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At least 469 records · Page 26Linked to original sources
PubMed1993

Projections of hypertension-related renal disease in middle-aged residents of the United States.

OBJECTIVE: To establish nationwide projections for hypertension-related renal disease among middle-aged residents of the United States and compare disease burden in demographic subgroups. DESIGN: Integrated analysis of data from the US Census, the National Health and Nutrition Examination Survey of 1976 through 1980 (NHANES II), the 1971 through 1975 NHANES I Epidemiologic Follow-up Study, the Hypertension Detection and Follow-up Program trial, and the US Renal Data System. POPULATION: African-American and white residents of the United States, aged 30 to 69 years. MAIN OUTCOME MEASURES: Incidence rates and counts of hypertension, hypertension-related hypercreatinemia, and hypertension-related end-stage renal disease (ESRD). RESULTS: Each year, approximately 1.8 million middle-aged Americans develop hypertension, 140,000 develop hypertension-related hypercreatinemia, and 5300 develop hypertension-related ESRD. African Americans are at increased risk for hypertension (relative risk [RR], 1.6; population-attributable risk [PAR], 5%), hypercreatinemia if hypertensive (RR, 2.4; PAR, 18%), ESRD if hypertensive with hypercreatinemia (RR, 2.7; PAR, 32%), and hypertension-related ESRD overall (RR, 8.0; PAR, 44%). Compared with women, men are at increased risk for hypertension (RR, 1.3; PAR, 13%) and hypertension-related ESRD (RR, 1.6; PAR, 23%). Most cases of hypercreatinemia in hypertensives (73%) occur among those with mild hypertension. CONCLUSIONS: Progression to ESRD is rare in persons with hypertension-related renal disease, and factors other than blood pressure probably play an important role. A large proportion of hypertension-related renal disease cases occur among population subgroups considered to be at low risk. Interventions that favorably influence factors associated with the progression of hypertension-related renal disease in African Americans, in men, and in persons with mild hypertension, hold the greatest potential for reducing the population burden of hypertension-related ESRD.

Adult↗
PubMed1997

Cost modeling to justify technology acquisitions.

In an era of diminishing resources, healthcare providers must justify new technology acquisitions. Cost modeling is one method of evaluating the financial impact a technology acquisition will have on a healthcare facility or integrated delivery system. This methodology requires careful data collection and a thorough analysis of both current costs and future cost savings resulting from the new technology. By using a cost modeling methodology, providers will be able to achieve competitive and economic advantages by analyzing both cost and value.

Capital Expenditures↗
PubMed2006

Integration between general practice and mental health services in Italy: guidelines for consultation-liaison services implementation.

PURPOSE: This paper illustrates some guidelines for the implementation of Consultation-liaison services in contexts where GPs work alone. We present some activity data of our experience in the period 1999-2004 and a critical evaluation of what works and what does not work. CONTEXT: In Italy single-sited spontaneous initiatives of co-operation and integration between general practice and psychiatry have been implemented in many regions. Recently, the Italian Health Care Government has begun to encourage integration between primary and secondary care for the management of mental health. The Bologna Consultation-liaison Service opened in 1999 in one area. The service was first located in the Community Mental Health Centre and subsequently in a medical non-psychiatric outpatient service. In 2002, the services were implemented in the overall city area, and the Bologna Consultation-liaison Service had its own office in the centre of the town. DATA SOURCE: Data have been collected by reviewing clinical charts. They include clinical (mental status examination, progress notes) and socio-demographic data, assessment scales that measure psychological distress and disability, reports for GPs, and consultation outcome. CONCLUSION: A consultation-liaison service like the one proposed in this paper could contribute to an efficient and fully-integrated collaborative management of common psychiatric disorders, reducing the use of mental health services.

Journal Article↗
PubMedDate not supplied

That pioneer spirit: implementing clinical episodes of care in an imperfect world.

