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PubMed2005

The who, what, and why of risk adjustment: a technology on the cusp of adoption.

Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them.

Diffusion of Innovation↗
PubMed2003

Tourism climatology: evaluating environmental information for decision making and business planning in the recreation and tourism sector.

This work grew from initiatives of the International Society of Biometeorology's Commission on Climate, Tourism and Recreation (ISBCCTR). The ISBCCTR was formed during the 15th Congress of the ISB held in November 1999 in Sydney, Australia. The aim of ISBCCTR is to promote research in tourism climatology. The first formal meeting of the Commission took place at the Meliton Resort, Halkidiki, Greece, 5-10 October 2001. The aims were to (1) bring together a selection of scientists and tourism experts to review the current state of knowledge of tourism climatology and (2) explore areas and priorities for future work and the role of the Commission in this. The Workshop highlighted the fact that, although climate is widely recognised as vitally important to tourism, relatively little is known about its effects. Even less is known about the economic impact or significance of climate on commercial prospects for tourism. Important research themes that warrant attention were identified. Among these was the need for a tourism climate index (or indices) that integrates all facets of climate, uses standard data and is objectively tested and verified. Work is also required on developing a better understanding of what climate-related information is required by both tourists and the tourism industry, exploring the distinction between the impact of climate on tourists and the impact on the tourism industry, setting a standard approach to tourism climate assessment, assessing the role of weather forecasts and long-term expectations of climate on choices made by tourists, the risks to tourism caused by extreme atmospheric events, what climate-related criteria people use to make decisions about tourism and recreational choices, how products giving information about weather and climate are currently used by the recreation and tourism industry and what are the existing and future requirements for this climate information.

Climate↗
PubMed2006

Current practices for risk zoning around nuclear power plants in comparison to other industry sectors.

This paper analyses the background and current status of the information basis leading to the definition of risk and emergency zones around nuclear power plants (NPPs) in different countries in Europe and beyond. Although dependable plant-specific probabilistic safety assessment (PSA) of level 2 and/or level 3 could in principle provide sufficiently detailed input to define the geographical dimension of a NPP's risk and emergency zones, the analysis of the status in some European and other countries shows that other, "deterministic" approaches using a reference accident are actually used in practice. Regarding use of level 2 PSA for emergency planning, the approach so far has been to use the level 2 PSA information retrospectively to provide the justification for the choice of reference accident(s) used to define the emergency plans and emergency planning zones (EPZs). There are significant differences in the EPZs that are defined in different countries, ranging from a few up to 80km. There is a striking contrast in the extent of using probabilistic information to define emergency zones between the nuclear and other high risk industry sectors, such as the chemical process industry, and the reasons for these differences are not entirely clear, since the risk of chemical industry is similar as that of the nuclear sector. The differences seem to be more related to risk perception than to the actual risk potential. Therefore, there is a strong need to be able to communicate risk information to the Public both before and following an accident. In addition, there is a need to educate the Public so that they can understand risk information in a comparative sense. Finally, based on the consensus discussions at a recent JRC/OECD International Seminar on Risk and Emergency Zoning around NPPs, a set of recommendations is given in the areas of: -a more comprehensive use of the available risk information for risk zoning purposes, -risk communication; -comparative (energy) risk assessment.

Disaster Planning↗
PubMed2006

What does it take to replace an old functioning information system with a new one? A case study.

PURPOSE: To investigate the case of a municipal wound care practice and the process of designing a specific computer documentation record system. In carrying out our kind of action research, creation of the system that integrate digital photos, was supposed to remake the old wound care documentation system and transform it into a more advanced and unified tool. METHODS: Ethnographic studies were conducted before and parallel to the design work. Nurse practitioners were involved in design and actively determining essentials of the computer artefact. Developmental Work Research (DWR) is the framework against which data from the work practice and system development where analyzed and interpreted. RESULTS: First, an old-fashioned information system (IS) within health care work will not successfully be replaced by a new one, unless the new is better "as a whole", that is, better supports work practices of a range of occupational and professional workers. Second, when designing information system for the public sector, system designers will almost always face dilemmas based on a contradiction between central, high level interest and a local level work-practice perspective. DISCUSSION: Our study reveals that the work practice of the municipal nurses is characterized by three distinctive features: High mobility, the need for face-to-face interaction in different locations, and a great variety of artefact usage. This implies that a new information system has to be "better as a whole" dealing with those characteristics.

Diffusion of Innovation↗
PubMed1999

A management information system for nurse/midwives.

