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At least 361 records · Page 20Linked to original sources
PubMed1998

Economic evaluation of programmes aiming at eradicating infectious diseases.

The subject of this article is to discuss the global and regional economic aspects of programmes for eradicating infectious diseases. The perspective on the issue is that scarce health care resources should be employed in the best possible way. The task is then to examine what the best possible use might be. A starting point is by asking the relevant policy questions attached to eradications: Is there a suitable technique, what are the costs, and what are the benefits? Of particular importance is the opportunity cost of using resources on eradication when other health care problems may require more urgent donation of resources. The paper attempts to set up a generic model for economic evaluation of eradication programmes. But, as there are many different treatment strategies varying from one country to another, such a generic model may need modifications to suit a particular strategy. However, the paper is contextual and should only be viewed as guidance for those wishing to conduct an economic analysis of eradication programmes, or as a initiative to create discussion among health care decision makers.

Communicable Disease Control↗
PubMed1980

Evaluation of an EMS regional referral system using a tracer methodology.

To improve patient care, cost effectiveness, and resource utilization, the Illinois EMS Program attempted to regionalize emergency medical care services by identifying referral centers for critically ill and injured patients. The performance of one referral region was evaluated applying a tracer method designed to tract patients whose clinical conditions, as determined by a clinical panel, required treatment at a designated regional center. The proportion of patients reaching the appropriate centers suggests that the regional referral system under study appropriately moved only about one half the patients with the tracer conditions to the designated referral center. Additional patients were transferred to hospitals with greater emergency department capabilities, although these hospitals were no formally designated centers. Except for low birth weight, factors that might be associated with referral patterns indicate no significant differences between those patients at the regional center and those treated elsewhere.

Adolescent↗
PubMed1989

The impact of a regionalized trauma system on trauma care in San Diego County.

A review of autopsy reports on traumatic deaths in 1986 was conducted to determine the impact on trauma mortality of the regionalized trauma system instituted in San Diego County in 1984. Determination of preventable death was made by a panel of experts and compared with an identical review of traumatic deaths in 1979, five years before the institution of regionalized trauma care. Of 211 traumatic deaths reviewed from 1986, two (1%) were classified as preventable, compared with 20 of 177 (11.4%) deaths in 1979 (P less than .001). A breakdown of trauma deaths into central nervous system and noncentral nervous system categories revealed the overall decline was in large part a consequence of the decline in non-central nervous system deaths from 16 of 83 in 1979 to one of 62 in 1986 (P less than .005). The decrease in central nervous system-related preventable deaths from four of 94 in 1979 to one of 149 in 1986 (P less than .10) was not statistically significant. Although it is likely the trauma system introduced in 1984 contributed to the decline in preventable death, it is not possible to isolate this variable from other changes that occurred during the interval between studies. A review of trauma deaths over the same time interval in a community with similar demographics but without a trauma system might help determine the relative contribution of the trauma system.

Adult↗
PubMedDate not supplied

[Financing regional health services. Problems and possible solutions].

The purpose of this paper is to highlight the fact that the present financial system of the Health Regional Services is constraining their management and development possibilities and thus, the System designed in the General Law of Health (Ley General de Salud); moreover, it is, hindering the development of the Autonomous Communities themselves, as the financing of these services is a hard weight to carry, within the own financing process of the Autonomous Communities. We just try to demonstrate there is no reason whatsoever that may justify the present financing procedure of the Health Services already Transferred to Government of the Autonomous Communities. We deem it is necessary to change such model, in order that principles of sufficiency, autonomy and interterritorial solidarity become effective. We are also of the opinion that we are now living the adequate moment to overcome these problems, as it is our must to renegotiate the application, for the five-year period 1992-1995, of the principles under the Organic Law for the financing of the Autonomous Communities. (Spanish, LOFCA).

Budgets↗
PubMed1997

Directly observed therapy in New York City. History, implementation, results, and challenges.

