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PubMed2002

The Outcomes of Cancer Outcomes Research: focusing on the National Cancer Institute's quality-of-care initiative.

BACKGROUND: To assess the impact of outcomes research, the Agency for Healthcare Policy and Research has proposed a four-level typology that successively distinguishes between research that (1) adds to the knowledge base only, (2) affects practice policies, (3) influences the delivery of care, and (4) leads to changes in health outcomes. The agency has concluded that outcomes research to date has made substantial contributions at level 1, but has had little impact at levels 2 to 4. OBJECTIVE: To describe the National Cancer Institute's emerging agenda in cancer outcomes research, focusing on how it has been shaped early on to support the institute's quality of care initiative and noting whether each new project represents outcomes research at level 1, 2, 3, or 4. RESULTS: Cancer outcomes research describes, interprets, and predicts the impact of various influences, especially (but not exclusively) interventions on endpoints that matter to decision makers. The institute's projects to improve the scientific quality of final endpoint measures, strengthen the methodologic and empirical basis for quality of care analysis, and enhance the application of health-related quality-of-life measures in clinical trials represent level 1 applications of outcomes research. Collaborative projects with federal agencies to translate evidence into practice and a new public and private effort to identify core measures of cancer quality represent level 2 and level 3 outcomes research. CONCLUSION: The stage has been set for carrying out a balanced portfolio of level 1 to 3 outcomes research projects in cancer, with the ultimate (level 4) aim of improving cancer-related health outcomes.

Clinical Trials as Topic↗
PubMed1993

[Cooperation. Education/clinical practice in primary health care, in Dakar].

Senegal recognizes universal health care for all, with health care policies that give priority to low income rural neighborhoods and maternal/child health. However, the reality is that official health care services cover only 13 per cent of the rural population. A collaborative program between the University of Montreal School of Nursing and the Centre for Higher Education in Dakar Senegal, illustrates the innovativeness of international co-operation. The goal of the program is to provide nursing education for students in primary health care and midwifery. The nursing students in this program would care for the residents of the town of Tivaouane, with emphasis on maternal/child health care. Nursing students from three schools in Dakar completed the clinical phase of the program working with health care professionals and the residents of Tivaouane. The program has four components: education, clinical, research and women's health. The education component consists of a revision of the current nursing program, a primary health care curriculum, and continuing education for instructors and health care personnel. The clinical component gives students the opportunity to provide hands on primary health care in Tivaouane. The research component includes the development of instruments to identify educational and health care needs. The fourth component includes educational activities relating to women's health.

Canada↗
PubMedDate not supplied

An Ontario initiative to enhance the effectiveness of AIDS Service Organizations: Community-Linked Evaluation of AIDS Resources.

This report describes the rationale, process, and early outcomes of establishing a community-based research unit. The AIDS Bureau of the Ontario Provincial Government established the Community-Linked Evaluation of AIDS Resources Unit (CLEAR), which works in partnership with the AIDS Bureau and 31 of 74 AIDS Service Organizations (ASOs) in Ontario.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Trust and the development of health care as a social institution.

Health systems are inherently relational and so many of the most critical challenges for health systems are relationship and behaviour problems. Yet the disciplinary perspectives that underlie traditional health policy analysis offer only limited and partial insights into human behaviour and relationships. The health sector, therefore, has much to learn from the wider literature on behaviour and the factors that influence it. A central feature of recent debates, particularly, but not only, in relation to social capital, is trust and its role in facilitating collective action, that is co-operation among people to achieve common goals. The particular significance of trust is that it offers an alternative approach to the economic individualism that has driven public policy analysis in recent decades. This paper considers what the debates on trust have to offer health policy analysis by exploring the meaning, bases and outcomes of trust, and its relevance to health systems. It, first, presents a synthesis of theoretical perspectives on the notion of trust. Second, it argues both that trust underpins the co-operation within health systems that is necessary to health production, and that a trust-based health system can make an important contribution to building value in society. Finally, five conclusions are drawn for an approach to health policy analysis that takes trust seriously.

Attitude to Health↗
PubMedDate not supplied

Meeting the needs of rural populations through interdisciplinary partnerships.

This article describes the organization and outcomes of a Rural Health Outreach Initiative (RHOI) designed to increase collaboration between the medical education and health care delivery sectors to improve the quality of health care delivery and health outcomes in rural communities. Two inter-related partnership strategies were utilized in rural communities to address the health and social service needs of rural populations. The partnerships were created through the efforts of a rural health professions education program located in a community-based medical school. The two partnership models were implemented at the same time and target the same rural populations. Both strategies relied upon interdisciplinary collaborations to achieve their goals and outcomes. One strategy involved the creation of partnerships among rural medical students and the projects they initiate, using the model of community oriented primary care (COPC). The second strategy involved the establishment of partnerships by a variety of rural, community-based entities that resulted from a three-year Health Resources and Services Administration Rural Health Outreach grant that supported a "mini-grant" program. This article summarizes the process and results of these innovative collaborations that occurred at two levels: (1) between health and service institutions representing multiple disciplines and (2) between academic institutions and local communities. Specific attention is given to projects that resulted from the work of the partnerships that address the needs of older adults residing in the rural communities. The two strategies are compared and implications for the success of similar efforts are discussed.

