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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.

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At least 379 records · Page 21Linked to original sources
PubMed1989

Medical evaluation of psychiatric patients. I. Results in a state mental health system.

Thorough medical evaluation of 529 patients drawn from eight program categories in California's public mental health system revealed active, important physical disease in 200 patients who had 291 diseases. Fourteen percent of the patients had diseases known to themselves but not to the mental health system, and 12% of the patients had diseases newly detected by the study team. We estimate that of the more than 300,000 patients treated in the California public mental health system in fiscal year 1983 to 1984, 45% had an active, important physical disease. The mental health system had recognized only 47% of study patients' physical diseases, including 32 of 38 diseases causing a mental disorder and 23 of 51 diseases exacerbating a mental disorder. Patients treated in public sector mental health facilities should receive careful medical evaluations.

Adult↗
PubMed2000

Integrating emergency services in an urban health system.

When planning for growth and management efficiency across urban health systems, economic and market factors present significant service line challenges and opportunities. This article describes the evolutionary integration of emergency services in St John Health System, a large, religious-sponsored health care system located in Detroit, Michigan. Critical business elements, including the System's vision, mission, and economic context, are defined as the framework for site-specific and System-wide planning. The impact of managed care and market changes prompted St John's clinicians and executives to explore how integrating emergency services could create a competitive market advantage.

Continuity of Patient Care↗
PubMed1989

Using strategy to promote knowledge utilization and change in community mental health systems.

The Washington community mental health system illustrates three examples of knowledge utilization: a long range strategy to improve the accountability of the service system and finances, the formulation and implementation of a strategy to expand minority services in provider agencies, and a process to expand the application of community support concepts for adults and children in local service systems. The management information system (MIS) implementation applies the Davis A VICTORY model.

Community Mental Health Services↗
PubMedDate not supplied

[Nurse's conception about the national health system: a way without return].

This study aimed to analyze the conception of the nurse on the National Health System principles and lines of direction and to point the limits, advances and perspectives of the nurse facing the health municipally process in Itabuna-BA. Data were collected through semi-structured interview. The subjects were 13 nurses. For data analysis it was used the hermeneutic dialetic method. Results point that nurses conceive the Health System in its principles and lines of direction; the knowledge and the awareness of the nurse on the Naional Health System are important for her adhesion and involvement in the municipally process; nurses see as limits, the established care model, the sevice disarticulation and, mainly, the lack of autonomy. Related to the perspectives, it is expected that the National Health System will be effetive and healthcare will be expanded with increase in quality.

Brazil↗
PubMed1996

A strategy for coping with change: an affiliation between a medical school and a managed care health system.

Case Western Reserve University School of Medicine (CWRU), a private research-focused medical school, and Henry Ford Health System (HFHS), an integrated health system with a preponderance of managed care, have established a formal, broad affiliation that includes substantial commitments that bind the two organizations. Among them are formal full-time faculty appointments at CWRU for qualified professional staff of HFHS, designation of an associate dean for CWRU at HFHS, election of HFHS faculty to key medical school committees such as admission, curriculum, and promotions and tenure, and the commitment of funds to the affiliation by both organizations: a grant from HFHS to CWRU for curriculum development, and investment from CWRU to HFHS. The alliance of two such organizations is made complex by a number of issues. They include differences of institutional cultures as well as traditional issues in academic health centers such as departmental authority over curriculum and faculty appointments, competition for academic preeminence, and competition among hospitals for patients. The affiliation was facilitated by shared commitments to education, agreement on the need to adapt student education to the emerging managed care environment, a shared commitment to health services research, investment in the concept that learners add value to a health care delivery setting, and the desire to develop graduates with knowledge of practice in managed care. The authors conclude that medical schools and integrated managed care health systems gain sufficiently from such an affiliation that the investment of time, effort, and resources is readily justified.

Academic Medical Centers↗
PubMedDate not supplied

What can developing economies learn from health system reforms of developed countries?