The history of the New York City Department of Health Bureau of Tuberculosis Control Program, and the events leading to the adoption of wide-scale directly observed therapy (DOT) in 1992 are described. The organization and role of Department of Health and non-Department of Health directly observed programs are discussed. Details are provided regarding the Department of Health's program: the use of standard treatment and program protocols, the use of incentives and enablers, a profile of the successful DOT worker, the detention program, and other issues. Program data and outcomes from 1992 through 1995 are presented, along with some of the challenges and questions for the future.

Communicable Disease Control↗
PubMed2001

The health promoting hospital (HPH): concept and development.

Health promoting hospitals (HPH) is a concept for hospital development that builds upon the health promotion concept of the WHO Ottawa Charter for health promotion, where the reorientation of health care services is considered as one of five major action areas for an overall health promotion development. The article outlines what such a re-orientation may mean for the main hospital functions. These include: the health promoting hospital setting; health promoting workplaces, the provision of health (related) services, training, education and research; the hospital as an advocate and "change agent" for health promotion in its community/environment; the "healthy" (metaphorically speaking) hospital organisation. Based on the concept, an international network of WHO, Europe has been developing since the late 1980s. The main projects of the international network so far were the first model project "health and hospital" (Vienna, 1989-1996), the European pilot hospital project of HPH (1993-1996), and the development of national/regional HPH networks (ongoing since 1995). It is argued that the further development of the HPH network will have to take into account some major changes that have occurred in the hospital landscape since the start of the network: the quality movement and, as a sub-set of this, the increasing importance of evidence based medicine.

Community Health Planning↗
PubMedDate not supplied

Characteristics of women-only and mixed-gender drug abuse treatment programs.

Specialized substance abuse treatment programs have been developed for women within the past two decades. This article presents the results of a secondary analysis of a regional database of drug abuse treatment programs that compared the characteristics of women-only (WO) and mixed-gender (MG) programs across three treatment modalities. In general, WO programs differed from MG programs in their policies regarding fees, sources of payment, special populations served, services offered, and treatment capacity, process, and duration. The differences in program characteristics reflect broader societal gender differences, including women's generally lower economic status and primary responsibility for child-rearing.

Adult↗
PubMed2002

A renal critical care educator: the interface between paediatric intensive care and nephrology.

This paper describes the new role of a renal critical care educator who is based in a regional paediatric renal unit 'outreaching' to three paediatric intensive care units (PICUs) within the region. For the first 18 months the objectives of training PICU staff in all aspects of haemofiltration has progressed in all units using flexible training programs which are under constant evaluation using questionnaires. The renal critical care educator has also worked alongside staff whilst continuous veno-venous haemofiltration (CVVH) is being performed to further instill confidence. Equipment and protocols have been largely standardised throughout the region and an ongoing survey of CVVH use has been initiated which should help to inform audit standards such as complication rates. The renal critical care educator has been the catalyst for the formation of a regional haemofiltration group which has shared in the development of guidelines and protocols and discussion of clinical data. Since CVVH is used infrequently in many PICUs the development of the renal critical care educator post could serve as a model for the development and maintenance of skills in other regions.

Attitude of Health Personnel↗
PubMed2000

An educational intervention for front-line health professionals in the assessment and management of suicidal patients (The STORM Project).

BACKGROUND: Suicide prevention is a health priority in many countries. Improved management of suicide risk may improve suicide prevention. This study aimed to assess the feasibility of health district-wide training in the assessment and management of people at risk of suicide; and to assess the impact of training on assessment and management skills. METHODS: Staff in three health care settings, namely primary care, accident and emergency departments and mental health services (N = 359), were offered suicide risk management training in a district-wide programme, using a flexible 'facilitator' approach. The main outcomes were the rate of attendance at training, and changes in suicide risk assessment and management skills following training. RESULTS: It was possible to deliver training to 167 health professionals (47 % of those eligible) during a 6 month training period. This included 95 primary care staff (39%), 21 accident and emergency staff(42%) and 51 mental health staff (78%). Of these, 103 (69%) attended all training. A volunteer sample of 28 staff who underwent training showed improvements in skills in the assessment and management of suicide risk. Satisfaction with training was high. The expected costs of district-wide training, if it were able to produce a 2.5% reduction in the suicide rate, would be 99,747 pound sterling per suicide prevented and 3,391 pound sterling per life year gained. CONCLUSIONS: Training in the assessment and management of suicide risk can be delivered to approximately half the targeted staff in primary care, accident and emergency departments and mental health services. The current training package can improve skills and is well accepted. If it were to produce a modest fall in the suicide rate, such training would be cost-effective. However, a future training programme should develop a broader training package to reach those who will not attend.

