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PubMed2004

Factors influencing length of hospital stay in community-acquired pneumonia: a study in 27 community hospitals.

We did a retrospective study of 1920 episodes of community-acquired pneumonia (CAP) in 27 community hospitals and analysed inter-hospital variability in length of hospital stay (LOS), mortality and readmission rates. The overall adjusted LOS (mean+/-S.D.) was 10.0+/-9.8 days. LOS increased according to the Pneumonia Severity Index (PSI) risk class: 7.3 days for class I to 11.3 days for class V (P<0.001). In a multiple regression model, LOS increased (P<0.001) according to the hospital (inter-hospital variability), PSI risk class, complications during hospitalization, admission to ICU, need of oxygen and transfer to a nursing home. Hospitals with shorter LOS did not show an increased readmission rate (adjusted OR 1.02, 95% CI 0.51-2.03, P = 0.97) and post-discharge mortality (adjusted OR 1.20, 95% CI 0.70-2.05, P=0.51). There are significant inter-hospital variations in LOS in patients with CAP which are related to differences in clinical management. The reduction of these differences will further improve efficiency and quality of care.

Aged↗
PubMed2003

Local newspapers, community partnerships, and health improvement projects: their roles in a comprehensive community initiative.

To understand local media's role in a community health initiative, a content analysis of 1,709 paragraphs from 173 news articles and editorials was undertaken. The articles were from three local newspapers, one in each of three communities. Analyses focused on article content combined with reflective personal interviews with local campaign directors. Results suggest that local campaign staff can be successful using commercial media to achieve objectives. Surprisingly, most coverage was not about projects with observable and easily identifiable benefits for local residents, but rather partnerships among influential residents engaged in decision-making about such projects. We conclude that the politics of resource distribution is more newsworthy to local journalists than tangible topics like access to health information, insurance coverage, and service provision.

Attitude to Health↗
PubMed2005

Forensic community mental health nurses' perceptions of statutory community aftercare: implications for practice.

The key role played by forensic community mental health nurses in statutory community aftercare for mentally disordered offenders in England and Wales has been successful. The nurses often have the most contact with this patient population, yet paradoxically, have not been asked to express their views about the process. The pivotal role undertaken by this professional group appears to be fundamental to the success of statutory aftercare for this patient group.

Aftercare↗
PubMed2000

Surgery and community participation in a community-based programme in war situations.

The paper presents the results and the experience gained from three 'mass surgical interventions' conducted in the Alpha Civil Hospital, Billing in south Sudan in the period between October 1996 and November 1997. The results showed that surgical services can be provided safely and economically even under most difficult conditions provided professional experience plus community commitment and participation are there. Such interventions lead to the development of strong community self-reliance and willingness which are fundamental if the programme is to be sustained.

Community Health Services↗
PubMed2002

Using a participatory approach to provide assistance to community-based organizations: the Seattle Partners Community Research Center.

Community-based organizations (CBOs), including grassroots, voluntary organizations, are an important part of any strategy for addressing social determinants of health. Because of the challenges faced by CBOs, "enabling systems" may be neededto help them survive and fulfill theirmissions, andresearchers have a variety of skills that allow them to play a role in such systems. The potential for researchers to play a role in supporting CBOs led the Seattle Urban Research Center (known as Seattle Partners) to establish a community research center (CRC) as one of its core projects. This article describes the operation of the Seattle Partners CRC and gives examples of how it has worked collaboratively with CBOs in providing technical assistance. The Discussion section draws from the CRC experience to examine the benefits and challenges of collaboration and the trade-off between capacity building and providing direct technical assistance in promoting long-term CBO viability.

Community Health Services↗
PubMed1976

Community control of health services. Dr. Martin Luther King, Jr. Health Center's community management system.

This article presents the case of Dr. Martin Luther King Jr. Health Center's unique community management system in which neighborhood workers have been developed to assume managerial responsibilities and are directing the Center. The Martin Luther King Center experience is instructive because the Center was able to achieve significant community control by focusing primarily on the internal dimension of control, namely, management, without experiencing destructive conflicts and the deterioration of health services.

Administrative Personnel↗
PubMedDate not supplied

Specialty versus community hospitals: referrals, quality, and community benefits.

In this paper we compare physician referral patterns, quality, patient satisfaction, and community benefits of physician-owned specialty versus peer competitor hospitals. Our results are based on evidence gathered from site visits to six markets, 2003 Medicare claims, patient focus groups, and Internal Revenue Service data. Although physician-owners are more likely than others to refer to their own facilities and treat a healthier population, there are rationales for these patterns aside from motives for profit. Specialty hospitals provide generally high-quality care to satisfied patients. Uncompensated care plus specialty hospitals' taxes represent a greater burden, in percentage terms, than community benefits provided by nonprofit providers.

Community-Institutional Relations↗
PubMed2004

Integrating the environment, the economy, and community health: a Community Health Center's initiative to link health benefits to smart growth.

