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PubMedDate not supplied

Hypertension control through the design of targeted delivery models.

If we discard some of the assumptions upon which curatively oriented medical care is based, we can design models to deliver more effective services for those with chronic diseases. Assumptions to be discarded are--that disease processes can be cured through the delivery of a "magic bullet" rather than controlled through continuous surveillance, -that the physician must be an active decision maker and thus act as gatekeeper and monitor for all disease victims, and -that care for a family of consumers must be provided together. Models for the delivery of services can then be designed to provide continuity of care for those with a specific chronic disease, and paraprofessionals can be used as gatekeepers and monitors, in combination with physicians, rather than physicians alone, to give services. Models can be targeted to reach specific high-risk groups within the population at the workplace, the school, unemployment office, or wherever groups routinely congregate for purposes other than health care. Building targeted models requires extensive knowledge of the specific geographic area and its population as well as knowledge of the natural history of the disease and its treatment. For hypertension programs, goals can be set in terms of numbers of persons whose disease is controlled and the number of new programs initiated as the result of the control efforts.

Comprehensive Health Care↗
PubMed1979

Into the breach: emergency psychiatry in the general hospital.

In its position at the interface between the community and the general hospital, the emergency ward (EW) serves to reconcile the complex needs of the local population with the traditional organizational structure of the hospital. In recent years, the EW has been faced with the dilemma of managing increasing numbers of psychotic patients with chronic illness and psychosocial problems. In response to this impressive growth in the utilization of psychiatric emergency services, a variety of general hospitals have developed model programs of service delivery and methods for the evaluation of their effectiveness. This paper is an overview of utilization patterns, organization of services, and assessment of the evaluation and referral model. This issues facing general hospitals in the development of emergency care are clarified. The need for further research, program development, and clinical implementation is discussed.

Crisis Intervention↗
PubMed1975

Role of behavior modification in community mental health.

This paper briefly reviews the original concept of the community mental health movement; points to ways in which current service delivery systems deviate from this; offers and alternative framework for service delivery, that is, a behavioral model; and argues that its implementation would move community services closer to this conception. The implications of this model for intervention in the natural environment as well as for transitional and prosthetic facilities are described and examples given of its use. Emphasis is placed on working in the natural environment whenever possible via the use and cultivation of significant others as well as via provision of training in self-directed behavior change in addition to the blending of case management with careful evaluation of service.

Behavior Therapy↗
PubMed1979

[Nursing in the National Health Plan of Honduras].

After summarizing the health situation in Honduras and describing the National Health Plan launched in 1973, the authors explain the changes that have come about in nursing, the difficulties that had to be surmounted to reach a new professional position, and the administrative decisions that had to be taken to devise a health policy. An account is given of the changes made in the training of nursing staff and in the functions that staff must perform in the planning, implementation, and evaluation of the coverage extensive program. The article high-lights the role of the Nursing Division in the Ministry of Public Health and Social Welfare and the levels of coordination established with the other technical divisions and institutions responsible for the health personnel training. In closing, the article points out that the nursing sector represents the keystone of the model for the delivery of services to attain the goal of health for all by the year 2000.

Education, Nursing↗
PubMedDate not supplied

The occupational therapist on a geriatric rehabilitation team.

This article describes a rehabilitation services team at a skilled nursing facility. The objectives were to explore what occupational therapy can offer nursing home residents and to provide a model in the delivery of rehabilitation services to the institutionalized elderly. Emphasis is placed upon program structure and rationale, staff interrelationships, and the role of the occupational therapist on the team.

Aged↗
PubMed1979

A proposed network to improve access to high-quality health care for Medicaid-eligible families.

