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PubMed1984

[Development of human resources and the Plan of Action].

This article (whose first part was published in the previous issue of Educación Médica y Salud) concludes an exhaustive review of manpower development in the Americas. This part considers the specific measures in this field enunciated in the Plan of Action; these measures pertain to four main areas: planning and programming of human resources, training in priority areas, utilization of human resources, and educational technology. The author discusses the present and future possibilities and obstacles of each of these activities and the steps to be taken to bring needs into line with real situations. It is of paramount importance that the national health authorities clearly spell out their policies for the development of human resources in the health field within the framework of general development policies. Another point to be insisted upon is the multiprofessional and multidisciplinary training of the health team and the importance of the education-service-supervision function, which usually results in permanent and continuing education, which in turn optimizes the utilization of personnel. However, none of this will be possible without an appropriate education technology with which to innovate, analyze and refine the entire education process and so meet the needs of both society and the health services.

Health Education↗
PubMed2005

Advanced practice nursing: leadership to effect policy change.

Nursing leaders used evidence-based thinking to engage key stakeholders when implementing advanced practice nursing roles in a traditional medically oriented tertiary oncology center. A strategic orientation to the policy change initiative was guided by a theoretical framework for connecting research and policy. Policy approaches that addressed stakeholder values and beliefs, while attending to questions of competence, standards of practice, fiscal savings, medical and nursing workload, and ongoing multidisciplinary teamwork were essential to facilitate change.

Cancer Care Facilities↗
PubMed2026

Examining gaps in institutional policies for clinical genomic data sharing: A cross-jurisdictional study.

The sharing of data generated by clinical genetic and genomic testing without explicit consent is important for timely diagnosis and treatment. While many jurisdictions permit the sharing of identifiable data for direct clinical care, institutional policies vary in how clearly they specify key elements, including when sharing is permitted, what data are covered, and what safeguards apply. Greater clarity around these elements may support responsible data sharing while balancing timely care with transparency and appropriate protections. We conducted a mixed-methods content analysis of data-sharing and privacy policies from 33 clinical genomic institutions across 17 countries and regions. Using a predefined analytical framework, we assessed how policies document key governance elements relevant to sharing without explicit consent. Two independent reviewers extracted information about clinical contexts, data types, justifications, and protections. Although 70% of institutions described circumstances permitting data sharing without explicit consent, most policies did not clearly define the scope or governance of such sharing. Policies also rarely distinguished clinical from research or secondary use and inconsistently specified privacy and security safeguards. While sharing was commonly justified for clinical care (78.3%) or testing services (43.5%), data recipient roles and onward-sharing expectations were often left undefined. This uneven documentation could make it difficult for clinical teams and institutional decision-makers to identify and justify decisions about what is permitted and under what conditions. A guidance framework specifying core governance elements and corresponding protections could help institutions communicate their governance choices more clearly and support comparable baseline practices for responsible data sharing.

Information Dissemination↗
PubMedDate not supplied

A framework for the continual improvement of behavioral healthcare. Part II--Policy for leadership.

In the first part of this article, published in the November/December 1993 issue of Behavioral Healthcare Tomorrow, the authors presented a framework for understanding the process of continuous quality improvement in the behavioral healthcare setting. Four elements of continual improvement were identified: underlying knowledge, policy for leadership, tools and methods, and daily work applications. They showed how traditional professional knowledge of one's subject, discipline and values must be augmented by improvement knowledge--which quality improvement guru W. Edwards Deming calls "the system of profound knowledge." In Part II, they focus on the second element of continual improvement, the importance of organizational leadership.

Decision Making, Organizational↗
PubMed1998

Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy.

Attention to the sustainability of health intervention programs both in the US and abroad is increasing, but little consensus exists on the conceptual and operational definitions of sustainability. Moreover, an empirical knowledge base about the determinants of sustainability is still at an early stage. Planning for sustainability requires, first, a clear understanding of the concept of sustainability and operational indicators that may be used in monitoring sustainability over time. Important categories of indicators include: (1) maintenance of health benefits achieved through an initial program, (2) level of institutionalization of a program within an organization and (3) measures of capacity building in the recipient community. Second, planning for sustainability requires the use of programmatic approaches and strategies that favor long-term program maintenance. We suggest that the potential influences on sustainability may derive from three major groups of factors: (1) project design and implementation factors, (2) factors within the organizational setting, and (3) factors in the broader community environment. Future efforts to develop sustainable health intervention programs in communities can build on the concepts and strategies proposed here.

Community Health Services↗
PubMedDate not supplied

Disparities and quality improvement: federal policy levers.

Using a quality improvement framework to address racial and ethnic disparities in health care highlights multiple opportunities for federal and state governments to exert policy leverage, particularly through their roles as purchasers and regulators. Under such a framework, federal and state governments can expand their roles in collecting race/ethnicity data; define universal and meaningful race/ethnicity categories; more broadly disseminate standards for cultural competence; and demand the reduction of disparities through leveraging their status as collectively the largest U.S. health care payer.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Developing an evidence base for policies and interventions to address health inequalities: the analysis of "public health regimes".

