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Health Care Delivery (health + care_delivery)
Terms modified by Health Care Delivery Selected AbstractsThe Visiting Specialist Model of Rural Health Care Delivery: A Survey in MassachusettsTHE JOURNAL OF RURAL HEALTH, Issue 4 2006Jacob Drew BA ABSTRACT:,Context: Hospitals in rural communities may seek to increase specialty care access by establishing clinics staffed by visiting specialists. Purpose: To examine the visiting specialist care delivery model in Massachusetts, including reasons specialists develop secondary rural practices and distances they travel, as well as their degree of satisfaction and intention to continue the visiting arrangement. Methods: Visiting specialists at 11 rural hospitals were asked to complete a mailed survey. Findings: Visiting specialists were almost evenly split between the medical (54%) and surgical (46%) specialties, with ophthalmology, nephrology, and obstetrics/gynecology the most common specialties reported. A higher proportion of visiting specialists than specialists statewide were male (P = .001). Supplementing their patient base and income were the most important reasons visiting specialists reported for having initiated an ancillary clinic. There was a significant negative correlation between a hospital's number of staffed beds and the total number of visiting specialists it hosted (r =,0.573, P = .032); study hospitals ranged in bed size from 15 to 129. Conclusions: The goal of matching supply of health care services with demand has been elusive. Visiting specialist clinics may represent an element of a market structure that expands access to needed services in rural areas. They should be included in any enumeration of physician availability. [source] Improving the Quality of Workers' Compensation Health Care Delivery: The Washington State Occupational Health Services ProjectTHE MILBANK QUARTERLY, Issue 1 2001Thomas M. Wickizer Researchers and health policy analysts in Washington State set out to determine the extent to which administrative process changes and delivery system interventions within workers' compensation affect quality and health outcomes for injured workers. This research included a pilot project to study the effects of providing occupationally focused health care through managed care arrangements on health outcomes, worker and employer satisfaction, and medical and disability costs. Based on the results, a new initiative was developed to incorporate several key delivery system components. The Washington State experience in developing a quality improvement initiative may have relevance for health care clinicians, administrators, policymakers, and researchers engaged in similar pursuits within the general medical care arena. [source] Diabetes trends in EuropeDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S3 2002Philippe Passa Abstract Estimates and projections suggest an epidemic expansion of diabetes incidence and prevalence in Europe. To evaluate trends in type 1 and type 2 diabetes in seven European countries (Finland, Denmark, the UK, Germany, France, Spain, and Italy), a variety of information is available, including population-based studies on small or large cohorts of subjects representative of the general population in a particular country, European co-operative studies, and sales figures for insulin and oral hypoglycemic agents that allow extrapolation of the number of pharmacologically treated diabetic patients. The incidence of type 1 diabetes in young people is increasing in most European countries, as is its prevalence in all age groups. Type 2 diabetes is the major contributor to the epidemic rise in diabetes. From 1995 to 1999, the prevalence of type 2 diabetes increased considerably, particularly in the UK, Germany, and France. Costs of ambulatory and in-hospital diabetic care (including antidiabetic, antihypertensive, and hypolipidemic agents) have increased even more rapidly than has the number of affected patients. Diabetes trends in Europe are alarming; health care professionals involved in diabetes care must be made aware of these detrimental trends, and health care delivery to patients with diabetes must be improved. Copyright © 2002 John Wiley & Sons, Ltd. [source] Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World Health Organization's panel data on national health care systemsHEALTH ECONOMICS, Issue 10 2004William Greene Abstract The most commonly used approaches to parametric (stochastic frontier) analysis of efficiency in panel data, notably the fixed and random effects models, fail to distinguish between cross individual heterogeneity and inefficiency. This blending of effects is particularly problematic in the World Health Organization's (WHO) panel data set on health care delivery, which is a 191 country, 5-year panel. The wide variation in cultural and economic characteristics of the worldwide sample produces a large amount of unmeasured heterogeneity in the data. This study examines several alternative approaches to stochastic frontier analysis with panel data, and applies some of them to the WHO data. A more general, flexible model and several measured indicators of cross country heterogeneity are added to the analysis done by previous researchers. Results suggest that there is considerable heterogeneity that has masqueraded as inefficiency in other studies using the same data. Copyright © 2004 John Wiley & Sons, Ltd. [source] Fair and Just Culture, Team Behavior, and Leadership Engagement: The Tools to Achieve High ReliabilityHEALTH SERVICES RESEARCH, Issue 4p2 2006Allan S. Frankel Background. Disparate health care provider attitudes about autonomy, teamwork, and