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PubMed2005

Legal. Sharing the risk.

Negotiating IT contracts isn't for the faint of heart. Increasingly, hospitals are demanding that vendors share some of the financial and legal risk in case of product failure or an error.

Competitive Bidding↗
PubMedDate not supplied

Planning preventive occupational health services at the community level.

Socio-sanitary data on occupational injuries and disease-specific exposures were used to plan preventive occupational health services in the territory of a Community Health Department in an industrial sector of Montreal, Quebec. Information was obtained from two complementary sources: Worker's Compensation and plant surveys. For prevention of injuries, three groups of planning options were identified: territorial injury surveillance, protection of the extremities and eyes, and the ergonomic diagnosis of the workplace for prevention of non-accidental injuries. In the prevention of occupational diseases, medical screening and worker's registry were two possible options. These options were put in perspective with the type of resources needed and the kind of commitment required for planning these services.

Accidents, Occupational↗
PubMed1989

[Cooperation concerning admission to and discharge of elderly people from the hospital. 1. The coordinated contributions of home care personnel].

In cooperation between the home care system in the Municipality of Rødovre and four hospital departments in the County of Copenhagen, a controlled and randomized investigation was undertaken among the hospitalized patients of 65 years and over from the Municipality of Rødovre. A nurse employed by the Municipality particularly for this project visited the hospital daily and followed the 135 participants in the intervention group with the objects of obtaining information from the primary sector if necessary, discussing discharge with the patient and the hospital staff, coordinating possible supportive measures in the patient's home and visiting the patient in his home immediately after discharge from hospital in order to ensure continuity in care and treatment. The 138 participants in the control group underwent the usual procedures in connection with admission to hospital. In this article, the consequences of the contributions by the health visitor in the hospital are described in relation to the course of hospitalization. The intervention group had an average stay in hospital of 11.0 days as compared with 14.3 days in the control group (p greater than 0.05), and the total number of bed-days were 1,490 and 1,970, respectively. In addition, the two groups were compared as regards the number of diagnostic procedures during hospitalization, the number of deaths, the diagnoses on discharge and the functional capacity. No differences were observed in these respects between the two groups. Three patients from the control group were discharged to residential institutions as compared with none in the intervention group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aftercare↗
PubMedDate not supplied

[The assessment of neurological care needs in the health sector of de San Juan de Alicante by key-informants model].

BACKGROUND: Specific health care planning should be based on the care request according the most adjusted evaluations method. Data obtained from each geographic area may be most comparable with other from close areas. AIM: To determinate the neurological needs in the health area 16 of Valencian Community that includes the care corresponding to Hospital of San Juan de Alicante. MATERIAL AND METHOD: We conducted a survey among key informants using the primary care physicians of the area. The population of the healthy area is 144,781 people and includes 78 primary care physicians. We used the formula proposed by Kurtzke in 1982 in order to calculate the neurological time. RESULTS: We obtain a response rate of 82% the total number of neurological hours requested was 5,823.84 hours by year, which supposes a need of 8.82 neurologists by 100,000 people and nears a needs of 12.77 neurologists for the healthy area. These data are clearly higher that the obtained in other close areas using the same methodology (5 neurologists by 100,000 inh in Alcoi, 6 neurologists by 100,000 inh in the area corresponding to General Hospital of Alicante). The topics that require more than 100 hours by year are: migraine (1,205), lumbar backache (1,104), alcoholism (762), cranial trauma (442), deafness (285), stroke (272), seizures (181), disk herniation (166), cervical backache (140), zoster (162), psychosis (118), which supposes 83.12% of the whole neurological time. CONCLUSIONS: The data situated the area within a model of direct neurological care similar to that in the United States.

Health Planning↗
PubMedDate not supplied

Medical community involvement in a breast cancer screening promotional project.

The analysis, mobilization, and involvement of medical communities in two counties targeted for intervention by the Washington State Community Breast Cancer Screening Project is described. Principles of community organization were applied to the health care sectors in the counties, and the PRECEDE-PROCEED model was used as a conceptual framework for considering individual physician behavior. Quantitative and qualitative medical community assessment methods included a demographic study, a survey of primary care physicians, personal interviews with physicians, and medical office staff focus groups. In both intervention areas, physician planning groups selected, developed, and helped implement intervention activities targeting the health care sectors. These activities included informational mailings to physicians, training of medical office staff members and clinical mammographers, and support for a reminder system. The experience demonstrated that physicians practicing in medium-sized cities are willing to be active in community disease prevention programs.

Breast Neoplasms↗
PubMed2003

A review of data on the U.S. health sector Fall 2002.

This report presents information on the state of U.S. health care in mid-2002. It provides data on the uninsured and underinsured and their difficulties in finding health care; the increasing costs of care; health, social, and economic inequalities; and the role of corporate money in health care. Information is also presented on mental health care, the hospital and pharmaceutical industries, Medicare HMOs, and the state of nursing. The author then provides updates on Congressional activity and the results of polls on matters of health, and some data on health care systems elsewhere in the world.

