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At least 253 records · Page 14Linked to original sources
PubMed1998

ASHP survey of ambulatory care responsibilities of pharmacists in integrated health systems--1997.

The results of a national survey of the ambulatory care functions of pharmacists in integrated health systems, including managed care organizations, are reported. Persons responsible for ambulatory care pharmaceutical services in 392 integrated health systems nationwide were interviewed by telephone and asked about their systems' organizational characteristics, information systems, pharmacist functions, and performance measures. Respondents reported a range of health-system components, including acute care hospitals, home health services, managed care products, and ambulatory care centers. Approximately 27% of respondents reported that their health system had an electronic medical records system, and 23% reported having one for ambulatory patients. Approximately 49% of respondents indicated that their system had an interdisciplinary care team for ambulatory patients that included a pharmacist. Overall, distributive functions consumed the largest portion (45%) of pharmacists' time, followed by clinical (30%) and administrative (21%) activities. The percentages of time spent on the different functions varied by geographic region and type of health system. Tracking adverse drug reactions, monitoring medication compliance, using pharmacoeconomic data for formulary decision-making, conducting medication management programs, and patient counseling were routinely provided as part of ambulatory care pharmaceutical services by 75% or more of health systems. Financial performance and patient satisfaction were the most frequently used performance-evaluation measures. Overall, pharmacists providing ambulatory care services in integrated health systems spent about 45% of their time on distributive, 30% on clinical, and 21% on administrative functions.

Ambulatory Care↗
PubMedDate not supplied

Change in the population of health systems: from 1985 to 1998.

This article compares the predictions in Stephen Shortell's 1988 seminal article, The Evolution of Hospital Systems: Unfulfilled Promises and Self-Fulfilling Prophesies, with current data on health systems over a 14-year period from 1985 to 1998. Specifically, we review five of Shortell's predictions related to the horizontal growth of health systems and compare these predictions with empirical data on structural changes in the population of health systems. Our analyses suggest that Shortell's predictions corresponded to much of the actual behavior demonstrated in the population over the past one-and-a-half decades. Support was found for the following: (1) health systems form in two recurring stages; (2) previously unaffiliated hospitals are affiliating with existing systems rather than participating in the creation of new systems; and (3) health systems have evolved into five different strata, each of which represents different shares of the population; such population patterns have important implications for individual hospitals and health systems. By attending to patterns of change in the industry's social structure, hospitals and health systems can determine whether it is likely to continue along past trajectories or whether it shows signs of change that may pave way for the breakdown of existing organizational forms, entry of new organizational players, and the emergence of new governance structures.

Delivery of Health Care↗
PubMed1994

Lessons from a child health system on opportunities and threats to quality from networked record systems.

The British Child Health System has been designed and widely implemented to support equity of access to preventive child health services, using case-based integrated records. Lately, telematics has been increasingly applied to improve the timeliness of data entry. A special project has been established to monitor overall quality of the system's use and of the resultant preventive services. The telematics application has been found to be a potential threat to quality in a way which would apply to all remote networked patient-based systems. The demonstration will show the methodology and interim results.

Child↗
PubMed1996

Venturing into new territory--health systems as Medicare risk contractors.

With each congressional budget debate, hospital and health system executives are reminded of their vulnerability to Medicare reimbursement rates. As health maintenance organizations (HMOs) have entered into Medicare risk contracts and negotiated separate hospital reimbursement rates, hospital and health system executives have recognized even less control of their Medicare reimbursement. One way for health systems to regain control of the Medicare dollar is to develop a Medicare risk contract that directly receives and distributes the Medicare risk premium. Before hospital and health system executives invest in the start-up and operational capital necessary to bid for a risk contract, careful analysis of the efficacy of the contract's contribution to the margin should be undertaken. The following will review observations and lessons from HMO Medicare risk contracting and introduce a methodology that health system executives can use to evaluate the annual financial impact of entering the business of direct Medicare risk contracting.

Capitation Fee↗
PubMed1978

Operational measures: indicators of health system performance.