The experiences of nurse/midwives with a simple management information system in the private sector are reported from four facilities in Nigeria. When such a system is being introduced, special attention should be given to strengthening the ability of health workers to record and collate data satisfactorily.

Adult↗
PubMed1990

Identification of the major cytoplasmic regions of the Neurospora crassa plasma membrane H(+)-ATPase using protein chemical techniques.

The transmembrane topography of the Neurospora crassa plasma membrane H(+)-ATPase has been investigated using purified, reconstituted components and direct protein chemical techniques. Reconstituted proteoliposomes containing H(+)-ATPase molecules oriented predominantly with their cytoplasmic surface facing outward were treated with trypsin to liberate peptides present on the cytoplasmic surface of the H(+)-ATPase as recently described (Hennessey, J.P., Jr., and Scarborough, G. (1990) J. Biol. Chem. 265, 532-537. The released peptides were then separated from the proteoliposomes by gel filtration chromatography and further purified by high performance liquid chromatography. Fourteen such peptides were identified by NH2-terminal amino acid sequence analysis, directly defining these parts of the molecule as present on the cytoplasmic surface of the membrane. Moreover, this information identified several additional flanking stretches as likely to be cytoplasmically located by virtue of the fact that they are too short to cross the membrane and return. These results and the results of other recent experiments establish 417 residues of the 919 present in the ATPase molecule, at positions 2-100, 186-256, 441-663, and 897-920, as cytoplasmically located. Taken together with the results of our preliminary investigations of the membrane embedded sectors of the ATPase, this information allows the formulation of a reasonably detailed model for the transmembrane topography of the ATPase polypeptide chain.

Amino Acid Sequence↗
PubMedDate not supplied

Review of internet health information quality initiatives.

BACKGROUND: The massive growth of health information on the Internet; the global nature of the Internet; the seismic shift taking place in the relationships of various actors in this arena, and the absence of real protection from harm for citizens who use the Internet for health purposes are seen to be real problems. One response to many of these problems has been the burgeoning output of codes of conduct by numerous organizations trying to address quality of health information. OBJECTIVES: Review the major self-regulatory initiatives in the English-speaking world to develop quality and ethical standards for health information on the Internet. Compare and analyze the approaches taken by the different initiatives. Clarify the issues around the development and enforcement of standards. METHODS: Quality initiatives selected meet one or more of the following criteria: Self-regulatory. A reasonable constituency. Diversity (eg, of philosophy, approach and process)-to achieve balance and wide representation, and to illustrate and compare different approaches. Historic value. A wider reach than a national audience, except when its reach is a significant sector of the Internet health information industry. The initiatives were compared in 3 ways: (1) Analysis and comparison of: key concepts, mechanism, or approach. Analysis of: the obligations that a provider has to meet to comply with the given initiative, the intended beneficiaries of that initiative, and the burdens imposed on different actors. These burdens are described in terms of their effect on the long-term sustainability and maintenance of the initiative by its developers. Analysis of the enforcement mechanisms. (2) Analysis and comparison by type of sponsoring organization, the reach of the initiative, and the sources of funding of the initiative or the sponsoring organization. (3) How the various initiatives fall under 1 of 3 key mechanisms and comparison of the advantages and disadvantages of these key mechanisms. RESULTS: The issues that affect the initiatives and future work on the quality of health information on the Internet are identified and analyzed. These issues are: (a) Three key mechanisms used in the quality initiatives (b) Sustainability issues that affect the initiatives: Burdens placed on health information providers, citizens and others. Currency and maintenance issues of the initiatives. Funding. Cost. Acceptance. Market conditions. User indifference or ambivalence. (c) Enforcement issues surrounding the initiatives (d) Adequacy of approach, scope, reach, and enforcement provisions of the various quality initiatives (e) Gaps that need to be addressed to achieve good quality of health information on the internet CONCLUSIONS: Ten conclusions are presented. A framework of action to be undertaken by the World Health Organization in the field of quality of health information on the Internet is recommended.

European Union↗
PubMed2004

From management to mediation: local forestry management and the forestry crisis in post-socialist Russia.

