An evaluation model for service programs.
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Curriculum↗
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A comprehensive philosophy for nursing: the total approach.
The political, social, economic, and technological forces being experienced within health care today demand that we apply creative models and philosophies for the delivery of nursing services. This paper describes the application of a "Quality Management Model" and presents a "Philosophy of Nursing Quality" that incorporates the elements of quality, cost, caring and nursing in a holistic manner. Application of this Model and Philosophy could provide nurse managers the guidance required to survive the turbulent 90's. In combination, they maximize the potential for success for both the health care recipient and care provider.
Empathy↗
A goal for nursing education.
Current trends of an increasingly multicultural society emphasize the need for nursing education programs that effectively address cultural issues. To understand the diverse cultural backgrounds of clients, nurses must strive to be culturally competent. Cultural competence requires the building of cultural awareness, knowledge, skill, encounters, and desire in the nurse. Clients will feel respected, valued, and have a greater desire to achieve mutually agreed upon health care goals if the nurse is culturally competent. Nurse educators can assist nursing students in acquiring cultural competence using a model created by Campinha-Bacote (1999) entitled "The Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care". The model contributes to the development of cultural competence in the nursing profession by providing a concrete guide that is useful for teaching and implementing cultural competence in nursing education.
Cultural Diversity↗
Developments in oral health policy in the Nordic countries since 1990.
PURPOSE: There is a number of systems for the provision of oral health care, one of which is the Nordic model of centrally planned oral health care provision. This model has historically been firmly based on the concept of a welfare state in which there is universal entitlement to services and mutual responsibility and agreement to financing them. This study reports and analyses oral health care provision systems and developments in oral health policy in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) since 1990. MATERIAL AND METHODS: Descriptions of and data on the oral health care provision systems in the Nordic countries were obtained from the Chief Dental Officers of the five countries, and contemporary scientific literature was appraised using cross-case analyses to identify generalisable features. RESULTS: It was found that in many respects the system in Iceland did not follow the 'Nordic' pattern. In the other four countries, tax-financed public dental services employing salaried dentists were complemented by publicly subsidised private services. Additional, totally private services were also available to a variable extent. Recently, the availabilty of publicly subsidised oral health care has been extended to cover wider groups of the total population in Finland and Sweden and, to a smaller extent, in Denmark. Concepts from market-driven care models have been introduced. In all five countries, relative to the national populations and other parts of the world, there were high numbers of dentists, dental hygienists and technicians. Access to oral health care services was good and utilisation rates generally high. In spite of anticipated problems with increasing health care costs, more public funds have recently been invested in oral health care in three of the five countries. CONCLUSION: The essential principles of the Nordic model for the delivery of community services, including oral health care, i.e. universal availability, high quality, finance through taxation and public provision, were still adhered to in spite of attempts at privatisation during the 1990 s. It appeared that, in general, the populations of the Nordic countries still believed that there was a need for health and oral health care to be paid for from public funds.
Delivery of Health Care↗
A proposed network to improve access to high-quality health care for Medicaid-eligible families.
There is today both a need and an opportunity to develop and test a variety of models--organizational and financial--for improving the delivery of health care services. This article describes the structure and functioning of one such model and highlights the organizational problems expected to arise during its implementation. The proposed health plan is intended to facilitate the access of Medicaid-eligible, inner-city families to already available health services. The central hypothesis is that in low-income urban areas the elementary schools offer an organizational focus for the development of a health plan. As a prepaid, community-based model, this plan is designed to address the issues of accessibility, equity, accountability, continuity of care, and consumer participation, primarily through the development of a coordinating agency, the health plan office (HPO), which assures the linking of consumers and providers of health care. Adapted from the Kaiser-Permanente model, the HPO also assumes responsibility for marketing, enrollment, coordination of services, consumer advocacy, and quality surveillance.
Child↗
Associate degree nursing in a community-based health center network: lessons in collaboration.
This exemplar highlights the ability of community experiences to enhance nursing students' understanding of the principles of community-based care: advocating self-care; focusing on prevention, family, culture, and community; providing continuity of care; and collaborating. An innovative teaching-practice model (i.e., a nurse-managed "network" of clinics), incorporating service-learning, was created. The Network's purposes are to provide practice sites in community-based primary care settings for student clinical rotations, increasing the awareness of the civic and social responsibility to provide quality health care for disadvantaged populations; and to reduce health disparities by increasing access to free primary health care, including health promotion and disease prevention, for disadvantaged individuals. Network clients receive free health care, referrals, and guidance to effectively obtain additional health care resources for themselves and their families. The Network is a national pioneer in modeling the delivery of primary care services through a faculty-student practice plan, with leadership emanating from a community college.
