers, patients who were not satisfied will leave the hospital and be a competitor's customers so be able caused a decrease in sales of products/services and in turn could reduce and even loss of profit, therefore, the hospital must provided the best service so that it could increase patient satisfaction. The purpose of this study was to exams the effect of Islamic caring model on increase pa...

  2. Requirements model generation to support requirements elicitation: The Secure Tropos experience

    NARCIS (Netherlands)

    Kiyavitskaya, N.; Zannone, N.

    2008-01-01

    In recent years several efforts have been devoted by researchers in the Requirements Engineering community to the development of methodologies for supporting designers during requirements elicitation, modeling, and analysis. However, these methodologies often lack tool support to facilitate their

  3. Requirements for and barriers towards interoperable ehealth technology in primary care

    NARCIS (Netherlands)

    Oude Nijeweme-d'Hollosy, Wendeline; van Velsen, Lex Stefan; Huygens, Martine; Hermens, Hermanus J.

    Despite eHealth technology's rapid growth, eHealth applications are rarely embedded within primary care, mostly because systems lack interoperability. This article identifies requirements for, and barriers towards, interoperable eHealth technology from healthcare professionals' perspective -- the

  4. Clinical Characteristics and Outcomes of Patients With Cellulitis Requiring Intensive Care

    NARCIS (Netherlands)

    Cranendonk, Duncan R.; van Vught, Lonneke A.; Wiewel, Maryse A.; Cremer, Olaf L.; Horn, Janneke; Bonten, Marc J.; Schultz, Marcus J.; van der Poll, Tom; Wiersinga, W. Joost

    2017-01-01

    Cellulitis is a commonly occurring skin and soft tissue infection and one of the most frequently seen dermatological diseases in the intensive care unit (ICU). However, clinical characteristics of patients with cellulitis requiring intensive care treatment are poorly defined. Necrotizing fasciitis

  5. Clinical Characteristics and Outcomes of Patients With Cellulitis Requiring Intensive Care

    NARCIS (Netherlands)

    Cranendonk, Duncan R; van Vught, Lonneke A; Wiewel, Maryse A; Cremer, Olaf L; Horn, Janneke; Bonten, Marc J; Schultz, Marcus J; van der Poll, Tom; Wiersinga, W Joost

    Importance: Cellulitis is a commonly occurring skin and soft tissue infection and one of the most frequently seen dermatological diseases in the intensive care unit (ICU). However, clinical characteristics of patients with cellulitis requiring intensive care treatment are poorly defined. Necrotizing

  6. Patient Care Physician Supply and Requirements: Testing COGME Recommendations. Council on Graduate Medical Education, Eighth Report.

    Science.gov (United States)

    Council on Graduate Medical Education.

    This report reassesses recommendations made by the Council on Graduate Medical Education in earlier reports which had, beginning in 1992, addressed the problems of physician oversupply. In this report physician supply and requirements are examined in the context of a health care system increasingly dominated by managed care. Patterns of physician…

  7. Health information needs of professional nurses required at the point of care

    Directory of Open Access Journals (Sweden)

    Esmeralda Ricks

    2015-06-01

    Conclusion: This study has enabled the researcher to identify the information needs required by professional nurses at the point of care to enhance the delivery of patient care. The research results were used to develop a mobile library that could be accessed by professional nurses.

  8. 45 CFR 1356.30 - Safety requirements for foster care and adoptive home providers.

    Science.gov (United States)

    2010-10-01

    ... licensing file for that foster or adoptive family must contain documentation which verifies that safety... 45 Public Welfare 4 2010-10-01 2010-10-01 false Safety requirements for foster care and adoptive... ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND...

  9. DECISION MAKING MODELING OF CONCRETE REQUIREMENTS

    Directory of Open Access Journals (Sweden)

    Suhartono Irawan

    2001-01-01

    Full Text Available This paper presents the results of an experimental evaluation between predicted and practice concrete strength. The scope of the evaluation is the optimisation of the cement content for different concrete grades as a result of bringing the target mean value of tests cubes closer to the required characteristic strength value by reducing the standard deviation. Abstract in Bahasa Indonesia : concrete+mix+design%2C+acceptance+control%2C+optimisation%2C+cement+content.

  10. Patterns of Palliative Care Referral in Patients Admitted With Heart Failure Requiring Mechanical Ventilation.

    Science.gov (United States)

    Wiskar, Katie J; Celi, Leo Anthony; McDermid, Robert C; Walley, Keith R; Russell, James A; Boyd, John H; Rush, Barret

    2018-04-01

    Palliative care is recommended for advanced heart failure (HF) by several major societies, though prior studies indicate that it is underutilized. To investigate patterns of palliative care referral for patients admitted with HF exacerbations, as well as to examine patient and hospital factors associated with different rates of palliative care referral. Retrospective nationwide cohort analysis utilizing the National Inpatient Sample from 2006 to 2012. Patients referred to palliative care were compared to those who were not. Patients ≥18 years of age with a primary diagnosis of HF requiring mechanical ventilation (MV) were included. A cohort of non-HF patients with metastatic cancer was created for temporal comparison. Between 2006 and 2012, 74 824 patients underwent MV for HF. A referral to palliative care was made in 2903 (3.9%) patients. The rate of referral for palliative care in HF increased from 0.8% in 2006 to 6.4% in 2012 ( P care referral in patients with cancer increased from 2.9% in 2006 to 11.9% in 2012 ( P care ( P care. The use of palliative care for patients with advanced HF increased during the study period; however, palliative care remains underutilized in this setting. Patient factors such as race and SES affect access to palliative care.

  11. Infrastructure for new models of care.

    Science.gov (United States)

    Peak, Steve

    2015-03-01

    The NHS is costing the taxpayer 2.5 times more than it did 50 years ago. Now accounting for 8.2 per cent of the UK's GDP, this trend is set to continue, but funding is not in place to support it. The Government faces a struggle between what is needed and what is affordable, pointing to a complete re-think of the way care is delivered. So says Steve Peak, business development director for Vanguard Healthcare, As the 2015 General Election brings the issue into sharper focus, he examines how estates managers are responding to the pressures and the practicalities of delivering the infrastructure to support a new model of care.

  12. [Human resources for health in Ecuador's new model of care].

    Science.gov (United States)

    Espinosa, Verónica; de la Torre, Daniel; Acuña, Cecilia; Cadena, Cristina

    2017-06-08

    Describe strategies implemented by Ecuador's Ministry of Public Health (MPH) to strengthen human resources for health leadership and respond to the new model of care, as a part of the reform process in the period 2012-2015. A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform. In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases. These elements constitute the initial core for development of human resources for health policy and a health-services study program consistent with the reform's objectives. Within the framework of the reform carried out from 2012 to 2015, intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.

  13. Experimental and theoretical requirements for fuel modelling

    International Nuclear Information System (INIS)

    Gatesoupe, J.P.

    1979-01-01

    From a scientific point of view it may be considered that any event in the life of a fuel pin under irradiation should be perfectly well understood and foreseen from that deterministic point of view, the whole behaviour of the pin maybe analysed and dismantled with a specific function for every component part and each component part related to one basic phenomenon which can be independently studied on pure physical grounds. When extracted from the code structure the subroutine is studied for itself by specialists who try to keep as close as possible to the physics involved in the phenomenon; that often leads to an impressive luxury in details and a subsequent need for many unavailable input data. It might seem more secure to follow that approach since it tries to be firmly based on theoretical grounds. One should think so if the phenomenological situation in the pin were less complex than it is. The codes would not be adequate for off-normal operating conditions since for the accidental transient conditions the key-phenomena would not be the same as for steady-state or slow transient conditions. The orientation given to fuel modelling is based on our two main technological constraints which are: no fuel melting; no cladding failure; no excessive cladding deformation. In this context, the only relevant models are those which have a significant influence on the maximum temperatures in the fuel or on the cladding damage hence the selection between key models and irrelevant models which will next be done. A rather pragmatic view is kept on codification with a special focus on a few determinant aspects of fuel behaviour and no attention to models which are nothing but decorative. Fuel modeling is merely considered as a link between experimental knowledge; it serves as a guide for further improvements in fuel design and as so happens to be quite useful. On this basis the main lacks in of fuel behaviour is described. These are mainly concerning: thermal transfer through

  14. A gap between need and reality: neonatal nursing staff requirements on a German intensive care unit

    Directory of Open Access Journals (Sweden)

    Christian Patry

    2014-03-01

    Full Text Available Recently, new staffing rules for neonatal nurses in intensive care units (ICU were issued in Germany, using categories of care of the British Association of Perinatal Medicine as blueprint. Neonates on intensive care require a nurse-to-patient ratio of 1:1, on intensive surveillance (high dependency care of 1:2. No requirements exist for special care, transitional care, and pediatric ICU patients. Using these rules, nursing staff requirement was calculated over a period of 31 consecutive days once a day in a combined pediatric and neonatal ICU of a metropolitan academic medical center in south-west Germany. Each day, 18.9±0.98 patients (mean±standard deviation were assessed (14.26±1.21 neonatal, 4.65±0.98 pediatric. Among neonates, 9.94±2.56 received intensive therapy, 3.77±1.85 intensive surveillance, and 0.65±0.71 special care. Average nursing staff requirement was 12.10±1.81 full time equivalents (FTE per shift. Considering additional pediatric patients in the ICU and actual nursing staff availability (8.97±0.87 FTE per shift, this ICU seems understaffed.

  15. Spreadsheet Decision Support Model for Training Exercise Material Requirements Planning

    National Research Council Canada - National Science Library

    Tringali, Arthur

    1997-01-01

    ... associated with military training exercises. The model combines the business practice of Material Requirements Planning and the commercial spreadsheet software capabilities of Lotus 1-2-3 to calculate the requirements for food, consumable...

  16. Extending enterprise architecture modelling with business goals and requirements

    NARCIS (Netherlands)

    Engelsman, W.; Quartel, Dick; Jonkers, Henk; van Sinderen, Marten J.

    The methods for enterprise architecture (EA), such as The Open Group Architecture Framework, acknowledge the importance of requirements modelling in the development of EAs. Modelling support is needed to specify, document, communicate and reason about goals and requirements. The current modelling

  17. St George Acute Care Team: the local variant of crisis resolution model of care.

    Science.gov (United States)

    Cupina, Denise D; Wand, Anne P F; Phelan, Emma; Atkin, Rona

    2016-10-01

    The objective of this study was to describe functioning and clinical activities of the St George Acute Care Team and how it compares to the typical crisis resolution model of care. Descriptive data including demographics, sources of referral, type of clinical intervention, length of stay, diagnoses and outcomes were collected from records of all patients who were discharged from the team during a 10 week period. There were 677 referrals. The team's functions consisted of post-discharge follow-up (31%), triage and intake (30%), case management support (23%) and acute community based assessment and treatment (16%). The average length of stay was 5 days. The majority of patients were diagnosed with a mood (23%) or a psychotic (25%) disorder. Points of contrast to other reported crisis resolution teams include shorter length of stay, relatively less focus on direct clinical assessment and more telephone follow-up and triage. St George Acute Care Team provides a variety of clinical activities. The focus has shifted away from the original model of crisis resolution care to meet local and governmental requirements. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  18. Extending enterprise architecture modelling with business goals and requirements

    Science.gov (United States)

    Engelsman, Wilco; Quartel, Dick; Jonkers, Henk; van Sinderen, Marten

    2011-02-01

    The methods for enterprise architecture (EA), such as The Open Group Architecture Framework, acknowledge the importance of requirements modelling in the development of EAs. Modelling support is needed to specify, document, communicate and reason about goals and requirements. The current modelling techniques for EA focus on the products, services, processes and applications of an enterprise. In addition, techniques may be provided to describe structured requirements lists and use cases. Little support is available however for modelling the underlying motivation of EAs in terms of stakeholder concerns and the high-level goals that address these concerns. This article describes a language that supports the modelling of this motivation. The definition of the language is based on existing work on high-level goal and requirements modelling and is aligned with an existing standard for enterprise modelling: the ArchiMate language. Furthermore, the article illustrates how EA can benefit from analysis techniques from the requirements engineering domain.

  19. Systems and context modeling approach to requirements analysis

    Science.gov (United States)

    Ahuja, Amrit; Muralikrishna, G.; Patwari, Puneet; Subhrojyoti, C.; Swaminathan, N.; Vin, Harrick

    2014-08-01

    Ensuring completeness and correctness of the requirements for a complex system such as the SKA is challenging. Current system engineering practice includes developing a stakeholder needs definition, a concept of operations, and defining system requirements in terms of use cases and requirements statements. We present a method that enhances this current practice into a collection of system models with mutual consistency relationships. These include stakeholder goals, needs definition and system-of-interest models, together with a context model that participates in the consistency relationships among these models. We illustrate this approach by using it to analyze the SKA system requirements.

  20. Organizational home care models across Europe: A cross sectional study.

    Science.gov (United States)

    Van Eenoo, Liza; van der Roest, Henriëtte; Onder, Graziano; Finne-Soveri, Harriet; Garms-Homolova, Vjenka; Jonsson, Palmi V; Draisma, Stasja; van Hout, Hein; Declercq, Anja

    2018-01-01

    Decision makers are searching for models to redesign home care and to organize health care in a more sustainable way. The aim of this study is to identify and characterize home care models within and across European countries by means of structural characteristics and care processes at the policy and the organization level. At the policy level, variables that reflected variation in health care policy were included based on a literature review on the home care policy for older persons in six European countries: Belgium, Finland, Germany, Iceland, Italy, and the Netherlands. At the organizational level, data on the structural characteristics and the care processes were collected from 36 home care organizations by means of a survey. Data were collected between 2013 and 2015 during the IBenC project. An observational, cross sectional, quantitative design was used. The analyses consisted of a principal component analysis followed by a hierarchical cluster analysis. Fifteen variables at the organizational level, spread across three components, explained 75.4% of the total variance. The three components made it possible to distribute home care organizations into six care models that differ on the level of patient-centered care delivery, the availability of specialized care professionals, and the level of monitoring care performance. Policy level variables did not contribute to distinguishing between home care models. Six home care models were identified and characterized. These models can be used to describe best practices. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Customer requirement modeling and mapping of numerical control machine

    Directory of Open Access Journals (Sweden)

    Zhongqi Sheng

    2015-10-01

    Full Text Available In order to better obtain information about customer requirement and develop products meeting customer requirement, it is necessary to systematically analyze and handle the customer requirement. This article uses the product service system of numerical control machine as research objective and studies the customer requirement modeling and mapping oriented toward configuration design. It introduces the conception of requirement unit, expounds the customer requirement decomposition rules, and establishes customer requirement model; it builds the house of quality using quality function deployment and confirms the weight of technical feature of product and service; it explores the relevance rules between data using rough set theory, establishes rule database, and solves the target value of technical feature of product. Using economical turning center series numerical control machine as an example, it verifies the rationality of proposed customer requirement model.

  2. Evidence-based models of care for people with epilepsy.

    LENUS (Irish Health Repository)

    Fitzsimons, Mary

    2012-02-01

    Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

  3. Using cognitive modeling for requirements engineering in anesthesiology

    NARCIS (Netherlands)

    Pott, C; le Feber, J

    2005-01-01

    Cognitive modeling is a complexity reducing method to describe significant cognitive processes under a specified research focus. Here, a cognitive process model for decision making in anesthesiology is presented and applied in requirements engineering. Three decision making situations of

  4. Fundamental care guided by the Careful Nursing Philosophy and Professional Practice Model©.

    Science.gov (United States)

    Meehan, Therese Connell; Timmins, Fiona; Burke, Jacqueline

    2018-02-05

    To propose the Careful Nursing Philosophy and Professional Practice Model © as a conceptual and practice solution to current fundamental nursing care erosion and deficits. There is growing awareness of the crucial importance of fundamental care. Efforts are underway to heighten nurses' awareness of values that motivate fundamental care and thereby increase their attention to effective provision of fundamental care. However, there remains a need for nursing frameworks which motivate nurses to bring fundamental care values to life in their practice and strengthen their commitment to provide fundamental care. This descriptive position paper builds on the Careful Nursing Philosophy and Professional Practice Model © (Careful Nursing). Careful Nursing elaborates explicit nursing values and addresses both relational and pragmatic aspects of nursing practice, offering an ideal guide to provision of fundamental nursing care. A comparative alignment approach is used to review the capacity of Careful Nursing to address fundamentals of nursing care. Careful Nursing provides a value-based comprehensive and practical framework which can strengthen clinical nurses' ability to articulate and control their practice and, thereby, more effectively fulfil their responsibility to provide fundamental care and measure its effectiveness. This explicitly value-based nursing philosophy and professional practice model offers nurses a comprehensive, pragmatic and engaging framework designed to strengthen their control over their practice and ability to provide high-quality fundamental nursing care. © 2018 John Wiley & Sons Ltd.

  5. Capabilities and requirements for modelling radionuclide transport in the geosphere

    International Nuclear Information System (INIS)

    Paige, R.W.; Piper, D.

    1989-02-01

    This report gives an overview of geosphere flow and transport models suitable for use by the Department of the Environment in the performance assessment of radioactive waste disposal sites. An outline methodology for geosphere modelling is proposed, consisting of a number of different types of model. A brief description of each of the component models is given, indicating the purpose of the model, the processes being modelled and the methodologies adopted. Areas requiring development are noted. (author)

  6. A sequential model for the structure of health care utilization.

    NARCIS (Netherlands)

    Herrmann, W.J.; Haarmann, A.; Baerheim, A.

    2017-01-01

    Traditional measurement models of health care utilization are not able to represent the complex structure of health care utilization. In this qualitative study, we, therefore, developed a new model to represent the health care utilization structure. In Norway and Germany, we conducted episodic

  7. Requiring influenza vaccination for health care workers: seven truths we must accept.

    Science.gov (United States)

    Poland, Gregory A; Tosh, Pritish; Jacobson, Robert M

    2005-03-18

    In this paper we outline the seven primary truths supporting the call for requiring influenza immunization of all health care workers. We view this as a serious patient safety issue, given the clear and compelling data regarding the frequency and severity of influenza infection. In addition, clear-cut safety, efficacy, economic, legal, and ethical platforms support the use of influenza vaccine. Unfortunately health care workers have demonstrated, over almost 25 years that they are unwilling to comply with voluntary influenza immunization programs utilizing a variety of education and incentive programs, at rates sufficient to protect the patients in their care. We suggest that an annual influenza immunization should be required for every health care worker with direct patient contact, unless a medical contraindication or religious objection exists, or an informed declination is signed by the health care worker. High rates of health care worker immunization will benefit patients, health care workers, their families and employers, and the communities within which they work and live.

  8. A Participatory Model of the Paradox of Primary Care

    Science.gov (United States)

    Homa, Laura; Rose, Johnie; Hovmand, Peter S.; Cherng, Sarah T.; Riolo, Rick L.; Kraus, Alison; Biswas, Anindita; Burgess, Kelly; Aungst, Heide; Stange, Kurt C.; Brown, Kalanthe; Brooks-Terry, Margaret; Dec, Ellen; Jackson, Brigid; Gilliam, Jules; Kikano, George E.; Reichsman, Ann; Schaadt, Debbie; Hilfer, Jamie; Ticknor, Christine; Tyler, Carl V.; Van der Meulen, Anna; Ways, Heather; Weinberger, Richard F.; Williams, Christine

    2015-01-01

    PURPOSE The paradox of primary care is the observation that primary care is associated with apparently low levels of evidence-based care for individual diseases, but systems based on primary care have healthier populations, use fewer resources, and have less health inequality. The purpose of this article is to explore, from a complex systems perspective, mechanisms that might account for the effects of primary care beyond disease-specific care. METHODS In an 8-session, participatory group model-building process, patient, caregiver, and primary care clinician community stakeholders worked with academic investigators to develop and refine an agent-based computer simulation model to test hypotheses about mechanisms by which features of primary care could affect health and health equity. RESULTS In the resulting model, patients are at risk for acute illness, acute life-changing illness, chronic illness, and mental illness. Patients have changeable health behaviors and care-seeking tendencies that relate to their living in advantaged or disadvantaged neighborhoods. There are 2 types of care available to patients: primary and specialty. Primary care in the model is less effective than specialty care in treating single diseases, but it has the ability to treat multiple diseases at once. Primary care also can provide disease prevention visits, help patients improve their health behaviors, refer to specialty care, and develop relationships with patients that cause them to lower their threshold for seeking care. In a model run with primary care features turned off, primary care patients have poorer health. In a model run with all primary care features turned on, their conjoint effect leads to better population health for patients who seek primary care, with the primary care effect being particularly pronounced for patients who are disadvantaged and patients with multiple chronic conditions. Primary care leads to more total health care visits that are due to more disease

  9. Models for Primary Eye Care Services in India

    Directory of Open Access Journals (Sweden)

    Vasundhra Misra

    2015-01-01

    In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.

  10. Requirements Validation: Execution of UML Models with CPN Tools

    DEFF Research Database (Denmark)

    Machado, Ricardo J.; Lassen, Kristian Bisgaard; Oliveira, Sérgio

    2007-01-01

    Requirements validation is a critical task in any engineering project. The confrontation of stakeholders with static requirements models is not enough, since stakeholders with non-computer science education are not able to discover all the inter-dependencies between the elicited requirements. Eve...... requirements, where the system to be built must explicitly support the interaction between people within a pervasive cooperative workflow execution. A case study from a real project is used to illustrate the proposed approach....

  11. Assessing decision quality in patient-centred care requires a preference-sensitive measure

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Cunich, Michelle; Salkeld, Glenn

    2014-01-01

    A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value...... aspects of decision making. Current instruments using the term 'decision quality' have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all...

  12. Requirements for work of nurses and technicians in a centre for specialized health care of irradiated persons

    International Nuclear Information System (INIS)

    Blaha, M.; Pidrman, V.; Vanasek, J.; Brandova, J.

    1982-01-01

    Experience is presented with the training of nurses of the Centre of Specialized Health Care For Irradiated Persons of the Unit for Treatment of Hematological Diseases, which may serve as the model for the treatment of acute radiation syndrome. The concept of the training course is presented. The basic requirement is a nursing school diploma and a post-secondary training course (theoretical and practical, including the preparation of the work place, the treatment of patients, psychotherapy, microbial checks, etc.). Experience has shown that 2 to 3 years work in this field is needed to master the required theoretical knowledge and skills. (J.B.)

  13. Requirements for work of nurses and technicians in a centre for specialized health care of irradiated persons

    Energy Technology Data Exchange (ETDEWEB)

    Blaha, M; Pidrman, V; Vanasek, J; Brandova, J [Vojensky Lekarsky Vyzkumny a Doskolovaci Ustav J.E. Purkyne, Hradec Kralove (Czechoslovakia)

    1982-12-01

    Experience is presented with the training of nurses of the Centre of Specialized Health Care For Irradiated Persons of the Unit for Treatment of Hematological Diseases, which may serve as the model for the treatment of acute radiation syndrome. The concept of the training course is presented. The basic requirement is a nursing school diploma and a post-secondary training course (theoretical and practical, including the preparation of the work place, the treatment of patients, psychotherapy, microbial checks, etc.). Experience has shown that 2 to 3 years work in this field is needed to master the required theoretical knowledge and skills.

  14. Women's opinions of legal requirements for drug testing in prenatal care.

    Science.gov (United States)

    Tucker Edmonds, Brownsyne; Mckenzie, Fatima; Austgen, MacKenzie B; Carroll, Aaron E; Meslin, Eric M

    2017-07-01

    To explore women's attitudes and perceptions regarding legal requirements for prenatal drug testing. Web-based survey of 500 US women (age 18-45) recruited from a market research survey panel. A 24-item questionnaire assessed their opinion of laws requiring doctors to routinely verbal screen and urine drug test patients during pregnancy; recommendations for consequences for positive drug tests during pregnancy; and opinion of laws requiring routine drug testing of newborns. Additional questions asked participants about the influence of such laws on their own care-seeking behaviors. Data were analyzed for associations between participant characteristics and survey responses using Pearson's chi-squared test. The majority of respondents (86%) stated they would support a law requiring verbal screening of all pregnant patients and 73% would support a law requiring universal urine drug testing in pregnancy. Fewer respondents were willing to support laws that required verbal screening or urine drug testing (68% and 61%, respectively) targeting only Medicaid recipients. Twenty-one percent of respondents indicated they would be offended if their doctors asked them about drug use and 14% indicated that mandatory drug testing would discourage prenatal care attendance. Women would be more supportive of policies requiring universal rather than targeted screening and testing for prenatal drug use. However, a noteworthy proportion of women would be discouraged from attending prenatal care - a reminder that drug testing policies may have detrimental effects on maternal child health.

  15. Comprehensive Care For Joint Replacement Model - Provider Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — Comprehensive Care for Joint Replacement Model - provider data. This data set includes provider data for two quality measures tracked during an episode of care:...

  16. Care Model Design for E-Health: Integration of Point-of-Care Testing at Dutch General Practices

    Directory of Open Access Journals (Sweden)

    Bart Verhees

    2017-12-01

    Full Text Available Point-of-care testing (POCT—laboratory tests performed with new mobile devices and online technologies outside of the central laboratory—is rapidly outpacing the traditional laboratory test market, growing at a rate of 12 to 15% each year. POCT impacts the diagnostic process of care providers by yielding high efficiency benefits in terms of turnaround time and related quality improvements in the reduction of errors. However, the implementation of this disruptive eHealth technology requires the integration and transformation of diagnostic services across the boundaries of healthcare organizations. Research has revealed both advantages and barriers of POCT implementations, yet to date, there is no business model for the integration of POCT within general practice. The aim of this article is to contribute with a design for a care model that enables the integration of POCT in primary healthcare. In this research, we used a design modelling toolkit for data collection at five general practices. Through an iterative design process, we modelled the actors and value transactions, and designed an optimized care model for the dynamic integration of POCTs into the GP’s network of care delivery. The care model design will have a direct bearing on improving the integration of POCT through the connectivity and norm guidelines between the general practice, the POC technology, and the diagnostic centre.

  17. Care Model Design for E-Health: Integration of Point-of-Care Testing at Dutch General Practices.

    Science.gov (United States)

    Verhees, Bart; van Kuijk, Kees; Simonse, Lianne

    2017-12-21

    Point-of-care testing (POCT)-laboratory tests performed with new mobile devices and online technologies outside of the central laboratory-is rapidly outpacing the traditional laboratory test market, growing at a rate of 12 to 15% each year. POCT impacts the diagnostic process of care providers by yielding high efficiency benefits in terms of turnaround time and related quality improvements in the reduction of errors. However, the implementation of this disruptive eHealth technology requires the integration and transformation of diagnostic services across the boundaries of healthcare organizations. Research has revealed both advantages and barriers of POCT implementations, yet to date, there is no business model for the integration of POCT within general practice. The aim of this article is to contribute with a design for a care model that enables the integration of POCT in primary healthcare. In this research, we used a design modelling toolkit for data collection at five general practices. Through an iterative design process, we modelled the actors and value transactions, and designed an optimized care model for the dynamic integration of POCTs into the GP's network of care delivery. The care model design will have a direct bearing on improving the integration of POCT through the connectivity and norm guidelines between the general practice, the POC technology, and the diagnostic centre.

  18. Associations between Depressive State and Impaired Higher-Level Functional Capacity in the Elderly with Long-Term Care Requirements.

    Science.gov (United States)

    Ogata, Soshiro; Hayashi, Chisato; Sugiura, Keiko; Hayakawa, Kazuo

    2015-01-01

    Depressive state has been reported to be significantly associated with higher-level functional capacity among community-dwelling elderly. However, few studies have investigated the associations among people with long-term care requirements. We aimed to investigate the associations between depressive state and higher-level functional capacity and obtain marginal odds ratios using propensity score analyses in people with long-term care requirements. We conducted a cross-sectional study based on participants aged ≥ 65 years (n = 545) who were community dwelling and used outpatient care services for long-term preventive care. We measured higher-level functional capacity, depressive state, and possible confounders. Then, we estimated the marginal odds ratios (i.e., the change in odds of impaired higher-level functional capacity if all versus no participants were exposed to depressive state) by logistic models using generalized linear models with the inverse probability of treatment weighting (IPTW) for propensity score and design-based standard errors. Depressive state was used as the exposure variable and higher-level functional capacity as the outcome variable. The all absolute standardized differences after the IPTW using the propensity scores were functional capacity.

  19. Developing a medication communication framework across continuums of care using the Circle of Care Modeling approach

    Science.gov (United States)

    2013-01-01

    Background Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication management involves key recurrent activities (determine need, prescribe, dispense, administer, and monitor/evaluate) with information communicated within and between each. Despite its importance, there is a lack of conceptual models that explore medication communication specifically across roles and settings. This research seeks to address that gap. Methods The Circle of Care Modeling (CCM) approach was used to build a model of medication communication activities across the circle of care. CCM positions the patient in the centre of his or her own healthcare system; providers and other roles are then modeled around the patient as a web of relationships. Recurrent medication communication activities were mapped to the medication management framework. The research occurred in three iterations, to test and revise the model: Iteration 1 consisted of a literature review and internal team discussion, Iteration 2 consisted of interviews, observation, and a discussion group at a Community Health Centre, and Iteration 3 consisted of interviews and a discussion group in the larger community. Results Each iteration provided further detail to the Circle of Care medication communication model. Specific medication communication activities were mapped along each communication pathway between roles and to the medication management framework. We could not map all medication communication activities to the medication management framework; we added Coordinate as a separate and distinct recurrent activity

  20. Developing a medication communication framework across continuums of care using the Circle of Care Modeling approach.

    Science.gov (United States)

    Kitson, Nicole A; Price, Morgan; Lau, Francis Y; Showler, Grey

    2013-10-17

    Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication management involves key recurrent activities (determine need, prescribe, dispense, administer, and monitor/evaluate) with information communicated within and between each. Despite its importance, there is a lack of conceptual models that explore medication communication specifically across roles and settings. This research seeks to address that gap. The Circle of Care Modeling (CCM) approach was used to build a model of medication communication activities across the circle of care. CCM positions the patient in the centre of his or her own healthcare system; providers and other roles are then modeled around the patient as a web of relationships. Recurrent medication communication activities were mapped to the medication management framework. The research occurred in three iterations, to test and revise the model: Iteration 1 consisted of a literature review and internal team discussion, Iteration 2 consisted of interviews, observation, and a discussion group at a Community Health Centre, and Iteration 3 consisted of interviews and a discussion group in the larger community. Each iteration provided further detail to the Circle of Care medication communication model. Specific medication communication activities were mapped along each communication pathway between roles and to the medication management framework. We could not map all medication communication activities to the medication management framework; we added Coordinate as a separate and distinct recurrent activity. We saw many examples of

  1. Cost Analysis of a Digital Health Care Model in Sweden.

    Science.gov (United States)

    Ekman, Björn

    2017-09-22

    Digital technologies in health care are expected to increase in scope and to affect ever more parts of the health care system. It is important to enhance the knowledge of whether new digital methods and innovations provide value for money compared with traditional models of care. The objective of the study was to evaluate whether a digital health care model for primary care is a less costly alternative compared with traditional in-office primary care in Sweden. Cost data for the two care models were collected and analyzed to obtain a measure in local currency per care contact. The comparison showed that the total economic cost of a digital consultation is 1960 Swedish krona (SEK) (SEK100 = US$11.29; February 2017) compared with SEK3348 for a traditional consultation at a health care clinic. Cost differences arose on both the provider side and on the user side. The digital health care model may be a less costly alternative to the traditional health care model. Depending on the rate of digital substitution, gross economic cost savings of between SEK1 billion and SEK10 billion per year could be realized if more digital consultations were made. Further studies are needed to validate the findings, assess the types of care most suitable for digital care, and also to obtain various quality-adjusted outcome measures.

  2. Health care administration in the year 2000: practitioners' views of future issues and job requirements.

    Science.gov (United States)

    Hudak, R P; Brooke, P P; Finstuen, K; Riley, P

    1993-01-01

    This research identifies the most important domains in health care administration (HCA) from now to the year 2000 and differentiates job skill, knowledge, and ability requirements necessary for successful management. Fellows of the American College of Healthcare Executives from about half of the United States responded to two iterations of a Delphi mail inquiry. Fellows identified 102 issues that were content-analyzed into nine domains by an HCA expert panel. Domains, in order of ranked importance, were cost/finance, leadership, professional staff interactions, health care delivery concepts, accessibility, ethics, quality/risk management, technology, and marketing. In the second Delphi iteration, Fellows reviewed domain results and rated job requirements on required job importance. Results indicated that while a business orientation is needed for organizational survival, an equal emphasis on person-oriented skills, knowledge, and abilities is required.

  3. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files. Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis. Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is

  4. A conceptual model: Redesigning how we provide palliative care for patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Philip, Jennifer; Crawford, Gregory; Brand, Caroline; Gold, Michelle; Miller, Belinda; Hudson, Peter; Smallwood, Natasha; Lau, Rosalind; Sundararajan, Vijaya

    2017-05-31

    Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns. Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers. Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia. A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver; (2) equitable, enabling access to components of palliative care for a group with significant needs; (3) accessible; and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care; (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as "usual" care by patients and clinicians alike; (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care; and (d) transition to usual palliative care services is facilitated as the patient nears death. Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with

  5. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  6. Beyond 'doing': Supporting clinical leadership and nursing practice in aged care through innovative models of care.

    Science.gov (United States)

    Venturato, Lorraine; Drew, Liz

    2010-06-01

    Contemporary health care environments are increasingly challenged by issues associated with the recruitment and retention of qualified nursing staff. This challenge is particularly felt by residential aged care providers, with registered nurse (RN) numbers already limited and resident acuity rapidly rising. As a result, aged care service providers are increasingly exploring creative and alternative models of care. This article details exploratory research into a pre-existing, alternative model of care in a medium sized, regional residential aged care facility. Research findings suggest that the model of care is complex and multi-faceted and is an example of an integrated model of care. As a result of the implementation of this model of care a number of shifts have occurred in the practice experiences and clinical culture within this facility. Results suggest that the main benefits of this model are: (1) increased opportunities for RNs to engage in clinical leadership and proactive care management; (2) improved management and communication in relation to work processes and practices; and (3) enhanced recruitment and retention of both RNs and care workers.

  7. [Development of weight-estimation formulae for the bedridden elderly requiring care].

    Science.gov (United States)

    Oonishi, Reiko; Fujii, Kouji; Tsuda, Hiroko; Imai, Katsumi

    2012-01-01

    Bedridden elderly persons requiring care need special body-weight measurement implements, and body-weighting assumes more difficult if they live at their own homes. Therefore, we tried to design a new weight-estimation formulae using various anthropometric variables. The subjects were 33 male and 132 female elderly inpatients certified to be at care level 4 or 5. The body composition included height, body weight, arm circumference, triceps skinfold thickness, subscapular skinfold thickness, calf circumference, and waist circumference. We studied the correlation between the body weight and each anthropometric variable and age. In men, the highest correlation with body weight was shown by waist circumference (r=0.891, pbedridden elderly patients requiring care.

  8. Wound care clinical pathway: a conceptual model.

    Science.gov (United States)

    Barr, J E; Cuzzell, J

    1996-08-01

    A clinical pathway is a written sequence of clinical processes or events that guides a patient with a defined problem toward an expected outcome. Clinical pathways are tools to assist with the cost-effective management of clinical outcomes related to specific problems or disease processes. The primary obstacles to developing clinical pathways for wound care are the chronic natures of some wounds and the many variables that can delay healing. The pathway introduced in this article was modeled upon the three phases of tissue repair: inflammatory, proliferative, and maturation. This physiology-based model allows clinicians to identify and monitor outcomes based on observable and measurable clinical parameters. The pathway design, which also includes educational and behavioral outcomes, allows the clinician to individualize the expected timeframe for outcome achievement based on individual patient criteria and expert judgement. Integral to the pathway are the "4P's" which help standardize the clinical processes by wound type: Protocols, Policies, Procedures, and Patient education tools. Four categories into which variances are categorized based on the cause of the deviation from the norm are patient, process/system, practitioner, and planning/discharge. Additional research is warranted to support the value of this clinical pathway in the clinical arena.

  9. Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

    Science.gov (United States)

    Chou, Deng-Wei; Wu, Shu-Ling; Chung, Kuo-Mou; Han, Shu-Chen; Cheung, Bruno Man-Hon

    2016-01-01

    OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential. PMID:27759843

  10. Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

    Directory of Open Access Journals (Sweden)

    Deng-Wei Chou

    Full Text Available OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%. The most common computed tomographic findings included a feeding vessel sign (90%, peripheral nodules without cavities (80% or with cavities (65%, and peripheral wedge-shaped opacities (75%. The most common primary source of infection was liver abscess (40%, followed by pneumonia (25%. The two most frequent causative pathogens were Klebsiella pneumoniae (50% and Staphylococcus aureus (35%. Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.

  11. GENERAL REQUIREMENTS FOR SIMULATION MODELS IN WASTE MANAGEMENT

    International Nuclear Information System (INIS)

    Miller, Ian; Kossik, Rick; Voss, Charlie

    2003-01-01

    Most waste management activities are decided upon and carried out in a public or semi-public arena, typically involving the waste management organization, one or more regulators, and often other stakeholders and members of the public. In these environments, simulation modeling can be a powerful tool in reaching a consensus on the best path forward, but only if the models that are developed are understood and accepted by all of the parties involved. These requirements for understanding and acceptance of the models constrain the appropriate software and model development procedures that are employed. This paper discusses requirements for both simulation software and for the models that are developed using the software. Requirements for the software include transparency, accessibility, flexibility, extensibility, quality assurance, ability to do discrete and/or continuous simulation, and efficiency. Requirements for the models that are developed include traceability, transparency, credibility/validity, and quality control. The paper discusses these requirements with specific reference to the requirements for performance assessment models that are used for predicting the long-term safety of waste disposal facilities, such as the proposed Yucca Mountain repository

  12. Collaborative care model improves self-care ability, quality of life and cardiac function of patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    C.Y. Hua

    2017-09-01

    Full Text Available Chronic heart failure (CHF is a common chronic disease that requires much care. This study aimed to explore the effects of collaborative care model (CCM on patients with CHF. A total of 114 CHF patients were enrolled in this study, and were randomly and equally divided into two groups: control and experimental. Patients in the two groups received either usual care or CCM for 3 continuous months. The impacts of CCM on the self-care ability and quality of life were assessed using self-care of heart failure index and short form health survey 12, respectively. Further, cardiac function was assessed by measuring left ventricular ejection fraction (LVEF and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP, and by the 6-min walking test. Clinical and demographic characteristics of patients in the control and CCM groups were statistically equivalent. Compared with usual care, CCM significantly enhanced self-care abilities of patients with CHF, including self-care maintenance, self-care management and self-care confidence (all P<0.05. The physical and mental quality of life was also significantly improved by CCM (P<0.01 or P<0.05. Compared with usual care, CCM significantly increased the LVEF (P<0.01, decreased the NT-proBNP level (P<0.01, and enhanced exercise capacity (P<0.001. In conclusion, CCM improved the self-care, quality of life and cardiac function of patients with CHF compared with usual care.

  13. Spreadsheet Decision Support Model for Training Exercise Material Requirements Planning

    National Research Council Canada - National Science Library

    Tringali, Arthur

    1997-01-01

    This thesis focuses on developing a spreadsheet decision support model that can be used by combat engineer platoon and company commanders in determining the material requirements and estimated costs...

  14. Commonsense Psychology and the Functional Requirements of Cognitive Models

    National Research Council Canada - National Science Library

    Gordon, Andrew S

    2005-01-01

    In this paper we argue that previous models of cognitive abilities (e.g. memory, analogy) have been constructed to satisfy functional requirements of implicit commonsense psychological theories held by researchers and nonresearchers alike...

  15. A Compositional Knowledge Level Process Model of Requirements Engineering

    NARCIS (Netherlands)

    Herlea, D.E.; Jonker, C.M.; Treur, J.; Wijngaards, W.C.A.

    2002-01-01

    In current literature few detailed process models for Requirements Engineering are presented: usually high-level activities are distinguished, without a more precise specification of each activity. In this paper the process of Requirements Engineering has been analyzed using knowledge-level

  16. Systems modeling and simulation applications for critical care medicine

    Science.gov (United States)

    2012-01-01

    Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area. PMID:22703718

  17. Systems modeling and simulation applications for critical care medicine.

    Science.gov (United States)

    Dong, Yue; Chbat, Nicolas W; Gupta, Ashish; Hadzikadic, Mirsad; Gajic, Ognjen

    2012-06-15

    Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area.

  18. Modeling Market Shares of Competing (e)Care Providers

    Science.gov (United States)

    van Ooteghem, Jan; Tesch, Tom; Verbrugge, Sofie; Ackaert, Ann; Colle, Didier; Pickavet, Mario; Demeester, Piet

    In order to address the increasing costs of providing care to the growing group of elderly, efficiency gains through eCare solutions seem an obvious solution. Unfortunately not many techno-economic business models to evaluate the return of these investments are available. The construction of a business case for care for the elderly as they move through different levels of dependency and the effect of introducing an eCare service, is the intended application of the model. The simulation model presented in this paper allows for modeling evolution of market shares of competing care providers. Four tiers are defined, based on the dependency level of the elderly, for which the market shares are determined. The model takes into account available capacity of the different care providers, in- and outflow distribution between tiers and churn between providers within tiers.

  19. Program Director Perceptions of Surgical Resident Training and Patient Care under Flexible Duty Hour Requirements.

    Science.gov (United States)

    Saadat, Lily V; Dahlke, Allison R; Rajaram, Ravi; Kreutzer, Lindsey; Love, Remi; Odell, David D; Bilimoria, Karl Y; Yang, Anthony D

    2016-06-01

    The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial was a national, cluster-randomized, pragmatic, noninferiority trial of 117 general surgery programs, comparing standard ACGME resident duty hour requirements ("Standard Policy") to flexible, less-restrictive policies ("Flexible Policy"). Participating program directors (PDs) were surveyed to assess their perceptions of patient care, resident education, and resident well-being during the study period. A survey was sent to all PDs of the general surgery residency programs participating in the FIRST trial (N = 117 [100% response rate]) in June and July 2015. The survey compared PDs' perceptions of the duty hour requirements in their arm of the FIRST trial during the study period from July 1, 2014 to June 30, 2015. One hundred percent of PDs in the Flexible Policy arm indicated that residents used their additional flexibility in duty hours to complete operations they started or to stabilize a critically ill patient. Compared with the Standard Policy arm, PDs in the Flexible Policy arm perceived a more positive effect of duty hours on the safety of patient care (68.9% vs 0%; p care (98.3% vs 0%; p care (71.8%), continuity of care (94.0%), quality of resident education (83.8%), and resident well-being (55.6%) would be improved with a hypothetical permanent adoption of more flexible duty hours. Program directors involved in the FIRST trial perceived improvements in patient safety, continuity of care, and multiple aspects of resident education and well-being with flexible duty hours. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Exploration of funding models to support hybridisation of Australian primary health care organisations.

    Science.gov (United States)

    Reddy, Sandeep

    2017-09-01

    Primary Health Care (PHC) funding in Australia is complex and fragmented. The focus of PHC funding in Australia has been on volume rather than comprehensive primary care and continuous quality improvement. As PHC in Australia is increasingly delivered by hybrid style organisations, an appropriate funding model that matches this set-up while addressing current issues with PHC funding is required. This article discusses and proposes an appropriate funding model for hybrid PHC organisations.

