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Health Care Delivery System (health + care_delivery_system)
Kinds of Health Care Delivery System Selected AbstractsDevelopment of an Algorithm to Identify Pregnancy Episodes in an Integrated Health Care Delivery SystemHEALTH SERVICES RESEARCH, Issue 2 2007Mark C. Hornbrook Objective. To develop and validate a software algorithm to detect pregnancy episodes and maternal morbidities using automated data. Data Sources/Study Setting. Automated records from a large integrated health care delivery system (IHDS), 1998,2001. Study Design. Through complex linkages of multiple automated information sources, the algorithm estimated pregnancy histories. We evaluated the algorithm's accuracy by comparing selected elements of the pregnancy history obtained by the algorithm with the same elements manually abstracted from medical records by trained research staff. Data Collection/Extraction Methods. The algorithm searched for potential pregnancy indicators within diagnosis and procedure codes, as well as laboratory tests, pharmacy dispensings, and imaging procedures associated with pregnancy. Principal Findings. Among 32,847 women with potential pregnancy indicators, we identified 24,680 pregnancies occuring to 21,001 women. Percent agreement between the algorithm and medical records review on pregnancy outcome, gestational age, and pregnancy outcome date ranged from 91 percent to 98 percent. The validation results were used to refine the algorithm. Conclusions. This pregnancy episode grouper algorithm takes advantage of databases readily available in IHDS, and has important applications for health system management and clinical care. It can be used in other settings for ongoing surveillance and research on pregnancy outcomes, pregnancy-related morbidities, costs, and care patterns. [source] US Health Care Reform and Transplantation, Part II: Impact on the Public Sector and Novel Health Care Delivery SystemsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010D. 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] Short- and Long-Term Mortality after an Acute Illness for Elderly Whites and BlacksHEALTH SERVICES RESEARCH, Issue 4 2008Daniel Polsky Objective. To estimate racial differences in mortality at 30 days and up to 2 years following a hospital admission for the elderly with common medical conditions. Data Sources. The Medicare Provider Analysis and Review File and the VA Patient Treatment File from 1998 to 2002 were used to extract patients 65 or older admitted with a principal diagnosis of acute myocardial infarction, stroke, hip fracture, gastrointestinal bleeding, congestive heart failure, or pneumonia. Study Design. A retrospective analysis of risk-adjusted mortality after hospital admission for blacks and whites by medical condition and in different hospital settings. Principal Findings. Black Medicare patients had consistently lower adjusted 30-day mortality than white Medicare patients, but the initial survival advantage observed among blacks dissipated beyond 30 days and reversed by 2 years. For VA hospitalizations similar patterns were observed, but the initial survival advantage for blacks dissipated at a slower rate. Conclusions. Racial disparities in health are more likely to be generated in the posthospital phase of the process of care delivery rather than during the hospital stay. The slower rate of increase in relative mortality among black VA patients suggests an integrated health care delivery system like the VA may attenuate racial disparities in health. [source] Development of an Algorithm to Identify Pregnancy Episodes in an Integrated Health Care Delivery SystemHEALTH SERVICES RESEARCH, Issue 2 2007Mark C. Hornbrook Objective. To develop and validate a software algorithm to detect pregnancy episodes and maternal morbidities using automated data. Data Sources/Study Setting. Automated records from a large integrated health care delivery system (IHDS), 1998,2001. Study Design. Through complex linkages of multiple automated information sources, the algorithm estimated pregnancy histories. We evaluated the algorithm's accuracy by comparing selected elements of the pregnancy history obtained by the algorithm with the same elements manually abstracted from medical records by trained research staff. Data Collection/Extraction Methods. The algorithm searched for potential pregnancy indicators within diagnosis and procedure codes, as well as laboratory tests, pharmacy dispensings, and imaging procedures associated with pregnancy. Principal Findings. Among 32,847 women with potential pregnancy indicators, we identified 24,680 pregnancies occuring to 21,001 women. Percent agreement between the algorithm and medical records review on pregnancy outcome, gestational age, and pregnancy outcome date ranged from 91 percent to 98 percent. The validation results were used to refine the algorithm. Conclusions. This pregnancy episode grouper algorithm takes advantage of databases readily available in IHDS, and has important applications for health system management and clinical care. It can be used in other settings for ongoing