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Biomedical subjects

T G Rundall

Publications and source records attributed to T G Rundall.

At least 19 recordsLinked to original sources
PubMed2001

Hospital restructuring and the work of registered nurses.

American hospitals have undergone three waves of organizational restructuring in the past two decades. These changes have had direct effects on a key set of employees--nurses. A review of the relevant literature to identify the ways in which hospital restructuring affects the work of registered nurses focuses on three important structural characteristics of nursing work: nurses' work roles, workload, and control of work. The review concludes that the impact of restructuring on each of the characteristics affects nurses' satisfaction with their work and may also affect the quality of patient care. While much of the policy debate around restructuring focuses on the extent to which reductions in nurse staffing levels affects quality of care, it is important to examine not only changes in nurse staffing levels, but changes in the work performed by registered nurses, as well.

Decision Making, Organizational↗
PubMed2001

Evidence-based management: from theory to practice in health care.

The rise of evidence-based clinical practice in health care has caused some people to start questioning how health care managers and policymakers make decisions, and what role evidence plays in the process. Though managers and policymakers have been quick to encourage clinicians to adopt an evidence-based approach, they have been slower to apply the same ideas to their own practice. Yet, there is evidence that the same problems (of the underuse of effective interventions and the overuse of ineffective ones) are as widespread in health care management as they are in clinical practice. Because there are important differences between the culture, research base, and decision-making processes of clinicians and managers, the ideas of evidence-based practice, while relevant, need to be translated for management rather than simply transferred. The experience of the Center for Health Management Research (CHMR) is used to explore how to bring managers and researchers together and promote the use of evidence in managerial decision-making. However, health care funders, health care organizations, research funders, and academic centers need wider and more concerted action to promote the development of evidence-based managerial practice.

Academic Medical Centers↗
PubMed2000

Managing patient trust in managed care.

Patient trust has been identified as an important element in the patient-physician relationship. However, common features of managed care, such as risk-sharing, utilization review, and limitations on benefits, may erode the traditionally high trust that patients have in their physicians. High trust is not always justified; rather, an optimal level of trust arises from the level of interdependence between patients and physicians. This analysis of the interrelationship between patient-physician trust and some of the key facets of managed care has important implications for managed care. A return to high levels of trust may be impracticable, and new strategies for balancing trust-building efforts by caregivers with checking mechanisms accessible to patients are recommended.

Confidentiality↗
PubMed1998

Type of health care coverage and the likelihood of being screened for cancer.

OBJECTIVES: This study explored whether type of outpatient health coverage affected the likelihood of men and women aged 20 to 64 years receiving recommended cancer screening procedures. METHODS: Data from the 1989 and 1990 California Behavioral Risk Factor Surveillance Surveys were used to compare Pap smear, mammogram, fecal occult blood test, and proctoscopic examination rates for adults with three different types of private health care coverage (Group/staff model health maintenance organization, Independent Practice Association Model health maintenance organization, indemnity plan) and no outpatient health insurance. Logistic regression models were used to control for sociodemographic and health characteristics and whether individuals had a usual health care provider. RESULTS: Individuals with Group Model health maintenance organization coverage were significantly more likely than those with indemnity plans to have had recent cervical, breast, and colorectal cancer screening, whereas screening likelihood for those with Independent Practice Association model health maintenance organization coverage did not differ substantially from those with indemnity plans. Individuals with no outpatient coverage were less likely to be screened than those with outpatient coverage. The most consistently significant predictor across cancer screening procedures for both men and women was having a usual doctor who knew their medical history. CONCLUSIONS: Adults who had private outpatient insurance were more likely to undergo recommended cancer detection procedures than those who did not. Adults who belonged to a health maintenance organization, which emphasizes and pays for a broader spectrum preventive care, were more likely to receive Pap smears, mammograms, and fecal occult blood tests than those covered by indemnity plans. Receiving care primarily from one doctor significantly increased the likelihood of having screening procedures, irrespective of type of health plan.

Adult↗
PubMed1995

Staffing in AIDS service organizations: the volunteer contribution.

This article reports results from a survey of AIDS service organizations (ASOs) that provide medical and social services to people with AIDS in the Oakland, California, area. The survey was designed to assess organizational and staffing characteristics of ASOs. Forty two of sixty-seven (62.7% response rate) ASOs responded, providing detailed data on their staffing patterns. ASOs that provided social services reported 48.5 percent of their total full-time equivalents (FTEs) as volunteers while medical organizations reported only 9.5 percent of their total FTEs as volunteers. Among the social service providers, ASOs that self-identified as private, non-profit community-based organizations (CBOs) reported greater than half (50.8 percent) of their total FTEs as volunteer staff. All CBOs that reported utilizing more than five volunteer FTEs were AIDS-specific providers and had designated a full-time, paid staff position as volunteer coordinator/director.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The integration of public health and medicine.

