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Sample records for va health system

  1. VA INFORMATION SYSTEMS: Computer Security Weaknesses Persist at the Veterans Health Administration

    National Research Council Canada - National Science Library

    2000-01-01

    .... To determine the status of computer security within VHA, we (1) evaluated information system general controls at the VA Maryland Health Cafe System, the New Mexico VA Health Care System, and the VA North Texas Health Care System and (2...

  2. Visionary leadership and the future of VA health system.

    Science.gov (United States)

    Bezold, C; Mayer, E; Dighe, A

    1997-01-01

    As the U.S. Department of Veterans Affairs (VA) makes the change over to Veterans Integrated Service Network (VISNs) the need for new and better leadership is warranted if VA wants to not only survive, but thrive in the emerging twenty-first century healthcare system. VA can prepare for the future and meet the challenges facing them by adopting a system of visionary leadership. The use of scenarios and vision techniques are explained as they relate to VA's efforts to move toward their new system of VISNs. The four scenarios provide snapshots of possible futures for the U.S. healthcare system as well as the possible future role and mission of VA--from VA disappearing to its becoming a premier virtual organization.

  3. Social work in the Veterans Health Administration (VA) System: rewards, challenges, roles and interventions.

    Science.gov (United States)

    Beder, Joan; Postiglione, Paul

    2013-01-01

    For the social worker in the Veterans Health Administration (VA) System, numerous challenges are faced and met while serving the nation's Veterans. As part of the multidisciplinary team, social workers perform a variety of tasks and function in diverse roles. The qualitative survey research reported in this article sought to detail what social workers identified about the impact and rewards of their work and what they saw as the challenges and frustrations. In addition the social workers were asked to clarify their role with the patient and the family. Intervention strategies used in the course of the social workers interaction with the Veterans was also ascertained.

  4. Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

    Science.gov (United States)

    Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.

    2008-01-01

    Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…

  5. VA National Bed Control System

    Data.gov (United States)

    Department of Veterans Affairs — The VA National Bed Control System records the levels of operating, unavailable and authorized beds at each VAMC, and it tracks requests for changes in these levels....

  6. VA Personal Health Record Sample Data

    Data.gov (United States)

    Department of Veterans Affairs — My HealtheVet (www.myhealth.va.gov) is a Personal Health Record portal designed to improve the delivery of health care services to Veterans, to promote health and...

  7. Non-VA Hospital System (NVH)

    Data.gov (United States)

    Department of Veterans Affairs — The Veterans Health Administration (VHA) pays for care provided to VA beneficiaries in non-VA hospitals through its contract hospitalization program as mandated by...

  8. VA Suicide Prevention Applications Network: A National Health Care System-Based Suicide Event Tracking System.

    Science.gov (United States)

    Hoffmire, Claire; Stephens, Brady; Morley, Sybil; Thompson, Caitlin; Kemp, Janet; Bossarte, Robert M

    2016-11-01

    The US Department of Veterans Affairs' Suicide Prevention Applications Network (SPAN) is a national system for suicide event tracking and case management. The objective of this study was to assess data on suicide attempts among people using Veterans Health Administration (VHA) services. We assessed the degree of data overlap on suicide attempters reported in SPAN and the VHA's medical records from October 1, 2010, to September 30, 2014-overall, by year, and by region. Data on suicide attempters in the VHA's medical records consisted of diagnoses documented with E95 codes from the International Classification of Diseases, Ninth Revision . Of 50 518 VHA patients who attempted suicide during the 4-year study period, data on fewer than half (41%) were reported in both SPAN and the medical records; nearly 65% of patients whose suicide attempt was recorded in SPAN had no data on attempted suicide in the VHA's medical records. Evaluation of administrative data suggests that use of SPAN substantially increases the collection of data on suicide attempters as compared with the use of medical records alone, but neither SPAN nor the VHA's medical records identify all suicide attempters. Further research is needed to better understand the strengths and limitations of both systems and how to best combine information across systems.

  9. VA Veterans Health Administration Access Data

    Data.gov (United States)

    Department of Veterans Affairs — At the Department of Veterans Affairs (VA), our most important mission is to provide the high quality health care and benefits Veterans have earned and deserve —...

  10. Cause of death during 2009–2012, using a probabilistic model (InterVA-4: an experience from Ballabgarh Health and Demographic Surveillance System in India

    Directory of Open Access Journals (Sweden)

    Sanjay K. Rai

    2014-10-01

    Full Text Available Objectives: The present study aimed to estimate the age and cause-specific mortality in Ballabgarh Health and Demographic Surveillance System (HDSS site for the years 2009 to 2012, using a probabilistic model (InterVA-4. Methods: All Deaths in Ballabgarh HDSS from January 1, 2009, to December 31, 2012, were included in the study. InterVA-4 model (version 4.02 was used for assigning cause of death (COD. Data from the verbal autopsy (VA tool were extracted and processed with the InterVA-4 model. Cause-specific mortality rate (CSMR per 1,000 person-years was calculated. Results: A total of 2,459 deaths occurred in the HDSS during the year 2009 to 2012. Among them, 2,174 (88.4% valid VA interviews were conducted. Crude death rate ranged from 7.1 (2009 to 6.4 (2012 per 1,000 population. The CSMR per 1,000 person-years over the years (2009–2012 for non-communicable diseases, communicable diseases, trauma, neoplasm, and maternal and neonatal diseases were 1.78, 1.68, 0.68, 0.49, and 0.48, respectively. The most common causes of death among children, adults, and the elderly were infectious diseases, trauma, and non-communicable diseases, respectively. Conclusions: Overall, non-communicable diseases constituted the largest proportion of mortality, whereas trauma was the most common COD among adults at Ballabgarh HDSS. Policy-makers ought to focus on prevention of premature CODs, especially prevention of infectious diseases in children, and intentional self-harm and road traffic accidents in the adult population.

  11. 75 FR 78806 - Agency Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

    Science.gov (United States)

    2010-12-16

    ... Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt.... 2900-0474.'' SUPPLEMENTARY INFORMATION: Title: Create Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt, VA Form 26-8986. OMB Control Number: 2900...

  12. Revenue Based Budgeting at VA Northern California Health Care System: A Model for Financially Aligning Organizational Incentives and Operations

    National Research Council Canada - National Science Library

    Stockwell, David

    1999-01-01

    .... Changes in sharing agreement regulations, TRICARE, and Medical Care Cost Recovery (MCCR) also provided each network with the ability to generate revenue from sources outside the traditional VA appropriation...

  13. 75 FR 61252 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

    Science.gov (United States)

    2010-10-04

    ... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... information through the Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J...

  14. 78 FR 59771 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

    Science.gov (United States)

    2013-09-27

    ... Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt.... Title: Create Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated... through the Federal Docket Management System (FDMS) at www.Regulations.gov or to Nancy J. Kessinger...

  15. 75 FR 61859 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

    Science.gov (United States)

    2010-10-06

    ... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... information through the Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J...

  16. Electronic Health Records: DOD's and VA's Sharing of Information Could Benefit from Improved Management

    National Research Council Canada - National Science Library

    2009-01-01

    ...) and the Department of Veterans Affairs (VA) are required to accelerate the exchange of health information between the departments and to develop systems or capabilities that allow for interoperability...

  17. Information Technology: DOD and VA Have Increased Their Sharing of Health Information, but Further Actions Are Needed

    National Research Council Canada - National Science Library

    Melvin, Valerie C

    2008-01-01

    ...) and the Department of Veterans Affairs (VA) to accelerate the exchange of health information between the departments and to develop systems or capabilities that allow for full interoperability...

  18. Accelerating Research Impact in a Learning Health Care System: VA's Quality Enhancement Research Initiative in the Choice Act Era.

    Science.gov (United States)

    Kilbourne, Amy M; Elwy, A Rani; Sales, Anne E; Atkins, David

    2017-07-01

    Since 1998, the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) has supported more rapid implementation of research into clinical practice. With the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act), QUERI further evolved to support VHA's transformation into a Learning Health Care System by aligning science with clinical priority goals based on a strategic planning process and alignment of funding priorities with updated VHA priority goals in response to the Choice Act. QUERI updated its strategic goals in response to independent assessments mandated by the Choice Act that recommended VHA reduce variation in care by providing a clear path to implement best practices. Specifically, QUERI updated its application process to ensure its centers (Programs) focus on cross-cutting VHA priorities and specify roadmaps for implementation of research-informed practices across different settings. QUERI also increased funding for scientific evaluations of the Choice Act and other policies in response to Commission on Care recommendations. QUERI's national network of Programs deploys effective practices using implementation strategies across different settings. QUERI Choice Act evaluations informed the law's further implementation, setting the stage for additional rigorous national evaluations of other VHA programs and policies including community provider networks. Grounded in implementation science and evidence-based policy, QUERI serves as an example of how to operationalize core components of a Learning Health Care System, notably through rigorous evaluation and scientific testing of implementation strategies to ultimately reduce variation in quality and improve overall population health.

  19. Feasibility and acceptability of interventions to delay gun access in VA mental health settings.

    Science.gov (United States)

    Walters, Heather; Kulkarni, Madhur; Forman, Jane; Roeder, Kathryn; Travis, Jamie; Valenstein, Marcia

    2012-01-01

    The majority of VA patient suicides are completed with firearms. Interventions that delay patients' gun access during high-risk periods may reduce suicide, but may not be acceptable to VA stakeholders or may be challenging to implement. Using qualitative methods, stakeholders' perceptions about gun safety and interventions to delay gun access during high-risk periods were explored. Ten focus groups and four individual interviews were conducted with key stakeholders, including VA mental health patients, mental health clinicians, family members and VA facility leaders (N=60). Transcripts were consensus-coded by two independent coders, and structured summaries were developed and reviewed using a consensus process. All stakeholder groups indicated that VA health system providers had a role in increasing patient safety and emphasized the need for providers to address gun access with their at-risk patients. However, VA mental health patients and clinicians reported limited discussion regarding gun access in VA mental health settings during routine care. Most, although not all, patients and clinicians indicated that routine screening for gun access was acceptable, with several noting that it was more acceptable for mental health patients. Most participants suggested that family and friends be involved in reducing gun access, but expressed concerns about potential family member safety. Participants generally found distribution of trigger locks acceptable, but were skeptical about its effectiveness. Involving Veteran Service Organizations or other individuals in temporarily holding guns during high-risk periods was acceptable to many participants but only with numerous caveats. Patients, clinicians and family members consider the VA health system to have a legitimate role in addressing gun safety. Several measures to delay gun access during high-risk periods for suicide were seen as acceptable and feasible if implemented thoughtfully. Published by Elsevier Inc.

  20. Electronic Health Records: DOD and VA Have Increased Their Sharing of Health Information, but More Work Remains

    National Research Council Canada - National Science Library

    Melvin, Valerie C; Oliver, Barbara S; Collier, Barbara; Shaw, Kelly; Williams, Jr, Robert

    2008-01-01

    ...) and the Department of Veterans Affairs (VA) are required to accelerate the exchange of health information between the departments and to develop systems or capabilities that allow for full interoperability...

  1. VA National Mental Health Statistics - 2015

    Data.gov (United States)

    Department of Veterans Affairs — VAMC-level statistics on the prevalence, mental health utilization, non-mental health utilization, mental health workload, and psychological testing of Veterans with...

  2. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

    Science.gov (United States)

    2011-11-21

    ... concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing... to ``RIN 2900-AN98--Payment for home health and services and hospice care by non-VA providers...

  3. VA Community Mental Health Service Providers' Utilization of and Attitudes toward Telemental Health Care: The Gatekeeper's Perspective

    Science.gov (United States)

    Jameson, John Paul; Farmer, Mary Sue; Head, Katharine J.; Fortney, John; Teal, Cayla R.

    2011-01-01

    Context: Mental health (MH) providers in community-based outpatient clinics (CBOCs) are important stakeholders in the development of the Veterans Health Administration (VA) telemental health (TMH) system, but their perceptions of these technologies have not been systematically examined. Purpose: The purpose of this study was to investigate the…

  4. Access to mental health care among women Veterans: is VA meeting women's needs?

    Science.gov (United States)

    Kimerling, Rachel; Pavao, Joanne; Greene, Liberty; Karpenko, Julie; Rodriguez, Allison; Saweikis, Meghan; Washington, Donna L

    2015-04-01

    Patient-centered access to mental health describes the fit between patient needs and resources of the system. To date, little data are available to guide implementation of services to women veterans, an underrepresented minority within Department of Veteran Affairs (VA) health care. The current study examines access to mental health care among women veterans, and identifies gender-related indicators of perceived access to mental health care. A population-based sample of 6287 women veterans using VA primary care services participated in a survey of past year perceived need for mental health care, mental health utilization, and gender-related mental health care experiences. Subjective rating of how well mental health care met their needs was used as an indicator of perceived access. Half of all women reported perceived mental health need; 84.3% of those women received care. Nearly all mental health users (90.9%) used VA services, although only about half (48.8%) reported that their mental health care met their needs completely or very well. Gender related experiences (availability of female providers, women-only treatment settings, women-only treatment groups, and gender-related comfort) were each associated with 2-fold increased odds of perceived access, and associations remained after adjusting for ease of getting care. Women VA users demonstrate very good objective access to mental health services. Desire for, and access to specialized mental health services for women varies across the population and are important aspects of shared decision making in referral and treatment planning for women using VA primary care.

  5. Strategies from a nationwide health information technology implementation: the VA CART story.

    Science.gov (United States)

    Box, Tamára L; McDonell, Mary; Helfrich, Christian D; Jesse, Robert L; Fihn, Stephan D; Rumsfeld, John S

    2010-01-01

    The VA Cardiovascular Assessment, Reporting, and Tracking (CART) system is a customized electronic medical record system which provides standardized report generation for cardiac catheterization procedures, serves as a national data repository, and is the centerpiece of a national quality improvement program. Like many health information technology projects, CART implementation did not proceed without some barriers and resistance. We describe the nationwide implementation of CART at the 77 VA hospitals which perform cardiac catheterizations in three phases: (1) strategic collaborations; (2) installation; and (3) adoption. Throughout implementation, success required a careful balance of technical, clinical, and organizational factors. We offer strategies developed through CART implementation which are broadly applicable to technology projects aimed at improving the quality, reliability, and efficiency of health care.

  6. CoVaCS: a consensus variant calling system.

    Science.gov (United States)

    Chiara, Matteo; Gioiosa, Silvia; Chillemi, Giovanni; D'Antonio, Mattia; Flati, Tiziano; Picardi, Ernesto; Zambelli, Federico; Horner, David Stephen; Pesole, Graziano; Castrignanò, Tiziana

    2018-02-05

    The advent and ongoing development of next generation sequencing technologies (NGS) has led to a rapid increase in the rate of human genome re-sequencing data, paving the way for personalized genomics and precision medicine. The body of genome resequencing data is progressively increasing underlining the need for accurate and time-effective bioinformatics systems for genotyping - a crucial prerequisite for identification of candidate causal mutations in diagnostic screens. Here we present CoVaCS, a fully automated, highly accurate system with a web based graphical interface for genotyping and variant annotation. Extensive tests on a gold standard benchmark data-set -the NA12878 Illumina platinum genome- confirm that call-sets based on our consensus strategy are completely in line with those attained by similar command line based approaches, and far more accurate than call-sets from any individual tool. Importantly our system exhibits better sensitivity and higher specificity than equivalent commercial software. CoVaCS offers optimized pipelines integrating state of the art tools for variant calling and annotation for whole genome sequencing (WGS), whole-exome sequencing (WES) and target-gene sequencing (TGS) data. The system is currently hosted at Cineca, and offers the speed of a HPC computing facility, a crucial consideration when large numbers of samples must be analysed. Importantly, all the analyses are performed automatically allowing high reproducibility of the results. As such, we believe that CoVaCS can be a valuable tool for the analysis of human genome resequencing studies. CoVaCS is available at: https://bioinformatics.cineca.it/covacs .

  7. Job satisfaction and burnout among VA and community mental health workers.

    Science.gov (United States)

    Salyers, Michelle P; Rollins, Angela L; Kelly, Yu-Fan; Lysaker, Paul H; Williams, Jane R

    2013-03-01

    Building on two independent studies, we compared burnout and job satisfaction of 66 VA staff and 86 community mental health center staff in the same city. VA staff reported significantly greater job satisfaction and accomplishment, less emotional exhaustion and lower likelihood of leaving their job. Sources of work satisfaction were similar (primarily working with clients, helping/witnessing change). VA staff reported fewer challenges with job-related aspects (e.g. flexibility, pay) but more challenges with administration. Community mental health administrators and policymakers may need to address job-related concerns (e.g. pay) whereas VA administrators may focus on reducing, and helping workers navigate, administrative policies.

  8. Use of the Decision Support System for VA cost-effectiveness research.

    Science.gov (United States)

    Barnett, P G; Rodgers, J H

    1999-04-01

    The Department of Veterans Affairs is adopting the Decision Support System (DSS), computer software and databases which include a cost-accounting system which determines the cost of health care products and patient encounters. A system for providing cost data for cost-effectiveness analysis should be provide valid, detailed, and comprehensive data that can be aggregated. The design of DSS is described and compared with those criteria. Utilization data from DSS was compared with other VA utilization data. Aggregate DSS cost data from 35 medical centers was compared with relative resource weights developed for the Medicare program. Data on hospital stays at 3 facilities found that 3.7% of the stays in DSS were not in the VA discharge database, whereas 7.6% of the stays in the discharge data were not in DSS. DSS reported between 68.8% and 97.1% of the outpatient encounters reported by six facilities in the ambulatory care data base. Relative weights for each Diagnosis Related Group based on DSS data from 35 VA facilities correlated with Medicare weights (correlation coefficient of .853). DSS will be useful for research if certain problems are overcome. It is difficult to distinguish long-term from acute hospital care. VA does not have a complete database of all inpatient procedures, so DSS has not assigned them a specific cost. The authority to access encounter-level DSS data needs to be centralized. Researchers can provide the feedback needed to improve DSS cost estimates. A comprehensive encounter-level extract would facilitate use of DSS for research.

  9. HIGH PREVALENCE OF AGENT ORANGE EXPOSURE AMONG THYROID CANCER PATIENTS IN THE NATIONAL VA HEALTHCARE SYSTEM.

    Science.gov (United States)

    Le, Karen T; Sawicki, Mark P; Wang, Marilene B; Hershman, Jerome M; Leung, Angela M

    2016-06-01

    Thyroid cancer is the most common endocrine malignancy and the most rapidly increasing cancer in the U.S. Little is known regarding the epidemiology and characteristics of patients with thyroid cancer within the national Veterans Health Administration (VHA) integrated healthcare system. The aim of this study was to further understand the characteristics of thyroid cancer patients in the VHA population, particularly in relation to Agent Orange exposure. This is a descriptive analysis of the VA (Veterans Affairs) Corporate Data Warehouse database from all U.S. VHA healthcare sites from October1, 1999, to December 31, 2013. Information was extracted for all thyroid cancer patients based on International Classification of Diseases-ninth revision diagnosis codes; histologic subtypes of thyroid cancer were not available. There were 19,592 patients (86% men, 76% white, 58% married, 42% Vietnam-era Veteran) in the VHA system with a diagnosis of thyroid cancer within this 14-year study period. The gender-stratified prevalence rates of thyroid cancer among the Veteran population during the study period were 1:1,114 (women) and 1:1,023 (men), which were lower for women but similar for men, when compared to the U.S. general population in 2011 (1:350 for women and 1:1,219 for men). There was a significantly higher proportion of self-reported Agent Orange exposure among thyroid cancer patients (10.0%), compared to the general VHA population (6.2%) (PAgent Orange exposure compared to the overall national VA patient population. T4 = thyroxine TCDD = 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin TSH = thyroid-stimulating hormone VA = Veterans Affairs VHA = Veterans Health Administration.

  10. Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers

    Directory of Open Access Journals (Sweden)

    Wang Virginia

    2013-01-01

    Full Text Available Abstract Background Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA, requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers. Methods We constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1 VA, (2 VA-outsourced settings, or (3 both (“dual” settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans’ baseline dialysis date. Results Of 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48% were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis. Conclusions VA expenditures for “buying” outsourced dialysis are high and increasing relative to “making” dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans’ access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services.

  11. Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers.

    Science.gov (United States)

    Wang, Virginia; Maciejewski, Matthew L; Patel, Uptal D; Stechuchak, Karen M; Hynes, Denise M; Weinberger, Morris

    2013-01-18

    Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA), requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers. We constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1) VA, (2) VA-outsourced settings, or (3) both ("dual") settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans' baseline dialysis date. Of 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48%) were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis. VA expenditures for "buying" outsourced dialysis are high and increasing relative to "making" dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans' access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services.

  12. VA Health Care: Processes to Evaluate, Implement, and Monitor Organizational Structure Changes Needed

    Science.gov (United States)

    2016-09-01

    their families , such as medallions and markers for headstones that signify veterans’ service. Page 3 GAO-16-803 VHA Organizational ... Research Oversight, and Chief Nursing Page 8 GAO-16-803 VHA Organizational Structure Officer. Also, the Chief Financial Officer and...VA HEALTH CARE Processes to Evaluate, Implement, and Monitor Organizational Structure Changes Needed Report to

  13. Predicting Adoption of Telemedicine by VA Mental Health Professionals

    Science.gov (United States)

    Pak, Wesley Chong Y.

    2013-01-01

    Providing primary health and specialty services to 3.4 million rural and highly rural veterans is a challenging task because of geographic barriers and the uneven distribution of rural healthcare providers. Although the Veterans Health Administration is hoping that technology such as telemedicine expands availability of specialties' access to…

  14. Improving Patient Safety: Avoiding Unread Imaging Exams in the National VA Enterprise Electronic Health Record.

    Science.gov (United States)

    Bastawrous, Sarah; Carney, Benjamin

    2017-06-01

    In the current digital and filmless age of radiology, rates of unread radiology exams remain low, however, may still exist in unique environments. Veterans Affairs (VA) health care systems may experience higher rates of unread exams due to coexistence of Veterans Health Information Systems and Technology Architecture (VistA) imaging and commercial picture archiving and communication systems (PACS). The purpose of this patient safety initiative was to identify any unread exams and causes leading to unread exams. Following approval by departmental quality assurance committee, a comprehensive review was performed of all radiology exams within VistA imaging from July 1, 2009 to June 30, 2014 to identify unread radiology exams. Over the 5-year period, the total unread exam rate was calculated to be 0.17%, with the highest yearly unread exam rate of 0.25%. The leading majority of unread exam type was plain radiographs. Analysis revealed unfinished dictations, unassociated accession numbers, technologist errors, and inefficient radiologist work lists as top contributors to unread exams. Once unread radiology exams were discovered and the causes identified, valuable process changes were implemented within our department to ensure simultaneous tracking of all unread exams in VistA imaging as well as the commercial PACS.

  15. OneVA Pharmacy

    Data.gov (United States)

    Department of Veterans Affairs — The OneVA Pharmacy application design consists of 3 main components: VistA Medication Profile screen, Health Data Record Clinical Data Service (HDR/CDS), and OneVA...

  16. Documentation of delirium in the VA electronic health record

    OpenAIRE

    Hope, Carol; Estrada, Nicollete; Weir, Charlene; Teng, Chia-Chen; Damal, Kavitha; Sauer, Brian C

    2014-01-01

    Background Delirium is a life-threatening, clinical syndrome common among the elderly and hospitalized patients. Delirium is under-recognized and misdiagnosed, complicating efforts to study the epidemiology and construct appropriate decision support to improve patient care. This study was primarily conducted to realize how providers documented confirmed cases of delirium in electronic health records as a preliminary step for using computerized methods to identify patients with delirium from e...

  17. Documentation of delirium in the VA electronic health record

    Science.gov (United States)

    2014-01-01

    Background Delirium is a life-threatening, clinical syndrome common among the elderly and hospitalized patients. Delirium is under-recognized and misdiagnosed, complicating efforts to study the epidemiology and construct appropriate decision support to improve patient care. This study was primarily conducted to realize how providers documented confirmed cases of delirium in electronic health records as a preliminary step for using computerized methods to identify patients with delirium from electronic health records. Methods The Mental Health Consult (MHC) team reported cases of delirium to the study team during a 6-month study period (December 1, 2009 - May 31, 2010). A chart extraction tool was developed to abstract documentation of diagnosis, signs and symptoms and known risk factors of delirium. A nurse practitioner, and a clinical pharmacist independently reviewed clinical notes during each patients hospital stay to determine if delirium and or sign and symptoms of delirium were documented. Results The MHC team reported 25 cases of delirium. When excluding MHC team notes, delirium was documented for 5 of the 25 patients (one reported case in a physician’s note, four in discharge summaries). Delirium was ICD-9 Coded for 7 of the 25 cases. Signs and symptoms associated with delirium were characterized in 8 physician notes, 11 discharge summaries, and 14 nursing notes, accounting for 16 of the 25 cases with identified delirium. Conclusions Documentation of delirium is highly inconsistent even with a confirmed diagnosis. Hence, efforts to use existing data to precisely estimate the prevalence of delirium or to conduct epidemiological studies based on medical records will be challenging. PMID:24708799

  18. Association between women veterans' experiences with VA outpatient health care and designation as a women's health provider in primary care clinics.

    Science.gov (United States)

    Bastian, Lori A; Trentalange, Mark; Murphy, Terrence E; Brandt, Cynthia; Bean-Mayberry, Bevanne; Maisel, Natalya C; Wright, Steven M; Gaetano, Vera S; Allore, Heather; Skanderson, Melissa; Reyes-Harvey, Evelyn; Yano, Elizabeth M; Rose, Danielle; Haskell, Sally

    2014-01-01

    Women veterans comprise a small percentage of Department of Veterans Affairs (VA) health care users. Prior research on women veterans' experiences with primary care has focused on VA site differences and not individual provider characteristics. In 2010, the VA established policy requiring the provision of comprehensive women's health care by designated women's health providers (DWHPs). Little is known about the quality of health care delivered by DWHPs and women veterans' experience with care from these providers. Secondary data were obtained from the VA Survey of Healthcare Experience of Patients (SHEP) using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient-centered medical home (PCMH) survey from March 2012 through February 2013, a survey designed to measure patient experience with care and the DWHPs Assessment of Workforce Capacity that discerns between DWHPs versus non-DWHPs. Of the 28,994 surveys mailed to women veterans, 24,789 were seen by primary care providers and 8,151 women responded to the survey (response rate, 32%). A total of 3,147 providers were evaluated by the SHEP-CAHPS-PCMH survey (40%; n = 1,267 were DWHPs). In a multivariable model, patients seen by DWHPs (relative risk, 1.02; 95% CI, 1.01-1.04) reported higher overall experiences with care compared with patients seen by non-DWHPs. The main finding is that women veterans' overall experiences with outpatient health care are slightly better for those receiving care from DWHPs compared with those receiving care from non-DWHPs. Our findings have important policy implications for how to continue to improve women veterans' experiences. Our work provides support to increase access to DWHPs at VA primary care clinics. Published by Elsevier Inc.

  19. Applying the High Reliability Health Care Maturity Model to Assess Hospital Performance: A VA Case Study.

    Science.gov (United States)

    Sullivan, Jennifer L; Rivard, Peter E; Shin, Marlena H; Rosen, Amy K

    2016-09-01

    The lack of a tool for categorizing and differentiating hospitals according to their high reliability organization (HRO)-related characteristics has hindered progress toward implementing and sustaining evidence-based HRO practices. Hospitals would benefit both from an understanding of the organizational characteristics that support HRO practices and from knowledge about the steps necessary to achieve HRO status to reduce the risk of harm and improve outcomes. The High Reliability Health Care Maturity (HRHCM) model, a model for health care organizations' achievement of high reliability with zero patient harm, incorporates three major domains critical for promoting HROs-Leadership, Safety Culture, and Robust Process Improvement ®. A study was conducted to examine the content validity of the HRHCM model and evaluate whether it can differentiate hospitals' maturity levels for each of the model's components. Staff perceptions of patient safety at six US Department of Veterans Affairs (VA) hospitals were examined to determine whether all 14 HRHCM components were present and to characterize each hospital's level of organizational maturity. Twelve of the 14 components from the HRHCM model were detected; two additional characteristics emerged that are present in the HRO literature but not represented in the model-teamwork culture and system-focused tools for learning and improvement. Each hospital's level of organizational maturity could be characterized for 9 of the 14 components. The findings suggest the HRHCM model has good content validity and that there is differentiation between hospitals on model components. Additional research is needed to understand how these components can be used to build the infrastructure necessary for reaching high reliability.

  20. Validity testing and neuropsychology practice in the VA healthcare system: results from recent practitioner survey (.).

    Science.gov (United States)

    Young, J Christopher; Roper, Brad L; Arentsen, Timothy J

    2016-05-01

    A survey of neuropsychologists in the Veterans Health Administration examined symptom/performance validity test (SPVT) practices and estimated base rates for patient response bias. Invitations were emailed to 387 psychologists employed within the Veterans Affairs (VA), identified as likely practicing neuropsychologists, resulting in 172 respondents (44.4% response rate). Practice areas varied, with 72% at least partially practicing in general neuropsychology clinics and 43% conducting VA disability exams. Mean estimated failure rates were 23.0% for clinical outpatient, 12.9% for inpatient, and 39.4% for disability exams. Failure rates were the highest for mTBI and PTSD referrals. Failure rates were positively correlated with the number of cases seen and frequency and number of SPVT use. Respondents disagreed regarding whether one (45%) or two (47%) failures are required to establish patient response bias, with those administering more measures employing the more stringent criterion. Frequency of the use of specific SPVTs is reported. Base rate estimates for SPVT failure in VA disability exams are comparable to those in other medicolegal settings. However, failure in routine clinical exams is much higher in the VA than in other settings, possibly reflecting the hybrid nature of the VA's role in both healthcare and disability determination. Generally speaking, VA neuropsychologists use SPVTs frequently and eschew pejorative terms to describe their failure. Practitioners who require only one SPVT failure to establish response bias may overclassify patients. Those who use few or no SPVTs may fail to identify response bias. Additional clinical and theoretical implications are discussed.

  1. Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management.

    Science.gov (United States)

    Jiménez-Rodríguez, Enrique; Feria-Domínguez, José Manuel; Sebastián-Lacave, Alonso

    2018-03-30

    Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI) that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR) concept in combination to the Loss Distribution Approach (LDA) is proved to be a proactive tool, within the frame of balanced scorecard (BSC), in health organizations. For this purpose, the historical events recorded in the Algo-OpData ® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA) have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls.

  2. Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

    Directory of Open Access Journals (Sweden)

    Enrique Jiménez-Rodríguez

    2018-03-01

    Full Text Available Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE. The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs. Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR concept in combination to the Loss Distribution Approach (LDA is proved to be a proactive tool, within the frame of balanced scorecard (BSC, in health organizations. For this purpose, the historical events recorded in the Algo-OpData® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls.

  3. Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

    Science.gov (United States)

    Jiménez-Rodríguez, Enrique; Sebastián-Lacave, Alonso

    2018-01-01

    Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI) that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR) concept in combination to the Loss Distribution Approach (LDA) is proved to be a proactive tool, within the frame of balanced scorecard (BSC), in health organizations. For this purpose, the historical events recorded in the Algo-OpData® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA) have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls. PMID:29601529

  4. 78 FR 68364 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date

    Science.gov (United States)

    2013-11-14

    ... providers of home health services and hospice care. The preamble of that final rule stated the effective... 17.56, applicable to non-VA home health services and hospice care. Section 17.56 provides, among... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and...

  5. GeVaDSs – decision support system for novel Genetic Vaccine development process

    Directory of Open Access Journals (Sweden)

    Blazewicz Jacek

    2012-05-01

    Full Text Available Abstract Background The lack of a uniform way for qualitative and quantitative evaluation of vaccine candidates under development led us to set up a standardized scheme for vaccine efficacy and safety evaluation. We developed and implemented molecular and immunology methods, and designed support tools for immunization data storage and analyses. Such collection can create a unique opportunity for immunologists to analyse data delivered from their laboratories. Results We designed and implemented GeVaDSs (Genetic Vaccine Decision Support system an interactive system for efficient storage, integration, retrieval and representation of data. Moreover, GeVaDSs allows for relevant association and interpretation of data, and thus for knowledge-based generation of testable hypotheses of vaccine responses. Conclusions GeVaDSs has been tested by several laboratories in Europe, and proved its usefulness in vaccine analysis. Case study of its application is presented in the additional files. The system is available at: http://gevads.cs.put.poznan.pl/preview/(login: viewer, password: password.

  6. High users of VA emergency room facilities: are outpatients abusing the system or is the system abusing them?

    Science.gov (United States)

    Schneider, K C; Dove, H G

    1983-01-01

    A phenomenon well known to emergency room personnel is the high use of ER facilities by a small number of patients. In this study of 335 patients followed in outpatient specialty clinics at a university-affiliated VA medical center, 23% of the patients accounted for 73% of the ER visits. Although some patients may be abusing the system, the problem is difficult to correct because of congressional legislation that deters the VA from providing primary care. Thus, a small subset of patients with chronic medical problems who live close to the hospital are likely to continue to consume a disproportionate amount of ER resources.

  7. Federal Health Care Center: VA and DOD Need to Address Ongoing Difficulties and Better Prepare for Future Integrations

    Science.gov (United States)

    2016-02-01

    related documentation, performing data reliability checks (such as examining the data for missing values), and interviewing FHCC officials. After taking...and personnel Staffing, training, and the transfer of DOD civilian personnel to VA Xa Property Construction, transfer of property, and physical ...29For example, geriatric and mental health clinical areas were initially grouped with other

  8. VA Health Care: VA Spends Millions on Post-Traumatic Stress Disorder Research and Incorporates Research Outcomes into Guidelines and Policy for Post-Traumatic Stress Disorder Services

    Science.gov (United States)

    2011-01-01

    post - traumatic stress disorder ( PTSD ) and...Veterans Affairs (VA) Intramural Post - Traumatic Stress Disorder ( PTSD ) Research Funding and VA’s Medical and Prosthetic Research Appropriation...Table 6: Department of Veterans Affairs (VA) Research Centers and Programs That Conduct or Support Post - Traumatic Stress Disorder ( PTSD ) Research

  9. The VA Ostomy Health-Related Quality of Life Study: objectives, methods, and patient sample.

    Science.gov (United States)

    Krouse, Robert S; Mohler, M Jane; Wendel, Christopher S; Grant, Marcia; Baldwin, Carol M; Rawl, Susan M; McCorkle, Ruth; Rosenfeld, Kenneth E; Ko, Clifford Y; Schmidt, C Max; Coons, Stephen Joel

    2006-04-01

    To present the design and methods of a multisite study of health-related quality of life (HR-QOL) in veterans living with ostomies. Veterans from Tucson, Indianapolis, and Los Angeles VA Medical Centers were surveyed using the validated City of Hope ostomy-specific tool (mCOH-QOL-Ostomy) and the SF-36V. Cases (ostomates) had a major gastrointestinal procedure that required an intestinal stoma, while controls had similar procedures for which an ostomy was not required. Ostomy subjects were recruited for four focus groups in each of two sites divided by ostomy type (colostomy versus ileostomy) and overall mCOH-QOL-Ostomy HR-QOL score (highest versus lowest quartile). The focus groups further evaluated barriers, concerns, and adaptation methods and skills. This report presents recruitment results, reliability of survey instruments, and demographic characteristics of the sample. The overall response (i.e., recruitment) rate across all sites was 48% and by site was 53%, 57%, and 37%, respectively (p ostomies had significantly longer time since surgery than controls (p ostomies is an illustration of a successful mixed methods approach to HR-QOL research. We collected meaningful quantitative and qualitative data that will be used in the development of new approaches to care that will lead to improved functioning and well-being in persons living with ostomies. Subsequent reports will provide the results of this research project.

  10. Measuring the risk of an Iranian banking system using Value at Risk (VaR Model

    Directory of Open Access Journals (Sweden)

    Sudabeh Morshedian Rafiee

    2012-10-01

    Full Text Available Measuring risk of financial institutes and banks plays an important role on managing them. Recent financial turmoil in United States banking system has motivated banking industry to monitor risk factors more closely. In this paper, we present an empirical study to measure the risk of some private banks in Iran called Bank Mellat using Value at Risk (VaR method. The proposed study collects the necessary information for the fiscal year of 2010 and analyses them using regression analysis. The study divides the financial data into two groups where the financial data of the first half of year is considered in the first group and the remaining information for the second half of year 2010 is considered in the second group. The implementation of VaR method indicates that financial risks increase during the time horizon. The study also uses linear regression method where independent variable is time, dependent variable is the financial risk, and the results confirm what we have found in the previous part of the survey.

  11. The impact of the Department of Veterans Affairs Health Care Personnel Enhancement Act of 2004 on VA physicians' salaries and retention.

    Science.gov (United States)

    Weeks, William B; Wallace, Tanner A; Wallace, Amy E

    2009-01-01

    To determine whether the Department of Veterans Affairs Health Care Personnel Enhancement Act (the Act), which was designed to achieve VA physician salary parity with American Academy of Medical Colleges (AAMC) Associate Professors and enacted in 2006, had achieved its goal. Using VA human resources datasets and data from the AAMC, we calculated mean VA physician salaries, with 95 percent confidence intervals, for 15 different medical specialties. For each specialty, we compared VA salaries to the median, 25th, and 75th percentile of AAMC Associate Professors' incomes. The Act's passage resulted in a $20,000 annual increase in VA physicians' salaries. VA primary care physicians, medical subspecialists, and psychiatrists had salaries that were comparable to their AAMC counterparts prior to and after enactment of the Act. However, VA surgical specialists', anesthesiologists', and radiologists' salaries lagged their AAMC counterparts both before and after the Act's enactment. Income increases were negatively correlated with full-time workforce changes. VA does not appear to provide comparable salaries for physicians necessary for surgical care. In certain cases, VA should consider outsourcing surgical services.

  12. Mixed-Methods Research in a Complex Multisite VA Health Services Study: Variations in the Implementation and Characteristics of Chiropractic Services in VA

    Directory of Open Access Journals (Sweden)

    Raheleh Khorsan

    2013-01-01

    Full Text Available Maximizing the quality and benefits of newly established chiropractic services represents an important policy and practice goal for the US Department of Veterans Affairs’ healthcare system. Understanding the implementation process and characteristics of new chiropractic clinics and the determinants and consequences of these processes and characteristics is a critical first step in guiding quality improvement. This paper reports insights and lessons learned regarding the successful application of mixed methods research approaches—insights derived from a study of chiropractic clinic implementation and characteristics, Variations in the Implementation and Characteristics of Chiropractic Services in VA (VICCS. Challenges and solutions are presented in areas ranging from selection and recruitment of sites and participants to the collection and analysis of varied data sources. The VICCS study illustrates the importance of several factors in successful mixed-methods approaches, including (1 the importance of a formal, fully developed logic model to identify and link data sources, variables, and outcomes of interest to the study’s analysis plan and its data collection instruments and codebook and (2 ensuring that data collection methods, including mixed-methods, match study aims. Overall, successful application of a mixed-methods approach requires careful planning, frequent trade-offs, and complex coding and analysis.

  13. 77 FR 19975 - VA Acquisition Regulation: Simplified Acquisition Procedures for Health-Care Resources (Section...

    Science.gov (United States)

    2012-04-03

    ... to which technology, economic conditions, or other factors have changed in the area affected by the... comments on factors described in the Supplementary Information. DATES: Comments must be received by VA on... (003A2A), Office of Acquisition, Logistics and Construction, Department of Veterans Affairs, 810 Vermont...

  14. VA Health Care: Improved Monitoring Needed for Effective Oversight of Care for Women Veterans

    Science.gov (United States)

    2016-12-01

    Congressional Requesters December 2016 GAO-17-52 United States Government Accountability Office United States Government Accountability Office...VHA officials said not all facilities require onsite gynecologists and facilities may authorize gynecological services from non-VA providers. They...including previously closed combat positions, which could contribute to the increase in the women veteran population. See GAO, Military Personnel: DOD Is

  15. Validation of the Monte Carlo Criticality Program KENO V.a for highly-enriched uranium systems

    International Nuclear Information System (INIS)

    Knight, J.R.

    1984-11-01

    A series of calculations based on critical experiments have been performed using the KENO V.a Monte Carlo Criticality Program for the purpose of validating KENO V.a for use in evaluating Y-12 Plant criticality problems. The experiments were reflected and unreflected systems of single units and arrays containing highly enriched uranium metal or uranium compounds. Various geometrical shapes were used in the experiments. The SCALE control module CSAS25 with the 27-group ENDF/B-4 cross-section library was used to perform the calculations. Some of the experiments were also calculated using the 16-group Hansen-Roach Library. Results are presented in a series of tables and discussed. Results show that the criteria established for the safe application of the KENO IV program may also be used for KENO V.a results

  16. Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center.

    Science.gov (United States)

    Eisenberg, Dan; Lohnberg, Jessica A; Kubat, Eric P; Bates, Cheryl C; Greenberg, Lauren M; Frayne, Susan M

    2017-04-01

    Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m 2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. Published by

  17. Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach.

    Science.gov (United States)

    Haun, Jolie N; Chavez, Margeaux; Nazi, Kim M; Antinori, Nicole

    2016-10-06

    The US Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major reorganization of VA HIT to develop a fully integrated system to meet consumer needs. Although extensive system documentation exists for various VA HIT systems, a more centralized and integrated perspective with clear documentation is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer's vision for the future. The objective of this study was to develop the VA HIT Systems Matrix, a novel tool designed to describe the existing VA HIT system and identify consumers' vision for the future of an integrated VA HIT system. This study utilized an expert panel and veteran informant focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (eg, look, feel, and function). Directed content analysis was used to analyze focus group data. The HIT Systems Matrix was developed with input from 47 veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA's existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non-VA mobile electronic devices, non-VA websites) are organized by row. Columns

  18. The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0.

    Directory of Open Access Journals (Sweden)

    Erin K Nichols

    2018-01-01

    Full Text Available Verbal autopsy (VA is a practical method for determining probable causes of death at the population level in places where systems for medical certification of cause of death are weak. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS systems, have developed rapidly in the last decade. These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed.In 2016, partners harmonized a WHO VA standard instrument that fully incorporates the indicators necessary to run currently available automated diagnostic algorithms. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. This VA instrument offers the opportunity to harmonize the automated diagnostic algorithms in the future.Despite all improvements in design and technology, VA is only recommended where medical certification of cause of death is not possible. The method can nevertheless provide sufficient information to guide public health priorities in communities in which physician certification of deaths is largely unavailable. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality.

  19. posttraumatic stress and its relationship to physical health functioning in a sample of Iraq and Afghanistan War veterans seeking postdeployment VA health care.

    Science.gov (United States)

    Jakupcak, Matthew; Luterek, Jane; Hunt, Stephen; Conybeare, Daniel; McFall, Miles

    2008-05-01

    The relationship between posttraumatic stress and physical health functioning was examined in a sample of Iraq and Afghanistan War veterans seeking postdeployment VA care. Iraq and Afghanistan War veterans (N = 108) who presented for treatment to a specialty postdeployment care clinic completed self-report questionnaires that assessed symptoms of posttraumatic stress disorder (PTSD), chemical exposure, combat exposure, and physical health functioning. As predicted, PTSD symptom severity was significantly associated with poorer health functioning, even after accounting for demographic factors, combat and chemical exposure, and health risk behaviors. These results highlight the unique influence of PTSD on the physical health in treatment seeking Iraq and Afghanistan War veterans.

  20. Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach

    Science.gov (United States)

    Chavez, Margeaux; Nazi, Kim M; Antinori, Nicole

    2016-01-01

    Background The US Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major reorganization of VA HIT to develop a fully integrated system to meet consumer needs. Although extensive system documentation exists for various VA HIT systems, a more centralized and integrated perspective with clear documentation is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer’s vision for the future. Objective The objective of this study was to develop the VA HIT Systems Matrix, a novel tool designed to describe the existing VA HIT system and identify consumers’ vision for the future of an integrated VA HIT system. Methods This study utilized an expert panel and veteran informant focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (eg, look, feel, and function). Directed content analysis was used to analyze focus group data. Results The HIT Systems Matrix was developed with input from 47 veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA’s existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non-VA mobile electronic devices, non-VA

  1. Report of VA Medical Training Programs

    Data.gov (United States)

    Department of Veterans Affairs — The Report of VA Medical Training Programs Database is used to track medical center health services trainees and VA physicians serving as faculty. The database also...

  2. VA and DOD Health Care: First Federal Health Care Center Established, but Implementation Concerns Need to Be Addressed

    Science.gov (United States)

    2011-07-01

    procedures for the reporting of information security incidents. However, VA and DOD did not meet designated deadlines for the three capabilities that were...addition to the contact named above, Marcia A. Mann, Assistant Director; Jill K. Center; Kaycee M. Glavich; E. Jane Whipple ; and Malissa G. Winograd

  3. Envisioning Transformation in VA Mental Health Services Through Collaborative Site Visits.

    Science.gov (United States)

    Kearney, Lisa K; Schaefer, Jeanne A; Dollar, Katherine M; Iwamasa, Gayle Y; Katz, Ira; Schmitz, Theresa; Schohn, Mary; Resnick, Sandra G

    2018-04-16

    This column reviews the unique contributions of multiple partners in establishing a standardized site visit process to promote quality improvement in mental health care at the Veterans Health Administration. Working as a team, leaders in policy and operations, staff of research centers, and regional- and facility-level mental health leaders developed a standardized protocol for evaluating mental health services at each site and using the data to help implement policy goals. The authors discuss the challenges experienced and lessons learned in this systemwide process and how this information can be part of a framework for improving mental health services on a national level.

  4. VA Mental Health: Clearer Guidance on Access Policies and Wait-Time Data Needed

    Science.gov (United States)

    2015-10-01

    Abuse and Mental Health Services Administration, the nation faces a current shortage in the mental health and addiction services workforce, and that...order. Call for additional information. Connect with GAO on Facebook , Flickr, Twitter, and YouTube. Subscribe to our RSS Feeds or E-mail Updates

  5. Suicide-related behaviors in older patients with new anti-epileptic drug use: data from the VA hospital system

    Directory of Open Access Journals (Sweden)

    Dersh Jeffrey J

    2010-01-01

    Full Text Available Abstract Background The U.S. Food and Drug Administration (FDA recently linked antiepileptic drug (AED exposure to suicide-related behaviors based on meta-analysis of randomized clinical trials. We examined the relationship between suicide-related behaviors and different AEDs in older veterans receiving new AED monotherapy from the Veterans Health Administration (VA, controlling for potential confounders. Methods VA and Medicare databases were used to identify veterans 66 years and older, who received a care from the VA between 1999 and 2004, and b an incident AED (monotherapy prescription. Previously validated ICD-9-CM codes were used to identify suicidal ideation or behavior (suicide-related behaviors cases, epilepsy, and other conditions previously associated with suicide-related behaviors. Each case was matched to controls based on prior history of suicide-related behaviors, year of AED prescription, and epilepsy status. Results The strongest predictor of suicide-related behaviors (N = 64; Controls N = 768 based on conditional logistic regression analysis was affective disorder (depression, anxiety, or post-traumatic stress disorder (PTSD; Odds Ratio 4.42, 95% CI 2.30 to 8.49 diagnosed before AED treatment. Increased suicide-related behaviors were not associated with individual AEDs, including the most commonly prescribed AED in the US - phenytoin. Conclusion Our extensive diagnostic and treatment data demonstrated that the strongest predictor of suicide-related behaviors for older patients newly treated with AED monotherapy was a previous diagnosis of affective disorder. Additional, research using a larger sample is needed to clearly determine the risk of suicide-related behaviors among less commonly used AEDs.