As P.L. 93-641, the National Health Planning and Resources Development Act of 1974 makes clear, Health Systems Agencies (HSAs) were created to improve the costs, availability, accessibility, acceptability, quality, and continuity of the health system. To fulfill this mandate, agencies require clear definitions of these six characteristics and valid measures which can be applied to assess the performance of the existing health system and the impact of proposed modifications. The current state of the planning art does not provide for either of these requirements. This is due to the lack of consensus regarding the definitions of the characteristics and our limited understanding of the variety and validity of measures presently in use. Recognizing these problems, DHEW'S Bureau of Health Planning and Resources Development (BHPRD) initiated a project with The Orkand Corporation in June 1976, to accomplish the following objectives: (1) develop mutually exclusive definitions for the six characteristics; (2) identify and develop model operational measures for each of the characteristics; (3) produce guidelines for the application of these measures; and (4) design a methodology for HSAs to use in appraising the various interrelationships among characteristics. This paper is an introduction to the operational measures project. It describes the operational measures concept and the measures' intended uses. The monograph to be produced by the project is described. Finally, the project findings to date are summarized.

Health Systems Agencies↗
PubMed1996

Primary care research from a health system perspective.

Vertically integrated systems of health care share a set of interests with academic health services researchers. These interests include questions about: the appropriate size and scope of the various system components; mechanisms for coordinating care across component parts; and "what works" in terms of clinical effectiveness within components. Primary care is a key system component in which all of these questions apply. Traditional research designs, however, are often difficult to apply in a health system context. The problems are (1) the rapid pace at which organizational change occurs, which renders some research findings obsolete before they are published, and (2) the difficulty in generalizing across a complex set of local environmental factors that vary from system to system. Useful research from a system perspective will either focus on problems of wide generalizability over place and time or be conducted according to new methodologies that offer much faster "cycle time" from design to findings.

Delivery of Health Care, Integrated↗
PubMed1994

Dimensions of health system reform.

During recent years there has been a growth of worldwide interest in health system reform. Countries at all levels of economic development are engaged in a creative search for better ways of organizing and financing health care, while promoting the goals of equity, effectiveness, and efficiency. Together with economic, political, and ideological reasons, this search has been fueled by the need to find answers to the complexities posed by the epidemiologic transition, whereby many nations are facing the simultaneous burdens of old, unresolved problems and new, emerging challenges. In order to better understand reform attempts, it is necessary to develop a clear conception of the object of reform: the health system. This paper presents the health system as a set of relationships among five major groups of actors: the health care providers, the population, the state as a collective mediator, the organizations that generate resources, and the other sectors that produce services with health effects. The relationships among providers, population, and the state form the basis for a typology of health care modalities. The type and number of modalities present in a country make it possible to characterize its health system. In the last part, the paper proposes that health system reform operates at four policy levels: systemic, which deals with the institutional arrangements for regulation, financing, and delivery of services; programmatic, which specifies the priorities of the system, by defining a universal package of health care interventions; organizational, which is concerned with the actual production of services by focusing on issues of quality assurance and technical efficiency; and instrumental, which generates the institutional intelligence for improving system performance through information, research, technological innovation, and human resource development. The dimensions of reform offer a repertoire of policy options, which need to be enriched by cross-national comparison of experiences and rigorous social experimentation. Maybe then reform will be a more systematic effort, and nations will be better able to learn from each other.

Delivery of Health Care↗
PubMed1992

An American health dilemma: a history of blacks in the health system.

The present black health crisis is a continuum. After 346 years of neglect, flawed efforts were made to admit black Americans to the "mainstream" health system. Gains were significant from 1965 to 1975; however, since then black health status has eroded. Since colonial times, the racial dilemma that affected America's liberal democratic system also distorted medical relationships and institutions. There are clear connections between campaigns to defeat bills that would improve the health of blacks and other disadvantaged groups and acquiescence with the present reassignment of them to the underfunded, overcrowded, inferior, public health-care sector. Physician leadership helped to establish the slaveocracy, create the racial inferiority myths, and build the segregated health subsystem for blacks and the poor. Clearly, if the history-based health disparities are to be resolved, black physician leadership will be necessary. Without justice and equity in health care, the dream of Martin Luther King will never become a reality for African Americans.

Black or African American↗
PubMed2001

[Perspectives of the Tunisian health system reform].

