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At least 703 records · Page 39Linked to original sources
PubMed1982

Simulation of alternative designs of a cardiovascular risk reduction program for the U.S. Air Force.

A screening and intervention program, soon to be implemented by the U.S. Air Force, will screen personnel for cardiovascular risk and treat those at highest risk. Design alternatives were analyzed relating to the organization and method of delivery of this health service program. A simulation model was devised to aid the analysis. It includes the effect of turnover of personnel, the effect of treatment on the therapy group, and the effect of aging on blood pressure and cholesterol level. The model determines how the overall incidence of cardiovascular disease in the U.S. Air Force may be expected to change each year through a 20-year period under each of several design policies. Results are given to justify the choice of several design options, and the scope of future improvements in the simulation are outlined. It appears possible to achieve a reduction of one-third in the calculated risk of cardiovascular disease, and this more than justifies the risk reduction program, based on a cost-effectiveness study performed earlier. All design decisions have not been made but will await the result of a demonstration implementation. The demonstration will produce more accurate data on initial distribution of risk factors and effect of therapy, which in turn will permit a sharpening of the analyses presented here.

Adolescent↗
PubMed1999

The use of research in local health service agencies.

A critical and often overlooked component of the use and transfer of research in the health care system is the local health and social service delivery agency. There is also very little understanding of the extent to which local community-based agencies conduct research internally to improve their operational capacity. More than ever, these local service organizations require research to guide activity in a rapidly changing health care environment which is characterized by diminishing health and social service budgets, de-institutionalization and concomitant increases and metamorphoses in service demands. This study interviewed 25 executive directors and held a focus group with a group of other directors to examine the use and transfer of research in these organizations. A number of central issues were identified by the directors that affect the contribution of research to the delivery of their programs and services. A conceptual model for developing 'locally-based research transfer' was subsequently outlined that could serve as the basis for enhanced research use and research transfer in other local area contexts.

Community Health Services↗
PubMed2003

Anxiety disorders in older adults.

Recent epidemiologic surveys indicate that anxiety disorders in older adults are more common than previously believed. Despite this, knowledge regarding the clinical characteristics of anxiety disorders in elderly patients is emerging slowly. In addition, detection of anxiety symptoms in elders is complicated by several factors, including a confounding of symptom picture by high medical comorbidity, frequent use of multiple prescribed and over-the-counter medications, difficulty of differentiating anxiety from depression, and a tendency of some older adults to resist psychiatric evaluation. Nonetheless, a comprehensive evaluation that includes a clinical interview, self-report measures, and laboratory results, can improve detection and accurate assessment of anxiety in elderly patients. Empirically validated knowledge regarding appropriate pharmacologic interventions in elderly patients is still sparse, and inferences from data in young and middle-aged populations typically form the basis of clinical practice in elderly patients. SSRIs and SNRIs are considered first-line interventions because of their efficacy and relative tolerability in elderly patients. Psychotherapy, particularly cognitive-behavioral therapy, also has been found to be efficacious for older adults with anxiety disorders. Collaborative care models that address physician, patient, and healthcare service delivery barriers, also hold promise for adequately treating anxiety disorders experienced by older adults.

Aged↗
PubMedDate not supplied

The Association of Nurses in AIDS Care. Position paper on harm reduction and HIV care for drug users: integrating harm-reduction methods and HIV care.

As the epidemic of HIV disease continues to grow among drug users and their sexual partners, new ways must be adopted to do prevention work, outreach, and service delivery to this population. The Harm Reduction Model offers methods of working with drug users, which are in contrast to traditional methods based on confrontation and that require abstinence before change can occur. This position paper examines the Harm Reduction Model and outlines areas in which the Association of Nurses in AIDS Care can play a role in the expansion of harm-reduction-based intervention and policies.

Attitude of Health Personnel↗
PubMed1995

Teaching (and learning) family medicine internationally: a cultural survival guide.

