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PubMed1989

[The relation of hospital and outpatient care: an important factor in geriatric practice].

An example of a way to establish contact between hospital and outpatient care was demonstrated by the method of working at a clinic for geriatrics and rehabilitation. The basis for evaluation of the working method concerning the patient is optimal information about his situation at the time of hospitalisation. An objective for the hospitalisation can be determined together with the patient. The progress achieved during hospitalisation is judged at regular intervals by the patient and the staff taking care of him. This makes an estimation of the length of required hospitalisation possible. About 40% of the patients returning to family practitioner care require outpatient care. The division between the different services involved is demonstrated. The working method was judged, based on an inquiry at the family practitioners.

Aged↗

PubMed2003

PM2.5 mass and light extinction reconstruction in IMPROVE.

Compliance under the Regional Haze Rule of 1999 is based on Interagency Monitoring of Protected Visual Environments (IMPROVE) protocols for reconstructing aerosol mass and light extinction from aerosol chemical concentrations measured in the IMPROVE network. The accuracy, consistency, and potential biases in these formulations were examined using IMPROVE aerosol chemistry and light extinction data from 1988-1999. Underestimation of particulate matter with an aerodynamic diameter < 2.5 microm (PM2.5) by the IMPROVE mass reconstruction formula by 12%, on average, appears to be related to the exclusion of sodium, chlorine, and other elements and to artifacts associated with the measurement of organic carbon, but not to absorption of water by sulfates and nitrates on IMPROVE Teflon filters during weighing. Light scattering measured by transmissometry is not consistent with nephelometer scattering or single-scatter albedos expected for remote locations. Light scattering was systematically overestimated by 34%, on average, with the IMPROVE particle scattering (Bsp) reconstruction formula. The use of climatologically based hygroscopic growth factors f(RH) suggested for compliance with the Haze Rule contributes significantly to this overestimation and increases the amount of light extinction attributable to sulfates for IMPROVE samples between 1993 and 1999 by 5 percentage points.

Air Pollutants↗

PubMedDate not supplied

Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

BACKGROUND: We wanted to determine the type of outpatient medical care reported by young adult survivors of childhood cancer and to examine factors associated with limited medical care. METHODS: We analyzed data from 9,434 adult childhood cancer survivors enrolled in a retrospective cohort study who completed a baseline questionnaire. They had a mean age of 26.8 years (range 18 to 48 years), 47% were female, 12% were minorities, and 16% were uninsured. Four self-reported outcome measures were used to determine outpatient medical care in a 2-year period: general contact with the health care system, general physical examination, cancer-related medical visit, and medical visit at a cancer center. RESULTS: Eighty-seven percent reported general medical contact, 71.4% a general physical examination, 41.9% a cancer-related visit, and 19.2%, a visit at a cancer center. Factors associated with not reporting a general physical examination, a cancer-related visit, or a cancer center visit included no health insurance (odds ratio [OR] = 2.34; 95% confidence interval [CI], 1.97-2.77), male sex (OR = 1.65; 95% CI, 1.44-1.88), lack of concern for future health (OR = 1.57; 95% CI, 1.36-1.82), and age 30 years or older in comparison with those 18 to 29 years (OR = 1.56; 95% CI, 1.35-1.81). The likelihood of reporting a cancer-related visit or a general physical examination decreased significantly as the survivor aged or the time from cancer diagnosis increased. This trend was also significant for those treated with therapies associated with substantial risk for cardiovascular disease or breast cancer. CONCLUSIONS: Primary care physicians provide health care for most of this growing high-risk population. To optimize risk-based care, it is critical that cancer centers and primary care physicians develop methods to communicate effectively and longitudinally.

Adolescent↗

PubMed2003

Predictors of improvement in quality of life of severely mentally ill substance abusers during 18 months of co-operation between psychiatric and social services.