Attitude of Health Personnel↗
Students with learning disabilities in Canadian colleges and universities: a primer for service provision.
The authors, both of whom are involved in providing support services to university students with learning disabilities, describe some of the current issues and challenges faced by students, staff, and faculty. Programs and initiatives in some Canadian institutions that have proven to be successful are described, such as a sequential five-step procedure model that directed the delivery of services at the university. Resource and reference lists are also provided.
Canada↗
Provision of comprehensive perinatal services through rural outreach: a model program.
A university-based program of perinatal care was extended to serve a spectrum of underserved populations through both urban and rural outreach. The program centered on the use of a multidisciplinary health care team comprised of a physician, nurse-midwife, health educator, social worker, nutritionist, pediatric nurse-practitioner, and patient case manager for health service delivery. It emphasized a decentralized service model with central referral and management of high-risk problems. The program has become a model for perinatal access and is reflected in current state legislation. The implementation of this program in four geographically rural communities is presented. Selected indices of perinatal outcome are presented, with San Diego County, CA, and national statistics as comparisons.
California↗
A model curriculum for mental disorders and behavioral problems in primary care.
Changes in the health care delivery system will increasingly emphasize the role of the primary care physician in diagnosing and treating mental disorders and behavioral problems. This increasing emphasis points to the need for more systematic definition of the knowledge and skills that future primary care physicians will need for effective delivery of mental health services. The model curriculum described in this paper represents the efforts of a multidisciplinary Task Force to describe basic training objectives for the psychiatric education of future primary care physicians.
Clinical Competence↗
Collaborative consultation: a systemic activity.
In a collaborative consultation model of speech-language service delivery, the treatment system is expanded beyond the traditional client-centered dyad. Further, services are provided in the context of the classroom rather than in the noncontextual environment of a therapy room, and treatment goals relate to aspects of the school, such as curriculum, classroom behavior, and social interactions with peers. The use of the model is illustrated with a child having a cognitive impairment.
Child↗
Different models of occupational health service provision and their activity profiles.
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Delivery of Health Care↗
Community-based team approach to the management of children with cleft palate.
The child born with a cleft palate may have many associated problems in feeding, respiration, dentition, hearing, speech, language, and intellectual development as well as in psycho-social development. If the cleft is associated with a specific craniofacial syndrome, other physical problems may be present such as cardiac, kidney, digital, and visual involvement. The need for an extensive treatment program can extend from birth through adulthood. Important to the successful habilitation of these children is the early involvement of a multitude of specialists working together with the family in a team approach. The primary task of the team is to make decisions concerning timing and sequence of intervention for each individual patient. Several models for the delivery of health care services to the patient with a cleft palate are now in use. A community-based team model will be described in this article as a unique approach to the management of this population and as one that may be implemented in a cost-effective manner in communities where cleft palate teams presently do not exist.
Child↗
Are larger dental practices more efficient? An analysis of dental services production.
Whether cost-efficiency in dental services production increases with firm size is investigated through application of an activity analysis production function methodology to data from a national survey of dental practices. Under this approach, service delivery in a dental practice is modeled as a linear programming problem that acknowledges distinct input-output relationships for each service. These service-specific relationships are then combined to yield projections of overall dental practice productivity, subject to technical and organizational constraints. The activity analysis reported here represents arguably the most detailed evaluation yet of the relationship between dental practice size and cost-efficiency, controlling for such confounding factors as fee and service-mix differences across firms. We conclude that cost-efficiency does increase with practice size, over the range from solo to four-dentist practices. Largely because of data limitations, we were unable to test satisfactorily for scale economies in practices with five or more dentists. Within their limits, our findings are generally consistent with results from the neoclassical production function literature. From the standpoint of consumer welfare, the critical question raised (but not resolved) here is whether these apparent production efficiencies of group practice are ultimately translated by the market into lower fees, shorter queues, or other nonprice benefits.
Cost-Benefit Analysis↗
Health policy and cost containment laws: lessons for public health education in social and behavioral change.
