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PubMed2003

Multi-agency, multi-professional work: experiences from a drug prevention project.

Policy documents at local, national and international level continue to call for greater multi-agency and multi-professional working. These calls are based on three arguments: (1) health and illness are created and influenced by multiple factors outside of health service policy, (2) health improvement requires collaboration between statutory, voluntary and private sector organizations, and (3) efficiency and effectiveness are aided when duplication of effect is avoided and service transition is as seamless as possible. However, there remains limited process-orientated research that has explored the difficulties and challenges faced during multi-agency and multi-professional work. This study employed qualitative methods (interviews, participant observation and documentary analysis) to understand the social construction of a multi-agency and multi-professional health promotion project orientated toward the prevention of drug-related harm. The findings illustrate the ways in which the processes involved in securing funding led to multiple and competing project aims, how changes in personnel and the internal (re)organization of agencies created disjunctions in project membership and shared understandings of key priorities, and how the social need to keep group members 'onside' and committed, competed with the imperatives of prioritization and addressing issues surrounding differentials in power between members and between agencies.

Cooperative Behavior↗

PubMedDate not supplied

Turning point and public health institutes: vehicles for systems change.

Public Health Institutes are free-standing multisector entities able to function as conveners to improve health status and foster innovations in health systems. Turning Point is a program funded by The Robert Wood Johnson Foundation, involving 21 statewide initiatives and 2 "linked" states that formed multisector collaborative partnerships for public health systems change. In 18 of the Turning Point states, there are also Public Health Institutes, some formed by Turning Point partnerships and some established independently. Both Turning Point and Public Health Institutes represent efforts to reform and enhance public health systems. What has been the relationship between these two organizational forms? This descriptive, qualitative study examined the relationships between state-level Turning Point partnerships and Public Health Institutes in states that have both. Key participants in both institutions were interviewed, and models were developed to represent those relationships. Principal findings suggest that the relationships of Turning Point state partnerships with Public Health Institutes have taken many shapes. Factors that influence the choices and sequencing of these options are largely related to the political and economic resources of each state. Turning Point participants perceived Public Health Institutes to be a useful organizational form for sustaining public health systems change. Public Health Institutes have more administrative and fiscal flexibility than state government and greater opportunities for policy development and advocacy. However, free-standing institutes also have greater financial uncertainty.

Academies and Institutes↗

PubMed1996

Assessment and related immunization issues in the Special Supplemental Nutrition Program for Women, Infants and Children: a status report.

This article reports the results of a survey undertaken to determine the current level of collaboration between Women, Infants and Children (WIC) programs and immunization services. While the results of this study are encouraging, WIC needs to continue to place emphasis on using written or computerized immunization records for client screening, utilize available computer hardware and software to assist assessments, and expand the use of food voucher incentives as a strategy to improve coverage.

Health Services Accessibility↗

PubMedDate not supplied

Using the National Neighborhood Indicators Partnership to improve public health.

The National Neighborhood Indicators Partnership (NNIP), a collaborative effort, uses local information in community building and policy making. A local intermediary in 19 NNIP partnership cities builds local data systems. Partners have learned five important lessons: (1) neighborhood-level data are essential for developing public policy, (2) technological advances have made it possible to maintain detailed local databases at relatively low cost, (3) various types of local organizations can serve as local partners, (4) good leadership is critical to building bridges across agencies, and (5) providing data is only the first step. Data must be used in ways that are visible, useful, and responsive to the community if the project is to succeed.

Community Health Planning↗

PubMed1995

The National Drug Control Strategy: the first-line approach to decreasing violence in our communities.

The National Drug Control Strategy is designed to address all aspects of drug abuse: drug use, drug trafficking, and drug-related crimes. The nine-pronged program encompasses efforts at the federal, state, and local levels, forming a partnership between government and the private and public sectors. The strategy includes prevention initiatives that reduce the demand for drugs; individualized treatment programs for high-risk groups; greater community policing efforts to reduce violent crimes by drug users and pushers; and education aimed at children and adults. It is a national strategy that strives to find solutions at the local level.

Adolescent↗

PubMed2006

A quest for quality in home healthcare. A perspective of work in the 6 and 7SOW into the 8SOW: improving acute care hospitalization.

This article discusses the effect that the quality improvement organizations (QIOs) have achieved in the home healthcare industry under their contracts with the Centers for Medicare and Medicaid Services (CMS). Specific successes are related to partnerships between QIOs and home health agencies (HHAs) and the future of outcome-based quality improvement (OBQI) in improving acute care hospitalization (ACH). Data are from the OBQI evaluation system and show outcomes for the baseline collection period (May 2001-April 2002) through the remeasurement period (April 2003-July 2004). Data reported are for cardiac care measures that affect ACH.