  1. Incidence and preventability of adverse events requiring intensive care admission: a systematic review.

    Science.gov (United States)

    Vlayen, Annemie; Verelst, Sandra; Bekkering, Geertruida E; Schrooten, Ward; Hellings, Johan; Claes, Neree

    2012-04-01

    Adverse events are unintended patient injuries or complications that arise from health care management resulting in death, disability or prolonged hospital stay. Adverse events that require critical care are a considerable financial burden to the health care system, but also their global impact on patients and society is probably underestimated. The objectives of this systematic review were to synthesize the best available evidence regarding the estimates of the incidence and preventability of adverse events that necessitate intensive care admission, to determine the type and consequences [mortality, length of intensive care unit (ICU) stay and costs] of these adverse events. MEDLINE (from 1966 to present), EMBASE (from 1974 to present) and CENTRAL (version 1-2010) were searched for studies reporting on unplanned admissions on ICUs. Several other sources were searched for additional studies. Only quantitative studies that used chart review for the detection of adverse events requiring intensive care admission were considered for eligibility. For the purposes of this systematic review, ICUs were defined as specialized hospital facilities which provide continuous monitoring and intensive care for acutely ill patients. Studies that were published in the English, Dutch, German, French or Spanish language were eligible for inclusion. Two reviewers independently extracted data and assessed the methodological quality of the included studies. A total of 27 studies were reviewed. Meta-analysis of the data was not appropriate because of methodological and statistical heterogeneity between studies; therefore, results are presented in a descriptive way. The percentage of surgical and medical adverse events that required ICU admission ranged from 1.1% to 37.2%. ICU readmissions varied from 0% to 18.3%. Preventability of the adverse events varied from 17% to 76.5%. Preventable adverse events are further synthesized by type of event. Consequences of the adverse events included a

  2. External validation of the Intensive Care National Audit & Research Centre (ICNARC) risk prediction model in critical care units in Scotland.

    Science.gov (United States)

    Harrison, David A; Lone, Nazir I; Haddow, Catriona; MacGillivray, Moranne; Khan, Angela; Cook, Brian; Rowan, Kathryn M

    2014-01-01

    Risk prediction models are used in critical care for risk stratification, summarising and communicating risk, supporting clinical decision-making and benchmarking performance. However, they require validation before they can be used with confidence, ideally using independently collected data from a different source to that used to develop the model. The aim of this study was to validate the Intensive Care National Audit & Research Centre (ICNARC) model using independently collected data from critical care units in Scotland. Data were extracted from the Scottish Intensive Care Society Audit Group (SICSAG) database for the years 2007 to 2009. Recoding and mapping of variables was performed, as required, to apply the ICNARC model (2009 recalibration) to the SICSAG data using standard computer algorithms. The performance of the ICNARC model was assessed for discrimination, calibration and overall fit and compared with that of the Acute Physiology And Chronic Health Evaluation (APACHE) II model. There were 29,626 admissions to 24 adult, general critical care units in Scotland between 1 January 2007 and 31 December 2009. After exclusions, 23,269 admissions were included in the analysis. The ICNARC model outperformed APACHE II on measures of discrimination (c index 0.848 versus 0.806), calibration (Hosmer-Lemeshow chi-squared statistic 18.8 versus 214) and overall fit (Brier's score 0.140 versus 0.157; Shapiro's R 0.652 versus 0.621). Model performance was consistent across the three years studied. The ICNARC model performed well when validated in an external population to that in which it was developed, using independently collected data.

  3. Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature.

    Science.gov (United States)

    Aij, Kjeld Harald; Rapsaniotis, Sofia

    2017-01-01

    As health care organizations face pressures to improve quality and efficiency while reducing costs, leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean. Successful Lean leaders appear to use a coaching leadership style that shares underlying principles with servant leadership. There is little information about specific similarities and differences between Lean and servant leaderships. We systematically reviewed the literature on Lean leadership, servant leadership, and health care and performed a comparative analysis of attributes using Russell and Stone's leadership framework. We found significant overlap between the two leadership styles, although there were notable differences in origins, philosophy, characteristics and behaviors, and tools. We conclude that both Lean and servant leaderships are promising models that can contribute to the delivery of patient-centered, high-value care. Servant leadership may provide the means to engage and develop employees to become successful Lean leaders in health care organizations.

  4. Requirements Modeling with the Aspect-oriented User Requirements Notation (AoURN): A Case Study

    Science.gov (United States)

    Mussbacher, Gunter; Amyot, Daniel; Araújo, João; Moreira, Ana

    The User Requirements Notation (URN) is a recent ITU-T standard that supports requirements engineering activities. The Aspect-oriented URN (AoURN) adds aspect-oriented concepts to URN, creating a unified framework that allows for scenario-based, goal-oriented, and aspect-oriented modeling. AoURN is applied to the car crash crisis management system (CCCMS), modeling its functional and non-functional requirements (NFRs). AoURN generally models all use cases, NFRs, and stakeholders as individual concerns and provides general guidelines for concern identification. AoURN handles interactions between concerns, capturing their dependencies and conflicts as well as the resolutions. We present a qualitative comparison of aspect-oriented techniques for scenario-based and goal-oriented requirements engineering. An evaluation carried out based on the metrics adapted from literature and a task-based evaluation suggest that AoURN models are more scalable than URN models and exhibit better modularity, reusability, and maintainability.

  5. Irrigation Requirement Estimation Using Vegetation Indices and Inverse Biophysical Modeling

    Science.gov (United States)

    Bounoua, Lahouari; Imhoff, Marc L.; Franks, Shannon

    2010-01-01

    We explore an inverse biophysical modeling process forced by satellite and climatological data to quantify irrigation requirements in semi-arid agricultural areas. We constrain the carbon and water cycles modeled under both equilibrium, balance between vegetation and climate, and non-equilibrium, water added through irrigation. We postulate that the degree to which irrigated dry lands vary from equilibrium climate conditions is related to the amount of irrigation. The amount of water required over and above precipitation is considered as an irrigation requirement. For July, results show that spray irrigation resulted in an additional amount of water of 1.3 mm per occurrence with a frequency of 24.6 hours. In contrast, the drip irrigation required only 0.6 mm every 45.6 hours or 46% of that simulated by the spray irrigation. The modeled estimates account for 87% of the total reported irrigation water use, when soil salinity is not important and 66% in saline lands.

  6. Standards of care and quality indicators for multidisciplinary care models for psoriatic arthritis in Spain.

    Science.gov (United States)

    Gratacós, Jordi; Luelmo, Jesús; Rodríguez, Jesús; Notario, Jaume; Marco, Teresa Navío; de la Cueva, Pablo; Busquets, Manel Pujol; Font, Mercè García; Joven, Beatriz; Rivera, Raquel; Vega, Jose Luis Alvarez; Álvarez, Antonio Javier Chaves; Parera, Ricardo Sánchez; Carrascosa, Jose Carlos Ruiz; Martínez, Fernando José Rodríguez; Sánchez, José Pardo; Olmos, Carlos Feced; Pujol, Conrad; Galindez, Eva; Barrio, Silvia Pérez; Arana, Ana Urruticoechea; Hergueta, Mercedes; Coto, Pablo; Queiro, Rubén

    2018-06-01

    To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.

  7. Validation of Power Requirement Model for Active Loudspeakers

    DEFF Research Database (Denmark)

    Schneider, Henrik; Madsen, Anders Normann; Bjerregaard, Ruben

    2015-01-01

    . There are however many advantages that could be harvested from such knowledge like size, cost and efficiency improvements. In this paper a recently proposed power requirement model for active loudspeakers is experimentally validated and the model is expanded to include the closed and vented type enclosures...

  8. Semelparous Penna Ageing Model with Parental Care

    Science.gov (United States)

    Fehsenfeld, K. M.; Sá Martins, J. S.; de Oliveira, S. Moss; Bernardes, A. T.

    In this paper we study the importance of parental care for the survival of semelparous species, that reproduce only once in life. We perform our simulations for sexual and asexual reproductions and show that catastrophic senescence (death soon after reproduction) is delayed if parental care is considered.

  9. Primary care clinicians' recognition and management of depression: a model of depression care in real-world primary care practice.

    Science.gov (United States)

    Baik, Seong-Yi; Crabtree, Benjamin F; Gonzales, Junius J

    2013-11-01

    Depression is prevalent in primary care (PC) practices and poses a considerable public health burden in the United States. Despite nearly four decades of efforts to improve depression care quality in PC practices, a gap remains between desired treatment outcomes and the reality of how depression care is delivered. This article presents a real-world PC practice model of depression care, elucidating the processes and their influencing conditions. Grounded theory methodology was used for the data collection and analysis to develop a depression care model. Data were collected from 70 individual interviews (60 to 70 min each), three focus group interviews (n = 24, 2 h each), two surveys per clinician, and investigators' field notes on practice environments. Interviews were audiotaped and transcribed for analysis. Surveys and field notes complemented interview data. Seventy primary care clinicians from 52 PC offices in the Midwest: 28 general internists, 28 family physicians, and 14 nurse practitioners. A depression care model was developed that illustrates how real-world conditions infuse complexity into each step of the depression care process. Depression care in PC settings is mediated through clinicians' interactions with patients, practice, and the local community. A clinician's interactional familiarity ("familiarity capital") was a powerful facilitator for depression care. For the recognition of depression, three previously reported processes and three conditions were confirmed. For the management of depression, 13 processes and 11 conditions were identified. Empowering the patient was a parallel process to the management of depression. The clinician's ability to develop and utilize interactional relationships and resources needed to recognize and treat a person with depression is key to depression care in primary care settings. The interactional context of depression care makes empowering the patient central to depression care delivery.

  10. Outcome evaluation of a new model of critical care orientation.

    Science.gov (United States)

    Morris, Linda L; Pfeifer, Pamela; Catalano, Rene; Fortney, Robert; Nelson, Greta; Rabito, Robb; Harap, Rebecca

    2009-05-01

    The shortage of critical care nurses and the service expansion of 2 intensive care units provided a unique opportunity to create a new model of critical care orientation. The goal was to design a program that assessed critical thinking, validated competence, and provided learning pathways that accommodated diverse experience. To determine the effect of a new model of critical care orientation on satisfaction, retention, turnover, vacancy, preparedness to manage patient care assignment, length of orientation, and cost of orientation. A prospective, quasi-experimental design with both quantitative and qualitative methods. The new model improved satisfaction scores, retention rates, and recruitment of critical care nurses. Length of orientation was unchanged. Cost was increased, primarily because a full-time education consultant was added. A new model for nurse orientation that was focused on critical thinking and competence validation improved retention and satisfaction and serves as a template for orientation of nurses throughout the medical center.

  11. Business Process Simulation: Requirements for Business and Resource Models

    Directory of Open Access Journals (Sweden)

    Audrius Rima

    2015-07-01

    Full Text Available The purpose of Business Process Model and Notation (BPMN is to provide easily understandable graphical representation of business process. Thus BPMN is widely used and applied in various areas one of them being a business process simulation. This paper addresses some BPMN model based business process simulation problems. The paper formulate requirements for business process and resource models in enabling their use for business process simulation.

  12. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    Science.gov (United States)

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  13. World Health Organization Public Health Model: A Roadmap for Palliative Care Development.

    Science.gov (United States)

    Callaway, Mary V; Connor, Stephen R; Foley, Kathleen M

    2018-02-01

    The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed to improve the care of adults and children with life-limiting illnesses. As a public health concern, progress in palliative care requires integration into health policy, education and training of health care professionals, availability of essential pain relieving medications, and health care services. IPCI created the Palliative Care Roadmap to serve as a model for government and/or nongovernment organizations to use to frame the necessary elements and steps for palliative care integration. The roadmap includes the creation of multiple Ministry of Health-approved working groups to address: palliative care inclusion in national health policy, legislation, and finance; availability of essential palliative care medications, especially oral opioids; education and training of health care professionals; and the implementation of palliative care services at home or in inpatient settings for adults and children. Each working group is tasked with developing a pathway with multiple signposts as indicators of progress made. The roadmap may be entered at different signposts depending upon the state of palliative care development in the country. The progress of the working groups often takes place simultaneously but at variable rates. Based on our experience, the IPCI Roadmap is one possible framework for palliative care development in resource constrained countries but requires both health care professional engagement and political will for progress to be made. Copyright © 2017. Published by Elsevier Inc.

  14. Designing a Care Pathway Model - A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway.

    Science.gov (United States)

    Oosterholt, Robin I; Simonse, Lianne Wl; Boess, Stella U; Vehmeijer, Stephan Bw

    2017-03-09

    Although the clinical attributes of total hip arthroplasty (THA) care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. The outpatient THA care pathway enables patients to be discharged on the day of surgery, shortening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi-structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1) and mobilisation & discharge (4). The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. The design addressed existing problems and is an optimisation of the case hospital's pathway. The network of actors consists of the patient (1), radiologist (1), anaesthetist (1), nurse specialist (1), pharmacist (1), orthopaedic surgeon (1,4), physiotherapist (1,4), nurse (4), doctor (4) and patient application (1,4). The critical value exchanges include patient preparation (mental and practical), patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

  15. Teaching spiritual care to nursing students:an integrated model.

    Science.gov (United States)

    Taylor, Elizabeth Johnston; Testerman, Nancy; Hart, Dynnette

    2014-01-01

    Graduating nurses are required to know how to support patient spiritual well-being, yet there is scant literature about how spiritual care is taught in undergraduate programs. Typically spiritual content only is sporadically included; the authors recommend intergrating spiritual can thoughout the nursing curriculum. This article describes how one Christian nursing school integrates spiritual care content, supports student spiritual well-being throughout the program, and evaluates spiritual care instruction at graduation.

  16. Surgical Care Required for Populations Affected by Climate-related Natural Disasters: A Global Estimation.

    Science.gov (United States)

    Lee, Eugenia E; Stewart, Barclay; Zha, Yuanting A; Groen, Thomas A; Burkle, Frederick M; Kushner, Adam L

    2016-08-10

    Climate extremes will increase the frequency and severity of natural disasters worldwide.  Climate-related natural disasters were anticipated to affect 375 million people in 2015, more than 50% greater than the yearly average in the previous decade. To inform surgical assistance preparedness, we estimated the number of surgical procedures needed.   The numbers of people affected by climate-related disasters from 2004 to 2014 were obtained from the Centre for Research of the Epidemiology of Disasters database. Using 5,000 procedures per 100,000 persons as the minimum, baseline estimates were calculated. A linear regression of the number of surgical procedures performed annually and the estimated number of surgical procedures required for climate-related natural disasters was performed. Approximately 140 million people were affected by climate-related natural disasters annually requiring 7.0 million surgical procedures. The greatest need for surgical care was in the People's Republic of China, India, and the Philippines. Linear regression demonstrated a poor relationship between national surgical capacity and estimated need for surgical care resulting from natural disaster, but countries with the least surgical capacity will have the greatest need for surgical care for persons affected by climate-related natural disasters. As climate extremes increase the frequency and severity of natural disasters, millions will need surgical care beyond baseline needs. Countries with insufficient surgical capacity will have the most need for surgical care for persons affected by climate-related natural disasters. Estimates of surgical are particularly important for countries least equipped to meet surgical care demands given critical human and physical resource deficiencies.

  17. Counseling People Living in Poverty: The CARE Model

    Science.gov (United States)

    Foss, Louisa L.; Generali, Margaret M.; Kress, Victoria E.

    2011-01-01

    Counselors frequently counsel clients who live in poverty. The authors describe the new CARE model that addresses the influence of multiple systems on poor clients' experiences. A social justice, humanistic intervention, the CARE model emphasizes cultivating a positive counseling relationship with poor clients, empathizing with their unique…

  18. Models of Human Information Requirements: "When Reasonable Aiding Systems Disagree"

    Science.gov (United States)

    Corker, Kevin; Pisanich, Gregory; Shafto, Michael (Technical Monitor)

    1994-01-01

    Aircraft flight management and Air Traffic Control (ATC) automation are under development to maximize the economy of flight and to increase the capacity of the terminal area airspace while maintaining levels of flight safety equal to or better than current system performance. These goals are being realized by the introduction of flight management automation aiding and operations support systems on the flight deck and by new developments of ATC aiding systems that seek to optimize scheduling of aircraft while potentially reducing required separation and accounting for weather and wake vortex turbulence. Aiding systems on both the flight deck and the ground operate through algorithmic functions on models of the aircraft and of the airspace. These models may differ from each other as a result of variations in their models of the immediate environment. The resultant flight operations or ATC commands may differ in their response requirements (e.g. different preferred descent speeds or descent initiation points). The human operators in the system must then interact with the automation to reconcile differences and resolve conflicts. We have developed a model of human performance including cognitive functions (decision-making, rule-based reasoning, procedural interruption recovery and forgetting) that supports analysis of the information requirements for resolution of flight aiding and ATC conflicts. The model represents multiple individuals in the flight crew and in ATC. The model is supported in simulation on a Silicon Graphics' workstation using Allegro Lisp. Design guidelines for aviation automation aiding systems have been developed using the model's specification of information and team procedural requirements. Empirical data on flight deck operations from full-mission flight simulation are provided to support the model's predictions. The paper describes the model, its development and implementation, the simulation test of the model predictions, and the empirical

  19. The primary care amplification model: taking the best of primary care forward

    Directory of Open Access Journals (Sweden)

    Nicholson Caroline

    2008-12-01

    Full Text Available Abstract Background Primary care internationally is approaching a new paradigm. The change agenda implicit in this threatens to de-stabilise and challenge established general practice and primary care. Discussion The Primary Care Amplification Model offers a means to harness the change agenda by 'amplifying' the strengths of established general practices around a 'beacon' practice. Conclusion Such 'beacon' practices can provide a mustering point for an expanded scope of practice for primary care, integrated primary/secondary service delivery, interprofessional learning, relevant local clinical research, and a focus on local service innovation, enhancing rather than fragmenting the collective capacity of existing primary care.

  20. Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Aij KH

    2017-01-01

    Full Text Available Kjeld Harald Aij, Sofia Rapsaniotis VU University Medical Center, Division Acute Care and Surgery, Amsterdam, The Netherlands Abstract: As health care organizations face pressures to improve quality and efficiency while reducing costs, leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean. Successful Lean leaders appear to use a coaching leadership style that shares underlying principles with servant leadership. There is little information about specific similarities and differences between Lean and servant leaderships. We systematically reviewed the literature on Lean leadership, servant leadership, and health care and performed a comparative analysis of attributes using Russell and Stone’s leadership framework. We found significant overlap between the two leadership styles, although there were notable differences in origins, philosophy, characteristics and behaviors, and tools. We conclude that both Lean and servant leaderships are promising models that can contribute to the delivery of patient-centered, high-value care. Servant leadership may provide the means to engage and develop employees to become successful Lean leaders in health care organizations. Keywords: management, leadership attributes, efficiency, patient-centered, high-value care

  1. System requirements for a computerised patient record information system at a busy primary health care clinic

    Directory of Open Access Journals (Sweden)

    PJ Blignaut

    2001-09-01

    Full Text Available A prototyping approach was used to determine the essential system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was implemented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.

  2. Requirements for a text that integrates the oncological pharmacy into the Cuban national health care system

    International Nuclear Information System (INIS)

    Arbesú Michelena, Ma Antonieta; Sedeño Argilagos, C. Caridad; Fernández Argüelles, Rogelio Alberto

    2015-01-01

    Introduction: oncological patients are cared for at all health care system levels. The pharmaceutical professional requires unifying instructions for his/her work in order to be part of the health team. Currently, there is no domestic literature for the pharmaceutical services, mainly that one devoted to oncological area, which comprises in just one text all the functional requirements and directs his/her professional daily work. Objective: to verify the requirement for national integral literature for the development of the oncological pharmaceutical service work. Methods: one two-question questionnaire was designed to assess the knowledge of experts and another with eight questions to learn about the requirement for literature on oncological pharmaceutical service adapted to the conditions of the Cuban health system. The questionnaires were e-mailed to 15 pharmacists who had an outstanding experience in several activities of the oncological pharmacy. Results: ten university experts, with 14.5 years of work experience as average in assistance activities from three provinces, responded. Two were excluded because their low level of information on oncological activity; poor incorporation of the pharmacist involved in services to activities inherent to his/her formation. All the experts believed that it was necessary to have a comprehensive text on the tasks, functions and activities linked to the oncological patient care, and to use the formal learning pathways for updating. A positive association with the favorable answers (1.40) was noticed. Conclusions: there exists a need for a text as a guide of the oncological pharmaceutical services according to the demands of the Cuban health care system. (author) 1

  3. Familial hypercholesterolaemia: a model of care for Australasia.

    Science.gov (United States)

    Watts, Gerald F; Sullivan, David R; Poplawski, Nicola; van Bockxmeer, Frank; Hamilton-Craig, Ian; Clifton, Peter M; O'Brien, Richard; Bishop, Warrick; George, Peter; Barter, Phillip J; Bates, Timothy; Burnett, John R; Coakley, John; Davidson, Patricia; Emery, Jon; Martin, Andrew; Farid, Waleed; Freeman, Lucinda; Geelhoed, Elizabeth; Juniper, Amanda; Kidd, Alexa; Kostner, Karam; Krass, Ines; Livingston, Michael; Maxwell, Suzy; O'Leary, Peter; Owaimrin, Amal; Redgrave, Trevor G; Reid, Nicola; Southwell, Lynda; Suthers, Graeme; Tonkin, Andrew; Towler, Simon; Trent, Ronald

    2011-10-01

    Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that causes marked elevation in plasma cholesterol and premature coronary heart disease. There are at least 45,000 people with FH in Australia and New Zealand, but the vast majority remains undetected and those diagnosed with the condition are inadequately treated. To bridge this major gap in coronary prevention the FH Australasia Network (Australian Atherosclerosis Society) has developed a consensus model of care (MoC) for FH. The MoC is based on clinical experience, expert opinion, published evidence and consultations with a wide spectrum of stakeholders, and has been developed for use primarily by specialist centres intending starting a clinical service for FH. This MoC aims to provide a standardised, high-quality and cost-effective system of care that is likely to have the highest impact on patient outcomes. The MoC for FH is presented as a series of recommendations and algorithms focusing on the standards required for the detection, diagnosis, assessment and management of FH in adults and children. The process involved in cascade screening and risk notification, the backbone for detecting new cases of FH, is detailed. Guidance on treatment is based on risk stratifying patients, management of non-cholesterol risk factors, safe and effective use of statins, and a rational approach to follow-up of patients. Clinical and laboratory recommendations are given for genetic testing. An integrative system for providing best clinical care is described. This MoC for FH is not prescriptive and needs to be complemented by good clinical judgment and adjusted for local needs and resources. After initial implementation, the MoC will require critical evaluation, development and appropriate modification. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  4. A maturity model for care pathways

    NARCIS (Netherlands)

    Schriek, M.; Turetken, O.; Kaymak, U.

    2016-01-01

    Over the last recent decades, increasing the quality of healthcare services while reducing costs has been among the top concerns in the healthcare landscape. Several healthcare institutions have initiated improvement programs and invested considerably in process orientation and management. Care

  5. Accelerating a Network Model of Care: Taking a Social Innovation to Scale

    Directory of Open Access Journals (Sweden)

    Kerry Byrne

    2012-07-01

    Full Text Available Government-funded systems of health and social care are facing enormous fiscal and human-resource challenges. The space for innovation in care is wide open and new disruptive patterns are emerging. These include self-management and personal budgets, participatory and integrated care, supported decision making and a renewed focus on prevention. Taking these disruptive patterns to scale can be accelerated by a technologically enabled shift to a network model of care to co-create the best outcomes for individuals, family caregivers, and health and social care organizations. The connections, relationships, and activities within an individual’s personal network lay the foundation for care that health and social care systems/policy must simultaneously support and draw on for positive outcomes. Practical tools, adequate information, and tangible resources are required to coordinate and sustain care. Tyze Personal Networks is a social venture that uses technology to engage and inform the individual, their personal networks, and their care providers to co-create the best outcomes. In this article, we demonstrate how Tyze contributes to a shift to a network model of care by strengthening our networks and enhancing partnerships between care providers, individuals, and family and friends.

  6. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges.

    Science.gov (United States)

    Phillips, Charles D

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

  7. A taxonomy of nursing care organization models in hospitals.

    Science.gov (United States)

    Dubois, Carl-Ardy; D'Amour, Danielle; Tchouaket, Eric; Rivard, Michèle; Clarke, Sean; Blais, Régis

    2012-08-28

    Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units' profile data. The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses' professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses' perceptions that the practice environment is less supportive of their professional work. This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an "ideal" nursing professional practice model described by some leaders in the

  8. A taxonomy of nursing care organization models in hospitals

    Science.gov (United States)

    2012-01-01

    Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an “ideal” nursing professional practice

  9. Job stress and job satisfaction: home care workers in a consumer-directed model of care.

    Science.gov (United States)

    Delp, Linda; Wallace, Steven P; Geiger-Brown, Jeanne; Muntaner, Carles

    2010-08-01

    To investigate determinants of job satisfaction among home care workers in a consumer-directed model. Analysis of data collected from telephone interviews with 1,614 Los Angeles home care workers on the state payroll in 2003. Multivariate logistic regression analysis was used to determine the odds of job satisfaction using job stress model domains of demands, control, and support. Abuse from consumers, unpaid overtime hours, and caring for more than one consumer as well as work-health demands predict less satisfaction. Some physical and emotional demands of the dyadic care relationship are unexpectedly associated with greater job satisfaction. Social support and control, indicated by job security and union involvement, have a direct positive effect on job satisfaction. Policies that enhance the relational component of care may improve workers' ability to transform the demands of their job into dignified and satisfying labor. Adequate benefits and sufficient authorized hours of care can minimize the stress of unpaid overtime work, caring for multiple consumers, job insecurity, and the financial constraints to seeking health care. Results have implications for the structure of consumer-directed models of care and efforts to retain long-term care workers.

  10. Sustainability in care through an ethical practice model.

    Science.gov (United States)

    Nyholm, Linda; Salmela, Susanne; Nyström, Lisbet; Koskinen, Camilla

    2018-03-01

    While sustainability is a key concept in many different domains today, it has not yet been sufficiently emphasized in the healthcare sector. Earlier research shows that ethical values and evidence-based care models create sustainability in care practice. The aim of this study was to gain further understanding of the ethical values central to the realization of sustainability in care and to create an ethical practice model whereby these basic values can be made perceptible and active in care practice. Part of the ongoing "Ethical Sustainable Caring Cultures" research project, a hermeneutical application research design was employed in this study. Dialogues were used, where scientific researchers and co-researchers were given the opportunity to reflect on ethical values in relation to sustainability in care. An ethical practice model with ethos as its core was created from the results of the dialogues. In the model, ethos is encircled by the ethical values central to sustainability: dignity, responsibility, respect, invitation, and vows. The model can be used as a starting point for ethical conversations that support carers' reflections on the ethical issues seen in day-to-day care work and the work community, allowing ethical values to become visible throughout the entire care culture. It is intended as a tool whereby carers can more deeply understand an organization's common basic values and what they entail in regard to sustainability in care.

  11. Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care

    Science.gov (United States)

    Lake, James; Turner, Mason Spain

    2017-01-01

    Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally. This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics. PMID:28898197

  12. Health information needs of professional nurses required at the point of care.

    Science.gov (United States)

    Ricks, Esmeralda; ten Ham, Wilma

    2015-06-11

    Professional nurses work in dynamic environments and need to keep up to date with relevant information for practice in nursing to render quality patient care. Keeping up to date with current information is often challenging because of heavy workload, diverse information needs and the accessibility of the required information at the point of care. The aim of the study was to explore and describe the information needs of professional nurses at the point of care in order to make recommendations to stakeholders to develop a mobile library accessible by means of smart phones when needed. The researcher utilised a quantitative, descriptive survey design to conduct this study. The target population comprised 757 professional nurses employed at a state hospital. Simple random sampling was used to select a sample of the wards, units and departments for inclusion in the study. A convenience sample of 250 participants was selected. Two hundred and fifty structured self-administered questionnaires were distributed amongst the participants. Descriptive statistics were used to analyse the data. A total of 136 completed questionnaires were returned. The findings highlighted the types and accessible sources of information. Information needs of professional nurses were identified such as: extremely drug-resistant tuberculosis, multi-drug-resistant tuberculosis, HIV, antiretrovirals and all chronic lifestyle diseases. This study has enabled the researcher to identify the information needs required by professional nurses at the point of care to enhance the delivery of patient care. The research results were used to develop a mobile library that could be accessed by professional nurses.

  13. Requirements for a minimum standard of care for phenylketonuria: the patients’ perspective

    Science.gov (United States)

    2013-01-01

    Phenylketonuria (PKU, ORPHA716) is an inherited disorder that affects about one in every 10,000 children born in Europe. Early and continuous application of a modified diet is largely successful in preventing the devastating brain damage associated with untreated PKU. The management of PKU is inconsistent: there are few national guidelines, and these tend to be incomplete and implemented sporadically. In this article, the first-ever pan- European patient/carer perspective on optimal PKU care, the European Society for Phenylketonuria and Allied Disorders (E.S.PKU) proposes recommendations for a minimum standard of care for PKU, to underpin the development of new pan-European guideline for the management of PKU. New standards of best practice should guarantee equal access to screening, treatment and monitoring throughout Europe. Screening protocols and interpretation of screening results should be standardised. Experienced Centres of Expertise are required, in line with current European Union policy, to guarantee a defined standard of multidisciplinary treatment and care for all medical and social aspects of PKU. Women of childbearing age require especially intensive management, due to the risk of severe risks to the foetus conferred by uncontrolled PKU. All aspects of treatment should be reimbursed to ensure uniform access across Europe to guideline-driven, evidence-based care. The E.S.PKU urges PKU healthcare professionals caring for people with PKU to take the lead in developing evidence based guidelines on PKU, while continuing to play an active role in serving as the voice of patients and their families, whose lives are affected by the condition. PMID:24341788

  14. The Shifting Landscape of Health Care: Toward a Model of Health Care Empowerment

    Science.gov (United States)

    2011-01-01

    In a rapidly changing world of health care information access and patients’ rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities. PMID:21164096

  15. The development of an integrated Indonesian health care model using Kano's model, quality function deployment and balanced scorecard

    Science.gov (United States)

    Jonny, Zagloed, Teuku Yuri M.

    2017-11-01

    This paper aims to present an integrated health care model for Indonesian health care industry. Based on previous researches, there are two health care models in the industry such as decease- and patient-centered care models. In their developments, the patient-centered care model is widely applied due to its capability in reducing cost and improving quality simultaneously. However, there is still no comprehensive model resulting in cost reduction, quality improvement, patient satisfaction and hospital profitability simultaneously. Therefore, this research is intended to develop that model. In doing so, first, a conceptual model using Kano's Model, Quality Function Deployment (QFD) and Balanced Scorecard (BSC) is developed to generate several important elements of the model as required by stakeholders. Then, a case study of an Indonesian hospital is presented to evaluate the validity of the model using correlation analysis. As a result, it can be concluded that the model is validated implying several managerial insights among its elements such as l) leadership (r=0.85) and context of the organization (r=0.77) improve operations; 2) planning (r=0.96), support process (r=0.87) and continual improvement (r=0.95) also improve operations; 3) operations improve customer satisfaction (r=0.89) and financial performance (r=0.93) and 4) customer satisfaction improves the financial performance (0.98).

  16. The feasibility of a pragmatic randomised controlled trial to compare usual care with usual care plus individualised homeopathy, in children requiring secondary care for asthma.

    Science.gov (United States)

    Thompson, E A; Shaw, A; Nichol, J; Hollinghurst, S; Henderson, A J; Thompson, T; Sharp, D

    2011-07-01

    To test the feasibility of a pragmatic trial design with economic evaluation and nested qualitative study, comparing usual care (UC) with UC plus individualised homeopathy, in children requiring secondary care for asthma. This included recruitment and retention, acceptability of outcome measures patients' and health professionals' views and experiences and a power calculation for a definitive trial. In a pragmatic parallel group randomised controlled trial (RCT) design, children on step 2 or above of the British Thoracic Society Asthma Guidelines (BTG) were randomly allocated to UC or UC plus a five visit package of homeopathic care (HC). Outcome measures included the Juniper Asthma Control Questionnaire, Quality of Life Questionnaire and a resource use questionnaire. Qualitative interviews were used to gain families' and health professionals' views and experiences. 226 children were identified from hospital clinics and related patient databases. 67 showed an interest in participating, 39 children were randomised, 18 to HC and 21 to UC. Evidence in favour of adjunctive homeopathic treatment was lacking. Economic evaluation suggests that the cost of additional consultations was not offset by the reduced cost of homeopathic remedies and the lower use of primary care by children in the homeopathic group. Qualitative data gave insights into the differing perspectives of families and health care professionals within the research process. A future study using this design is not feasible, further investigation of a potential role for homeopathy in asthma management might be better conducted in primary care with children with less severe asthma. Copyright © 2011 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  17. Formal Requirements Modeling for Reactive Systems with Coloured Petri Nets

    DEFF Research Database (Denmark)

    Tjell, Simon

    This dissertation presents the contributions of seven publications all concerned with the application of Coloured Petri Nets (CPN) to requirements modeling for reactive systems. The publications are introduced along with relevant background material and related work, and their contributions...... to take into concern that the behavior of human actors is less likely to be predictable than the behavior of e.g. mechanical components.   In the second approach, the CPN model is parameterized and utilizes a generic and reusable CPN module operating as an SD interpreter. In addition to distinguishing...... and events. A tool is presented that allows automated validation of the structure of CPN models with respect to the guidelines. Next, three publications on integrating Jackson's Problem Frames with CPN requirements models are presented: The first publication introduces a method for systematically structuring...

  18. Model-based human reliability analysis: prospects and requirements

    International Nuclear Information System (INIS)

    Mosleh, A.; Chang, Y.H.

    2004-01-01

    Major limitations of the conventional methods for human reliability analysis (HRA), particularly those developed for operator response analysis in probabilistic safety assessments (PSA) of nuclear power plants, are summarized as a motivation for the need and a basis for developing requirements for the next generation HRA methods. It is argued that a model-based approach that provides explicit cognitive causal links between operator behaviors and directly or indirectly measurable causal factors should be at the core of the advanced methods. An example of such causal model is briefly reviewed, where due to the model complexity and input requirements can only be currently implemented in a dynamic PSA environment. The computer simulation code developed for this purpose is also described briefly, together with current limitations in the models, data, and the computer implementation

  19. Critical Business Requirements Model and Metrics for Intranet ROI

    OpenAIRE

    Luqi; Jacoby, Grant A.

    2005-01-01

    Journal of Electronic Commerce Research, Vol. 6, No. 1, pp. 1-30. This research provides the first theoretical model, the Intranet Efficiency and Effectiveness Model (IEEM), to measure intranet overall value contributions based on a corporation’s critical business requirements by applying a balanced baseline of metrics and conversion ratios linked to key business processes of knowledge workers, IT managers and business decision makers -- in effect, closing the gap of understanding...

  20. NASA Standard for Models and Simulations: Philosophy and Requirements Overview

    Science.gov (United States)

    Blattnig, Steve R.; Luckring, James M.; Morrison, Joseph H.; Sylvester, Andre J.; Tripathi, Ram K.; Zang, Thomas A.

    2013-01-01

    Following the Columbia Accident Investigation Board report, the NASA Administrator chartered an executive team (known as the Diaz Team) to identify those CAIB report elements with NASA-wide applicability and to develop corrective measures to address each element. One such measure was the development of a standard for the development, documentation, and operation of models and simulations. This report describes the philosophy and requirements overview of the resulting NASA Standard for Models and Simulations.

  1. Funding models in palliative care: Lessons from international experience

    Science.gov (United States)

    Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss EM

    2017-01-01

    Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest. PMID:28156188

  2. Funding models in palliative care: Lessons from international experience.

    Science.gov (United States)

    Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss Em

    2017-04-01

    Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. To assess national models and methods for financing and reimbursing palliative care. Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.

  3. Public vs. Private Provision of Charity Care? Evidence from the Expiration of Hill-Burton Requirements in Florida

    OpenAIRE

    Douglas Almond; Janet Currie; Emilia Simeonova

    2010-01-01

    This paper explores the consequences of the expiration of charity care requirements imposed on private hospitals by the Hill-Burton Act. We examine delivery care and the health of newborns using the universe of Florida births from 1989-2003 combined with hospital data from the American Hospital Association. We find that charity care requirements were binding on hospitals, but that private hospitals under obligation "cream skimmed" the least risky maternity patients. Conditional on patient cha...

  4. Leadership models in health care - a case for servant leadership.

    Science.gov (United States)

    Trastek, Victor F; Hamilton, Neil W; Niles, Emily E

    2014-03-01

    Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  5. Religious care required for Japanese terminally ill patients with cancer from the perspective of bereaved family members.

    Science.gov (United States)

    Okamoto, Takuya; Ando, Michiyo; Morita, Tatsuya; Hirai, Kei; Kawamura, Ryo; Mitsunori, Miyashita; Sato, Kazuki; Shima, Yasuo

    2010-02-01

    The aim of this study was to explore the most suitable religious care for Japanese terminally ill patients with cancer based on the opinions of bereaved family members. A multicenter questionnaire survey on palliative care service was sent to 592 bereaved family members of patients with cancer who were admitted to palliative care units in Japan, and 430 responded by mail. In the section of the questionnaire about religious care, 382 responses were used for quantitative analysis, and 71 responses about religious care for qualitative analysis. In the current study, the 71 responses were grouped into families with and without a religion and were analyzed qualitatively. Families with a religion (N = 28) chose answers such as ''Instrumental care'' such as music or a religious event, ''Freedom of choice of kinds for religious care,'' ''Staff involvement of religious care,'' ''Meeting with a pastoral care workers,'' and ''Burden of offering a different kind of personal religion.'' In contrast, families without a religion (N = 44) chose answers such as ''Instrumental care,'' ''Freedom of choice whether patients receive religious care or not,'' ''Spiritual care,'' ''Not being able to accept religious care,'' and ''Burden of thinking about a religion and nuisance.'' These findings suggest that Japanese bereaved families with a religion generally regard religious care positively and prefer care through their own religion, whereas some families without a religion require religious care but some do not prefer it.

  6. Developing a Family-Centered Care Model for Critical Care After Pediatric Traumatic Brain Injury.

    Science.gov (United States)

    Moore, Megan; Robinson, Gabrielle; Mink, Richard; Hudson, Kimberly; Dotolo, Danae; Gooding, Tracy; Ramirez, Alma; Zatzick, Douglas; Giordano, Jessica; Crawley, Deborah; Vavilala, Monica S

    2015-10-01

    This study examined the family experience of critical care after pediatric traumatic brain injury in order to develop a model of specific factors associated with family-centered care. Qualitative methods with semi-structured interviews were used. Two level 1 trauma centers. Fifteen mothers of children who had an acute hospital stay after traumatic brain injury within the last 5 years were interviewed about their experience of critical care and discharge planning. Participants who were primarily English, Spanish, or Cantonese speaking were included. None. Content analysis was used to code the transcribed interviews and develop the family-centered care model. Three major themes emerged: 1) thorough, timely, compassionate communication, 2) capacity building for families, providers, and facilities, and 3) coordination of care transitions. Participants reported valuing detailed, frequent communication that set realistic expectations and prepared them for decision making and outcomes. Areas for capacity building included strategies to increase provider cultural humility, parent participation in care, and institutional flexibility. Coordinated care transitions, including continuity of information and maintenance of partnerships with families and care teams, were highlighted. Participants who were not primarily English speaking reported particular difficulty with communication, cultural understanding, and coordinated transitions. This study presents a family-centered traumatic brain injury care model based on family perspectives. In addition to communication and coordination strategies, the model offers methods to address cultural and structural barriers to meeting the needs of non-English-speaking families. Given the stress experienced by families of children with traumatic brain injury, careful consideration of the model themes identified here may assist in improving overall quality of care to families of hospitalized children with traumatic brain injury.

  7. Diffusion of a collaborative care model in primary care: a longitudinal qualitative study

    Directory of Open Access Journals (Sweden)

    Vedel Isabelle

    2013-01-01

    Full Text Available Background Although collaborative team models (CTM improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs. The objectives of this study are to understand: (1 how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2 the model's diffusion process. Methods We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 PCPs and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics. Results Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM's diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the critical mass of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM's compatibility with norms, values and practices and its relative advantage (impact on patient management and work practices. Opinion leaders played a key role in the diffusion of the CTM among PCPs. Conclusion CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a critical mass of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians.

  8. Creating A Sustainable Model of Spine Care in Underserved Communities

    DEFF Research Database (Denmark)

    Haldeman, Scott; Nordin, Margareta; Outerbridge, Geoff

    2015-01-01

    The world lacks sustainable models of care to manage spinal disorders in poor and underserved communities. The purpose of this article is to: (1) review the rationale and importance of developing a sustainable evidence-based model of care at low cost for people with spinal disorders in underserved...... adequate care, World Spine Care (WSC) was established to "improve lives in underserved communities through sustainable, integrated, evidence-based, spinal care." WSC is comprised of volunteers and institutions from 6 continents and several countries, and incorporates a Board of Directors, an executive...... are adapted to and integrated within each community in collaboration with local decision makers, existing health care workers and traditional healers. Cornerstones of WSC's emphasis on long-term sustainability are (1) education of community partners, governments and local health professionals, and (2...

  9. Generic skills requirements (KSA model) towards future mechanical ...

    African Journals Online (AJOL)

    ... Statistics and Discriminant Analysis (DA) as required to achieve the objective of the study. This study will guide all future engineers, especially in the field of Mechanical Engineering in Malaysia to penetrate the job market according to the current market needs. Keywords: generic skills; KSA model; mechanical engineers; ...

  10. Fusing Quantitative Requirements Analysis with Model-based Systems Engineering

    Science.gov (United States)

    Cornford, Steven L.; Feather, Martin S.; Heron, Vance A.; Jenkins, J. Steven

    2006-01-01

    A vision is presented for fusing quantitative requirements analysis with model-based systems engineering. This vision draws upon and combines emergent themes in the engineering milieu. "Requirements engineering" provides means to explicitly represent requirements (both functional and non-functional) as constraints and preferences on acceptable solutions, and emphasizes early-lifecycle review, analysis and verification of design and development plans. "Design by shopping" emphasizes revealing the space of options available from which to choose (without presuming that all selection criteria have previously been elicited), and provides means to make understandable the range of choices and their ramifications. "Model-based engineering" emphasizes the goal of utilizing a formal representation of all aspects of system design, from development through operations, and provides powerful tool suites that support the practical application of these principles. A first step prototype towards this vision is described, embodying the key capabilities. Illustrations, implications, further challenges and opportunities are outlined.

