Care Organizations (care + organization)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Care Organizations

  • health care organization
  • managed care organization
  • primary care organization


  • Selected Abstracts


    Employed Family Physician Satisfaction and Commitment to Their Practice, Work Group, and Health Care Organization

    HEALTH SERVICES RESEARCH, Issue 2 2010
    Ben-Tzion Karsh
    Objective. Test a model of family physician job satisfaction and commitment. Data Sources/Study Setting. Data were collected from 1,482 family physicians in a Midwest state during 2000,2001. The sampling frame came from the membership listing of the state's family physician association, and the analyzed dataset included family physicians employed by large multispecialty group practices. Study Design and Data Collection. A cross-sectional survey was used to collect data about physician working conditions, job satisfaction, commitment, and demographic variables. Principal Findings. The response rate was 47 percent. Different variables predicted the different measures of satisfaction and commitment. Satisfaction with one's health care organization (HCO) was most strongly predicted by the degree to which physicians perceived that management valued and recognized them and by the extent to which physicians perceived the organization's goals to be compatible with their own. Satisfaction with one's workgroup was most strongly predicted by the social relationship with members of the workgroup; satisfaction with one's practice was most strongly predicted by relationships with patients. Commitment to one's workgroup was predicted by relationships with one's workgroup. Commitment to one's HCO was predicted by relationships with management of the HCO. Conclusions. Social relationships are stronger predictors of employed family physician satisfaction and commitment than staff support, job control, income, or time pressure. [source]


    Alcohol Drinking Patterns and Health Care Utilization in a Managed Care Organization

    HEALTH SERVICES RESEARCH, Issue 3 2004
    Gary A. Zarkin
    Objective. To estimate the relationship between current drinking patterns and health care utilization over the previous two years in a managed care organization (MCO) among individuals who were screened for their alcohol use. Study Design. Three primary care clinics at a large western MCO administered a short health and lifestyle questionnaire to all adult patients on their first visit to the clinic from March 1998 through December 1998. Patients who exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for moderate drinking were given a more comprehensive alcohol screening using a modified version of the Alcohol Use Disorders Identification Test (AUDIT). Health care encounter data for two years preceding the screening visit were linked to the remaining individuals who responded to one or both instruments. Using both quantity,frequency and AUDIT-based drinking pattern variables, we estimated negative binomial models of the relationship between drinking patterns and days of health care use, controlling for demographic characteristics and other variables. Principal Findings. For both the quantity,frequency and AUDIT-based drinking pattern variables, current alcohol use is generally associated with less health care utilization relative to abstainers. This relationship holds even for heavier drinkers, although the differences are not always statistically significant. With some exceptions, the overall trend is that more extensive drinking patterns are associated with lower health care use. Conclusions. Based on our sample, we find little evidence that alcohol use is associated with increased health care utilization. On the contrary, we find that alcohol use is generally associated with decreased health care utilization regardless of drinking pattern. [source]


    Ambulatory Use of Ticlopidine and Clopidogrel in Association with Percutaneous Coronary Revascularization Procedures in a National Managed Care Organization

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002
    DEBORAH SHATIN PH.D.
    The aim of this study was to quantify ambulatory use of ticlopidine and clopidogrel in association -with percutaneous coronary revascularization procedures (PTCA, atherectomy, stent) in a national managed care organization. Retrospective administrative claims data over a 3-year period (1996,1998) from 12 UnitedHealth Group-affiliated health plans in four geographic regions were collected. Pharmacy and medical claims data were used to determine the patients exposed to ticlopidine and clopidogrel between January 1, 1996 and December 31, 1998, the duration of use, prescriptions within 2 weeks of a coronary procedure, and stent patients prescribed either drug within 2 weeks of stent placement in 1998. Substantial short-term use of ticlopidine and clopidogrel was found. The percentage of members with duration of use , 30 days ranged from 50.4% in 1996 to 56.9% in 1998 for ticlopidine and was 52.7% for clopidogrel. In 1998, 46% and 33% of ticlopidine and clopidogrel users, respectively, had a medical claim for a coronary procedure that fell within 2 weeks of a prescription. The rate was lower for Medicare beneficiaries. In 1998, 78% of stent patients filled a prescription for either drug within 2 weeks of stent implantation. Although little difference was found overall in the use of these agents across geographic regions, a higher proportion of stent patients in the Southeast were prescribed ticlopidine within this timeframe. The findings suggest that during the study time period ticlopidine and clopidogrel are frequently used off-label in association with percutaneous coronary revascularization procedures. These results were important in considering the overall benefit-risk profile. [source]


