Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Integrated Programs”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources
PubMed1996

Vertical integration strategies: revenue effects in hospital and Medicare markets.

The purpose of this study was to evaluate the revenue effects of seven vertically integrated strategies on California hospitals. The strategies investigated were managed care contracts, physician affiliations, ambulatory care, ambulatory surgery, home health services, inpatient rehabilitation, and skilled nursing care. The study population included 242 not-for-profit hospitals in continuous operation from 1983 to 1990. Many hospitals developed vertically integrated programs in the 1980s as inpatient utilization fell in response to the Medicare Prospective Payment program. Net revenue rose on average by $2,080 from 1983 to 1990, but fell by $2,421 from the Medicare program. On the whole, the more physicians affiliated with a hospital, the higher the net revenue. However, in the Medicare population, the number of managed care contracts was significant. The pre-hospital strategies generated significant revenue, while the post-hospital strategies did not. In the Medicare program, inpatient rehabilitation significantly reduced revenue.

California↗
PubMed2002

The effect of an integrated stress management program on the psychologic and physiologic stress reactions of peptic ulcer in Korea.

The purpose of this study was to identify the effects of an integrated stress management program on symptoms of stress and ulcer healing in a sample of Koreans at a major medical center in Seoul, Korea. The study employed an experimental design with two treatment groups. One treatment group (n=23) participated in an integrated stress management program that consisted of seven 1h sessions over a 4-week period. A second treatment group (n=24) was only given a tape on progressive muscle relaxation. Data were collected over a 4-month period on 47 subjects. Participants were randomly assigned to the two treatment groups. Symptoms of stress were measured by the symptoms of stress scale (Kogan, Self-regulation on Stress Reaction by Biofeedback, Korean Psychiatric Academic Society, Korea) translated into Korean. Stage of ulcer healing was evaluated by a physician using an endoscope. Physiologic stress reactions were measured by biofeedback equipment. The integrated stress management program treatment group reported significantly lower stress symptom scores than the progressive muscle relaxation-only group (t=3.66, P<0.001). The integrated stress management group also demonstrated a greater improvement in ulcer healing than the progressive muscle relaxation group (t=1.95, P<0.05). The integrated stress management program was more effective in decreasing self-reported stress symptoms and resulted in a more significant ulcer healing than the progressive muscle relaxation treatment.

Adolescent↗
PubMed1979

Social work and primary health care: an integrative approach.

An interinstitutional, interagency Consortium has been formed in Houston to develop an innovative service model and provide interdisciplinary primary care/mental health training. The Houston Consortium Program integrates mental health professionals and trainees into the primary care framework of a neighborhood center serving a low-income, predominatly Mexican-American population. The introduction of mental health, psychosocial, and cross-cultural perspectives to complement the long-standing physiological concerns of health professionals fosters an holistic approach to patient care. The social workers' full participation as members of primary care teams builds upon their traditional training to provide them the experience and skills required to function effectively in the expanded coordinative capacity of health/mental health manager as defined by the President's Commission on Mental Health. It is anticipated that Consortium Program can serve as a heuristic model in the development of a nationwide pattern of comprehensive care.

Community Health Centers↗
PubMedDate not supplied

International Health Fellowship: a proposed curriculum for emergency physicians.

There are a growing number of emergency physicians (EPs) working in health care abroad. There are, however, no formal training programs for EPs in international health. An International Health Fellowship has been developed to provide training for EPs in public health and international medicine. The fundamental competencies of a fellow completing the International Health Fellowship include assessment of medical need, program development, integration of programs into the existing health care framework, and evaluation of projects. This article outlines the philosophy of a training program in international health, provides an overview of the goals and objectives for such a program, and describes the development of an existing fellowship. The International Health Fellowship will develop leaders in the field of global health by combining clinical expertise, practical field experience, formal public health training, and research and education in international health. Physicians completing a fellowship will be prepared to work within foreign health systems to develop, integrate, and evaluate health care programs on an international scale.

Curriculum↗
PubMed2004

A review of clinical characteristics and residential treatments for adolescent delinquents with mental health disorders: a promising residential program.

As treatment systems throughout the country have deinstitutionalized, under-use of community-based residential treatment systems has escalated. Reliance on juvenile justice systems for the care of the mentally ill adolescent has increased. There is considerable overlap between the mentally ill adolescent population within the community-based mental health systems and the offender population within the juvenile justice systems. With the inconsistent epidemiological prevalence and longitudinal treatment data, mental health treatment providers have also begun addressing this problem. This is currently being done by designing and implementing community-based residential mental health programs for delinquent adolescents of the juvenile justice system as well as nondelinquent adolescents within the mental health treatment systems. Providers have relied on both systems' literature in establishing theoretical treatment programs. The authors review critical treatment components currently used by both the treatment and juvenile justice systems. A promising integrative program is described.

