Providing FP services in rural Madagascar: an OR study comparing three models of service delivery.
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Africa↗
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Results for “Service delivery models”
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REACH: a model for service delivery and professional development within remote/rural regions of the United States and U.S. Territories. American Speech-Language-Hearing Association. Ad Hoc Committee on Services to Remote/Rural Populations.
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American Speech-Language-Hearing Association↗
Commentary: Meta-analysis is a blunt and potentially misleading instrument for analysing models of service delivery.
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Delivery of Health Care↗
Needle exchange programs. Delivery and access issues.
OBJECTIVE: Examine the challenges of four service delivery models (i.e., fixed, mobile, satellite and home visits) and how service delivery may impact on NEP HIV prevention efforts. METHODS: Using a modified ethnographic approach, semi-structured interviews concerning policies and procedures were conducted with staff (n = 59) of NEPs (n = 15) in Ontario. An iterative, inductive analytic process was used. RESULTS: According to workers and managers, effectiveness of NEP prevention efforts depend on client development and retention and service design. Fixed and satellite sites, home visits and mobile services provide varied levels of temporal and spatial accessibility. Combining modes of delivery can offset the disadvantages of individual modes. DISCUSSION: NEP evaluations that do not consider service and resource factors run the risk of concluding that NEPs are ineffective when it may be that the program works for a small proportion of IDUs whom the NEP has the resources to serve.
Attitude of Health Personnel↗
Building comprehensive HIV/AIDS care services.
This article presents the experiences of three innovative programs for HIV/AIDS-related health care funded by the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program. The Comprehensive Healthcare projects were funded as part of a larger initiative for innovative HIV service delivery models, consisting of 27 grantees, the funding agency (HRSA), and an Evaluation and Dissemination Center. These projects--the University of Nevada School of Medicine's Early Nutrition Intervention in HIV and AIDS project, the University of Vermont and State Agricultural College's Rural HIV Service Delivery project, and Washington University School of Medicine's Helena Hatch Special Care Center for Women--have developed specialized medical care models within the context of a continuum of services in a medical clinic. This article serves to describe the initial experiences of these three service demonstration projects, and some of the lessons learned as a result of their implementation. All of these projects share the goal of providing integrated services, such as medical care, nutrition, case management, and social and mental health services to people living with HIV/AIDS. However, the projects target different populations, (e.g., those in rural areas versus those in a large inner city), and use contrasting service delivery models of comprehensive HIV care. These projects have undertaken diverse activities and have used numerous effective strategies to increase their ability to provide a continuum of care and services for people living with HIV/AIDS. Based on the valuable lessons that the Comprehensive Healthcare projects learned during the first 2 years of funding, a number of collective recommendations have been made. It is expected that these suggestions will prove extremely useful to other programs that consider offering comprehensive health-care services to people living with HIV/AIDS or other complex medical conditions.
Academic Medical Centers↗
Treatment inside the drug treatment court: the who, what, where, and how of treatment services.
Drug treatment courts provide a new strategy for providing treatment services to offenders within the criminal justice system. With over 400 drug treatment courts in the United States, the courts have evolved to provide treatment services under different models. This article will review the different typologies for delivery of treatment services to drug user offenders in the drug treatment court setting, and it will raise questions about some of the difficult issues underscoring an integrated service delivery model. The paper then identifies some research questions for the future.
Case Management↗
Emergence of a rehabilitation medicine model for low vision service delivery, policy, and funding.
BACKGROUND: A rehabilitation medicine model for low vision rehabilitation is emerging. There have been many challenges to reaching consensus on the roles of each discipline (optometry, ophthalmology, occupational therapy, and vision rehabilitation professionals) in the service delivery model and finding a place in the reimbursement system for all the providers. METHODS: The history of low vision, legislation associated with Centers for Medicare and Medicaid Services coverage for vision rehabilitation, and research on the effectiveness of low vision service delivery are reviewed. RESULTS: Vision rehabilitation is now covered by Medicare under Physical Medicine and Rehabilitation codes by some Medicare carriers, yet reimbursement is not available for low vision devices or refraction. Also, the role of vision rehabilitation professionals (rehabilitation teachers, orientation and mobility specialists, and low vision therapists) in the model needs to be determined. In a recent systematic review of the scientific literature on the effectiveness of low vision services contracted by the Agency for Health Care Quality Research, no clinical trials were found. The literature consists primarily of longitudinal case studies, which provide weak support for third-party funding for vision rehabilitative services. CONCLUSIONS: Providers need to reach consensus on medical necessity, treatment plans, and protocols. Research on low vision outcomes is needed to develop an evidence base to guide clinical practice, policy, and funding decisions.
