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PubMed2005

Intermediate care: for better or worse? Process evaluation of an intermediate care model between a university hospital and a residential home.

BACKGROUND: Intermediate care was developed in order to bridge acute, primary and social care, primarily for elderly persons with complex care needs. Such bridging initiatives are intended to reduce hospital stays and improve continuity of care. Although many models assume positive effects, it is often ambiguous what the benefits are and whether they can be transferred to other settings. This is due to the heterogeneity of intermediate care models and the variety of collaborating partners that set up such models. Quantitative evaluation captures only a limited series of generic structure, process and outcome parameters. More detailed information is needed to assess the dynamics of intermediate care delivery, and to find ways to improve the quality of care. Against this background, the functioning of a low intensity early discharge model of intermediate care set up in a residential home for patients released from an Amsterdam university hospital has been evaluated. The aim of this study was to produce knowledge for management to improve quality of care, and to provide more generalisable insights into the accumulated impact of such a model. METHODS: A process evaluation was carried out using quantitative and qualitative methods. Registration forms and patient questionnaires were used to quantify the patient population in the model. Statistical analysis encompassed T-tests and chi-squared test to assess significance. Semi-structured interviews were conducted with 21 staff members representing all disciplines working with the model. Interviews were transcribed and analysed using both 'open' and 'framework' approaches. RESULTS: Despite high expectations, there were significant problems. A heterogeneous patient population, a relatively unqualified staff and cultural differences between both collaborating partners impeded implementation and had an impact on the functioning of the model. CONCLUSION: We concluded that setting up a low intensity early discharge model of intermediate care between a university hospital and a residential home is less straightforward than was originally perceived by management, and that quality of care needs careful monitoring to ensure the change is for the better.

Aged↗

PubMed1994

The strategic marketing reaction of conventional nonprofit hospitals to the market entry of alternative care provider organizations.

A study was conducted examining the competitive reaction of incumbent firms to the market entry of new form competition in the health care services industry. Specifically, the study addressed the relative impact of both objective and perceptual characteristics of the threat potential posed by the entrance of alternative care facilities (ACF's) into markets previously dominated by nonprofit hospital organizations. The results showed that incumbent hospitals tend to rely most extensively on limited, low-risk market differentiation when responding to the threat posed by ACF entrants. Objective characteristics reflective of the structural complexity of the threat were found to be less important in influencing incumbent reaction than were administrators' perceptions of new entrant threat.

Ambulatory Care Facilities↗

PubMed1986

Implementation of a statewide perinatal automated medical network (PAM/NET) for Michigan.

PAM/NET is a computerized data base and conferencing system used by nine neonatal intensive care units in Michigan and Illinois. The system depends on the timesharing resource of a large university mainframe computer. The data base functions are managed by a sophisticated inverted file relational data base management system capable of mass storage and rapid and specific retrieval of individual cases or summary data. Data stored in the system are used to generate admission, discharge and developmental assessment clinic summaries that serve as such for the medical record and as letters to primary physicians. We report here the early experience in the design and dissemination of this database network to the participating hospitals. Conflicting goals of sharing and confidentiality of clinical data are addressed in the design of this system.

Ambulatory Care Facilities↗

PubMed2006

The future of medical licensure in the United States.

Medical licensure in the United States is undergoing significant change. With calls for greater accountability and transparency, state medical boards and their membership association, the Federation of State Medical Boards (FSMB), are seeking ways to assure the public that physicians are maintaining their competence throughout the lifetime of their practice of medicine. At present, competence in cognitive, clinical, and communicative skills is regularly measured only at initial licensure. Yet, the public and policy-related organizations are demanding ongoing assessment of physicians' ability to safely and competently practice medicine. The author reports on activities that involve the FSMB and other national organizations, including the Educational Commission for Foreign Medical Graduates, in planning for a future of increased accountability and transparency of the licensing and regulatory communities that oversee the practice of medicine. He notes that topics of discussion include possible nationalization of what has been traditionally state-based licensure. He raises questions about a future that may include specialty-based licensure and greater national and even international license portability.

Clinical Competence↗

PubMed2000

An empirical analysis of the purchaser-provider relationship in the NHS internal market.