Adolescent↗
PubMed1991

Clinical and experimental approaches to varieties of memory.

Memory is described as a complex aspect of cognitive functioning. Memory is dependent upon input from the sensory modalities; it relies upon the passage of time; and it requires intervening processes for initial acquisition and subsequent access. Based upon questions posed concerning the relationship between clinical and experimental advances in memory and memory disorders, an example is given to illustrate the influence of research upon techniques for diagnosis and rehabilitation. Suggestions are provided about how to approach answering other related questions in neuropsychology. An integrated program is suggested with the aim of bringing together findings from neuroanatomy, neurochemistry, and neurobehavior. Emphasis is placed upon integrating results of research based upon human and nonhuman models of disordered memory and other cognitive functions. Neuroanatomical systems important for performing delayed-reaction tasks are reviewed, as are results of delayed response and delayed alternation testing in several human populations with neurological dysfunction suggestive of frontal lobe damage.

Adult↗
PubMedDate not supplied

A model for dual disorder treatment in acute psychiatry in a VA population.

One model for addressing the dual disorders of substance abuse and a concomitant mental disorder in an acute-psychiatry inpatient ward of a VA Medical Center utilized psychoeducation and ward policies to empower patients to make decisions affecting their recoveries. Existing staff shared responsibilities for implementing activities and creating ward milieu that supported psychiatric patients toward a life free of alcohol and drugs as they gained in acceptance of responsibility for the management of their mental disorders. Integrated programming assisted patients in constructing a meaningful path of recovery out of multiple treatment approaches and philosophies. Treatment principles, ward policies, and goals for an integrated acute-psychiatry model evolved over 4 years. Designed from a consumer-oriented "strengths perspective," patients responded to the new programming with satisfaction and gratitude. Recent adaptation of these policies, principles, and goals to a newly instituted continuous-care treatment program indicates the appropriateness of their application for outpatient dual disorder treatment and programming as well.

Anti-Anxiety Agents↗
PubMed2003

Integrating treatment with rehabilitation for persons with major mental illnesses.

Psychiatric treatment and rehabilitation are integrated, seamless approaches aimed at restoring persons with major mental disorders to their best possible level of functioning and quality of life. Driven by a thorough assessment, treatment and rehabilitation are keyed to the stage and type of each individual's disorder. Examples of coordinated treatment and rehabilitation are pharmacotherapy, supported employment, social skills training, family psychoeducation, assertive community treatment, and integrated programs for persons with dual diagnoses. The authors conclude by proposing seven principles to guide mental health practitioners in their integration of pharmacologic and psychosocial interventions.

Adult↗
PubMed1996

Drug use prevention efforts at colleges and universities in the United States.

This study examined the extent to which program comprehensiveness, programmatic outcomes, program integration, and environmental factors are being addressed by 336 urban and rural United States college and university drug use prevention programs. College-based prevention programs employed a range of programmatic goals, prevention communication channels, and prevention strategies within a centralized department for drug use prevention. Most program coordinators reported no perceived change in alcohol, tobacco and other drug use, alcohol/drug-related problems, faculty/staff drug use, and alcohol and drug-related crime resulting from prevention efforts on campus. The level of prevention activity differed across institutional type.

Adolescent↗
PubMedDate not supplied

The development and evaluation of lighten up, an Australian community-based weight management program.

UNLABELLED: Programs of widely ranging size were conducted successfully in seven localities and thus the program was considered an operational success. The reductions in weight, blood pressure, and waist and hip measurements observed at the 3-month follow-up compared well with reports of other community-based programs. Almost all participants evaluated the program highly and reported positive changes in behaviors related to food and exercise. Qualitative data indicate that the coordinators developed a sense of ownership of the program--which will be vital to its sustainability. Rapport between coordinators and participants was more easily established in smaller programs than in larger ones and was an important underlying determinant of retention rates. SIGNIFICANCE: The Lighten Up program integrates environmental and individual strategies to facilitate changes towards a positive, lifestyle approach to long-term weight management. The program aims to establish sustainable social support networks with effective links to health services. This study has demonstrated that, with appropriate training and resources, existing public sector, primary health care personnel with no previous experience in health promotion can implement the program successfully in several communities concurrently. In the Australian context, this program can play an important role as one strategy in a range of interventions required to address the issue of obesity. The stepped-care model described by Brownell proposes that program options of varying intensity, and thus cost, be available to meet the variety of needs of overweight people who wish to lose weight. The Lighten Up program was close to the midpoint of that range in that it combined population strategies with one-on-one contact with health care personnel. LIMITATIONS: Participants in the study were self-selected people who had acted quickly to enroll in the program, and it is therefore likely that the sample was overrepresented with early adopters who may have been more successful than others would have been. We cannot tell from this developmental study whether or not the program will appeal to population groups known to be at high risk for obesity. This is an important question that needs to be addressed in future research. No control group was included in the design and thus we cannot be sure the benefits experienced by the participants resulted from the program. However, process evaluation data indicate that nothing that might explain the findings, other than the program, occurred in the communities during the time of the study. Further important issues to be evaluated include: the long-term maintenance of weight loss; whether or not the program will reach targeted populations, particularly groups of low socioeconomic status; and the extent to which the public health staff will maintain enthusiasm for the training and the programs.