Around the world, family medicine is emerging as an important model for the delivery of primary health care services. Clinician-educators from countries with successful family medicine programmes will be looked to for leadership in the international development of the specialty. Family medicine educators who are asked to teach internationally will face numerous challenges as they work to adapt their knowledge and expertise to fit local needs. These challenges can become either insurmountable obstacles or enriching experiences. The purpose of this article is to help guide educators as they explore, enter into and return from teaching family medicine abroad. It offers practical suggestions in response to three questions important in the course of work abroad: What are one's expectations for working abroad? What will one's attitude be toward daily work overseas? What will one have learned upon returning home? The suggestions can be used to enhance personal and professional development, promote common pathways in the development of family medicine as a specialty, and encourage bilateral exchange of knowledge and experiences among family physicians worldwide.

Culture↗
PubMed1991

Coming of age: critical challenges to the future development of pediatric psychology.

Described five professional challenges that will affect the future development of pediatric psychology: specialization and professional identity, relationships with other professions, securing resources necessary for effective functioning, the conflict between clinical service delivery and prevention, and development of training models. To meet these challenges, pediatric psychologists need to maintain strong connections with other psychologists, develop new models of collaborative training, practice, and research, emphasize prevention activities, and enhance the scientific basis of pediatric psychology through innovative training programs and support for faculty development.

Child↗
PubMed2004

Developing programs for homeless veterans: understanding driving forces in implementation.

Between 1992 and 2003, services for homeless veterans at the Veterans Affairs Greater Los Angeles Healthcare System went from inappropriate utilization of hospital medical and psychiatric beds, to a continuum of residential treatment, transitional housing, and employment programs through arrangements with private agencies. The authors use elements of Hasenfeld and Brock's Political Economy Model (1991) to explain this transformation in service delivery that was spearheaded by a VA social work leadership team. It is argued that three driving forces crucial to program implementation were present: technological certainty, economic stability, and concentration of power. Evidence of the implementation's impact includes creation of new homeless program beds, a reduction in use of medical/psychiatric beds, and a large number of formerly homeless veterans with housing and employment at program discharge. Study limitations and implications for future studies are discussed.

Employment↗
PubMed1996

Managed care in the pediatric subspecialty of neonatology. The challenges, impact, and consequences.

As our health care system moves toward a more managed competition model, the delivery of pediatric and pediatric specialists' services, especially the intensive and procedural services of neonatology, will be impacted. Pediatricians and pediatric subspecialists cannot avoid being buffeted from the powerful market forces that are now driving revolutionary changes in our health care system; they, like nonpediatric physicians, are often concerned and bewildered about the new realities of the day.

Female↗
PubMed2002

Mental health services for African Americans: a cultural/racial perspective.

African Americans have made consistent progress toward first-class citizenship since 1965. Nonetheless, mental health services for this population have been biased, incomplete, and deficient because similarities to European Americans have been emphasized whereas differences were largely ignored. This article addresses some differences, including cultural/racial identity and the cultural self, that affect assessment, psychiatric diagnoses, and psychotherapy or other interventions. An assessment-intervention model illustrates how cultural information can inform service delivery and improve services to African Americans. Cultural/racial perspectives on mental health in a multicultural society suggest innovations in the design of these services and access to them that can increase utilization by African Americans.

Black or African American↗
PubMed1989

Genetic support groups in the delivery of comprehensive genetic services.

This research sought information about the services provided by genetic support groups, their members' experiences in obtaining genetic and related services, and members' recommendations for improving services. Results from a survey of 43 directors of genetic support groups showed that these organizations not only provide their members with a wide range of informational and supportive services but also address the need for education of both the public and health professionals about genetic disorders. A second survey of 931 members of genetic support groups found that, although they obtained genetic information from a variety of professional and informal sources, many of them experienced barriers to obtaining sufficient genetic information. Respondents called for professionals to improve their interpersonal skills in working with clients and to assist families in obtaining a wider variety of services. On the basis of these findings, a service model and priorities are proposed to bring together genetic specialists, community professionals, and genetic support groups for the delivery of comprehensive services to individuals and families with genetic disorders.