Delivery of Health Care↗
A tiered model of psychogeriatric service delivery: an evidence-based approach.
BACKGROUND: Previous models of mental health care for older persons have not considered the full spectrum of mental disorders. AIM: To describe a tiered model for comprehensive evidence-based planning of service delivery for mental disorders in late life. METHOD: The model depicts tiers of mental disorders in ascending order of severity and consequent interventions required. RESULTS: Interventions aim both to avert individuals from moving up tiers (prevention) and to move individuals down tiers (treatment). Individuals in the lower tiers have no mental disorders and prevention strategies are targeted at known risk factors. In the middle tiers, individuals with mild-moderate mental disorders will mainly be treated in primary care, often in collaboration with specialist mental health services for older people. Individuals in the top tiers with severe mental disorders usually require institutional care. CONCLUSION: The tiered model provides a basis for planning comprehensive service delivery.
Aged↗
Assertive community treatment of the mentally ill: service model and effectiveness.
OBJECTIVE: To provide a description of the service delivery model of an assertive community treatment (ACT) team in the management of a group of severely mentally ill patients and examine the effectiveness of this team in reducing readmissions to a psychiatric inpatient service. METHOD: A clinical case audit was performed on a single day in September 2001. Admission episodes and duration were collected for patients registered with the team in the 12 month period prior to ACT and for a period of 12 months ending on the day of the audit. Forty-three patients were registered with the team at the time of data collection. The majority (79%) were diagnosed with schizophrenia and there were high rates of comorbidity (76%) and disability (mean Global Assessment of Functioning score 45.9). The main outcome measures were the number of readmissions and readmission days before and after the institution of ACT. RESULTS: The mean number of readmission days reduced from 70.9 to 10.2 (p<0.05) following the institution of ACT. CONCLUSION: Assertive community treatment conducted in a naturalistic clinical environment is effective in significantly reducing the number of readmission days in a group of patients suffering from long-term and persistent severe mental illness.
Case Management↗
Issues for palliative care in rural Australia.
A project funded by the Commonwealth Government's National Palliative Care Program examined rural (non remote) palliative care services in eight rural regions of Australia with the aim of identifying sound service delivery models. The research methodology included, development of a palliative care service baseline, postal survey of all services in the selected regions followed by field examinations, and section of four regions for in depth analysis using interviews and group sessions with medical practitioners, clinicians, former carers and service managers. The research established that patients and carers want palliative care services to first address symptom management and pain control. The service should then place experienced care as the next highest priority, in conjunction with the provision of family supports. Service models should aim to deliver services in the home or in environments which are home-like and located close to families. Research has demonstrated that even the smallest hospitals can incorporate a palliative care unit. Palliative care service planning in rural areas needs to make a distinction between the main provincial city in the region and the rural hinterland as different planning approaches will often apply. Palliative care teams should vary according to the nature of the service catchment. Particular attention should be given to the method of providing palliative care nursing expertise in a region. This project concluded that when active treatment is no longer beneficial, palliative services in rural regions are commonly of a high quality, although access to tertiary services remains as a limitation during the pre-palliative treatment phase.
Australia↗
Implementing home care in Canada: four critical elements.
While MacAdam proposes a "national approach to home care#8221; the obstacles to this are well known and substantial. They are the likely cost and the limitations of the federal government s role in healthcare. Building on MacAdam's assessment, this paper outlines four problems embedded in the various home-care service delivery models in Canada: the lack of factual client outcome information to support decision-making, the limited client choice of provider, the perverse incentive of fee for service and the bias against the for-profit provider. The paper proposes that the assessment, classification and measurement of outcomes for every recipient of home-care services be standardized using a proven assessment instrument, such as OASIS-B or MDS-HC, by healthcare professionals certified in its use. The resulting information would be captured in a regional database and available for analysis and research. CIHI would be contracted to manage a national database and to fund the training and certification of assessors. The paper proposes a new service delivery and funding model, utilizing standard client outcome information, different roles for regional health authorities and service providers, and a prospective payment mechanism replacing fee for service. A national home care program may be an elusive dream, but that shouldn't stop experimentation, evaluation and improvement.
Canada↗
A life needs model of pediatric service delivery: services to support community participation and quality of life for children and youth with disabilities.
