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PubMed1997

Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child.

This article describes the technical basis for the guidelines for the integrated management of childhood illness (IMCI), which are presented in the WHO/UNICEF training course on IMCI for outpatient health workers at first-level health facilities in developing countries. These guidelines include the most important case management and preventive interventions against the leading causes of childhood mortality--pneumonia, diarrhoea, malaria, measles and malnutrition. The training course enables health workers who use the guidelines to make correct decisions in the management of sick children. The guidelines have been refined through research studies and field-testing in the Gambia, Ethiopia, Kenya, and United Republic of Tanzania, as well as studies on clinical signs in the detection of anaemia and malnutrition. These studies, and two others from Uganda and Bangladesh, are presented in this Supplement to the Bulletin of the World Health Organization.

Ambulatory Care↗
PubMed1998

Managing risks in managed care environment.

The healthcare environment is rapidly changing as managed care penetrates your community. Risk management in the office setting is becoming more critical as the strategies for preventing claims in the first place become more important. It is time to reexamine the environment that is being created, increase the involvement of patients in their own care, create documentation systems and recognize when you are at risk.

Documentation↗
PubMed1991

Measurement and management of quality in managed care organizations: alive and improving.

Leatherman et al, Schlackman, and McGuirk-Porell et al all provide important examples of how managed care organizations (MCOs) will measure quality in this decade (except for health care status, which none have yet incorporated). All three organizations rely on insurance claims as a data source and quality management as a tool for improving quality; United Health Care and US Health-care use claims data to improve care for the entire membership, a still unrealized potential for MCOs. All three programs, relatively new, can be only minimally evaluated in terms of measurement validity, cost-efficiency, and improvement in the quality of care. The impact of such MCOs depends on policy initiatives, improvements in outcome and process measures, and MCOs' commitment to serve the total population, including the uninsured and Medicaid populations.

Health Services Research↗
PubMedDate not supplied

Information management for managed care.

A key concern for medical groups is how to manage information in a dual environment of capitation and fee for service. Information systems that work for one may not work for the other. Finding a system that works for both is critical. Some of the data that would be beneficial to collect for starting managing capitation contracts include: age/sex ratios of the practice patient population, average number of visits per patient per year, average number of visits by ICD-9 code for total population, average procedures per patient per year, and analysis of paverage payment per visit/procedure for commercial and Medicare patients. Some of the major concerns addressed include operational issues, financial viability and automated billing systems.

Capitation Fee↗
PubMed1987

How patient accounts managers can influence managed care contracting.

The five main areas for consideration outlined in this article can be a good starting point for patient accounting managers who want to develop a risk contracting strategy flexible enough to meet market growth objectives, provide needed information for effective patient accounts management, and provide needed guidance to information services departments so they can design better systems for further support.

Accounting↗
PubMed2000

Management matters: technology succeeds when management innovates.

It is widely believed that better technology means better business: now that consumers and patients have direct access to computers and information services, the cost of care should decrease and services improve. Yet even with the advent of computer technology and the phenomenal growth of the Internet, costs have increased and quality problems have persisted. Far more important than the technology, then, is how business is conducted and systems are organized. Despite overwhelming evidence that computer services can significantly reduce the costs of care, healthcare organizations have not adopted the changes, or have tried and failed. This article explores what it will take to succeed. We propose a list of necessary nontechnical changes. Patient expectations will change the nature of care; clinicians' roles and training, the gatekeeper profession, healthcare financing and bundling of services, and capital costs will all change. In the end, management innovations make the difference between the success and failure of new technology. Technology is important, but it is not enough. Without new practices, we can buy the technology but will fail to effectively use it. Unless management modifies the very nature of its business, technology's promise to the healthcare industry will go unfulfilled.

Capital Expenditures↗
PubMed2001

Dealing with human factors and managing change in knowledge management: a phased approach.