Introduces the relationship marketing paradigm as a means of analysing the purchaser-provider relationship within the NHS internal market. This focus is justified in the context of the limitations of orthodox economic analysis. The research evidence is based upon a national survey of all NHS trust hospitals in England. The survey consisted of key questions relating to the process of relationship building strategies employed by NHS hospital trusts. In particular, emphasis was given to non-price competitive behaviour, i.e. the extent to which health care contracts were augmented or customized by providers. An empirical analysis is presented, identifying those factors driving such non-price competitive behaviour, based upon a LOGIT model. The results suggest the hypotheses tested are consistent with the evidence from our survey. Finally, the model is used to make some tentative predictions regarding the future of the purchaser-provider relationship within the reformed NHS.

Contract Services↗

PubMed1999

[Uncertainty, relations with agencies and asymmetric information (III)].

In this the third part of the article on uncertainty, agent relationships and asymmetrical information, Doctor Lara passes through Reykiavik and London on her to her final description in Seville. She takes advantage of this analogy to conceptualize the problem of principal and agent, analyzing generic agency relationships pertaining directly with health organizations. When dealing with the interesting question if the problem of principal and agent in health organizations can be lessened, a few equally interesting answers were formulated: allow the professionals to assume the mission and the values of the organization; a well thought out leadership policy; and improvement in information provided; an incentive policy; compatibility of interests between the principal and the agent; ethics and competitive advantage; quality management....

Decision Making, Organizational↗

PubMed2002

Inter-agency collaboration: the North East Health Promotion Centre.

OBJECTIVE: The management of interagency collaborations needs to be approached in particular, but not well defined, ways. In this paper the management and ways of working of a successful co-ordinating unit are discussed and located in the context of inter-agency partnerships. METHODS: The text is based on qualitative archival research and a critical review of practice. CONCLUSIONS: The evidence indicates that the agencies participating in the centre valued its work in facilitating inter-agency collaboration. The structural arrangements of the centre, and its modus operandi, manifest the characteristics of an 'obligational co-ordinating unit' in which success is based on establishing and maintaining appropriate interactions between partner agencies. The ways the centre operationalised the key principles of independence, member support, power and trust relations are discussed. Finally, the importance of 'environmental fit' and the impact of a changing policy environment on the centre are discussed. IMPLICATIONS: In health promotion, and public health more broadly, efforts to co-ordinate the work of agencies and their members are common. However, the precise structures and work practices that are effective rarely have a foundation in evidence or theory. This paper will contribute to our knowledge of how the work of co-ordination can be effectively undertaken in the context of agencies voluntarily entering negotiated relationships to pursue joint goals in public health.

Catchment Area, Health↗

PubMed2006

Implementation of an intervention plan designed to optimize donor referral in a donor hospital network.

CONTEXT: The shortage of donor organs remains the most important factor of waiting list mortality in organ transplantation worldwide. Donor detection is influenced by the legal system, family refusal, and underreporting caused by erroneous knowledge of donation criteria and lack of familiarity with the procedure. OBJECTIVE: To identify possible key factors of donor referral patterns within an existing cooperation with donor hospitals and donor units across the Dutch-speaking part of Belgium, an area of approximately 3 million inhabitants. An intervention plan to optimize the cooperation and procedure quality and efficiency was designed. DESIGN: The intervention plan was based on 3 essential principles in donor referral by donor reporters, information on donor criteria, facilitation of the donor procedure, and communication between donor reporters and the transplant center. The interventions were structured to optimize all 3 of these principles. Two successive periods of 4 years were retrospectively compared. PARTICIPANTS: Data were collected retrospectively on donor referral behavior from a total of 37 donor hospitals and donor units over an 8-year period. MAIN OUTCOME MEASURES: The referrals were reviewed for potential donors, effective donors, percentage of effective donors, refusal rate of relatives, number of tissue donors, impact on local and national transplant programs, and national donor numbers. RESULTS: Data showed a significant positive impact on donor referrals and donor referral behavior (+27% potential donors, +30% effective donors, +172.7% tissue donors, -7% family refusals rates, +9.63% national donors). The results stress the importance of reduced workload and optimization of communication and information availability in an existing donor hospital network.

Belgium↗

PubMed1989

[Improving the organizational aspects of coordinating research on the problem of "scientific principles of environmental hygiene"].