administrative operations have added to the complexity of health care delivery and are a central factor in medicine's unacceptably high rate of errors. Other industries have improved their reliability by applying innovative concepts to interpersonal relationships and administrative hierarchical structures (Chandler 1962). In the last 10 years the science of patient safety has become more sophisticated, with practical concepts identified and tested to improve the safety and reliability of care. Objective. Three initiatives stand out as worthy regarding interpersonal relationships and the application of provider concerns to shape operational change: The development and implementation of Fair and Just Culture principles, the broad use of Teamwork Training and Communication, and tools like WalkRounds that promote the alignment of leadership and frontline provider perspectives through effective use of adverse event data and provider comments. Methods. Fair and Just Culture, Teamwork Training, and WalkRounds are described, and implementation examples provided. The argument is made that they must be systematically and consistently implemented in an integrated fashion. Conclusions. There are excellent examples of institutions applying Just Culture principles, Teamwork Training, and Leadership WalkRounds,but to date, they have not been comprehensively instituted in health care organizations in a cohesive and interdependent manner. To achieve reliability, organizations need to begin thinking about the relationship between these efforts and linking them conceptually. [source] Recognising our role: improved confidence of general nurses providing care to young people with a mental illness in a rural paediatric unitJOURNAL OF CLINICAL NURSING, Issue 9-10 2010Lorna Moxham Objective., To implement and evaluate strategies suggested by general nurses to improve management of children and adolescents with mental health problems admitted to a paediatric unit of a general hospital. Background., The first phase of a study using a Participatory Action Research approach identified several concerns associated with general nurses providing care to young people with mental disorders in paediatric units of general hospitals, together with suggestions for strategies to address these issues. This paper describes the second and third phase of the Participatory Action Research study, involving the implementation and evaluation of these strategies. Design., Participatory Action Research. Methods., Actions that occurred during phase two of the Participatory Action Research study included revision and introduction of policies and procedures for mental health care in the unit, education and training sessions for paediatric nursing staff and opportunities to strengthen communication between existing mental health services. In phase three, two focus groups were conducted to explore current perceptions of mental health care delivery in the unit and evaluate change, following phase two. Results., Changes in clinical practice for paediatric mental health care were acknowledged by participants. Reflection has assisted nurses to better understand their strengths and weaknesses and to acknowledge and challenge the assumptions on which their ideas, feelings and actions about patients with mental health issues are based. Participants also recognised the existing skills and expertise they possess that are relevant to the management of young people with a mental health problem, although they continue to seek ongoing education and support in this field. Conclusions., This study demonstrates that through Participatory Action Research it is possible to enhance mental health nursing care in a rural paediatric unit. Relevance to clinical practice., Such changes have the potential to improve the experience of young people and their families whilst receiving treatment for mental health conditions in a general paediatric unit. [source] Reporting a research project on the potential of aged care nurse practitioners in the Australian Capital TerritoryJOURNAL OF CLINICAL NURSING, Issue 2 2009Paul Arbon Aim., This paper reports a project investigating the potential role of the nurse practitioner in aged care across residential, community and acute care venues in the Australian Capital Territory. Background., Australia, like many other countries, faces unprecedented challenges in the provision of health care. Escalating health care costs, an ageing population, increasing prevalence of comorbidities and chronic illnesses, inefficient health care delivery, changing models of health care and shifting professional role boundaries are factors that have contributed to the development of advanced practice roles for nursing. Design., This was a mixed methods study using multiple data sources. Methods., Student aged care nurse practitioners were examined across the continuum of care in the acute, community and residential aged care settings. The potential role of the nurse practitioner in these areas was evaluated qualitatively and quantitatively to identify a model of care to enhance the delivery of efficient and effective health care. Results., The project findings have demonstrated that there is potential for significant improvement in client outcomes arising from a transboundary aged care nurse practitioner model. The improved outcomes are associated with a decrease in acute hospital admissions for residential care clients, timely intervention for a range of common conditions and strengthened multidisciplinary approaches to care provision for older people. Conclusions., Overall the project findings strongly support the potential of a transboundary aged care nurse practitioner