  6. Validation of KENO V.a for highly enriched uranium systems with hydrogen and/or carbon moderation

    International Nuclear Information System (INIS)

    Elliott, E.P.; Vornehm, R.G.; Dodds, H.L. Jr.

    1993-01-01

    This paper describes the validation in accordance with ANSI/ANS-8.1-1983(R1988) of KENO V.a using the 27-group ENDF/B-IV cross-section library for systems containing highly-enriched uranium, carbon, and hydrogen and for systems containing highly-enriched uranium and carbon with high carbon to uranium (C/U) atomic ratios. The validation has been performed for two separate computational platforms: an IBM 3090 mainframe and an HP 9000 Model 730 workstation, both using the Oak Ridge Y-12 Plant Nuclear Criticality Safety Software (NCSS) code package. Critical experiments performed at the Oak Ridge Critical Experiments Facility, in support of the Rover reactor program, and at the Pajarito site at Los Alamos National Laboratory were identified as having the constituents desired for this validation as well as sufficient experimental detail to allow accurate construction of KENO V.a calculational models. Calculated values of k eff for the Rover experiments, which contain uranium, carbon, and hydrogen, are between 1.0012 ± 0.0026 and 1.0245 ± 0.0023. Calculation of the Los Alamos experiments, which contain uranium and carbon at high C/U ratios, yields values of k eff between 0.9746 ± 0.0028 and 0.9983 ± 0.0027. Safety criteria can be established using this data for both types of systems

  7. Educational system factors that engage resident physicians in an integrated quality improvement curriculum at a VA hospital: a realist evaluation.

    Science.gov (United States)

    Ogrinc, Greg; Ercolano, Ellyn; Cohen, Emily S; Harwood, Beth; Baum, Karyn; van Aalst, Robertus; Jones, Anne C; Davies, Louise

    2014-10-01

    Learning about quality improvement (QI) in resident physician training is often relegated to elective or noncore clinical activities. The authors integrated teaching, learning, and doing QI into the routine clinical work of inpatient internal medicine teams at a Veterans Affairs (VA) hospital. This study describes the design factors that facilitated and inhibited the integration of a QI curriculum-including real QI work-into the routine work of inpatient internal medicine teams. A realist evaluation framework used three data sources: field notes from QI faculty; semistructured interviews with resident physicians; and a group interview with QI faculty and staff. From April 2011 to July 2012, resident physician teams at the White River Junction VA Medical Center used the Model for Improvement for their QI work and analyzed data using statistical process control charts. Three domains affected the delivery of the QI curriculum and engagement of residents in QI work: setting, learner, and teacher. The constant presence of the QI material on a public space in the team workroom was a facilitating mechanism in the setting. Explicit sign-out of QI work to the next resident team formalized the handoff in the learner domain. QI teachers who were respected clinical leaders with QI expertise provided role modeling and local system knowledge. Integrating QI teaching into the routine clinical and educational systems of an inpatient service is challenging. Identifiable, concrete strategies in the setting, learner, and teacher domains helped integrate QI into the clinical and educational systems.

  8. Group Cognitive-Behavioral Therapy for Insomnia in a VA Mental Health Clinic

    Science.gov (United States)

    Perlman, Lawrence M.; Arnedt, J. Todd; Earnheart, Kristie L.; Gorman, Ashley A.; Shirley, Katherine G.

    2008-01-01

    Effective cognitive-behavioral therapies for insomnia have been developed over the past 2 decades, but they have not been systematically evaluated in some clinical settings. While insomnia is common among veterans with mental health problems, the availability of effective treatments is limited. We report on the group application of a…

  9. 78 FR 26250 - Payment for Home Health Services and Hospice Care to Non-VA Providers

    Science.gov (United States)

    2013-05-06

    ..., Department of Veterans Affairs, 3773 Cherry Creek Drive North, East Tower, Ste. 485, Denver, CO 80209, (303... approaches that maximize net benefits (including potential economic, environmental, public health and safety... Regulation and Regulatory Review) emphasizes the importance of quantifying both costs and benefits, reducing...

  10. Evaluating the Productivity of VA, NIH, and AHRQ Health Services Research Career Development Awardees.

    Science.gov (United States)

    Finney, John W; Amundson, Erin O; Bi, Xiaoyu; Cucciare, Michael A; Eisen, Seth A; Finlay, Andrea K; Halvorson, Max A; Hayashi, Ko; Owens, Douglas K; Maisel, Natalya C; Timko, Christine; Weitlauf, Julie C; Cronkite, Ruth C

    2016-04-01

    To evaluate the academic advancement and productivity of Department of Veterans Affairs Health Services Research and Development (HSR&D) Career Development Award (CDA) program recipients, National Institutes of Health (NIH) K awardees in health services research (HSR), and Agency for Healthcare Research and Quality (AHRQ) K awardees. In all, 219 HSR&D CDA recipients from fiscal year (FY) 1991 through FY2010; 154 NIH K01, K08, and K23 awardees FY1991-FY2010; and 69 AHRQ K01 and K08 awardees FY2000-FY2010 were included. Most data were obtained from curricula vitae. Academic advancement, publications, grants, recognition, and mentoring were compared after adjusting for years since award, and personal characteristics, training, and productivity prior to the award. No significant differences emerged in covariate-adjusted tenure-track academic rank, number of grants as primary investigator (PI), major journal articles as first/sole author, Hirsch h-index scores, likelihood of a journal editorship position or membership in a major granting review panel, or mentoring postgraduate researchers between the HSR&D CDA and NIH K awardees from FY1991-FY2010, or among the three groups of awardees from FY2000 or later. Among those who reported grant funding levels, HSR&D CDAs from FY1991-2010 had been PI on more grants of $100,000 than NIH K awardees. HSR&D CDAs had a higher mean number of major journal articles than NIH K awardees from FY1991-2010. Findings show that all three HSR career development programs are successfully selecting and mentoring awardees, ensuring additional HSR capacity to improve the quality and delivery of high-value care.

  11. Whistle-blower accuses VA inspector general of a "whitewash"

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-09-01

    Full Text Available No abstract available. Article truncated after 150 words. Yesterday, Dr. Sam Foote, the initial whistle-blower at the Phoenix VA, criticized the Department of Veterans Affairs inspector general's (VAOIG report on delays in healthcare at the Phoenix VA at a hearing before the House Committee of Veterans Affairs (1,2. Foote accused the VAOIG of minimizing bad patient outcomes and deliberately confusing readers, downplaying the impact of delayed health care at Phoenix VA facilities. "At its best, this report is a whitewash. At its worst, it is a feeble attempt at a cover-up," said Foote. Foote earlier this year revealed that as many as 40 Phoenix patients died while awaiting care and that the Phoenix VA maintained secret waiting lists while under-reporting patient wait times for appointments. His disclosures triggered the national VA scandal. Richard Griffin, the acting VAOIG, said that nearly 300 patients died while on backlogged wait lists in the Phoenix VA Health Care System, a much higher ...

  12. Production of electricity through biomass gasification system downdraft and generator group with a capacity of 50 kVA

    Directory of Open Access Journals (Sweden)

    Fabrízio Luiz Figueiredo

    2012-11-01

    Full Text Available This paper presents the results of tests performed with an internal combustion engine adapted to MWM Otto cycle, coupled to an electricity generator with a capacity of 50 kVA, fed exclusively with synthesis gas from a biomass gasifier downdraft, using wood eucalyptus. Also featured are the characteristics and efficiency of the generator set, in order to assess the feasibility of applying the system in remote locations, where biomass is available and the system of conventional electric power transmission is hampered by distance. The synthesis gas generated showed the average composition of 16,9% H2, 20% CO, 10,9% CO2, CH4, 2% and 50,1% N2. The performance of the span was monitored by applying loads of 0, 7, 13, 20,1 and 26,4 kW, the generator, keeping the average voltage of 222 V and currents of 0, 18,5, 33, 51, 84 and 67 A.

  13. Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guardand Reserve Service Member seen in Non VA Facilities

    Science.gov (United States)

    2016-10-01

    through the Affordable Healthcare Act ( ACA ) and other sources. Most veterans are not seen in VA facilities. The Geisinger Clinic, the community partner...group practice, ten hospital campuses, a 467,000-member health plan, and is one of the largest employers in the state. The knowledge gained from...Complete Analyses for Study Aim 3 ( Effectiveness ) and for Aim 4 (Genetics), Prepare Final Manuscripts for Review and Submission, Convene Final Conferences

  14. Federal Health Care Center: VA and DOD Need to Develop Better Information to Monitor Operations and Improve Efficiency

    Science.gov (United States)

    2017-01-01

    Defense (DOD) responsibility for contracting support Quality assurance Accreditation and oversight from external entities and credentialing and...MTF designation would introduce additional operational requirements and challenges to the FHCC, including financial management and quality assurance...departments—including DOD’s operational readiness mission—by integrating services previously provided by the former North Chicago VA Medical Center

  15. VA and DOD Health Care: Department-Level Actions Needed to Assess Collaboration Performance, Address Barriers, and Identify Opportunities

    Science.gov (United States)

    2012-09-01

    approximately 150 hospitals, 130 nursing homes, 800 community-based outpatient clinics, as well as other facilities to provide care to veterans. VA also...receive care and have to return for rescheduled appointments. Such missed appointments can lead to lost revenue for the military treatment facility

  16. KENO-VA-PVM KENO-VA-SM, KENO5A for Parallel Processors

    International Nuclear Information System (INIS)

    Ramon, Javier; Pena, Jorge

    2002-01-01

    1 - Description of program or function: This package contains versions KENO-Va-SM (Shared Memory version) and KENO-Va-PVM (Parallel Virtual Machine version) based on SCALE-4.1. KENO-Va three-dimensional Boltzmann transport equation for neutron multiplying systems. The primary purpose of KENO-Va is to determine k-effective. Other calculated quantities include lifetime and generation time, energy-dependent leakages, energy- and region-dependent absorptions, fissions, fluxes, and fission densities. 2 - Method of solution: KENO-Va employs the Monte Carlo technique

  17. HEALTH SYSTEMS

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

    many levels, and underscores the fact that health ... The health of mothers and their children depends on the status of women. INSIGHT ... tions find fertile ground when poverty ... Dr Gita Sen, Professor of Public Policy at the Indian Institute.

  18. VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data

    Science.gov (United States)

    2014-11-01

    2009-2013 13 Contents Page ii GAO-15-55 VA Psychiatric Medications and Suicide Data Table 2: Number of Veterans in GAO’s Sample...anxiety, depressed mood, ruminations , suicidal ideation, sleep problems, intrusive memories, drug seeking behaviors, flashbacks, guilt/remorse...recommendation, with estimated completion dates in calendar year 2015. As agreed with your office, unless you publicly announce the contents of this

  19. E VA Space Suit Power, Avionics, and Software Systems, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA is interested in a reliable, robust, and low Size Weight and Power (SWAP) input device that will allow for EVA astronauts to navigate display menu systems. The...

  20. Methods for estimating and comparing VA outpatient drug benefits with the private sector.

    Science.gov (United States)

    Render, Marta L; Nowak, John; Hammond, Emmett K; Roselle, Gary

    2003-06-01

    To estimate and compare Veterans Health Administration (VA) expenditures for outpatient pharmaceuticals for veterans at six VA facilities with hypothetical private sector costs. Using the VA Pharmacy Benefits Management Strategic Health Care Group (PBM) database, we extracted data for all dispensed outpatient prescriptions from the six study sites over federal fiscal year 1999. After extensive data validation, we converted prescriptions to the same units and merged relevant VA pricing information by National Drug Code to Redbook listed average wholesale price and the Medicaid maximal allowable charge, where available. We added total VA drug expenditures to personnel cost from the pharmacy portion of that medical center's cost distribution report. Hypothetical private sector payments were $200.8 million compared with an aggregate VA budget of $118.8 million. Using National Drug Code numbers, 97% of all items dispensed from the six facilities were matched to private sector price data. Nonmatched pharmaceuticals were largely generic over-the-counter pain relievers and commodities like alcohol swabs. The most commonly prescribed medications reflect the diseases and complaints of an older male population: pain, cardiovascular problems, diabetes, and depression or other psychiatric disorders. Use of the VA PBM database permits researchers to merge expenditure and prescription data to patient diagnoses and sentinel events. A critical element in its use is creating similar units among the systems. Such data sets permit a deeper view of the variability in drug expenditures, an important sector of health care whose inflation has been disproportionate to that of the economy and even health care.

  1. Patient deaths blamed on long waits at the Phoenix VA

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated at 150 words. This morning the lead article in the Arizona Republic was a report blaming as many as 40 deaths at the Phoenix VA on long waits (1. Yesterday, Rep. Jeff Miller, the chairman of the House Committee on Veterans Affairs, held a hearing titled “A Continued Assessment of Delays in VA Medical Care and Preventable Veteran Deaths.” “It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care,” Miller announced to a stunned audience. The committee has spent months investigating patient-care scandals and allegations at VA facilities in Pittsburgh, Atlanta, Miami and other cities. said that dozens of VA hospital patients in Phoenix may have died while awaiting medical care. He went on to say that staff investigators have evidence that the Phoenix VA Health Care System keeps two sets of records to conceal prolonged waits that patients must endure for ...

  2. VA Telemedicine: An Analysis of Cost and Time Savings.

    Science.gov (United States)

    Russo, Jack E; McCool, Ryan R; Davies, Louise

    2016-03-01

    The Veterans Affairs (VA) healthcare system provides beneficiary travel reimbursement ("travel pay") to qualifying patients for traveling to appointments. Travel pay is a large expense for the VA and hence the U.S. Government, projected to cost nearly $1 billion in 2015. Telemedicine in the VA system has the potential to save money by reducing patient travel and thus the amount of travel pay disbursed. In this study, we quantify this savings and also report trends in VA telemedicine volumes over time. All telemedicine visits based at the VA Hospital in White River Junction, VT between 2005 and 2013 were reviewed (5,695 visits). Travel distance and time saved as a result of telemedicine were calculated. Clinical volume in the mental health department, which has had the longest participation in telemedicine, was analyzed. Telemedicine resulted in an average travel savings of 145 miles and 142 min per visit. This led to an average travel payment savings of $18,555 per year. Telemedicine volume grew significantly over the study period such that by the final year the travel pay savings had increased to $63,804, or about 3.5% of the total travel pay disbursement for that year. The number of mental health telemedicine visits rose over the study period but remained small relative to the number of face-to-face visits. A higher proportion of telemedicine visits involved new patients. Telemedicine at the VA saves travel distance and time, although the reduction in travel payments remains modest at current telemedicine volumes.

  3. The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center

    International Nuclear Information System (INIS)

    Wadia, Roxanne J; Yao, Xiaopan; Deng, Yanhong; Li, Jia; Maron, Steven; Connery, Donna; Gunduz-Bruce, Handan; Rose, Michal G

    2015-01-01

    There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care

  4. Has the VA Become a White Elephant?

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-11-01

    Full Text Available No abstract available. Article truncated at 150 words. As I write this Dennis Wagner is publishing a series of articles in the Arizona Republic describing his quest to find out if care at VA hospitals have improved over the last 2 years (1. To begin the article Wagner describes the fable of the King of Siam who presented albino pachyderms to his enemies knowing they would be bankrupted because the cost of food and care outweighed all usefulness. A modern expression derives from this parable: the white elephant. The Department of Veterans Affairs (VA has prided itself on being a leader in healthcare. It is the largest healthcare system in the US, implemented the first electronic medical record, and more than 70 percent of all US doctors have received training in the VA healthcare system (2. This year the VA is celebrating the 70th anniversary of its partnership with US medical schools. Beginning in 1946, the VA partnered ...

  5. Comment Response on the Final Report: Peer Review of the Total System Performance Assessment-Viability Assessment (TSPA-VA)

    International Nuclear Information System (INIS)

    Pendleton, M. W.

    1999-01-01

    The Management and Operating Contractor established a Performance Assessment Peer Review Panel (hereinafter ''the Panel'') at the request of the U.S. Department of Energy Yucca Mountain Site Characterization Office. The objectives of the peer review were to provide: (1) A formal, independent evaluation and critique of Viability Assessment of a Repository at Yucca Mountain: Total System Performance Assessment, Volume 3 (DOE 1998a; hereinafter ''Total System Performance Assessment-Viability Assessment'') that was conducted in support of the Viability Assessment of a Repository at Yucca Mountain (DOE 1998b). (2) Suggestions for improvements as the U.S. Department of Energy prepares to develop the documentation for a Total System Performance Assessment to support a potential License Application. The Panel conducted a phased review over a two-year period to observe the development and, ultimately, to review the Total System Performance Assessment-Viability Assessment (DOE 1998a). During the development of the Total System Performance Assessment-Viability Assessment (DOE 1998a), the Panel submitted three Interim Reports (Whipple et al., 1997a, 1997b, and 1998) to the Management and Operating Contractor with recommendations and comments on the process models, model abstractions, and draft documentation for the Total System Performance Assessment-Viability Assessment (DOE 1998a). The Panel's Final Report Total System Performance Assessment Peer Review Panel (Whipple et al. 1999; hereinafter ''Final Report'') on the Total System Performance Assessment-Viability Assessment (DOE 1998a) is based primarily on the completed Total System Performance Assessment-Viability Assessment (DOE 1998a), the Total System Performance Assessment-Viability Assessment (TSPA-VA) Analyses Technical Basis Document (CRWMS M and O 1998), and the cited references. The Final Report (Whipple et al. 1999) includes the major points from the three Interim Reports (Whipple et al. 1997a, 1997b, and 1998

  6. VA office of inspector general releases scathing report of Phoenix VA

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-08-01

    Full Text Available No abstract available. Article truncated at 150 words. The long-awaited Office of Inspector General’s (OIG report on the Phoenix VA Health Care System (PVAHCS was released on August 27, 2014 (1. The report was scathing in its evaluation of VA practices and leadership. Five questions were investigated: 1.Were there clinically significant delays in care? 2. Did PVAHCS omit the names of veterans waiting for care from its Electronic Wait List (EWL? 3. Were PVAHCS personnel not following established scheduling procedures? 4. Did the PVAHCS culture emphasize goals at the expense of patient care? 5. Are scheduling deficiencies systemic throughout the VA? In each case, the OIG found that the allegations were true. Despite initial denials, the OIG report showed that former PVAHCS director Sharon Helman, associate director Lance Robinson, hospital administration director Brad Curry, chief of staff Darren Deering and other senior executives were aware of delays in care and unofficial wait lists. Perhaps most disturbing is ...

  7. VA-LCP anterior clavicle plate: the anatomically precontoured fixation system with angular stability for clavicle shaft.

    Science.gov (United States)

    van Olden, G D J

    2014-12-01

    The aim of this investigation was to evaluate the introduction of the VA-LCP anterior clavicle plate in the treatment of clavicle fractures. From March 2011 to March 2013, 42 clavicle fractures were treated; 40 were middle-third and 2 lateral-third, and 13/42 (31 %) patients were treated due to painful nonunion. Patient age ranged from 16 to 81 years. Complications were screw placement through the AC-joint, one superficial wound infection and one neuropraxia of the nervus radialis with dropping hand. We had some difficulties prebending both lateral to low and lateral to high but without clinical consequences. In all cases, the fracture healed with full functionality. After 1 year, 4 patients underwent a removal of the hardware. The VA-LCP anterior plate showed good reliability and sufficient stability with both middle-third, lateral and nonunion fractures of the clavicle.

  8. A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use

    Science.gov (United States)

    Pope, Charlene A.; Davis, Boyd H.; Wine, Leticia; Nemeth, Lynne S.; Axon, Robert N.

    2018-01-01

    Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving. PMID:29482411

  9. Health System Measurement Project

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Health System Measurement Project tracks government data on critical U.S. health system indicators. The website presents national trend data as well as detailed...

  10. Race-ethnicity and gender differences in VA health care service utilization among U.S. veterans of recent conflicts.

    Science.gov (United States)

    Koo, Kelly H; Madden, Erin; Maguen, Shira

    2015-05-01

    The purpose of this study was to compare health care utilization patterns by race-ethnicity and gender among veterans returning from Iraq and Afghanistan. A retrospective analysis was conducted with records from U.S. service members and veterans returning from Iraq and Afghanistan who enrolled in health care through the Veterans Health Administration, who received a psychiatric diagnosis, and who had used primary or mental health outpatient care between October 7, 2001, and December 31, 2012 (N=309,050). Racial-ethnic minority groups were first collapsed together and compared with whites and then separated by racial-ethnic group. Gender was also tested as a moderator of utilization. Although rates of mental health outpatient care, primary care, and emergency service utilization were relatively similar for racial-ethnic minority groups and whites, minority groups were admitted to psychiatric inpatient care at lower rates than whites. When veterans were separately categorized by specific racial-ethnic groups, some differences in utilization rates emerged; most notably, only black and Hispanic men were admitted less frequently to psychiatric inpatient care, and male and female Asian/Pacific Islander veterans used emergency services less, than their white counterparts. Gender moderated the association between race-ethnicity and mental health outpatient use, such that American Indian and Hispanic women used mental health outpatient services less than white women, but American Indian and Hispanic men showed the opposite pattern. Furthermore, black men were more likely than white men to use mental health outpatient services, but there was no difference between these women. Although service utilization rates between minority groups and whites were similar when minority groups were combined, examination of utilization by racial-ethnic groups and by men and women separately yielded more robust findings.

  11. Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

    Science.gov (United States)

    Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

    2017-01-01

    Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

  12. VA Pipeline for Future Nurse Leaders: an Exploration of Current Nurse Leadership Development in the Veteran’s Health Administration

    Science.gov (United States)

    2016-06-10

    Democratic Society White House Leadership Development Program (WHLD) Harvard Kennedy School (HKS)–Senior Executive Fellows Program George......Nurse Leaders: An Exploration of Current Nurse Leadership Development in the Veterans Health Administration 5a. CONTRACT NUMBER 5b. GRANT NUMBER

  13. Henry Ford Health Systems

    Science.gov (United States)

    Henry Ford Health Systems evolved from a hospital into a system delivering care to 2.5 million patients and includes the Cancer Epidemiology, Prevention and Control Program, which focuses on epidemiologic and public health aspects of cancer.

  14. Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

    OpenAIRE

    Enrique Jiménez-Rodríguez; José Manuel Feria-Domínguez; Alonso Sebastián-Lacave

    2018-01-01

    Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identificati...

  15. Dental Health Status of Schizophrenic Patients in the Chronic Psychiatric Care Center in the Province of Chaharmahal va Bakhtiyary

    Directory of Open Access Journals (Sweden)

    Masoud Nik-Farjam

    2011-07-01

    Full Text Available Objective: Schizophrenia is a chronic disease . Schizophrenic patients are unable in personal fuction and self care such as dental health. Especially, side effects of anti– psych otic drugs cause some dental problems in the patient . Also dental problems may lead to some disease , so it is necessary to play full attention to dental health condition in schizophrenic patients. The aim of study was assessing the dental health status of schizophrenic patients confined in chronic psychiatric care center on Chaharmahal & Bakhtiyari. Materials & Methods: This survey is an analytical descriptive and cross-sectional study, 123 schizophrenic patients are assessed in 2008. The data was collected through interview, (using the Scale for the assessment of positive and negative symptom (SAPS and SANS, Decayed, Missed, Filled Teeth index (DMFT, Gingival index and demographic questionnaire. Quantities analysis of data was undertaken by using X 2, Man vetney test and Pearson r test . Results: The mean of DMFT was 19.43±7.71. There was a significant correlation between age, smoking history and cigarettes per day, oral hygiene condition and other negative symptoms and average DMFT (P&le0.05. Also there was a significant correlation between the severity of periodentitis and sex, history of smoking, number of smoked cigarettes per day, previous hospital admission and average of negative and positive symptoms. No significant correlation between the severity of periodentitis and mean DMFT (P&le0.05 was seen. Conclusion: Results of the study demonstrated that dental health of people with schizophrenia is poor.

  16. Validation of KENO V.a. and two cross-section libraries for criticality calculations of low-enriched uranium systems

    International Nuclear Information System (INIS)

    Easter, M.E.

    1985-07-01

    The SCALE code system, utilizing the Monte Carlo computer code KENO V.a, was employed to calculate 37 critical experiments. The critical assemblies had 235 U enrichments of 5% or less and cover a variety of geometries and materials. Values of k/sub eff/ were calculated using two different results using either of the cross-section libraries. The 16-energy-group Hansen-Roach and the 27-energy-group ENDF/B-IV cross-section libraries, available in SCALE, were used in this validation study, and both give good results for the experiments considered. It is concluded that the code and cross sections are adequate for low-enriched uranium systems and that reliable criticality safety calculations can be made for such systems provided the limits of validated applicability are not exceeded

  17. Engaging multilevel stakeholders in an implementation trial of evidence-based quality improvement in VA women's health primary care.

    Science.gov (United States)

    Hamilton, Alison B; Brunner, Julian; Cain, Cindy; Chuang, Emmeline; Luger, Tana M; Canelo, Ismelda; Rubenstein, Lisa; Yano, Elizabeth M

    2017-09-01

    The Veterans Health Administration (VHA) has undertaken primary care transformation based on patient-centered medical home (PCMH) tenets. VHA PCMH models are designed for the predominantly male Veteran population, and require tailoring to meet women Veterans' needs. We used evidence-based quality improvement (EBQI), a stakeholder-driven implementation strategy, in a cluster randomized controlled trial across 12 sites (eight EBQI, four control) that are members of a Practice-Based Research Network. EBQI involves engaging multilevel, inter-professional leaders and staff as stakeholders in reviewing evidence and setting QI priorities. The goal of this analysis was to examine processes of engaging stakeholders in early implementation of EBQI to tailor VHA's medical home for women. Four inter-professional regional stakeholder planning meetings were conducted; these meetings engaged stakeholders by providing regional data about gender disparities in Veterans' care experiences. Subsequent to each meeting, qualitative interviews were conducted with 87 key stakeholders (leaders and staff). Stakeholders were asked to describe QI efforts and the use of data to change aspects of care, including women's health care. Interview transcripts were summarized and coded using a hybrid deductive/inductive analytic approach. The presentation of regional-level data about gender disparities resulted in heightened awareness and stakeholder buy-in and decision-making related to women's health-focused QI. Interviews revealed that stakeholders were familiar with QI, with regional and facility leaders aware of inter-disciplinary committees and efforts to foster organizational change, including PCMH transformation. These efforts did not typically focus on women's health, though some informal efforts had been undertaken. Barriers to engaging in QI included lack of communication across clinical service lines, fluidity in staffing, and lack of protected time. Inter-professional, multilevel

  18. Denmark: Health system review

    DEFF Research Database (Denmark)

    Juul, Annegrete; Krasnik, Allan; Rudkjøbing, Andreas

    The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery...... of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health...... system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability)....

  19. Connecting the dots: interprofessional health education and delivery system redesign at the Veterans Health Administration.

    Science.gov (United States)

    Gilman, Stuart C; Chokshi, Dave A; Bowen, Judith L; Rugen, Kathryn Wirtz; Cox, Malcolm

    2014-08-01

    Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care.

  20. Comparison of rates of potentially inappropriate medication use according to the Zhan criteria for VA versus private sector medicare HMOs.

    Science.gov (United States)

    Barnett, Mitchell J; Perry, Paul J; Langstaff, Jodi D; Kaboli, Peter J

    2006-06-01

    Inappropriate prescribing in the elderly is common, but rates across different health care systems and the impact of formulary restrictions are not well described. To determine if rates of inappropriate medication use in the elderly differ between the Veterans Affairs (VA) health care system and the private sector Medicare health maintenance organization (HMO) patients. A cross-sectional study design compared administrative pharmacy claims from 10 distinct geographic regions in the United States in the VA health care system and 10 analogous regions for patients enrolled in Medicare HMOs. The cohorts included 123,633 VA and 157,517 Medicare HMO patients aged 65 years and older. Inappropriate medication use was identified using the Zhan modification of the Beers criteria, which categorizes 33 potentially inappropriate drugs into 3 major classifications: "always avoid," "rarely appropriate," and "some indications." Comparisons between the VA health care system and the private sector Medicare HMO were performed for overall differences and stratified by gender and age. The drug formulary status of the Zhan-criteria drugs was known for the VA health system but not for the Medicare HMO patients. Compared with private sector patients, VA patients were less likely to receive any inappropriate medication (21% vs. 29%, P private sector for males (21% vs. 24%, P private sector Medicare HMOs, elderly VA patients were less likely to receive medications defined by the Zhan criteria as potentially inappropriate. A restrictive formulary that excludes 12 of the 33 Zhan criteria drugs may be a factor in the reduction of undesired prescribing patterns in elderly populations.

  1. Ukraine: health system review.

    Science.gov (United States)

    Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica

    2015-03-01

    This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system. World Health Organization 2015 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  2. Development of a parallelization method for KENO V.a

    International Nuclear Information System (INIS)

    Basoglu, B.; Bentley, C.; Dunn, M.

    1995-01-01

    The KENO V.a codes is a widely used Monte carlo codes that is part of the SCALE modular codes system for performing standardized computer analysis of nuclear systems for licensing evaluation. In the past few years, attempts have been made to speed up KENO V.a using new generation computers. In this paper we report on the initial development of a parallel version of KENO V.a for the Kendall Square Research supercomputer (KSRI) at ORNL. Investigations thus far have shown that the parallel code provides accurate results with significantly reduced computation times relative to the conventional KENO V.a code

  3. Slovenia: Health System Review.

    Science.gov (United States)

    Albreht, Tit; Pribakovic Brinovec, Radivoje; Josar, Dusan; Poldrugovac, Mircha; Kostnapfel, Tatja; Zaletel, Metka; Panteli, Dimitra; Maresso, Anna

    2016-06-01

    This analysis of the Slovene health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the population has improved over the last few decades. While life expectancy for both men and women is similar to EU averages, morbidity and mortality data show persistent disparities between regions, and mortality from external causes is particularly high. Satisfaction with health care delivery is high, but recently waiting times for some outpatient specialist services have increased. Greater focus on preventive measures is also needed as well as better care coordination, particularly for those with chronic conditions. Despite having relatively high levels of co-payments for many services covered by the universal compulsory health insurance system, these expenses are counterbalanced by voluntary health insurance, which covers 95% of the population liable for co-payments. However, Slovenia is somewhat unique among social health insurance countries in that it relies almost exclusively on payroll contributions to fund its compulsory health insurance system. This makes health sector revenues very susceptible to economic and labour market fluctuations. A future challenge will be to diversify the resource base for health system funding and thus bolster sustainability in the longer term, while preserving service delivery and quality of care. Given changing demographics and morbidity patterns, further challenges include restructuring the funding and provision of long-term care and enhancing health system efficiency through reform of purchasing and provider-payment systems. World Health Organization 2016 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  4. Belgium: Health system review.

    Science.gov (United States)

    Gerkens, Sophie; Merkur, Sherry

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Belgian population continues to enjoy good health and long life expectancy. This is partly due to good access to health services of high quality. Financing is based mostly on proportional social security contributions and progressive direct taxation. The compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. This Belgian HiT profile (2010) presents the evolution of the health system since 2007, including detailed information on new policies. While no drastic reforms were undertaken during this period, policy-makers have pursued the goals of improving access to good quality of care while making the system sustainable. Reforms to increase the accessibility of the health system include measures to reduce the out-of-pocket payments of more vulnerable populations (low-income families and individuals as well as the chronically ill). Quality of care related reforms have included incentives to better integrate different levels of care and the establishment of information systems, among others. Additionally, several measures on pharmaceutical products have aimed to reduce costs for both the National Institute for Health and Disability Insurance (NIHDI) and patients, while maintaining the quality of care. World Health Organization 2010, on behalf of the European Observatory on health systems and Policies.

  5. France: Health System Review.

    Science.gov (United States)

    Chevreul, Karine; Berg Brigham, Karen; Durand-Zaleski, Isabelle; Hernandez-Quevedo, Cristina

    2015-01-01

    This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending. World Health Organization 2015 (acting as the host organization for, and secretariat of, the

  6. Malta: Health system review.

    Science.gov (United States)

    Azzopardi Muscat, Natasha; Calleja, Neville; Calleja, Antoinette; Cylus, Jonathan

    2014-01-01

    This analysis of the Maltese health system reviews the developments in its organization and governance, health financing, health-care provision, health reforms and health system performance. The health system in Malta consists of a public sector, which is free at the point of service and provides a comprehensive basket of health services for all its citizens, and a private sector, which accounts for a third of total health expenditure and provides the majority of primary care. Maltese citizens enjoy one of the highest life expectancies in Europe. Nevertheless, non-communicable diseases pose a major concern with obesity being increasingly prevalent among both adults and children. The health system faces important challenges including a steadily ageing population, which impacts the sustainability of public finances. Other supply constraints stem from financial and infrastructural limitations. Nonetheless, there exists a strong political commitment to ensure the provision of a healthcare system that is accessible, of high quality, safe and also sustainable. This calls for strategic investments to underpin a revision of existing processes whilst shifting the focus of care away from hospital into the community. World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  7. Austria: health system review.

    Science.gov (United States)

    Hofmarcher, Maria M; Quentin, Wilm

    2013-01-01

    This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibilities and frequently results in inadequate coordination. For this reason, efforts have been made for several years to achieve more joint planning, governance and financing of the health-care system at the federal and regional level. As in any health system, a number of challenges remain. The costs of the health-care system are well above the EU15 average, both in absolute terms and as a percentage of GDP. There are important structural imbalances in healthcare provision, with an oversized hospital sector and insufficient resources available for ambulatory care and preventive medicine. This is coupled with stark regional differences in utilization, both in curative services (hospital beds and specialist physicians) and preventative services such as preventive health check-ups, outpatient rehabilitation, psychosocial and psychotherapeutic care and nursing. There are clear social inequalities in the use of medical services, such as preventive health check-ups, immunization or dentistry

  8. Health care delivery systems.

    NARCIS (Netherlands)

    Stevens, F.; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

  9. VaST: A variability search toolkit

    Science.gov (United States)

    Sokolovsky, K. V.; Lebedev, A. A.

    2018-01-01

    Variability Search Toolkit (VaST) is a software package designed to find variable objects in a series of sky images. It can be run from a script or interactively using its graphical interface. VaST relies on source list matching as opposed to image subtraction. SExtractor is used to generate source lists and perform aperture or PSF-fitting photometry (with PSFEx). Variability indices that characterize scatter and smoothness of a lightcurve are computed for all objects. Candidate variables are identified as objects having high variability index values compared to other objects of similar brightness. The two distinguishing features of VaST are its ability to perform accurate aperture photometry of images obtained with non-linear detectors and handle complex image distortions. The software has been successfully applied to images obtained with telescopes ranging from 0.08 to 2.5 m in diameter equipped with a variety of detectors including CCD, CMOS, MIC and photographic plates. About 1800 variable stars have been discovered with VaST. It is used as a transient detection engine in the New Milky Way (NMW) nova patrol. The code is written in C and can be easily compiled on the majority of UNIX-like systems. VaST is free software available at http://scan.sai.msu.ru/vast/.

  10. John M. Eisenberg Patient Safety Awards. System innovation: Veterans Health Administration National Center for Patient Safety.

    Science.gov (United States)

    Heget, Jeffrey R; Bagian, James P; Lee, Caryl Z; Gosbee, John W

    2002-12-01

    In 1998 the Veterans Health Administration (VHA) created the National Center for Patient Safety (NCPS) to lead the effort to reduce adverse events and close calls systemwide. NCPS's aim is to foster a culture of safety in the Department of Veterans Affairs (VA) by developing and providing patient safety programs and delivering standardized tools, methods, and initiatives to the 163 VA facilities. To create a system-oriented approach to patient safety, NCPS looked for models in fields such as aviation, nuclear power, human factors, and safety engineering. Core concepts included a non-punitive approach to patient safety activities that emphasizes systems-based learning, the active seeking out of close calls, which are viewed as opportunities for learning and investigation, and the use of interdisciplinary teams to investigate close calls and adverse events through a root cause analysis (RCA) process. Participation by VA facilities and networks was voluntary. NCPS has always aimed to develop a program that would be applicable both within the VA and beyond. NCPS's full patient safety program was tested and implemented throughout the VA system from November 1999 to August 2000. Program components included an RCA system for use by caregivers at the front line, a system for the aggregate review of RCA results, information systems software, alerts and advisories, and cognitive acids. Following program implementation, NCPS saw a 900-fold increase in reporting of close calls of high-priority events, reflecting the level of commitment to the program by VHA leaders and staff.

  11. Switzerland: Health System Review.

    Science.gov (United States)

    De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm

    2015-01-01

    This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to

  12. Estonia: health system review.

    Science.gov (United States)

    Lai, Taavi; Habicht, Triin; Kahur, Kristiina; Reinap, Marge; Kiivet, Raul; van Ginneken, Ewout

    2013-01-01

    This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  13. Poland health system review.

    Science.gov (United States)

    Sagan, Anna; Panteli, Dimitra; Borkowski, W; Dmowski, M; Domanski, F; Czyzewski, M; Gorynski, Pawel; Karpacka, Dorota; Kiersztyn, E; Kowalska, Iwona; Ksiezak, Malgorzata; Kuszewski, K; Lesniewska, A; Lipska, I; Maciag, R; Madowicz, Jaroslaw; Madra, Anna; Marek, M; Mokrzycka, A; Poznanski, Darius; Sobczak, Alicja; Sowada, Christoph; Swiderek, Maria; Terka, A; Trzeciak, Patrycja; Wiktorzak, Katarzyna; Wlodarczyk, Cezary; Wojtyniak, B; Wrzesniewska-Wal, Iwona; Zelwianska, Dobrawa; Busse, Reinhard

    2011-01-01

    Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) the sole payer in the system is in charge of health care financing and contracts with public and non-public health care providers. The Ministry of Health is the key policy-maker and regulator in the system and is supported by a number of advisory bodies, some of them recently established. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. In 2009, Poland spent 7.4% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance covers 98% of the population and guarantees access to a broad range of health services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall at most proportional: while financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures

  14. Bulgaria health system review.

    Science.gov (United States)

    Dimova, Antoniya; Rohova, Maria; Moutafova, Emanuela; Atanasova, Elka; Koeva, Stefka; Panteli, Dimitra; van Ginneken, Ewout

    2012-01-01

    In the last 20 years, demographic development in Bulgaria has been characterized by population decline, a low crude birth rate, a low fertility rate, a high mortality rate and an ageing population. A stabilizing political situation since the early 2000s and an economic upsurge since the mid-2000s were important factors in the slight increase of the birth and fertility rates and the slight decrease in standardized death rates. In general, Bulgaria lags behind European Union (EU) averages in most mortality and morbidity indicators. Life expectancy at birth reached 73.3 years in 2008 with the main three causes of death being diseases of the circulatory system, malignant neoplasms and diseases of the respiratory system. One of the most important risk factors overall is smoking, and the average standardized death rate for smoking-related causes in 2008 was twice as high as the EU15 average. The Bulgarian health system is characterized by limited statism. The Ministry of Health is responsible for national health policy and the overall organization and functioning of the health system and coordinates with all ministries with relevance to public health. The key players in the insurance system are the insured individuals, the health care providers and the third party payers, comprising the National Health Insurance Fund, the single payer in the social health insurance (SHI) system, and voluntary health insurance companies (VHICs). Health financing consists of a publicprivate mix. Health care is financed from compulsory health insurance contributions, taxes, outofpocket (OOP) payments, voluntary health insurance (VHI) premiums, corporate payments, donations, and external funding. Total health expenditure (THE) as a share of gross domestic product (GDP) increased from 5.3% in 1995 to 7.3% in 2008. At the latter date it consisted of 36.5% OOP payments, 34.8% SHI, 13.6% Ministry of Health expenditure, 9.4% municipality expenditure and 0.3% VHI. Informal payments in the health

  15. Comparing Catheter-associated Urinary Tract Infection Prevention Programs Between VA and Non-VA Nursing Homes

    Science.gov (United States)

    Mody, Lona; Greene, M. Todd; Saint, Sanjay; Meddings, Jennifer; Trautner, Barbara W.; Wald, Heidi L.; Crnich, Christopher; Banaszak-Holl, Jane; McNamara, Sara E.; King, Beth J.; Hogikyan, Robert; Edson, Barbara; Krein, Sarah L.

    2018-01-01

    OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that U.S. Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non-VA nursing homes. SETTING VA and non-VA nursing homes participating in the “AHRQ Safety Program for Long-term Care” collaborative. METHODS Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention. RESULTS A total of 353 (71%; 47 VA, 306 non-VA) of 494 nursing homes from 41 states responded. VA nursing homes reported more hours/week devoted to infection prevention-related activities (31 vs. 12 hours, P<.001), and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs. 66%, P<.001), sharing CAUTI data with leadership (94% vs. 70%, P=.014) and nursing personnel (85% vs. 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs. 81%, P=.004) and catheter insertion (83% vs. 94%, P=.004). CONCLUSIONS Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems. PMID:27917728

  16. Circumpolar Inuit health systems.

    Science.gov (United States)

    Ellsworth, Leanna; O'Keeffe, Annmaree

    2013-01-01

    The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic - Canada, Greenland, USA (Alaska) and Russia (Chukotka). In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska) and Russia (Chukotka) and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Literature review. It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems' effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of comparison in terms of methodology and timing of the available data

  17. Circumpolar Inuit health systems

    Directory of Open Access Journals (Sweden)

    Leanna Ellsworth

    2013-08-01

    Full Text Available Background . The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic – Canada, Greenland, USA (Alaska and Russia (Chukotka. In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. Objective . To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska and Russia (Chukotka and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Study design . Literature review. Results . It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems’ effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of

  18. Partnerships in Health Promotion for Black Americans. Proceedings of the Annual Meeting of the National Society of Allied Health (Virginia Beach, VA, March 29-30, 1985).

    Science.gov (United States)

    Douglas, Harry E., III, Comp.

    This conference report of the National Society of Allied Health focusses on the theme of health promotion for black Americans, with emphasis on creating cooperative partnerships to address the various social and environmental conditions adversely affecting minority group health status. The keynote speaker provided an historical perspective on…

  19. 76 FR 52230 - Establishment of Class E Airspace; Forest, VA

    Science.gov (United States)

    2011-08-22

    ...-0378; Airspace Docket No. 11-AEA-11] Establishment of Class E Airspace; Forest, VA AGENCY: Federal... at Forest, VA, to accommodate the new Area Navigation (RNAV) Global Positioning System (GPS) Standard... published in the Federal Register a notice of proposed rulemaking to establish Class E airspace at Forest...

  20. Health Information Systems

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

    the technology and expertise to process and share ... services. GEHS supports efforts that reach beyond healthcare institutions to capture evidence ... Health information systems are a foundation for quality care, and can increase accountability ...

  1. Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system

    International Nuclear Information System (INIS)

    Zullig, Leah L; Williams, Christina D; Fortune-Britt, Alice G

    2015-01-01

    Lung cancer (LC) and colorectal cancer (CRC) are the second- and third-most commonly diagnosed cancers in the Veterans Affairs (VA) health care system. While many studies have evaluated the treatment quality and outcomes of various aspects of VA LC and CRC care, there are no known reviews synthesizing this information across studies. The purpose of this literature review was to describe LC and CRC treatment (ie, surgical and nonsurgical) and outcomes (eg, mortality, psychosocial, and other) in the VA health care system as reported in the existing peer-reviewed scientific literature. We identified potential articles through a search of published literature using the PubMed electronic database. Our search strategy identified articles containing Medical Subject Headings terms and keywords addressing veterans or veterans’ health and LC and/or CRC. We limited articles to those published in the previous 11 years (January 1, 2003 through December 31, 2013). A total of 230 articles were retrieved through the search. After applying the selection criteria, we included 74 studies (34 LC, 47 CRC, and seven both LC and CRC). VA provides a full array of treatments, often with better outcomes than other health care systems. More work is needed to assess patient-reported outcomes

  2. System health monitoring

    International Nuclear Information System (INIS)

    Reneke, J.A.; Fryer, M.O.

    1995-01-01

    Well designed large systems include many instrument taking data. These data are used in a variety of ways. They are used to control the system and its components, to monitor system and component health, and often for historical or financial purposes. This paper discusses a new method of using data from low level instrumentation to monitor system and component health. The method uses the covariance of instrument outputs to calculate a measure of system change. The method involves no complicated modeling since it is not a parameter estimation algorithm. The method is iterative and can be implemented on a computer in real time. Examples are presented for a metal lathe and a high efficiency particulate air (HEPA) filter. It is shown that the proposed method is quite sensitive to system changes such as wear out and failure. The method is useful for low level system diagnostics and fault detection

  3. Nephroprotective action of renin-angiotensin-aldosterone system blockade in chronic kidney disease patients: the landscape after ALTITUDE and VA NEPHRON-D trails.

    Science.gov (United States)

    Rutkowski, Boleslaw; Tylicki, Leszek

    2015-03-01

    The intervention in the renin-angiotensin-aldosterone system (RAAS) is currently the most effective strategy that combines blood pressure lowering and renoprotection. Several large, randomized, controlled trials evidenced the renoprotective potential of the angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in nephropathies of almost any etiology. Mineralocorticoid receptor antagonists and direct renin inhibitor, aliskiren, as add-on treatments to standard therapy including the optimal dose of ACEIs or ARBs reduce albuminuria or proteinuria and slow development of renal dysfunction more than placebo. No clinical evidence is available however about whether these strategies may influence on long-term kidney outcome. Three recent trials suggested that aggressive RAAS blockade, that is, combination of 2 RAAS-blocking agents, does not decrease cardiovascular and renal morbidity and may carry an increased risk of serious complications. This article reviews an evidence-based approach on the use of RAAS-inhibiting agents in chronic kidney disease and considers the implementation of dual RAAS blockade with reference to the results of ALTITUDE and VA NEPHRON-D trails aiming to aid clinicians in their treatment decisions for patients with chronic kidney disease. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  4. Greece: Health system review.

    Science.gov (United States)

    Economou, Charalambos

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The health status of the Greek population has strongly improved over the last few decades and seems to compare relatively favourably with other OECD and European Union (EU) countries. The health system is a mixture of public integrated, public contract and public reimbursement models, comprising elements from both the public and private sectors and incorporating principles of different organizational patterns. Access to services is based on citizenship as well as on occupational status.The system is financed by the state budget, social insurance contributions and private payments.The largest share of health expenditure constitutes private expenditure, mainly in the form of out of pocket payments which is also the element contributing most to the overall increase in health expenditure. The delivery of health care services is based on both public and private providers. The presence of private providers is more obvious in primary care,especially in diagnostic technologies, private physicians' practices and pharmaceuticals. Despite success in improving the health of the population, the Greek health care system faces serious structural problems concerning the organization, financing and delivery of services. It suffers from the absence of cost-containment measures and defined criteria for funding, resulting in sickness funds experiencing economic constraints and budget deficits. The high percentage of private expenditure goes against the principle of fair

  5. A thyristor breaker of 1.5 109 V.A. for the poloidal field system of TORUS SUPRA

    International Nuclear Information System (INIS)

    Bareyt, B.; Leloup, C.; Rijnoudt, E.