surveillance and research on pregnancy outcomes, pregnancy-related morbidities, costs, and care patterns. [source] Improving oral healthcare delivery systems through workforce innovations: an introductionJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2010Elizabeth A. Mertz PhD Abstract The objective of this paper is to describe the purpose, rationale and key elements of the special issue, Improving Oral Healthcare Delivery Systems through Workforce Innovations. The purpose of the special issue is to further develop ideas presented at the 2009 Institute of Medicine (IOM) workshop, Sufficiency of the U.S. Oral Health Workforce in the Coming Decade. Using the IOM discussions as their starting point, the authors evaluate oral health care delivery system performance for specific populations' needs and explore the roles that the workforce can play in improving the care delivery model. The contributing articles provide a broad framework for stimulating and evaluating innovation and change in the oral health care delivery system. The articles in this special issue point to many deficits in the current oral health care delivery system and provide compelling arguments and proposals for improvements. The issues presented and solutions recommended are not entirely new, but add to a growing body of work that is of critical importance given the context of wider health care reform. [source] Attributes of an ideal oral health care systemJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2010DrPH, Scott L. Tomar DMD Abstract Objectives: The sense of urgency concerning the inadequacies of the current U.S. oral health care system in better preventing oral diseases, eliminating oral health disparities, and ensuring access to basic oral health services has increased in recent years. This paper sought to articulate the attributes that an ideal oral health care system would possess, which would be consistent with the principles of the leading authorities on the public's health. Methods: The authors reviewed policy statements and position papers of the World Health Organization, The Institute of Medicine, The American Public Health Association, Healthy People 2010 Objectives for the Nation, and the American Association of Public Health Dentistry. Results: Consistent with leading public health authorities, an ideal oral health care system would be have the following attributes: integration with the rest of the health care system; emphasis on health promotion and disease prevention; monitoring of population oral health status and needs; evidence-based; effective; cost-effective; sustainable; equitable; universal; comprehensive; ethical; includes continuous quality assessment and assurance; culturally competent; and empowers communities and individuals to create conditions conducive to health. Conclusions: Although there are some attributes of an ideal oral health care system on which the United States has made initial strides, it falls far short in many areas. The development of an oral health care delivery system that meets the characteristics described above is possible but would require tremendous commitment and political will on the part of the American public and its elected officials to bring it to fruition. [source] Perceived Health Needs of Urban African American Church CongregantsPUBLIC HEALTH NURSING, Issue 5 2001Kathleen A. Baldwin Ph.D. Theory-based assessment of congregant expectations and needs should be conducted prior to beginning a parish nurse program. However, no such assessments are found in the literature. Using Andersen's Health Access Model as a framework, investigators conducted interviews with 117 randomly selected congregants in five urban African American churches to describe their perceived needs and expectations. Causing most concern were the following: (a) symptoms of illness,high blood pressure (50.4%), dental problems (43.6%), and back pain (41%); and (b) health habits/risks,weight (75%), exercise (63%), and diet (63%). Younger adults were significantly more concerned about all aspects of their health than their older counterparts. Women were significantly more likely to express concern about health habits and health risks than males. No significant relationship was found between perceived need and access to care. Although terming health care services "adequate", congregants expressed many unmet health needs. This seemingly contradictory finding may illuminate a concrete role for the parish nurse, i.e., addressing personal health care concerns not alleviated by the current "adequate" health care delivery system. This study's significance lies not only in providing programming guidance, but also in theoretical insights into the role of the parish nurse. [source] Rural Policy Development: An NRHA and PACE Association Collaborative ModelTHE JOURNAL OF RURAL HEALTH, Issue 1 2004Peter Fitzgerald MSc ABSTRACT: The Program of All-Inclusive Care for the Elderly (PACE) offers a unique model of comprehensive care for frail, elderly people. To date, all of the PACE programs have been located in urban areas. Rural advocates and policymakers, however, believe the program