role. This role would focus on skilled assessment, timely assessment and intervention, brokering around access to care and clinical leadership and education for nurses. Relevance to clinical practice., This paper offers further evidence of support for the role of nurse practitioners in complementing existing health services and improving delivery of care. [source] Solving nursing shortages: a common priorityJOURNAL OF CLINICAL NURSING, Issue 24 2008James Buchan Aims and objectives., This paper provides a context for this special edition. It highlights the scale of the challenge of nursing shortages, but also makes the point that there is a policy agenda that provides workable solutions. Results., An overview of nurse:population ratios in different countries and regions of the world, highlighting considerable variations, with Africa and South East Asia having the lowest average ratios. The paper argues that the ,shortage' of nurses is not necessarily a shortage of individuals with nursing qualifications, it is a shortage of nurses willing to work in the present conditions. The causes of shortages are multi-faceted, and there is no single global measure of their extent and nature, there is growing evidence of the impact of relatively low staffing levels on health care delivery and outcomes. The main causes of nursing shortages are highlighted: inadequate workforce planning and allocation mechanisms, resource constrained undersupply of new staff, poor recruitment, retention and ,return' policies, and ineffective use of available nursing resources through inappropriate skill mix and utilisation, poor incentive structures and inadequate career support. Conclusions., What now faces policy makers in Japan, Europe and other developed countries is a policy agenda with a core of common themes. First, themes related to addressing supply side issues: getting, keeping and keeping in touch with relatively scarce nurses. Second, themes related to dealing with demand side challenges. The paper concludes that the main challenge for policy makers is to develop a co-ordinated package of policies that provide a long term and sustainable solution. Relevance to clinical practice., This paper highlights the impact that nursing shortages has on clinical practice and in health service delivery. It outlines scope for addressing shortage problems and therefore for providing a more positive staffing environment in which clinical practice can be delivered. [source] Community-oriented primary care: a multidisciplinary community-oriented approach to primary care?JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 1 2001Penny Lenihan Abstract Developing more of a local public health focus, and involving local communities in Great Britain in health care decision-making, are key aspects of the radically changing face of primary care. Community-oriented primary care (COPC) is an international model for innovative primary health care delivery historically applied in developing or deprived communities, but increasingly seen as having broader relevance for a wider range of primary care settings. COPC has a long history of development in deprived communities, it is still however seen as innovative. It fits the current requirements of clinical governance and the ,Modern and Dependable NHS', but does its long history also provide information about it's pitfalls? COPC is promoted as an approach that is applicable to community mental health problems, community psychologists can provide the expertise to facilitate addressing community mental health in COPC programmes. This paper describes the COPC model and highlights the relevance of the COPC philosophy and the problems of its implementation for community psychologists in primary care. Copyright © 2001 John Wiley & Sons, Ltd. [source] Shortening of Median Door-to-Balloon Time in Primary Percutaneous Coronary Intervention in Singapore by Simple and Inexpensive Operational Measures: Clinical Practice Improvement ProgramJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2008CHI-HANG LEE M.B.B.S., F.A.C.C. Background: Primary percutaneous coronary intervention is the standard reperfusion strategy for ST-segment elevation myocardial infarction in our center. We aimed to shorten the median door-to-balloon time from over 100 minutes to 90 minutes or less. Methods: We have been using three strategies since March 2007 to shorten the door-to-balloon time: (1) the intervention team is now activated by emergency department physicians (where previously it had been activated by coronary care unit); (2) all members of the intervention team have converted from using pagers to using cell phones; and (3) as soon as the intervention team is activated, patients are transferred immediately to the cardiac catheterization laboratory (where previously they had waited in the emergency department for the intervention team to arrive). An in-house physician and a nurse would stay with the patients before arrival of the intervention team. Results: During 12 months, 285 nontransfer patients (analyzed, n = 270) underwent primary PCI. The shortest monthly median door-to-balloon time was 59 minutes; the longest monthly median door-to-balloon time was 111 minutes. The overall median door-to-balloon time for the entire 12 months was 72 minutes. On a per-month basis, the median door-to-balloon time was 90 minutes or less in 10 of 12 months. On a per-patient basis, the median door-to-balloon time was 90 minutes or less in 182 patients (67.4%). There was 1 case (0.4%) of inappropriate activation by the emergency department. While waiting for the intervention team to convene, 1 patient (0.4%) deteriorated and had to be resuscitated in the