  11. Models of protein and amino acid requirements for cattle

    Directory of Open Access Journals (Sweden)

    Luis Orlindo Tedeschi

    2015-03-01

    Full Text Available Protein supply and requirements by ruminants have been studied for more than a century. These studies led to the accumulation of lots of scientific information about digestion and metabolism of protein by ruminants as well as the characterization of the dietary protein in order to maximize animal performance. During the 1980s and 1990s, when computers became more accessible and powerful, scientists began to conceptualize and develop mathematical nutrition models, and to program them into computers to assist with ration balancing and formulation for domesticated ruminants, specifically dairy and beef cattle. The most commonly known nutrition models developed during this period were the National Research Council (NRC in the United States, Agricultural Research Council (ARC in the United Kingdom, Institut National de la Recherche Agronomique (INRA in France, and the Commonwealth Scientific and Industrial Research Organization (CSIRO in Australia. Others were derivative works from these models with different degrees of modifications in the supply or requirement calculations, and the modeling nature (e.g., static or dynamic, mechanistic, or deterministic. Circa 1990s, most models adopted the metabolizable protein (MP system over the crude protein (CP and digestible CP systems to estimate supply of MP and the factorial system to calculate MP required by the animal. The MP system included two portions of protein (i.e., the rumen-undegraded dietary CP - RUP - and the contributions of microbial CP - MCP as the main sources of MP for the animal. Some models would explicitly account for the impact of dry matter intake (DMI on the MP required for maintenance (MPm; e.g., Cornell Net Carbohydrate and Protein System - CNCPS, the Dutch system - DVE/OEB, while others would simply account for scurf, urinary, metabolic fecal, and endogenous contributions independently of DMI. All models included milk yield and its components in estimating MP required for lactation

  12. Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

    Directory of Open Access Journals (Sweden)

    Shafazand Masoud

    2012-03-01

    Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

  13. Recommendations on basic requirements for intensive care units: structural and organizational aspects.

    Science.gov (United States)

    Valentin, Andreas; Ferdinande, Patrick

    2011-10-01

    To provide guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine. The Working Group on Quality Improvement (WGQI) of the European Society of Intensive Care Medicine (ESICM) identified the basic requirements for ICUs by a comprehensive literature search and an iterative process with several rounds of consensus finding with the participation of 47 intensive care physicians from 23 countries. The starting point of this process was an ESICM recommendation published in 1997 with the need for an updated version. The document consists of operational guidelines and design recommendations for ICUs. In the first part it covers the definition and objectives of an ICU, functional criteria, activity criteria, and the management of equipment. The second part deals with recommendations with respect to the planning process, floorplan and connections, accommodation, fire safety, central services, and the necessary communication systems. This document provides a detailed framework for the planning or renovation of ICUs based on a multinational consensus within the ESICM.

  14. A new risk prediction model for critical care: the Intensive Care National Audit & Research Centre (ICNARC) model.

    Science.gov (United States)

    Harrison, David A; Parry, Gareth J; Carpenter, James R; Short, Alasdair; Rowan, Kathy

    2007-04-01

    To develop a new model to improve risk prediction for admissions to adult critical care units in the UK. Prospective cohort study. The setting was 163 adult, general critical care units in England, Wales, and Northern Ireland, December 1995 to August 2003. Patients were 216,626 critical care admissions. None. The performance of different approaches to modeling physiologic measurements was evaluated, and the best methods were selected to produce a new physiology score. This physiology score was combined with other information relating to the critical care admission-age, diagnostic category, source of admission, and cardiopulmonary resuscitation before admission-to develop a risk prediction model. Modeling interactions between diagnostic category and physiology score enabled the inclusion of groups of admissions that are frequently excluded from risk prediction models. The new model showed good discrimination (mean c index 0.870) and fit (mean Shapiro's R 0.665, mean Brier's score 0.132) in 200 repeated validation samples and performed well when compared with recalibrated versions of existing published risk prediction models in the cohort of patients eligible for all models. The hypothesis of perfect fit was rejected for all models, including the Intensive Care National Audit & Research Centre (ICNARC) model, as is to be expected in such a large cohort. The ICNARC model demonstrated better discrimination and overall fit than existing risk prediction models, even following recalibration of these models. We recommend it be used to replace previously published models for risk adjustment in the UK.

  15. A Model for Community-Based Pediatric Oral Heath: Implementation of an Infant Oral Care Program

    Directory of Open Access Journals (Sweden)

    Francisco J. Ramos-Gomez

    2014-01-01

    Full Text Available The Affordable Care Act (ACA mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0–5 and their caregivers. In collaboration with the Venice Family Clinic's Simms/Mann Health and Wellness Center, UCLA Pediatrics, Women, Infants, and Children (WIC, and Early Head Start and Head Start programs, the IOCP increases family-centered care access and promotes early utilization of dental services in nontraditional, primary care settings. Emphasizing disease prevention, management, and care that is sensitive to cultural, language, and oral health literacy challenges, IOCP patients achieve better oral health maintenance “in health” not in “disease modality”. IOCP uses interprofessional education to promote pediatric oral health across multiple disciplines and highlights the necessity for the “age-one visit”. This innovative clinical model facilitates early intervention and disease management. It sets a new standard of minimally invasive dental care that is widely available and prevention focused, with high retention rates due to strong collaborations with the community-based organizations serving these vulnerable, high-risk children.

  16. A model for community-based pediatric oral heath: implementation of an infant oral care program.

    Science.gov (United States)

    Ramos-Gomez, Francisco J

    2014-01-01

    The Affordable Care Act (ACA) mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP) in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0-5 and their caregivers. In collaboration with the Venice Family Clinic's Simms/Mann Health and Wellness Center, UCLA Pediatrics, Women, Infants, and Children (WIC), and Early Head Start and Head Start programs, the IOCP increases family-centered care access and promotes early utilization of dental services in nontraditional, primary care settings. Emphasizing disease prevention, management, and care that is sensitive to cultural, language, and oral health literacy challenges, IOCP patients achieve better oral health maintenance "in health" not in "disease modality". IOCP uses interprofessional education to promote pediatric oral health across multiple disciplines and highlights the necessity for the "age-one visit". This innovative clinical model facilitates early intervention and disease management. It sets a new standard of minimally invasive dental care that is widely available and prevention focused, with high retention rates due to strong collaborations with the community-based organizations serving these vulnerable, high-risk children.

  17. Required experimental accuracy to select between supersymmetrical models

    Science.gov (United States)

    Grellscheid, David

    2004-03-01

    We will present a method to decide a priori whether various supersymmetrical scenarios can be distinguished based on sparticle mass data alone. For each model, a scan over all free SUSY breaking parameters reveals the extent of that model's physically allowed region of sparticle-mass-space. Based on the geometrical configuration of these regions in mass-space, it is possible to obtain an estimate of the required accuracy of future sparticle mass measurements to distinguish between the models. We will illustrate this algorithm with an example. This talk is based on work done in collaboration with B C Allanach (LAPTH, Annecy) and F Quevedo (DAMTP, Cambridge).

  18. Integrated community-based dementia care: the Geriant model

    Directory of Open Access Journals (Sweden)

    Ludo Glimmerveen

    2015-09-01

    Full Text Available This article gives an in-depth description of the service delivery model of Geriant, a Dutch organization providing community-based care services for people suffering from dementia. Core to its model is the provision of clinical case management, embedded in multidisciplinary dementia care teams. As Geriant's client group includes people from the first presumption of dementia until they can no longer live at home, its care model provides valuable lessons about how different mechanisms of integration are flexibly put to use if the complexity of clients” care needs increases. It showcases how the integration of services for a specific sub-population is combined with alignment of these services with generalist network partners. After a detailed description of the programme and its results, this article builds on the work of Walter Leutz for a conceptual discussion of Geriant's approach to care integration. 

  19. Development of an International School Nurse Asthma Care Coordination Model.

    Science.gov (United States)

    Garwick, Ann W; Svavarsdóttir, Erla Kolbrun; Seppelt, Ann M; Looman, Wendy S; Anderson, Lori S; Örlygsdóttir, Brynja

    2015-03-01

    To identify and compare how school nurses in Reykjavik, Iceland and St. Paul, Minnesota coordinated care for youth with asthma (ages 10-18) and to develop an asthma school nurse care coordination model. Little is known about how school nurses coordinate care for youth with asthma in different countries. A qualitative descriptive study design using focus group data. Six focus groups with 32 school nurses were conducted in Reykjavik (n = 17) and St. Paul (n = 15) using the same protocol between September 2008 and January 2009. Descriptive content analytic and constant comparison strategies were used to categorize and compare how school nurses coordinated care, which resulted in the development of an International School Nurse Asthma Care Coordination Model. Participants in both countries spontaneously described a similar asthma care coordination process that involved information gathering, assessing risk for asthma episodes, prioritizing healthcare needs and anticipating and planning for student needs at the individual and school levels. This process informed how they individualized symptom management, case management and/or asthma education. School nurses played a pivotal part in collaborating with families, school and healthcare professionals to ensure quality care for youth with asthma. Results indicate a high level of complexity in school nurses' approaches to asthma care coordination that were responsive to the diverse and changing needs of students in school settings. The conceptual model derived provides a framework for investigators to use in examining the asthma care coordination process of school nurses in other geographic locations. © 2014 John Wiley & Sons Ltd.

  20. [Comparison of level of satisfaction of users of home care: integrated model vs. dispensaries model].

    Science.gov (United States)

    Gorina, Marta; Limonero, Joaquín T; Peñart, Xavier; Jiménez, Jordi; Gassó, Javier

    2014-01-01

    To determine the level of satisfaction of users that receive home health care through two different models of primary health care: integrated model and dispensaries model. cross-sectional, observational study. Two primary care centers in the province of Barcelona. The questionnaire was administered to 158 chronic patients over 65 years old, of whom 67 were receiving health care from the integrated model, and 91 from the dispensaries model. The Evaluation of Satisfaction with Home Health Care (SATISFAD12) questionnaire was, together with other complementary questions about service satisfaction of home health care, as well as social demographic questions (age, sex, disease, etc). The patients of the dispensaries model showed more satisfaction than the users receiving care from the integrated model. There was a greater healthcare continuity for those patients from the dispensaries model, and a lower percentage of hospitalizations during the last year. The satisfaction of the users from both models was not associated to gender, the health perception,or independence of the The user satisfaction rate of the home care by primary health care seems to depend of the typical characteristics of each organisational model. The dispensaries model shows a higher rate of satisfaction or perceived quality of care in all the aspects analysed. More studies are neede to extrapolate these results to other primary care centers belonging to other institutions. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  1. Cognition and procedure representational requirements for predictive human performance models

    Science.gov (United States)

    Corker, K.

    1992-01-01

    Models and modeling environments for human performance are becoming significant contributors to early system design and analysis procedures. Issues of levels of automation, physical environment, informational environment, and manning requirements are being addressed by such man/machine analysis systems. The research reported here investigates the close interaction between models of human cognition and models that described procedural performance. We describe a methodology for the decomposition of aircrew procedures that supports interaction with models of cognition on the basis of procedures observed; that serves to identify cockpit/avionics information sources and crew information requirements; and that provides the structure to support methods for function allocation among crew and aiding systems. Our approach is to develop an object-oriented, modular, executable software representation of the aircrew, the aircraft, and the procedures necessary to satisfy flight-phase goals. We then encode in a time-based language, taxonomies of the conceptual, relational, and procedural constraints among the cockpit avionics and control system and the aircrew. We have designed and implemented a goals/procedures hierarchic representation sufficient to describe procedural flow in the cockpit. We then execute the procedural representation in simulation software and calculate the values of the flight instruments, aircraft state variables and crew resources using the constraints available from the relationship taxonomies. The system provides a flexible, extensible, manipulative and executable representation of aircrew and procedures that is generally applicable to crew/procedure task-analysis. The representation supports developed methods of intent inference, and is extensible to include issues of information requirements and functional allocation. We are attempting to link the procedural representation to models of cognitive functions to establish several intent inference methods

  2. Promoting excellence in end-of-life care: a report on innovative models of palliative care.

    Science.gov (United States)

    Byock, Ira; Twohig, Jeanne Sheils; Merriman, Melanie; Collins, Karyn

    2006-02-01

    Promoting Excellence in End-of Life Care, a national program of The Robert Wood Johnson Foundation, funded 22 demonstration projects representing a wide range of health care settings and patient populations to develop innovative models for delivering palliative care that addressed documented deficiencies in the care of patients and families facing the final stage of life. To determine the practicality (feasibility of development and operation as well as acceptance by stakeholders) of new models of care and to determine the impact of the models on access to, quality of and financing for palliative care. The program cannot report scientifically rigorous outcomes, but the grant-funded projects used a variety of methods and measures to assess acceptance of new models and their impact from the perspectives of various stakeholders, including patients and their families, clinicians, administrators and payers. While it is not possible to aggregate data across projects, the data reported to the Promoting Excellence national program office were used to describe program impact with respect to the practicality of palliative care service integration into existing clinical care settings (feasibility and acceptance by stakeholders), the availability and use of palliative care services (access), quality of care (conformance to patient expectations and accepted clinical standards) and costs of care. The 22 projects provided services in urban as well as rural settings, in integrated health systems, hospitals, outpatient clinics, cancer centers, nursing homes, renal dialysis clinics, inner city public health and safety net systems and prisons. Populations served included prison inmates, military veterans, renal dialysis patients, Native Americans, Native Alaskans, and African American patients, inner-city medically underserved patients, pediatric patients, and persons with serious mental illness patients. Hosting or adopting institutions sustained or expanded twenty of the 22 models

  3. Toward population management in an integrated care model.

    Science.gov (United States)

    Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

    2013-01-01

    Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative. © 2013 S. Karger AG, Basel.

  4. Quality management in home care: models for today's practice.

    Science.gov (United States)

    Verhey, M P

    1996-01-01

    In less than a decade, home care providers have been a part of two major transitions in health care delivery. First, because of the advent of managed care and a shift from inpatient to community-based services, home care service delivery systems have experienced tremendous growth. Second, the principles and practices of total quality management and continuous quality improvement have permeated the organization, administration, and practice of home health care. Based on the work of Deming, Juran, and Crosby, the basic tenets of the new quality management philosophy involve a focus on the following five key areas: (1) systems and processes rather than individual performance; (2) involvement, collaboration, and empowerment; (3) internal and external "customers"; (4) data and measurement; and (5) standards, guidelines, and outcomes of care. Home care providers are among those in the forefront who are developing and implementing programs that integrate these foci into the delivery of quality home care services. This article provides a summary of current home care programs that address these five key areas of quality management philosophy and provide models for innovative quality management practice in home care. For further information about each program, readers are referred to the original reports in the home care and quality management journal literature, as cited herein.

  5. Consulting Psychiatry within an Integrated Primary Care Model

    Science.gov (United States)

    Schreiter, Elizabeth A. Zeidler; Pandhi, Nancy; Fondow, Meghan D. M.; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L.; Serrano, Neftali

    2014-01-01

    Summary After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population. PMID:24185149

  6. Examining a "Household" Model of Residential Long-term Care in Nova Scotia

    Directory of Open Access Journals (Sweden)

    Janice Keefe

    2017-04-01

    Full Text Available In 2006, Nova Scotia began to implement its Continuing Care Strategy which was grounded in a vision of providing client-centered care for continuing care clients, including residents of nursing homes. Considerable evidence pointed to the benefits of the “household” model of care—which led the province to adopt the smaller self-contained household model as a requirement for owners/operators seeking to build government-funded new and replacement nursing homes. The specific goals of the reform (the adoption of the household model included increasing the proportion of single rooms, improving the home-likeness of the facility, and more generally, providing high-quality care services. The reform was influenced by recognition of the need for change, rapid population aging in the province, and strong political will at a time when fiscal resources were available. To achieve the reform, Nova Scotia Department of Health released two key documents (2007 to guide the design and operation of all new and replacement facilities procured using a request for proposal process: The Long Term Care Program Requirements and the Space and Design Requirements. Results from a research study examining resident quality of life suggest regardless of physical design or staffing approach high resident quality of life can be experienced, while at the same time recognizing that the facilities with “self-contained household” design and expanded care staff roles were uniquely supporting relationships and home-likeness and positively impacting resident quality of life.

  7. Children's health care assistance according to their families: a comparison between models of Primary Care

    Directory of Open Access Journals (Sweden)

    Vanessa Bertoglio Comassetto Antunes de Oliveira

    2015-02-01

    Full Text Available OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS with the Family Health Strategy (ESF units for presence and extent of attributes of Primary Health Care (APS, specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care, but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil.

  8. Models of care and organization of services.

    Science.gov (United States)

    Markova, Alina; Xiong, Michael; Lester, Jenna; Burnside, Nancy J

    2012-01-01

    This article examines the overall organization of services and delivery of health care in the United States. Health maintenance organization, fee-for-service, preferred provider organizations, and the Veterans Health Administration are discussed, with a focus on structure, outcomes, and areas for improvement. An overview of wait times, malpractice, telemedicine, and the growing population of physician extenders in dermatology is also provided. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Information Models, Data Requirements, and Agile Data Curation

    Science.gov (United States)

    Hughes, John S.; Crichton, Dan; Ritschel, Bernd; Hardman, Sean; Joyner, Ron

    2015-04-01

    The Planetary Data System's next generation system, PDS4, is an example of the successful use of an ontology-based Information Model (IM) to drive the development and operations of a data system. In traditional systems engineering, requirements or statements about what is necessary for the system are collected and analyzed for input into the design stage of systems development. With the advent of big data the requirements associated with data have begun to dominate and an ontology-based information model can be used to provide a formalized and rigorous set of data requirements. These requirements address not only the usual issues of data quantity, quality, and disposition but also data representation, integrity, provenance, context, and semantics. In addition the use of these data requirements during system's development has many characteristics of Agile Curation as proposed by Young et al. [Taking Another Look at the Data Management Life Cycle: Deconstruction, Agile, and Community, AGU 2014], namely adaptive planning, evolutionary development, early delivery, continuous improvement, and rapid and flexible response to change. For example customers can be satisfied through early and continuous delivery of system software and services that are configured directly from the information model. This presentation will describe the PDS4 architecture and its three principle parts: the ontology-based Information Model (IM), the federated registries and repositories, and the REST-based service layer for search, retrieval, and distribution. The development of the IM will be highlighted with special emphasis on knowledge acquisition, the impact of the IM on development and operations, and the use of shared ontologies at multiple governance levels to promote system interoperability and data correlation.

  10. Nutrition and dementia care: developing an evidence-based model for nutritional care in nursing homes.

    Science.gov (United States)

    Murphy, Jane L; Holmes, Joanne; Brooks, Cindy

    2017-02-14

    There is a growing volume of research to offer improvements in nutritional care for people with dementia living in nursing homes. Whilst a number of interventions have been identified to support food and drink intake, there has been no systematic research to understand the factors for improving nutritional care from the perspectives of all those delivering care in nursing homes. The aim of this study was to develop a research informed model for understanding the complex nutritional problems associated with eating and drinking for people with dementia. We conducted nine focus groups and five semi-structured interviews with those involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (nurses, care workers, catering assistants, dietitians, speech and language therapists) and family carers. The resulting conceptual model was developed by eliciting care-related processes, thus supporting credibility from the perspective of the end-users. The seven identified domain areas were person-centred nutritional care (the overarching theme); availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information. This collaboratively developed, person-centred model can support the design of new education and training tools and be readily translated into existing programmes. Further research is needed to evaluate whether these evidence-informed approaches have been implemented successfully and adopted into practice and policy contexts and can demonstrate effectiveness for people living with dementia.

  11. Reactor core modeling practice: Operational requirements, model characteristics, and model validation

    International Nuclear Information System (INIS)

    Zerbino, H.

    1997-01-01

    The physical models implemented in power plant simulators have greatly increased in performance and complexity in recent years. This process has been enabled by the ever increasing computing power available at affordable prices. This paper describes this process from several angles: First the operational requirements which are more critical from the point of view of model performance, both for normal and off-normal operating conditions; A second section discusses core model characteristics in the light of the solutions implemented by Thomson Training and Simulation (TT and S) in several full-scope simulators recently built and delivered for Dutch, German, and French nuclear power plants; finally we consider the model validation procedures, which are of course an integral part of model development, and which are becoming more and more severe as performance expectations increase. As a conclusion, it may be asserted that in the core modeling field, as in other areas, the general improvement in the quality of simulation codes has resulted in a fairly rapid convergence towards mainstream engineering-grade calculations. This is remarkable performance in view of the stringent real-time requirements which the simulation codes must satisfy as well as the extremely wide range of operating conditions that they are called upon to cover with good accuracy. (author)

  12. Integrated Care Model Developed by the Rwanda Biomedical ...

    African Journals Online (AJOL)

    : Integrated Care Model, psychological Interventions, genocide, ... ate a resurgence of memories from the genocide itself. ... interventions to be available throughout the commemo- .... allows easier accessibility with a strong professionally net-.

  13. Family-centred care delivery: comparing models of primary care service delivery in Ontario.

    Science.gov (United States)

    Mayo-Bruinsma, Liesha; Hogg, William; Taljaard, Monica; Dahrouge, Simone

    2013-11-01

    To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC. Cross-sectional study. Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery. A total of 137 practices, 363 providers, and 5144 patients. Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations. Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural. Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC.

  14. Review series: Examples of chronic care model: the home-based chronic care model: redesigning home health for high quality care delivery.

    Science.gov (United States)

    Suter, Paula; Hennessey, Beth; Florez, Donna; Newton Suter, W

    2011-01-01

    Individuals with chronic obstructive pulmonary disease (COPD) face significant challenges due to frequent distressing dyspnea and deficits related to activities of daily living. Individuals with COPD are often hospitalized frequently for disease exacerbations, negatively impacting quality of life and healthcare expenditure burden. The home-based chronic care model (HBCCM) was designed to address the needs of patients with chronic diseases. This model facilitates the re-design of chronic care delivery within the home health sector by ensuring patient-centered evidence-based care. This HBCCM foundation is Dr. Edward Wagner s chronic care model and has four additional areas of focus: high touch delivery, theory-based self management, specialist oversight and the use of technology. This article will describe this model in detail and outline how model use for patients with COPD can bring value to stakeholders across the health care continuum.

  15. The Benefit of Ambiguity in Understanding Goals in Requirements Modelling

    DEFF Research Database (Denmark)

    Paay, Jeni; Pedell, Sonja; Sterling, Leon

    2011-01-01

    This paper examines the benefit of ambiguity in describing goals in requirements modelling for the design of socio-technical systems using concepts from Agent-Oriented Software Engineering (AOSE) and ethnographic and cultural probe methods from Human Computer Interaction (HCI). The authors’ aim...... ambiguity in the process of elicitation and analysis through the use of empirically informed quality goals attached to functional goals. The authors demonstrate the benefit of articulating a quality goal without turning it into a functional goal. Their study shows that quality goals kept at a high level...... of abstraction, ambiguous and open for conversations through the modelling process add richness to goal models, and communicate quality attributes of the interaction being modelled to the design phase, where this ambiguity is regarded as a resource for design....

  16. [Family Health Teams in Ontario: Ideas for Germany from a Canadian Primary Care Model].

    Science.gov (United States)

    Ulrich, Lisa-R; Pham, Thuy-Nga Tia; Gerlach, Ferdinand M; Erler, Antje

    2017-07-11

    The German healthcare system is struggling with fragmentation of care in the face of an increasing shortage of general practitioners and allied health professionals, and the time-demanding healthcare needs of an aging, multimorbid patient population. Innovative interprofessional, intersectoral models of care are required to ensure adequate access to primary care across a variety of rural and urban settings into the foreseeable future. A team approach to care of the complex multimorbid patient population appears particularly suitable in attracting and retaining the next generation of healthcare professionals, including general practitioners. In 2014, the German Advisory Council on the Assessment of Developments in the Health Care System highlighted the importance of regional, integrated care with community-based primary care centres at its core, providing comprehensive, population-based, patient-centred primary care with adequate access to general practitioners for a given geographical area. Such centres exist already in Ontario, Canada; within Family Health Teams (FHT), family physicians work hand-in-hand with pharmacists, nurses, nurse practitioners, social workers, and other allied health professionals. In this article, the Canadian model of FHT will be introduced and we will discuss which components could be adapted to suit the German primary care system. © Georg Thieme Verlag KG Stuttgart · New York.

  17. An Integrative Behavioral Health Care Model Using Automated SBIRT and Care Coordination in Community Health Care.

    Science.gov (United States)

    Dwinnells, Ronald; Misik, Lauren

    2017-10-01

    Efficient and effective integration of behavioral health programs in a community health care practice emphasizes patient-centered medical home principles to improve quality of care. A prospective, 3-period, interrupted time series study was used to explore which of 3 different integrative behavioral health care screening and management processes were the most efficient and effective in prompting behavioral health screening, identification, interventions, and referrals in a community health practice. A total of 99.5% ( P < .001) of medical patients completed behavioral health screenings; brief intervention rates nearly doubled to 83% ( P < .001) and 100% ( P < .001) of identified at-risk patients had referrals made using a combination of electronic tablets, electronic medical record, and behavioral health care coordination.

  18. Perspective: A new model of leadership performance in health care.

    Science.gov (United States)

    Souba, Wiley

    2011-10-01

    Current leadership models are based largely on concepts and explanations, which provide limited access to the being and actions of an effective leader in health care. Rather than teaching leadership from a theoretical vantage point, the ontological perspective teaches leadership as it is lived and experienced. When one exercises leadership "as lived," concurrently informed by theories, one performs at one's best. A distinctive feature of the ontological approach resides in its capacity to disclose human ways of being and acting that limit our freedom to lead effectively as our natural self-expression. Ontological leadership maintains that our worldviews and mental maps affect the way we lead and are shaped by and accessible through language--hence, to lead more effectively, mastery of a new conversational domain of leadership is required. This emerging model of leadership performance reveals that (1) our actions as leaders are correlated with the way in which the leadership situation we are dealing with occurs for us, and (2) this "occurring" is shaped by the context we bring to that situation. Master leaders use language to recontextualize their leadership challenges so that their naturally correlated ways of being and acting can emerge, resulting in effective leadership. When leaders linguistically unveil limiting contexts, they are freed up to create new contexts that shift the way leadership challenges occur for them. This provides leaders--physicians, scientists, educators, executives--with new opportunity sets (previously unavailable) for exercising exemplary leadership. The ontological approach to leadership offers a powerful framework for tackling health care's toughest challenges.

  19. Development of an International School Nurse Asthma Care Coordination Model

    Science.gov (United States)

    Garwick, Ann W.; Svavarsdóttir, Erla Kolbrun; Seppelt, Ann M.; Looman, Wendy S.; Anderson, Lori S.; Örlygsdóttir, Brynja

    2015-01-01

    Aim To identify and compare how school nurses in Reykjavik, Iceland and St. Paul, Minnesota coordinated care for youth with asthma (ages 10–18) and to develop an asthma school nurse care coordination model. Background Little is known about how school nurses coordinate care for youth with asthma in different countries. Design A qualitative descriptive study design using focus group data. Methods Six focus groups with 32 school nurses were conducted in Reykjavik (n=17) and St. Paul (n=15) using the same protocol between September 2008 – January 2009. Descriptive content analytic and constant comparison strategies were used to categorize and compare how school nurses coordinated care, which resulted in the development of an International School Nurse Asthma Care Coordination Model. Findings Participants in both countries spontaneously described a similar asthma care coordination process that involved information gathering, assessing risk for asthma episodes, prioritizing health care needs and anticipating and planning for student needs at the individual and school levels. This process informed how they individualized symptom management, case management and/or asthma education. School nurses played a pivotal part in collaborating with families, school and health care professionals to ensure quality care for youth with asthma. Conclusions Results indicate a high level of complexity in school nurses’ approaches to asthma care coordination that were responsive to the diverse and changing needs of students in school settings. The conceptual model derived provides a framework for investigators to use in examining the asthma care coordination process of school nurses in other geographic locations. PMID:25223389

  20. Transformational change in health care systems: an organizational model.

    Science.gov (United States)

    Lukas, Carol VanDeusen; Holmes, Sally K; Cohen, Alan B; Restuccia, Joseph; Cramer, Irene E; Shwartz, Michael; Charns, Martin P

    2007-01-01

    The Institute of Medicine's 2001 report Crossing the Quality Chasm argued for fundamental redesign of the U.S. health care system. Six years later, many health care organizations have embraced the report's goals, but few have succeeded in making the substantial transformations needed to achieve those aims. This article offers a model for moving organizations from short-term, isolated performance improvements to sustained, reliable, organization-wide, and evidence-based improvements in patient care. Longitudinal comparative case studies were conducted in 12 health care systems using a mixed-methods evaluation design based on semistructured interviews and document review. Participating health care systems included seven systems funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and five systems with long-standing commitments to improvement and high-quality care. Five interactive elements appear critical to successful transformation of patient care: (1) Impetus to transform; (2) Leadership commitment to quality; (3) Improvement initiatives that actively engage staff in meaningful problem solving; (4) Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization; and (5) Integration to bridge traditional intra-organizational boundaries among individual components. These elements drive change by affecting the components of the complex health care organization in which they operate: (1) Mission, vision, and strategies that set its direction and priorities; (2) Culture that reflects its informal values and norms; (3) Operational functions and processes that embody the work done in patient care; and (4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization. The conceptual model holds promise for guiding health care

  1. Specification of advanced safety modeling requirements (Rev. 0)

    International Nuclear Information System (INIS)

    Fanning, T. H.; Tautges, T. J.

    2008-01-01

    The U.S. Department of Energy's Global Nuclear Energy Partnership has lead to renewed interest in liquid-metal-cooled fast reactors for the purpose of closing the nuclear fuel cycle and making more efficient use of future repository capacity. However, the U.S. has not designed or constructed a fast reactor in nearly 30 years. Accurate, high-fidelity, whole-plant dynamics safety simulations will play a crucial role by providing confidence that component and system designs will satisfy established design limits and safety margins under a wide variety of operational, design basis, and beyond design basis transient conditions. Current modeling capabilities for fast reactor safety analyses have resulted from several hundred person-years of code development effort supported by experimental validation. The broad spectrum of mechanistic and phenomenological models that have been developed represent an enormous amount of institutional knowledge that needs to be maintained. Complicating this, the existing code architectures for safety modeling evolved from programming practices of the 1970s. This has lead to monolithic applications with interdependent data models which require significant knowledge of the complexities of the entire code in order for each component to be maintained. In order to develop an advanced fast reactor safety modeling capability, the limitations of the existing code architecture must be overcome while preserving the capabilities that already exist. To accomplish this, a set of advanced safety modeling requirements is defined, based on modern programming practices, that focuses on modular development within a flexible coupling framework. An approach for integrating the existing capabilities of the SAS4A/SASSYS-1 fast reactor safety analysis code into the SHARP framework is provided in order to preserve existing capabilities while providing a smooth transition to advanced modeling capabilities. In doing this, the advanced fast reactor safety models will

  2. Modelling requirements for future assessments based on FEP analysis

    International Nuclear Information System (INIS)

    Locke, J.; Bailey, L.

    1998-01-01

    This report forms part of a suite of documents describing the Nirex model development programme. The programme is designed to provide a clear audit trail from the identification of significant features, events and processes (FEPs) to the models and modelling processes employed within a detailed safety assessment. A scenario approach to performance assessment has been adopted. It is proposed that potential evolutions of a deep geological radioactive waste repository can be represented by a base scenario and a number of variant scenarios. The base scenario is chosen to be broad-ranging and to represent the natural evolution of the repository system and its surrounding environment. The base scenario is defined to include all those FEPs that are certain to occur and those which are judged likely to occur for a significant period of the assessment timescale. The structuring of FEPs on a Master Directed Diagram (MDD) provides a systematic framework for identifying those FEPs that form part of the natural evolution of the system and those, which may define alternative potential evolutions of the repository system. In order to construct a description of the base scenario, FEPs have been grouped into a series of conceptual models. Conceptual models are groups of FEPs, identified from the MDD, representing a specific component or process within the disposal system. It has been found appropriate to define conceptual models in terms of the three main components of the disposal system: the repository engineered system, the surrounding geosphere and the biosphere. For each of these components, conceptual models provide a description of the relevant subsystem in terms of its initial characteristics, subsequent evolution and the processes affecting radionuclide transport for the groundwater and gas pathways. The aim of this document is to present the methodology that has been developed for deriving modelling requirements and to illustrate the application of the methodology by

  3. Hospital-in-the-Home — essential to an integrated model of paediatric care

    LENUS (Irish Health Repository)

    Hensey, CC

    2017-01-01

    The National Clinical Programme for Paediatrics and Neonatology is proposing a model of care that will determine the future delivery of children’s health services in Ireland1. The focus is on the provision of an integrated service with improved co-ordination between primary, secondary, and tertiary level facilities. A parallel goal is improvements in chronic care and medical care in the home. An expanded role for ambulatory care and hospital at home schemes with a reduced reliance on inpatient care is proposed in line with international best practice. Achieving these goals requires a paradigm shift in delivery of children’s health care, and reconfiguration of current services to deliver multidisciplinary care in hospital and at home. The recently approved planning application for the new children’s hospital provides an opportunity and heralds a change in the structure of paediatric services in Ireland. It will act as the nexus of paediatric care throughout Ireland; supporting paediatric services nationally through outreach programmes, and ensuring children are treated as close to home as possible. A Hospital-in-the-Home (HITH) program would help meet these objectives; and could provide home based acute paediatric care, leading to economic benefits, and the delivery of quality family-centred care.

  4. A survey of system architecture requirements for health care-based wireless sensor networks.

    Science.gov (United States)

    Egbogah, Emeka E; Fapojuwo, Abraham O

    2011-01-01

    Wireless Sensor Networks (WSNs) have emerged as a viable technology for a vast number of applications, including health care applications. To best support these health care applications, WSN technology can be adopted for the design of practical Health Care WSNs (HCWSNs) that support the key system architecture requirements of reliable communication, node mobility support, multicast technology, energy efficiency, and the timely delivery of data. Work in the literature mostly focuses on the physical design of the HCWSNs (e.g., wearable sensors, in vivo embedded sensors, et cetera). However, work towards enhancing the communication layers (i.e., routing, medium access control, et cetera) to improve HCWSN performance is largely lacking. In this paper, the information gleaned from an extensive literature survey is shared in an effort to fortify the knowledge base for the communication aspect of HCWSNs. We highlight the major currently existing prototype HCWSNs and also provide the details of their routing protocol characteristics. We also explore the current state of the art in medium access control (MAC) protocols for WSNs, for the purpose of seeking an energy efficient solution that is robust to mobility and delivers data in a timely fashion. Furthermore, we review a number of reliable transport layer protocols, including a network coding based protocol from the literature, that are potentially suitable for delivering end-to-end reliability of data transmitted in HCWSNs. We identify the advantages and disadvantages of the reviewed MAC, routing, and transport layer protocols as they pertain to the design and implementation of a HCWSN. The findings from this literature survey will serve as a useful foundation for designing a reliable HCWSN and also contribute to the development and evaluation of protocols for improving the performance of future HCWSNs. Open issues that required further investigations are highlighted.

  5. A Survey of System Architecture Requirements for Health Care-Based Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Abraham O. Fapojuwo

    2011-05-01

    Full Text Available Wireless Sensor Networks (WSNs have emerged as a viable technology for a vast number of applications, including health care applications. To best support these health care applications, WSN technology can be adopted for the design of practical Health Care WSNs (HCWSNs that support the key system architecture requirements of reliable communication, node mobility support, multicast technology, energy efficiency, and the timely delivery of data. Work in the literature mostly focuses on the physical design of the HCWSNs (e.g., wearable sensors, in vivo embedded sensors, et cetera. However, work towards enhancing the communication layers (i.e., routing, medium access control, et cetera to improve HCWSN performance is largely lacking. In this paper, the information gleaned from an extensive literature survey is shared in an effort to fortify the knowledge base for the communication aspect of HCWSNs. We highlight the major currently existing prototype HCWSNs and also provide the details of their routing protocol characteristics. We also explore the current state of the art in medium access control (MAC protocols for WSNs, for the purpose of seeking an energy efficient solution that is robust to mobility and delivers data in a timely fashion. Furthermore, we review a number of reliable transport layer protocols, including a network coding based protocol from the literature, that are potentially suitable for delivering end-to-end reliability of data transmitted in HCWSNs. We identify the advantages and disadvantages of the reviewed MAC, routing, and transport layer protocols as they pertain to the design and implementation of a HCWSN. The findings from this literature survey will serve as a useful foundation for designing a reliable HCWSN and also contribute to the development and evaluation of protocols for improving the performance of future HCWSNs. Open issues that required further investigations are highlighted.

  6. Requirements for High Level Models Supporting Design Space Exploration in Model-based Systems Engineering

    OpenAIRE

    Haveman, Steven P.; Bonnema, G. Maarten

    2013-01-01

    Most formal models are used in detailed design and focus on a single domain. Few effective approaches exist that can effectively tie these lower level models to a high level system model during design space exploration. This complicates the validation of high level system requirements during detailed design. In this paper, we define requirements for a high level model that is firstly driven by key systems engineering challenges present in industry and secondly connects to several formal and d...

  7. Understanding Emergency Care Delivery Through Computer Simulation Modeling.

    Science.gov (United States)

    Laker, Lauren F; Torabi, Elham; France, Daniel J; Froehle, Craig M; Goldlust, Eric J; Hoot, Nathan R; Kasaie, Parastu; Lyons, Michael S; Barg-Walkow, Laura H; Ward, Michael J; Wears, Robert L

    2018-02-01

    In 2017, Academic Emergency Medicine convened a consensus conference entitled, "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes." This article, a product of the breakout session on "understanding complex interactions through systems modeling," explores the role that computer simulation modeling can and should play in research and development of emergency care delivery systems. This article discusses areas central to the use of computer simulation modeling in emergency care research. The four central approaches to computer simulation modeling are described (Monte Carlo simulation, system dynamics modeling, discrete-event simulation, and agent-based simulation), along with problems amenable to their use and relevant examples to emergency care. Also discussed is an introduction to available software modeling platforms and how to explore their use for research, along with a research agenda for computer simulation modeling. Through this article, our goal is to enhance adoption of computer simulation, a set of methods that hold great promise in addressing emergency care organization and design challenges. © 2017 by the Society for Academic Emergency Medicine.

  8. Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

    Science.gov (United States)

    2017-01-03

    This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

  9. A service model for delivering care closer to home.

    Science.gov (United States)

    Dodd, Joanna; Taylor, Charlotte Elizabeth; Bunyan, Paul; White, Philippa Mary; Thomas, Siân Myra; Upton, Dominic

    2011-04-01

    Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects.

  10. The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality.

    Science.gov (United States)

    Fennell, Mary L; Das, Irene Prabhu; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew

    2010-01-01

    Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care.

  11. Modelling human resource requirements for the nuclear industry in Europe

    Energy Technology Data Exchange (ETDEWEB)

    Roelofs, Ferry [Nuclear Research and Consultancy Group (NRG) (Netherlands); Flore, Massimo; Estorff, Ulrik von [Joint Research Center (JRC) (Netherlands)

    2017-11-15

    The European Human Resource Observatory for Nuclear (EHRO-N) provides the European Commission with essential data related to supply and demand for nuclear experts in the EU-28 and the enlargement and integration countries based on bottom-up information from the nuclear industry. The objective is to assess how the supply of experts for the nuclear industry responds to the needs for the same experts for present and future nuclear projects in the region. Complementary to the bottom-up approach taken by the EHRO-N team at JRC, a top-down modelling approach has been taken in a collaboration with NRG in the Netherlands. This top-down modelling approach focuses on the human resource requirements for operation, construction, decommissioning, and efforts for long term operation of nuclear power plants. This paper describes the top-down methodology, the model input, the main assumptions, and the results of the analyses.

  12. Modelling human resource requirements for the nuclear industry in Europe

    International Nuclear Information System (INIS)

    Roelofs, Ferry; Flore, Massimo; Estorff, Ulrik von

    2017-01-01

    The European Human Resource Observatory for Nuclear (EHRO-N) provides the European Commission with essential data related to supply and demand for nuclear experts in the EU-28 and the enlargement and integration countries based on bottom-up information from the nuclear industry. The objective is to assess how the supply of experts for the nuclear industry responds to the needs for the same experts for present and future nuclear projects in the region. Complementary to the bottom-up approach taken by the EHRO-N team at JRC, a top-down modelling approach has been taken in a collaboration with NRG in the Netherlands. This top-down modelling approach focuses on the human resource requirements for operation, construction, decommissioning, and efforts for long term operation of nuclear power plants. This paper describes the top-down methodology, the model input, the main assumptions, and the results of the analyses.

  13. [Model to predict staffing for anesthesiology and post-anesthesia intensive care units and pain clinics].

    Science.gov (United States)

    Canet, J; Moral, V; Villalonga, A; Pelegrí, D; Gomar, C; Montero, A

    2001-01-01

    Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.

  14. ProvenCare perinatal: a model for delivering evidence/ guideline-based care for perinatal populations.

    Science.gov (United States)

    Berry, Scott A; Laam, Leslie A; Wary, Andrea A; Mateer, Harry O; Cassagnol, Hans P; McKinley, Karen E; Nolan, Ruth A

    2011-05-01

    Geisinger Health System (GHS) has applied its ProvenCare model to demonstrate that a large integrated health care delivery system, enabled by an electronic health record (EHR), could reengineer a complicated clinical process, reduce unwarranted variation, and provide evidence-based care for patients with a specified clinical condition. In 2007 GHS began to apply the model to a more complicated, longer-term condition of "wellness"--perinatal care. ADAPTING PROVENCARE TO PERINATAL CARE: The ProvenCare Perinatal initiative was more complex than the five previous ProvenCare endeavors in terms of breadth, scope, and duration. Each of the 22 sites created a process flow map to depict the current, real-time process at each location. The local practice site providers-physicians and mid-level practitioners-reached consensus on 103 unique best practice measures (BPMs), which would be tracked for every patient. These maps were then used to create a single standardized pathway that included the BPMs but also preserved some unique care offerings that reflected the needs of the local context. A nine-phase methodology, expanded from the previous six-phase model, was implemented on schedule. Pre- to postimplementation improvement occurred for all seven BPMs or BPM bundles that were considered the most clinically relevant, with five statistically significant. In addition, the rate of primary cesarean sections decreased by 32%, and birth trauma remained unchanged as the number of vaginal births increased. Preliminary experience suggests that integrating evidence/guideline-based best practices into work flows in inpatient and outpatient settings can achieve improvements in daily patient care processes and outcomes.

  15. Are stipulated requirements for the quality of maternity care complied with?

    Science.gov (United States)

    Johansen, Lars T; Pay, Aase Serine Devold; Broen, Lise; Roland, Brit; Øian, Pål

    2017-09-19

    The Directorate of Health’s national guide Et trygt fødetilbud – kvalitetskrav til fødselsomsorgen [A safe maternity service – requirements regarding the quality of maternity care] was published in December 2010 and was intended to provide a basis for an improved and more predictable maternity service. This article presents data from the maternity institutions on compliance with the quality requirements, including information on selection, fetal monitoring, organisation, staffing and competencies. The information was acquired with the aid of an electronic questionnaire in the period January–May 2015. The form was sent by e-mail to the medical officer in charge at all maternity units in Norway as at 1 January 2015 (n=47). There was a 100 % response to the questionnaire. The criteria for selecting where pregnant women should give birth were stated to be in conformity with the quality requirements. Some maternity institutions failed to describe the areas of responsibilities of doctors and midwives (38.5 % and 15.4 %, respectively). Few institutions recorded whether the midwife was present with the patient during the active phase. Half of the maternity departments (level 2 birth units) reported unfilled doctors’ posts, and a third of the university hospitals/central hospitals (level 1 birth units) reported a severe shortage of locum midwives. Half of the level 2 birth units believed that the quality requirements had resulted in improved training, but reported only a limited degree of interdisciplinary or mandatory instruction. The study reveals that there are several areas in which the health enterprises have procedures that conform to national quality requirements, but where it is still unclear whether they are observed in practice. Areas for improvement relate to routines describing areas of responsibility, availability of personnel resources and staff training.