    Providing a Dental Home for Pregnant Women: A Community Program to Address Dental Care Access , A Brief Communication

    JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2008
    Peter Milgrom
    Abstract Objective: This paper describes a community-based intervention to provide a dental home for women covered by Medicaid in Klamath County, Oregon. In 2001, 8.8 percent of pregnant women served by Medicaid in Oregon received care. The long-term goal of the program is to promote preventive oral care for both mothers and their new infants. Methods: Pregnant women received home/Women, Infant and Children visits and were assigned a dental home under a dental managed care program [Dental Care Organization (DCO)]. All initial care was provided at the Oregon Institute of Technology Dental Hygiene Clinic under the contract with the DCO. Emergency, preventive, and restorative care was provided. Results: Between February 2004 and January 2006, 503 pregnant women were identified; 421 women were contactable. Of these, 339 received home visits (339/421, 80.5 percent) and 235 received care (235/339, 69.3 percent). Overall, 55.8 percent of eligible women received care (235/421). Most who did not have a visit either moved or were not the caretaker of the baby. The missed appointment rate was 9 percent. Conclusion: A community health partnership led to a successful and sustainable model extending care to pregnant women and is being extended to promote preventive care for both new mothers and their offspring. [source]


    Satisfaction and Use of Prenatal Care: Their Relationship Among African-American Women in a Large Managed Care Organization

    BIRTH, Issue 1 2003
    Arden Handler DrPH
    ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States,a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003) [source]


    US Health Care Reform and Transplantation, Part II: Impact on the Public Sector and Novel Health Care Delivery Systems

    AMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010
    D. A. Axelrod
    The Patient Protection and Affordable Care Act passed in 2010 will result in dramatic expansion of publically funded health insurance coverage for low-income individuals. It is estimated that of the 32 million newly insured, 16 million will obtain coverage through expansion of the Medicaid Program, and the remaining 16 million will purchase coverage through their employer or newly legislated insurance exchanges. While the Act contains numerous provisions to improve access to private insurance as discussed in Part I of this analysis, public sector coverage will significantly be affected. The cost of health care reform will be borne disproportionately by Medicare, which faces nearly $500 billion in cuts to be identified by a new independent board. Transplant centers should be concerned about the impact of the reform on the financial aspects of transplantation. In addition, this legislation also utilizes the Medicare Program to drive reform of the health care delivery system, by encouraging the development of integrated Accountable Care Organizations, experimentation with new ,models' of health care delivery, and expanded support for Comparative Effectiveness Research. Transplant providers, including transplant centers and physicians/surgeons need to lead this movement, drawing on our experience providing comprehensive multidisciplinary care under global budgets with publically reported outcomes. [source]


    Triggering Creativity in Teams: An Exploratory Investigation

    CREATIVITY AND INNOVATION MANAGEMENT, Issue 1 2002
    Sven F. KyleŽn
    Triggering, developing and maintaining creativity in teams is critical to the economic performance of the firm. This article presents an exploratory action research effort in a health care organization that focused on interaction patterns amongst team members, creativity and performance. The results indicate that the teams' inquiry and dialogue into their interaction patterns have the potential of influencing creativity. Team interaction patterns were found to influence team performance. Directions for future research are discussed. [source]


    Between Endless Needs and Limited Resources: The Gendered Construction of a Greedy Organization

    GENDER, WORK & ORGANISATION, Issue 5 2004
    Bente Rasmussen
    One of the strategies of the modernization of public services is the decentralization of responsibilities and organizing work in autonomous co- operative teams with varied tasks. The empowerment of the public service workers in the front line is therefore a strategy in local government in Norway today. Under the assumption that women have ,natural' skills in caring, workers on the lowest levels are given responsibility for care and nursing. A study of the decentralization of public care for the elderly in their homes showed that being given interesting tasks and increased responsibility mobilized the efforts of the care workers. However, since the power of resources has been centralized, this has led to an intensification of work. In gendering the relevant discourses by explaining women's experiences of an over-heavy workload as a result of their ,mothering' and their inability to set limits, women care workers were constructed by their managers as unprofessional and not to be taken seriously. This has made the public care organization a greedy organization for the women care workers. [source]


