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Biomedical subjects

C Brindis

Publications and source records attributed to C Brindis.

At least 19 recordsLinked to original sources
PubMed1997

Benchmarking the perioperative process. I. Patient routing systems: a method for continual improvement of patient flow and resource utilization.

The article presents an overview of the design and application of a real-time patient routing system, based on barcode and local area network technology, that was designed to track the progress of patients during the perioperative process. We present data on all patients undergoing ambulatory surgery. Patients' progress during their surgical stay was recorded at 17 strategic events using this real-time patient tracking technology. These times were used to identify inefficiencies in the perioperative process by identifying bottlenecks and areas of high variation. We found that both raw and actual operating room (OR) utilization efficiency was less than 50%. Points of high variation in a patient's progress occurred during the time from admit to the hospital until the patient was ready for the OR; the time from when a patient was ready for the OR until they were called for; and the time a patient spends in the OR preoperative holding room. Causes for variation were identified and traced back to individual procedures, activities, and work processes. Multidisciplinary improvement teams were created to improve the pinpointed problem areas. The real-time patient routing system is a process that has proven to be highly valuable to all participants in the surgical process in bringing about rational, data driven efficiencies in perioperative services. This process has the potential to facilitate multidisciplinary cooperation in efforts to contain and reduce costs of perioperative services.

Appointments and Schedules↗
PubMed1997

At the crossroads: options for financing college health services in the 21st century.

At a time when increasing numbers of uninsured and underinsured students are attending college, many college health programs face formidable challenges in their efforts to sustain services. As financial pressures increase, college health programs must revisit their funding options, including (1) maintaining the current level and source of funding but requiring additional out-of-pocket fees for certain services from students, (2) establishing their own insurance plans, (3) qualifying as a preferred provider organization, or (4) some combination of the above. Whatever strategies are selected and pursued, college health programs must continue to try to provide quality services at a reasonable cost while maintaining an emphasis on prevention, health education, and the provision of services most needed by the college population, including mental health and substance abuse services.

Adolescent↗
PubMed1995

The associations between immigrant status and risk-behavior patterns in Latino adolescents.

PURPOSE: The purpose of this study was to identify differences in patterns of risk-taking behavior among Latino adolescents with respect to immigrant status and in comparison to their native non-Hispanic white counterparts. METHODS: In fall of 1988 and spring of 1989 a confidential Teen Health Risk Survey was administered to 1,789 students at two high schools in northern California, both of which have a school health center on-site, and which had large numbers of Latino students enrolled. We divided the Latino adolescent population into two groups: Latinos who were born in the United States (native-born Latinos) and Latinos who had immigrated to the United States (Latino immigrants). Eight different risk-taking behaviors were identified for this study: alcohol, cigarette, marijuana, illicit drug use, self-violence, drunk driving, unintended pregnancy, and violence. RESULTS: We found that in general, Latino students engaged in a greater number of risk-taking behaviors than native non-Hispanic whites. The mean number of risk behaviors was highest for Latino immigrants (1.78), followed by native-born Latinos (1.71), and native non-Hispanic whites (.99). A t-test revealed that non-Hispanic whites were statistically different from both Latino populations in either level of risk-taking behavior (p < 0.05). CONCLUSIONS: This sample of immigrant Latino students appeared to be vulnerable to engaging in risk-taking behaviors and did not exhibit the anticipated cultural protective factors associated with recent immigrants. The extent and variety of risk-taking behaviors clearly call for the development of culturally sensitive and accessible health education and health care services within a broader array of social, educational and support services.

Adolescent↗
PubMed1995

The impact of health insurance status on adolescents' utilization of school-based clinic services: implications for health care reform.

PURPOSE: 1) To examine variations among students with different health insurance coverage in their use of school-based clinics (SBCs), reasons for not receiving health care when needed, and reasons for using or not using SBCs, and 2) to determine if insurance status is a significant factor in predicting SBC use, after controlling for demographic variables and health status. METHODS: Confidential questionnaires were administered to 2,860 adolescents attending 3 urban high schools with on-site SBCs. Chi-square and multiple logistic regression analyses were used to assess differences among insurance groups in patterns of SBC use and reasons for clinic use/nonuse. RESULTS: Students with private insurance or HMO coverage had the highest rates of SBC utilization (67% & 66%) and students without health insurance and with Medicaid had the lowest (57% & 59%) (p < 0.01). While there was no difference among adolescents according to insurance group membership in their use of SBC medical services, a significantly higher proportion of students with Medicaid coverage used SBC mental health services. Students without health insurance were less likely to receive health care from any source when it was needed. After controlling for demographic variables and health status, no insurance factors remained significant. CONCLUSIONS: SBC users represent a variety of insurance groups. Health care reform efforts need to take into account the special needs of adolescents and the challenges they face in accessing care that go beyond financial barriers to care. SBC have been shown to provide a convenient and acceptable source of care, as well as offering the opportunity to provide preventive and primary care services to at-risk youth. As the country moves to a managed care environment potential partnerships with SBCs represent a unique opportunity to improve the delivery of care to adolescents, assuring increased access to a package of health services that they need.