The local branches of the Russian Forestry Service, the leskhozy, were known for their efficiency and management skills in the Soviet era and were one of the very few community-based "Soviet-type" institutions to survive the transition. This article examines the role of the leskhozy in the new market economy. Our analysis is based on data from interviews with informants attached to the forestry sector in the Murmansk area. In some cases their knowledge of the leskhozy stretches back to the emergence of the system in 1947. Our principal finding is that the struggle to survive as a federal body in the current legal and economic climate is forcing the leskhozy to relegate sustainable forestry management, presumably their primary raison d'être, to the lower portions of their list of priorities. Several consequences result. There is a heightened incidence of illegal logging, and corruption informs the allocation of forest areas to private interests. Stumpage prices have plummeted as timber from subsidized commercial cutting (ostensibly sanitary cutting or thinning) has flooded the markets. The root cause of these tribulations lies with the market-based harvesting permit system. Its introduction in the 1990s did little to eliminate the self-seeking practices of the old Soviet forestry management hierarchies. In the free market, local forestry managers can turn their dual responsibilities to their own advantage inasmuch as they control the allocation of harvesting permits while at the same time controlling logging practices.

Conservation of Natural Resources↗
PubMedDate not supplied

The state of automated information systems in ambulatory health care.

The development of moderately priced microprocessors has led to a new and complex set of information processing alternatives within the healthcare sector. Small group practices and some solo practitioners now find it technologically possible and economically feasible to automate some parts of their information system. With the introduction of this new and highly complicated technology comes a series of opportunities and problems for the healthcare consumer and provider. The article examines a number of the issues related to computer utilization in the ambulatory care setting.

Computers↗
PubMed2005

Monitoring sustainable forest management in different jurisdictions.

The concept of sustainable forest management (SFM) requires forest resource managers to monitor and collect information pertaining to their environmental, economic and social impact. There are increasing expectations from a variety of publics (government, customers, and other stakeholders) that forests be demonstrably well-managed, creating incentives for forest managers to design credible systems for assessing their management performance. It is against this background that local, national and international approaches to regulating forest practices have been evolving. This article reviews the different dimensions of governance as they relate to monitoring and information reporting in the forest sector. Specifically, it discusses the changing role of sovereignty, the effects of globalization and the emergence of civil society stakeholders in forestry-related decision-making. Concepts such as sovereignty and globalization have important implications for monitoring forest practices and for defining SFM. Whether SFM standard creation and enforcement involves a sovereign, shared-sovereignty or civil society approach will affect the level and nature of SFM monitoring. As a result, we need to better consider the concept of monitoring appropriate to the scale and intensity of operations, how monitoring and information reporting standards differ between jurisdictions, and what this means for independently verifying SFM at an inter-jurisdictional level.

Conservation of Natural Resources↗
PubMed1998

Community pharmacy practice in Japan--results of a survey.

OBJECTIVE: To survey the present condition of community pharmacies as future sites for pharmacy students' externship in Japan. METHOD: A questionnaire consisting of 55 questions was sent to 425 graduates from Kobe Gakuin University, School of Pharmacy, who owned or worked in community pharmacies. RESULTS: Of the 85 responders, about half were owners and half employees of pharmacies. Ninety per cent of pharmacy owners operated three and fewer pharmacies. Fifty per cent of pharmacies only dispensed drugs, 32% handled both OTC drugs and dispensing, and 18% handled only OTC drugs. Among the 44 dispensing pharmacies, 16 were one-to-one type pharmacies, 13 were located in front of the big medical institutions, nine dispensed prescriptions from various medical institutions and five were hospital-owned pharmacies. Forty-five per cent of pharmacies employed 1-4 part-time pharmacists and 52% employed 1-4 pharmacist assistants. Thirty-one per cent of prescriptions came from internal medicine departments and the daily number of prescriptions dispensed by each pharmacy was in the range 10-99 for 41% of the pharmacies and 100-199 for 36% of the pharmacies. The average daily number of prescriptions dispersed by each pharmacist was in the range 30-39 for 29% of pharmacies and in the range 20-29 for 22% of pharmacies. Pharmaceutical information was provided at 73% of pharmacies and patients were counselled orally on their medication at 80% of pharmacies. Patients' medication histories were recorded at 88% pharmacies. Only 15% of pharmacies conducted patients' medication counselling at their home, but 34% of pharmacies were planning to start this service. Community pharmacists attended very few professional meetings or continuing education programmes and only 20% of them obtained information through computers. Forty-seven pharmacists out of the 85 obtained their information from medical representatives of pharmaceutical companies and 32 pharmacists through marketing specialists of wholesalers. Ninety per cent of community pharmacists who responded thought that separation of prescribing and dispensing functions would progress further in the future and 50% of them thought positively about the future social status of pharmacists. Most of our graduates who responded were willing to accept pharmacy students from Kobe Gakuin University as externs at their pharmacies. CONCLUSION: Despite the low response rate, our survey suggests that community pharmacy in Japan requires substantial improvement. This is to ensure that pharmacists working in that sector can provide the quality information that is required for the optimum management of patients and that the environment is suitable for pharmacy externships.

