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PubMed2001

Use factor analysis to identify difficulties in implementing a case payment reimbursement system in Taiwan.

BACKGROUND: Taiwan's National Health Insurance Program (NHIP) began on March 1, 1995. The major purpose of National Health Insurance is to remove financial barriers to care and enhance accessibility to comprehensive health care for all citizens in Taiwan. However, due to the rapid rise in medical expenses and unanticipated accumulation of overdue premiums, the program went into debt in 1999. In response to this financial crisis, the Bureau of National Health Insurance proposed to change hospital financing from a cost-based to a case-based reimbursement system. The major purpose of this study is to identify the difficulties in implementing a case payment reimbursement system in Taiwan. METHODS: This study was conducted in four stages: structured interviewing, questionnaire development and testing, surveying, and data analysis. In this study, the sampling surgeons were selected based on availability from 7 teaching hospitals and 10 regional hospitals. RESULTS: The results of factor analysis indicated that a five-factor structure has emerged in the use of the newly developed survey administered to 372 surgeons in Taiwan. These five factors accounted for approximately 97% of the overall variance. The alpha coefficient for this 22-item scale was 0.914. The researchers concluded that these five factors are considered evidence of adequate internal consistency for use in measuring difficulty in the implementation of case payment. CONCLUSIONS: These five factors were named as follows: perceived barriers to compliance, perceived barriers to quality assurance, perceived financial pressure, perceived threats to physicians' autonomy, and inadequate allowance for patient severity. Policy recommendations including annual revision of coding system, physician education, and hospital specialization were also made to address the perceived difficulties identified in this study.

Adult↗
PubMed1976

The dynamics of dietetics.

The forces which have and are producing change in dietetics are recapitulated, as are developments in the profession which have evolved since 1972 when the Study Commission on Dietetics made its report. The coordinated undergraduate program in dietetics has gained much ground; in 1972, there were but seven such programs. Today there are forty-three. More than three hundred traineeships are currently preparing over five hundred trainees to take their places in the profession. Another facet of training involves programs for dietetic technicians and dietetic assistants, designed to open up the career ladder concept. Continuing education is of prime importance for those beyond the entry-level of competence. The dietitian's first responsibility is to society, preceding that for the profession-as has been plainly indicated in a number of A.D.A. Position Papers and the emphasis of the Association in its legislative thrust on the value of nutrition education in preventive health care. Concern of the Association about the competency of practicing dietitians has also been reflected in the early appointment of a Committee on Professional Standards Review. The Association, as a member of the National Nutrition Consortium, is an advocate for a "National Nutrition Policy" and must continue to work for recognition that nutritional care is basic to comprehensive health care.

Accreditation↗
PubMed1991

Recognizing and responding to adolescent depression.

We have seen that depression is increasingly recognized as a problem which affects adolescents as well as adults. Race by itself is not a factor which increases vulnerability to depression, but the multitude of sociodemographic, biological, and personal factors contributing to the development of depression are not fully understood. Research is needed to better understand how these factors interact in order to better develop prevention strategies and treatment modalities. With regard to treatment, adolescents are truly underserved. There is an awkward fit between the traditional mental health system and the developmental needs of adolescents. Unlike the majority of depressed adults who receive some treatment from general practitioners and medical clinics, adolescents do not tend to visit their pediatricians when they are depressed. One proposed solution is the adolescent comprehensive health care clinic providing a holistic approach to assessment, early intervention, and collaborative treatment between primary provider and mental health worker. Data from our adolescent program suggest that this approach has been successful in dealing with the problem of depression, especially in its early stages. Again, more research is needed to support these preliminary findings, but we believe that the adolescent comprehensive health care approach can be an effective, efficient way of addressing the health needs, mental and physical, of our teens at risk. Federal money for research must be made available, liberalization of health insurance must occur, and state-sponsored services must be developed so that these programs can be made more effective and can be brought to more of the adolescents who need them.

Adolescent↗
PubMed2004

Wisconsin Medical Home Learning Collaborative: a model for implementing practice change.

A child with special health care needs is defined as having, or are at increased risk for, a chronic physical, developmental, behavioral, or emotional condition that requires health and related services of a type or amount beyond that required by children generally. In Wisconsin nearly 14% of children are identified as having or being at risk for special health care needs. Healthy People 2010 and the federal Child Health Maternal Bureau have challenged each state to "assure access to ongoing comprehensive health care through a medical home" for all children with special health care needs. A medical home is defined as "an approach to providing continuous and comprehensive primary pediatric care." States are challenged to translate the concepts of medical home to clinical practice activities. This article discusses Wisconsin's participation in a national Medical Home Learning Collaborative and Wisconsin's replication of the Collaborative as a means to develop practical strategies for practice implementation of a medical home.