BACKGROUND: The aim of this study was to investigate predictors of Quality of Life in a group of severely mentally ill substance abusers. These patients took part in a multi-centre study aimed at improving co-operation between psychiatric and social services in Sweden during the years 1995 to 1998. METHODS: Two hundred and eighty-eight patients, 62.4 % men, were included in the study. The criteria to enter the study were to have a diagnosis of severe mental illness and a diagnosis of substance dependence according to the DSM-III-R criteria. Quality of Life (QoL) was measured by a global assessment, Cantril's ladder (1965). Initially and after 18 months the following measurements were also used: Addiction Severity Index (ASI), Symptom Check List 90 (SCL-90) and The Clinical Rating Scale (CRS) for Alcohol Use (AUS) and Drug Use (DUS). RESULTS: Initially those who were older and those who had an apartment of their own or who lived in sheltered living had a higher QoL than the others. Those belonging to the borderline personality disorder subgroup had a lower QoL than those belonging to other psychiatric diagnostic subgroups. At follow-up QoL had improved significantly. Improvement in QoL was related to improvements in physical health, legal and family problems, psychiatric symptoms and a reduction of alcohol and drug problems (ASI), global functioning (GAF) and psychological problems (SCL-90). A multiple stepwise regression analysis showed that improvement in QoL primarily was predicted by improvements in psychiatric symptoms. Number of months without alcohol and drugs were positively associated with improvement in QoL. As a whole, at follow-up the QoL is still not high. CONCLUSIONS: In this group of severely mentally ill substance abusers, improvement in QoL was primarily predicted by improvements in psychiatric symptoms. Further, less alcohol and drug abuse seems to augment the subjective feeling of QoL.

Adult↗

PubMed1997

Not-so-strange bedfellows: models of interaction between managed care plans and public health agencies.

Alliances between managed care plans and public health agencies are a growing phenomenon in local health care markets, with profound implications for health care quality, cost, and accessibility. A typology of interorganizational relations between managed care plans and local public health agencies is drawn from observations of over 60 public health jurisdictions. Relations are described along three dimensions corresponding to the strategic intent, functional operation, and structural design of each alliance type. The identified models of interaction reveal the motivations for forming alliances, the mechanics of their operation, and the possible outcomes. These alliances suggest that a wide range of interorganizational strategies is possible in order to pursue the shared interests of local public health agencies and managed care plans. Nonetheless, public health agencies may face challenges in forging managed care alliances that benefit community-wide populations and that are open to participation by the full spectrum of health care providers in the community.

Contract Services↗

PubMed2006

Understanding the conditions that lead to effective health services delivery networks.

This commentary addresses four of the paradoxes proposed by Huerta et al.--resourcing, synergy, defragmentation and evaluation--and uses recent evidence from the Ontario Regional Stroke Strategy and the Dementia Care Networks Study to explore the challenges identified in greater depth. Seven strategies are also proposed to advance the practice and research agendas related to network development and evaluation: developing a shared vision of care for particular groups of care recipients/clients, products and services that goes beyond a single sector (e.g., acute care only); identifying the aspects of care that will most likely benefit from a network structure; embedding networks within broader strategies; developing both clinical and management leadership and collaborations at the organizational and network levels; developing mechanisms to understand care-recipient flow and where gains can be achieved through interactions of key organizations and service providers; using administrative and information mechanisms to increase efficiencies within networks; and acknowledging that, even with a centralized strategy, variations will exist between similar networks.

Canada↗

PubMed2006

HIV/AIDS and other infectious diseases among correctional inmates: transmission, burden, and an appropriate response.

Correctional inmates engage in drug-related and sexual risk behaviors, and the transmission of HIV, hepatitis, and sexually transmitted diseases occurs in correctional facilities. However, there is uncertainty about the extent of transmission, and hyperbolic descriptions of its extent may further stigmatize inmates and elicit punitive responses. Whether infection was acquired within or outside correctional facilities, the prevalence of HIV and other infectious diseases is much higher among inmates than among those in the general community, and the burden of disease among inmates and releasees is disproportionately heavy. A comprehensive response is needed, including voluntary counseling and testing on request that is linked to high-quality treatment, disease prevention education, substance abuse treatment, and discharge planning and transitional programs for releasees.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Management without frontiers: health system convergence leads to health care management convergence.