    Physician characteristics associated with prescription of inappropriate medications using Beers criteria

    GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2007
    Hirohisa Imai
    Background: The prescription of potentially inappropriate medications (PIM) for elderly patients represents a major problem. In the published work, various practice characteristics associated with physicians prescribing habits have been reported. However, existing data has shed little light on the characteristics of physicians who tend to prescribe PIM. We examined whether personal, professional or practice characteristics differ between physicians who prescribe PIM and those who do not. Methods: The subjects comprised primary care and general practice physicians. Physicians were identified from the pharmacy database of a managed care organization as having prescribed medications for Medicare patients over 65 years enrolled in a managed care plan. We adopted Beers criteria to describe the prevalence of PIM use. The physicians were divided into three groups according to number of PIM prescribed. To examine the extent of associations between all the physician-related characteristics studied, polychotomous logistic regression was conducted. Results: Physicians who prescribed one to five PIMs were 0.63 (95% confidence interval [CI], 0.41,0.98) times more likely to have publications than physicians who prescribed no PIM. Physicians who prescribed more than six PIM were 3.18 (95% CI, 2.05,4.95) times more likely to be certified by an internal medicine board, 0.48 (95% CI, 0.30,0.78) times more likely to have publications, and 1.84 (95% CI, 1.01,3.35) times more likely to be in solo practice than physicians who prescribed no PIM. Conclusion: In this study, we found three predictors of PIM prescribing incidence. Since the current study could only describe associations and not causality, further research is necessary. [source]


    Employed Family Physician Satisfaction and Commitment to Their Practice, Work Group, and Health Care Organization

    HEALTH SERVICES RESEARCH, Issue 2 2010
    Ben-Tzion Karsh
    Objective. Test a model of family physician job satisfaction and commitment. Data Sources/Study Setting. Data were collected from 1,482 family physicians in a Midwest state during 2000,2001. The sampling frame came from the membership listing of the state's family physician association, and the analyzed dataset included family physicians employed by large multispecialty group practices. Study Design and Data Collection. A cross-sectional survey was used to collect data about physician working conditions, job satisfaction, commitment, and demographic variables. Principal Findings. The response rate was 47 percent. Different variables predicted the different measures of satisfaction and commitment. Satisfaction with one's health care organization (HCO) was most strongly predicted by the degree to which physicians perceived that management valued and recognized them and by the extent to which physicians perceived the organization's goals to be compatible with their own. Satisfaction with one's workgroup was most strongly predicted by the social relationship with members of the workgroup; satisfaction with one's practice was most strongly predicted by relationships with patients. Commitment to one's workgroup was predicted by relationships with one's workgroup. Commitment to one's HCO was predicted by relationships with management of the HCO. Conclusions. Social relationships are stronger predictors of employed family physician satisfaction and commitment than staff support, job control, income, or time pressure. [source]


    Alcohol Drinking Patterns and Health Care Utilization in a Managed Care Organization

    HEALTH SERVICES RESEARCH, Issue 3 2004
    Gary A. Zarkin
    Objective. To estimate the relationship between current drinking patterns and health care utilization over the previous two years in a managed care organization (MCO) among individuals who were screened for their alcohol use. Study Design. Three primary care clinics at a large western MCO administered a short health and lifestyle questionnaire to all adult patients on their first visit to the clinic from March 1998 through December 1998. Patients who exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for moderate drinking were given a more comprehensive alcohol screening using a modified version of the Alcohol Use Disorders Identification Test (AUDIT). Health care encounter data for two years preceding the screening visit were linked to the remaining individuals who responded to one or both instruments. Using both quantity,frequency and AUDIT-based drinking pattern variables, we estimated negative binomial models of the relationship between drinking patterns and days of health care use, controlling for demographic characteristics and other variables. Principal Findings. For both the quantity,frequency and AUDIT-based drinking pattern variables, current alcohol use is generally associated with less health care utilization relative to abstainers. This relationship holds even for heavier drinkers, although the differences are not always statistically significant. With some exceptions, the overall trend is that more extensive drinking patterns are associated with lower health care use. Conclusions. Based on our sample, we find little evidence that alcohol use is associated with increased health care utilization. On the contrary, we find that alcohol use is generally associated with decreased health care utilization regardless of drinking pattern. [source]