A retrospective and scientific metric analysis of the work of the task-force committee "Scientific principles of environmental hygiene", its sections and subordinate institutions was carried out. The analysis demonstrated a major role of hygienic institutes in the development of the above problem and the least contribution of research epidemiologic, microbiologic and hygienic institutes along with chairs of medical institutes. Emphasis was given to a low share (33%) of materials introduced at the All-Union level in relation to the whole amount of the research on the problem, to easing of control on the realization of plans for introducing research results into practice since 1981 by the sections of the task-force committee, inconsistence of the research subjects and their results introduced. Attention was paid to the shortcomings in the work of the task-force committee and its sections, necessity of their work intensification, primarily in planning which is one of major levels in raising efficacy of the research, their orientation at solving priority problems.

Academies and Institutes↗

PubMed2004

Discursive influences on clinical teaching in Australian undergraduate nursing programs.

Clinical teaching is a vital, yet multidimensional component of Australian undergraduate nursing courses. Unlike other parts of curricula, clinical teaching relies on the both higher education and health care sectors to meet prescribed goals and for effective student learning to occur. As such it is influenced by discourses from within both education and health. Whilst there is considerable literature related to undergraduate nursing clinical teaching; it mainly deals with practical aspects such as effectiveness of clinical teaching or discussions of models employed. Only a small pool of literature exists that discusses the construction of clinical teaching including the factors that have influenced the development of practices both in the past and present. Using the work of Foucault, this paper examines dominant and competing discourses influencing clinical teaching through their constructions within the literature. These are discourses of academia, nursing, and economics. The discussion situates these discourses and discusses how some of the resultant issues surrounding clinical education remain largely unresolved.

Australia↗

PubMed2001

Results of a collaborative study of the EDNAP group regarding the reproducibility and robustness of the Y-chromosome STRs DYS19, DYS389 I and II, DYS390 and DYS393 in a PCR pentaplex format.

A collaborative exercise was carried out by the European DNA Profiling Group (EDNAP) in the frame work of the STADNAP program, i.e. standardization of DNA profiling in Europe, in order to evaluate the performance of a Y-chromosome STR pentaplex, which includes the loci DYS19, DYS389 I and II, DYS390 and DYS393 and to determine whether uniformity of results could be achieved among different European laboratories. Laboratories were asked to analyze the five Y-STRs using singleplex and multiplex conditions in three bloodstains and one mixed stain (95% female and 5% male). All the laboratories reported the same results even for the mixed stain included in the exercise. This demonstrates the reproducibility and robustness of Y-chromosome STR typing even with multiplex formats and proves the usefulness of Y-STR systems for analyzing mixed stains with a male component.A total of 930 male samples from 10 different populations from Europe were also analysed for all the loci included in the pentaplex. Eight of these ten populations also included haplotype data. As for single gene analysis, haplotype diversity was higher in Germany and Italy and lower in Western European countries and Finland. Pairwise haplotype analysis shows the Finnish departure from the rest of the populations and a relatively homogeneity in the other European populations with F(ST) estimates lower than 0.05.UPGMA analysis shows an association of Western European population (Ireland, UK, Portugal and Galicia) on the one hand and central European populations on the other.

Blood Stains↗

PubMed1991

Coordinating psychosocial nursing care across treatment settings.

A criticism sometimes made of nurse practitioners is that they want to be or think they are doctors. Who has not heard a nurse administrator accused of having lost her nursing identity, or of a faculty person who no longer knows nursing? Before BSN degrees were common, there were stories of 4-year nurses who believed they were above providing direct care and identified only with the administrative roles on the unit. These criticisms have been made by nurses. It is only recently that nurses are recognizing that fragmentation of the profession along these and other lines disempowers us and may result in non-nurses delineating what our practice will be. Perhaps stimulated by the nursing shortage and an increased awareness of our collective power, nurses are more vocal and we are owning our identity as nurses. Psychosocial nurses, perhaps because of conflicts related to professional territory with psychiatry, psychology, and social work, or because of the ramifications of third party payments, are less likely to assume the generic title of "therapist" than in the past. More often, there seems to be a coming together of psychosocial nurses with each other and with the nursing community as a whole. This coming together enhances the potential for nurse-to-nurse communication and sets the stage to allow nursing to become the bridge needed by consumers of mental health services. I am hopeful that psychosocial nursing will meet this challenge.

Communication↗

PubMedDate not supplied

Changing relations between hospitals and primary health care: new challenges for hospital management.

