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PubMed1977

Advances in the study of diffusion of innovation in health care organizations.

Federal government programs of the 1960s to rapidly diffuse technologies have been displaced on the '70s by efforts to constrain costly technological growth. As a guide to action, the understanding of reasons for adoption of innovation is essential; but the utility of available diffusion theory is limited by its focus on the speed of diffusion rather than any reasons for its adoption by organizations. In a practical sense, more is known about the administrator as decision maker than about those increasing situatiions in which physicians play a more central part. Until coherent, empirically grounded theories of organizational innovation are available, large-scale "tests" are premature and wasteful.

Creativity↗
PubMedDate not supplied

[Gerontologic and geriatric education in the USA].

Training in gerontology in American institutes of higher education is conceptualized and realized in response to present societal demands. Although plurality of approaches prevails, gerontology has become an institutionalized discipline which in its research, training and application is formally sponsored by the national government. Programs are offered in many colleges and universities and assessed in terms of scientific excellence, of efficiency in teaching knowledge from multiple disciplines, and in terms of practicality. But still, problems of poor research and "quasi-professional" teaching, as well as of insufficiently founded practical work concern gerontologists. In a time of expansion, "instant gerontologists" have become a threat to the field. A brief "instant gerontologists" have become a threat to the field. A brief overview on questions presently discussed among teachers in gerontology is given, and a model-institution for gerontological training is briefly described, the Andrus Gerontology Center at the University of Southern California.

Aged↗
PubMed1983

Isolation and characterization of chondrocytes and non-chondrocytes from high-density chick limb bud cell cultures.

This communication describes a replating technique for the separation of the chondrogenic and non-chondrogenic cells from stage-24 chick limb bud mesenchymal cell cultures by means of sequential digestion with collagenase. Four sub-populations of cells were obtained: The first consisted solely of non-chondrocytes and the next three were progressively enriched in chondrocytes. In addition to morphological differences, the four cell populations differed from each other in their rates of incorporation of sulfate into macromolecular material which were roughly proportional to the percentage of chondrocytes. The chondrocytes and non-chondrocytes no longer exhibited a density dependence of phenotype. In addition, the normal multilayered nodular morphology associated with cartilage development was not observed. These isolated cells have been used as starting material for detailed biochemical studies. Together, these studies indicate that the expressional program governing biosynthetic changes in chondrocytes is not controlled by the extracellular matrix.

Animals↗
PubMedDate not supplied

[Preparation of the promotion of therapeutic studies as an open planning process].

During the preparation of the government program "Health Research and Development", which was started in 1978, an attempt was made to involve the scientific community directly in establishing priorities for research on rheumatic diseases. At a planning conference open to all interested research scientists the following questions were considered: 1. What are the methodological requirements for therapeutic trials? 2. What are the open questions in the field of clinical rheumatology and which of them should be given priority? 3. What are the conditions for running multicenter therapeutic trials successfully? This paper describes the methodology and the results of the analysis of research needs and priorities and discusses the special problems of clinical rheumatology research in the Federal Republic of Germany.

Clinical Trials as Topic↗
PubMed1981

An overview of hospital gynecologic practice.

Table 1 presents an overview of current gynecologic practice in hospitals as illustrated by three New England states. We believe the balance of diagnoses and operations displayed are reasonably typical of practice elsewhere in the United States. However, since operative rates are lower in New England than in other parts of the country, the proportions of women undergoing hysterectomy or a sterilization procedure will be somewhat higher elsewhere. The general issue of variation in rates of diagnoses and operations is presented; professional uncertainty is a fact which may account for the variation. Further controlled studies are urgently needed to decrease this element of uncertainty and to distinguish too much diagnosis and treatment from too little. Ultimately, nothing less will meet the standards of the best care for patients or satisfy health insurance or government programs that premiums or taxes are supporting an appropriate level of health care.

Female↗
PubMed1995

Multivariate cost-effectiveness analysis: an application to optimizing ambulatory care for hypertension.

Cost-effectiveness analysis (CEA) is being used increasingly to allocate health resources efficiently. This paper develops an extension of CEA based on multivariate regression analysis and applies it to hypertension treatment. After assembling clinic and patient characteristics, outcomes, and costs for 2,439 randomly chosen patients in the 32 special hypertension clinics of the Department of Veterans Affairs (VA), we identified 19 significant predictors of cost and diastolic blood pressure (DBP) using multiple regression analysis. We classified these independent variables as "unambiguous" if a given change was associated with both lower cost and better DBP, or as "trade-off" variables if any change improving DBP entailed higher costs. The results suggest that fully implementing all unambiguous clinic changes would reduce costs by 33% while improving DBP. Multivariate CEA could help managed care companies and government programs with cost and outcome data to reduce costs and improve outcomes.

Ambulatory Care↗
PubMed1995

Practice guidelines: what the family physician should know.

