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PubMedDate not supplied

[Hospital maintenance: management, risks, and responsibilities].

Principal activities of maintenance carried out in hospital, staff required, various type of organization (inside team or global service), management aspects are described. Subjects responsible of maintenance are characterized and the relationships between Service of Maintenance and Service of Prevention and Protection in hospital are specified. Responsibility aspects concerning safety of maintenance workers and main risks which are exposed are defined. The importance of disponibility of a good maintenance handbook and of projects and programs of practice for new hospitals are emphasized.

Humans↗
PubMed1997

How HMOs assess medical groups and IPAs.

California health maintenance organizations (HMOs) frequently capitate physician organizations--independent practice associations (IPAs) and multispecialty medical groups--to export their risk for professional and outpatient ancillary services. Physician organizations benefit when successful in managing the risk, and from having greater control over medical management decisions. HMOs carefully assess the physician organization's ability to manage capitated risk and provide high-quality care. HMOs gather information on the physician organization's finances, business relationships, physician compensation arrangements, credentialing, hospital relationships, ancillary contracts, procedures for 24-hour care, claims administration, member services, information systems for reporting and tracking utilization, and procedures for utilization/quality management. These data are analyzed to determine whether capitation contract negotiation should proceed.

California↗
PubMed2001

The effect of selective serotonin reuptake inhibitor treatment of panic disorder on emergency room and laboratory resource utilization.

BACKGROUND: While it has been well documented that patients with untreated panic disorder frequently utilize emergency room (ER) and laboratory services, no published data evaluate whether selective serotonin reuptake inhibitor (SSRI) treatment of patients with panic disorder is associated with decreased use of these services in the managed care organization setting. METHOD: A medical and pharmacy claims database representing individuals from several managed care organizations was used to analyze ER and laboratory resource utilization and cost for 120 patients with panic disorder (ICD-9-CM criteria) who received SSRI treatment. RESULTS: SSRI treatment was associated with a reduction in the mean number of ER and laboratory visits and costs in the 6-month period following therapy initiation compared with the 6-month period prior to therapy initiation (sertraline: visits, -79.5%; costs, -85.2%; p < .05; fluoxetine: visits, -25.0%; costs, -69.5%; p = NS; and paroxetine: visits, -8.6%; costs, -30.8%; p = NS). CONCLUSION: The results of the current study suggest that appropriate treatment of panic disorder may decrease unnecessary resource utilization for the medical symptoms associated with panic disorder.

Adolescent↗
PubMed1985

Great Falls Corporation, Auburn, Maine.

On November 1, 1984, Androscoggin Home Health Services restructured itself into three separate entities corporately linked via a holding company and with overlapping governance among the parent and its two subsidiaries. AHHS the parent and its two subsidiaries. AHHS remains the Medicare-certified agency with additional grant-funded programs. Great Falls Homecare Corporation is the private-pay personal care services subsidiary. As third subsidiary, Great Falls Management Corporation, has recently been organized for more effective and responsive management services. If asked whether corporate restructuring appears at this time to ensure survival over the long haul, a resounding "yes" would be heard from management and directors alike. Restructuring isn't easy, but it is insurance worth purchasing for the future.

Home Care Services↗
PubMed2006

Care managers' time use: differences between community mental health and older people's services in the United Kingdom.

Since the community care reforms of the early 1990s, care management in the United Kingdom has become the usual means of arranging services for even the most straightforward of social care needs. This paper presents data from a diary study of care managers' time use, from a sample of social services commissioning organizations representing the most common forms of care management practiced in England at the end of the 20th century. It compares the working practices of care managers in community mental health service settings to the practices of those situated in older people's services. Evidence is provided to suggest that while the former follow a more clinical model of care management, those working with older people take an almost exclusively administrative approach to their work. In addition, the multidisciplinary nature of mental health service teams appears to facilitate a more integrated health and social care approach to care management compared to the approach to older people's services. Further enquiry is needed as to the comparative effectiveness of these different modes of working in each service setting.

Adolescent↗
PubMed1994

[Management of health services--financing method tool].

Financing methods for health care have great actuality in the Nordic countries. Incentive theory background is briefly presented. The main categories and subcategories of financing methods are listed. For the global budget solutions capitation and global budget based on historical costs, the advantages and problems are discussed. The two main categories per-case reimbursement, retrospective and prospective, are presented. The retrospective category includes per-diem rates and fee-for-service payment. Prospective reimbursement can be done on the basis of product definitions or episodes of care. The possibility of result grading the per-case reimbursement is mentioned. Problem solving by hybrid methods of financing is presented. Requirements to reimbursement methods can be: 1) They should be clinically neutral or assist in reaching formulated goals. 2) They should not result in unwanted use of any level of care. 3) They should not present barriers to justified referral between any level of care.

Budgets↗
PubMed1995

Reproductive health practices of HMOs serving urban low-income women.