Systematic reviews have become an important methodology in the United Kingdom by which research informs health policy, and their use now extends beyond evidence-based medicine to evidence-based public health and, particularly, health inequalities policies. This article reviews the limitations of systematic reviews as stand-alone tools for this purpose and suggests a complementary approach to make better use of the evidence. That is, systematic reviews and other sources of evidence should be incorporated into a wider analytical framework, the public health regime (defined here as the specific legislative, social, political, and economic structures that have an impact on both public health and the appropriateness and effectiveness of public health interventions adopted). At the national level this approach would facilitate analysis at all levels of the policy framework, countering the current focus on individual interventions. It could also differentiate at the international level between those policies and interventions that are effective in different contexts and are therefore potentially generalizable and those that depend on particular conditions for success.

Evidence-Based Medicine↗
PubMed2006

Reference frameworks for the health management of measles, breast cancer and diabetes (type II).

This paper presents reference frameworks which order effective and feasible policies and interventions for the health management of measles, breast cancer and diabetes (type II). These reference frameworks can be used to rapidly appraise regional health policy documents and existing health management systems. Furthermore, the reference frameworks can serve health policy makers for the planning of health management measures.

Benchmarking↗
PubMed2006

A process for the systematic review of community-based rehabilitation evaluation reports: formulating evidence for policy and practice.

A methodological framework for conducting a systematic, mostly qualitative, meta-synthesis of community-based rehabilitation (CBR) project evaluation reports is described. Developed in the course of an international pilot study, the framework proposes a systematic review process in phases which are strongly collaborative, methodologically rigorous and detailed. Through this suggested process, valuable descriptive data about CBR practice, strategies and outcomes may be synthesized. It is anticipated that future application of this methodology will contribute to an improved evidence base for CBR, which will facilitate the development of more appropriate policy and practice guidelines for disability service delivery in developing countries. The methodology will also have potential applications in areas beyond CBR, which are similarly "evidence poor" (lacking empirical research) but "data rich" (with plentiful descriptive and evaluative reports).

Humans↗
PubMed1995

Health policy making: the Dutch experience.

The European Strategy for Health for All by the Year 2000 urged member states to develop a national health policy. In the developmental process of HFA2000 the notion of 'healthy public policy' was conceived in the framework of the WHO Health Promotion Programme. Such healthy public policy--simply referred to as 'health policy' in this article--would take health consequences in all governmental and societal realms into account. Health policy development in The Netherlands was laid down in a 1986 memorandum, 'Nota 2000'. The developmental process of the document is reviewed, and chances for factual implementation analysed. The article concludes with a list of actions to be pursued if health policy is to be successful.

Health Care Reform↗
PubMed1999

Excess capacity: markets regulation, and values.

OBJECTIVE: To examine the conceptual bases for the conflicting views of excess capacity in healthcare markets and their application in the context of today's turbulent environment. STUDY SETTING: The policy and research literature of the past three decades. STUDY DESIGN: The theoretical perspectives of alternative economic schools of thought are used to support different policy positions with regard to excess capacity. Changes in these policy positions over time are linked to changes in the economic and political environment of the period. The social values implied by this history are articulated. DATA COLLECTION: Standard library search procedures are used to identify relevant literature. PRINCIPAL FINDINGS: Alternative policy views of excess capacity in healthcare markets rely on differing theoretical foundations. Changes in the context in which policy decisions are made over time affect the dominant theoretical framework and, therefore, the dominant policy view of excess capacity. CONCLUSIONS: In the 1990s, multiple perspectives of optimal capacity still exist. However, our evolving history suggests a set of persistent values that should guide future policy in this area.

Attitude to Health↗
PubMed2006

Doing it from your heart: the role of older women as informal volunteers.

This paper explores the contributions made by older women to the community as informal volunteers. It argues that ageing policy is not gender neutral and tends to ignore the contributions made by women outside paid work. As well as being ignored in policy, women's unpaid roles have been denigrated by some feminist commentators, who suggest that these roles subordinate the position of women. The aim of the present paper is to explore the lived experiences of older women in relation to their informal volunteer roles, using role identity theory as a framework. The study utilizes data from a qualitative study using focus group methodology. Findings demonstrate that informal volunteering contributes to the women's identity and gives their lives meaning. These findings suggest that a more positive policy framework around ageing is needed to ensure that the worth of these contributions is recognised.

Aged↗
PubMed2004

Policy implementation in practice: the case of national service frameworks in general practice.