This article presents a life needs model of pediatric service delivery that is based on the values of the intrinsic worth, dignity, and strengths of individuals. This developmental, socio-ecological model outlines the major types of service delivery needs of children and youth with disabilities, their families, and their communities within three spheres of life (the personal, interpersonal, and external spheres). The model legitimizes the concept of need, emphasizes the values of family-centered services, and recognizes child and family strengths and capacities. We discuss the utility of this transdisciplinary model in guiding pediatric service delivery to meet the long-range goals of community participation and quality of life of children and youth with disabilities.
Adolescent↗
The Process of Cultural Competence in the Delivery of Healthcare Services: a model of care.
Several models of service care delivery have emerged to meet the challenges of providing health care to our growing multi-ethnic world. This article will present Campinha-Bacote's model of cultural competence in health care delivery: The Process of Cultural Competence in the Delivery of Healthcare Services. This model views cultural competence as the ongoing process in which the health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client (individual, family, community). This ongoing process involves the integration of cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.
Anthropology, Cultural↗
Self-regulating service delivery systems: a model for children and youth at risk.
A conceptual model of self-regulating service delivery is proposed for use by governments, planners, and policymakers to help children reach optimal adult functioning. It addresses most problems of present service delivery and is applicable to children in the general population and registered consumers of mental health, child welfare, special education, drug dependency, and juvenile justice (young offender) services. It has four essential components: (1) outcome measurements that reflect the mental health statuses of children in services and in the general population; (2) regular feedback of these measurements to governments, the public, and service delivery organizations; (3) powerful and significant rewards and incentives for the most desired outcomes to increase their salience and to motivate provider behavior; and (4) decision making that can affect all entities that contribute to the health of children. The evaluable expected benefits are improved mental health for children and greater efficiency within the "system."
Adolescent↗
Selling open access health care delivery to patients and administrators: what's the hook?
A new concept in health care delivery involves the use of Open Access Scheduling for patients. In an attempt to manage spiraling medical costs and patient care demands many medical practices and managed care organizations are looking for alternative delivery models for health care. Open Access Scheduling has been garnering many advocates and converts from past traditional medical service delivery models. Unfortunately, due to its limited penetration into the medical community, little of Open Access' essential characteristics are generally understood. This paper looks at Open Access from the perspectives of: patients, medical administrators, office staff and providers. We discuss the tenets of Open Access, the benefits from its use, its challenges, and the steps necessary to initiate this type of service delivery.
Appointments and Schedules↗
Re-vitalizing public health care systems: a proposal for public competition in Sweden.
This article examines the health policy opportunities presented by building market-style incentives into the structure of a national public health system. The goal is to develop a service delivery model which can achieve simultaneously high levels of patient service, economic efficiency and social responsibility. The article develops its "public competition" approach implicitly, through a detailed case study of the Swedish health care system. The broad theory appears to hold promise for a variety of existing and emerging national public health systems in Europe.
Economic Competition↗
Evaluation of a peer provider reproductive health service model for adolescents.
CONTEXT: The use of peer providers in family planning clinics has been proposed as a strategy that could better serve sexually active adolescent populations. METHODS: Baseline and follow-up survey data from 1,424 female and 166 male adolescent clients of five California community health clinics were analyzed to assess the effectiveness of a peer provider model between 1996 and 1999. Multivariable analyses examined differences in outcomes between clients' first and last clinic visits, and by whether clients received only clinical services or other components of the model (outreach and telephone follow-up) as well. RESULTS: Female clients were significantly more likely at their last visit than at their first visit to report consistent birth control use (odds ratio, 1.9), use at last intercourse (1.8) and use of effective methods (3.5), and were significantly less likely to report consistent condom use (0.7). There were no significant differences in male birth control or condom use between first and last visits. Females who received all components of the model were more likely than those who received only clinical services to return for an annual exam (2.2) and to make three or more visits during the study period (1.7). The full model was particularly effective for females who were Hispanic, had been born to adolescent mothers or had had more than one sexual partner in the six months before their first clinic visit. CONCLUSIONS: The peer provider model appears to be a promising addition to the mix of service delivery models, particularly for certain subgroups of clients. The findings underscore the importance of tailoring programs on the basis of clients' risk profiles.
Adolescent↗
Cluster care: an alternative to traditional care.
Studies of client satisfaction of the Traditional and Cluster Care service delivery models are virtually nonexistent. In an effort to provide healthcare services to Medicaid-eligible elderly home care clients, the New York City Human Resources Administration has implemented a new concept, Cluster Care. Because Cluster Care is probably going to be the wave of the 21st century, nurses need to be creative so that this new model will be more palatable to its recipients.
Aged↗