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PubMed2000

Planning for successful outcomes in the new millennium.

The complexity of the health care environment will increase in the next millennium. Organizations must adopt an approach of selecting outcomes management solutions that are focused on data capture, analysis, and comparative reviews and reporting. They must decisively and creatively implement, in a phased approach, integrated solutions from existing robust systems, while considering future systems targeted for implementation. Outcomes management solutions must be integrated with the organization's information systems strategic plan. The successful organization must be able to turn business-critical data into information that supports both business and clinical decision-making activities. In short, health care organizations will have to become information-driven.

Benchmarking↗
PubMedDate not supplied

Client perceptions of parish nursing.

The purpose of this study was to examine parish nursing from a client's perspective. Parish nursing is a relatively new health delivery model that has rarely been investigated. In order to describe the client perception, an ethnographic approach was used. The convenience sample included clients from two congregations in a southeastern Appalachian area served by parish nurses. Face-to-face client interviews were conducted, and the Spradley's ethnographic approach to data analysis of transcripts was used. Each interview was analyzed separately by the research group for patterns and meanings reflecting the emic perspective. Five themes of client perception of parish nursing emerged from the data: (1) being available, (2) integrating spirituality and health, (3) helping us help ourselves, (4) exploring parish nursing, and (5) evaluating parish nursing.Clients perceived having a parish nurse as positive and beneficial for individuals, the congregation, the church, and community. Parish nursing was viewed as a useful, meaningful, and effective health intervention and setting, and parish nurses were viewed as effective and meaningful health providers. Further exploration of the effectiveness of this nursing delivery model is warranted.

Adult↗
PubMed2004

Integration challenges of clinical information systems developed without a shared data dictionary.

Legacy systems have proven to be long-term integration challenges for Intermountain Health Care (IHC) despite commitment and attention to share clinical information across settings and among clinicians. This study measures the extent of the disparity of data elements across three independent data systems in current use. A sample of relevant data elements was selected across systems covering prenatal, labor and delivery, and newborn intensive care units (NICU). The findings revealed only 17% of these sample data elements had compatible structure across all three systems. The implications from differences in granularity, missing data, and duplicate data entry, include diminished data quality, greater risk for medical error, increased costs of integration and inefficient use of clinician time. Retrospective guidelines for managing conceptual context and granularity are given to assist in designing an integrated longitudinal patient electronic medical record.

Delivery of Health Care, Integrated↗
PubMed2006

A secure web-based approach for accessing transitional health information for people with traumatic brain injury.

A web-based transitional health record was created to provide regional healthcare professionals with ubiquitous access to information on people with brain injuries as they move through the healthcare system. Participants included public, private, and community healthcare organizations/providers in Eastern Ontario (Canada). One hundred and nineteen service providers and 39 brain injury survivors registered over 6 months. Fifty-eight percent received English and 42% received bilingual services (English-French). Public health providers contacted the regional service coordinator more than private providers (52% urban centres, 26% rural service providers, and 22% both areas). Thirty-five percent of contacts were for technical difficulties, 32% registration inquiries, 21% forms and processes, 6% resources, and 6% education. Seventeen technical enquiries required action by technical support personnel: 41% digital certificates, 29% web forms, and 12% log-in. This web-based approach to clinical information sharing provided access to relevant data as clients moved through or re-entered the health system. Improvements include automated digital certificate management, institutional health records system integration, and more referral tracking tools. More sensitive test data could be accessed on-line with increasing consumer/clinician confidence. In addition to a strong technical infrastructure, human resource issues are a major information security component and require continuing attention to ensure a viable on-line information environment.

Brain Injuries↗
PubMed2005

Maternal and child health and family planning service utilization in Guatemala: implications for service integration.