    1980-09-01

    The poloidal field system of Torus Supra has an inductive storage of approximately 38 MJ, which has conducted to research the best solution for a D.C. breaker (55 kA., 27 kV). A solid-state breaker has been chosen. The working principles have been tested on a small size model. The final circuit breaker will contain a large number of thyristors in series and in parallel; the critical problem lies in the series arrangement. A test unit for full tension has been constructed. In this unit the thyristors are submitted to the maximum current as well as to the maximum voltage. The surges measured during tests are not higher than the calculated values. A synthetic circuit of the poloidal field system has been used for test under the final working conditions

  6. Fuel Cell/ Super-capacitor power management system assessment and Lifetime Cost study in a 500kVA UPS

    Directory of Open Access Journals (Sweden)

    Imen Ben Amira

    2018-03-01

    Full Text Available A 500 KVA Uninterruptible power supply (UPS using Fuel Cells (FC and super-capacitors (SCs was studied with the worst case of 10 minutes and eight hours of interruption per day. A power management system was established to control the FC and the SCs in order to extract the hybridization benefits with a comparison between a Proton exchange membrane FC (PEMFC working alone and another combined with SCs. Moreover, possible FC degradations were discussed. The start/stop cycling, the high-power loads and load changes degradations were taken into consideration in order to estimate the FC lifetime span using a prediction formula. Besides, the FC costs were studied to estimate the best average cost. Finally, the SCs filter constant time and their charging currents were revealed.

  7. Canada: Health system review.

    Science.gov (United States)

    Marchildon, Gregory

    2013-01-01

    Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD countries; however, infant and maternal mortality rates tend to be worse than in countries such as Australia, France and Sweden. About 70% of total health expenditure comes from the general tax revenues of the federal, provincial and territorial governments. Most public revenues for health are used to provide universal medicare (medically necessary hospital and physician services that are free at the point of service for residents) and to subsidise the costs of outpatient prescription drugs and long-term care. Health care costs continue to grow at a faster rate than the economy and government revenue, largely driven by spending on prescription drugs. In the last five years, however, growth rates in pharmaceutical spending have been matched by hospital spending and overtaken by physician spending, mainly due to increased provider remuneration. The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and

  8. VA announces aggressive new approach to produce rapid improvements in VA medical centers

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2018-02-01

    Full Text Available No abstract available. Article truncated at 150 words. The U.S. Department of Veterans Affairs (VA announced steps that it is taking as part of an aggressive new approach to produce rapid improvements at VA’s low-performing medical facilities nationwide (1. VA defines its low-performing facilities as those medical centers that receive the lowest score in its Strategic Analytics for Improvement and Learning (SAIL star rating system, or a one-star rating out of five. The SAIL star rating was initiated in 2016 and uses a variety of measures including mortality, length of hospital stay, readmission rates, hospital complications, physician productivity and efficiency. A complete listing of the VA facilities, their star ratings and the metrics used to determine the ratings is available through the end of fiscal year 2017 (2. Based on the latest ratings, the VA currently has 15 one-star facilities including Denver, Loma Linda, and Phoenix in the Southwest (Table 1. Table 1. VA facilities with one-star ratings …

  9. Myosin Va associates with mRNA in ribonucleoprotein particles present in myelinated peripheral axons and in the central nervous system.

    Science.gov (United States)

    Calliari, Aldo; Farías, Joaquina; Puppo, Agostina; Canclini, Lucía; Mercer, John A; Munroe, David; Sotelo, José R; Sotelo-Silveira, José R

    2014-03-01

    Sorting of specific mRNAs to particular cellular locations and regulation of their translation is an essential mechanism underlying cell polarization. The transport of RNAs by kinesins and dyneins has been clearly established in several cell models, including neurons in culture. A similar role appears to exist in higher eukaryotes for the myosins. Myosin Va (Myo5a) has been described as a component of ribonucleoprotein particles (RNPs) in the adult rat nervous system and associated to ZBP1 and ribosomes in ribosomal periaxoplasmic plaques (PARPs), making it a likely candidate for mediating some aspects of RNA transport in neurons. To test this hypothesis, we have characterized RNPs containing Myo5a in adult brains of rats and mice. Microarray analysis of RNAs co-immunoprecipitated with Myo5a indicates that this motor may associate with a specific subpopulation of neuronal mRNAs. We found mRNAs encoding α-synuclein and several proteins with functions in translation in these RNPs. Immunofluorescence analyses of RNPs showed apparent co-localization of Myo5a with ribosomes, mRNA and RNA-binding proteins in discrete structures present both in axons of neurons in culture and in myelinated fibers of medullary roots. Our data suggest that PARPs include RNPs bearing the mRNA coding for Myo5a and are equipped with kinesin and Myo5a molecular motors. In conclusion, we suggest that Myo5a is involved in mRNA trafficking both in the central and peripheral nervous systems. Copyright © 2013 Wiley Periodicals, Inc.

  10. 48 CFR 852.219-9 - VA Small business subcontracting plan minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA Small business... Provisions and Clauses 852.219-9 VA Small business subcontracting plan minimum requirements. As prescribed in subpart 819.709, insert the following clause: VA Small Business Subcontracting Plan Minimum Requirements...

  11. 48 CFR 852.219-71 - VA mentor-protégé program.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA mentor-protégÃ....219-71 VA mentor-protégé program. As prescribed in 819.7115(a), insert the following clause: VA Mentor-Protégé Program (DEC 2009) (a) Large businesses are encouraged to participate in the VA Mentor-Protégé...

  12. VA Vascular Injury Study (VAVIS): VA-DoD extremity injury outcomes collaboration.

    Science.gov (United States)

    Shireman, Paula K; Rasmussen, Todd E; Jaramillo, Carlos A; Pugh, Mary Jo

    2015-02-03

    Limb injuries comprise 50-60% of U.S. Service member's casualties of wars in Afghanistan and Iraq. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars. Improvements in medical and surgical trauma care, including initial in-theatre limb salvage approaches (IILS) have resulted in improved survival and fewer amputations, however, the long-term outcomes such as morbidity, functional decline, and risk for late amputation of salvaged limbs using current process of care have not been studied. The long-term care of these injured warfighters poses a significant challenge to the Department of Defense (DoD) and Department of Veterans Affairs (VA). The VA Vascular Injury Study (VAVIS): VA-DoD Extremity Injury Outcomes Collaborative, funded by the VA, Health Services Research and Development Service, is a longitudinal cohort study of Veterans with vascular extremity injuries. Enrollment will begin April, 2015 and continue for 3 years. Individuals with a validated extremity vascular injury in the Department of Defense Trauma Registry will be contacted and will complete a set of validated demographic, social, behavioral, and functional status measures during interview and online/ mailed survey. Primary outcome measures will: 1) Compare injury, demographic and geospatial characteristics of patients with IILS and identify late vascular surgery related limb complications and health care utilization in Veterans receiving VA vs. non-VA care, 2) Characterize the preventive services received by individuals with vascular repair and related outcomes, and 3) Describe patient-reported functional outcomes in Veterans with traumatic vascular limb injuries. This study will provide key information about the current process of care for Active Duty Service members and Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. The results of this study will be the first step for clinicians in VA and

  13. Croatia: health system review.

    Science.gov (United States)

    Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina

    2014-01-01

    Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991 to 1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of concessions in 2009 (public private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIFs revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope

  14. Measuring name system health

    NARCIS (Netherlands)

    Casalicchio, Emiliano; Caselli, Marco; Coletta, Alessio; Di Blasi, Salvatore; Fovino, Igor Nai; Butts, Jonathan; Shenoi, Sujeet

    2012-01-01

    Modern critical infrastructure assets are exposed to security threats arising from their use of IP networks and the Domain Name System (DNS). This paper focuses on the health of DNS. Indeed, due to the increased reliance on the Internet, the degradation of DNS could have significant consequences for

  15. Health system reform.

    Science.gov (United States)

    Ortolon, Ken

    2009-06-01

    A vote on reforming the nation's health care system seems likely this summer as President Obama makes good on a campaign pledge. Although the Democratic leadership in Congress appears ready to push through reform legislation before the next election, TMA and AMA leaders say very little is known about what that "reform" likely will look like.

  16. Maximum power per VA control of vector controlled interior ...

    Indian Academy of Sciences (India)

    Thakur Sumeet Singh

    2018-04-11

    Apr 11, 2018 ... Department of Electrical Engineering, Indian Institute of Technology Delhi, New ... The MPVA operation allows maximum-utilization of the drive-system. ... Permanent magnet motor; unity power factor; maximum VA utilization; ...

  17. PROLOGUE : Health Information System

    OpenAIRE

    Tomar, Shivanjali

    2013-01-01

    Prologue is a health information system developed for underserved communities in Bihar, India. It is aimed at helping people living in poverty and with low literacy to take the right steps to manage their and their family’s health. Bihar suffers from one of the worst healthcare records in the country. This is as much due to the lack of access to the right information as it is due to the economic condition of the region. The inaccessibility of information is aggravated by the complex social se...

  18. The Geometric-VaR Backtesting Method

    DEFF Research Database (Denmark)

    Wei, Wei; Pelletier, Denis

    2014-01-01

    This paper develops a new test to evaluate Value af Risk (VaR) forecasts. VaR is a standard risk measure widely utilized by financial institutions and regulators, yet estimating VaR is a challenging problem, and popular VaR forecast relies on unrealistic assumptions. Hence, assessing...

  19. Health Information Systems.

    Science.gov (United States)

    Sirintrapun, S Joseph; Artz, David R

    2015-06-01

    This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Troubles continue for the Phoenix VA

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-10-01

    Full Text Available No abstract available. Article truncated after 150 words. According to the Joint Commission on the Accreditation of Healthcare Organizations (Joint Commission, JCAHO, an independent organization that reviews hospitals, the Phoenix VA does not comply with U.S. standards for safety, patient care and management (1. The hospital was at the epicenter of the national scandal over the quality of care being afforded to the nation's veterans where the now notorious practice of double-booking patient appointments was first exposed. The hospital's indifferent management provoked congressional investigations that uncovered still more system-wide abuses leading to the removal of the hospital director and the resignation of then VA secretary, Eric Shinseki. The hospital maintains its accreditation but with a follow-up survey in 1-6 months where it must show that it has successfully addressed the 13 identified problems (1. Inspectors who conducted the review in July found that VA employees were unable to report concerns "without retaliatory action from the hospital." Other alarming ...

  1. VA Enterprise Data Inventory

    Data.gov (United States)

    Department of Veterans Affairs — The Department of Veterans Affairs Enterprise Data Inventory accounts for all of the datasets used in the agency's information systems. This entry was approved for...

  2. 75 FR 33216 - Payment or Reimbursement for Emergency Treatment Furnished by Non-VA Providers in Non-VA...

    Science.gov (United States)

    2010-06-11

    ... health care services for veterans).'' Proposed Sec. 17.121(a) would establish the clinical decision maker... practice to utilize the services of health care professionals, such as nurses, for purposes of clinical review. For this reason, establishing the clinical decision maker as a ``designated VA clinician'' would...

  3. Advanced Battery Manufacturing (VA)

    Energy Technology Data Exchange (ETDEWEB)

    Stratton, Jeremy

    2012-09-30

    LiFeBATT has concentrated its recent testing and evaluation on the safety of its batteries. There appears to be a good margin of safety with respect to overheating of the cells and the cases being utilized for the batteries are specifically designed to dissipate any heat built up during charging. This aspect of LiFeBATT’s products will be even more fully investigated, and assuming ongoing positive results, it will become a major component of marketing efforts for the batteries. LiFeBATT has continued to receive prismatic 20 Amp hour cells from Taiwan. Further testing continues to indicate significant advantages over the previously available 15 Ah cells. Battery packs are being assembled with battery management systems in the Danville facility. Comprehensive tests are underway at Sandia National Laboratory to provide further documentation of the advantages of these 20 Ah cells. The company is pursuing its work with Hybrid Vehicles of Danville to critically evaluate the 20 Ah cells in a hybrid, armored vehicle being developed for military and security applications. Results have been even more encouraging than they were initially. LiFeBATT is expanding its work with several OEM customers to build a worldwide distribution network. These customers include a major automotive consulting group in the U.K., an Australian maker of luxury off-road campers, and a number of makers of E-bikes and scooters. LiFeBATT continues to explore the possibility of working with nations that are woefully short of infrastructure. Negotiations are underway with Siemens to jointly develop a system for using photovoltaic generation and battery storage to supply electricity to communities that are not currently served adequately. The IDA has continued to monitor the progress of LiFeBATT’s work to ensure that all funds are being expended wisely and that matching funds will be generated as promised. The company has also remained current on all obligations for repayment of an IDA loan and lease

  4. Health & demographic surveillance system profile: the Nahuche Health and Demographic Surveillance System, Northern Nigeria (Nahuche HDSS).

    Science.gov (United States)

    Alabi, Olatunji; Doctor, Henry V; Jumare, Abdulazeez; Sahabi, Nasiru; Abdulwahab, Ahmad; Findley, Sally E; Abubakar, Sani D

    2014-12-01

    The Nahuche Health and Demographic Surveillance System (HDSS) study site, established in 2009 with 137 823 individuals is located in Zamfara State, north western Nigeria. North-West Nigeria is a region with one of the worst maternal and child health indicators in Nigeria. For example, the 2013 Nigeria Demographic and Health Survey estimated an under-five mortality rate of 185 deaths per 1000 live births for the north-west geo-political zone compared with a national average of 128 deaths per 1000 live births. The site comprises over 100 villages under the leadership of six district heads. Virtually all the residents of the catchment population are Hausa by ethnicity. After a baseline census in 2010, regular update rounds of data collection are conducted every 6 months. Data collection on births, deaths, migration events, pregnancies, marriages and marriage termination events are routinely conducted. Verbal autopsy (VA) data are collected on all deaths reported during routine data collection. Annual update data on antenatal care and household characteristics are also collected. Opportunities for collaborations are available at Nahuche HDSS. The Director of Nahuche HDSS, M.O. Oche at [ochedr@hotmail.com] is the contact person for all forms of collaboration. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  5. The value from investments in health information technology at the U.S. Department of Veterans Affairs.

    Science.gov (United States)

    Byrne, Colene M; Mercincavage, Lauren M; Pan, Eric C; Vincent, Adam G; Johnston, Douglas S; Middleton, Blackford

    2010-04-01

    We compare health information technology (IT) in the Department of Veterans Affairs (VA) to norms in the private sector, and we estimate the costs and benefits of selected VA health IT systems. The VA spent proportionately more on IT than the private health care sector spent, but it achieved higher levels of IT adoption and quality of care. The potential value of the VA's health IT investments is estimated at $3.09 billion in cumulative benefits net of investment costs. This study serves as a framework to inform efforts to measure and calculate the benefits of federal health IT stimulus programs.

  6. Feasibility Analysis and Simulation of a Stand-Alone Photovoltaic Energy System for Electricity Generation and Environmental Sustainability – Equivalent to 650VA Fuel-Powered Generator – Popularly Known as “I Pass My Neighbour”

    International Nuclear Information System (INIS)

    Ani, Vincent Anayochukwu

    2015-01-01

    Photovoltaic (PV) power system can be used to replace wholly 650VA generator for electricity generation for household use in Nigeria. This paper presented the feasibility analysis of load data and simulation study of a stand-alone PV power system that produced the electrical needs of a household. This study is based on designing of PV energy system for household use. The patterns of load consumption within the household were studied and suitably modeled for simulation. The simulation study indicates that energy requirements to provide electricity, which is equivalent to 650VA generator for household use in Nigeria, can be accomplished by 520 W solar PV array, 2312 Ah nominal capacity battery, and a 1 kW DC/AC inverter. This would be suitable for deployment of 100% clean energy for environmental sustainability and uninterruptable power performance in the household. The results of this research show that, with a low-power consuming appliances, it is possible to meet the entire annual electricity demand of a single household solely through a stand-alone PV energy supply. Installing solar panels by most Nigerian home can significantly reduce home reliance on government power thereby reduce the strain on the current capacity of our power generation infrastructure. A detailed design and description of the system were presented in this paper.

  7. Feasibility Analysis and Simulation of a Stand-Alone Photovoltaic Energy System for Electricity Generation and Environmental Sustainability – Equivalent to 650VA Fuel-Powered Generator – Popularly Known as “I Pass My Neighbour”

    Energy Technology Data Exchange (ETDEWEB)

    Ani, Vincent Anayochukwu, E-mail: vincent_ani@yahoo.com [Department of Electronic Engineering, University of Nigeria Nsukka, Nsukka (Nigeria)

    2015-09-11

    Photovoltaic (PV) power system can be used to replace wholly 650VA generator for electricity generation for household use in Nigeria. This paper presented the feasibility analysis of load data and simulation study of a stand-alone PV power system that produced the electrical needs of a household. This study is based on designing of PV energy system for household use. The patterns of load consumption within the household were studied and suitably modeled for simulation. The simulation study indicates that energy requirements to provide electricity, which is equivalent to 650VA generator for household use in Nigeria, can be accomplished by 520 W solar PV array, 2312 Ah nominal capacity battery, and a 1 kW DC/AC inverter. This would be suitable for deployment of 100% clean energy for environmental sustainability and uninterruptable power performance in the household. The results of this research show that, with a low-power consuming appliances, it is possible to meet the entire annual electricity demand of a single household solely through a stand-alone PV energy supply. Installing solar panels by most Nigerian home can significantly reduce home reliance on government power thereby reduce the strain on the current capacity of our power generation infrastructure. A detailed design and description of the system were presented in this paper.

  8. Building capacity in VA to provide emergency gynecology services for women.

    Science.gov (United States)

    Cordasco, Kristina M; Huynh, Alexis K; Zephyrin, Laurie; Hamilton, Alison B; Lau-Herzberg, Amy E; Kessler, Chad S; Yano, Elizabeth M

    2015-04-01

    Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care. To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care. Semistructured interviews with VA emergency and women's health key informants. ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities. Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies. Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.

  9. The Netherlands: health system review

    NARCIS (Netherlands)

    Schäfer, W.; Kroneman, M.; Boerma, W.; van den Berg, M.; Westert, G.; Devillé, W.; van Ginneken, E.

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of health systems and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of

  10. TRICARE, Military Health System

    Science.gov (United States)

    ... Claim Get Proof of TRICARE Coverage View My Military Health Record Less TRICARE Enrollment Freeze Starting Dec. ... Disaster Information Download a Form Go Paperless My Military Health Records Multimedia Center Plan Information Kits Recoupment ...

  11. Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guard and Reserve Service Member seen in Non-VA Facilities

    Science.gov (United States)

    2017-10-01

    Other Physical and Psychological Health Problems," which was chosen as one of the top 5 posters submitted to the conference. In addition, a brief...mild traumatic brain injury (mTBI) in veterans from the Iraq and Afghanistan conflict in relation to other physical and psychological health ...associated with other physical and psychological health problems among veterans seen in clinical practice. Methods As part of a larger study involving

  12. [The health system of Ecuador].

    Science.gov (United States)

    Lucio, Ruth; Villacrés, Nilhda; Henríquez, Rodrigo

    2011-01-01

    This paper describes the health conditions in Ecuador and, in more detail, the characteristics of the Ecuadorian health system, including its structure and coverage, its financial sources, the physical, material and human resources available, and the stewardship activities developed by the Ministry of Public Health. It also describes the structure and content of its health information system, and the participation of citizens in the operation and evaluation of the health system. The paper ends with a discussion of the most recent policy innovations implemented in the Ecuadorian system, including the incorporation of a chapter on health into the new Constitution which recognizes the protection of health as a human right, and the construction of the Comprehensive Public Health Network.

  13. The personal health record paradox: health care professionals' perspectives and the information ecology of personal health record systems in organizational and clinical settings.

    Science.gov (United States)

    Nazi, Kim M

    2013-04-04

    Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement. The purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems. In-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model. Study findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals' accounts and analysis of organizational

  14. An academic-VA partnership: Student interprofessional teams integrated with VA PACT teams.

    Science.gov (United States)

    Swenty, Constance L; Schaar, Gina L; Butler, Ryan M

    2016-12-01

    Veterans are challenged with multiple unique healthcare issues related to their military service environment. Likewise, health care providers must understand the special concerns associated with military conflict and recognize how the veteran's care can be optimized by interprofessional care delivery. Little is taught didactically or clinically that supports nursing students in addressing the unique issues of the veteran or the student's need to work collaboratively with allied health team members to enhance the veteran's care. Because of limited exposure to the veteran's special conditions, nursing students who may seek a career with the veteran population often face challenges in rendering appropriate care. The VA offers an invaluable opportunity for health profession students to collaborate with VA interprofessional Patient Aligned Care Teams (PACT) ultimately optimizing veteran health outcomes. This academic partnership, that implements an interprofessional model, will prepare students to better embrace the veteran population. This article describes the immersion of health profession students in interprofessional collaborative practice (IPCP) using PACT team principles which ultimately promotes the students' ability to link theory content to patient care delivery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. VA's National PTSD Brain Bank: a National Resource for Research.

    Science.gov (United States)

    Friedman, Matthew J; Huber, Bertrand R; Brady, Christopher B; Ursano, Robert J; Benedek, David M; Kowall, Neil W; McKee, Ann C

    2017-08-25

    The National PTSD Brain Bank (NPBB) is a brain tissue biorepository established to support research on the causes, progression, and treatment of PTSD. It is a six-part consortium led by VA's National Center for PTSD with participating sites at VA medical centers in Boston, MA; Durham, NC; Miami, FL; West Haven, CT; and White River Junction, VT along with the Uniformed Services University of Health Sciences. It is also well integrated with VA's Boston-based brain banks that focus on Alzheimer's disease, ALS, chronic traumatic encephalopathy, and other neurological disorders. This article describes the organization and operations of NPBB with specific attention to: tissue acquisition, tissue processing, diagnostic assessment, maintenance of a confidential data biorepository, adherence to ethical standards, governance, accomplishments to date, and future challenges. Established in 2014, NPBB has already acquired and distributed brain tissue to support research on how PTSD affects brain structure and function.

  16. Fixing Health Systems

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

    In Africa, health care has been in a state of crisis for several decades. ..... Instead, think about them as representations of real people — people with families that ...... blood screening; patient care, counseling, and social support; palliative care.

  17. 48 CFR 853.236-70 - VA Form 10-6298, Architect-Engineer Fee Proposal.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA Form 10-6298, Architect-Engineer Fee Proposal. 853.236-70 Section 853.236-70 Federal Acquisition Regulations System DEPARTMENT OF...-Engineer Fee Proposal. VA Form 10-6298, Architect-Engineer Fee Proposal, shall be used as prescribed in 836...

  18. Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria

    Science.gov (United States)

    Peterson, Rachel; Gundlapalli, Adi V.; Metraux, Stephen; Carter, Marjorie E.; Palmer, Miland; Redd, Andrew; Samore, Matthew H.; Fargo, Jamison D.

    2015-01-01

    Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations. PMID:26172386

  19. Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria.

    Directory of Open Access Journals (Sweden)

    Rachel Peterson

    Full Text Available Researchers at the U.S. Department of Veterans Affairs (VA have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012 of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services, plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%. Adding allied V60 codes increased that to 31,260 (rate 3.3%. While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

  20. Power system health analysis

    International Nuclear Information System (INIS)

    Billinton, Roy; Fotuhi-Firuzabad, Mahmud; Aboreshaid, Saleh

    1997-01-01

    This paper presents a technique which combines both probabilistic indices and deterministic criteria to reflect the well-being of a power system. This technique permits power system planners, engineers and operators to maximize the probability of healthy operation as well as minimizing the probability of risky operation. The concept of system well-being is illustrated in this paper by application to the areas of operating reserve assessment and composite power system security evaluation

  1. Dental Encounter System (DES)

    Data.gov (United States)

    Department of Veterans Affairs — Dental Encounter System (DES) is an automated health care application designed to capture critical data about the operations of VA Dental Services. Information on...

  2. Hawaii's public mental health system.

    Science.gov (United States)

    VanderVoort, Debra J

    2005-03-01

    The following article addresses the nature of and problems with the public mental health system in Hawaii. It includes a brief history of Hawaii's public mental health system, a description and analysis of this system, economic factors affecting mental health, as well as a needs assessment of the elderly, individuals with severe mental illness, children and adolescents, and ethnically diverse individuals. In addition to having the potential to increase suicide rates and unnecessarily prolong personal suffering, problems in the public mental health system such as inadequate services contribute to an increase in social problems including, but not limited to, an increase in crime rates (e.g., domestic violence, child abuse), divorce rates, school failure, and behavioral problems in children. The population in need of mental health services in Hawaii is under served, with this inadequacy of services due to economic limitations and a variety of other factors.

  3. Integrated Systems Health Management for Intelligent Systems

    Science.gov (United States)

    Figueroa, Fernando; Melcher, Kevin

    2011-01-01

    The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

  4. OneVA EA Vision and Strategy

    Data.gov (United States)

    Department of Veterans Affairs — The outcomes/goals supported by effective use of an EA are: Improved Service Delivery, Functional Integration, Resource Optimization and Authoritative Reference. VA...

  5. Geographic Distribution of VA Expenditures FY 2016

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  6. Geographic Distribution of VA Expenditures FY2010

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  7. Geographic Distribution of VA Expenditures FY2012

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  8. Geographic Distribution of VA Expenditures FY2004

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  9. Geographic Distribution of VA Expenditures FY1998

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  10. Geographic Distribution of VA Expenditures FY2009

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  11. Geographic Distribution of VA Expenditures FY2013

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  12. Geographic Distribution of VA Expenditures FY2002

    Data.gov (United States)

    Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

  13. Comparing VA and private sector healthcare costs for end-stage renal disease.

    Science.gov (United States)

    Hynes, Denise M; Stroupe, Kevin T; Fischer, Michael J; Reda, Domenic J; Manning, Willard; Browning, Margaret M; Huo, Zhiping; Saban, Karen; Kaufman, James S

    2012-02-01

    Healthcare for end-stage renal disease (ESRD) is intensive, expensive, and provided in both the public and private sector. Using a societal perspective, we examined healthcare costs and health outcomes for Department of Veterans Affairs (VA) ESRD patients comparing those who received hemodialysis care at VA versus private sector facilities. Dialysis patients were recruited from 8 VA medical centers from 2001 through 2003 and followed for 12 months in a prospective cohort study. Patient demographics, clinical characteristics, quality of life, healthcare use, and cost data were collected. Healthcare data included utilization (VA), claims (Medicare), and patient self-report. Costs included VA calculated costs, Medicare dialysis facility reports and reimbursement rates, and patient self-report. Multivariable regression was used to compare costs between patients receiving dialysis at VA versus private sector facilities. The cohort comprised 334 patients: 170 patients in the VA dialysis group and 164 patients in the private sector group. The VA dialysis group had more comorbidities at baseline, outpatient and emergency visits, prescriptions, and longer hospital stays; they also had more conservative anemia management and lower baseline urea reduction ratio (67% vs. 72%; Pprivate sector dialysis group (Pprivate sector settings is critical in informing health policy options for patients with complex chronic illnesses such as ESRD.

  14. The reality of virtual learning for nurses in the largest integrated health care system in the nation.

    Science.gov (United States)

    Rick, Cathy; Kearns, Martha A; Thompson, Nancy A

    2003-01-01

    The health care network and hospital system within the Department of Veterans Affairs (VA), the Veterans Health Administration (VHA), provides employment to more than 56,000 nursing personnel and serves as clinical education site to countless other nursing and health professional students. Nurse administrators and educators are posed with the challenge of providing an environment in which each nurse is able to gain needed knowledge, learn new skills, and share and communicate this knowledge with other colleagues. The education of nurses improves the health status of veterans while also realizing individual professional enhancement. Regional and cultural diversity of the system present challenges to education, in both delivery and content. VHA's learning organizations, the Employee Education System and the Office of Special Projects, have maximized new technologies and information systems to provide innovative, virtual education opportunities, capitalizing on the benefits of informal and formal learning, thus moving VHA to the forefront in knowledge sharing and dissemination. The Virtual Learning Center, VA Knowledge Network, Learning Catalog, and VA Learning Online provide VHA's nurses with interactive, desktop virtual learning opportunities.

  15. VA Library Service--Today's look at Tomorrow's Library.

    Science.gov (United States)

    Veterans Administration, Washington, DC.

    The Conference Poceedings are divided into three broad topics: systems planning, audiovisuals in biomedical communication, and automation and networking. Speakers from within the Veterans Administration (VA), from the National Medical Audiovisual Center, and the Lister Hill National Center for Biomedical Communications, National Library of…

  16. Mobile health systems and emergence

    NARCIS (Netherlands)

    Jones, Valerie M.; Graziosi, Barbara

    2015-01-01

    Changes in the age distribution of the population and increased prevalence of chronic illnesses, together with a shortage of health professionals and other resources, will increasingly challenge the ability of national healthcare systems to meet rising demand for services. Large-scale use of eHealth

  17. Czechoslovakia's changing health care system.

    Science.gov (United States)

    Raffel, M W; Raffel, N K

    1992-01-01

    Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services.

  18. Breast Health Belief Systems Study

    National Research Council Canada - National Science Library

    Williams, Mary

    1999-01-01

    .... The hypothesis underlying this research is that a breast health promotion approach that is based in specific belief systems among three disparate African American rural populations of low socioeconomic status (SES...

  19. A Stochastic Dominance Approach to the Basel III Dilemma: Expected Shortfall or VaR?

    NARCIS (Netherlands)

    C-L. Chang (Chia-Lin); J.A. Jiménez-Martín (Juan-Ángel); E. Maasoumi (Esfandiar); M.J. McAleer (Michael); T. Pérez-Amaral (Teodosio)

    2015-01-01

    markdownabstract__Abstract__ The Basel Committee on Banking Supervision (BCBS) (2013) recently proposed shifting the quantitative risk metrics system from Value-at-Risk (VaR) to Expected Shortfall (ES). The BCBS (2013) noted that “a number of weaknesses have been identified with using VaR for

  20. 48 CFR 803.7000 - Display of the VA Hotline poster.

    Science.gov (United States)

    2010-10-01

    ... poster. 803.7000 Section 803.7000 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Improper Business Practices 803.7000 Display of the VA Hotline poster. (a) Under the circumstances described in paragraph (b) of this section, a contractor must display prominently a VA Hotline poster...

  1. Revenue Based Budgeting at VA Northern California Health Care System: A Model for Financially Aligning Organizational Incentives and Operations

    National Research Council Canada - National Science Library

    Stockwell, David

    1999-01-01

    .... In 1996 the Veterans Equitable Resource Allocation (VERA) model began to disperse the annual congressional appropriation based upon numbers of veterans seen within each of the integrated service networks (VISNs...

  2. [Corruption and health care system].

    Science.gov (United States)

    Marasović Šušnjara, Ivana

    2014-06-01

    Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.

  3. Health Systems Strengthening

    DEFF Research Database (Denmark)

    Hanlin, Rebecca; Andersen, Margrethe Holm

    The Global Network for the Economics of Learning, Innovation, and Competence Building Systems (Globelics) is an open and diverse community of scholars working on innovation and competence building in the context of economic development. The major purpose of the network is to contribute to buildin...

  4. Intelligent Integrated System Health Management

    Science.gov (United States)

    Figueroa, Fernando

    2012-01-01

    Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems

  5. [The health system of Guatemala].

    Science.gov (United States)

    Becerril-Montekio, Víctor; López-Dávila, Luis

    2011-01-01

    This paper describes the health conditions in Guatemala and, in more detail, the characteristics of the Guatemalan health system, including its structure en coverage, its financial sources, the stewardship functions developed by the Ministry of Health, as well as the generation of health information and the development of research activities. It also discusses the recent efforts to extend coverage of essential health services, mostly to poor rural areas.The most recent innovations also discussed in this paper include the Program for the Expansion of Coverage of Essential Services, the Program to Expand Access to Essential Drugs and the agreements between the Ministry of Health and several non-governmental organizations to provide essential services in rural settings.

  6. Strengthening Governance in Health Systems for Reproductive ...

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

    Home · What we do ... As a result, Pakistan's health system has suffered and health service delivery has worsened. ... This four-year project aims to strengthen health systems governance for reproductive health and rights in Pakistan.

  7. Characteristics Associated With Utilization of VA and Non-VA Care Among Iraq and Afghanistan Veterans With Post-Traumatic Stress Disorder.

    Science.gov (United States)

    Finley, Erin P; Mader, Michael; Bollinger, Mary J; Haro, Elizabeth K; Garcia, Hector A; Huynh, Alexis K; Pugh, Jacqueline A; Pugh, Mary Jo

    2017-11-01

    , <50% service connection for PTSD, and reporting high stoicism were more likely to receive no professional treatment. The best model constructed from survey variables correctly predicted utilization group 76% of the time, whereas a model constructed only from variables currently available in VA data predicted utilization group correctly 64% of the time. Important variables distinguishing utilization groups included household income, percent PTSD service connection, routine use of VA health care, having non-VA insurance, past PTSD care at a VA facility or at a community-based facility, attitudes regarding medication, discomfort with mental health care seeking, and perceived treatment efficacy in community-based settings. These findings suggest that preferences for care setting among IAV with PTSD have less influence on care utilization than actual access factors such as household income and service connection. Given that nearly a quarter of respondents indicated receiving as least some PTSD care in community settings, working toward seamless VA/non-VA care coordination remains an important goal for ensuring high-quality care. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  8. Mobile health information system: a mobile app. to aid health ...

    African Journals Online (AJOL)

    Mobile health information system: a mobile app. to aid health workers relate health information. ... Global Journal of Mathematical Sciences ... phones in delivering vital health information and effective fieldwork reporting is of significance.

  9. Introduction on health recommender systems.

    Science.gov (United States)

    Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L

    2015-01-01

    People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described.

  10. Development of a continuous energy version of KENO V.a

    International Nuclear Information System (INIS)

    Dunn, M.E.; Bentley, C.L.; Goluoglu, S.; Paschal, L.S.; Dodds, H.L.

    1997-01-01

    KENO V.a is a multigroup Monte Carlo code that solves the Boltzmann transport equation and is used extensively in the nuclear criticality safety community to calculate the effective multiplication factor k eff of systems containing fissile material. Because of the smaller amount of disk storage and CPU time required in calculations, multigroup approaches have been preferred over continuous energy (point) approaches in the past to solve the transport equation. With the advent of high-performance computers, storage and CPU limitations are less restrictive, thereby making continuous energy methods viable for transport calculations. Moreover, continuous energy methods avoid many of the assumptions and approximations inherent in multigroup methods. Because a continuous energy version of KENO V.a does not exist, the objective of the work is to develop a new version of KENO V.a that utilizes continuous energy cross sections. Currently, a point cross-section library, which is based on a raw continuous energy cross-section library such as ENDF/B-V is not available for implementation in KENO V.a; however, point cross-section libraries are available for MCNP, another widely used Monte Carlo transport code. Since MCNP cross sections are based on ENDF data and are readily available, a new version of KENO V.a named PKENO V.a has been developed that performs the random walk using MCNP cross sections. To utilize point cross sections, extensive modifications have been made to KENO V.a. At this point in the research, testing of the code is underway. In particular, PKENO V.a, KENO V.a, and MCNP have been used to model nine critical experiments and one subcritical problem. The results obtained with PKENO V.a are in excellent agreement with MCNP, KENO V.a, and experiments

  11. Effects of a pain education program in Complementary and Alternative Medicine treatment utilization at a VA medical center.

    Science.gov (United States)

    Cosio, David; Lin, Erica H

    2015-06-01

    Past studies have shown that U.S. Veterans are consumers of CAM. However, more than 75% of Veteran non-users report they would utilize these treatment options if made available. Thus, Veterans may not be fully aware of the CAM options currently available to them in the current U.S. VA health care system. The current study tested the hypothesis that Veterans would report an increase in CAM utilization after completing a formal pain education program in a VA medical center. The study used a quasi-experimental, one-group, pre/post-test design. Midwestern, U.S. VA Medical Center. The responses from 103 Veterans who elected to participate in the program and the assessment measures were included in the outcome analyses. "Pain Education School" is a 12-week, educational program that is open to all Veterans and their families. It is a comprehensive program that introduces patients to 23 different disciplines at the VA Medical Center that deal with chronic, non-cancer pain. An adaptation of the Complementary and Alternative Medicine Questionnaire(©), SECTION A: Use of Alternative Health Care Providers. There was a significant difference found in overall utilization of CAM after completing the pain education program. The most utilized CAM modality was the chiropractor; the least utilized were hypnosis and aromatherapy. Not all health care systems or providers may have access to an education-focused, professionally driven program as an amenity. However, lessons can be learned from this study in terms of what pain providers may be able to accomplish in their practice. Published by Elsevier Ltd.

  12. Technology Reference Model (TRM) Reports: VA Category Mapping Report

    Data.gov (United States)

    Department of Veterans Affairs — The One VA Enterprise Architecture (OneVA EA) is a comprehensive picture of the Department of Veterans Affairs' (VA) operations, capabilities and services and the...

  13. Technology Reference Model (TRM) Reports: VA Category Framework Count Report

    Data.gov (United States)

    Department of Veterans Affairs — The One VA Enterprise Architecture (OneVA EA) is a comprehensive picture of the Department of Veterans Affairs' (VA) operations, capabilities and services and the...

  14. VA Suicide Prevention Applications Network

    Science.gov (United States)

    Stephens, Brady; Morley, Sybil; Thompson, Caitlin; Kemp, Janet; Bossarte, Robert M.

    2016-01-01

    Objectives: The US Department of Veterans Affairs’ Suicide Prevention Applications Network (SPAN) is a national system for suicide event tracking and case management. The objective of this study was to assess data on suicide attempts among people using Veterans Health Administration (VHA) services. Methods: We assessed the degree of data overlap on suicide attempters reported in SPAN and the VHA’s medical records from October 1, 2010, to September 30, 2014—overall, by year, and by region. Data on suicide attempters in the VHA’s medical records consisted of diagnoses documented with E95 codes from the International Classification of Diseases, Ninth Revision. Results: Of 50 518 VHA patients who attempted suicide during the 4-year study period, data on fewer than half (41%) were reported in both SPAN and the medical records; nearly 65% of patients whose suicide attempt was recorded in SPAN had no data on attempted suicide in the VHA’s medical records. Conclusion: Evaluation of administrative data suggests that use of SPAN substantially increases the collection of data on suicide attempters as compared with the use of medical records alone, but neither SPAN nor the VHA’s medical records identify all suicide attempters. Further research is needed to better understand the strengths and limitations of both systems and how to best combine information across systems. PMID:28123228

  15. Portable Health Algorithms Test System

    Science.gov (United States)

    Melcher, Kevin J.; Wong, Edmond; Fulton, Christopher E.; Sowers, Thomas S.; Maul, William A.

    2010-01-01

    A document discusses the Portable Health Algorithms Test (PHALT) System, which has been designed as a means for evolving the maturity and credibility of algorithms developed to assess the health of aerospace systems. Comprising an integrated hardware-software environment, the PHALT system allows systems health management algorithms to be developed in a graphical programming environment, to be tested and refined using system simulation or test data playback, and to be evaluated in a real-time hardware-in-the-loop mode with a live test article. The integrated hardware and software development environment provides a seamless transition from algorithm development to real-time implementation. The portability of the hardware makes it quick and easy to transport between test facilities. This hard ware/software architecture is flexible enough to support a variety of diagnostic applications and test hardware, and the GUI-based rapid prototyping capability is sufficient to support development execution, and testing of custom diagnostic algorithms. The PHALT operating system supports execution of diagnostic algorithms under real-time constraints. PHALT can perform real-time capture and playback of test rig data with the ability to augment/ modify the data stream (e.g. inject simulated faults). It performs algorithm testing using a variety of data input sources, including real-time data acquisition, test data playback, and system simulations, and also provides system feedback to evaluate closed-loop diagnostic response and mitigation control.

  16. Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010-2011.

    Science.gov (United States)

    Collett, Garen A; Song, Kangwon; Jaramillo, Carlos A; Potter, Jennifer S; Finley, Erin P; Pugh, Mary Jo

    2016-03-01

    The increase in the quantities of central nervous system (CNS)-acting medications prescribed has coincided with increases in overdose mortality, suicide-related behaviors, and unintentional deaths in military personnel deployed in support of the wars in Iraq and Afghanistan. Data on the extent and impact of prescribing multiple CNS drugs among Iraq and Afghanistan Veterans (IAVs) are sparse. We sought to identify the characteristics of IAVs with CNS polypharmacy and examine the association of CNS polypharmacy with drug overdose and suicide-related behaviors controlling for known risk factors. This cross-sectional cohort study examined national data of Iraq and Afghanistan Veterans (N = 311,400) who used the Veterans Health Administration (VHA) during the fiscal year 2011. CNS polypharmacy was defined as five or more CNS-acting medications; drug/alcohol overdose and suicide-related behaviors were identified using ICD-9-CM codes. Demographic and clinical characteristics associated with CNS polypharmacy were identified using a multivariable logistic regression model. We found that 25,546 (8.4 %) of Iraq and Afghanistan Veterans had CNS polypharmacy. Those with only post-traumatic stress disorder (PTSD) (adjusted odds ratio (AOR) 6.50, 99 % confidence interval (CI) 5.96-7.10), only depression (AOR 6.42, 99 % CI 5.86-7.04), co-morbid PTSD and depression (AOR 12.98, 99 % CI 11.97-14.07), and co-morbid traumatic brain injury (TBI), PTSD, and depression (AOR 15.30, 99 % CI 14.00-16.73) had the highest odds of CNS polypharmacy. After controlling for these co-morbid conditions, CNS polypharmacy was significantly associated with drug/alcohol overdose and suicide-related behavior. CNS polypharmacy was most strongly associated with PTSD, depression, and TBI, and independently associated with overdose and suicide-related behavior after controlling for known risk factors. These findings suggest that CNS polypharmacy may be used as an indicator of risk for adverse outcomes

  17. KENO V.a Primer: A Primer for Criticality Calculations with SCALE/KENO V.a Using CSPAN for Input

    International Nuclear Information System (INIS)

    Busch, R.D.

    2003-01-01

    The SCALE (Standardized Computer Analyses for Licensing Evaluation) computer software system developed at Oak Ridge National Laboratory (ORNL) is widely used and accepted around the world for criticality safety analyses. The well-known KENO V.a three-dimensional Monte Carlo criticality computer code is the primary criticality safety analysis tool in SCALE. The KENO V.a primer is designed to help a new user understand and use the SCALE/KENO V.a Monte Carlo code for nuclear criticality safety analyses. It assumes that the user has a college education in a technical field. There is no assumption of familiarity with Monte Carlo codes in general or with SCALE/KENO V.a in particular. The primer is designed to teach by example, with each example illustrating two or three features of SCALE/KENO V.a that are useful in criticality analyses. The primer is based on SCALE 4.4a, which includes the Criticality Safety Processor for Analysis (CSPAN) input processor for Windows personal computers (PCs). A second edition of the primer, which uses the new KENO Visual Editor, is currently under development at ORNL and is planned for publication in late 2003. Each example in this first edition of the primer uses CSPAN to provide the framework for data input. Starting with a Quickstart section, the primer gives an overview of the basic requirements for SCALE/KENO V.a input and allows the user to quickly run a simple criticality problem with SCALE/KENO V.a. The sections that follow Quickstart include a list of basic objectives at the beginning that identifies the goal of the section and the individual SCALE/KENO V.a features which are covered in detail in the example problems in that section. Upon completion of the primer, a new user should be comfortable using CSPAN to set up criticality problems in SCALE/KENO V.a

  18. [The health system of Brazil].

    Science.gov (United States)

    Montekio, Víctor Becerril; Medina, Guadalupe; Aquino, Rosana

    2011-01-01

    This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.

  19. The Chinese Health Care System

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi

    In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...

  20. Strengthening Health Systems Research Capacity in Mozambique ...

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

    Mozambique's health sector is dealing with system-wide challenges. ... the Ministry's work on national health accounts, resource allocation, and national health ... a combined INS-FIOCRUS program, and the master's in public health and field ...

  1. African Health Systems Initiative (AHSI) | IDRC - International ...

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

    The African Health Systems Initiative (AHSI) is a 10-year Canadian International ... for strengthening African-led health systems and human resources for health. ... IDRC congratulates first cohort of Women in Climate Change Science Fellows.

  2. Private sector in public health care systems

    OpenAIRE

    Matějusová, Lenka

    2008-01-01

    This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...

  3. 77 FR 12647 - Fund Availability Under VA's Homeless Providers Grant and Per Diem Program

    Science.gov (United States)

    2012-03-01

    ... women veterans with or without the care of dependent children. 2. Funding Priority 2--VA is offering the... homeless veterans (i.e., veterans who are not incarcerated but are involved in the criminal justice system...

  4. Energy Systems and Population Health

    Energy Technology Data Exchange (ETDEWEB)

    Ezzati, Majid; Bailis, Rob; Kammen, Daniel M.; Holloway, Tracey; Price, Lynn; Cifuentes, Luis A.; Barnes, Brendon; Chaurey, Akanksha; Dhanapala, Kiran N.

    2004-04-12

    It is well-documented that energy and energy systems have a central role in social and economic development and human welfare at all scales, from household and community to regional and national (41). Among its various welfare effects, energy is closely linked with people s health. Some of the effects of energy on health and welfare are direct. With abundant energy, more food or more frequent meals can be prepared; food can be refrigerated, increasing the types of food items that are consumed and reducing food contamination; water pumps can provide more water and eliminate the need for water storage leading to contamination or increased exposure to disease vectors such as mosquitoes or snails; water can be disinfected by boiling or using other technologies such as radiation. Other effects of energy on public health are mediated through more proximal determinants of health and disease. Abundant energy can lead to increased irrigation, agricultural productivity, and access to food and nutrition; access to energy can also increase small-scale income generation such as processing of agricultural commodities (e.g., producing refined oil from oil seeds, roasting coffee, drying and preserving fruits and meats) and production of crafts; ability to control lighting and heating allows education or economic activities to be shielded from daily or seasonal environmental constraints such as light, temperature, rainfall, or wind; time and other economic resources spent on collecting and/or transporting fuels can be used for other household needs if access to energy is facilitated; energy availability for transportation increases access to health and education facilities and allow increased economic activity by facilitating the transportation of goods and services to and from markets; energy for telecommunication technology (radio, television, telephone, or internet) provides increased access to information useful for health, education, or economic purposes; provision of energy

  5. Employment status, employment functioning, and barriers to employment among VA primary care patients.

    Science.gov (United States)

    Zivin, Kara; Yosef, Matheos; Levine, Debra S; Abraham, Kristen M; Miller, Erin M; Henry, Jennifer; Nelson, C Beau; Pfeiffer, Paul N; Sripada, Rebecca K; Harrod, Molly; Valenstein, Marcia

    2016-03-15

    Prior research found lower employment rates among working-aged patients who use the VA than among non-Veterans or Veterans who do not use the VA, with the lowest reported employment rates among VA patients with mental disorders. This study assessed employment status, employment functioning, and barriers to employment among VA patients treated in primary care settings, and examined how depression and anxiety were associated with these outcomes. The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical Center. Bivariate and multivariable analyses were conducted examining associations between socio-demographic and clinical predictors of six employment domains, including: employment status, job search self-efficacy, work performance, concerns about job loss among employed Veterans, and employment barriers and likelihood of job seeking among not employed Veterans. 54% of respondents were employed, 36% were not employed, and 10% were economically inactive. In adjusted analyses, participants with depression or anxiety (43%) were less likely to be employed, had lower job search self-efficacy, had lower levels of work performance, and reported more employment barriers. Depression and anxiety were not associated with perceived likelihood of job loss among employed or likelihood of job seeking among not employed. Single VA primary care clinic; cross-sectional study. Employment rates are low among working-aged VA primary care patients, particularly those with mental health conditions. Offering primary care interventions to patients that address mental health issues, job search self-efficacy, and work performance may be important in improving health, work, and economic outcomes. Published by Elsevier B.V.