There is today both a need and an opportunity to develop and test a variety of models--organizational and financial--for improving the delivery of health care services. This article describes the structure and functioning of one such model and highlights the organizational problems expected to arise during its implementation. The proposed health plan is intended to facilitate the access of Medicaid-eligible, inner-city families to already available health services. The central hypothesis is that in low-income urban areas the elementary schools offer an organizational focus for the development of a health plan. As a prepaid, community-based model, this plan is designed to address the issues of accessibility, equity, accountability, continuity of care, and consumer participation, primarily through the development of a coordinating agency, the health plan office (HPO), which assures the linking of consumers and providers of health care. Adapted from the Kaiser-Permanente model, the HPO also assumes responsibility for marketing, enrollment, coordination of services, consumer advocacy, and quality surveillance.

Child↗
PubMed1976

The Imbrication Model for the integration of social services in a community.

An innovative model for organising social services in a community, the Imbrication Model, is contrasted with two traditional models, the Entrepreneurial and the Umbrella Agency. The structural characteristics and dynamics of the three models are illustrated with actual case histories. Imbrication Model calls for the interlocking of personnel from several agencies, with the purpose of redirecting the dysfunctional interagency rivalry prevalent in the traditional models. Imbrications at all organisational levels--Board of Directors, Administrators and Staff--facilitate adoption of the superordinate goal of providing clients with the best services available, regardless of which particular agency delivers the service. Few observers of the current social service scene would challenge the statement that needs for service are unlimited and resources limited. In the USA the imbalance between needs and resources persists despite a decade of massive governmental programmes intended to alleviate social ills. Recent substantial cutbacks in federal funds, moreover are not likely to improve the situation. The resource shortage involves more than a limitation of funds. Deliverers of service and competent programme administrators are also on critically short supply. These shortages are more often than not exacerbated by a chronic spirit of competition among agencies and programmes at the local level. Three organizational models for the delivery and administration of social services, two conventional and one of more recent date, are examined in this article. The innovative model, which has been named the Imbrication Model, explicitly calls for redirecting interagency rivalry and competition. Its ambitious goal is to integrate the efforts of those attempting to meet a community's social service needs.

Adolescent↗
PubMed1976

The contractual model for prison health care.

In New York City, the Department of Health is responsible for providing health services to 8 correctional facilities which receive 60,000 admissions annually. A large component of this prison health system is a contract with Montefiore Hospital, a voluntary institution, to provide medical services to the population on Rikers Island, a penal complex. This contractual agreement is unique in that an operating entity, Monefiore Hospital, has agreed to provide a "package" of health services to a defined prisoner population. The City agreed to reimbruse to the Hospital for the three year term of the contract, a total amount not to exceed +11.7 million. Because of delays in renovation of the prison facilities, for the majority of the period of the three year contract, only two prisons were served via the contractual route. Since 1973, the program has provided a range of services including screening of new prisoners, primary, emergency, infirmary and limited speciality care. Major improvements in laboratory and radiology services were implemented. The early experience with this program indicates that in this setting the contractual model possesses a number of distinct advantages over the direct delivery of prison health services. Disadvantages include a significantly higher cost.

Delivery of Health Care↗
PubMed1976

Friendship Manor: a community geriatrics model.

Models for the delivery of medical services are attracting much attention lately. It appears that geriatrics will become more important in the future. These facts have led to a narrative about the development of a system of medical care for a retirement community in Roanoke, Virginia.

Aged↗
PubMed1979

Hospitals in the 1980s: service, training, and research.

Several factors press for change in the psychiatric hospital of the 1980s, including knowledge obtained from recent controlled studies of outcome of different approaches and length of hospital stay, changes in the social-political-economic climate, and new methods of organizing the delivery of services. In the proposed model of inpatient treatment, the primary use of hospitalization will be for brief treatment (three to 21 days). For a very small subgroup, longer hospitalization may be needed. The hospital will also be used for triage and disposition of persons with a broad range of problems, which will rarely take more than three days. Complementary changes will be required in training and research; a promising training model may be continuous care teams by which trainees can manage chronic, multiproblem patients through different levels of care within and outside the hospital. Research must move to the out-of-hospital settings if the new patterns of care are to be understood and improved.