Ten human factors affect the implementation of knowledge management initiatives, including fear, cultural change, capturing of tacit knowledge, ease of use, stakeholder involvement, and benefits realization. To deal with these factors, a phased change management approach is offered, consisting of an assessment, strategic planning, organization development, systems design, orientation and training, team building, and continuous evaluation and improvement.

Attitude of Health Personnel↗
PubMed1999

A structured teaching and self-management program for patients receiving oral anticoagulation: a randomized controlled trial. Working Group for the Study of Patient Self-Management of Oral Anticoagulation.

CONTEXT: Control of oral anticoagulation therapy has been reported to often be inadequate. Previous retrospective investigations suggest that patients' self-adjustment of oral anticoagulants may lead to improved control. OBJECTIVE: To investigate the effects of patients' self-management of oral anticoagulation therapy on accuracy of control and measures of treatment-related quality of life. DESIGN: Randomized, single-blind, multicenter trial. SETTING AND PARTICIPANTS: A total of 179 patients receiving long-term oral anticoagulation treatment were enrolled at 5 referral centers in Germany. INTERVENTION: Patients were randomized to an oral anticoagulation self-management group based on a structured treatment and teaching program and international normalized ratio (INR) self-monitoring. The control group received conventional care as provided by family physicians, including referral to specialists if necessary. MAIN OUTCOME MEASURES: Deviation of INR values from the individual INR target range (squared) and the 5 categories of treatment-related quality of life. RESULTS: Deviation of INR value from the mean of the INR target range was significantly lower in the intervention group at 3-month (squared INR deviation, 0.59 vs 0.95; P<.001) and 6-month follow-up (0.65 vs 0.83; P=.03) compared with the control group. Also, the intervention group had INR values within the target range more often (repeated measurement analysis for categorical data, P=.006). The results were mainly due to less frequent suboptimal INR values in the intervention group (32.8% vs 50.0% [P=.03] at 3-month, and 33.7% vs 48.2% [P=.08] at 6-month follow-up). Treatment-related quality-of-life measures, especially treatment satisfaction scores, were significantly higher in the intervention group compared with controls. CONCLUSIONS: An anticoagulation education program that includes self-management of anticoagulation therapy results in improved accuracy of anticoagulation control and in treatment-related quality-of-life measures. Further studies are needed to describe whether the program will reduce risk of bleeding or thromboembolism.

Administration, Oral↗
PubMed2004

Communication in ecosystem management: a case study of cross-disciplinary integration in the assessment phase of the interior Columbia Basin Ecosystem Management Project.

Effective communication is essential to the success of collaborative ecosystem management projects. In this paper, we investigated the dynamics of the Interior Columbia Basin Ecosystem Management Project's (ICBEMP) cross-disciplinary integration process in the assessment phase. Using a case study research design, we captured the rich trail of experience through conducting in-depth interviews and collecting information from internal and public documents, videos, and meetings related to the ICBEMP. Coding and analysis was facilitated by a qualitative analysis software, NVivo. Results include the range of internal perspectives on barriers and facilitators of cross-disciplinary integration in the Science Integration Team (SIT). These are arrayed in terms of discipline-based differences, organizational structures and activities, individual traits of scientists, and previous working relationships. The ICBEMP organization included a team of communication staffs (CT), and the data described the CT as a mixed group in terms of qualifications and educational backgrounds that played a major role in communication with actors external to the ICBEMP organization but a minor one in terms of internal communication. The data indicated that the CT-SIT communication was influenced by characteristics of actors and structures related to organizations and their cultures. We conclude that the ICBEMP members may not have had a sufficient level of shared understanding of central domains, such as the task at hand and ways and timing of information sharing. The paper concludes by suggesting that future ecosystem management assessment teams use qualified communications specialists to design and monitor the development of shared cognition among organization members in order to improve the effectiveness of communication and cross-disciplinary integration.

Communication↗
PubMed2004

Waste management in Guangdong cities: the waste management literacy and waste reduction preferences of domestic waste generators.