Perspectives of development of the Tunisian health system are presented, in reference to the conceptual framework recommended by the World Health Organization, while a project of health insurance reform of the social security regimes is submitted to a dialogue with the different concerned parts. Recommended orientations articulate around five axes: 1. The promotion of care provision by improving the accessibility to services, notably in zones under served, by introducing new modes of dispensation, organization and management of care provision in the framework of a continuous quality assurance strategy. 2. The financing of health care, with the implementation of the health insurance reform, has to allow an improvement of the financial accessibility of the population to health care, while supervising the evolution of total health expenditures and by developing the system's management capacities. 3. Proposals relative to the mobilization of resources are advanced in areas of medicine, training of health professionals and research on the health system. 4. Adaptation of the health system governance to the new context is necessary and would have to be developed around evolving standards for the health system, on evaluation of its performances and on information and communication with its users. 5. The health system responsiveness, new motion whose contours are again blurred, would have to be analysed and adapted to the specific context of the country.

Decision Making, Organizational↗
PubMedDate not supplied

Local public health agency capacity and its relationship to public health system performance.

he study described in this article identifies local public health agency capacity characteristics that are related to their local public health systems' performance scores on the CDC's National Public Health Performance Standards Program assessment instrument. Public health system performance scores from a test version of the National Public Health Performance Standards instrument (5b) from county and city/county jurisdictions in three states were matched to organizational capacity data from the 1997 National Association of County and City Health Officials profile of health departments, resulting in a sample of 152 jurisdictions. Twenty-eight capacity variables from the profile and all 10 scores on the Essential Public Health Services plus the total performance score were analyzed in 11 separate multivariate regression models. Public health agency capacities in the areas of funding, organizational leadership, and certain nonprovider partnerships were found to be significantly related to public health system performance. Further study is needed to determine if these relationships between agency capacities and system performance are found, with data from other states now using the nationally released performance assessment instruments and with capacity measures that are more specific for evaluating public health system performance.

Health Policy↗
PubMed1996

Managed care in the public mental health system.

The movement towards managed care in the public mental health system has surpassed efforts to develop a systematic literature concerning its theory, practice, and outcome. In particular little has been written about potential challenges and difficulties in translating managed care systems from their origins in the private sector to the delivery of public sector mental health services. This paper provides an overview of managed care definitions, organizational arrangements, administrative techniques, and roles and responsibilities using a theoretical framework adopted from economics referred to as principal-agent theory. Consistent with this theory, we assert that the primary function of the managed care organization is to act as agent for the payor and to manage the relationships between payors, providers, and consumers. From this perspective, managed care organizations in the public mental health system will be forced to manage an extremely complex set of relationships between multiple government payors, communities, mental health providers, and consumers. In each relationship, we have identified many challenges for managed care including the complexity of public financing, the vulnerable nature of the population served, and the importance of synchronization between managed care performance and community expectations for the public mental health system. In our view, policy regarding the role of managed care in the public mental health system must evolve from an understanding of the dynamics of government-community-provider-consumer "agency relationships".

Community Mental Health Services↗
PubMed2004

A framework and toolkit for capturing the communicable disease programmes within health systems: tuberculosis control as an illustrative example.

The frameworks and methods used for analysis, monitoring and evaluation of communicable disease control vary greatly. Although a number of manuals exist instruments for a detailed analysis of wider health system context are lacking. This is surprising given that the success of vertical programmes is often determined by the constraints of health systems. The importance of the context and the health system in determining the successful implementation of national tuberculosis programmes is well recognized by the WHO, which recommends analysis of national tuberculosis programmes within the context of health care system, health reform and the economic status of the country. However, current approaches inadequately capture intelligence on the health systems variables impacting on programme efficacy, limiting the ability of policy makers to draw lessons for wider use. A recent WHO report highlights the major systemic constraints to DOTS implementation and recommends a comprehensive and multi-sectoral approach to tuberculosis control. This obviates the need for tools that take into account health systems issues as well as focusing on a particular vertical programme but no such comprehensive tool exists. This paper outlines the conceptual basis for a model and a toolkit for rapid assessment, monitoring, and evaluation of the context, the elements of the health system and vertical communicable disease programme. It describes the framework, the potential strengths and weaknesses, approach and piloting of the toolkit and its two elements: first for 'horizontal assessment' of the health system within which the programme is embedded and second for 'vertical assessment' of the infectious disease-specific programme.

Communicable Disease Control↗
PubMedDate not supplied

National Public Health Performance Standards: are they a means of evaluating the local public health system?

