Setting standards for primary health services.
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Community Health Workers↗
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The doctor's role in rural health care.
A new pattern of health care in developing countries promises to meet the needs of rural people and still provide reasonable gratification for health workers. The service must have mutually strengthening linkages between all levels of the health care system. Reallocating roles in the health team requires turning routine medical care over to auxiliaries so that professionals can concentrate on more complex problems, such as community diagnosis and therapy. Young doctors are reasonable and willing to undertake a rural rotation early in their medical careers. This will help to identify those few who will provide leadership in improving rural services.
Attitude of Health Personnel↗
Australia's national mental health policy.
In April 1992 the health ministers of all Australian states, territories, and the federal government endorsed Australia's first National Mental Health Policy. The major principles outlined in the policy include protecting consumers' rights, setting national service standards, mainstreaming mental health services with general health services, better integrating inpatient and community mental health services to ensure continuity of care, and linking mental health services and other social and disability services. A five-year National Mental Health Plan, accompanied by additional federal funding, has also been released, with time frames for implementing the policy in all states and territories and at the federal level.
Australia↗
Transition to university and vigorous physical activity: implications for health and psychological well-being.
The authors investigated vigorous physical activity and psychological well-being during transition from high school to first-year university in a sample of 145 Canadian undergraduates. Participants completed retrospective measures assessing vigorous physical activity during their first 2 months at university and their last 2 months at high school as well as measures assessing psychological well-being. According to nationally recommended (US Department of Health and Human Services) standards, two thirds (66.2%) of students reported adequate levels of vigorous activity in high school, whereas significantly fewer (44.1%) met the standard during their first 8 weeks at university. One third of students were active in high school but became insufficiently active once at university; 33% were active at both times; 23% consistently fell short of recommended levels; and only 11% became active once at university. Students who had become insufficiently active reported higher levels of fatigue and lower levels of vigor compared with those who continued to be active.
Adolescent↗
Physical activity is associated with better health and psychological well-being during transition to university life.
The authors investigated vigorous physical activity, psychological well-being, and self-reported illness during transition to first-year university life in a sample of 175 Canadian undergraduates. At the completion of their first year of university study, participants completed retrospective measures assessing vigorous physical activity, upper respiratory infectious illness (URI), doctor visits, as well as measures of psychological well-being. Based on nationally recommended (US Department of Health and Human Services) standards, 61% of students reported engaging in adequate levels of vigorous activity during their first year at university. The authors found no differences in URIs between sufficiently and insufficiently active students. However, insufficiently active students scored lower on psychological well-being and were twice as likely to have consulted a physician regarding an illness compared with sufficiently active students.
Adolescent↗
What can rural agencies do to address the additional costs of rural services? A typology of rural service innovation.
There is a national commitment to ensuring that, regardless of where patients live, they should be provided with an acceptable level of service in terms of quality, effectiveness and accessibility. Because of differences in the distributions of their populations, rural and urban areas present quite different challenges for the optimal design of health services and social care. However, this has not been fully acknowledged in the development of national policies to unify service standards. The problems of providing services in sparsely populated areas are not new. However, until the case for a rural premium in English health resource allocation is accepted, rural agencies must either tolerate lower levels of services (an option made difficult by the introduction of national service standards) or develop very different approaches to service delivery. To date, there has been little systematic knowledge about the extent of innovative rural practice, a paucity of evaluation of such initiatives and few opportunities to disseminate learning from one area to another. The present paper begins to address this deficit. Drawing upon a review of the formal literature and a comprehensive evaluation of projects developed within a rural Health Action Zone, it presents a typology of innovative responses at the health/social care interface. Examples of service innovations which fall into six broad categories are provided. These not only suggest possibilities for the transfer of good practice, but also the potential for future research.
Diffusion of Innovation↗
National maternal mortality ratio in Egypt halved between 1992-93 and 2000.