    Managed Behavioral Health Care: An Instrument to Characterize Critical Elements of Public Sector Programs

    HEALTH SERVICES RESEARCH, Issue 4 2002
    M. Susan Ridgely
    Objective. To develop an instrument to characterize public sector managed behavioral health care arrangements to capture key differences between managed and ,unmanaged" care and among managed care arrangements. Study Design. The instrument was developed by a multi-institutional group of collaborators with participation of an expert panel. Included are six domains predicted to have an impact on access, service utilization, costs, and quality. The domains are: characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability. Data are collected at three levels: managed care organization, subcontractor, and network of service providers. Data Collection Methods. Data are collected through contract abstraction and key informant interviews. A multilevel coding scheme is used to organize the data into a matrix along key domains, which is then reviewed and verified by the key informants. Principal Findings This instrument can usefully differentiate between and among Medicaid fee-for-service programs and Medicaid managed care plans along key domains of interest. Beyond documenting basic features of the plans and providing contextual information, these data will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care. Conclusions. If managed behavioral health care research is to advance beyond simple case study comparisons, a well-conceptualized set of instruments is necessary. [source]


    Effects of a group-based exercise program on the mood state of frail older women after discharge from hospital

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2002
    L. Timonen
    Abstract Background Older people with somatic illnesses are at increased risk of depression. It is not known whether exercise alleviates depressive symptoms in frail, very old people recuperating from an acute illness. Objective To determine the effects of a group-based exercise training program on mood. Methods Sixty-eight women (mean age 83.0, SD 3.9 years) who were hospitalized due to an acute illness, and were mobility impaired at admission, were randomized into group-based 10-week strength training intervention (N=34) and home exercise control (N=34) groups. Twenty-four women in the training and 28 in the control group completed the follow-up. Measures of mood state with the Zung Self-Rating Depression Scale (ZSDS) were performed before and after the training intervention, and follow-up data was collected 3 and 9 months after the end of the intervention. Results After the intervention, there was a significant improvement in mood in the intervention group compared to the home exercise control group: ,3.1 (SD 9.0) points vs +1.3 (SD 7.6) points (p=0.048) and the positive effect was still apparent three months after the intervention ceased: ,2.6 (SD 7.7) points vs +3.5 (SD 9.7) points (p=0.015). Improvement of mood state at the first follow-up measurement was associated with the improvement in lower limb isometric muscle strength. Conclusions Group-based exercise program organized in the context of a Finnish health care organization improved mood in frail older women recuperating from an acute illness. Copyright © 2002 John Wiley & Sons, Ltd. [source]


    A methodological and operative framework for the evaluation of an e-health project

    INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2008
    Luca Buccoliero
    Abstract Assessing public sector ICT investments represents the premise for successful implementation of an e-health strategy. The recent literature stresses the importance of going beyond the mere financial and/or technical dimensions of the analysis. Consequently, the paper proposes an example of e-health project evaluation aiming to develop measures which get close to the notion of benefits to the different stakeholders involved: top management, patients, local community. The case study refers to an Italian health care organization that implemented a project of digitalization of its clinical reports production few years ago. Based on on-field research, different approaches are used to assess costs and benefits from different stakeholders' perspectives. The results of a multidimensional evaluation are reported to emphasize the need for different measures to assess the sustainability of an e-health project according to the financial convenience, the social role of the organization, and the contingent situation. Copyright © 2007 John Wiley & Sons, Ltd. [source]


    Does the method of data collection affect patients' evaluations of quality of care?

    INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 6 2000
    Bodil Wilde Larsson RNT
    The aim of the study was to compare two methods of data collection,personal interviews and self-administered questionnaires,with patients' evaluations of the quality of care they received. The sample consisted of 41 matched pairs of inpatients at a medical clinic. In each pair, one patient was interviewed and one responded to a questionnaire. Data were collected using the questionnaire ,Quality from the Patients Perspective' (QPP). The QPP consists of 54 items designed to measure the following four quality dimensions: (i) the medical,technical competence and (ii) the degree of identityorientation in the action of the caregivers; (iii) the physical,technical conditions; and (iv) the sociocultural atmosphere of the care organization. Results showed that patients who were interviewed had significantly less favourable scores on the ,softer' quality dimension scales,the identity-oriented approach of the caregivers and the sociocultural atmosphere of the care setting. Possible reasons for this were discussed, including the possibility that the questions designed to measure these two dimensions were more abstract and emotionally loaded than the items of the other two quality dimensions. [source]


    Connecting what we do with what we know: building a community of research and practice

    INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2009
    Julianne Cheek PhD
    How to think about, develop, maintain and optimize connections between research and practice remains a vexed and contested area in the increasingly complex multidisciplinary and inter-professional practice that constitutes contemporary healthcare and service delivery. A body of literature challenging linear and passive notions of research uptake has emerged which views research uptake as a dynamic, contextualized and active process. This paper explores the development of a successful and exciting community of research and practice involving a university and an aged care organization in Australia. The community of research and practice is premised on dynamic, contextual and active interaction between research and practice; where the categories of research and practice are not mutually exclusive or static; and where community is more than just a structure to facilitate collaborative research projects. It is proposed that the idea of a community of research and practice is a useful one in terms of seeking to better understand and provide strategies for knowledge translation between researchers and practitioners and those who are both. [source]


    Schematic representation of case study research designs

    JOURNAL OF ADVANCED NURSING, Issue 4 2007
    John P. Rosenberg
    Abstract Title.,Schematic representation of case study research designs Aim., The paper is a report of a study to demonstrate how the use of schematics can provide procedural clarity and promote rigour in the conduct of case study research. Background., Case study research is a methodologically flexible approach to research design that focuses on a particular case , whether an individual, a collective or a phenomenon of interest. It is known as the ,study of the particular' for its thorough investigation of particular, real-life situations and is gaining increased attention in nursing and social research. However, the methodological flexibility it offers can leave the novice researcher uncertain of suitable procedural steps required to ensure methodological rigour. Method., This article provides a real example of a case study research design that utilizes schematic representation drawn from a doctoral study of the integration of health promotion principles and practices into a palliative care organization. Discussion., The issues discussed are: (1) the definition and application of case study research design; (2) the application of schematics in research; (3) the procedural steps and their contribution to the maintenance of rigour; and (4) the benefits and risks of schematics in case study research. Conclusion., The inclusion of visual representations of design with accompanying explanatory text is recommended in reporting case study research methods. [source]


    Benefit of Adherence With Bisphosphonates Depends on Age and Fracture Type: Results From an Analysis of 101,038 New Bisphosphonate Users,,

    JOURNAL OF BONE AND MINERAL RESEARCH, Issue 9 2008
    Jeffrey R Curtis
    Abstract The relationship between high adherence to oral bisphosphonates and the risk of different types of fractures has not been well studied among adults of different ages. Using claims data from a large U.S. health care organization, we quantified adherence after initiating bisphosphonate therapy using the medication possession ratio (MPR) and identified fractures. Cox proportional hazards models were used to evaluate the rate of fracture among nonadherent persons (MPR < 50%) compared with highly adherent persons (MPR , 80%) across several age strata and a variety of types of clinical fractures. In conjunction with fracture incidence rates among the nonadherent, these estimates were used to compute the number needed to treat with high adherence to prevent one fracture, by age and fracture type. Among 101,038 new bisphosphonate users, the proportion of persons with high adherence at 1, 2, and 3 yr was 44%, 39%, and 35%, respectively. Among 65- to 78-yr-old persons with a physician diagnosis of osteoporosis, the crude and adjusted rate of hip fracture among the nonadherent was 1.96 (95% CI, 1.48,2.60) and 1.74 (95% CI, 1.30,2.31), respectively, resulting in a number needed to treat with high adherence to prevent one hip fracture of 107. The impact of high adherence was substantially less for other types of fractures and for younger persons. Analysis of adherence in a non,time-dependent fashion artifactually magnified differences in fracture rates between adherent and nonadherent persons. The antifracture effectiveness associated with high adherence to oral bisphosphonates varied substantially by age and fracture type. These results provide estimates of absolute fracture effectiveness across age subgroups and fracture types that have been minimally evaluated in clinical trials and may be useful for future cost-effectiveness studies. [source]