  6. All SiC Grid-Connected PV Supply with HF Link MPPT Converter: System Design Methodology and Development of a 20 kHz, 25 kVA Prototype

    Directory of Open Access Journals (Sweden)

    Serkan Öztürk

    2018-05-01

    Full Text Available Design methodology and implementation of an all SiC power semiconductor-based, grid-connected multi-string photovoltaic (PV supply with an isolated high frequency (HF link maximum power point tracker (MPPT have been described. This system configuration makes possible the use of a simple and reliable two-level voltage source inverter (VSI topology for grid connection, owing to the galvanic isolation provided by the HF transformer. This topology provides a viable alternative to the commonly used non-isolated PV supplies equipped with Si-based boost MPPT converters cascaded with relatively more complex inverter topologies, at competitive efficiency figures and a higher power density. A 20 kHz, 25 kVA prototype system was designed based on the dynamic model of the multi-string PV panels obtained from field tests. Design parameters such as input DC link capacitance, switching frequencies of MPPT converter and voltage source inverter, size and performance of HF transformer with nanocrystalline core, DC link voltage, and LCL filter of the VSI were optimized in view of the site dependent parameters such as the variation ranges of solar insolation, module surface temperature, and grid voltage. A modified synchronous reference frame control was implemented in the VSI by applying the grid voltage feedforward to the reference voltages in abc axes directly, so that zero-sequence components of grid voltages are taken into account in the case of an unbalanced grid. The system was implemented and the proposed design methodology verified satisfactorily in the field on a roof-mounted 23.7 kW multi-string PV system.

  7. 1000-kVA arc power supply

    International Nuclear Information System (INIS)

    Wright, R.E.; Barber, G.C.; Ponte, N.S.

    1979-01-01

    Because of ever-increasing power demands for the development of the Oak Ridge duoPIGatron ion source, a continuous-duty arc power supply was constructed for the Medium Energy Test Facility (METF) to furnish power for the plasma generator of experimental ion sources. The power supply utilizes 12-pulse rectification with half-wave switching in a delta and wye full-wave bridge that may be connected in series or parallel. It will deliver 340 V dc, 2500 A to an ion source when series connected and 170 V dc, 5000 A when paralleled connected. Silicon-controlled rectifiers (SCR) in each rectifier bridge can be switched for pulses as short as 10 ms through continuous duty. The filter section that reduces the ripple in the output consists of an inductor-to-capacitor (L-C) filter to smooth the 720-Hz pulses. The power transformer serves as an isolation transformer allowing the secondary to be elevated to the accelerating potential of the ion source. The dc output level is controlled with a 1000-kVA auto transformer connected to the primary of the power transformer. All elevated voltages and currents are monitored at ground potential with an optical telemetry system. This paper describes the power supply in detail, including block diagrams, component specifications, and waveforms when supplying power to an ion source

  8. COPD, COOP and BREATH at the VA

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2011-02-01

    Full Text Available No abstract available. Article truncated at 150 words. The February 2011 Pulmonary Journal Club reviews a study by Rice and colleagues (1 of high-risk COPD patients (click here for Pulmonary Journal Club. This review was authored by Kevin Park who also authored an ACP Journal Club review (2. In Rice’s study a single educational session, an individualized care plan, and monthly case-manager telephone calls, resulted in a 41% decrease in hospitalizations and emergency room visits and a nonsignficant trend toward decreased mortality.Rice’s study was supported and conducted in the Veterans Integrated Service Network (VISN 23 (Minnesota, Iowa, Nebraska and the Dakotas. The COPD patients in this study were recruited and followed primarily using the VA computer system. The study represents a potential model of data-based management leading to improved patient outcomes. The authors; Robert Petzel MD, then VISN 23 Director (now Veterans Healthcare Administration Undersecretary; and Janet Murphy, then VISN Primary Care Service Line CEO (now VISN …

  9. Dependence Structures and Systemic Risk of Government Securities Markets in Central and Eastern Europe: A CoVaR-Copula Approach

    Directory of Open Access Journals (Sweden)

    Lu Yang

    2018-01-01

    Full Text Available Abstract: In this study, we proposed a new empirical method by combining generalized autoregressive score functions and a copula model with high-frequency data to model the conditional time-varying joint distribution of the government bond yields between Poland/Czech Republic/Hungary, and Germany. Capturing the conditional time-varying joint distribution of these bond yields allowed us to precisely measure the dependence of the government securities markets. In particular, we found a high dependence of these government securities markets in the long term, but a low dependence in the short term. In addition, we report that the Czech Republic showed the highest dependence with Germany, while Hungary showed the lowest. Moreover, we found that the systemic risk dynamics were consistent with the idea that the global financial crisis not only had spillover effects on countries with weak economic fundamentals (e.g., Hungary, which had the highest systemic risk, but also had contagion effects for both CEEC-3 countries and Germany. Finally, we confirm that three major market events, namely the EU accession, the global financial crisis, and the European debt crisis, caused structural changes to the dynamic correlation.

  10. Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals?

    Science.gov (United States)

    Weeks, William B.; Lee, Richard E.; Wallace, Amy E.; West, Alan N.; Bagian, James P.

    2009-01-01

    Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine…

  11. Model behavior and sensitivity in an application of the cohesive bed component of the community sediment transport modeling system for the York River estuary, VA, USA

    Science.gov (United States)

    Fall, Kelsey A.; Harris, Courtney K.; Friedrichs, Carl T.; Rinehimer, J. Paul; Sherwood, Christopher R.

    2014-01-01

    The Community Sediment Transport Modeling System (CSTMS) cohesive bed sub-model that accounts for erosion, deposition, consolidation, and swelling was implemented in a three-dimensional domain to represent the York River estuary, Virginia. The objectives of this paper are to (1) describe the application of the three-dimensional hydrodynamic York Cohesive Bed Model, (2) compare calculations to observations, and (3) investigate sensitivities of the cohesive bed sub-model to user-defined parameters. Model results for summer 2007 showed good agreement with tidal-phase averaged estimates of sediment concentration, bed stress, and current velocity derived from Acoustic Doppler Velocimeter (ADV) field measurements. An important step in implementing the cohesive bed model was specification of both the initial and equilibrium critical shear stress profiles, in addition to choosing other parameters like the consolidation and swelling timescales. This model promises to be a useful tool for investigating the fundamental controls on bed erodibility and settling velocity in the York River, a classical muddy estuary, provided that appropriate data exists to inform the choice of model parameters.

  12. Validation of KENO V.a: Comparison with critical experiments

    International Nuclear Information System (INIS)

    Jordan, W.C.; Landers, N.F.; Petrie, L.M.

    1986-12-01

    Section 1 of this report documents the validation of KENO V.a against 258 critical experiments. Experiments considered were primarily high or low enriched uranium systems. The results indicate that the KENO V.a Monte Carlo Criticality Program accurately calculates a broad range of critical experiments. A substantial number of the calculations showed a positive or negative bias in excess of 1 1/2% in k-effective (k/sub eff/). Classes of criticals which show a bias include 3% enriched green blocks, highly enriched uranyl fluoride slab arrays, and highly enriched uranyl nitrate arrays. If these biases are properly taken into account, the KENO V.a code can be used with confidence for the design and criticality safety analysis of uranium-containing systems. Sections 2 of this report documents the results of investigation into the cause of the bias observed in Sect. 1. The results of this study indicate that the bias seen in Sect. 1 is caused by code bias, cross-section bias, reporting bias, and modeling bias. There is evidence that many of the experiments used in this validation and in previous validations are not adequately documented. The uncertainty in the experimental parameters overshadows bias caused by the code and cross sections and prohibits code validation to better than about 1% in k/sub eff/. 48 refs., 19 figs., 19 tabs

  13. Health Care Information System (HCIS) Data File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A...

  14. Causes of death in the Taabo health and demographic surveillance system, Côte d'Ivoire, from 2009 to 2011.

    Science.gov (United States)

    Koné, Siaka; Fürst, Thomas; Jaeger, Fabienne N; Esso, Emmanuel L J C; Baïkoro, Nahoua; Kouadio, Kouamé A; Adiossan, Lukas G; Zouzou, Fabien; Boti, Louis I; Tanner, Marcel; Utzinger, Jürg; Bonfoh, Bassirou; Dao, Daouda; N'Goran, Eliézer K

    2015-01-01

    Current vital statistics from governmental institutions in Côte d'Ivoire are incomplete. This problem is particularly notable for remote rural areas that have limited access to the health system. To record all deaths from 2009 to 2011 and to identify the leading causes of death in the Taabo health and demographic surveillance system (HDSS) in south-central Côte d'Ivoire. Deaths recorded in the first 3 years of operation of the Taabo HDSS were investigated by verbal autopsy (VA), using the InterVA-4 model. InterVA-4 is based on the World Health Organization 2012 VA tool in terms of input indicators and categories of causes of death. Overall, 948 deaths were recorded, of which 236 (24.9%) had incomplete VA data. Among the 712 deaths analyzed, communicable diseases represented the leading causes (58.9%), with most deaths attributed to malaria (n=129), acute respiratory tract infections (n=110), HIV/AIDS (n=80), and pulmonary tuberculosis (n=46). Non-communicable diseases accounted for 18.9% of the deaths and included mainly acute abdomen (n=38), unspecified cardiac diseases (n=15), and digestive neoplasms (n=13). Maternal and neonatal conditions accounted for 8.3% of deaths, primarily pneumonia (n=19) and birth asphyxia (n=16) in newborns. Among the 3.8% of deaths linked to trauma and injury, the main causes were assault (n=6), accidental drowning (n=4), contact with venomous plants/animals (n=4), and traffic-related accidents (n=4). No clear causes were determined in 10.0% of the analyzed deaths. Communicable diseases remain the predominant cause of death in rural Côte d'Ivoire. Based on these findings, measures are now being implemented in the Taabo HDSS. It will be interesting to monitor patterns of mortality and causes of death in the face of rapid demographic and epidemiological transitions in this part of West Africa.

  15. Health policy, health systems research and analysis capacity ...

    African Journals Online (AJOL)

    Introduction: Health Policy and Systems Research and Analysis (HPSR&A) is an applied science that deals with complexity as it tries to provide lessons, tools and methods to understand and improve health systems and health policy. It is defined by the kinds of questions asked rather than a particular methodology.

  16. Software for Intelligent System Health Management

    Science.gov (United States)

    Trevino, Luis C.

    2004-01-01

    This viewgraph presentation describes the characteristics and advantages of autonomy and artificial intelligence in systems health monitoring. The presentation lists technologies relevant to Intelligent System Health Management (ISHM), and some potential applications.

  17. The public health system in England

    National Research Council Canada - National Science Library

    Hunter, David J; Marks, Linda; Smith, Katherine E

    2010-01-01

    .... The Public Health System in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted over time...

  18. The VA mission act: Funding to fail?

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2018-06-01

    Full Text Available No abstract available. Article truncated after 150 words. Yesterday on D-Day, the 74th anniversary of the invasion of Normandy, President Trump signed the VA Mission Act. The law directs the VA to combine a number of existing private-care programs, including the so-called Choice program, which was created in 2014 after veterans died waiting for appointments at the Phoenix VA (1. During the signing Trump touted the new law saying “there has never been anything like this in the history of the VA” and saying that veterans “can go right outside [the VA] to a private doctor”-but can they? Although the bill authorizes private care, it appropriates no money to pay for it. Although a bipartisan plan to fund the expansion is proposed in the House, the White House has been lobbying Republicans to vote the plan down (2. Instead Trump has been asking Congress to pay for veteran’s programs by cutting spending elsewhere (2. We in Arizona are …

  19. Validating the InterVA model to estimate the burden of mortality from verbal autopsy data: a population-based cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Sebsibe Tadesse

    Full Text Available BACKGROUND: In countries with incomplete or no vital registration systems, verbal autopsy data are often reviewed by physicians in order to assign the probable cause of death. But in addition to being time and energy consuming, the method is liable to produce inconsistent results. The aim of this study is to validate the InterVA model for estimating the burden of mortality from verbal autopsy data by using physician review as a reference standard. METHODS AND FINDINGS: A population-based cross-sectional study was conducted from March to April, 2012. All adults aged ≥ 14 years and died between 01 January, 2010 and 15 February, 2012 were included in the study. The verbal autopsy interviews were reviewed by the InterVA model and physicians to estimate cause-specific mortality fractions. Cohen's kappa statistic, sensitivity, specificity, positive predictive value, and negative predictive value were applied to compare the agreement between the InterVA model and the physician review. A total of 408 adult deaths were studied. There was a general similarity and just slight differences between the InterVA model and the physicians in assigning cause-specific mortality. Both approaches showed an overall agreement in 298 (73% cases [kappa = 0.49, 95% CI: 0.37-0.60]. The observed sensitivities and specificities across causes of death categories varied from 13.3% to 81.9% and 77.7% to 99.5%, respectively. CONCLUSIONS: In understanding the burden of disease and setting health intervention priorities in areas that lack reliable vital registration systems, an accurate analysis of verbal autopsies is essential. Therefore, users should be aware of the suboptimal performance of the InterVA model. Similar validation studies need to be undertaken considering the limitation of the physician review as gold standard since physicians may misinterpret some of the verbal autopsy data and finally reach a wrong conclusion of the cause of death.

  20. [Health services research for the public health service (PHS) and the public health system].

    Science.gov (United States)

    Hollederer, A; Wildner, M

    2015-03-01

    There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.

  1. Strengthening of oral health systems

    DEFF Research Database (Denmark)

    Petersen, Poul Erik

    2014-01-01

    is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral...... diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work......Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care...

  2. Veterans Health Administration: Management Attention Is Needed to Address Systemic, Long standing Human Capital Challenges

    Science.gov (United States)

    2016-12-01

    assess VHA’s employee performance management processes, we reviewed VA directives and handbooks , and procedures related to the performance...primary pay and classification system.30 VHA’s HR staff are classified as either an HR specialist, who manage , supervise, and deliver HR products ...Board. 815 C.F.R. § 430; Department of Veterans Affairs, Performance Management Systems, VA Handbook 5013, Part I. VHA Needs to Strengthen

  3. Assessing the quality of VA Human Research Protection Programs: VA vs. affiliated University Institutional Review Board.

    Science.gov (United States)

    Tsan, Min-Fu; Nguyen, Yen; Brooks, Robert

    2013-04-01

    We compared the Human Research Protection Program (HRPP) quality indicator data of the Department of Veterans Affairs (VA) facilities using their own VA institutional review boards (IRBs) with those using affiliated university IRBs. From a total of 25 performance metrics, 13 did not demonstrate statistically significant differences, while 12 reached statistically significance differences. Among the 12 with statistically significant differences, facilities using their own VA IRBs performed better on four of the metrics, while facilities using affiliate IRBs performed better on eight. However, the absolute difference was small (0.2-2.7%) in all instances, suggesting that they were of no practical significance. We conclude that it is acceptable for facilities to use their own VA IRBs or affiliated university IRBs as their IRBs of record.

  4. Integrated System Health Management Development Toolkit

    Science.gov (United States)

    Figueroa, Jorge; Smith, Harvey; Morris, Jon

    2009-01-01

    This software toolkit is designed to model complex systems for the implementation of embedded Integrated System Health Management (ISHM) capability, which focuses on determining the condition (health) of every element in a complex system (detect anomalies, diagnose causes, and predict future anomalies), and to provide data, information, and knowledge (DIaK) to control systems for safe and effective operation.

  5. Managing Health Information System | Campbell | Nigerian ...

    African Journals Online (AJOL)

    The effective planning, management monitoring and evaluation of health services, health resources and indeed the health system requires a wealth of health information, with its simultaneous effective and efficient management. It is an instrument used to help policy-making, decision making and day to day actions in the ...

  6. Synergy between indigenous knowledge systems, modern health ...

    African Journals Online (AJOL)

    ... the people of this country should harness a synergy between indigenous health care systems, scientific research and modern health care methods. This article attempts to address the historical evolution of health care methods in South Africa, its effect on the community as well as challenges facing the health professions.

  7. Military Health System Transformation Implications on Health Information Technology Modernization.

    Science.gov (United States)

    Khan, Saad

    2018-03-01

    With the recent passage of the National Defense Authorization Act for Fiscal Year 2017, Congress has triggered groundbreaking Military Health System organizational restructuring with the Defense Health Agency assuming responsibility for managing all hospitals and clinics owned by the Army, Navy, and Air Force. This is a major shift toward a modern value-based managed care system, which will require much greater military-civilian health care delivery integration to be in place by October 2018. Just before the National Defense Authorization Act for Fiscal Year 2017 passage, the Department of Defense had already begun a seismic shift and awarded a contract for the new Military Health System-wide electronic health record system. In this perspective, we discuss the implications of the intersection of two large-scope and large-scale initiatives, health system transformation, and information technology modernization, being rolled out in the largest and most complex federal agency and potential risk mitigating steps. The Military Health System will require an expanded unified clinical leadership to spearhead short-term transformation; furthermore, developing, organizing, and growing a cadre of informatics expertise to expand the use and diffusion of novel solutions such as health information exchanges, data analytics, and others to transcend organizational barriers are still needed to achieve the long-term aim of health system reform as envisioned by the National Defense Authorization Act for Fiscal Year 2017.

  8. 38 CFR 74.27 - How will VA store information?

    Science.gov (United States)

    2010-07-01

    ... (CONTINUED) VETERANS SMALL BUSINESS REGULATIONS Records Management § 74.27 How will VA store information? VA... examination visits will be scanned onto portable media and fully secured in the Center for Veterans Enterprise...

  9. 77 FR 67063 - VA Directive 0005 on Scientific Integrity

    Science.gov (United States)

    2012-11-08

    ... in multiple areas, including data integrity, ethics, privacy, and human research protections, as well... replace the Association for the Accreditation of Human Research Protection Programs (AAHRPP) with Alion... human research protection programs. VA Response: VA is currently reviewing its accreditation...

  10. Accessing VA Healthcare During Large-Scale Natural Disasters.

    Science.gov (United States)

    Der-Martirosian, Claudia; Pinnock, Laura; Dobalian, Aram

    2017-01-01

    Natural disasters can lead to the closure of medical facilities including the Veterans Affairs (VA), thus impacting access to healthcare for U.S. military veteran VA users. We examined the characteristics of VA patients who reported having difficulty accessing care if their usual source of VA care was closed because of natural disasters. A total of 2,264 veteran VA users living in the U.S. northeast region participated in a 2015 cross-sectional representative survey. The study used VA administrative data in a complex stratified survey design with a multimode approach. A total of 36% of veteran VA users reported having difficulty accessing care elsewhere, negatively impacting the functionally impaired and lower income VA patients.

  11. Integrating ICTs within health systems | IDRC - International ...

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

    2016-06-10

    Jun 10, 2016 ... But for too long, ICT and health system researchers have worked in isolation ... be used to enable the governance and functioning of health systems in ... most African countries adopted direct payment for health services as the ...

  12. Occupational Health Record-keeping System (OHRS)

    Data.gov (United States)

    Department of Veterans Affairs — Occupational Health Record-keeping System (OHRS) is part of the Clinical Information Support System (CISS) portal framework and the initial CISS partner system. OHRS...

  13. [A Maternal Health Care System Based on Mobile Health Care].

    Science.gov (United States)

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

  14. Mental health and substance use disorder spending in the Department of Veterans Affairs, fiscal years 2000-2007.

    Science.gov (United States)

    Wagner, Todd H; Sinnott, Patricia; Siroka, Andrew M

    2011-04-01

    This study analyzed spending for treatment of mental health and substance use disorders in the Department of Veterans Affairs (VA) in fiscal years (FYs) 2000 through 2007. VA spending as reported in the VA Decision Support System was linked to patient utilization data as reported in the Patient Treatment Files, the National Patient Care Database, and the VA Fee Basis files. All care and costs from FY 2000 to FY 2007 were analyzed. Over the study period the number of veterans treated at the VA increased from 3.7 million to over 5.1 million (an average increase of 4.9% per year), and costs increased .7% per person per year. For mental health and substance use disorder treatment, the volume of inpatient care decreased markedly, residential care increased, and spending decreased on average 2% per year (from $668 in FY 2000 to $578 per person in FY 2007). FY 2007 saw large increases in mental health spending, bucking the trend from FY 2000 through FY 2006. VA's continued emphasis on outpatient and residential care was evident through 2007. This trend in spending might be unimpressive if VA were enrolling healthier Veterans, but the opposite seems to be true: over this time period the prevalence of most chronic conditions, including depression and posttraumatic stress disorder, increased. VA spending on mental health care grew rapidly in 2007, and given current military activities, this trend is likely to increase.

  15. Balancing Demand and Supply for Veterans' Health Care: A Summary of Three RAND Assessments Conducted Under the Veterans Choice Act.

    Science.gov (United States)

    Farmer, Carrie M; Hosek, Susan D; Adamson, David M

    2016-06-20

    In response to concerns that the Department of Veterans Affairs (VA) has faced about veterans' access to care and the quality of care delivered, Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 ("Veterans Choice Act") in August 2014. The law was passed to help address access issues by expanding the criteria through which veterans can seek care from civilian providers. In addition, the law called for a series of independent assessments of the VA health care system across a broad array of topics related to the delivery of health care services to veterans in VA-owned and -operated facilities, as well as those under contract to VA. RAND conducted three of these assessments: Veteran demographics and health care needs (A), VA health care capabilities (B), and VA authorities and mechanisms for purchasing care (C). This article summarizes the findings of our assessments and includes recommendations from the reports for improving the match between veterans' needs and VA's capabilities, including VA's ability to purchase necessary care from the private sector.

  16. Mobile health monitoring system for community health workers

    CSIR Research Space (South Africa)

    Sibiya, G

    2014-09-01

    Full Text Available of hypertension as it provides real time information and eliminates the need to visit a healthcare facility to take blood pressure readings. Our proposed mobile health monitoring system enables faster computerization of data that has been recorded... pressure, heart rate and glucose readings. These reading closely related to most common NCDs. D. Feedback to health worker and the subject of care Community health workers are often not professionally trained on health. As a result they are not expected...

  17. Multipurpose Health Care Telemedicine System

    National Research Council Canada - National Science Library

    Kyriacou, E

    2001-01-01

    .... Ambulances, Rural Health Centers (RHC) or other remote health location, Ships navigating in wide seas and Airplanes in flight are common examples of possible emergency sites, while critical care telemetry, and telemedicine home follow-ups...

  18. Strengthening Health Systems Governance in Latin American ...

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

    This project seeks to improve the governance of health systems by designing and ... of the data (locally elected officials, health authorities, civil society groups), the ... In partnership with UNESCO's Organization for Women in Science for the ...

  19. Governance for Equity in Health Systems

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

    GEHS

    allocation, and power distribution in health systems are addressed to improve health ... development of a knowledge base on innovative and rigorous research ..... The Public Sector Anti-retroviral Treatment in Free State – Phase II; and Impact ...

  20. Participatory Action Research in Health Systems: Empowering ...

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

    2014-12-02

    Dec 2, 2014 ... Home · Resources · Publications ... A new publication, Participatory Action Research in Health Systems: a methods ... organizations, most African countries adopted direct payment for health services as the primary means.

  1. Fourth Global Health Systems Research Symposium features ...

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

    2017-01-13

    Jan 13, 2017 ... Home · Resources · Publications ... These solutions touch on diverse aspects of health systems, ... Read more on how IDRC is helping increase equitable access to health services for the poor in Mali and Burkina Faso.

  2. Effectiveness of Expanded Implementation of STAR-VA for Managing Dementia-Related Behaviors Among Veterans.

    Science.gov (United States)

    Karel, Michele J; Teri, Linda; McConnell, Eleanor; Visnic, Stephanie; Karlin, Bradley E

    2016-02-01

    Nonpharmacological, psychosocial approaches are first-line treatments for managing behavioral symptoms in dementia, but they can be challenging to implement in long-term care settings. The Veterans Health Administration implemented STAR-VA, an interdisciplinary behavioral approach for managing challenging dementia-related behaviors in its Community Living Center (CLCs, nursing home care) settings. This study describes how the program was implemented and provides an evaluation of Veteran clinical outcomes and staff feedback on the intervention. One mental health professional and registered nurse team from 17 CLCs completed STAR-VA training, which entailed an experiential workshop followed by 6 months of expert consultation as they worked with their teams to implement STAR-VA with Veterans identified to have challenging dementia-related behaviors. The frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation were evaluated at baseline and at intervention completion. Staff provided feedback regarding STAR-VA feasibility and impact. Seventy-one Veterans completed the intervention. Behaviors clustered into 6 types: care refusal or resistance, agitation, aggression, vocalization, wandering, and other. Frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation all significantly decreased, with overall effect sizes of 1 or greater. Staff rated both benefits for Veterans and program feasibility favorably. This evaluation supports the feasibility and effectiveness of STAR-VA, an interdisciplinary, behavioral intervention for managing challenging behaviors among residents with dementia in CLCs. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

  3. Systems Biology and Health Systems Complexity in;

    NARCIS (Netherlands)

    Donald Combs, C.; Barham, S.R.; Sloot, P.M.A.

    2016-01-01

    Systems biology addresses interactions in biological systems at different scales of biological organization, from the molecular to the cellular, organ, organism, societal, and ecosystem levels. This chapter expands on the concept of systems biology, explores its implications for individual patients

  4. Mapping Health Needs to Support Health System Management in Poland

    Science.gov (United States)

    Holecki, Tomasz; Romaniuk, Piotr; Woźniak-Holecka, Joanna; Szromek, Adam R.; Syrkiewicz-Świtała, Magdalena

    2018-01-01

    In Poland, following the example of other EU countries, the first maps of health needs prepared by the Ministry of Health were presented in 2016. The maps constitute a foundation for rational decision-making in the management of health care resources, being potentially useful for all actors in health system. This refers in particular to the institutions responsible for distribution of funds and contracting health service, but also for decision-makers, who determine the scope of funds to be utilized in the health system, or the structure of benefits provided to patients. Service providers are also addressees of the maps, to give them a basis for planning future activities. The article presents a structured assessment of the current state of affairs, based on recent experience and sets out likely directions for the development of health needs in mapping in Poland in the future. We discuss the criticism addressed toward maps by representatives of various groups acting in health care. It includes the lack of recognition of some of the key health needs, or wrong emphases, where much more attention is paid to the recognition of current resources in the health system, instead of making prognoses regarding the future developments of health needs. Nonetheless, we find that this instrument is potentially of high usability, in case of elimination of the existing weaknesses. PMID:29662876

  5. Health, Health Care, and Systems Science: Emerging Paradigm.

    Science.gov (United States)

    Janecka, Ivo

    2017-02-15

    Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public's health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite of

  6. Interrogating resilience in health systems development.

    Science.gov (United States)

    van de Pas, Remco; Ashour, Majdi; Kapilashrami, Anuj; Fustukian, Suzanne

    2017-11-01

    The Fourth Global Symposium on Health Systems Research was themed around 'Resilient and responsive health systems for a changing world.' This commentary is the outcome of a panel discussion at the symposium in which the resilience discourse and its use in health systems development was critically interrogated. The 2014-15 Ebola outbreak in West-Africa added momentum for the wider adoption of resilient health systems as a crucial element to prepare for and effectively respond to crisis. The growing salience of resilience in development and health systems debates can be attributed in part to development actors and philanthropies such as the Rockefeller Foundation. Three concerns regarding the application of resilience to health systems development are discussed: (1) the resilience narrative overrules certain democratic procedures and priority setting in public health agendas by 'claiming' an exceptional policy space; (2) resilience compels accepting and maintaining the status quo and excludes alternative imaginations of just and equitable health systems including the socio-political struggles required to attain those; and (3) an empirical case study from Gaza makes the case that resilience and vulnerability are symbiotic with each other rather than providing a solution for developing a strong health system. In conclusion, if the normative aim of health policies is to build sustainable, universally accessible, health systems then resilience is not the answer. The current threats that health systems face demand us to imagine beyond and explore possibilities for global solidarity and justice in health. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. A system of health accounts 2011

    National Research Council Canada - National Science Library

    2011-01-01

    .... As demands for information increase and more countries implement and institutionalize health accounts according to the system, the data produced are expected to be more comparable, more detailed...

  8. [The national health system in Peru].

    Science.gov (United States)

    Sánchez-Moreno, Francisco

    2014-01-01

    In 1975, a group of professionals in Peru who were experts on national health systems began a process that led the country to be the first in South America to initiate a modern organization of the health system. This pioneering development meant that the creation of the National Health Services System [in Peru] in 1978 occurred before the health system reforms in Chile (1980), Brazil (1990), Colombia (1993), and Ecuador (2008). This encouraging start has had permanent reformist fluctuations since then, with negative development because of the lack of a State policy. Current features of the Peruvian system are inefficient performance, discontinuity, and lack of assessment, which creates a major setback in comparison with other health systems in America. In the 21st century, significant technical efforts have been missed to modernize the system and its functions. The future is worrying and the role of new generations will be decisive.

  9. Health system vision of iran in 2025.

    Science.gov (United States)

    Rostamigooran, N; Esmailzadeh, H; Rajabi, F; Majdzadeh, R; Larijani, B; Dastgerdi, M Vahid

    2013-01-01

    Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage. After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system. Vision statement in evolutionary plan of health system is considered to be :"a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region(1) and with the regarding to health in all policies, accountability and innovation". An explanatory context was compiled either to create a complete image of the vision. Social values and leaders' strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders' strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system.

  10. Embedded Sensor Systems for Health - A Step Towards Personalized Health.

    Science.gov (United States)

    Lindén, Maria; Björkman, Mats

    2018-01-01

    The demography is changing towards older people, and the challenge to provide an appropriate care is well known. Sensor systems, combined with IT solutions are recognized as one of the major tools to handle this situation. Embedded Sensor Systems for Health (ESS-H) is a research profile at Mälardalen University in Sweden, focusing on embedded sensor systems for health technology applications. The research addresses several important issues: to provide sensor systems for health monitoring at home, to provide sensor systems for health monitoring at work, to provide safe and secure infrastructure and software testing methods for physiological data management. The user perspective is important in order to solve real problems and to develop systems that are easy and intuitive to use. One of the overall aims is to enable health trend monitoring in home environments, thus being able to detect early deterioration of a patient. Sensor systems, signal processing algorithms, and decision support algorithms have been developed. Work on development of safe and secure infrastructure and software testing methods are important for an embedded sensor system aimed for health monitoring, both in home and in work applications. Patient data must be sent and received in a safe and secure manner, also fulfilling the integrity criteria.

  11. Building health research systems to achieve better health

    Directory of Open Access Journals (Sweden)

    González Block Miguel

    2006-11-01

    Full Text Available Abstract Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics

  12. Building National Health Research Information Systems (COHRED ...

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

    Building National Health Research Information Systems (COHRED). This grant will allow the Council on Health Research for Development (COHRED) to create, host and maintain a web-based resource on national health research in low- and middle-income countries in partnership with institutions in the South. Called ...

  13. Creating a sampling frame for population-based veteran research: Representativeness and overlap of VA and Department of Defense databases

    OpenAIRE

    Donna L. Washington, MD, MPH; Su Sun, MPH; Mark Canning, BA

    2010-01-01

    Most veteran research is conducted in Department of Veterans Affairs (VA) healthcare settings, although most veterans obtain healthcare outside the VA. Our objective was to determine the adequacy and relative contributions of Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and Department of Defense (DOD) administrative databases for representing the U.S. veteran population, using as an example the creation of a sampling frame for the National Survey of Women Vete...

  14. The State Public Health Laboratory System.

    Science.gov (United States)

    Inhorn, Stanley L; Astles, J Rex; Gradus, Stephen; Malmberg, Veronica; Snippes, Paula M; Wilcke, Burton W; White, Vanessa A

    2010-01-01

    This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.

  15. Mental health service delivery following health system reform in Colombia.

    Science.gov (United States)

    Romero-González, Mauricio; González, Gerardo; Rosenheck, Robert A

    2003-12-01

    In 1993, Colombia underwent an ambitious and comprehensive process of health system reform based on managed competition and structured pluralism, but did not include coverage for mental health services. In this study, we sought to evaluate the impact of the reform on access to mental health services and whether there were changes in the pattern of mental health service delivery during the period after the reform. Changes in national economic indicators and in measures of mental health and non-mental health service delivery for the years 1987 and 1997 were compared. Data were obtained from the National Administrative Department of Statistics of Colombia (DANE), the Department of National Planning and Ministry of the Treasury of Colombia, and from national official reports of mental health and non-mental health service delivery from the Ministry of Health of Colombia for the same years. While population-adjusted access to mental health outpatient services declined by -2.7% (-11.2% among women and +5.8% among men), access to general medical outpatient services increased dramatically by 46%. In-patient admissions showed smaller differences, with a 7% increase in mental health admissions, as compared to 22.5% increase in general medical admissions. The health reform in Colombia imposed competition across all health institutions with the intention of encouraging efficiency and financial autonomy. However, the challenge of institutional survival appears to have fallen heavily on mental health care institutions that were also expected to participate in managed competition, but that were at a serious disadvantage because their services were excluded from the compulsory standardized package of health benefits. While the Colombian health care reform intended to close the gap between those who had and those who did not have access to health services, it appears to have failed to address access to specialized mental health services, although it does seem to have promoted a

  16. Causes of death in two rural demographic surveillance sites in Bangladesh, 2004–2010: automated coding of verbal autopsies using InterVA-4

    Directory of Open Access Journals (Sweden)

    Nurul Alam

    2014-10-01

    Full Text Available Objective: Population-based information on causes of death (CoD by age, sex, and area is critical for countries with limited resources to identify and address key public health issues. This study analysed the demographic surveillance and verbal autopsy (VA data to estimate age- and sex-specific mortality rates and cause-specific mortality fractions in two well-defined rural populations within the demographic surveillance system in Abhoynagar and Mirsarai subdistricts, located in different climatic zones. Design: During 2004–2010, the sample demographic surveillance system registered 1,384 deaths in Abhoynagar and 1,847 deaths in Mirsarai. Trained interviewers interviewed the main caretaker of the deceased with standard VA questionnaires to record signs and symptoms of diseases or conditions that led to death and health care experiences before death. The computer-automated InterVA-4 method was used to analyse VAs to determine probable CoD. Results: Age- and sex-specific death rates revealed a higher neonatal mortality rate in Abhoynagar than Mirsarai, and death rates and sex ratios of male to female death rates were higher in the ages after infancy. Communicable diseases (CDs accounted for 16.7% of all deaths in Abhoynagar and 21.2% in Mirsarai – the difference was due mostly to more deaths from acute respiratory infections, pneumonia, and tuberculosis in Mirsarai. Non-communicable diseases (NCDs accounted for 56.2 and 55.3% of deaths in each subdistrict, respectively, with leading causes being stroke (16.5–19.3%, neoplasms (13.2% each, cardiac diseases (8.9–11.6%, chronic obstructive pulmonary diseases (5.1–6.3%, diseases of the digestive system (3.1–4.1%, and diabetes (2.8–3.5%, together accounting for 49.2–51.2% points of the NCD deaths in the two subdistricts. Injury and other external causes accounted for another 7.5–7.7% deaths, with self-harm being higher among females in Abhoynagar. Conclusions: The computer

  17. EFFECTS OF VARIOUS SOIL ENVIRONMENTAL STRESSES ON THE OCCURRENCE, DISTRIBUTION AND EFFECTIVENESS OF VA MYCORRHIZAE

    Directory of Open Access Journals (Sweden)

    A.G. KHAN

    1995-01-01

    Full Text Available The vesicular - arbuscular (VA mycorrhizal fungi are geographically ubiquitous soil inhabitants and form universal symbiotic relationship with plants from every phylum. These fungi link host plants with host soils and their biota in the mycorrhizosphere and play an important role in plant health, productivity and soil structure. Although VA mycorrhizal fungi do not show any host specificity, there is increasing evidence that various climatic and edaphic environmental factors such as land use and management practices, physical, chemical and biological properties of host soils and host plant characteristics influence their occurrence, taxonomic distribution and effectiveness. The interaction of these factors with vesicular-arbuscular mycorrhizae (VAM is poorly understood except in a few cases. It is now very clear that VA mycorrhizal associations are ecologically significant factors that require more attention than previously accorded. This paper discusses the occurrence, distribution and significance of VAM in environmentally stressed soil conditions that limit plant growth such as drought, waterlogging and salinity.

  18. Health Systems Sustainability and Rare Diseases.

    Science.gov (United States)

    Ferrelli, Rita Maria; De Santis, Marta; Egle Gentile, Amalia; Taruscio, Domenica

    2017-01-01

    The paper is addressing aspects of health system sustainability for rare diseases in relation to the current economic crisis and equity concerns. It takes into account the results of the narrative review carried out in the framework of the Joint Action for Rare Diseases (Joint RD-Action) "Promoting Implementation of Recommendations on Policy, Information and Data for Rare Diseases", that identified networks as key factors for health systems sustainability for rare diseases. The legal framework of European Reference Networks and their added value is also presented. Networks play a relevant role for health systems sustainability, since they are based upon, pay special attention to and can intervene on health systems knowledge development, partnership, organizational structure, resources, leadership and governance. Moreover, sustainability of health systems can not be separated from the analysis of the context and the action on it, including fiscal equity. As a result of the financial crisis of 2008, cuts of public health-care budgets jeopardized health equity, since the least wealthy suffered from the greatest health effects. Moreover, austerity policies affected economic growth much more adversely than previously believed. Therefore, reducing public health expenditure not only is going to jeopardise citizens' health, but also to hamper fair and sustainable development.

  19. Continuous-energy version of KENO V.a for criticality safety applications

    International Nuclear Information System (INIS)

    Dunn, Michael E.; Greene, N. Maurice; Petrie, Lester M.

    2003-01-01

    KENO V.a is a multigroup Monte Carlo code that solves the Boltzmann transport equation and is used extensively in the criticality safety community to calculate the effective multiplication factor of systems with fissionable material. In this work, a continuous-energy or pointwise version of KENO V.a has been developed by first designing a new continuous-energy cross-section format and then by developing the appropriate Monte Carlo transport procedures to sample the new cross-section format. In order to generate pointwise cross sections for a test library, a series of cross-section processing modules were developed and used to process 50 ENDF/B-6 Release 7 nuclides for the test library. Once the cross-section processing procedures were in place, a continuous-energy version of KENO V.a was developed and tested by calculating 21 critical benchmark experiments. The point KENO-calculated results for the 21 benchmarks are in agreement with calculated results obtained with the multigroup version of KENO V.a using the 238-group ENDF/B-5 and 199-group ENDF/B-6 Release 3 libraries. Based on the calculated results with the prototypic cross-section library, a continuous-energy version of the KENO V.a code has been successfully developed and demonstrated for modeling systems with fissionable material. (author)

  20. 48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

    Science.gov (United States)

    2010-10-01

    ..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

  1. E-health, health systems and social innovation

    DEFF Research Database (Denmark)

    Brem, Alexander; Sliwa, Sophie Isabel; Agarwal, Nivedita

    2017-01-01

    This paper explores telecare as one of the practical applications in the field of e-health. Using 11 expert interviews the study evaluates development of cross-national analogies between the different institutional contexts of health systems in Germany, Austria, and Denmark. Telecare is treated a...... to be driving socially innovative solutions. Implications for research and practice, as well as future research directions, are elaborated....... as a set of ideas regarding future processes in health and home care services, involving technological solutions, starting to change stakeholders' behaviour, work practices, and social roles. A system-centric framework is proposed to evaluate the interdependencies between telecare, the changing...

  2. United States of America: health system review.

    Science.gov (United States)

    Rice, Thomas; Rosenau, Pauline; Unruh, Lynn Y; Barnes, Andrew J; Saltman, Richard B; van Ginneken, Ewout

    2013-01-01

    This analysis of the United States health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The US health system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor measures on many objective and subjective measures of quality and outcomes, an unequal distribution of resources and outcomes across the country and among different population groups, and lagging efforts to introduce health information technology. It is difficult to determine the extent to which deficiencies are health-system related, though it seems that at least some of the problems are a result of poor access to care. Because of the adoption of the Affordable Care Act in 2010, the United States is facing a period of enormous potential change. Improving coverage is a central aim, envisaged through subsidies for the uninsured to purchase private insurance, expanded eligibility for Medicaid (in some states) and greater protection for insured persons. Furthermore, primary care and public health receive increased funding, and quality and expenditures are addressed through a range of measures. Whether the ACA will indeed be effective in addressing the challenges identified above can only be determined over time. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  3. Malaria epidemiology in the Pakaanóva (Wari') Indians, Brazilian Amazon.

    Science.gov (United States)

    Sá, D Ribeiro; Souza-Santos, R; Escobar, A L; Coimbra, C E A

    2005-04-01

    This paper reports the results of a longitudinal study of malaria incidence (1998-2002) among the Pakaanóva (Wari') Indians, Brazilian southwest Amazon region, based on data routinely gathered by Brazilian National Health Foundation outposts network in conjunction with the Indian health service. Malaria is present yearlong in the Pakaanóva. Statistically significant differences between seasons or months were not noticed. A total of 1933 cases of malaria were diagnosed in the Pakaanóva during this period. The P. vivax / P. falciparum ratio was 3.4. P. vivax accounted for 76.5% of the cases. Infections with P. malariae were not recorded. Incidence rates did not differ by sex. Most malaria cases were reported in children < 10 years old (45%). About one fourth of all cases were diagnosed on women 10-40 years old. An entomological survey carried out at two Pakaanóva villages yielded a total of 3.232 specimens of anophelines. Anopheles darlingi predominated (94.4%). Most specimens were captured outdoors and peak activity hours were noted at early evening and just before sunrise. It was observed that Pakaanóva cultural practices may facilitate outdoor exposure of individuals of both sexes and all age groups during peak hours of mosquito activities (e.g., coming to the river early in the morning for bathing or to draw water, fishing, engaging in hunting camps, etc). In a context in which anophelines are ubiquitous and predominantly exophilic, and humans of both sexes and all ages are prone to outdoor activities during peak mosquito activity hours, malaria is likely to remain endemic in the Pakaanóva, thus requiring the development of alternative control strategies that are culturally and ecologically sensitive.

  4. Primary health care and public health: foundations of universal health systems.

    Science.gov (United States)

    White, Franklin

    2015-01-01

    The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. © 2015 S. Karger AG, Basel.

  5. SlaVaComp Fonts Converter

    Directory of Open Access Journals (Sweden)

    Simon Skilevic

    2013-12-01

    Full Text Available This paper presents a fonts converter that was developed as a part of the Freiburg project on historical corpus linguistics. The tool named SlaVaComp-Konvertierer converts Church Slavonic texts digitized with non-Unicode fonts into the Unicode format without any loss of information contained in the original file and without damage to the original formatting. It is suitable for the conversion of all idiosyncratic fonts—not only Church Slavonic—and therefore can be used not only in Palaeoslavistic, but also in all historical and philological studies.

  6. "Walking in a maze": community providers' difficulties coordinating health care for homeless patients.

    Science.gov (United States)

    LaCoursiere Zucchero, Terri; McDannold, Sarah; McInnes, D Keith

    2016-09-07

    While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population. Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used. HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received. Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons.

  7. Reforming the health care system: implications for health care marketers.

    Science.gov (United States)

    Petrochuk, M A; Javalgi, R G

    1996-01-01

    Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

  8. Health record systems that meet clinical needs

    Directory of Open Access Journals (Sweden)

    Gabriella Negrini

    2012-10-01

    Full Text Available Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

  9. Welcome to health information science and systems.

    Science.gov (United States)

    Zhang, Yanchun

    2013-01-01

    Health Information Science and Systems is an exciting, new, multidisciplinary journal that aims to use technologies in computer science to assist in disease diagnoses, treatment, prediction and monitoring through the modeling, design, development, visualization, integration and management of health related information. These computer-science technologies include such as information systems, web technologies, data mining, image processing, user interaction and interface, sensors and wireless networking and are applicable to a wide range of health related information including medical data, biomedical data, bioinformatics data, public health data.

  10. Environmental health risk assessment: Energy systems

    International Nuclear Information System (INIS)

    Krewski, D.; Somers, E.; Winthrop, S.O.

    1984-01-01

    Most industrialized nations have come to rely on a variety of systems for energy production, both of a conventional and non-conventional nature. In the paper, the spectrum of energy systems currently in use in Canada is outlined along with their potential health risks. Several examples of environmental health studies involving both outdoor and indoor air pollution related to energy production in Canada are reported. The limitations of current technologies for assessing health risks are discussed and possible approaches to managing energy related health risks are indicated. (author)

  11. Health care financing and the sustainability of health systems.

    Science.gov (United States)

    Liaropoulos, Lycourgos; Goranitis, Ilias

    2015-09-15

    The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.

  12. Medical Student Psychiatry Examination Performance at VA and Non-VA Clerkship Sites

    Science.gov (United States)

    Tucker, Phebe; von Schlageter, Margo Shultes; Park, EunMi; Rosenberg, Emily; Benjamin, Ashley B.; Nawar, Ola

    2009-01-01

    Objective: The authors examined the effects of medical student assignment to U.S. Department of Veterans Affairs (VA) Medical Center inpatient and outpatient psychiatry clerkship sites versus other university and community sites on the performance outcome measure of National Board of Medical Examiners (NBME) subject examination scores. Methods:…

  13. In aftermath of financial investigation Phoenix VA employee demoted after her testimony

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-03-01

    Full Text Available No abstract available. Article truncated after 150 words. A previous Southwest Journal of Pulmonary and Critical Care Journal editorial commented on fiscal mismanagement at the Department of Veterans Affairs (VA Medical Center in Phoenix (1. Now Paula Pedene, the former Phoenix VA public affairs officer, claims she was demoted for testimony she gave to the VA Inspector General’s Office (OIG regarding that investigation (2. In 2011, the OIG investigated the Phoenix VA for excess spending on private care of patients (3. The report blamed systemic failures for controls so weak that $56 million in medical fees were paid during 2010 without adequate review. The report particularly focused on one clinician assigned by the Chief of Staff to review hundreds of requests per week and the intensive care unit physicians for transferring patients to chronic ventilator units (1,3. After the investigation, the director and one of the associate directors left the VA and the chief of staff was promoted …

  14. New Reforms to the Health System

    OpenAIRE

    Tran Dai, Candice; Duchâtel, Mathieu

    2012-01-01

    Based on:– Li Ling, “Successful reform of the health system hangs on two key elements,” Zhongguo jingyingbao (China Management News), 18 April 2009.– Li Hongmei, Li Xiaohong, Wang Junping, “Ten experts comment on the new reform of the health system: Providing better and cheaper access to medical care,” Renmin ribao (People’s Daily), 15 April 2009.– Yao Qi, “The new reform of the health system must first and foremost compensate for the shortcomings in the local hospitals,” Yangcheng wanbao (Ya...