As an extension of a contribution by Health Policy and Law to Public Health Education in areas of mutual concern, a descriptive model of cost containment policy in health care delivery is developed. The model starts from the basis of a typology of key Congressional enactments promoting economically motivated policymaking in the Medicare and Medicaid programs. These policies and laws are, in turn, related to the resulting multilevel adaptive behavior in health care services delivery and acquisition. From this descriptive model the thesis is developed that although government has improved its effectiveness in attaining economic and budgetary goals, this type of policy is also creating displacements and generally leading to the retrenchment of national commitment to equity-promoting social welfare policy and the possibility of abandoning longstanding historical commitments on strictly economic and budgetary grounds. The article concludes by placing emphasis on the need for public health disciplines to collaborate in order to strengthen national policy, to create a new health policy synthesis, and to strengthen the ability of individuals to qualitatively improve their situation and more effectively assert their health and social welfare rights.
Cost Control↗
An overview of health--health: a community systems model.
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Community Health Services↗
Developing research management and governance capacity in primary care organizations: transferable learning from a qualitative evaluation of UK pilot sites.
BACKGROUND: The capacity and capabilities for undertaking primary care research have increased both within and outside of the UK in recent years. The UK Department of Health aims to facilitate this further by establishing a national network of primary care organizations (PCOs) ready to act as hosts for shared research governance systems. However, it is unclear which models offer the most effective option. In addition, there is confusion over new processes and concern that researchers may be deterred from addressing important questions. OBJECTIVES: The research ascertains how PCOs selected as pilot sites have organized research management and governance (RM&G). METHODS: We adopted a case study approach involving interviews with key informants in a purposive sample of eight pilot PCO (RM&G) sites. RESULTS: Motivating factors for PCOs to host RM&G included the possibility of additional resources and more effective use of research to improve service delivery. A range of organizational models were adopted, often reflecting existing strategic alliances. It is envisaged that it will not be effective or cost-effective for many PCOs to make individual arrangements for RM&G, and so models are already developing among groups of PCOs and partner organizations. The extent of partnerships between PCOs varied with concern over critical mass and dilution of expertise in larger groupings. The development and implementation of systems in pilot sites was facilitated by the support of the wider PCO in recognizing research as a valued and integral part of the organization; the effective management of relationships and the establishment of equal partnership arrangements for RM&G, and the effective use of existing R&D infrastructure and expertise. CONCLUSIONS: RM&G partnerships vary according to local circumstances. It is likely that groupings will develop in the future with increasing co-terminosity and across wider health organization boundaries, such as Strategic Heath Authorities (in the UK) or primary care research networks. Critical mass of RM&G arrangements is likely to be linked to levels of research activity. There are real concerns over the levels of bureaucracy associated with the implementation of research governance; however, those PCOs that develop as RM&G sites have the opportunity to enrich their organizations and expand clinically relevant R&D. Partnership working within PCOs and with primary care research networks, academic departments or acute trusts, may be the key to success. Those undertaking research within primary care settings outside of the UK can learn important lessons from the UK experience and ensure development of high quality research that informs improvements in patient care.
Delivery of Health Care↗
Comparing the quality of three models of postabortion care in public hospitals in Mexico City.
CONTEXT: Each year, an estimated 120,000 women in Mexico seek treatment in public hospitals for abortion-related complications--the country's fourth leading cause of maternal mortality. Models of postabortion care emphasizing counseling and provision of contraceptives have the potential to improve the quality of care these women receive. METHODS: Between April 1997 and August 1998, women treated for abortion complications in six Mexican Institute of Social Security (IMSS) hospitals in the Mexico City metropolitan area were surveyed. Data related to patient-provider interaction, information provision and counseling were analyzed for three models of care: sharp curettage standard care, sharp curettage postabortion care and manual vacuum aspiration postabortion care. RESULTS: Women in the two postabortion care groups rated the quality of services they received more highly than did those receiving sharp curettage standard care. A significantly greater proportion of women treated under the postabortion care models than of those treated under the sharp curettage standard model received information about their health status before treatment, the uterine evacuation procedure, signs of postabortion complications and care at home. In addition, a greater proportion of women treated under the postabortion care models accepted a contraceptive method before leaving the facility (64-78% vs. 40%). CONCLUSIONS: Implementation of a postabortion care model contributes to the delivery of high-quality services to women experiencing abortion complications. The standard IMSS model of postabortion treatment should be modified to emulate those in hospitals that systematically link general counseling and family planning services to the clinical services provided to women with abortion complications.
Abortion, Induced↗
Models of nursing care delivery and case management: clarification of terms.
Case management is a popular term used to describe a wide variety of nursing care programs in acute hospital and community settings. However, confusion exists about what programs and services compose case management, and how case management differs from nursing care delivery models. Defining nursing care delivery models and case management programs in acute-care and community settings, and identifying criteria for defining case management facilitates comprehension of program purposes and services.
Community Health Nursing↗