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PubMed1995

Collaborative social and medical service application.

Baylor College of Medicine has five Teen Health Clinics (THC) dispersed throughout Harris county. The population served by the clinics includes inner-city adolescent boys and girls 19 years of age and under. Patients receive services such as family planning, sexually transmitted disease screening and treatment, perinatal care, counseling, and support services. Adolescents may receive services at any one of the clinics at no cost to the adolescent or their dependents. Given the geographical distribution of the clinics and the reliance on paper-based records, client services cannot be provided efficiently or expeditiously. According to the statistics developed by Clinic staff, ineffective coordination of service needs and client schedules undermine the follow-up needed for effective care. For example, a counselor will often need to balance a school schedule, clinic visits, well baby follow-up, and the Best Friends Program for a new mother. In addition, the lack of ready access to patient information impairs the ability of clinical and social service staff to provide continuity of care. In fact, some cases of client dropout are attributable to these difficulties. We have developed the Collaborative Social and Medical Service Application (CSMSA) to facilitate the provision of social and medical services to this population. The CSMSA is a domain-specific application based on a robust infrastructure known as the Ambulatory Services Architecture (ASA). This system is designed to support integrated social and ambulatory care. The ASA is a Baylor developed application framework and architecture for the computerization of the patient medical record in the ambulatory care setting. The working environment for the CSMSA user is an integrated desktop which provides an operating environment for both third-party applications and the CSMSA, as well as a fundamental set of services. The integrated desktop services include a mechanism for object organization or grouping, a facility for the management of desktop objects including disposal and storage, and an embedded search utility to assist in the location of desktop objects as well as other application objects. The access control mechanism will provide the security for the desktop environment by requiring the user to log into and out of the environment. This security mechanism will also enable/disable CSMSA tools based on the user's role at the clinic. The CSMSA is designed to provide work process, functionality and data access appropriate to the responsibilities of the user, e.g., a THC clerk may have permission to view a patient's orders but does not have the facility to create an order. Patient context is defined through a patient browser containing the master patient index or a user defined patient list. Patient encounters are managed using forms based on the process for each encounter type (e.g., initial visit). Forms are used for data entry and for queries. Data entry forms are only committed to the patient database (i.e., making the patient data available to other users who have permission to access the data) when the user approves the data. The CSMSA provides a means to suspend an entry into a chart by saving incomplete or non-committed data entry forms as part of the desktop state which is restored when the user logs into the system. CSMSA was designed to provide a robust, expandable application capable of accommodating the changes in health care and social services delivery while encompassing evolving software standards and new technology. This goal was achieved using object-oriented methodologies and technologies, combined with an object-oriented database management system as the foundation of our server to facilitate the evolution of our data model.

Adolescent↗
PubMedDate not supplied

[Proposed design for a randomized effectiveness study in social medicine].

For ethical, medical, financial as well as legal reasons scientific evaluation is mandatory in the field of public health or rehabilitative medicine. We prototype a fictive randomised and controlled study, taking into account numerous concerns against such a type of statistical analysis in the special field. The theoretical benefits of the study design do well balance its modest cost.

Data Interpretation, Statistical↗
PubMed1989

The evaluation of pharmacist-technician teams applied to a satellite pharmacy.

The team work group design has been suggested as a mechanism to integrate clinical and distributive pharmacy services, expand clinical roles, enhance staff satisfaction, and promote resource efficiency. A pharmacist-technician team was created at Henry Ford Hospital, Detroit, and the effects of the team were assessed via pre and post data collection of attitudinal, behavioral and pharmacy service aspects. Each of three satellite teams were responsible for all pharmacy services to a target group of patients. The results of the team design include a significant decrease in pharmacist and technician perceptions of role stress, especially in the categories of role overload, role isolation, and role ambiguity, and less total hours of work lost by pharmacists (54% improved) and technicians (29% improved). The nurses perceived slightly better pharmacy services upon survey, although not statistically significant, and IV solution wastage decreased 5.6%. Clinical pharmacist compliance to standards of practice was unchanged in spite of increased supervisional responsibilities. We were able to show that the pharmacist-technician team design decreased stress and created more efficient pharmacy services.

Attitude of Health Personnel↗
PubMed1991

Record linkage strategies. Part I: Estimating information and evaluating approaches.

Record linkage techniques can help identify the same patient for matching diverse files (hospital discharge abstracts, insurance claims, registries, Vital Statistics data) which contain similar identifiers. Prior knowledge of whether a linkage is feasible is important to prevent wasted effort (additional data collection or data manipulation), which decreases the cost-effectiveness of the linkage. Using examples generated by linking the Manitoba Health Services Commission data with Vital Statistic files, a method of estimating the information in each data set is presented first. Further, the feasibility of several different record linkage strategies is described and tested, given varying amounts of information. At the margin, relatively small amounts of information (having just one more variable to match with) can make a great difference. Probabilistic linkage's great advantage was found in those situations where only a moderate amount of extra information was available. By using the above techniques when working with one or both files in a proposed record linkage project, a much more informed judgement can now be made as to whether a linkage will or will not work. In facilitating record linkage, flexibility of both software and the strategy for matching is very important.

