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Results for “Models, Organizational”

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At least 271 records · Page 15Linked to original sources

PubMed2003

Work organization and patient care staff injuries: the impact of different care models for "alternate level of care" patients.

BACKGROUND: The number of elderly patients who do not have acute-care needs has increased in many North American hospitals. These alternate level care (ALC) patients are often cognitively impaired or physically dependent. The physical and psychosocial demands on caregivers may be growing with the increased presence of ALC patients leading to greater risk for injury among staff. METHODS: This prospective cohort study characterized several models for ALC care in four acute-care hospitals in British Columbia, Canada. A cohort of 2,854 patient care staff was identified and followed for 6 months. The association between ALC model of care and type and severity of injury was examined using multinomial and ordinal logistic regression. RESULTS: Regression models demonstrated that the workers on ALC/medical nursing units with "high" ALC patient loads and specialized geriatric assessment units had the greatest risk for injury and the greatest risk for incurring serious injury. Among staff caring for ALC patients, those on dedicated ALC units had the least risk for injury and the least risk for incurring serious injury. CONCLUSIONS: The way in which ALC care is organized in hospitals affects the risk and severity of injuries among patient care staff.

Accidents, Occupational↗

PubMed2005

In search of coherence: a view from the Accreditation Council for Graduate Medical Education.

The Conjoint Committee on Continuing Medical Education has developed a position paper, a set of recommendations, and next steps in the reform of continuing medical education (CME). The Accreditation Council for Graduate Medical Education (ACGME) sets standards for and accredits residency programs in graduate medical education and is not directly involved with CME. This article offers a perspective about the Conjoint Committee's recommendations from the executive director of the ACGME. It is a personal rather than an organizational perspective. Each of the 7 recommendations of the Conjoint Committee offers some opportunity for the ACGME and identifies issues that confront medical educators and accreditors at earlier stages of the formation of physicians. The Conjoint Committee's report also exposes the painful reality that organized medicine is almost hopelessly fragmented at a time when it is important to work together. Earlier efforts to produce a more coherent system of professional oversight have failed, but several emerging realities now may make possible what was not before. These include a common language for the competencies needed to practice medicine, common metrics of competence, technologic advances in learning portfolios, conceptual advances about the use of data on physician competence, and an inexorable focus on improvement of patient care. The possibility of patient-centered rather than profession-centered oversight is emerging. The most profound consequence of the Conjoint Committee's work may be a new organizational model, based on readily available data, that enhances trust. If so, a radical transformation of the accreditation of medical education will follow.

Accreditation↗

PubMed2005

On a policy of transferring public patients to private practice.

We consider an economy where public hospitals are capacity-constrained, and we analyse the willingness of health authorities to reach agreements with private hospitals to have some of their patients treated there. When physicians are dual suppliers, we show that a problem of cream-skimming arises and reduces the incentives of the health authority to undertake such a policy. We argue that the more dispersed are the severities of the patients, the greater the reduction in the incentives will be. We also show that, despite the patient selection problem, when the policy is implemented it is often the case that health authorities decide a more intensive transfer of patients to private practice.

Benchmarking↗

PubMedDate not supplied

Intermunicipal health care consortia in Brazil: strategic behavior, incentives and sustainability.

This article studies strategic behavior in municipal health care consortia where neighboring municipalities form a partnership to supply high-complexity health care. Each municipality partially funds the organization. Depending on the partnership contract, a free rider problem may jeopardize the organization. A municipality will default its payments if it can still benefit from the services, especially when political pressures for competing expenditure arise. The main result is that the partnership sustainability depends on punishment mechanisms to a defaulting member, the gains from joint provision of services and the overall economic environment. Possible solutions to the incentive problem are discussed.

Brazil↗

PubMedDate not supplied

Multicenter epidemiologic and health services research on therapeutics in the HMO Research Network Center for Education and Research on Therapeutics.

