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PubMed2000

Implementing the second generation social health maintenance organization.

BACKGROUND: In 1996 the Health Care Financing Administration implemented a second generation of the Social HMO demonstration. This model retained the chronic care benefits of the original Social HMOs while attempting to develop a geriatric service model integrated into primary care and a screening and assessment process focused directly on healthcare risk factors. Other refinements included risk-adjusted capitation payment, broadened eligibility for expanded care benefits, low co-payments for these benefits, and no caps on the expanded care benefits expenditures. OBJECTIVES: The geriatric approach is designed to facilitate integration among providers and levels of care. This includes timely application of primary care monitoring and treatment to reduce illness and disability as well as a geriatric education and consultation program to provide specialty support for complex cases. Care management is designed for those requiring home-based care, those discharged from hospitals or nursing homes, and those having difficulty with treatment regimens. DESIGN: A case study of the Social HMO implementation through the Fall of 1999. SETTING: Health Plan of Nevada (HPN), with locations in Las Vegas, Reno, and surrounding areas. PARTICIPANTS: More than 25,000 Medicare beneficiaries participated during the study period. MEASUREMENTS: Administrative reports, charts, and interviews with administrators and clinicians. RESULTS: Within 12 months of operation under this authority, HPN succeeded in putting in place most of the components of the planned geriatric approach: a screening program to identify patients "at risk" for high service costs and disability and timely application of primary care treatment to reduce illness and disability. Geriatric education and a consultation program for complex cases were available, but full implementation was delayed until the plan was able to hire a full time geriatrician. CONCLUSIONS: Health Plan of Nevada's Social HMO program reflects current perspectives on how to integrate chronic care into an HMO. The accomplishments affirm that the provision of risk-adjusted reimbursement, along with the 5 % supplement to the normal Medicare capitation payment, are sufficient incentives for a health plan to restructure itself so that it places a priority on retaining and serving populations at risk for high expenditures.

Aged↗
PubMed1995

Rehabilitation services in the health sector: the perspectives of providers and consumers: Part 1.

AIMS: To establish the degree of implementation of the Strategic Planning Guidelines for Area Health Boards--Services for Adults with Physical Disability, published by the Department of Health in 1989, the services being provided, and the priorities for future service provision. METHODS: Two postal surveys of area health boards (AHB's) were carried out in 1991. The first asked about the terminology of rehabilitation, administrative structure, advocacy, service audit, inventory of services, regional service delivery, and consultation processes. The second asked about the rehabilitation services provided, the type of disability of the consumers of the service, the reasons why services were or were not provided, the service gaps that existed, and the priorities that existed to fill those service gaps. RESULTS: The major finding was that while all area health boards adopted the rehabilitation concepts in principle, service development was impeded in many cases by the failure to provide resources to plan and develop the service. Some were providing comprehensive services. Most AHB's provided services for people with physical or multiple disabilities. All provided statutory services such as district nursing and home help, while most provided regular medical reviews, physiotherapy, occupational therapy, speech therapy, etc. Only about half provided attendant care, driving assessment, and swimming for people with disabilities, while less than half supported disability information services (DIS). Attendant care was seen as high priority to fill gaps in service, but was seen as the funding responsibility of the Department of Social Welfare. CONCLUSIONS: Service provision reflected a traditional approach to the provision of rehabilitation services. The development of innovative service delivery will require crown health enterprises to reevaluate their present level of commitment to rehabilitation services and to assess the effectiveness of reallocating some funds from acute services into rehabilitation.

Guidelines as Topic↗
PubMed2005

Faculty internships in environmental health: planning and implementation.

Faculty internships, in which a faculty member works temporarily for a government organization or a private business, are a concept that is becoming popular at universities. This paper discusses how a faculty internship can be developed and implemented, and it reports on the advantages of the internship for academia, the sponsoring institution, and the professor. In addition, suggestions on structuring and implementing the internship are offered. The major objective of the paper is to encourage environmental health educators to seriously consider faculty internships as a means of bridging the gaps between academia and the business world. Faculty internships should be beneficial primarily for two groups of professors. First are those professors who, after earning doctorates, enter the teaching profession without any environmental health practicum experience. Second are those who once worked full time as environmental health practitioners but have been out of the field for a significant number of years with little or no contact with the "real world" of environmental health practice. The information presented is based on the experience of the author, who served as a faculty intern for the environmental health division of a county health department in rural west-central Indiana, Some of the benefits of faculty internships are improved teaching methods, practical experience, community contacts, and increased internship opportunities for students. The experience can enhance classroom theory for students, and the implementation of practice can be clarified for the educator.

Commerce↗
PubMed1997

Developing injury prevention capacity in New York City: the role of a local health department in fostering collaborations.

Injuries have long been a leading cause of mortality in urban areas such as New York City. While efforts to address injuries were undertaken by the New York City Department of Health (NYCDOH) starting in the 1940s, it was not until the department received a Capacity Building Grant from the Centers for Disease Control and Prevention (CDC) in 1989 that a more comprehensive program could be developed. The NYCDOH launched several collaborative projects with a variety of organizations and institutions. These efforts indicate that through collaborations, local health departments can increase their effectiveness and better promote their approach to injury prevention.

Community Networks↗
PubMed2000

Assessing risk communication effectiveness: perspectives of agency practitioners.

