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At least 487 records · Page 27Linked to original sources
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↗
PubMed1999

Executive directors and community health centers--facing the healthcare transition.

This paper examines the impressions and experiences of administrators who manage Community Health Centers (CHCs) in Region VI, US Department of Health and Human Services, with the goal of identifying leadership skills and intrinsic values that are needed to run integrated service delivery sites. As the delivery of healthcare service shifts to health promotion and disease prevention, Community Health Centers are well positioned to assume major roles in this transition. However, some CHC administrators may need additional skills in order to address the changing healthcare environment. A survey of CHC Executive Directors was conducted to identify their impressions and experiences. Information obtained from this exploratory study should be beneficial in educating the next generation of healthcare administrators.

Administrative Personnel↗
PubMedDate not supplied

The gross national health product: a proposed population health index.

A population health status index designated as the gross national health product (GNHP) is proposed as a general measure of the health of nations or population groups. The GNHP integrates mortality and disability data into a single number in units of disability-free life years lived per 100,000 population. It is based primarily on mortality ratios and life expectancies of component age groups of the population, modified by their respective disability experiences. A computational example with data currently available on U.S. geographic regions from publications of the National Center for Health Statistics shows that the GNHP was highest in the West, indicating the highest number of disability-free years lived. Because of simplicity in its computation and interpretation, the GNHP can be used by health systems agencies (HSAs) in monitoring their performance or in conducting comparative studies.

Adolescent↗
PubMed1994

The need for security--a clinical view.

Systems which process patient health data of any kind are considered to be medical information systems. Some data can be categorized as non-personal, non-identifiable, or non-patient-based such as knowledge bases. Others are considered as highly sensitive because of the 'need to know' to deliver health care to patient. Access is not only justifiable for doctors and nurses, but, for specific purposes to administrative personnel and public health organisations. Of special concern are registers on sexually transmitted diseases, mental health and genetic diseases. In future, patients might gain more autonomy and also have access to some parts of their own record. Telematics allows them to update a data base and to consult a knowledge base. Clearly, physicians in charge of the cases have a responsibility that has been recognised by law in all Western countries. Access to patient's data should take into account this responsibility. Although most health professionals would still believe that confidentiality is the main issue, it appears that data integrity and availability are as important in the context of the 'paperless' electronic record. Information should be complete and correct, to be only accessed by authorized persons. The health care environment is characterised by an open nature of clinics that leaves them vulnerable to theft, damage and unauthorized access. Disclosure of information may affect the patient's social standing as well as their general health. The health professions lack sufficiently well-defined organisational structure, culture and perceptions to support security.

Computer Communication Networks↗
PubMed2006

Issues in Medicaid policy and system transformation: recommendations from the President's Commission.

Efforts to ensure that people with disabilities participate fully in their communities have raised awareness of current Medicaid policies that impede provision of best-practice mental health services. The author summarizes issues that were examined by the Medicaid Subcommittee of the President's New Freedom Commission and its recommendations in four areas: access, service delivery, service coordination, and quality. Because of Medicaid's substantial role as a payer for mental health services, more creative and flexible program policies can promote system transformation. Current eligibility rules and time-consuming procedures can inhibit timely access to Medicaid coverage for people with mental illness. Medicaid benefit plans may create financial incentives for maintaining more traditional but less effective models of care. Some policies impede states' ability to coordinate Medicaid funding with other sources of funding to create systems of community-based care. Medicaid does not provide specific requirements to ensure that individuals with depression are identified and offered informed choices about treatment through primary or specialty care providers. Action steps to address these and other issues include use of presumptive eligibility and parity, retention of coverage as enrollees enter the workplace, guidance to states on evidence-based practices and service coordination with other agencies, more flexible financing mechanisms, improved data collection and reporting, and enhanced integration of primary and mental health care.

Advisory Committees↗
PubMed1994

The effectiveness of health care cost management strategies: a review of the evidence.