Research and education programs in therapeutics that combine the data, organizational capabilities, and expertise of several managed care organizations working in concert can serve an important role when a single organization is not large enough to address a question of interest, when diversity in populations or delivery systems is required, and when it is necessary to establish consistency of results in different settings. Nine members of the HMO Research Network, a consortium of health maintenance organizations (HMOs) that perform public domain research, have formed a Center for Education and Research on Therapeutics (CERT), sponsored by the Agency for Healthcare Research and Quality, to conduct multicenter research in therapeutics. The CERT uses a distributed organizational model with shared leadership, in which data reside at the originating organization until they are needed to support a specific study. Extraction of data from the host computer systems, and some manipulation of data, is typically accomplished through computer programs that are developed centrally, then modified for use at each site. For complex studies, pooled analysis files are created by a coordinating center, and then analysed by investigators throughout the HMOs. It is also possible to contact HMO members when necessary. This multicenter environment has several benefits, addressing: (1) a wide array of questions about the safety and effectiveness of therapeutics, (2) the impact of efforts to change clinicians' and patients' behavior, and (3) pharmacoeconomic and pharmacogenetic questions.

Community Networks↗

PubMed2005

High-frequency health data and spline functions.

Seasonal variations are highly relevant for health service organization. In general, short run movements of medical magnitudes are important features for managers in this field to make adequate decisions. Thus, the analysis of the seasonal pattern in high-frequency health data is an appealing task. The aim of this paper is to propose procedures that allow the analysis of the seasonal component in this kind of data by means of spline functions embedded into a structural model. In the proposed method, useful adaptions of the traditional spline formulation are developed, and the resulting procedures are capable of capturing periodic variations, whether deterministic or stochastic, in a parsimonious way. Finally, these methodological tools are applied to a series of daily emergency service demand in order to capture simultaneous seasonal variations in which periods are different.

Delivery of Health Care↗

PubMed2002

Individual and ecological assets and positive developmental trajectories among gang and community-based organization youth.

The Search Institute framework for conceptualizing developmental assets was used in a longitudinal study of African American male youth involved in gangs or in community-based organizations (CBOs) serving youth. Analyses of intraindividual change indicated that individual and ecological assets are linked to positive developmental trajectories among these youth.

Achievement↗

PubMed1976

[Postoperative care of cancer patients: an interdisciplinary responsibility (author's transl)].

Postoperative care of cancer patients is the joint interdisciplinary responsibility of surgeons, general practitioners (GP'S) and registered specialists. The necessary centralization in hosptal is ensured through cooperation on the part of the general practitioners. By means of a standardized follow-up programme, the organizational model described guarantees 9 postoperative check-ups at predetermined intervals within a period of 5 years. Clinical cancer registers are a mark of quality for hospitals and ensure detection and analysis of the pathography of cancer patients. Surgeons must also acquire the knowledge necessary for their use.

Female↗

PubMed1996

Exploring new territory: police organizational responses to child sexual abuse.

Police response to the escalating numbers of child sexual abuse cases has led to the development of a wide range of organizational models within both police departments and the interagency context. This paper compares the results of different models of police intervention in New South Wales, Australia. The data suggest that specialist police units in which police manage the full investigation provide a more comprehensive service than those where the police response is fragmented between units within the police force.

Child↗

PubMed1986

Behavioral medicine: treatment and organizational issues.