    ASH Position Paper: Adherence and Persistence With Taking Medication to Control High Blood Pressure

    JOURNAL OF CLINICAL HYPERTENSION, Issue 10 2010
    Martha N. Hill RN
    J Clin Hypertens (Greenwich). 2010;12:757-764. © 2010 Wiley Periodicals, Inc. Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self-management, a team approach to patient care, technology-supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now. [source]


    Managing corporate governance risks in a nonprofit health care organization

    JOURNAL OF HEALTHCARE RISK MANAGEMENT, Issue 3 2005
    Glenn T. Troyer Esq. Partner
    Triggered by corporate scandals, there is increased oversight by governmental bodies and in part by the Sarbanes-Oxley Act of 2002. Corporations are developing corporate governance compliance initiatives to respond to the scrutiny of regulators, legislators, the general public and constituency groups such as investors. Due to state attorney general initiatives, new legislation and heightened oversight from the Internal Revenue Service, nonprofit entities are starting to share the media spotlight with their for-profit counterparts. These developments are changing nonprofit health care organizations as well as the traditional role of the risk manager. No longer is the risk manager focused solely on patients' welfare and safe passage through a complex delivery system. The risk manager must be aware of corporate practices within the organization that could allow the personal objectives of a few individuals to override the greater good of the community in which the nonprofit organization serves. [source]


    Ambulatory Use of Ticlopidine and Clopidogrel in Association with Percutaneous Coronary Revascularization Procedures in a National Managed Care Organization

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002
    DEBORAH SHATIN PH.D.
    The aim of this study was to quantify ambulatory use of ticlopidine and clopidogrel in association -with percutaneous coronary revascularization procedures (PTCA, atherectomy, stent) in a national managed care organization. Retrospective administrative claims data over a 3-year period (1996,1998) from 12 UnitedHealth Group-affiliated health plans in four geographic regions were collected. Pharmacy and medical claims data were used to determine the patients exposed to ticlopidine and clopidogrel between January 1, 1996 and December 31, 1998, the duration of use, prescriptions within 2 weeks of a coronary procedure, and stent patients prescribed either drug within 2 weeks of stent placement in 1998. Substantial short-term use of ticlopidine and clopidogrel was found. The percentage of members with duration of use , 30 days ranged from 50.4% in 1996 to 56.9% in 1998 for ticlopidine and was 52.7% for clopidogrel. In 1998, 46% and 33% of ticlopidine and clopidogrel users, respectively, had a medical claim for a coronary procedure that fell within 2 weeks of a prescription. The rate was lower for Medicare beneficiaries. In 1998, 78% of stent patients filled a prescription for either drug within 2 weeks of stent implantation. Although little difference was found overall in the use of these agents across geographic regions, a higher proportion of stent patients in the Southeast were prescribed ticlopidine within this timeframe. The findings suggest that during the study time period ticlopidine and clopidogrel are frequently used off-label in association with percutaneous coronary revascularization procedures. These results were important in considering the overall benefit-risk profile. [source]


    The course and correlates of high hospital utilization in sickle cell disease: Evidence from a large, urban Medicaid managed care organization,

    AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2009
    C. Patrick Carroll
    Although most patients with sickle cell disease (SCD) are hospitalized infrequently and manage painful crises at home, a small subpopulation is frequently admitted to emergency departments and inpatient units. This small group accounts for the majority of health care expenses for patients with SCD. Using inpatient claims data from a large, urban Medicaid MCO for 5 consecutive years, this study sought to describe the course of high inpatient utilization (averaging four or more admissions enrolled per year for at least 1 year) in members with a diagnosis of SCD and a history of hospitalizations for vaso-occlusive crisis. High utilizers were compared with the other members with SCD on demographics, medical and psychiatric comorbidity, and use of other health care resources. Members who were high utilizers had more diagnostic mentions of sickle cell complications than low utilizers. However, the pattern of high inpatient utilization was likely to moderate over successive years, and return to the pattern after moderation was uncommon. Despite this, a small subpopulation engaged in exceptional levels of inpatient utilization over multiple years. Am. J. Hematol., 2009. © 2009 Wiley-Liss, Inc. [source]