This Issue Brief discusses the evolution of the health care delivery and financing systems and its effects on health care cost management and describes the changes in the health care delivery system as they pertain to managed care. It presents empirical evidence on the effectiveness of managed care and concludes with an analysis of the potential of future health care reform to influence the evolution of the health care delivery system and affect health care costs. Between 1987 and 1993, total enrollment in health maintenance organizations (HMOs) increased from 28.6 million to 39.8 million, representing an additional 11.2 million individuals, or 4 percent of the U.S. population. At the same time, new forms of managed care organizations emerged. Enrollment in preferred provider organizations increased from 12.2 million individuals in 1987 to 58 million in 1992, and enrollment in point-of-service plans increased from virtually none in 1987 to 2.3 million individuals in 1992. In addition, the percentage of traditional fee-for-service plans with some form of utilization review increased to 95 percent in 1990 from 41 percent in 1987. Measuring the effects of the changing delivery system on the costs and quality of health care services has been a difficult task, resulting in considerable disagreement as to whether or not costs have been affected. In a recent report, the Congressional Budget Office recognizes two new major findings. First, managed care can provide cost-effective health care at a level of quality comparable with the care typically provided by a fee-for-service plan. Second, independent practice associations can be as effective as group- or staff-model HMOs under certain conditions. In the future, we are likely to see a continued movement of Americans into managed care arrangements, an increase in the number of physicians forming networks, a reduction in the number of insurers, an increase in the number of employers joining coalitions to purchase health care services for their employees, and a health care system that is generally more concentrated and vertically integrated.

Cost Control↗
PubMed2001

Turning tapes into text: issues surrounding the transcription of interviews.

Transcription of interview data is a common practice in qualitative health research. However, there has been little discussion of the techniques of transcription and the issues inherent in the use of transcription as a strategy for managing qualitative data in nursing publications. The process of transcription may disclose or obscure certain information. Researchers need to question practices of transcription that have been taken for granted and make transparent the processes used to preserve the integrity of data. This paperfirst examines research reported in nursing and allied health journals employing interviews for data collection and the attention given to the transcription phase. It then deals with issues of concern regarding the transcription of interviews, and offers suggestions for promoting validity.

Ethics↗
PubMed2003

Estimation of usual intakes: What We Eat in America-NHANES.

Usual intakes of nutrients are reliable indicators for making associations between diet and health or disease risks. Estimates of consumption of specific foods and food groups are also important for evaluating the progress in meeting key objectives in such national public health initiatives as Healthy People 2010. Reliable and valid estimates of intakes of particular foods, food ingredients, dietary supplements and other bioactive substances are also needed for dietary assessment and regulatory purposes. The ability to generate useful estimates of these constituents often requires much larger sample sizes than are needed for estimating nutrient intakes. Statistical methods recommended by the National Academy of Sciences are described that provide estimates of distributions of usual nutrient intakes and permit dietary assessment and planning at the population level. Statistical and modeling approaches for estimating intakes of foods, dietary supplements and other bioactive substances are also summarized. Based on the deliberations of discussion groups consisting of members of key stakeholder groups involved in the planning, implementation and utilization of national survey data, a high priority was placed on the need for more research to determine the best approaches for applying these methods to dietary data in the integrated What We Eat in America-National Health and Nutrition Examination Survey (NHANES).

Aged↗
PubMed1993

[Analysis of the medical decision].

Analysis of clinical decision making is a quantitative method using probabilities to evaluate the process in uncertain situations. It provides a model of clinical decision making by integrating experimental and epidemiological data, the opinions of specialists and an assessment of the patient's state of health. There is also a place for the integration of the patients' opinions and of their quality of life. Using this information and eventually associating the cost of management, analysis of decision making tries to demonstrate a preference for a given strategy in a given clinical or public health problem. This article presents the methodological basis of analysis of decision making using a simple example of clinical cardiological practice and discusses the value of this method for debating a clinical choice with criteria integrating the patients' quality of life and the cost to society.

Cost of Illness↗
PubMedDate not supplied

Security aspects of electronic data interchange between a state health department and a hospital emergency department.

Electronic emergency department reporting provides the potential for enhancing local and state surveillance capabilities for a wide variety of syndromes and reportable conditions. The task of protecting data confidentiality and integrity while developing electronic data interchange between a hospital emergency department and a state public health department proved more complex than expected. This case study reports on the significant challenges that had to be resolved to accomplish this goal; these included application restrictions and incompatibilities, technical malfunctions, changing standards, and insufficient dedicated resources. One of the key administrative challenges was that of coordinating project security with enterprise security. The original project has evolved into an ongoing pilot, with the health department currently receiving secure data from the emergency department at four-hour intervals. Currently, planning is underway to add more emergency departments to the project.