Practice guidelines that specify how to treat medical conditions and perform procedures are appearing with greater frequency in the medical literature. Their use by managed care plans, hospitals and government programs is expected to affect the practice of medicine substantially in the coming years. This article reviews the key information that family physicians should have in order to evaluate and use practice guidelines effectively: how they are developed; how they differ from textbooks, review articles and other sources of expert consultation; whether they promote "cookbook medicine"; when to modify one's clinical practice in response to new guidelines, and how to cope with conflicting recommendations. Practice guidelines can improve the quality of care by summarizing current evidence and expert opinion, but they can also reduce the quality of care if the recommendations are poorly supported by scientific evidence and clinical reasoning. Economic and medicolegal concerns can also influence the potential benefits and harms of practice guidelines. Since hundreds of practice guidelines are anticipated to be developed in the coming years, family physicians should become informed consumers of guidelines, avoid accepting them on face value, and ask specific questions to judge their quality.

Family Practice↗
PubMedDate not supplied

A decentralized model for case management.

Case management has been implemented in a variety of health care settings. The implementation of case management at one hospital, including rationale for selection and outcomes, is described here. A decentralized model emphasizing staff nurse control is recommended for hospitals with TQM and shared governance programs already in place.

Decision Making, Organizational↗
PubMed1993

Universal health coverage.

Although over 12% of our gross national product is spent on health care, approximately 14% to 17% of Americans are not covered by any form of health insurance. The cost, benefits, and deficiencies of private insurance and government programs are discussed in this article. The increasing percentage of persons surviving into older age, improved technology, patient demands and expectations, administrative costs, medical malpractice and defensive medicine, and other factors contribute to the steadily increasing cost of care. Physicians must participate in health care reform or passively accept determinations made in their absence.

Health Care Costs↗
PubMed1996

[Portable oxygen therapy in the Madrid area].

Portable oxygen therapy using liquid oxygen has been available in the Madrid area since 1992 as part of a government program. The prescription of liquid oxygen theoretically requires the careful selection of patients who will benefit from a portable source of oxygen, as well as the performance of a series of treadmill tests with and without supplemental oxygen in order to assess the benefit derived from this expensive means of delivering therapy. As no studies had been done of whether these criteria for prescribing liquid oxygen were being met, we conducted telephone interviews with patients residing in the Madrid area who had portable oxygen sources at their disposal. Of a total of 190 patients, whose names were provided by oxygen supply companies, 145 could be evaluated. Liquid oxygen was not being used by 17%. Stress tests had not been performed before prescription of liquid oxygen in 65%. In conclusion, it can be suspected that a high percentage of patients receive liquid oxygen who do not meet the criteria for prescription and who have not performed the recommended tests, and that compliance is low.

Exercise Test↗
PubMedDate not supplied

[Viral hepatitis type A. Who should be vaccinated?].

In order to find out the variations in the Prevalence of HAV ab and identify the persons who should be vaccinated against Hepatitis A virus, we assessed HAV ab to 200 patients without any occupational risk. They were classified by their socioeconomic status; in the following categoris: High (level I n = 0); Medium-High (level II n = 50); Medium-Low (level III, n = 50); Low (level IV, n = 50); and Very Low (level V, n = 50). The percentage of positivity ofr serum HAV ab was: Level II: 12%, Level III: 18%, Level IV: 38% and Level V: 40%. The difference between levels II and III and between levels IV and V was no significant (p > 0.05), but after making a comparation between levels II and III as a group and levels IV V as another one, we found a statistical significant difference (p < 0.005). We concluded: There is a bimodal behavior for the prevalence of serum HAV ab in our study: one group with high prevalence (78%) and another one with low prevalence (30%). The massive Vaccination government programs and the vaccionation in particular cases in the daily medical practice should be done after assessing the personal Socioeconomic status in order to improve the use of this tool and achieve a progressive reduction in the morbiditi and high endemicity of HAV in our city.

Adolescent↗
PubMedDate not supplied

Nursing informatics in Australia.

The development of nursing informatics in Australia began around 1984 and has had a tortuous history. Nevertheless, it has helped create awareness of the discipline of informatics and the technology available. Nurses have been important in stimulating interest in health informatics throughout the country. This paper discusses nursing informatics in Australia in terms of historical roots, professional organizations, education, work experience, research, and government programs.

Australia↗
PubMed1997

Cancer screening and prevention in rural Wisconsin: the Greater Marshfield Experience.

BACKGROUND: Providing medical services to rural residents results in unique challenges to providers and patients. Cancer screening (CS) and early detection services (EDS) are frequently underutilized with rural residents often presenting with advanced cancer at diagnosis. A comprehensive approach to determine barriers and overcome them constitutes "The Greater Marshfield Experience." METHODS: Focus groups with rural residents determined the greatest barriers to receipt of CS and EDS were distance, cost, time from work and self-reliant behavior. Directives to address these concerns were to keep information simple and provide services at the workplace. In response, Marshfield Clinic and its research division developed a collaborative research partnership with public health agencies (PHA), federally funded government programs and volunteer agencies. RESULTS: In-house activities to remove barriers for providing CS and EDS included the development of a separate screening unit for these activities. Reminder systems were employed to notify patients of the need and availability of preventative services. Co-payments for health screening services were eliminated from the clinic owned health plan. Area residents near poverty level were encouraged to enroll in federally subsidized health plans that promoted and paid for CS and EDS. Federally funded cancer screening studies were implemented that funded breast and cervical cancer screening and evaluated the benefits of screening for prostate, lung, colorectal and ovarian cancers (PLCO). Outreach activities included developing partnerships with local PHA and minority groups and providing mobile screening services to remote areas. CONCLUSION: Concentrated, collaborative efforts to develop in-house systems and outreach activities resulted in delivery of CS and EDS in remote areas.

