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PubMed2005

Social work at the heart of the medical team.

This paper proposes one model of hospital social work delivery services that places social work in a facilitative role within the medical team, and describes a pilot project designed to evaluate these services. Social work's role in this teaching hospital setting was tailored to provide patients and medical staff access to social work services upon admission, rather than at the time of discharge. This change places social work at the pivotal juncture to improve medical care and addresses the social, cultural and environmental concerns as they surface during patient stay. Unique to this demonstration model is the added advantage of placing the social worker at the hub of the physician-led medical team. Medical students, residents, and attending physicians all learn, observe, and experience the advantages social workers bring to the process. Educating medical students on teams with social workers bodes well for the profession. The authors summarize the program design, results and implications for social work practice in a teaching hospital setting.

Hospitals, Teaching↗
PubMed2005

Context specific learning opportunities--adapting training to discrete areas.

BACKGROUND: Australian general practice training was regionalised in 2002 to better meet the specific health care needs of local communities. As a result, 22 unique regions were established, each containing a variety of training practices and learning contexts. The core learning opportunities in distinct learning contexts have not been well explored. METHODS: The research group identified criteria for delineating learning contexts and applied them to the training practices in the Northern Territory. Using focus groups of general practice registrars, we identified the learning opportunities available in each context. RESULTS: Context criteria were identified as: model of health service organisation and delivery; rurality; and community demography. Four distinct contexts were identified: mainstream general practice; regional hospital; Aboriginal Medical Service (AMS); and Aboriginal community clinic. Each learning context demonstrated both strengths and deficiencies, and also provided unique learning opportunities. DISCUSSION: Benefits in defining the learning contexts and opportunities within a general practice training region apply to registrars, trainers, providers, policy makers and standard setters. Context definition provides a valuable tool for more targeted and effective training, contributes to curriculum development and facilitates a more responsive and appropriate education program. We encourage adaptation of this model to other regions.

Family Practice↗
PubMed1997

PSNs: a new model for Medicare risk contracting.

The 1995 Republican House Medicare reform proposal introduced the provider services network (PSN) concept as a new healthcare delivery model for accepting and administering Medicare risk contracts. A PSN operates much like an HMO, but is not subject to the reserve requirements established for HMOs. Providers that want to enter the Medicare risk contracting arena and exercise more control over the delivery of healthcare services may consider forming a PSN. To form a PSN, providers must be sufficiently capitalized to compete with HMOs, create a formal legal organization, and develop a financial plan. To ensure that its goals are met, the PSN must develop a sales promotion plan, enroll members, control and monitor financial resources and clinical outcomes, and implement a management information system. Other crucial capabilities that a PSN must develop include establishing mechanisms for utilization review, membership information maintenance, claims adjudication, physician credentialing, quality assurance, and member grievance procedures.

Capital Financing↗
PubMed1994

Essential program components for perinatal home care.

Home care will continue to be a rapidly expanding area of health care. This growth will be evident in the perinatal nursing specialty. There are multiple models for delivery of perinatal home services. In each case, consideration needs to be given to licensing and other standards; to operational areas such as staffing, supplies, equipment, and reimbursement; and to quality issues, such as staff development, internal and external customer service, and a continuous quality improvement program. Successful marketing of the services requires recognition that the product is nursing care.

Community Health Nursing↗
PubMed1996

Technology assessment methods for radiology systems.

This article discusses the strengths and weaknesses of technology assessment methods for the evaluation of novel and complex radiology systems, including picture archiving and communication systems (PACS), computed radiography (CR), teleradiology, and other new models for the delivery of radiology services. Using examples from PACS and CR, we review early economic assessments of PACS from the radiology department. We then broaden our perspective to discuss the analytic criteria that can be used to evaluate economic analyses of PACS as the health care delivery system shifts toward managed care. We close with a proposal for optimizing the integration of information technology into the clinical environment through ongoing target data collection during the implementation of new radiology systems.

Cost Savings↗
PubMed1993

Healthcare reform: the role of coordinated critical care.

OBJECTIVE: To evaluate and editorialize the evolving role of the discipline of critical care as a healthcare delivery system in the process of healthcare reform. DATA SOURCES: The sources included material from the Federal Office of Management and Budget, Health Care Financing Review, President Bush's Office, Association of American Medical Colleges, and publications of the Society of Critical Care Medicine. STUDY SELECTION: Data were selected that the author felt was relevant to the healthcare reform process and its implications for the discipline of critical care. DATA EXTRACTION: The data were extracted by the author to illustrate the forces behind healthcare reform, the implications for the practice of critical care, and role of critical care as a coordinated (managed) care system in the process of healthcare reform. DATA SYNTHESIS: Healthcare reform has been initiated because of a number of considerations that arise in evaluating the current healthcare delivery system: access, financing, cost, dissatisfactions with the mechanisms of delivery, and political issues. The reform process will occur with or without the involvement of critical care practitioners. Reforms may greatly alter the delivery of critical care services, education, training, and research in critical care. Critical care has evolved into a healthcare delivery system that provides services to patients who need and request them and provides these services in a coordinated (managed) care model. CONCLUSIONS: Critical care practitioners must become involved in the healthcare reform process, and critical care services that are effective must be preserved, as must the education, training, and research programs. Critical care as a healthcare delivery system utilizing a coordinated (managed) care model has the potential to provide services to all patients who need them and to deliver them in a manner that is cost effective and recognized as providing added value.