Does the utilization of modern maternal and child health (MCH) services influence subsequent contraceptive use? The answer to this question holds important implications for proposals which advocate MCH and family planning service integration. This study uses data from the 1995/6 Guatemalan Demographic Health Survey and its 1997 Providers Census to test the influence of MCH service utilization on individual contraceptive use decisions. We use a full-information maximum likelihood regression model to control for unobserved heterogeneity. This model produces estimates of the MCH effect, independent of individual women's underlying receptiveness to MCH and contraceptive messages. The results of the analysis indicate that the intensity of MCH service use is indeed positively associated with subsequent contraceptive use among Guatemalan women, even after controlling for observed and unobserved individual- , household- , and community-level factors. Importantly, this finding holds even after controlling for the unobserved factors that 'predispose' some women to use both types of services. Simulations reveal that, for these Guatemalan women, key determinants such as age and primary schooling work indirectly through MCH service use to increase contraceptive utilization.

Adolescent↗
PubMed2003

Organisational culture matters for system integration in health care.

This paper illustrates the importance of organisational culture for Clinical Information Systems (CIS) integration. The study is based on data collected in intensive care units in the UK and Denmark. Data were collected using qualitative methods, i.e., observations, interviews and shadowing of health care providers, together with a questionnaire at each site. The data are analysed to extract salient variables for CIS integration, and it is shown that these variables can be separated into two categories that describe the 'Actual Usefulness' of the system and the 'Organisational Culture'. This model is then extended to show that CIS integration directly affects the work processes of the organisation, forming an iterative process of change as a CIS is introduced and integrated.

Attitude to Computers↗
PubMed2000

Evaluation of the first strategic plan for Aboriginal health in south western Sydney, 1993-98.

The 1993-98 Aboriginal Health Strategic Plan for South Western Sydney represented the first partnership of its kind between an Area Health Service, local Aboriginal Health Workers and the local Aboriginal Community Controlled Health Service in Australia. During 1998, an evaluation of the plan was undertaken as part of the preparation for the second Aboriginal Health Plan. Of the 45 strategies in the first plan, 38% had been fully implemented, 42% had been partly implemented, and 20% were not implemented at all. This paper discusses the importance of data collection and monitoring systems, the integration of Aboriginal health into mainstream services, the further development of Aboriginal health infrastructure, and continued leadership by senior managers.

Child↗
PubMed2004

[Methodology and research of public health].

The statistical sources now available within Russia's healthcare systems as well as their potentialities in respect to evaluating the public health standards are analyzed in the paper both analytically and comparatively. The most informative sources are enumerated; additionally to the verified data of the medical-and-demographic nature, parameters of the integrated health condition, which are based on questionnaires, self-assessment and medical documentation known to respondents, are suggested. The above methods and evaluation tools, that are in line with the world standards, ensure the compatibility of data and provide for a more tense usage of joint healthcare programs.

Global Health↗
PubMed2000

The use of socioeconomic factors in mapping tuberculosis risk areas in a city of northeastern Brazil.

In Brazil the challenge of meeting the needs of those living in deprived areas has generated discussions on replacing the existing approach to epidemiological surveillance with an integrated public health surveillance system. This new approach would supplant the traditional focus on high-risk individuals with a method for identifying high-risk populations and the areas where these persons live. Given the magnitude of the problem that tuberculosis (TB) poses for Brazil, we chose that disease as an example of how such a new, integrated public health surveillance system could be constructed. We integrated data from several sources with geographic information to create an indicator of tuberculosis risk for Olinda, a city in the Brazilian state of Pernambuco. In order to stratify the urban space in Olinda and to check for an association between the resulting TB risk gradient and the mean incidence of the disease between 1991 and 1996, we applied two different methods: 1) a "social deprivation index" and 2) principal component analysis followed by cluster analysis. Our results showed an association between social deprivation and the occurrence of TB. The results also highlighted priority groups and areas requiring intervention. We recommend follow-up that would include treating acid-fast bacilli smear-positive pulmonary TB cases, tracing of these persons' contacts, and monitoring of multidrug-resistant cases, all in coordination with local health services.

Brazil↗
PubMed2005

Meeting the information needs of the 'Health for all' challenge--lessons from Scotland.