Managing care in integrated settings requires new frames of reference for assessing the cost and quality of care delivered. One approach, tracking episodes of care, has been discussed for decades, but it's been stymied by insufficient data. Now, the authors argue, the time has come for providers to develop episode-based protocols and outcomes measures that compensate for data liabilities.

Clinical Protocols↗
PubMed2005

Design and implementation considerations for a personalized patient education system in burn care.

Patient education is a significant factor in the provision of health care services, contributing to improved disease management and health care outcomes. Personalization has been suggested as a means for increasing patient education effectiveness and computer-based approaches have been explored as a possible means of achieving this goal. The success and capabilities of the resulting applications have been restricted by the absence of a direct link to patient data and the reliance on locally produced written material, which is expensive to produce, update and tailor. In our research project STructured Evaluated Personalized Patient Support (STEPPS), we are investigating the potential of a novel strategy for personalized or tailored patient education, based on the integration of electronic patient record data and material derived from online health information resources. In this paper we present an overview of the pertinent technical issues and the way we have addressed them in the context of our development work in the domain of burn care. Further, we discuss how the choices made in the design of the system interrelate with the considerations for its implementation in health care practice settings.

Burns↗
PubMed2006

[Family planning in Brazil today: an analysis of recent research].

This two-component study (descriptive cross-sectional and qualitative) assessed the availability of contraceptives in primary care clinics in Brazilian municipalities. The family planning program was also analyzed as part of the country's Family Health Strategy. Phone interviews were held with local health managers to obtain information on contraceptive supply in a selected sample of municipalities. Four municipalities were selected and visited for the qualitative analysis, using direct observation and semi-structured interviews with health professionals and managers. Descriptive statistical and multiple logistic regression analyses were performed. Content analysis technique was used for qualitative data. According to the results, family planning activities are often not integrated with other health activities. Health professionals and managers failed to understand family planning as part of primary health care and felt unable to assist patients. Family planning in Brazil is marked by the unavailability of contraceptives in public health programs.

Adolescent↗
PubMedDate not supplied

Decision support and data warehousing tools boost competitive advantage.

The ability to communicate across the care continuum is fast becoming an integral component of the successful health enterprise. As integrated delivery systems are formed and patient care delivery is restructured, health care professionals must be able to distribute, access, and evaluate information across departments and care settings. The Aberdeen Group, a computer and communications research and consulting organization, believes that "the single biggest challenge for next-generation health care providers is to improve on how they consolidate and manage information across the continuum of care. This involves building a strategic warehouse of clinical and financial information that can be shared and leveraged by health care professionals, regardless of the location or type of care setting" (Aberdeen Group, Inc., 1997). The value and importance of data and systems integration are growing. Organizations that create a strategy and implement DSS tools to provide decision-makers with the critical information they need to face the competition and maintain quality and costs will have the advantage.

Decision Making, Computer-Assisted↗
PubMed1999

Overcoming the barriers to cross-continuum information integration.

Due to the lack of a single information system solution that can meet all of the data management requirements of an integrated delivery system (IDS), IDSs must pursue various strategies to ensure that they manage their data as efficiently as possible. An IDS can identify which strategies will work best for its circumstances by evaluating the chief factors that contribute to inefficient data management across its organization. The IDS then should adopt a written plan, with a clear mission and vision, that describes the strategies to be pursued to improve data management.

Data Collection↗
PubMed2003

Design considerations for a personalised patient education system.

Patient education is a significant factor in the provision of health care services, contributing to improved disease management and health care outcomes. In order to be most effective, patient education should be adapted to the characteristics of the individual recipient. Computer-based approaches have been explored as a possible means of achieving this goal. The success and capabilities of the resulting applications have been restricted by the absence of a direct link to patient data and the reliance on locally produced written material, which is expensive to produce, update and tailor. In our research project STructured Evaluated Personalized Patient Support (STEPPS), we are investigating the potential of a novel strategy for personalized or tailored patient education, based on the integration of electronic patient record data and material derived from online health information and knowledge resources. In this paper we present an overview of the pertinent technical issues and the way we have addressed them in the context of our development work in the domain of burn care. Further, we discuss how the choices made in the design of the system interrelate with the considerations for its implementation in health care practice settings.