Drug Industry↗
PubMed2006

A review of data on the U.S. health sector spring 2006.

This report presents information on the state of the U.S. health system in the spring of 2006. It includes data on the uninsured and underinsured and their access to health care, on socioeconomic inequality in health care, and on the rising costs of the U.S. health system. It also presents information on the role of corporate money in health care, focusing on the pharmaceutical industry, Medicare HMOs, and corporate-government conflicts of interest. The author includes a survey of recent public opinion polls on health care and health system reform and an update on the U.S. national health insurance legislation. The article ends by reviewing recent data on international health systems and international system comparisons.

Attitude to Health↗
PubMed1998

Health and nursing informatics education.

In Europe, coordinated activities in healthcare informatics education started in the late 1980's with the establishment of European Courses in Health Telematics. At the same time the European Commission foresaw the need for spreading the knowledge of IT in the Healthcare Sector. Therefore the EC, since then, have supported the initiatives that aim to create awareness, stimulate diffusion, educate and train the users (healthcare professionals) in the application of Information Technology to the Healthcare Sector. Such initiatives are the NIGHTINGALE project, which is an essential project in the planning and implementation of strategy in training the Nursing profession in using and applying healthcare information systems, the IT EDUCTRA project, which is a very practical project in the field of the education and training of the Healthcare Professionals in Information Technologies, and the ERASMUS Master's Course, which is aiming at giving those working, or intending to work in the health service and related activities a broad, advanced postgraduate education in Health Informatics.

Curriculum↗
PubMed1991

Hospital accounting and information systems: a critical assessment.

Public sector organisations seem to be caught up in the global wave of 'neo-Thatcherism'. As such, they are being held 'accountable' today by their respective government finance departments for the costs and benefits of the services they provide to the general public. As the public purse tightens, hospitals (and related health service units) more and more compete with other public sector organisations (old-age pensions and services, post-secondary education, day-care centres, port authorities, unemployment insurance, parks and recreation, elite sport programs, aboriginal peoples aid and development, and so on) for a diminishing piece of what seems a smaller and smaller pie. In this 'fight-for-funding', hospitals seem particularly vulnerable. Sky-rocketing costs, public resentment of doctors' high income and a deliberate restriction and limiting of medical school places, among other things, contribute to general public antagonism. The message for hospitals is that cost-effective accountability will loom large when hospitals come begging at the public trough. Even left-wing politicians today seem to be heeding the words of free-market economists like Freedman of Chicago. 'Privatisation' is the constant threat for those deemed inefficient. As a consequence, hospital administrators around the world, caught up in this trend, seem to be stampeding to 'boot-up' some kind of new accounting information system. For example, at my own university hospital (Queen's University, Kingston, Canada), the hospital administrators are in the process of introducing a version of the Johns Hopkins Hospital (Baltimore, Maryland) case-mix-loading cost-accumulation system. In other parts of the world they are known by other fancy names such as 'patient-costing', 'diagnosis-related-groups' (or DRGs). Trendy accounting systems seem to be the order of the day, a sort of panacea for the current plague of problems hospitals face. As the new systems become operational, however, traditional management accounting issues will likely surface. Particular departments, wards and surgeons will be fingered by the system for excessive costs, inefficiency, and under-utilisation of equipment. When this happens, the medical professionals will begin to pay attention to these systems. They will discover that the accounting decisions (which cast them in an unfavourable light) are subjective, arbitrary, and problematic. The old debates, such as incremental versus full-costing, transfer pricing and cost of capital, will be played out again; but now on the turf of hospitals. As the debates drag on, it seems likely that in the interim the new accounting systems could do more harm than help. The rest of the paper attempts to explain why.

Accounting↗
PubMedDate not supplied

Mortality of a cohort of road construction and maintenance workers with work disability compensation.