Child↗
PubMed2003

Health seeking behavior among insured persons under the Social Security Act, 1990.

Since having health insurance cannot guarantee access to care among the insured persons, their actual health seeking behavior should be evidence reflecting true access. Therefore, the study aimed to present the patterns of health seeking behavior among the insured persons who actually were able to get free services from their registered hospitals under the Social Security Scheme. Purposive sampling was done of 1,003 insured persons who were willing to participate in the study from small, medium and large establishments in the Huai Khwang district in Bangkok. A health diary was employed as one of the data collecting tools with a follow-up period of six months. The average illness rate found was 6.44 episodes/person/year. The characteristics of illnesses reported were described in terms of symptom groups, perceived severity, duration, work or non-work related cause. No treatment or self care, seeking help from non-registered health facilities and seeking help from registered hospitals and clinics were the patterns of health seeking behaviors found in the study. The patterns of health seeking behaviors among the participants varied depending on the stage of treatment, perceived severity of illness and types of additional health benefits. Seeking care from registered hospitals and clinics was found among the illnesses with a higher level of perceived severity, among the participants with chronic diseases, and among the illnesses that were treated with higher stages. Therefore, health insurance might not be able to guarantee true access to needed care for people unless the comprehensive health care provider networks are designed to cover more types of services, be more convenient and have more accessible health care providers.

Adult↗
PubMed1963

Quality of medical care.

QUALITY OF MEDICAL CARE MAY BE CONSIDERED UNDER THREE HEADINGS: (1) how to describe or define it; (2) how to measure it; (3) how to achieve it.The profession, the health administrator, the consumer, and others, in attempting to define quality of medical care are like the blind men describing an elephant, because of their different viewpoints. Quality is not an absolute but a goal. Measurement is, therefore, piecemeal and judgmental, and various attributes of quality have been studied-clinical, records, economy, effect on health status. One must study to relate the phenomenon measured to the goal. Methods of improving quality are implicit in the descriptions and in the attributes measured. Prepaid group practice is an effective and a growing method of bringing comprehensive health care with quality control to the American people.

Comprehensive Health Care↗
PubMed1975

Scalability of Community Participation in Health Program Decisions.

The achievement of significant levels of influence on six program decision areas by communities served by health care program is investigated using Guttman scale analysis in a sample of 50 Children and Youth comprehensive health care projects in the United States to determine whether such achievement occurs in an ordered or a random sequence. Evidence presented indicates that the achievement of relative levels of community influence is orderly for initial levels of influence; higher levels of community influence apparently do not follow the same order. Implications of these findings for planning and predicting the development of personal health service programs are discussed.

Child Health Services↗
PubMed2004

Development of a provisional domain model for the nursing process for use within the Health Level 7 reference information model.

OBJECTIVE: Since 1999, the Nursing Terminology Summits have promoted the development, evaluation, and use of reference terminology for nursing and its integration into comprehensive health care data standards. The use of such standards to represent nursing knowledge, terminology, processes, and information in electronic health records will enhance continuity of care, decision support, and the exchange of comparable patient information. As part of this activity, working groups at the 2001, 2002, and 2003 Summit Conferences examined how to represent nursing information in the Health Level 7 (HL7) Reference Information Model (RIM). DESIGN: The working groups represented the nursing process as a dynamic sequence of phases, each containing information specific to the activities of the phase. They used Universal Modeling Language (UML) to represent this domain knowledge in models. An Activity Diagram was used to create a dynamic model of the nursing process. After creating a structural model of the information used at each stage of the nursing process, the working groups mapped that information to the HL7 RIM. They used a hierarchical structure for the organization of nursing knowledge as the basis for a hierarchical model for "Findings about the patient." The modeling and mapping reported here were exploratory and preliminary, not exhaustive or definitive. The intent was to evaluate the feasibility of representing some types of nursing information consistently with HL7 standards. MEASUREMENTS: The working groups conducted a small-scale validation by testing examples of nursing terminology against the HL7 RIM class "Observation." RESULTS: It was feasible to map patient information from the proposed models to the RIM class "Observation." Examples illustrate the models and the mapping of nursing terminology to the HL7 RIM. CONCLUSION: It is possible to model and map nursing information into the comprehensive health care information model, the HL7 RIM. These models must evolve and undergo further validation by clinicians. The integration of nursing information, terminology, and processes in information models is a first step toward rendering nursing information machine-readable in electronic patient records and messages. An eventual practical result, after much more development, would be to create computable, structured information for nursing documentation.