Adult↗
PubMed1992

Organizing for cancer control. The diffusion of a dynamic innovation in a community cancer network.

This paper examines the diffusion of a "dynamic" innovation--research on the prevention and control of cancer--in a community cancer network. By analyzing the social structures and communication strategies of network members, as well as the attributes of the innovation, the authors explain why this innovation is diffusing more slowly than its "formed" counterpart--research on the treatment of cancer.

Diffusion of Innovation↗
PubMed2000

The Assaulted Staff Action Program (ASAP) and declines in rates of assault: mixed replicated findings.

The Assaulted Staff Action Program (ASAP) is a crisis intervention program that has been associated with providing both needed support for employee victims of patient assault and declines in rates of assaults in traditional state hospital and community mental health settings. This study examined the possible role of ASAP and declines in rates of assault in three community-based services impacted by privatization and managed care approaches: community residences, an acute care rural community mental health center, and an urban intermediate/extended care facility. ASAP was associated with a statistically significant decline in the rate of assault in the intermediate/extended care facility. The community residence program was not a true test because of structural issues associated with managed care. The community mental health center appeared to be a true failed replication. The extended care facility's decline in the rate of assault was interrupted by the aftermath of one serious clinical incident during one month and then continued to decline. The implications are discussed.

Adult↗
PubMed2000

Commissioning regional specialist services-HIV and AIDS. Experiences of a consortium arrangement in the North East of England.

The introduction of effective double combination therapy for HIV disease in 1996 and triple therapy in 1997 had cost implications for both purchasers and providers of regional specialist services. There is evidence that more patients presented for treatment. A consortium purchasing approach was undertaken in the North East of England to manage the introduction of combination therapy, to ensure that therapy was available for those who could benefit and to minimise the financial risk for individual health districts. The strengths and weaknesses of such an approach are discussed as well as the potential application to commissioning other specialist services.

Anti-HIV Agents↗
PubMed2002

Supermarket model for vascular disease care.

A supermarket model for vascular patient care proposes an interdisciplinary group of health care teams such as vascular nurses, interventional radiologists, vascular surgeons, angiologists, internists, cardiologists, and neurologists and facilities such as diagnostic testing laboratories, subcenters such as wound care and foot care centers, atherosclerotic risk prevention centers, rehabilitation centers, vein centers, and socioeconomic follow-up centers that would provide health care of vascular disease in a comprehensive manner in terms of quality care, convenience for patients, 1-stop shopping, education and training, and research and development.

Academies and Institutes↗
PubMed1998

The selection and validation of indicators for monitoring progress towards self-sustainment in community-directed, ivermectin-treatment programmes for onchocerciasis control in Uganda.

A retrospective analysis was made of quantitative data on coverage obtained over 4 years of annual ivermectin treatment of the eligible populations (approximately 56,000 individuals) of 71 communities with endemic onchocerciasis in the Kabale, Kisoro and Rukungiri districts of Uganda. The objective was to formulate methods for defining sustainability in community-directed, ivermectin-treatment programmes (CDITP). Three dependent-variable scales of programme sustainability (PS), PS1, PS2, and PS3, were tested for statistical significance by analysis of variance. The inhabitants of a random sample of 230 households drawn from 23 communities [each containing one community leader and one community-based distributor (CBD)] were then invited to answer a questionnaire covering seven independent variables. These variables were analysed in regression and correlation models, with the PS scales as dependent variables. In the regression model, only one variable, selection of CBD by community members (P = 0.038), which scored 100% on the scale of programme-indicator sensitivity, passed as a useful indicator for predicting the sustainability and monitoring the sustainment of CDITP at the community level. The same variable was also selected in the correlation model (P = 0.028). Although two other variables--involvement of CBD in other primary-health-care activities (P = 0.0594) and provision of incentives for the CBD (P = 0.0558)--showed weak negative associations with sustainability in the correlation model, they did not exhibit a linear relationship with it and cannot therefore be used as valid indicators for predicting sustainability or monitoring sustainment.