  16. Everyday ethical problems in dementia care: a teleological model.

    Science.gov (United States)

    Bolmsjö, Ingrid Agren; Edberg, Anna-Karin; Sandman, Lars

    2006-07-01

    In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and nurses' ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses' everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care.

  17. Comparison of childbirth care models in public hospitals, Brazil.

    Science.gov (United States)

    Vogt, Sibylle Emilie; Silva, Kátia Silveira da; Dias, Marcos Augusto Bastos

    2014-04-01

    To compare collaborative and traditional childbirth care models. Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used. Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia. The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.

  18. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    OpenAIRE

    Phillips, Charles D.

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...

  19. Accessing patient-centered care using the advanced access model.

    Science.gov (United States)

    Tantau, Catherine

    2009-01-01

    Waits and delays for healthcare are legendary. These delays are not only frustrating and potentially hazardous for patients and providers but also represent significant cost to office practices. The traditional medical model that defines urgent care versus routine care is a vain and futile attempt to sort demand. This approach is at constant odds with patients' definition of urgency. Trusting patients to determine when and how they want to access care makes sense from a customer service perspective. If approached systematically using the principles of Advanced Access, patient demand patterns can be tracked to forecast demand. These demand patterns become the template for deploying the resources necessary to meet patients' needs. Although not a simple journey, the transformation to Advanced Access provides an entree to patient-centered care where patients can say, "I get exactly the care I want and need, when I want and need it."

  20. Prerequisites for sustainable care improvement using the reflective team as a work model.

    Science.gov (United States)

    Jonasson, Lise-Lotte; Carlsson, Gunilla; Nyström, Maria

    2014-01-01

    Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.

  1. Animal models of chronic wound care

    DEFF Research Database (Denmark)

    Trøstrup, Hannah; Thomsen, Kim; Calum, Henrik

    2016-01-01

    on nonhealing wounds. Relevant hypotheses based on clinical or in vitro observations can be tested in representative animal models, which provide crucial tools to uncover the pathophysiology of cutaneous skin repair in infectious environments. Disposing factors, species of the infectious agent(s), and time...

  2. Changing the model of care delivery: nurses' perceptions of job satisfaction and care effectiveness.

    Science.gov (United States)

    Wells, Judith; Manuel, Madonna; Cunning, Glenda

    2011-09-01

    To examine nurses' perceptions of job satisfaction, empowerment, and care effectiveness following a change from team to a modified total patient care (TPC) delivery model. Empirical data related to TPC is limited and inconclusive. Similarly, evidence demonstrating nurses' experience with change and restructuring is limited. A mixed method, longitudinal, descriptive design was used. Registered nurses and licenced practical nurses in two acute-care nursing units completed quantitative and qualitative surveys. Lewin's change theory provided the framework for the study. No significant change in job satisfaction was observed; however, it was less than optimal at all three time-periods. Nurses were committed to their jobs but relatively dissatisfied with their input into the goals and processes of the organization. Client care was perceived to be more effective under TPC. Job satisfaction remained consistent following the transition to TPC. However, nurses perceived that client care within the modified TPC model was more effective than in the previous model. Nursing administration must work collaboratively with nurses to improve processes in nursing practice that could enhance nurses' job satisfaction and improve client care delivery. 2011 Blackwell Publishing Ltd.

  3. Stochastic modeling of consumer preferences for health care institutions.

    Science.gov (United States)

    Malhotra, N K

    1983-01-01

    This paper proposes a stochastic procedure for modeling consumer preferences via LOGIT analysis. First, a simple, non-technical exposition of the use of a stochastic approach in health care marketing is presented. Second, a study illustrating the application of the LOGIT model in assessing consumer preferences for hospitals is given. The paper concludes with several implications of the proposed approach.

  4. Business model framework applications in health care: A systematic review.

    Science.gov (United States)

    Fredriksson, Jens Jacob; Mazzocato, Pamela; Muhammed, Rafiq; Savage, Carl

    2017-11-01

    It has proven to be a challenge for health care organizations to achieve the Triple Aim. In the business literature, business model frameworks have been used to understand how organizations are aligned to achieve their goals. We conducted a systematic literature review with an explanatory synthesis approach to understand how business model frameworks have been applied in health care. We found a large increase in applications of business model frameworks during the last decade. E-health was the most common context of application. We identified six applications of business model frameworks: business model description, financial assessment, classification based on pre-defined typologies, business model analysis, development, and evaluation. Our synthesis suggests that the choice of business model framework and constituent elements should be informed by the intent and context of application. We see a need for harmonization in the choice of elements in order to increase generalizability, simplify application, and help organizations realize the Triple Aim.

  5. Staying Connected: Sustaining Collaborative Care Models with Limited Funding.

    Science.gov (United States)

    Johnston, Brenda J; Peppard, Lora; Newton, Marian

    2015-08-01

    Providing psychiatric services in the primary care setting is challenging. The multidisciplinary, coordinated approach of collaborative care models (CCMs) addresses these challenges. The purpose of the current article is to discuss the implementation of a CCM at a free medical clinic (FMC) where volunteer staff provide the majority of services. Essential components of CCMs include (a) comprehensive screening and assessment, (b) shared development and communication of care plans among providers and the patient, and (c) care coordination and management. Challenges to implementing and sustaining a CCM at a FMC in Virginia attempting to meet the medical and psychiatric needs of the underserved are addressed. Although the CCM produced favorable outcomes, sustaining the model long-term presented many challenges. Strategies for addressing these challenges are discussed. Copyright 2015, SLACK Incorporated.

  6. Specification of advanced safety modeling requirements (Rev. 0).

    Energy Technology Data Exchange (ETDEWEB)

    Fanning, T. H.; Tautges, T. J.

    2008-06-30

    The U.S. Department of Energy's Global Nuclear Energy Partnership has lead to renewed interest in liquid-metal-cooled fast reactors for the purpose of closing the nuclear fuel cycle and making more efficient use of future repository capacity. However, the U.S. has not designed or constructed a fast reactor in nearly 30 years. Accurate, high-fidelity, whole-plant dynamics safety simulations will play a crucial role by providing confidence that component and system designs will satisfy established design limits and safety margins under a wide variety of operational, design basis, and beyond design basis transient conditions. Current modeling capabilities for fast reactor safety analyses have resulted from several hundred person-years of code development effort supported by experimental validation. The broad spectrum of mechanistic and phenomenological models that have been developed represent an enormous amount of institutional knowledge that needs to be maintained. Complicating this, the existing code architectures for safety modeling evolved from programming practices of the 1970s. This has lead to monolithic applications with interdependent data models which require significant knowledge of the complexities of the entire code in order for each component to be maintained. In order to develop an advanced fast reactor safety modeling capability, the limitations of the existing code architecture must be overcome while preserving the capabilities that already exist. To accomplish this, a set of advanced safety modeling requirements is defined, based on modern programming practices, that focuses on modular development within a flexible coupling framework. An approach for integrating the existing capabilities of the SAS4A/SASSYS-1 fast reactor safety analysis code into the SHARP framework is provided in order to preserve existing capabilities while providing a smooth transition to advanced modeling capabilities. In doing this, the advanced fast reactor safety models

  7. Life sciences research in space: The requirement for animal models

    Science.gov (United States)

    Fuller, C. A.; Philips, R. W.; Ballard, R. W.

    1987-01-01

    Use of animals in NASA space programs is reviewed. Animals are needed because life science experimentation frequently requires long-term controlled exposure to environments, statistical validation, invasive instrumentation or biological tissue sampling, tissue destruction, exposure to dangerous or unknown agents, or sacrifice of the subject. The availability and use of human subjects inflight is complicated by the multiple needs and demands upon crew time. Because only living organisms can sense, integrate and respond to the environment around them, the sole use of tissue culture and computer models is insufficient for understanding the influence of the space environment on intact organisms. Equipment for spaceborne experiments with animals is described.

  8. Dental Care Coverage and Use: Modeling Limitations and Opportunities

    Science.gov (United States)

    Moeller, John F.; Chen, Haiyan

    2014-01-01

    Objectives. We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage. Methods. We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use. Results. Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth. Conclusions. Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use. PMID:24328635

  9. Provision of protein and energy in relation to measured requirements in intensive care patients

    DEFF Research Database (Denmark)

    Allingstrup, Matilde Jo; Esmailzadeh, Negar; Knudsen, Anne Wilkens

    2012-01-01

    , also when adjusted for baseline prognostic variables (APACHE II, SOFA scores and age). Provision of energy, measured resting energy expenditure or energy and nitrogen balance was not related to mortality. The possible cause-effect relationship is discussed after a more detailed analysis of the initial......BACKGROUND & AIMS: Adequacy of nutritional support in intensive care patients is still a matter of investigation. This study aimed to relate mortality to provision, measured requirements and balances for energy and protein in ICU patients. DESIGN: Prospective observational cohort study of 113 ICU...... part of the admission. CONCLUSION: In these severely ill ICU patients, a higher provision of protein and amino acids was associated with a lower mortality. This was not the case for provision of energy or measured resting energy expenditure or energy or nitrogen balances. The hypothesis that higher...

  10. Palliative care policy analysis in Iran: A conceptual model

    Directory of Open Access Journals (Sweden)

    Mojgan Ansari

    2018-01-01

    Full Text Available Background: Palliative care programs are rapidly evolving for patients with life-threatening illnesses. Increased and earlier access for facilities is a subject of growing importance in health services, policy, and research. Aim: This study was conducted to explain stakeholders' perceptions of the factors affecting the design of such a palliative care system and its policy analysis. Methodology: Semi-structured in-depth interviews conducted following purposive sampling of the participants. Twenty-two participants were included in the study. The interviews were analyzed using qualitative-directed content analysis based on "policy analysis triangle" framework. Results: The findings showed the impact of four categories, namely context (political, social, and structural feasibility, content (target setting, process (attracting stakeholder participation, the standardization of care, and education management, and actors (the Ministry of Health and Medical Education, health-care providers, and volunteers in the analysis of the palliative care policies of Iran. Conclusion: In the past 6 years, attention to palliative care has increased significantly as a result of the National Cancer Research Network with the support of the Ministry of Health. The success of health system plan requires great attention to its aspects of social, political, and executive feasibility. Careful management by policymakers of different stakeholders is vital to ensure support for any national plan, but this is challenging to achieve.

  11. Modeling the Potential Economic Impact of the Medicare Comprehensive Care for Joint Replacement Episode-Based Payment Model.

    Science.gov (United States)

    Maniya, Omar Z; Mather, Richard C; Attarian, David E; Mistry, Bipin; Chopra, Aneesh; Strickland, Matt; Schulman, Kevin A

    2017-11-01

    The Medicare program has initiated Comprehensive Care for Joint Replacement (CJR), a bundled payment mandate for lower extremity joint replacements. We sought to determine the degree to which hospitals will invest in care redesign in response to CJR, and to project its economic impacts. We defined 4 potential hospital management strategies to address CJR: no action, light care management, heavy care management, and heavy care management with contracting. For each of 798 hospitals included in CJR, we used hospital-specific volume, cost, and quality data to determine the hospital's economically dominant strategy. We aggregated data to assess the percentage of hospitals pursuing each strategy; savings to the health care system; and costs and percentages of CJR-derived revenues gained or lost for Medicare, hospitals, and postacute care facilities. In the model, 83.1% of hospitals (range 55.0%-100.0%) were expected to take no action in response to CJR, and 16.1% of hospitals (range 0.0%-45.0%) were expected to pursue heavy care management with contracting. Overall, CJR is projected to reduce health care expenditures by 0.5% (range 0.0%-4.1%) or $14 million (range $0-$119 million). Medicare is expected to save 2.2% (range 2.2%-2.2%), hospitals are projected to lose 3.7% (range 4.7% loss to 3.8% gain), and postacute care facilities are expected to lose 6.5% (range 0.0%-12.8%). Hospital administrative costs are projected to increase by $63 million (range $0-$148 million). CJR is projected to have a negligible impact on total health care expenditures for lower extremity joint replacements. Further research will be required to assess the actual care management strategies adopted by CJR hospitals. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Assessing decision quality in patient-centred care requires a preference-sensitive measure

    Science.gov (United States)

    Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn; Dowie, Jack

    2014-01-01

    A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value aspects of decision making. Current instruments using the term ‘decision quality’ have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient’s individual preferences for eight quality criteria (expressed as importance weights) and their ratings of the decision just taken on each of these criteria (expressed as performance rates). It thus provides an index of decision quality that encompasses both these aspects. It also provides patients with help in prioritizing quality criteria for future decision making by calculating, for each criterion, the Incremental Value of Perfect Rating, that is, the increase in their decision quality score that would result if their performance rating on the criterion had been 100%, weightings unchanged. MyDecisionQuality, which is a web-based generic and preference-sensitive instrument, can constitute a key patient-reported measure of the quality of the decision-making process. It can provide the basis for future decision improvement, especially when the clinician (or other stakeholders) completes the equivalent instrument and the extent and nature of concordance and discordance can be established. Apart from its role in decision preparation and evaluation, it can also provide real time and relevant documentation for the patient

  13. A Case Report: Cornerstone Health Care Reduced the Total Cost of Care Through Population Segmentation and Care Model Redesign.

    Science.gov (United States)

    Green, Dale E; Hamory, Bruce H; Terrell, Grace E; O'Connell, Jasmine

    2017-08-01

    Over the course of a single year, Cornerstone Health Care, a multispecialty group practice in North Carolina, redesigned the underlying care models for 5 of its highest-risk populations-late-stage congestive heart failure, oncology, Medicare-Medicaid dual eligibles, those with 5 or more chronic conditions, and the most complex patients with multiple late-stage chronic conditions. At the 1-year mark, the results of the program were analyzed. Overall costs for the patients studied were reduced by 12.7% compared to the year before enrollment. All fully implemented programs delivered between 10% and 16% cost savings. The key area for savings factor was hospitalization, which was reduced by 30% across all programs. The greatest area of cost increase was "other," a category that consisted in large part of hospice services. Full implementation was key; 2 primary care sites that reverted to more traditional models failed to show the same pattern of savings.

  14. Modeling of the global carbon cycle - isotopic data requirements

    International Nuclear Information System (INIS)

    Ciais, P.

    1994-01-01

    Isotopes are powerful tools to constrain carbon cycle models. For example, the combinations of the CO 2 and the 13 C budget allows to calculate the net-carbon fluxes between atmosphere, ocean, and biosphere. Observations of natural and bomb-produced radiocarbon allow to estimate gross carbon exchange fluxes between different reservoirs and to deduce time scales of carbon overturning in important reservoirs. 18 O in CO 2 is potentially a tool to make the deconvolution of C fluxes within the land biosphere (assimilation vs respirations). The scope of this article is to identify gaps in our present knowledge about isotopes in the light of their use as constraint for the global carbon cycle. In the following we will present a list of some future data requirements for carbon cycle models. (authors)

  15. Model Penentuan Nilai Target Functional Requirement Berbasis Utilitas

    Directory of Open Access Journals (Sweden)

    Cucuk Nur Rosyidi

    2012-01-01

    Full Text Available In a product design and development process, a designer faces a problem to decide functional requirement (FR target values. That decision is made under a risk since it is conducted in the early design phase using incomplete information. Utility function can be used to reflect the decision maker attitude towards the risk in making such decision. In this research, we develop a utility-based model to determine FR target values using quadratic utility function and information from Quality Function Deployment (QFD. A pencil design is used as a numerical example using quadratic utility function for each FR. The model can be applied for balancing customer and designer interest in determining FR target values.

  16. Facilitators and barriers of implementing the chronic care model in primary care: a systematic review.

    Science.gov (United States)

    Kadu, Mudathira K; Stolee, Paul

    2015-02-06

    The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation. This study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings. Searches were performed in three data bases: Web of Knowledge, Pubmed and Scopus. Article abstracts and titles were read based on whether they met the following inclusion criteria: 1) studies published after 2003 that described or evaluated the implementation of the CCM; 2) the care setting was primary care; 3) the target population of the study was adults over the age of 18 with chronic conditions. Studies were categorized by reference, study design and methods, participants and setting, study objective, CCM components used, and description of the intervention. The next stage of data abstraction involved qualitative analysis of cited barriers and facilitators using the Consolidating Framework for Research Implementation. This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation and characteristics of the individual healthcare providers. These included: organizational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs. These findings highlight the importance of assessing organizational capacity and needs prior

  17. Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care.

    Science.gov (United States)

    Feld, April; Madden-Baer, Rose; McCorkle, Ruth

    2016-01-01

    The Centers for Medicare and Medicaid Services Innovation Center's Episode-Based Payment initiatives propose a large opportunity to reduce cost from waste and variation and stand to align hospitals, physicians, and postacute providers in the redesign of care that achieves savings and improve quality. Community-based organizations are at the forefront of this care redesign through innovative models of care aimed at bridging gaps in care coordination and reducing hospital readmissions. This article describes a community-based provider's approach to participation under the Bundled Payments for Care Improvement initiative and a 90-day model of care for congestive heart failure in home care.

  18. Towards a model for integrative medicine in Swedish primary care

    Directory of Open Access Journals (Sweden)

    Falkenberg Torkel

    2007-07-01

    Full Text Available Abstract Background Collaboration between providers of conventional care and complementary therapies (CTs has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM. The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care. Methods Investigative procedures involved research group and key informant meetings with multiple stakeholders including general practitioners, CT providers, medical specialists, primary care administrators and county council representatives. Data collection included meeting notes which were fed back within the research group and used as ongoing working documents. Data analysis was made by immersion/crystallisation and research group consensus. Results were categorised within a public health systems framework of structures, processes and outcomes. Results The outcome was an IM model that aimed for a patient-centered, interdisciplinary, non-hierarchical mix of conventional and complementary medical solutions to individual case management of patients with pain in the lower back and/or neck. The IM model case management adhered to standard clinical practice including active partnership between a gate-keeping general practitioner, collaborating with a team of CT providers in a consensus case conference model of care. CTs with an emerging evidence base included Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong. Conclusion Despite identified barriers such as no formal recognition of CT professions in Sweden, it was possible to develop a model for IM adapted to Swedish primary care. The IM model calls for testing and refinement in a pragmatic randomised controlled trial to explore its clinical effectiveness.

  19. An evidence-based health workforce model for primary and community care

    Directory of Open Access Journals (Sweden)

    Leach Matthew J

    2011-08-01

    Full Text Available Abstract Background The delivery of best practice care can markedly improve clinical outcomes in patients with chronic disease. While the provision of a skilled, multidisciplinary team is pivotal to the delivery of best practice care, the occupational or skill mix required to deliver this care is unclear; it is also uncertain whether such a team would have the capacity to adequately address the complex needs of the clinic population. This is the role of needs-based health workforce planning. The objective of this article is to describe the development of an evidence-informed, needs-based health workforce model to support the delivery of best-practice interdisciplinary chronic disease management in the primary and community care setting using diabetes as a case exemplar. Discussion Development of the workforce model was informed by a strategic review of the literature, critical appraisal of clinical practice guidelines, and a consensus elicitation technique using expert multidisciplinary clinical panels. Twenty-four distinct patient attributes that require unique clinical competencies for the management of diabetes in the primary care setting were identified. Patient attributes were grouped into four major themes and developed into a conceptual model: the Workforce Evidence-Based (WEB planning model. The four levels of the WEB model are (1 promotion, prevention, and screening of the general or high-risk population; (2 type or stage of disease; (3 complications; and (4 threats to self-care capacity. Given the number of potential combinations of attributes, the model can account for literally millions of individual patient types, each with a distinct clinical team need, which can be used to estimate the total health workforce requirement. Summary The WEB model was developed in a way that is not only reflective of the diversity in the community and clinic populations but also parsimonious and clear to present and operationalize. A key feature of the

  20. Models of care in nursing: a systematic review.

    Science.gov (United States)

    Fernandez, Ritin; Johnson, Maree; Tran, Duong Thuy; Miranda, Charmaine

    2012-12-01

    This review investigated the effect of the various models of nursing care delivery using the diverse levels of nurses on patient and nursing outcomes. All published studies that investigated patient and nursing outcomes were considered. Studies were included if the nursing delivery models only included nurses with varying skill levels. A literature search was performed using the following databases: Medline (1985-2011), CINAHL (1985-2011), EMBASE (1985 to current) and the Cochrane Controlled Studies Register (Issue 3, 2011 of Cochrane Library). In addition, the reference lists of relevant studies and conference proceedings were also scrutinised. Two reviewers independently assessed the eligibility of the studies for inclusion in the review, the methodological quality and extracted details of eligible studies. Data were analysed using the RevMan software (Nordic Cochrane Centre, Copenhagen, Denmark). Fourteen studies were included in this review. The results reveal that implementation of the team nursing model of care resulted in significantly decreased incidence of medication errors and adverse intravenous outcomes, as well as lower pain scores among patients; however, there was no effect of this model of care on the incidence of falls. Wards that used a hybrid model demonstrated significant improvement in quality of patient care, but no difference in incidence of pressure areas or infection rates. There were no significant differences in nursing outcomes relating to role clarity, job satisfaction and nurse absenteeism rates between any of the models of care. Based on the available evidence, a predominance of team nursing within the comparisons is suggestive of its popularity. Patient outcomes, nurse satisfaction, absenteeism and role clarity/confusion did not differ across model comparisons. Little benefit was found within primary nursing comparisons and the cost effectiveness of team nursing over other models remains debatable. Nonetheless, team nursing does

  1. Evaluating topic model interpretability from a primary care physician perspective.

    Science.gov (United States)

    Arnold, Corey W; Oh, Andrea; Chen, Shawn; Speier, William

    2016-02-01

    Probabilistic topic models provide an unsupervised method for analyzing unstructured text. These models discover semantically coherent combinations of words (topics) that could be integrated in a clinical automatic summarization system for primary care physicians performing chart review. However, the human interpretability of topics discovered from clinical reports is unknown. Our objective is to assess the coherence of topics and their ability to represent the contents of clinical reports from a primary care physician's point of view. Three latent Dirichlet allocation models (50 topics, 100 topics, and 150 topics) were fit to a large collection of clinical reports. Topics were manually evaluated by primary care physicians and graduate students. Wilcoxon Signed-Rank Tests for Paired Samples were used to evaluate differences between different topic models, while differences in performance between students and primary care physicians (PCPs) were tested using Mann-Whitney U tests for each of the tasks. While the 150-topic model produced the best log likelihood, participants were most accurate at identifying words that did not belong in topics learned by the 100-topic model, suggesting that 100 topics provides better relative granularity of discovered semantic themes for the data set used in this study. Models were comparable in their ability to represent the contents of documents. Primary care physicians significantly outperformed students in both tasks. This work establishes a baseline of interpretability for topic models trained with clinical reports, and provides insights on the appropriateness of using topic models for informatics applications. Our results indicate that PCPs find discovered topics more coherent and representative of clinical reports relative to students, warranting further research into their use for automatic summarization. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Diabetes Care in Malaysia: Problems, New Models, and Solutions.

    Science.gov (United States)

    Hussein, Zanariah; Taher, Sri Wahyu; Gilcharan Singh, Harvinder Kaur; Chee Siew Swee, Winnie

    2015-01-01

    Diabetes is a major public health concern in Malaysia, and the prevalence of type 2 diabetes (T2D) has escalated to 20.8% in adults above the age of 30, affecting 2.8 million individuals. The burden of managing diabetes falls on primary and tertiary health care providers operating in various settings. This review focuses on the current status of diabetes in Malaysia, including epidemiology, complications, lifestyle, and pharmacologic treatments, as well as the use of technologies in its management and the adoption of the World Health Organization chronic care model in primary care clinics. A narrative review based on local available health care data, publications, and observations from clinic experience. The prevalence of diabetes varies among the major ethnic groups in Malaysia, with Asian Indians having the highest prevalence of T2D, followed by Malays and Chinese. The increase prevalence of overweight and obesity has accompanied the rise in T2D. Multidisciplinary care is available in tertiary and primary care settings with integration of pharmacotherapy, diet, and lifestyle changes. Poor dietary adherence, high consumption of carbohydrates, and sedentary lifestyle are prevalent in patients with T2D. The latest medication options are available with increasing use of intensive insulin regimens, insulin pumps, and continuous glucose monitoring systems for managing glycemic control. A stepwise approach is proposed to expand the chronic care model into an Innovative Care for Chronic Conditions framework to facilitate implementation and realize better outcomes in primary care settings. A comprehensive strategy and approach has been established by the Malaysian government to improve prevention, treatment, and control of diabetes as an urgent response to this growing chronic disease. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  3. A model for ageing-home-care service process improvement

    OpenAIRE

    Yu, Shu-Yan; Shie, An-Jin

    2017-01-01

    The purpose of this study was to develop an integrated model to improve service processes in ageing-home-care. According to the literature, existing service processes have potential service failures that affect service quality and efficacy. However, most previous studies have only focused on conceptual model development using New Service Development (NSD) and fail to provide a systematic model to analyse potential service failures and facilitate managers developing solutions to improve the se...

  4. Requirements for high level models supporting design space exploration in model-based systems engineering

    NARCIS (Netherlands)

    Haveman, Steven; Bonnema, Gerrit Maarten

    2013-01-01

    Most formal models are used in detailed design and focus on a single domain. Few effective approaches exist that can effectively tie these lower level models to a high level system model during design space exploration. This complicates the validation of high level system requirements during

  5. A GENERALIZATION OF TRADITIONAL KANO MODEL FOR CUSTOMER REQUIREMENTS ANALYSIS

    Directory of Open Access Journals (Sweden)

    Renáta Turisová

    2015-07-01

    Full Text Available Purpose: The theory of attractiveness determines the relationship between the technically achieved and customer perceived quality of product attributes. The most frequently used approach in the theory of attractiveness is the implementation of Kano‘s model. There exist a lot of generalizations of that model which take into consideration various aspects and approaches focused on understanding the customer preferences and identification of his priorities for a selling  product. The aim of this article is to outline another possible generalization of Kano‘s model.Methodology/Approach: The traditional Kano’s model captures the nonlinear relationship between reached attributes of quality and customer requirements. The individual attributes of quality are divided into three main categories: must-be, one-dimensional, attractive quality and into two side categories: indifferent and reverse quality. The well selling product has to contain the must-be attribute. It should contain as many one-dimensional attributes as possible. If there are also supplementary attractive attributes, it means that attractiveness of the entire product, from the viewpoint of the customer, nonlinearly sharply rises what has a direct positive impact on a decision of potential customer when purchasing the product. In this article, we show that inclusion of individual quality attributes of a product to the mentioned categories depends, among other things, also on costs on life cycle of the product, respectively on a price of the product on the market.Findings: In practice, we are often encountering the inclusion of products into different price categories: lower, middle and upper class. For a certain type of products the category is either directly declared by a producer (especially in automotive industry, or is determined by a customer by means of assessment of available market prices. To each of those groups of a products different customer expectations can be assigned

  6. Toward a Unified Integration Approach: Uniting Diverse Primary Care Strategies Under the Primary Care Behavioral Health (PCBH) Model.

    Science.gov (United States)

    Sandoval, Brian E; Bell, Jennifer; Khatri, Parinda; Robinson, Patricia J

    2017-12-12

    Primary care continues to be at the center of health care transformation. The Primary Care Behavioral Health (PCBH) model of service delivery includes patient-centered care delivery strategies that can improve clinical outcomes, cost, and patient and primary care provider satisfaction with services. This article reviews the link between the PCBH model of service delivery and health care services quality improvement, and provides guidance for initiating PCBH model clinical pathways for patients facing depression, chronic pain, alcohol misuse, obesity, insomnia, and social barriers to health.

  7. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    Science.gov (United States)

    Phillips, Charles D.

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744

  8. The Pediatric Home Care/Expenditure Classification Model (P/ECM: A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    Directory of Open Access Journals (Sweden)

    Charles D. Phillips

    2015-01-01

    Full Text Available Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

  9. 48 CFR 801.602-73 - Review requirements for scarce medical specialist contracts and contracts for health-care resources.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Review requirements for scarce medical specialist contracts and contracts for health-care resources. 801.602-73 Section 801.602... Responsibilities 801.602-73 Review requirements for scarce medical specialist contracts and contracts for health...

  10. Validation of the Continuum of Care Conceptual Model for Athletic Therapy

    Directory of Open Access Journals (Sweden)

    Mark R. Lafave

    2015-01-01

    Full Text Available Utilization of conceptual models in field-based emergency care currently borrows from existing standards of medical and paramedical professions. The purpose of this study was to develop and validate a comprehensive conceptual model that could account for injuries ranging from nonurgent to catastrophic events including events that do not follow traditional medical or prehospital care protocols. The conceptual model should represent the continuum of care from the time of initial injury spanning to an athlete’s return to participation in their sport. Finally, the conceptual model should accommodate both novices and experts in the AT profession. This paper chronicles the content validation steps of the Continuum of Care Conceptual Model for Athletic Therapy (CCCM-AT. The stages of model development were domain and item generation, content expert validation using a three-stage modified Ebel procedure, and pilot testing. Only the final stage of the modified Ebel procedure reached a priori 80% consensus on three domains of interest: (1 heading descriptors; (2 the order of the model; (3 the conceptual model as a whole. Future research is required to test the use of the CCCM-AT in order to understand its efficacy in teaching and practice within the AT discipline.

  11. Shared mental models of integrated care: aligning multiple stakeholder perspectives.

    Science.gov (United States)

    Evans, Jenna M; Baker, G Ross

    2012-01-01

    Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter-organizational and inter-professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration. The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration-task, system-role, and integration-belief. The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory-based framework of psychological factors that may influence inter-organizational and inter-professional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions (or lack thereof) across the continuum of care. MMIC may help to: explain what differentiates effective from ineffective integration initiatives; determine system readiness to integrate; diagnose integration problems; and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care. Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems; the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.

  12. Modeling the minimum enzymatic requirements for optimal cellulose conversion

    International Nuclear Information System (INIS)

    Den Haan, R; Van Zyl, W H; Van Zyl, J M; Harms, T M

    2013-01-01

    Hydrolysis of cellulose is achieved by the synergistic action of endoglucanases, exoglucanases and β-glucosidases. Most cellulolytic microorganisms produce a varied array of these enzymes and the relative roles of the components are not easily defined or quantified. In this study we have used partially purified cellulases produced heterologously in the yeast Saccharomyces cerevisiae to increase our understanding of the roles of some of these components. CBH1 (Cel7), CBH2 (Cel6) and EG2 (Cel5) were separately produced in recombinant yeast strains, allowing their isolation free of any contaminating cellulolytic activity. Binary and ternary mixtures of the enzymes at loadings ranging between 3 and 100 mg g −1 Avicel allowed us to illustrate the relative roles of the enzymes and their levels of synergy. A mathematical model was created to simulate the interactions of these enzymes on crystalline cellulose, under both isolated and synergistic conditions. Laboratory results from the various mixtures at a range of loadings of recombinant enzymes allowed refinement of the mathematical model. The model can further be used to predict the optimal synergistic mixes of the enzymes. This information can subsequently be applied to help to determine the minimum protein requirement for complete hydrolysis of cellulose. Such knowledge will be greatly informative for the design of better enzymatic cocktails or processing organisms for the conversion of cellulosic biomass to commodity products. (letter)

  13. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model : A Qualitative Study

    NARCIS (Netherlands)

    Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.

    2015-01-01

    Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this

  14. [Kinshicho Model for Community Care by Multifunctional Vertical Integration of Psychiatric Care].

    Science.gov (United States)

    Kubota, Akira

    2015-01-01

    The future of psychiatric community care in Japan requires a medical team for outpatient care to offer support and take responsibility for a region; respecting human rights and supporting high risk patients who have concluded a long-period of hospitalized or repeated involuntary commitment, and for people who suffer from social withdraws over a long period of time. There are over 3,000 private psychiatric outpatient clinics in Japan. Over 400 of them are multifunctional psychiatric outpatient clinics that provide daycare services and outreach activities. In the future, if systematized those clinics entrusted by an administrative organ with performing as a "community mental health center". Multifunctional vertical integration of psychiatric care is possible in Japan to create a catchment area with 24 hours phone service and continued free access.

  15. Development of a model of situational leadership in residential care for older people.

    Science.gov (United States)

    Lynch, Brighide M; McCormack, Brendan; McCance, Tanya

    2011-11-01

    The aim of the present study was to present the process used to develop a composite model of situational leadership enacted within a person-centred nursing framework in residential care. Transforming the culture of the residential unit from a restrictive institution to a vibrant community of older adults requires transformational leadership. Situational leadership is one form of transformational leadership, which claims that there is not one leadership style that works in all situations. A model of situational leadership in residential care was developed through a series of systematic steps that identified direct linkages between situational leadership and the main constructs of the Person-Centred Nursing Framework. The process included reviewing the evidence, undertaking a comparative analysis, identifying key concepts, connecting the concepts and developing a model. A conceptual model is presented which integrates person-centredness with leadership thinking in order to effectively impact on the follower's performance in managing the care environment and delivering person-centred care. Currently the model is being utilized in an action research study to evaluate the role of leaders in the practice setting of long-term care. While some of the connecting concepts have been identified in the present study, more work needs to be done to unravel these connections in further study of leaders in practice. © 2011 Blackwell Publishing Ltd.

  16. Early chronic kidney disease: diagnosis, management and models of care

    Science.gov (United States)

    Wouters, Olivier J.; O'Donoghue, Donal J.; Ritchie, James; Kanavos, Panos G.; Narva, Andrew S.

    2015-01-01

    Chronic kidney disease (CKD) is a prevalent condition in many countries, and it is estimated that over $1 trillion is spent globally on end-stage renal disease (ESRD) care. There is a clear clinical and economic rationale for designing timely and appropriate health system responses to limit progression from CKD to ESRD. This article reviews the gaps in our knowledge about which early CKD interventions are appropriate, the optimal time to intervene, and what model of care to adopt. The available diagnostic tests exhibit key limitations. Clinical care may improve if early-stage (1–3) CKD with risk for progression towards ESRD is differentiated from early CKD that is unlikely to advance. It is possible that CKD should be re-conceptualized as a part of primary care. Additional research is needed to better understand the risk factors for CKD progression. Systems modelling can be used to evaluate the impact of different care models on CKD outcomes and costs. The US Indian Health Service experience has demonstrated that an integrated, system-wide approach, even in an underfunded system, can produce significant benefits. PMID:26055354

  17. Innovative care models for high-cost Medicare beneficiaries: delivery system and payment reform to accelerate adoption.

    Science.gov (United States)

    Davis, Karen; Buttorff, Christine; Leff, Bruce; Samus, Quincy M; Szanton, Sarah; Wolff, Jennifer L; Bandeali, Farhan

    2015-05-01

    these models to other organizations will require provider payment policy changes. Integration of acute and long-term care would further spur adoption of effective strategies for reducing or delaying entry into long-term institutional care.

  18. System dynamics modeling on health care: supply and demand of dementia care

    NARCIS (Netherlands)

    Rouwette, E.A.J.A.

    2006-01-01

    This presentation will address the use of system dynamics models to analyze complex problems in health care. System dynamics has been used on health related issues since at least the 1960s and in the Netherlands since the 1980s. In this approach a group of experts and stakeholders participates in

  19. Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care.

    Science.gov (United States)

    de Montmollin, Etienne; Demeret, Sophie; Brulé, Noëlle; Conrad, Marie; Dailler, Frédéric; Lerolle, Nicolas; Navellou, Jean-Christophe; Schwebel, Carole; Alves, Mikaël; Cour, Martin; Engrand, Nicolas; Tonnelier, Jean-Marie; Maury, Eric; Ruckly, Stéphane; Picard, Géraldine; Rogemond, Véronique; Magalhaes, Éric; Sharshar, Tarek; Timsit, Jean-François; Honnorat, Jérôme; Sonneville, Romain

    2017-02-15

    Encephalitis caused by anti-N-methyl-d-aspartate receptor (NMDAR) antibodies is the leading cause of immune-mediated encephalitis. There are limited data on intensive care unit (ICU) management of these patients. To identify prognostic factors of good neurologic outcome in patients admitted to an ICU with anti-NMDAR encephalitis. This was an observational multicenter study of all consecutive adult patients diagnosed with anti-NMDAR encephalitis at the French National Reference Centre, admitted to an ICU between 2008 and 2014. The primary outcome was a good neurologic outcome at 6 months after ICU admission, defined by a modified Rankin Scale score of 0-2. Seventy-seven patients were included from 52 ICUs. First-line immunotherapy consisted of steroids (n = 61/74; 82%), intravenous immunoglobulins (n = 71/74; 96%), and plasmapheresis (n = 17/74; 23%). Forty-five (61%) patients received second-line immunotherapy (cyclophosphamide, rituximab, or both). At 6 months, 57% of patients had a good neurologic outcome. Independent factors of good neurologic outcome were early (≤8 d after ICU admission) immunotherapy (odds ratio, 16.16; 95% confidence interval, 3.32-78.64; for combined first-line immunotherapy with steroids and intravenous immunoglobulins vs. late immunotherapy), and a low white blood cell count on the first cerebrospinal examination (odds ratio, 9.83 for 50 cells/mm 3 ; 95% confidence interval, 1.07-90.65). Presence of nonneurologic organ failures at ICU admission and occurrence of status epilepticus during ICU stay were not associated with neurologic outcome. The prognosis of adult patients with anti-NMDAR encephalitis requiring intensive care is good, especially when immunotherapy is initiated early, advocating for prompt diagnosis and early aggressive treatment.

  20. Definition of Specific Functions and Procedural Skills Required by Cuban Specialists in Intensive Care and Emergency Medicine.

    Science.gov (United States)

    Véliz, Pedro L; Berra, Esperanza M; Jorna, Ana R

    2015-07-01

    INTRODUCTION Medical specialties' core curricula should take into account functions to be carried out, positions to be filled and populations to be served. The functions in the professional profile for specialty training of Cuban intensive care and emergency medicine specialists do not include all the activities that they actually perform in professional practice. OBJECTIVE Define the specific functions and procedural skills required of Cuban specialists in intensive care and emergency medicine. METHODS The study was conducted from April 2011 to September 2013. A three-stage methodological strategy was designed using qualitative techniques. By purposive maximum variation sampling, 82 professionals were selected. Documentary analysis and key informant criteria were used in the first stage. Two expert groups were formed in the second stage: one used various group techniques (focus group, oral and written brainstorming) and the second used a three-round Delphi method. In the final stage, a third group of experts was questioned in semistructured in-depth interviews, and a two-round Delphi method was employed to assess priorities. RESULTS Ultimately, 78 specific functions were defined: 47 (60.3%) patient care, 16 (20.5%) managerial, 6 (7.7%) teaching, and 9 (11.5%) research. Thirty-one procedural skills were identified. The specific functions and procedural skills defined relate to the profession's requirements in clinical care of the critically ill, management of patient services, teaching and research at the specialist's different occupational levels. CONCLUSIONS The specific functions and procedural skills required of intensive care and emergency medicine specialists were precisely identified by a scientific method. This product is key to improving the quality of teaching, research, administration and patient care in this specialty in Cuba. The specific functions and procedural skills identified are theoretical, practical, methodological and social contributions to

  1. User Interface Requirements for Web-Based Integrated Care Pathways: Evidence from the Evaluation of an Online Care Pathway Investigation Tool.

    Science.gov (United States)

    Balatsoukas, Panos; Williams, Richard; Davies, Colin; Ainsworth, John; Buchan, Iain

    2015-11-01

    Integrated care pathways (ICPs) define a chronological sequence of steps, most commonly diagnostic or treatment, to be followed in providing care for patients. Care pathways help to ensure quality standards are met and to reduce variation in practice. Although research on the computerisation of ICP progresses, there is still little knowledge on what are the requirements for designing user-friendly and usable electronic care pathways, or how users (normally health care professionals) interact with interfaces that support design, analysis and visualisation of ICPs. The purpose of the study reported in this paper was to address this gap by evaluating the usability of a novel web-based tool called COCPIT (Collaborative Online Care Pathway Investigation Tool). COCPIT supports the design, analysis and visualisation of ICPs at the population level. In order to address the aim of this study, an evaluation methodology was designed based on heuristic evaluations and a mixed method usability test. The results showed that modular visualisation and direct manipulation of information related to the design and analysis of ICPs is useful for engaging and stimulating users. However, designers should pay attention to issues related to the visibility of the system status and the match between the system and the real world, especially in relation to the display of statistical information about care pathways and the editing of clinical information within a care pathway. The paper concludes with recommendations for interface design.

  2. Care production for tuberculosis cases:analysis according to the elements of the Chronic Care Model.

    Science.gov (United States)

    Silva, Daiane Medeiros da; Farias, Hérika Brito Gomes de; Villa, Tereza Cristina Scatena; Sá, Lenilde Duarte de; Brunello, Maria Eugênia Firmino; Nogueira, Jordana de Almeida

    2016-04-01

    To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum. The organization of care for tuberculosis and supported self-care presented reasonable capacity.In the coordination with the community, the presence of the community agent presented optimum capacity.Partnership with organizations of the community and involvement of experts presented limited capacity.The qualification of professionals, the system for scheduling and monitoring tuberculosis in the community, and the clinical information system presented basic capacity. The capacity of the primary health care services to produce tuberculosis-related care according to the elements of the Chronic Care Model is still limited.Overcoming the fragmentation of care and prioritizing a systemic operation between actions and services of the health care network remains as a major challenge. Analisar,segundo os elementos doChronicCareModel,a produção do cuidado aos casos de tuberculose nos serviços de Atenção Primária à Saúde. Estudo transversal, realizado em capital do nordeste brasileiro, envolvendo 83 profissionais da Estratégia Saúde da Família. Aplicou-se um instrumento estruturado, adaptado para atenção à tuberculose no Brasil. A análise pautou-se na construção de indicadores, cujacapacidade para produção de cuidados variou entre limitada a ótima. A organização da atenção à tuberculose e o autocuidado apoiado apresentaram capacidade razoável. Na articulação com a comunidade, a presençadoagente comunitário de saúde apresentou capacidade ótima. A parceria com organizações da

  3. Primary care for diabetes mellitus patients from the perspective of the care model for chronic conditions

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Salci

    Full Text Available ABSTRACT Objective: to assess the health care Primary Health Care professionals provide to diabetes mellitus patients from the perspective of the Modelo de Atenção às Condições Crônicas. Method: qualitative study, using the theoretical framework of Complex Thinking and the Modelo de Atenção às Condições Crônicas and the methodological framework of assessment research. To collect the data, 38 interviews were held with health professionals and managers; observation of the activities by the health teams; and analysis of 25 files of people who received this care. The data analysis was supported by the software ATLAS.ti, using the directed content analysis technique. Results: at the micro level, care was distant from the integrality of the actions needed to assist people with chronic conditions and was centered on the biomedical model. At the meso level, there was disarticulation among the professionals of the Family Health Strategy, between them and the users, family and community. At the macro level, there was a lack of guiding strategies to implement public policies for diabetes in care practice. Conclusion: the implementation of the Modelo de Atenção às Condições Crônicas represents a great challenge, mainly needing professionals and managers who are prepared to work with chronic conditions are who are open to break with the traditional model.

