PubMed · 9832760
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D B Williams. Case management 2000.. https://pubmed.ncbi.nlm.nih.gov/9832760/
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The potential of electronic communication in medicine is assessed based on an analysis of a pilot project pertaining to internet based communication among referring and hospital physicians. Advantages of electronic data exchange in medicine pertain to speed and capacity for data transfer, availability of data and data integration, ultimately enabling consistent medical case management. Quality requirements of electronic communication of medical data are related to safety, availability, data integration, potential for case management and system qualities. Medical efficiency can be increased by use of electronic communication only if complex functions beyond the substitution of conventional mail by e-mail are implemented and an exhaustive use of the technology can be achieved.
OBJECTIVE: To evaluate if INFECTOM, a multicomponent behaviour change strategy, would alter the care received by children visiting private healthcare providers so that it was more consistent with the IMCI algorithm. METHODS: Community surveys in two low income communities in Pakistan identified children who had visited healthcare providers in the preceding 2 weeks complaining of diarrhoea, cough or rapid breathing, or fever. Interviewers asked the mothers of these children whether providers performed specific behaviours recommended by the Integrated Management of Childhood Illness (IMCI) algorithm. These data were analysed to generate provider-specific IMCI-related behaviour profiles. A team including community representatives met with the providers, discussed the correct IMCI algorithm behaviour, reviewed the percentage of time each of their practices was consistent with IMCI recommendations, and negotiated a contract with a numerical target for improved practices. This cycle of survey, discussion of results and contracting was repeated three times over 10 months. RESULTS: Twenty-two providers, 13 of whom (59%) had a medical degree, regularly treated children in the two communities. Sixteen of the 21 targeted behaviours (76%) occurred with significantly increased frequency during the course of the intervention. Of the 10 practices that ill children with any of the syndromes should have received, at baseline children averaged receiving 4.3. In the final model, each subsequent round of evaluation was associated with a 0.57 increase in the number of appropriate practices performed at visits to non-Bachelor's Degree in Medicine (MBBS) qualified providers (P < 0.001) and a 0.75 increase among visits to MBBS qualified providers (P=0.004). The percentage of children who received an injection decreased from 70 to 56% (P=0.03). CONCLUSIONS: INFECTOM altered the practices of private providers so that they were more consistent with the IMCI algorithm. Efforts to further develop this approach could improve the quality of clinical healthcare in other settings.
Interfaces can cause disruptions in the care provision process. They can, however, also signify a differentiated and specialized division of labour of the care providing system. Three models for the description of interfaces are presented and compared: a linear model oriented towards the continuity of the provision of care for individuals, the Principal Agent (PA) Model from contract theory, and a complex systems model. In all three models coupling and information management are identified as essential interface functions. In regard to optimisation possibilities, the linear model leads to the case-management concept, the PA Model to integrated forms of provision and systems theory to context controlling.