Two surveys of maternal mortality conducted in Egypt, in 1992-93 and in 2000, collected data from a representative sample of health bureaus covering all of Egypt, except for five frontier governorates which were covered only by the later survey, using the vital registration forms. The numbers of maternal deaths were determined and interviews conducted. The medical causes of death and avoidable factors were determined. Results showed that the maternal mortality ratio (MMR) had dropped by 52% within that period (from 174 to 84/100,000 live births). The National Maternal Mortality Survey in 1992-93 (NMMS) revealed that the metropolitan areas and Upper Egypt had a higher MMR than Lower Egypt. In response to these results, the Egyptian Ministry of Health and Population (MOHP) intensified the efforts of its Safe Motherhood programmes in Upper Egypt with the result that the regional situation had reversed in 2000. Consideration of the intermediate and outcome indicators suggests that the greatest effect of maternal health interventions was on the death-related avoidable factors "substandard care by health providers" and "delays in recognizing problems or seeking medical care". The enormous improvements in these areas are certainly due in part to extensive training, revised curricula, the publication of medical protocols and services standards, the upgrading of facilities, and successful community outreach programmes and media campaigns. The impact on the utilization of antenatal care (ANC) has been less successful. Other areas that remain problematic are inadequate supplies of blood, drugs and equipment. Although the number of maternal deaths linked to haemorrhage has been drastically reduced, it remains the primary cause. The drop in maternal mortality in the 1990s in response to Safe Motherhood programmes was impressive and the ability to tailor interventions based on the data from the NMMS of 1992-93 and 2000 was clearly demonstrated. To ensure the continuing availability of information to guide and evaluate programmes for reducing maternal mortality, an Egyptian national maternal mortality surveillance system is being developed.
Adolescent↗
Predictors of cross-informant syndromes among children and youths referred for mental health services.
This study sought to identify which syndromes of initial problems predicted later syndromes among children and youths referred for mental health services. Standardized parent reports on the Child Behavior Checklist obtained at intake were compared to standardized parent, teacher, and self-reports obtained at follow-up. There were 1,103 subjects (774 males and 329 females) 4 to 18 years old, followed up an average of 6 years after referral. High quantitative and categorical stability was found for cross-informant syndromes within samples of younger and older subjects. Throughout childhood and into young adulthood, parent ratings of most syndromes at the time of referral predicted the counterpart cross-informant syndrome construct at follow-up, controlling for other types of problems at referral. There were multiple additional independent predictors of many syndromes, including Delinquent Behavior, Aggressive Behavior, and Shows Off for young adult males. Time 1 Social Problems and Attention Problems independently predicted diverse problems at Time 2 for younger males. A wide variety of problems also predicted younger males' self-ratings of withdrawal, anxiety, and depression. The stability of problems for the referred sample was similar to that found for demographically matched nonreferred subjects drawn from a national sample.
Adolescent↗
Developing behavioural services to meet defined standards within a national system of specialist education services.
In response to increasing demand for more accountability and improved outcomes in the provision of behavioural services, Specialist Education Services (SES) in New Zealand employed the trainer of trainers programme developed by the Institute for Applied Behaviour Analysis (IABA). The goal was to develop a national training team capable of training SES staff to carry out assessments and develop support plans that could meet defined standards. The purpose of this study was to evaluate the outcomes of this trainer of trainers project. The primary methods of evaluation included the pre-post training comparisons of trainees' functional assessments and positive behaviour support plans, against 140 defined criteria. The results of this project indicated that the SES national training team was able to train SES staff to meet the same standards of service delivery as the external IABA trainers. Further, a Periodic Service Review (PSR) system was implemented to insure that service standards could be maintained at a high level. A major conclusion reached in this study was that a trainer of trainer approach appears to be effective in preparing large numbers of educational personnel to meet the increasing demands by schools for professionals to meet a high standard of service delivery.
Behavior Therapy↗
Quality dimensions for school psychology services.
Varying standards and quality among Norwegian school psychology services (SPS) have resulted in national SPS support and developmental programs. The present study aimed to reveal SPS quality dimensions to suggest a basis for development of service standards. Teachers (333) and administrators (136) responsible for corresponding cases referred to the SPS responded to a questionnaire including indices of case service quality and collaboration between schools and SPS. The statistical analyses included factor analyses and a multiple regression analysis. The data and results from an earlier study of parents' quality dimensions were included in an items analyses. The result suggests five central SPS quality dimensions: availability, participation, consideration, effectiveness and security. While effectiveness has the strongest effect on the evaluation of case service quality both for parents and school personnel, the dimensions have different significance for different consumer groups. Relations to general service quality dimensions and consequences of the findings are discussed.
Adult↗
Lessons from the English smoking treatment services.