Acute Disease↗

PubMed2001

Catholic social policy and U.S. health care reform: a relationship revisited.

The Roman Catholic Church is the single largest denomination in the United States and the one with the most extensive provider stake in health (and related social service) care. As a follow-up to an earlier analysis of the Catholic role in the thwarted health care reform effort of 1993-94, this article looks at the revival of interest in reform and at the rationale behind and strategy of the Catholic Church's current agenda-setting initiative. The emphasis in this article is on the delicate relationship between organized religion and social policy in a society with an officially secular culture.

Catholicism↗

PubMed1992

Inter-institutional information exchange in healthcare.

In this paper the results of the standardization efforts and an evaluation study concerning electronic data interchange (EDI) performed by the 31 (Inter Institutional Information exchange)-project are described. In an earlier paper the results of a preliminary study were reported. EDI concerns communication between autonomous information systems and therefore needs standardization of the messages to be exchanged. In the 31-project ten different types of standard messages have been defined. The use of these messages for exchanging information between hospitals, GPs and pharmacies is described. It is concluded that relatively large time savings can be obtained when communicating electronically. It is also concluded that the electronic data interchange between hospitals and GPs can be performed without additional costs. The electronic communication of prescriptions between GPs and pharmacies does raise the costs of communication at the moment. The impact of EDI on the functioning of people in the organizations involved varies widely.

Clinical Pharmacy Information Systems↗

PubMed2006

Heatwaves and public health in Europe.

Public health measures need to be implemented to prevent heat-related illness and mortality in the community and in institutions that care for elderly or vulnerable people. Heat health warning systems (HHWS) link public health actions to meteorological forecasts of dangerous weather. Such systems are being implemented in Europe in the absence of strong evidence of the effectiveness of specific measures in reducing heatwave mortality or morbidity. Passive dissemination of heat avoidance advice is likely to be ineffective given the current knowledge of high-risk groups. HHWS should be linked to the active identification and care of high-risk individuals. The systems require clear lines of responsibility for the multiple agencies involved (including the weather service, and the local health and social care agencies). Other health interventions are necessary in relation to improved housing, and the care of the elderly at home and vulnerable people in institutions. European countries need to learn from each other how to prepare for and effectively cope with heatwaves in the future. Including evaluation criteria in the design of heatwave early warning systems will help ensure effective and efficient system operation.

Cause of Death↗

PubMed2001

The contributions of managed care plans to public health practice: evidence from the nation's largest local health departments.

OBJECTIVE: The authors examine the extent and nature of managed care plans participating in local public health activities. METHODS: In 1998, the authors surveyed the directors of all US local health departments serving jurisdictions of at least 100,000 residents to collect information about public health activities performed in their jurisdictions and about organizations participating in the activities. Multivariate logistic and linear regression models were used to examine organizational and market characteristics associated with managed care plan participation in public health activities. RESULTS: Managed care plans were reported to participate in public health activities in 164 (46%) of the jurisdictions surveyed, and to contribute to 13% of the public health activities performed in the average jurisdiction. Plans appeared most likely to participate in public health activities involving the delivery or management of personal health services and the exchange of health-related information. Managed care participation was more likely to occur in jurisdictions with higher HMO penetration, fewer competing plans, and larger proportions of plans enrolling Medicaid recipients. Participation was positively associated with the overall scope and perceived effectiveness of local public health activities. CONCLUSIONS: Although plans participate in a narrow range of activities, these contributions may complement the work of public health agencies.

Administrative Personnel↗

PubMed2003

Establishing consensus about the baccalaureate entry-to-practice policy.

This article is based on the results of a qualitative study examining educational reforms in New Brunswick, Canada, during the 1980s. Using the province of New Brunswick as a case study, three issues related to the baccalaureate entry-to-practice policy are examined. First, the process of upgrading nursing education to a baccalaureate degree and the conflict this change created between the Nurses Association of New Brunswick and the New Brunswick Nursing Union are described. Second, the reasons leaders of the professional nursing organization desired to upgrade nursing education are examined, and third, the issues underlying the conflict over nursing education are discussed.

Attitude of Health Personnel↗

PubMed2006

Prisons and health reforms in England and Wales.

Prison health in England and Wales has seen rapid reform and modernization. Previously it was characterized by over-medicalization, difficulties in staff recruitment, and a lack of professional development for staff. The Department of Health assumed responsibility from Her Majesty's Prison Service for health policymaking in 2000, and full budgetary and health care administration control were transferred by April 2006. As a result of this reorganization, funding has improved and services now relate more to assessed health need. There is early but limited evidence that some standards of care and patient outcomes have improved. The reforms address a human rights issue: that prisoners have a right to expect their health needs to be met by services that are broadly equivalent to services available to the community at large. We consider learning points for other countries which may be contemplating prison health reform, particularly those with a universal health care system.