Health care managers and policymakers throughout the industrialized world are faced with a variety of new challenges at the same time that traditional constraints on action are becoming ever more restrictive. These pressures have stimulated a variety of health care reforms involving four different strategies for change: cost-containment efforts, quality and administrative efficiency improvements, cost-shifting efforts, and the adoption of market-related concepts from the private sector. These changes are leading to convergence among health systems, as seen by the reforms underway in the Netherlands, Germany, and the English component of the United Kingdom's National Health Service. This in turn will create convergence in the problems and issues faced by health care managers. Issues such as hospital contracting, managed mental health care, primary care gatekeeping, and four others are explored to illustrate how American managers can learn from the experiences of colleagues in other industrialized nations. A final section identifies common themes for health care executives in this period of global convergence.

Aged↗

PubMed2006

Nursing lessons from the MHA keystone ICU project: developing and implementing an innovative approach to patient safety.

Given the pivotal role of nurses in providing and supervising patient care, it is essential that nursing professionals are engaged fully in making care safer. Nursing involvement was instrumental in the Michigan Health and Hospital Association Keystone ICU Project, which resulted in rapid reduction in catheter-related blood stream infection rates and ventilator-associated pneumonia rates. Nurses of every credential and every nursing position participated in this broad scale improvement effort. This article describes the MHA Keystone ICU Project, including challenges implicit in changing nursing practice and team behavior in the ICU. The improvement strategies implemented by Keystone ICU teams, and lessons learned by nurses engaged in the work, are likely to have application in other clinical settings.

Catheterization, Central Venous↗

PubMed1993

Post-basic cancer nursing education in Belgium: an innovative collaboration between a nursing school, a comprehensive cancer centre and the Oncology Nursing Society.

Since 1989, the Nursing School attached to the Free University, Brussels, has organized post-basic courses in cancer nursing, with the collaboration of the Belgian Oncology Nursing Society (French speaking) (SIO) and a comprehensive cancer centre, the Jules Bordet Institute. The 1-day-a-week course evolves over 30 weeks and is open to registered nurses. Its structure and its content respect the recommendations of the Core Curriculum for a Post-Basic Course in Cancer Nursing (EONS, 1989). However, there are some differences related to the entry requirements, the clinical experience, and the evaluation of both the course and the students' performance. So far, 72 nurses from different cancer units from the southern part of Belgium have obtained the certificate at the end of this course. In parallel with the 1-day-a-week course, seven modular courses were set up during the first semester of 1992, with the financial support of the 'Europe against Cancer' Programme. Each module tackles a specific theme: Basic Principles in Oncology Nursing; Training the Trainers; Prevention and Early Screening; Rehabilitation--Palliative Care--Psycho-oncology (one short and one long module); Radiotherapy; and Chemotherapy.

Adult↗

PubMedDate not supplied

Global Health Watch Canada? Mobilizing the Canadian public health community around a global health advocacy agenda.

Growing poverty, collapsing health care systems, the AIDS pandemic and the widening of health and health care inequities within and between countries all point to the limited success of global public health interventions over the past few decades. Notwithstanding the efforts of multilateral agencies such as the World Health Organization and the many existing contributions from the Canadian community of health professionals, this commentary argues and appeals for further action particularly in relation to the social and political impediments to better health and justice. Specifically, it calls for the development of a robust instrument to assess the impact of Canada as a whole on the state of global health, and to monitor the performance of key Canadian institutions. It is suggested that such an instrument would result in a process that enhances global citizenship and public accountability, and buttresses the efforts of civil society to forge trans-national links in pursuit of a fairer and healthier world. Public health professionals, by virtue of their social standing as well as the nature and tools of their discipline, should be at the forefront of such civic efforts.

Canada↗

PubMed2006

Re-examining the paradox of structure: a child health network perspective.