President Clinton's American Health Security Act proposes to reform and integrate the medical care and public health service delivery systems. Historically, there have been examples of efforts to integrate public health and medical activities. Yet, while many have acknowledged the inherent value of such an integrated approach to improving health, the fact is that these efforts have had only limited success. The "new deal" President Clinton has proposed for these health institutions is examined in this context. If the notion of integration is taken seriously--that is to mean the extent to which each system's diverse activities complement each other, fitting together to form an integrated whole--then it will not be easy to achieve. Review of the "visions" of public health and medicine and of examples of efforts to integrate public health and medicine in this country suggest five conditions that must be met if successful integration is to be achieved. While the resources necessary to integrate public health and medicine are great, of equal importance is the acceptance of a shared vision of an integrated health care system, and of the respective roles and responsibilities of public health and medical care in that system. The benefits to our nation's health of proceeding in this way, however, are enormous. As we move into the twenty-first century, an integrated system of public health and medical care services is our nation's best hope for not only improving the health of all our citizens, but for closing the "health gap" between socioeconomically disadvantaged groups and the rest of the population.

Clinical Medicine↗
PubMed1990

Restrictive reimbursement policies and uncompensated care in California hospitals, 1981-1986.

To examine the effect of restrictive state, federal, and private hospital reimbursement policies in California, we examined trends in uncompensated care and other deductions from hospital revenues from 1981 to 1986. During a period when the number of uninsured in California increased substantially, uncompensated care grew, but not as rapidly as other deductions from revenue, especially Medi-Cal and private-sector contractual allowances. A trend toward redistribution of uncompensated care from public to private hospitals reversed. Voluntary teaching hospitals, whose Medi-Cal and private-sector contractual allowances grew rapidly, recently reported a decline in uncompensated care. As reimbursement pressures increase, private hospitals may resist pressures to provide uncompensated care, increasing the burden on public institutions and perhaps limiting the access of indigents to quality care.

California↗
PubMed1988

A meta-analysis of school-based smoking and alcohol use prevention programs.

Tobacco and alcohol use among adolescents continue at historically high rates, and school-based interventions designed to deter students from smoking and drinking are increasingly being implemented. This study reports a meta-analysis of 47 smoking and 29 alcohol school-based intervention programs published after 1970. Results indicate that, in general, smoking and alcohol interventions have equally modest effects on immediate behavioral outcomes. Smoking interventions, however, have been more successful than alcohol interventions at altering students' long term behavior. All of the alcohol programs and all but one of the smoking programs reviewed successfully increased knowledge regarding the risks of these behaviors. Attitude change appears to be more difficult to achieve. Twenty-nine of 33 smoking studies and only 19 of 31 alcohol studies successfully changed students' attitudes. Finally, the data indicate that for immediate smoking outcomes and long-term alcohol outcomes innovative interventions relying upon social reinforcement, social norms, and developmental behavioral models are more effective than traditional "awareness" programs designed to inform adolescents about the health risks associated with tobacco and alcohol use. The implications of these findings for future of school-based health promotion programs are discussed.

Adolescent↗
PubMed1985

Public hospitals under contract management. An assessment of operating performance.

Numerous changes in their operating environments have caused many public hospitals to experience serious fiscal deterioration. One increasingly common response to this situation is contracting with private organizations for the provision of total management services. This study examines the effects of these contract management arrangements on the operating performance of public hospitals. Three areas of performance are considered: operating efficiency, service structure, and Medicare/Medicaid case load. Eighty short-term public hospitals operating under contract management in 1980 are compared with 122 traditionally managed public hospitals and 74 hospitals 1-2 years prior to entering contract management. Controlling for a series of hospital and environmental variables, contract managed hospitals display several financial and organizational differences vis a vis the comparison groups. These findings are discussed in terms of their implications for policymakers, hospital managers, and researchers.

Contract Services↗
PubMed1984

The private management of public hospitals.

Since the public sector traditionally has provided the public goods viewed as unprofitable by the private sector, the growing trend to manage public hospitals under outside private contract raises some fundamental issues of concern. It is hypothesized here that the system maintenance and output goals of privately managed public hospitals become increasingly similar to those of investor-owned hospitals. The thesis is empirically tested using documented effects of private contract management on the operative goals of short-term, general hospitals owned by local governmental bodies. Traditionally managed public hospitals matched with the study hospitals on important characteristics serve as the control group. Costs do appear to be reduced under private contract management, but the service structure becomes somewhat altered. It is the task of public health policymakers to reconcile the cost-control and efficiency mechanisms brought about by private management with the community's right of access to comprehensive medical care. Carefully structured regionalization plans--a possible means of providing both--will require the stimulation of more government involvement during an era of cutbacks.

Contract Services↗