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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↗
PubMed2005

Strengthening the HIV/AIDS service delivery system in Liberia: an international research capacity-building strategy.

Liberia's prolonged post-conflict transition has negatively impacted its health infrastructure, including the functioning of its health care delivery system. Considering the current national health crises, a study was conducted to identify research gaps and the need to propose changes for improving the health care delivery system in the country. The study results clearly demonstrated a lack of HIV/AIDS research infrastructure including organizational structure, linkages, leadership, champions, expertise, resources, and policies and procedures. Alignment of research needs and practice, and research use to support HIV/AIDS service delivery programmes in the country was also limited. An international research capacity-building partnership is proposed as an effective planned change strategy to strengthen HIV/AIDS-related research infrastructure and to inform management and practice within the Liberian HIV/AIDS service delivery system. A proposed capacity-building planning model can also strengthen research infrastructure and the production and use of research to positively impact the HIV/AIDS epidemic in Liberia and other developing countries.

Community Health Planning↗
PubMed1995

Older Alabamians System of Information and Services (OASIS): a model Title VII chapter 2 low vision rehabilitation program.

BACKGROUND: Little attention has been paid in the ophthalmic literature to programmatic issues of low vision rehabilitation services delivery. The Older Alabamians System of Information and Services (Project OASIS) is a model low vision rehabilitation program functioning within the state of Alabama. This program is funded through Title VII, chapter 2 of the Rehabilitation Act, Independent Living Services for Older Blind Individuals. The program provides a comprehensive array of independent living services, including optometric low vision evaluation and low vision devices, to persons who are older and blind. Through intergency agreements between various state agencies and private entities, OASIS is able to maximize limited resources and reduce service redundancies. METHODS: Components of the OASIS consortium are reviewed along with outcomes of participants in fiscal year 1993-94. RESULTS: In fiscal year 1993-94 1,114 persons were entered into Project OASIS. Over half (569/1,114) of individuals accepted into the program received traditional optometric low vision rehabilitation services. More than 80% (586/717) of persons were able to achieve their independent living goals. CONCLUSIONS: Through a consortium effort between aging and rehabilitative services, minimal resources have been maximized to allow older visually impaired adults to benefit from comprehensive low vision rehabilitation services.

Activities of Daily Living↗
PubMedDate not supplied

Innovative service redesign and resource reallocation: responding to political realities, mental health reform and community mental health needs.

General hospital mental health programs in large inner city communities face challenges in developing responsive services for populations facing high rates of serious mental illness, substance abuse, homelessness, and poverty. In addition provincial political pressures such as Mental Health Reform and hospital restructuring have caused general hospital mental health programs to reevaluate how services are delivered and resources are allocated. This paper describes how one inner city mental health service in a university teaching setting developed successful strategies to respond to these pressures. Strategies included: (a) merging two general hospital mental health services to pool resources; (b) allocating resources to innovative care delivery models consistent with provincial reforms and community needs; (c) fostering staff role changes, job transitions, and the development of new professional competencies to complement the innovative care delivery models; and (d) developing processes to evaluate the effects of these changes on client.

Community Mental Health Services↗
PubMed1997

Integrating comprehensive adolescent preventive services into routine medicine care. Rationale and approaches.

Relying on therapeutic interventions to address health problems after they occur has proven costly and does not address the need to reduce the number of youth who develop these health problems. Primary care physicians have an important role to play in promoting adolescent health through a strategy of providing health guidance to adolescents and parents, screening, and promoting immunizations. Reducing the health risk behaviors of adolescents is a challenge that is best accomplished with the support of other preventive initiatives. Clinical preventive services should complement and reinforce preventive efforts in schools (i.e., comprehensive school health programs) and communities (i.e., mass media campaigns and health regulations). GAPS recommendations developed by the AMA and recommendations from other groups provide a model for organizing the content and delivery of comprehensive preventive services for adolescents. Physicians and other primary care health providers may use these recommendations to expand the quantity and quality of preventive services they offer to adolescents. Additional information about preventive services and GAPS, including a complete list of the recommendations, dates for future GAPS training, a description of the materials developed to help implement preventive services, other national efforts in adolescent preventive services, and current articles in scientific literature, can be reviewed on the AMA web site (http:/(/)www.AMA-Assn.Org/Adolhlth/Adolhlth+ ++.htm).

Adolescent↗
PubMed2005

Acute service delivery in a police-mental health program for children exposed to violence and trauma.

