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This article describes a project involving various stakeholders designed to develop a learning network for care homes in Bristol and the scoping exercise that gave the project team direction.
This article describes the role of the registered childminder in caring for children with disabilities. It explains the community childminding networks that help put parents in touch with appropriate childminders and then provide continuing support to the parents and the childminder. These networks help provide additional tailored training for childminders to enable them to meet the special needs of a particular child. The networks link in with other local authority and health services and may sometime help to fund placements.
We present the development and the evaluation of a Bayesian network for the diagnosis of community-acquired pneumonia. The Bayesian network is intended to be part of a larger decision support system which assists emergency room physicians in the management of pneumonia patients. Minimal data entry from the nurse or the physician, timely availability of clinical parameters, and high accuracy were requirements we tried to meet. Data from more than 32,000 emergency room patients over a period of 2 years (June 1995-June 1997) were extracted from the clinical information system to train and test the Bayesian network. The network performed well in discriminating patients with pneumonia from patients with other diseases. The Bayesian network achieved a sensitivity of 95%, a specificity of 96.5%, an area under the receiver operating characteristic of 0.98, and a predictive value positive of 26.8%. Our feasibility study demonstrates that the proposed Bayesian network is an appropriate method to detect pneumonia patients with high accuracy. The study suggests that the proposed Bayesian network may represent a successful component within a larger decision support system for the management of community-acquired pneumonia.
Since 1993, the HIV/AIDS Program Office of the Broward County Health Department has recognized the importance of targeting the population of those aged 50 years and older. Close examination of epidemiological data for the south Florida area and requests from health care providers showed that targeted intervention had to address the needs of the seniors as well as the beliefs and perceptions of their health practitioners. Originally designed to provide community training, identify and train volunteer peer educators, and increase awareness and sensitivity among providers of health services, the senior initiative was officially expanded with funding from the Florida Department of Elder Affairs in 1997. The resulting Senior HIV Intervention Project (SHIP) is more comprehensive than the original senior training program, addressing the increased need for early intervention activities, HIV counseling, and testing. SHIP also links HIV-positive seniors to care and treatment services through a network of trained staff and volunteers. SHIP's considerable experience in serving the needs of older adults offers useful insight for others developing successful HIV/AIDS programming for people aged 50 years and older.
OBJECTIVE: To describe an infection control network (the Duke Infection Control Outreach Network [DICON]) and its impact on nosocomial infection rates in community hospitals. DESIGN: Prospective cohort study of rates of nosocomial infections and exposures of employees to bloodborne pathogens in hospitals during the first 3 years of their affiliation with DICON. Attributable cost and mortality estimates were obtained from published studies.Setting. Twelve community hospitals in North Carolina and Virginia. RESULTS: During the first 3 years of hospital affiliation with DICON, annual rates of nosocomial bloodstream infections at study hospitals decreased by 23% (P = .009). Annual rates of nosocomial infection and colonization due to methicillin-resistant Staphylococcus aureus decreased by 22% (P = .002), and rates of ventilator-associated pneumonia decreased by 40% (P = .001). Rates of exposure of employees to bloodborne pathogens decreased by 18% (P = .003). CONCLUSIONS: The establishment of an infection control network within a group of community hospitals was associated with substantial decreases in nosocomial infection rates. Standard surveillance methods, frequent data analysis and feedback, and interventions based on guidelines and protocols from the Centers for Disease Control and Prevention were the principal strategies used to achieve these reductions. In addition to lessening the adverse clinical outcomes due to nosocomial infections, these reductions substantially decreased the economic burden of infection: the decline in nosocomial bloodstream infections and ventilator-associated pneumonia alone yielded potential savings of 578,307 US dollars to 2,195,954 US dollars per year at the study hospitals.
Frustrated by high costs, many organizers of community health information networks are tuning to low-cost, easy-to-implement Internet technologies and protocols. Of the 22 broad network initiatives still under way, about half are either planning to build intranets or incorporating Internet technologies on some form.
Detecting community structure is fundamental for uncovering the links between structure and function in complex networks and for practical applications in many disciplines such as biology and sociology. A popular method now widely used relies on the optimization of a quantity called modularity, which is a quality index for a partition of a network into communities. We find that modularity optimization may fail to identify modules smaller than a scale which depends on the total size of the network and on the degree of interconnectedness of the modules, even in cases where modules are unambiguously defined. This finding is confirmed through several examples, both in artificial and in real social, biological, and technological networks, where we show that modularity optimization indeed does not resolve a large number of modules. A check of the modules obtained through modularity optimization is thus necessary, and we provide here key elements for the assessment of the reliability of this community detection method.
