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At least 199 records · Page 11Linked to original sources
PubMed2003

Frail elderly patients. New model for integrated service delivery.

PROBLEM BEING ADDRESSED: Given the complex needs of frail older people and the multiplicity of care providers and services, care for this clientele lacks continuity. OBJECTIVE OF PROGRAM: Integrated service delivery (ISD) systems have been developed to improve continuity and increase the efficacy and efficiency of services. PROGRAM DESCRIPTION: The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is an innovative ISD model based on coordination. It includes coordination between decision makers and managers of different organizations and services; a single entry point; a case-management process; individualized service plans; a single assessment instrument based on clients' functional autonomy, coupled with a case-mix classification system; and a computerized clinical chart for communicating between institutions and professionals for client monitoring. CONCLUSION: Preliminary results on the efficacy of this model showed a decreased incidence of functional decline, a decreased burden for caregivers, and a smaller proportion of older people wishing to enter institutions.

Aged↗
PubMed1994

School health delivery programs throughout the United States.

This is the second of a two-part series on School-based and School-linked Health Centers. Through NASN's Board of Directors, various models of health service delivery were examined, and leaders in school nursing interviewed from five different sites. The first article, which appeared in the February 1994 issue of the Journal of School Nursing, addressed the purpose of integrating traditional school health services with newer models of health service delivery, depicted possible models and considered some of the issues of this union.

Delivery of Health Care↗
PubMed1994

The practice of school nursing: integration with new models of health service delivery.

The leadership of the NASN recognizes the growth of the school-based and school-linked health center movement, and the interest of school nurses in this topic. The following is the first of two articles devoted to the integration of traditional school health services and school-based or school-linked health centers or clinics. The purpose of these articles is to increase general knowledge about "integrated, comprehensive school health programs," as well as promote an awareness of important opportunities that exist in the school-based/school-linked health center movement for school nurses. This article reviews the purpose of integration, depicts possible models of school-based/school-linked health centers, and considers some of the issues of this model. The April issue will highlight various school health delivery programs.

Comprehensive Health Care↗
PubMed1997

Geriatric assessment, coordinated case management, and information systems: an integrated model for delivery of services to nursing home residents.

Several interventions have been developed to minimize the effects of a fragmented health care system and improve services to older adults in long-term care settings. In the context of scarce specialized resources and expertise, this article describes Comprehensive Geriatric Assessment, Minimum Data Set, and Resident Assessment Protocols, the integration of which offers promise for effective evaluation and case management. The model's significance and potential benefits for targeting services to residents at risk for adverse outcomes are explored as components of an integrated information system for enhancing the care of nursing home residents.

Aged↗
PubMed1996

Formulating a functional model of attention deficit hyperactivity disorder for the practicing speech-language pathologist.

Speech-language pathologists need to embrace new models of service delivery if their work with children having ADHD is to be successful. Old models that are oriented toward deficits have proven to be ineffective, but application of a systems-theory approach from the social sciences to ADHD, together with support from recent educational research, provides a contextually-related model of service delivery. This model is discussed in terms of three major issues--identifying and describing students with ADHD, helping them overcome their problems, and meeting the needs of their teachers and parents--and how it may guide more effective assessment and intervention of ADHD students in educational settings.

Adolescent↗
PubMed2003

PRISMA: a new model of integrated service delivery for the frail older people in Canada.

PURPOSE: PRISMA is an innovative co-ordination-type Integrated Service Delivery System developed to improve continuity and increase the efficacy and efficiency of services, especially for older and disabled populations. DESCRIPTION: The mechanisms and tools developed and implemented by PRISMA include: (1) co-ordination between decision-makers and managers, (2) a single entry point, (3) a case management process, (4) individualised service plans, (5) a single assessment instrument based on the clients' functional autonomy, and (6) a computerised clinical chart for communicating between institutions for client monitoring purposes. PRELIMINARY RESULTS: The efficacy of this model has been tested in a pilot project that showed a decreased incidence of functional decline, a decreased burden for caregivers and a smaller proportion of older people wishing to be institutionalised. CONCLUSION: The on-going implementation and effectiveness study will show evidence of its real value and its impact on clienteles and cost.

Journal Article↗
PubMed2001

Competitive health policies and community health.

Since 1992 there have been fundamental changes in health care policy in Victoria, Australia, as the state government moves to competitive market models of service delivery and the measurement of service provision through output based funding. The introduction of competitive relationships to the public health system has had a major impact in the primary health care sector, particularly on community health centres. Most community health centres in Victoria have traditionally been semi-independent agencies controlled by community based committees of management. Such policies have had huge implications for the management and organisation of these agencies, as they have led to different patterns of service delivery and different models of management practice, often devaluing traditional philosophical perspectives of 'primary health care practice'. Although many agencies have embraced change as providing opportunities for growth and development and to have more influence in the provision of mainstream public health care, primary health care models of practice should be supported for their intrinsic and increasing value.

Community Health Centers↗
PubMed1999

A model for clinical and educational psychiatric service delivery in remote communities.

OBJECTIVE: A model of intermittent psychiatric service provision to rural and remote New South Wales communities by metropolitan psychiatrists and mental health professionals has been evaluated. The services provided included peer support to lone mental health and generic health workers, direct psychiatric care to clients in their own environment and skills development education sessions to general health staff and other professionals affiliated with health care (e.g. police and ambulance officers). METHOD: There were 10 visits of teams made up of a psychiatrist and another mental health professional to six rural and remote locations. Outcomes of the services delivered were examined including clinical services and teaching skills training sessions. Indirect outcome measures included changes to Pharmaceutical Benefits Scheme prescription patterns in areas serviced and data regarding transfer of clients for psychiatric care in regional centres. Difficulties in evaluation are discussed. RESULTS: The feasibility of intermittent service provision was demonstrated. Education packages were well received and a positive change in workers' attitudes toward mental health practice was found. CONCLUSION: Intermittent psychiatric services in remote settings add value to health care delivery particularly when dovetailed with skills-based education sessions.