  4. Formative evaluation of practice changes for managing depression within a Shared Care model in primary care.

    Science.gov (United States)

    Beaulac, Julie; Edwards, Jeanette; Steele, Angus

    2017-01-01

    Aim To investigate the implementation and initial impact of the Physician Integrated Network (PIN) mental health indicators, which are specific to screening and managing follow-up for depression, in three primary care practices with Shared Mental Health Care in Manitoba. Manitoba Health undertook a primary care renewal initiative in 2006 called the PIN, which included the development of mental health indicators specific to screening and managing follow-up for depression. These indicators were implemented in three PIN group practice sites in Manitoba, which are also part of Shared Mental Health Care. The design was a non-experimental longitudinal design. A formative evaluation investigated the implementation and initial impact of the mental health indicators using mixed methods (document review, survey, and interview). Quantitative data was explored using descriptive and comparative statistics and a content and theme analysis of the qualitative interviews was conducted. Survey responses were received from 32 out of 36 physicians from the three sites. Interviews were conducted with 15 providers. Findings This evaluation illustrated providers' perceived attitudes, knowledge, skills, and behaviours related to recognizing and treating depression and expanded our understanding of primary care processes related to managing depression related to the implementation of a new initiative. Depression is viewed as an important problem in primary care practice that is time consuming to diagnose, manage and treat and requires further investigation. Implementation of the PIN mental health indicators was variable across sites and providers. There was an increase in use of the indicators across time and a general sentiment that benefits of screening outweigh the costs; however, the benefit of screening for depression remains unclear. Consistent with current guidelines, a question the findings of this evaluation suggests is whether there are more effective ways of having an impact on

  5. Estimated Budget Impact of Adopting the Affordable Care Act's Required Smoking Cessation Coverage on United States Healthcare Payers.

    Science.gov (United States)

    Baker, Christine L; Ferrufino, Cheryl P; Bruno, Marianna; Kowal, Stacey

    2017-01-01

    Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice. This study presents current cessation patterns, real-world drug costs and plan benefit design data, and estimates the 1- to 5-year pharmacy budget impact of providing ACA-required coverage for smoking cessation products to understand the fiscal impact to a US healthcare plan. A closed cohort budget impact model was developed in Microsoft Excel ® to estimate current and projected costs for US payers (commercial, Medicare, Medicaid) covering smoking cessation medicines, with assumptions for coverage and smoking cessation product utilization based on current, real-world national and state-level trends for hypothetical commercial, Medicare, and Medicaid plans with 1 million covered lives. A Markov methodology with five health states captures quit attempt and relapse patterns. Results include the number of smokers attempting to quit, number of successful quitters, annual costs, and cost per-member per-month (PMPM). The projected PMPM cost of providing coverage for smoking cessation medications is $0.10 for commercial, $0.06 for Medicare, and $0.07 for Medicaid plans, reflecting a low incremental PMPM impact of covering two attempts ranging from $0.01 for Medicaid to $0.02 for commercial and Medicare payers. The projected PMPM impact of covering two quit attempts with access to all seven cessation medications at no patient cost share remains low. Results of this study reinforce that the impact of adopting the ACA requirements for smoking cessation coverage will have a limited near-term impact

  6. Development of the Transitional Care Model for nursing care in Mainland China: A literature review

    Directory of Open Access Journals (Sweden)

    Zeng-Jie Ye

    2016-03-01

    Full Text Available Background: The Transitional Care Model (TCM for nursing care has yet to be implemented in China despite its success in Western countries. However, rapid social changes have demanded an upgrade in the quality of nursing care; in 2010, the Chinese government has acknowledged the need to implement the TCM in China. Objective: This study has the following objectives: (1 perform a thorough review of the literature regarding the development and implementation of the TCM in Mainland China within the past 5 years; (2 provide a comprehensive discussion of the current status, problems, and strategies related to the implementation of the TCM in Mainland China; and (3 suggest strategies pertaining to the future of the TCM in China. Design: The current pertinent literature is systematically reviewed. Data sources: Systematic and manual searches in computerized databases for relevant studies regarding the TCM led to the inclusion of 26 papers in this review. Review methods: Abstracts that satisfied the inclusion criteria were reviewed independently by the two authors of this manuscript, and discrepancies were resolved through discussion. The same reviewers independently assessed the paper in its entirety for selected abstracts. Results: The present English literature review revealed a paucity of updated information about the development and implementation of the TCM in Mainland China. Nevertheless, the dramatic growth of the TCM in the past 5 years has had a vital impact within the society and in nursing development. This review also revealed numerous issues regarding the focus of the TCM. Overall implications for practice and recommendations for future research are discussed. Conclusion: Despite the potential of this nursing model to have a successful and beneficial impact in Mainland China, it remains an under-researched topic. Further research on education and training as well as premium policies for nurses under the TCM are needed. Keywords: Transitional

  7. Technologies of birth and models of midwifery care

    Directory of Open Access Journals (Sweden)

    Christine McCourt

    2014-08-01

    Full Text Available This article is based on a study of a reform in the organisation of maternity services in the United Kingdom, which aimed towards developing a more woman-centred model of care. After decades of fragmentation and depersonalisation of care, associated with the shift of birth to a hospital setting, pressure by midwives and mothers prompted government review and a relatively radical turnaround in policy. However, the emergent model of care has been profoundly influenced by concepts and technologies of monitoring. The use of such technologies as ultrasound scans, electronic foetal monitoring and oxytocic augmentation of labour, generally supported by epidural anaesthesia for pain relief, have accompanied the development of a particular ecological model of birth – often called active management –, which is oriented towards the idea of an obstetric norm. Drawing on analysis of women’s narrative accounts of labour and birth, this article discusses the impact on women’s embodiment in birth, and the sources of information they use about the status of their own bodies, their labour and that of the child. It also illustrates how the impact on women’s experiences of birth may be mediated by a relational model of support, through the provision of caseload midwifery care.

  8. 75 FR 65282 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Science.gov (United States)

    2010-10-22

    .... Palliative care in an LTC facility involves addressing physical, intellectual, emotional, social, and... Disability, Aging and Long-Term Care Policy and the Urban Institute; ``Synthesis and Analysis of Medicare..., mental, social, or emotional status; clinical complications that suggested a need to alter the care plan...

  9. A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings.

    Science.gov (United States)

    Petersen, Inge; Lund, Crick; Bhana, Arvin; Flisher, Alan J

    2012-01-01

    BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.

  10. A new approach to scoring systems to improve identification of acute medical admissions that will require critical care.

    Science.gov (United States)

    Carmichael, H A; Robertson, E; Austin, J; McCruden, D; Messow, C M; Belcher, P R

    2011-11-01

    Removal of the intensive care unit (ICU) at the Vale of Leven Hospital mandated the identification and transfer out of those acute medical admissions with a high risk of requiring ICU. The aim of the study was to develop triaging tools that identified such patients and compare them with other scoring systems. The methodology included a retrospective analysis of physiological and arterial gas measurements from 1976 acute medical admissions produced PREEMPT-1 (PRE-critical Emergency Medical Patient Triage). A simpler one for ambulance use (PREAMBLE-1 [PRE-Admission Medical Blue-Light Emergency]) was produced by the addition of peripheral oxygen saturation to a modification of MEWS (Modified Early Warning Score). Prospective application of these tools produced a larger database of 4447 acute admissions from which logistic regression models produced PREEMPT-2 and PREAMBLE-2, which were then compared with the original systems and seven other early warning scoring systems. Results showed that in patients with arterial gases, the area under the receiver operator characteristic curve was significantly higher in PREEMPT-2 (89·1%) and PREAMBLE-2 (84.4%) than all other scoring systems. Similarly, in all patients, it was higher in PREAMBLE-2 (92·4%) than PREAMBLE-1 (88·1%) and the other scoring systems. In conclusion, risk of requiring ICU can be more accurately predicted using PREEMPT-2 and PREAMBLE-2, as described here, than by other early warning scoring systems developed over recent years.

  11. Financial impact of nursing professionals staff required in an Intensive Care Unit.

    Science.gov (United States)

    Araújo, Thamiris Ricci de; Menegueti, Mayra Gonçalves; Auxiliadora-Martins, Maria; Castilho, Valéria; Chaves, Lucieli Dias Pedreschi; Laus, Ana Maria

    2016-11-21

    to calculate the cost of the average time of nursing care spent and required by patients in the Intensive Care Unit (ICU) and the financial expense for the right dimension of staff of nursing professionals. a descriptive, quantitative research, using the case study method, developed in adult ICU patients. We used the workload index - Nursing Activities Score; the average care time spent and required and the amount of professionals required were calculated using equations and from these data, and from the salary composition of professionals and contractual monthly time values, calculated the cost of direct labor of nursing. the monthly cost of the average quantity of available professionals was US$ 35,763.12, corresponding to 29.6 professionals, and the required staff for 24 hours of care is 42.2 nurses, with a monthly cost of US$ 50,995.44. the numerical gap of nursing professionals was 30% and the monthly financial expense for adaptation of the structure is US$ 15,232.32, which corresponds to an increase of 42.59% in the amounts currently paid by the institution. calcular o custo do tempo médio de assistência de enfermagem despendido e requerido pelos pacientes internados em Unidade de Terapia Intensiva (UTI) e o dispêndio financeiro para adequação do quadro de profissionais de enfermagem. pesquisa descritiva, quantitativa, na modalidade de estudo de caso, desenvolvida na UTI de pacientes adultos. Utilizou-se o índice de carga de trabalho - Nursing Activities Score; o tempo médio de assistência despendido, requerido e o quantitativo de profissionais requerido foram calculados por meio de equações e, a partir desses dados, e de valores da composição salarial dos profissionais e tempo mensal contratual, calculou-se o custo da mão de obra direta de enfermagem. o custo mensal do quantitativo médio de profissionais disponível foi de US$ 35.763,12, correspondendo a 29,6 profissionais, e o requerido para 24 horas de cuidado é de 42,2 profissionais de

  12. Low-level waste management in the South. Task 4.2 - long-term care requirements

    International Nuclear Information System (INIS)

    1983-01-01

    This paper provides an analysis of the long-term care requirements of low-level radioactive waste disposal facilities. Among the topics considered are the technical requirements for long-term care, the experiences of the three inactive and three active commercial disposal facilities concerning perpetual care and maintenance, and the financial management of a perpetual care fund. In addition, certain recommendations for the establishment of a perpetual care fund are provided. The predominant method of disposing of low-level radioactive wastes is shallow land burial. After studying alternative methods of disposal, the U.S Nuclear Regulatory Commission (NRC) concluded that there are no compelling reasons for abandoning this disposal method. Of the 22 shallow land burial facilities in the U.S., the federal government maintains 14 active and two inactive disposal sites. There are three active (Barnwell, South Carolina; Hanford, Washington; and Beatty, Nevada) and three inactive commercial disposal facilities (Maxey Flats, Kentucky; Sheffield, Illinois; and West Valley, New York). The life of a typical facility can be broken into five phases: preoperational, operational, closure, postclosure observation and maintenance, and institutional control. Long-term care of a shallow land burial facility will begin with the disposal site closure phase and continue through the postclosure observation and maintenance and institutional control phases. Since the postclosure observation and maintenance phase will last about five years and the institutional control phase 100 years, the importance of a well planned long-term care program is apparent. 26 references, 1 table

  13. Mental models of audit and feedback in primary care settings.

    Science.gov (United States)

    Hysong, Sylvia J; Smitham, Kristen; SoRelle, Richard; Amspoker, Amber; Hughes, Ashley M; Haidet, Paul

    2018-05-30

    Audit and feedback has been shown to be instrumental in improving quality of care, particularly in outpatient settings. The mental model individuals and organizations hold regarding audit and feedback can moderate its effectiveness, yet this has received limited study in the quality improvement literature. In this study we sought to uncover patterns in mental models of current feedback practices within high- and low-performing healthcare facilities. We purposively sampled 16 geographically dispersed VA hospitals based on high and low performance on a set of chronic and preventive care measures. We interviewed up to 4 personnel from each location (n = 48) to determine the facility's receptivity to audit and feedback practices. Interview transcripts were analyzed via content and framework analysis to identify emergent themes. We found high variability in the mental models of audit and feedback, which we organized into positive and negative themes. We were unable to associate mental models of audit and feedback with clinical performance due to high variance in facility performance over time. Positive mental models exhibit perceived utility of audit and feedback practices in improving performance; whereas, negative mental models did not. Results speak to the variability of mental models of feedback, highlighting how facilities perceive current audit and feedback practices. Findings are consistent with prior research  in that variability in feedback mental models is associated with lower performance.; Future research should seek to empirically link mental models revealed in this paper to high and low levels of clinical performance.

  14. A 2nd generation static model of greenhouse energy requirements (horticern) : a comparison with dynamic models

    CERN Document Server

    Jolliet, O; Munday, G L

    1989-01-01

    Optimisation of a greenhouse and its components requires a suitable model permitting precise determination of its energy requirements. Existing static models are simple but lack precision; dynamic models though more precise, are unsuitable for use over long periods and difficult to handle in practice. A theoretical study and measurements from the CERN trial greenhouse have allowed the development of new static model named "HORTICERN", precise and easy to use for predicting energy consumption and which takes into account effects of solar energy, wind and radiative loss to the sky. This paper compares the HORTICERN model with the dynamic models of Bot, Takakura, Van Bavel and Gembloux, and demonstrates that its precision is comparable; differences on average being less than 5%, it is independent of type of greenhouse (e.g. single or double glazing, Hortiplus, etc.) and climate. The HORTICERN method has been developed for PC use and is proving to be a powerful tool for greenhouse optimisation by research work...

  15. Psychiatric consultation in the collaborative care model: The "bipolar sieve" effect.

    Science.gov (United States)

    Phelps, James R; James, James

    2017-08-01

    Around the world, psychiatrists are in exceptionally short supply. The majority of mental health treatment is delivered in primary care. In the United States, the Collaborative Care Model (CCM) addresses the shortfall of psychiatrists by providing indirect consultation in primary care. A Cochrane meta-analysis affirms the efficacy this model for depression and anxiety. However, our experience with the CCM suggests that most patients referred for consultation have problems far more complex than simple depression and anxiety. Based on preliminary data, we offer five linked hypotheses: (1) in an efficient collaborative care process, the majority of mental illnesses can be handled by providers who are less expensive and more plentiful than psychiatrists. (2) A majority of the remaining cases will be bipolar disorder variations. Differentiating these from PTSD, the most common alternative or comorbid diagnosis, is challenging and often requires a psychiatrist's input. (3) Psychiatric consultants can teach their primary care colleagues that bipolar diagnoses are estimations based on rigorously assessed probabilities, and that cases fall on a spectrum from unipolar to bipolar. (4) All providers must recognize that when bipolarity is missed, antidepressant prescription often follows. Antidepressants can induce bipolar mixed states, with extreme anxiety and potentially dangerous impulsivity and suicidality. (5) Psychiatrists can help develop clinical approaches in primary care that identify bipolarity and differentiate it from (or establish comorbidity with) PTSD; and psychiatrists can facilitate appropriate treatment, including bipolar-specific psychotherapies as well as use of mood stabilizers. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. ProvenCare: Geisinger's Model for Care Transformation through Innovative Clinical Initiatives and Value Creation.

    Science.gov (United States)

    2009-04-01

    Geisinger's system of care can be seen as a microcosm of the national delivery of healthcare, with implications for decision makers in other health plans. In this interview, Dr Ronald A. Paulus focuses on Geisinger's unique approach to patient care. In its core, this approach represents a system of quality and value initiatives based on 3 major programs-Proven Health Navigation (medical home); the ProvenCare model; and transitions of care. The goal of such an approach is to optimize disease management by using a rational reimbursement paradigm for appropriate interventions, providing innovative incentives, and engaging patients in their own care as part of any intervention. Dr Paulus explains the reasons why, unlike Geisinger, other stakeholders, including payers, providers, patients, and employers, have no intrinsic reasons to be concerned with quality and value initiatives. In addition, he says, an electronic infrastructure that could be modified as management paradigms evolve is a necessary tool to ensure the healthcare delivery system's ability to adapt to new clinical realities quickly to ensure the continuation of delivering best value for all stakeholders.

  17. Palliative Care Office Hours for Patients with Hematologic Malignancies: An Innovative Model for Symptom Management and Education.

    Science.gov (United States)

    Foxwell, Anessa M; Moyer, Mary E; Casarett, David J; O'Connor, Nina R

    2017-10-01

    Palliative care programs are experiencing rapid growth, with demand for consults surpassing staffing. Innovative models are needed to equip nonpalliative care providers to manage basic palliative care issues. To develop a novel program of palliative care office hours for hematologic oncology advanced practice providers, and to evaluate its impact on palliative care consult volume and composition. A palliative care nurse practitioner or pharmacist was available for weekday office hours to all inpatient hematologic oncology advanced practice providers at an academic medical center to offer advice on pain, nonpain symptoms, and psychosocial distress. A retrospective study looking at outcome measures after six months of office hour utilization and palliative care consults from the hematologic oncology services. Palliative care office hours had a mean duration of 16 minutes per day (range 5 to 55). A mean of 11 patients were discussed per week (range 4 to 20). Pain, nausea, and anxiety were the issues most frequently raised. Of 299 patients discussed during office hours, 44 (14.7%) subsequently required a full palliative care consult. Overall, palliative care consults from the hematologic oncology services decreased from 19.6% to 10.2% of admissions (87/445 vs. 61/594, p Office hours are an efficient way to address palliative care needs when demand for palliative care consults exceeds capacity. Office hours may serve an educational function as well, enabling primary teams to manage basic palliative care issues with increasing independence over time.

  18. Intravenous dextrose administration reduces postoperative antiemetic rescue treatment requirements and postanesthesia care unit length of stay.

    Science.gov (United States)

    Dabu-Bondoc, Susan; Vadivelu, Nalini; Shimono, Chantelle; English, Annette; Kosarussavadi, Boonsri; Dai, Feng; Shelley, Kirk; Feinleib, Jessica

    2013-09-01

    , postanesthesia IV dextrose administration resulted in improved PONV management as defined by reductions in antiemetic rescue medication requirements and PACU length of stay that are worthy of further study. In light of its ease, low risk, and benefit to patient care and satisfaction, this therapeutic modality could be considered.

  19. Defining Requirements and Applying Information Modeling for Protecting Enterprise Assets

    Science.gov (United States)

    Fortier, Stephen C.; Volk, Jennifer H.

    The advent of terrorist threats has heightened local, regional, and national governments' interest in emergency response and disaster preparedness. The threat of natural disasters also challenges emergency responders to act swiftly and in a coordinated fashion. When a disaster occurs, an ad hoc coalition of pre-planned groups usually forms to respond to the incident. History has shown that these “system of systems” do not interoperate very well. Communications between fire, police and rescue components either do not work or are inefficient. Government agencies, non-governmental organizations (NGOs), and private industry use a wide array of software platforms for managing data about emergency conditions, resources and response activities. Most of these are stand-alone systems with very limited capability for data sharing with other agencies or other levels of government. Information technology advances have facilitated the movement towards an integrated and coordinated approach to emergency management. Other communication mechanisms, such as video teleconferencing, digital television and radio broadcasting, are being utilized to combat the challenges of emergency information exchange. Recent disasters, such as Hurricane Katrina and the tsunami in Indonesia, have illuminated the weaknesses in emergency response. This paper will discuss the need for defining requirements for components of ad hoc coalitions which are formed to respond to disasters. A goal of our effort was to develop a proof of concept that applying information modeling to the business processes used to protect and mitigate potential loss of an enterprise was feasible. These activities would be modeled both pre- and post-incident.

  20. Direct and indirect effects of nutritional status, physical function and cognitive function on activities of daily living in Japanese older adults requiring long-term care.

    Science.gov (United States)

    Kamo, Tomohiko; Nishida, Yuusuke

    2014-10-01

    To identify the direct and indirect effects of nutritional status, physical function, and cognitive function on activities of daily living in Japanese older adults requiring long-term care. In total, 179 participants aged ≥ 65 years who were eligible for long-term care insurance (mean age 85.5 ± 7.8 years) were recruited for this study. Nutritional status (Mini Nutritional Assessment, Short Form) and physical function (Short Physical Performance Battery) were examined. Activities of daily living, cognitive function and frailty were assessed using the Barthel Index, Mini-Mental State Examination and Clinical Frailty Scale, respectively. Path analysis was used to determine relationships between these factors and the activities of daily living. For Japanese older adults requiring long-term care, pathways were modeled for nutritional status, physical function and the activities of daily living. The total effect of nutritional status was 0.516 (Pphysical function on the activities of daily living was 0.458 (Pphysical function in aged Japanese people requiring long-term care. These findings suggest that maintaining good nutritional status and nutritional support might delay physical function decline, and prolong the activities of daily living. © 2013 Japan Geriatrics Society.

  1. The Modeling of Factors That Influence Coast Guard Manpower Requirements

    Science.gov (United States)

    2014-12-01

    applications, and common data warehouses needed to fully develop an effective and efficient manpower requirements engineering and management program. The... manpower requirements determination ensures a ready force, and safe and effective mission execution. Shortage or excess of manpower is the catalyst...FACTORS THAT INFLUENCE COAST GUARD MANPOWER REQUIREMENTS by Kara M. Lavin December 2014 Thesis Advisor: Ronald E. Giachetti Co-Advisor

  2. Models and data requirements for human reliability analysis

    International Nuclear Information System (INIS)

    1989-03-01

    It has been widely recognised for many years that the safety of the nuclear power generation depends heavily on the human factors related to plant operation. This has been confirmed by the accidents at Three Mile Island and Chernobyl. Both these cases revealed how human actions can defeat engineered safeguards and the need for special operator training to cover the possibility of unexpected plant conditions. The importance of the human factor also stands out in the analysis of abnormal events and insights from probabilistic safety assessments (PSA's), which reveal a large proportion of cases having their origin in faulty operator performance. A consultants' meeting, organized jointly by the International Atomic Energy Agency (IAEA) and the International Institute for Applied Systems Analysis (IIASA) was held at IIASA in Laxenburg, Austria, December 7-11, 1987, with the aim of reviewing existing models used in Probabilistic Safety Assessment (PSA) for Human Reliability Analysis (HRA) and of identifying the data required. The report collects both the contributions offered by the members of the Expert Task Force and the findings of the extensive discussions that took place during the meeting. Refs, figs and tabs

  3. Method for modeling social care processes for national information exchange.

    Science.gov (United States)

    Miettinen, Aki; Mykkänen, Juha; Laaksonen, Maarit

    2012-01-01

    Finnish social services include 21 service commissions of social welfare including Adoption counselling, Income support, Child welfare, Services for immigrants and Substance abuse care. This paper describes the method used for process modeling in the National project for IT in Social Services in Finland (Tikesos). The process modeling in the project aimed to support common national target state processes from the perspective of national electronic archive, increased interoperability between systems and electronic client documents. The process steps and other aspects of the method are presented. The method was developed, used and refined during the three years of process modeling in the national project.

  4. A Cyclical Approach to Continuum Modeling: A Conceptual Model of Diabetic Foot Care

    Directory of Open Access Journals (Sweden)

    Martha L. Carvour

    2017-12-01

    Full Text Available “Cascade” or “continuum” models have been developed for a number of diseases and conditions. These models define the desired, successive steps in care for that disease or condition and depict the proportion of the population that has completed each step. These models may be used to compare care across subgroups or populations and to identify and evaluate interventions intended to improve outcomes on the population level. Previous cascade or continuum models have been limited by several factors. These models are best suited to processes with stepwise outcomes—such as screening, diagnosis, and treatment—with a single defined outcome (e.g., treatment or cure for each member of the population. However, continuum modeling is not well developed for complex processes with non-sequential or recurring steps or those without singular outcomes. As shown here using the example of diabetic foot care, the concept of continuum modeling may be re-envisioned with a cyclical approach. Cyclical continuum modeling may permit incorporation of non-sequential and recurring steps into a single continuum, while recognizing the presence of multiple desirable outcomes within the population. Cyclical models may simultaneously represent the distribution of clinical severity and clinical resource use across a population, thereby extending the benefits of traditional continuum models to complex processes for which population-based monitoring is desired. The models may also support communication with other stakeholders in the process of care, including health care providers and patients.

  5. A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

    Directory of Open Access Journals (Sweden)

    Chong Mei

    2011-08-01

    Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

  6. Improving pain care through implementation of the Stepped Care Model at a multisite community health center

    Directory of Open Access Journals (Sweden)

    Anderson DR

    2016-11-01

    Full Text Available Daren R Anderson,1 Ianita Zlateva,1 Emil N Coman,2 Khushbu Khatri,1 Terrence Tian,1 Robert D Kerns3 1Weitzman Institute, Community Health Center, Inc., Middletown, 2UCONN Health Disparities Institute, University of Connecticut, Farmington, 3VA Connecticut Healthcare System, West Haven, CT, USA Purpose: Treating pain in primary care is challenging. Primary care providers (PCPs receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM at a large, multisite Federally Qualified Health Center. Methods: The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results: Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009. There was no

  7. The importance of health belief models in determining self-care behaviour in diabetes.

    Science.gov (United States)

    Harvey, J N; Lawson, V L

    2009-01-01

    Patients' self-care behaviours have a major role in diabetes management. Diabetes education provides the required knowledge, but despite this, self-care is often suboptimal. The degree to which patients follow advice as regards the various self-care behaviours is determined by their health beliefs (Illness Representations or Personal Models) of diabetes. Psychometric studies have tried to categorize and measure the beliefs about illness that influence patients to adhere to treatment recommendations in diabetes. Various models have been proposed to explain the relationship between beliefs and behaviour. Leventhal's Self-Regulatory Model, which takes account of the emotional as well as the objective rational response to illness, currently seems to offer the best system for identifying the determinants of patient self-care behaviour. A review of interventions indicates those based on psychological theory offer professionals the best chance of maximizing their patients' contribution to diabetes self-management and achieving improved outcomes, both glycaemic and psychosocial. Studies designed specifically to modify illness representations are now being undertaken. This brief review aims to summarize developments in this area of psychological theory over the last 20 years and the implications for promoting better self-care behaviour in diabetes.

  8. Gordon's model applied to nursing care of people with depression.

    Science.gov (United States)

    Temel, M; Kutlu, F Y

    2015-12-01

    Psychiatric nurses should consider the patient's biological, psychological and social aspects. Marjory Gordon's Functional Health Pattern Model ensures a holistic approach for the patient. To examine the effectiveness of Gordon's Functional Health Pattern Model in reducing depressive symptoms, increasing self-efficacy, coping with depression and increasing hope in people with depression. A quasi-experimental two-group pre-test and post-test design was adopted. Data were collected from April 2013 to May 2014 from people with depression at the psychiatry clinic of a state hospital in Turkey; they were assigned to the intervention (n = 34) or control group (n = 34). The intervention group received nursing care according to Gordon's Functional Health Pattern Model and routine care, while the control group received routine care only. The Beck Depression Inventory, Beck Hopelessness Scale and Depression Coping Self-Efficacy Scale were used. The intervention group had significantly lower scores on the Beck Depression Inventory and Beck Hopelessness Scale at the post-test and 3-month follow-up; they had higher scores on the Depression Coping Self-Efficacy Scale at the 3-month follow-up when compared with the control group. The study was conducted at only one psychiatry clinic. The intervention and control group patients were at the clinic at the same time and influenced each other. Moreover, because clinical routines were in progress during the study, the results cannot only be attributed to nursing interventions. Nursing models offer guidance for the care provided. Practices based on the models return more efficient and systematic caregiving results with fewer health problems. Gordon's Functional Health Pattern Model was effective in improving the health of people with depression and could be introduced as routine care with ongoing evaluation in psychiatric clinics. More research is needed to evaluate Gordon's Nursing Model effect on people with depression. Future

  9. The role of unfinished root canal treatment in odontogenic maxillofacial infections requiring hospital care.

    Science.gov (United States)

    Grönholm, L; Lemberg, K K; Tjäderhane, L; Lauhio, A; Lindqvist, C; Rautemaa-Richardson, R

    2013-01-01

    The aim of this study was to evaluate clinical and radiological findings and the role of periapical infection and antecedent dental treatment of infected focus teeth in odontogenic maxillofacial abscesses requiring hospital care. In this retrospective cohort study, we evaluated medical records and panoramic radiographs during the hospital stay of patients (n = 60) admitted due to odontogenic maxillofacial infection originating from periapical periodontitis. Twenty-three (38 %) patients had received endodontic treatment and ten (17 %) other acute dental treatment. Twenty-seven (45 %) had not visited the dentist in the near past. Median age of the patients was 45 (range 20-88) years and 60 % were males. Unfinished root canal treatment (RCT) was the major risk factor for hospitalisation in 16 (27 %) of the 60 cases (p = .0065). Completed RCT was the source only in 7 (12 %) of the 60 cases. Two of these RCTs were adequate and five inadequate. The initiation of inadequate or incomplete primary RCT of acute periapical periodontitis appears to open a risk window for locally invasive spread of infection with local abscess formation and systemic symptoms. Thereafter, the quality of the completed RCT appears to have minor impact. However, a considerable proportion of the patients had not received any dental treatment confirming the importance of good dental health. Thus, thorough canal debridement during the first session is essential for minimising the risk for spread of infection in addition to incision and drainage of the abscess. If this cannot be achieved, tooth extraction should be considered. Incomplete or inadequate canal debridement and drainage of the abscess may increase the risk for spread of endodontic infection.

  10. Financial and Temporal Advantages of Virtual Consultation in Veterans Requiring Specialty Care.

    Science.gov (United States)

    Abbott, Daniel E; Macke, Ryan A; Kurtz, Jodi; Safdar, Nasia; Greenberg, Caprice C; Weber, Sharon M; Voils, Corrine I; Fisher, Deborah A; Maloney, James D

    2018-01-01

    Access to specialty health care in the Veterans Affairs (VA) system continues to be problematic. Given the potential temporal and fiscal benefits of telehealth, the Madison VA developed a virtual consultation (VC) mechanism to expedite diagnostic and therapeutic interventions for Veterans with incidentally discovered pulmonary nodules. Materials and. VC, a remote encounter between referring provider and thoracic surgeon for incidentally discovered pulmonary nodules, was implemented at the Madison VA between 2009 and 2011. Time from request to completion of consultation, hospital cost, and travel costs were determined for 157 veterans. These endpoints were then compared with in-person consultations over a concurrent 6-mo period. For the entire study cohort, the mean time to completion of VC was 3.2 d (SD ± 4.4 d). For the 6-mo period of first VC availability, the mean time to VC completion versus in-person consultation was 2.8 d (SD ± 2.8 d) and 20.5 d (SD ± 15.6 d), respectively (p < 0.05). Following initial VC, 84 (53%) veterans were scheduled for virtual follow-up alone; no veteran required an additional office visit before further diagnostic or therapeutic intervention. VA hospital cost was $228 per in-person consultation versus $120 per episode for VC - a 47.4% decrease. The average distance form veteran home to center was 86 miles, with an average travel reimbursement of $112 per in-person consultation, versus no travel cost associated with VC. VC for incidentally discovered pulmonary nodules significantly decreases time to consultation completion, hospital cost, and veteran travel cost. These data suggest that a significant opportunity exists for expansion of telehealth into additional practice settings within the VA system. © Association of Military Surgeons of the United States 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  11. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    Directory of Open Access Journals (Sweden)

    Marc Carreras

    2016-08-01

    Full Text Available Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care. Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain for the year 2012 (N = 92,498 individuals. A set of individual cost models as a function of sex, age and morbidity burden were adjusted and individual healthcare costs were calculated using a retrospective full-costing system. The individual morbidity burden was inferred using the Clinical Risk Groups (CRG patient classification system. Results: Depending on the characteristics of the data, and according to the algorithm criteria, the choice of model was a linear model on the log of costs or a generalized linear model with a log link. We checked for goodness of fit, accuracy, linear structure and heteroscedasticity for the models obtained. Conclusion: The proposed algorithm identified a set of suitable cost models for the distinct groups of services integrated care entails. The individual morbidity burden was found to be indispensable when allocating appropriate resources to targeted individuals.

  12. The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

    Directory of Open Access Journals (Sweden)

    Monique Venter

    2016-11-01

    Full Text Available Background. Critical care transfers (CCT refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft of patients who are of high acuity. In South Africa (SA, advanced life support (ALS paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7, consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81 of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.

  13. Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury

    Directory of Open Access Journals (Sweden)

    J.H.A. Bloemen-Vrencken

    2005-06-01

    Full Text Available Purposes: The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. Methods: The transmural care model was developed in cooperation with the Dutch Association of Spinal Cord Injured Patients, community nurses, general practitioners, rehabilitation nurses, rehabilitation managers, physiatrists and researchers. The core component of the care model consists of a transmural nurse, who ‘liaises’ between people with SCI living in the community, professional primary care professionals and the rehabilitation centre. The transmural care model provides a job description containing activities to support people with SCI and their family/partners and activities to promote continuity of care. The transmural care model was implemented in two Dutch rehabilitation centres. The following three aspects, as experienced by the transmural nurses, were evaluated: the extent to which the care model was implemented; enabling factors and barriers for implementation; strength and weakness of the care model. Results: The transmural care model was not implemented in all its details, with a clear difference between the two rehabilitation centres. Enabling factors and barriers for implementation were found at three levels: 1. the level of the individual professional (e.g. competencies, attitude and motivation, 2. the organisational and financing level (e.g. availability of facilities and finances, and 3. the social context (the opinion of colleagues, managers and other professionals involved with the care. The most important weakness experienced was that there was not enough time to put all the activities into practice

  14. 5 CFR 792.220 - What are the requirements that child care providers must meet in order to participate in this...

    Science.gov (United States)

    2010-01-01

    ..., where applicable, by local authorities where the child care service is delivered. Outside of the United States, agencies may adopt or create criteria to ensure a child care center or family child care home is... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What are the requirements that child care...

  15. Modelling elderly cardiac patients decision making using Cognitive Work Analysis: identifying requirements for patient decision aids.

    Science.gov (United States)

    Dhukaram, Anandhi Vivekanandan; Baber, Chris

    2015-06-01

    Patients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs. This paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making. This study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise. The results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use. CWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. A model for ubiquitous care of noncommunicable diseases.

    Science.gov (United States)

    Vianna, Henrique Damasceno; Barbosa, Jorge Luis Victória

    2014-09-01

    The ubiquitous computing, or ubicomp, is a promising technology to help chronic diseases patients managing activities, offering support to them anytime, anywhere. Hence, ubicomp can aid community and health organizations to continuously communicate with patients and to offer useful resources for their self-management activities. Communication is prioritized in works of ubiquitous health for noncommunicable diseases care, but the management of resources is not commonly employed. We propose the UDuctor, a model for ubiquitous care of noncommunicable diseases. UDuctor focuses the resources offering, without losing self-management and communication supports. We implemented a system and applied it in two practical experiments. First, ten chronic patients tried the system and filled out a questionnaire based on the technology acceptance model. After this initial evaluation, an alpha test was done. The system was used daily for one month and a half by a chronic patient. The results were encouraging and show potential for implementing UDuctor in real-life situations.

  17. Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study.

    Science.gov (United States)

    Warmelink, J Catja; de Cock, T Paul; Combee, Yvonne; Rongen, Marloes; Wiegers, Therese A; Hutton, Eileen K

    2017-01-11

    A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care. This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed. Students felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care. Final year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth. The graduating

  18. Health Care Analysis for the MCRMC Insurance Cost Model

    Science.gov (United States)

    2015-06-01

    incentive to reduce utilization  Subsidy to leave TRICARE and use other private health insurance  Increases in TRICARE premiums and co-pays  This...analysis develops the estimated cost of providing health care through a premium -based insurance model consistent with an employer-sponsored benefit...State  Income  Plan premium data  Contract cost data 22 May 2015 9 Agenda  Overview  Background  Data  Insurance Cost Estimate Methodology

  19. The Preventable Admissions Care Team (PACT): A Social Work-Led Model of Transitional Care.

    Science.gov (United States)

    Basso Lipani, Maria; Holster, Kathleen; Bussey, Sarah

    2015-10-01

    In 2010, the Preventable Admissions Care Team (PACT), a social work-led transitional care model, was developed at Mount Sinai to reduce 30-day readmissions among high-risk patients. PACT begins with a comprehensive bedside assessment to identify the psychosocial drivers of readmission. In partnership with the patient and family, a patient-centered action plan is developed and carried out through phone calls, accompaniments, navigations and home visits, as needed, in the first 30 days following discharge. 620 patients were enrolled during the pilot from September 2010-August 2012. Outcomes demonstrated a 43% reduction in inpatient utilization and a 54% reduction in emergency department visits among enrollees. In addition, 93% of patients had a follow-up appointment within 7-10 days of discharge and 90% of patients attended the appointment. The success of PACT has led to additional funding from the Centers for Medicare and Medicaid Services under the Community-based Care Transitions Program and several managed care companies seeking population health management interventions for high risk members.

  20. Minimum standard guidelines of care on requirements for setting up a laser room

    Directory of Open Access Journals (Sweden)

    Dhepe Niteen

    2009-08-01

    Full Text Available Introduction, definition, rationale and scope: Lasers are now becoming an integral part of dermatological practice in India, with more and more dermatologists starting laser dermatology practice. Lasers, when are used with care, by properly trained operators, in carefully designed environment, can deliver a range of useful aesthetic and dermatologic treatments. Facility: Laser treatment is an office procedure, hence it does not require hospital set-up. The laser room facility requires careful planning keeping in mind safety of both patient and operator, convenience of operating, and optimum handling of costly equipments. The facility should be designed to handle procedures under local anesthesia and sedation. Facilities, staff and equipment to handle any emergencies should be available. Location: A room in existing dermatology clinic can be adequately converted to a laser room. Dimensions of laser room, its door and patient′s table should be such that it should facilitate easy movement of patient, machine trolley, operator and assistant in case of routine procedures and in emergency. Physician Qualification: Any dermatologist with MD or diploma in dermatology can do laser procedures, provided he/ she has acquired necessary skills by virtue of training, observing a competent dermatologist. Such training may be obtained during post graduation or later in specified workshops or courses under a competent dermatologist or at centre which routinely performs such procedures. Electricity and uninterrupted power supply: Laser equipments should be connected to stabilizer or UPS circuits only. Preferably an on line UPS as recommended by the laser company should be installed. Earthing of the equipment is essential to avoid damage to the equipment and electrical shocks to the operator. Sufficient power back up to complete the procedure if power is off midway, is essential. Air-conditioning: Laser machines should be operated in low ambient temperature, with

  1. Attitudes of Doctors and Nurses toward the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Rolando Bonal Ruiz

    2015-06-01

    Full Text Available Background: the fact that chronic diseases replace traditional causes of morbidity and mortality in a country, or are on a par with major common health problems, demands the development of new strategies to address them. Objective: to explore attitudes of doctors and nurses from the Rolando López Peña Polyclinic toward the Chronic Care Model. Methods: a quantitative and qualitative cross-sectional study was conducted including the 22 family physicians and 26 nurses who provide care to patients with chronic diseases and were at the polyclinic at the time of the study. All were administered a 5 point Likert scale and a focus group interview, which was taped, transcribed and analyzed. Results: the attitudinal results correspond with the actions assessed in each component of the model, being the most common barriers: the lack of awareness and training on the new approaches to care of these patients, work overload created by other programs such as the maternal-child and vector control programs, uncertainties on the effectiveness of patient education and ignorance of the practice guidelines. Conclusions: favorable attitudes toward the introduction of the model to the practice of the family physician and nurse predominated as long as organizational changes are made and the suggestions of these service providers are put into practice with the support of the decision makers of the health sector.

  2. The CARE model of social accountability: promoting cultural change.

    Science.gov (United States)

    Meili, Ryan; Ganem-Cuenca, Alejandra; Leung, Jannie Wing-sea; Zaleschuk, Donna

    2011-09-01

    On the 10th anniversary of Health Canada and the Association of Faculties of Medicine of Canada's publication in 2001 of Social Accountability: A Vision for Canadian Medical Schools, the authors review the progress at one Canadian medical school, the College of Medicine at the University of Saskatchewan, in developing a culture of social accountability. They review the changes that have made the medical school more socially accountable and the steps taken to make those changes possible. In response to calls for socially accountable medical schools, the College of Medicine created a Social Accountability Committee to oversee the integration of these principles into the college. The committee developed the CARE model (Clinical activity, Advocacy, Research, Education and training) as a guiding tool for social accountability initiatives toward priority health concerns and as a means of evaluation. Diverse faculty and student committees have emerged as a result and have had far-reaching impacts on the college and communities: from changes in curricula and admissions to community programming and international educational experiences. Although a systematic assessment of the CARE model is needed, early evidence shows that the most significant effects can be found in the cultural shift in the college, most notably among students. The CARE model may serve as an important example for other educational institutions in the development of health practitioners and research that is responsive to the needs of their communities.

  3. An emerging model of maternity care: smartphone, midwife, doctor?

    Science.gov (United States)

    Tripp, Nadia; Hainey, Kirsten; Liu, Anthony; Poulton, Alison; Peek, Michael; Kim, Jinman; Nanan, Ralph

    2014-03-01

    Mobile technology in the form of the smartphone is widely used, particularly in pregnancy and they are an increasing and influential source of information. To describe the diverse nature of pregnancy related applications (apps) for the smartphone and to flag that these apps can potentially affect maternity care and should be considered in future planning of care provision. The 2 smartphone platforms, Apple and Android, were searched for pregnancy related apps and reviewed for their purpose and popularity. iTunes and Google Play returned 1059 and 497 pregnancy related apps respectively. Forty percent of the apps were informative, 13% interactive, 19% had features of a medical tool and 11% were social media apps. By far the most popular apps, calculated as the number of reviews multiplied by average reviewer rating, were those with interactive features. The popularity of pregnancy-related apps could indicate a shift towards patient empowerment within maternity care provision. The traditional model of 'shared maternity care' needs to accommodate electronic devices into its functioning. Reliance on healthcare professionals may be reduced by the availability of interactive and personalised information delivered via a smartphone. This combined with the fact that smartphones are widely used by many women of childbearing age, has the potential to modify maternity care and experiences of pregnancy. Therefore it is important that healthcare professionals and policy-makers are more aware of these new developments, which are likely to influence healthcare and alter health-seeking behaviour. In addition healthcare professionals need to consider whether to discuss the use of apps in pregnancy with the women in their care. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  4. The cost of universal health care in India: a model based estimate.