This paper outlines some general lessons developing nations can draw from the health system reform experiences of developed nations. Using the experiences of developed countries, developing countries should be better able to anticipate socio-economic changes and choose an optimal path for their health systems development to accompany those changes. Most developed countries have adopted rather common objectives and principles in their health systems because of market failure in health care; developing countries may start adopting those principles because they do not have market conditions in the first place. It is suggested that developing countries strengthen what is probably the most fundamental initial systemic asset they have: public finance. They should do so by attracting democratically, possibly through earmarked taxes, resources otherwise channelled through the private sector, competing with public finance for limited real resources. This effort can be promoted by giving consumers, mainly of high income groups and in urban areas, more say (through institutions performing the OMCC function) in the nature of care these groups have access to under auspices of public finance. Where feasible, private insurance as a major source of finance should be seen as a transitional phenomenon, giving way to the emergence of OMCC institutions which require similar financial and managerial market infrastructure. Private and competitive provision of care may be unrealistic in many developing areas because of both scarcity of real resources, mainly manpower, and health needs. The challenge of government is, as resources grow, to divest itself from the provision of care and stay involved in activities and facilities that are of 'public nature'--under specific circumstances--that foster private competitive provision. In general, the government should play an enabling role also by investing in health promotions and management skills for health systems.

Developed Countries↗
PubMed1996

What is driving health system change?

Socially amoral economic forces now drive health system change. The authors, assisted by a panel of experts on employers, health plans, providers, and consumers, discuss current drivers such as (1) employers' price-focused purchasing, without good quality/value measures; (2) health plans' growing successes and market clout; (3) providers declining prospects and fears about their future; and (4) consumers' worries about less choice. Future influences will include Medicare reforms, better information, and pro-consumer regulation of managed care, as well as rising social distress. The health system's future is now open for resolution in an evolving, imperfect market.

Choice Behavior↗
PubMed1977

The health systems agency: a new bureaucracy.

A Federal law signed by President Ford in 1975 (PL 93-641) mandates the establishment of Health Systems Agencies across the country. The major intent of the law is to provide local direction and control of health care planning. Each Agency shall have a professional staff under the aegis of a board of directors composed of a majority of consumers and a minority of providers. Data identifying health care needs shall be translated into a Health Systems Plan, which is a statement of goals for each Agency; an Annual Implementation Plan shall be developed as a statement of objectives, projects, and strategies requisite to achieving the Health Systems Plan. The concept of the Health Systems Agency has correlate state and federal bureaucratic strata to facilitate health care planning coordination.

Community Participation↗
PubMed2002

Urging health system research: identifying gaps and fortifying tuberculosis control in Pakistan.

AIM: To assess the significance of health system research in reducing the burden of tuberculosis and improving the performance of National Tuberculosis Control Program in Pakistan. METHOD: Qualitative and quantitative content analysis of research papers on tuberculosis and influence of the research knowledge on the efficiency of the National Tuberculosis Control Program. RESULTS: We analyzed 268 research papers on tuberculosis in Pakistan published in the 1960-2002 period, from both national and international perspectives. The majority of the studies covered epidemiology of tuberculosis (n=76) in Pakistan, whereas the rest of the papers addressed issues like pediatric tuberculosis (n=53), tuberculosis among Pakistani immigrants (n=35), tuberculosis-HIV synergism (n=24), care seeking (n=19), adherence with tuberculosis treatment (n=14), tuberculosis among women (n=12), tuberculosis prevention (n=12), directly observed treatment short-course (DOTS) strategy modification (n=5), tuberculosis drug resistance (n=7), operational research (n=5), tuberculosis case management (n=4), and research on Mycobacterium (n=2). Qualitative analysis revealed that research and spending on tuberculosis policy and nationwide tuberculosis interventions are not sufficient. Available research knowledge has not yet been translated into the tuberculosis policy and interventions. Furthermore, the lack of insight of the health system on community dynamics and tuberculosis intervention has led to failure in achieving the desired targets in tuberculosis control. CONCLUSION: Health system in Pakistan needs to improve tuberculosis control interventions by conducting extensive research on the various potential weaknesses in the field. For an effective tuberculosis eradication program in a highly endemic country such as Pakistan, health system research should be an integral part of the National Tuberculosis Control Program.

Child↗
PubMed2005

Barriers to sustainable tuberculosis control in the Russian Federation health system.