Hospitals in the Netherlands are now operating in a rapidly changing environment. Most changes directly result from government's policy to achieve effective cost containment in health care. Some of them basically affect the existence and functioning of hospitals. These changing environmental conditions inspire hospitals to undertake innovative activities to protect or even strengthen their position. This will be illustrated below by a case in which a small acute hospital attempted to establish a close relationship with primary health care in order to protect its position. Our focus will be upon this innovative initiative and upon some management problems that must then be resolved.

Comprehensive Health Care↗

PubMed2006

The national suicide prevention strategy for England: the reality of a national strategy for the nursing profession.

Suicide is recognized as a global phenomenon and many countries now have national suicide prevention strategies. International guidance on suicide prevention and accepted epidemiological and treatment-based research underpins healthcare policy relating to suicide reduction. There has been an established comprehensive strategy in England since 2002. However, the rate of suicide continues to be a concern and nurses hold a key role in the implementation of national, regional and local policy into practice. The aim of this paper is to consider the current implications of the national suicide prevention strategy in England for nursing. This discussion paper draws upon both empirical evidence-based literature, governmental guidance and policy-related documentation. The national suicide prevention strategy for England currently continues to have a multifaceted impact on the nursing profession. This ranges from clinical practice issues such as risk assessment through to broader public health responsibilities. If nurses and allied health professionals are to be effective in their role within suicide prevention, they will need to be supported in building awareness of the wider context of the national policy. In particular, this will mean working effectively and collaboratively with the voluntary sector, service users and other non-medical agencies.

Cooperative Behavior↗

PubMed2004

Lost in transition: challenges and opportunities for improving the quality of transitional care.

Transitional care has been defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care in the same location. Transitional care, which primarily concerns the relatively brief time interval that begins with preparing a patient to leave one setting and concludes when the patient is received in the next setting, poses challenges that distinguish it from other types of care. Many transitions are unplanned, result from unanticipated medical problems, occur in "real time" during nights and on weekends, involve clinicians who may not have an ongoing relationship with the patient, and happen so quickly that formal and informal support mechanisms cannot respond in a timely manner. This article describes the challenges involved in and potential solutions for improving the quality of transitional care.

Continuity of Patient Care↗

PubMed1993

Just-in-time: implications for the hospital industry.

The Just-In-Time system is an operations technique that was developed in Japan and became a growing trend in U.S. industry. JIT applications are relatively new to the hospital industry. Entry into a JIT arrangement requires a good deal of forethought and planning prior to implementation. Hospitals, in order to profitably implement JIT, must commit to a limited number of suppliers, share "vital" information about their operations, and importantly, remove functions they are presently performing as the supplier provides additional services. Introducing JIT in hospital operations involves more than simple edicts from management. If implemented correctly, it has the ability to slash costs, increase productivity levels, utilization of equipments, reduce the need for certain indirect labor, such as material handlers and increase profits.

Computer Communication Networks↗

PubMed2004

Examination of the relationship between community support and tobacco control activities as a part of youth empowerment programs.

Through the American Legacy Foundation's Statewide Youth Movement Against Tobacco Use (SYMATU), programs aimed at empowering youths to take action against tobacco use were funded. It is believed that the activities these groups undertake result in changes at the community level. This article examines the relationships between community support of tobacco control and the number and types of tobacco control-related activities these local youth groups conduct. Regression analyses examine the influence that different levels and sources of community support have on the quantity and focus of a group's activities. The influences of community support are briefly explored to understand if certain group characteristics have an impact on the quantity or sources of support for tobacco control. A deeper understanding of the importance and impact of community support will help groups understand the need for building community support networks and how these networks can assist them with implementation of program activities.

Adolescent↗

PubMed1985

Conducting clinical research in geriatric populations.

Clinical research on geriatric populations requires adaptation of traditional methodologies, modification of expectations, and the development of new procedures. Some aspects of research methodology are unique to studies of geriatric populations. Experience in this relatively new area of geriatric research indicates that new partnerships between researchers and long-term care providers are needed. These new relationships require an understanding of the needs of geriatric populations and of the differences between providers of long-term care and of acute-care. Researchers must consider heterogeneity of the population, the probability of multiple diagnoses and treatments, subject attrition, and the possibility of invalid data. Such considerations require extra staff, more time, and increased funding as well as new thinking about study design and protocol implementation.

Aged↗