Data Collection↗
PubMed2002

The interface between hospital and residential aged care.

The last 15 years have seen substantial changes in both the aged care and the acute hospital sectors. This article focuses on the impact of those changes on the interface between hospital and residential care. It examines trends in expenditure, supply and patterns of service use in the two sectors. Despite good national databases on hospitals and aged care services, there is little national information on the interface of the two sectors. The material presented here is based on work being undertaken at the Australian Institute of Health and Welfare, as part of a project aimed at developing a national database linking residential aged care and hospital morbidity data.

Aged↗
PubMed2001

What is 'best practice' in health care? State of the art and perspectives in improving the effectiveness and efficiency of the European health care systems.

A framework for the classification of information on maintaining or improving effectiveness and efficiency in health care systems is proposed. Activities, disciplines and methods that are available to identify, implement and monitor the available evidence in health care are called 'best practice'. We reviewed the literature in order to (1) establish a definition for 'best practice' in the health sector, (2) develop a framework to classify relevant information, and (3) synthesise the literature on activities, disciplines and methods pertinent to the concept. Health care, public health activities and health policy should be advised by the best available evidence. Currently, the concept can be broken down into three activities (Health Technology Assessment (HTA), Evidence-Based Medicine (EBM), Clinical Practice Guidelines (CPGs)) by which evidence is synthesised either as an evidence base (EBM and most HTA) or in the form of recommendations (CPGs and some HTA) for different decision purposes in health care. These activities gain input mainly through four disciplines: clinical research, clinical epidemiology, health economics and health services research. The different disciplines are related to each other in three 'domains': (a) input, (b) dissemination/implementation and (c) monitoring/outcome. These provide evidence on (a) the (potential) effects of health care interventions and policies; (b) on ways to implement them; and (c) on ways to monitor their actual outcome. None of these separate approaches and activities exclusively forms a successful and all-embracing strategy to ascertain 'best practice'. A collective approach in the management of information is expected to add value to individual efforts. Resources should be devoted to increase quality and quantity of both primary and secondary research as well as the establishment of networks to synthesise, disseminate, implement and monitor 'best practice'.

Benchmarking↗
PubMed1998

Learning on clinical placement: the experience of six Australian student nurses.

Concerns about the adequacy of clinical education in nursing courses in Australia have escalated since the transfer of pre-registration nursing education into the tertiary sector. This descriptive, interpretative study, informed by the tradition of critical social science, sought to understand the clinical learning experiences of undergraduate nursing students. At the same time, it fostered an active participation of students in their own learning. Daily post-clinical conferences with the students were taped and transcribed verbatim to provide data for the study. Additional data was collected from informal discussions and observations of the students during the placement. Analysis revealed three main categories, which reflected the students' experiences. These included: (1) I don't belong; (2) doing and practising: progress at last; and (3) transitions in thinking. Feeling part of the team was closely linked to the opportunity to learn, emphasizing the important role not only of educators but also clinicians in undergraduate learning on clinical placement. Though the findings reflect age-long problems associated with student learning in the clinical field, it serves to remind all nurses of the importance they play in the learning process. This study reflects the importance of effective communication between the health and education sectors and the need to concentrate on strategies which will strengthen this bond.

Clinical Competence↗
PubMed1999

The assent of a nation: genethics and Iceland.

The Icelandic parliament passed legislation authorizing the establishment of a national health sector database which will be sponsored financially by private enterprises through DeCode Genetics Inc. Health related data will be gathered from patients, without their informed consent, from all points of contact with Icelandic public and private health care providers. A centralized data curator will 'non-personalize' the identity of the subjects in a one-way coding system which the government and DeCode Genetics argue overrides the need for informed consent. This legislation is in conflict with the European Data Protection Act, which requires informed consent for the collection of personal data. The law raises many ethical questions regarding the central tenets of informed consent, the power of government, the rights of the human subject, and finally, the responsibility of the clinician balancing commitments of the patient and research.

Bioethics↗
PubMed1982

Toxic chemical regulation in Canada: preliminary estimates of costs and benefits.

This paper makes an assessment of the impact of toxic chemical regulation in Canada. Ranges of costs and benefits, supplemented by survey information, analogous American data, interviews and case studies have been used to demonstrate the general usefulness of a cost-benefit framework for public sector decision-making even where information availability is constrained and complete analysis is not feasible. It is concluded that, with few exceptions, the impact of environmental regulation on chemical producers in Canada is neither excessive nor unduly onerous.

Air Pollution↗