A questionnaire survey was conducted in 2002 on 1365 households in two prefectural-level cities in the Pearl River Delta, Jiangmen and Zhongshan. Three groups of issues are covered in this paper: 1) waste management literacy, concerns, and public participation; 2) waste recycling practices and the potential for waste avoidance; and 3) public environmental literacy. This study confirms findings from previous surveys and provides new information on important issues such as imposing monetary charges on waste and environmental activities, littering, source separation programs (SSPs), and public participation and expectations in local waste management. Saving up recyclable materials for redemption in waste depots is commonly practiced in mainland China regardless of the level of development of a city, although at the household level, high-income families tend to place less value on the revenues to be gained from redemption than lower income groups do. Data from the previous and the present studies indicate that such voluntary but largely economically driven waste recovery behavior diverts at least 10% of the household waste from the waste stream. Although uncompensated SSP is less appealing in the two cities than compensated SSP, it was found that when the median per capita income of a city reaches RMB2000 per month, a high participation rate for uncompensated waste recovery is more likely to occur. Education and income levels are the chief factors affecting littering behavior and the potential for waste avoidance. Contrary to general belief, the local Chinese community is active in microwaste management. The concern, however, is over the inability of the grassroots bureaucracy to deal with rising expectations for waste collection services and neighborhood cleanliness.

Adolescent↗
PubMed2000

Blunt abdominal trauma in children: epidemiology, management, and management problems in a developing country.

Trauma is the leading cause of death in children in developed countries. In tropical Africa, it is only beginning to assume importance as infections and malnutrition are controlled. In developed countries, the availability of advanced imaging modalities has now reduced the necessity for laparotomy to less than 10% following blunt abdominal trauma (BAT) in children. This report reviews the epidemiology, management, and unnecessary laparotomies for pediatric BAT in a developing country in a retrospective review of 57 children aged 15 years or less at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria over 12 years. The average age was 9 years and the male-female ratio 3.8:1. Seventy-four percent (74%) of abdominal injuries in children were due to blunt trauma. The commonest causes of injury were road traffic accidents (RTA) (57%), 88% in pedestrians and 59% in children aged 5-9 years. Falls were the cause of trauma in 36%, 60% of them aged 10-15 years. Other causes of injury were sports in 5% and animals in 2%. Diagnosis was clinical, supported by diagnostic peritoneal lavage or paracentesis. Two patients had ultrasonography, and none had computed tomography. Fifty-three patients had a laparotomy, 2 died before surgery, 1 was managed nonoperatively, and in 1 surgery was declined. There were 34 splenic injuries, 20 treated by splenic preservation, splenectomy in 13, and non-operative in 1. Fourteen gastrointestinal injuries were treated in 12 patients. Of 9 hepatic injuries, 4 were minor and were left untreated, 3 were repaired, 1 was packed to arrest hemorrhage, and a lacerated accessory liver was excised. Four injuries to the urinary tract (bladder contusion 2, bladder rupture 1, ruptured hydronephrotic kidney 1) were treated accordingly. There were 4 retroperitoneal hematomas associated with other intra-abdominal injuries and 2 pancreatic contusions. One lacerated gallbladder was treated by cholecystectomy and a ruptured left hemidiaphragm was repaired transperitoneally. In retrospect, 27 (51%) patients could have been managed by observation (splenic injury 20, liver injury 5, bladder contusion 2) using advanced imaging modalities. One patient developed an intra-abdominal abscess following splenorrhaphy. The average hospital stay was 17 days. Mortality was 8 (14.5%) from gastric perforation (3), liver injury (2), splenic injury (1), and 2 patients died before surgery. BAT in this population results predominantly from RTA in pedestrians. Laparotomy may be avoided in 51% of cases if advanced imaging modalities are readily available.

Abdominal Injuries↗
PubMed2005

Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management.