Abstracting and Indexing↗
PubMed2006

Integrated assessment of environment and health: America's children and the environment.

The significance of the environment for health is increasingly being recognized. There is a need for systematic approaches to assessment of environmental factors most relevant to health, health outcomes most influenced by the environment, and the relationships between them, as well as for approaches to representing the results of such assessments in policy deliberations. As a step in the development of such methods, we used findings and data from the environmental protection and public health sectors to develop a set of measures representing topics relevant to children's environmental health. We used a definition of the environment that emphasized contaminants and a process that involved both analytic and deliberative elements. The steps in this process were to a) develop a conceptual framework to depict relationships between environment and health with relevant types of data and information, b) select topic areas of significance for children, c) identify best available data sources and devise measures, d) assess possible surrogate data sources and measures when needed, e) design and implement metrics for computation of measures using specified data elements, f) select graphical representations of measures, g) identify related measures, and h) identify data gaps. Representatives of policy and stakeholder audiences participated in this process. The measures are presented in three groups that reflect contaminants in the environment, contaminants in human tissues, and diseases and disorders. The measures present scientifically based representations of data understandable to stakeholders and policy makers that integrate key information from the health and environment sectors in a consistent format.

Biomarkers↗
PubMed2001

Using the national registry of HIV-infected veterans in research: lessons for the development of disease registries.

Disease-specific registries have many important applications in epidemiologic, clinical and health services research. Since 1989 the Department of Veterans Affairs has maintained a national HIV registry. VA's HIV registry is national in scope, it contains longitudinal data and detailed resource utilization and clinical information. To describe the structure, function, and limitations of VA's national HIV registry, and to test its accuracy and completeness. The VA's national HIV registry contains data that are electronically extracted from VA's computerized comprehensive clinical and administrative databases, called Veterans Integrated Health Systems Technology and Architecture (VISTA). We examined the number of AIDS patients and the number of new patients identified to the registry, by year, through December 1996. We verified data elements against information obtained from the medical records at five VA sites. By December 1996, 40,000 HIV-infected patients had been identified to the registry. We encountered missing data and problems with data classification. Missing data occurred for some elements related to the computer programming that creates the registry (e.g., pharmacy files), and for other elements because manual entry is required (e.g., ethnicity). Lack of a standardized data classification system was a problem, especially for the pharmacy and laboratory files. In using VA's national HIV registry we have learned important lessons, which, if taken into account in the future, could lead to the creation of model disease-specific registries.

HIV Infections↗
PubMed1995

System reform in integrated health systems.

As the debate progresses on health care reform and the ultimate form of the U.S. system, important lessons can be drawn from examinations of other health care systems. From the U.S. perspective, European health systems appear to have a certain homogeneity about them. Americans tend to look at all European arrangements as single-source financing systems. Because these systems all provide universal coverage, the assumption is that there must be a strong cohesion and similarity among them. Viewed from the European perspective, the reality appears to be rather different. In this article, the health cae systems of Nordic countries are analyzed in terms of their differences both from other European systems and from the United States approach.

Data Collection↗
PubMed2002

Providing evidence of good allied health care for the veteran population: development of a unique management system.

A unique management system was developed to enhance the quality of allied health care for the elderly. The management system is a multipronged framework of processes and outcomes, which address key stakeholder needs, and is based on best scientific evidence. Use of the management system provides efficiencies for funding bodies in data collection and monitoring service quality. It also confirms the professional integrity of the allied health service provider and underscores the importance of client-therapist partnership in determining appropriate health outcomes. Further testing is required to assess the relationship between use of the allied health management system and better quality service provision, cost containment, and consistently good client health outcomes.

Aged↗
PubMedDate not supplied

Primary-care doctors lured, and integrated delivery systems surge.

Respondents of this survey revealed that hospitals as critical pieces of IDSs have declined, while primary-care centers have skyrocketed. According to a spokesperson from the company that conducted the survey, "Healthcare organizations may be well on their way toward forming IDSs and turning family physicians into gatekeepers, but, in many ways, they're still novices when it comes to using capitation and compensation as tools to control costs."