The Sixteenth Street Community Health Center (SSCHC) in Milwaukee, Wis, is making a difference in the livability of surrounding neighborhoods and the overall health of the families it serves. SSCHC is going beyond traditional health care provider models and working to link the environment, the economy, and community health through urban brownfield redevelopment and sustainable land-use planning. In 1997, SSCHC recognized that restoration of local air and water quality and other environmental conditions, coupled with restoring family-supporting jobs in the neighborhood, could have a substantial impact on the overall health of families. Recent events indicate that SSCHC's pursuit of smart growth strategies has begun to pay off.

Benchmarking↗
PubMed1988

Community service for the mentally ill: what is the community?

In his study of the successive efforts of a DHA to plan for community services for the mentally ill, Dylan Tomlinson argues that there is a basic question which is necessary, but difficult, to answer: "In which neighbourhood is the pattern of ordinary social interaction such as to foster good relationships between 'ex patient' and other residents in a community?"

Community Mental Health Services↗
PubMed1999

[The ODEC (Organization for Development and Community Networks) and mental health: from networking to opening in the local community].

The Organisme de développement et d'entraide communautaire (ODEC) is a nonprofit mental health organization that was established in 1987 and offers mutual help and community development services in the Vallée-de-la-Lièvre region in the Outaouais area of Quebec. Starting with an individual accompaniment service for people living with mental health problems, ODEC has succeeded in establishing a significant mutual help network that now involves more than 100 people. This article comes out of an in-depth case study of ODEC. By analysing the major parameters of its journey over more than 10 years, it brings to the fore the impact in the mental health field of providing a network in close association with community involvement.

Community Mental Health Services↗
PubMed2001

[Necessity of co-operation of the community medical system based on the results from the survey by questionnaires-participation of the home healthcare and/or hospice systems in southern Tama community hospitals].

Home Care Division of Fujisawa Pharmaceutical Co. Ltd. has been providing the local public with the following services: 1) providing aseptic medicines prescribed in the clean room, 2) renting the infusion fluid pumps, and 3) supporting the community cooperation in healthcare services. Last year, we surveyed questionnaires to the public users (patients and caretakers) of these services, in order to understand the actual status of patients after changing from conventional hospitalization to the home infusion therapy (HIT). From the results of our present survey, it was found that the patients and their family members had positively accepted HIT, while 61% of the HIT users exhibited a strong anxiety in their skills and methods of HIT. Moreover, it was also shown that 61% had other means of nursing and treatment in addition to HIT, indicating a great financial burden on the families. Among them, 69% of the HIT users considered that visiting nurses and primary care physicians were the best co-operators, and changed their conventional healthcare system (hospitalization) to HIT. However, the home caretakers showed a high anxiety in their skill in the home healthcare system, specifically HIT, which was generally highly dependent on the medical care, Thus, a good relationship and co-operation with visiting nurses and primary care physicians was one of the major factors for the users to decide to choose HIT instead of their old medical hospitalization. Therefore, in order to make HIT more useful and widely prevail, it is concluded that establishment of the co-operative systems within our local community, where visiting nurses and primary care physicians can easily provide the patients and their family with professional suggestions, advice and actual care whenever the home caretakers need them.

Community Health Services↗
PubMed2004

[A retrospective analysis of community-acquired pneumonia between 2000 and 2002 in a community hospital].

We previously reported a hospital-based retrospective study on community-acquired pneumonia (CAP) at Tagami Hospital, which was a community hospital, between 1994 and 1997. This study was designed to clarify the etiology of CAP diagnosed between 2000 and 2002. We analyzed a total of 124 cases of CAP in our hospital during the study period, and compared the results with the previous data. Identification of the causative organisms of CAP was based on gram staining, the morphology of the colonies, quantitative culture of the sputum, and the serological tests. During the study period, we determined the causative organisms in 42 cases (33.8%). Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were the major causative organisms. The severity of the cases was classified into three groups according to the guideline for CAP, which was edited by the Japanese Respiratory Society. The survival rates in the moderate and severe groups were significantly (p < 0.001) higher than that of the mild group, as analyzed by the Kaplan-Meier method, as follows: 70% (moderate) vs 100% (mild); and 40% (severe) vs 100% (mild). In a total of 7 patients who died, we found the following risk factors: elderly male patients, bedridden status with cerebral infarction, and micro-aspiration, including recurrent pneumonia at short intervals of less than 17 days. Our study indicated that the JRS-edited guideline for CAP is a very useful tool for analyzing cases with CAP in Japan.

Aged↗
PubMed1990

[Geriatric psychiatry in the regimen of community psychiatry. 2. Psychiatric consultation service at a primary care community nursing home for the physically handicapped].

