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PubMed1991

Health resources management and physician control in a San Francisco, California, hospital.

The continued escalation in health care spending has caused money to become an increasingly limited resource, which may eventually affect the ability of health professionals to provide complete health care services. Health care payers have stressed efficiency and the appropriateness of health care measures and are putting greater financial pressures on health professionals by making them more accountable for services provided. Hospitals and physicians must take a more active role in monitoring health care delivery and work together to improve performance efficiency. Efficiency can be gained through a comprehensive program that emphasizes high-quality care and the effective use of health care resources. The Health Resource Management Program is a model for carrying out this function that integrates data analysis and physician input and education.

Delivery of Health Care↗
PubMedDate not supplied

Defining home health care nursing: implications for continuing nursing education.

The purpose of this qualitative interpretivist study was to analyze and articulate the characteristics of nursing practice in the home health care context. Researchers sought to describe expert home health care nursing practice and how it developed. Twenty-one nurses, at various stages of practice development, were asked to write three clinical narratives describing their home health care practice. Data were analyzed to elicit themes and characteristics of nursing practice in the home health care context. Findings indicate that in the context of home health care, expert nursing practice develops along a continuum, until nurses can integrate physiological data with environmental and family data to provide seamless, intuitive, and highly complex nursing care. The results of this research can assist continuing education and staff development providers as they develop educational programs designed to facilitate professional development of new graduates and newly employed nurses in home health care.

Community Health Nursing↗
PubMed2005

Navigating the information technology highway: computer solutions to reduce errors and enhance patient safety.

Standardized, seamless, integrated information technology in the health-care environment used with other industry tools can markedly decrease preventable errors or adverse events and increase patient safety. According to an Institute of Medicine (IOM) report released in 1999, preventable errors have caused between 44,000 and 98,000 deaths per year. Following the report, President Bill Clinton requested that the Agency of Healthcare Research and Quality, a government agency, look into the issue and fund, at the local or state level, processes that can reduce errors. Funding subsequently was made available for research that utilizes best practice tools in clinical practice to increase patient safety. The Joint Commission on Accreditation of Healthcare Organization has placed a great deal of emphasis on strategies to reduce patient identification errors. Fragmented systems tout the individual as well as enhanced safety applications. These applications, however, are related to prevention in specific conditions and in specific health-care settings. Systems are not integrated with common reference data and common terminology aggregated at a regional or national level to provide access to patient safety risks for timely interventions before errors and adverse events occur. Standardized integrated patient care information systems are not available either on a regional or on a national level. This article examines tangible options to increase patient safety through improved state-of-the-art tools that can be incorporated into the health-care system to prevent errors.

Accreditation↗
PubMedDate not supplied

[Incidence of Haemophilus influenzae type b meningitis in Italy. Preliminary results].

The Authors describe the survey's results aimed at quantifying the Haemophilus influenzae type b meningitis incidence rate in Italy. The survey collected all the cases of 1994 notified per region to the Ministry of Health; furthermore, regional incidence rates are compared and integrated with other data obteined from local ad hoc studies. The results obtained show a high incidence in the age group 0-2 years and a large discrepancy in the incidence rate between regions (from 0.0 to 16.8 cases per 100,000); furthermore, in the same age group, for a large amount of meningitis cases (18% of the total) the aetiological diagnosis was not successful; this phaenomenon is certainly one of the causes for the underestimation of the disease. The integration with data collected in longitudinal studies, increases largely the regional incidence rate, showing the highest rate in the Lazio Region (18.5 cases per 100,000). The Authors conclude by stressing the need to increase the cooperation between the Regional Health Authorities and the Ministry of Health, in order to obtain more reliable figures of the national incidence rates.

Age Factors↗
PubMed2005

Information subsystem of the Ca/Mg ratio as a database for studying its influence on human health.

Dalmatia is situated in the Dinaric karst in Southern Croatia. It is characterized by insufficient quantities of water during the summer months and a relatively excessive amount of rainfall during the winter and spring months. Other hydrographic characteristics of Dinaric carst include scarce and long surface streamflows with a few tributaries with changeable capacities, a small number of springs, and a relatively great number of submarine springs along the coast. The water supply and health-care institutions are especially interested in observing and monitoring water quality. A relational database has been developed for carrying out chemical analyses expressed by the Ca/Mg ratio since it is necessary to organize and integrate a large number of analytical and ecological health data. The database can serve as a methodological platform for the study of environmental factors influencing human health. The prototype database consists of data obtained by investigations which have been conducted by the water Examination Department of the Public Health Institute of the Split Dalmatian county (Croatia) University of Split Medical School. The database currently contains more than 2500 data.