Adolescent↗

PubMed1998

Organizational characteristics associated with agency position in community care networks.

This study examines how organizational characteristics affect agency participation and centrality in community service networks. We find that the network structure of agency relations varies for administrative and client-related activities among the 69 agencies studied, which include all but the most isolated agencies serving people with physical disabilities in a single community. In identifying structurally equivalent groups using network analysis, we find that all types of agencies except HMOs are found throughout community service networks. Analyses show that among the five types of relations, minimal intergroup activity occurs within funding and planning networks and that organizational size and ownership are the best organizational predictors of network location and centrality. Non-profits are the most central for planning and client referrals, and large agencies are the most central for funding. We explore the implications of these findings, particularly for sustaining cooperation within the service networks and for the role of non-profits and medical providers in the community.

Community Networks↗

PubMed1983

Organization sponsorship and influence reputation of social influence associations.

This paper draws from a resource-dependence perspective on relations among organizations to consider this question: What effect does diversity among organizations which contribute resources to social influence associations, have on the capacity of such associations to maintain their autonomy (as indicated by their reputations for influence) while pursuing public policy objectives? Data from 70 Indianapolis associations and organizations reveal a substantial impact of sponsorship on reputation, controlling for network social position and association attributes. In turn, association members' ratings of goal effectiveness seem to be most affected by influence reputation and only indirectly by resource sponsorship.

Community Health Services↗

PubMed2006

Joint National Cancer Institute-Food and Drug Administration workshop on research strategies, study designs, and statistical approaches to biomarker validation for cancer diagnosis and detection.

Cancer remains the second leading cause of death in the United States, in spite of tremendous advances made in therapeutic and diagnostic strategies. Successful cancer treatment depends on improved methods to detect cancers at early stages when they can be treated more effectively. Biomarkers for early detection of cancer enable screening of asymptomatic populations and thus play a critical role in cancer diagnosis. However, the approaches for validating biomarkers have yet to be addressed clearly. In an effort to delineate the ambiguities related to biomarker validation and related statistical considerations, the National Cancer Institute, in collaboration with the Food and Drug Administration, conducted a workshop in July 2004 entitled "Research Strategies, Study Designs, and Statistical Approaches to Biomarker Validation for Cancer Diagnosis and Detection." The main objective of this workshop was to review basic considerations underpinning the study designs, statistical methodologies, and novel approaches necessary to rapidly advance the clinical application of cancer biomarkers. The current commentary describes various aspects of statistical considerations and study designs for cancer biomarker validation discussed in this workshop.

Biomarkers, Tumor↗

PubMed2002

Public health emergencies and the public health/managed care challenge.

The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

Disasters↗

PubMed1999

Resource dependency, doctors and the state: quality control in Sweden.

This paper focuses on the interaction between the state and the medical profession on the national level in Sweden with respect to issues concerning quality in health care. Using the concepts of policy network and resource dependency as points of departure, two examples of interorganisational relationships are analysed which relate to medical/professional quality and organisational quality, respectively. These are (1) the control of the national quality registers and (2) the development of third-party accreditation in health care organisations. During the 1990s the state has become increasingly dependent on participation by the profession in order to obtain outcome data and other resources controlled by the profession. In Sweden, a fragmented state has established various types of linkages with the organised medical profession, all of which are characterised by mutual resource dependency.

Accreditation↗

PubMed2000

Collaboration in disability policies--collaboration between stakeholders of disability policies in the South and in the North.

Four studies have been recently undertaken at the Centre for International Child Health on the collaboration between the stakeholders of disability policies, in Southern and Northern countries. Informed by the literature, the authors have explored the roles disabled people's organizations, non-governmental organizations, government and professionals play in the design, provision and evaluation of services for disabled people. They also highlight the different forms participation can take and their most relevant features. The main factors influencing collaboration processes are then classified in three different categories: social factors, ideology-related factors and project-related factors. They are subsequently analysed. The first group encompasses the societal framework in which collaboration may take place, while the identity of the stakeholders is reflected in the ideology-related factors. The nature of the activities undertaken by stakeholders is characterized by the third group of factors. In the conclusion it is suggested that stakeholders, and especially disabled people's counterparts, should increase their awareness of the social model of disability, adopt participatory practices and promote participation at higher levels. However, they should acknowledge that it implies more trust between partners and an alteration of their structures.

Community Networks↗