As managed competition expands, many health plans wish to open their membership to those on Medicaid, mostly women and children. This study examines the reproductive services of 10 diverse managed care organizations historically targeting large numbers of poor women for care through prepaid Medicaid contracts. These institutions think themselves united and unique within managed care because of their long-term commitment to serving patients on Medicaid. Although the interviews with providers and administrators explore many aspects of reproductive care, most of these health maintenance organizations (HMOs), by the nature of their funding and federal mandates, have more aggressive and defined programs for pregnant women and for infants. These urban-based providers have discovered by trial and error the challenges of getting quality health care to poor women: external administrative or bureaucratic challenges because of Medicaid, internal administrative or provider barriers, and the artifacts of patient behavior. Strategies to address these problems involve attending to political and bureaucratic factors affecting care, taking a broader social view of patients and their community, using community resources to supplement HMO benefits, maximizing each contact with patients with multiple interventions, case management to monitor underutilization, aggressive outreach, service, and follow-up.

Female↗
PubMed1989

[Systems analysis in hospital management].

Organization is one of the most important concepts for contemporary society. Whereas in recent years industry and the private services field have adopted management criteria to establish aims and methods, and to manage their organizations, the same is not true for public services. So in this area, particularly in health services, the need for a managerial type of organization is particularly evident. The basic change in the approach to the solution of organization problems, in accordance with a management type criterion, is the substitution of the traditional analytical approach with an assessment of systemic type that examines relations and interactions between the various components of an organization. Of the various methods proposed, one conceptual instrument that permits a management-type analysis of an organization is the "7S" method. An approach of this type may be particularly useful for the evaluation of an extremely complex structure like that of a hospital. According to this method, the interactions between strategy, structure, systems, staff, style, skills, and system of prevalent values of the hospital's organization structure are analysed with the purpose of improving their management.

Hospital Administration↗
PubMedDate not supplied

Clinic provision of contraceptive services to managed care enrollees.

CONTEXT: Since the initiation of managed health care, little information has been available on whether family planning agencies are seeking ways to serve (and obtain reimbursement for serving) the growing number of clients who are managed care enrollees. METHODS: A 1995 mail survey sought information from a nationally representative sample of publicly funded family planning agencies about the agencies' involvement with managed health care plans and related clinic services, policies and practices. Completed surveys were received from 603 agencies, for an overall response rate of 68%. RESULTS: One-half of all publicly funded family planning agencies had served known enrollees or managed care plans. One-quarter (24%) had served managed care enrollees under contract, while others sought out-of-plan reimbursement for services provided to enrollees (13%) or used other sources to cover the cost of these services (12%). Family planning clinics administered by hospitals and community health centers were more likely than other types of clinics to have contracts to provide full primary-care services to managed care enrollees, whereas Planned Parenthood affiliates were more likely to have contracts that covered the provision of contraceptive care only. Clinics administered by health departments rarely had secured managed care contracts (10%), and only 36% reported even serving managed care enrollees. CONCLUSIONS: The challenges presented by managed care, and agencies' responses to these challenges, vary according to the type of organization providing contraceptive care. Family planning agencies need to seek relationships with managed care organizations based on those services that their clinics can best supply.

Ambulatory Care Facilities↗
PubMed1984

Organization and implementation of a community hospital microsurgical service for the management of amputation injuries.

The genesis of a voluntary referral system with the establishment of a microsurgical replantation center in a community hospital is described. Specific hospital and emergency care protocols are outlined, along with the percentage distribution of peripheral hospitals utilizing this service. Over the initial 6-year period, a success rate greater than 85% has been achieved in those cases that have satisfied the criteria for revascularization and replantation.

Amputation, Traumatic↗
PubMed2005

GEE estimation of a misspecified time-varying covariate: an example with the effect of alcoholism treatment on medical utilization.

The generalized estimation equation (GEE) method is widely used in longitudinal data analysis, particularly when the outcome variable is non-Gaussian distributed. Under mild regulatory conditions, the parameter estimates are consistent and their asymptotic variances are efficient. In an observational study focusing on alcoholism patients, we applied the GEE method to longitudinal count data from medical utilization records from a large national managed care organization. The health services research question was whether there was a change in medical utilization for patients after engaging in alcoholism treatment as compared to before treatment. Thus, the main effect of interest was a time-varying covariate indicating whether the patient had undergone treatment yet or not. GEE under five different working correlations was employed and mixed results regarding the significance of the treatment effect were found. Because of the large sample size, i.e. 8485 patients with an average of 46 repeated measurements per patient, differences across the estimates produced by the different working correlation structures was suspicious. It is shown that these differences are maybe caused by the fact that the time-varying covariate in the marginal mean model is misspecified. A simulation study is performed to demonstrate that misspecification of the time-varying covariate in the marginal mean structure can cause differences in GEE results across various choices of working correlation structure.

