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Services System (services + system)

Distribution by Scientific Domains

Medical Sciences	44%

Selected Abstracts

Evaluating the Impact of an Educational Intervention on Documentation of Decision-making Capacity in an Emergency Medical Services System

ACADEMIC EMERGENCY MEDICINE, Issue 7 2004
Jennifer Riley MD
Abstract Objectives: To compare the documentation of decision-making capacity by advanced life support (ALS) providers and signature acquisition before, one month after, and one year after an educational intervention. Methods:The intervention comprised a one-and-a-half-hour module on assessment and documentation of decision-making capacity. Ambulance call reports were reviewed for all ALS calls occurring during three two-month periods, and refusals of transport were recorded. Provider compliance with documentation of decision-making capacity and signature acquisition were determined from a convenience sample of 75 reports from each period. Reviewers were blinded to study period. Twenty-percent double data entry was undertaken to evaluate accuracy. Ninety-five percent confidence intervals were calculated to compare frequencies of cancelled calls and documentation. Results: From the emergency medical services database, 7,744 calls before the intervention, 7,444 immediately after, and 7,604 one year later were identified. Documentation rates in the second and third periods did not differ from that prior to the intervention (1.3% vs. 0.0% and 0.0% in subsequent periods), nor did the rates of signature acquisition differ (85.3% vs. 85.3% and 78.6%). The accuracy of data entry was 92.6%. However, the frequency of call refusals decreased significantly after the intervention (from 9.0% to 2.0% and 6.6% in the respective periods). Conclusions: An educational intervention resulted in no change in the rate of decision-making capacity documentation or signature acquisition by ALS providers for refusal of transport. There was a temporary increase in the number of transported patients. [source]

Customer Satisfaction in a Large Urban Fire Department Emergency Medical Services System

ACADEMIC EMERGENCY MEDICINE, Issue 1 2004
David E. Persse MD
Objectives: The purpose of this study was to determine if emergency medical services (EMS) customer satisfaction could be assessed using telephone-survey methods. The process by which customer satisfaction with the EMS service in a large, fire department,based EMS system is reported, and five month results are presented. Methods: Ten percent of all patients transported during the period of October 15, 2001, through March 15, 2002, were selected for study. In addition, during the same period, all EMS incidents in which a patient was not transported were identified for contact. Customer-service representatives contacted patients via telephone and surveyed them from prepared scripts. Results: A total of 88,528 EMS incidents occurred during the study period. Of these, 53,649 resulted in patient transports and 34,879 did not. Ten percent of patients transported (5,098) were selected for study participation, of which 2,498 were successfully contacted; of these, 2,368 (94.8%) reported overall satisfaction with the service provided. Of the 34,879 incidents without transport, only 5,859 involved patients who were seen but not transported. All of these patients were selected for study. Of these, 2,975 were successfully contacted, with 2,865 (96.3%) reporting overall satisfaction. The most common reason given for nonsatisfaction in both groups was the perception of a long response time. Conclusions: It is possible to conduct a survey of EMS customer satisfaction using telephone-survey methods. Although difficulties exist in contacting patients, useful information is made available with this method. Such surveys should be an integral part of any EMS system's quality-improvement efforts. In this survey, the overwhelming majority of patients, both transported and not transported, were satisfied with their encounter with EMS. [source]

Dyadic Developmental Psychotherapy: an effective and evidence-based treatment , comments in response to Mercer and Pignotti

CHILD & FAMILY SOCIAL WORK, Issue 1 2010
Arthur Becker-Weidman
ABSTRACT This paper describes the evidence base for Dyadic Developmental Psychotherapy as an evidence-based, empirically validated, and effective family-therapy treatment for children with reactive attachment disorder and complex trauma. It is in response to a note by Mercer, Pennington, Pignotti, & Rosa. to our previous paper describing the evidence-base of Dyadic Developmental Psychotherapy. The paper summarizes the extensive empirical literature that describes the effectiveness of such dimensions of Dyadic Develop-mental Psychotherapy as affect arousal and regulation, gradual expo-sure to trauma, parent education and consultation, explaining how the past may be continuing to affect present behaviour, forming and maintaining a therapeutic relationship through therapist acceptance, affirmation, empathy and various other dimensions. The paper presents several generally accepted criteria for determining evidence-based practice and evidence-based treatment and demonstrates how Dyadic Developmental Psychotherapy meets those criteria. These criteria include those developed by Saunders et al., the UK National Health Services system, and the US Preventative Services Task Force system for ranking the quality of evidence. Finally, the paper responds to specific points raised by Mercer et al. indicating those with which we agree and those with which we disagree. [source]