  15. 77 FR 65939 - Privacy Act of 1974; System of Records

    Science.gov (United States)

    2012-10-31

    ...) is amending the system of records currently entitled ``Veterans Health Information Systems and... Health Information Systems and Technology Architecture (VistA) Records-VA ROUTINE USES OF RECORDS... DEPARTMENT OF VETERANS AFFAIRS Privacy Act of 1974; System of Records AGENCY: Department of...

  16. Digital health and the challenge of health systems transformation.

    Science.gov (United States)

    Alami, Hassane; Gagnon, Marie-Pierre; Fortin, Jean-Paul

    2017-01-01

    Information and communication technologies have transformed all sectors of society. The health sector is no exception to this trend. In light of "digital health", we see multiplying numbers of web platforms and mobile health applications, often brought by new unconventional players who produce and offer services in non-linear and non-hierarchal ways, this by multiplying access points to services for people. Some speak of a "uberization" of healthcare. New realities and challenges have emerged from this paradigm, which question the abilities of health systems to cope with new business and economic models, governance of data and regulation. Countries must provide adequate responses so that digital health, based increasingly on disruptive technologies, can benefit for all.

  17. Health for All - Italia, an informative health system

    Directory of Open Access Journals (Sweden)

    Marzia Loghi

    2008-06-01

    Full Text Available

    Background: On ISTAT website the informative system Health for All – Italia is available. It collects indicators on health coming from various sources to make up a basis for constructing an organic and joint framework on the country’s health reality. The system includes more than 4000 indicators about: demographic and socioeconomic context; causes of death; life styles; disease prevention; chronic and infectious diseases; disability; health status and life expectancy; health facilities; hospital discharges by diagnosis; health care resources. The database-related software was developed by the World Health Organization to make it easier for any user to access the information available either as tables, graphs and territorial maps.

    Methods: The system has been built considering data coming from different sources and using, if possible, the same definitions, classifications and desegregations. Time series goes from 1980 to the last year available (which can differ among the different sources. Indicators are calculated by provinces (if possible, regions, big areas and Italy. In order to compare indicators over time and space, standardised rates are calculated, using the same population reference. For each indicator metadata are available to give users additional notes necessary to correctly read and use the data, and publications or internet websites to examine more in-depth the argument.

    Results: Different kind of users find Health for All – Italia very useful for their aims: students, researchers, doctors, socio-sanitary operators, policy makers. Some examples of official reports from public institutions are briefly described in the paper.

    Conclusions: The increasing number of users of Health for All – Italia make necessary the online version and an English version for international comparisons.

  18. Cognitive systems engineering in health care

    CERN Document Server

    Bisantz, Ann M; Fairbanks, Rollin J

    2014-01-01

    Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...

  19. Systemic antioxidants and skin health.

    Science.gov (United States)

    Nguyen, Gloria; Torres, Abel

    2012-09-01

    Most dermatologists agree that antioxidants help fight free radical damage and can help maintain healthy skin. They do so by affecting intracellular signaling pathways involved in skin damage and protecting against photodamage, as well as preventing wrinkles and inflammation. In today's modern world of the rising nutraceutical industry, many people, in addition to applying topical skin care products, turn to supplementation of the nutrients missing in their diets by taking multivitamins or isolated, man-made nutraceuticals, in what is known as the Inside-Out approach to skin care. However, ingestion of large quantities of isolated, fragmented nutrients can be harmful and is a poor representation of the kind of nutrition that can be obtained from whole food sources. In this comprehensive review, it was found that few studies on oral antioxidants benefiting the skin have been done using whole foods, and that the vast majority of current research is focused on the study of compounds in isolation. However, the public stands to benefit greatly if more research were to be devoted toward the impact that physiologic doses of antioxidants (obtained from fruits, vegetables, and whole grains) can have on skin health, and on health in general.

  20. Networked Biomedical System for Ubiquitous Health Monitoring

    Directory of Open Access Journals (Sweden)

    Arjan Durresi

    2008-01-01

    Full Text Available We propose a distributed system that enables global and ubiquitous health monitoring of patients. The biomedical data will be collected by wearable health diagnostic devices, which will include various types of sensors and will be transmitted towards the corresponding Health Monitoring Centers. The permanent medical data of patients will be kept in the corresponding Home Data Bases, while the measured biomedical data will be sent to the Visitor Health Monitor Center and Visitor Data Base that serves the area of present location of the patient. By combining the measured biomedical data and the permanent medical data, Health Medical Centers will be able to coordinate the needed actions and help the local medical teams to make quickly the best decisions that could be crucial for the patient health, and that can reduce the cost of health service.

  1. Budget-makers and health care systems.

    Science.gov (United States)

    White, Joseph

    2013-10-01

    Health programs are shaped by the decisions made in budget processes, so how budget-makers view health programs is an important part of making health policy. Budgeting in any country involves its own policy community, with key players including budgeting professionals and political authorities. This article reviews the typical pressures on and attitudes of these actors when they address health policy choices. The worldview of budget professionals includes attitudes that are congenial to particular policy perspectives, such as the desire to select packages of programs that maximize population health. The pressures on political authorities, however, are very different: most importantly, public demand for health care services is stronger than for virtually any other government activity. The norms and procedures of budgeting also tend to discourage adoption of some of the more enthusiastically promoted health policy reforms. Therefore talk about rationalizing systems is not matched by action; and action is better explained by the need to minimize blame. The budget-maker's perspective provides insight about key controversies in healthcare policy such as decentralization, competition, health service systems as opposed to health insurance systems, and dedicated vs. general revenue finance. It also explains the frequency of various "gaming" behaviors. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  2. Veneto Region, Italy. Health system review.

    Science.gov (United States)

    Toniolo, Franco; Mantoan, Domenico; Maresso, Anna

    2012-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. This HiT is one of the first to be written on a subnational level of government and focuses on the Veneto Region of northern Italy. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Veneto Region is one of Italy's richest regions and the health of its resident population compares favourably with other regions in Italy. Life expectancy for both men and women, now at 79.1 and 85.2 years, respectively, is slightly higher than the national average, while mortality rates are comparable to national ones. The major causes of death are tumours and cardiovascular diseases. Under Italy's National Health Service, the organization and provision of health care is a regional responsibility and regions must provide a nationally defined (with regional input) basic health benefit package to all of their citizens; extra services may be provided if budgets allow. Health care is mainly financed by earmarked central and regional taxes, with regions receiving their allocated share of resources from the National Health Fund. Historically, health budget deficits have been a major problem in most Italian regions, but since the early 2000s the introduction of efficiency measures and tighter procedures on financial management have contributed to a significant decrease in the Veneto Regions health budget deficit.The health system is governed by the Veneto Region government (Giunta) via the Departments of Health and Social Services, which receive technical support from a single General Management Secretariat. Health care is

  3. Big Data: Implications for Health System Pharmacy.

    Science.gov (United States)

    Stokes, Laura B; Rogers, Joseph W; Hertig, John B; Weber, Robert J

    2016-07-01

    Big Data refers to datasets that are so large and complex that traditional methods and hardware for collecting, sharing, and analyzing them are not possible. Big Data that is accurate leads to more confident decision making, improved operational efficiency, and reduced costs. The rapid growth of health care information results in Big Data around health services, treatments, and outcomes, and Big Data can be used to analyze the benefit of health system pharmacy services. The goal of this article is to provide a perspective on how Big Data can be applied to health system pharmacy. It will define Big Data, describe the impact of Big Data on population health, review specific implications of Big Data in health system pharmacy, and describe an approach for pharmacy leaders to effectively use Big Data. A few strategies involved in managing Big Data in health system pharmacy include identifying potential opportunities for Big Data, prioritizing those opportunities, protecting privacy concerns, promoting data transparency, and communicating outcomes. As health care information expands in its content and becomes more integrated, Big Data can enhance the development of patient-centered pharmacy services.

  4. Implementing the learning health care system.

    NARCIS (Netherlands)

    Verheij, R.; Barten, D.J.; Hek, K.; Nielen, M.; Prins, M.; Zwaanswijk, M.; Bakker, D. de

    2014-01-01

    Background: As computerisation of primary care facilities is rapidly increasing, a wealth of data is created in routinely recorded electronic health records (EHRs). This data can be used to create a true learning health care system, in which routinely available data are processed and analysed in

  5. Software for Intelligent System Health Management (ISHM)

    Science.gov (United States)

    Trevino, Luis C.

    2004-01-01

    The slide presentation is a briefing in four areas: overview of health management paradigms; overview of the ARC-Houston Software Engineering Technology Workshop held on April 20-22, 2004; identified technologies relevant to technical themes of intelligent system health management; and the author's thoughts on these topics.

  6. Quality systems in Dutch health care institutions.

    NARCIS (Netherlands)

    Casparie, A.F.; Sluijs, E.M.; Wagner, C.; Bakker, D.H. de

    1997-01-01

    The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire-derived

  7. Revisiting Health System Performance Assessment in Africa

    NARCIS (Netherlands)

    Achoki, Tom

    2016-01-01

    Health systems in Africa have long faced a huge burden of disease, amidst pressing resource constraints. However, despite the constraints, the last three decades have seen the region make progress in tackling some of the most critical health challenges. Notably, many countries have registered

  8. Health-system strengthening and tuberculosis control.

    Science.gov (United States)

    Atun, Rifat; Weil, Diana E C; Eang, Mao Tan; Mwakyusa, David

    2010-06-19

    Weak health systems are hindering global efforts for tuberculosis care and control, but little evidence is available on effective interventions to address system bottlenecks. This report examines published evidence, programme reviews, and case studies to identify innovations in system design and tuberculosis control to resolve these bottlenecks. We outline system bottlenecks in relation to governance, financing, supply chain management, human resources, health-information systems, and service delivery; and adverse effects from rapid introduction of suboptimum system designs. This report also documents innovative solutions for disease control and system design. Solutions pursued in individual countries are specific to the nature of the tuberculosis epidemic, the underlying national health system, and the contributors engaged: no one size fits all. Findings from countries, including Bangladesh, Cambodia, India, Tanzania, Thailand, and Vietnam, suggest that advances in disease control and system strengthening are complementary. Tuberculosis care and control are essential elements of health systems, and simultaneous efforts to innovate systems and disease response are mutually reinforcing. Highly varied and context-specific responses to tuberculosis show that solutions need to be documented and compared to develop evidence-based policies and practice. Copyright 2010 Elsevier Ltd. All rights reserved.

  9. Improving mental health systems in Africa

    African Journals Online (AJOL)

    problematic. To comment on mental health systems in Africa, .... be an option for assisting with both de-stigmatization and ... deinstitutionalization with a reduction in both chronic and ... such as the family, societal change, bullying in schools,.

  10. Wearable Health Monitoring Systems, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — The objective of this proposal is to demonstrate the feasibility of producing a wearable health monitoring system for the human body that is functional, comfortable,...

  11. FIXING HEALTH SYSTEMS / Executive Summary (2008 update ...

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

    2010-12-14

    Dec 14, 2010 ... FIXING HEALTH SYSTEMS / Executive Summary (2008 update) ... In several cases, specific approaches recommended by the TEHIP team have been acted upon regionally and internationally, including the ... Related articles ...

  12. Wearable Health Monitoring Systems, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — The objective of this proposal is to demonstrate the feasibility of producing a wearable health monitoring system for the human body that is functional, comfortable,...

  13. The military health system's personal health record pilot with Microsoft HealthVault and Google Health.

    Science.gov (United States)

    Do, Nhan V; Barnhill, Rick; Heermann-Do, Kimberly A; Salzman, Keith L; Gimbel, Ronald W

    2011-01-01

    To design, build, implement, and evaluate a personal health record (PHR), tethered to the Military Health System, that leverages Microsoft® HealthVault and Google® Health infrastructure based on user preference. A pilot project was conducted in 2008-2009 at Madigan Army Medical Center in Tacoma, Washington. Our PHR was architected to a flexible platform that incorporated standards-based models of Continuity of Document and Continuity of Care Record to map Department of Defense-sourced health data, via a secure Veterans Administration data broker, to Microsoft® HealthVault and Google® Health based on user preference. The project design and implementation were guided by provider and patient advisory panels with formal user evaluation. The pilot project included 250 beneficiary users. Approximately 73.2% of users were Microsoft® HealthVault, and 81 (32.4%) selected Google® Health as their PHR of preference. Sample evaluation of users reflected 100% (n = 60) satisfied with convenience of record access and 91.7% (n = 55) satisfied with overall functionality of PHR. Key lessons learned related to data-transfer decisions (push vs pull), purposeful delays in reporting sensitive information, understanding and mapping PHR use and clinical workflow, and decisions on information patients may choose to share with their provider. Currently PHRs are being viewed as empowering tools for patient activation. Design and implementation issues (eg, technical, organizational, information security) are substantial and must be thoughtfully approached. Adopting standards into design can enhance the national goal of portability and interoperability.

  14. United Kingdom (England): Health system review.

    Science.gov (United States)

    Boyle, Seán

    2011-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Various indicators show that the health of the population has improved over the last few decades. However, inequalities in health across socioeconomic groups have been increasing since the 1970s. The main diseases affecting the population are circulatory diseases, cancer, diseases of the respiratory system and diseases of the digestive system. Risk factors such as the steadily rising levels of alcohol consumption, the sharp increases in adult and child obesity and prevailing smoking levels are among the most pressing public health concerns, particularly as they reflect the growing health inequalities among different socioeconomic groups. Health services in England are largely free at the point of use. The NHS provides preventive medicine, primary care and hospital services to all those ordinarily resident. Over 12% of the population is covered by voluntary health insurance schemes, known in the United Kingdom as private medical insurance (PMI), which mainly provides access to acute elective care in the private sector. Responsibility for publicly funded health care rests with the Secretary of State for Health, supported by the Department of Health. The Department operates at a regional level through 10 strategic health authorities (SHAs), which are responsible for ensuring the quality and performance of local health services within their geographic area. Responsibility for commissioning health services at the local level lies with 151 primary care

  15. The chinese health care system

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter Raahave; Yu, Yi

    2011-01-01

    We describe the structure and present situation of the Chinese healthcare system and discuss its primary problems and challenges. We discuss problems with inefficient burden sharing, adverse provider incentives and huge inequities, and seek explanations in the structural features of the Chinese...

  16. Racial and Ethnic Differences in Total Knee Arthroplasty in the Veterans Affairs Health Care System, 2001-2013.

    Science.gov (United States)

    Hausmann, Leslie R M; Brandt, Cynthia A; Carroll, Constance M; Fenton, Brenda T; Ibrahim, Said A; Becker, William C; Burgess, Diana J; Wandner, Laura D; Bair, Matthew J; Goulet, Joseph L

    2017-08-01

    To examine black-white and Hispanic-white differences in total knee arthroplasty from 2001 to 2013 in a large cohort of patients diagnosed with osteoarthritis (OA) in the Veterans Affairs (VA) health care system. Data were from the VA Musculoskeletal Disorders cohort, which includes data from electronic health records of more than 5.4 million veterans with musculoskeletal disorders diagnoses. We included white (non-Hispanic), black (non-Hispanic), and Hispanic (any race) veterans, age ≥50 years, with an OA diagnosis from 2001-2011 (n = 539,841). Veterans were followed from their first OA diagnosis until September 30, 2013. As a proxy for increased clinical severity, analyses were also conducted for a subsample restricted to those who saw an orthopedic or rheumatology specialist (n = 148,844). We used Cox proportional hazards regression to examine racial and ethnic differences in total knee arthroplasty by year of OA diagnosis, adjusting for age, sex, body mass index, physical and mental diagnoses, and pain intensity scores. We identified 12,087 total knee arthroplasty procedures in a sample of 473,170 white, 50,172 black, and 16,499 Hispanic veterans. In adjusted models examining black-white and Hispanic-white differences by year of OA diagnosis, total knee arthroplasty rates were lower for black than for white veterans diagnosed in all but 2 years. There were no Hispanic-white differences regardless of when diagnosis occurred. These patterns held in the specialty clinic subsample. Black-white differences in total knee arthroplasty appear to be persistent in the VA, even after controlling for potential clinical confounders. © 2016, American College of Rheumatology.

  17. Improving the use of health data for health system strengthening

    Directory of Open Access Journals (Sweden)

    Tara Nutley

    2013-02-01

    Full Text Available Background: Good quality and timely data from health information systems are the foundation of all health systems. However, too often data sit in reports, on shelves or in databases and are not sufficiently utilised in policy and program development, improvement, strategic planning and advocacy. Without specific interventions aimed at improving the use of data produced by information systems, health systems will never fully be able to meet the needs of the populations they serve. Objective: To employ a logic model to describe a pathway of how specific activities and interventions can strengthen the use of health data in decision making to ultimately strengthen the health system. Design: A logic model was developed to provide a practical strategy for developing, monitoring and evaluating interventions to strengthen the use of data in decision making. The model draws on the collective strengths and similarities of previous work and adds to those previous works by making specific recommendations about interventions and activities that are most proximate to affect the use of data in decision making. The model provides an organizing framework for how interventions and activities work to strengthen the systematic demand, synthesis, review, and use of data. Results: The logic model and guidance are presented to facilitate its widespread use and to enable improved data-informed decision making in program review and planning, advocacy, policy development. Real world examples from the literature support the feasible application of the activities outlined in the model. Conclusions: The logic model provides specific and comprehensive guidance to improve data demand and use. It can be used to design, monitor and evaluate interventions, and to improve demand for, and use of, data in decision making. As more interventions are implemented to improve use of health data, those efforts need to be evaluated.

  18. Reusable Rocket Engine Turbopump Health Management System

    Science.gov (United States)

    Surko, Pamela

    1994-01-01

    A health monitoring expert system software architecture has been developed to support condition-based health monitoring of rocket engines. Its first application is in the diagnosis decisions relating to the health of the high pressure oxidizer turbopump (HPOTP) of Space Shuttle Main Engine (SSME). The post test diagnostic system runs off-line, using as input the data recorded from hundreds of sensors, each running typically at rates of 25, 50, or .1 Hz. The system is invoked after a test has been completed, and produces an analysis and an organized graphical presentation of the data with important effects highlighted. The overall expert system architecture has been developed and documented so that expert modules analyzing other line replaceable units may easily be added. The architecture emphasizes modularity, reusability, and open system interfaces so that it may be used to analyze other engines as well.

  19. Environmental health surveillance system; Kankyo hoken surveillance system

    Energy Technology Data Exchange (ETDEWEB)

    Ono, M. [National Inst. for Environmental Studies, Tsukuba (Japan)

    1998-02-01

    The Central Environmental Pollution Prevention Council pointed out the necessity to establish an environmental health surveillance system (hereinafter referred to as System) in its report `on the first type district specified by the Environmental Pollution Caused Health Damages Compensation Act,` issued in 1986. A study team, established in Environment Agency, has been discussing to establish System since 1986. This paper outlines System, and some of the pilot surveillance results. It is not aimed at elucidation of the cause-effect relationships between health and air pollution but at discovery of problems, in which the above relationships in a district population are monitored periodically and continuously from long-term and prospective viewpoints, in order to help take necessary measures in the early stage. System is now collecting the data of the chronic obstructive lung diseases on a nation-wide scale through health examinations of 3-year-old and preschool children and daily air pollution monitoring. 6 refs., 3 figs., 1 tab.

  20. Requirements and Solutions for Personalized Health Systems.

    Science.gov (United States)

    Blobel, Bernd; Ruotsalainen, Pekka; Lopez, Diego M; Oemig, Frank

    2017-01-01

    Organizational, methodological and technological paradigm changes enable a precise, personalized, predictive, preventive and participative approach to health and social services supported by multiple actors from different domains at diverse level of knowledge and skills. Interoperability has to advance beyond Information and Communication Technologies (ICT) concerns, including the real world business domains and their processes, but also the individual context of all actors involved. The paper introduces and compares personalized health definitions, summarizes requirements and principles for pHealth systems, and considers intelligent interoperability. It addresses knowledge representation and harmonization, decision intelligence, and usability as crucial issues in pHealth. On this basis, a system-theoretical, ontology-based, policy-driven reference architecture model for open and intelligent pHealth ecosystems and its transformation into an appropriate ICT design and implementation is proposed.

  1. 77 FR 70708 - VA Acquisition Regulation: Electronic Submission of Payment Requests

    Science.gov (United States)

    2012-11-27

    ... electronic data interchange (EDI) formats; or (3) another electronic form as prescribed by the contract....fsc.va.gov/einvoice.asp .); or, (b) A system that conforms to the X12 electronic data interchange (EDI... Institute (ANSI). The X12 EDI Web site ( http://www.x12.org ) includes additional information on EDI 810 and...

  2. Choosing Expected Shortfall over VaR in Basel III Using Stochastic Dominance

    NARCIS (Netherlands)

    C-L. Chang (Chia-Lin); J.A. Jiménez-Martín (Juan-Ángel); E. Maasoumi (Esfandiar); M.J. McAleer (Michael)

    2015-01-01

    textabstractBank risk managers follow the Basel Committee on Banking Supervision (BCBS) recommendations that recently proposed shifting the quantitative risk metrics system from Value-at-Risk (VaR) to Expected Shortfall (ES). The Basel Committee on Banking Supervision (2013, p. 3) noted that: “a

  3. Digital health and the challenge of health systems transformation

    Science.gov (United States)

    Gagnon, Marie-Pierre; Fortin, Jean-Paul

    2017-01-01

    Information and communication technologies have transformed all sectors of society. The health sector is no exception to this trend. In light of “digital health”, we see multiplying numbers of web platforms and mobile health applications, often brought by new unconventional players who produce and offer services in non-linear and non-hierarchal ways, this by multiplying access points to services for people. Some speak of a “uberization” of healthcare. New realities and challenges have emerged from this paradigm, which question the abilities of health systems to cope with new business and economic models, governance of data and regulation. Countries must provide adequate responses so that digital health, based increasingly on disruptive technologies, can benefit for all. PMID:28894741

  4. Data liquidity in health information systems.

    Science.gov (United States)

    Courtney, Paul K

    2011-01-01

    In 2001, the Institute of Medicine report Crossing the Quality Chasm and the National Committee on Vital and Health Statistics report Information for Health were released, and they provided the context for the development of information systems used to support health-supporting processes. Both had as their goals, implicit or explicit, to ensure the right data are provided to the right person at the right time, which is one definition of "data liquidity." This concept has had some traction in recent years as a shorthand way to express a system property for health information technology, but there is not a well-defined characterization of what properties of a system or of its components give it better or worse data liquidity. This article looks at some recent work that help to identify those properties and perhaps can help to ground the concept with metrics that are assessable.

  5. Health Care Performance Indicators for Health Information Systems.

    Science.gov (United States)

    Hyppönen, Hannele; Ronchi, Elettra; Adler-Milstein, Julia

    2016-01-01

    Health Information Systems (HISs) are expected to have a positive impact on quality and efficiency of health care. Rapid investment in and diffusion of HISs has increased the importance of monitoring the adoption and impacts of them in order to learn from the initiatives, and to provide decision makers evidence on the role of HISs in improving health care. However, reliable and comparable data across initiatives in various countries are rarely available. A four-phase approach is used to compare different HIS indicator methodologies in order to move ahead in defining HIS indicators for monitoring effects of HIS on health care performance. Assessed approaches are strong on different aspects, which provide some opportunities for learning across them but also some challenges. As yet, all of the approaches do not define goals for monitoring formally. Most focus on health care structural and process indicators (HIS availability and intensity of use). However, many approaches are generic in description of HIS functionalities and context as well as their impact mechanisms on health care for HIS benchmarking. The conclusion is that, though structural and process indicators of HIS interventions are prerequisites for monitoring HIS impacts on health care outputs and outcomes, more explicit definition is needed of HIS contexts, goals, functionalities and their impact mechanisms in order to move towards common process and outcome indicators. A bottom-up-approach (participation of users) could improve development and use of context-sensitive HIS indicators.

  6. Health systems around the world - a comparison of existing health system rankings.

    Science.gov (United States)

    Schütte, Stefanie; Acevedo, Paula N Marin; Flahault, Antoine

    2018-06-01

    Existing health systems all over the world are different due to the different combinations of components that can be considered for their establishment. The ranking of health systems has been a focal points for many years especially the issue of performance. In 2000 the World Health Organization (WHO) performed a ranking to compare the Performance of the health system of the member countries. Since then other health system rankings have been performed and it became an issue of public discussion. A point of contention regarding these rankings is the methodology employed by each of them, since no gold standard exists. Therefore, this review focuses on evaluating the methodologies of each existing health system performance ranking to assess their reproducibility and transparency. A search was conducted to identify existing health system rankings, and a questionnaire was developed for the comparison of the methodologies based on the following indicators: (1) General information, (2) Statistical methods, (3) Data (4) Indicators. Overall nine rankings were identified whereas six of them focused rather on the measurement of population health without any financial component and were therefore excluded. Finally, three health system rankings were selected for this review: "Health Systems: Improving Performance" by the WHO, "Mirror, Mirror on the wall: How the Performance of the US Health Care System Compares Internationally" by the Commonwealth Fund and "the Most efficient Health Care" by Bloomberg. After the completion of the comparison of the rankings by giving them scores according to the indicators, the ranking performed the WHO was considered the most complete regarding the ability of reproducibility and transparency of the methodology. This review and comparison could help in establishing consensus in the field of health system research. This may also help giving recommendations for future health rankings and evaluating the current gap in the literature.

  7. Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform.

    Science.gov (United States)

    Guyon, Ak'ingabe; Perreault, Robert

    2016-10-20

    Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.

  8. Strengthening health systems through linking research evidence to ...

    African Journals Online (AJOL)

    informed policies. Accordingly, a critical way of addressing these challenges facing health systems in the region is through the linking of health research findings to policy. Keywords: Evidence; Sub-Saharan Africa; Health Policy; Health Systems ...

  9. Institutional analysis of health system governance.

    Science.gov (United States)

    Abimbola, Seye; Negin, Joel; Martiniuk, Alexandra L; Jan, Stephen

    2017-11-01

    It is important that researchers who study health system governance have a set of collective understandings of the meanings of governance, which can then inform the methods used in research. We present an institutional framing and definition of health system governance; that is, governance refers to making, changing, monitoring and enforcing the rules that govern the demand and supply of health services. This pervasive, relational view of governance is to be preferred to approaches that focus primarily on structures of governments and health care organizations, because health system governance involves communities and service users, and because governments in many low- and middle-income countries tend to under-govern. Therefore, the study of health system governance requires institutional analysis; an approach that focuses not only on structures, but also on the rules (both formal and informal) governing demand and supply relations. Using this 'structure-relations' lens, and based on our field experience, we discuss how this focus could be applied to the three approaches to framing and studying health system governance that we identified in the literature. In order of decreasing focus on structures ('hardware') and increasing focus on relations ('software'), they are: (1) the government-centred approach, which focuses on the role of governments, above or to the exclusion of non-government health system actors; (2) the building-block approach, which focuses on the internal workings of health care organizations, and treats governance as one of the several building blocks of organizations; and (3) the institutional approach, which focuses on how the rules governing social and economic interactions are made, changed, monitored and enforced. Notably, either or both qualitative and quantitative methods may be used by researchers in efforts to incorporate the analysis of how rules determine relations among health system actors into these three approaches to health system

  10. X-33/RLV System Health Management/Vehicle Health Management

    Science.gov (United States)

    Mouyos, William; Wangu, Srimal

    1998-01-01

    To reduce operations costs, Reusable Launch Vehicles (RLVS) must include highly reliable robust subsystems which are designed for simple repair access with a simplified servicing infrastructure, and which incorporate expedited decision-making about faults and anomalies. A key component for the Single Stage To Orbit (SSTO) RLV system used to meet these objectives is System Health Management (SHM). SHM incorporates Vehicle Health Management (VHM), ground processing associated with the vehicle fleet (GVHM), and Ground Infrastructure Health Management (GIHM). The primary objective of SHM is to provide an automated and paperless health decision, maintenance, and logistics system. Sanders, a Lockheed Martin Company, is leading the design, development, and integration of the SHM system for RLV and for X-33 (a sub-scale, sub-orbit Advanced Technology Demonstrator). Many critical technologies are necessary to make SHM (and more specifically VHM) practical, reliable, and cost effective. This paper will present the X-33 SHM design which forms the baseline for the RLV SHM, and it will discuss applications of advanced technologies to future RLVs. In addition, this paper will describe a Virtual Design Environment (VDE) which is being developed for RLV. This VDE will allow for system design engineering, as well as program management teams, to accurately and efficiently evaluate system designs, analyze the behavior of current systems, and predict the feasibility of making smooth and cost-efficient transitions from older technologies to newer ones. The RLV SHM design methodology will reduce program costs, decrease total program life-cycle time, and ultimately increase mission success.

  11. Systems Thinking for Transformational Change in Health

    Science.gov (United States)

    Willis, Cameron D.; Best, Allan; Riley, Barbara; Herbert, Carol P.; Millar, John; Howland, David

    2014-01-01

    Incremental approaches to introducing change in Canada's health systems have not sufficiently improved the quality of services and outcomes. Further progress requires 'large system transformation', considered to be the systematic effort to generate coordinated change across organisations sharing a common vision and goal. This essay draws on…

  12. The Child Health Care System in Italy.

    Science.gov (United States)

    Corsello, Giovanni; Ferrara, Pietro; Chiamenti, Gianpietro; Nigri, Luigi; Campanozzi, Angelo; Pettoello-Mantovani, Massimo

    2016-10-01

    Pediatric care in Italy has been based during the last 40 years on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health and well-being of their children. The pediatric health care system in Italy is part of the national health system. It is made up of 3 main levels of intervention: first access/primary care, secondary care/hospital care, and tertiary care based on specialty hospital care. This overview will also include a brief report on neonatal care, pediatric preventive health care, health service accreditation programs, and postgraduate training in pediatrics. The quality of the Italian child health care system is now considered to be in serious danger because of the restriction of investments in public health caused both by the 2008 global and national economic crisis and by a reduction of the pediatric workforce as a result of progressively insufficient replacement of specialists in pediatrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Managing interoperability and complexity in health systems.

    Science.gov (United States)

    Bouamrane, M-M; Tao, C; Sarkar, I N

    2015-01-01

    In recent years, we have witnessed substantial progress in the use of clinical informatics systems to support clinicians during episodes of care, manage specialised domain knowledge, perform complex clinical data analysis and improve the management of health organisations' resources. However, the vision of fully integrated health information eco-systems, which provide relevant information and useful knowledge at the point-of-care, remains elusive. This journal Focus Theme reviews some of the enduring challenges of interoperability and complexity in clinical informatics systems. Furthermore, a range of approaches are proposed in order to address, harness and resolve some of the many remaining issues towards a greater integration of health information systems and extraction of useful or new knowledge from heterogeneous electronic data repositories.

  14. Child Poverty and the Health Care System.

    Science.gov (United States)

    Racine, Andrew D

    2016-04-01

    The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights

  15. 78 FR 22525 - Privacy Act of 1974; System of Records

    Science.gov (United States)

    2013-04-16

    ... 10-0004 System name: Occupational, Safety, Health, and Environmental Management Records (July 2, 2010...: Delete entry and replace with ``This system will manage occupational, safety, health, and environmental... Management System Office, 4800 Mark Center Drive; East Tower, 2nd Floor, Suite 02G09, Alexandria, VA 22350...

  16. The Veteran-Initiated Electronic Care Coordination: A Multisite Initiative to Promote and Evaluate Consumer-Mediated Health Information Exchange.

    Science.gov (United States)

    Klein, Dawn M; Pham, Kassi; Samy, Leila; Bluth, Adam; Nazi, Kim M; Witry, Matthew; Klutts, J Stacey; Grant, Kathleen M; Gundlapalli, Adi V; Kochersberger, Gary; Pfeiffer, Laurie; Romero, Sergio; Vetter, Brian; Turvey, Carolyn L

    2017-04-01

    Information continuity is critical to person-centered care when patients receive care from multiple healthcare systems. Patients can access their electronic health record data through patient portals to facilitate information exchange. This pilot was developed to improve care continuity for rural Veterans by (1) promoting the use of the Department of Veterans Affairs (VA) patient portal to share health information with non-VA providers, and (2) evaluating the impact of health information sharing at a community appointment. Veterans from nine VA healthcare systems were trained to access and share their VA Continuity of Care Document (CCD) with their non-VA providers. Patients and non-VA providers completed surveys on their experiences. Participants (n = 620) were primarily older, white, and Vietnam era Veterans. After training, 78% reported the CCD would help them be more involved in their healthcare and 86% planned to share it regularly with non-VA providers. Veterans (n = 256) then attended 277 community appointments. Provider responses from these appointments (n = 133) indicated they were confident in the accuracy of the information (97%) and wanted to continue to receive the CCD (96%). Ninety percent of providers reported the CCD improved their ability to have an accurate medication list and helped them make medication treatment decisions. Fifty percent reported they did not order a laboratory test or another procedure because of information available in the CCD. This pilot demonstrates feasibility and value of patient access to a CCD to facilitate information sharing between VA and non-VA providers. Outreach and targeted education are needed to promote consumer-mediated health information exchange.

  17. VA Dental Insurance Program--federalism. Direct final rule.

    Science.gov (United States)

    2013-10-22

    The Department of Veterans Affairs (VA) is taking direct final action to amend its regulations related to the VA Dental Insurance Program (VADIP), a pilot program to offer premium-based dental insurance to enrolled veterans and certain survivors and dependents of veterans. Specifically, this rule will add language to clarify the limited preemptive effect of certain criteria in the VADIP regulations.

  18. ESTIMASI NILAI VaR PORTOFOLIO MENGGUNAKAN FUNGSI ARCHIMEDEAN COPULA

    Directory of Open Access Journals (Sweden)

    AULIA ATIKA PRAWIBTA SUHARTO

    2017-01-01

    Full Text Available Value at Risk explains the magnitude of the worst losses occurred in financial products investments with a certain level of confidence and time interval. The purpose of this study is to estimate the VaR of portfolio using Archimedean Copula family. The methods for calculating the VaR are as follows: (1 calculating the stock return; (2 calculating descriptive statistics of return; (3 checking for the nature of autocorrelation and heteroscedasticity effects on stock return data; (4 checking for the presence of extreme value by using Pareto tail; (5 estimating the parameters of Achimedean Copula family; (6 conducting simulations of Archimedean Copula; (7 estimating the value of the stock portfolio VaR. This study uses the closing price of TLKM and GGRM. At 90% the VaR obtained using Clayton, Gumbel, Frank copulas are 0.9562%, 1.0189%, 0.9827% respectively. At 95% the VaR obtained using Clayton, Gumbel, Frank copulas are 1.2930%, 1.2522%, 1.3152% respectively. At 99% the VaR obtained using Clayton, Gumbel, Frank copulas are 2.0327%, 1.9164%, is 1.8678% respectively. In conclusion estimation of VaR using Clayton copula yields the highest VaR.

  19. Beyond the Iron Triangle: Implications for the Veterans Health Administration in an Uncertain Policy Environment

    Science.gov (United States)

    2014-12-04

    VAMC VA Medical Center VBA Veterans Benefits Administration VFW Veterans of Foreign War of the United States VHA Veterans Health...System, August 26, 2014, accessed August 27, 2014, http://www.va.gov/oig/pubs/VAOIG-14-02603-267.pdf. 2 Sloan D. Gibson, “Remarks of Acting Secretary...Sloan D. Gibson During VFW Annual Convention” (address at the 115th VFW Annual Meeting, St. Louis, MO, July 22, 2014), accessed July 27, 2014, http

  20. THE E-HEALTH SYSTEMS IN POLAND

    Directory of Open Access Journals (Sweden)

    Zdzisław PÓLKOWSKI

    2013-11-01

    Full Text Available Information Technologies are disruptive technologies that have caused major changes in health system in Poland. Current digital economy is driven by modern information and new IT tools, which offer hospitals, doctors and patient access to any type of information, regardless of its form of existence, storage type or geographical location. These tools encourage the development of new activities, health services. The purpose of this article is to analyze the the current state of development of e-services in Poland in the context of nowadays health system. In the first part of the paper, the authors present various programmes, which enable the access to the medical services and patients’ data online. The next part of the paper is devoted to examining the technical aspects of the said programmes and presenting their advantages as well as the areas which might be improved.The last part of the work will be focused on the websites of the selected health institutions. According to the authors, WWW services provide much information on how the process of computer systems are being implemented, what data the services include and the capacity of the equipment as well as the software, human resources and the knowledge in this sphere. Moreover this section highlights the latest trends in e-health with particular emphasis on aspects such as the use of private and public cloud computer and t heir integration with web sites of health institutions. This study brings its contribution to the understanding of the change of health system in Poland behavior by using a new perspective e-health systems and IT tools above by doctors, officers and patients.

  1. Strengthening Rehabilitation in Health Systems Worldwide by Integrating Information on Functioning in National Health Information Systems.

    Science.gov (United States)

    Stucki, Gerold; Bickenbach, Jerome; Melvin, John

    2017-09-01

    A complete understanding of the experience of health requires information relevant not merely to the health indicators of mortality and morbidity but also to functioning-that is, information about what it means to live in a health state, "the lived experience of health." Not only is functioning information relevant to healthcare and the overall objectives of person-centered healthcare but to the successful operation of all components of health systems.In light of population aging and major epidemiological trends, the health strategy of rehabilitation, whose aim has always been to optimize functioning and minimize disability, will become a key health strategy. The increasing prominence of the rehabilitative strategy within the health system drives the argument for the integration of functioning information as an essential component in national health information systems.Rehabilitation professionals and researchers have long recognized in WHO's International Classification of Functioning, Disability and Health the best prospect for an internationally recognized, sufficiently complete and powerful information reference for the documentation of functioning information. This paper opens the discussion of the promise of integrating the ICF as an essential component in national health systems to secure access to functioning information for rehabilitation, across health systems and countries.

  2. 38 CFR 1.203 - Information to be reported to VA Police.

    Science.gov (United States)

    2010-07-01

    ... reported to VA Police. 1.203 Section 1.203 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... be reported to VA Police. Information about actual or possible violations of criminal laws related to... occurs on VA premises, will be reported by VA management officials to the VA police component with...

  3. The health production function of oral health services systems

    DEFF Research Database (Denmark)

    Vlad, R.S.; Petersen, P.E.

    2000-01-01

    Attitudes, dental status, socioeconomic factors, oral health care, production of oral health, health status, quality of life......Attitudes, dental status, socioeconomic factors, oral health care, production of oral health, health status, quality of life...

  4. VaR Methodology Application for Banking Currency Portfolios

    Directory of Open Access Journals (Sweden)

    Daniel Armeanu

    2007-02-01

    Full Text Available VaR has become the standard measure that financial analysts use to quantify market risk. VaR measures can have many applications, such as in risk management, to evaluate the performance of risk takers and for regulatory requirements, and hence it is very important to develop methodologies that provide accurate estimates. In particular, the Basel Committee on Banking Supervision at the Bank for International Settlements imposes to financial institutions such as banks and investment firms to meet capital requirements based on VaR estimates. In this paper we determine VaR for a banking currency portfolio and respect rules of National Bank of Romania regarding VaR report.

  5. Transformation of health system in Ecuador

    Directory of Open Access Journals (Sweden)

    Wilson Giovanni Jiménez Barbosa

    2017-05-01

    Full Text Available Objective: To describe the transformations of the structure of the health system in Ecuador, taking into account the constitutional and policy context of that country, and to reflect on the historical context in which it occurred and its implications for the welfare of the people from Ecuador. Materials and methods: A bibliographic review was made, beginning with the regulations of Ecuador since the Constitution of 1979, where health is considered as a right, passing by the Organic Law of Health, the Social Security Act, among others, including the last reform of the Constitution in 2008. Results: The transformation of the Health System of Ecuador is the result of the action of economic and political forces, both internal and external, that have affected this country throughout the studied period.

  6. Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance

    Science.gov (United States)

    Pleasant, Andrew

    2014-01-01

    The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health. PMID:25491583

  7. Transformation of health system in Ecuador

    OpenAIRE

    Wilson Giovanni Jiménez Barbosa; María Luisa Granda Kuffo; Diana Margoth Ávila Guzmán; Leidy Johanna Cruz Díaz; Julián Camilo Flórez Parra; Luisa Silvana Mejía; Diana Carolina Vargas Suárez

    2017-01-01

    Objective: To describe the transformations of the structure of the health system in Ecuador, taking into account the constitutional and policy context of that country, and to reflect on the historical context in which it occurred and its implications for the welfare of the people from Ecuador. Materials and methods: A bibliographic review was made, beginning with the regulations of Ecuador since the Constitution of 1979, where health is considered as a right, passing by the Organic Law of Hea...

  8. Embedding health literacy into health systems: a case study of a regional health service.

    Science.gov (United States)

    Vellar, Lucia; Mastroianni, Fiorina; Lambert, Kelly

    2017-12-01

    Objective The aim of the present study was to describe how one regional health service the Illawarra Shoalhaven Local Health District embedded health literacy principles into health systems over a 3-year period. Methods Using a case study approach, this article describes the development of key programs and the manner in which clinical incidents were used to create a health environment that allows consumers the right to equitably access quality health services and to participate in their own health care. Results The key outcomes demonstrating successful embedding of health literacy into health systems in this regional health service include the creation of a governance structure and web-based platform for developing and testing plain English consumer health information, a clearly defined process to engage with consumers, development of the health literacy ambassador training program and integrating health literacy into clinical quality improvement processes via a formal program with consumers to guide processes such as improvements to access and navigation around hospital sites. Conclusions The Illawarra Shoalhaven Local Health District has developed an evidence-based health literacy framework, guided by the core principles of universal precaution and organisational responsibility. Health literacy was also viewed as both an outcome and a process. The approach taken by the Illawarra Shoalhaven Local Health District to address poor health literacy in a coordinated way has been recognised by the Australian Commission on Safety and Quality in Health Care as an exemplar of a coordinated approach to embed health literacy into health systems. What is known about the topic? Poor health literacy is a significant national concern in Australia. The leadership, governance and consumer partnership culture of a health organisation can have considerable effects on an individual's ability to access, understand and apply the health-related information and services available to them

  9. The association of PTSD with physical and mental health functioning and disability (VA Cooperative Study #569: the course and consequences of posttraumatic stress disorder in Vietnam-era Veteran twins)

    Science.gov (United States)

    Magruder, Kathryn M.; Forsberg, Christopher W.; Kazis, Lewis E.; Üstün, T. Bedirhan; Friedman, Matthew J.; Litz, Brett T.; Vaccarino, Viola; Heagerty, Patrick J.; Gleason, Theresa C.; Huang, Grant D.; Smith, Nicholas L.

    2018-01-01

    Purpose To assess the relationship of posttraumatic stress disorder (PTSD) with health functioning and disability in Vietnamera Veterans. Methods A cross-sectional study of functioning and disability in male Vietnam-era Veteran twins. PTSD was measured by the Composite International Diagnostic Interview; health functioning and disability were assessed using the Veterans RAND 36-Item Health Survey (VR-36) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). All data collection took place between 2010 and 2012. Results Average age of the 5,574 participating Veterans (2,102 Vietnam theater and 3,472 non-theater) was 61.0 years. Veterans with PTSD had poorer health functioning across all domains of VR-36 and increased disability for all subscales of WHODAS 2.0 (all p < .001) compared with Veterans without PTSD. Veterans with PTSD were in poorer overall health on the VR-36 physical composite summary (PCS) (effect size = 0.31 in theater and 0.47 in non-theater Veterans; p < .001 for both) and mental composite summary (MCS) (effect size = 0.99 in theater and 0.78 in non-theater Veterans; p < .001 for both) and had increased disability on the WHODAS 2.0 summary score (effect size = 1.02 in theater and 0.96 in non-theater Veterans; p < .001 for both). Combat exposure, independent of PTSD status, was associated with lower PCS and MCS scores and increased disability (all p < .05, for trend). Within-pair analyses in twins discordant for PTSD produced consistent findings. Conclusions Vietnam-era Veterans with PTSD have diminished functioning and increased disability. The poor functional status of aging combat-exposed Veterans is of particular concern. PMID:24318083

  10. Four centuries on from Bacon: progress in building health research systems to improve health systems?

    Science.gov (United States)

    Hanney, Stephen R; González-Block, Miguel A

    2014-09-23

    In 1627, Francis Bacon's New Atlantis described a utopian society in which an embryonic research system contributed to meeting the needs of the society. In this editorial, we use some of the aspirations described in New Atlantis to provide a context within which to consider recent progress in building health research systems to improve health systems and population health. In particular, we reflect on efforts to build research capacity, link research to policy, identify the wider impacts made by the science, and generally build fully functioning research systems to address the needs identified. In 2014, Health Research Policy and Systems has continued to publish one-off papers and article collections covering a range of these issues in both high income countries and low- and middle-income countries. Analysis of these contributions, in the context of some earlier ones, is brought together to identify achievements, challenges and possible ways forward. We show how 2014 is likely to be a pivotal year in the development of ways to assess the impact of health research on policies, practice, health systems, population health, and economic benefits.We demonstrate how the increasing focus on health research systems will contribute to realising the hopes expressed in the World Health Report, 2013, namely that all nations would take a systematic approach to evaluating the outputs and applications resulting from their research investment.

  11. Optimal Sensor Selection for Health Monitoring Systems

    Science.gov (United States)

    Santi, L. Michael; Sowers, T. Shane; Aguilar, Robert B.

    2005-01-01

    Sensor data are the basis for performance and health assessment of most complex systems. Careful selection and implementation of sensors is critical to enable high fidelity system health assessment. A model-based procedure that systematically selects an optimal sensor suite for overall health assessment of a designated host system is described. This procedure, termed the Systematic Sensor Selection Strategy (S4), was developed at NASA John H. Glenn Research Center in order to enhance design phase planning and preparations for in-space propulsion health management systems (HMS). Information and capabilities required to utilize the S4 approach in support of design phase development of robust health diagnostics are outlined. A merit metric that quantifies diagnostic performance and overall risk reduction potential of individual sensor suites is introduced. The conceptual foundation for this merit metric is presented and the algorithmic organization of the S4 optimization process is described. Representative results from S4 analyses of a boost stage rocket engine previously under development as part of NASA's Next Generation Launch Technology (NGLT) program are presented.

  12. Dealing with Health and Health Care System Challenges in China: assessing health determinants and health care reforms

    NARCIS (Netherlands)

    H. Zhang (Hao)

    2017-01-01

    markdownabstractThis dissertation investigates the challenges faced by China around 2010 in two domains – population health and the health care system. Specifically, chapters 2 and 3 are devoted to health challenges, explaining the female health disadvantage in later life and assessing the effect

  13. System impact research - increasing public health and health care system performance.

    Science.gov (United States)

    Malmivaara, Antti

    2016-01-01

    Interventions directed to system features of public health and health care should increase health and welfare of patients and population. To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. System Impact Research - creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population. Key messages The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features. SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services. SIR creates the

  14. System impact research – increasing public health and health care system performance

    Science.gov (United States)

    Malmivaara, Antti

    2016-01-01

    Abstract Background Interventions directed to system features of public health and health care should increase health and welfare of patients and population. Aims To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). Methods The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. Results The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. Conclusions System Impact Research – creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population.Key messagesThe new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features.SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency

  15. Prognostics and health management of photovoltaic systems

    Science.gov (United States)

    Johnson, Jay; Riley, Daniel

    2018-04-10

    The various technologies presented herein relate to providing prognosis and health management (PHM) of a photovoltaic (PV) system. A PV PHM system can eliminate long-standing issues associated with detecting performance reduction in PV systems. The PV PHM system can utilize an ANN model with meteorological and power input data to facilitate alert generation in the event of a performance reduction without the need for information about the PV PHM system components and design. Comparisons between system data and the PHM model can provide scheduling of maintenance on an as-needed basis. The PHM can also provide an approach for monitoring system/component degradation over the lifetime of the PV system.