Computer Communication Networks↗
PubMed1997

Health-2000: an integrated large-scale expert system for the hospital of the future.

Decision making and management are problems which plague health systems in developing countries, particularly in Sub-Saharan Africa where there is significant waste of resources. The need goes beyond national health management information systems, to tools required in daily micro-management of various components of the health system. This paper describes an integrated expert system, Health-2000, an information-oriented tool for acquiring, processing and disseminating medical knowledge, data and decisions in the hospital of the future. It integrates six essential features of the medical care environment: personnel management, patient management, medical diagnosis, laboratory management, propharmacy, and equipment management. Disease conditions covered are the major tropical diseases. An intelligent tutoring feature completes the package. Emphasis is placed on the graphical user interface to facilitate interactions between the user and the system, which is developed for PCs using Pascal, C, Clipper and Prolog.

Expert Systems↗
PubMed2006

Provider practice models for and costs of delivering medication abortion -- evidence from 11 US abortion care settings.

PURPOSE: Understanding practice models and provider costs for medication abortion (MAB) provision may elucidate ways to facilitate MAB integration into a larger arena of health care services. This study provides descriptive data on the diverse MAB practice models currently being utilized by US health care providers and the costs associated with the components of those models. METHOD: Data were gathered from a sample of 11 abortion care settings, using clinic administrative records and patient satisfaction surveys. RESULTS: Practice models varied dramatically, with a wide range in the type of staff employed to provide MAB. The total episode cost for providing MAB ranged from 252 to 460 US Dollars, and patient satisfaction was high across all practices. CONCLUSION: Information from this study can be used to guide decisions regarding MAB integration into practices not currently providing abortion or which provide only aspiration abortions. The information may also be useful for providers wishing to refine their MAB services.

Abortifacient Agents, Steroidal↗
PubMed2000

Ryan White CARE Act Title IV: building networks to improve healthcare delivery to the HIV infected.

There has been little evaluation of the implementation of HIV consortia that were created under Title IV of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. In 1993, Mor and colleagues reported that the effectiveness of networks established by the Robert Wood Johnson Foundation had been compromised by the inability of the participating agencies to work together, given their competing goals and varied institutional cultures. In a study published in 1995, Roy and colleagues identified the following as determinants of successful project implementation: federal and local government support, management-level support and technical assistance, and linkages between participating agencies. This article describes the role that network infrastructure can play in developing interagency collaboration, and the importance of network infrastructure in coordinating the delivery of care at the service-delivery level. The authors describe the efforts of the Lower New York Consortium for Families with HIV (hereafter, "the Consortium") to develop integrative mechanisms at both the network level and the program level. As the number of infected women grows, so does the need to improve the delivery of services and to reduce barriers to the receipt of care. In itself, the support of individual agencies that provide case-management services may not be enough to improve service delivery and reduce barriers; the experiences of networks such as the Consortium may help inform the development of guidelines for creating and enhancing the coordination of services to assure improvements in care. Systematic studies are needed to evaluate different models of collaboration and of coordinating care to determine whether the effort to develop consortia is justified by improved access to care and improved health.

Case Management↗
PubMed2027

Global Genomic Surveillance.

Global genomic surveillance has emerged as a foundational pillar of public health in the twenty-first century, enabling real-time tracking of pathogen evolution and informing outbreak response. This chapter examines the strategic architecture of global genomic surveillance, focusing on its application to arboviruses such as chikungunya virus (CHIKV). It explores the integration of genomic data with epidemiological, clinical, and environmental information within a One Health framework, while addressing critical challenges in governance, equity, and interoperability. The discussion covers the entire genomic surveillance workflow, from sample collection and sequencing to bioinformatic analysis and phylogenetic inference, and highlights the transformative role of artificial intelligence (AI) in predictive surveillance. By analyzing global initiatives, operational barriers, and emerging technologies, this chapter underscores the necessity of sustainable, equitable, and interoperable genomic systems to proactively address current and future infectious disease threats.

Humans↗