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Results for “Service delivery models”

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At least 739 records · Page 41Linked to original sources
PubMed1992

Models of healthcare delivery in cancer pain management.

The delivery of pain management services to patients with cancer varies across healthcare settings. Identification of areas common to successful programs would be helpful to healthcare professionals developing or restructuring their own programs. The delivery of pain management services in six different systems is described with respect to organizational structure, service process, and essential components. Three elements common to successful programs are identified: (1) team effort and coordination, (2) provision of education, and (3) accountability and administrative support. The authors conclude that these three elements are critical to the delivery of pain management services across healthcare settings.

Health Personnel↗
PubMed1999

Training family practice residents in psychiatry: an ambulatory care training model.

OBJECTIVE: To demonstrate the importance of providing psychiatric training to primary care practitioners in ambulatory care settings. Additionally, to describe the model used for this purpose in the Department of Psychiatry and Behavioral Sciences of the University of Texas Medical School at Houston in order to further stimulate educational opportunities on this topic. METHOD: A review of the psychiatric curriculum offered to family practice residents during their PGY-2 year one-month rotation in psychiatry at the University of Texas Mental Sciences Institute is provided. Emphasis is given to key areas of the curriculum such as: knowledge, skills, and attitude development. Special focus on the clinical and educational experiences is also offered for the purpose of providing unique perspectives about the curriculum methodology. RESULTS: The careful assessment of the feedback obtained from the family practice residents who were exposed to this ambulatory training model demonstrates that this type of setting was satisfactory for the teaching of psychiatry to primary care residents. CONCLUSIONS: Primary care residents have always treated a large number of psychiatric patients. Given the current status of our health care system, primary care practitioners should have even a greater role in the future delivery of psychiatric services. In this article, we offer a model of training for primary care residents in psychiatry, which emphasize cost-effectiveness, high quality of care, and ambulatory care settings.

Academic Medical Centers↗
PubMed1996

The cost of coverage: rural health insurance in China.

China has undergone great economic and social change since 1978 with far reaching implications for the health care system and ultimately for the health status of the population. The Chinese Medical Reform of the 1980s made cost recovery a primary objective. The urban population is mostly protected by generous government health insurance. A high share government budget is allocated to urban health care. Rural cooperative health insurance reached a peak in the mid-1970s when 90% of the rural population were covered. In the 1980s rural cooperative health insurance collapsed and present coverage is less than 8%. The decline has been accompanied by reports of growing equity problems in the financing of and access to health care. This article is the first in a four-year study of the impact on equity of the changes in Chinese health care financing. The article examines the relationship between rural cooperative health insurance as the explanatory variable and health care expenditure, curative vs. preventive expenditure and tertiary curative care expenditure as dependent variables using a natural experimental design with a 'twin' county as a control. The findings support the hypothesis that cooperative health insurance will induce higher growth of health care expenditure. The findings also support the hypothesis that cooperative health insurance will lead to a shift from preventive medicine to curative medicine and to a higher level of tertiary curative care expenditure. The empirical evidence from the Chinese counties is contradicting World Bank health financing policies.

China↗
PubMed1983

The itinerant health worker: an experiment in rural health care delivery.

A model of rural health-care delivery employing itinerant health workers has been presented. Itinerant workers, whose role is principally community organization and technical assistance to village health committees in matters of environment health and endemic disease control, are suggested as an interim measure for strengthening village social structures in preparation for the eventual emergence of village health workers. The effectiveness of the model is reflected in the multiplier effect on the number of organized villages, the diffusion of the model to other parts of the Cameroun, and the impact on policy-making. The efficiency of the model, however, may be limited by such questions as budget for transport and per diem expenses and more seriously the limitation on training facilities. A deliberate allocation of budget to overcoming these obstacles is suggested as important to bringing the advantages of the model to the entire rural population.

Allied Health Personnel↗
PubMed1995

Continuing care retirement communities: prospects for reducing institutional long-term care.

Continuing care retirement communities (CCRCs) combine housing and long-term care (LTC) services, including personal and nursing home care. The amount of LTC that is prepaid varies by type of CCRC, with one-third offering extensive (fully prepaid) contracts for LTC. CCRCs are a potentially promising model for LTC delivery because they offer a full continuum of services and can substitute less expensive supportive care for institutional care. Using data on CCRCs, we tested one central hypothesis: Provision of supportive services, particularly when combined with capitation, reduces use of nursing home care. To test this hypothesis, we studied the effect of various contract types for LTC services offered by CCRCs and provision of support services on utilization of nursing home and personal care units. Compared with other types of CCRCs, those offering completely prepaid LTC coverage reduced use of nursing home care by 13 percent and personal care by 5 percent. CCRCs with prepaid LTC coverage did not use more stringent health screening at entry, so "cream-skimming" does not appear to explain this result. However, affordability is an important issue: CCRC residents with extensive contracts were wealthier than were other CCRC residents.

Aged↗
PubMed1994

Analysis, requirements and development of a collaborative social and medical services data model.

In any medical and social service setting, patient data must be readily shared among multiple providers for delivery of expeditious, quality care. This paper describes the development and implementation of a generalized social and medical services data model for an ambulatory population. The model, part of the Collaborative Social and Medical Services System Project, is based on the data needs of the Baylor College of Medicine Teen Health Clinics and follows the guidelines of the ANSI HISPP/MSDS JWG for a Common Data Model. Design details were determined by informal staff interviews, operational observations, and examination of clinic guidelines and forms. The social and medical services data model is implemented using object-oriented data modeling techniques and will be implemented in C++ using an Object-Oriented Database Management System.