  16. Radiometric system for clinical applications in the National Health System

    International Nuclear Information System (INIS)

    Mesa Perez, G.; Arteche Diaz, R.; Camejo Batista, A.; Fonfria Bragado, C.

    2013-01-01

    In this paper it is presented the radiometric detection system SRNIC-02, manufactured at CEADEN. The system has three major components: a well-type Nal(TI) scintillator detector with its collimator, a measurement module, and the application software, which allows fixing the working parameters of the system, as well as the acquisition and processing of data. The system has two main applications in the National Health System, one for the quality control in Radiopharmacy, and in RIA/IRMA blood tests. There are 16 systems installed, in 13 provinces of the country up to this date. (Author)

  17. The Child Health Care System of Croatia.

    Science.gov (United States)

    Mestrovic, Julije; Bralic, Irena; Simetin, Ivana Pavic; Mujkic, Aida; Radonić, Marija; Rodin, Urelija; Trošelj, Mario; Stevanović, Ranko; Benjak, Tomislav; Pristaš, Ivan; Mayer, Dijana; Tomić, Branimir

    2016-10-01

    The Republic of Croatia is a Parliamentary Republic with a population of 4.2 million people that sits on the Adriatic coast within Central Europe. Gross domestic product is approximately 60% of the European Union average, which in turn, limits health service spending. The health system is funded through universal health insurance administered by the Croatian Health Insurance Fund based on the principles of social solidarity and reciprocity. The children of Croatia are guaranteed access to universal primary, hospital, and specialist care provided by a network of health institutions. Pediatricians and school medicine specialists provide comprehensive preventive health care for both preschool and school-aged children. Despite the Croatian War of Independence in the late 20th century, indicators of child health and measures of health service delivery to children and families are steadily improving. However, similar to many European countries, Croatia is experiencing a rise in the "new morbidities" and is responding to these new challenges through a whole society approach to promote healthy lifestyles and insure good quality of life for children. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Marketing in Greek National Health System

    Directory of Open Access Journals (Sweden)

    Maria Tseroni

    2009-01-01

    Full Text Available Introduction: The international financial situation in combination with an aging population and the appropriation of health services imposes the management of hospital services as a necessity for the survival of hospitals.Aim: To examine the perceptions of 450 upper administrative hospital executives (Nursing, Medicine and Administrative services in the wider region of Attica, on marketing, communication, and public relations in health-care.Population study: Four hundred and fifty (450 higher health executives from the three basic fields of services in health institutions (medical, nursing, administration constituted the total sample of the research. These people are employed at 9 of the 36 hospitals in the 3 Health Regions of Attica (H.Re.Materials and method:The type of design that was chosen (to gather data for the study of attitudes and perceptions of the health personnel of the health institutions of G.S.H (Greek System of Health is a cross- sectional survey.Results: The participating subjects, even though expressed some reservations at first, formed a favorable attitude towards marketing and its application in the field of health-care. Statistically important correlations emerged between the perceptions of executives and their socio-demographic background including age, sex, education, and profession, work experience in health-care and specifically in their current position in the services as well as statistically important differences between doctors, nurses and administrators as to their perceptions of some issues in marketing.Conclusions: From the comments in the survey it appears there is a need to apply marketing correctly when providing quality care, respecting the patients’ rights and using human and not financial criteria as a guide. Based on the results of the research, important proposals are being submitted in the areas of health-care research, education and clinical practice.

  19. Health promotion and health systems: some unfinished business.

    Science.gov (United States)

    Ziglio, Erio; Simpson, Sarah; Tsouros, Agis

    2011-12-01

    One of the five action domains in the Ottawa Charter was Reorienting Health Services. In this paper, we reflect on why progress in this domain has been somewhat lethargic, particularly compared with some of the other action domains, and why now it is important to renew our commitment to this domain. Reorienting health services has been largely overlooked and opportunities missed, although good exceptions do exist. The occasion of the 25th anniversary of the Ottawa Charter represents an important opportunity for health promotion to: (i) renew its active voice in current policy debate and action and (ii) enhance achievements made to date by improving our efforts to advocate, enable and mediate for the reorientation of health services and systems. We outline six steps to reactivate and invest more in this action domain so as to be in a better position to promote health equitably and sustainably in today's fast changing world. Though our experience is mainly based in the European context, we hope that our reflections will be of some value to countries outside of this region.

  20. Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison.

    Science.gov (United States)

    Carlson, Kathleen F; Taylor, Brent C; Hagel, Emily M; Cutting, Andrea; Kerns, Robert; Sayer, Nina A

    2013-01-01

    To examine the prevalence and correlates of headache diagnoses, by gender, among Iraq and Afghanistan War Veterans who use Department of Veterans Affairs (VA) health care. Understanding the health care needs of recent Veterans, and how these needs differ between women and men, is a priority for the VA. The potential for a large burden of headache disorders among Veterans seeking VA services exists but has not been examined in a representative sample. We conducted a historical cohort study using national VA inpatient and outpatient data from fiscal year 2011. Participants were all (n = 470,215) Iraq and Afghanistan War Veteran VA users in 2011; nearly 13% were women. We identified headache diagnoses using International Classification of Diseases (ICD-9) diagnosis codes assigned during one or more VA inpatient or outpatient encounters. Descriptive analyses included frequencies of patient characteristics, prevalence and types of headache diagnoses, and prevalence of comorbid diagnoses. Prevalence ratios (PR) with 95% confidence intervals (CI) were used to estimate associations between gender and headache diagnoses. Multivariate models adjusted for age and race. Additional models also adjusted for comorbid diagnoses. In 2011, 56,300 (11.9%) Veterans received a headache-related diagnosis. While controlling for age and race, headache diagnoses were 1.61 times more prevalent (95% CI = 1.58-1.64) among women (18%) than men (11%). Most of this difference was associated with migraine diagnoses, which were 2.66 times more prevalent (95% CI = 2.59-2.73) among women. Cluster and post-traumatic headache diagnoses were less prevalent in women than in men. These patterns remained the same when also controlling for comorbid diagnoses, which were common among both women and men with headache diagnoses. The most prevalent comorbid diagnoses examined were depression (46% of women with headache diagnoses vs 40% of men), post-traumatic stress disorder (38% vs 58%), and back

  1. Strengthening global health security by embedding the International Health Regulations requirements into national health systems.

    Science.gov (United States)

    Kluge, Hans; Martín-Moreno, Jose Maria; Emiroglu, Nedret; Rodier, Guenael; Kelley, Edward; Vujnovic, Melitta; Permanand, Govin

    2018-01-01

    The International Health Regulations (IHR) 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. But poor implementation in countries hampers their effectiveness. In the wake of a number of major international health crises, such as the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, it has become clear that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response. WHO is working directly with its Member States to promote this approach, more specifically around how to better embed the IHR (2005) core capacities into the main health system functions. This paper looks at how and where the intersections between the IHR and the health system can be best leveraged towards developing greater health system resilience. This merging of approaches is a key component in pursuit of Universal Health Coverage and strengthened global health security as two mutually reinforcing agendas.

  2. 76 FR 40453 - Agency Information Collection (Application for VA Education Benefits) Activity Under OMB Review

    Science.gov (United States)

    2011-07-08

    ... (Application for VA Education Benefits) Activity Under OMB Review AGENCY: Veterans Benefits Administration... Education Benefits, VA Form 22-1990. b. Application for Family Member to Use Transferred Benefits, VA Form 22-1990E. [[Page 40454

  3. The right to health, health systems development and public health policy challenges in Chad.

    Science.gov (United States)

    Azétsop, Jacquineau; Ochieng, Michael

    2015-02-15

    There is increasing consensus that the right to health can provide ethical, policy and practical groundings for health systems development. The goals of the right to health are congruent with those of health systems development, which are about strengthening health promotion organizations and actions so as to improve public health. The poor shape and performance of health systems in Chad question the extent of realization of the right to health. Due to its comprehensiveness and inclusiveness, the right to health has the potential of being an organizational and a normative backbone for public health policy and practice. It can then be understood and studied as an integral component of health systems development. This paper uses a secondary data analysis of existing documents by the Ministry of Public Health, Institut National de la Statistique, des Etudes Economiques et Démographiques (INSEED), the Ministry of Economy and Agence Française de Cooperation to analyze critically the shape and performance of health systems in Chad based on key concepts and components of the right to health contained in article 12 of the International Covenant on Economic, Social and Cultural Rights, and on General Comment 14. The non-realization of the right to health, even in a consistently progressive manner, raises concerns about the political commitment of state officials to public health, about the justice of social institutions in ensuring social well-being and about individual and public values that shape decision-making processes. Social justice, democratic rule, transparency, accountability and subsidiarity are important groundings for ensuring community participation in public affairs and for monitoring the performance of public institutions. The normative ideals of health systems development are essentially democratic in nature and are rooted in human rights and in ethical principles of human dignity, equality, non-discrimination and social justice. These ideals are grounded

  4. Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

    Science.gov (United States)

    Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

    2012-04-01

    This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

  5. FAILSAFE Health Management for Embedded Systems

    Science.gov (United States)

    Horvath, Gregory A.; Wagner, David A.; Wen, Hui Ying; Barry, Matthew

    2010-01-01

    The FAILSAFE project is developing concepts and prototype implementations for software health management in mission- critical, real-time embedded systems. The project unites features of the industry-standard ARINC 653 Avionics Application Software Standard Interface and JPL s Mission Data System (MDS) technology (see figure). The ARINC 653 standard establishes requirements for the services provided by partitioned, real-time operating systems. The MDS technology provides a state analysis method, canonical architecture, and software framework that facilitates the design and implementation of software-intensive complex systems. The MDS technology has been used to provide the health management function for an ARINC 653 application implementation. In particular, the focus is on showing how this combination enables reasoning about, and recovering from, application software problems.

  6. Integrated Systems Health Management (ISHM) Toolkit

    Science.gov (United States)

    Venkatesh, Meera; Kapadia, Ravi; Walker, Mark; Wilkins, Kim

    2013-01-01

    A framework of software components has been implemented to facilitate the development of ISHM systems according to a methodology based on Reliability Centered Maintenance (RCM). This framework is collectively referred to as the Toolkit and was developed using General Atomics' Health MAP (TM) technology. The toolkit is intended to provide assistance to software developers of mission-critical system health monitoring applications in the specification, implementation, configuration, and deployment of such applications. In addition to software tools designed to facilitate these objectives, the toolkit also provides direction to software developers in accordance with an ISHM specification and development methodology. The development tools are based on an RCM approach for the development of ISHM systems. This approach focuses on defining, detecting, and predicting the likelihood of system functional failures and their undesirable consequences.

  7. Understanding The Resistance to Health Information Systems

    OpenAIRE

    David Ackah; Angelito E Alvarado; Heru Santoso Wahito Nugroho; Sanglar Polnok; Wiwin Martiningsih

    2017-01-01

    User resistance is users’ opposition to system implementation. Resistance often occurs as a result of a mismatch between management goals and employee preferences. There are two types of resistance to health iformation system namely active resistance and passive resistance. The manifestation of active resistance are being critical,  blaming/accusing, blocking, fault finding, sabotaging, undermining, ridiculing, intimidating/threatening, starting rumors, appealing to fear, manipulating arguing...

  8. A cluster randomized Hybrid Type III trial testing an implementation support strategy to facilitate the use of an evidence-based practice in VA homeless programs.

    Science.gov (United States)

    Smelson, David A; Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Sawh, Leon; Glickman, Mark

    2015-05-28

    The Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is one of the largest initiatives to end Veteran homelessness. However, mental health and substance use disorders continue to reduce client stability and impede program success. HUD-VASH programs do not consistently employ evidence-based practices that address co-occurring mental health and substance use disorders. This paper presents a study protocol to evaluate the implementation of an evidence-based, co-occurring disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) in HUD-VASH using an implementation strategy called Getting To Outcomes (GTO). In three large VA Medical Centers, this Hybrid Type III trial will randomize case managers and their clients by HUD-VASH sub-teams to receive either MISSION-Vet Implementation as Usual (IU-standard training and access to the MISSION-Vet treatment manuals) or MISSION-Vet implementation augmented by GTO. In addition to testing GTO, effectiveness of the treatment (MISSION-Vet) will be assessed using existing Veteran-level data from the HUD-VASH data monitoring system. This project will compare GTO and IU case managers and their clients on the following variables: (1) fidelity to the MISSION-Vet intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use, and functional outcomes among Veterans; and (4) factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model. This project is an important step for developing an implementation strategy to increase adoption of evidence-based practice use in VA homeless programs, and to further examine efficacy of MISSION-Vet in HUD-VASH. This project has important implications for program managers, policy makers, and researchers within the homelessness field. VA Central IRB approval

  9. A Critique of Health System Performance Measurement.

    Science.gov (United States)

    Lynch, Thomas

    2015-01-01

    Health system performance measurement is a ubiquitous phenomenon. Many authors have identified multiple methodological and substantive problems with performance measurement practices. Despite the validity of these criticisms and their cross-national character, the practice of health system performance measurement persists. Theodore Marmor suggests that performance measurement invokes an "incantatory response" wrapped within "linguistic muddle." In this article, I expand upon Marmor's insights using Pierre Bourdieu's theoretical framework to suggest that, far from an aberration, the "linguistic muddle" identified by Marmor is an indicator of a broad struggle about the representation and classification of public health services as a public good. I present a case study of performance measurement from Alberta, Canada, examining how this representational struggle occurs and what the stakes are. © The Author(s) 2015.

  10. Scaling Health Information Systems in Developing Countries

    DEFF Research Database (Denmark)

    Mengiste, Shegaw Anagaw; Neilsen, Petter

    2006-01-01

    This article addresses the issues of scaling health information system in the context of developing countries by taking a case study from Ethiopia. Concepts of information infrastructure have been used as an analytical lens to better understand scaling of Health Information systems. More...... specifically, we question the fruitfulness of focusing on not being installed base hostile and suggest focusing on how to be installed base “friendly” by underscoring how the installed base can also be draw upon and shaped by human agents. The paper conceptualizes health information infrastructure (HII......) building as an intertwined process of the evolution of the installed base and the construction activities of human agents. Overall, we argue that it is not only the adverse situation that determines how things develop, but HII builders need to navigate and take into account a wide range of issues related...

  11. Designing and Conducting Health Systems Research Projects ...

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

    Home · Resources · Publications. Designing and Conducting Health Systems Research Projects Volume 1: Proposal Development and Fieldwork ... IDRC and the United Kingdom's Global AMR Innovation Fund—managed by the ... New website will help record vital life events to improve access to services for all.

  12. Health Occupations Module. The Integumentary System.

    Science.gov (United States)

    Temple Univ., Philadelphia, PA. Div. of Vocational Education.

    This module on the integumentary system is one of eight modules designed for individualized instruction in health occupations education programs at both the secondary and postsecondary levels. This module contains an introduction to the module topic, objectives (e.g., list and describe the types of glands formed in the skin, and explain the…

  13. Activity monitoring systems in health care

    NARCIS (Netherlands)

    Kröse, B.; van Oosterhout, T.; van Kasteren, T.; Salah, A.A.; Gevers, T.

    2011-01-01

    This chapter focuses on activity monitoring in a home setting for health care purposes. First the most current sensing systems are described, which consist of wearable and ambient sensors. Then several approaches for the monitoring of simple actions are discussed, like falls or therapies. After

  14. Governance for Equity in Health Systems Deadline

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

    Jean-Claude Dumais

    2012-09-12

    Sep 12, 2012 ... of training and mentorship in research, research management, and grant administration allows awardees to pursue their research goals in a dynamic team environment in one of the world's leaders in generating new knowledge to meet global challenges. IDRC's Governance for Equity in Health Systems ...

  15. Sofosbuvir and Simeprevir Combination Therapy for HCV Genotype 1 Infection: Results of a Single-Center VA Experience

    Science.gov (United States)

    Hernandez, Maria Del Pilar; Vance, Evan; Gilinski, Dani; Youtseff, Helen; Toro, Maribel; Antoine, Marie; Jeffers, Lennox J.; Peyton, Adam

    2016-01-01

    Treatment of chronic hepatitis C virus (HCV) infection remains a priority in the veterans affairs (VA) health care system nationwide, as there is a high burden of liver disease due to HCV infection among US veterans. The combination of sofosbuvir and simeprevir was the first all-oral antiviral regimen used in clinical practice to treat veterans with HCV infection. In this study, we report a single-center experience showing both the feasibility and effectiveness of this all-oral combination to treat HCV genotype 1 infection. One hundred patients with HCV genotype 1 infection were treated between December 2013 and June 2014. Eighty-six patients were treated with sofosbuvir and simeprevir, with or without ribavirin, for 12 weeks; 12 patients were treated with sofosbuvir, pegylated interferon, and ribavirin for 12 weeks; and 2 patients were treated with sofosbuvir and ribavirin for 24 weeks. Overall, treatment was well tolerated and feasible, with compliance rates over 95% in patients treated with all-oral therapy. The sustained virologic response (SVR) rate for sofosbuvir and simeprevir (88.4%) was superior to the rate for sofosbuvir, pegylated interferon, and ribavirin (50.0%). Subgroup analysis showed diminished SVR rates in cirrhotic patients vs noncirrhotic patients. There were no significant differences in SVR when comparing treatment with or without ribavirin or among genotype subtypes. In conclusion, this study demonstrated excellent completion rates for all-oral treatment of veterans with chronic HCV infection. Additionally, treatment was highly effective, nearing a 90% cure rate. Thus, we recommend that the VA health care system continue to incorporate new HCV medications into its formulary so as to expand HCV treatment for US veterans. PMID:27917084

  16. Integrated Systems Health Management for Space Exploration

    Science.gov (United States)

    Uckun, Serdar

    2005-01-01

    Integrated Systems Health Management (ISHM) is a system engineering discipline that addresses the design, development, operation, and lifecycle management of components, subsystems, vehicles, and other operational systems with the purpose of maintaining nominal system behavior and function and assuring mission safety and effectiveness under off-nominal conditions. NASA missions are often conducted in extreme, unfamiliar environments of space, using unique experimental spacecraft. In these environments, off-nominal conditions can develop with the potential to rapidly escalate into mission- or life-threatening situations. Further, the high visibility of NASA missions means they are always characterized by extraordinary attention to safety. ISHM is a critical element of risk mitigation, mission safety, and mission assurance for exploration. ISHM enables: In-space maintenance and repair; a) Autonomous (and automated) launch abort and crew escape capability; b) Efficient testing and checkout of ground and flight systems; c) Monitoring and trending of ground and flight system operations and performance; d) Enhanced situational awareness and control for ground personnel and crew; e) Vehicle autonomy (self-sufficiency) in responding to off-nominal conditions during long-duration and distant exploration missions; f) In-space maintenance and repair; and g) Efficient ground processing of reusable systems. ISHM concepts and technologies may be applied to any complex engineered system such as transportation systems, orbital or planetary habitats, observatories, command and control systems, life support systems, safety-critical software, and even the health of flight crews. As an overarching design and operational principle implemented at the system-of-systems level, ISHM holds substantial promise in terms of affordability, safety, reliability, and effectiveness of space exploration missions.

  17. Brand-Name Prescription Drug Use Among Diabetes Patients in the VA and Medicare Part D: A National Comparison

    Science.gov (United States)

    Gellad, Walid F.; Donohue, Julie M.; Zhao, Xinhua; Mor, Maria K.; Thorpe, Carolyn T.; Smith, Jeremy; Good, Chester B.; Fine, Michael J.; Morden, Nancy E.

    2013-01-01

    Background Medicare Part D and the Department of Veterans Affairs (VA) use different approaches to manage prescription drug benefits, with implications for spending. Medicare relies on private plans with distinct formularies, whereas VA administers its own benefit using a national formulary. Objective To compare overall and regional rates of brand-name drug use among older adults with diabetes in Medicare and VA. Design Retrospective cohort Setting Medicare and VA Patients National sample in 2008 of 1,061,095 Part D beneficiaries and 510,485 Veterans age 65+ with diabetes. Measurements Percent of patients on oral hypoglycemics, statins, and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-blockers who filled brand-name drugs and percent of patients on long-acting insulin who filled analogues. We compared sociodemographic and health-status adjusted hospital referral region (HRR) brand-name use to examine local practice patterns, and calculated changes in spending if each system’s brand-name use mirrored the other. Results Brand-name use in Medicare was 2–3 times that of VA: 35.3% vs. 12.7% for oral hypoglycemics, 50.7% vs. 18.2% for statins, 42.5% vs. 20.8% for angiotensin-converting-enzyme inhibitors/angiotensin-receptor-blockers, and 75.1% vs. 27.0% for insulin analogues. Adjusted HRR brand-name statin use ranged (5th to 95th percentile) from 41.0%–58.3% in Medicare and 6.2%–38.2% in VA. For each drug group, the HRR at the 95th percentile in VA had lower brand-name use than the 5th percentile HRR in Medicare. Medicare spending in this population would have been $1.4 billion less if brand-name use matched the VA for these medications. Limitation This analysis cannot fully describe the factors underlying differences in brand-name use. Conclusions Medicare beneficiaries with diabetes use 2–3 times more brand-name drugs than a comparable group within VA, at substantial excess cost. Primary Funding Sources VA; NIH; RWJF PMID:23752663

  18. Outcome mapping for health system integration

    Directory of Open Access Journals (Sweden)

    Tsasis P

    2013-03-01

    Full Text Available Peter Tsasis,1 Jenna M Evans,2 David Forrest,3 Richard Keith Jones4 1School of Health Policy and Management, Faculty of Health, York University, Toronto, Canada; 2Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Canada; 3Global Vision Consulting Ltd, Victoria, Canada; 4R Keith Jones and Associates, Victoria, Canada Abstract: Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care. Keywords: integrated care, integrated delivery systems, complex adaptive systems, social capital

  19. Rocket Testing and Integrated System Health Management

    Science.gov (United States)

    Figueroa, Fernando; Schmalzel, John

    2005-01-01

    Integrated System Health Management (ISHM) describes a set of system capabilities that in aggregate perform: determination of condition for each system element, detection of anomalies, diagnosis of causes for anomalies, and prognostics for future anomalies and system behavior. The ISHM should also provide operators with situational awareness of the system by integrating contextual and timely data, information, and knowledge (DIaK) as needed. ISHM capabilities can be implemented using a variety of technologies and tools. This chapter provides an overview of ISHM contributing technologies and describes in further detail a novel implementation architecture along with associated taxonomy, ontology, and standards. The operational ISHM testbed is based on a subsystem of a rocket engine test stand. Such test stands contain many elements that are common to manufacturing systems, and thereby serve to illustrate the potential benefits and methodologies of the ISHM approach for intelligent manufacturing.

  20. THE QATAR HEALTH SYSTEM: CHALLENGES AND OPPORTUNITIES

    Directory of Open Access Journals (Sweden)

    Shaher ALSHAMARI

    2017-06-01

    Full Text Available Qatar’s healthcare system is comparatively new and has experienced noteworthy developments over its brief history. In this paper, our aim is to look at the unique challenges this small nation has faced in building that system. This paper will describe the accomplishments of Qatar’s medical authorities and the challenges they faced. It will also compare public and private healthcare providers. Today, the government of Qatar has financed all the health care for this rapidly-developing, multicultural nation, but it is now planning to introduce medical insurance. This report of its experience will benefit other nations wanting to develop their own healthcare systems.

  1. Peak Oil, Food Systems, and Public Health

    Science.gov (United States)

    Parker, Cindy L.; Kirschenmann, Frederick L.; Tinch, Jennifer; Lawrence, Robert S.

    2011-01-01

    Peak oil is the phenomenon whereby global oil supplies will peak, then decline, with extraction growing increasingly costly. Today's globalized industrial food system depends on oil for fueling farm machinery, producing pesticides, and transporting goods. Biofuels production links oil prices to food prices. We examined food system vulnerability to rising oil prices and the public health consequences. In the short term, high food prices harm food security and equity. Over time, high prices will force the entire food system to adapt. Strong preparation and advance investment may mitigate the extent of dislocation and hunger. Certain social and policy changes could smooth adaptation; public health has an essential role in promoting a proactive, smart, and equitable transition that increases resilience and enables adequate food for all. PMID:21778492

  2. Utilization of Health Information System at District Level in Jimma ...

    African Journals Online (AJOL)

    Therefore, in-service training and updating of staff involved in health information system (HIS) at district, strengthening health information system inputs, timely and concrete feedbacks with establishment of functional health management information system (HMIS). KEY WORDS: Health Management Information System, ...

  3. Sustainable quality systems for every Health Service

    International Nuclear Information System (INIS)

    Touzet, Rodolfo; Pittaluga, Roberto R.

    2008-01-01

    The implementation of a Quality system is an indispensable requirement to assure the protection and the radiological safety, especially in those facilities where the potential risks are important. One of the 'general conclusions' of the Conference of Malaga (to achieve the RPP) is also the implementation of quality systems. Lamentably the great majority of the Services of Health in the world, more than 95 %, has not nowadays any formal quality system but only any elements what can be named a 'natural quality system' that includes protocols of work, records of several processes, certified of training of the personnel and diverse practices that are realized in systematic form but that not always are documented. Most health services do not have the necessary means available to adhere quickly to international standards. At the same time the health services do not have either qualified or trained personnel to lead a certification or accreditation project and most of them do not have the resources available to hire external consultants, especially the public hospitals. The scenario described represents a challenge for the Regulatory Authorities who must determine 'how to ensure that installations comply with an acceptable standard of quality without it placing an impossible strain on their budget?' Due to these circumstances a 'Basic Guide' has developed for the implementation of a quality system in every Health Service that takes the elements as a foundation of the standard ISO - 9000:2000 and the standard for systems management GSR-3 of the IAEA. The criteria and the methodologies are showed in the presentation. (author)

  4. Health system challenges of NCDs in Tunisia.

    Science.gov (United States)

    Ben Romdhane, Habiba; Tlili, Faten; Skhiri, Afef; Zaman, Shahaduz; Phillimore, Peter

    2015-01-01

    The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs). Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process. Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void. This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.

  5. Completeness and reliability of mortality data in Viet Nam: Implications for the national routine health management information system.

    Science.gov (United States)

    Hong, Tran Thi; Phuong Hoa, Nguyen; Walker, Sue M; Hill, Peter S; Rao, Chalapati

    2018-01-01

    Mortality statistics form a crucial component of national Health Management Information Systems (HMIS). However, there are limitations in the availability and quality of mortality data at national level in Viet Nam. This study assessed the completeness of recorded deaths and the reliability of recorded causes of death (COD) in the A6 death registers in the national routine HMIS in Viet Nam. 1477 identified deaths in 2014 were reviewed in two provinces. A capture-recapture method was applied to assess the completeness of the A6 death registers. 1365 household verbal autopsy (VA) interviews were successfully conducted, and these were reviewed by physicians who assigned multiple and underlying cause of death (UCOD). These UCODs from VA were then compared with the CODs recorded in the A6 death registers, using kappa scores to assess the reliability of the A6 death register diagnoses. The overall completeness of the A6 death registers in the two provinces was 89.3% (95%CI: 87.8-90.8). No COD recorded in the A6 death registers demonstrated good reliability. There is very low reliability in recording of cardiovascular deaths (kappa for stroke = 0.47 and kappa for ischaemic heart diseases = 0.42) and diabetes (kappa = 0.33). The reporting of deaths due to road traffic accidents, HIV and some cancers are at a moderate level of reliability with kappa scores ranging between 0.57-0.69 (pViet Nam.

  6. SlaVaComp: Konvertierungstool (= SlaVaComp Fonts Converter

    Directory of Open Access Journals (Sweden)

    Simon Skilevic

    2013-12-01

    Full Text Available Der vorliegende Beitrag informiert über ein Tool, das im Rahmen eines Freiburger Projekts zur historischen Korpuslinguistik entwickelt wurde und dazu dient, kirchenslavische Texte, die ohne Einsatz von Unicode digitalisiert wurden, ohne Verlust von Information bzw. Formatierung ins Unicode-Format zu überführen. Das Tool heißt SlaVaComp-Konvertierer. Es eignet sich für die Konvertierung aller idiosynkratischen Fonts und kann somit nicht nur in der Paläoslavistik, sondern in allen historisch arbeitenden Philologien eingesetzt werden. ____________________ This paper presents a fonts converter that was developed as a part of the Freiburg project on historical corpus linguistics. The tool named SlaVaComp-Konvertierer converts Church Slavonic texts digitized with non-Unicode fonts into the Unicode format without any loss of information contained in the original file and without damage to the original formatting. It is suitable for the conversion of all idiosyncratic fonts—not only Church Slavonic—and therefore can be used not only in Palaeoslavistic, but also in all historical and philological studies.

  7. 77 FR 5313 - Privacy Act of 1974; System of Records

    Science.gov (United States)

    2012-02-02

    ... Affairs (VA) is amending the system of records entitled ``Alternative Dispute Resolution Tracking System... records entitled ``Alternative Dispute Resolution Tracking System-VA'' (116VA09) in 67 FR 49392-49395 (July 30, 2002). The system of records tracked alternative dispute resolution (ADR) activity within VA...

  8. Racial disparities in cancer care in the Veterans Affairs health care system and the role of site of care.

    Science.gov (United States)

    Samuel, Cleo A; Landrum, Mary Beth; McNeil, Barbara J; Bozeman, Samuel R; Williams, Christina D; Keating, Nancy L

    2014-09-01

    We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12,897), lung (n = 25,608), or prostate (n = 38,202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between- or within-hospital differences. Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10). Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.

  9. VA Enterprise Design Patterns - 5.1 (Mobility) Mobile

    Data.gov (United States)

    Department of Veterans Affairs — First of a set of guidance documents that establish the architectural foundation for mobile computing in the VA. This document outlines the enterprise capabilities...

  10. VA Enterprise Design Patters - 2.5 (Enterprise Architecture)

    Data.gov (United States)

    Department of Veterans Affairs — Enterprise architectural guidelines and constraints that provide references to the use of enterprise capabilities that will enable the VA to access and exchange data...

  11. Health systems research in the time of health system reform in India: a review.

    Science.gov (United States)

    Rao, Krishna D; Arora, Radhika; Ghaffar, Abdul

    2014-08-09

    Research on health systems is an important contributor to improving health system performance. Importantly, research on program and policy implementation can also create a culture of public accountability. In the last decade, significant health system reforms have been implemented in India. These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. This paper provides a situation analysis of health systems research during the reform period. We reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed and IndMED. Articles were classified according to the WHO classification of health systems building blocks. Our findings indicate the number of publications on health systems progressively increased every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery (40%), with fewer on information (16%), medical technology and vaccines (15%), human resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by an author based in India, the majority by authors located in only four states. Several states, particularly in eastern and northeastern India, did not have a single paper published by a lead author located in a local institution. Moreover, many of these states were not the subject of a single published paper. Further, a few select institutions produced the bulk of research. Of the foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and Switzerland). The growth of published research during the reform period in India is a positive development. However, bulk of this research is produced in a few states and by a few select institutions Further strengthening health systems research requires attention to neglected health systems domains like human resources, financing, and governance. Importantly, research capacity needs to be strengthened in

  12. [Organization development of the public health system].

    Science.gov (United States)

    Pfaff, Holger; Klein, Jürgen

    2002-05-15

    Changes in the German health care system require changes in health care institutions. Organizational development (OD) techniques can help them to cope successfully with their changing environment. OD is defined as a collective process of learning aiming to induce intended organizational change. OD is based on social science methods and conducted by process-oriented consultants. In contrast to techniques of organizational design, OD is characterized by employee participation. One of the most important elements of OD is the so-called "survey-feedback-technique". Five examples illustrate how the survey-feedback-technique can be used to facilitate organisational learning. OD technique supports necessary change in health care organizations. It should be used more frequently.

  13. Wearable medical systems for p-Health.

    Science.gov (United States)

    Teng, Xiao-Fei; Zhang, Yuan-Ting; Poon, Carmen C Y; Bonato, Paolo

    2008-01-01

    Driven by the growing aging population, prevalence of chronic diseases, and continuously rising healthcare costs, the healthcare system is undergoing a fundamental transformation, from the conventional hospital-centered system to an individual-centered system. Current and emerging developments in wearable medical systems will have a radical impact on this paradigm shift. Advances in wearable medical systems will enable the accessibility and affordability of healthcare, so that physiological conditions can be monitored not only at sporadic snapshots but also continuously for extended periods of time, making early disease detection and timely response to health threats possible. This paper reviews recent developments in the area of wearable medical systems for p-Health. Enabling technologies for continuous and noninvasive measurements of vital signs and biochemical variables, advances in intelligent biomedical clothing and body area networks, approaches for motion artifact reduction, strategies for wearable energy harvesting, and the establishment of standard protocols for the evaluation of wearable medical devices are presented in this paper with examples of clinical applications of these technologies.

  14. Operating health analysis of electric power systems

    Science.gov (United States)

    Fotuhi-Firuzabad, Mahmud

    The required level of operating reserve to be maintained by an electric power system can be determined using both deterministic and probabilistic techniques. Despite the obvious disadvantages of deterministic approaches there is still considerable reluctance to apply probabilistic techniques due to the difficulty of interpreting a single numerical risk index and the lack of sufficient information provided by a single index. A practical way to overcome difficulties is to embed deterministic considerations in the probabilistic indices in order to monitor the system well-being. The system well-being can be designated as healthy, marginal and at risk. The concept of system well-being is examined and extended in this thesis to cover the overall area of operating reserve assessment. Operating reserve evaluation involves the two distinctly different aspects of unit commitment and the dispatch of the committed units. Unit commitment health analysis involves the determination of which unit should be committed to satisfy the operating criteria. The concepts developed for unit commitment health, margin and risk are extended in this thesis to evaluate the response well-being of a generating system. A procedure is presented to determine the optimum dispatch of the committed units to satisfy the response criteria. The impact on the response wellbeing being of variations in the margin time, required regulating margin and load forecast uncertainty are illustrated. The effects on the response well-being of rapid start units, interruptible loads and postponable outages are also illustrated. System well-being is, in general, greatly improved by interconnection with other power systems. The well-being concepts are extended to evaluate the spinning reserve requirements in interconnected systems. The interconnected system unit commitment problem is decomposed into two subproblems in which unit scheduling is performed in each isolated system followed by interconnected system evaluation

  15. The Effect of Mantram Repetition on Burnout and Stress Among VA Staff.

    Science.gov (United States)

    Leary, Sheryl; Weingart, Kimberly; Topp, Robert; Bormann, Jill

    2018-03-01

    In this study, the authors determined the effect of a structured Internet-delivered Mantram Repetition Program (MRP) on burnout and stress of conscience (SOC), stress related to ambiguity from ethical or moral conflicts among health care workers (HCWs) within the Veteran Affairs (VA) Healthcare System. A secondary purpose was to determine whether practicing meditation prior to the study combined with MRP affected burnout or SOC. The MRP teaches the mindful practices of repeating a mantram, slowing down, and one-pointed attention for managing stress. Thirty-nine HCW volunteers who provided direct patient care completed the Internet-delivered MRP. The outcomes of burnout (i.e., exhaustion, cynicism, and professional efficacy) and SOC (i.e., frequency of stressful events and troubled conscience about those events) were measured at baseline (T1), postintervention (T2), and 3-months postintervention (T3). Repeated measures ANOVA indicated that exhaustion significantly ( p stressful events significantly declined between T1 and T2 and troubled conscience declined between T1 and T3. Secondary analysis demonstrated that individuals who did not practice meditation at baseline ( n = 16, 41%) significantly decreased exhaustion, frequency of stressful events, and troubled conscience between T1 and T3, and improved professional efficacy between T1 and T2. Individuals who practiced meditation at baseline ( n = 23, 59%) did not demonstrate significant change on any study outcomes. An MRP intervention may reduce burnout and SOC in those individuals who are naïve to practicing meditation.

  16. The health and health system of South Africa: historical roots of current public health challenges.

    Science.gov (United States)

    Coovadia, Hoosen; Jewkes, Rachel; Barron, Peter; Sanders, David; McIntyre, Diane

    2009-09-05

    The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.

  17. Toward systems epidemiology of coffee and health.

    Science.gov (United States)

    Cornelis, Marilyn C

    2015-02-01

    Coffee is one of the most widely consumed beverages in the world and has been associated with many health conditions. This review examines the limitations of the classic epidemiological approach to studies of coffee and health, and describes the progress in systems epidemiology of coffee and its correlated constituent, caffeine. Implications and applications of this growing body of knowledge are also discussed. Population-based metabolomic studies of coffee replicate coffee-metabolite correlations observed in clinical settings but have also identified novel metabolites of coffee response, such as specific sphingomyelin derivatives and acylcarnitines. Genome-wide analyses of self-reported coffee and caffeine intake and serum levels of caffeine support an overwhelming role for caffeine in modulating the coffee consumption behavior. Interindividual variation in the physiological exposure or response to any of the many chemicals present in coffee may alter the persistence and magnitude of their effects. It is thus imperative that future studies of coffee and health account for this variation. Systems epidemiological approaches promise to inform causality, parse the constituents of coffee responsible for health effects, and identify the subgroups most likely to benefit from increasing or decreasing coffee consumption.

  18. Capital investment strategies in health care systems.

    Science.gov (United States)

    Reiter, K L; Smith, D G; Wheeler, J R; Rivenson, H L

    2000-01-01

    Capital investment decisions are among the most important decisions made by firms. They determine the firm's capacity for providing services and commit the firm's cash for an extended period of time. Interviews with chief financial officers of leading health care systems reveal capital investment strategies that generally follow the recommendations of modern finance theory. Still, there is substantial variation in capital budgeting techniques, methods of risk adjustment, and the importance of qualitative considerations in investment decision making. There is also variation in delegation of investment decision making to operating units and methods of performance evaluation. Health care systems face the same challenges as other organizations in developing and implementing capital investment strategies that use consistent methods for evaluation of projects that have inconsistent aims and outcomes.

  19. Making Technology Ready: Integrated Systems Health Management

    Science.gov (United States)

    Malin, Jane T.; Oliver, Patrick J.

    2007-01-01

    This paper identifies work needed by developers to make integrated system health management (ISHM) technology ready and by programs to make mission infrastructure ready for this technology. This paper examines perceptions of ISHM technologies and experience in legacy programs. Study methods included literature review and interviews with representatives of stakeholder groups. Recommendations address 1) development of ISHM technology, 2) development of ISHM engineering processes and methods, and 3) program organization and infrastructure for ISHM technology evolution, infusion and migration.

  20. 30 CFR 57.22204 - Main fan operation and inspection (I-A, II-A, III, and V-A mines).

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Main fan operation and inspection (I-A, II-A, III, and V-A mines). 57.22204 Section 57.22204 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Main fan operation and inspection (I-A, II-A, III, and V-A mines). Main fans shall be— (a) Provided...

  1. Integrated System Health Management (ISHM) and Autonomy

    Science.gov (United States)

    Figueroa, Fernando; Walker, Mark G.

    2018-01-01

    Systems capabilities on ISHM (Integrated System Health Management) and autonomy have traditionally been addressed separately. This means that ISHM functions, such as anomaly detection, diagnostics, prognostics, and comprehensive system awareness have not been considered traditionally in the context of autonomy functions such as planning, scheduling, and mission execution. One key reason is that although they address systems capabilities, both ISHM and autonomy have traditionally individually been approached as independent strategies and models for analysis. Additionally, to some degree, a unified paradigm for ISHM and autonomy has been difficult to implement due to limitations of hardware and software. This paper explores a unified treatment of ISHM and autonomy in the context of distributed hierarchical autonomous operations.

  2. Security for decentralized health information systems.

    Science.gov (United States)

    Bleumer, G

    1994-02-01

    Health care information systems must reflect at least two basic characteristics of the health care community: the increasing mobility of patients and the personal liability of everyone giving medical treatment. Open distributed information systems bear the potential to reflect these requirements. But the market for open information systems and operating systems hardly provides secure products today. This 'missing link' is approached by the prototype SECURE Talk that provides secure transmission and archiving of files on top of an existing operating system. Its services may be utilized by existing medical applications. SECURE Talk demonstrates secure communication utilizing only standard hardware. Its message is that cryptography (and in particular asymmetric cryptography) is practical for many medical applications even if implemented in software. All mechanisms are software implemented in order to be executable on standard-hardware. One can investigate more or less decentralized forms of public key management and the performance of many different cryptographic mechanisms. That of, e.g. hybrid encryption and decryption (RSA+DES-PCBC) is about 300 kbit/s. That of signing and verifying is approximately the same using RSA with a DES hash function. The internal speed, without disk accesses etc., is about 1.1 Mbit/s. (Apple Quadra 950 (MC 68040, 33 MHz, RAM: 20 MB, 80 ns. Length of RSA modulus is 512 bit).

  3. VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes.

    Science.gov (United States)

    Nazi, Kim M; Turvey, Carolyn L; Klein, Dawn M; Hogan, Timothy P; Woods, Susan S

    2015-03-01

    To explore the experience of early patient adopters who accessed their clinical notes online using the Blue Button feature of the My HealtheVet portal. A web-based survey of VA patient portal users from June 22 to September 15, 2013. 33.5% of respondents knew that clinical notes could be viewed, and nearly one in four (23.5%) said that they had viewed their notes at least once. The majority of VA Notes users agreed that accessing their notes will help them to do a better job of taking medications as prescribed (80.1%) and be better prepared for clinic visits (88.6%). Nine out of 10 users agreed that use of visit notes will help them understand their conditions better (91.8%), and better remember the plan for their care (91.9%). In contrast, 87% disagreed that VA Notes will make them worry more, and 88.4% disagreed that access to VA Notes will be more confusing than helpful. Users who had either contacted their provider or healthcare team (11.9%) or planned to (13.5%) primarily wanted to learn more about a health issue, medication, or test results (53.7%). Initial assessment of the patient experience within the first 9 months of availability provides evidence that patients both value and benefit from online access to clinical notes. These findings are congruent with OpenNotes study findings on a broader scale. Additional outreach and education is needed to enhance patient awareness. Healthcare professionals should author notes keeping in mind the opportunity patient access presents for enhanced communication. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Organizational Structure and Management in Romanian Health System

    OpenAIRE

    Boldureanu Daniel; Boldureanu Gabriela

    2010-01-01

    The health system in Romania in a continuous transformation from a centralized system (type Semashko) exists before 1989 year to one based on social health insurance (type Bismark). This paper examines the management and the organizational structure of the health system in Romania, and the relations between them in the context of the Health Reform Law.

  5. 42 CFR 438.242 - Health information systems.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Health information systems. 438.242 Section 438.242... Measurement and Improvement Standards § 438.242 Health information systems. (a) General rule. The State must ensure, through its contracts, that each MCO and PIHP maintains a health information system that collects...

  6. Contributions of Global Health Diplomacy to Health Systems in Sub ...

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

    New research will help boost Africa's bargaining power in global health diplomacy, ... need to assert their public health interests in global health diplomacy from an ... Brazil, and India; and 3) the involvement of African actors in getting universal ...

  7. KENO3D Visualization Tool for KENO V.a and KENO-VI Geometry Models

    International Nuclear Information System (INIS)

    Horwedel, J.E.; Bowman, S.M.

    2000-01-01

    Criticality safety analyses often require detailed modeling of complex geometries. Effective visualization tools can enhance checking the accuracy of these models. This report describes the KENO3D visualization tool developed at the Oak Ridge National Laboratory (ORNL) to provide visualization of KENO V.a and KENO-VI criticality safety models. The development of KENO3D is part of the current efforts to enhance the SCALE (Standardized Computer Analyses for Licensing Evaluations) computer software system

  8. Calculation of criticality of the AP600 reactor with KENO V.a code

    Energy Technology Data Exchange (ETDEWEB)

    Krumbein, A; Caner, M; Shapira, M [Israel Atomic Energy Commission, Yavne (Israel). Soreq Nuclear Research Center

    1996-12-01

    The Westinghouse AP600 PWR has been modeled using the KENO V.a three dimensional Monte Carlo criticality program of the SCALE-PC code system. These calculations and the use of a Monte Carlo neutron transport code such as KENO will provide us with an independent check on our WIMS/CITATION calculations for the AP600 as well as for other reactors. It will also enable us to model more complicated geometries. (authors).

  9. Disruptive Innovation: Implementation of Electronic Consultations in a Veterans Affairs Health Care System.

    Science.gov (United States)

    Gupte, Gouri; Vimalananda, Varsha; Simon, Steven R; DeVito, Katerina; Clark, Justice; Orlander, Jay D

    2016-02-12

    Electronic consultations (e-consults) offer rapid access to specialist input without the need for a patient visit. E-consult implementation began in 2011 at VA Boston Healthcare System (VABHS). By early 2013, e-consults were available for all clinical services. In this implementation, the requesting clinician selects the desired consultation within the electronic health record (EHR) ordering menu, which creates an electronic form that is pre-populated with patient demographic information and allows free-text entry of the reason for consult. This triggers a message to the requesting clinician and requested specialty, thereby enabling bidirectional clinician-clinician communication. The aim of this study is to examine the utilization of e-consults in a large Veterans Affairs (VA) health care system. Data from the electronic health record was used to measure frequency of e-consult use by provider type (physician or nurse practitioner (NP) and/or physician assistant), and by the requesting and responding specialty from January 2012 to December 2013. We conducted chart reviews for a purposive sample of e-consults and semi-structured interviews with a purposive sample of clinicians and hospital leaders to better characterize the process, challenges, and usability of e-consults. A total of 7097 e-consults were identified, 1998 from 2012 and 5099 from 2013. More than one quarter (27.56%, 1956/7097) of the e-consult requests originated from VA facilities in New England other than VABHS and were excluded from subsequent analysis. Within the VABHS e-consults (72.44%, 5141/7097), variability in frequency and use of e-consults across provider types and specialties was found. A total of 64 NPs requested 2407 e-consults (median 12.5, range 1-415). In contrast, 448 physicians (including residents and fellows) requested 2349 e-consults (median 2, range 1-116). More than one third (37.35%, 1920/5141) of e-consults were sent from primary care to specialists. While most e

  10. 75 FR 9277 - Proposed Information Collection (VA National Rehabilitation Special Events, Event Registration...

    Science.gov (United States)

    2010-03-01

    ... Sports Clinic Application, VA Form 0924--233 hours. b. National Veterans Wheelchair Games Application, VA.... National Veterans TEE Tournament Application, VA Form 0927--133 hours. e. National Veterans Summer Sports... Form 0929--67 hours. OMB Control Number: 2900-New (VA Form 0924). Type of Review: Existing collection...