Behavioral medicine is a newly emerging field dating back to the early 1970s. In this short time, a great deal of controversy and confusion has arisen as to even the definition of the term. Similarly, there are now a variety of different operational applications of this concept in patient care, research, and health care system organizations. It is proposed that the title "behavioral medicine" be used in the most general way, consistent with the definition developed by the Institute of Medicine meeting in 1978. In it, behavioral medicine is a term designating a very large field and is not analogous to a profession, medical specialty, or discipline. This term denotes a body of psychologic and social knowledge and a set of techniques applied to research, prevention, and treatment of medical illness, including psychiatric illness. By this definition, behavioral medicine treatment techniques would include psychotherapy, hypnosis, relaxation, behavior therapy, behavior modification, biofeedback, and pharmacotherapy. One of the cardinal principles of behavioral medicine as a field is that well-defined treatment techniques are used for specific target symptoms or signs of illness. It is proposed that individual behavioral medicine treatment programs be called by the name of either the specific treatment utilized or of the target(s) of the intervention. It is important to ensure collaboration between the variety of treatment and research programs that would fall under this general definition of behavioral medicine, which includes consultation-liaison psychiatry. An organizational model is proposed that would combine all such programs within a multidisciplinary division of a department of psychiatry. This division might be entitled with one or both names, e.g., "consultation-liaison psychiatry and behavioral medicine." Perhaps most importantly, this new field should not promise more than it may be able to provide, particularly in trying to achieve the biopsychosocial model of medicine. Many factors have contributed to the rise of biomedicine and to the decline of personal medicine, most of them far beyond the scope and control of behavioral medicine.

Behavioral Medicine↗

PubMed1996

Organizational structure and communication strategies of the bypass angioplasty revascularization investigation: a multicenter clinical trial.

Efficient communication is a challenge for the many operating components of a multicenter randomized clinical trial. Traditional management theory states that communications generally flow along a path established by a hierarchical organizational structure. A multicenter clinical trial does not fit traditional organizational models well and requires modification of traditional communication techniques. While the scientific community typically views a clinical trial as one large and cohesive enterprise, at each site the trial may actually be conducted as a small project related to the medical specialty of the investigator. Therefore overall trial management must be accomplished through collaboration rather than through direct management. In the Bypass Angioplasty Revascularization Investigation (BARI), the BARI clinical coordinating center has designed and utilized several mechanisms that facilitate effective communication and administrative control of a multicenter clinical trial. These mechanisms provide a framework of communication techniques that accommodate the specific needs of a complex organization.

Angioplasty, Balloon, Coronary↗

PubMed1982

The optimum utilization and appropriate responsibilities of allied health professionals.

A number of issues related to the optimum utilization and appropriate responsibilities of allied health professionals are raised based upon the perspective of the experience of the U.S. in recent years. Various definitions and concepts related to these issues are presented in order to assess the state of both training and use of allied health professionals in diverse settings. It is suggested that idiosyncratic needs and solutions in specific cultural contexts do not allow a generalizable conclusion to be drawn, although several principles can be put forward. The experience in the development and training of allied health professionals in the U.S. is analyzed using a variety of frameworks, including structural-organizational models as well as an historical approach. An empirical example of the extent and level of responsibilities of a variety of types of allied health professionals is offered, and the role of associated practice characteristics is observed to impinge upon role performance, giving an insight into the problems and potentials of these manpower resources. Finally, a discussion of the western model as a paradigm for allied health professional training and utilization in the global context is considered, and various strategies and suggestions for the future are offered.

Allied Health Personnel↗

PubMed1986

Health sector structures: the case of Belgium.

In Belgium, the formal framework of health care is a composite of public and private practice forming a policy that is the product of negotiation between differing power groups. An inter-university and inter-disciplinary research and development project was set up in 1974 by the Government, in order to inform and prepare a primary health care (PHC) policy. A preliminary evaluation of the project shows that it made major contributions to the development of an acceptable framework of PHC, to political, professional and lay support for PHC, to the development of organizational models for PHC, and to an increase of research capability within PHC. Overall, the project is a clear demonstration that research can be a strategic agent for innovation.

Belgium↗

PubMed2006

Examining the physician's role with assisted living residents.

In response to the rapid growth of the assisted living (AL) residents, this article considers the resulting range of roles, opportunities, and challenges physicians may face as increasing numbers of their older adult patients choose residence in AL facilities. The problem is framed by providing an overview of the AL industry and reviewing AL resident demographics and health status characteristics. The discussion section examines the pervasive involvement of physicians with AL residents, reviews professional position statements on health care in AL, and reviews the emerging AL-focused clinical literature. In conclusion, the paper proposes key elements of a research agenda including establishing baseline physician-AL activity levels, physician collaboration with mid-level practitioners, and exploring physician involvement in chronic care and health promotion in AL.

