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A financially strapped rural hospital is helping control the costs of indigent care by giving away prescriptions to residents with diabetes, asthma, and other chronic illnesses. The program's small expense is more than offset by the reductions in acute care costs.
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In Vermont, too much was spent on institutional care and not enough on home and community-based services. One study, written for Vermont's General Assembly, suggested that Vermont should work toward a gradual shift in spending with more spent on home care services and less on nursing home care.
Policy research into the service needs of persons with dementia had its origin looking at challenges confronting caregivers--extended hours of instrumental task assistance, social isolation, fatigue, depression--and how public policy might support informal care-giving while saving public expenditures from nursing home care. This paper, drawing on the experience of the Medicare Alzheimer's Disease Demonstration and other work, provides suggestions for extending care and financing considerations to include health care use and the medical management of chronic health conditions. Basic research is needed to document current use and risk factors, as is experimentation with clinical and other interventions designed to achieve desired quality of care and cost outcomes. This section of the paper will be of direct interest to both US and international readers. The second half of the paper reviews the US state role in regulating and financing nursing homes, home and community-based care, and residential care. All these sectors have high rates of staff turnover, staff shortages, and concerns with quality of care. The international community and US states provide naturally occurring opportunities for delivery system experimentation and innovation. Research taking advantage of these opportunities could greatly inform public policy.
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Explore the source record for details and available documents.
Community-based programs have produced mixed results. Community capacity is thought to be a major determinant of program effectiveness. Thus, enhancing community capacity may increase the beneficial effects of existing programs and enhance future program effectiveness. This highlights the need to focus on understanding the components of capacity and the methods of enhancing capacity. Although we are just beginning to examine and understand key concepts, community capacity is probably influenced by both relatively nonmodifiable characteristics (such as demographic factors, institutional resources, and social structures) and relatively modifiable characteristics (such as knowledge, skills, and the ability and willingness of members and agencies to work collaboratively). In their relationships with community members and agencies, academicians and public health practitioners may help acquire categorical funding to enhance opportunities to build community capacity and their own capacity as well. The relationship between academicians/practitioners and community members/agencies probably is influenced by a host of characteristics which determine the degree to which capacity can be built. This paper discusses: the key components of capacity; the factors that influence building capacity through collaborations; a community health advisor (CHA) model which both builds on sociocultural aspects of African American culture and is consistent with methods for building community capacity; and how modifications to this model allow it to be compatible with categorically funded projects.
Community-based programs have produced mixed results. Community capacity is thought to be a major determinant of program effectiveness. Thus, enhancing community capacity may increase the beneficial effects of existing programs and enhance future program effectiveness. This highlights the need to focus on understanding the components of capacity and the methods of enhancing capacity. Although we are just beginning to examine and understand key concepts, community capacity is probably influenced by both relatively nonmodifiable characteristics (such as demographic factors, institutional resources, and social structures) and relatively modifiable characteristics (such as knowledge, skills, and the ability and willingness of members and agencies to work collaboratively). In their relationships with community members and agencies, academicians and public health practitioners may help acquire categorical funding to enhance opportunities to build community capacity and their own capacity as well. The relationship between academicians/practitioners and community members/agencies probably is influenced by a host of characteristics which determine the degree to which capacity can be built. This paper discusses: the key components of capacity; the factors that influence building capacity through collaborations; a community health advisor (CHA) model which both builds on sociocultural aspects of African American culture and is consistent with methods for building community capacity; and how modifications to this model allow it to be compatible with categorically funded projects.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
CONTEXT: Many state, federal, and foundation resources have been invested in improving the recruitment of primary care providers to rural communities. The Southern Rural Access Program of the Robert Wood Johnson Foundation (RWJF) has provided varying levels of support to several southern states to assist with retention of those providers. PURPOSE: This study describes the strategies that 6 states used to develop and implement practice management technical assistance services for rural health care providers. METHODS: Practice managers in each of the 6 states were surveyed regarding how their service was structured, what types of entities were eligible, and the nature of the technical assistance offered. Information regarding what types of entities used the service, characteristics of the practices, and the number of practices served was also collected. FINDINGS: The survey results showed that almost half (46%) of all practices assisted were private stand-alone physician practices, with overall practice assessments being the practice management service rendered most often. Although the type of organisational home for the technical assistance services varied by state, overall states employed an average of 1.67 full-time equivalent practice managers (0.81 full-time equivalent supported by RWJF) and received an average of $136,055 per state from the RWJF for the 2-year period beginning April 2002 for practice management support. CONCLUSIONS: Overall, the study found that the type of organizational home did not appear to affect the type of technical assistance services offered. However, the type of orgnizational home did appear to affect what types of providers used the service, with trade associations assisting their members or constituents at least half the time.
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