  11. Occupational Safety and Health Management System (OSHMS)

    International Nuclear Information System (INIS)

    Shyen, A.K.S.; Mohd Khairul Hakimin; Manisah Saedon

    2011-01-01

    Safe work environment has always been one of the major concerns at workplace. For this, Occupational Safety and Health Act 1994 has been promulgated for all workplaces to ensure the Safety, Health and Welfare of its employees and any person at workplaces. Malaysian Nuclear Agency therefore has started the initiative to review and improve the current Occupational Safety and Health Management System (OSHMS) by going for OHSAS 18001:2007 and MS 1722 standards certification. This would also help in our preparation to bid as the TSO (Technical Support Organization) for the NPP (Nuclear Power Plant) when it is established. With a developed and well maintained OSHMS, it helps to create a safe working condition and thus enhancing the productivity, quality and good morale. Ultimately, this will lead to a greater organization profit. However, successful OSHMS requires full commitment and support from all level of the organization to work hand in hand in implementing the safety and health policy. Therefore it is essential for all to acknowledge the progress of the implementation and be part of it. (author)

  12. The role of health system governance in strengthening the rural health insurance system in China.

    Science.gov (United States)

    Yuan, Beibei; Jian, Weiyan; He, Li; Wang, Bingyu; Balabanova, Dina

    2017-05-23

    Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding

  13. Pilot Implementation of Health Information Systems

    DEFF Research Database (Denmark)

    Bansler, Jørgen P.; Havn, Erling C.

    2009-01-01

    Pilot implementation is a powerful and widely used approach in identifying design flaws and implementation issues before the full-scale deployment of new health information systems. However, pilot implementations often fail in the sense that they say little about the usability and usefulness...... of the proposed system designs. This calls for studies that seek to uncover and analyze the reasons for failure, so that guidelines for conducting such pilots can be developed. In this paper, we present a qualitative field study of an ambitious, but unsuccessful pilot implementation of a Danish healthcare...... information system. Based on the findings from this study, we identify three main challenges: (1) defining an appropriate scope for pilot implementation, (2) managing the implementation process, and (3) ensuring commitment to the pilot. Finally, recommendations for future research and implications...

  14. 76 FR 54770 - Public Meeting: Notification by Capital One Financial Corporation, McLean, VA, To Acquire ING...

    Science.gov (United States)

    2011-09-02

    ... FEDERAL RESERVE SYSTEM Public Meeting: Notification by Capital One Financial Corporation, McLean, VA, To Acquire ING Bank, FSB, Wilmington, DE, and Indirectly To Acquire Shares of Sharebuilder... Reserve System. ACTION: Notice of public meeting. SUMMARY: Three public meetings will be held regarding...

  15. Social health insurance in Nepal: A health system departure toward the universal health coverage.

    Science.gov (United States)

    Pokharel, Rajani; Silwal, Pushkar Raj

    2018-04-10

    The World Health Organization has identified universal health coverage (UHC) as a key approach in reducing equity gaps in a country, and the social health insurance (SHI) has been recommended as an important strategy toward it. This article aims to analyze the design, expected benefits and challenges of realizing the goals of UHC through the recently launched SHI in Nepal. On top of the earlier free health-care policy and several other vertical schemes, the SHI scheme was implemented in 2016 and has reached population coverage of 5% in the implemented districts in just within a year of implementation. However, to achieve UHC in Nepal, in addition to operationalizing the scheme, several other requirements must be dealt simultaneously such as efficient health-care delivery system, adequate human resources for health, a strong information system, improved transparency and accountability, and a balanced mix of the preventive, health promotion, curative, and rehabilitative services including actions to address the social determinants of health. The article notes that strong political commitment and persistent efforts are the key lessons learnt from countries achieving progressive UHC through SHI. Copyright © 2018 John Wiley & Sons, Ltd.

  16. Hearing aid patients in private practice and public health (Veterans Affairs) clinics: are they different?

    Science.gov (United States)

    Cox, Robyn M; Alexander, Genevieve C; Gray, Ginger A

    2005-12-01

    group to the other. Further, compared with PP patients, VA patients consistently reported more favorable hearing aid fitting outcomes. Additional study is indicated to explore the determinants of this result and its generalizability to other public health service delivery systems such as those in other countries. Moreover, efforts should be made to assess the potential for transferring positive elements from the VA system to the PP service delivery system, if possible.

  17. Health and environmental risks of energy systems

    International Nuclear Information System (INIS)

    Hamilton, L.D.

    1984-01-01

    This paper gives four examples of health risk assessments of energy systems: (1) Comparative risk assessment of the health effects of the coal and nuclear fuel cycles. Estimates differ from previous values chiefly by inclusion of ranges of uncertainty, but some coal-cycle numbers were re-estimated. Upper-boundary public disease risks of air pollution from coal-fired plants dominate. Reactors probably account for most of the potential effect of major nuclear accidents. Accidental death rates in electricity generation are low for reactors and higher for coal. (2) Upper boundary air pollution health risks of existing fossil-based energy technologies in the United States. Preliminary mortality estimates were obtained combining potential impacts of three index pollutants - SO 4 , NO 2 , and CO - as independent measures of risk. Four fuel cycle trajectories leading to three end-uses were analyzed. Example results: domestic wood burning has substantial potential impact, with an upper boundary exceeding that of coal; upper-boundary air pollution impacts of gas can exceed those of oil, because of NO 2 . (3) Health risks of acid deposition and other transported air pollutants, carried out as part of an assessment of the US Congress Office of Technology Assessment (OTA) Acid Rain and Transported Air Pollutants - Implications for Public Policy. Three scenarios were examined, leading to estimates of 40,000 to 50,000 annual premature deaths, depending on year (1978 vs 2000) and scenario (holding total emissions constant vs 30% reduction). (4) health effects of uranium mill tailings piles. Mortality risk is estimated to be minuscule (8.7 x 10 -9 average individual lifetime cancer risk from a model mill, compared with 9.5 x 10 -4 for background radiation). Methods that sum risks over the indefinite future are shown to be to be unrealistic. 39 references, 7 figures, 15 tables

  18. Health and environmental risks of energy systems

    International Nuclear Information System (INIS)

    Hamilton, L.D.

    1984-01-01

    The paper gives four examples of health risk assessments of energy systems: (1) Comparative risk assessment of the health effects of the coal and nuclear fuel cycles. Estimates differ from previous values chiefly by inclusion of ranges of uncertainty, but some coal-cycle numbers were re-estimated. Upper-boundary public disease risks of air pollution from coal-fired plants dominate. Reactors probably account for most of the potential effect of major nuclear accidents. Accidental death rates in electricity generation are low for reactors and higher for coal. (2) Upper-boundary air pollution health risks of existing fossil-fuel-based energy technologies in the United States of America. Preliminary mortality estimates were obtained combining potential impacts of three index pollutants - SO 4 , NO 2 , and CO - as independent measures of risk. Four fuel cycle trajectories leading to three end-uses were analysed. (3) Health risks of acid deposition and other transported air pollutants, carried out as part of an assessment of the US Congress Office of Technology Assessment (OTA) 'Acid Rain and Transported Air Pollutants. (4) Health effects of uranium mill tailings piles. Mortality risk is estimated to be minuscule (8.7x10 -9 average individual lifetime cancer risk from a model mill, compared with 9.5x10 -4 for background radiation). Methods that sum risks over the indefinite future are shown to be unrealistic. As a final example of risk analysis, the cost-effectiveness analysis for proposed EPA standards for radionuclides is shown to be deficient by an analysis concluding that the cost per potential cancer avoided could range from US $70 million to US $140 billion

  19. Highlight: Improving health systems research in West Africa | IDRC ...

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

    2016-04-15

    Apr 15, 2016 ... ... by the University of Ghana School of Public Health, in partnership with WAHO and IDRC. Health systems research experts and partners from across the ... adopted direct payment for health services as the primary means.

  20. Privacy, confidentiality and automated health information systems.

    Science.gov (United States)

    Vuori, H

    1977-12-01

    Professor Vuori's paper, first presented at the fourth Medico-legal Conference in Prague in the spring of this year, deals with the problem of the maintenance of confidentiality in computerized health records. Although more and more information is required, the hardware of the computer systems is so sophisticated that it would be very expensive indeed to 'break in' and steal from a modern data bank. Those concerned with programming computers are becoming more aware of their responsibilities concerning confidentiality and privacy, to the extent that a legal code of ethics for programmers is being formulated. They are also aware that the most sensitive of all relationships--the doctor-patient relationship--could be in danger if they failed to maintain high standards of integrity. An area of danger is where administrative boundaries between systems must be crossed--say between those of health and employment. Protection of privacy must be ensured by releasing full information about the type of data being stored, and by maintaining democratic control over the establishment of information systems.

  1. Biosecurity through Public Health System Design.

    Energy Technology Data Exchange (ETDEWEB)

    Beyeler, Walter E. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Finley, Patrick D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Arndt, William [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Walser, Alex Christian [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Mitchell, Michael David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-11-01

    We applied modeling and simulation to examine the real-world tradeoffs between developingcountry public-health improvement and the need to improve the identification, tracking, and security of agents with bio-weapons potential. Traditionally, the international community has applied facility-focused strategies for improving biosecurity and biosafety. This work examines how system-level assessments and improvements can foster biosecurity and biosafety. We modeled medical laboratory resources and capabilities to identify scenarios where biosurveillance goals are transparently aligned with public health needs, and resource are distributed in a way that maximizes their ability to serve patients while minimizing security a nd safety risks. Our modeling platform simulates key processes involved in healthcare system operation, such as sample collection, transport, and analysis at medical laboratories. The research reported here extends the prior art by provided two key compone nts for comparative performance assessment: a model of patient interaction dynamics, and the capability to perform uncertainty quantification. In addition, we have outlined a process for incorporating quantitative biosecurity and biosafety risk measures. Two test problems were used to exercise these research products examine (a) Systemic effects of technological innovation and (b) Right -sizing of laboratory networks.

  2. Diffusion of innovation in women's health care delivery: the Department of Veterans Affairs' adoption of women's health clinics.

    Science.gov (United States)

    Yano, Elizabeth M; Goldzweig, Caroline; Canelo, Ismelda; Washington, Donna L

    2006-01-01

    In response to concerns about the availability and quality of women's health services in Department of Veterans Affairs (VA) medical centers in the early 1990s, Congress approved landmark legislation earmarking funds to enhance women's health services. A portion of the appropriation was used to launch Comprehensive Women's Health Centers as exemplars for the development of VA women's health care throughout the system. We report on the diffusion and characteristics of VA women's health clinics (WHCs) 10 years later. In 2001, we surveyed the senior women's health clinician at each VA medical center serving > or =400 women veterans (83% response rate) regarding their internal organizational characteristics in relation to factors associated with organizational innovation (centralization, complexity, formalization, interconnectedness, organizational slack, size). We evaluated the comparability of WHCs (n = 66) with characteristics of the original comprehensive women's health centers (CWHCs; n = 8). Gender-specific service availability in WHCs was comparable to that of CWHCs with important exceptions in mental health, mammography and osteoporosis management. WHCs were less likely to have same-gender providers (p business case for managers faced with small female patient caseloads.

  3. A Role for Myosin Va in Human Cytomegalovirus Nuclear Egress.

    Science.gov (United States)

    Wilkie, Adrian R; Sharma, Mayuri; Pesola, Jean M; Ericsson, Maria; Fernandez, Rosio; Coen, Donald M

    2018-03-15

    Herpesviruses replicate and package their genomes into capsids in replication compartments within the nuclear interior. Capsids then move to the inner nuclear membrane for envelopment and release into the cytoplasm in a process called nuclear egress. We previously found that nuclear F-actin is induced upon infection with the betaherpesvirus human cytomegalovirus (HCMV) and is important for nuclear egress and capsid localization away from replication compartment-like inclusions toward the nuclear rim. Despite these and related findings, it has not been shown that any specific motor protein is involved in herpesvirus nuclear egress. In this study, we have investigated whether the host motor protein, myosin Va, could be fulfilling this role. Using immunofluorescence microscopy and coimmunoprecipitation, we observed associations between a nuclear population of myosin Va and the viral major capsid protein, with both concentrating at the periphery of replication compartments. Immunoelectron microscopy showed that nearly 40% of assembled nuclear capsids associate with myosin Va. We also found that myosin Va and major capsid protein colocalize with nuclear F-actin. Importantly, antagonism of myosin Va with RNA interference or a dominant negative mutant revealed that myosin Va is important for the efficient production of infectious virus, capsid accumulation in the cytoplasm, and capsid localization away from replication compartment-like inclusions toward the nuclear rim. Our results lead us to suggest a working model whereby human cytomegalovirus capsids associate with myosin Va for movement from replication compartments to the nuclear periphery during nuclear egress. IMPORTANCE Little is known regarding how newly assembled and packaged herpesvirus capsids move from the nuclear interior to the periphery during nuclear egress. While it has been proposed that an actomyosin-based mechanism facilitates intranuclear movement of alphaherpesvirus capsids, a functional role for

  4. Addressing the Health Concerns of VA Women with Sexual Trauma

    Science.gov (United States)

    2017-10-01

    age of 14. The average age for participants enrolled in the OT was 41 years old (range= 25-63). 19 (95%) had been granted a service disability , 8...Sexual Trauma (Open Trial) Consented and enrolled (n=35) I Excluded (n=lS): .. Not meeting inclusion criteria (n=12) ~ .. Incomplete screener (n=l...Excluded (n=29): .. Not meeting inclusion :- Pending participants (n=S) criteria (n=25) I+- .. Lost to follow-up (n=4) ,, Consented for Randomized

  5. Addressing the Health Concerns of VA Women With Sexual Trauma

    Science.gov (United States)

    2016-10-01

    PT140100 10/1/15 – 9/30/19 3CM CDMRP/Department of Defense Role: Joint-PI/PD The following grants have ended: Integrated Alcohol and Sexual...1U24AA022003 (Kahler: PI) 09/1/16-08/31/21 2.4 Calendar NIAAA Positive Psychotherapy for Smoking Cessation Enhanced with Text Messaging: A Randomized

  6. Social Workers' Role in the Canadian Mental Health Care System

    Science.gov (United States)

    Towns, Ashley M.; Schwartz, Karen

    2012-01-01

    Objective: Using Canadian survey data this research provides social workers in Canada with a better understanding of their role in the Canadian mental health care system. Methods: By analyzing data from the Canadian Community Health Survey, Cycle 1.2 Mental Health and Well-being, the role of social workers in the Canadian mental health system was…

  7. Understanding The Resistance to Health Information Systems

    Directory of Open Access Journals (Sweden)

    David Ackah

    2017-07-01

    Full Text Available User resistance is users’ opposition to system implementation. Resistance often occurs as a result of a mismatch between management goals and employee preferences. There are two types of resistance to health iformation system namely active resistance and passive resistance. The manifestation of active resistance are being critical,  blaming/accusing, blocking, fault finding, sabotaging, undermining, ridiculing, intimidating/threatening, starting rumors, appealing to fear, manipulating arguing, using facts selectively, distorting facts and  raising objections. The manifestation of passive resistance are agreeing verbally but not following through, failing to implement change, procrastinating/dragging feet, feigning ignorance, withholding information, suggestions, help or support, and standing by and allowing the change to fail.

  8. A VME based health monitoring system

    International Nuclear Information System (INIS)

    Huang Yiming; Wang Chunhong

    2011-01-01

    It introduces a VME based health system for monitoring the working status of VME crates in the BEPCⅡ. It consists of a PC and a VME crate where a CMM (Classic Monitor System) is installed. The CMM module is responsible for collecting data from the power supply and temperature as well as fan speed inside the VME crate and send these data to the PC via the serial port. The author developed EPICS asynchronous driver by using a character-based device protocol StreamDevice. The data is saved into EPICS IOC database in character. Man-machine interface which is designed by BOY displays the running status of the VME crate including the power supply and temperature as well as fan speed. If the value of records display unusual, the color of the value will be changed into red. This can facilitate the maintenance of the VME crates. (authors)

  9. Canadian initiative leading the way for equitable health systems and ...

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

    2016-04-27

    Apr 27, 2016 ... Home · Resources · Publications ... The field of health systems research has grown into a vibrant community. IDRC grantees are actively involved in Health Systems Global, a newinternational agency that gathers researchers, ...

  10. Health financing: Who pays for equitable health systems? | IDRC ...

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

    2012-10-24

    Oct 24, 2012 ... Countries rich and poor face difficult choices in funding quality health care for ... while 31 member states of the World Health Organization pay less than ... on how poor families are benefiting from services – or being excluded.

  11. Evaluation of Microbial Contamination and Chemical Qualities of Cream-filled Pastries in Confectioneries of Chaharmahal Va Bakhtiari Province (Southwestern Iran).

    Science.gov (United States)

    Sharifzadeh, Ali; Hajsharifi-Shahreza, Mohammad; Ghasemi-Dehkordi, Payam

    2016-12-01

    High consumption of bakery products such as cream-filled pastries may cause serious health risks and food poisoning to humans. Therefore, investigation of the microbial and chemical qualities of bakery products containing cream is necessary. The purpose of the present study was to investigate the chemical qualities and microbial contaminations of cream-filled pastries collected from confectioneries located in six cities in Chaharmahal Va Bakhtiari province (Southwestern Iran). Microbial tests and chemical characteristics (fat and acidity level) were done on 228 cream-filled pastries samples that were collected randomly from various confectioneries. After microbial tests, it was found that 33.33% of all samples were contaminated by microbial agents. The microbial tests showed that Shahrekord (10.09%) and Broujen (9.21%) cities had high levels of contamination and in Koohrang (1.31%) it was low compared with the other four cities. High contamination of coliforms (61.84%), staphylococci (48.68%), and yeast (27.63%) were observed in almost all samples. The chemical analysis showed maximum amounts of fat content and titratable acidity in cream-filled pastry samples obtained from Lordegan and Shahrekord cities, respectively. The findings of the present work demonstrated that the microbial contamination and chemical quality of cream-filled pastries produced in confectionaries of Chaharmahal Va Bakhtiari province were not in acceptable ranges. These problems may be related to fecal contamination of cream samples or lack of hygiene by handlers and it is necessary to observe the standards of hygiene and to develop safe food handling techniques and aseptic pastry manufacturing systems in some confectioneries of Chaharmahal Va Bakhtiari province.

  12. Health information systems: failure, success and improvisation.

    Science.gov (United States)

    Heeks, Richard

    2006-02-01

    The generalised assumption of health information systems (HIS) success is questioned by a few commentators in the medical informatics field. They point to widespread HIS failure. The purpose of this paper was therefore to develop a better conceptual foundation for, and practical guidance on, health information systems failure (and success). Literature and case analysis plus pilot testing of developed model. Defining HIS failure and success is complex, and the current evidence base on HIS success and failure rates was found to be weak. Nonetheless, the best current estimate is that HIS failure is an important problem. The paper therefore derives and explains the "design-reality gap" conceptual model. This is shown to be robust in explaining multiple cases of HIS success and failure, yet provides a contingency that encompasses the differences which exist in different HIS contexts. The design-reality gap model is piloted to demonstrate its value as a tool for risk assessment and mitigation on HIS projects. It also throws into question traditional, structured development methodologies, highlighting the importance of emergent change and improvisation in HIS. The design-reality gap model can be used to address the problem of HIS failure, both as a post hoc evaluative tool and as a pre hoc risk assessment and mitigation tool. It also validates a set of methods, techniques, roles and competencies needed to support the dynamic improvisations that are found to underpin cases of HIS success.

  13. A Support Database System for Integrated System Health Management (ISHM)

    Science.gov (United States)

    Schmalzel, John; Figueroa, Jorge F.; Turowski, Mark; Morris, John

    2007-01-01

    The development, deployment, operation and maintenance of Integrated Systems Health Management (ISHM) applications require the storage and processing of tremendous amounts of low-level data. This data must be shared in a secure and cost-effective manner between developers, and processed within several heterogeneous architectures. Modern database technology allows this data to be organized efficiently, while ensuring the integrity and security of the data. The extensibility and interoperability of the current database technologies also allows for the creation of an associated support database system. A support database system provides additional capabilities by building applications on top of the database structure. These applications can then be used to support the various technologies in an ISHM architecture. This presentation and paper propose a detailed structure and application description for a support database system, called the Health Assessment Database System (HADS). The HADS provides a shared context for organizing and distributing data as well as a definition of the applications that provide the required data-driven support to ISHM. This approach provides another powerful tool for ISHM developers, while also enabling novel functionality. This functionality includes: automated firmware updating and deployment, algorithm development assistance and electronic datasheet generation. The architecture for the HADS has been developed as part of the ISHM toolset at Stennis Space Center for rocket engine testing. A detailed implementation has begun for the Methane Thruster Testbed Project (MTTP) in order to assist in developing health assessment and anomaly detection algorithms for ISHM. The structure of this implementation is shown in Figure 1. The database structure consists of three primary components: the system hierarchy model, the historical data archive and the firmware codebase. The system hierarchy model replicates the physical relationships between

  14. Poststroke Rehabilitation and Restorative Care Utilization: A Comparison Between VA Community Living Centers and VA-contracted Community Nursing Homes.

    Science.gov (United States)

    Jia, Huanguang; Pei, Qinglin; Sullivan, Charles T; Cowper Ripley, Diane C; Wu, Samuel S; Bates, Barbara E; Vogel, W Bruce; Bidelspach, Douglas E; Wang, Xinping; Hoffman, Nannette

    2016-03-01

    Effective poststroke rehabilitation care can speed patient recovery and minimize patient functional disabilities. Veterans affairs (VA) community living centers (CLCs) and VA-contracted community nursing homes (CNHs) are the 2 major sources of institutional long-term care for Veterans with stroke receiving care under VA auspices. This study compares rehabilitation therapy and restorative nursing care among Veterans residing in VA CLCs versus those Veterans in VA-contracted CNHs. Retrospective observational. All Veterans diagnosed with stroke, newly admitted to the CLCs or CNHs during the study period who completed at least 2 Minimum Data Set assessments postadmission. The outcomes were numbers of days for rehabilitation therapy and restorative nursing care received by the Veterans during their stays in CLCs or CNHs as documented in the Minimum Data Set databases. For rehabilitation therapy, the CLC Veterans had lower user rates (75.2% vs. 76.4%, P=0.078) and fewer observed therapy days (4.9 vs. 6.4, Pcare, CLC Veterans had higher user rates (33.5% vs. 30.6%, Pcare days (9.4 vs. 5.9, Pcare (coefficient=5.48±0.37, Pcare both before and after risk adjustment.

  15. Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities.

    Science.gov (United States)

    Seal, Karen H; Bertenthal, Daniel; Miner, Christian R; Sen, Saunak; Marmar, Charles

    2007-03-12

    Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) have endured high combat stress and are eligible for 2 years of free military service-related health care through the Department of Veterans Affairs (VA) health care system, yet little is known about the burden and clinical circumstances of mental health diagnoses among OEF/OIF veterans seen at VA facilities. US veterans separated from OEF/OIF military service and first seen at VA health care facilities between September 30, 2001 (US invasion of Afghanistan), and September 30, 2005, were included. Mental health diagnoses and psychosocial problems were assessed using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The prevalence and clinical circumstances of and subgroups at greatest risk for mental health disorders are described herein. Of 103 788 OEF/OIF veterans seen at VA health care facilities, 25 658 (25%) received mental health diagnosis(es); 56% of whom had 2 or more distinct mental health diagnoses. Overall, 32 010 (31%) received mental health and/or psychosocial diagnoses. Mental health diagnoses were detected soon after the first VA clinic visit (median of 13 days), and most initial mental health diagnoses (60%) were made in nonmental health clinics, mostly primary care settings. The youngest group of OEF/OIF veterans (age, 18-24 years) were at greatest risk for receiving mental health or posttraumatic stress disorder diagnoses compared with veterans 40 years or older. Co-occurring mental health diagnoses and psychosocial problems were detected early and in primary care medical settings in a substantial proportion of OEF/OIF veterans seen at VA facilities. Targeted early detection and intervention beginning in primary care settings are needed to prevent chronic mental illness and disability.

  16. HEALTH CARE SYSTEM AS AN OBJECT OF STATISTICAL RESEARCH

    Directory of Open Access Journals (Sweden)

    Pavel A. Smelov

    2015-01-01

    Full Text Available The article describes the health care system of the Russian Federation as anobject of statistical analysis. The features of accounting of the health system in Russia. The article highlights the key aspects of the health system, which is characterized as fully as possible the object of study.

  17. Systems Thinking and the Leadership Conundrum in Health Care

    Science.gov (United States)

    Marchildon, Gregory P.; Fletcher, Amber J.

    2016-01-01

    The ability to think in terms of a system is critical to achieving common direction, alignment, and commitment in highly distributed health systems. In Canada, provincial and territorial ministries of health provide leadership on the direction of health reform while leadership to align system levels is determined by a far more distributed group of…

  18. Call for applications_2013_VA_Final

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

    Lindsay Beck

    2013-04-12

    Apr 12, 2013 ... graduate level field-‐school, taught by UNBC and CoPEH-‐Canada team members1 . Final ... and most of the sessions in the course will be given in English. ... o demonstrated interest in Ecosystem approaches to health.

  19. Intelligent Integrated Health Management for a System of Systems

    Science.gov (United States)

    Smith, Harvey; Schmalzel, John; Figueroa, Fernando

    2008-01-01

    An intelligent integrated health management system (IIHMS) incorporates major improvements over prior such systems. The particular IIHMS is implemented for any system defined as a hierarchical distributed network of intelligent elements (HDNIE), comprising primarily: (1) an architecture (Figure 1), (2) intelligent elements, (3) a conceptual framework and taxonomy (Figure 2), and (4) and ontology that defines standards and protocols. Some definitions of terms are prerequisite to a further brief description of this innovation: A system-of-systems (SoS) is an engineering system that comprises multiple subsystems (e.g., a system of multiple possibly interacting flow subsystems that include pumps, valves, tanks, ducts, sensors, and the like); 'Intelligent' is used here in the sense of artificial intelligence. An intelligent element may be physical or virtual, it is network enabled, and it is able to manage data, information, and knowledge (DIaK) focused on determining its condition in the context of the entire SoS; As used here, 'health' signifies the functionality and/or structural integrity of an engineering system, subsystem, or process (leading to determination of the health of components); 'Process' can signify either a physical process in the usual sense of the word or an element into which functionally related sensors are grouped; 'Element' can signify a component (e.g., an actuator, a valve), a process, a controller, an actuator, a subsystem, or a system; The term Integrated System Health Management (ISHM) is used to describe a capability that focuses on determining the condition (health) of every element in a complex system (detect anomalies, diagnose causes, prognosis of future anomalies), and provide data, information, and knowledge (DIaK) not just data to control systems for safe and effective operation. A major novel aspect of the present development is the concept of intelligent integration. The purpose of intelligent integration, as defined and

  20. Health status and health systems financing in the MENA region: roadmap to universal health coverage.

    Science.gov (United States)

    Asbu, Eyob Zere; Masri, Maysoun Dimachkie; Kaissi, Amer

    2017-01-01

    and GDP growth rate, and high OOPS pose serious challenges for universal health coverage. Using multi-sector interventions, countries should develop and implement evidence-informed health system financing roadmaps to address these obstacles and move forward toward universal health coverage.

  1. Public health system - current status and world experience

    Directory of Open Access Journals (Sweden)

    Andreyeva І.А.

    2016-09-01

    Full Text Available In the review, the evolution of Public Health and global development tendencies of Public Health system have been discussed. Stages of formation of the updated concept, principles of Public Health organization and the role of various organizations have been shown in the connection with development of the global concept of "Health for All". A well-functioning public health system is primarily the result of multisectoral cooperation. The aim of modern Public Health is to provide conditions of access to appropriate and cost-effective health care for all population groups, including health promotion and disease prevention.

  2. MOTIVATION AND COMPENSATION IN HEALTH SYSTEM

    Directory of Open Access Journals (Sweden)

    K. N. Borisov

    2015-01-01

    Full Text Available By the definition accepted by WHO, «health» it is not simple absence of an illness, but a condition of full physical, moral, mental and social wellbeing. By this definition forms of behavior and a way of life of the people, allowing prolonging the period of active, creative and happy life are meant. Health of each person – the main value for modern society. A crisis state of population as open social system, it is shown by its indignation in reply to stressful influences of negative socio-economic factors. It is accompanied by change of a condition of the public health which level refl ects depth of occurring changes. In the conditions of market managing also, the policy in the field of compensation, material encouragement and social support of medical workers essentially changes. A certain level of compensation regardless of should be guaranteed to the medical worker, whether mechanisms of economic incentives of its work are used or not. At the same time, the desire of the worker to hold a position with higher salary and desire to work on it is productive and is qualitative – far not same. Increase of material compensation not always leads to increase of labor motivation and aspiration it is better to work. Socially psychological bases of labor motivation of medical workers are those new approaches that will allow solving problems of increase of labor motivation more effectively. In article the assessment of labor motivation is analyzed by medical workers, measures for increase of labor motivation and according to improvement of quality of medical care are off ered. The majority of the western experts inefficiency of management recognize as the main problem of health care ofRussia. The conclusion that medical institutes, academies and institutes of a post degree obrazoyovaniye, professional development faculties, and, probably, and institutes an upravleyoniya, should adapt foreign experience (motivational, conceptual, technological and

  3. MOTIVATION AND COMPENSATION IN HEALTH SYSTEM

    Directory of Open Access Journals (Sweden)

    K. N. Borisov

    2014-01-01

    Full Text Available By the defi nition accepted by WHO, «health» it is not simple absence of an illness, but a condition of full physical, moral, mental and social wellbeing. By this defi nition forms of behavior and a way of life of the people, allowing prolonging the period of active, creative and happy life are meant. Health of each person – the main value for modern society. A crisis state of population as open social system, it is shown by its indignation in reply to stressful infl uences of negative socio-economic factors. It is accompanied by change of a condition of the public health which level refl ects depth of occurring changes. In the conditions of market managing also, the policy in the fi eld of compensation, material encouragement and social support of medical workers essentially changes. A certain level of compensation regardless of should be guaranteed to the medical worker, whether mechanisms of economic incentives of its work are used or not. At the same time, the desire of the worker to hold a position with higher salary and desire to work on it is productive and is qualitative – far not same. Increase of material compensation not always leads to increase of labor motivation and aspiration it is better to work. Socially psychological bases of labor motivation of medical workers are those new approaches that will allow solving problems of increase of labor motivation more eff ectively. In article the assessment of labor motivation is analyzed by medical workers, measures for increase of labor motivation and according to improvement of quality of medical care are off ered. The majority of the western experts ineffi ciency of management recognize as the main problem of health care ofRussia. The conclusion that medical institutes, academies and institutes of a post degree obrazoyovaniye, professional development faculties, and, probably, and institutes an upravleyoniya, should adapt foreign experience (motivational, conceptual, technological

  4. Ambivalent implications of health care information systems: a study in the Brazilian public health care system

    Directory of Open Access Journals (Sweden)

    João Porto de Albuquerque

    2011-01-01

    Full Text Available This article evaluates social implications of the "SIGA" Health Care Information System (HIS in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

  5. KENO3D, Visualisation Tool for KENO V.A and KENO-VI Geometry Models

    International Nuclear Information System (INIS)

    2008-01-01

    1 - Description of program or function: The KENO3D Visualization Tool for KENO Geometry Models is a powerful state-of-the-art visualization tool that enables KENO V.a users and KENO-VI to interactively display their three-dimensional geometry models. The KENO3D interactive options include: - Shaded or wire-frame images ; - Standard views such as top view, side view, front view, and isometric(3-D) view; - Rotating the model ; - Zooming in on selected locations ; - Selecting parts of the model to display ; - Editing colors and displaying legends ; - Displaying properties of any unit in the model ; - Creating cut-away views ; - Removing units from the model; - Printing image or saving image to a common graphics formats. KENO3D was developed for use by criticality safety specialists that use the KENO three-dimensional Monte Carlo criticality computer code. KENO V.a and KENO-VI are part of the SCALE (Standardized Computer Analyses for Licensing Evaluations) computer software system developed at Ridge National Laboratory (ORNL) that is widely used and accepted around the world for criticality safety analyses. 2 - Methods: KENO3D reads CSAS, KENO V.a, or KENO-VI input files. It attempts to verify that the KENO geometry input is 'legal', i.e., it conforms to the code input guidelines. KENO3D prints a warning message for illegal geometry input, and if possible, it displays the illegal KENO geometry to facilitate debugging of the input. Problems with more than 300,000 KENO V.a bodies have been successfully tested and displayed. KENO3D has the look and feel of a typical PC Windows application. Toolbar buttons are included for all major menu options. There is a setup dialog that allows the user to specify toolbars that should be displayed

  6. Direct observation of the myosin Va recovery stroke that contributes to unidirectional stepping along actin.

    Directory of Open Access Journals (Sweden)

    Katsuyuki Shiroguchi

    2011-04-01

    Full Text Available Myosins are ATP-driven linear molecular motors that work as cellular force generators, transporters, and force sensors. These functions are driven by large-scale nucleotide-dependent conformational changes, termed "strokes"; the "power stroke" is the force-generating swinging of the myosin light chain-binding "neck" domain relative to the motor domain "head" while bound to actin; the "recovery stroke" is the necessary initial motion that primes, or "cocks," myosin while detached from actin. Myosin Va is a processive dimer that steps unidirectionally along actin following a "hand over hand" mechanism in which the trailing head detaches and steps forward ∼72 nm. Despite large rotational Brownian motion of the detached head about a free joint adjoining the two necks, unidirectional stepping is achieved, in part by the power stroke of the attached head that moves the joint forward. However, the power stroke alone cannot fully account for preferential forward site binding since the orientation and angle stability of the detached head, which is determined by the properties of the recovery stroke, dictate actin binding site accessibility. Here, we directly observe the recovery stroke dynamics and fluctuations of myosin Va using a novel, transient caged ATP-controlling system that maintains constant ATP levels through stepwise UV-pulse sequences of varying intensity. We immobilized the neck of monomeric myosin Va on a surface and observed real time motions of bead(s attached site-specifically to the head. ATP induces a transient swing of the neck to the post-recovery stroke conformation, where it remains for ∼40 s, until ATP hydrolysis products are released. Angle distributions indicate that the post-recovery stroke conformation is stabilized by ≥ 5 k(BT of energy. The high kinetic and energetic stability of the post-recovery stroke conformation favors preferential binding of the detached head to a forward site 72 nm away. Thus, the recovery

  7. Advantages of Information Systems in Health Services

    Directory of Open Access Journals (Sweden)

    MARIA MALLIAROU & SOFIA ZYGA

    2009-01-01

    Full Text Available Nursing Information System (NIS has been defined as “a part of a health care information system that deals with nursing aspects, particularly the maintenance of the nursing record”. Nursing Uses of Information Systems in order to assess patient acuity and condition, prepare a plan of care or critical pathway, specify interventions, document care, track outcomes and control quality in the given patient care. Patient care processes, Communication, research, education and ward management can be easily delivered using NIS. There is a specific procedure that should be followed when implementing NISs. The electronic databases CINAHL and Medline were used to identify studies for review. Studies were selected from a search that included the terms ‘nursing information systems’, ‘clinical information systems’, ‘hospital information systems’, ‘documentation’, ‘nursing records’, combined with ‘electronic’ and ‘computer’. Journal articles, research papers, and systematic reviews from 1980 to 2007 were included. In Greek Hospitals there have been made many trials and efforts in order to develop electronic nursing documentation with little results. There are many difficulties and some of them are different levels of nursing education, low nurse to patient ratios, not involvement of nurses in the phases of their implementation, resistance in change. Today’s nursing practice in Greece needs to follow others counties paradigm and phase its controversies and problems in order to follow the worldwide changes in delivering nursing care.

  8. Structure health assessment and warning system (SHAWS)

    Science.gov (United States)

    Bock, Daniel M.; Kim, Keehoon; Mapar, Jalal

    2008-03-01

    We are developing a Structure Health Assessment and Warning System (SHAWS) based on building displacement measurements and wireless communication. SHAWS will measure and predict the stability/instability of a building, determine whether it is safe for emergency responders to enter during an emergency, and provide individual warnings on the condition of the structure. SHAWS incorporates remote sensing nodes (RSNs) installed on the exterior frame of a building. Each RSN includes a temperature sensor, a three-axis accelerometer making static-acceleration measurements, and a ZigBee wireless system (IEEE 802.15.4). The RSNs will be deployed remotely using an air cannon delivery system, with each RSN having an innovative adhesive structure for fast (<10 min) and strong installation under emergency conditions. Once the building has moved past a threshold (~0.25 in./building story), a warning will be issued to emergency responders. In addition to the RSNs, SHAWS will include a base station located on an emergency responder's primary vehicle, a PDA for mobile data display to guide responders, and individual warning modules that can be worn by each responder. The individual warning modules will include visual and audio indicators with a ZigBee receiver to provide the proper degree of warning to each responder.

  9. Small RNA sequence analysis of adenovirus VA RNA-derived miRNAs reveals an unexpected serotype-specific difference in structure and abundance.

    Directory of Open Access Journals (Sweden)

    Wael Kamel

    Full Text Available Human adenoviruses (HAds encode for one or two highly abundant virus-associated RNAs, designated VA RNAI and VA RNAII, which fold into stable hairpin structures resembling miRNA precursors. Here we show that the terminal stem of the VA RNAs originating from Ad4, Ad5, Ad11 and Ad37, all undergo Dicer dependent processing into virus-specific miRNAs (so-called mivaRNAs. We further show that the mivaRNA duplex is subjected to a highly asymmetric RISC loading with the 3'-strand from all VA RNAs being the favored strand, except for the Ad37 VA RNAII, where the 5'-mivaRNAII strand was preferentially assembled into RISC. Although the mivaRNA seed sequences are not fully conserved between the HAds a bioinformatics prediction approach suggests that a large fraction of the VA RNAII-, but not the VA RNAI-derived mivaRNAs still are able to target the same cellular genes. Using small RNA deep sequencing we demonstrate that the Dicer processing event in the terminal stem of the VA RNAs is not unique and generates 3'-mivaRNAs with a slight variation of the position of the 5' terminal nucleotide in the RISC loaded guide strand. Also, we show that all analyzed VA RNAs, except Ad37 VA RNAI and Ad5 VA RNAII, utilize an alternative upstream A start site in addition to the classical +1 G start site. Further, the 5'-mivaRNAs with an A start appears to be preferentially incorporated into RISC. Although the majority of mivaRNA research has been done using Ad5 as the model system our analysis demonstrates that the mivaRNAs expressed in Ad11- and Ad37-infected cells are the most abundant mivaRNAs associated with Ago2-containing RISC. Collectively, our results show an unexpected variability in Dicer processing of the VA RNAs and a serotype-specific loading of mivaRNAs into Ago2-based RISC.

  10. Making housing first happen: organizational leadership in VA's expansion of permanent supportive housing.

    Science.gov (United States)

    Kertesz, Stefan G; Austin, Erika Laine; Holmes, Sally K; Pollio, David E; Schumacher, Joseph E; White, Bert; Lukas, Carol VanDeusen

    2014-12-01

    While most organizational literature has focused on initiatives that transpire inside the hospital walls, the redesign of American health care increasingly asks that health care institutions address matters outside their walls, targeting the health of populations. The US Department of Veterans Affairs (VA)'s national effort to end Veteran homelessness represents an externally focused organizational endeavor. Our aim was to evaluate the role of organizational practices in the implementation of Housing First (HF), an evidence-based homeless intervention for chronically homeless individuals. This was an interview-based comparative case study conducted across eight VA Medical Centers (VAMCs). Front line staff, mid-level managers, and senior leaders at VA Medical Centers were interviewed between February and December 2012. Using a structured narrative and numeric scoring, we assessed the correlation between successful HF implementation and organizational practices devised according to the organizational transformation model (OTM). Scoring results suggested a strong association between HF implementation and OTM practice. Strong impetus to house Veterans came from national leadership, reinforced by Medical Center directors closely tracking results. More effective Medical Center leaders differentiated themselves by joining front-line staff in the work (at public events and in process improvement exercises), by elevating homeless-knowledgeable persons into senior leadership, and by exerting themselves to resolve logistic challenges. Vertical alignment and horizontal integration advanced at sites that fostered work groups cutting across service lines and hierarchical levels. By contrast, weak alignment from top to bottom typically also hindered cooperation across departments. Staff commitment to ending homelessness was high, though sustainability planning was limited in this baseline year of observation. Key organizational practices correlated with more successful

  11. Collaborating across the Departments of Veterans Affairs and Defense to integrate mental health and chaplaincy services.

    Science.gov (United States)

    Nieuwsma, Jason A; Jackson, George L; DeKraai, Mark B; Bulling, Denise J; Cantrell, William C; Rhodes, Jeffrey E; Bates, Mark J; Ethridge, Keith; Lane, Marian E; Tenhula, Wendy N; Batten, Sonja V; Meador, Keith G

    2014-12-01

    Recognizing that clergy and spiritual care providers are a key part of mental health care systems, the Department of Veterans Affairs (VA) and Department of Defense (DoD) jointly examined chaplains' current and potential roles in caring for veterans and service members with mental health needs. Our aim was to evaluate the intersection of chaplain and mental health care practices in VA and DoD in order to determine if improvement is needed, and if so, to develop actionable recommendations as indicated by evaluation findings. A 38-member multidisciplinary task group partnered with researchers in designing, implementing, and interpreting a mixed methods study that included: 1) a quantitative survey of VA and DoD chaplains; and 2) qualitative interviews with mental health providers and chaplains. Quantitative: the survey included all full-time VA chaplains and all active duty military chaplains (n = 2,163 completed of 3,464 invited; 62 % response rate). Qualitative: a total of 291 interviews were conducted with mental health providers and chaplains during site visits to 33 VA and DoD facilities. Quantitative: the online survey assessed intersections between chaplaincy and mental health care and took an average of 37 min to complete. Qualitative: the interviews assessed current integration of mental health and chaplain services and took an average of 1 h to complete. When included on interdisciplinary mental health care teams, chaplains feel understood and valued (82.8-100 % of chaplains indicated this, depending on the team). However, findings from the survey and site visits suggest that integration of services is often lacking and can be improved. Closely coordinating with a multidisciplinary task group in conducting a mixed method evaluation of chaplain-mental health integration in VA and DoD helped to ensure that researchers assessed relevant domains and that findings could be rapidly translated into actionable recommendations.

  12. A Case for Open Network Health Systems: Systems as Networks in Public Mental Health.

    Science.gov (United States)

    Rhodes, Michael Grant; de Vries, Marten W

    2017-01-08

    Increases in incidents involving so-called confused persons have brought attention to the potential costs of recent changes to public mental health (PMH) services in the Netherlands. Decentralized under the (Community) Participation Act (2014), local governments must find resources to compensate for reduced central funding to such services or "innovate." But innovation, even when pressure for change is intense, is difficult. This perspective paper describes experience during and after an investigation into a particularly violent incident and murder. The aim was to provide recommendations to improve the functioning of local PMH services. The investigation concluded that no specific failure by an individual professional or service provider facility led to the murder. Instead, also as a result of the Participation Act that severed communication lines between individuals and organizations, information sharing failures were likely to have reduced system level capacity to identify risks. The methods and analytical frameworks employed to reach this conclusion, also lead to discussion as to the plausibility of an unconventional solution. If improving communication is the primary problem, non-hierarchical information, and organizational networks arise as possible and innovative system solutions. The proposal for debate is that traditional "health system" definitions, literature and narratives, and operating assumptions in public (mental) health are 'locked in' constraining technical and organization innovations. If we view a "health system" as an adaptive system of economic and social "networks," it becomes clear that the current orthodox solution, the so-called integrated health system, typically results in a "centralized hierarchical" or "tree" network. An overlooked alternative that breaks out of the established policy narratives is the view of a 'health systems' as a non-hierarchical organizational structure or 'Open Network.' In turn, this opens new technological and

  13. [eHealth in Peru: implementation of policies to strengthen health information systems].

    Science.gov (United States)

    Curioso, Walter H

    2014-01-01

    Health information systems play a key role in enabling high quality, complete health information to be available in a timely fashion for operational and strategic decision-making that makes it possible to save lives and improve the health and quality of life of the population. In many countries, health information systems are weak, incomplete, and fragmented. However, there is broad consensus in the literature of the need to strengthen health information systems in countries around the world. The objective of this paper is to present the essential components of the conceptual framework to strengthen health information systems in Peru. It describes the principal actions and strategies of the Ministry of Health of Peru during the process of strengthening health information systems. These systems make it possible to orient policies for appropriate decision-making in public health.

  14. Priority-setting in health systems

    DEFF Research Database (Denmark)

    Byskov, Jens

    2013-01-01

    improvements work similarly in the vast array of social and other local contextual factors. Local, fair and accountable priority setting processes are neccessary to make the best of ever shifting national level strategies and priorities. An approach is described, which can assist in the involvement......DBL - under core funding from Danish International Development Agency (Danida) 2013 WHY HAVE HEALTH SYSTEMS WHEN EFFECTIVE INTERVENTIONS ARE KNOWN? Case: A teenage mother lives in a poor sub-Saharan village next to a big lake. The area is known to have malaria transmission all year around......, and surveys in nearby villages have shown a high prevalence of intestinal helminthiasis and schistosomiasis. The HIV prevalence in similar rural settings is about 10% in her age group. She has been losing weight over the last months and now her one-year-old child feels hot and is not eating well. She has...

  15. Sustainable food systems for optimal planetary health.

    Science.gov (United States)

    Canavan, Chelsey R; Noor, Ramadhani A; Golden, Christopher D; Juma, Calestous; Fawzi, Wafaie

    2017-06-01

    Sustainable food systems are an important component of a planetary health strategy to reduce the threat of infectious disease, minimize environmental footprint and promote nutrition. Human population trends and dietary transition have led to growing demand for food and increasing production and consumption of meat, amid declining availability of arable land and water. The intensification of livestock production has serious environmental and infectious disease impacts. Land clearing for agriculture alters ecosystems, increases human-wildlife interactions and leads to disease proliferation. Context-specific interventions should be evaluated towards optimizing nutrition resilience, minimizing environmental footprint and reducing animal and human disease risk. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

  16. Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations

    Science.gov (United States)

    de Savigny, Don; Riley, Ian; Chandramohan, Daniel; Odhiambo, Frank; Nichols, Erin; Notzon, Sam; AbouZahr, Carla; Mitra, Raj; Cobos Muñoz, Daniel; Firth, Sonja; Maire, Nicolas; Sankoh, Osman; Bronson, Gay; Setel, Philip; Byass, Peter; Jakob, Robert; Boerma, Ties; Lopez, Alan D.

    2017-01-01

    ABSTRACT Background: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death. Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance. Conclusions: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems. PMID:28137194

  17. Oral health information systems--towards measuring progress in oral health promotion and disease prevention

    DEFF Research Database (Denmark)

    Petersen, Poul Erik; Bourgeois, Denis; Bratthall, Douglas

    2005-01-01

    and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information...... been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health...... programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers...

  18. Application of ubiquitous computing in personal health monitoring systems.

    Science.gov (United States)

    Kunze, C; Grossmann, U; Stork, W; Müller-Glaser, K D

    2002-01-01

    A possibility to significantly reduce the costs of public health systems is to increasingly use information technology. The Laboratory for Information Processing Technology (ITIV) at the University of Karlsruhe is developing a personal health monitoring system, which should improve health care and at the same time reduce costs by combining micro-technological smart sensors with personalized, mobile computing systems. In this paper we present how ubiquitous computing theory can be applied in the health-care domain.