    Palivizumab efficacy in preterm infants with gestational age ,30 weeks without bronchopulmonary dysplasia

    PEDIATRIC PULMONOLOGY, Issue 3 2007
    Marianne Grimaldi MD
    Abstract The present study was designed to determine the efficacy of administration of palivizumab to preterm infants with gestational age (GA) ,30 weeks without bronchopulmonary dysplasia (BPD). All patients born with GA ,30 weeks without BPD on Day 28 and hospitalized for RSV bronchiolitis in Burgundy (12 hospitals) from December 1 to April 30 of the next year were included in this prospective observational study during five successive RSV seasons (1999,2000, 2000,2001, 2001,2002, 2002,2003, and 2003,2004). Palivizumab was given to premature infants with a gestational age ,30 weeks without BPD in the 2002,2003 and 2003,2004 periods only. In the cohort of premature infants with GA ,30 weeks without BPD, the respiratory syncytial virus (RSV) bronchiolitis hospitalization rate was reduced significantly (P,<,0.01) in the two seasons with palivizumab prophylaxis (2002,2003: 0% and 2003,2004: 2%) versus the three previous RSV seasons (1999,2000: 14.3%; 2000,2001: 16.7%; 2001,2002: 10.2%). The number needed to treat to prevent one hospitalization for RSV bronchiolitis was 6 (95%CI: 4,11). Such favorable results have not been always found in the few available postmarketing epidemiological studies on hospitalization rate after palivizumab prophylaxis. Differences in health care organization could explain those discrepancies. Pediatr Pulmonol. 2007; 42:189,192. © 2007 Wiley-Liss, Inc. [source]


    Validity of computerized diagnoses, procedures, and drugs for inflammatory bowel disease in a northern California managed care organization,,

    PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 11 2009
    Liyan Liu MD
    Abstract Purpose Resources for studying inflammatory bowel disease (IBD) are needed in evaluations of drug safety including traditional drugs and new biologics agents. We developed an IBD registry, with ascertainment from computerized visit information. Objective We sought to characterize the positive predictive value (PPV) of IBD case-finding using computerized data compared with chart review. Methods We identified 2906 persons aged 89 years or younger with one or more IBD diagnoses in computerized visit data during the period of 1996,2002. The diagnosis of IBD was confirmed through chart review. Adopting chart review as the gold standard, the validity of computerized encounter data to determine IBD was estimated. Results Among the 2906 study subjects with one or more ICD-9 diagnosis codes of 555 or 556 in computerized data, 81% were confirmed as having IBD by chart review. Defining cases as those who underwent two or more visits without regard to diagnostic procedures or drug utilization maximized the correct classification of cases (PPV, 95%). Conclusions The quality of IBD diagnoses in computerized data is adequate to meet the aims of a wide range of research studies. Copyright © 2009 John Wiley & Sons, Ltd. [source]


    Nursing the Community, a Look Back at the 1984 Dialogue Between Virginia A. Henderson and Sherry L. Shamansky

    PUBLIC HEALTH NURSING, Issue 4 2007
    Sarah E. Abrams
    ABSTRACT Dr. Sherry L. Shamansky, one of the founding editors of Public Health Nursing, interviewed renowned 20th-century leader, Virginia Avenal Henderson (1897,1996), then research associate emeritus at Yale University School of Nursing, about the nursing of "aggregates." Their discussion, originally published in Public Health Nursing, in 1984 (Vol. 1, No. 4), highlights Henderson's views about the scope of nursing, health care organization and funding, and perceived tension between direct care of the sick in the community and preventive activities directed toward communities or populations at risk. Readers familiar with Henderson's influential definition of nursing may find her responses to interview questions helpful in understanding her view of the opportunities and challenges faced by public or community health nurses of the time. [source]


    Satisfaction and Use of Prenatal Care: Their Relationship Among African-American Women in a Large Managed Care Organization

    BIRTH, Issue 1 2003
    Arden Handler DrPH
    ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States,a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003) [source]


    The Audit Commission review of diabetes services in England and Wales, 1998,2001

    DIABETIC MEDICINE, Issue 2002
    B. Fitzsimons
    Abstract Aims of the Audit Commission The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies. Methods Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self-nomination. Results Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self-management. Conclusion As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs. [source]