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    Shankar Prinja

    Full Text Available INTRODUCTION: As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. METHODS: We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. RESULTS: We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73 per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8% of the GDP for universalizing health care services. CONCLUSION: The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

  5. The cost of universal health care in India: a model based estimate.

    Science.gov (United States)

    Prinja, Shankar; Bahuguna, Pankaj; Pinto, Andrew D; Sharma, Atul; Bharaj, Gursimer; Kumar, Vishal; Tripathy, Jaya Prasad; Kaur, Manmeet; Kumar, Rajesh

    2012-01-01

    As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73) per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8%) of the GDP for universalizing health care services. The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

  6. Department of Defense Enterprise Requirements and Acquisition Model

    Science.gov (United States)

    2011-06-01

    30  Figure 11: ExtendSim Icons ...collected through a series of interviews with space requirements and acquisition personnel from AFSPC Requirements directorate (AFSPC/ A5 ), the Under...of the many ExtendSim® icons are described and illustrated in Figure 11. The “Event/Activity” icon is implemented with a time duration allowing a

  7. Genomic selection needs to be carefully assessed to meet specific requirements in livestock breeding programs.

    Science.gov (United States)

    Jonas, Elisabeth; de Koning, Dirk-Jan

    2015-01-01

    Genomic selection is a promising development in agriculture, aiming improved production by exploiting molecular genetic markers to design novel breeding programs and to develop new markers-based models for genetic evaluation. It opens opportunities for research, as novel algorithms and lab methodologies are developed. Genomic selection can be applied in many breeds and species. Further research on the implementation of genomic selection (GS) in breeding programs is highly desirable not only for the common good, but also the private sector (breeding companies). It has been projected that this approach will improve selection routines, especially in species with long reproduction cycles, late or sex-limited or expensive trait recording and for complex traits. The task of integrating GS into existing breeding programs is, however, not straightforward. Despite successful integration into breeding programs for dairy cattle, it has yet to be shown how much emphasis can be given to the genomic information and how much additional phenotypic information is needed from new selection candidates. Genomic selection is already part of future planning in many breeding companies of pigs and beef cattle among others, but further research is needed to fully estimate how effective the use of genomic information will be for the prediction of the performance of future breeding stock. Genomic prediction of production in crossbreeding and across-breed schemes, costs and choice of individuals for genotyping are reasons for a reluctance to fully rely on genomic information for selection decisions. Breeding objectives are highly dependent on the industry and the additional gain when using genomic information has to be considered carefully. This review synthesizes some of the suggested approaches in selected livestock species including cattle, pig, chicken, and fish. It outlines tasks to help understanding possible consequences when applying genomic information in breeding scenarios.

  8. Genomic selection needs to be carefully assessed to meet specific requirements in livestock breeding programs

    Directory of Open Access Journals (Sweden)

    Elisabeth eJonas

    2015-02-01

    Full Text Available Genomic selection is a promising development in agriculture, aiming improved production by exploiting molecular genetic markers to design novel breeding programs and to develop new markers-based models for genetic evaluation. It opens opportunities for research, as novel algorithms and lab methodologies are developed. Genomic selection can be applied in many breeds and species. Further research on the implementation of genomic selection in breeding programs is highly desirable not only for the common good, but also the private sector (breeding companies. It has been projected that this approach will improve selection routines, especially in species with long reproduction cycles, late or sex-limited or expensive trait recording and for complex traits. The task of integrating genomic selection into existing breeding programs is, however, not straightforward. Despite successful integration into breeding programs for dairy cattle, it has yet to be shown how much emphasis can be given to the genomic information and how much additional phenotypic information is needed from new selection candidates. Genomic selection is already part of future planning in many breeding companies of pigs and beef cattle among others, but further research is needed to fully estimate how effective the use of genomic information will be for the prediction of the performance of future breeding stock. Genomic prediction of production in crossbreeding and across-breed schemes, costs and choice of individuals for genotyping are reasons for a reluctance to fully rely on genomic information for selection decisions. Breeding objectives are highly dependent on the industry and the additional gain when using genomic information has to be considered carefully. This review synthesizes some of the suggested approaches in selected livestock species including cattle, pig, chicken and fish. It outlines tasks to help understanding possible consequences when applying genomic information in

  9. A model for reducing health care employee turnover.

    Science.gov (United States)

    Nowak, Paul; Holmes, Gary; Murrow, Jim

    2010-01-01

    Explaining the rationale as to why employees leave their jobs has led to many different strategies to retain employees. The model presented here seeks to explain why employees choose to stay or to leave their place of employment. The information from the analysis will provide managers with well-tested tools to reduce turnover and to ascertain what employees value from their work environment in order to help the organization to retain those employees. The model identifies key factors that management can utilize to provide barriers to exit and retain professional employees in their health care units. Recommendations are provided that reward loyalty and build barriers to exit.

  10. Chronic care model for the management of depression: synthesis of barriers to, and facilitators of, success.

    Science.gov (United States)

    Holm, Anne Lise; Severinsson, Elisabeth

    2012-12-01

    Depression is a socially- and physically-disabling condition. The Chronic Care Model (CCM) was developed to promote better management of long-term conditions, such as depression, in primary care settings. The aim of the study was to identify barriers to, and facilitators of, success when implementing the CCM for the management of depression in primary care. A systematic search was conducted in electronic databases from January 2005 to December 2011. Thirteen articles met the inclusion criteria and were reviewed by means of a thematic analysis. The barriers were categorized under two themes: lack of organizational, administrative, and professional ability to change and implement the components of the CCM; and lack of clarity pertaining to the responsibility inherent in the role of care manager (often a nurse) when it comes to promoting the patient's self-management ability. In terms of the facilitators of success, two themes emerged: leadership support and vision, and redesigning the delivery system. When shaping an environment for organizational change, leadership and professionals must work towards a common goal and vision. Such processes require a care manager with a clear role and responsibilities in order for the health-care system to meet the needs of the person with depression. © 2012 The Authors. International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

  11. Translating Pressure Ulcer Prevention Into Intensive Care Nursing Practice: Overlaying a Care Bundle Approach With a Model for Research Implementation.

    Science.gov (United States)

    Tayyib, Nahla; Coyer, Fiona

    This article reports on the development and implementation process used to integrate a care bundle approach (a pressure ulcer [PU] prevention bundle to improve patients' skin integrity in intensive care) and the Ottawa Model of Research Use (OMRU). The PU prevention care bundle demonstrated significant reduction in PU incidence, with the OMRU model providing a consolidated framework for the implementation of bundled evidence in an effective and consistent manner into daily clinical nursing practice.

  12. Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices: A Modeling Study.

    Science.gov (United States)

    Basu, Sanjay; Phillips, Russell S; Bitton, Asaf; Song, Zirui; Landon, Bruce E

    2015-10-20

    Physicians have traditionally been reimbursed for face-to-face visits. A new non-visit-based payment for chronic care management (CCM) of Medicare patients took effect in January 2015. To estimate financial implications of CCM payment for primary care practices. Microsimulation model incorporating national data on primary care use, staffing, expenditures, and reimbursements. National Ambulatory Medical Care Survey and other published sources. Medicare patients. 10 years. Practice-level. Comparison of CCM delivery approaches by staff and physicians. Net revenue per full-time equivalent (FTE) physician; time spent delivering CCM services. If nonphysician staff were to deliver CCM services, net revenue to practices would increase despite opportunity and staffing costs. Practices could expect approximately $332 per enrolled patient per year (95% CI, $234 to $429) if CCM services were delivered by registered nurses (RNs), approximately $372 (CI, $276 to $468) if services were delivered by licensed practical nurses, and approximately $385 (CI, $286 to $485) if services were delivered by medical assistants. For a typical practice, this equates to more than $75 ,00 of net annual revenue per FTE physician and 12 hours of nursing service time per week if 50% of eligible patients enroll. At a minimum, 131 Medicare patients (CI, 115 to 140 patients) must enroll for practices to recoup the salary and overhead costs of hiring a full-time RN to provide CCM services. If physicians were to deliver all CCM services, approximately 25% of practices nationwide could expect net revenue losses due to opportunity costs of face-to-face visit time. The CCM program may alter long-term primary care use, which is difficult to predict. Practices that rely on nonphysician team members to deliver CCM services will probably experience substantial net revenue gains but must enroll a sufficient number of eligible patients to recoup costs. None.

  13. Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature

    OpenAIRE

    Aij,Kjeld Harald; Rapsaniotis,Sofia

    2017-01-01

    Kjeld Harald Aij, Sofia Rapsaniotis VU University Medical Center, Division Acute Care and Surgery, Amsterdam, The Netherlands Abstract: As health care organizations face pressures to improve quality and efficiency while reducing costs, leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean. Successful Lean leaders appear to use a coaching leadership style that shares underlying principles with servant leadership. There is little inform...

  14. A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP

    Directory of Open Access Journals (Sweden)

    Francis Rebecca

    2010-01-01

    Full Text Available Abstract Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT. Methods/Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. Trial registration The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR with number ACTRN12609000251224.

  15. A statewide model program to improve emergency department readiness for pediatric care.

    Science.gov (United States)

    Cichon, Mark E; Fuchs, Susan; Lyons, Evelyn; Leonard, Daniel

    2009-08-01

    Pediatric emergency patients have unique needs, requiring specialized personnel, training, equipment, supplies, and medications. Deficiencies in these areas have resulted in historically poorer outcomes for pediatric patients versus adults. Since 1985, federally funded Emergency Medical Services for Children (EMSC) programs in each state have been working to improve the quality of pediatric emergency care. The Health Resources and Services Administration now requires that all EMSC grantees report on specific performance measures. This includes implementation of a standardized system recognizing hospitals that are able to stabilize or manage pediatric medical emergencies and trauma cases. We describe the steps involved in implementing Illinois' 3-level facility recognition process to illustrate a model that other states might use to provide appropriate pediatric care and comply with new Health Resources and Services Administration performance measures.

  16. Chronic care model in primary care: can it improve health-related quality of life?

    Directory of Open Access Journals (Sweden)

    Aryani FMY

    2016-01-01

    Full Text Available Faridah Md Yusof Aryani,1 Shaun Wen Huey Lee,2 Siew Siang Chua,3 Li Ching Kok,4 Benny Efendie,2 Thomas Paraidathathu5 1Pharmaceutical Services Division, Ministry of Health Malaysia, Petaling Jaya, 2School of Pharmacy, Monash University Malaysia, Bandar Sunway, 3Department of Pharmacy, Faculty of Medicine, University of Malaya, 4Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, 5School of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia Purpose: Chronic diseases such as hypertension, diabetes mellitus, and hyperlipidemia are public health concerns. However, little is known about how these affect patient-level health measures. The aim of the study was to examine the impact of a chronic care model (CCM on the participant’s health-related quality of life (QoL. Patients and methods: Participants received either usual care or CCM by a team of health care professionals including pharmacists, nurses, dietitians, and general practitioners. The participants in the intervention group received medication counseling, adherence, and dietary advice from the health care team. The QoL was measured using the EQ-5D (EuroQoL-five dimension, health-related quality of life questionnaire and comparison was made between usual care and intervention groups at the beginning and end of the study at 6 months. Results: Mean (standard deviation EQ-5D index scores improved significantly in the intervention group (0.92±0.10 vs 0.95±0.08; P≤0.01, but not in the usual care group (0.94±0.09 vs 0.95±0.09; P=0.084. Similarly, more participants in the intervention group reported improvements in their QoL compared with the usual care group, especially in the pain/discomfort and anxiety/depression dimensions. Conclusion: The implementation of the CCM resulted in significant improvement in QoL. An interdisciplinary team CCM approach should be encouraged, to ultimately result in behavior changes and improve the QoL of the patients. Keywords: diabetes

  17. User Requirements Model for University Timetable Management System

    OpenAIRE

    Ahmad Althunibat; Mohammad I. Muhairat

    2016-01-01

    Automated timetables are used to schedule courses, lectures and rooms in universities by considering some constraints. Inconvenient and ineffective timetables often waste time and money. Therefore, it is important to investigate the requirements and potential needs of users. Thus, eliciting user requirements of University Timetable Management System (TMS) and their implication becomes an important process for the implementation of TMS. On this note, this paper seeks to propose a m...

  18. Characteristics and trends in required home care by GPs in Austria: diseases and functional status of patients

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    Pichler Ingrid

    2006-10-01

    Full Text Available Abstract Background Almost all societies carry responsibility towards patients who require continuous medical care at home. In many health systems the general practitioner cooperates with community based services of home care and coordinates all medical and non medical activities. In Austria the general practitioner together and in cooperation with relatives of the patient and professional organisations usually takes on this task by visiting his patients. This study was carried out to identify diseases that need home care and to describe the functional profile of home care patients in eastern Austria. Methods Cross sectional observational study with 17 GP practices participating during 2 study periods in 1997 and in 2004 in eastern Austria. Each GP identified patients requiring home care and assessed their underlying diseases and functional status by filling in a questionnaire personally after an encounter. Patients in nursing homes were excluded. Statistical tests used were t-tests, contingency tables, nonparametric Wilcoxon signed rank sum test and Fisher-combination test. Results Patients with degenerative diseases of the central nervous system (65% caused by Alzheimer's disease and cerebrovascular occlusive disease and patients with degenerative diseases of the skeletal system (53% were the largest groups among the 198 (1997 and 261 (2004 home care cases of the 11 (1997 and 13 (2004 practices. Malignant diseases in a terminal state constituted only 5% of the cases. More than two thirds of all cases were female with an average age of 80 years. Slightly more than 70% of the patients were at least partially mobile. Conclusion Home care and home visits for patients with degenerative diseases of the central nervous and skeletal system are important elements of GP's work. Further research should therefore focus on effective methods of training and rehabilitation to better the mental and physical status of patients living in their private homes.

  19. Modeling the determinants of Medicaid home care payments for children with special health care needs: A structural equation model approach.

    Science.gov (United States)

    Adepoju, Omolola E; Zhang, Yichen; Phillips, Charles D

    2014-10-01

    The management of children with special needs can be very challenging and expensive. To examine direct and indirect cost drivers of home care expenditures for this vulnerable and expensive population. We retrospectively assessed secondary data on children, ages 4-20, receiving Medicaid Personal Care Services (PCS) (n = 2760). A structural equation model assessed direct and indirect effects of several child characteristics, clinical conditions and functional measures on Medicaid home care payments. The mean age of children was 12.1 years and approximately 60% were female. Almost half of all subjects reported mild, moderate or severe ID diagnosis. The mean ADL score was 5.27 and about 60% of subjects received some type of rehabilitation services. Caseworkers authorized an average of 25.5 h of PCS support per week. The SEM revealed three groups of costs drivers: indirect, direct and direct + indirect. Cognitive problems, health impairments, and age affect expenditures, but they operate completely through other variables. Other elements accumulate effects (externalizing behaviors, PCS hours, and rehabilitation) and send them on a single path to the dependent variable. A few elements exhibit a relatively complex position in the model by having both significant direct and indirect effects on home care expenditures - medical conditions, intellectual disability, region, and ADL function. The most important drivers of home care expenditures are variables that have both meaningful direct and indirect effects. The only one of these factors that may be within the sphere of policy change is the difference among costs in different regions. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Designing a Care Pathway Model – A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway

    Directory of Open Access Journals (Sweden)

    Robin I. Oosterholt

    2017-03-01

    Full Text Available Introduction: Although the clinical attributes of total hip arthroplasty (THA care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. Theory: The outpatient THA care pathway enables patients to be discharged on the day of surgery, short- ening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. Methods: An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi- structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. Results: The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1 and mobilisation & discharge (4. The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. Conclusion: The design addressed existing problems and is an optimisation of the case hospital’s pathway. The network of actors consists of the patient (1, radiologist (1, anaesthetist (1, nurse specialist (1, pharmacist (1, orthopaedic surgeon (1,4, physiotherapist (1,4, nurse (4, doctor (4 and patient applica- tion (1,4. The critical value exchanges include patient preparation (mental and practical, patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

  1. Modelling the affordability and distributional implications of future health care financing options in South Africa.

    Science.gov (United States)

    McIntyre, Di; Ataguba, John E

    2012-03-01

    South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. Modelling the resource and revenue generation requirements of alternative reform options is critical to inform decision-making. This paper considers three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependents with the remainder using tax-funded services; and maintaining the status quo. Each scenario was modelled over a 15-year period using a spreadsheet model. Statistical analyses were also undertaken to evaluate the impact of options on the distribution of health care financing burden and benefits from using health services across socio-economic groups. Universal coverage would result in total health care spending levels equivalent to 8.6% of gross domestic product (GDP), which is comparable to current spending levels. It is lower than the status quo option (9.5% of GDP) and far lower than the option of expanding private insurance cover (over 13% of GDP). However, public funding of health services would have to increase substantially. Despite this, universal coverage would result in the most progressive financing system if the additional public funding requirements are generated through a surcharge on taxable income (but not if VAT is increased). The extended private insurance scheme option would be the least progressive and would impose a very high payment burden; total health care payments on average would be 10.7% of household consumption expenditure compared with the universal coverage (6.7%) and status quo (7.5%) options. The least pro-rich distribution of service benefits would be achieved under universal coverage. Universal coverage is affordable and would promote health system equity, but

  2. Managing health care decisions and improvement through simulation modeling.

    Science.gov (United States)

    Forsberg, Helena Hvitfeldt; Aronsson, Håkan; Keller, Christina; Lindblad, Staffan

    2011-01-01

    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.

  3. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities.

    Science.gov (United States)

    Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen

    2015-01-01

    Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Models of care for orphaned and separated children and upholding children's rights: cross-sectional evidence from western Kenya.

    Science.gov (United States)

    Embleton, Lonnie; Ayuku, David; Kamanda, Allan; Atwoli, Lukoye; Ayaya, Samuel; Vreeman, Rachel; Nyandiko, Winstone; Gisore, Peter; Koech, Julius; Braitstein, Paula

    2014-04-01

    Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children's basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. The Orphaned and Separated Children's Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher's exact test was also used if some cells had expected value of less than 5. Included in this analysis are data from 300 households, 19 Charitable Children's Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI's and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as 'Pure CCI' for those only providing residential care, 'CCI-Plus' for those providing both residential care and community-based supports to orphaned children , and 'CCI-Shelter' which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately

  5. [Application of the Balance of Care model in decision-making regarding the best care for patients with dementia].

    Science.gov (United States)

    Risco, Ester; Zabalegui, Adelaida; Miguel, Susana; Farré, Marta; Alvira, Carme; Cabrera, Esther

    To describe the implementation of the Balance of Care model in decision-making regarding the best care for patients with dementia in Spain. The Balance of Care model was used, which consists of (1) describing the profile of the typical cases of people with dementia and their caregivers, (2) identifying the most suitable care setting for each of the cases (home-care or long-term care institution), (3) designing specific care plans for each case, and (4) evaluating the cost of the proposed care plans. A total of 1,641 people with dementia and their caregivers from eight European countries were used in the case design. The evaluation of cases was conducted by 20 experts in different medical fields of dementia. In Spain, the results indicated that initially the most suitable placement to take care of people with dementia was the home, however in cases with higher dependency in activities of daily living, the long-term care setting was the best option. For the best care plan, the following resources were chosen: professional help to perform basic activities; day center; multidisciplinary home care team; financial support; community nurse; and social worker. The Balance of Care method allows us to assess the most appropriate place of care for people with dementia systematically, objectively and with a multidisciplinary team. Other cost-effective interventions should be integrated in patients with dementia care in order to improve home care. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Neuro-Ophthalmology: Transitioning From Old to New Models of Health Care Delivery.

    Science.gov (United States)

    Frohman, Larry P

    2017-06-01

    In contradiction to fundamental laws of supply and demand, 2 decades of payment policies have led to some medical specialties experiencing declines in both manpower and reimbursement. This paradox has resulted in increasingly long wait times to see some specialists, some specialties becoming less attractive to potential trainees, and a dearth of new trainees entering these fields. Evolving models of health care delivery hold the promise of increasing patient access to most providers and may diminish costs and improve outcomes for most patients/conditions. However, patients who need care in understaffed fields may, in the future, be unable to quickly access a specialist with the requisite expertise. Impeding the sickest and most complex patients from seeing physicians with appropriate expertise may lead to increased costs and deleterious outcomes-consequences contrary to the goals of health care reform. To ensure appropriate access for these patients requires 2 conditions: 1. Compensation models that do not discourage trainees from pursuing nonprocedural specialties, and 2. A care delivery model that expediently identifies and routes these patients to the appropriate specialist.

  7. Bioenergy crop models: Descriptions, data requirements and future challenges

    Energy Technology Data Exchange (ETDEWEB)

    Nair, S. Surendran [University of Tennessee, Knoxville (UTK); Kang, Shujiang [ORNL; Zhang, Xuesong [Pacific Northwest National Laboratory (PNNL); Miguez, Fernando [Iowa State University; Izaurralde, Dr. R. Cesar [Pacific Northwest National Laboratory (PNNL); Post, Wilfred M [ORNL; Dietze, Michael [University of Illinois, Urbana-Champaign; Lynd, L. [Dartmouth College; Wullschleger, Stan D [ORNL

    2012-01-01

    Field studies that address the production of lignocellulosic biomass as a source of renewable energy provide critical data for the development of bioenergy crop models. A literature survey revealed that 14 models have been used for simulating bioenergy crops including herbaceous and woody bioenergy crops, and for crassulacean acid metabolism (CAM) crops. These models simulate field-scale production of biomass for switchgrass (ALMANAC, EPIC, and Agro-BGC), miscanthus (MISCANFOR, MISCANMOD, and WIMOVAC), sugarcane (APSIM, AUSCANE, and CANEGRO), and poplar and willow (SECRETS and 3PG). Two models are adaptations of dynamic global vegetation models and simulate biomass yields of miscanthus and sugarcane at regional scales (Agro-IBIS and LPJmL). Although it lacks the complexity of other bioenergy crop models, the environmental productivity index (EPI) is the only model used to estimate biomass production of CAM (Agave and Opuntia) plants. Except for the EPI model, all models include representations of leaf area dynamics, phenology, radiation interception and utilization, biomass production, and partitioning of biomass to roots and shoots. A few models simulate soil water, nutrient, and carbon cycle dynamics, making them especially useful for assessing the environmental consequences (e.g., erosion and nutrient losses) associated with the large-scale deployment of bioenergy crops. The rapid increase in use of models for energy crop simulation is encouraging; however, detailed information on the influence of climate, soils, and crop management practices on biomass production is scarce. Thus considerable work remains regarding the parameterization and validation of process-based models for bioenergy crops; generation and distribution of high-quality field data for model development and validation; and implementation of an integrated framework for efficient, high-resolution simulations of biomass production for use in planning sustainable bioenergy systems.

  8. Team-Based Models for End-of-Life Care: An Evidence-Based Analysis

    Science.gov (United States)

    2014-01-01

    Background End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. Objectives Our objective was to determine whether an optimal team-based model of care exists for service delivery at end of life. In systematically reviewing such models, we considered their core components: team membership, services offered, modes of patient contact, and setting. Data Sources A literature search was performed on October 14, 2013, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to October 14, 2013. Review Methods Abstracts were reviewed by a single reviewer and full-text articles were obtained that met the inclusion criteria. Studies were included if they evaluated a team model of care compared with usual care in an end-of-life adult population. A team was defined as having at least 2 health care disciplines represented. Studies were limited to English publications. A meta-analysis was completed to obtain pooled effect estimates where data permitted. The GRADE quality of the evidence was evaluated. Results Our literature search located 10 randomized controlled trials which, among them, evaluated the following 6 team-based models of care: hospital, direct contact home, direct contact home, indirect contact comprehensive, indirect contact comprehensive, direct contact comprehensive, direct, and early contact Direct contact is when team members see the patient; indirect contact is when they advise another health care practitioner (e.g., a family doctor) who sees

  9. [The transformation of the healthcare model in Catalonia to improve the quality of care].

    Science.gov (United States)

    Padrosa, Josep Maria; Guarga, Àlex; Brosa, Francesc; Jiménez, Josep; Robert, Roger

    2015-11-01

    The changes taking place in western countries require health systems to adapt to the public's evolving needs and expectations. The healthcare model in Catalonia is undergoing significant transformation in order to provide an adequate response to this new situation while ensuring the system's sustainability in the current climate of economic crisis. This transformation is based on converting the current disease-centred model which is fragmented into different levels, to a more patient-centred integrated and territorial care model that promotes the use of a shared network of the different specialities, the professionals, resources and levels of care, entering into territorial agreements and pacts which stipulate joint goals or objectives. The changes the Catalan Health Service (CatSalut) has undergone are principally focused on increasing resolution capacity of the primary level of care, eliminating differences in clinical practice, evolving towards more surgery-centred hospitals, promoting alternatives to conventional hospitalization, developing remote care models, concentrating and organizing highly complex care into different sectors at a territorial level and designing specific health codes in response to health emergencies. The purpose of these initiatives is to improve the effectiveness, quality, safety and efficiency of the system, ensuring equal access for the public to these services and ensuring a territorial balance. These changes should be facilitated and promoted using several different approaches, including implementing shared access to clinical history case files, the new model of results-based contracting and payment, territorial agreements, alliances between centres, harnessing the potential of information and communications technology and evaluation of results. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  10. The Norrtaelje model: a unique model for integrated health and social care in Sweden.

    Science.gov (United States)

    Bäck, Monica Andersson; Calltorp, Johan

    2015-01-01

    Many countries organise and fund health and social care separately. The Norrtaelje model is a Swedish initiative that transformed the funding and organisation of health and social care in order to better integrate care for older people with complex needs. In Norrtaelje model, this transformation made it possible to bringing the team together, to transfer responsibility to different providers, to use care coordinators, and to develop integrated pathways and plans around transitions in and out of hospital and from nursing homes to hospital. The Norrtaelje model operates in the context of the Swedish commitment to universal coverage and public programmes based on tax-funded resources that are pooled and redistributed to citizens on the basis of need. The experience of Norrtaelje model suggests that one way to promote integration of health and social care is to start with a transformation that aligns these two sectors in terms of high level organisation and funding. This transformation then enables the changes in operations and management that can be translated into changes in care delivery. This "top-down" approach must be in-line with national priorities and policies but ultimately is successful only if the culture, resource allocation and management are changed throughout the local system.

  11. Commonsense Psychology and the Functional Requirements of Cognitive Models

    National Research Council Canada - National Science Library

    Gordon, Andrew S

    2005-01-01

    .... Rather than working to avoid the influence of commonsense psychology in cognitive modeling research, we propose to capitalize on progress in developing formal theories of commonsense psychology...

  12. Requirements for data integration platforms in biomedical research networks: a reference model.

    Science.gov (United States)

    Ganzinger, Matthias; Knaup, Petra

    2015-01-01

    Biomedical research networks need to integrate research data among their members and with external partners. To support such data sharing activities, an adequate information technology infrastructure is necessary. To facilitate the establishment of such an infrastructure, we developed a reference model for the requirements. The reference model consists of five reference goals and 15 reference requirements. Using the Unified Modeling Language, the goals and requirements are set into relation to each other. In addition, all goals and requirements are described textually in tables. This reference model can be used by research networks as a basis for a resource efficient acquisition of their project specific requirements. Furthermore, a concrete instance of the reference model is described for a research network on liver cancer. The reference model is transferred into a requirements model of the specific network. Based on this concrete requirements model, a service-oriented information technology architecture is derived and also described in this paper.

  13. Design Challenges of an Episode-Based Payment Model in Oncology: The Centers for Medicare & Medicaid Services Oncology Care Model.

    Science.gov (United States)

    Kline, Ronald M; Muldoon, L Daniel; Schumacher, Heidi K; Strawbridge, Larisa M; York, Andrew W; Mortimer, Laura K; Falb, Alison F; Cox, Katherine J; Bazell, Carol; Lukens, Ellen W; Kapp, Mary C; Rajkumar, Rahul; Bassano, Amy; Conway, Patrick H

    2017-07-01

    The Centers for Medicare & Medicaid Services developed the Oncology Care Model as an episode-based payment model to encourage participating practitioners to provide higher-quality, better-coordinated care at a lower cost to the nearly three-quarter million fee-for-service Medicare beneficiaries with cancer who receive chemotherapy each year. Episode payment models can be complex. They combine into a single benchmark price all payments for services during an episode of illness, many of which may be delivered at different times by different providers in different locations. Policy and technical decisions include the definition of the episode, including its initiation, duration, and included services; the identification of beneficiaries included in the model; and beneficiary attribution to practitioners with overall responsibility for managing their care. In addition, the calculation and risk adjustment of benchmark episode prices for the bundle of services must reflect geographic cost variations and diverse patient populations, including varying disease subtypes, medical comorbidities, changes in standards of care over time, the adoption of expensive new drugs (especially in oncology), as well as diverse practice patterns. Other steps include timely monitoring and intervention as needed to avoid shifting the attribution of beneficiaries on the basis of their expected episode expenditures as well as to ensure the provision of necessary medical services and the development of a meaningful link to quality measurement and improvement through the episode-based payment methodology. The complex and diverse nature of oncology business relationships and the specific rules and requirements of Medicare payment systems for different types of providers intensify these issues. The Centers for Medicare & Medicaid Services believes that by sharing its approach to addressing these decisions and challenges, it may facilitate greater understanding of the model within the oncology

  14. Modelling and Simulation for Requirements Engineering and Options Analysis

    Science.gov (United States)

    2010-05-01

    should be performed to work successfully in the domain; and process-based techniques model the processes that occur in the work domain. There is a crisp ...acad/sed/sedres/ dm /erg/cwa. DRDC Toronto CR 2010-049 39 23. Can the current technique for developing simulation models for assessments

  15. Single High Fidelity Geometric Data Sets for LCM - Model Requirements

    Science.gov (United States)

    2006-11-01

    designed specifically to withstand severe underwater explosion (UNDEX) loading caused by the detonation of weapons such as bombs, missiles, mines and... Explosions ( BLEVEs ): The energy from a BLEVE is from a sudden change of phase of stored material. Tanks of liquids immersed in pool fires BLEVE when the...2.10.3 Summary of Data Requirements ....................................................... 46 2.11 Underwater Explosion

  16. Requirements engineering for trust management: Model, methodology, and reasoning

    NARCIS (Netherlands)

    Giorgini, P.; Massacci, F.; Mylopoulos, J.; Zannone, N.

    2006-01-01

    A number of recent proposals aim to incorporate security engineering into mainstream software engineering. Yet, capturing trust and security requirements at an organizational level, as opposed to an IT system level, and mapping these into security and trust management policies is still an open

  17. Evaluating Diabetes Care for Patients With Serious Mental Illness Using the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Kelly Vaez

    2017-10-01

    Full Text Available People with serious mental illness (SMI have a higher incidence of type 2 diabetes mellitus (T2DM and shorter life span due to medical health problems. The chronic care model (CCM has been used to improve care of patients with T2DM. One clinical organization that provided primary care to patients with SMI had excellent diabetes outcomes but did not have information on how they achieved those outcomes. Thus, we conducted a pilot study chart review for 30 patients with T2DM and SMI to determine how well the clinic’s system aligned with the overall CCM components and which components correlated with diabetes control. We also evaluated use of the CCM using the Assessment of Chronic Illness Care provider survey. Results showed that the clinic had an overall basic implementation level of the CCM, which allows opportunity for improvement. Two elements of the CCM were correlated with hemoglobin A 1C and both were in an unexpected direction: self-management support in the variable of percentage of visits that included patient-specific goal-setting ( r s = .52; P = .004 and delivery system design in the variable of number of nurse practitioner visits per study period ( r s = .43; P = .02. These findings suggest that the clinic may have made more concentrated efforts to manage diabetes for patients who were not in good diabetes control. Providers noted the influence of SMI and social service organization support on these patients’ clinical outcomes. The findings will be reexamined after a fuller implementation of the CCM to further improve management in this population.

  18. A model for 'reverse innovation' in health care.

    Science.gov (United States)

    Depasse, Jacqueline W; Lee, Patrick T

    2013-08-30

    'Reverse innovation,' a principle well established in the business world, describes the flow of ideas from emerging to more developed economies. There is strong and growing interest in applying this concept to health care, yet there is currently no framework for describing the stages of reverse innovation or identifying opportunities to accelerate the development process. This paper combines the business concept of reverse innovation with diffusion of innovation theory to propose a model for reverse innovation as a way to innovate in health care. Our model includes the following steps: (1) identifying a problem common to lower- and higher-income countries; (2) innovation and spread in the low-income country (LIC); (3) crossover to the higher-income country (HIC); and (4) innovation and spread in the HIC. The crucial populations in this pathway, drawing from diffusion of innovation theory, are LIC innovators, LIC early adopters, and HIC innovators. We illustrate the model with three examples of current reverse innovations. We then propose four sets of specific actions that forward-looking policymakers, entrepreneurs, health system leaders, and researchers may take to accelerate the movement of promising solutions through the reverse innovation pipeline: (1) identify high-priority problems shared by HICs and LICs; (2) create slack for change, especially for LIC innovators, LIC early adopters, and HIC innovators; (3) create spannable social distances between LIC early adopters and HIC innovators; and (4) measure reverse innovation activity globally.

  19. Bronchial thermoplasty: a novel treatment for severe asthma requiring monitored anesthesia care.

    Science.gov (United States)

    Lee, Jamille A; Rowen, David W; Rose, David D

    2011-12-01

    Dexmedetomidine used in monitored anesthesia care produces a safe and effective technique well documented in research. We report the successful use of dexmedetomidine for sedation during bronchial thermoplasty, a new treatment for patients with severe persistent asthma refractory to inhaled corticosteroids and long-term beta-2 agonists.

  20. Barriers and requirements for achieving interoperable eHealth technology in primary care

    NARCIS (Netherlands)

    Oude Nijeweme-d'Hollosy, Wendeline; van Velsen, Lex Stefan; Hermens, Hermanus J.

    2015-01-01

    Despite its great promises, eHealth is not yet structurally embedded within the IT infrastructure of primary care. This is mainly due to the fact that healthcare technologies have been developed without coordination and a centralized approach [1], which in turn has led to a lack of shared standards

  1. Current models of care for disorders of sex development

    DEFF Research Database (Denmark)

    Kyriakou, Andreas; Dessens, Arianne; Bryce, Jillian

    2016-01-01

    BACKGROUND: To explore the current models of practice in centres delivering specialist care for children with disorders of sex development (DSD), an international survey of 124 clinicians, identified through DSDnet and the I-DSD Registry, was performed in the last quarter of 2014. RESULTS: A total...... by 14 (19 %) centres. In addition to complex biochemistry and molecular genetic investigations, 40 clinicians (51 %) also had access to next generation sequencing. A genetic test was reported to be more preferable than biochemical tests for diagnosing 5-alpha reductase deficiency and 17-beta...

  2. Childhood Heart Disease - A partnership model of integrated care

    OpenAIRE

    Williams, Holly; Brooke, Mark

    2018-01-01

    HeartKids is a national charity supporting infants, children, young people and adults living with or impacted by congenital / childhood heart disease. For over 20 years HeartKids has worked in partnership with Lady Cilento Children's Hospital to deliver services and support to families.HeartKids supports families in hosptial and in the commuity with a suite of support programs lead by both health profesisonals and volunteers.  Critical to our model of care is a partnership with Lady Cilento C...

  3. Conducting requirements analyses for research using routinely collected health data: a model driven approach.

    Science.gov (United States)

    de Lusignan, Simon; Cashman, Josephine; Poh, Norman; Michalakidis, Georgios; Mason, Aaron; Desombre, Terry; Krause, Paul

    2012-01-01

    Medical research increasingly requires the linkage of data from different sources. Conducting a requirements analysis for a new application is an established part of software engineering, but rarely reported in the biomedical literature; and no generic approaches have been published as to how to link heterogeneous health data. Literature review, followed by a consensus process to define how requirements for research, using, multiple data sources might be modeled. We have developed a requirements analysis: i-ScheDULEs - The first components of the modeling process are indexing and create a rich picture of the research study. Secondly, we developed a series of reference models of progressive complexity: Data flow diagrams (DFD) to define data requirements; unified modeling language (UML) use case diagrams to capture study specific and governance requirements; and finally, business process models, using business process modeling notation (BPMN). These requirements and their associated models should become part of research study protocols.

  4. Design and application of a theory-based case/care management model for home care: advanced practice for nurses as care managers.

    Science.gov (United States)

    Sears, Nancy A

    2002-01-01

    Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.

  5. The redefinition of the familialist home care model in France: the complex formalization of care through cash payment.

    Science.gov (United States)

    Le Bihan, Blanche

    2012-05-01

    This article investigates the impact of policy measures on the organisation of home-based care for older people in France, by examining the balance between formal and informal care and the redefinition of the initial familialist model. It focuses on the specific cash for care scheme (the Allocation personnalisée d'autonomie - Personalised allowance for autonomy) which is at the core of the French home-based care policy. The author argues that in a redefined context of 'welfare mix', the French public strategy for supporting home-based care in France is articulated around two major objectives, which can appear contradictory. It aims to formalise a professional care sector, with respect to the employment policy while allowing the development of new forms of informal care, which cannot be considered to be formal employment. The data collection is two-fold. Firstly, a detailed analysis was made of different policy documents and public reports, together with a systematic review of existing studies. Secondly, statistical analysis on home-based care resources were collected, which was not easy, as home-care services for older people in France are part of a larger sector of activity, 'personal services' (services à la personne). The article exposes three main findings. First, it highlights the complexity of the formalisation process related to the introduction of the French care allowance and demonstrates that formalisation, which facilitates the recognition of care as work, does not necessarily mean professionalisation. Second, it outlines the diversity of the resources available: heterogeneous professional care, semi-formal forms of care work with the possibility to employ a relative and informal family care. Finally, the analysis outlines the importance of the regulation of cash payments on the reshaping of formal and informal care and comments on its impact on the redefinition of informal caring activities. © 2012 Blackwell Publishing Ltd.

  6. Providing surgical care in Somalia: A model of task shifting.

    Science.gov (United States)

    Chu, Kathryn M; Ford, Nathan P; Trelles, Miguel

    2011-07-15

    Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65%) were male and the median age was 22 (interquartile range, 17-30). 1460 (70%) of interventions were emergent. Trauma accounted for 76% (1585) of all surgical pathology; gunshot wounds accounted for 89% (584) of violent injuries. Operative mortality (0.5% of all surgical interventions) was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully trained surgeon and anesthesiologists. If security improves

  7. Four Reference Models for Transparency Requirements in Information Systems

    OpenAIRE

    Hosseini, Mahmoud; Shahri, Alimohammad; Phalp, Keith T.; Ali, Ra

    2017-01-01

    Transparency is a key emerging requirement in modern businesses and their information systems. Transparency refers to the information which flows amongst stakeholders for the purpose of informed decision-making and taking the right action. Transparency is generally associated with positive connotations such as trust and accountability. However, it has been shown that it could have adverse effects such as information overload and affecting decisions objectiveness. This calls for systematic app...

  8. Modelling catchment areas for secondary care providers: a case study.

    Science.gov (United States)

    Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

    2011-09-01

    Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

  9. Guideline validation in multiple trauma care through business process modeling.

    Science.gov (United States)

    Stausberg, Jürgen; Bilir, Hüseyin; Waydhas, Christian; Ruchholtz, Steffen

    2003-07-01

    Clinical guidelines can improve the quality of care in multiple trauma. In our Department of Trauma Surgery a specific guideline is available paper-based as a set of flowcharts. This format is appropriate for the use by experienced physicians but insufficient for electronic support of learning, workflow and process optimization. A formal and logically consistent version represented with a standardized meta-model is necessary for automatic processing. In our project we transferred the paper-based into an electronic format and analyzed the structure with respect to formal errors. Several errors were detected in seven error categories. The errors were corrected to reach a formally and logically consistent process model. In a second step the clinical content of the guideline was revised interactively using a process-modeling tool. Our study reveals that guideline development should be assisted by process modeling tools, which check the content in comparison to a meta-model. The meta-model itself could support the domain experts in formulating their knowledge systematically. To assure sustainability of guideline development a representation independent of specific applications or specific provider is necessary. Then, clinical guidelines could be used for eLearning, process optimization and workflow management additionally.

  10. Characteristics of evolving models of care for arthritis: A key informant study

    Directory of Open Access Journals (Sweden)

    Veinot Paula

    2008-07-01

    Full Text Available Abstract Background The burden of arthritis is increasing in the face of diminishing health human resources to deliver care. In response, innovative models of care delivery are developing to facilitate access to quality care. Most models have developed in response to local needs with limited evaluation. The primary objective of this study is to a examine the range of models of care that deliver specialist services using a medical/surgical specialist and at least one other health care provider and b document the strengths and challenges of the identified models. A secondary objective is to identify key elements of best practice models of care for arthritis. Methods Semi-structured interviews were conducted with a sample of key informants with expertise in arthritis from jurisdictions with primarily publicly-funded health care systems. Qualitative data were analyzed using a constant comparative approach to identify common types of models of care, strengths and challenges of models, and key components of arthritis care. Results Seventy-four key informants were interviewed from six countries. Five main types of models of care emerged. 1 Specialized arthritis programs deliver comprehensive, multidisciplinary team care for arthritis. Two models were identified using health care providers (e.g. nurses or physiotherapists in expanded clinical roles: 2 triage of patients with musculoskeletal conditions to the appropriate services including specialists; and 3 ongoing management in collaboration with a specialist. Two models promoting rural access were 4 rural consultation support and 5 telemedicine. Key informants described important components of models of care including knowledgeable health professionals and patients. Conclusion A range of models of care for arthritis have been developed. This classification can be used as a framework for discussing care delivery. Areas for development include integration of care across the continuum, including primary

  11. Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis.

    Science.gov (United States)

    Johnston, Maximilian J; King, Dominic; Arora, Sonal; Cooper, Kerri; Panda, Neha Aparajita; Gosling, Rebecca; Singh, Kaushiki; Sanders, Bradley; Cox, Benita; Darzi, Ara

    2014-08-01

    In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety. © 2014 John Wiley & Sons, Ltd.

  12. Model of care for a changing healthcare system: are there foundational pillars for design?

    Science.gov (United States)

    Booker, Catriona; Turbutt, Adam; Fox, Robyn

    2016-04-01

    Currently, healthcare organisations are being challenged to provide optimal clinical services within budget limitations while simultaneously being confronted by aging consumers and labour and skill shortages. Within this dynamic and changing environment, the ability to remain responsive to patient needs while managing these issues poses further challenges. Development or review of the model of care (MOC) may provide a possible solution to support efficiencies in service provision. Although MOC are not readily understood or appreciated as an efficiency strategy, they can be more easily explained by considering several recurring pillars when developing or redesigning an MOC. Generic and recurring foundational pillars include integrated care models, team functioning and communication, leadership, change management and lean thinking. These foundational pillars should be incorporated into the development and application of MOC in order to achieve desired outcomes. However, sustainability requires continuous review to enable improvement and must be integrated into routine business. Moreover, successful review of MOC requires collaboration and commitment by all stakeholders. Leaders are critical to motivating clinicians and stakeholders in the review process. Further, it is imperative that leaders engage stakeholders to commit to support the agreed strategies designed to provide efficient and comprehensive healthcare services. Redesign of MOC can significantly improve patient care by applying the agreed strategies. In the current healthcare environment, these strategies can favourably affect healthcare expenditure and, at the same time, improve the quality of interprofessional health services.

  13. Honoring Choices Minnesota: preliminary data from a community-wide advance care planning model.

    Science.gov (United States)

    Wilson, Kent S; Kottke, Thomas E; Schettle, Sue

    2014-12-01

    Advance care planning (ACP) increases the likelihood that individuals who are dying receive the care that they prefer. It also reduces depression and anxiety in family members and increases family satisfaction with the process of care. Honoring Choices Minnesota is an ACP program based on the Respecting Choices model of La Crosse, Wisconsin. The objective of this report is to describe the process, which began in 2008, of implementing Honoring Choices Minnesota in a large, diverse metropolitan area. All eight large healthcare systems in the metropolitan area agreed to participate in the project, and as of April 30, 2013, the proportion of hospitalized individuals 65 and older with advance care directives in the electronic medical record was 12.1% to 65.6%. The proportion of outpatients aged 65 and older was 11.6% to 31.7%. Organizations that had sponsored recruitment initiatives had the highest proportions of records containing healthcare directives. It was concluded that it is possible to reduce redundancy by recruiting all healthcare systems in a metropolitan area to endorse the same ACP model, although significantly increasing the proportion of individuals with a healthcare directive in their medical record requires a campaign with recruitment of organizations and individuals. © 2014 The Authors.The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

  14. A model linking clinical workforce skill mix planning to health and health care dynamics

    Directory of Open Access Journals (Sweden)

    McDonnell Geoff

    2010-04-01

    Full Text Available Abstract Background In an attempt to devise a simpler computable tool to assist workforce planners in determining what might be an appropriate mix of health service skills, our discussion led us to consider the implications of skill mixing and workforce composition beyond the 'stock and flow' approach of much workforce planning activity. Methods Taking a dynamic systems approach, we were able to address the interactions, delays and feedbacks that influence the balance between the major components of health and health care. Results We linked clinical workforce requirements to clinical workforce workload, taking into account the requisite facilities, technologies, other material resources and their funding to support clinical care microsystems; gave recognition to productivity and quality issues; took cognisance of policies, governance and power concerns in the establishment and operation of the health care system; and, going back to the individual, gave due attention to personal behaviour and biology within the socio-political family environment. Conclusion We have produced the broad endogenous systems model of health and health care which will enable human resource planners to operate within real world variables. We are now considering the development of simple, computable national versions of this model.