The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in the Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes.

Communicable Disease Control↗
PubMed2003

[Descentralization as a guiding principle in the reorganization and implementation of the principles of the Unified Health System].

The organization of the health sector in Brazil changed significantly after the ratification of the Federal Constitution in 1988 and the Organic Health Laws in 1990. Decentralization of health services has been the basis for the implementation of the organizational and management principles in the Brazilian Unified Health System. This study presents some of the experiences in the health sector that have contributed decisively to the development of such principles, caused important changes in the present care model, and achieved significant results in social health production.

Brazil↗
PubMed2006

Public health systems research: setting a national agenda.

The Institute of Medicine has recommended that policy decisions about improvement of national public health systems be guided by sound scientific evidence. However, to date there is no national research agenda to help guide public health systems. The Centers for Disease Control and Prevention was called upon to lead a collaborative consensus-based process to define key research questions and establish a framework to create opportunities to better coordinate, leverage, and identify public health resources, which are increasingly scarce. The public health systems research agenda that emerged from this process has 14 over-arching priority research themes. This national agenda should stimulate and guide research to meet the urgent need to improve the nation's public health systems.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Post-conflict reconstruction of the health system of Afghanistan: assisting in the rehabilitation of a provincial hospital--context and experience.

Over more than two decades of conflict, Afghanistan's health system came to depend heavily on assistance from donors and non-governmental organizations (NGOs). When the Taliban fell in November 2001 the health system was in a state of collapse; Afghanistan's health indicators were amongst the worst in the world. National Health Policy is to deliver an essential package of health services to the entire population. It is acknowledged that reconstruction of the health system will depend on donor financial support and NGO involvement in health programmes. An example is Médecins du Monde's involvement in health system rehabilitation in the Ghor province. Investing in health can contribute to peace, stability and political transition. Security, needed for reconstruction and for NGOs to continue their crucial work in health, has recently deteriorated in parts of Afghanistan. Joint Regional Teams to provide security to outlying areas have been announced by the US. There is concern that their proposed humanitarian and development role could compromise perception of the neutrality and impartiality of NGOs.

Afghanistan↗
PubMedDate not supplied

Local public health system partnerships.

OBJECTIVES: Interorganizational collaboration aimed at community health improvement is an expectation of local public health systems. This study assessed the extent to which such collaboration occurred within one state (Wisconsin), described the characteristics of existing partnerships, and identified factors associated with partnership effectiveness. METHODS: In Stage 1, local health department (LHD) directors in Wisconsin were surveyed (93% response rate). In Stage 2, LHDs completed self-administered mailed surveys for each partnership identified in Stage 1 (85% response rate). Two-level hierarchical logit regression methods were used to model relationships between partnership and LHD variables and partnership outcomes. Data from 924 partnerships associated with 74 LHDs were included in the analysis. RESULTS: Partnerships most frequently addressed tobacco prevention and control, maternal and child health, emergency planning, community assessment and planning, and immunizations. Partnering was most frequent with other government agencies, hospitals, medical practices or clinics, community-based organizations, and schools. Partnership effectiveness was predicted by having a budget, having more partners contributing financially, having a broader array of organizations involved, and having been in existence for a longer period of time. A government mandate to start the partnership was inversely related to successful outcomes. Characteristics of LHDs did not predict partnership effectiveness. CONCLUSIONS: Financial support, having a broader array of partners, and allowing sufficient time for partnerships to succeed contribute to partnership effectiveness. Further study-using objective outcome measures-is needed to examine the effects of organizational and community characteristics on the effectiveness of local public health system partnerships.

Community Health Planning↗
PubMed2000

Using the essential services as a foundation for performance measurement and assessment of local public health systems.

Efforts are under way to develop a performance measurement monitoring system for state and local public health systems and to develop a strategic planning tool for local public health systems. The development of these measures is being based on the Essential Public Health Services. This article provides the rationale for why the Essential Services offer a good framework for identifying, analyzing, and evaluating public health activities. The article also reviews the history of local public health and the development and application of the Essential Public Health Services and their predecessor frameworks such as the core functions, the organizational practices, and the essential elements.

Community Health Services↗