  19. Physicochemical properties of direct compression tablets with spray dried and ball milled solid dispersions of tadalafil in PVP-VA.

    Science.gov (United States)

    Wlodarski, K; Tajber, L; Sawicki, W

    2016-12-01

    The aim of this research was to develop immediate release tablets comprising solid dispersion (IRSDTs) of tadalafil (Td) in a vinylpyrrolidone and vinyl acetate block copolymer (PVP-VA), characterized by improved dissolution profiles. The solid dispersion of Td in PVP-VA (Td/PVP-VA) in a weight ratio of 1:1 (w/w) was prepared using two different processes i.e. spray drying and ball milling. While the former process has been well established in the formulation of IRSDTs the latter has not been exploited in these systems yet. Regardless of the preparation method, both Td/PVP-VA solid dispersions were amorphous as confirmed by PXRD, DSC and FTIR. However, different morphology of particles (SEM) resulted in differences in water apparent solubility and disk intrinsic dissolution rate (DIDR). Both solid dispersions and crystalline Td were successfully made into directly compressible tablets at three doses of Td, i.e. 2.5mg, 10mgand20mg, yielding nine different formulations (D 1 -D 9 ). Each of the lots met the requirements set by Ph.Eur. and was evaluated with respect to appearance, diameter, thickness, mass, hardness, friability, disintegration time and content of Td. IRSDTs performed as supersaturable formulations and had significantly improved water dissolution profiles in comparison with equivalent tablets containing crystalline Td and the marketed formulations. Tablets with both spray dried and ball milled Td/PVP-VA revealed the greatest improvement in dissolution depending on the investigated doses, i.e. 2.5mgand20mg, respectively. Also, dissolution of Td from Td/PVP-VA delivered in different forms occurred in the following order: powders>tablets>capsules. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Homeland security and public health: role of the Department of Veterans Affairs, the US Department of Homeland Security, and implications for the public health community.

    Science.gov (United States)

    Koenig, Kristi L

    2003-01-01

    The terrorist attacks of 11 September 2001 led to the largest US Government transformation since the formation of the Department of Defense following World War II. More than 22 different agencies, in whole or in part, and >170,000 employees were reorganized to form a new Cabinet-level Department of Homeland Security (DHS), with the primary mission to protect the American homeland. Legislation enacted in November 2002 transferred the entire Federal Emergency Management Agency and several Department of Health and Human Services (HHS) assets to DHS, including the Office of Emergency Response, and oversight for the National Disaster Medical System, Strategic National Stockpile, and Metropolitan Medical Response System. This created a potential separation of "health" and "medical" assets between the DHS and HHS. A subsequent presidential directive mandated the development of a National Incident Management System and an all-hazard National Response Plan. While no Department of Veterans Affairs (VA) assets were targeted for transfer, the VA remains the largest integrated healthcare system in the nation with important support roles in homeland security that complement its primary mission to provide care to veterans. The Emergency Management Strategic Healthcare Group (EMSHG) within the VA's medical component, the Veteran Health Administration (VHA), is the executive agent for the VA's Fourth Mission, emergency management. In addition to providing comprehensive emergency management services to the VA, the EMSHG coordinates medical back-up to the Department of Defense, and assists the public via the National Disaster Medical System and the National Response Plan. This article describes the VA's role in homeland security and disasters, and provides an overview of the ongoing organizational and operational changes introduced by the formation of the new DHS. Challenges and opportunities for public health are highlighted.

  1. Are there differences in health information exchange by health system type?

    Science.gov (United States)

    Opoku-Agyeman, William; Menachemi, Nir

    2016-01-01

    Despite the potential of health information exchange (HIE) to improve safety and reduce cost, hospitals have been slow to adopt HIE with only 30% of U.S. hospitals doing so in 2012. The aim of this study was to explore the relationship between different health system types and how they engage in HIE. Data on health system types and engagement in HIE activity were combined with secondary hospital characteristics. Ordinal logistic regression analyses were used to examine the relationship between a scale measuring the level of HIE engagement and health system type controlling for hospital and market characteristics. Data from 1552 hospitals were available for analyses. Overall, hospital in a health system of any kind exchanged more patient data elements (e.g., patient demographics, clinical summaries, laboratory results, medication history, and radiology report) compared with stand-alone hospitals (3.82 vs. 1.80, p centralized health systems, 75 (4.8%) were in centralized physician/insurance health system, 284 (18.3%) were in moderately centralized health system, 391 (25.2%) were in decentralized health system, and 91 (5.9%) were in independent health system. In regression analyses, hospitals belonging to a health system were more likely to exchange patient health data with other hospitals in the same system (OR = 3.94, p < .001) but not with hospitals outside their system (OR = 1.89, p = .445). Across health system types, there was no significant difference in the exchange of patient health data. Hospital engagement in HIE is associated with health system membership. These findings will assist hospital leaders and managers to better understand how the structure and nature of their system may influence what their individual hospital can and cannot do in their decision to engage in HIE and other decisions that support the overall system objectives.

  2. The relationship between local area labor market conditions and the use of Veterans Affairs health services.

    Science.gov (United States)

    Wong, Edwin S; Liu, Chuan-Fen

    2013-03-13

    In the U.S., economic conditions are intertwined with labor market decisions, access to health care, health care utilization and health outcomes. The Veterans Affairs (VA) health care system has served as a safety net provider by supplying free or reduced cost care to qualifying veterans. This study examines whether local area labor market conditions, measured using county-level unemployment rates, influence whether veterans obtain health care from the VA. We used survey data from the Behavioral Risk Factor Surveillance System in years 2000, 2003 and 2004 to construct a random sample of 73,964 respondents self-identified as veterans. VA health service utilization was defined as whether veterans received all, some or no care from the VA. Hierarchical ordered logistic regression was used to address unobserved state and county random effects while adjusting for individual characteristics. Local area labor market conditions were defined as the average 12-month unemployment rate in veterans' county of residence. The mean unemployment rate for veterans receiving all, some and no care was 5.56%, 5.37% and 5.24%, respectively. After covariate adjustment, a one percentage point increase in the unemployment rate in a veteran's county of residence was associated with an increase in the probability of receiving all care (0.34%, p-value = 0.056) or some care (0.29%, p-value = 0.023) from the VA. Our findings suggest that the important role of the VA in providing health care services to veterans is magnified in locations with high unemployment.

  3. 78 FR 62441 - VA Dental Insurance Program-Federalism

    Science.gov (United States)

    2013-10-22

    ...--Federalism AGENCY: Department of Veterans Affairs. ACTION: Direct final rule. SUMMARY: The Department of... that they are submitted in response to ``RIN 2900-AO85-VA Dental Insurance Program-- Federalism... add preemption language in accordance with the discussion above. Executive Order 13132, Federalism...

  4. 78 FR 63143 - VA Dental Insurance Program-Federalism

    Science.gov (United States)

    2013-10-23

    ...--Federalism AGENCY: Department of Veterans Affairs. ACTION: Proposed rule. SUMMARY: The Department of Veterans... that they are submitted in response to ``RIN 2900-AO86-VA Dental Insurance Program-- Federalism... Order 13132, Federalism Section 6(c) of Executive Order 13132 (entitled ``Federalism'') requires an...

  5. What does Shulkin's firing mean for the VA?

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2018-03-01

    Full Text Available No abstract available. Article truncated at 150 words. David Shulkin MD, Secretary for Veterans Affairs (VA was finally fired by President Donald Trump ending long speculation (1. Trump nominated his personal physician, Ronny Jackson MD, to fill Shulkin’s post. The day after his firing, Shulkin criticized his firing in a NY Times op-ed claiming pro-privatization factions within the Trump administration led to his ouster (2. “They saw me as an obstacle to privatization who had to be removed,” Dr. Shulkin wrote. “That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.” Former Secretary Shulkin’s tenure at the VA has had several controversies. First, as undersecretary of Veterans Healthcare and later as secretary money appropriated to the VA to obtain private care under the Veterans Access, Choice, and Accountability Acts of 2014 and the VA Choice and Quality Employment Act of …

  6. Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes.

    Science.gov (United States)

    Valentine, Nicole Britt; Bonsel, Gouke J

    2016-01-01

    Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002-2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems' responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. Health determinants' indicators - access to improved drinking sources, accountability, and average years of schooling - were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child

  7. [Framework for the strengthening of health information systems in Peru].

    Science.gov (United States)

    Curioso, Walter H; Espinoza-Portilla, Elizabeth

    2015-01-01

    In this article we present the essential components and policies that are most relevant regarding the conceptual framework to strengthen the health information systems in Peru. The article also presents the main policies, actions and strategies made in the field of electronic health in Peru that are most significant. The health information systems in Peru play a key role and are expected to achieve an integrated and interoperable information system. This will allow health information to be complete, efficient, of good quality and available in a timely manner to achieve better quality of life for people and allow meaningful modernization of public health in the context of health reform in Peru.

  8. Multimethod evaluation of the VA's peer-to-peer Toolkit for patient-centered medical home implementation.

    Science.gov (United States)

    Luck, Jeff; Bowman, Candice; York, Laura; Midboe, Amanda; Taylor, Thomas; Gale, Randall; Asch, Steven

    2014-07-01

    Effective implementation of the patient-centered medical home (PCMH) in primary care practices requires training and other resources, such as online toolkits, to share strategies and materials. The Veterans Health Administration (VA) developed an online Toolkit of user-sourced tools to support teams implementing its Patient Aligned Care Team (PACT) medical home model. To present findings from an evaluation of the PACT Toolkit, including use, variation across facilities, effect of social marketing, and factors influencing use. The Toolkit is an online repository of ready-to-use tools created by VA clinic staff that physicians, nurses, and other team members may share, download, and adopt in order to more effectively implement PCMH principles and improve local performance on VA metrics. Multimethod evaluation using: (1) website usage analytics, (2) an online survey of the PACT community of practice's use of the Toolkit, and (3) key informant interviews. Survey respondents were PACT team members and coaches (n = 544) at 136 VA facilities. Interview respondents were Toolkit users and non-users (n = 32). For survey data, multivariable logistic models were used to predict Toolkit awareness and use. Interviews and open-text survey comments were coded using a "common themes" framework. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analyses. The Toolkit was used by 6,745 staff in the first 19 months of availability. Among members of the target audience, 80 % had heard of the Toolkit, and of those, 70 % had visited the website. Tools had been implemented at 65 % of facilities. Qualitative findings revealed a range of user perspectives from enthusiastic support to lack of sufficient time to browse the Toolkit. An online Toolkit to support PCMH implementation was used at VA facilities nationwide. Other complex health care organizations may benefit from adopting similar online peer-to-peer resource libraries.

  9. Consultation on the Libyan health systems: towards patient-centred ...

    African Journals Online (AJOL)

    To start the planning process to re-engineer the health sector, the Libyan Ministry of Health in collaboration with the World Health Organisation (WHO) and other international experts in the field sponsored the National Health Systems Conference in Tripoli, Libya, between the 26th and the 30th of August 2012. The aim of ...

  10. The Role of Education in Health System Performance

    Science.gov (United States)

    Grignon, Michel

    2008-01-01

    I investigate the role of education on health, using country-level data and the production frontier framework suggested by the World Health Organization (WHO) to assess performances of health care systems. I find that the impact of human capital on health is much smaller than suggested by the WHO frontier model, and the relationship exhibits…

  11. Implementing a routine health management information system in ...

    African Journals Online (AJOL)

    South Sudan has recently acquired statehood. Planning and management of the health care system, based on evidence, requires a constant flow of information from health services. The Division of Monitoring and Evaluation (M&E) of the Ministry of Health developed the framework for the health sector of the country in 2008.

  12. Performance of community health workers:situating their intermediary position within complex adaptive health systems

    OpenAIRE

    Kok, Maryse. C; Broerse, Jacqueline E.W; Theobald, Sally; Ormel, Hermen; Dieleman, Marjolein; Taegtmeyer, Miriam

    2017-01-01

    Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors. This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income countries. It examines their unique intermediary position between the communities they serve and actors in the health sector, and the complexity of the health systems in which they operate. The assessment...

  13. Guidelines for Psychological Practice in Health Care Delivery Systems

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

    Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

  14. ISWHM: Tools and Techniques for Software and System Health Management

    Science.gov (United States)

    Schumann, Johann; Mengshoel, Ole J.; Darwiche, Adnan

    2010-01-01

    This presentation presents status and results of research on Software Health Management done within the NRA "ISWHM: Tools and Techniques for Software and System Health Management." Topics include: Ingredients of a Guidance, Navigation, and Control System (GN and C); Selected GN and C Testbed example; Health Management of major ingredients; ISWHM testbed architecture; and Conclusions and next Steps.

  15. Global Health Systems and Policy Development: Implications for Health Literacy Research, Theory and Practice.

    Science.gov (United States)

    Rowlands, Gillian; Dodson, Sarity; Leung, Angela; Levin-Zamir, Diane

    2017-01-01

    Accessible and responsive health systems are critical to population health and human development. While progress has been made toward global health and development targets, significant inequities remain within and between countries. Expanding health inequities suggest a widespread and systemic neglect of vulnerable citizens, and a failure to enshrine within policies a responsibility to tailor care to the variable capabilities of citizens. Implementation of health and social policies that drive the design of accessible health systems, services, products and infrastructure represents the next frontier for health reform. Within this chapter we argue the need to consider health and health literacy across policy domains, to operationalize the intent to address inequities in health in meaningful and pragmatic ways, and to actively monitor progress and impact within the context of the Sustainable Development Goals (SDGs). We contend that viewing and developing policies and systems within a health literacy framework will assist in placing citizens and equity considerations at the center of development efforts. In this chapter, we explore the relationship between health literacy and equitable access to health care, and the role of health system and policy reform. We first explore international policies, health literacy, and the SDGs. We then explore national policies and the role that national and local services and systems play in building health literacy, and responding to the health literacy challenges of citizens. We discuss the World Health Organization's (WHO) Framework for Integrated People-Centered Health Services and the way in which health services are being encouraged to understand and respond to citizen health literacy needs. Each section of the chapter ends with a summary and a review of health literacy research and practice. Throughout, we illustrate our points through 'vignettes' from around the world.

  16. Thinking shift on health systems: from blueprint health programmes towards resilience of health systems Comment on "Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries".

    Science.gov (United States)

    Blanchet, Karl

    2015-03-03

    International health is still highly dominated by equilibrium approaches. The emergence of systems thinking in international health provides a great avenue to develop innovative health interventions adapted to changing contexts. The public health community, nevertheless, has the responsibility to translate concepts related to systems thinking and complexity into concrete research methods and interventions. One possibility is to consider the properties of systems such as resilience and adaptability as entry points to better understand how health systems react to shocks. © 2015 by Kerman University of Medical Sciences.

  17. Viewpoint: Re-instating a 'public health' system under universal health care in India.

    Science.gov (United States)

    George, Mathew

    2015-02-01

    I examine possibilities for strengthening essential public health functions in the context of India's drive to implement universal health care. In a country where population health outcomes are rooted in social, political, economic, cultural, and ecological conditions, it is important to have a state mediated public health system that can modify the causes of the major public health problems. This calls for strengthening the social epidemiological approach in public health by demarcating public health functions distinct from medical care. This will be a prerequisite for the growth of the public health profession in the country, because it can offer avenues for newly trained professionals within the country to work in 'core' public health.

  18. Principles and core functions of integrated child health information systems.

    Science.gov (United States)

    Hinman, Alan R; Atkinson, Delton; Diehn, Tonya Norvell; Eichwald, John; Heberer, Jennifer; Hoyle, Therese; King, Pam; Kossack, Robert E; Williams, Donna C; Zimmerman, Amy

    2004-11-01

    Infants undergo a series of preventive and therapeutic health interventions and activities. Typically, each activity includes collection and submission of data to a dedicated information system. Subsequently, health care providers, families, and health programs must query each information system to determine the child's status in a given area. Efforts are underway to integrate information in these separate information systems. This requires specifying the core functions that integrated information systems must perform.

  19. Increment 23/24 Critical Readiness Review Health Maintenance System

    Science.gov (United States)

    Nieschwitz, Linda

    2010-01-01

    This slide presentation reviews the Health Maintenance System. It includes information on the carbon dioxide (CO2) and moisture removal system (CMRS), the variable oxygen system,rendevous station panels, and the crew contamination protection kit (CCPK).

  20. Rationing in health systems: A critical review.

    Science.gov (United States)

    Keliddar, Iman; Mosadeghrad, Ali Mohammad; Jafari-Sirizi, Mehdi

    2017-01-01

    Background: It is difficult to provide health care services to all those in need of such services due to limited resources and unlimited demands. Thus, priority setting and rationing have to be applied. This study aimed at critically examining the concept of rationing in health sector and identifying its purposes, influencing factors, mechanisms, and outcomes. Methods: The critical interpretive synthesis methodology was used in this study. PubMed, Cochrane, and Proquest databases were searched using the related key words to find related documents published between 1970 and 2015. In total, 161 published reports were reviewed and included in the study. Thematic content analysis was applied for data analysis. Results: Health services rationing means restricting the access of some people to useful or potentially useful health services due to budgetary limitation. The inherent features of the health market and health services, limited resources, and unlimited needs necessitate health services rationing. Rationing can be applied in 4 levels: health care policy- makers, health care managers, health care providers, and patients. Health care rationing can be accomplished through fixed budget, benefit package, payment mechanisms, queuing, copayments, and deductibles. Conclusion: This paper enriched our understanding of health services rationing and its mechanisms at various levels and contributed to the literature by broadly conceptualizing health services rationing.

  1. Health system resilience: Lebanon and the Syrian refugee crisis

    Science.gov (United States)

    Ammar, Walid; Kdouh, Ola; Hammoud, Rawan; Hamadeh, Randa; Harb, Hilda; Ammar, Zeina; Atun, Rifat; Christiani, David; Zalloua, Pierre A

    2016-01-01

    Background Between 2011 and 2013, the Lebanese population increased by 30% due to the influx of Syrian refugees. While a sudden increase of such magnitude represents a shock to the health system, threatening the continuity of service delivery and destabilizing governance, it also offers a unique opportunity to study resilience of a health system amidst ongoing crisis. Methods We conceptualized resilience as the capacity of a health system to absorb internal or external shocks (for example prevent or contain disease outbreaks and maintain functional health institutions) while sustaining achievements. We explored factors contributing to the resilience of the Lebanese health system, including networking with stakeholders, diversification of the health system, adequate infrastructure and health human resources, a comprehensive communicable disease response and the integration of the refugees within the health system. Results In studying the case of Lebanon we used input–process–output–outcome approach to assess the resilience of the Lebanese health system. This approach provided us with a holistic view of the health system, as it captured not only the sustained and improved outcomes, but also the inputs and processes leading to them. Conclusion Our study indicates that the Lebanese health system was resilient as its institutions sustained their performance during the crisis and even improved. PMID:28154758

  2. A Case for Open Network Health Systems: Systems as Networks in Public Mental Health

    Directory of Open Access Journals (Sweden)

    Michael Grant Rhodes

    2017-03-01

    Full Text Available Increases in incidents involving so-called confused persons have brought attention to the potential costs of recent changes to public mental health (PMH services in the Netherlands. Decentralized under the (Community Participation Act (2014, local governments must find resources to compensate for reduced central funding to such services or “innovate.” But innovation, even when pressure for change is intense, is difficult. This perspective paper describes experience during and after an investigation into a particularly violent incident and murder. The aim was to provide recommendations to improve the functioning of local PMH services. The investigation concluded that no specific failure by an individual professional or service provider facility led to the murder. Instead, also as a result of the Participation Act that severed communication lines between individuals and organizations, information sharing failures were likely to have reduced system level capacity to identify risks. The methods and analytical frameworks employed to reach this conclusion, also lead to discussion as to the plausibility of an unconventional solution. If improving communication is the primary problem, non-hierarchical information, and organizational networks arise as possible and innovative system solutions. The proposal for debate is that traditional “health system” definitions, literature and narratives, and operating assumptions in public (mental health are ‘locked in’ constraining technical and organization innovations. If we view a “health system” as an adaptive system of economic and social “networks,” it becomes clear that the current orthodox solution, the so-called integrated health system, typically results in a “centralized hierarchical” or “tree” network. An overlooked alternative that breaks out of the established policy narratives is the view of a ‘health systems’ as a non-hierarchical organizational structure or

  3. 76 FR 79067 - Payment or Reimbursement for Emergency Treatment Furnished by Non-VA Providers in Non-VA...

    Science.gov (United States)

    2011-12-21

    ... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN49 Payment or Reimbursement for Emergency..., authorize the Secretary of Veterans Affairs to reimburse eligible veterans for costs related to non-VA.... Specifically, section 1725 authorizes reimbursement for emergency treatment for eligible veterans with...

  4. Information technology law and health systems in the European Union.

    Science.gov (United States)

    Mossialos, Elias; Thomson, Sarah; Ter Linden, Annemarie

    2004-01-01

    This study aims to examine the impact of European Union (EU) law relating to information technology (IT) on health systems. The study identifies EU directives relating to IT, analyzes them in terms of their impact on the use of IT in health systems, and outlines their implications for health technology assessment (HTA). Analysis is based on a review of literature identified through relevant databases and Internet searches. Developments in IT have serious implications for EU health systems, presenting policy makers with new challenges. The European Commission has adopted a range of legal measures to protect consumers in the "information society" However, as few of them are health-specific, it is not evident that they have implications for health, health systems, or HTA, and they may not be effective in protecting consumers in the health sector. In light of the growing importance of IT in the health sector, legal and nonlegal measures need to be further developed at EU and international level. Where possible, future initiatives should pay attention to the particular characteristics of health goods and services and health systems. Although definitions of HTA usually recognize the importance of evaluating both the indirect, unintended consequences of health technologies and the legal aspects of their application, it seems that, in practice, HTA often overlooks or underestimates legislative matters. Those involved in HTA should be aware of the legal implications of using IT to provide health goods and services and compile, store, transfer, and disseminate health information electronically.

  5. A Blueprint for Innovation to Achieve Health System Transformation.

    Science.gov (United States)

    Snowdon, Anne W

    2017-01-01

    Global health systems are challenged by escalating costs and growing demands for care created by the demands of aging populations and rising rates of chronic illness which place unsustainable pressure on health systems to meet population health needs. To overcome these challenges, transformational change is needed to strengthen health system performance and sustainability. Innovation is widely viewed as the strategy to drive transformational change in health systems; yet to date, innovation has lacked a clearly defined focus or agenda to achieve transformation. An actionable innovation agenda is needed to achieve transformational change for health systems. The key conditions for success as an innovation strategy are examined, including clearly defined innovation objectives, key milestones, and actionable steps every system stakeholder must pursue in order to guide the innovation agenda and ultimately accelerate the transformational changes needed for a sustainable healthcare system that delivers value to populations.

  6. Integrating ICTs within health systems | IDRC - International ...

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

    2016-06-10

    Jun 10, 2016 ... ... to help improve service delivery, build local capacity for primary health care, and address the ... There is limited evidence on how electronic health (eHealth) technologies can be ... The world is now home to the greatest num.

  7. Comparing causes of death between formal and informal neighborhoods in urban Africa: evidence from Ouagadougou Health and Demographic Surveillance System.

    Science.gov (United States)

    Soura, Abdramane Bassiahi; Lankoande, Bruno; Millogo, Roch; Bangha, Martin

    2014-01-01

    The probable coexistence of two or more epidemiological profiles in urban Africa is poorly documented. In particular, very few studies have focused on the comparison of cause-specific mortality between two types of neighborhoods that characterize contemporary southern cities: formal neighborhoods, that is, structured or delineated settlements (planned estates) that have full access to public utilities (electricity and water services), and the informal neighborhoods, that is, spontaneous and unplanned peri-urban settlements where people live in slum-like conditions, often with little or no access to public utilities. To compare the causes of death between the formal and informal neighborhoods covered by the Ouagadougou Health and Demographic Surveillance Systems (HDSS). The data used come from the INDEPTH pooled dataset which includes the contribution of Ouagadougou HDSS and are compiled for the INDEPTH Network Data repository. The data were collected between 2009 and 2011 using verbal autopsy (VA) questionnaires completed by four fieldworkers well trained in the conduction of VAs. The VA data were then interpreted using the InterVA-4 program (version 4.02) to arrive at the causes of death. Communicable diseases are the leading cause of death among children (aged between 29 days and 14 years) in both formal and informal neighborhoods, contributing more than 75% to the mortality rate. Mortality rates from non-communicable diseases (NCDs) are very low before age 15 but are the leading causes from age 50, especially in formal neighborhoods. Mortality from injuries is very low, with no significant difference between the two neighborhoods. The fact that mortality from NCDs is higher among adults in formal neighborhoods seems consistent with the idea of a correlation between modern life and epidemiological transition. However, NCDs do affect informal neighborhoods as well. They consist mainly of cardiovascular diseases and neoplasms most of which are preventable and

  8. Comparing causes of death between formal and informal neighborhoods in urban Africa: evidence from Ouagadougou Health and Demographic Surveillance System

    Directory of Open Access Journals (Sweden)

    Abdramane Bassiahi Soura

    2014-10-01

    Full Text Available Background: The probable coexistence of two or more epidemiological profiles in urban Africa is poorly documented. In particular, very few studies have focused on the comparison of cause-specific mortality between two types of neighborhoods that characterize contemporary southern cities: formal neighborhoods, that is, structured or delineated settlements (planned estates that have full access to public utilities (electricity and water services, and the informal neighborhoods, that is, spontaneous and unplanned peri-urban settlements where people live in slum-like conditions, often with little or no access to public utilities. Objective: To compare the causes of death between the formal and informal neighborhoods covered by the Ouagadougou Health and Demographic Surveillance Systems (HDSS. Design: The data used come from the INDEPTH pooled dataset which includes the contribution of Ouagadougou HDSS and are compiled for the INDEPTH Network Data repository. The data were collected between 2009 and 2011 using verbal autopsy (VA questionnaires completed by four fieldworkers well trained in the conduction of VAs. The VA data were then interpreted using the InterVA-4 program (version 4.02 to arrive at the causes of death. Results: Communicable diseases are the leading cause of death among children (aged between 29 days and 14 years in both formal and informal neighborhoods, contributing more than 75% to the mortality rate. Mortality rates from non-communicable diseases (NCDs are very low before age 15 but are the leading causes from age 50, especially in formal neighborhoods. Mortality from injuries is very low, with no significant difference between the two neighborhoods. Conclusions: The fact that mortality from NCDs is higher among adults in formal neighborhoods seems consistent with the idea of a correlation between modern life and epidemiological transition. However, NCDs do affect informal neighborhoods as well. They consist mainly of

  9. Collaboration for Health Systems Analysis and Innovation (CHESAI ...

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

    Adding a social science perspective to the field of health policy and systems research ... Other expected outcomes include publications, teaching material, podcasts, ... implementation of a primary health care reform in a South African province.

  10. Implementing a routine health management information system in ...

    African Journals Online (AJOL)

    combination of appropriate tools, training and support resulted in health facilities, counties ... database for the South Sudan information system was developed in the District Health .... if operating at State level they send reports to the SMOH.

  11. Sensor Area Network for Integrated Systems Health Management, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — The term Integrated Systems Health Management (ISHM) is used to describe a capability that focuses on determining the condition (health) of every element in a...

  12. National healthcare systems and the need for health information governance.

    Science.gov (United States)

    Hovenga, Evelyn J S

    2013-01-01

    This chapter gives an overview of health data, information and knowledge governance needs and associated generic principles so that information systems are able to automate such data collections from point-of-care operational systems. Also covered are health information systems' dimensions and known barriers to the delivery of quality health services, including environmental, technology and governance influences of any population's health status within the context of national health systems. This is where health information managers and health informaticians need to resolve the many challenges associated with eHealth implementations where data are assets, efficient information flow is essential, the ability to acquire new knowledge desirable, and where the use of data and information needs to be viewed from a governance perspective to ensure reliable and quality information is obtained to enhance decision making.

  13. Measuring health systems strength and its impact: experiences from the African Health Initiative.

    Science.gov (United States)

    Sherr, Kenneth; Fernandes, Quinhas; Kanté, Almamy M; Bawah, Ayaga; Condo, Jeanine; Mutale, Wilbroad

    2017-12-21

    Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Using the World Health Organization's health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership's leadership team were asked to list - in rank order - the importance of the six building blocks in relation to their intervention. Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and

  14. Local health systems in 21st century: who cares?-An exploratory study on health system governance in Amsterdam.

    Science.gov (United States)

    Plochg, T; Delnoij, D M J; Hogervorst, W V G; van Dijk, P; Belleman, S; Klazinga, N S

    2006-10-01

    There is a growing awareness that there should be a public health perspective to health system governance. Its intrinsic population health orientation provides the ultimate ground for determining the health needs and governing collaborative care arrangements within which these needs can be met. Notwithstanding differences across countries, population health concerns are not central to European health reforms. Governments currently withdraw leaving governance roles to care providers and/or financiers. Thereby, incentives that trigger the uptake of a public health perspective are often ignored. In this study we addressed this issue in the city of Amsterdam. Using a qualitative study design, we explored whether there is a public health perspective to the governance practices of the municipality and the major sickness fund in Amsterdam. And if so, what the scope of this perspective is. And if not, why not. Findings indicate that the municipality has a public health perspective to local health system governance, but its scope is limited. The municipality facilitates rather than governs health care provision in Amsterdam. Furthermore, the sickness fund runs major financial risks when adapting a public health perspective. It covers an insured population that partly overlaps the Amsterdam population. Returns on investments in population health are therefore uncertain, as competitors would also profit from the sickness fund's investments. The local health system in Amsterdam is not consistently aligned to the health needs of the Amsterdam population. The Amsterdam case is not unique and general consequences for local health system governance are discussed.

  15. Fellowship Program in Health System Improvement: A novel approach integrating leadership development and patient-centred health system transformation.

    Science.gov (United States)

    Philippon, Donald J; Montesanti, Stephanie; Stafinski, Tania

    2018-03-01

    This article highlights a novel approach to professional development, integrating leadership, development and patient-centred health system transformation in the new Fellowship Program in Health System Improvement offered by the School of Public Health at the University of Alberta. Early assessment of the program is also provided.

  16. Reforming the reform: the Greek National Health System in transition.

    Science.gov (United States)

    Tountas, Yannis; Karnaki, Panagiota; Pavi, Elpida

    2002-10-01

    The National Health System (ESY) in Greece, which was established in 1983, is in a state of continuous crisis. This situation is caused mainly by the system's problematic administration, low productivity and inadequate Primary Health Care. These have led the re-elected PASOK government to introduce by the end of 2000 a radical reform of the health system. The 200 reform measures announced by the new Minister of Health and Welfare include changes aiming at: the decentralization of the ESY, the creation of a unified financing system for the social insurance funds, a new management structure in public hospitals, the organization of a Primary Health System in urban areas, and the strengthening of Public Health and Health Promotion. These changes are presented and discussed in this paper.

  17. The impact of mHealth interventions on health systems: a systematic review protocol.

    Science.gov (United States)

    Fortuin, Jill; Salie, Faatiema; Abdullahi, Leila H; Douglas, Tania S

    2016-11-25

    Mobile health (mHealth) has been described as a health enabling tool that impacts positively on the health system in terms of improved access, quality and cost of health care. The proposed systematic review will examine the impact of mHealth on health systems by assessing access, quality and cost of health care as indicators. The systematic review will include literature from various sources including published and unpublished/grey literature. The databases to be searched include: PubMed, Cochrane Library, Google Scholar, NHS Health Technology Assessment Database and Web of Science. The reference lists of studies will be screened and conference proceedings searched for additional eligible reports. Literature to be included will have mHealth as the primary intervention. Two authors will independently screen the search output, select studies and extract data; discrepancies will be resolved by consensus and discussion with the assistance of the third author. The systematic review will inform policy makers, investors, health professionals, technologists and engineers about the impact of mHealth in strengthening the health system. In particular, it will focus on three metrics to determine whether mHealth strengthens the health system, namely quality of, access to and cost of health care services. Systematic review registration: PROSPERO CRD42015026070.

  18. Overcoming Barriers to Rural Children's Mental Health: An Interconnected Systems Public Health Model

    Science.gov (United States)

    Huber, Brenda J.; Austen, Julie M.; Tobin, Renée M.; Meyers, Adena B.; Shelvin, Kristal H.; Wells, Michael

    2016-01-01

    A large, Midwestern county implemented a four-tiered public health model of children's mental health with an interconnected systems approach involving education, health care, juvenile justice and community mental health sectors. The community sought to promote protective factors in the lives of all youth, while improving the capacity,…

  19. System of Health Accounts and Health Satellite Accounts : Application in Low- and Middle-Income Countries

    NARCIS (Netherlands)

    Nakhimovsky, S.; Hernandez-Peña, P.; van Mosseveld, C.; Palacios, A.

    2014-01-01

    Health accounting data that show economic and financial resource flows within a health system are critical to informing health and economic policy – at both national and international levels. However, countries vary widely in their health accounting histories as well as the demand for and capacity

  20. Paying for and receiving benefits from health services in South Africa: is the health system equitable?

    Science.gov (United States)

    Ataguba, John E; McIntyre, Di

    2012-03-01

    There is a global challenge for health systems to ensure equity in both the delivery and financing of health care. However, many African countries still do not have equitable health systems. Traditionally, equity in the delivery and the financing of health care are assessed separately, in what may be termed 'partial' analyses. The current debate on countries moving toward universal health systems, however, requires a holistic understanding of equity in both the delivery and the financing of health care. The number of studies combining these aspects to date is limited, especially in Africa. An assessment of overall health system equity involves assessing health care financing in relation to the principles of contributing to financing according to ability to pay and benefiting from health services according to need for care. Currently South Africa is considering major health systems restructuring toward a universal system. This paper examines together, for both the public and the private sectors, equity in the delivery and financing of health care in South Africa. Using nationally representative datasets and standard methodologies for assessing progressivity in health care financing and benefit incidence, this paper reports an overall progressive financing system but a pro-rich distribution of health care benefits. The progressive financing system is driven mainly by progressive private medical schemes that cover a small portion of the population, mainly the rich. The distribution of health care benefits is not only pro-rich, but also not in line with the need for health care; richer groups receive a far greater share of service benefits within both public and private sectors despite having a relatively lower share of the ill-health burden. The importance of the findings for the design of a universal health system is discussed.

  1. 78 FR 77204 - Proposed Information Collection (VA National Veterans Sports Programs and Special Event Surveys...

    Science.gov (United States)

    2013-12-20

    ... AGENCY: Office of Public & Intergovernmental Affairs, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Office of Public Affairs (OPA), Department of Veterans Affairs (VA), is announcing an... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-NEW] Proposed Information Collection (VA...

  2. Vitamin D in ocular and systemic health

    Directory of Open Access Journals (Sweden)

    Solani D. Mathebula

    2015-06-01

    Vitamin D is produced in skin exposed to sunlight UVB radiation and is then metabolised by the kidney into calciferol, which is an active form. The main function of vitamin D is to promote calcium and phosphorus absorption, and studies have shown that a lack of itplays an important role in ocular conditions, such as age-related macular degeneration and diabetic retinopathy. Recent studies have suggested that vitamin D may protect the diabetic retina; however, other vitamin D-associated conditions (diabetes, hypertension and cardiovascular diseases may result in secondary ocular manifestations and the potential forsight-threatening complications. The purpose of this review is to describe the current literature on the role of vitamin D in ocular and systemic wellness. However, more research is needed to determine if increasing levels of this vitamin can assist in preventing age-related macular degeneration or diabetic retinopathy. Since vitamin D is a circulating steroid hormone, its receptors are found in almost every cell in the human body, and this suggests that vitamin D might have a very broad role for overall health. However, there is still demand for further research to clarify the clinical use of vitamin D in the prevention and treatment of various chronic diseases.

  3. Health Rights and Equity-oriented Health System Change in ...

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

    The private sector is the largest health provider in India, and unregulated private ... and girls in the last two decades, yet gender inequality and gender-based ... View moreIWRA/IDRC webinar on climate change and adaptive water ... Socially equitable climate action is essential to strengthen the resilience of all people, ...

  4. Contributions of Global Health Diplomacy to Health Systems in Sub ...

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

    African policymakers and other relevant actors will be exposed to the arguments, methods, and challenges of global health diplomacy so they can engage more ... L'Association internationale de ressources en eau (IWRA), en étroite collaboration avec le CRDI, organise un webinaire intitulé "Changements climatiques et ...

  5. Development of blood extraction system for health monitoring system

    Science.gov (United States)

    Tsuchiya, Kazuyoshi; Nakanishi, Naoyuki; Nakamachi, Eiji

    2004-03-01

    The purpose of this research is to develop the compact human blood sampling device applied for a health monitoring system(HMS), which is called "Mobile Hospital". The HMS consists of (1) a micro electrical pumping system for blood extraction, (2) a bio-sensor to detect and evaluate an amount of Glucose, Cholesterol and Urea in extracted blood, by using enzyme such as Glucoseoxidase (GOD), Cholesteroloxidase and Urease. The mechanical design elements of the device are bio-compatible microneedle, indentation unit using a shape memory alloy(SMA) actuator and pumping unit using a piezoelectric microactuator. The design concept is the biomimetic micromachine of female mosquito"s blood sampling mechanism. The performances of the main mechanical elements such as indentation force of the microneedle, actual stroke of the indentation unit using a SMA actuator and liquid sampling ability of the pumping unit using PZT piezoelectric microactuator were measured. The 3 mm stroke of the indentation load generated by SMA actuator was 0.8mN. The amount of imitation blood extracted by using bimorph PZT actuators was about 0.5 microliters for 10 sec. A 60-micrometer outer diameter and 25-micrometer inner diameter Titanium microneedle, which size is same as female mosquito"s labium, was produced by sputter deposition.

  6. Point systems in Games for Health: A bibliometric scoping study

    OpenAIRE

    Kokol, Peter

    2018-01-01

    Very few details about point systems used in games for health are reported in scientific literature. To shed some light on this topic a bibliometric study, analyzing the papers containing terms related to games for health and point systems was performed and a mini taxonomy was derived. The search string game* AND health AND (point* OR score) AND system* in a Scopus bibliographic database was used to produce the corpus. We limited the search to articles, reviews and conference papers written i...

  7. Health at the center of health systems reform: how philosophy can inform policy.

    Science.gov (United States)

    Sturmberg, Joachim P; Martin, Carmel M; Moes, Mark M

    2010-01-01

    Contemporary views hold that health and disease can be defined as objective states and thus should determine the design and delivery of health services. Yet health concepts are elusive and contestable. Health is neither an individual construction, a reflection of societal expectations, nor only the absence of pathologies. Based on philosophical and sociological theory, empirical evidence, and clinical experience, we argue that health has simultaneously objective and subjective features that converge into a dynamic complex-adaptive health model. Health (or its dysfunction, illness) is a dynamic state representing complex patterns of adaptation to body, mind, social, and environmental challenges, resulting in bodily homeostasis and personal internal coherence. The "balance of health" model-emergent, self-organizing, dynamic, and adaptive-underpins the very essence of medicine. This model should be the foundation for health systems design and also should inform therapeutic approaches, policy decision-making, and the development of emerging health service models. A complex adaptive health system focused on achieving the best possible "personal" health outcomes must provide the broad policy frameworks and resources required to implement people-centered health care. People-centered health systems are emergent in nature, resulting in locally different but mutually compatible solutions across the whole health system.

  8. 38 CFR 26.7 - VA environmental decision making and documents.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA environmental decision making and documents. 26.7 Section 26.7 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) ENVIRONMENTAL EFFECTS OF THE DEPARTMENT OF VETERANS AFFAIRS (VA) ACTIONS § 26.7 VA environmental decision making and document...

  9. 76 FR 24570 - Proposed Information Collection (Application for VA Education Benefits) Activity; Comment Request

    Science.gov (United States)

    2011-05-02

    ... (Application for VA Education Benefits) Activity; Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA... Under the Montgomery GI Bill, VA Form 22-1990E. c. Application for VA Education Benefits Under the...

  10. 78 FR 18425 - Proposed Information Collection VA Police Officer Pre-Employment Screening Checklist); Comment...

    Science.gov (United States)

    2013-03-26

    ... techniques or the use of other forms of information technology. Title: VA Police Officer Pre-Employment... Police Officer Pre-Employment Screening Checklist); Comment Request AGENCY: Office of Operations... approved collection. Abstract: VA personnel complete VA Form 0120 to document pre- employment history and...

  11. 78 FR 56271 - FY 2014-2020 Draft VA Strategic Plan

    Science.gov (United States)

    2013-09-12

    ... DEPARTMENT OF VETERANS AFFAIRS FY 2014-2020 Draft VA Strategic Plan AGENCY: Department of Veterans... Affairs (VA) is announcing the availability of the FY 2014-2020 Draft VA Strategic Plan (Strategic Plan... Act of 2010 (GPRAMA) (Pub. L. 111-352). The Strategic Plan provides the Department's long-term...

  12. 78 FR 76412 - Agency Information Collection (VA National Rehabilitation Special Events, Event Registration...

    Science.gov (United States)

    2013-12-17

    ... INFORMATION: Titles: a. National Disabled Veterans Winter Sports Clinic Application, VA Form 0924a, c, d and..., c, e. j. Voluntary Service Application, VA Form 0927f. k. National Veterans Summer sports Clinic... Festival Event Application, VA0929a, b, c, d, e, f, g, h. Type of Review: Revision of an already approved...

  13. [European health systems and the integration problem of modern societies].

    Science.gov (United States)

    Lüschen, G

    2000-04-01

    With reference to the national health systems in Germany and the UK we must acknowledge that it was in particular Bismarck's Reform, originally directed toward a solidarity among the socially weak, which entailed in its development a marked redistribution via progressive health fees and standardized health services. In view of Alfred Marshall's original expectations this has resulted in a specific integration of the socially weak and with some difference for nationally tax-financed and social security financed health systems to a genuine contribution towards integration of modern society. An open research question is whether as a consequence of solidarity and integration through health systems there is a decline of social inequality for health. Equally open is the question as to the socio-structural and economic consequences the expansion of modern health systems has.

  14. Corruption in the health care system: the circumstantial evidence.

    Science.gov (United States)

    Ibrahim, Joseph; Majoor, Jennifer

    2002-01-01

    Health care systems are under intense scrutiny, and there is an increasing emphasis on patient safety and quality of care in general. Evidence continues to emerge demonstrating that health systems are performing at sub-optimal levels. The evidence includes the under-use, over-use and mis-use of health care services; new standards asking for respect, dignity, honesty and transparency; the corporatization of health; and the existing inequalities in power and health outcomes. Recommendations for improving health care often refer to increasing the level of collaboration and consultation. These strategies are unlikely to remedy the root causes of our ailing health systems if we accept the circumstantial evidence that suggests the system is rotten.

  15. Kollidon VA64, a membrane-resealing agent, reduces histopathology and improves functional outcome after controlled cortical impact in mice.

    Science.gov (United States)

    Mbye, Lamin H; Keles, Eyup; Tao, Luyang; Zhang, Jimmy; Chung, Joonyong; Larvie, Mykol; Koppula, Rajani; Lo, Eng H; Whalen, Michael J

    2012-03-01

    Loss of plasma membrane integrity is a feature of acute cellular injury/death in vitro and in vivo. Plasmalemma-resealing agents are protective in acute central nervous system injury models, but their ability to reseal cell membranes in vivo has not been reported. Using a mouse controlled cortical impact (CCI) model, we found that propidium iodide-positive (PI+) cells pulse labeled at 6, 24, or 48 hours maintained a degenerative phenotype and disappeared from the injured brain by 7 days, suggesting that plasmalemma permeability is a biomarker of fatal cellular injury after CCI. Intravenous or intracerebroventricular administration of Kollidon VA64, poloxamer P188, or polyethylene glycol 8000 resealed injured cell membranes in vivo (P<0.05 versus vehicle or poloxamer P407). Kollidon VA64 (1 mmol/L, 500 μL) administered intravenously to mice 1  hour after CCI significantly reduced acute cellular degeneration, chronic brain tissue damage, brain edema, blood-brain barrier damage, and postinjury motor deficits (all P<0.05 versus vehicle). However, VA64 did not rescue pulse-labeled PI+ cells from eventual demise. We conclude that PI permeability within 48 hours of CCI is a biomarker of eventual cell death/loss. Kollidon VA64 reduces secondary damage after CCI by mechanisms other than or in addition to resealing permeable cells.

  16. [The Mexican health system: does it require a transformation?].

    Science.gov (United States)

    Chertorivski Woldenberg, Salomón; Fajardo Dolci, German

    2012-01-01

    National health systems represent an organized social response that enables countries to improve, maintain and enhance the health status of their citizens. These evolve and are transformed according to changes in the biological, economic, political and social components of health. In Mexico there is currently a segmented health system, consisting of a bismarckian model of social security and a social protection in health model. The latter developed to comply with the fourth constitutional article by which health is no longer described as a right linked to the employment status of the individual. Given this reality at least three alternatives seem to emerge for the future: the permanence of a mixed health system with social security and social protection institutions with a similar weight within the national health system, or its opposite, the extension of social protection as a mechanism for widespread access. Given the challenges we face, it is desirable to establish a unified health system, the aim should be that health care is universally protected, as currently happens, but is guaranteed through a much more efficient and based in primary care health care system.

  17. Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy

    DEFF Research Database (Denmark)

    Kayser, Lars; Kushniruk, Andre; Osborne, Richard H

    2015-01-01

    BACKGROUND: eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often...... the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information...... model with the domains of a new concept of eHealth literacy. METHODS: This approach expands an existing method for supporting health IT system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs...

  18. HealthStyles: a new psychographic segmentation system for health care marketers.

    Science.gov (United States)

    Endresen, K W; Wintz, J C

    1988-01-01

    HealthStyles is a new psychographic segmentation system specifically designed for the health care industry. This segmentation system goes beyond traditional geographic and demographic analysis and examines health-related consumer attitudes and behaviors. Four statistically distinct "styles" of consumer health care preferences have been identified. The profiles of the four groups have substantial marketing implications in terms of design and promotion of products and services. Each segment of consumers also has differing expectations of physician behavior.

  19. VaR: Exchange Rate Risk and Jump Risk

    Directory of Open Access Journals (Sweden)

    Fen-Ying Chen

    2010-01-01

    Full Text Available Incorporating the Poisson jumps and exchange rate risk, this paper provides an analytical VaR to manage market risk of international portfolios over the subprime mortgage crisis. There are some properties in the model. First, different from past studies in portfolios valued only in one currency, this model considers portfolios not only with jumps but also with exchange rate risk, that is vital for investors in highly integrated global financial markets. Second, in general, the analytical VaR solution is more accurate than historical simulations in terms of backtesting and Christoffersen's independence test (1998 for small portfolios and large portfolios. In other words, the proposed model is reliable not only for a portfolio on specific stocks but also for a large portfolio. Third, the model can be regarded as the extension of that of Kupiec (1999 and Chen and Liao (2009.

  20. Efficiency performance of China's health care delivery system.

    Science.gov (United States)

    Zhang, Luyu; Cheng, Gang; Song, Suhang; Yuan, Beibei; Zhu, Weiming; He, Li; Ma, Xiaochen; Meng, Qingyue

    2017-07-01

    Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system. Copyright © 2017 John Wiley & Sons, Ltd.