Threshold-based admission control for a multimedia Grid: analysis and performance evaluation

CONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 14 2006
Yang Zhang
Abstract In a Grid-based services system facing a large number of requests with different services and profits significance, there is always a trade-off between the system profits and the Quality of Service (QoS). In such systems, admission control plays an important role: the system has to employ a proper strategy to make admission control decisions and reserve resources for the coming requests thus to achieve greater profits without violating the QoS of the requests already admitted. In this paper, we introduce three essential admission control strategies with threshold on resource reservation and a newly proposed strategy with layered threshold. Through comprehensive theoretical analyses and extensive simulations, we demonstrate that the strategy with layered threshold is more efficient and flexible than the existing strategies for Grid-based multimedia services systems. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Parent-Identified Barriers to Pediatric Health Care: A Process-Oriented Model

HEALTH SERVICES RESEARCH, Issue 1 2006
Elisa J. Sobo
Objective. To further understand barriers to care as experienced by health care consumers, and to demonstrate the importance of conjoining qualitative and quantitative health services research. Data Sources. Transcripts from focus groups conducted in San Diego with English- and Spanish-speaking parents of children with special health care needs. Study Design. Participants were asked about the barriers to care they had experienced or perceived, and their strategies for overcoming these barriers. Using elementary anthropological discourse analysis techniques, a process-based conceptual model of the parent experience was devised. Principal Findings. The analysis revealed a parent-motivated model of barriers to care that enriched our understanding of quantitative findings regarding the population from which the focus group sample was drawn. Parent-identified barriers were grouped into the following six temporally and spatially sequenced categories: necessary skills and prerequisites for gaining access to the system; realizing access once it is gained; front office experiences; interactions with physicians; system arbitrariness and fragmentation; outcomes that affect future interaction with the system. Key to the successful navigation of the system was parents' functional biomedical acculturation; this construct likens the biomedical health services system to a cultural system within which all parents/patients must learn to function competently. Conclusions. Qualitative analysis of focus group data enabled a deeper understanding of barriers to care,one that went beyond the traditional association of marker variables with poor outcomes ("what") to reveal an understanding of the processes by which parents experience the health care system ("how,""why") and by which disparities may arise. Development of such process-oriented models furthers the provision of patient-centered care and the creation of interventions, programs, and curricula to enhance such care. Qualitative discourse analysis, for example using this project's widely applicable protocol for generating experientially based models, can enhance our knowledge of the parent/patient experience and aid in the development of more powerful conceptualizations of key health care constructs. [source]

L'ajustement mutuel dans le fonctionnement organique du système multiorganisationnel d'aide et de services aux sans-abri de Montréal