may hold great promise for use in rural areas, which have higher percentages of elderly residents than urban areas. In 2002, the National Rural Health Association and the National PACE Association convened a meeting that brought together PACE experts, policymakers, and rural health care providers to examine PACE and its applicability for rural communities. The meeting participants concluded that there were many rural communities where the PACE model might not only be appropriate but also highly successful in caring for rural, frail, elderly people. This article examines the notion of expanding the PACE model to rural communities, including some of the barriers and some of the possible solutions that might make PACE a viable part of the rural health care delivery system. [source] US Health Care Reform and Transplantation, Part II: Impact on the Public Sector and Novel Health Care Delivery SystemsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010D. 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] Patient Safety: A Curriculum for Teaching Patient Safety in Emergency MedicineACADEMIC EMERGENCY MEDICINE, Issue 1 2003Karen S. Cosby MD Abstract The last decade has witnessed a growing awareness of medical error and the inadequacies of our health care delivery systems. The Harvard Practice Study and subsequent Institute of Medicine Reports brought national attention to long-overlooked problems with health care quality and patient safety. The Committee on Quality of Health Care in America challenged professional societies to develop curriculums on patient safety and adopt patient safety teaching into their training and certification requirements. The Patient Safety Task Force of the Society for Academic Emergency Medicine (SAEM) was charged with that mission. The curriculum presented here offers an approach to teaching patient safety in emergency medicine. [source] European health policy challengesHEALTH ECONOMICS, Issue S1 2005Alan Maynard Abstract Few countries are immune to the international health care ,virus' of reform, with many countries regularly re-cycling changes that shift costs and benefits in ways that are arbitrary, inefficient and offer short term political palliation. Much of this activity has little evidence base and reveals lack of clarity in defining public policy goals, establishing trade-offs and aligning incentive structures with these objectives. Well established failures in health care delivery systems such as variations in medical practice and continuing absence of systematic outcome measurement, have persisted for decades as nations grapple inefficiently with recurring problems of expenditure inflation and waiting times. The lack of emphasis on evidence to inform the efficient management of chronic disease and the reduction of health inequalities is a product of perverse incentives and managerial inertia that maintains the incomes of powerful interest groups. Copyright © 2005 John Wiley & Sons, Ltd. [source] Barriers to the self-care of type 2 diabetes from both patients' and providers' perspectives: literature reviewJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 1 2009Sandra PY Pun MHA Aim., To review systematically the literature about barriers to diabetes self-care from both patients' and healthcare providers' perspectives. Background., Diabetes mellitus is a global health concern due to rapidly increasing prevalence. The healthcare costs for diabetes care and related complications are high. Tight glycaemic control achieved by intensive therapy has been shown to lower the risk of complications. Despite the provision of comprehensive management programmes, patients are often unable to achieve the desired outcomes. It is essential to understand the barriers to diabetes self-care in order to promote successfully self-care behaviours. Methods., A search of OVID Medline (R), CINAHL, Cochrane Library and British Nursing Index was carried out during 1986,2007 using keywords: Type 2 Diabetes Mellitus, self care, patient compliance, patient adherence and barriers to diabetes self care. Manual searching of relevant nursing journals and sourcing of secondary research extended the search. Results., A total of 16 original research papers using various methods including survey, descriptive correlational, sequential explanatory mixed-method and qualitative exploratory design were reviewed. In total, over 8900 patients and 4550 healthcare providers were recruited from over 28 countries in these studies. Major barriers identified included psychosocial, socioeconomic, physical, environmental and cultural factors. Conclusions., Healthcare providers can enhance patient empowerment and participation with family support to achieve feasible targets. Better health care delivery systems and reforms that improve affordability, accessibility, and efficiency of care are essential for helping both providers and patients to meet desirable standards of diabetes care. Relevance to clinical practice., Understanding barriers to diabetes self-care is the first step in facilitating providers to identify their role in enabling patients to overcome these barriers. Healthcare