cardiac catheterization laboratory. Conclusions: Improved health care delivery can be achieved by changing simple and inexpensive operational processes. [source] A Comparison of HMO Efficiencies as a Function of Provider AutonomyJOURNAL OF RISK AND INSURANCE, Issue 1 2004Patrick L. Brockett Current debates in the insurance and public policy literatures over health care financing and cost control measures continue to focus on managed care and HMOs. The lower utilization rates found in HMOs (compared to traditional fee-for-service indemnity plans) have generally been attributed to the organization's incentive to eliminate all unnecessary medical services. As a consequence HMOs are often considered to be a more efficient arrangement for delivering health care. However, it is important to make a distinction between utilization and efficiency (the ratio of outcomes to resources). Few studies have investigated the effect that HMO arrangements would have on the actual efficiency of health care delivery. Because greater control over provider autonomy appears to be a recurrent theme in the literature on reform, it is important to investigate the effects these restrictions have already had within the HMO market. In this article, the efficiencies of two major classes of HMO arrangements are compared using "game-theoretic" data envelopment analysis (DEA) models. While other studies confirm that absolute costs to insurance firms and sponsoring companies are lowered using HMOs, our empirical findings suggest that, within this framework, efficiency generally becomes worse when provider autonomy is restricted. This should give new fuel to the insurance companies providing fee-for-service (FFS) indemnification plans in their marketplace contentions. [source] International Collaboration: Initial Steps and StrategiesJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 8 2000Barbara Sheer DNSc, FAANP, FNP-C ABSTRACT The nurse practitioner (NP) movement, which began in the United States in 1965, has caused sweeping changes both in nursing and in health care delivery. The concept of NPs then spread to the United Kingdom (U.K.) and continues to move globally. The international development of NPs has been streamlined through collaborative efforts of the U.S. and the U.K. There have been striking similarities in the evolution of expanded practice roles in both countries. In 1993, NPs from the U.S. and the U.K. came together to support the first international NP conference and, in the process, developed a framework for global international collaboration. This article summarizes the collective knowledge and the strategies for success developed through this collaborative effort. [source] Comparison of trait and ability measures of emotional intelligence in medical studentsMEDICAL EDUCATION, Issue 11 2009Michael T Brannick Context, Emotional intelligence (EI), the ability to perceive emotions in the self and others, and to understand, regulate and use such information in productive ways, is believed to be important in health care delivery for both recipients and providers of health care. There are two types of EI measure: ability and trait. Ability and trait measures differ in terms of both the definition of constructs and the methods of assessment. Ability measures conceive of EI as a capacity that spans the border between reason and feeling. Items on such a measure include showing a person a picture of a face and asking what emotion the pictured person is feeling; such items are scored by comparing the test-taker's response to a keyed emotion. Trait measures include a very large array of non-cognitive abilities related to success, such as self-control. Items on such measures ask individuals to rate themselves on such statements as: ,I generally know what other people are feeling.' Items are scored by giving higher scores to greater self-assessments. We compared one of each type of test with the other for evidence of reliability, convergence and overlap with personality. Methods, Year 1 and 2 medical students completed the Meyer,Salovey,Caruso Emotional Intelligence Test (MSCEIT, an ability measure), the Wong and Law Emotional Intelligence Scale (WLEIS, a trait measure) and an industry standard personality test (the Neuroticism,Extroversion,Openness [NEO] test). Results, The MSCEIT showed problems with reliability. The MSCEIT and the WLEIS did not correlate highly with one another (overall scores correlated at 0.18). The WLEIS was more highly correlated with personality scales than the MSCEIT. Conclusions, Different tests that are supposed to measure EI do not measure the same thing. The ability measure was not correlated with personality, but the trait measure was correlated with personality. [source] Databases for outcomes research: what has 10 years of experience taught us?PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 5 2001Lynn Bosco MD Abstract This paper describes how the mission of the Agency for Healthcare Research and Quality (AHRQ) is being executed through the many programs that it has developed and implemented. The Evidence-based Practice Center program was developed to provide systematic reviews on common and expensive conditions and health technologies and to ensure that this information is used to improve health care outcomes and costs. The National Guidelines Clearinghouse provides an internet-based source of clinical practice guidelines that are produced by clinical specialty organizations for the primary purpose of improving health care delivery and outcomes. Relevant to this symposium on databases, AHRQ has supported the development of databases to track hospital utilization on a state-by-state basis. The Healthcare