In their lead paper, Huerta, Casebeer and VanderPlaat argue that there are several key forces driving the development of health services delivery (HSD) networks, and propose a series of paradoxes and propositions to initiate this timely and essential dialogue. Ultimately, they submit that networks are likely to remain within the healthcare system to build system capacity and drive integration. Given this, they challenge us to further the dialogue and investigate these networks. While this peer commentary shares many of the lead author's perspectives, the generic nature of the discussion does not bring us to the relative complexities revealed in some HSD network practices. A Canadian child health network lens is used to re-examine the lead paper's conceptualization of network typologies and the proposed paradox of structure. We combine network practice and academic expertise to highlight the structural, governance and leadership tensions between traditional hierarchical public service organizations and the non-hierarchical nature of inter-organizational networks. Child health network leaders and members must examine and work with the challenges associated with importing traditional organizational cultures into an inter-organizationally networked context, while simultaneously maintaining these dual (or duelling) cultures.

Canada↗

PubMed2004

Using plant status data for off-site emergency management: technical and political aspects.

Subsequent to the TMI and Chernobyl accidents, emergency management is investigating the possibility of taking balanced decisions on interventions as early as possible. This process relies more and more on in-plant data to assess the term of releases. The paper discusses the regulatory aspects of the communication related to the source term between the utility and the national authorities, and the authorities of a host country and neighbouring countries that may be affected. The technical aspects of the assessment process are summarised, with the emphasis on the handling of uncertainties. Notwithstanding the technical progress, the main dilemma for the decision makers remains the same. Risk management and prevention measures become more familiar to authorities. Utilities and national authorities have to get rid of complexes with respect to accidents covered by the accepted residual risk. International emergency management has to look for an organisation type ensuring the continuity of countermeasures independent of the presence of administrative borders, and with respect to national autonomies.

Decision Support Systems, Management↗

PubMed2002

Performance-based contracting in Wisconsin public health: transforming state-local relations.

In 2000, the Wisconsin Division of Public Health reorganized its allocation of federal and state funds by basing contracts on performance rather than audited costs. This created a quasi market in which the state acted as the buyer and the local health departments as the sellers of public health services. In its first year of operation, the program more effectively defined public health objectives to its funders and constituencies, linked its fiscal accountability more closely to attainment, and documented performance more carefully. In the next two years, the program will focus on improving the quality of objectives and training all parties in negotiation skills. The 2003-6 contract cycle will concentrate on multiyear and multiprogram objectives and a Web-based contract management system. This new contract system will not, however, be established permanently until its long-range impact on funding levels and population health status is known.

Contract Services↗

PubMedDate not supplied

Sexually transmitted diseases and managed care: an inquiry and review of issues affecting service delivery.

To understand the potential role of managed care organizations (MCOs) in prevention and control of sexually transmitted diseases (STDs), we conducted a systematic review of articles on STDs and managed care and sought qualitative information from MCOs on STD-related activities. The review focused on prevention, risk assessment, patient education, counseling, screening, and costs of care, but revealed relatively few published articles. Barriers to STD service delivery included competing priorities, lack of time or supporting organizational structures, and differing mandates of health departments and MCOs. Facilitators included collaboration between health departments and MCOs, regulatory and performance incentives, buy-in from key stakeholders, availability of infrastructure to support data collection, and inclusion of chlamydia screening in the Health Employer Data and Information Set to monitor plan performance. Because of the shift of STD service delivery from the public to private sector, incentives need to maximize interest and cooperation of patients, clinicians, and MCOs in STD prevention.

Attitude of Health Personnel↗

PubMed1997

Acquiring capital equipment through shared-risk agreements.