Adult↗
PubMed1998

A new measure of contemporary life stress: development, validation, and reliability of the CRISYS.

OBJECTIVE: To develop and validate a measure of contemporary life stressors. STUDY SETTING: Three interview studies: Study 1 (pilot), 32 caregivers receiving case management services for a child with chronic illness; Study 2 (validation), 311 caregivers of children receiving general pediatric care at a university clinic; Study 3 (reliability), 17 caregivers of children with a complex medical diagnosis. STUDY DESIGN: Study 1: item development via discussions with case managers; piloted with caregivers. Study 2 examined psychometric properties of the measure and correlated it with the CES-D, a measure of depressive symptomatology and the PRQ85-Part 2, a measure of perceived social support, to establish its convergent construct validity. Study 3 established the test-retest reliability of the measure over two weeks by correlating two administrations of the index. DATA COLLECTION: Face-to-face interviews in homes (Study 1) or in clinic waiting rooms (Studies 2 and 3) and by telephone (Study 3 retest). PRINCIPAL FINDINGS: The CRISYS is a flexible, multidimensional tool that demonstrates strong face, content, and construct validity, and excellent test-retest reliability. The format is easy to use and well accepted by respondents and is suitable for low-income populations. CONCLUSIONS: Researchers will find the CRISYS useful when evaluating the success of a clinical model or a healthcare system, and the effectiveness of an insurance plan or a government program. Clinicians may also find that the CRISYS is an effective screen for family needs.

Adult↗
PubMed1985

U.S. Government quality control program for Limulus amebocyte lysate and endotoxin.

The U.S. Government has licensed seven Limulus Amebocyte Lysate manufacturers. Each manufacturer must determine the sensitivity of each lot by using the U.S. Standard Endotoxin, EC-5 which is identical to the U.S. Pharmacopeia (USP) Endotoxin Standard (Lot F). A licensed firm must be inspected annually and submit a protocol along with potency testing results on each lot of lysate before it can be released. The FDA tests each lot for at least potency before releasing it to be marketed. The release criteria for both the gelation and chromogenic lysate tests are discussed.

Chromogenic Compounds↗
PubMed2001

The impact of Federal Alcohol and Drug Abuse block grants on state and local government substance abuse program expenditures: the role of federal oversight.

Are the federal Alcohol and Drug Abuse (ADA) block grant funds substituting for or supplementing state and local government spending on substance abuse? Using panel data on state and local government substance abuse programs, this study explores the fiscal effects of the ADA block grant money and the increased enforcement (after 1989) of federal restrictions on state spending of ADA block grants. The findings here reveal that for the current period, the federal ADA grant has no statistically significant effect on state and local government substance abuse spending both before and after 1989, and the increased enforcement of federal restrictions on the ADA grants after 1989 does not change this result. An additional finding is that lagged ADA grants have had a large effect on substance abuse spending both before and after 1989--a feature of the program not considered in previous studies.

Financing, Government↗
PubMed1995

[Feasibility of "well-aging facility" of "well-aging community promotion program"].

The government "Well-Aging Community Promotion Program" (WAC) defines a "Well-Aging Facility" (WAF) consisting of a gymnasium for the elderly, an education-center for the elderly, a service-center for handicapped elderly and their families, and a fee-for-service nursing home, and incorporated funding provisions for WAF. Because of economic reasons, with the exception of fee-for-service nursing home, there is only one WAF at present. An economic-feasibility study of WAF was conducted based on regional analysis of existing public facilities and the needs of the elderly, and proposals for promoting WAF and WAC were made. The results are as follows: 1. In large and middle-size cities, many types of public facilities exist within walking distance, but the number per capita of elderly is low. In small-size cities and towns the number per capita of elderly is high, but are rarely within walking distance. 2. Rather than investment in facilities, the role of private business in WAC can be described as investment in services such as management-services for public facilities and transportation among facilities. 3. As for economic feasibility of WAF, in large and middle-size cities the education-center is viable, but for the gymnasium facility it would be based on utilization of facilities not only for elderly but multi-generational. The feasibility for the service-center will be high in large cities but low in middle-size cities. 4. For small-size cities and towns, the management of the gymnasium, and the education-center will be feasible, but the service-center will be difficult. 5. To promote WAC in small-size cities and towns, the following will be needed. a. The development of transportation systems between homes and facilities. b. The promotion of multi-purpose use of facilities beyond the established purpose of each WAC public facility. c. The establishment of new multi-sectional management entities by both the public and private sectors to manage existing public facilities. d. Development of financial support program by the government for upgrading and remodeling of existing facilities to function as an alternative of the WAF.

Aged↗