BACKGROUND: Surveillance systems of occupational mortality are useful tools to identify cases of diseases suspected as occupational and to monitor their occurrence over time, in space and in population subgroups. Many surveillance systems make use of administrative data in which information about occupations and/or economic sectors of the subjects enrolled is reported, such as death certificates, hospital discharge data, census data, tax and pension records, and workers' compensation archives. OBJECTIVES: In the present study we analyzed the mortality of a cohort of road construction and maintenance workers enrolled through the Italian national archive of work disability compensations, also in order to evaluate the possible use of this administrative source to monitor occupational mortality. METHODS: 8,000 subjects (7,879 males) receiving a disability compensation while working in the "road construction and maintenance" sector were identified from INAIL (National Institute for Insurance of Accidents at Work) archives. Vital status of these subjects was ascertained using the information available in INAIL archives and in the national tax register. For those found to be deceased from INAIL or tax archives, or without any information on vital status, a mail follow-up was started. We considered as observation period the years from 1980 to 1993. A record linkage with the ISTAT (Italian Institute of Statistics) national mortality registry was performed and the cause of death was retrieved for 964 out of 1,259 subjects. The analysis was restricted to males, leaving altogether 863 observed deaths with ascertained cause (84.7% of 1,019 total male deaths). SMR for overall mortality and PMR for specific cause mortality were computed, using the general Italian male population as reference. RESULTS: Overall mortality was significantly reduced (SMR = 79.0; 95% CI = 74.2-84.0). Proportional mortality analysis revealed significant excess risks for all malignant tumours (332 deaths, PMR = 1.08) and for digestive diseases (87 deaths, PMR = 1.34), while mortality for cardiovascular diseases was significantly decreased (288 deaths, PMR = 0.90). Among specific causes of death, significant excess mortality was found for cancer of testicles (2 deaths, PMR = 5.98), liver and biliary ducts (32 deaths, PMR = 1.40), and for silicosis (10 deaths, PMR = 3.07) and cirrhosis (64 deaths, PMR = 1.40). CONCLUSIONS: The excess mortality observed for all cancers, digestive diseases and silicosis, and the decreased risk for cardiovascular diseases are in agreement with the results of other studies conducted on workers in road construction and maintenance. As expected, the low overall mortality and the reduced risk from cardiovascular diseases indicate that these workers present a strong "healthy worker effect".

Cause of Death↗
PubMedDate not supplied

Public and private psychiatry: can they work together and is it worth the effort?

OBJECTIVE: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative 'shared care' arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems. METHOD: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area. RESULTS: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: 'Difficulty communicating' endorsed by 71.4% of public clinicians and 72% of private psychiatrists, 'Confusion of roles and responsibilities' endorsed by 62.9% and 66%, respectively, and 'Different treatment approach' by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors. CONCLUSIONS: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.

Attitude of Health Personnel↗
PubMed1995

Using the information system to assess change: the impact of downsizing the acute sector.

A population-based approach was used to monitor impact of hospital bed closures in Winnipeg, Manitoba. Four years of administrative data were analyzed. Access to hospital services was not adversely affected: The reduction in beds resulted in increases in outpatient surgery and earlier discharges. In addition, access favored the admission of persons with more health care needs. Quality of care, as measured by mortality within 3 months of admission, readmission rates within 30 days of discharge, and increased contact with physicians within 30 days of discharge, did not change. The health status of the Winnipeg population, measured by premature mortality, did not change. However, health status and hospital use was found to be strongly related to socioeconomic status. In light of this gradient, the authors conclude that well designed and evaluated experiments that focus on the determinants of health, rather than on providing more health care services, could help identify ways of reducing hospital use.

Adolescent↗
PubMed1988

Mothers in the workforce.

This evaluation of maternity leave was completed by the Australian Institute of Family Studies. The use of maternity leave was investigated in 3 separate surveys. In 1, all women throughout Australia who had borne a child during 1 week in May 1984 (2000 women) were surveyed 18 months after the birth. The 2nd and 3rd surveys examined the experience of maternity leave in 1252 private sector businesses of varying sizes and a smaller number of public sector organizations. The study found that 46% of women are in the workforce during pregnancy. However, looking only at women in employment before the 1st birth, 3/4 of them are in the workforce. 44% of women took maternity leave, 33% were eligible but did not take leave, and the remaining 24% were ineligible for maternity leave either because they were casual workers or because they had not been in continuous employment with their employer for the required minimum period of 12 months. Of all maternity leave taken, 78% is taken by public sector employees and only 21% by women employed in the private sector. 1/2 of the women eligible for maternity leave in the private sector who did not take up the option had no information about maternity leave provisions. The main determinants of taking maternity leave, apart from having information about it, are working in the public sector, having a strong attachment to the workforce, having values which see work and child rearing as complementary, being a member of a trade union, having a high education and high status occupation, and being employed in a large establishment. Other survey findings follow. 1) 55% of women who were in employment before their 1st child returned to the workforce within 18 months of the birth. 2) 45% of women returned to work used informal child care provided by family or friends (usually unpaid). 32% used formal care only. 23% used a combination of formal and informal child care. 3) Women are spending an average of between 20% and 25% of their income on child care. 4) Financial reasons are the main reasons given by women for their return to the workforce. 5) Cost and availability of child care is an important issue in determining women's workforce participation after the birth of a child. 6) 60% of women do not return to the workforce after childbirth; 90% of these women intend to do so in the future. 7) For the majority of women who give birth, motherhood emerges as their most important role in life. Almost 1/2 the women agree that a woman should give up her job if it inconveniences her husband and children. 8) 2/3 of working women can establish just as warm and secure a relationship as non-working mothers, compared with 4 out of 10 non-working mothers.

Adolescent↗