Developing risk-adjusted monitoring systems: illustration of an approach.
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Health Services Research↗
Biomedical subjects
J E Rohrer
Publications and source records attributed to J E Rohrer.
Measuring health system performance from a community service perspective: the case of pediatric preventive services in Mason City.
The effectiveness of the local medical system may be evaluated using hospital discharge rates. The method is illustrated using the case of preventable pediatric admissions. Results of the analysis support the validity of admission rates for bronchitis and asthma, pneumonia, gastroenteritis, and otitis media as indicators of the primary care delivery system. The results also suggest that the study community, Mason City, Iowa, is performing well on these indicators.
Asthma↗
Community health assessment: diagnosis and prescription.
Community health assessments are ideally a joint effort by all the major health care providers in the community, working in concert with local government, business, and concerned community groups. A noble activity, no doubt, but clearly a lot of trouble. Physicians, whose potential to contribute to community assessments is obvious, frequently avoid them. Whether in management or clinical practice, they ask: Is this really worth my time? Will it make any difference? Isn't there a better way? But, rightly or wrongly, physicians often have a disproportionate amount of influence on the community assessment process. That influence, whether you attribute it to respect, credibility, or power, adds value to the process. The most important quality the physician brings to the process is genuine concern for his or her patients that generalizes to the health of the entire community.
Community Health Planning↗
Small area analysis: descriptive epidemiology in health services research.
Small area analysis is descriptive epidemiology applied to health care events. Several methodological issues complicate such studies. Nevertheless, it is possible to derive several conclusions about the determinants of regional variation in medical care use from the small area analysis literature. Most of these conclusions are specific to the procedures, times, and places studied. Changes in technology, economic incentives, and epidemiological factors may invalidate study findings. Nevertheless, small area analysis studies are useful management tools if performed periodically rather than as one-time events. Small area analysis can contribute to our understanding and control of costs, quality, and the accessibility of care, and thus have relevance for both management and policy.
Adult↗
Determinants of successful community health system planning.
Needs assessment and other community health planning projects are being conducted in many parts of the country. Whether these projects are successful, in that they lead to implementation of recommendations, has not been systematically assessed. This study describes how local public health officials in Iowa view the planning projects that were conducted in their communities. Planning projects occurred in over half of the counties in the state. Most were led by local public health agencies. Hospitals were participants in three-fourths of the projects. Successful implementation was associated with the number of planning techniques used and the breadth of representation on the steering committee. The most common recommendations related to the expansion of prevention/promotion services and community health nursing. Public health nursing had been integrated with local hospitals in one-third of the counties, with no reductions in performance.
Community Health Planning↗
Health planning as social evolution.
Failure to actively plan the health care system has permitted many problems to develop and go uncorrected. However, the notion of a planned health system is out of fashion. In this essay, a rationale is offered that defends a return to development of a planned system. A view of an evolving health system is presented that might be characterized as organic or sociobiological. Drawing from the work of theorists who have applied evolution theory to social science, the author discusses the main elements of a more organized health system and the policy changes required to achieve it. This extension of the theory of evolution suggests that a planned system is more likely to survive environmental disruption. Finally, changes in the roles of planners are suggested.
Biological Evolution↗
Mission-driven marketing: a rural example.
Marketing receives little attention in the academic healthcare management literature, possibly because it is associated with pursuit of profit rather than community benefit. However, a marketing perspective can be applied to the pursuit of the traditional missions of healthcare delivery organizations. Mission-oriented market selection criteria could include characteristics such as relevance to mission, underserved or vulnerable population status, resistance to care, limited resources, and low accessibility. A survey conducted in a rural county is used to demonstrate ways that underserved market segments can be identified and targeted. In the market surveyed, men used less medical care than women; depressed people and those with low levels of education used less medical care than people without these characteristics. Consumers were more likely to defer care because of cost if they lacked health insurance coverage, were female, were under age 55, had fair health status, were depressed, and were chronically ill. Marketing strategies worthy of consideration relate to price (e.g., free care, coupons and sales for eligible individuals), distribution (e.g., visiting nurses, malls and fairs, occupational medicine programs), product (e.g., satisfaction, waiting time, attractiveness, assertive follow-up), and promotion (education about insurance benefits, facilitating development of regular sources of care, health education).
Adult↗