Critical Care↗
PubMed1998

Retention of clients in service under two models of home health care for HIV/AIDS.

OBJECTIVE: To determine if a Transprofessional, care-management approach (experimental group) produces different patterns of retention in home treatment as compared to a Traditional treatment approach (control group). The care-management approach utilizes an interdisciplinary mix of allied health professionals who adhere to a service delivery protocol based on active medical, surgical treatment (curative services) as well as on pain, symptoms, and emotional care (palliative services). Initially, the Transprofessional Model should lead to a greater retention rate in the program as patients bond to blended care managers, but in later stages clients needing hospice should be moved off-services resulting in lower retention rates in the medical-surgical home care venue. DATA SOURCES AND STUDY SETTING: Data were collected from 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). Demographic and disease-specific data were collected from admitting records; service-utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: Upon admission for home-care services, patients were randomly assigned to an experimental (Transprofessional) or control (Traditional) treatment group. Service levels were comparable. PRIMARY FINDING: In the earliest stages, Transprofessional patients tend to be more likely to stay in treatment, probably due to the greater bonding to the program. After about one year, the Transprofessional patients are more likely to leave the program as they are transitioned into hospice care. CONCLUSIONS: An integrated model of service delivery, which is based on interdisciplinary care-management and blended modalities of service, provides a quality of life enhancing and a cost-effective method in the provision of home-care services for terminally ill AIDS patients.

Continuity of Patient Care↗
PubMed2000

System and cost research issues in treatments for people with autistic disorders.

Parents of children with autism and pervasive developmental disorder and educational and clinical practitioners providing services to them regularly confront a wide range of service selection and financial decisions that are not as yet effectively addressed by applied research. Relevant systems issues span a very broad range of concerns: (a) systems delivery models and issues (e.g., costs of services, implementation of intensive intervention, and teacher or therapist training); (b) how best to integrate treatments; (c) providing treatment to those with limited monetary resources; (d) cost and cost/benefit analyses; (e) how to educate adult psychiatrists (as well as other practitioners and personnel) regarding autism; and (f) gaps between research and practice.

Adult↗
PubMed1992

A computerized information system for monitoring and evaluating substance misuse services.

A computerized, comprehensive information system for the managerial monitoring and evaluation of local substance misuse service delivery is presented. It is based on a model which comprises basic elements of service provision such as, client caseload, time management and workload, work and client satisfaction, in both quantitative and qualitative terms. Findings from its initial implementation in a community drug team and drug dependency units in one of the London District Health Authorities are discussed. The possibility of using this evaluation package by drug and alcohol agencies themselves for the purpose of self-evaluation and monitoring as well as quality assurance is also discussed.

Journal Article↗
PubMed2004

Rural public health service delivery: promising new directions.

I describe variations in the structure and in the practice of rural public health and how rural communities meet the challenges of current public health practice, including primary methods of service delivery and partnership development. I present examples of promising models for the creation of rural public health capacity-the ability of local health departments to carry out core public health responsibilities.

Congresses as Topic↗
PubMed2001

Hepatic carnitine palmitoyl transferase 1 (CPT1 A) deficiency in North American Hutterites (Canadian and American): evidence for a founder effect and results of a pilot study on a DNA-based newborn screening program.

We describe six patients with hepatic carnitine palmitoyl transferase (CPT1 A) deficiency who are members of a large extended Hutterite kindred living in widely scattered communities in the United States and Canadian Prairies. Two patients have significant neurological impairment due to severe recurrent hypoglycemic crises. The remaining four patients with earlier detection and treatment have near normal outcomes. The Canadian and American Hutterite families share two common ancestors who married in 1812, about 60 years before the Hutterites arrived in North America and prior to their subdivision into the three groups (Schmiedeleut, Dariusleut, and the Lehrerleut). These patients share a common haplotype on chromosome 11q13 and are all homozygous for a common CPT1 A G710E mutation, suggesting a founder effect. The clustering of such a rare disorder of fatty acid oxidation prompted us to initiate a pilot DNA-based neonatal screening program to determine the carrier frequency of this mutation in Hutterite newborns with the participation and support of the community. To date our carrier frequency is 1/16, close to the predicted frequency based on diagnosed patients and number of births. We believe our newborn screening program for CPT1 A deficiency in the Hutterite community will serve as a prototype model for delivery of targeted genetic services to other similar unique genetic isolates.

Adolescent↗
PubMed1985

Developing independence.