Adult↗
PubMed2000

Ready to answer ORYX data questions? Here's what Joint Commission will ask.

The Joint Commission on Accreditation of Healthcare Organizations' ORYX program integrates performance measurement into the accreditation process. Your hospital already should have chosen six measures to report for the ORYX program, and those measures may affect the ED. Surveyors will want to see comparison charts, so your ED can be measured against other facilities, and control charts with internal data. Automatic type I recommendations result if institutions fail to report data they said they would report for two quarters in a row. Your control charts may have findings that are statistically, but not clinically, significant.

Accreditation↗
PubMed2002

Diabetes disease management in a community-based setting.

PURPOSE: The medical cost of diabetes in the United States in 1997 was at least $98 billion. This study illustrates the behavioral change and medical-care utilization impact that occurs in a community-based setting of a diabetes disease-management program that is applied to program participants in a health insurance plan's health maintenance organization and preferred provider organization. DESIGN: A historical control comparison of diabetes-management participants. METHODOLOGY: One hundred twenty-seven identified diabetes patients are followed from baseline through 1 year. Differences in behavior are compared at program intake and at a 6-month reassessment. Differences in medical-service utilization are compared in the baseline year and the year subsequent to program enrollment. Poisson multivariate-regression models are estimated for counts of inpatient, emergency department, physician evaluation and management, and facility visits, while also controlling for potential confounders. PRINCIPAL FINDINGS: Behaviors improved between program intake and the 6-month reassessment. From patient reports, the number of participants having a hemoglobin A1c test increased by 44.9 percent (p < .001), and there was a 53.2-percent decrease in symptoms of hyperglycemia (p = .002). From medical claims after program enrollment, a drop occurred during the program year in every dimension of medical-service utilization. Regression results show that in-patient admissions decreased by 391 (p < .001) per 1,000 for each group, while controlling for age, length of membership, and the number of comorbid claims for congestive heart failure. In the analysis of costs that were pre- and post-enrollment, which included disease-management program costs, a 4.34:1 return on investment was calculated. CONCLUSION: The diabetes program provides patients with comprehensive information and counseling relative to practicing self-management of diabetes through a number of integrated program components. This study strongly suggests that the implementation of such a program is associated with positive behavioral change and, thus, with substantial reduction in medical-service utilization. In addition, the intervention resulted in a net decrease in direct medical costs.

Aged↗
PubMed2004

Integration of microbial ecology and statistics: a test to compare gene libraries.

Libraries of 16S rRNA genes provide insight into the membership of microbial communities. Statistical methods help to determine whether differences in library composition are artifacts of sampling or are due to underlying differences in the communities from which they are derived. To contribute to a growing statistical framework for comparing 16S rRNA libraries, we present a computer program, integral -LIBSHUFF, which calculates the integral form of the Cramér-von Mises statistic. This implementation builds upon the LIBSHUFF program, which uses an approximation of the statistic and makes a number of modifications that improve precision and accuracy. Once integral -LIBSHUFF calculates the P values, when pairwise comparisons are tested at the 0.05 level, the probability of falsely identifying a significant P value is 0.098 for a study with two libraries, 0.265 for three libraries, and 0.460 for four libraries. The potential negative effects of making the multiple pairwise comparisons necessitate correcting for the increased likelihood that differences between treatments are due to chance and do not reflect biological differences. Using integral -LIBSHUFF, we found that previously published 16S rRNA gene libraries constructed from Scottish and Wisconsin soils contained different bacterial lineages. We also analyzed the published libraries constructed for the zebrafish gut microflora and found statistically significant changes in the community during development of the host. These analyses illustrate the power of integral -LIBSHUFF to detect differences between communities, providing the basis for ecological inference about the association of soil productivity or host gene expression and microbial community composition.

