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PubMed2000

[Analysis of costs involved in activities of regional occupational health centers].

In this paper the authors continue considering the financial economy in the selected Regional Occupational Health Centres (ROHC). The paper contains an analysis of costs involved in the implementation of the ROHC activities, which constitute one of the components of the financial economy of health care institutions. Due to analyses carried out thus far it was possible to infer conclusions regarding the level and structure of the ROHC financing. The cost analysis supplements the considerations on the financial sources, and illustrates at the same time how the financial means have been used by these facilities. The ROHC expenditures were analysed in two dimensions: in the kind dimension and the subject-object dimension. Single costs were also the subject of the analysis. The comparison of the results obtained allowed for formulating conclusions on the financial economy of the selected ROHC. However, these conclusions cannot be generalised in terms of all facilities as the relationship between the structure and level of the costs, and the structure and level of financing was not common. The relationship between the highest share of salaries in the ROHC expenditures and a high level of financial support provided by regional Governors in 1998 was most frequently observed. A number of considerable limitations in the analysis performed were discussed in the final section of the paper.

Costs and Cost Analysis↗
PubMed2001

[Pediatric follow-up network in the south Ile-de-France].

Regional organization of perinatal care, with maternal tranfers, has largely contributed to the increasing survival rate of very preterm infants. Nevertheless, follow-up and care the of these surviving children at risk of neurodevelopmental impairment are insufficiently organized. For this reason, a pediatric network of care and follow-up has been set up in continuity of a regional perinatal network ("réseau périnatal et réseau pédiatrique du sud-ouest de l'Ile de France"). Two missions are devoted to this network: organize local follow-up and care of infants at risk of abnormal outcome and collect follow-up data with specific forms. One form per year of age is to be filled with Items concerning growth, health, cognitive and motor development, family and society integration, quality of life.

Aftercare↗
PubMed2001

[Increased percentages of breastfed infants in Amsterdam].

OBJECTIVE: To investigate the prevalence of breastfeeding amongst infants in Amsterdam prior to and following an active breastfeeding policy that has been operating in Amsterdam since 1993; investigate the link between ethnic origin and breastfeeding and the reasons mothers give for stopping breastfeeding. DESIGN: Retrospective, descriptive study. METHOD: During the period 1998 to 2000, 1274 mothers in six child health centres in Amsterdam, the Netherlands, were asked about how they had fed their infant, aged 6 to 8 months, from the first week onwards, and their reasons for starting formula feeding. The breastfeeding percentages were compared with a study for the period 1992 to 1993. RESULTS: During the first week of the infant's life, 87% of the mothers gave breastfeeding, and at 25 weeks this figure was 30%. For the period 1998 to 2000, the breastfeeding rate at 15 weeks was higher compared with the period 1992 to 1993, 45.1% as opposed to 36.4%. An increased percentage of breastfed infants were found in each ethnic group studied. More Turkish and Moroccan mothers than Dutch mothers started to breastfeed, and they breastfed for a similar period. Surinam mothers started breastfeeding as often as Dutch mothers, but breastfed for a shorter period. Concern about inadequate milk supply was stated as the most important reason for starting formula feeding (44%). This was also the most important reason stated by each of the ethnic groups, Dutch (139/411; 34%), Surinam (63/129; 49%), Moroccan (70/130; 54%) and Turkish women (42/67; 63%). CONCLUSION: An active breastfeeding policy in Amsterdam that has been operating since 1993 has been accompanied by an increase in the number of breastfed infants. This has also been the case in non-Dutch groups. Health programmes should devote greater attention to mothers' concerns about a shortage of milk.

Age Factors↗
PubMed2001

Costs-effectiveness of the urban health center in Nakhon Ratchasima: a case study on diabetes and hypertension.

Health care reforms in Thailand are looking for a better health infrastructure within the urban setting. The urban health center is one of the models tried in many provinces. This study compared the costs--effectiveness of the urban health center in Nakhon Ratchsima with the Maharaj Nakhon Ratchasima Hospital, using diabetes and hypertension as tracer conditions. The point estimates by a retrospective review and cross-sectional study revealed that the overall costs (provider plus patient costs) of the urban health center for these tracers were lower than the costs of the Maharaj Hospital. The effectiveness of treatment at the urban health center was also better. It was concluded that the urban health center should be considered as a better alternative of primary care institution within the urban area.

Chronic Disease↗
PubMed2002

Impact of a voluntary trauma system on mortality, length of stay, and cost at a level I trauma center.