Child↗
PubMed2000

Nursing and genetics: a feminist critique moves us towards transdisciplinary teams.

Genetic information and technologies are increasingly important in health care, not only in technologically advanced countries, but world-wide. Several global factors promise to increase future demand for morally conscious genetic health services and research. Although they are the largest professional group delivering health care world-wide, nurses have not taken the lead in meeting this challenge. Insights from feminist analysis help to illuminate some of the social institutions and cultural obstacles that have impeded the integration of genetics technology into the discipline of nursing. An alternative model is suggested--the transdisciplinary model--which was developed initially by a nurse and introduced in the 1970s into the delivery of health care and social services for children with developmental disabilities. This holistic model enables all health care professionals to have an equal voice in determining how genetic health care will be globalized.

Competitive Behavior↗
PubMed2000

A community pediatric prevention partnership: linking schools, providers, and tertiary care services.

Integrated school health services traditionally have been provided through the local board of education or health department. However, increased competitiveness in the health care arena has challenged providers to find innovative models to deliver health services to school-aged children. This article describes a partnership among a hospital, a university, private providers, and a local school system and health department to provide school health services. Noteworthy aspects of the project include the organizational structure and funding of the program, implementation of a case management model, and a focus on documenting outcomes. This program has been successful in building local alliances to provide health care services to school children. Implications for other school systems struggling to fund health services for school-aged children are discussed.

Case Management↗
PubMed1999

Outcome evaluation: an essential component for CNS practice.

Tumultuous changes in healthcare costs, delivery, and service are requiring revolutionary new approaches by healthcare professionals to meet current and future needs. Multidisciplinary teams are creating many innovative care delivery models. It is essential that healthcare professionals evaluate the cost effectiveness and impact of their care and service on both patient and system outcomes. Clinical nurse specialists (CNSs) are an integral component in these models and are uniquely qualified both to implement and to evaluate care delivery and systems changes. The purpose of this article is to describe the role of the CNS in outcomes evaluation. Specifically, various types of outcomes are delineated, with a differentiation between nurse-sensitive and medical and collaborative care outcomes. Examples of valid and reliable measurement tools that are easy to use and have wide comparability are described, and implications for CNS practice are posed.

Humans↗
PubMedDate not supplied

[External quality assessment of clinical services in Europe].

All countries and clinical specialties have some elements of systems for quality improvement, but their aims, configurations, models standards and assessments are often not formally recognised or integrated. External programmes to assess service delivery in Europe include the International Standardisation Organisation (ISO) and Excellence (EFQM - European Foundation Quality Management) models (industry based, management focus), peer review and accreditation (health care based, professional focus) and inspection (regulatory, safety-focused). Patient surveys and disease registers also contribute to assessment and benchmarking best performance. There are legal, cultural, professional and commercial reasons to adopt common core standards but there is little legislative framework to allow formal harmonisation within and between countries and clinical specialties. Examples are given of various approaches to the definition, assessment and improvement of standards for clinical services in Europe in order to encourage specialist associations to develop self-regulations based on the experience of others. Clinical practice and clinical services could be more efficiently and effectively harmonised by the professions than by their respective governments.

Accreditation↗
PubMed1977

A model for certification of need for long-term-care beds.

A model relating bed supply and utilization is presented in the context of the match between need and service, which is controlled by the screening process that allows or denies access to beds. The conventional cost-minimization approach to certification of need, that of seeking to reduce inappropriate use, is contrasted with a service-delivery approach that seeks to promote appropriate use of facilities. The model expresses the quality of the screening process and the sensitivity and specificity of utilization in terms of bed supply, utilization, and need for service, which allows it to be used for needs assessment. The model is applied to data on supply and use of beds in Massachusetts skilled nursing facilities, with screening quality estimated by Monte Carlo methods; the results suggest that need and bed supply are positively associated and that the regional variation in skilled-nursing beds in Massachusetts may reflect real variations in need.