Cost and Utilization Project (HCUP) allows comparisons between states and within regions of individual states. New initiatives have been launched to evaluate interventions across systems rather than focusing on the individual patient (Translating Research into Practice,TRIP). The Centers for Education and Research on Therapeutics (CERTs) program was developed to conduct real world evaluations to better understand the benefits and risks of single and combined therapy. Both programs further the mission of the AHRQ to improve the outcomes and quality of health care, with additional focus on the cost-effectiveness, patient safety, and increasing access to care for all. Information on programs developed by the AHRQ is available in more detail at the Agency Web site http://www.ahrq.gov. Copyright © 2001 John Wiley & Sons, Ltd. [source] The decentralization of primary health care delivery in ChilePUBLIC ADMINISTRATION & DEVELOPMENT, Issue 3 2001Article first published online: 30 MAY 200, Jasmine Gideon The article argues that during the 1980s the process of decentralization in Chile under the military government of General Pinochet shifted the delivery of primary health care to the municipal level. Despite the return to more democratic forms of government in 1990 the overall structure of local-level service delivery has remained largely unchanged. The municipalities have retained responsibility for service delivery but resources remain centrally determined. In an attempt to enhance accessibility, choice and the responsiveness of the system to individual and local need, reform has been made to the financial transfer mechanisms and a new model of primary health care delivery has recently been introduced. However, problems of resourcing and implementation limit the effectiveness of some of the changes that have accompanied decentralization. Problems have resulted in primary health care delivery because administrative decentralization has not been accompanied by fiscal decentralization, nor effective political decentralization. Copyright © 2001 John Wiley & Sons, Ltd. [source] Differences in clinical trial conduct in US and EU investigational sitesQUALITY ASSURANCE JOURNAL, Issue 1 2001Douglas R. Mackintosh Abstract Observations by clinical auditors about good clinical practice (GCP) compliance in US and EU investigational sites are described. Specific differences between the two regions are noted for institutional review boards (IRBs) and ethics committees; subject recruiting and consenting; investigator/study coordinator qualifications and functions; organization and recording of source data; health care delivery; quality of monitoring; and filing of regulatory documents. Neither region of the world demonstrated GCP superiority in the conduct of its clinical trials. Copyright © 2001 John Wiley & Sons, Ltd. [source] The greying of resource communities in northern British Columbia: implications for health care delivery in already-underserviced communitiesTHE CANADIAN GEOGRAPHER/LE GEOGRAPHE CANADIEN, Issue 1 2005Neil Hanlon The delivery of ,rural' health care services has long confronted the geographic problems of distance, low user densities, low-order facilities and caregiver shortages. As a result, rural and remote communities across Canada have struggled with health care delivery. For rural and remote communities in resource hinterlands, population ageing driven by industrial restructuring presents a significant departure from past experience. Drawing on examples from northern British Columbia (BC), this paper examines this context of ageing in rural and remote locations with the purpose of highlighting impending challenges for health care service provision. In the first part of this paper, we provide a demographic overview of population change and ageing in northern BC. In the second part, we present data on the availability of services throughout the region to support seniors who age-in-place. Population ageing, in areas that have never dealt with this issue before, highlights not only important servicing questions but also important policy questions about how to provide for needs that the policy and community context are not presently equipped to meet. Ce n'est pas d'hier que la prestation de services de soins de santé en milieu «rural» doit composer avec les problèmes géographiques liés aux distances, à la faible densité d'usagers, aux établissements de bas ordre et à la pénurie de personnel soignant. C'est pourquoi, pour les collectivités rurales et éloignées du Canada, la prestation de soins de santé constitue un problème de longue date. Pour ces collectivités rurales et éloignées de l'arrière-pays industriel, le vieillissement de la population découlant de la restructuration industrielle représente une dérogation notable à l'ordre normal des choses. En s'appuyant sur des exemples du Nord de la Colombie-Britannique, le présent article examine le contexte du vieillissement en milieu rural et éloigné afin de faire ressortir les défis imminents à la prestation de services de soins de santé. La première partie de l'article présente un aperçu démographique du changement et du vieillissement de la population dans le Nord de la Colombie-Britannique. La seconde partie présente des données sur la disponibilité, dans la région, de services de soutien aux personnes âgées qui «vieillissent sur place». Pour les régions qui ne s'y sont pas encore attardées, le vieillissement de la population soulève non seulement d'importantes questions ayant trait à la prestation de services, mais aussi des questions de politiques visant la réponse à des besoins auxquels le contexte communautaire et le cadre de politique actuels ne répondent