  15. A model linking clinical workforce skill mix planning to health and health care dynamics.

    Science.gov (United States)

    Masnick, Keith; McDonnell, Geoff

    2010-04-30

    In an attempt to devise a simpler computable tool to assist workforce planners in determining what might be an appropriate mix of health service skills, our discussion led us to consider the implications of skill mixing and workforce composition beyond the 'stock and flow' approach of much workforce planning activity. Taking a dynamic systems approach, we were able to address the interactions, delays and feedbacks that influence the balance between the major components of health and health care. We linked clinical workforce requirements to clinical workforce workload, taking into account the requisite facilities, technologies, other material resources and their funding to support clinical care microsystems; gave recognition to productivity and quality issues; took cognisance of policies, governance and power concerns in the establishment and operation of the health care system; and, going back to the individual, gave due attention to personal behaviour and biology within the socio-political family environment. We have produced the broad endogenous systems model of health and health care which will enable human resource planners to operate within real world variables. We are now considering the development of simple, computable national versions of this model.

  16. Chronic care model and cost reduction in initial health: a new approach for satisfaction and improvement of chronicity

    Directory of Open Access Journals (Sweden)

    Stefano Marcelli

    2017-10-01

    Full Text Available Nowadays, the number of elderly is growing, with consequent increase of chronic diseases. An effective approach to reduce the costs incurred is required. The Chronic Care Model has proven to be a good starting point for a better management of economic and human resources.

  17. Cost-Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care: Economic Evaluation Alongside a Stepped-Wedge Cluster-Randomized Trial

    NARCIS (Netherlands)

    van Leeuwen, K.M.; Bosmans, J.E.; Jansen, A.P.D.; Hoogendijk, E.O.; Muntinga, M.E.; van Hout, H.P.J.; Nijpels, G.; van der Horst, H.E.; van Tulder, M.W.

    2015-01-01

    Objectives To evaluate the cost-effectiveness of the Geriatric Care Model (GCM), an integrated care model for frail older adults based on the Chronic Care Model, with that of usual care. Design Economic evaluation alongside a 24-month stepped-wedge cluster-randomized controlled trial. Setting

  18. Cost-Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care : Economic Evaluation Alongside a Stepped-Wedge Cluster-Randomized Trial

    NARCIS (Netherlands)

    van Leeuwen, Karen M; Bosmans, Judith E; Jansen, Aaltje P D; Hoogendijk, Emiel O; Muntinga, Maaike E; van Hout, Hein P J; Nijpels, Giel; van der Horst, Henriette E; van Tulder, Maurits W

    2015-01-01

    OBJECTIVES: To evaluate the cost-effectiveness of the Geriatric Care Model (GCM), an integrated care model for frail older adults based on the Chronic Care Model, with that of usual care. DESIGN: Economic evaluation alongside a 24-month stepped-wedge cluster-randomized controlled trial. SETTING:

  19. Mathematical Formulation Requirements and Specifications for the Process Models

    International Nuclear Information System (INIS)

    Steefel, C.; Moulton, D.; Pau, G.; Lipnikov, K.; Meza, J.; Lichtner, P.; Wolery, T.; Bacon, D.; Spycher, N.; Bell, J.; Moridis, G.; Yabusaki, S.; Sonnenthal, E.; Zyvoloski, G.; Andre, B.; Zheng, L.; Davis, J.

    2010-01-01

    The Advanced Simulation Capability for Environmental Management (ASCEM) is intended to be a state-of-the-art scientific tool and approach for understanding and predicting contaminant fate and transport in natural and engineered systems. The ASCEM program is aimed at addressing critical EM program needs to better understand and quantify flow and contaminant transport behavior in complex geological systems. It will also address the long-term performance of engineered components including cementitious materials in nuclear waste disposal facilities, in order to reduce uncertainties and risks associated with DOE EM's environmental cleanup and closure activities. Building upon national capabilities developed from decades of Research and Development in subsurface geosciences, computational and computer science, modeling and applied mathematics, and environmental remediation, the ASCEM initiative will develop an integrated, open-source, high-performance computer modeling system for multiphase, multicomponent, multiscale subsurface flow and contaminant transport. This integrated modeling system will incorporate capabilities for predicting releases from various waste forms, identifying exposure pathways and performing dose calculations, and conducting systematic uncertainty quantification. The ASCEM approach will be demonstrated on selected sites, and then applied to support the next generation of performance assessments of nuclear waste disposal and facility decommissioning across the EM complex. The Multi-Process High Performance Computing (HPC) Simulator is one of three thrust areas in ASCEM. The other two are the Platform and Integrated Toolsets (dubbed the Platform) and Site Applications. The primary objective of the HPC Simulator is to provide a flexible and extensible computational engine to simulate the coupled processes and flow scenarios described by the conceptual models developed using the ASCEM Platform. The graded and iterative approach to assessments naturally

  20. What kind of information will be required if we are to reform health care?

    Science.gov (United States)

    Kaplan, J G

    1994-10-01

    The only logical way to avoid unnecessary future costs and improve quality is to analyze the past, providing input for the present. The informational management strategies are ready. There is continuous quality improvement, profiling with case-mix adjustment, and other techniques that will help us manage care and caring. But these strategies all rely on the customer being empowered to make truly informed decisions (the ethical principle of autonomy) and for us to advocate for patients (beneficence). Translating relevant data into information is the concentration of medical informatics. Virtually everyone in medical management can attest to the fact that, competitive forces notwithstanding, it is time for us to recognize not only that we are in the information business, but also that this information belongs to a larger community. Clearly, it is time to collaborate!

  1. Interdisciplinary Care Model Independently Decreases Use of Critical Care Services After Corrective Surgery for Adult Degenerative Scoliosis.

    Science.gov (United States)

    Adogwa, Owoicho; Elsamadicy, Aladine A; Sergesketter, Amanda R; Ongele, Michael; Vuong, Victoria; Khalid, Syed; Moreno, Jessica; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

    2018-03-01

    Interdisciplinary management of elderly patients requiring spine surgery has been shown to improve short- and long-term outcomes. The aim of this study was to determine whether an interdisciplinary team approach mitigates use of intensive care unit (ICU) resources. A unique comanagement model for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Peri-operative Optimization of Senior Health Program (POSH) was launched with the aim of improving outcomes in elderly patients (>65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, comanages daily throughout hospital course, and coordinates multidisciplinary rehabilitation, along with the neurosurgical team. We retrospectively reviewed the first 100 cases after the initiation of the POSH protocol and compared them with the immediately preceding 25 cases to assess the rates of ICU transfer and independent predictors of ICU admission. A total of 125 patients undergoing lumbar decompression and fusion surgery were enrolled in this pilot program. Baseline characteristics and intraoperative variables, as well as number of fusion levels and duration of surgery, were similar between both cohorts. There was a significant difference in the use of ICU services (ICU admission rates) between both cohorts, with the non-POSH cohort having a 3-fold increase compared with the POSH cohort (P < 0.0001). In a multivariate analysis, lack of an interdisciplinary comanagement team approach was an independent predictor for ICU transfers in elderly patients undergoing corrective surgery (odds ratio 8.51, 95% confidence interval 2.972-24.37, P < 0.0001). Our study suggests that an interdisciplinary comanagement model between geriatrics and neurosurgery is independently associated with reduced use of critical care services. Copyright © 2018 Elsevier Inc. All rights reserved.

  2. Care delivery for Filipino Americans using the Neuman systems model.

    Science.gov (United States)

    Angosta, Alona D; Ceria-Ulep, Clementina D; Tse, Alice M

    2014-04-01

    Filipino Americans are at risk of coronary heart disease due to the presence of multiple cardiometabolic factors. Selecting a framework that addresses the factors leading to coronary heart disease is vital when providing care for this population. The Neuman systems model is a comprehensive and wholistic framework that offers an innovative method of viewing clients, their families, and the healthcare system across multiple dimensions. Using the Neuman systems model, advanced practice nurses can develop and implement interventions that will help reduce the potential cardiovascular problems of clients with multiple risk factors. The authors in this article provides insight into the cardiovascular health of Filipino Americans and has implications for nurses and other healthcare providers working with various Southeast Asian groups in the United States.

  3. Who steers the ship? Rural family physicians' views on collaborative care models for patients with dementia.

    Science.gov (United States)

    Kosteniuk, Julie; Morgan, Debra; Innes, Anthea; Keady, John; Stewart, Norma; D'Arcy, Carl; Kirk, Andrew

    2014-01-01

    Little is known about the views of rural family physicians (FPs) regarding collaborative care models for patients with dementia. The study aims were to explore FPs' views regarding this issue, their role in providing dementia care, and the implications of providing dementia care in a rural setting. This study employed an exploratory qualitative design with a sample of 15 FPs. All rural FPs indicated acceptance of collaborative models. The main disadvantages of practicing rural were accessing urban-based health care and related services and a shortage of local health care resources. The primary benefit of practicing rural was FPs' social proximity to patients, families, and some health care workers. Rural FPs provided care for patients with dementia that took into account the emotional and practical needs of caregivers and families. FPs described positive and negative implications of rural dementia care, and all were receptive to models of care that included other health care professionals.

  4. Quality Assurance in Breast Health Care and Requirement for Accreditation in Specialized Units.

    Science.gov (United States)

    Güler, Sertaç Ata; Güllüoğlu, Bahadır M

    2014-07-01

    Breast health is a subject of increasing importance. The statistical increase in the frequency of breast cancer and the consequent increase in death rate increase the importance of quality of services to be provided for breast health. For these reasons, the minimum standards and optimum quality metrics of breast care provided to the community are determined. The quality parameters for breast care service include the results, the structure and the operation of services. Within this group, the results of breast health services are determined according to clinical results, patient satisfaction and financial condition. The structure of quality services should include interdisciplinary meetings, written standards for specific procedures and the existence of standardized reporting systems. Establishing breast centers that adopt integrated multidisciplinary working principles and their cost-effective maintenance are important in terms of operation of breast health services. The importance of using a "reviewing/auditing" procedure that checks if all of these functions existing in the health system are carried out at the desired level and an "accreditation" system indicating that the working breast units/centers provide minimum quality adequacy in all aspects, is undeniable. Currently, the accreditation system for breast centers is being used in the European Union and the United States for the last 5-10 years. This system is thought to provide standardization in breast care services, and is accepted as one of the important factors that resulted in reduction in mortality associated with breast cancer.

  5. Who Cares for the Children? Denmark's Unique Public Child-Care Model.

    Science.gov (United States)

    Polakow, Valerie

    1997-01-01

    U.S. working mothers wrestle daily with a child-care crisis characterized by unavailable infant care, high costs, and inadequate access and regulation. In Denmark, high-quality child care is a guaranteed entitlement for every child. Other benefits include paid parental leaves, single-parent allowances, housing subsidies, and universal health care.…

  6. Three Tier Unified Process Model for Requirement Negotiations and Stakeholder Collaborations

    Science.gov (United States)

    Niazi, Muhammad Ashraf Khan; Abbas, Muhammad; Shahzad, Muhammad

    2012-11-01

    This research paper is focused towards carrying out a pragmatic qualitative analysis of various models and approaches of requirements negotiations (a sub process of requirements management plan which is an output of scope managementís collect requirements process) and studies stakeholder collaborations methodologies (i.e. from within communication management knowledge area). Experiential analysis encompass two tiers; first tier refers to the weighted scoring model while second tier focuses on development of SWOT matrices on the basis of findings of weighted scoring model for selecting an appropriate requirements negotiation model. Finally the results are simulated with the help of statistical pie charts. On the basis of simulated results of prevalent models and approaches of negotiations, a unified approach for requirements negotiations and stakeholder collaborations is proposed where the collaboration methodologies are embeded into selected requirements negotiation model as internal parameters of the proposed process alongside some external required parameters like MBTI, opportunity analysis etc.

  7. A Joint Force Medical Command is Required to Fix Combat Casualty Care

    Science.gov (United States)

    2017-10-05

    DISTRIBUTION STATEMENT: A Approved for Public Release Distribution is Unlimited The views expressed herein are those of the author(s) and do not...MHS) is required to provide medical operational forces for military and contingency operations while also providing services that maintain a healthy...provide timely support of joint forcible entry or other contingencies requiring rapid response. Further, the complexity and cost of the beneficiary

  8. Do telemonitoring projects of heart failure fit the Chronic Care Model?

    Science.gov (United States)

    Willemse, Evi; Adriaenssens, Jef; Dilles, Tinne; Remmen, Roy

    2014-07-01

    This study describes the characteristics of extramural and transmural telemonitoring projects on chronic heart failure in Belgium. It describes to what extent these telemonitoring projects coincide with the Chronic Care Model of Wagner. The Chronic Care Model describes essential components for high-quality health care. Telemonitoring can be used to optimise home care for chronic heart failure. It provides a potential prospective to change the current care organisation. This qualitative study describes seven non-invasive home-care telemonitoring projects in patients with heart failure in Belgium. A qualitative design, including interviews and literature review, was used to describe the correspondence of these home-care telemonitoring projects with the dimensions of the Chronic Care Model. The projects were situated in primary and secondary health care. Their primary goal was to reduce the number of readmissions for chronic heart failure. None of these projects succeeded in a final implementation of telemonitoring in home care after the pilot phase. Not all the projects were initiated to accomplish all of the dimensions of the Chronic Care Model. A central role for the patient was sparse. Limited financial resources hampered continuation after the pilot phase. Cooperation and coordination in telemonitoring appears to be major barriers but are, within primary care as well as between the lines of care, important links in follow-up. This discrepancy can be prohibitive for deployment of good chronic care. Chronic Care Model is recommended as basis for future.

  9. The eHealth Enhanced Chronic Care Model: a theory derivation approach.

    Science.gov (United States)

    Gee, Perry M; Greenwood, Deborah A; Paterniti, Debora A; Ward, Deborah; Miller, Lisa M Soederberg

    2015-04-01

    Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools. The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses. Using Theory Derivation processes, we identified a "parent theory", the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms "CCM or Chronic Care Model" AND "eHealth" or the specific identified components of eHealth. Additionally, "Chronic Illness Self-management support" AND "Technology" AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM. We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be

  10. Mathematical Formulation Requirements and Specifications for the Process Models

    Energy Technology Data Exchange (ETDEWEB)

    Steefel, C.; Moulton, D.; Pau, G.; Lipnikov, K.; Meza, J.; Lichtner, P.; Wolery, T.; Bacon, D.; Spycher, N.; Bell, J.; Moridis, G.; Yabusaki, S.; Sonnenthal, E.; Zyvoloski, G.; Andre, B.; Zheng, L.; Davis, J.

    2010-11-01

    The Advanced Simulation Capability for Environmental Management (ASCEM) is intended to be a state-of-the-art scientific tool and approach for understanding and predicting contaminant fate and transport in natural and engineered systems. The ASCEM program is aimed at addressing critical EM program needs to better understand and quantify flow and contaminant transport behavior in complex geological systems. It will also address the long-term performance of engineered components including cementitious materials in nuclear waste disposal facilities, in order to reduce uncertainties and risks associated with DOE EM's environmental cleanup and closure activities. Building upon national capabilities developed from decades of Research and Development in subsurface geosciences, computational and computer science, modeling and applied mathematics, and environmental remediation, the ASCEM initiative will develop an integrated, open-source, high-performance computer modeling system for multiphase, multicomponent, multiscale subsurface flow and contaminant transport. This integrated modeling system will incorporate capabilities for predicting releases from various waste forms, identifying exposure pathways and performing dose calculations, and conducting systematic uncertainty quantification. The ASCEM approach will be demonstrated on selected sites, and then applied to support the next generation of performance assessments of nuclear waste disposal and facility decommissioning across the EM complex. The Multi-Process High Performance Computing (HPC) Simulator is one of three thrust areas in ASCEM. The other two are the Platform and Integrated Toolsets (dubbed the Platform) and Site Applications. The primary objective of the HPC Simulator is to provide a flexible and extensible computational engine to simulate the coupled processes and flow scenarios described by the conceptual models developed using the ASCEM Platform. The graded and iterative approach to assessments

  11. 20 CFR 404.450 - Required reports of work outside the United States or failure to have care of a child.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Required reports of work outside the United States or failure to have care of a child. 404.450 Section 404.450 Employees' Benefits SOCIAL SECURITY... Nonpayments of Benefits § 404.450 Required reports of work outside the United States or failure to have care...

  12. Identifying Variability in Mental Models Within and Between Disciplines Caring for the Cardiac Surgical Patient.

    Science.gov (United States)

    Brown, Evans K H; Harder, Kathleen A; Apostolidou, Ioanna; Wahr, Joyce A; Shook, Douglas C; Farivar, R Saeid; Perry, Tjorvi E; Konia, Mojca R

    2017-07-01

    The cardiac operating room is a complex environment requiring efficient and effective communication between multiple disciplines. The objectives of this study were to identify and rank critical time points during the perioperative care of cardiac surgical patients, and to assess variability in responses, as a correlate of a shared mental model, regarding the importance of these time points between and within disciplines. Using Delphi technique methodology, panelists from 3 institutions were tasked with developing a list of critical time points, which were subsequently assigned to pause point (PP) categories. Panelists then rated these PPs on a 100-point visual analog scale. Descriptive statistics were expressed as percentages, medians, and interquartile ranges (IQRs). We defined low response variability between panelists as an IQR ≤ 20, moderate response variability as an IQR > 20 and ≤ 40, and high response variability as an IQR > 40. Panelists identified a total of 12 PPs. The PPs identified by the highest number of panelists were (1) before surgical incision, (2) before aortic cannulation, (3) before cardiopulmonary bypass (CPB) initiation, (4) before CPB separation, and (5) at time of transfer of care from operating room (OR) to intensive care unit (ICU) staff. There was low variability among panelists' ratings of the PP "before surgical incision," moderate response variability for the PPs "before separation from CPB," "before transfer from OR table to bed," and "at time of transfer of care from OR to ICU staff," and high response variability for the remaining 8 PPs. In addition, the perceived importance of each of these PPs varies between disciplines and between institutions. Cardiac surgical providers recognize distinct critical time points during cardiac surgery. However, there is a high degree of variability within and between disciplines as to the importance of these times, suggesting an absence of a shared mental model among disciplines caring for

  13. Modelling the cost effectiveness of antidepressant treatment in primary care.

    Science.gov (United States)

    Revicki, D A; Brown, R E; Palmer, W; Bakish, D; Rosser, W W; Anton, S F; Feeny, D

    1995-12-01

    The aim of this study was to estimate the cost effectiveness of nefazodone compared with imipramine or fluoxetine in treating women with major depressive disorder. Clinical decision analysis and a Markov state-transition model were used to estimate the lifetime health outcomes and medical costs of 3 antidepressant treatments. The model, which represents ideal primary care practice, compares treatment with nefazodone to treatment with either imipramine or fluoxetine. The economic analysis was based on the healthcare system of the Canadian province of Ontario, and considered only direct medical costs. Health outcomes were expressed as quality-adjusted life years (QALYs) and costs were in 1993 Canadian dollars ($Can; $Can1 = $US0.75, September 1995). Incremental cost-utility ratios were calculated comparing the relative lifetime discounted medical costs and QALYs associated with nefazodone with those of imipramine or fluoxetine. Data for constructing the model and estimating necessary parameters were derived from the medical literature, clinical trial data, and physician judgement. Data included information on: Ontario primary care physicians' clinical management of major depression; medical resource use and costs; probabilities of recurrence of depression; suicide rates; compliance rates; and health utilities. Estimates of utilities for depression-related hypothetical health states were obtained from patients with major depression (n = 70). Medical costs and QALYs were discounted to present value using a 5% rate. Sensitivity analyses tested the assumptions of the model by varying the discount rate, depression recurrence rates, compliance rates, and the duration of the model. The base case analysis found that nefazodone treatment costs $Can1447 less per patient than imipramine treatment (discounted lifetime medical costs were $Can50,664 vs $Can52,111) and increases the number of QALYs by 0.72 (13.90 vs 13.18). Nefazodone treatment costs $Can14 less than fluoxetine

  14. Functional requirements of a mathematical model of the heart.

    Science.gov (United States)

    Palladino, Joseph L; Noordergraaf, Abraham

    2009-01-01

    Functional descriptions of the heart, especially the left ventricle, are often based on the measured variables pressure and ventricular outflow, embodied as a time-varying elastance. The fundamental difficulty of describing the mechanical properties of the heart with a time-varying elastance function that is set a priori is described. As an alternative, a new functional model of the heart is presented, which characterizes the ventricle's contractile state with parameters, rather than variables. Each chamber is treated as a pressure generator that is time and volume dependent. The heart's complex dynamics develop from a single equation based on the formation and relaxation of crossbridge bonds. This equation permits the calculation of ventricular elastance via E(v) = partial differentialp(v)/ partial differentialV(v). This heart model is defined independently from load properties, and ventricular elastance is dynamic and reflects changing numbers of crossbridge bonds. In this paper, the functionality of this new heart model is presented via computed work loops that demonstrate the Frank-Starling mechanism and the effects of preload, the effects of afterload, inotropic changes, and varied heart rate, as well as the interdependence of these effects. Results suggest the origin of the equivalent of Hill's force-velocity relation in the ventricle.

  15. Modelling of capital requirements in the energy sector: capital market access. Final memorandum

    Energy Technology Data Exchange (ETDEWEB)

    1978-04-01

    Formal modelling techniques for analyzing the capital requirements of energy industries have been performed at DOE. A survey has been undertaken of a number of models which forecast energy-sector capital requirements or which detail the interactions of the energy sector and the economy. Models are identified which can be useful as prototypes for some portion of DOE's modelling needs. The models are examined to determine any useful data bases which could serve as inputs to an original DOE model. A selected group of models are examined which can comply with the stated capabilities. The data sources being used by these models are covered and a catalog of the relevant data bases is provided. The models covered are: capital markets and capital availability models (Fossil 1, Bankers Trust Co., DRI Macro Model); models of physical capital requirements (Bechtel Supply Planning Model, ICF Oil and Gas Model and Coal Model, Stanford Research Institute National Energy Model); macroeconomic forecasting models with input-output analysis capabilities (Wharton Annual Long-Term Forecasting Model, Brookhaven/University of Illinois Model, Hudson-Jorgenson/Brookhaven Model); utility models (MIT Regional Electricity Model-Baughman Joskow, Teknekron Electric Utility Simulation Model); and others (DRI Energy Model, DRI/Zimmerman Coal Model, and Oak Ridge Residential Energy Use Model).

  16. National Child Care Regulatory, Monitoring and Evaluation Systems Model.

    Science.gov (United States)

    Fiene, Richard

    The relation between compliance with child care regulations and the quality of day care programs is discussed, and predictors of child care compliance are identified. Substantial compliance (90-97 percent, but not a full 100 percent compliance with state day care regulations) positively affects children. Low compliance (below 85 percent…

  17. An agent-based simulation model of patient choice of health care providers in accountable care organizations.

    Science.gov (United States)

    Alibrahim, Abdullah; Wu, Shinyi

    2018-03-01

    Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.

  18. An aging population and growing disease burden will require a large and specialized health care workforce by 2025.

    Science.gov (United States)

    Dall, Timothy M; Gallo, Paul D; Chakrabarti, Ritasree; West, Terry; Semilla, April P; Storm, Michael V

    2013-11-01

    As the US population ages, the increasing prevalence of chronic disease and complex medical conditions will have profound implications for the future health care system. We projected future prevalence of selected diseases and health risk factors to model future demand for health care services for each person in a representative sample of the current and projected future population. Based on changing demographic characteristics and expanded medical coverage under the Affordable Care Act, we project that the demand for adult primary care services will grow by approximately 14 percent between 2013 and 2025. Vascular surgery has the highest projected demand growth (31 percent), followed by cardiology (20 percent) and neurological surgery, radiology, and general surgery (each 18 percent). Market indicators such as long wait times to obtain appointments suggest that the current supply of many specialists throughout the United States is inadequate to meet the current demand. Failure to train sufficient numbers and the correct mix of specialists could exacerbate already long wait times for appointments, reduce access to care for some of the nation's most vulnerable patients, and reduce patients' quality of life.

  19. A tertiary care-primary care partnership model for medically complex and fragile children and youth with special health care needs.

    Science.gov (United States)

    Gordon, John B; Colby, Holly H; Bartelt, Tera; Jablonski, Debra; Krauthoefer, Mary L; Havens, Peter

    2007-10-01

    To evaluate the impact of a tertiary care center special needs program that partners with families and primary care physicians to ensure seamless inpatient and outpatient care and assist in providing medical homes. Up to 3 years of preenrollment and postenrollment data were compared for patients in the special needs program from July 1, 2002, through June 30, 2005. A tertiary care center pediatric hospital and medical school serving urban and rural patients. A total of 227 of 230 medically complex and fragile children and youth with special needs who had a wide range of chronic disorders and were enrolled in the special needs program. Care coordination provided by a special needs program pediatric nurse case manager with or without a special needs program physician. Preenrollment and postenrollment tertiary care center resource utilization, charges, and payments. A statistically significant decrease was found in the number of hospitalizations, number of hospital days, and tertiary care center charges and payments, and an increase was found in the use of outpatient services. Aggregate data revealed a decrease in hospital days from 7926 to 3831, an increase in clinic visits from 3150 to 5420, and a decrease in tertiary care center payments of $10.7 million. The special needs program budget for fiscal year 2005 had a deficit of $400,000. This tertiary care-primary care partnership model improved health care and reduced costs with relatively modest institutional support.

  20. A queueing network model to analyze the impact of parallelization of care on patient cycle time.

    Science.gov (United States)

    Jiang, Lixiang; Giachetti, Ronald E

    2008-09-01

    The total time a patient spends in an outpatient facility, called the patient cycle time, is a major contributor to overall patient satisfaction. A frequently recommended strategy to reduce the total time is to perform some activities in parallel thereby shortening patient cycle time. To analyze patient cycle time this paper extends and improves upon existing multi-class open queueing network model (MOQN) so that the patient flow in an urgent care center can be modeled. Results of the model are analyzed using data from an urgent care center contemplating greater parallelization of patient care activities. The results indicate that parallelization can reduce the cycle time for those patient classes which require more than one diagnostic and/ or treatment intervention. However, for many patient classes there would be little if any improvement, indicating the importance of tools to analyze business process reengineering rules. The paper makes contributions by implementing an approximation for fork/join queues in the network and by improving the approximation for multiple server queues in both low traffic and high traffic conditions. We demonstrate the accuracy of the MOQN results through comparisons to simulation results.

  1. More than a name: Heterogeneity in characteristics of models of maternity care reported from the Australian Maternity Care Classification System validation study.

    Science.gov (United States)

    Donnolley, Natasha R; Chambers, Georgina M; Butler-Henderson, Kerryn A; Chapman, Michael G; Sullivan, Elizabeth A

    2017-08-01

    Without a standard terminology to classify models of maternity care, it is problematic to compare and evaluate clinical outcomes across different models. The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics and an overarching broad model descriptor (Major Model Category). This study aimed to assess the extent of variability in the defining characteristics of models of care grouped to the same Major Model Category, using the Maternity Care Classification System. All public hospital maternity services in New South Wales, Australia, were invited to complete a web-based survey classifying two local models of care using the Maternity Care Classification System. A descriptive analysis of the variation in 15 attributes of models of care was conducted to evaluate the level of heterogeneity within and across Major Model Categories. Sixty-nine out of seventy hospitals responded, classifying 129 models of care. There was wide variation in a number of important attributes of models classified to the same Major Model Category. The category of 'Public hospital maternity care' contained the most variation across all characteristics. This study demonstrated that although models of care can be grouped into a distinct set of Major Model Categories, there are significant variations in models of the same type. This could result in seemingly 'like' models of care being incorrectly compared if grouped only by the Major Model Category. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  2. "Open Access" Requires Clarification: Medical Journal Publication Models Evolve.

    Science.gov (United States)

    Lubowitz, James H; Brand, Jefferson C; Rossi, Michael J; Provencher, Matthew T

    2017-03-01

    While Arthroscopy journal is a traditional subscription model journal, our companion journal Arthroscopy Techniques is "open access." We used to believe open access simply meant online and free of charge. However, while open-access journals are free to readers, in 2017 authors must make a greater sacrifice in the form of an article-processing charge (APC). Again, while this does not apply to Arthroscopy, the APC will apply to Arthroscopy Techniques. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. Do new and traditional models of primary care differ with regard to access?: Canadian QUALICOPC study.

    Science.gov (United States)

    Miedema, Baukje; Easley, Julie; Thompson, Ashley E; Boivin, Antoine; Aubrey-Bassler, Kris; Katz, Alan; Hogg, William E; Breton, Mylaine; Francoeur, Danièle; Wong, Sabrina T; Wodchis, Walter P

    2016-01-01

    To examine access to primary care in new and traditional models using 2 dimensions of the concept of patient-centred access. An international survey examining the quality and costs of primary health care (the QUALICOPC study) was conducted in 2013 in Canada. This study adopted a descriptive cross-sectional survey method using data from practices across Canada. Each participating practice filled out the Family Physician Survey and the Practice Survey, and patients in each participating practice were asked to complete the Patient Experiences Survey. All 10 Canadian provinces. A total of 759 practices and 7172 patients. Independent t tests were conducted to examine differences between new and traditional models of care in terms of availability and accommodation, and affordability of care. Of the 759 practices, 407 were identified as having new models of care and 352 were identified as traditional. New models of care were distinct with respect to payment structure, opening hours, and having an interdisciplinary work force. Most participating practices were from large cities or suburban areas. There were few differences between new and traditional models of care regarding accessibility and accommodation in primary care. Patients under new models of care reported easier access to other physicians in the same practice, while patients from traditional models reported seeing their regular family physicians more frequently. There was no difference between the new and traditional models of care with regard to affordability of primary care. Patients attending clinics with new models of care reported that their physicians were more involved with them as a whole person than patients attending clinics based on traditional models did. Primary care access issues do not differ strongly between traditional and new models of care; however, patients in the new models of care believed that their physicians were more involved with them as people.

  4. Applying Bureaucratic Caring Theory and the Chronic Care Model to Improve Staff and Patient Self-Efficacy.

    Science.gov (United States)

    Potter, Marcia A; Wilson, Candy

    Patient activation and engagement can be powerful enablers for health outcomes that are just as important as staff engagement and satisfaction. The authors applied the Bureaucratic Caring Theory and the Chronic Care Model to a process improvement project designed to link activation, engagement, satisfaction, and health outcomes. Twenty-two adults with diabetes and 7 staff members caring for them participated in a 12-week process improvement project that incorporated a time-based element of longitudinal care with skill-based competencies to provide collaborative, team-based care to patients with type 2 diabetes. Patients completed satisfaction surveys at the end of their clinical encounters. Staff members completed satisfaction surveys pre- and postimplementation. The authors analyzed hemoglobin A1C levels pre- and postimplementation. As engagement and activation increased for both staff and patients, hemoglobin A1C levels decreased. The clinical implication is that the use of Bureaucratic Caring Theory may foster caring while broad application of the Chronic Care Model may improve self-efficacy, create healthier populations, and reduce health care costs.

  5. A burn center paradigm to fulfill deferred consent public disclosure and community consultation requirements for emergency care research.

    Science.gov (United States)

    Blackford, Martha G; Falletta, Lynn; Andrews, David A; Reed, Michael D

    2012-09-01

    To fulfill Food and Drug Administration and Department of Health and Human Services emergency care research informed consent requirements, our burn center planned and executed a deferred consent strategy gaining Institutional Review Board (IRB) approval to proceed with the clinical study. These federal regulations dictate public disclosure and community consultation unique to acute care research. Our regional burn center developed and implemented a deferred consent public notification and community consultation paradigm appropriate for a burn study. Published accounts of deferred consent strategies focus on acute care resuscitation practices. We adapted those strategies to design and conduct a comprehensive public notification/community consultation plan to satisfy deferred consent requirements for burn center research. To implement a robust media campaign we engaged the hospital's public relations department, distributed media materials, recruited hospital staff for speaking engagements, enlisted community volunteers, and developed initiatives to inform "hard-to-reach" populations. The hospital's IRB determined we fulfilled our obligation to notify the defined community. Our communication strategy should provide a paradigm other burn centers may appropriate and adapt when planning and executing a deferred consent initiative. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  6. [Neonatal ABO incompatibility underlies a potentially severe hemolytic disease of the newborn and requires adequate care].

    Science.gov (United States)

    Senterre, T; Minon, J-M; Rigo, J

    2011-03-01

    ABO allo-immunization is the most frequent hemolytic disease of the newborn and ABO incompatibility is present in 15-25 % of pregnancies. True ABO alloimmunization occurs in approximately one out of 150 births. Intensity is generally lower than in RhD allo-immunization. We report on three cases showing that ABO allo-immunization can lead to severe hemolytic disease of the newborn with potentially threatening hyperbilirubinemia and complications. Early diagnosis and adequate care are necessary to prevent complications in ABO incompatibility. A direct antiglobulin test is the cornerstone of diagnosis and should be performed at birth on cord blood sampling in all group infants born to O mothers, especially if of African origin. Risk factor analysis and attentive clinical monitoring during the first days of life are essential. Vigilance is even more important for infants discharged before the age of 72 h. Every newborn should be assessed for the risk of developing severe hyperbilirubinemia and should be examined by a qualified healthcare professional in the first days of life. Treatment depends on the total serum bilirubin level, which may increase very rapidly in the first 48 h of life in cases of hemolytic disease of the newborn. Phototherapy and, in severe cases, exchange transfusion are used to prevent hyperbilirubinemia encephalopathy. Intravenous immunoglobulins are used to reduce exchange transfusion. Treatments of severe hemolytic disease of the newborn should be provided and performed by trained personnel in neonatal intensive care units. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  7. Do stable non-ST-segment elevation acute coronary syndromes require admission to coronary care units?

    Science.gov (United States)

    van Diepen, Sean; Lin, Meng; Bakal, Jeffrey A; McAlister, Finlay A; Kaul, Padma; Katz, Jason N; Fordyce, Christopher B; Southern, Danielle A; Graham, Michelle M; Wilton, Stephen B; Newby, L Kristin; Granger, Christopher B; Ezekowitz, Justin A

    2016-05-01

    Clinical practice guidelines recommend admitting patients with stable non-ST-segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two-thirds of patients are admitted to higher-acuity critical care units (CCUs). The outcomes of patients with stable NSTE ACS initially admitted to a CCU vs a cardiology ward with telemetry have not been described. We used population-based data of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada, between April 1, 2007, and March 31, 2013. We compared outcomes among patients initially admitted to a CCU (n=5,141) with those admitted to cardiology telemetry wards (n=2,728). Patients admitted to cardiology telemetry wards were older (median 69 vs 65years, PST-segment myocardial infarction or unstable angina. There were no differences in clinical outcomes observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an opportunity to reduce hospital costs and critical care capacity strain. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis.

    Science.gov (United States)

    Baggaley, Rebecca F; Irvine, Michael A; Leber, Werner; Cambiano, Valentina; Figueroa, Jose; McMullen, Heather; Anderson, Jane; Santos, Andreia C; Terris-Prestholt, Fern; Miners, Alec; Hollingsworth, T Déirdre; Griffiths, Chris J

    2017-10-01

    Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care. We modelled the effect of the four-times higher diagnosis rate observed in the intervention arm of the RHIVA2 randomised controlled trial done in Hackney, London (UK), a borough with high HIV prevalence (≥0·2% adult prevalence). We constructed a dynamic, compartmental model representing incidence of infection and the effect of screening for HIV in general practices in Hackney. We assessed cost-effectiveness of the RHIVA2 trial by fitting model diagnosis rates to the trial data, parameterising with epidemiological and behavioural data from the literature when required, using trial testing costs and projecting future costs of treatment. Over a 40 year time horizon, incremental cost-effectiveness ratios were £22 201 (95% credible interval 12 662-132 452) per quality-adjusted life-year (QALY) gained, £372 207 (268 162-1 903 385) per death averted, and £628 874 (434 902-4 740 724) per HIV transmission averted. Under this model scenario, with UK cost data, RHIVA2 would reach the upper National Institute for Health and Care Excellence cost-effectiveness threshold (about £30 000 per QALY gained) after 33 years. Scenarios using cost data from Canada (which indicate prolonged and even higher health-care costs for patients diagnosed late) suggest this threshold could be reached in as little as 13 years. Screening for HIV in primary care has important public health benefits as well as clinical benefits. We predict it to be cost-effective in the UK in the medium term. However, this intervention might be cost-effective far sooner, and even cost-saving, in settings where long-term health-care costs of late-diagnosed patients in high

  9. 77 FR 28790 - Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act

    Science.gov (United States)

    2012-05-16

    ... Internet Web site of the Department of Health and Human Services.'' In addition, section 1103(b) of the... other things, ``require the inclusion of information on the percentage of total premium revenue expended..., pursuant to this final rule, for the 2011 MLR reporting year. \\5\\ Source: Agency for Healthcare Research...

  10. 78 FR 38594 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Science.gov (United States)

    2013-06-27

    .... The LTC facility regulations clearly specify what services the facility is required to provide to... professional caregivers and are often paid by third-party payers, such as Medicaid. These facilities are... benefit. In regulations at 42 CFR 418.112(c), we specify what must be included in a written agreement...

  11. Requirements for modeling airborne microbial contamination in space stations

    Science.gov (United States)

    Van Houdt, Rob; Kokkonen, Eero; Lehtimäki, Matti; Pasanen, Pertti; Leys, Natalie; Kulmala, Ilpo

    2018-03-01

    Exposure to bioaerosols is one of the facets that affect indoor air quality, especially for people living in densely populated or confined habitats, and is associated to a wide range of health effects. Good indoor air quality is thus vital and a prerequisite for fully confined environments such as space habitats. Bioaerosols and microbial contamination in these confined space stations can have significant health impacts, considering the unique prevailing conditions and constraints of such habitats. Therefore, biocontamination in space stations is strictly monitored and controlled to ensure crew and mission safety. However, efficient bioaerosol control measures rely on solid understanding and knowledge on how these bioaerosols are created and dispersed, and which factors affect the survivability of the associated microorganisms. Here we review the current knowledge gained from relevant studies in this wide and multidisciplinary area of bioaerosol dispersion modeling and biological indoor air quality control, specifically taking into account the specific space conditions.

  12. [Requirements imposed on model objects in microevolutionary investigations].

    Science.gov (United States)

    Mina, M V

    2015-01-01

    Extrapolation of results of investigations of a model object is justified only within the limits of a set of objects that have essential properties in common with the modal object. Which properties are essential depends on the aim of a study. Similarity of objects emerged in the process of their independent evolution does not prove similarity of ways and mechanisms of their evolution. If the objects differ in their essential properties then extrapolation of results of investigation of an object on another one is risky because it may lead to wrong decisions and, moreover, to the loss of interest to alternative hypotheses. Positions formulated above are considered with the reference to species flocks of fishes, large African Barbus in particular.

  13. Developing a Comprehensive Model of Intensive Care Unit Processes: Concept of Operations.

    Science.gov (United States)

    Romig, Mark; Tropello, Steven P; Dwyer, Cindy; Wyskiel, Rhonda M; Ravitz, Alan; Benson, John; Gropper, Michael A; Pronovost, Peter J; Sapirstein, Adam

    2015-04-23

    This study aimed to use a systems engineering approach to improve performance and stakeholder engagement in the intensive care unit to reduce several different patient harms. We developed a conceptual framework or concept of operations (ConOps) to analyze different types of harm that included 4 steps as follows: risk assessment, appropriate therapies, monitoring and feedback, as well as patient and family communications. This framework used a transdisciplinary approach to inventory the tasks and work flows required to eliminate 7 common types of harm experienced by patients in the intensive care unit. The inventory gathered both implicit and explicit information about how the system works or should work and converted the information into a detailed specification that clinicians could understand and use. Using the ConOps document, we created highly detailed work flow models to reduce harm and offer an example of its application to deep venous thrombosis. In the deep venous thrombosis model, we identified tasks that were synergistic across different types of harm. We will use a system of systems approach to integrate the variety of subsystems and coordinate processes across multiple types of harm to reduce the duplication of tasks. Through this process, we expect to improve efficiency and demonstrate synergistic interactions that ultimately can be applied across the spectrum of potential patient harms and patient locations. Engineering health care to be highly reliable will first require an understanding of the processes and work flows that comprise patient care. The ConOps strategy provided a framework for building complex systems to reduce patient harm.

  14. [Model for the regional allocation of the National Health Care Fund].

    Science.gov (United States)

    Loreti, P; Muzzi, A; Bruni, G

    1989-01-01

    In 1978 a National Health Service (Servizio Sanitario Nazionale = SSN) was constituted in Italy which exercises jurisdiction in the sector of health care and is duty bound to assist all citizens. Basically speaking, the NHS is organized on three levels (national, regional and local) with the management of direct operations assigned to the (about 700) Local Health Boards (Unità Sanitaria Locale = USL) each of which covers a well determined territorial area. The Authors indicate that rarely discussed or evaluated are the procedures for the regional allocation of health care funding which is determined by Parliament within the ambit of the National Budget (The National Health Care Fund). The current allocation model distributes the available capital resources for each expense item (e.g. hospitalization, pharmaceutical assistance, etc.) on a per capita basis with respect to the regional populations modified in order to allow for differing degrees of health care requirements. The regional populations are subdivided into broad age groups (e.g. children, intermediary, the elderly) with specific weighting factors expressing the different level of health care requirements. The application of these weighting factors alters the regional populations (with no change in the total population of the country) in order to express them in equivalent units with respect to the health care need. Moreover, standardized death rates are introduced into the model as indicators of the different health risk, and their application leads to a further modification in the level of the regional populations so as to express them in equivalent units with respect to the health risk as well. Once the available financial resources have been subdivided in this "theoretical" way, the following corrective factors are applied: a) hospital mobility correction factor: the regions with a credit admissions balance are assigned an additional cost which is borne by the regions with a debit admissions balance; b

  15. Evaluating the Quality of the Learning Outcome in Healthcare Sector: The Expero4care Model

    Science.gov (United States)

    Cervai, Sara; Polo, Federica

    2015-01-01

    Purpose: This paper aims to present the Expero4care model. Considering the growing need for a training evaluation model that does not simply fix processes, the Expero4care model represents the first attempt of a "quality model" dedicated to the learning outcomes of healthcare trainings. Design/Methodology/Approach: Created as development…

  16. Cost Analysis of Prenatal Care Using the Activity-Based Costing Model: A Pilot Study

    Science.gov (United States)

    Gesse, Theresa; Golembeski, Susan; Potter, Jonell

    1999-01-01

    The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care. PMID:22945985

  17. Cost analysis of prenatal care using the activity-based costing model: a pilot study.

    Science.gov (United States)

    Gesse, T; Golembeski, S; Potter, J

    1999-01-01

    The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.