Bed Occupancy↗
PubMed2006

Comparison of outcomes using 2 delivery models of anticoagulation care.

BACKGROUND: Studies demonstrate the effectiveness of anticoagulation management service (AMS) in providing antithrombotic therapy for eligible patients. We sought to extend this concept by determining whether an interim telephone model (IT) is comparable to our current AMS model at achieving optimal therapeutic outcomes. METHODS: The 36-month trial (24-month study plus 12-month extension) enrolled 192 eligible patients receiving long-term warfarin therapy at a Veterans Affairs hospital. Consenting participants were randomly assigned to either our current face-to-face clinic model (AMS), or our IT model. The primary outcome was the percentage of time individuals' international normalized ratios (INRs) were maintained within their target INR range (2.0-3.0 or 2.5-3.5). Secondary outcomes included the number of adverse events (eg, thromboembolism or hemorrhage) experienced during the study. RESULTS: We found no statistically significant difference between the 2 groups in the percentage of time maintained within INR target range overall (55.1% for AMS; 57.8% for IT; P = .28) nor over the course of the study. There were no statistically significant differences in the rate of thromboembolic or serious bleeding events between IT and AMS participants. Nevertheless, we did note differences related to intensity of anticoagulation. The IT group receiving treatment at a higher intensity (INR, 2.5-3.5) experienced greater anticoagulation control (P = .04) and fewer complications than the AMS group. The IT participants, however, reported a significantly higher rate of minor bleeding events, experienced mainly by those at an INR range of 2.0 to 3.0. CONCLUSION: Our IT model is a viable modification of our AMS model for the management of patients undergoing chronic anticoagulant therapy.

Aged↗
PubMed1998

Understanding change in primary care practice using complexity theory.

BACKGROUND: Understanding the organization of primary care practices is essential for implementing changes related to delivery of preventive or other health care services. A theoretical model derived from complexity theory provides a framework for understanding practice change. METHODS: Data were reviewed from brief participant observation fieldnotes collected in the 84 practices of the Direct Observation of Primary Care (DOPC) study and in 27 practices from three similar studies investigating preventive services delivery. These data were synthesized with information from an extensive search of the social science, nursing, and health services literature concerning practice organization, and of the literature on complexity theory from the fields of mathematics, physics, biology, management, medicine, and family systems, to create a complexity model of primary care practice. RESULTS: Primary care practices are understood as complex adaptive systems consisting of agents, such as patients, office staff, and physicians, who enact internal models of income generation, patient care, and organizational operations. These internal models interact dynamically to create each unique practice. The particular shape of each practice is determined by its primary goals. The model suggests three strategies for promoting change in practice and practitioner behavior: joining, transforming, and learning. CONCLUSIONS: This model has important implications for understanding change in primary care practice. Practices are much more complex than present strategies for change assume. The complexity model identified why some strategies work in particular practices and others do not.

Family Practice↗
PubMed1990

Managing inpatient clinical nutrition services: a comprehensive program assures accountability and success.

A major challenge facing clinical dietitians today is justifying inpatient clinical nutrition services. To meet this challenge, a comprehensive program for the delivery and management of clinical nutrition services was developed at Yale-New Haven Hospital. It is based on seven nutritional risk factors--age, diagnosis/treatment, diet, metabolic or mechanical problems, significant lab values, pertinent medications, and weight for height. These risk factors are used to categorize patients into one of seven classifications. In essence, this classification system is the screening tool used to provide the foundation for standards of practice and nutrition assessment and intervention. The inherent advantage of such a program is that it identifies patients at high nutritional risk, regardless of wide variations in patient population or diagnosis. It also provides standardized criteria for evaluating quality of care, patient acuity, and productivity and staffing. Clinical nutrition services can then be measured for both quality and quantity. Because protein-calorie malnutrition poses a serious threat to cost containment and quality patient care, this type of program can appeal to hospital administrators, physicians, and site visitors alike. It can serve as an adaptable model for the delivery and management of inpatient clinical nutrition services in a wide variety of health care facilities.

Adult↗