Adolescent↗
PubMed1995

Decategorizing health services: interim findings from the Robert Wood Johnson Foundation's Child Health Initiative.

Although results from the evaluation are preliminary thus far, certain tentative conclusions can be reached. First, both care coordination on a small scale and the production of community health report cards are achievable within the relatively short life of a foundation grant. Moreover, both efforts can result in tangible improvements for children and their families. Report cards associated with the initiative have made children's issues more prominent and appear to have led many community leaders to focus greater attention on children's needs. Likewise, many of the care coordination systems developed under the initiative have produced real change for children and their families by guiding them to needed health care and other services. It is important, however, to keep these accomplishments in perspective. While of significant benefit to demonstration communities, the monitoring and care coordination components of this initiative are not unique. A large number of communities have adopted monitoring and reporting programs in recent years. Similarly, care coordination efforts are well established in many communities. What is unique about the RWJF initiative is its attempt at decategorization, and much less progress has been demonstrated for this component. The less-than-hoped-for progress in implementing decategorization at the original sites appears to be the product of a number of interrelated factors. These include an absence of existing models and appropriate technical assistance; political difficulties in gaining cooperation from multiple local agencies involved in service provision; limited progress in establishing needed connections with the state and federal agencies that have authority over categorical programs; and difficulties in implementing major programatic changes when the health care system itself is undergoing rapid change. In combination, these barriers have proven to be largely insurmountable for the originally funded sites, although it is too early in the project to determine which of these factors is predominantly responsible for the lack of success. Whether the newer sites can learn from the experience of the first group and adapt strategies to overcome the multiple hurdles involved remains to be seen. Decategorization is a tool that has the potential to rationalize a fragmented service system by facilitating the coordination of services, especially for children and families with multiple needs. The need for decategorization of funds will not disappear, even if the federal government chooses to combine more of its grant programs to the states into block grants.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1995

Promising approaches for adolescent reproductive health service delivery. The role of school-based health centers in a managed care environment.

Within the arena of adolescent health care, the most critical service delivery issue is access to care. Efforts to contain health care expenditures through managed care plans inevitably conflict with efforts to deliver truly comprehensive preventive services to all adolescents. Because of the substantial increase in risk behaviors, prevention efforts require frequent contacts if interventions are to be made before risk behaviors occur or soon after their onset. In addition, yearly screening for all adolescents is likely to identify many teens who could benefit from early interventions. Enabling school-based health centers to provide services in coordination with managed care systems would go far to ensure access to care, as well as appropriate attention to the special needs of adolescents, in a timely and cost-effective way. Furthermore, that access would not be tied solely to the family's choice of provider or to the provider mandated by the adolescent's insurance plan. Underlying any approach to coordination of services, however, is the need for managed care providers to understand and affirm a preventive care investment in young people as a means of reducing health care expenditures, an investment that would pay dividends not only during the adolescent years but into adulthood as well. Whether the willingness exists to make this investment, when the cost savings may not directly accrue to the adolescent's current HMO, presents a conflict between the present interests of the HMO and the future interests of whatever provider the adolescent sees as an adult. As managed care systems are more widely adopted, it will be important to ensure that they adequately incorporate the service delivery components that have been found to be efficacious in serving adolescents. Given the leading role school-based health centers can play in providing preventive health care and health promotion, managed care providers should be encouraged to develop strong partnerships with such centers, so that the dual goals of high-quality care and cost containment can be achieved.

Adolescent↗
PubMed1995

A case management program for chemically dependent clients with multiple needs.

As part of a 3-year federal demonstration project, San Francisco health clinics provided case management services to chemically dependent individuals who were low-income and often homeless. Many of those participating in the project had also been diagnosed with HIV infection and/or mental illness. The intent of the demonstration project was to use case management as a mechanism for strengthening the linkages between substance abuse treatment and primary care systems. Case management was adopted as the catalyst for increased communication between medical personnel and other service providers to develop a more comprehensive approach to responding to the myriad of client needs. A specially designed management information system (MIS) was developed to help document client information and case management activities, as well as provide a tickler system to improve client continuity. This report integrates both qualitative and quantitative findings to provide a context for understanding case management activities, client problems and successes, and the systemic problems facing clients and case managers in linking primary care, substance abuse treatment, and mental health services.