Aged↗
PubMedDate not supplied

Tracing the evolution of pluralism in community-based coalitions.

In this study, a crisis of leadership succession led to greater subsequent pluralism by the previously less inclusive coalition. Substantial tension existed between both coalitions and the federally funded Appalachia Cancer Network, especially around its evidence-based mission. The fact that this tension occurred even at the more locally inclusive site indicates that pluralism may vary across levels within the same coalition. This article contributes to theory by exploring how coalitions evolve over time across community boundaries, as well as to management practice by yielding guidance about how to build inclusive organizations.

Appalachian Region↗
PubMedDate not supplied

Community care networks: cornerstone of health care reform.

Calls to reform the American health care delivery system include proposals to expand access to insurance and to impose expenditure controls. That approach is flawed and could only lead to an increase in costs. To truly reform the system, the U.S. must fundamentally alter its health care delivery system. One proposal is to create community care networks to coordinate the care of patients. Such a system could operate under a capitated payment system that is publicly accountable.

American Hospital Association↗
PubMed2006

Nova Awards 2006. The American Hospital Association 2006 Award winners.

Whether their projects target children with asthma; those whose working parents cannot afford health insurance, but do not quality for federal aid; or immigrants or poor elderly, the hospitals and health systems that won the 2006 NOVA Awards understand that collaboration with other organizations is the most effective way to achieve a community's health care goals.

American Hospital Association↗
PubMedDate not supplied

Writing for Health Care Publications. A partnership between service and education.

A collaborative partnership between a school of nursing and hospital provided a foundation on which to promote writing for publication skills of health care professionals from both organizations. The implementation of an interdisciplinary graduate course, Writing for Health Care Publications, resulted in publishable manuscripts and positive outcomes related to the strategic plans of both service and educational settings.

Authorship↗
PubMed1994

Quality assurance in the voluntary sector.

Reports on a small-scale quality assurance analysis of rural mental health drop-in centres. Within a cross-sectional research design, measures were taken of the centres' structure, process and outcome. The instruments used to take these measures were structured interviews, questionnaires and direct observation, which were applied to clients, staff and referrers. It was found that the centres achieved their objectives with considerable success, including high levels of client and referrer satisfaction. Concludes that the three centres provided a quality service which complements the formal options (i.e. NHS and Social Services). Draws implications for the extension of NHS staff roles in relation to the voluntary sector.

Adult↗
PubMed2006

Culture, community networks, and HIV/AIDS outreach opportunities in a south Indian Siddha organization.

BACKGROUND: Gandeepam is an NGO in rural south India, with an HIV prevalence rate estimated at 2-7 times the national average. Aside from several outreach programs, Gandeepam practices Siddha medicine. OBJECTIVE: Evaluate Gandeepam's strengths and opportunities to promote HIV education. DESIGN: Three weeks of observing clinic practice, meeting patients, and discussing organizational structure. A survey of attitudes toward HIV was completed. RESULTS: Gandeepam reaches a broad cross-section of its community, and effectively disseminates information. No primary HIV prevention efforts were observed. CONCLUSION: Current strengths include an established network for information dissemination, and a strong community reputation. Tremendous social obstacles for disseminating effective HIV prevention messages remain.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Parents, practitioners, and researchers: community-based participatory research with early head start.

Community-based participatory research (CBPR) is an approach to research and evaluation that is receiving increased attention in the field of public health. Our report discusses the application of this approach to research and evaluation with an Early Head Start (EHS) program in Pittsburgh, Pa. Our primary purpose is to illustrate the key elements that contributed to effective collaboration among researchers, EHS practitioners, and parents of EHS children in the conduct of the study. The focus is not on research findings but on research process. Our goal is to make the practices of CBPR visible and explicit so they can be analyzed, further developed, and effectively applied to a range of public health issues in a diversity of community contexts.

Academies and Institutes↗
PubMed1994

Collaborative partnerships involving the community.

Riverside Methodist Hospitals in Columbus, OH, is the 1,063-bed flagship hospital of the U.S. Health Corporation. Riverside depends on collaborative activities to carry out its mission to improve the health status of the community, and credits the collaborative spirit to a top-down leadership philosophy. To strengthen the concept of collaboration, education and experiential training are provided to board members, medical and executive staff, and employees to demonstrate the interrelatedness between the hospital and other systems in the community. Collaboration is a process which can be learned by any individual or organization. As Riverside's experience demonstrates, choosing collaborative partners carefully and using several key strategies facilitate successful collaborative efforts.

Community Health Services↗
PubMedDate not supplied

Health and housing in Savannah.

St. Joseph's/Candler, a two-hospital system in Savannah, GA, and Mercy Housing East (MHE), Atlanta, a regional subsidiary of the Denver organization, collaborate on housing projects in southeastern Georgia. In Savannah, the partners transformed two local landmarks, a former hospital and a former school, into an 88-apartment development for low-income, predominantly African-American residents. St. Joseph's/Candler also provides health services to the community. As a result of their work, MHE and St. Joseph's/Candler have helped restore a historic city neighborhood. In Pembroke, GA, MHE (with support from St. Joseph's/Candler) has constructed a two-story, 30-unit, independent-living apartment development for senior citizens. Last year, St. Joseph's/Candler opened a health care facility in Pembroke.

Black or African American↗