Calcium↗
PubMedDate not supplied

Ensuring health care quality: perspective from a member of NCQA's Committee on performance measurement. National Committee on Quality Assurance.

Using the California Public Employees' Retirement System (CalPERS) as an example, this paper illustrates how an employer can abandon the more traditional role of passive purchaser of health care benefits and become an active participant in cost containment and quality improvement in the health care industry. Through the use of the Health Plan Employer Data Information Set (HEDIS) 3.0 and other data collection and reporting methods, the communication gap between consumers, purchasers, health plans, and providers is narrowing. Increasingly, purchasers like CalPERS are becoming involved in quality improvement; they are recognizing the need to serve as intermediaries between consumers and health plans, to understand available data, and to disseminate that information to the consumer. The purchaser's impact on the health care community's business practices is growing. As a result, the collection and reporting of HEDIS data are now emerging as substantial fiduciary reporting responsibilities for health plans. This paper outlines a plan implemented in California for improving HEDIS data gathering and examines surveys, results, and problems encountered in improving and integrating health care information.

Humans↗
PubMed2000

Social support and cardiovascular reactivity.

Recent experimental work on the benefits of social support in buffering cardiovascular stress responses builds on prior epidemiological, psychological, and physiological work. Epidemiological data show that social integration is associated with better health, but cannot unambiguously establish causality (it could be that healthy people attract more friends), nor that the mechanism is psychological (the mechanism could be behavioral; for example, with friends encouraging exercise). Social psychological work suggests that people prefer to be with others, especially in times of stress, and that they evaluate themselves, and their emotional responses, by observing the people around them. This work, while establishing a desire for affiliation, does not show that being with others translates into health benefits. Physiological evidence suggests that exaggerated cardiovascular responses to stress are associated with the development of hypertension and cardiovascular disease, but does not indicate how such potentially damaging stress responses can be reduced. Experimental work on social support and cardiovascular reactivity overcomes many of these limitations. The presence of an ally, especially a female, markedly reduces cardiovascular responses compared both to the presence of an non-supportive other, and to experiencing the stress alone. One fruitful area for further work is the role of social support following stress, both in speeding the cardiovascular return to pre-stress levels, and in limiting rumination-induced cardiovascular responses.

Animals↗
PubMed2002

Identifying environmental risk factors for endemic cholera: a raster GIS approach.

The bacteria that cause cholera are known to be normal inhabitants of surface water, however, the environmental risk factors for different biotypes of cholera are not well understood. This study identifies environmental risk factors for cholera in an endemic area of Bangladesh using a geographic information systems (GIS) approach. The study data were collected from a longitudinal health and demographic surveillance system and the data were integrated within a geographic information system database of the research area. Two study periods were chosen because they had different dominant biotypes of the disease. From 1992 to 1996 El Tor cholera was dominant and from 1983 to 1987 classical cholera was dominant. The study found the same three risk factors for the two biotypes of cholera including proximity to surface water, high population density, and poor educational level. The GIS database was used to measure the risk factors and spatial filtering techniques were employed. These robust spatial methods are offered as an example for future epidemiological research efforts that define environmental risk factors for infectious diseases.

Bangladesh↗
PubMed2004

Integrating preventive health services within community health centers: lessons from WISEWOMAN.

BACKGROUND: Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) provides low-income, underserved women ages 40-64 with risk factor screening and lifestyle intervention and referral services to prevent cardiovascular disease (CVD). Integrating WISEWOMAN's services with the culturally appropriate medical care and support services offered by community health centers may improve the program's ability to reduce CVD burden among underserved women. METHODS: We conducted a formative assessment of the perceived opportunities, challenges, and strategies associated with integrating WISEWOMAN into community health center settings. A panel of stakeholders that included health center and WISEWOMAN representatives was convened in 2002, and a semistructured discussion guide was used to elicit perspectives about integration. We also conducted an in-depth review of WISEWOMAN's history of collaboration with health centers in North Carolina. RESULTS: Stakeholders perceived a clear need for integrating WISEWOMAN within health center settings, indicating that centers have few other resources to expand preventive services delivery and offer effective lifestyle interventions for underserved populations. Perceived barriers to integration included competing demands on health center resources, difficulties hiring staff for new programs, and administrative burdens associated with data collection and reporting. Experiences within North Carolina's WISEWOMAN project demonstrate, however, that lifestyle interventions can be designed in ways that facilitate integration by health centers. CONCLUSIONS: Integration strategies need to be tailored to the resources, skills, and capacities available within health centers. As health centers and WISEWOMAN projects gain more experience in collaborating, additional research should be conducted to identify how best to achieve integration within specific institutional and community contexts.