Adolescent↗
PubMed2007

Co-located substance use treatment and HIV prevention and primary care services, New York State, 1990-2002: a model for effective service delivery to a high-risk population.

The New York State Department of Health (NYSDOH) AIDS Institute (AI) began an initiative in 1990 in collaboration with the Office of Alcoholism and Substance Abuse Services (OASAS) to colocate HIV prevention and clinical services at drug treatment clinics. In 1990, the initiative began funding drug treatment programs to provide HIV counseling, testing, and prevention services. HIV primary care was added the following year. Program implementation and development are described. An analysis is included of HIV counseling and testing data for the period 1990-2002 and quality of care data for five standardized quality measures with comparisons to data from other clinical settings. In the first 13 years of the initiative 168,340 HIV-antibody tests were conducted including 52,562 tests of injection drug users (IDUs) identifying 14,612 HIV-infected persons; the seroprevalence was 8.68%. By the end of 2000, the HIV primary care caseload peaked at 3,815 patients. Quality of primary medical care services among participating drug treatment programs has consistently matched or exceeded that provided in more conventional health care settings such as the hospitals and community health centers that were used as a basis for comparison. Colocating HIV primary care within substance use treatment is an effective strategy for providing accessible high-quality HIV prevention and primary care services.

AIDS Serodiagnosis↗
PubMed2002

Improving service delivery to the dually diagnosed in Los Angeles County.

Service delivery to dually diagnosed individuals remains problematic in many communities because of entrenched administrative structures that maintain the separation of mental health and substance abuse treatment systems. This article describes efforts to improve service delivery to dually diagnosed individuals in Los Angeles County by increasing communication, coordination, and collaboration across the two treatment systems. Findings are presented on the relationships among program models of service delivery, treatment orientations of programs, and interactions with other service providers to the dually diagnosed. Results showed that drug treatment programs that adhered more closely to an integrated model of service delivery received more patient referrals from case management outreach teams and that programs with a stronger counseling approach to treatment had more linkages with other service providers. Knowledge gained from research on these differing models of service delivery can be combined with new clinical advances to improve service delivery to the dually diagnosed.

Analysis of Variance↗
PubMed2003

Implementation of TeleCare services: benefit assessment and organisational models.

All industrial societies are ageing. This has profound socio-economic and health sector implications. Innovative services based on Information Society Technologies (IST), like telehomecare are regarded as promising avenues to follow both to allow (national) health systems to cope with these challenges and to improve the quality of life of chronically ill and frail older citizens. The aim of the TEN-HMS project is to convincingly prove that telemonitoring of congestive heart failure (CHF) patients at home can improve medical outcome for these patients as well as their quality of life and the efficiency of healthcare delivery processes. But this will not (yet) be enough for the sustained success of such a service. Unless it takes into account the interests of the various players in the health care arena and a long-term Business Case can be proven, it will be very difficult to integrate such services into routine health care delivery processes. Before developing concrete delivery models for such a telemonitoring service, the "players" directly involved in such a service need to be identified--customers/patients, health services providers, IT services suppliers, and public/private insurance funds as payers--and their assessment perspectives considered. Then four concrete telemonitoring delivery models and their probability of success are discussed. Our analysis suggests that telemonitoring will presently only be successful if the service delivery model applied reflects national health system idiosyncrasies, takes into account established organisational boundaries and adapts to patient quality of life and health professional preferences. In the longer term, the new paradigm of seamless, patient-centred care will, however, require new, more efficient service delivery models integrating all aspects of the health services value chain.

Aged↗
PubMed2003

Physical therapy in preschool classrooms: successful integration of therapy into classroom routines.

PURPOSE: This exploratory investigation identifies factors that contribute to success of physical therapy services delivered in the context of the daily routines in preschool classroom settings. METHODS: Ten pediatric physical therapists from rural and urban communities across North Carolina served as informants during telephone interviews. RESULTS: Qualitative analysis of the data led to the identification of six major themes: interactions among classroom personnel, impact of the classroom environment, individual characteristics of the child, logistical considerations, administrative policies and practices, and service delivery options. All 10 informants shared the perception that the cooperation and commitment of the teacher was essential for successful incorporation of therapy activities in classroom routines. Furthermore, the informants agreed that multiple models of service delivery were necessary to meet the individual needs of children. CONCLUSIONS: These results lead the authors to question the wisdom of promoting any one service delivery model as "best practice" and suggest guidelines for successful integration of physical therapy in the preschool classroom.

Journal Article↗
PubMed2003

Bridging the gap: transitional rehabilitation services for people with spinal cord injury.

PURPOSE: To review the current international rehabilitation and healthcare climate and describe a new model of service delivery aimed at enhancing the continuity of care for people with spinal cord injury (SCI). METHOD: An extensive literature review was undertaken and a new model of service delivery conceptualized and implemented in the Australian context of SCI rehabilitation. RESULTS: This new model of service delivery aims to improve the rehabilitation continuum for people with SCI by reducing the time spent in hospital, increasing consumer control over the rehabilitation environment and enhancing community re-integration. The new model recognizes the changing nature of the healthcare system, the legislative frameworks within which rehabilitation services are provided and the increasing role of the consumer. CONCLUSIONS: Models of rehabilitation that address the need for shorter periods of hospitalization and attempt to improve client outcomes are integral to ensure sustainable rehabilitation services in the future.

Community Health Services↗