CANADIAN PUBLIC ADMINISTRATION/ADMINISTRATION PUBLIQUE DU CANADA, Issue 1 2009
Alain Dupuis
Sommaire : Notre étude de l'organisation du secteur de l'aide et des services aux sans-abri à Montréal Centre met en lumière un système multiorganisationnel de services de santé et de services sociaux qui n'est pas intégré hiérarchiquement dans son ensemble et qui n'est pas soumis à une « entente de gestion et d'imputabilité» globale propre à une gestion fondée sur la normalisation des résultats. L'étude présente un système d'ensemble de type « organique » plutôt que bureaucratique, largement fondé sur des ajustements mutuels entre les nombreux acteurs publics et « communautaires » de ce secteur. La coordination des services se réalise alors essentiellement dans les interactions entre les intervenants alors qu'ils accomplissent leur travail, et ce avec le soutien des gestionnaires. À l'aide de nombreux extraits d'entrevues, nous étudions le fonctionnement de ce système « organique » sous la forme de trois catégories de processus d'ajustement mutuel qui se superposent et se complètent pour assurer la valeur des services : disjoint unilatéral, conjoint bilatéral et conjoint multilatéral. Selon les sciences de l'organisation, un tel système est potentiellement mieux adaptéà composer avec la complexité des connaissances et des valeurs caractéristiques des services humains, qu'un à système formellement intégré et contrôlé par des règles, des indicateurs et des cibles quantifiables. Abstract: This study of the organization of the sector dedicated to providing aid and services to the homeless in Central Montreal reveals a multiorganizational health and social services system that is neither hierarchically integrated as a whole nor subject to a comprehensive "management and accountability agreement" specific to standardized results-based management. The study details a comprehensive system that is "organic," rather than bureaucratic, and broadly organized based on mutual adjustments among the numerous public and "community" practitioners in this sector. The coordination of services is therefore essentially achieved through the interaction of the workers as they perform their jobs, with the support of management. This study draws on a number of extracts from interviews to examine how this "organic" system operates, in the form of three distinct processes of mutual adjustment that are superimposed and complementary to ensure the value of the services: "unilateral disjoined,""bilateral joined" and "multilateral joined." According to organizational science, this type of system is potentially more likely to address the complexities inherent in the knowledge and values that are characteristic of human services than a formally integrated system that is controlled by rules, indicators and quantifiable targets. [source]

The "Vertical Response Time": Barriers to Ambulance Response in an Urban Area

ACADEMIC EMERGENCY MEDICINE, Issue 9 2007
Robert A. Silverman MD
Background: Ambulance response time is typically reported as the time interval from call dispatch to arrival on-scene. However, the often unmeasured "vertical response time" from arrival on-scene to arrival at the patient's side may be substantial, particularly in urban areas with high-rise buildings or other barriers to access. Objectives: To measure the time interval from arrival on-scene to the patient in a large metropolitan area and to identify barriers to emergency medical services arrival. Methods: This was a prospective observational study of response times for high-priority call types in the New York City 9-1-1 emergency medical services system. Research assistants riding with paramedics enrolled a convenience sample of calls between 2001 and 2003. Results: A total of 449 paramedic calls were included, with a median time from call dispatch to arrival on-scene of 5.2 minutes. The median on-scene to patient arrival interval was 2.1 minutes, leading to an actual response interval (dispatch to patient) of 7.6 minutes. The median on-scene to patient interval was 2.8 minutes for residential buildings, 2.7 minutes for office complexes, 1.3 minutes for private homes (less than four stories), and 0.5 minutes for outdoor calls. Overall, for all calls, the on-scene to patient interval accounted for 28% of the actual response interval. When an on-scene escort provided assistance in locating and reaching the patient, the on-scene to patient interval decreased from 2.3 to 1.9 minutes. The total dispatch to patient arrival interval was less than 4 minutes in 8.7%, less than 6 minutes in 28.5%, and less than 8 minutes in 55.7% of calls. Conclusions: The time from arrival on-scene to the patient's side is an important component of overall response time in large urban areas, particularly in multistory buildings. [source]

Threshold-based admission control for a multimedia Grid: analysis and performance evaluation

Legal Accountability in the Service-Based Welfare State: Lessons from Child Welfare Reform

LAW & SOCIAL INQUIRY, Issue 3 2009
Kathleen G. Noonan
Current trends intensify the longstanding problem of how the rule of law should be institutionalized in the welfare state. Welfare programs are being redesigned to increase their capacities to adapt to rapidly changing conditions and to tailor their responses to diverse clienteles. These developments challenge the understanding of legal accountability developed in the Warren Court era. This article reports on an emerging model of accountable administration that strives to reconcile programmatic flexibility with rule-of-law values. The model has been developed in the reform of state child protective services systems, but it has potentially broad application to public law. It also has novel implications for such basic rule-of-law issues as the choice between rules and standards, the relation of bureaucratic and judicial control, the proper scope of judicial intervention into dysfunctional public agencies, and the justiciability of "positive" (or social and economic) rights. [source]