Community Health Services↗
PubMed2006

The long-term effect of local policies to restrict retail sale of tobacco to youth.

Many adolescent smokers rely significantly on retail tobacco sources to initiate or maintain their smoking behavior. Though promising, the results from various interventions aimed at curtailing retail tobacco access have been mixed. In the present study, 14 communities were randomly assigned to intervention and control groups in an attempt to determine the long-term effect of local youth access laws and policies on adolescent smoking. The intervention continued for 32 months. Assessments were conducted at baseline (1991) and at years 3, 5, and 7. The intervention was based on a community-organizing approach that mobilized community members to support adoption and enforcement of local ordinances to restrict minors' access to commercial sources of tobacco. The major outcome measure for the study was cross-sectional prevalence of daily tobacco use among all students in grades 8, 9, and 10 in each community, measured by a self-administered student survey. A short-term significant intervention effect was observed and reported previously. That difference between intervention and control communities was maintained through the year 5 assessment but had dissipated by the year 7 assessment, very likely related to adoption of ordinances by control communities. Restricting commercial access to tobacco through local ordinances is effective in reducing adolescent smoking both immediately after the intervention (year 3) and 2 years later (year 5). Longer-term results are still inconclusive, because control communities adopted ordinances similar to those in the intervention communities.

Adolescent↗
PubMed2004

Atlantic Telehealth Knowledge Exchange.

Atlantic Canada has some of the earliest, most comprehensive, well-established networks, and innovative applications for telehealth in the country. The region offers a range of models for telehealth, in terms of management structure, coordination, funding, equipment, utilization, and telehealth applications. Collectively, this diversity, experience, and wealth of knowledge can significantly contribute to the development of a knowledge base for excellence in telehealth services. There is no formal process in place for the sharing of information amongst the provinces. Information sharing primarily occurs informally through professional contacts and participation in telehealth organizations. A core group of organizations partnered to develop a process for knowledge exchange to occur. This type of collaborative approach is favored in Atlantic Canada, given the region's economy and available resources. The Atlantic Telehealth Knowledge Exchange (ATKE) project centred on the development of a collaborative structure, information sharing and dissemination, development of a knowledge repository and sustainability. The project is viewed as a first step in assisting telehealth stakeholders with sharing knowledge about telehealth in Atlantic Canada. Significant progress has been made throughout the project in increasing the profile of telehealth in Atlantic Canada. The research process has captured and synthesized baseline information on telehealth, and fostered collaboration amongst telehealth providers who might otherwise have never come together. It has also brought critical awareness to the discussion tables of governments and key committees regarding the value of telehealth in sustaining our health system, and has motivated decision makers to take action to integrate telehealth into e-health discussions.

Benchmarking↗
PubMed1990

Evaluating performance of statewide regionalized systems of trauma care.

A new methodology is presented for evaluating the extent to which patients within regionalized systems of trauma care are treated at the appropriate hospitals. Criteria are proposed for retrospectively classifying trauma patients as to whether they should have been treated at a trauma center. The criteria were developed by a panel of nationally recognized trauma experts and are based on the age of the patient and the type and AIS severity of injuries sustained. The criteria were then applied to uniformly collected data available for all trauma discharges in 1988 from acute care hospitals in a state with a well developed system of regionalized trauma care. According to the criteria, 19% of all trauma discharges in 1988 should have been treated at a trauma centers. Of those who should have been treated at a trauma center according to criteria, 66% actually received treatment at a center. Of those who were classified not to have required care at a trauma center, 62% actually were treated at non-trauma center hospitals. The congruence between where patients should have been treated and the actual level of hospital care received varied by the type and severity of the traumatic injuries sustained. The results of the analysis provide insights into the characteristics of trauma patients at higher risk of not getting the appropriate level of trauma care and should assist in improving guidelines for triage and transfer within a regionalized system of care.

Adolescent↗