The Child Development Community Policing Program represents a national model of community-based collaboration between police and mental health professionals for violence-exposed and traumatized children. Administrative data from clinical records of a 24-hour consultation service were examined through stepwise multivariate logistic regression to identify child and event characteristics associated with a direct, in-person response at the time of police contact. Of 2361 children, 809 (34.3%) received a direct, in-person response. Relative to Caucasian children, Hispanic youth were more likely to receive this form of response (OR = 1.36). An acute clinical response was more likely for incidents of gang involvement (OR = 8.12), accidents (OR = 5.21), felony assaults (OR = 2.97), property crimes (OR = 2.30), family violence (OR = 1.53) and psychiatric crises (OR = 1.29). Acute response was less likely when juvenile conduct problems (OR = 0.61), fires (OR = 0.59), child maltreatment (OR = 0.57), and domestic violence (OR = 0.44) were involved. Incidents that were more severe or involved a primary mental health component were related to utilization of intensive CDCP resources.

Adolescent↗
PubMed2002

Identifying and overcoming the barriers to Aboriginal access to general practitioner services in Rural New South Wales.

The Wiradjuri General Practitioners and Aboriginal Health Workers Project aimed to help improve Aboriginal health in central western New South Wales (NSW) by identifying and overcoming the barriers to the Aboriginal population's access to general practitioner services. The central strategy of the project was to convene three rounds of consultative meetings in five towns: Bathurst, Orange, Cowra, Forbes and Condobolin. These meetings brought together Aboriginal community members, general practitioners and Aboriginal health workers to express and define local issues and problems, and to propose solutions. The solutions included general practitioner outreach clinics, a focus on prewinter immunisation, bulk-billing of Aboriginal patients, Aboriginal cultural awareness training for all general practice personnel, employing Aboriginal staff in general practice, and closer professional interaction between general practitioners and Aboriginal health workers. Most participants evaluated the meetings as positive and constructive. The project substantiates the perceived need for alternative models for the funding and delivery of general practitioner services to Aboriginal communities.

Community-Institutional Relations↗
PubMed1987

Leadership training in UAFs supported by the Division of Maternal and Child Health.

University Affiliated Facilities (UAFs) were established to promote improved care for mentally retarded and handicapped children and their families. Specifically, they are charged with the interdisciplinary training of professionals who provide leadership within their respective disciplines and, thus, impact a greater service delivery system. A definition of leadership training and two potential models for implementation within the UAF system are developed. Data available for FY 1983-1984 indicate the UAFs funded by the Division of Maternal and Child Health (DMCH) trained 3,450 graduate or post-graduate students. Preliminary estimates indicate that approximately 25% of long-term UAF trainees eventually fill positions of leadership within the service delivery system. More systematic assessment of the impact of UAF training is suggested.

Administrative Personnel↗
PubMed1994

Perioperative nursing model redesign.

The Surgical Services Division at a university hospital has created a patient delivery system that integrates the TQM values: continuous improvement, shared governance and staff empowerment. A divisional shared governance model includes specific roles for several councils: departmental shared governance, clinical practice, professional practice and systems. This model has promoted a proactive, monthly approach to quality assessment and improvement, compared to the traditional quarterly review.

Decision Making, Organizational↗
PubMed1996

HealthSouth's integrated service model: a case study.

The HealthSouth Corporation's St. Louis, Missouri, provider network is a forward-looking example of an alternative approach to integrated delivery. Patients are served through a continuum of care weighted toward outpatient services.

Ambulatory Care↗
PubMed2002

Chronic illness care as a balancing act. A qualitative study.

OBJECTIVE: Current health care reforms aim to assist general practitioners in providing chronic illness care. This study investigates GPs' models of care including their role and responsibilities and their delivery of care models. METHODS: Sixteen GPs, as key informants representing diverse backgrounds, were interviewed about their general chronic illness care and responses to case vignettes. Thematic analysis was based upon the categorizing of GP interviews. RESULTS: The key responsibility in GP models of care was to address the presenting problem and to manage disease and treatment. Models encompassed providing preventive and psychosocial care; and care coordination, but in relation to need as time permitted. Experience and education, rather than reforms and incentives shaped care models. While patient-centredness was a universal theme, gender and location influenced its implementation. Care delivery was an individualized balance of patient needs with other pressures over a series of consultations. DISCUSSION: General practitioners balance models of care with organisational and resource constraints in everyday consultations. Consistent common models of care are subjected to a wide range of influences and translated into varied modes of service delivery and presumably patient outcomes. CONCLUSION: Reforms to improve outcomes for people with chronic illness must address GP care models and adaptive balancing of needs and resources and recognise internal and external constraints that encroach upon patient centred comprehensive care. Policymakers need to research and consult in order that reforms can realistically facilitate care.

Adult↗
PubMedDate not supplied

Fixed values and a flexible partial hospital program model.