Trauma systems have been shown to decrease injury-related mortality; however, their development has been slow often requiring legislative codification. The purpose of this study was to evaluate the impact of a voluntary regional trauma system on outcomes at a Level I trauma center. We conducted a retrospective cohort study in an American College of Surgeons-verified Level I trauma center including all patients admitted to a Level I trauma center during the periods April 1995 through March 1996 (T-1) and April 1997 through March 1998 (T-2). Our main outcome measures were in-hospital mortality, hospital length of stay, cost of care Compared with T-1 patients T-2 patients had lower mortality (odds ratio 0.48, 95% confidence interval 0.32-0.71). A similar decline in mortality was observed for the entire six-county region compared with the remainder of the state. Among the most severely injured patients (Injury Severity Score > or = 16) T-2 patients had a shorter length of stay (16.5 vs 19.5 days; P < 0.05) and lower mean cost of care ($29,795 vs $34,983; P < 0.05). A voluntary trauma system can be implemented without the need for legislative mandate. After system implementation patient and financial outcomes were improved at an individual Level I trauma center.

Adult↗
PubMed2002

The challenge of developing a regional palliative care data system: a tale of two cities.

This article reviews the purposes of health care databases and the findings from a literature review of the use of patient databases in palliative care. We present the history and goals of databases developed in two Canadian settings, Hamilton and Halifax. We present data on the strengths, limitations, and difficulties encountered in each setting. We review the types of data collected and the potential of these databases, and we offer practical recommendations for others looking to set up such systems.

Data Collection↗
PubMed2002

Development of a regional health care network and the effect of knowledge intensive work on personnel and organisation.

OBJECTIVES: a) To present a regional health care communication system developed in the North Karelia Hospital District with the help of two EU funded information technology projects namely the TERVE project (1) which was implemented at the national level financed by the regional subsidy 6 of the ERDF and the CHIN project (2) that was implemented at the European level. b) To present the questions and issues that arose when implementing new technologies in a regional health care environment. RESULTS: Transformations in information technology are usually parts of other organisational transformations in health care. As a result of these issues, implementation of great information technology transformations has failed because of too strong a technology emphasis, insufficient participative touch and underestimation of social factors. Another result is that there is a cultural shock for physicians working in organisations where there are networks rather than hierarchies and relationships are predominantly contractual rather than professional. CONCLUSIONS: The effectiveness, productivity and profitability of the hospitals will be decisively dependent on information technology as well as its regional applications. Transformations in information technology are parts of other organisational transformations in health care, and can induce cultural shocks for physicians since the networked environment has a different philosophy than the hierarchy-based environment which was the case until recently. Finally, in a taxation based system, one key requirement is to understand that the network contacts and the time spent on networks must bring additional value to health care.

Decision Support Systems, Clinical↗
PubMed2002

Cancer Care Ontario's New Drug Funding Program: controlled introduction of expensive anticancer drugs.

In the mid 1990s, the high cost and increasing number of new anticancer and supportive care drugs began to result in an inequality of access to promising new treatment approaches in the Province of Ontario. Starting with a single drug, paclitaxel, in 1995, the New Drug Funding Program has evolved to a provincial program that enables cancer patients in Canada's most populous province to equitably access new and expensive, intravenously administered drugs. This article describes the development of the program, including the evolution of the administrative mechanisms necessary to manage the program and the decisions of the Policy Advisory Committee that shape provincial funding policies. In fiscal year 2000/2001, the Program made 14 drugs available for 24 indications for a total provincial expenditure of approximately $37.7 million. These intravenous drugs can now be accessed through nine Regional Cancer Centres, the province's only cancer hospital (Princess Margaret Hospital) and 80 community hospitals and will directly benefit more than 8,700 patients.

Antineoplastic Agents↗
PubMedDate not supplied

Piloting cross-boundary training to develop cancer care nursing.

Flexible approaches to lifelong learning have the potential to increase motivation and influence recruitment and retention. This paper explores how the introduction of a collaborative rotational placement programme between the NHS and the voluntary sector helped qualified staff to develop their practice in caring for patients with cancer from diagnosis through to bereavement. Staff experienced an increase in their personal motivation, confidence and enthusiasm.

Attitude of Health Personnel↗
PubMedDate not supplied

Steve Fonyo Cancer Prevention Program: description of an innovative program.

The Steve Fonyo Cancer Prevention Program (SFCPP) was a demonstration project of community-based education strategies designed to increase behaviours which will result in reduced cancer deaths, and to assess the feasibility of the involvement of a provincial cancer agency in the delivery of community-based prevention programs. Using primarily two different strategies, the SFCPP attempted to influence people to choose healthy lifestyles which would reduce their risk of getting cancer and to practice those behaviours which would increase early detection. The health unit intervention component consisted of risk assessment, personalized feedback and an invitation to appropriate health education programs delivered by a nurse. The community-based component involved community members in the planning and delivery of cancer prevention programs. The program began in four small cities (combined population 165,000) in early 1987. A baseline survey was done prior to implementation to facilitate evaluation. The purpose of this article is to describe the planning and implementation of the Steve Fonyo Cancer Prevention Program.

Alberta↗