Data Collection↗
PubMed2000

Limitations of secondary data for strategic marketing in rural areas.

Market research is an important element of the strategic marketing process. By understanding the healthcare needs of a market area, hospital and health system managers can set priorities for new services and allocate resources appropriately. The process of market research often begins with an evaluation of health status and socioeconomic indicators collected from secondary sources. Unfortunately, indicators that have been recommended in the literature may not be feasible for use in rural markets because of their lack of statistical precision or inability to differentiate healthcare service needs. This study evaluated the statistical precision and variability of 79 secondary health status and socioeconomic measures reported at the county level in Iowa, USA, a largely rural state. Our findings suggest that many readily available health status and socioeconomic indicators do not discriminate need among rural health care markets. Only six health status and two socioeconomic indicators met our statistical precision and variability criteria. These findings have important implications for managers planning health services in rural localities. Managers of rural health systems may need to employ alternative market research methods, such as analysis of claims-based utilization rates or community health surveys.

Data Collection↗
PubMed1999

The Physician Belief Scale and psychosocial problems in children: a report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network.

Clinicians' management of children with psychosocial problems may vary with their attitudes and beliefs. However, we lack sound instruments to assess these factors. This study examined the psychometric properties of the Physician Belief Scale (PBS). A modified version of the PBS was sent to clinicians who participated in two primary care research networks. Using factor analysis, we reduced the PBS to 14 items and 2 subscales. Cronbach's alpha values were high. Female clinicians, those using DSM-IV, and those having completed training earlier rated themselves as more psychosocially oriented. Identification and treatment of psychosocial problems were significantly related to scores on the Belief and Feeling subscale. The PBS provided only a modest amount of information regarding primary care practices. It is not clear if these limitations are attributable to the instrument or the many other barriers to effective psychosocial care.

Attitude of Health Personnel↗
PubMed1982

HCFA program statistics.

Explore the source record for details and available documents.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1983

HCFA program statistics.

Explore the source record for details and available documents.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

[Institutionalized elderly in Reykjavik in 1984. Their opinions of dental visits, need for dental service and possible changes in dental service and third party payments].

In 1984 an investigation was done among a random sample of 400 old-age pensioners, 67 yrs, and older, who were either inmates of old people's residential or nursing homes or long-term patients in geriatric departments at the hospitals in Reykjavík. A dentist asked all participants standardised questions, among which were: questions concerning dental visiting habits; opinion on the dental public health system; subjective estimation on own need for dental services; opinion on the services rendered by the dental profession; and refunds of dental fees by the public health system. During the last twelve month period only 16.6% had visited a dentist and 34% had not gone to a dentist for more than 20 years. Of those who had made use of dental services during the last 5-10 years, 79.6% said they were satisfied. Barely 75% considered themselves in need of dental services, and 67.6% claimed that they would not seek dental services more frequently if they were made available in the institution, or if free transportation were available to the dentist's office. Only 35.9% said that they would make use of free dental checkups, while 82.2% however were in favour of free health services for old age pensioners. For statistical analysis chi-square at 5% level was used, comparing the answers by sex, age, and institution. There was no statistically significant difference with the exception of difference between institutions with regard to a question of free dental services (0.005 less than p less than 0.01). This question however did not give a significant difference between the sexes or the two different age groups.

Aged↗
PubMed2004

Does health service utilisation vary by remoteness? South Australian population data and the Accessibility and Remoteness Index of Australia.

OBJECTIVE: To compare rates of self-reported use of health services between rural, remote and urban South Australians. METHODS: Secondary data analysis from a population-based survey to assess health and well-being, conducted in South Australia in 2000. In all, 2,454 adults were randomly selected and interviewed using the computer-assisted telephone interview (CATI) system. We analysed health service use by Accessibility and Remoteness Index of Australia (ARIA) category. RESULTS: There was no statistically significant difference in the median number of uses of the four types of health services studied across ARIA categories. Significantly fewer residents of highly accessible areas reported never using primary care services (14.4% vs. 22.2% in very remote areas), and significantly more reported high use (> or =6 visits, 29.3% vs. 21.5%). Fewer residents of remote areas reported never attending hospital (65.6% vs. 73.8% in highly accessible areas). Frequency of use of mental health services was not statistically significantly different across ARIA categories. Very remote residents were more likely to spend at least one night in a public hospital (15.8%) than were residents of other areas (e.g. 5.9% for highly accessible areas). CONCLUSION: The self-reported frequency of use of a range of health services in South Australia was broadly similar across ARIA categories. However, use of primary care services was higher among residents of highly accessible areas and public hospital use increased with increasing remoteness. There is no evidence for systematic rural disadvantage in terms of self-reported health service utilisation in this State.

Adolescent↗
PubMed1992

A survey of tinnitus management in National Health Service hospitals.

This paper reports the results of a postal questionnaire survey to ascertain the current status of NHS hospital services for patients with tinnitus. Statistics are given on the various managements used, e.g. about two-thirds of consultants prescribe tinnitus maskers. A total of 66 tinnitus clinics have been identified. The data are interpreted as illustrative of the steady improvements in the last 10-15 years in tinnitus management services.

Counseling↗