Adolescent↗
PubMed1989

Overview of alcoholism treatment: settings and approaches.

The alcoholism treatment service delivery system is described in terms of facility characteristics, funding, and demographics of clientele served. A brief discussion of the "Minnesota Model," the most pervasive therapeutic approach to alcoholism in the United States is then offered. The article concludes with a synopsis of key research findings and current public debate issues which may impact the future delivery of treatment services to alcoholics.

Alcoholism↗
PubMedDate not supplied

Alternative models in the delivery of primary and secondary prevention programs.

Despite the strong scientific evidence supporting the effectiveness of cardiovascular risk reduction interventions, their application is inconsistent across medical care settings and patient groups. Traditional approaches have been largely ineffective. Thus, there is an urgent need to develop and implement innovative approaches that provide persons with or at risk for coronary heart disease effective risk reduction interventions that are accessible and affordable. Advanced practice nurses and community health workers providing care as members of multidisciplinary teams have been successful strategies for improving outcomes. This paper describes the evidence supporting these alternative models and suggests strategies for the delivery of such programs for the primary and secondary prevention of coronary heart disease.

Cardiovascular Diseases↗
PubMed2006

[Implementation of the multi-center basis documentation CL-BaDo for conciliar and liaison services: generating data for internal quality management and cost calculation].

In the German DRG system the funding of CL services is not ensured. The documentation of psychiatric comorbidity and CL care delivery is a pre-condition to the development of funding models for CL-services. A task force of several German psychosomatic associations (German College of Psychosomatic Medicine, German Society of Psychosomatic Medicine and Psychotherapy, General Medical Society for Psychotherapy) developed a new documentation form for CL-services (CL-BaDo). The pilot study explored the multicenter implementation of CL-BaDo and the use of the documentation form for quality management and cost calculation. Over a period of at least three months, participating CL-services documented all CL cases consecutively with the CL-BaDo. One site applied full electronic data processing. 2116 CL cases from eight psychosomatic CL-services were analysed. The CL-BaDo is a time-efficient, feasible and acceptable documentation form for CL-service delivery. The full electronic data processing enables networking with a hospital information system to produce higher data quality. The data of CL-BaDo can be used locally for quality management, development of management strategies and communication with consultants, as well as nationwide for health policy questions and research.

Austria↗
PubMed1990

Implementing preventive services. Success and failure in an outpatient trial.

Physicians endorse prevention but provide only low levels of screening, health counseling, and immunization. Between 1981 and 1986, a randomized controlled trial was conducted at the Seattle (Wash) Veterans Affairs Medical Center to assess the effectiveness of the following three methods of delivery of preventive services: (1) a physician-oriented model that includes education and motivation, a chart flowsheet listing recommended activities, and periodic feedback about performance; (2) a patient education model in which patients were mailed an informative brochure advising them to ask physicians for preventive services as depicted in a patient-held pocket guide; and (3) a health promotion clinic that patients were invited to attend. A control group received their usual care. A total of 1224 male outpatients were enrolled in the trial. Baseline prevention rates for 12 age-specific prevention activities were below 25%. Neither the control group rates during the 5-year trial nor the rates for the two educational models, either singly or as a combined intervention, changed. Only the health promotion clinic model was effective, tripling prevention rates in its first year and sustaining these levels for all 5 years. It is difficult to change the clinic roles of experienced physicians and their long-term patients in a specialized multiclinic setting. Providing a separate health promotion clinic option is popular with patients, bypasses gatekeeper barriers, is reasonable in cost, and warrants wider application.

Adult↗
PubMed1997

Evaluating performance and change in mental health systems serving children and youth: an interorganizational network approach.

Planning for the delivery of community mental health services has evolved from models of services within individual agencies to community-wide systems of care, but development of methodologies for assessing system performance has lagged behind. This article presents one approach to system-level assessment by viewing children's mental health systems as an interorganizational network. Data are presented on two county-based child mental health systems in North Carolina that participated in the Robert Wood Johnson Foundation Mental Health Services Program for Youth. Site-specific data on client referrals, fund exchanges, and information flows were collected at two time points (1991 and 1993) to measure the cohesiveness and concentration of the service system using network k-core analyses. In addition, stakeholder ratings of service adequacy, quality, availability, coordination, and overall demonstration project goal attainment were obtained at both time periods. Findings indicate that the rural system was outperforming the urban system at the time of the first survey, but the urban system caught up over the study interval. There was high agreement between the network and stakeholder ratings of system performance at both time periods. The method of data collection and analysis used in this study provides tools that can be used in a variety of settings to assess service system growth and development.

Adolescent↗
PubMedDate not supplied

The role of the speech-language pathologist with hearing-impaired infants.

The educators of the deaf, the audiologists, and other similar professional groups appear to have reasonably clearly delineated roles to play in the management of the hearing-impaired child. Not so with the speech-language pathologist. This paper specifies such a role and offers a model for the delivery of speech-language pathology services to the hearing-impaired infant.

Child Development↗
PubMed1996

Why don't nurses delegate?

Restructuring clinical services to a team-based model of care delivery relies on the registered nurse's ability to effectively delegate and supervise team members. The authors define issues and leadership actions necessary for successful restructuring projects that optimize the registered nurse professional role and achieve economic benefits.

Attitude of Health Personnel↗