Adolescent↗
PubMed1993

Health policy reform and comprehensive school health education: the need for an effective partnership.

This article offers a framework for considering how health care reform issues will impact the success of any national movement to implement Comprehensive School Health Education and the potential role that CSHE proponents can play in advocating reforms congruent with CSHE goals. The effectiveness of the CSHE movement within this arena will depend largely on its ability to critically self-diagnose its potential contributions to short-term and long-term positive health outcomes, and on its ability to join forces in ensuring that a variety of health, educational, and social services are made available in nontraditional sites--particularly schools--that are able to reach children and their families. An important step will be to expand the availability of Comprehensive School Health Education throughout the country: only one-half of all states currently mandate Comprehensive School Health Education programs, and implementation is spotty in some of these states. Another boost for the potential role of CSHE proponents can be found in the Year 2000 health objectives, of which more than one-third of 300 objectives geared to promoting health and disease prevention are devoted to the health behavior of school-age children and youth. Many of these objectives can be achieved directly or indirectly in schools, contingent upon appropriate financing and the establishment of CSHE goals as priorities at the policymaking level. An important factor will be the ability of the CSHE movement to provide its programs in the most cost-effective and cost-efficient manner, possibly including redeployment of staff and relocating resources as needed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Financing health care for adolescents: problems, prospects, and proposals.

Currently, one in every seven adolescents, aged 10-18, is uninsured. This translates to nearly 5 million uninsured adolescents nationwide. Uninsured adolescents, as opposed to insured adolescents, are more likely to be members of poor and minority families. In addition, adolescents without health insurance use fewer health services than their insured counterparts even after controlling for health status differences. Improving the health insurance status of adolescents is becoming an important public policy objective, although Congress recently rejected legislation that would have expanded Medicaid coverage for poor adolescents. Despite this setback, legislators and child health associates are increasingly striving for public and private insurance expansions for adolescents. These efforts are described, and the prospects for future improvements in health insurance coverage of adolescents are discussed.

Adolescent↗
PubMed1989

Birth weight outcomes in a teenage pregnancy case management project.

While many comprehensive health care programs for pregnant adolescents are designed to improve the birth weights of the babies born, few provide statistical evidence that they were able to do so. In this study, information was gathered prospectively on 411 mothers in a Teenage Pregnancy and Parenting Program (TAPP) that coordinated medical, educational, and social services through individual case management and agency-level coordination, information on the mothers, their pregnancy, and services received. The low birth weight rate for TAPP participants was significantly lower than the rate for San Francisco teens prior to the establishment of the program (8.1% versus 12.0% p less than 0.05). The mean weights of babies born to teens in TAPP were significantly higher than those in San Francisco after controlling for differences in the race, infant gender, parity, and age (p less than 0.0001). Participation in the TAPP program prior to delivery was more strongly associated with better birth weight outcomes than was race, age, parity, or gender. Participation in the TAPP program was associated with significantly better birth weights independent of receiving a minimal number of prenatal medical visits adequate for the gestational age of the baby at birth. Our results provide evidence of better health outcomes for the babies of teens who had case management that included continuous individual counseling and coordination of health, education, psychosocial, and nutrition services.

Adolescent↗
PubMed1987

Pew Memorial Trust policy synthesis: 3. Adolescent pregnancy: the responsibilities of policymakers.

In recent years, adolescent pregnancy and childbearing have emerged as major health and social policy issues, sparking debates in local and national forums. The concern is a response to rates of adolescent sexual activity, pregnancy, and out-of-wedlock childbirth that have risen sharply in the past 20 years. The deleterious effects of early parenthood, especially in poor communities, have been amply documented; education, future employment, and health status are among the areas affected. Efforts at intervention have ranged from preventing pregnancy by encouraging celibacy to trying to enhance the options available to those who are already parents. Many of these efforts have fallen short, proving unequal to the complexity of the issues being tackled. Relatively successful approaches have also been developed, however, and the synthesis describes several. Strategies addressing the needs of adolescents comprehensively and involving a multiplicity of concerned players appear to be most effective in the long term. There is a pressing need for more program documentation to substantiate this and other promising strategies.

Adolescent↗
PubMedDate not supplied

The interplay of national, state, and local policy in financing care for drug-affected women and children in California.

