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PubMed1999

Accreditation by the National Committee on Quality Assurance (NCQA): a description.

The objective of this article is to describe the National Committee on Quality Assurance (NCQA). The NCQA is one of many organizations that is addressing the issues of quality assurance of health care for HMOs. It is of concern that when HMOs focus on cost they may stint on services. Also it is difficult for HMOs to compete for both quality and cost if there is not a comparable objective standard of measurement. The NCQA offers a level of accreditation that is representative of organizational structure and resources. The Health Plan Employer Data and Information Set (HEDIS) is used to compare outcomes and professional resources. The results of both the accreditation and the HEDIS measures are compiled in a national data base, The Quality Compass. There is skepticism that the NCQA is measuring the correct data for basing quality measurement decisions and also the data obtained is severely underutilized by health care purchasers (employers with less than 1,000 employees).

Accreditation↗
PubMedDate not supplied

Population health in Canada: issues and challenges for policy, practice and research.

The population health movement has gained prominence in Canada and elsewhere with policy makers, program planners and researchers taking note that health is strongly influenced by factors that lie largely beyond the health-care system. The development of population health in Canada was the focus of the National Conference on Shared Responsibility for Health & Social Impact Assessments: Advancing the Agenda held May 2-3 1999 in Vancouver, Canada. A longer version of this paper was distributed to conference participants to provide some common knowledge and vocabulary. It also introduced and discussed definitional, normative, logistical, political, methodological, structural and resource considerations with respect to furthering the population health agenda in Canada.

Canada↗
PubMed2001

[Current approaches for the implementation of guidelines by means of information technologies].

Clinical practice guidelines (CPGs) play an increasingly important role in the harmonisation process of health care delivery and disease management. It is known that nationally or internationally produced guidelines that have no consistent implementation strategy, have limited impact in changing physicians' behaviour and patterns of care. The literature provides evidence for the effectiveness of computerisation of CPGs for increasing compliance and improving patient outcomes. The integration of knowledge-based functions for decision support or monitoring in clinical information systems is one effective way. Another approach relies on the original, mostly text-based, guidelines. By structuring these resources with the eXtensible Markup Language (XML) we are able to improve the availability of clinically relevant knowledge at the point of care. XML allows for in-context searching and the customized presentation of guideline content. We are confident that this new approach will improve the acceptance and the benefits of the increasing number of guidelines in medicine.

Biomedical Technology↗
PubMedDate not supplied

Welfare reform and parenting: reasonable expectations.

Although the primary goals of federal welfare reform legislation were to move welfare mothers into the workforce and reduce births outside of marriage, promotion of responsible parenting was also an important underlying theme. Parenting is a complex, multifaceted phenomenon, however, encompassing a wide range of functions related to nurturing, discipline, stimulation, values, activities, and routines. This article provides a framework for assessing the impact of welfare reform on various dimensions of parenting, with the following key findings: Many aspects of life affect parenting and child development, such as parent characteristics, child characteristics, family economic resources, family structure, parental mental health, marital or partner relationships, and the quality of parents' kin and social networks. About two-thirds of states are using federal welfare funds to promote better parenting through programs such as home visits to new parents and parenting classes, but virtually no state parenting programs have been evaluated. Welfare reform appears to have limited effects on parenting. The only dimension of parenting significantly affected by some welfare demonstration programs was parents' choice of child care settings and extracurricular activities for their children. The programs with the greatest positive impact on parenting were those with more generous work supports and more flexible work requirements. Not only did these programs lead to different choices concerning child care and activities for preschool and school-age children, but they also resulted in more stable marriages and less violence between partners, which also could lead to improved parenting. The authors conclude that many important aspects of the connection between welfare reform and parenting have yet to be examined, and that further research is needed to identify the ways states' welfare programs can promote better parenting.

Child↗
PubMedDate not supplied

[Management or strategy within hospitals].

A study was conducted on certain number of hospital departments to identify the kind of variables which determine decision-making and decision-implementation as concerns innovations, both in medical process and hospital organization. Among the internal variables, one can quote the size of the hospital, its ownership type, its main field of activity, its situation in the local health structure, its resources ... Among the external variables one can quote the supply of care at the local level, the local health networking, the state of technological development, interrelationship of the health sector, the manufacturing sector and the research sector, the presence of managerial tools and skills...

France↗
PubMed2002

New genomic resources for the honey bee(Apis mellifera L.): development of a deep-coverage BAC library and a preliminary STC database.