National Service Frameworks are an integral part of the government's drive to 'modernise' the NHS, intended to standardise both clinical care and the design of the services used to deliver that clinical care. This article uses evidence from qualitative case studies in three general practices to illustrate the difficulties associated with the implementation of such top-down guidelines and models of service. In these studies it was found that, while there had been little explicit activity directed at implementation overall, the National Service Framework for coronary heart disease had in general fared better than that for older people. Gunn's notion of 'perfect implementation' is used to make sense of the findings.

Family Practice↗
PubMed2004

Stimulating policy debate on blood transfusion services through the work of an emergency obstetric care project in Nepal.

PURPOSE: To improve the quality and accessibility of emergency obstetric care (EmOC) at district level. METHODS: As the availability of safe and reliable blood transfusion services is a critical component of EmOC, financial and management support was provided to the blood transfusion service centers in the 3 project's Phase 1 districts. EVALUATION: An evaluation after 3 years showed that, with modest financial outlays and the development of supportive district level partnerships, substantial improvements in quality and management of services had been achieved. The evaluation also identified limitations imposed by lack of legal frameworks and central support; although the Nepal Red Cross Society has a government mandate to supply the national blood needs, the operating procedures and guidelines have no legal base. The evaluation report was widely circulated, and the findings used in national policy discussions. RESULTS: Following this a task force was commissioned to develop a legal policy framework to ensure standardized quality blood services with defined management and monitoring roles and responsibilities.

Blood Transfusion↗
PubMed2001

Application of population screening principles to genetic screening for adult-onset conditions.

Recent advances in molecular genetics have highlighted the potential use of genetic testing to screen for adult-onset chronic diseases. Several issues must be addressed, however, before such tests can be recommended for population-based prevention programs. These issues include the adequacy of the scientific evidence, the balance of risks and benefits, the need for counseling and informed consent, and the costs and resources required. Ongoing assessment of the screening program and quality assurance of laboratory testing are also needed. This paper considers the application of general principles for mass screening to genetic testing for susceptibility to adult-onset chronic diseases. Evaluation of proposals for genetic screening in context of these principles reveals that needed evidence is often absent, particularly with respect to the predictive value of tests, efficacy of interventions, and social consequences of testing. The principles of population screening are developed into a framework for public health policy on genetic screening that has three stages: assessment of the screening test and interventions for those who test positive, including assessment of risks and costs, policy development, and program evaluation. Essential elements are identified, including evaluation of evidence and processes for consensus development and program evaluation. The proposed framework for public health policymaking outlined in this commentary, when combined with future efforts that involve an authoritative consensus process, may be useful for the evaluation and planning of genetic screening programs aimed at reducing morbidity and mortality from adult-onset chronic diseases.

Adult↗
PubMedDate not supplied

Public policy analysis of Indiana's minority health initiatives.

Similar to national health trends in the US, racial/ethnic minorities in the state of Indiana continue to experience disparities in poor health status from preventable health conditions. To address this problem, people from minority communities across the state mobilized a broad base of individuals and organizations to facilitate the successful legislative enactment of a statewide minority health initiative. A case study of the initiative is presented for public policy analysis. The theoretical framework for the study is Etzioni's Societal Guidance Theory. The findings show that minority health advocates were able to impact favorably on public policy formulation and funding of the initiative by increasing knowledge about minority health status among grass-roots people, generating public consensus for public policy intervention, setting mutual goals via a 5-year strategic minority health plan, creating organizational structures to implement the plan and utilizing power to push the initiative through the legislative process. The weaknesses of the initiative efforts include a limited infrastructure development of minority health coalitions, restricted effective use of the legislative process and varying degrees of linkages among other advocacy groups. Improvements in these areas are discussed and recommendations are made for the implementation phase of the initiative.

Health Knowledge, Attitudes, Practice↗
PubMed2000

Access to health care: effects of public funding on the uninsured.

PURPOSE: To determine whether a state funding policy influenced access to health care for the uninsured in one county of the American Midwest. DESIGN: The Aday, Andersen, and Fleming (1980) Access Framework guided this descriptive study. The Framework indicates that health policy may directly affect the characteristics of the health care system, which in turn may affect utilization patterns and satisfaction of consumers. METHODS: A descriptive cross-sectional survey in 1996 was used to explore client satisfaction with care at Health Care Access (HCA), the only organization in the county that received funding under a new state policy. HCA's purpose was to provide primary health care to the medically underserved. Satisfaction was measured using an adapted version of the Patient Satisfaction with Health Care Provider Scale (Marsh, 1996). To measure utilization patterns according to insurance status, data were collected to determine visits to the Emergency Department (ED) at the only hospital (LMH) in the county before and after implementation of the state policy. ED data were collected for 1988, 1990, 1993, and 1995; initial funding to HCA began in April 1992. FINDINGS: Within 3 years after state funding was initiated, uninsured visits to the ED decreased by almost 40%, while insured visits continued to increase. The survey results showed that HCA clients had a high level of satisfaction. CONCLUSIONS: This descriptive study showed that the change in state policy increased access to health care for the medically underserved.

Consumer Behavior↗