Sustainability is a key requirement for partnership success and a major challenge for such organizations. Despite the critical importance of sustainability to the success of community health partnerships and the many threats to sustainability, there is little evidence that would provide partnerships with clear guidance on long-term viability. This article attempts to (1) develop a conceptual model of sustainability in community health partnerships and (2) identify potential determinants of sustainability using comparative qualitative data from four partnerships from the Community Care Network (CCN) Demonstration Program. Based on a grounded theory examination of qualitative data from the CCN evaluation, the authors hypothesize that there are five primary attributes/ activities of partnerships leading to consequential value and eventually to sustainability of collaborative capacity. They include outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages. The context in which the partnership operates provides the conditions for determining the appropriateness and relative impact of each of the factors related to creating consequential value in the partnership.
BACKGROUND: This article reports on the results of a community health project that was implemented in the Dutch municipality of Bergeyk. The major goal was to reduce four cancer-related risk behaviors: smoking, high fat consumption, excessive alcohol use, and exposure to artificial sunlight. A control community received no new intervention. Intervention methods included mass media messages, self-help materials, small group activities, lectures, and structural activities. Community organization principles such as a social network approach, community participation, and intersectoral cooperation were applied in the project. METHODS: Data were collected from both communities among cohort research samples on three occasions using telephone interviews. RESULTS: The results indicate a significant reduction in fat intake in the experimental community. No other significant behavioral effects were found. Further analysis among respondents in the experimental condition showed that those personally exposed to the project as indicated by familiarity with and discussion about the project, had a greater decrease in fat consumption between baseline survey and second post-test than those who were not. Also, the percentage of smokers who quit between baseline survey and second post-test was greater among those who knew about the project than among those who did not. Finally, discriminant analysis was used to further examine the determinants of project exposure. Community involvement, marital status, education, and sex were related to project exposure. CONCLUSIONS: It is concluded that with the time limitations of the project in mind, the findings are encouraging.
This article summarizes the perspectives gained in the course of evaluating a 4-year demonstration program that supported rural hospital networks as mechanisms for improving rural health care delivery. Findings include: (1) joining a network is a popular, low-cost strategic response for rural hospitals in an uncertain environment; (2) rural hospital network survival is enhanced by the mutual resource dependence of members and the presence of a formalized management structure; (3) rural hospitals join networks primarily to improve cost efficiency but, on average, hospitals do not appear to realize short-term economic benefit from network membership; and (4) some of the benefits of these networks may be realized outside of the communities in which rural hospitals are located.
The development of community-based coalitions has acquired great popularity as a health promotion strategy. The Institute of Medicine recommends that community-based health coalitions employ a performance monitoring process in their efforts. The results of the current study indicate that in the community setting, implementing a performance monitoring process and sustaining the specialized functions entailed in this strategy are challenging. Many of the challenges result from fundamental differences between the organizational environment of bureaucracies--in which these techniques are developed, supported, and greatly successful--and the realities of the loosely-structured and resource-limited community environment. The performance monitoring process is measurement-driven. One challenge of implementing this process at the community level is that public health problems of local concern are not always documented in current surveillance systems and thus a performance monitoring strategy is not always, or immediately, applicable. When data which document a health problem of local concern are available, a second challenge facing community-based coalitions is acquiring the resources, especially the wide-range of specialized expertise, required to fully implement and sustain the performance monitoring process. These issues are examined in the context of the Massachusetts Department of Public Health's Community Health Network Area (CHNA) Initiative which entails the formation of coalitions of local health service providers. The CHNA initiative is a statewide project in which health service providers in specified geographic regions work collaboratively on health improvement projects.
Prior research on Mexican migration has shown that social networks and economic incentives play an important role in determining migration outcomes. We use experimental data from PROGRESA, Mexico's primary poverty-reduction program, to evaluate the effects of conditional cash transfers on migration both domestically and to the United States. Our study complements a growing body of literature aimed at overcoming longstanding hurdles to the establishment of causal validity in empirical studies of migration. Analysis based on the data collected before and after the program's onset shows that conditional transfers reduce U.S. migration but not domestic migration. The data also enable us to explore the role of existing family and community migration networks. The results show that migration networks strongly influence migration, but that the effect of conditional transfers on migration is apparently not mediated by existing migration network structures. Our results suggest that conditional transfers may be helpful in managing rural out-migration, particularly to the United States.
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