A study conducted by the Agency for Toxic Substances and Disease Registry (ATSDR), a US public health agency, evaluated ATSDR's risk communication process, specifically the roles and responsibilities, planning, implementation, and coordination of activities in response to illegal indoor spraying of methyl parathion, a hazardous pesticide, in Pascagoula, MS. Interviews of staff members involved in the intervention were conducted and an analysis revealed strengths and areas in need of improvement in the design and implementation of risk communication strategies. Key recommendations included developing a clear strategy for planning and conducting communication activities; determining staff roles and responsibilities for coordination; and developing clear and consistent health messages, a dissemination strategy, and training in the delivery and evaluation of messages, effects, and outcomes.

Air Pollutants↗
PubMed1998

Waking the health plan giant: Group Health Cooperative stops counting sheep and starts counting key tobacco indicators.

Implementing a comprehensive approach to decreasing tobacco use in a large health plan requires hard work and commitment on the part of many individuals. We found that major organisational change can be accomplished and sustained. Keys to our success included our decision to remove access barriers to our cessation programmes (including cost); obtaining top leadership buy-in; identifying accountable individuals who owned responsibility for change; measuring key processes and outcomes; and finally keeping at it tenaciously through multiple cycles of improvement.

Adult↗
PubMed2003

Human resources for health in Palestine: a policy analysis. Part II. The process of policy formulation and implementation.

This article is the presentation of part II of the analysis aiming at providing an insight and better understanding of human resources for health development within a conflicting and transitional context. This part focuses on the human resources for health (HRH) policy development in Palestine taking into consideration the critical elements in policy formulation and implementation, such as sound data based policy and planning, key stakeholders, role and implications of international cooperation. Moreover, it examines recent progress of HRH policy and constraints for implementation. Part I addresses the current situation and recent developments in HRH in Palestine.

Arabs↗
PubMed2003

Health technology assessment, research, and implementation within a health region in Alberta, Canada.

OBJECTIVES: To determine the need for and implement health technology assessment (HTA) to inform decision making and policy within a regional health care system in Calgary (Alberta, Canada). METHODS: Published literature and organizational materials for the Calgary Health Region (CHR) and HTA units worldwide were reviewed. Key individuals within the provincial health ministry (Alberta Health and Wellness), CHR, the University of Calgary (U of C), funding agencies, and HTA organizations were consulted in a structured fashion. A structure for a regional HTA program was developed, taking into account relationships between these organizations. RESULTS: A locally focused HTA and implementation unit was deemed desirable. The Calgary Health Technology Implementation Unit (CaHTIU) was established. The CaHTIU was designed to efficiently integrate with CHR planning as well as undertake independent research activities. HTA activities focus primarily on CHR needs and are managed by a Health Technology Advisory Committee (HTAC) that consists of CHR management and other key individuals. Working groups contribute to and coordinate HTAs and implementation under the leadership of the unit Director, and include content as well as management individuals. The unit cooperates where appropriate with extant Canadian HTA organizations. CONCLUSIONS: The Calgary HTA unit is unique in Canada, because it functions within a regional health care system as well as a research institution. Advantages include a local focus in terms of applied HTAs, a systematic process for implementation of recommendations, and a collaborative atmosphere for research within the U of C.

Alberta↗
PubMedDate not supplied

Using participatory action research to provide health promotion for disadvantaged elders in Shaanxi province, China.

OBJECTIVES: The objectives of the study were to (a) determine health promotion issues concerning disadvantaged elders, (b) identify social, economic, environmental, and personal factors that adversely influence disadvantaged elders' health, and (c) enable various stakeholders working within a coordinated framework to promote health among elders. DESIGN: A participatory action research (PAR) model was used over a 2-year period in a remote disadvantaged rural village in Shaanxi province, China. SAMPLE: Participants were 20 elders and 5 local administrators including government officers and village leaders. RESULTS: Three themes were identified, including (a) health is the absence of illness and the ability to sustain self-sufficiency; (b) diseases are inevitable among elders; and (c) cost is the key barrier to accessing health services. Action plans were developed and plans were implemented by the participants and project team. CONCLUSIONS: The project demonstrated that PAR is an optimum research method, which allows researchers to facilitate collaboration with all participants through research and supports democratic dialogue and deliberation through the participation process. Interpersonal relationship skills of researchers are crucially important in building cooperation among all stakeholders. Local government mobilization is essential for successful implementation and sustainability of the project.

Aged↗
PubMed2001

A client-centered approach to family planning: the Davao project.

The reproductive health approach to family planning shifts the focus of service provision from macro-level demographic objectives to meeting clients' needs. Little field experience exists to date, however, to indicate how to implement this approach. This study describes a field project in Davao del Norte and Compostela Valley provinces in the Philippines that implemented the reproductive health approach on a quasi-experimental basis. The intervention was designed to address clients' self-defined reproductive needs by providing them with relevant and accurate information and services of good quality. It consisted of two components: Providers were trained in information exchange at fixed clinics, and supervisors were trained in facilitative supervision. The results presented here indicate that the client-centered intervention was successful in enhancing service providers' knowledge and improving the content of information exchange between providers and clients. One provincial health officer has expanded the intervention throughout his province, while other provinces are interested in duplicating the model.

Adult↗