We have constructed a bacterial artificial chromosome (BAC) library for a European honey bee strain using the cloning enzyme HindIII in order to develop resources for structural genomics research. The library contains 36,864 clones (ninety-six 384-well plates). A random sampling of 247 clones indicated an average insert size of 113 kb (range = 27 to 213 kb) and 2% empty vectors. Based on an estimated genome size of 270 Mb, this library provides approximately 15 haploid genome equivalents, allowing >99% probability of recovering any specific sequence of interest. High-density colony filters were gridded robotically using a Genetix Q-BOT in a 4 x 4 double-spotted array on 22.5-cm2 filters. Screening of the library with four mapped honey bee genomic clones and two bee cDNA probes identified an average of 21 positive signals per probe, with a range of 7-38 positive signals per probe. An additional screening was performed with nine aphid gene fragments and one Drosophila gene fragment resulting in seven of the nine aphid probes and the Drosophila probe producing positive signals with a range of 1 to 122 positive signals per probe (average of 45). To evaluate the utility of the library for sequence tagged connector analysis, 1152 BAC clones were end sequenced in both forward and reverse directions, giving a total of 2061 successful reads of high quality. End sequences were queried against SWISS-PROT, insect genomic sequence GSS, insect EST, and insect transposable element databases. Results in spreadsheet format from these searches are publicly available at the Clemson University Genomics Institute (CUGI) website in a searchable format (http://www.genome.clemson.edu/projects/stc/bee/AM__Ba/).

Animals↗
PubMed2005

[General practitioners' views on the cooperation with nursing homes].

BACKGROUND: In addition to the coordination between primary and secondary health care, the collaboration between the general practitioner (GP) and the community-based nursing services is a challenge. While the GPs are responsible for his or her list patients' needs, the organisational structure and resource allocation of nursing home services is a community-based responsibility. MATERIAL AND METHODS: Data on GPs' view on collaborative aspects of nursing home services was collected in a cross-sectional questionnaire survey among all Norwegian list-patient GPs in 2004 (N=1633). RESULTS: Out of the 1637/3338 (48%) responding GPs, 1180 (72%) performed community-based services; 462 (37%) of the latter as nursing home physicians. Four out of five GPs found physician-based services for their list patients satisfactory. The GPs had an influence on the provision of nursing and care services in approximately 50% of cases. The less satisfied GPs were less frequently informed when their list patients received nursing home beds and less frequently asked to contribute patient information when the need for nursing home facilities was assessed. These latter GPs were more often of the opinion that GPs should play a major role in the decision for home-based versus nursing home services. INTERPRETATION: Although there is a potential for improvement in the exchange of information between nursing homes and GPs, 80% of the GPs were satisfied with physician-based services in nursing homes.

Attitude of Health Personnel↗
PubMedDate not supplied

Nurse-physician communication: an organizational accountability.

Dysfunctional nurse-physician communication has been linked to medication errors, patient injuries, and patient deaths. The organization is accountable for providing a context that supports effective nurse-physician communication. Organizational strategies to create such a context are synthesized from the structural, human resource, political, and cultural frameworks of organizational behavior.

Attitude of Health Personnel↗
PubMed2006

Pacific healthcare workers and their treatment interventions for Pacific clients with alcohol and drug issues in New Zealand.

AIM: To provide an overview of the treatment interventions and practices of Pacific alcohol and other drugs (AOD) services in New Zealand. METHODS: Face-to-face interviews were conducted with 31 Pacific staff members from 13 services registered with the Alcohol Advisory Council of New Zealand National Directory. Issues around assessment, treatment interventions, outcome measures, service structure, and resources were explored. RESULTS: Overall, the practices in District Health Board (DHB) and Non-Government Organisation (NGO) Pacific services were found to be similar. The clinical concepts of assessment, treatment, and outcome measures were not clearly understood by Pacific workers. This was due to the lack of attention towards Pacific concepts and practices and values. A holistic approach was viewed to be the best approach when working with Pacific clients based on health belief models, such as the Fonofale model. CONCLUSIONS: The findings of this study provide baseline data of treatment interventions and service practices of Pacific AOD services. There appears to be a Pacific way of working with Pacific clients. The most effective worker for Pacific people is someone who has sound knowledge of AOD, Pacific cultures and processes, and has the ability to integrate both Palangi (European) and Pacific knowledge to help the client.

Adolescent↗
PubMed1991

[Care of tuberculosis patients at the community level in the state of Chiapas, Mexico].