Activities of Daily Living↗

PubMed2005

ARAMIS project: a comprehensive methodology for the identification of reference accident scenarios in process industries.

In the frame of the Accidental Risk Assessment Methodology for Industries (ARAMIS) project, this paper aims at presenting the work carried out in the part of the project devoted to the definition of accident scenarios. This topic is a key-point in risk assessment and serves as basis for the whole risk quantification. The first result of the work is the building of a methodology for the identification of major accident hazards (MIMAH), which is carried out with the development of generic fault and event trees based on a typology of equipment and substances. The term "major accidents" must be understood as the worst accidents likely to occur on the equipment, assuming that no safety systems are installed. A second methodology, called methodology for the identification of reference accident scenarios (MIRAS) takes into account the influence of safety systems on both the frequencies and possible consequences of accidents. This methodology leads to identify more realistic accident scenarios. The reference accident scenarios are chosen with the help of a tool called "risk matrix", crossing the frequency and the consequences of accidents. This paper presents both methodologies and an application on an ethylene oxide storage.

Accidents, Occupational↗

PubMed2005

Communications systems and their models: Massachusetts parent compliance with recommended specialty care after positive cystic fibrosis newborn screening result.

OBJECTIVE: To evaluate compliance with recommendations for sweat testing/specialty evaluation and genetic counseling after a positive cystic fibrosis newborn screening (CF NBS) result. STUDY DESIGN: All infants with positive CF NBS results require a diagnostic sweat test at a CF center. Results that were "screen positive and diagnosis negative" prompted family genetic counseling. Parent compliance with follow-up protocol recommendations was retrospectively analyzed relative to the communications model in place at a particular CF Center. RESULTS: At each of the 5 MA CF centers, 95% of the CF NBS-positive infants completed recommended sweat testing. In contrast, there was wide disparity in compliance (32%-90%) with completion of genetic counseling between CF centers. CONCLUSION: CF centers that escorted parents through the 2 recommended follow-up steps in 1 day had higher compliance with the second step (genetic counseling) than centers that required a return visit for genetic counseling.

Aftercare↗

PubMedDate not supplied

Transformation for health: a framework for health disparities research.

The task of generating knowledge addressing disparities in health among vulnerable populations in American society is explored. The community-based participatory approach as an alternate paradigm to traditional research is mentioned as a process for understanding the realities of the populations of interest. Identification and testing of mediating and moderating variables is suggested to guide the process of increasing knowledge regarding health disparities. Transformation for Health is proposed as a conceptual framework to study how these third variables influence the relationship between the primary variables of interest. A theoretical example is offered describing the application of the framework to study the mediators and moderators in an investigation of childhood obesity. Analytical challenges in the exploration of "third variables" are described, and the authors recommend that salient methodological issues should be addressed when conducting these types of investigations.

Attitude of Health Personnel↗

PubMedDate not supplied

Access in health services research: the battle of the frameworks.

BACKGROUND: Access is an important concept in the study of the organization, financing and delivery of healthcare services. It is also an important political symbol and policy goal. PURPOSE: This article reviews the major theoretical frameworks that have been used to support the study of access and measure the degree to which healthcare systems have met standards of access. METHOD: The article uses a critical review of the major works of the leading theorists in the field of access studies. DISCUSSION: Theories of access accept that it is a dynamic process where there is the potential for individuals and families to learn and modify their behavior. That learning and adaptation is less often explored in empirical research of access to health care. CONCLUSION: Researchers should consider the more dynamic aspects of access as they attempt to understand how to improve the health care delivery system. Access models can be used to direct the formulation of better health policy if they reflect real world processes.

Community Health Planning↗