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PubMed2005

Full-service community schools: a strategy--not a program.

The concept that drives the emerging full-service community school movement is this: Schools cannot address all the problems and needs of disadvantaged children, youth, and families. Community schools are operated jointly by school systems and community agencies, are open extended hours, and may provide the site for after-school programs, primary-care health services, mental health counseling, parent education and involvement, and community development. No two community schools are alike. They grow out of a planning process that involves all stakeholders, school personnel, community-based organizations, city and county government, parents, and students. The Quitman Street Community School in Newark, New Jersey, exemplifies this approach.

Adolescent↗
PubMed1998

An interview with Dick Davidson. Interview by Mary Grayson.

Dick Davidson, president of the American Hospital Association since 1991, has witnessed--and advocated--a revolution among the members. Hospitals have become much more than providers of acute care. Many of them now strive to manage a continuum of coordinated services to their communities. Their next big step is learning to manage risk for Medicare patients by becoming provider sponsored organizations. None of this is made easier, Davidson believes, by the public's sagging confidence in hospitals. In fact, he sees regaining that trust and respect as health care's top priority.

American Hospital Association↗
PubMed1998

Community-based outreach HIV intervention for street-recruited drug users in Madras, India.

OBJECTIVE: Community-based outreach to drug injectors is an important component of human immunodeficiency virus (HIV) prevention strategy. The purpose of this chapter is to evaluate the effectiveness of community-based outreach HIV intervention that has been implemented in two locations in the city of Madras, India, to reduce risk behaviors for HIV transmission. METHODS: Baseline data were collected for street-recruited injecting drug users (IDUs) at two outreach locations in Madras, India (n = 250), and follow-up data are available at 18 months (n = 61). Baseline (n = 150) and follow-up data (n = 87) were obtained from control group of IDUs recruited from locations at which outreach services were not utilized. RESULTS: Significant decline in injecting risk behavior was noted at 18-month follow-up from baseline for the IDUs recruited from outreach locations. CONCLUSION: Results indicate that outreach service for drug users produce significant changes in injecting risk behavior but that sexual risk behavior is difficult to change. There are problems in implementing and evaluating the interventions, and the research findings are limited because HIV serodata were not studied for all participants.

Adolescent↗
PubMedDate not supplied

Community health center-led networks: cooperating to compete.

The primary mission of community health centers (CHCs) is to provide primary and preventive healthcare for the underserved and vulnerable populations, including the uninsured, underinsured, and Medicaid beneficiaries. Economic and regulatory challenges have placed these safety net providers in a precarious position, forcing some to respond using cooperative strategies. This article focuses on seven CHC-led networks, delineating their integrative efforts in the core areas of managed care, clinical, administrative, information, and finance. Interviews with key representatives from each network highlight the networks' accomplishments and the critical success factors and outcomes of their integrative efforts. Several underlying themes emerged from this study that are consistent with findings of previous studies conducted in other organizational settings. Specifically participants in CHC-led networks cite the following factors as contributors to success: reciprocity, communication, trust, and long-standing relationships among key individuals. This is the first study to provide a rich depiction of CHC network activities.

American Hospital Association↗
PubMed1999

Technology transfer of Network Therapy to community-based addictions counselors.

This paper describes a technology transfer initiative in which Network Therapy (NT), a substance abuse treatment that utilizes peer and family support, was disseminated to a cohort of addictions counselors located in an outpatient community-based addictions treatment center. Training methods included a didactic seminar, role-playing, use of videotaped illustrations, and clinical supervision, and are described in detail. Counselors then implemented the NT approach with a sample of cocaine-abusing patients (N = 10) who were being treated concurrently with the standard program provided by the treatment setting. NT patients were compared by chart review with a cohort of cocaine abusers who received community treatment--as-usual (TAU) (N = 20). The groups did not differ on demographic variables or the amount of TAU received at the community program. However, NT patients had significantly less positive urinalyses than TAU patients, though they were not significantly different in terms of treatment retention. Implications for technology transfer are discussed.

Adult↗
PubMed2003

Whom do they serve? Community responsiveness among hospitals affiliated with health systems and networks.

BACKGROUND: As the US hospital sector becomes more consolidated, concerns have been raised about whether participation in health systems and health networks may reduce community hospitals' response to community health needs. OBJECTIVES: The following were examined: (1) whether freestanding hospitals and system- and network-affiliated hospitals differed in their level of community responsiveness; and (2) how systems and networks affect the level of community responsiveness in community hospitals. METHODS: A cross-sectional design was used. The dependent variables included community orientation, provision of community health services, and Medicaid inpatient load. Independent variables were system/network membership and policy and organizational attributes of the health system/network. RESULTS: With few exceptions, a significantly greater involvement of system and network hospitals was found in providing community health services and inpatient services to Medicaid patients, relative to freestanding hospitals. Community health mission of the system/network and the involvement of the system/network in community partnerships or coalitions were positively related to community orientation in member hospitals. Hospitals affiliated with health systems and hospitals affiliated with more diversified systems or networks tended to provide more community health services. Community health mission of the health system or network was related to greater Medicaid inpatient load in member hospitals. CONCLUSIONS: In general, affiliation with health systems and health networks appears to be positively related to community responsiveness in community hospitals. Research future can examine whether such greater community responsiveness is because of the development and improvement of communication channels among elements of health systems and health networks and the ability of health systems and health networks to build a platform of general, administrative services to link various constituencies.

Community Health Services↗
PubMed1992

Community-based treatment of psychiatric disorders in U.S.A. and Norway: insights for new service delivery systems.