Since the 1990s, societal and economic factors have constrained mental health care service delivery in the United States. Partial hospital (PH) programs have been presented with the challenge of using limited resources to treat complex patients in very short time frames; yet predominant psychosocial models and evidence-based treatment approaches have not adjusted sufficiently to the combined demands of patient care and the new health care environment. An updated PH model can advance existing psychosocial theory and practice. The basic assumption of the model is that both clinical and organizational aspects of a PH program must be inherently adaptable to maintain consistent effectiveness. The set of fixed values described here are instrumental in establishing priorities, guiding decision making, and creating a proactive, flexible organization. These values are drawn from the history of psychosocial and milieu treatments from the 1930s to the present and from assumptions and practices of cognitive-behavioral therapy, and are augmented by insights from psychodynamic psychiatry, business management, and leadership. The PH treatment approach aims to translate evidence-based cognitive-behavioral treatments into pragmatic interventions with emphases on psychoeducation and skills training. The context is brief treatment (i.e., one to two weeks) for mood, anxiety, and personality disordered patients in a private sector, managed care environment. Elements of this model may be generalized to inpatient, residential, and intensive outpatient programs, as well as to those that are starting up or being reorganized.

Ambulatory Care↗
PubMed1994

Integration of primary care dental and medical services: a pilot investigation.

During the past decade the development of primary care medical services has been based on the medico-social model of health care delivery and this has resulted in the creation of the primary care team. These changes have so far not involved the general dental services. It was therefore decided to test the potential for coordination and integration of general dental practice in the primary care services. This started by examining a general medical and a general dental practice, occupying the same site, but functioning separately. Around 24% of patients were common to both practices. The initial data collected from a pilot study have been analysed and assessed in relation to patient attendance, record systems, staff cooperation, screening programmes, health promotion, patient referrals and staff education. The potential of this model for improving patient care and targeting the pre-school, middle-aged and elderly is described. It is concluded that coordinated primary care dental and medical services is an important area for further health services and educational research.

Dental Care↗
PubMed1997

The association between program characteristics and service delivery in assertive community treatment.

The authors describe the relationship between service intensity and staffing, organizational, client, and site characteristics in 19 programs based on the Thresholds Bridge adaptation of the assertive community treatment (ACT) model. Pearson correlations were examined between 14 program characteristics and intensity of ACT services. Several staffing and organizational attributes were related to service intensity: larger team size, shared caseloads, greater supervisor involvement in direct client services, and assignment of primary responsibility for the client to the team. The potential facilitating relationship between several aspects of team operation and intensive services is discussed as are implications for local implementation of ACT.

Community Mental Health Services↗
PubMedDate not supplied

Tailoring pattern of pastoral care. Five models for achieving quality.

Facilities can restructure pastoral care delivery in a number of ways without sacrificing quality. Five models for pastoral care services attempt to define and evaluate what "quality" in pastoral services means: The departmental model offers a formal pattern of defined relationships within the pastoral care department and requires a certified director and properly trained and certified staff. The shared services model provides for one pastoral care director serving several facilities in close proximity. A pastoral services advisory council, consisting of community members, identifies and recruits pastoral care staff, participates in program development and implementation, and creates appropriate models of evaluation. In the contractual services model, members of local churches or organizations with trained ministers contract to provide pastoral care. The pedagogical model employs either a certified clinical pastoral education supervisor or a trained pastoral professional who educates and supervises pastoral care staff and students. The model of pastoral care delivery must fit a particular facility or community's needs and finances, with an honest, fair, and qualitative assessment of a facility's pastoral care strengths and weaknesses together with an acknowledgement and realization of pastoral care trends.

Chaplaincy Service, Hospital↗
PubMed1998

Assessing the performance of community systems for children.

OBJECTIVE: To present a framework for measuring the quality of community systems for children, based on key attributes of systems performance for children's services. We present a research agenda for refining the model, evaluating indicators across the performance domains identified, developing normative standards for performance, and assessing the empirical basis for performance criteria. PRINCIPAL FINDINGS: Systems performance can be measured. A systems approach to evaluating community systems for children needs to incorporate the multilevel service delivery networks, programs, and systems of care for children. A model of community systems performance for children includes key dimensions of structure, financing, and accountability. Attributes within these dimensions serve as indicators that communities can use to evaluate systems quality. Performance standards can be based on the evidence from field demonstrations as well as from normative assessments. RECOMMENDATIONS: The model of community systems performance should be refined and developed using empirical findings of analyses of children's systems. A set of indicators that capture vital aspects of performance and that are relevant, scientifically valid, and feasible should be developed and tested in field studies. Once indicators are evaluated for use in performance monitoring, communities will be able to implement performance monitoring.

Child↗