From August 1989 to August 1990 in the municipio of Chicomuselo, State of Chiapas--an area with a high incidence of tuberculosis--health promoters were trained to carry out priority actions as part of the National Campaign Against Tuberculosis. A program to provide training, semi-monthly evaluation of the work carried out, detection of new cases, treatment supervision, and contact tracing was established utilizing the structure and resources of the Campaign. The health promoters were assigned the following functions: searching for patients with respiratory symptoms and conducting sputum smear examinations, examining postvaccination scars in persons under 15 years of age, and tracing tuberculosis patient contacts. In total, 1,778 doses of BCG vaccine were administered to individuals under 15 years of age in 35 communities; 144 patients with respiratory symptoms were studied; 257 sputum smear examinations were carried out; and 26 cases of tuberculosis were diagnosed. The most affected age group consisted of those 15 to 45 years old. Patients were monitored during treatment through sputum smear examinations. Twenty-nine persons started the treatment and 24 completed it; 24 were cured, five did not complete the treatment, two abandoned it, and three died. There were no treatment failures. The efficiency of the program was 82% and its effectiveness, 100%. The results show that it is possible to utilize the human resources in a community to carry out health programs. The community members' acceptance of and support for the program was due in part to that fact that their interests were taken into account in its implementation.

Adolescent↗
PubMed1991

Consumer strategies in health care acquisition in the United Kingdom and the United States.

Conflicts in health care financing have emerged as controversial political issues in the United Kingdom and the United States. Given the health care structures and resource allocation patterns of each country, the study of resource acquisition is significant because of scarce resources, changes in health policy, and shifts in consumer demand.

Community Participation↗
PubMed1982

Delivery of genetic services in Lyons (France) 1960-1980.

In conclusion, the delivery of genetic services seems guaranteed now because it is based on a university school of medicine, important hospitals, and private resources. Other structures in different cities of the world are certainly as effective as or better than these. The European Club of genetic counseling was created in Lyons in 1972 to bring together the geneticists of 52 university towns of French-speaking Western Europe. The 120 members of this club meet each year for a congress. The themes of our seminars are genetic counseling and the exchange of information to allow us to improve the delivery of genetic services. Generally speaking, in the Rhône-Alpes region, the delivery of genetic services has indeed taken advantage of new discoveries. In an early stage, routine services have worked with conventional techniques borrowed from other centers. Today they enable us to reap the fruit of modern research.

Delivery of Health Care↗
PubMed1981

Postwar trends in family size.

Recognizing that postwar trends in family size derive both from changes in the living arrangements of adults and from changes in the presence of children, this paper develops annual estimates of mean family size, mean members less than 18, and mean members 18 and older by race, by family type, and by age of head. Group differences in the course and source of changes in family size are evident as anticipated on the basis of group differences in family structure, economic resources and life cycle stage.

Adolescent↗
PubMedDate not supplied

Getting the community involved in developing a PHC curriculum in Tonga.

To be relevant and effective, a nursing curriculum must reflect societal needs, health and community structures and resources. Below is a case study of a contractual collaboration between various stakeholders in a post-graduate programme based on primary health care in public health nursing in Tonga. It is one example of the influence and collaborative roles that communities play in the health of people.

Community Participation↗
PubMedDate not supplied

Project management for nurses: guidelines for success.

Nurses often are called on to plan, participate in, and manage special projects. These projects and special assignments can be managed most effectively when business principles of project management are applied. This method includes defining the project, developing a work breakdown structure, assigning resources, calculating budget implications, presenting and negotiating the plan, implementation, and evaluation. When appropriately used, project management skills can have a major impact on the success or failure of a plan.

Humans↗
PubMed1996

Ethnic differences in children's intelligence test scores: role of economic deprivation, home environment, and maternal characteristics.

We examine differences in intelligence test scores of black and white 5-year-olds. The Infant Health and Development Program data set includes 483 low birthweight premature children who were assessed with the Wechsler Preschool and Primary Scale of Intelligence. These children had been followed from birth, with data on neighborhood and family poverty, family structure, family resources, maternal characteristics, and home environment collected over the first 5 years of life. Black children's IQ scores were 1 SD lower than those of white children. Adjustments for ethnic differences in poverty reduced the ethnic differential by 52%. Adjustments for maternal education and whether the head of household was female did not reduce the ethnic difference further. However, differences in home environment reduced the ethnic differential by an additional 28%. Adjustments for economic and social differences in the lives of black and white children all but eliminate differences in the IQ scores between these two groups.

Black or African American↗