pas. [source] Evaluation of a training to improve management of pediatric overweightTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2005Josephine Hinchman MPH Research Associate Abstract Introduction: Despite widespread concern about pediatric obesity, health care professionals report low proficiency for identifying and treating this condition. This paper reports on the evaluation of pediatric overweight assessment and management training for clinicians and staff in a managed care system. The training was evaluated for its impact on assessment practices and utilization of management tools. Methods: A delayed-control design was utilized to measure the effects of two 60-minute interactive Continuing Medical education (CME) trainings for the pediatric health care teams. Chart abstraction was conducted at 0-, 3- and 6-months after training, recording the proportion of charts containing the recommended assessment methods and management tools. Results: The training was associated with a significant increase in the utilization of some tools and practices, including charting BMI-for-age percentile (p<0.001) and using a nutrition and activity self-history form (p<0.001). Overall, from baseline to 3-months post training, charting BMI-for-age percentiles increased from zero to 25.2% and utilization of the self-history form increased from zero to 35.3%. These increases were sustained at 6-months post training. Other tools guiding clinician counseling were less widely utilized, although a behavioral prescription pad was used with 20% of overweight patients. Discussion: A modest investment in clinician and staff training designed to be feasible in a clinical setting was associated with substantial increases in the use of appropriate tools and practices for the assessment and management of pediatric overweight. Such training may help to augment and improve the processes of pediatric health care delivery for addressing overweight. The training provides a viable model for future CME efforts in other health care settings. [source] Shifting the culture of continuing medical education: What needs to happen and why is it so difficult?THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2000Angela Towle PhD Faculty of Medicine Abstract A revolution in health care is occurring as a result of changes in the practice of medicine and in society. These include changing demographics and the pattern of disease; new technologies; changes in health care delivery; increasing consumerism, patient empowerment, and autonomy; an emphasis on effectiveness and efficiency; and changing professional roles. The issues raised by these changes present challenges for the content and delivery of the whole continuum of medical education. The ways in which continuing medical education (CME) needs to respond to these challenges are outlined. The Informed Shared Decision Making (ISDM) Project at the University of British Columbia is used as a case study to illustrate some of the practical problems in providing CME that address these current trends in health care, is effective, and is attractive to physicians. Two particular problems are posed: how to respond to a demonstrated need when there is no perceived need on the part of physicians and how to enable change agents on the margins to develop allies and get ownership from stakeholders and opinion leaders on the inside. Two strategies for change are discussed: the substantive incorporation of CME into the continuum of medical education and the involvement of patients in the planning and delivery of CME. A final challenge is raised for the leaders of CME to define and agree what "shifting the culture of CME" means and to make a commitment of time and energy into making it happen. [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] The Impact of Blue Cross Conversions on Accessibility, Affordability, and the Public InterestTHE MILBANK QUARTERLY, Issue 4 2003MARK A. HALL For-profit organization in health care delivery has been a major public policy issue least since at least the 1980s, driven by the growth of for-profit hospital chains and a wave of conversions by nonprofit hospitals. As significant as these events have been, however, they pale in comparison with the potential impact of conversions by Blue Cross and/or Blue Shield plans (which we refer to generically as Blue Cross, abbreviated BC). Because Blue Cross plans are the largest health insurer in almost every state (or substate region where they operate), these conversions could remake the corporate landscape of health care finance. Although BC plans no longer hold the overwhelming market share they enjoyed 50 years ago (when they commanded more than two-thirds of the commercial market; see Blackstone and Fuhr 1998), their share still is considerable. Blue Cross controls at least half the individual market in 33 states and more than a third of the group market in 29 states (Chollet, Kirk, and Chow 2000; McCann 2003). [source] The Tyranny of Diagnosis: Specific Entities and Individual ExperienceTHE MILBANK QUARTERLY, Issue 2 2002Charles E. Rosenberg Diagnosis has always played a pivotal role in medical practice, but in the past two centuries, that role has been reconfigured and has become more central as medicine,like Western society in general,has become increasingly technical, specialized, and bureaucratized. Disease explanations and clinical practices have incorporated, paralleled, and, in some measure, constituted these larger structural changes. This modern history of diagnosis is inextricably related to disease specificity, to the notion that diseases can and should be thought of as entities existing outside the unique manifestations of