Share your vision, voice.
Use the approach discussed here to develop sharing relationships between nurse executives and bedside caregivers.
Communication↗
SEARCH · PubMed Health
Results for “shared approaches”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Improving access to drugs by poor households through a cost sharing drug scheme: a wealth ranking approach.
In Nepal lack of drugs in government health institutions has markedly reduced access to essential drugs by poor patients. Despite the implementation of a drug scheme with adequate availability of drugs and with provision of fee exemption for the poor, the poorest people still had no access to drugs. We carried out a wealth ranking process to identify poorest of the poor households in a village. Each of the poorest household was provided with a free treatment card and information about the availability of free service at the local health post. Baseline and post intervention data on service utilisation and prescribing practices were collected using carbon copies of prescriptions. Data were also collected about the attitude of patients, using qualitative interviews. About 1.8% of the total annual patient visits to the Health Post were from cardholder households. The annual health post utilization rate for the poor patients was about 1.2, whereas among other patients it was 0.7. On average, about 2.4 drugs were prescribed to any of the cardholder patients, and 50.8% of prescriptions included at least one antibiotic drug. No injection was prescribed. Within 18 months, the total fee exemption provided to a poorest household was equivalent to about US dollars 1.6. Since the method is valued by local people, and is also feasible to implement through the communities' efforts, it is recommended to initiate it in other drug scheme areas as well.
Drug Prescriptions↗
Pressure on for gain-sharing demos. Nov. 1 deadline fast approaching, CMS already one step behind.
Explore the source record for details and available documents.
Centers for Medicare and Medicaid Services, U.S.↗
Medical Data GRIDs as approach towards secure cross enterprise document sharing (based on IHE XDS).
Quality and efficiency of health care services is expected to be improved by the electronic processing and trans-institutional availability of medical data. A prototype architecture based on the IHE-XDS profile is currently being developed. Due to legal and organizational requirements specific adaptations to the IHE-XDS profile have been made. In this work the services of the health@net reference architecture are described in details, which have been developed with focus on compliance to both, the IHE-XDS profile and the legal situation in Austria. We expect to gain knowledge about the development of a shared electronic health record using Medical Data Grids as an Open Source reference implementation and how proprietary Hospital Information systems can be integrated in this environment.
Austria↗
Genetics of complex human diseases: genome screening, association studies and fine mapping.
Positional cloning has been applied successfully to many Mendelian disorders. Because of the public health significance, there is strong interest in mapping susceptibility genes for common disorders, such as asthma and allergy, that have a genetic component. Genome-wide screening has been very useful in detecting regions of the genome likely to contain susceptibility genes. There are multiple chromosomal regions implicated in asthma and now the difficult process of finding the genes and relevant mutations is underway. Two approaches that are being utilized are those of association studies in candidate genes, and haplotype sharing or identical by descent (IBD) mapping. Although these are useful approaches, it is important to realize the strengths and limitations of each. The level of significance needed for an initial study or a replication study should be considered in light of the prior evidence for studying a specific gene polymorphism. Haplotype-sharing approaches, although difficult to use in outbred heterogeneous populations, may provide important insight into fine mapping and gene localization.
Asthma↗
HLA matching: a comparison of conventional and molecular approaches.
1. The UNOS national sharing program has produced a 5-fold increase in the number of compatible transplants since 1987. 2. Transplants with 0 broad HLA-antigen mismatches had 87% 1-year graft survival and an 18-year half-life, essentially the same result as with conventional matching. 3. Equally impressive results were obtained with public determinant matching: 1-year graft survival ranging from 84 to 88% and a half-life of 12-15 years. 4. Increasing the number of matched determinants improved the results but reduced the number of compatible recipients identified. 5. Less than 10% of the current transplants have 0 public determinants mismatched. This fraction could be increased to 66% with local sharing and to over 90% with national sharing. 6. The results for cadaver transplants would approach those of related kidneys if compatible grafts were transplanted at the 90% rate obtainable with molecular matching.