providers can develop strategies to clarify and individualise treatment guidelines, implement continuing education, improve communication skills, and help motivate patients to achieve desired behavioral changes. [source] The clinical nurse leader: a catalyst for improving quality and patient safetyJOURNAL OF NURSING MANAGEMENT, Issue 5 2008FAAN, JOAN M. STANLEY PhD Aim, The clinical nurse leader (CNL®) is a new nursing role introduced by the American Association of Colleges of Nursing (AACN). This paper describes its potential impact in practice. Background, Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources. Method, A naturalistic approach is used to evaluate the impact the CNL has had on outcomes of care. Case studies describe the CNL implementation experiences at three different practice settings within the same geographic region. Results, Cost savings, including improvement on Centers for Medicare and Medicaid Services (CMS) core measures, are realized quickly in settings where the CNL role has been integrated into the care delivery model. Conclusions, With the growing calls for improved outcomes and more cost-effective care, the CNL role provides an opportunity for nursing to lead innovation by maximizing health care quality while minimizing costs. Implications for nursing management, Nursing is in a unique position to address problems that plague the nation's health system. The CNL represents an exciting and promising opportunity for nursing to take a leadership role, in collaboration with multiple practice partners, and implement quality improvement and patient safety initiatives across all health care settings. [source] A global perspective on changes in the burden of caries and periodontitis: implications for dentistry,JOURNAL OF ORAL REHABILITATION, Issue 12 2007V. BAELUM Summary, The structure and contents of most oral health care systems and the contents of dental curricula reflect a deep-rooted tradition for attempting to cure oral diseases by refined technological means. However, better oral health conditions for the world's populations necessitate the application of up-to-date scientific knowledge to control the major oral diseases. This review points out that not only should the structure and contents of oral health care delivery systems be based on state-of-the-art knowledge about the biology of the oral diseases; they must also take into account the trends for change in caries and periodontal diseases within and between populations, and acknowledge the impact of changes in treatment philosophies for these trends. The oral disease profiles for populations in low- and high-income countries are briefly described, and it is concluded that the rapidly changing disease profiles observed in high-income countries necessitate re-thinking of the future role and organization of dentistry in such countries. The priorities for low- and middle-income countries must be to avoid repeating the mistakes made in the high-income countries. Instead, these societies might take advantage of setting priorities based on a population-based common risk factor approach. If such an approach is adopted, the training of personnel with oral health care competence must be rethought. The authors suggest three different cadres of dental care providers to be considered for an approach that allows health care planners in different populations around the world to prioritize appropriate oral health care with due respect for the socio-economic conditions prevailing. [source] Comparing health care delivery systems , initiating a student exchange project between Europe and the United StatesMEDICAL EDUCATION, Issue 7 2001Elizabeth G Armstrong Background Cross-cultural contact among different health care systems can provide a framework for identifying the strengths and weaknesses of one's own healthcare system. However, such contact has rarely had much impact upon medical education curricula. Despite intense debate on reforming the healthcare delivery systems (HCDS) in Europe and the United States, there is very little formal representation of this interdisciplinary field in our educational programs. Description To address this problem, a medical student exchange program was conducted in which students developed case studies that produced comparative analyses of HCDS in Germany, Sweden, Denmark and the United States. Each case is intended to highlight critical differences among the systems. Evaluation Students and their faculty preceptors completed pre- and post-exchange questionnaires to assess perceived knowledge of the HCDS and the adequacy of time devoted to it in their curricula. Both perceived that too little attention was devoted to this content in their programs. Following the exchange, students described clear increases in perceived knowledge. Discussion Our common interest in curriculum reform was key to implementing the exchange. The written cases generated by the students are being developed as course material in some of the schools and a conference is planned to disseminate the cases and the implementation strategies for their inclusion in medical curricula. [source] | ||||||||||