In January 1988, three gerontopsychiatric teams were established in the Copenhagen County Hospital, Nordvang. One of their rasks was to supply outpatient psychiatric service for nursing homes. The object of this investigation was to investigate how much this offer was utilised, and assessment of this service by the nursing homes in a geographically delimited region consisting of 11 primary communities. The investigation was retrospective. Where all of the patients were concerned, the following were registered: age, sex, diagnosis and residence at the conclusion of treatment. After 12 months, a questionnaire was sent to all departments in nursing homes with questions about whether they had utilised this offer and how they had assessed it. During the period from 1.1.1988 to 31.12.1988, 184 patients were referred corresponding to 7.6% of all residents in nursing homes. Two gerontopsychiatric teams had had contact with 80 out of 116 possible departments and had arranged teaching about psychiatric illness in elderly persons in 39 out of 48 nursing homes. The consultant service given included individual diagnosis and treatment and also teaching and advice to the staff. The positive assessment reflected the need for a gerontopsychiatric service in nursing homes. An offer of gerontopsychiatric service should be included in the total community psychiatric service.

Aged↗
PubMed2000

A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin.

CONTEXT: Large variations exist among hospitals in the use of treatment resources for community-acquired pneumonia (CAP). Lack of a common approach to the diagnosis and treatment of CAP has been cited as an explanation for these variations. OBJECTIVE: To determine if use of a critical pathway improves the efficiency of treatment for CAP without compromising the well-being of patients. DESIGN: Multicenter controlled clinical trial with cluster randomization and up to 6 weeks of follow-up. SETTING: Nineteen teaching and community hospitals in Canada. PATIENTS: A total of 1743 patients with CAP presenting to the emergency department at 1 of the participating institutions between January 1 and July 31, 1998. INTERVENTION: Hospitals were assigned to continue conventional management (n = 10) or implement the critical pathway (n = 9), which consisted of a clinical prediction rule to guide the admission decision, levofloxacin therapy, and practice guidelines. MAIN OUTCOME MEASURES: Effectiveness of the critical pathway, as measured by health-related quality of life on the Short-Form 36 Physical Component Summary (SF-36 PCS) scale at 6 weeks; and resource utilization, as measured by the number of bed days per patient managed (BDPM). RESULTS: Quality of life and the occurrence of complications, readmission, and mortality were not different for the 2 strategies; the 1-sided 95% confidence limit of the between-group difference in the SF-36 PCS change score was 2.4 points, which was within a predefined 3-point boundary for equivalence. Pathway use was associated with a 1.7-day reduction in BDPM (4.4 vs 6.1 days; P = .04) and an 18% decrease in the admission of low-risk patients (31% vs 49%; P = .01). Although inpatients at critical pathway hospitals had more severe disease, they required 1.7 fewer days of intravenous therapy (4.6 vs 6.3 days; P = .01) and were more likely to receive treatment with a single class of antibiotic (64% vs 27%; P<.001). CONCLUSION: In this study, implementation of a critical pathway reduced the use of institutional resources without causing adverse effects on the well-being of patients.

Aged↗
PubMed1987

Community health projects as part of a core clinical clerkship: teaching research skills in a community setting.

Although medical student research has been advocated as a valuable learning experience and specific programs have been developed to offer research opportunities, only a minority of students have participated in these programs. We report a student research program that is integrated into a required six week clinical clerkship in Community Health, thus ensuring that all students participate in a research project. The program offers the additional advantage that research projects are student initiated and executed. Although the limited time frame usually results in pilot or exploratory studies, the program introduces students to all facets of a research project within a community setting and promotes independent learning. The program has been well received by students and may stimulate further research interests in some students.

Clinical Clerkship↗
PubMed1975

Community mental health and the community college.

This paper represents one solution to the present mental health dilemma facing today's colleges and universities--static or declining services in the face of increased student needs. What is unique to this solution is that it developed out of a collaborative interaction between a community college and a prototype of a community mental health center in the same geographical area. Multiple interfaces between systems and various members within these systems were established in an effort to provide improved mental health services and the training of all personnel so involved to a higher level of professional functioning.

Community Mental Health Services↗
PubMed2004

Community participation in natural resources management: reality or rhetoric? Lessons learnt from the Kasanka Game Management Area (GMA) communities, Serenje District, Zambia.

In the developing world, the term 'participation' has in recent years become a household word in the same way that 'democracy' or 'gender' have. Development agencies are demanding increased participation in their programmes. The use of the word or its application has become a centre of debate. Due to the difficulties involved in measuring 'participation' or indeed determining levels at which participation should take place, who participates and when, many 'doubting Thomases' have questioned its effectiveness. It has, however been acknowledged in many areas that popular participation changes policies and enhances management and governance. In complex issues of natural resources management, participatory techniques have helped communities develop collective responsibilities towards management of their resources and projects. This paper discusses the complexities of community participation in natural resources management, ranging from interrelations among stakeholders to resource ownership based on the experiences in the Kasanka Game Management Area (KGMA).

Animals↗
PubMed2005

Sustainability of community coalitions: an evaluation of communities that care.

The relationships between community coalition processes during initial 3-year state seed funding and markers of sustainability post-funding were investigated in 20 Communities That Care (CTC) sites in Pennsylvania. Coalition processes were assessed using interviews with coalition members, ratings from the research team and ratings from state technical consultants. We found members' knowledge of prevention, coalition internal functioning, and fidelity to the CTC model during early coalition functioning predictive of later sustained coalition board activity. Findings suggest domains of early coalition functioning that may be important for understanding and promoting sustainability.

Community Networks↗