Cadaver↗
Anesthesia gas monitoring: central system or stand-alone?
Two approaches to intraoperative anesthetic gas monitoring exist today. Central, mass-spectrometer-based systems share cost and analyzer time among several remote locations. Stand-alone monitors are usually infrared analyzers and are dedicated to a single monitoring location. The advantages and disadvantages of each are due primarily to the shared versus dedicated approaches. Dedicated analyzers, while limited somewhat by infrared technology, offer uninterrupted, real-time analysis of anesthetic and respiratory gases. Central systems offer excellent monitoring but are limited to periodic updates of each monitored location. This article attempts a complete analysis of these and other factors affecting the use, reliability, and cost effectiveness of these two approaches to anesthesia gas monitoring.
Anesthesia, Inhalation↗
The development of a naturalistic data collection system to perform critical incident analysis: an investigation of safety and fatigue issues in long-haul trucking.
Traditionally, both epidemiological and empirical methods have been used to assess driving safety. This paper describes an alternative, hybrid, naturalistic approach to data collection that shares advantages with each traditional approach. Though this naturalistic approach draws on elements of several safety techniques that have been developed in the past, including the Hazard Analysis Technique, instrumented vehicle studies, and fleet studies of driving safety interventions, it has a number of unique elements. Sophisticated instrumented vehicles collected over 400,000 km of commercial vehicle data to address the long-haul trucking application described in this paper. The development of this data collection and analysis method and data collection instrumentation has resulted in a set of valuable tools to advance the current state-of-the-practice in driving safety assessment. An application of this unique approach to a study of long-haul truck driver performance, behavior, and fatigue is described herein.
Adult↗
Decision-making in community-based paediatric physiotherapy: a qualitative study of children, parents and practitioners.
Approaches to practice based on partnership and shared decision-making with patients are now widely recommended in health and social care settings, but less attention has been given to these recommendations in children's services, and to the decision-making experiences of non-medical practitioners and their patients or clients. This study explored children's, parents' and practitioners' accounts of shared decision-making in the context of community-based physiotherapy services for children with cerebral palsy. Semi-structured interviews were conducted with 11 children with cerebral palsy living in an inner city area of northern England, and with 12 of their parents. Two focus groups were conducted with 10 physiotherapy practitioners. Data were analysed using the constant comparative method. When asked explicitly about decision-making, parents, children and practitioners reported little or no involvement, and each party saw the other as having responsibility for decisions. However, when talking in more concrete terms about their experiences, each party did report some involvement in decision-making. Practitioners' accounts focused on their responsibility for making decisions about resource allocation, and thereby, about the usefulness and intensity of interventions. Parents indicated that these practitioner-led decisions were sometimes in conflict with their aspirations for their child. Parents and children appeared to have most involvement in decisions about the acceptability and implementation of interventions. Children's involvement was more limited than parents'. While parents could legitimately curtail unacceptable interventions, children were mostly restricted to negotiating about how interventions were implemented. In these accounts the involvement of each party varied with the type of issue being decided and decision-making appeared more unilateral than shared. In advocating shared decision-making, greater understanding of its weaknesses as well as its strengths, and greater clarity about the domains that are suitable for a shared decision-making approach and the roles of different parties, would seem a helpful step.
Cerebral Palsy↗
A comprehensive quality management approach.
Value analysis and shared governance are two management concepts relatively new to the health care industry. Operating together, they complement each other and can result in a comprehensive "quality management" plan. An example of this model in a purchasing decision illustrates the benefits that can result from use of this collaborative, multidisciplinary approach.
Decision Making, Organizational↗
Epidemiologic concerns for ergonomists: illustrations from the musculoskeletal disorder literature.