The transition from living a life as others want (dependence) to living it as the adolescent wants to live it (independence) is extraordinarily difficult for most teen-agers and their families. The difficulty is compounded in the case of adolescents with disabilities. They are often denied access to the same opportunities of life that are accessible to the nondisabled. They face special problems in augmenting their inherent capacities so that they can take fuller advantage of the accommodations that society makes in an effort to grant them access. In particular, they need training designed to increase their capacities to make, communicate, implement, and evaluate their own life-choices. The recommendations made in this paper are grounded in the long-standing tradition of parens patriae and enlightened paternalism; they seek to be deliberately and cautiously careful about the lives of adolescents with disabilities and their families. We based them on the recent tradition of anti-institutionalism and they are also consistent with some of the major policy directions of the past 15-20 years. These include: normalization, integration, and least-restrictive alternatives; the unity and integrity of the family; the importance of opportunities for self-advocacy; the role of consumer consent and choice in consumer-professional relationships; the need for individualized services; the importance of the developmental model as a basis for service delivery; the value of economic productivity of people with disabilities; and the rights of habilitation, amelioration, and prevention.

Activities of Daily Living↗
PubMed1999

Creativity: the fuel of innovation.

Market-leveled changes occurring in the health care industry require new and creative models of organization, management, and service delivery. One of today's primary management challenges is the development of organizational cultures that value innovation, change, and creativity. The adoption of an ethic of innovativeness allows the organization to stretch the limits of individual and collective knowledge, skill, and ability to meet complex consumer needs. Creativity within organizations is influenced by management practices in conjunction with creativity-relevant work group skills. A common wisdom exists that professional nurses are creative in finding solutions for complex patient care needs. The expansion of this creativity within organizational systems will allow for the evolution of professional nursing practice, improvement in care delivery, and organizational performance.

Creativity↗
PubMed1999

Community care for people with chronic conditions: an analysis of nine studies of health and social service utilization in Ontario.

A series of studies conducted in the same region found that programmatic, community-based health and social service interventions have a positive impact on client well-being. These proactive interventions, designed to address the full range of health and social needs, were usually provided at the same--or even lower--costs as uncoordinated, illness-focused care. The results of this series suggest that across-the-board health care reduction, at least in a system of national health insurance, will produce poorer results, at higher cost, for people with chronic conditions living in the community. Policy planners need more research that concentrates on comparisons of outcomes between and within different models of health and social service delivery. The studies should be designed to help them determine who benefits from different service configurations carried out within a range of policy environments at various costs.

Canada↗
PubMed1976

Friendship Manor: a community geriatrics model.

Models for the delivery of medical services are attracting much attention lately. It appears that geriatrics will become more important in the future. These facts have led to a narrative about the development of a system of medical care for a retirement community in Roanoke, Virginia.

Aged↗
PubMed1979

Hospitals in the 1980s: service, training, and research.

Several factors press for change in the psychiatric hospital of the 1980s, including knowledge obtained from recent controlled studies of outcome of different approaches and length of hospital stay, changes in the social-political-economic climate, and new methods of organizing the delivery of services. In the proposed model of inpatient treatment, the primary use of hospitalization will be for brief treatment (three to 21 days). For a very small subgroup, longer hospitalization may be needed. The hospital will also be used for triage and disposition of persons with a broad range of problems, which will rarely take more than three days. Complementary changes will be required in training and research; a promising training model may be continuous care teams by which trainees can manage chronic, multiproblem patients through different levels of care within and outside the hospital. Research must move to the out-of-hospital settings if the new patterns of care are to be understood and improved.

Community Mental Health Services↗
PubMed1988

Social marketing and public health intervention.

The rapid proliferation of community-based health education programs has out-paced the knowledge base of behavior change strategies that are appropriate and effective for public health interventions. However, experiences from a variety of large-scale studies suggest that principles and techniques of social marketing may help bridge this gap. This article discusses eight essential aspects of the social marketing process: the use of a consumer orientation to develop and market intervention techniques, exchange theory as a model from which to conceptualize service delivery and program participation, audience analysis and segmentation strategies, the use of formative research in program design and pretesting of intervention materials, channel analysis for devising distribution systems and promotional campaigns, employment of the "marketing mix" concept in intervention planning and implementation, development of a process tracking system, and a management process of problem analysis, planning, implementation, feedback and control functions. Attention to such variables could result in more cost-effective programs that reach larger numbers of the target audience.

Health Promotion↗
PubMed1977

Peer sex education training and evaluation.

Human sexuality has been recognized as an important developmental, emotional, and medical concern on the college campus. The Peer Sex Education Program at the University of Massachusetts/Amherst has been developed as a model for the use of trained students in an educational, referral, and counseling role. This paper describes the program and outlines the methodology used in the documentation and evaluation of various program aspects. Aspects described include the program's rationale and background, the recruiting process, roles and responsibilities, training and supervision models, community development, and delivery of service. Categories of documentation and evaluation considered include effort, performance, adequacy of performance, efficiency, and process. These are related to consumer acceptance and satisfaction, outcome measures of knowledge, attitude, and behavior, effectiveness of referral and other functions, and effect of program on the peer educators' growth and development. The allocation of energy and resources between program development, service delivery and evaluation needs is highlighted.

Humans↗