This paper summarizes and discusses the key findings of the evaluation of the English smoking treatment services, which were established in 1999 as part of the English National Health Service. Within 4 years these services existed throughout the country and were working at full capacity, a total of pound 76 million having been spent on them over this period, excluding medication costs. In the fourth year almost 235,000 people attended treatment and set a quit date, and the total budget, including medications, was approximately pound 50 million. At the end of the fourth year the government allocated pound 138 million for the services for the period April 2003-March 2006. The CO-validated 4-week abstinence rate was 53%, the validated 52-week abstinence rate was 15%, and the relapse rate from 4 to 52 weeks was 75%. There was no sex difference in cessation rates at long-term follow-up. The cessation results and relapse rate from weeks 4 to 52 are consistent with results from published studies, including clinical trials. The estimated cost per life-year saved was pound 684 and the figure is even lower if the potential future health care cost savings are taken into account at pound 438 per life-year saved. This compares with the benchmark of pound 20,000 per life-year saved, which the National Institute for Clinical Excellence (NICE) is using to recommend new health care interventions in the National Health Service. The services were also succeeding in reaching disadvantaged smokers. However, there have been problems, and other health care systems considering an initiative of this kind should: set national training standards and increase training capacity before launching the services; standardize the provision of pharmaceutical treatments and make them as accessible as possible before launching the services; and give the services at least 5 years of central funding to allow them to become well established. Monitoring is extremely important but should not be so much of a burden that it detracts from developing a quality service and although cessation targets can be helpful, care needs to be taken that they are reasonable and do not promote throughput at the expense of quality.
Cost-Benefit Analysis↗
Centralization of services: standard setting and outcomes.
OBJECTIVE: To test specific standards set in the newly established cleft lip and palate service in three regions of the U.K. The standards relate to record collection and outcomes. DESIGN: Retrospective analysis. PATIENTS: Records of 31 children, 5 years of age, who were born in 1997 with complete unilateral clefts of lip and palate and were treated by surgeons in three regions. MAIN OUTCOME MEASURES: Record collection standards were measured by collecting dental study models. Outcomes were measured with the 5-Year-Old Index. RESULTS: Of the 31 subjects, 52% had excellent and good outcomes. The 31 cases represented 62% of the total records collected. CONCLUSIONS: The three regions examined fell short of the standards set, but the outcomes were improved compared with previous national outcomes. The failings in record collection need to be rectified. This study provides baseline data for further development of cleft services within three regions.
Child, Preschool↗
Standardisation of costs: the Dutch Manual for Costing in economic evaluations.
The lack of a uniform costing methodology is often considered a weakness of economic evaluations that hinders the interpretation and comparison of studies. Standardisation is therefore an important topic within the methodology of economic evaluations and in national guidelines that formulate the formal requirements for studies to be considered when deciding on the reimbursement of new medical therapies. Recently, the Dutch Manual for Costing: Methods and Standard Costs for Economic Evaluations in Health Care (further referred to as "the manual") has been published, in addition to the Dutch guidelines for pharmacoeconomic research. The objectives of this article are to describe the main content of the manual and to discuss some key issues of the manual in relation to the standardisation of costs. The manual introduces a six-step procedure for costing. These steps concern: the scope of the study;the choice of cost categories;the identification of units;the measurement of resource use;the monetary valuation of units; andthe calculation of unit costs. Each step consists of a number of choices and these together define the approach taken. In addition to a description of the costing process, five key issues regarding the standardisation of costs are distinguished. These are the use of basic principles, methods for measurement and valuation, standard costs (average prices of healthcare services), standard values (values that can be used within unit cost calculations), and the reporting of outcomes. The use of the basic principles, standard values and minimal requirements for reporting outcomes, as defined in the manual, are obligatory in studies that support submissions to acquire reimbursement for new pharmaceuticals. Whether to use standard costs, and the choice of a particular method to measure or value costs, is left mainly to the investigator, depending on the specific study setting. In conclusion, several instruments are available to increase standardisation in costing methodology among studies. These instruments have to be used in such a way that a balance is found between standardisation and the specific setting in which a study is performed. The way in which the Dutch manual tries to reach this balance can serve as an illustration for other countries.
Health Care Costs↗
South-East Asia sets standards for midwifery practice.
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Asia↗
[Standards of nursing services for private hospitals].
The formalization of nursing quality assurance in private hospitals is of critical importance. The purpose of this study was to formulate national nursing service standards for private hospitals. A structured two phase research technique was utilised to validate the standards by a representative national group of experts. Statistical validity of the standards was calculated by means of a content validity index for each standard. Fourteen (5%) of these standards (N = 275) were rejected and 25 (9%) require reformulation. It is recommended that these standards should serve as optimum standards for nurse administrators in private hospitals, and that these standards be published formally.
Disaster Planning↗