Aeromonas↗
PubMedDate not supplied

A data-based agenda for doctoral nursing education reform.

BACKGROUND: Continuing concerns over the diverse degree names and the quality and quantity of doctoral nursing programs make it essential that nursing leadership take consensus-driven action on the basis of today's educational realities. PURPOSE: To explore the state of US doctoral nursing education to determine what leadership initiatives are needed in program definition, scope, and resources. METHOD: The researchers used a mailed survey (63.4% response rate) and Web site review (all remaining progress) to gather data on all US doctoral nursing education programs (n = 87). The survey included 12 items pertaining to each degree program and 11 institutional environmental questions. DISCUSSION: The doctor of philosophy was the most common degree title (n = 71). Degree title was not consistently associated with requirements (eg, dissertation and practica requirements) or stated degree purposes. Reports of program resources, as defined by faculty rank and research experience, indicated fiscal and educational threats to program integrity in many schools. CONCLUSIONS: Although individual schools should continue efforts to increase educational quality, consensus and action by all doctoral programs is needed. Five recommendations for immediate action are proposed.

Curriculum↗
PubMed1996

Improving patient care delivery with integrated case management.

Providers and payers in an integrated delivery system can increase the coordination and cost-effectiveness of the services they provide by developing a strong case management program. Integrated case management can provide the common thread for developing and meeting joint goals, such as reduced lengths of stay, cost-per-case reductions, decreased admission/readmission rates, and increased patient satisfaction. Providers and payers should design and integrate their case management services to allow for greater sharing of resources and integration of patient care goals and incentives.

Case Management↗
PubMed1999

[Is vocational integration in the competitive labor market a realistic goal for the chronically mentally ill?].

A wide range of sheltered jobs has been created in the second or special labour market with the aim of enabling the chronically mentally ill to participate in working life. However, having a job in the special labour market often precludes the chance of obtain-ing employment in the competitive labour market. To date, vocational integration programs enable only a small number of persons with psychiatric disabilities to attain reintegration into competitive employment. The predictors of successful vocational integration are subsequently discussed. A substantial increase in both sheltered and competitive jobs on the common labour market could be achieved for mentally ill and disabled people by adapting the "supported employment" model, as widely practised in the USA, to European labour market standards and appropriately funding its implementation. The utilisation of this model could serve to reduce the necessity of further expansion in the special labour market.

Employment↗
PubMed2002

Comparison of anthracycline-induced death of human leukemia cells: programmed cell death versus necrosis.

We investigated the mode of cell death induced by the anthracyclines, aclarubicin, doxorubicin and daunorubicin in the human leukemia cell lines, HL60 and Jurkat. The cells were incubated with drug concentrations up to 500 nM for periods between 3 and 24 hours, followed by morphological and biochemical analyses. All three substances induced DNA fragmentation, evident as DNA laddering and appearance of cells with hypodiploid DNA content, externalization of phosphatidyl serine, activation of caspases and degradation of the apoptosis-specific endonuclease inhibitor DFF45. However, concentrations and times necessary for these effects to occur were different, aclarubicin being the quickest acting drug with a lag phase of 3 h, followed by daunorubicin with 6 h and doxorubicin with 24 h. More importantly, aclarubicin induced these effects while the cell membrane was intact, whereas doxorubicin and daunorubicin led to immediate loss of membrane integrity. Programmed cell death is characterised by preservation of membrane integrity in order to allow removal of apoptotic bodies, whereas cell rupture is an early event in necrosis. We therefore suggest that, in our experimental settings, doxorubicin- and daunorubicin-induced cell death occurs by necrosis, while aclarubicin induces programmed cell death.

Aclarubicin↗
PubMed1998

Effectiveness of in-patient rehabilitation for sub-chronic and chronic low back pain by an integrative group treatment program (Swiss Multicentre Study).

In this multicentre intervention study, we compared an integrated group treatment program which combines psychological and education methods into a more active training approach, with the traditional individual approach of physiotherapy and physical procedures for sub-chronic and chronic low back pain. Our 411 patients had a 4-week inpatient treatment: 243 patients in an experimental program and 168 in a traditional program. Outcomes of 283 patients were assessed 3 months and 1 year after entry. The dropout rate was 31.1%. Both conditions demonstrated favourable initial effects on functional and psychological parameters, but the integrated approach showed better long-term results for work rehabilitation than the traditional approach. The most successful patients (n = 58) were younger and had a higher educational level in comparison to the unsuccessful subgroup (n = 71). The main conclusion is that an integrated approach promoting self control and behaviour change through educational measures achieves better long-term results than the traditional individual physiotherapy approach.

Adult↗