Capitation Fee↗
PubMed1995

Use of facility-based assessment in the evaluation of a comprehensive leprosy training program in Nepal.

A facility-based assessment (FBA) was done to evaluate a comprehensive leprosy training program in Nepal. The training course was developed to prepare the Basic Health Services staff for integrated leprosy work. FBA is a coordinated set of data collection activities designed to determine the extent to which patients are properly diagnosed, treated, and cared for in the treatment facility. During the present evaluation, the data collection activities included: observation of health worker performance, exit interviews with leprosy patients, interviews with health workers, inventory of essential equipment and supplies, and collection of routine statistical data. The objectives of the training course were used as guidelines for the evaluation. Surveys and observation visits were done repeatedly and compared with a (untrained) control group. Different actors involved in leprosy care were used as informants, and different data collection methods were used which enabled cross-checking of the information. Part of the data collection activities was already routinely carried out. FBA proved to be a very useful and effective tool for the evaluation of a leprosy training program. Those parts of the training which need extra attention during the course itself as well as during refresher training and supervision visits became obvious.

Health Facilities↗
PubMed2005

Impact of IMCI health worker training on routinely collected child health indicators in Northeast Brazil.

The Integrated Management of Childhood Illness (IMCI) is a global strategy including improvements in case management at health facilities, strengthening health systems support and improving key family and community practices relevant to child health. In Brazil, IMCI was introduced in 1997, being largely restricted to training health workers in case management. IMCI training of doctors and nurses took place in many municipalities, but implementation of the other two components of IMCI was very limited. We analyze the impact of IMCI health worker training on infant mortality in three states in north-eastern Brazil, by comparing three groups of municipalities over the period 1999 to 2002: 23 with training coverage of 50% or greater, 216 with lower training coverage, and 204 without any IMCI training. Two sources of mortality data are used: vital registration of deaths and births, and the community health workers' (CHW) demographic surveillance system. The latter resulted in a larger number of deaths being reported and in more stable mortality rates over time than the former. Infant mortality rates (IMR) declined rapidly according to both sources of information, during the study period. After adjustment for confounding factors, there was no association between IMCI training coverage and infant mortality measured through either information system. According to the CHW data, the adjusted annual changes were of -7.2 deaths per 1,000 births in the high IMCI training coverage group, -4.6 in the low IMCI training coverage and -5.0 in the no IMCI group (p=0.46). According to vital statistics, the corresponding average annual changes were -5.0, -4.2 and -2.8 deaths per 1,000 births (p=0.16). The negative findings from the Brazil evaluation suggest that IMCI clinical training, in the absence of the other two components of IMCI, and in an area with infant mortality under 50 per 1,000, is unlikely to lead to a measurable impact on mortality.

Brazil↗
PubMed1997

Faith-based health needs assessment: implications for empowerment of the Faith community.

Churches are often caught in the middle of the struggle between health care institutions and managed care organizations. A faith-based center of excellence model is proposed that would establish a middle ground between the secular and "sacred" aspects of health care. Such a model would focus on using the faith community to influence the behavior and lifestyle of persons within the organized public health model, thus providing a new model of ministry. This process can increase an understanding of the tools needed for the clergy to be better caregivers, more influential co-change agents, and more informed about data-driven outcome ministry. This integrated process is critical for real change in health outcomes, for the improvement of primary prevention, and for reducing disease mortality.

Community Health Services↗
PubMed1999

Managing health services: how the Population Health Information System (POPULIS) works for policymakers.

OBJECTIVES: University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for answering such questions as: Which populations need more physician services? Which need fewer? Are high-risk populations poorly served? or do they have poor health outcomes despite being well served? Does high utilization represent overuse? or is it related to high need? More specifically, this system provides decision makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and countries, utilization review within a single hospital, and longitudinal research on health reform. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.

Community Health Planning↗