Community Mental Health Services↗
PubMed1977

Peer sex education training and evaluation.

Human sexuality has been recognized as an important developmental, emotional, and medical concern on the college campus. The Peer Sex Education Program at the University of Massachusetts/Amherst has been developed as a model for the use of trained students in an educational, referral, and counseling role. This paper describes the program and outlines the methodology used in the documentation and evaluation of various program aspects. Aspects described include the program's rationale and background, the recruiting process, roles and responsibilities, training and supervision models, community development, and delivery of service. Categories of documentation and evaluation considered include effort, performance, adequacy of performance, efficiency, and process. These are related to consumer acceptance and satisfaction, outcome measures of knowledge, attitude, and behavior, effectiveness of referral and other functions, and effect of program on the peer educators' growth and development. The allocation of energy and resources between program development, service delivery and evaluation needs is highlighted.

Humans↗
PubMed1979

Basic Health Services in Nigeria: models for primary care in America.

The basic problems in delivery of health care in the United States and in Nigeria are similar; the major differences are in magnitude. Nigeria's Basic Health Services Scheme, now being implemented, is a bold effort to make quality health care accessible to the entire population. American health planners should look to such developing countries for concepts adaptable to our own health care delivery system. In developing primary care programs in particular, they should consider three basic components of the Nigerian scheme: (1) delegation of appropriate responsibilities to non-physician health providers in order to augment physician manpower in underserved areas; (2) location of training centers in environments similar to those where the trainees will serve; and (3) use of home-based care records to increase patient participation in health care.

Delivery of Health Care↗
PubMed1976

Rationalizing the delivery of eye care--part I.

The often proclaimed health care crisis has led to a variety of efforts to reorganize and rationalize the existing health care system. One such effort has been to develop a conceptual model for the delivery of personal health services in which the region is the fundamental planning unit and levels of care form its organizational framework. Three levels of care are defined--primary, secondary, and tertiary--each level being based on a combination of the frequency with which a service is needed and its professional and technical sophistication. The regionalization of health services would serve to "achieve a balance between the public's request for decentralized resources and the centralization required so that they may be used efficiently."

Delivery of Health Care↗
PubMed1979

"What's new about independent living?".

The major purpose of this article is to examine important differences between independent living and traditional rehabilitation models of service provision, including comprehensive medical rehabilitation programs, state vocational rehabilitation agencies, and group homes designed to deinstitutionalize developmentally disabled individuals. The article is introduced by an overview of types of independent living programs in this country and their evolution. Goals, methods of service delivery, and program management techniques in independent living programs are contrasted with those of traditional models. Finally, trends that may develop as independent living becomes a standardized service entitlement are addressed, and the potential usefulness of some independent living concepts and methods in traditional rehabilitation programs are suggested.

Delivery of Health Care↗
PubMed1979

Rural areas face woes in health care delivery, try model systems.

Health planning such as consolidation and closure of facilities and services to contain costs often contradicts rural populations' needs for increased access to better or even basic services/Model programs to meet these needs are discussed.

Delivery of Health Care↗
PubMed1977

A model for certification of need for long-term-care beds.

A model relating bed supply and utilization is presented in the context of the match between need and service, which is controlled by the screening process that allows or denies access to beds. The conventional cost-minimization approach to certification of need, that of seeking to reduce inappropriate use, is contrasted with a service-delivery approach that seeks to promote appropriate use of facilities. The model expresses the quality of the screening process and the sensitivity and specificity of utilization in terms of bed supply, utilization, and need for service, which allows it to be used for needs assessment. The model is applied to data on supply and use of beds in Massachusetts skilled nursing facilities, with screening quality estimated by Monte Carlo methods; the results suggest that need and bed supply are positively associated and that the regional variation in skilled-nursing beds in Massachusetts may reflect real variations in need.

Bed Occupancy↗