Feasibility Studies↗
PubMed1989

[The status and perspectives of general pediatrics in Czechoslovakia].

Health community paediatric care in Czechoslovakia has the character of comprehensive health care ensured completely by the paediatrician who is to an increasing extent acting as the family paediatrician. He cooperates closely with other health workers concerned with child care in other areas and disciplines of nation-wide child care. His work is closely linked with other facilities and institutions of health care, in particular all types of hospitals with policlinics. In the article the main tasks and perspectives of paediatric care in the health community are given; close cooperation of the paediatrician with the child's family and the child is essential. Preventive care is closely linked with curative care, the latter must in future be mainly in the home rather than in hospital. The school health service integrated into the health community system, while respecting health and hygienic needs of all classes and the school, in relation to the teaching process, is given new tasks. The author discusses problems of postgraduate training, methodical guidance and evaluation of the effectiveness of work of the paediatrician in the first line of contact.

Child↗
PubMed1991

Comprehensive primary health care antiepileptic drug treatment programme in rural and semi-urban Kenya. ICBERG (International Community-based Epilepsy Research Group)

A programme of antiepileptic treatment in a rural and semi-urban region in Kenya was assessed. Patients with generalised tonic-clonic seizures were treated according to one of two simple drug protocols. Health workers screened cases reported by key informants in the community. From the 529 patients identified by health workers as having active seizures 302 patients aged 6-65 years were recruited by a psychiatrist for therapy with carbamazepine or phenobarbitone. Treatment was supervised largely by primary health workers, and the programme was monitored by a research team, which assessed the effectiveness of treatment. Of the 249 patients who completed the study, 53% became seizure-free in the second 6 months of therapy, and another 26% had substantially (50% or more reduction) fewer seizures than in the 6 months before therapy. The similarity of these findings to those obtained in newly diagnosed patients in the developed world, the low drop-out rate, the low rate of withdrawal due to adverse effects, and the acceptable compliance with therapy indicate that health workers can monitor therapy adequately. Most patients had had several years of delay before starting therapy for their epilepsy, yet they responded well--a finding that does not support the suggestion that the disorder becomes intractable if not treated early.

Adolescent↗
PubMed1986

Why health improves: defining the issues concerning 'comprehensive primary health care' and 'selective primary health care'.

What is the impact of technology on improving the life situations of people, especially the poor? How is this impact analyzed in terms of health improvements? These questions are paramount in the minds of health planners as they pursue national policies of primary health care, a policy popularized by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) and accepted by over 150 governments at Alma Ata in 1978. The purpose of this paper is to explore these questions in depth. It begins by giving the background to the debate, then examines the origins of two concepts which have dominated the field, those of 'primary health care' and 'selective primary health care.' On this basis it suggests areas of differences in the two concepts and discusses the policy and practical implications of confusing the two approaches. The paper suggests that the differences are firstly who controls the outcome of technological interventions and the perceived time frame in which plans can be carried out.

Health Policy↗
PubMed1999

The integration of comprehensive psychiatric/mental health care into the primary health system: diagnosis and treatment.

This research study was funded by the Health Systems Trust in Cape Town through the University of Natal in Durban. OBJECTIVES. The objectives of this study were to teach primary health care nurses to diagnose and treat common psychiatric conditions, to refer those patients whom they cannot handle, and to evaluate the implementation of these functions in their primary health care practice. METHODS. Twenty nurses from six clinics in one province of South Africa were trained, and implementation was studied. History taking, diagnosis, pharmacological treatment and referral were studied through record reviews. Record reviews were done by two independent psychiatrists, who achieved an inter-rater reliability of 0.68. RESULTS. Record reviews showed that at the end of the project nurses could take substantially complete psychiatric histories in 89% cases, five axis diagnoses were correct in 63% of cases, and when STAT medication was prescribed it was appropriate in 92% of cases. Appropriate long-term medication was prescribed in 60% of cases. ETHICAL ISSUES. Permission was obtained from the provincial office, the Municipal Offices and participating clinics. Informed consent was obtained by the registered nurses from all participating clients. LIMITATIONS. The sample for the clinics was not representative of all clinics in the Eastern Cape but a representation of rural-urban settings sampled from 20 clinics in a region. The sample of consumers was convenient and may not represent the client population in each clinic. For this reason the findings may not be a true reflection of the entire region, and generalization of the findings should be made at the utmost discretion of the reader.

Data Collection↗