The organizations, agencies, and entities within a community that contribute to the health of the public through the delivery of essential public health services define the body of the local public health system. These public, private, and voluntary entities have differing roles, relationships, and interactions within the system and for the population served. Combining the Genesee Valley Network and the Livingston County Community Health Partnership in the Year 2000 formed the Genesee Valley Health Partnership, Livingston County, New York, consisting of 30 organizational members. In the spring of 2001, this partnership utilized the 10 Essential Services outlined in Mobilizing for Action through Planning and Partnerships's Local Public Health System Assessment to measure the capacity and performance of Livingston County's local health system. Through a process that asked two basic questions, "What are the components, activities, competencies, and capabilities of our local public health system?" and "How are the Essential Services being provided to our community?" the Partnership determined the following: (1) in 8 out of the 10 Essential Services, the system met the standard by more than 50 percent; and (2) the system excelled in five of the Essential Services. The Partnership concluded that many valuable programs and services were conducted throughout the community; however, partners did not know what services were available, how to access those services, or how to coordinate with each other. The NPHPS provided a standard measurement for the local public health system and identified gaps in the system.

Community Health Services↗
PubMed2000

Using benchmarking data to evaluate and support pharmacy programs in health systems.

The use of benchmarking data to evaluate and support pharmacy programs in health systems is discussed. Benchmarking is a method of comparing the outcomes of health care products, services, and practices at an institution against those of competitors in order to learn what might be improved. Benchmarking programs can provide valuable feedback about both positive and negative outcomes. However, it is imperative to avoid inappropriate comparisons and inappropriate assessments. Ideal services for benchmarking are those that have a good likelihood of improving patient care and other outcomes. Successful benchmarking requires sound and thorough data, which is why as many health systems as possible should participate in a benchmarking program. The National Committee for Quality Assurance has formulated guidelines that should enable health systems to develop an information framework that will improve their ability to collect and use data for benchmarking. Standardization in collecting and submitting information is important because it enables institutions to share data easily. Benchmarking can help health-system pharmacists understand the value and outcomes of efforts by their colleagues at other institutions. In addition, benchmarking can help convince health-system administrators of the value of pharmaceutical services in terms of patient care and the bottom line. Benchmarking provides a means of evaluating and supporting the development of pharmacy programs that improve care and save money.

Benchmarking↗
PubMedDate not supplied

From cooperation to competition in national health systems--and back?: impact on professional ethics and quality of care.

Ethical behaviour in health workers is the jewel in the crown of health services. Health system policies need to nurture a professional service ethic. The primary health care policy envisioned a national health system led by the public sector and based on a philosophy of cooperation. A common theme of 'health sector reform' in OECD countries, introduced in the context of neoliberalism, has been the use of 'managed competition' to increase efficiency. Some countries that flirted with health system competition have returned to cooperation. Market relationships tend to be oppositional and to stimulate self-seeking behaviour. Health system relationships should encourage patient and community centred behaviour. The World Bank and bilateral donors have exported health sector reform theories from the north to the south, involving privatization and marketization policies. This is despite the lack of evidence on their desirability or feasibility of implementing them. Private health care has increased in many developing countries, more as a result of economic crisis and liberalization than specific health sector reforms. Much of this private practice is unlicensed and unregulated, and informal privatization has had a damaging effect on health worker ethics. The lead policy should be reconstruction of the public health system, involving decentralization, democratization and improved management. Commonsense contracting of an existing private sector is different from a policy of proactive privatization and marketization. Underlying the two approaches is whether health care should be viewed as a human right best served by socialized provision or a private good requiring governments only to correct market failures and ensure basic care for the poor. It is a matter of politics, not economics.

Cooperative Behavior↗
PubMed1999

[Participation of dental auxiliary personnel in local health systems].

Though numerous local health systems (sistemas locales de salud, or SILOS) in Brazil employ dental assistants, there is little information on the contributions these workers make to oral health programs. The purpose of this study was to examine the role of such workers in 10 SILOS in five municipalities in the state of São Paulo. Of the 325 dental assistants and dental hygienists employed in those systems, 245 (75.4%) answered a questionnaire that had been prepared. The results showed variations in the degree to which dental assistants participated in oral health promotion activities in the SILOS studied. In some SILOS, these workers devoted more time to dental health promotion activities than to helping perform dental tasks with individual patients. The most frequent oral health promotion activities were fluoride rinses, plaque detection followed by supervised brushing, and educational activities at basic health units and schools. In all cases, dental assistants working in the SILOS played a significant role in helping transform the practice of dentistry within the sphere of public health.

Brazil↗