Adult↗
PubMed2003

Future directions for the integrated CSFII-NHANES: What We Eat in America-NHANES.

The history of the integration of the dietary data collection from the National Health and Nutrition Examination Survey (NHANES) and the Continuing Survey of Food Intakes by Individuals (CSFII) is reviewed. The purposes and process of the workshop are presented. The three key topics of the workshop are summarized. The key roles of cosponsors and participants are acknowledged.

Consensus Statements as Topic↗
PubMed2005

Disparities and survival among breast cancer patients.

BACKGROUND: Although rates of survival for women with breast cancer have improved, the survival disparity between African American and white women in the United States has increased. PURPOSE: To determine whether this survival disparity persists in an insured population with access to medical care. METHODS: In this retrospective cohort study, we extracted data from the tumor registries of six nonprofit, integrated health care delivery systems affiliated with the Cancer Research Network and assessed the survival of African American (n = 2276) and white (n = 18 879) female enrollees who were diagnosed with invasive breast cancer from January 1, 1993, through December 31, 1998. Cox proportional hazards regression was used to estimate the death rate among African American women relative to that of white women after adjustment for potential explanatory factors including stage at diagnosis, tumor characteristics, and treatment. RESULTS: Five-year survival was lower for African American women (73.8%) than for white women (81.6%). African American women were less likely to have tumor characteristics with good prognosis. Controlling for age at diagnosis, stage, grade, tumor size, and estrogen and progesterone receptor status, the adjusted hazard rate ratio for African American women was 1.34 (95% confidence interval = 1.22 to 1.46). Similar risks were found among women ages 20-49 and 50 and older. Controlling for treatment slightly lowered the hazard rate ratio to 1.31 (95% confidence interval = 1.20 to 1.43). CONCLUSIONS: Among women with invasive breast cancer, being insured and having access to medical care does not eliminate the survival disparity for African American women.

Adult↗
PubMed2004

Using geographic information systems for exposure assessment in environmental epidemiology studies.

Geographic information systems (GIS) are being used with increasing frequency in environmental epidemiology studies. Reported applications include locating the study population by geocoding addresses (assigning mapping coordinates), using proximity analysis of contaminant source as a surrogate for exposure, and integrating environmental monitoring data into the analysis of the health outcomes. Although most of these studies have been ecologic in design, some have used GIS in estimating environmental levels of a contaminant at the individual level and to design exposure metrics for use in epidemiologic studies. In this article we discuss fundamentals of three scientific disciplines instrumental to using GIS in exposure assessment for epidemiologic studies: geospatial science, environmental science, and epidemiology. We also explore how a GIS can be used to accomplish several steps in the exposure assessment process. These steps include defining the study population, identifying source and potential routes of exposure, estimating environmental levels of target contaminants, and estimating personal exposures. We present and discuss examples for the first three steps. We discuss potential use of GIS and global positioning systems (GPS) in the last step. On the basis of our findings, we conclude that the use of GIS in exposure assessment for environmental epidemiology studies is not only feasible but can enhance the understanding of the association between contaminants in our environment and disease.

Cluster Analysis↗
PubMed1995

Designing the future: physician poll rates the trends.

A recent interactive electronic poll of 160 physicians attending an educational conference at ACPE's Future Forum reveals some opinions physicians have about the transition of medicine into the 21st century. Emerging issues include capitation, quality, law, and how to manage integrated delivery systems. Overall, respondents are concerned about remaining solvent is a capitated managed care environment.

Attitude of Health Personnel↗
PubMed1998

[Human parasitoses in Burkina Faso. Histopathologic approach].

The aim of this first study was to assess parasitic diseases encountered in histological practice in Burkina Faso. An examination of 3410 pathological specimens showed 138 cases of parasitic diseases which represented 4% of the results observed for 5 years in the laboratory of YALGADO OUEDRAOGO National Hospital. The parasitic diseases diagnosed were in decreasing order Schistosomiasis 53.6%, Cysticercosis 13.1%, Mycetoma 12.3%, Cutaneous Leishmaniasis 8%, Amebiasis 6.6%, Filariasis 4.3%, and Histoplasmosis 2.1%. We recommend better data collection for integration of these diseases into the health policy of Burkina.

Adolescent↗