Adult↗
PubMedDate not supplied

Community health workers in national programmes: the case of the family welfare educators of Botswana.

Community health worker programmes have become a prominent feature of many primary health care schemes in developing countries. This paper, which is based on a larger collaborative study undertaken in 3 countries, focuses on the experiences with such workers in Botswana, and concludes that many of the key issues that were highlighted in the Botswana study are similar to those in other countries. These can be summarized under four headings: unrealistic expectations, poor initial planning, problems of sustainability, and the difficulty of maintaining quality of care. The future success of these workers will depend on their being integrated more systematically into local services, with concomitant strengthening of management support and supervision.

Botswana↗
PubMed1991

National drug policy and rational drug use: a model curriculum for developing countries.

Of the world's five billion people, 75% of whom live in developing countries, 25-50% have little or no access to basic pharmaceuticals. To ensure an adequate supply of safe and effective drugs of good quality, a national drug policy (NDP) should be incorporated into the national health policy. Elements of a NDP include: identification of therapeutic needs; objective selection of essential drugs; drug supply and distribution system; effective legislation and regulation; quality assurance; manpower development; and dissemination of drug-related information. Drug availability does not ensure their rational prescribing or dispensing or appropriate patient use. It is proposed that a flexible multi-disciplinary curriculum be established for healthcare professionals and students and public policy formulators to provide instruction in NDP elements and the principles of rational drug use. Such courses may stimulate multi-disciplinary drug-related scholarly activities.

Developing Countries↗
PubMed2002

Policy initiatives to promote healthy aging.

An overwhelming array of policies and programs can be used to help older people (and future older people) maintain healthy lifestyles. How can clinicians help ensure that their patients take advantage of these opportunities? How can these broad-scope policies, educational and information initiatives, and direct service programs be turned into tools to help older people maximize health and independence? First, physicians do not need to do it all themselves. They need to know where to send their patients. For example, case managers in local aging service organizations and social workers, nurses, and discharge planners in hospitals can help connect elderly patients to appropriate benefits and services. Physicians play a critical role in creating a bridge between patients and the array of programs and information that can help them change their individual patterns of behavior. A serious lack of integration exists between what is known about healthy behaviors and lifestyles and what is really happening and available to older people today. From the earlier articles in this issue we know that much can be done to prevent many types of age-related disease and disability. This article provides examples of mechanisms that can be used to broadly disseminate knowledge about effective behavior and treatment changes and create mechanisms to turn this knowledge into real and widespread client-level, practice-level, health system, and community-wide interventions. Second, physicians need to understand that they are not merely subject to these policies and initiatives. They can help formulate and shape them. This political involvement includes active participation in policy initiatives of professional associations, involvement in research and demonstration activities, keeping informed about policy proposals at the federal and state levels, and helping advance ideas for improving health behaviors by speaking up and working toward change. These changes go beyond health initiatives to involve improving housing, nutrition, transportation, and other arenas that play a role in the health of communities and cities. According to the IOM, the most successful interventions are aimed at families, neighborhoods and communities. Interventions are also most likely to be successful when legislative, media, and marketing efforts support them [50]. These broader policies may actually have the most potential impact in terms of developing sustainable lifestyle changes that reach all Americans, especially those with the greatest health needs. Within the aging population, those with greatest health needs include members of minority groups, recent immigrants, and the old-old. These groups are often overlooked when designing and implementing health promotion programs. It is important, however, to remember, for patients and for ourselves, you are never too old to benefit from prevention.

Aged↗
PubMed2000

Differences in use of coronary angiography and outcome of myocardial infarction in Toulouse (France) and Gerona (Spain). The MONICA-Toulouse and REGICOR investigators.

AIMS: Differences in the management and organization of health services may account for some of the variability in myocardial infarction case fa tality in different geographic areas. The 28-day outcome was compared i n two regions with similar myocardial infarction incidence and mortality rates that had opposing patients in the use of coronary angiography an d coronary revascularization. METHODS AND RESULTS: The 28-day case fatality of patients aged 35 to 64 years with myocardial infarction, surviving the first hour post-admission to hospitals with coronary care units, was compared in the population of myocardial infarction registries of Toulouse, France and Gerona, Spain. Patient characteristics were similar. In Toulouse, 93% of the 819 registered patients underwent coronary angiography compared with only 6% of the 454 in Gerona. Among hospitalized patients 28-day case fatality was 4.3% and 9.3% in Toulouse and Gerona, respectively (P=0.0003). Rates of thrombolysis and beta-blocker use were higher in Toulouse, although severity indicators were similar to those of Gerona. A model adjusted for these variables showed that the risk of death was 1.90 (95% confidence interval: 1.17-3.07) in Gerona patients compared with those of Toulouse. CONCLUSIONS: Routine angiography use is associated with better 28-day myocardial infarction prognosis than restrictive use. However, the optimum proportion of myocardial infarction patients who have to receive angiography procedures remains unclear.

Adult↗