Ergonomics and epidemiology are unique fields that share some common interests. Epidemiologic methods are increasingly being utilized in ergonomic studies of the work-related risk factors of musculoskeletal disorders. This multidisciplinary approach requires a shared knowledge base and understanding of the methodology of both disciplines. In this paper, basic epidemiologic concepts are introduced. Examples from the upper extremity musculoskeletal disorder literature are used to illustrate study design issues and to suggest improved study methods. Epidemiologic design problems including selection bias (healthy worker survivor effect), misclassification, and confounding are discussed. Prospective research designs are described as a feasible approach for the study of these disorders. Increased collaboration between ergonomists and epidemiologists is encouraged to improve progress towards the reduction of workplace injuries and illnesses.
Epidemiology↗
Hospital service scope expansion and market share improvement: a dynamic modeling and multivariate approach.
In a national trend, large, acute-care hospitals located in urban areas of the nation were continuously broadening their service scope, adding services at the rate of one each year, from 1982 to 1987. This study proposes that the underlying rationale of hospital service-scope expansion is status-gap minimization. This perspective was quantitatively interpreted and tested by a dynamic modeling analysis. Findings support status-gap minimization as the rationale for service-scope expansion. Using multivariate regression and dynamic modeling analysis, the study demonstrates that the cross-sectional relationship between two steady states--the relationship between service scope and market share--is positive and statistically significant. However, the market share change is not related to hospital service scope. The interpretation offered is that hospitals expand the scope of services looking not so much to increase their market share benefit in the short run as to raise their organizational status. In the long run, higher organizational status such as broader service scope then benefits market share.
Catchment Area, Health↗
Medicaid program; cost sharing demonstrations--HCFA. General notice.
HCFA is soliciting applications from State Medicaid agencies for demonstration projects that will permit States to apply cost sharing to any services for Medicaid eligible individuals. Currently, States are permitted to apply nominal cost sharing to any services for the medically needy, but only to optional services for the categorically needy. Research on cost sharing for the general population indicates it can have an effect on utilization of medical services. By allowing the States greater flexibility to apply a variety of approaches to cost sharing under Medicaid, we expect that States will conduct demonstrations to provide additional, useful information to HCFA, and through HCFA, to all the States, on the effectiveness of several methods of cost sharing. This information should enable HCFA to determine whether alternative methods of cost sharing will further the objectives of the Medicaid program by enabling States to continue to provide medical services. This solicitation also contains information about demonstration requirements and application procedures.
Centers for Medicare and Medicaid Services, U.S.↗
An assessment of the shared-decision model in parents of children with acute otitis media.
OBJECTIVE: Medicine is shifting from a doctor-centered approach to a model entailing more shared decision-making. Many organizations now recommend a shared-decision approach to treating children with acute otitis media (AOM). Our primary objectives in this study were to assess (1) which style of decision-making on the physician's part would most effectively reduce parents' proclivity to use antibiotics for treatment of their child's AOM and (2) parental satisfaction with different doctor-patient decision-making styles. METHODS: We conducted a cross-sectional survey to examine how parents respond to doctor-patient communication styles in 3 clinical vignettes that presented 2 versions of a shared-decision model (SDM) and 1 paternalistic model. Parents were randomly assigned to receive 1 of 3 vignettes. The main predictor variable was the vignette assignment, and the main outcomes were (1) parent proclivity to use antibiotics and (2) parent ratings of care by the physician in the vignette. Using logistic regression, we adjusted for caregivers' age, gender, income, knowledge of antibiotics, decision-making preference, confidence in physician, and length of relationship with personal physician. RESULTS: Four hundred sixty-six parents met inclusion criteria, with a response rate of 94%. General characteristics were similar across vignette assignment groups. Parents who received the paternalistic-model vignettes were more likely to say that they would use antibiotics than those who received the SDM vignettes (odds ratio: 4.9; 95% confidence interval: 2.3-10.6). This result remained statistically significant after adjustment for potential confounders. In addition, parents in the shared-decision groups were more satisfied (93% and 84%) than those in the paternalistic-model group (76%). CONCLUSIONS: To our knowledge, this is the first study to examine parent interest, acceptance, and satisfaction with the SDM. Our findings suggest that shared decision-making for AOM may lead to less antibiotic usage and higher levels of parental satisfaction. Although more studies are needed to examine how best to incorporate parents in the SDM, our study serves as an example of the potential benefit of this approach in pediatric medicine.