illness in particular men and women. During the past century especially, diagnosis, prognosis, and treatment have been linked ever more tightly to specific, agreed-upon disease categories, in both concept and everyday practice. In fact, this essay might have been entitled "Diagnosis Mediates an Invisible Revolution: The Social and Intellectual Significance of Specific Disease Concepts." It would have been even more precise, if rather less arresting. The articulation and acceptance of specific disease entities constitute one of the most important intellectual and cultural events of the past two centuries. This notion is central to how we organize health care delivery, think about ourselves, debate and formulate social policy, and define and manage deviance. Diagnosis is indispensable to linking specific disease concepts with doctor and patient and the social and economic institutions shaping such clinical interactions. Disease is a social entity, not an array of ideal types. The history of medicine is partly the story of how disease entities have become social entities, accumulating the flesh of diagnostic and therapeutic practice, social expectation, and bureaucratic reification. Despite criticism of reductionist medicine in the West and less focus on disease entities and mechanisms, our social response still depends on this concept of sickness. But this concept can no longer remain invisible if we are to understand contemporary medicine as both a social and a technological system. The articulation and acceptance of specific disease entities constitute one of the most important intellectual and cultural events of the past two centuries. This notion is central to how we organize health care delivery, think about ourselves, debate and formulate social policy, and define and manage deviance. Diagnosis is indispensable to linking specific disease concepts with doctor and patient and the social and economic institutions shaping such clinical interactions. Disease is a social entity, not an array of ideal types. The history of medicine is partly the story of how disease entities have become social entities, accumulating the flesh of diagnostic and therapeutic practice, social expectation, and bureaucratic reification. Despite criticism of reductionist medicine in the West and less focus on disease entities and mechanisms, our social response still depends on this concept of sickness. But this concept can no longer remain invisible if we are to understand contemporary medicine as both a social and a technological system. The articulation and acceptance of specific disease entities constitute one of the most important intellectual and cultural events of the past two centuries. This notion is central to how we organize health care delivery, think about ourselves, debate and formulate social policy, and define and manage deviance. Diagnosis is indispensable to linking specific disease concepts with doctor and patient and the social and economic institutions shaping such clinical interactions. Disease is a social entity, not an array of ideal types. The history of medicine is partly the story of how disease entities have become social entities, accumulating the flesh of diagnostic and therapeutic practice, social expectation, and bureaucratic reification. Despite criticism of reductionist medicine in the West and less focus on disease entities and mechanisms, our social response still depends on this concept of sickness. But this concept can no longer remain invisible if we are to understand contemporary medicine as both a social and a technological system. The articulation and acceptance of specific disease entities constitute one of the most important intellectual and cultural events of the past two centuries. This notion is central to how we organize health care delivery, think about ourselves, debate and formulate social policy, and define and manage deviance. Diagnosis is indispensable to linking specific disease concepts with doctor and patient and the social and economic institutions shaping such clinical interactions. Disease is a social entity, not an array of ideal types. The history of medicine is partly the story of how disease entities have become social entities, accumulating the flesh of diagnostic and therapeutic practice, social expectation, and bureaucratic reification. Despite criticism of reductionist medicine in the West and less focus on disease entities and mechanisms, our social response still depends on this concept of sickness. But this concept can no longer remain invisible if we are to understand contemporary medicine as both a social and a technological system. [source] INCARNATIONAL THEOLOGY AND THE GOSPEL: EXPLORING THE MISSISSIPPI MODEL OF EPISCOPAL MEDICAL MISSIONS TO PANAMAANNALS OF ANTHROPOLOGICAL PRACTICE, Issue 1 2010Robert P. Connolly This article explores the faith-based medical missions of the Episcopal Diocese of Mississippi to underserved rural indigenous peoples of Panama. The Mississippi Model focuses on health care delivery and de-emphasizes conversion to a religious faith, an approach that some may classify as a faith-based community performing secular tasks. However, the Mississippi Model arises from incarnational theology, which,viewed from both historical and contemporary perspectives,argues against a secular categorizing of the mission clinics. Consistently, our interviews with missioners, participant-observations, and review of the Episcopal Church literature, both nationally and in Mississippi, suggest that mission performance is considered a practice of faith not distinct from other expressions of faith, such as liturgical worship. [source] Pragmatic indicators for remote