This article reports on a successful community-based psychiatric treatment program in Philadelphia, Pennsylvania and describes subsequent experiences seeking approval of similar programs in Philadelphia and in Oslo, Norway. Previous studies have shown that the Philadelphia community-based program, which used patient social networks and indigenous community workers assisted by psychological and psychiatric professionals, provided better treatment outcomes than traditional hospital programs and socioenvironmental treatment programs. On the basis of these experiences a new service delivery system was proposed which integrates patient social networks, community workers, and lay community organizations with mental health center professionals. Examination of differences in official responses to the proposal shows the importance of several factors, including the mental health bureaucracy's perception of patient potential, their openness to social psychological therapy, and the power struggles within the bureaucracy and the professional community.

Activities of Daily Living↗
PubMed2004

Use of genetic algorithms for neural networks to predict community-acquired pneumonia.

BACKGROUND: Genetic algorithms have been used to solve optimization problems for artificial neural networks (ANN) in several domains. We used genetic algorithms to search for optimal hidden-layer architectures, connectivity, and training parameters for ANN for predicting community-acquired pneumonia among patients with respiratory complaints. METHODS: Feed-forward back-propagation ANN were trained on sociodemographic, symptom, sign, comorbidity, and radiographic outcome data among 1044 patients from the University of Illinois (the training cohort), and were applied to 116 patients from the University of Nebraska (the testing cohort). Binary chromosomes with genes representing network attributes, including the number of nodes in the hidden layers, learning rate and momentum parameters, and the presence or absence of implicit within-layer connectivity using a competition algorithm, were operated on by various combinations of crossover, mutation, and probabilistic selection based on network mean-square error (MSE), and separately on average cross entropy (ENT). Predictive accuracy was measured as the area under a receiver-operating characteristic (ROC) curve. RESULTS: Over 50 generations, the baseline genetic algorithm evolved an optimized ANN with nine nodes in the first hidden layer, zero nodes in the second hidden layer, learning rate and momentum parameters of 0.5, and no within-layer competition connectivity. This ANN had an ROC area in the training cohort of 0.872 and in the testing cohort of 0.934 (P-value for difference, 0.181). Algorithms based on cross-generational selection, Gray coding of genes prior to mutation, and crossover recombination at different genetic levels, evolved optimized ANN identical to the baseline genetic strategy. Algorithms based on other strategies, including elite selection within generations (training ROC area 0.819), and inversions of genetic material during recombination (training ROC area 0.812), evolved less accurate ANN. CONCLUSION: ANN optimized by genetic algorithms accurately discriminated pneumonia within a training cohort, and within a testing cohort consisting of cases on which the networks had not been trained. Genetic algorithms can be used to implement efficient search strategies for optimal ANN to predict pneumonia.

Adolescent↗
PubMed1999

Asthma care in community health centers: a study by the southeast regional clinicians' network.

Federally funded community health centers (CHCs) were surveyed to assess their ability to serve low-income asthma patients in the southeastern United States. Data were collected on CHC clinicians, pharmacy services, and patient characteristics. Twenty-six (74%) of 35 participating CHCs provided data on 83 distinct clinic sites in eight states, representing 898,977 billable patient visits to 318,920 people during the one-year study period. Participating CHCs provided 23% of all CHC patient visits in Region IV in 1995. Sixty-two percent of patients had a family income below poverty level. Almost 75% of the patients were uninsured or receiving Medicaid. Asthma was the diagnosis code for 2.04% of all medical encounters. Twenty-nine percent of sites were unable to provide medications for uninsured asthma patients, while 66% could provide drug samples. Thirty-three percent of CHCs had in-house pharmacies and 33% offered pharmacy vouchers. Eighty-two percent could provide beta-agonist inhalers, 54% could provide steroid inhalers, and 17% could provide peak flow meters. Federally funded CHCs provide care to many asthma patients from the highest risk segments of the population, but often do not have the resources needed to follow current clinical guidelines.

Adrenergic beta-Agonists↗
PubMed1996

Physician-run health plans and antitrust. American College of Physicians.

As the health care system changes and large managed care entities gain greater control in some markets, proponents of antitrust reform have expressed concern that physicians could lose their autonomy. To respond to this concern, the American College of Physicians has consistently argued that physicians should be allowed to establish their own health plans and networks to provide high-quality and cost-effective care. Moreover, the College has advocated utilization review reform and due process protections to empower physicians in their dealings with insurers. Under current antitrust law, as interpreted by the federal enforcement agencies, physicians already have the legal authority to form their own health plans and networks, and many state medical societies are sponsoring such plans. The law also allows physicians to operate the clinical components of a health plan, regardless of who owns it. Moreover, physicians can share information about quality, utilization, and, in some circumstances, fees. An examination of federal enforcement agency actions since the mid-1970s shows that physician networks have rarely been challenged. In light of market developments, however, the College has urged the federal antitrust agencies to analyze the effect of their current enforcement policies on physician activities and adopt a more flexible approach. Further monitoring and analysis of the changing health care marketplace are necessary to ensure that physicians are being treated fairly and to determine which factors spur or inhibit the development of physician-run health plans and networks.

Antitrust Laws↗
PubMed1997

Developing a secure healthcare information network on the Internet.

Healthcare professionals across the country are using the Internet for a variety of activities, including the transmission of medical record data via e-mail. The transmission of confidential information, however, is a serious concern of healthcare consumers, providers, and payers alike. At Indiana University School of Medicine, security on the Internet is no longer a concern. The Internet is, in fact, the heart of a healthcare information network currently in development for the Indianapolis area. A complex set of encryption/decryption algorithms and user identifier and private passwords currently in development should greatly reduce the risk of security breach on the network.

Community Networks↗