Adult↗
Nurse executives' perspectives on succession planning.
Six nurse executives from 5 settings were interviewed to learn more about how succession planning is being applied in today's practice. Their experiences, presented in this article, provide a snapshot of ways succession planning can be applied in different organizations. Interviewees share their personal philosophy, concepts, and approaches to succession planning. Although these nurse executives approach succession planning differently, they share a belief that succession planning is embedded in the nurse executive role and that succession planning is key to sustaining quality nursing practice. Insights and recommendations for further study of succession planning are summarized.
Attitude of Health Personnel↗
Communicating prognosis in the dialysis consent process: a patient-centered, guideline-supported approach.
Recent guidelines recommend shared decision making between patients and nephrologists as the model for dialysis decision making. A key component of this shared decision making is obtaining informed consent. As part of this process, nephrologists have an obligation to inform patients with chronic kidney disease of their prognosis. Ideally, patients themselves should be involved in the decision-making process; however, some patients will not possess decision-making capacity, and others may be unwilling to participate. Determining what to tell patients about prognosis requires tailoring the conversation to the individual patient's preferences. Conversations about prognosis need to occur in a timely fashion so that patients have the opportunity to consider options and make decisions before dialysis is inevitable. Communication strategies are available to assist nephrologists in breaking the bad news of the need for dialysis and its associated burdens. The approach described in this article should help nephrologists discuss prognosis with their patients in a way that is patient centered and in accordance with clinical practice guideline recommendations.
Communication↗
The epistemology of communitarian bioethics: traditions in the public debates.
I consider the problem liberalism poses for bioethics. Liberalism is a view that advocates that the state remain neutral to views of the good life. This view is sometimes supported by a skeptical moral epistemology that tends to propel liberalism toward libertarianism. I argue that the possibilities for shared agreement on moral matters are more promising than is sometimes appreciated by such a view of liberalism. Using two examples of public debates of moral issues, I show that commonly shared intuitions may ground moral principles even if they may be given different weight by persons of different moral and religious traditions. Nevertheless, the fact that the intuition and principle is widely shared may be sufficient to chart some directions for public policy or cooperative action even if they do not lead to complete agreement. As a result, I argue that a liberal communitarianism that presupposes a fairly minimalist epistemology is a legitimate approach to achieving shared agreement in a pluralistic society.
Abortion, Legal↗
Primary care services promoting optimal child development from birth to age 3 years: review of the literature.
OBJECTIVE: To examine the evidence base for primary health care services promoting the optimal development of typically developing children aged birth to 3 years. DATA SOURCES: Peer-reviewed publications addressing clinical evaluations of primary care services from the MEDLINE and PsychINFO databases. STUDY SELECTION: Criteria for selection were as follows: (1) publication between 1979 and 1999; (2) evaluation of efficacy or effectiveness of education, intervention, and care coordination services or validation of assessment approaches; (3) services applicable to an office practice setting; (4) target population including children aged birth to 3 years; and (5) publication in English. DATA EXTRACTION: A total of 312 publications were abstracted and reviewed by both of us; 47 were selected for inclusion. DATA SYNTHESIS: Assessments of parental concerns and psychosocial risk factors using validated approaches seem to be more accurate in identifying developmental problems than clinicians' appraisals. In general, study results support the efficacy of (1) primary care educational efforts toward promoting optimal parent-child interaction, parents' understanding of child temperament, book-sharing activities, and approaches to healthy sleep habits and (2) office interventions such as counseling for the management of excessive infant crying and sleep problems. CONCLUSIONS: The literature suggests that many primary care activities promoting the optimal development of children are efficacious. Evaluations of developmental assessment and services in primary care should be expanded in depth and breadth. The implications for clinical practice, training, and health care policy are discussed.
Child Development↗