  18. Integrated Payment and Delivery Models Offer Opportunities and Challenges for Residential Care Facilities

    OpenAIRE

    Grabowski, David C.; Caudry, Daryl J.; Dean, Katie M.; Stevenson, David G.

    2015-01-01

    Under health care reform, a series of new financing and delivery models are being piloted to integrate health and long-term care services for older adults. To date, these programs have not encompassed residential care facilities, with most programs focusing on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with simila...

  19. Nontraditional or noncentralized models of diabetes care: models in which other HCPs take on a leading role in managing patients' diabetes.

    Science.gov (United States)

    Arnold, K C

    2011-11-01

    Nurse practitioners (NPs) are advanced practice nurses who have increased responsibility,such as prescribing authority. In the NP-led model, the NP is the primary care provider for clinic patients and takes on an autonomous role in patient management. In some states, NP-led clinics are required to have a supervising or collaborating physician. There is evidence that NP-led and physician-led primary care is comparable for multiple health outcomes. The NP-led model emphasizes the strong interaction between health care provider and patient. Challenges of NP-led care include physician resistance, legal restrictions, inaccessibility and cost of malpractice insurance, and limited payouts from insurance companies

  20. Testing cost-benefit models of parental care evolution using lizard populations differing in the expression of maternal care.

    Directory of Open Access Journals (Sweden)

    Wen-San Huang

    Full Text Available Parents are expected to evolve tactics to care for eggs or offspring when providing such care increases fitness above the costs incurred by this behavior. Costs to the parent include the energetic demands of protecting offspring, delaying future fecundity, and increased risk of predation. We used cost-benefit models to test the ecological conditions favoring the evolution of parental care, using lizard populations that differ in whether or not they express maternal care. We found that predators play an important role in the evolution of maternal care because: (1 evolving maternal care is unlikely when care increases predation pressure on the parents; (2 maternal care cannot evolve under low levels of predation pressure on both parents and offspring; and (3 maternal care evolves only when parents are able to successfully defend offspring from predators without increasing predation risk to themselves. Our studies of one of the only known vertebrate species to exhibit interpopulation differences in the expression of maternal care provide clear support for some of the hypothesized circumstances under which maternal care should evolve (e.g., when nests are in exposed locations, parents are able to defend the eggs from predators, and egg incubation periods are brief, but do not support others (e.g., when nest-sites are scarce, life history strategies are "risky", reproductive frequency is low, and environmental conditions are harsh. We conclude that multiple pathways can lead to the evolution of parental care from a non-caring state, even in a single population of a widespread species.

  1. Models of home care services for persons with dementia: a narrative review.

    Science.gov (United States)

    Low, Lee-Fay; Fletcher, Jennifer

    2015-10-01

    Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care. We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs. Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study. There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

  2. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

    Science.gov (United States)

    Spoorenberg, Sophie L W; Wynia, Klaske; Fokkens, Andrea S; Slotman, Karin; Kremer, Hubertus P H; Reijneveld, Sijmen A

    2015-01-01

    Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2) Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

  3. Quantitative and Functional Requirements for Bioluminescent Cancer Models.

    Science.gov (United States)

    Feys, Lynn; Descamps, Benedicte; Vanhove, Christian; Vermeulen, Stefan; Vandesompele, J O; Vanderheyden, Katrien; Messens, Kathy; Bracke, Marc; De Wever, Olivier

    2016-01-01

    Bioluminescent cancer models are widely used but detailed quantification of the luciferase signal and functional comparison with a non-transfected control cell line are generally lacking. In the present study, we provide quantitative and functional tests for luciferase-transfected cells. We quantified the luciferase expression in BLM and HCT8/E11 transfected cancer cells, and examined the effect of long-term luciferin exposure. The present study also investigated functional differences between parental and transfected cancer cells. Our results showed that quantification of different single-cell-derived populations are superior with droplet digital polymerase chain reaction. Quantification of luciferase protein level and luciferase bioluminescent activity is only useful when there is a significant difference in copy number. Continuous exposure of cell cultures to luciferin leads to inhibitory effects on mitochondrial activity, cell growth and bioluminescence. These inhibitory effects correlate with luciferase copy number. Cell culture and mouse xenograft assays showed no significant functional differences between luciferase-transfected and parental cells. Luciferase-transfected cells should be validated by quantitative and functional assays before starting large-scale experiments. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  4. An osteoarthritis model of care should be a national priority for New Zealand.

    Science.gov (United States)

    Baldwin, Jennifer; Briggs, Andrew; Bagg, Warwick; Larmer, Peter

    2017-12-15

    Osteoarthritis is highly prevalent, disabling and costly to the person and the community. The burden of this chronic condition is predicted to increase dramatically over the coming decades. Healthcare spending on osteoarthritis is unsustainable and action is needed to improve care delivery. At present, there is an over-emphasis on surgical and pharmacological interventions, despite evidence supporting conservative treatments such as exercise, weight loss and education. While clinical guidelines provide recommendations regarding best practice (ie, what to do), they fail to address how to operationalise these recommendations into clinical practice. Models of care (MoCs) can help bridge the evidence-practice gap by outlining evidence-informed interventions as well as how to implement them within a local system. However, New Zealand has no osteoarthritis MoC. The Mobility Action Programme, funded by the Ministry of Health, is delivering evidence-informed, multi-disciplinary care for osteoarthritis through local initiatives. Although the programme remains under evaluation it presents an opportunity to inform development of a national osteoarthritis MoC for New Zealand. A policy framework, such as a MoC, is needed to scale up successful programs and deliver best practice care nationwide. Ultimately, addressing the burden of osteoarthritis will require system-wide approaches involving public policy responses to target primary prevention.

  5. Current State and Model for Development of Technology-Based Care for Attention Deficit Hyperactivity Disorder

    Science.gov (United States)

    Riley, Steven J.; Calub, Catrina A.; Schweitzer, Julie B.

    2016-01-01

    Abstract Introduction: Care (i.e., evaluation and intervention) delivered through technology is used in many areas of mental health services, including for persons with attention deficit hyperactivity disorder (ADHD). Technology can facilitate care for individuals with ADHD, their parents, and their care providers. The adoption of technological tools for ADHD care requires evidence-based studies to support the transition from development to integration into use in the home, school, or work for persons with the disorder. The initial phase, which is development of technological tools, has begun in earnest; however, the evidence base for many of these tools is lacking. In some instances, the uptake of a piece of technology into home use or clinical practice may be further along than the research to support its use. Methods: In this study, we review the current evidence regarding technology for ADHD and also propose a model to evaluate the support for other tools that have yet to be tested. Results: We propose using the Research Domain Criteria as a framework for evaluating the tools' relationships to dimensions related to ADHD. Conclusion: This article concludes with recommendations for testing new tools that may have promise in improving the evaluation or treatment of persons with ADHD. PMID:26985703

  6. Multipayer patient-centered medical home implementation guided by the chronic care model.

    Science.gov (United States)

    Gabbay, Robert A; Bailit, Michael H; Mauger, David T; Wagner, Edward H; Siminerio, Linda

    2011-06-01

    A unique statewide multipayer ini Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) guided by the Chronic Care Model (CCM) with diabetes as an initial target disease. This project represents the first broad-scale CCM implementation with payment reform across a diverse range of practice organizations and one of the largest PCMH multipayer initiatives. Practices implemented the CCM and PCMH through regional Breakthrough Series learning collaboratives, supported by Improving Performance in Practice (IPIP) practice coaches, with required monthly quality reporting enhanced by multipayer infrastructure payments. Some 105 practices, representing 382 primary care providers, were engaged in the four regional collaboratives. The practices from the Southeast region of Pennsylvania focused on diabetes patients (n = 10,016). During the first intervention year (May 2008-May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients. Transforming primary care delivery through implementation of the PCMH and CCM supported by multipayer infrastructure payments holds significant promise to improve diabetes care.

  7. Nursing Care Model Based on Knowledge Management in Preventing Nosocomial Infection After Caesarean Section in Hospital

    Directory of Open Access Journals (Sweden)

    Ahsan Ahsan

    2016-09-01

    Full Text Available Introduction: Nosocomial infection is one indicator of the quality of health services in the community, which also determines the image of health care institutions becauseit was a major cause of morbidityand death rate (mortality in hospital. Nursing care based on knowledge management is established from identification knowledge which is required, prevention performance of nosocomial infections post section caesarea. Nosocomial infections component consists of wound culture result. Method: This study was an observational study with a quasi experimental design. The population was all of nursing staff who working in obstetrics installation in hospitals A and B as much as 46 people. Sample was the total population. Data was collected through questionnaire, observation sheets and examination of the wound culture. Data was analyzed using t test B 1.274 dan p=0.028 Result: The result showed that 1 there was difference in knowledge management implementation before and after training; 2 there was difference in nurse’s performance in preventing nosocomial infection before and after training; 3 there is significant relationship between nurse’s performance in preventing nosocomial infection and infection incidence; 4 there is no significant difference of nursing care impementation on nosocomial incidence. Discussion: In conclusion, the development of nursing care based on knowledge management as a synthesis or induction of findings directed at 1 nurses’ knowledge does not affect the performance of the prevention of nosocomial infections; 2 knowledge management has a positive effect on the performance of the prevention of nosocomial infections; 3 implementation of infection prevention is integrated capabilities between knowledge, skills and attitudes of nurses in implementing performance in care. Keywords: model prevention, nosocomial infections, nursing care, knowledge management, sectio Caesarea

  8. A subacute model of geriatric care for frail older persons: the Tan Tock Seng Hospital experience.

    Science.gov (United States)

    Chong, Mei Sian; Empensando, Esmiller F; Ding, Yew Yoong; Tan, Thai Lian

    2012-08-01

    The subacute care unit in Tan Tock Seng Hospital (TTSH) was set up in May 2009. We examined its impact on the transitions at the nexus between hospital and community sectors, patients' discharge destination and functional performance. We studied patients admitted during the initial 6-month period (May to October 2009). Differences in demographics, length of stay (LOS), comorbidity and severity of illness measures, functional outcomes (modified Barthel Index (MBI)) according to discharge destinations were obtained. We also studied the impact of LOS on the geriatric department and the bill size over the pre- and post-subacute implementation periods. Majority of the subacute patients' hospital stay was in subacute care. Of these patients, 44.9% were discharged home, 24.2% to a slow stream rehabilitation (SSR) setting and 29.2% to nursing homes. 16.9% consisted of a subgroup of dementia patients requiring further behavioural and functional interventions, of which 50% managed to be discharged home. Functional gains were seen during subacute stay; with greatest gains observed in the SSR group. There were no differences in overall LOS nor total bill size (DRG-adjusted) for the geriatric medicine department during the first 6 months of operating this new subacute model compared with the prior 4-month period. We propose this subacute model of geriatric care, which allows right-siting of care and improved functional outcomes. It fulfills the role easing transitions between acute hospital and community sectors. In particular, it provides specialised care to a subgroup of dementia patients with challenging behaviours and is fiscally sound from the wider hospital perspective.

  9. Big data modeling to predict platelet usage and minimize wastage in a tertiary care system.

    Science.gov (United States)

    Guan, Leying; Tian, Xiaoying; Gombar, Saurabh; Zemek, Allison J; Krishnan, Gomathi; Scott, Robert; Narasimhan, Balasubramanian; Tibshirani, Robert J; Pham, Tho D

    2017-10-24

    Maintaining a robust blood product supply is an essential requirement to guarantee optimal patient care in modern health care systems. However, daily blood product use is difficult to anticipate. Platelet products are the most variable in daily usage, have short shelf lives, and are also the most expensive to produce, test, and store. Due to the combination of absolute need, uncertain daily demand, and short shelf life, platelet products are frequently wasted due to expiration. Our aim is to build and validate a statistical model to forecast future platelet demand and thereby reduce wastage. We have investigated platelet usage patterns at our institution, and specifically interrogated the relationship between platelet usage and aggregated hospital-wide patient data over a recent consecutive 29-mo period. Using a convex statistical formulation, we have found that platelet usage is highly dependent on weekday/weekend pattern, number of patients with various abnormal complete blood count measurements, and location-specific hospital census data. We incorporated these relationships in a mathematical model to guide collection and ordering strategy. This model minimizes waste due to expiration while avoiding shortages; the number of remaining platelet units at the end of any day stays above 10 in our model during the same period. Compared with historical expiration rates during the same period, our model reduces the expiration rate from 10.5 to 3.2%. Extrapolating our results to the ∼2 million units of platelets transfused annually within the United States, if implemented successfully, our model can potentially save ∼80 million dollars in health care costs.

  10. Diabetes management using modern information and communication technologies and new care models.

    Science.gov (United States)

    Spanakis, Emmanouil G; Chiarugi, Franco; Kouroubali, Angelina; Spat, Stephan; Beck, Peter; Asanin, Stefan; Rosengren, Peter; Gergely, Tamas; Thestrup, Jesper

    2012-10-04

    Diabetes, a metabolic disorder, has reached epidemic proportions in developed countries. The disease has two main forms: type 1 and type 2. Disease management entails administration of insulin in combination with careful blood glucose monitoring (type 1) or involves the adjustment of diet and exercise level, the use of oral anti-diabetic drugs, and insulin administration to control blood sugar (type 2). State-of-the-art technologies have the potential to assist healthcare professionals, patients, and informal carers to better manage diabetes insulin therapy, help patients understand their disease, support self-management, and provide a safe environment by monitoring adverse and potentially life-threatening situations with appropriate crisis management. New care models incorporating advanced information and communication technologies have the potential to provide service platforms able to improve health care, personalization, inclusion, and empowerment of the patient, and to support diverse user preferences and needs in different countries. The REACTION project proposes to create a service-oriented architectural platform based on numerous individual services and implementing novel care models that can be deployed in different settings to perform patient monitoring, distributed decision support, health care workflow management, and clinical feedback provision. This paper presents the work performed in the context of the REACTION project focusing on the development of a health care service platform able to support diabetes management in different healthcare regimes, through clinical applications, such as monitoring of vital signs, feedback provision to the point of care, integrative risk assessment, and event and alarm handling. While moving towards the full implementation of the platform, three major areas of research and development have been identified and consequently approached: the first one is related to the glucose sensor technology and wearability, the second

  11. Acute renal failure requiring renal replacement therapy in the intensive care unit: impact on prognostic assessment for shared decision making.

    Science.gov (United States)

    Johnson, Robert F; Gustin, Jillian

    2011-07-01

    A 69-year-old female was receiving renal replacement therapy (RRT) for acute renal failure (ARF) in an intensive care unit (ICU). Consultation was requested from the palliative medicine service to facilitate a shared decision-making process regarding goals of care. Clinician responsibility in shared decision making includes the formulation and expression of a prognostic assessment providing the necessary perspective for a spokesperson to match patient values with treatment options. For this patient, ARF requiring RRT in the ICU was used as a focal point for preparing a prognostic assessment. A prognostic assessment should include the outcomes of most importance to a discussion of goals of care: mortality risk and survivor functional status, in this case including renal recovery. A systematic review of the literature was conducted to document published data regarding these outcomes for adult patients receiving RRT for ARF in the ICU. Forty-one studies met the inclusion criteria. The combined mean values for short-term mortality, long-term mortality, renal-function recovery of short-term survivors, and renal-function recovery of long-term survivors were 51.7%, 68.6%, 82.0%, and 88.4%, respectively. This case example illustrates a process for formulating and expressing a prognostic assessment for an ICU patient requiring RRT for ARF. Data from the literature review provide baseline information that requires adjustment to reflect specific patient circumstances. The nature of the acute primary process, comorbidities, and severity of illness are key modifiers. Finally, the prognostic assessment is expressed during a family meeting using recommended principles of communication.

  12. Comprehensive care of elderly patients with hip fracture: the orthogeriatric model

    OpenAIRE

    Carlo Frondini; Maria L. Lunardelli

    2013-01-01

    Introduction: Hip fractures in the elderly are a major source of morbidity and mortality. Interdisciplinary hospital care models proposed for the treatment of these patients include consultant teams, integrated orthopedic-geriatric care, and comprehensive geriatric-led care settings. A prospective interventional cohort study was conducted in 4 public hospitals in the Emilia-Romagna Region of Italy to compare the outcomes of these different care models. This report presents the preliminary res...

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

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

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

  14. Implementation and evaluation of a depression care model for homebound elderly.

    Science.gov (United States)

    Madden-Baer, Rose; McConnell, Eleanor; Rosati, Robert J; Rosenfeld, Peri; Edison, Ilaina

    2013-01-01

    Depression affects 14% to 46% of homebound elderly and is costly and disabling. Home health agencies face significant challenges delivering effective depression care. In response, an evidence-based depression care model was developed in a home health agency. Twelve-month program evaluation data demonstrated a 2.99 mean reduction in depression scores (P Depression Scale and confirmed that a clinically effective, operationally feasible, and financially sustainable depression care model can be implemented in home health care.

  15. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency. Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model. Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection. Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  16. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency.Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model.Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection.Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  17. Defense Health Care. Reimbursement of Hospitals Not Meeting CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) Copayment Requirements.

    Science.gov (United States)

    1988-06-01

    8217JntedState* General AccouýLg Office __ Rteport to Congmesoa Commitee A,""FILE COPYAD-A197 876 DF7-EANSE HEF.ALTHl L’W Reimbur emen--t Of I...Secretary of Defense grant a waiver from CHAMPUS copayment requirements and be approved, tuader certain criteria, to be reimbursed for care to...that a provider waives patient copayments, it denies the provider’s claim for reimbursement . . In fiscal year 1987, cHAmpus payments to civilian

  18. Barriers and facilitators to replicating an evidence-based palliative care model.

    Science.gov (United States)

    Davis, E Maxwell; Jamison, Paula; Brumley, Richard; Enguídanos, Susan

    2006-01-01

    Recognition of the difficulties involved in replicating evidence- based interventions is well documented in the literature within the medical field. Promising research findings are often not translated into practice, and if they are, there is a significant time gap between study conclusion and practice adoption. The purpose of this article is to describe the barriers and facilitators encountered by two managed care organizations while replicating an evidence-based end of life in-home palliative care model. Using Diffusion of Innovation Theory as a theoretical framework, results from focus groups and interviews with the project's clinical, administrative and research teams are presented and recommendations made for improving translational efforts. The process of replicating the end of life in-home palliative care model clearly illustrated the key elements required for successfully diffusing innovation. These key elements include marketing and communication, leadership, organizational support and training and mentorship. This qualitative process study provides clear, real world perspectives of the myriad of challenges encountered in replicating an evidence-based project.

  19. Sex Differences in Health Care Requirements Aboard U.S. Navy Ships

    Science.gov (United States)

    1990-03-20

    asymptomatic in females, and yet may lead to serious complications, requires more sensitive laboratory and test capabilities than currently exist aboard...DISEASES OF THE DIGESTIVE SYSTEM (520-579) 18.0 28.1 14.7 1.92 522 Diseases of pulp or periapical tissues .08 .00 .11 -- 523 Gingival or periodontal ...ORGANIZATION 6b OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATiON Naval Health Research Center (if apicable ) Chief 40 Bureau of Medicine and Surgery 6c ADDRESS

  20. Nurse-directed care model in a psychiatric hospital: a model for clinical accountability.

    Science.gov (United States)

    E-Morris, Marlene; Caldwell, Barbara; Mencher, Kathleen J; Grogan, Kimberly; Judge-Gorny, Margaret; Patterson, Zelda; Christopher, Terrian; Smith, Russell C; McQuaide, Teresa

    2010-01-01

    The focus on recovery for persons with severe and persistent mental illness is leading state psychiatric hospitals to transform their method of care delivery. This article describes a quality improvement project involving a hospital's administration and multidisciplinary state-university affiliation that collaborated in the development and implementation of a nursing care delivery model in a state psychiatric hospital. The quality improvement project team instituted a new model to promote the hospital's vision of wellness and recovery through utilization of the therapeutic relationship and greater clinical accountability. Implementation of the model was accomplished in 2 phases: first, the establishment of a structure to lay the groundwork for accountability and, second, the development of a mechanism to provide a clinical supervision process for staff in their work with clients. Effectiveness of the model was assessed by surveys conducted at baseline and after implementation. Results indicated improvement in clinical practices and client living environment. As a secondary outcome, these improvements appeared to be associated with increased safety on the units evidenced by reduction in incidents of seclusion and restraint. Restructuring of the service delivery system of care so that clients are the center of clinical focus improves safety and can enhance the staff's attention to work with clients on their recovery. The role of the advanced practice nurse can influence the recovery of clients in state psychiatric hospitals. Future research should consider the impact on clients and their perceptions of the new service models.

  1. Clinical data integration model. Core interoperability ontology for research using primary care data.

    Science.gov (United States)

    Ethier, J-F; Curcin, V; Barton, A; McGilchrist, M M; Bastiaens, H; Andreasson, A; Rossiter, J; Zhao, L; Arvanitis, T N; Taweel, A; Delaney, B C; Burgun, A

    2015-01-01

    This article is part of the Focus Theme of METHODS of Information in Medicine on "Managing Interoperability and Complexity in Health Systems". Primary care data is the single richest source of routine health care data. However its use, both in research and clinical work, often requires data from multiple clinical sites, clinical trials databases and registries. Data integration and interoperability are therefore of utmost importance. TRANSFoRm's general approach relies on a unified interoperability framework, described in a previous paper. We developed a core ontology for an interoperability framework based on data mediation. This article presents how such an ontology, the Clinical Data Integration Model (CDIM), can be designed to support, in conjunction with appropriate terminologies, biomedical data federation within TRANSFoRm, an EU FP7 project that aims to develop the digital infrastructure for a learning healthcare system in European Primary Care. TRANSFoRm utilizes a unified structural / terminological interoperability framework, based on the local-as-view mediation paradigm. Such an approach mandates the global information model to describe the domain of interest independently of the data sources to be explored. Following a requirement analysis process, no ontology focusing on primary care research was identified and, thus we designed a realist ontology based on Basic Formal Ontology to support our framework in collaboration with various terminologies used in primary care. The resulting ontology has 549 classes and 82 object properties and is used to support data integration for TRANSFoRm's use cases. Concepts identified by researchers were successfully expressed in queries using CDIM and pertinent terminologies. As an example, we illustrate how, in TRANSFoRm, the Query Formulation Workbench can capture eligibility criteria in a computable representation, which is based on CDIM. A unified mediation approach to semantic interoperability provides a

  2. The pharmacokinetics of enteral antituberculosis drugs in patients requiring intensive care.

    Science.gov (United States)

    Koegelenberg, C F N; Nortje, A; Lalla, U; Enslin, A; Irusen, E M; Rosenkranz, B; Seifart, H I; Bolliger, C T

    2013-04-05

    There is a paucity of data on the pharmacokinetics of fixed-dose combination enteral antituberculosis treatment in critically ill patients. To establish the pharmacokinetic profile of a fixed-dose combination of rifampicin, isoniazid, pyrazinamide and ethambutol given according to weight via a nasogastric tube to patients admitted to an intensive care unit (ICU). We conducted a prospective, observational study on 10 patients (mean age 32 years, 6 male) admitted to an ICU and treated for tuberculosis (TB). Serum concentrations of the drugs were determined at eight predetermined intervals over 24 hours by means of high-performance liquid chromatography. The therapeutic maximum plasma concentration (Cmax) for rifampicin at time to peak concentration was achieved in only 4 patients, whereas 2 did not achieve therapeutic Cmax for isoniazid. No patient reached sub-therapeutic Cmax for pyrazinamide (6 were within and 4 above therapeutic range). Three patients reached sub-therapeutic Cmax for ethambutol, and 6 patients were within and 1 above the therapeutic range. Patients with a sub-therapeutic rifampicin level had a higher mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p=0.03) and a lower estimated glomerular filtration rate (GFR) (p=0.03). A fixed-dose combination tablet, crushed and mixed with water, given according to weight via a nasogastric tube to patients with TB admitted to an ICU resulted in sub-therapeutic rifampicin plasma concentrations in the majority of patients, whereas the other drugs had a more favourable pharmacokinetic profile. Patients with a sub-therapeutic rifampicin concentration had a higher APACHE II score and a lower estimated GFR, which may contribute to suboptimal outcomes in critically ill patients. Studies in other settings have reported similar proportions of patients with 'sub-therapeutic' rifampicin concentrations.

  3. On Early Conflict Identification by Requirements Modeling of Energy System Control Structures

    DEFF Research Database (Denmark)

    Heussen, Kai; Gehrke, Oliver; Niemann, Hans Henrik

    2015-01-01

    issues early. For requirements formulation of control structures, cyber and physical aspects need to be jointly represented to express interdependencies, check for consistency and discover potentially conflicting requirements. Early identification of potential conflicts may prevent larger problems...... at later design stages. However, languages employed for requirements modeling today do not offer the expressiveness necessary to represent control purposes in relation to domain level interactions and therefore miss several types of interdependencies. This paper introduces the idea of control structure...... modeling for early requirements checking using a suitable modeling language, and illustrates how this approach enables the identification of several classes of controller conflict....

  4. Requirements-level semantics and model checking of object-oriented statecharts

    NARCIS (Netherlands)

    Eshuis, H.; Jansen, D.N.; Wieringa, Roelf J.

    2002-01-01

    In this paper we define a requirements-level execution semantics for object-oriented statecharts and show how properties of a system specified by these statecharts can be model checked using tool support for model checkers. Our execution semantics is requirements-level because it uses the perfect

  5. [The Community Care as a model of social and health integration at the local level].

    Science.gov (United States)

    Ridolfi, Luciana

    2013-01-01

    The article develops a hypothesis for improving primary care services through health care solutions that can exceed the models in use (essentially hierarchical and based on tasks) in favor of new relational, multi-sectoral and network approaches that could privilege the integration of social and health services at the regional and district level (Community care). A qualitative methodological approach which analyzes the role of social networks in Community care, some national and international experiences of primary care models and the evaluation of the different role given to primary care both in the hierarchical-pyramidal approach and in the horizontal one (network approach). Some Italian regions are experimenting effective organizational models of care such as Primary Care Teams, Primary Care Units, Regional teams, Departments of Primary Care, Houses of Health ... At international level, it should be mentioned the Chronic Care Model (CCM), recently identified by WHO as a reference model, and adopted by the Tuscany Region (Italy). People-centered health care projects need shared interventions by competent and functional multiprofessional teams: the best outcome for the patient depends on the good interaction between individuals. It's necessary that relationships between members of the group are based on interdependence, integration and consistency to avoid risks of group illusion.

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

    Directory of Open Access Journals (Sweden)

    Van Royen Paul

    2009-08-01

    Full Text Available Abstract Background Most research publications on Chronic Care Model (CCM implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Belgian healthcare setting, a setting where the organisational framework for chronic care is mainly hospital-centered. Methods Process evaluation of an action research project (2003–2007 guided by the CCM in a well-defined geographical area with 76,826 inhabitants and an estimated number of 2,300 type 2 diabetes patients. In consultation with the region a program for type 2 diabetes patients was developed. The degree of implementation of the CCM in the region was assessed using the Assessment of Chronic Illness Care survey (ACIC. A multimethod approach was used to evaluate the implementation process. The resulting data were triangulated in order to identify the main facilitators and barriers encountered during the implementation process. Results The overall ACIC score improved from 1.45 (limited support at the start of the study to 5.5 (basic support at the end of the study. The establishment of a local steering group and the appointment of a program manager were crucial steps in strengthening primary care. The willingness of a group of well-trained and motivated care providers to invest in quality improvement was an important facilitator. Important barriers were the complexity of the intervention, the lack of quality data, inadequate information technology support, the lack of commitment procedures and the uncertainty about sustainable funding. Conclusion Guided by the CCM, this study highlights the opportunities and the bottlenecks for adapting chronic care

  7. Understanding stakeholder important outcomes and perceptions of equity, acceptability and feasibility of a care model for haemophilia management in the US: a qualitative study.

    Science.gov (United States)

    Lane, S J; Sholapur, N S; Yeung, C H T; Iorio, A; Heddle, N M; Sholzberg, M; Pai, M

    2016-07-01

    Care for persons with haemophilia (PWH) is most commonly delivered through the integrated care model used by Hemophilia Treatment Centers (HTCs). Although this model is widely accepted as the gold standard for the management of haemophilia; there is little evidence comparing different care models. We performed a qualitative study to gain insight into issues related to outcomes, acceptability, equity and feasibility of different care models operating in the US. We used a qualitative descriptive approach with semi-structured interviews. Purposive sampling was used to recruit individuals with experience providing or receiving care for haemophilia in the US through either an integrated care centre, a specialty pharmacy or homecare company, or by a specialist in a non-specialized centre. Persons with haemophilia, parents of PWH aged ≤18, healthcare providers, insurance company representatives and policy developers were invited to participate. Twenty-nine interviews were conducted with participants representing 18 US states. Participants in the study sample had experience receiving or providing care predominantly within an HTC setting. Integrated care at HTCs was highly acceptable to participants, who appreciated the value of specialized, expert care in a multidisciplinary team setting. Equity and feasibility issues were primarily related to health insurance and funding limitations. Additional research is required to document the impact of care on health and psychosocial outcomes and identify effective ways to facilitate equitable access to haemophilia treatment and care. © 2016 John Wiley & Sons Ltd.

  8. Usefulness of a 50-meter round walking test for fall prediction in the elderly requiring long-term care

    Science.gov (United States)

    Hachiya, Mizuki; Murata, Shin; Otao, Hiroshi; Ihara, Takehiko; Mizota, Katsuhiko; Asami, Toyoko

    2015-01-01

    [Purpose] This study aimed to verify the usefulness of a 50-m round walking test developed as an assessment method for walking ability in the elderly. [Subjects] The subjects were 166 elderly requiring long-term care individuals (mean age, 80.5 years). [Methods] In order to evaluate the factors that had affected falls in the subjects in the previous year, we performed the 50-m round walking test, functional reach test, one-leg standing test, and 5-m walking test and measured grip strength and quadriceps strength. [Results] The 50-m round walking test was selected as a variable indicating fall risk based on the results of multiple logistic regression analysis. The cutoff value of the 50-m round walking test for determining fall risk was 0.66 m/sec. The area under the receiver operating characteristic curve was 0.64. The sensitivity of the cutoff value was 65.7%, the specificity was 63.6%, the positive predictive value was 55.0%, the negative predictive value was 73.3%, and the accuracy was 64.5%. [Conclusion] These results suggest that the 50-m round walking test is a potentially useful parameter for the determination of fall risk in the elderly requiring long-term care. PMID:26834327

  9. Criteria required for an acceptable point-of-care test for UTI detection: Obtaining consensus using the Delphi technique.

    Science.gov (United States)

    Weir, Nichola-Jane M; Pattison, Sally H; Kearney, Paddy; Stafford, Bob; Gormley, Gerard J; Crockard, Martin A; Gilpin, Deirdre F; Tunney, Michael M; Hughes, Carmel M

    2018-01-01

    Urinary Tract Infections (UTIs) are common bacterial infections, second only to respiratory tract infections and particularly prevalent within primary care. Conventional detection of UTIs is culture, however, return of results can take between 24 and 72 hours. The introduction of a point of care (POC) test would allow for more timely identification of UTIs, facilitating improved, targeted treatment. This study aimed to obtain consensus on the criteria required for a POC UTI test, to meet patient need within primary care. Criteria for consideration were compiled by the research team. These criteria were validated through a two-round Delphi process, utilising an expert panel of healthcare professionals from across Europe and United States of America. Using web-based questionnaires, panellists recorded their level of agreement with each criterion based on a 5-point Likert Scale, with space for comments. Using median response, interquartile range and comments provided, criteria were accepted/rejected/revised depending on pre-agreed cut-off scores. The first round questionnaire presented thirty-three criteria to the panel, of which 22 were accepted. Consensus was not achieved for the remaining 11 criteria. Following response review, one criterion was removed, while after revision, the remaining 10 criteria entered the second round. Of these, four were subsequently accepted, resulting in 26 criteria considered appropriate for a POC test to detect urinary infections. This study generated an approved set of criteria for a POC test to detect urinary infections. Criteria acceptance and comments provided by the healthcare professionals also supports the development of a multiplex point of care UTI test.

  10. 76 FR 34712 - Medicare Program; Pioneer Accountable Care Organization Model; Extension of the Submission...

    Science.gov (United States)

    2011-06-14

    ... stakeholders to develop initiatives to test innovative payment and service delivery models to reduce program...] Medicare Program; Pioneer Accountable Care Organization Model; Extension of the Submission Deadlines for... of the Pioneer Accountable Care Organization Model letters of intent to June 30, 2011 and the...

  11. 76 FR 29249 - Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications

    Science.gov (United States)

    2011-05-20

    ... Affordable Care Act, to test innovative payment and service delivery models that reduce spending under.... This Model will test the effectiveness of a combination of the following: Payment arrangements that...] Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications AGENCY: Centers for...

  12. 78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

    Science.gov (United States)

    2013-02-06

    ... develop and test innovative health care payment and service delivery models that show promise of reducing... test innovative payment and service delivery models that reduce spending under Medicare, Medicaid or...] Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement AGENCY: Centers for...

  13. Holistic models for end of life care: establishing the place of culture

    NARCIS (Netherlands)

    Selman, L.; Speck, P.; Barfield, R.C.; Gysels, M.; Higginson, I.J.; Harding, R.

    2014-01-01

    Introduction This article presents a holistic model for clinical palliative care and research which expands and improves previous models by fully recognizing the place of culture in illness. Methods Literature review and philosophical enquiry. Results Holistic models of patient care are essential to

  14. A standardised graphic method for describing data privacy frameworks in primary care research using a flexible zone model.

    Science.gov (United States)

    Kuchinke, Wolfgang; Ohmann, Christian; Verheij, Robert A; van Veen, Evert-Ben; Arvanitis, Theodoros N; Taweel, Adel; Delaney, Brendan C

    2014-12-01

    To develop a model describing core concepts and principles of data flow, data privacy and confidentiality, in a simple and flexible way, using concise process descriptions and a diagrammatic notation applied to research workflow processes. The model should help to generate robust data privacy frameworks for research done with patient data. Based on an exploration of EU legal requirements for data protection and privacy, data access policies, and existing privacy frameworks of research projects, basic concepts and common processes were extracted, described and incorporated into a model with a formal graphical representation and a standardised notation. The Unified Modelling Language (UML) notation was enriched by workflow and own symbols to enable the representation of extended data flow requirements, data privacy and data security requirements, privacy enhancing techniques (PET) and to allow privacy threat analysis for research scenarios. Our model is built upon the concept of three privacy zones (Care Zone, Non-care Zone and Research Zone) containing databases, data transformation operators, such as data linkers and privacy filters. Using these model components, a risk gradient for moving data from a zone of high risk for patient identification to a zone of low risk can be described. The model was applied to the analysis of data flows in several general clinical research use cases and two research scenarios from the TRANSFoRm project (e.g., finding patients for clinical research and linkage of databases). The model was validated by representing research done with the NIVEL Primary Care Database in the Netherlands. The model allows analysis of data privacy and confidentiality issues for research with patient data in a structured way and provides a framework to specify a privacy compliant data flow, to communicate privacy requirements and to identify weak points for an adequate implementation of data privacy. Copyright © 2014 Elsevier Ireland Ltd. All rights

  15. A stepped-wedge evaluation of an initiative to spread the collaborative care model for depression in primary care.

    Science.gov (United States)

    Solberg, Leif I; Crain, A Lauren; Maciosek, Michael V; Unützer, Jürgen; Ohnsorg, Kris A; Beck, Arne; Rubenstein, Lisa; Whitebird, Robin R; Rossom, Rebecca C; Pietruszewski, Pamela B; Crabtree, Benjamin F; Joslyn, Kenneth; Van de Ven, Andrew; Glasgow, Russell E

    2015-09-01

    Scale-up and spread of evidence-based practices is one of the most important challenges facing health care. We tested whether a statewide initiative, Depression Improvement Across Minnesota-Offering a New Direction (DIAMOND), to implement the collaborative care model for depression in 75 primary care clinics resulted in patient outcome improvements corresponding to those reported in randomized controlled trials. Health plans provided a new monthly payment to participating clinics after a 6-month intensive training program with ongoing data submission, networking, and consultation. Implementation was staggered, with 5 sequences of 10 to 40 clinics every 6 months. Payers provided weekly contact information for members from participating clinics who were filling antidepressant prescriptions, and we conducted baseline and 6-month surveys of 1,578 patients about their care and outcomes. There were 466 patients in DIAMOND clinics who received usual care before implementation (UCB), 559 who received usual care in DIAMOND clinics after implementation (UCA), 245 who received DIAMOND care after implementation (DCA), and 308 who received usual care in comparison clinics (UC). Patients who received DIAMOND care after implementation reported more collaborative care depression services than the 3 comparison groups (10.9 vs 6.4-6.7, on a scale of 0 of 14, where higher numbers indicate more services; P <.001) and more satisfaction with their care (4.0 vs 3.4 on a scale 1 to 5, in which higher scores indicate higher satisfaction; P ≤.001). Depression remission rates, however, were not significantly different among the 4 groups (36.4% DCA vs 35.8% UCB, 35.0% UCA, 33.9% UC; P = .94). Despite the incentive of a supporting payment change and intensive training and support for clinics volunteering to participate, no difference in depression outcomes was documented. Specific unmeasured actions present in trials but not present in these clinics may be critical for successful outcome

  16. Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

    OpenAIRE

    Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

    2013-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the H...

  17. Primary care for diabetes mellitus patients from the perspective of the care model for chronic conditions.

    Science.gov (United States)

    Salci, Maria Aparecida; Meirelles, Betina Hörner Schlindwein; Silva, Denise Maria Guerreiro Vieira da

    2017-03-09

    to assess the health care Primary Health Care professionals provide to diabetes mellitus patients from the perspective of the Modelo de Atenção às Condições Crônicas. qualitative study, using the theoretical framework of Complex Thinking and the Modelo de Atenção às Condições Crônicas and the methodological framework of assessment research. To collect the data, 38 interviews were held with health professionals and managers; observation of the activities by the health teams; and analysis of 25 files of people who received this care. The data analysis was supported by the software ATLAS.ti, using the directed content analysis technique. at the micro level, care was distant from the integrality of the actions needed to assist people with chronic conditions and was centered on the biomedical model. At the meso level, there was disarticulation among the professionals of the Family Health Strategy, between them and the users, family and community. At the macro level, there was a lack of guiding strategies to implement public policies for diabetes in care practice. the implementation of the Modelo de Atenção às Condições Crônicas represents a great challenge, mainly needing professionals and managers who are prepared to work with chronic conditions are who are open to break with the traditional model. evaluar la atención de salud desarrollada por los integrantes de la Atención Primaria de Salud a las personas con diabetes mellitus en la perspectiva del Modelo de Atenção às Condições Crônicas. estudio cualitativo, con referencial teórico del Pensamiento Complejo y del Modelo de Atenção às Condições Crônicas y metodológico de la investigación evaluativa. Para recolectar los datos fueron efectuadas 38 entrevistas con profesionales de salud y gestores; observación de las actividades practicadas por los equipos de salud: y análisis de 25 archivos de personas que recibían esa atención. Los datos fueron analizados con auxilio del software

  18. Activity-based funding model provides foundation for province-wide best practices in renal care.

    Science.gov (United States)

    Levin, Adeera; Lo, Clifford; Noel, Kevin; Djurdjev, Ogjnenka; Amano, Erlyn C

    2013-01-01

    British Columbia has a unique funding model for renal care in Canada. Patient care is delivered through six health authorities, while funding is administered by the Provincial Renal Agency using an activity-based funding model. The model allocates funding based on a schedule of costs for every element of renal care, excluding physician fees. Accountability, transparency of allocation and tracking of outcomes are key features that ensure successful implementation. The model supports province-wide best practices and equitable care and fosters innovation. Since its introduction, the outpatient renal services budget has grown less than the population, while maintaining or improving clinical outcomes. Copyright © 2013 Longwoods Publishing.

  19. Identifying models of HIV care and treatment service delivery in Tanzania, Uganda, and Zambia using cluster analysis and Delphi survey.

    Science.gov (United States)

    Tsui, Sharon; Denison, Julie A; Kennedy, Caitlin E; Chang, Larry W; Koole, Olivier; Torpey, Kwasi; Van Praag, Eric; Farley, Jason; Ford, Nathan; Stuart, Leine; Wabwire-Mangen, Fred

    2017-12-06

    Organization of HIV care and treatment services, including clinic staffing and services, may shape clinical and financial outcomes, yet there has been little attempt to describe different models of HIV care in sub-Saharan Africa (SSA). Information about the relative benefits and drawbacks of different models could inform the scale-up of antiretroviral therapy (ART) and associated services in resource-limited settings (RLS), especially in light of expanded client populations with country adoption of WHO's test and treat recommendation. We characterized task-shifting/task-sharing practices in 19 diverse ART clinics in Tanzania, Uganda, and Zambia and used cluster analysis to identify unique models of service provision. We ran descriptive statistics to explore how the clusters varied by environmental factors and programmatic characteristics. Finally, we employed the Delphi Method to make systematic use of expert opinions to ensure that the cluster variables were meaningful in the context of actual task-shifting of ART services in SSA. The cluster analysis identified three task-shifting/task-sharing models. The main differences across models were the availability of medical doctors, the scope of clinical responsibility assigned to nurses, and the use of lay health care workers. Patterns of healthcare staffing in HIV service delivery were associated with different environmental factors (e.g., health facility levels, urban vs. rural settings) and programme characteristics (e.g., community ART distribution or integrated tuberculosis treatment on-site). Understanding the relative advantages and disadvantages of different models of care can help national programmes adapt to increased client load, select optimal adherence strategies within decentralized models of care, and identify differentiated models of care for clients to meet the growing needs of long-term ART patients who require more complicated treatment management.

  20. Solar Sail Models and Test Measurements Correspondence for Validation Requirements Definition

    Science.gov (United States)

    Ewing, Anthony; Adams, Charles

    2004-01-01

    Solar sails are being developed as a mission-enabling technology in support of future NASA science missions. Current efforts have advanced solar sail technology sufficient to justify a flight validation program. A primary objective of this activity is to test and validate solar sail models that are currently under development so that they may be used with confidence in future science mission development (e.g., scalable to larger sails). Both system and model validation requirements must be defined early in the program to guide design cycles and to ensure that relevant and sufficient test data will be obtained to conduct model validation to the level required. A process of model identification, model input/output documentation, model sensitivity analyses, and test measurement correspondence is required so that decisions can be made to satisfy validation requirements within program constraints.

  1. Health Insurance, Medical Care, and Health Outcomes: A Model of Elderly Health Dynamics

    Science.gov (United States)

    Yang, Zhou; Gilleskie, Donna B.; Norton, Edward C.

    2009-01-01

    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…

  2. Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs.

    Science.gov (United States)

    Ssonko, Charles; Gonzalez, Lucia; Mesic, Anita; da Fonseca, Marcio Silveira; Achar, Jay; Safar, Nadia; Martin, Beatriz; Wong, Sidney; Casas, Esther C

    2017-07-21

    Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentia