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PubMed2003

Pregnancy--reducing maternal deaths and disability in Sri Lanka: national strategies.

The declining trend in the maternal mortality rate (MMR) from the 1930s to the late 1990s resulted from several strategies implemented within and outside the health sector. Expansion of both field-based and institutional services through the past decades contributed to improved geographical access and provision of 'free' services improved economic access. These led to increased use of antenatal and natal services provided by trained midwives and other personnel followed by improvements in the availability of specialized care and emergency obstetric care. Integration of family planning and other inputs to the maternal health programme has yielded positive results. The role of the private sector is limited to provision of a component of antenatal services. The organization for service provision and an information system made significant contributions towards improvement. The commitment of the health sector to provide services free of charge supported by non-health inputs, especially female education, has enabled Sri Lanka to make gains in maternal health.

Female↗
PubMed2005

HMIS and decision-making in Zambia: re-thinking information solutions for district health management in decentralized health systems.

At the onset of health system decentralization as a primary health care strategy, which constituted a key feature of health sector reforms across the developing world, efficient and effective health management information systems (HMIS) were widely acknowledged and adopted as a critical element of district health management strengthening programmes. The focal concern was about the performance and long-term sustainability of decentralized district health systems. The underlying logic was that effective and efficient HMIS would provide district health managers with the information required to make effective strategic decisions that are the vehicle for district performance and sustainability in these decentralized health systems. However, this argument is rooted in normative management and decision theory without significant unequivocal empirical corroboration. Indeed, extensive empirical evidence continues to indicate that managers' decision-making behaviour and the existence of other forms of information outside the HMIS, within the organizational environment, suggest a far more tenuous relationship between the presence of organizational management information systems (such as HMIS) and effective strategic decision-making. This qualitative comparative case-study conducted in two districts of Zambia focused on investigating the presence and behaviour of five formally identified, different information forms, including that from HMIS, in the strategic decision-making process. The aim was to determine the validity of current arguments for HMIS, and establish implications for current HMIS policies. Evidence from the eight strategic decision-making processes traced in the study confirmed the existence of different forms of information in the organizational environment, including that provided by the conventional HMIS. These information forms attach themselves to various organizational management processes and key aspects of organizational routine. The study results point to the need for a radical re-think of district health management information solutions in ways that account for the existence of other information forms outside the formal HMIS in the district health system.

Decision Making↗
PubMed1998

Utilisation and costs of community mental health services. PRiSM Psychosis Study. 5.

BACKGROUND: The costs and the effectiveness of mental health services need to be evaluated if provision is to be efficient. Service use and costs are described for two geographical areas in south London. METHOD: Service use was measured comprehensively for clients in both sectors for two six-month time periods using the Client Service Receipt Interview. This information was combined with unit costs to calculate service costs. The 'hidden' costs of informal care and unsupported accommodation were also calculated. RESULTS: At baseline significantly more intensive sector clients had in-patient stays but by the follow-up this difference had disappeared. There was significantly more use of supported accommodation in the intensive sector during both time periods. Baseline and follow-up total service costs were significantly higher for the intensive sector. Costs were spread disproportionately and a small number of services accounted for a large proportion of cost. CONCLUSIONS: While the cost at Time 2 was significantly greater in the intensive sector, this was largely due to the high use of supported accommodation. There was some convergence in cost between the sectors over time.

Community Mental Health Services↗
PubMed2004

New points of production: homework and shoemaking in Asia.

Globalization--and the manner in which it has been governed during the last decade--has harmed various public policy infrastructures of developing nations, but especially those in health, social, and environmental sectors. The poorest population suffers the most severe consequences, as production takes place in the "informal" economy and in homes. Work safety and health in the informal economy has not gained the attention it warrants and requires, considering that this "sector" constitutes the majority of the world's labor force. The purpose of this article is twofold: (i) to describe the working environment in home-based shoemaking--based on Indonesian and Philippines experience by Markkanen [1]; and (ii) to examine the research framework proposed by Levenstein and Tuminaro in The Political Economy of Occupational Disease [2] and further developed in Wooding and Levenstein, The Point of Production, 1999 [3]. The field investigation by Markkanen employed this approach to explore how hazardous working conditions and inadequate health protection are the product of complex, converging relationships among diverse "actors" or agents at international, national, community, and shoe industry levels.

Journal Article↗
PubMed2001

Creating portals to quality: how the Internet is changing health care delivery to consumers.

The number of Americans visiting health care sites on the Internet has steadily increased every year. However, while many say the sites are helpful, more are looking to these sites to change from static to interactive--to provide information tailored to their needs, to enhance self-care, to encourage better provider communication, and to aid in lifestyle management. Some health care organizations are beginning to provide new services that promise to give e-health a new look.

Community Participation↗
PubMedDate not supplied

[Private sector health services use in the Omsk region].

The progress made by the private medical sector in different Russia's regions has been uneven. A key share of private medical facilities is concentrated in big cities. The frequency rate of citizens' asking the rural and urban private practitioners for medical care was investigated by the example of the Omsk Region. The dynamic morbidity and the specificity of its structure are described on the basis of the data contained in basic medical registration documents borrowed from private medical institutions. The importance and value of the information-and-analytical cooperation between the private-sector structures, on the one hand, and the healthcare management bodies, on the other hand, are pointed out.

Adolescent↗
PubMed1998

How Pennsylvania hospitals have responded to publicly released reports on coronary artery bypass graft surgery.

BACKGROUND: A Consumer Guide to Coronary Artery Bypass Graft Surgery, published annually since 1992 by the Pennsylvania Health Care Cost Containment Council, compares the outcomes and charges for the state's hospitals and surgeons providing this surgery. To determine whether performance data caused hospitals to change their policies and practices, hospitals were surveyed in Pennsylvania, where the state releases annual coronary artery bypass graft (CABG) outcomes data and, as a control, in New Jersey, where the state does not release these data. METHODS: Key informants representing hospitals, health insurance payers, health maintenance organizations, and purchasers were asked to list specific changes made because of comparative performance data released in public reports. Focus groups were conducted and surveys were then developed and administered to samples of hospitals, payers, and purchasers in both states. RESULTS: The results suggested, for example, that access to performance information encouraged hospitals to implement new approaches to marketing their CABG services. Thirty-eight percent of Pennsylvania CABG hospitals reported using performance information to recruit staff thoracic surgeons and residents, compared with none in New Jersey. For the most frequently initiated changes in patient care, the Pennsylvania hospitals depended on performance information released by a "government agency" to a much greater degree than did the hospitals in New Jersey. DISCUSSION: The results suggest that public release of performance information has encouraged hospitals in Pennsylvania to make changes in the areas of marketing, governance, and clinical care and that the impact of the release of public data on performance was greater in Pennsylvania hospitals than New Jersey hospitals.

Chief Executive Officers, Hospital↗
PubMed2001

An innovative approach to research and development: the CEFRIEL experience.

CEFRIEL (Centre for Research and Training in Information Technology) is a non-profit organization that represents a point of contact among University, Technological Companies and Public Government. Since its foundation in 1988 its goal has been related to the education and the research in Information and Communication Technology (ICT). CEFRIEL constitutes itself in seven areas embracing all the aspects of ICT, from hardware design to software engineering. The enormous number of trained specialized technicians represents the most important result of the Centre: more than 500 specialists and about 100 researchers for the ICT sector. In 1998 CEFRIEL created a new area, the Information and communication TEchnology for Medicine area (ITEM), as the result of the previous positive experiences in the healthcare field. In the last two years the results obtained by the ITEM area show that CEFRIEL's approach could be profitable also in the healthcare sector. These activities represent a natural outlet for the expertise and skills collected and enrich the contents of the training courses through continuous reference to the realities of the Industry and the Service sector.

Italy↗
PubMed2004

Accountability and health systems: toward conceptual clarity and policy relevance.

Improved accountability is often called for as an element in improving health system performance. At first glance, the notion of better accountability seems straightforward, but it contains a high degree of complexity. If accountability is to be more than an empty buzzword, conceptual and analytical clarity is required. This article elaborates a definition of accountability in terms of answerability and sanctions, and distinguishes three types of accountability: financial, performance and political/democratic. An analytic framework for mapping accountability is proposed that identifies linkages among health sector actors and assesses capacity to demand and supply information and exercise oversight and sanctions. The article describes three accountability purposes: reducing abuse, assuring compliance with procedures and standards, and improving performance/learning. Using an accountability lens can: (1) help to generate a system-wide perspective on health sector reform, (2) identify connections among individual improvement interventions, and (3) reveal gaps requiring policy attention. These results can enhance system performance, improve service delivery and contribute to sound policymaking.

Delivery of Health Care↗
PubMed2005

[Infectious disease surveillance based on the Protection against Infection Act in the German public health sector].

By the Protection against Infection Act new instruments were established for infectious disease surveillance in Germany. The main innovations were a shift of responsibility for notifications from clinicians to laboratories, the validation of cases by means of case definitions in local public health departments, and the electronic transmission of single case data via state health departments to the Robert Koch Institute. Four years after the Protection against Infection Act was enacted, its implementation was successful from the perspective of state and national health authorities. This was proven by the detection and successful investigation of several diffuse outbreaks. However, further improvements seem necessary and the following points should be considered in a revision of the act: reduction of time limits for data transmission, unambiguous regulation of responsibilities and for data exchange in non-localized outbreaks as well as for international exchange of case data, and introduction of an obligation for clinicians to supply local public health departments with complementary information regarding laboratory reports on demand. The public health sector can contribute to a further improvement of the surveillance system by working to better inform clinicians and laboratories and therewith motivate them to comply with their obligations for notifying diseases and by promoting the scientific evaluation of the system, in particular concerning potential underreporting.

Communicable Disease Control↗
PubMedDate not supplied

Pressure sore management in the independent sector: 2.

This is the second of two articles looking at pressure sore prevention and treatment in the independent sector of a large northern city. Part one presented background information, details of data collection and analysis, baseline data on current practice and initial conclusions which included an assessment of the extent of evidence-based practice, equipment use, educational needs, patient and informal carer involvement and quality of care maintenance. Part two considers these findings in greater depth. Both positive and negative aspects of pressure sore management in the independent sector are explored. Factors such as the number and types of pressure-relieving equipment used and the lack of independent evidence regarding product efficacy are considered. The survey highlights gaps in educational provision, and the lack of research evidence on certain aspects of care. The article concludes with a detailed series of recommendations with regard to practice, education and research.

Beds↗
PubMed2004

The role of industry in improving quality of life for persons with an ostomy: a Canadian consensus.

Financial and clinical resources (which include 260 enterostomal therapy nurses nationwide) to provide clinical and rehabilitative expertise to the estimated 50,000 to 60,000 Canadians living with an ostomy are limited. Hence, many persons with an ostomy fall through the cracks in the early pre- and postoperative period or are lost to follow-up afterdischarge. Problems and issues related to ostomy management continue to surface throughout their lives. As a result,the time required for rehabilitation is often lengthy, affecting the person's quality of life. The First Canadian Enterostomal Therapy Nurses' Advisory Council consisting of 10 Canadian enterostomal therapy nurses met in February 2004 to identify key issues and concerns for Canadians living the ostomy experience and to identify gaps in information and services available before surgery, during the immediate postoperative period, and as the time from surgery lengthened and patients moved through age-related life issues. The two most important gaps identified were the development of quality, pertinent resources and the dissemination of those resources. The Council also identified potential strategies to bridge these gaps, including utilizing the resources of manufacturer Customer Service departments to follow a communications protocol to provide information to patients, retailers, and providers. Finally, a process map from which individual ostomy manufacturers can build programs and processes for improving patient/provider/manufacturer communication was developed.

Adaptation, Psychological↗
PubMed1987

A program of poison center services to business and industry.

Poison information centers have been developed to serve the poison information, treatment, and prevention education needs of the residents within their regions. These services are generally provided and funded by hospital-based centers. A limited number of centers receive local and state government financial support. In general poison information centers are nonrevenue-generating and rely upon these sources of fiscal support. As cost containment within the health care industry becomes more critical, poison centers are falling victims to budget cuts and even being eradicated in the interest of saving money. The private sector has provided grants to poison centers, but this represents a short term solution to a long term problem--the need for consistent funding. Business and industry have been overlooked as a source of potential revenue. Our poison center has developed an extensive program of services for the private sector. These include providing 24-hour-a-day poison information service on their behalf; developing a workers' right-to-know program; identifying epidemiologic trends with their products, preparing exposure reports; etc. These services are provided for a specific fee which is determined by anticipated call volume, number of products to be included, medical and legal liability, etc. By providing services to the private sector, we have reduced the financial liability of our poison center by over 25%.

Commerce↗
PubMed2001

Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States.

This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, usersatisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.

Attitude of Health Personnel↗
PubMedDate not supplied

[The characteristics of the information support for the process of the state accreditation of public health institutions in Ukraine].

Introduction of novel information technologies in the health system of Ukraine is a requisite condition of enhancing the effectiveness of work of medical bodies, ensuring high-quality medical care. Our objective in this study was to devise a mechanism of information support of the process of state accreditation of the public health institutions. A structural scheme is developed of a uniform information-analytical system for information support of the process of accreditation of medical institutions. An automated information system has been set up at the level of medico-prophylactic institutions, which consists of information-reference and information-analytical subsystems and provides information support for the process of accreditation. Ways are discussed of setting up an information-control system of accreditation using potentialities of the sectoral corporative computer network "Ukrmednet".

Accreditation↗
PubMed2000

Socioeconomic costs of rheumatic diseases. Implications for technology assessment.

OBJECTIVES: To study the socioeconomic impact of rheumatic illness in Sweden and to discuss the consequences for technology assessment studies. METHODS: A cost-of-illness study based on data from official statistics and treatment studies. RESULTS: The total socioeconomic cost was 52 billion Swedish kronor (SEK) in 1994. The imbalance between direct (10% of total) and indirect costs (90 effectiveness of the healthcare sector, the need for new treatment methods, appropriate information systems, and technology assessment studies as well as the institutional arrangements for rehabilitation and basic medical research. CONCLUSIONS: A discussion of solutions for financial cooperation between county councils and regional social insurance offices should be considered. The new biotechnological pharmaceuticals will increase the cost for drugs in health care about 20 times, but the total socioeconomic cost for society may remain at the same level due to a decrease of inpatient costs and indirect costs for loss of production as well as a decrease of transfer payments from social insurance. It is unavoidable that the new pharmaceuticals require priority discussions and active resource allocation in health care and in other sectors of society.

Cost of Illness↗
PubMed2005

Identification of Australians from culturally and linguistically diverse backgrounds in national health data collections.

In multicultural Australia, comprehensive and up-to-date information on ethnicity and health is essential to guide policy and service development in the health sector. Data collected for purposes other than research are a potentially important source of information. This study explored the extent to which indicators of cultural and linguistic diversity are currently included in national health and welfare service data collections, and the data standards employed. We identified and reviewed 44 relevant bodies of work: 7 national data dictionaries, 15 national data sets, 10 national health data collections and 12 national surveys. Each of the large data dictionaries (health, community services and housing assistance) contained several ethnicity-related variables. Immigrant Australians were identified (usually by country of birth, sometimes by language, and occasionally by period of residence or year of arrival) in all the major national health and community data sets, health data collections and surveys. Australian Bureau of Statistics standards and classifications relating to cultural and linguistic diversity were widely used. Researchers, health policy makers and planners should fully exploit these secondary data sources, as well as undertaking or commissioning primary research.

Australia↗