Recent guidelines have stated that anesthesia for electroconvulsive therapy (ECT) should be administered by a specially trained anesthesiologist, and that anesthesiologists have overall responsibility, not only for anesthesia itself, but also for cardiopulmonary management and emergency care. Accordingly, anesthesiologists who administer anesthesia for ECT should have sufficient knowledge regarding the physiologically and pharmacologically unique effects of ECT. Electrical current during ECT stimulates the autonomic nervous system and provokes unique hemodynamic changes in systemic and cerebral circulation. Excessive alterations in heart rate, blood pressure, and cardiac functions should be prevented by medications with anticholinergic and antihypertensive agents. Ventilation should be adequately maintained to ensure the efficacy of the therapy and to stabilize the hemodynamics immediately after the electrical stimulation. Reports of serious complications of this therapy are not frequent; however, patients with ischemic heart disease or cerebrovascular problems must be managed with special care to prevent myocardial infarction or neurological disorders. Safe physical management by anesthesiologists greatly contributes to the establishment of ECT under muscle relaxation. To maintain social confidence and to refine the therapy, anesthesiologists should play an essential role both in clinical activities and in laboratory research.

Anesthesia↗
PubMed1993

Health care managers in British Columbia, Part I: Who manages our system?

Part I of this article provides, for the first time, the supply side overview of middle- and high-level managers in the B.C. health care system. It presents findings from two province-wide surveys and describes the sociodemographic characteristics and the employment experiences of the population of interest. Part II presents a detailed analysis of management tasks and management roles, and of competency requirements for future managerial roles.

Administrative Personnel↗
PubMed2003

Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy.

This article critically reviews the available literature regarding nonsurgical management for lumbar spinal stenosis (LSS) and presents a case series of three patients managed with manual physical therapy. This case series uses a well-defined, impairment-based, noninvasive, outpatient treatment program for patients with LSS and provides patient-centered, long-term outcome information. The outpatient treatment program focuses on patients' individualized, prioritized impairments identified on initial examination, and emphasizes manual physical therapy techniques targeting each patient's impairments, specific exercises to either reinforce the manual physical therapy treatment or strengthen specific muscles, and a walking program. The results demonstrate that patients with LSS can make significant gains in disability, symptoms, and function in relatively short periods of time and that these gains can be maintained for up to 18 months. Under this physical therapy program, patients experienced significant improvements, and the potential adverse effects of invasive therapies or pharmacologic management strategies, which often are included in other "nonsurgical" treatment programs, were avoided.

Aged↗
PubMedDate not supplied

Principles of disaster management. Lesson 7: Management leadership styles and methods.

This lesson explores the use of different management leadership styles and methods that are applied to disaster management situations. Leadership and command are differentiated. Mechanisms that can be used to influence others developed include: 1) coercion; 2) reward; 3) position; 4) knowledge; and 5) admiration. Factors that affect leadership include: 1) individual characteristics; 2) competence; 3) experience; 4) self-confidence; 5) judgment; 6) decision-making; and 8) style. Experience and understanding the task are important factors for leadership. Four styles of leadership are developed: 1) directive; 2) supportive; 3) participative; and 4) achievement oriented. Application of each of these styles is discussed. The styles are discussed further as they relate to the various stages of a disaster. The effects of interpersonal relationships and the effects of the environment are stressed. Lastly, leadership does not just happen because a person is appointed as a manager--it must be earned.

Disaster Planning↗
PubMed1983

A pharmaceutical information manager's viewpoint on R & D information resource management.

An overview of the environment (from my perspective) related to information resource management in pharmaceutical R & D has been presented. Some notions of organizational preference (functional), employee selection (chemist turned information scientist), automation (user friendly, cost effective), and the value of project teams (information transfer) have been noted. Difficulties associated with keeping our innovative tools sharp were observed. Finally, we noted that our bottom line--productivity--should first consider what is useful (effectiveness) and then learn how to do it well--efficiency. Success in the management of information resources depends on the proactive delivery of information packets which find their way into problem solving and decision support for scientists or line managers.

Chemistry, Pharmaceutical↗