Aboriginal maternal and infant health care: why it matters and where to startAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010Malinda Steenkamp Abstract Objective: There are challenges in delivering maternal and infant health (MIH) care to remote Northern Territory (NT) communities. These include fragmented care with birthing in regional hospitals resulting in cultural and geographical dislocation for Aboriginal women. Many NT initiatives are aimed at improving care. Indicators for evaluating these for remote Aboriginal mothers and infants need to be clearer. We reviewed existing indicators to inform a set of pragmatic indicators for reporting improvement in remote MIH care. Methods: Scientific databases and grey literature (organisational websites and Google Scholar) were searched using the terms ,Aboriginal/maternal/infant/remote health/monitoring performance'. Key stakeholders identified omitted indicators sets. Relevant sets were reviewed and organised by indicator type, stage of patient journey, topic and theme. Results: Forty-two indicators sets were found. Seven focused on Aboriginal health, 23 on reproductive/maternal health, eight on child/infant health and four on other aspects, e.g. remote health. We identified more than 1,000 individual indicators. Of these, 656 were relevant for our purpose and were subsequently organised into 300 topics and 16 themes for antenatal, birth and postpartum, and infant care by indicator type. Conclusion: There are many measures for monitoring health care delivery to mothers and infants. Few are framed around remote MIH services, despite poorer health outcomes of remote mothers and infants and the specific challenges with providing care in this setting. Establishing relevant indicators is vital to support relevant data collection and the development of appropriate policy for remote Aboriginal maternal and infant care. [source] Reducing racism in Aboriginal health care in Australia: where does cultural education fit?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010Angela Durey Abstract Objective: This paper discusses whether educating health professionals and undergraduate students in culturally respectful health service delivery is effective in reducing racism, improving practice and lessening the disparities in health care between Aboriginal and non-Aboriginal Australians. Approach: The paper supports the concept of race as a social construction that is discursively produced and reproduced. Studies on the effectiveness of cross-cultural education for undergraduate students and health professionals to reduce racism and deliver culturally respectful health care to indigenous or minority populations are examined for evidence of sustained improvements to practice. Conclusion: Programs in culturally respectful health care delivery can lead to short-term improvements to practice. Sustained change is more elusive as few programs conducted long-term evaluations. Long-term evaluation of programs in culturally respectful health care delivery is necessary to identify whether early changes to behavior and practices are sustained. Strategies linking policies to practice to reduce health disparities between Aboriginal and non-Aboriginal Australians are also needed. Implications: Confronting the effects of racism in health services towards Aboriginal Australians is a priority requiring a multi-tiered commitment to strategies linking policy to practice to reduce health disparities between Aboriginal and non-Aboriginal Australians. Part of this strategy includes preparing undergraduates and health professionals for culturally respectful health care with education programs that are evaluated for long-term improvements to practice. [source] Patient Protection and Affordable Care Act of 2010: Summary, Analysis, and Opportunities for Advocacy for the Academic Emergency PhysicianACADEMIC EMERGENCY MEDICINE, Issue 7 2010Jeffrey A. Kline MD ACADEMIC EMERGENCY MEDICINE 2010; 17:E69,E74 © 2010 by the Society for Academic Emergency Medicine Abstract The Patient Protection and Affordable Care Bill, commonly referred to as the "Health Care Bill" or the "Health Care Reform Bill," was enacted in March 2010. This article is a review and analysis of the sections of this Act that are relevant to researchers and teachers of emergency care. The purpose of this document is to serve as a citable reference for interested parties and a reference to quickly locate the sections of the Bill relevant to academic emergency physicians. When appropriate, text was copied verbatim from the Bill. The source of the downloaded Act, and the page numbers of the text sections, are provided to help the reader to find the sections described. This review is presented in two parts. Part I presents 11 sections extirpated from the Act, with short interpretations of the significance of each section. Part II presents an analysis of the sections that the authors believe represent opportunities for emergency care researchers and teachers to make the most impact, through active involvement with the various departments and agencies of the federal government that will be charged with interpreting and implementing this Act. The Act contains sections that could lead to new funding opportunities for research in emergency care, especially for comparative clinical trials and clinical studies that focus on integration and efficiency of health care delivery. The Act will establish several new institutes, centers, and committees that will create policies highly relevant to emergency care. The authors conclude that this Act can be expected to have a profound influence on research and training in emergency care. [source] | ||||||||||||||||