Recent prevalence studies in California indicate that perinatal alcohol and other drug use remains a serious issue for large numbers of women and their children. In response, national, state and local policymakers have taken steps to address the problem, including increasing funding for treatment services. To gauge the impact of policy attention to this problem, the Center for the Vulnerable Child at Children's Hospital, Oakland, California, surveyed state and local administrators of programs that serve drug-affected women and children in California. Information collected included the scope of program services, indicators of access, and sources of program funding. Surveyed programs were funded through federal, state, county, and foundation sources. Despite new policy and funding initiatives to serve this population, the study found wide gaps between the kinds of services that are believed to be appropriate for drug-affected women and children and the service system that currently exists. Problems in access to care included long waiting times, exclusion of women from programs based on their pregnancy or parenting status, and exclusion of drug-exposed children from programs with medically based eligibility criteria. Program funding sources appeared to impede access, as traditional federal, state, and county funding sources do not support programs that are comprehensive, family-centered, and easily accessible to these women and children. Analysis of the study data suggests that policymakers consider new approaches to promote access to care for these underserved women and children, particularly now as Congress and the states redesign health and social service funding mechanisms and delivery systems.

Adult↗
PubMedDate not supplied

Options for recovery: promoting success among women mandated to treatment.

In recent years imprisonment has been used increasingly for a wide range of nonviolent and petty offenses committed by women. Among incarcerated women, particularly those who are pregnant or parenting, substance use and its deleterious consequences are often exacerbated by imprisonment. Women who have been identified as chemically dependent are also at high risk for losing custody of their children. In California, the Options for Recovery (OFR) treatment program provided an alternative to incarceration or relinquishment of custody of children for chemically dependent pregnant and parenting women. This three-year pilot project offered alcohol and other drug abuse treatment and case management to these women, and included special training and recruitment of foster parents for their children. Findings from a three-year, multimethod evaluation study showed that women who were mandated to OFR treatment programs were more likely to successfully complete treatment than women who had enrolled in OFR voluntarily. An economic analysis of the costs associated with women in OFR compared with the combined costs of incarceration and alcohol and other drug abuse treatment produced a ratio in favor of OFR. Additionally, some innovative service alternatives for women mandated to treatment were developed during the project. The impact of such changes have implications for improving women's and family health.

Adult↗
PubMedDate not supplied

Trends in rates of live births and abortions following state restrictions on public funding of abortion.

Abortion rates rose following the expanded legalization of abortion by the Supreme Court decision in Roe v. Wade. As a result, the impact of the restriction on Federal funding of abortions under the Hyde Amendment in 1977 was not clear. However, abortion rates had plateaued by 1985, when State funding of Medicaid abortions was restricted in Colorado, North Carolina, and Pennsylvania. Analysis of statewide data from the three States indicated that following restrictions on State funding of abortions, the proportion of reported pregnancies resulting in births, rather than in abortions, increased in all three States. In 1985, the first year of State restrictions on the use of public funds for abortion, Colorado, North Carolina, and Pennsylvania recorded 1.9 to 2.4 percent increases in the proportion of reported pregnancies resulting in live births, after years of declining rates. With adjustments for underreporting of abortion, there was an overall 1.2 percent rise in the proportion of pregnancies resulting in live births in those States. Nationally the proportion rose only 0.4 percent. By 1987, the three States had experienced increases above 1984 levels of 1.6 to 5.9 percent in the proportion of reported pregnancies resulting in live births. The experiences of the three States can be used in projecting an expected increase in the proportions of reported pregnancies resulting in live births, rather than in abortions, for similar States. A projection for California, for example, showed that an increase could be expected in the first year of restrictions on the use of public funds for abortion of at least 4,000 births, which could be expected largely to affect women of low income.

Abortion, Legal↗
PubMedDate not supplied

High fertility among Indochinese refugees.

From 1975 to 1988, nearly 900,000 Indochinese refugees were resettled in the United States. This paper examines patterns of fertility among these refugees from Cambodia, Laos, and Vietnam who have exhibited high levels of reproduction since their arrival. Data are drawn from sample surveys in San Diego and San Francisco, CA. Fertility levels were found to exceed five children per ever-married woman, a level that is consistent with perceptions of ideal family size in the homeland. Fertility levels were significantly higher among rural second-wave refugees than in the more urban first-wave groups. One explanation for the high fertility is that couples have migrated from areas where fertility is high, and they have not yet adapted their reproductive behavior to the low fertility environment of the United States. This possibility is reinforced by a general gender preference for boys and exacerbated by the fact that, while a majority of women are aware of methods of fertility control, access is still limited by cultural and financial barriers, and the motivation to use family planning still appears to be relatively low. The data suggest that this refugee population will continue to put pressure on maternal and child health resources, and that continued residence in the United States could lead to desires to limit family size, thus increasing demand for methods of fertility control.

Adult↗