The Medical Center at the University of California, San Francisco (UCSF) developed a shared-risk relationship with a vendor to manage the costs of infusion therapy. The relationship was centered on upgrading UCSF's aging stock of infusion pumps. Over the course of the 60-month agreement, the vendor agreed to provide the medical center with 750 new infusion pumps, upgrades on related software, a full warranty, full maintenance on the pumps, and assistance with ensuring appropriate utilization. Additional pumps were to be available if required to meet demand. In exchange, UCSF agreed to pay the vendor a fixed rate based on the number of admissions. If the number of pumps required exceeded 775 or fell below 730, the fixed rate could be reassessed. As a result of the agreement, UCSF has needed fewer infusion pumps and infusion sets. A slight increase in operating expenses has been more than offset by avoidance of the 7 to 10 percent interest the medical center would have had to pay if it had borrowed funds to purchase new pumps.

Commerce↗

PubMed2003

Collaborative planning for formative assessment and cultural appropriateness in the Girls health Enrichment Multi-site Studies (GEMS): a retrospection.

OBJECTIVE: The Girls health Enrichment Multi-site Studies (GEMS), Phase 1, developed and pilot-tested interventions to prevent obesity in African-American preadolescent girls. This article describes the collaborative planning process undertaken to take full advantage of formative assessment activities for improving contextual relevance and cultural appropriateness. DESIGN: Working group activities were designed to stimulate awareness and reflection among group members and, through them, among other field center investigators and staff about developmental, cultural, and contextual issues for formative assessment. SETTING: Telephone, Internet, and face-to-face interactions across GEMS field centers in Houston, Texas; Memphis, Tennessee; Minneapolis, Minnesota; and Palo Alto, California. PARTICIPANTS: Investigators and staff involved in intervention development. MAIN OUTCOME MEASURES: The utility of the process was judged from feedback by participants and field center principal investigators about the contribution of the collaborative effort to improving the perceived relevance and cultural appropriateness of formative assessment data collection and interpretation. RESULTS: A working bibliography was compiled. A detailed matrix of programmatic, child, family, and contextual issues related to ethnicity, socioeconomic status, general health and lifestyle, food, physical activity, and body image/weight control was completed. Additional guidance was derived from a workshop that involved scholars with expertise in aspects of African-American culture, child development, and family processes. CONCLUSIONS: This process improved the breadth and depth of GEMS formative assessment activities by increasing the appreciation of the complex structural, contextual, and personal forces at play. A similar process may be useful to other investigators when attempting to develop culturally appropriate interventions.

Black or African American↗

PubMedDate not supplied

Initial results from a multi-institutional collaboration to monitor harmful algal blooms in South Carolina.

The rapid rate of development in the South Carolina (SC) coastal zone has heightened public concern for the condition of the state's estuaries, and alerted scientists to the potential that novel and adverse effects on estuarine ecosystems may result. Although well-developed databases from long-term monitoring programs exist for many variables valuable in predicting and following system responses, information on phytoplankton distributions in SC estuaries has lagged. Knowledge of the dynamical relationship between environmental (e.g., nutrient quantity and quality) and biological (e.g., grazing) regulation, and phytoplankton biomass and composition is critical to understanding estuarine susceptibility to eutrophication or harmful algal blooms (HABs). Recently, SC scientists from federal, state, and academic institutions established a collaborative monitoring program to assess HAB distribution and ecology statewide. The South Carolina Harmful Algal Bloom Program includes: a) intensive temporal monitoring at areas of known HAB occurrence or those exhibiting symptoms potentially related to HABs (e.g., prevalent fish lesions), b) extensive spatial monitoring in coordination with existing statewide efforts, c) a citizen volunteer monitoring network, d) nutrient response bioassays, and e) laboratory-based physiological experiments on HAB isolates. By combining "trip-wire" surveillance and rapid response systems, routine monitoring of environmental parameters and HAB distribution, and process-oriented studies examining the physiological functioning of HAB species, an enhanced understanding of the impact and environmental control of HABs in SC estuaries will be achieved. The application of this approach to studies on the distribution and physiological ecology of a new widespread SC red tide, and to the discovery of several potentially toxic blooms (including Pfiesteria) in SC holding ponds, are described.

Biomass↗