OBJECTIVE: To create a public health data resource for Scotland that is based on a socio-ecological model of the determinants of health and would, therefore, meets the needs of the emerging public health agenda. DESIGN: Action research, in which the approach moved logically through stages of action (conception, feasibility study, pilot projects, leading to a national set of integrated health and well-being profiles). Each stage built on the results of the previous research. RESULTS: The conceptual stage identified the need for an approach to public health data that kept pace with the increasingly accepted socio-ecological models of the determinants of health. A feasibility study concluded that sufficient data were available to populate the health fields that represented the important determinants of health. At this time strengths and weakness in data were defined. This led to the articulation of a 'vision' for integrated public heath data in Scotland that was the subject of a wide consultation. Pilot studies provided local stakeholders with imaginatively presented data (on population demographics, health and function, behaviour, social environment, economy, physical environment, morbidity and mortality) for their local communities. The response to these was so positive that a demand was created for a comprehensive set of 'community profiles'. These, in addition to parliamentary constituency profiles, have now been created and widely disseminated. CONCLUSIONS: It has been possible, despite many difficulties, to develop approaches to public health information that are informed by the socio-ecological model of health and create outputs that represent a significant advance on previous approaches to public health data. This is a work in progress and many issues remain unresolved. Interaction with others engaged in parallel tasks will facilitate the next steps.

Community Participation↗
PubMed2003

Denver Health: a model for the integration of a public hospital and community health centers.

Two major pillars of the United States' safety net system are urban public hospitals and community health centers. Their common mission is to care for the uninsured and other vulnerable populations. However, in most communities these important components of the safety net remain organizationally and functionally separate, which inhibits the continuum of care and creates substantial inefficiencies. Denver Health is a long-standing vertically and horizontally integrated system for vulnerable populations. The integration benefits the patient and the system and serves as a model for the U.S. safety net. This paper outlines the benefits of integration to the patient, provider, and health system, using data from the National Association of Public Hospitals and Health Systems, the Bureau of Primary Health Care, and Denver Health.

Colorado↗
PubMed2002

Introducing an academic data warehouse into the undergraduate medical curriculum.

There is increasing interest in integrating population health and informatics topics into the undergraduate medical curriculum, yet little consensus exists on the most effective approach to accomplish this. We introduced the use of an academic data warehouse of encrypted patient information into an existing 2nd year medical school course. Exercises were developed requiring students to retrieve and interpret information regarding local disease prevalence, practice patterns, and patient characteristics. These exercises were integrated into existing weekly problem sets in a multiple-choice format. Faculty and student perceptions were assessed with surveys, and augmented with interviews of student volunteers, and database usage statistics. Our results indicate widespread agreement among both students and faculty that population-based medicine warrants inclusion in undergraduate medical education. The majority of the students felt the exercises complemented the clinical cases around which they were structured. There was less agreement, however, that the exercises were valuable, with several students suggesting a more open-ended, discussion-oriented approach. It was clear that faculty perceptions had a significant impact on student reactions.

Attitude to Computers↗
PubMedDate not supplied

[Linkage of environmental and health data: health risk analysis of the Rio de Janeiro water supply by using geographical information systems].

Exposure assessment of population groups is based on linkage of environmental and health data. This relationship can be hard to establish due to spatial and temporal lags in data sets. Environmental data generally refer to scattered sampling points, while epidemiological data integrate periods of time within administrative territories. GIS can be used as a basis for organizing health-related and environmental data sets. We examined potential health risk in the Rio de Janeiro city water supply based on the overlay of information layers containing data on the presence and quality of water supply services. We used census tracts as the primary georeferenced data, since they contain information on how households are supplied, water supply pipes, sources, and reservoirs, and water quality according to the monitoring program. Population groups exposed to risks were located and quantified using spatial operations among these layers and adopting different risk criteria. The main problems related to water supply are located on the northern slope of the Tijuca Mountain Range (involving the absence or poor quality of water) and in the western area of the city of Rio, where the population relies on alternative water supply sources. The different origins, objectives, and structures of data have to be analyzed critically, and GIS can be used as a data validation tool as well as an instrument for detailed identification of inconsistencies.

Brazil↗