    Effect of Ethnicity on Denial of Authorization for Emergency Department Care by Managed Care Gatekeepers

    ACADEMIC EMERGENCY MEDICINE, Issue 3 2001
    Robert A. Lowe MD
    Abstract. Objective: After a pilot study suggested that African American patients enrolled in managed care organizations (MCOs) were more likely than whites to be denied authorization for emergency department (ED) care through gatekeeping, the authors sought to determine the association between ethnicity and denial of authorization in a second, larger study at another hospital. Methods: A retrospective cohort design was used, with adjustment for triage score, age, gender, day and time of arrival at the ED, and type of MCO. Results: African Americans were more likely to be denied authorization for ED visits by the gatekeepers representing their MCOs even after adjusting for confounders, with an odds ratio of 1.52 (95% CI = 1.18 to 1.94). Conclusions: African Americans were more likely than whites to be denied authorization for ED visits. The observational study design raises the possibility that incomplete control of confounding contributed to or accounted for the association between ethnicity and gatekeeping decisions. Nevertheless, the questions that these findings raise about equity of gatekeeping indicate a need for additional research in this area. [source]


    Developing indicators for measuring Research Capacity Development in primary care organizations: a consensus approach using a nominal group technique

    HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2009
    Gill Sarre LCST
    Abstract Research Capacity Development (RCD) in the National Health Service supports the production of evidence for decision-making in policy and practice. This study aimed to establish a level of consensus on a range of indicators to measure research capacity in primary care organizations. Indicators were developed in a two-stage process using workshops and modified nominal group technique. In 2005, workshops were used to generate possible indicators from a wide range of research active and research-interested people. A theoretical framework of six principles of RCD was used to explore and identify indicators. Data were thematically coded, and a 129-item, 9-point Likert scale questionnaire was developed. A purposive sample of nine experts in developing research capacity in primary care agreed to take part in a nominal group in April 2006. The questionnaire was circulated prior to the meeting, and analysis of the responses formed the basis for structured discussion. Participants were then asked to rescore the questionnaire. Only seven participants were able to take part in the discussion and rescore stages. Data were analysed in two ways: level of relevance attributed to each indicator as a measure of organizational RCD, represented by median responses (medians of 7,9 defined strong support, 4,6 indicated moderate support and 1,3 indicated weak support), and level of consensus reached by the group. Consensus was reached if 85% of the group rated an indicator within the same band. Eighty-nine (68%) indicators were ranked as strongly relevant, and for seventy-three of these indicators, a consensus was reached. The study was successful in generating a set of agreed indicators considered relevant for measuring RCD in primary care organizations. These will form the basis of a pilot tool kit to assist primary care organizations to develop research capacity. Further work will explore the applicability of the indicators in practice. [source]


    Lay perceptions of the desired role and type of user involvement in clinical governance

    HEALTH EXPECTATIONS, Issue 1 2009
    Andrea Litva BA (Comb Hons) MA PhD
    Abstract Objective, The aim of this paper is to explore variations in lay perceptions of user involvement in clinical governance. Context, The English National Health Service has sought to build a dependable health service through enhanced effectiveness, responsiveness and consistency. Clinical governance, a policy for improving service quality, is a key pillar of these reforms. It is a statutory duty of primary care organizations to ensure that users are involved in all service planning and decision making, including clinical governance. Yet surveys indicated that user involvement in clinical governance was underdeveloped and underutilized. Design, Focus groups were conducted with different types of lay people to explore their perceptions around public involvement in different aspects of clinical governance policy. Results, Content analysis of the transcripts reveals that different groups of lay people varied in their desired role perspective and preferred type of involvement in different aspects of clinical governance policy. Drawing upon existing models of user involvement, we identified three role perspectives that lay people could take in user involvement , consumer, advocate and citizen. We compared our findings regarding the desired type of involvement with existing models of user involvement, and identified a new type of involvement, overseeing, that is relevant to clinical governance policy. Conclusions, These findings suggest that to facilitate user involvement in clinical governance, it would be necessary to use different strategies to accommodate the differing role perspectives and types of involvement desired by different groups of lay people. [source]