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PubMedDate not supplied

Clinical service lines in integrated delivery systems: an initial framework and exploration.

The increasing pressures on integrated healthcare delivery systems (IDSs) to provide coordinated and cost-effective care focuses attention on the question of how to best integrate across multiple sites of care. One increasingly common approach to this issue is the development of clinical service lines that integrate specific bundles of services across the operating units of a system. This article presents a conceptual model of service lines and reports results from a descriptive investigation of service line development among members of the Industry Advisory Board--a research consortium comprising IDSs. The experiences of these IDSs (1) provide valuable insights into the range of organizational arrangements and implementation issues that are associated with service line management in healthcare systems and (2) suggest aspects of service line management worthy of further inquiry.

Delivery of Health Care, Integrated↗

PubMed2004

Plaque reduction over time of an integrated oral hygiene system.

This article compares the efficacy of a prototype integrated system (the IntelliClean System from Sonicare and Crest) in the reduction of supragingival plaque to that of a manual toothbrush and conventional toothpaste. The integrated system was compared to a manual toothbrush with conventional toothpaste in a randomized, single-blinded, parallel, 4-week, controlled clinical trial with 100 subjects randomized to each treatment group. There was a low dropout rate, with 89 subjects in the manual toothbrush group (11% loss to follow-up) and 93 subjects in the integrated system group (7% loss to follow-up) completing the study. The Turesky modification of the Quigley and Hein Plaque Index was used to assess full-mouth plaque scores for each subject. Prebrushing plaque scores were obtained at baseline and at 4 weeks after 14 to 20 hours of plaque accumulation. A survey also was conducted at the conclusion of the study to determine the attitude toward the two oral hygiene systems. The integrated system was found to significantly reduce overall and interproximal prebrushing plaque scores over 4 weeks, both by 8.6%, demonstrating statistically significant superiority in overall plaque reduction (P = .002) and interproximal plaque reduction (P < .001) compared to the manual toothbrush with conventional toothpaste, which showed no significant reduction in either overall plaque or interproximal plaque. This study demonstrates that the IntelliClean System from Sonicare and Crest is superior to a manual toothbrush with conventional toothpaste in reducing overall plaque and interproximal plaque over time.

Adolescent↗

PubMed2002

The application accuracy of the NeuroMate robot--A quantitative comparison with frameless and frame-based surgical localization systems.

The NeuroMatetrade mark robot system (Integrated Surgical Systems, Davis, CA) is a commercially available, image-guided, robotic-assisted system used for stereotactic procedures in neurosurgery. In this article, we present a quantitative comparison of the application accuracy of the NeuroMate with that of standard frame-based and frameless stereotactic techniques. The article discusses a five-way application accuracy comparison study. The variables of our comparison and their mean errors are as follows: (1) with the robot in a frame-based configuration, the RMS was 0.86 +/- 0.32 mm; (2) with the robot in the frameless configuration, the RMS was 1.95 +/- 0.44 mm; (3) in a standard stereotactic (ZD) frame-based approach, the RMS was 1.17 +/- 0.25 mm; (4) with an infrared tracking system using the frame for fiducial registration, the RMS was 1.47 +/- 0.45 mm; (5) with an infrared tracking system using screw markers for registration, the RMS was 0.68 +/- 0.26 mm. The study was performed with 2-mm sections of CT scans. These results show that the application accuracy of the frame-based NeuroMate robot is comparable to that of standard localizing systems, whether they are frame-based or infrared tracked.

Equipment Design↗

PubMed2003

Membrane-assisted extractive bioconversions.

This chapter summarizes the use of membrane reactors in extractive bioconversions as process integration systems leading to in situ product recovery. Several membrane reactor configurations are analyzed, taking into account the type of bioconversion, biocatalyst type and location (either in the aqueous phase or in the membrane), membrane chemistry and morphology, solvent (extractant) type and its biocompatibility. Modeling of liquid-liquid extractive membrane bioreactors operation is also analyzed considering kinetics and mass-transfer aspects. The chapter includes examples from the authors' laboratory as well as other published in the field. Both enzyme and whole cell-based bioconversions are considered. Relevant aspects related to the solvent (extractant) toxicity and how the membrane could protect the biocatalytic activity are analyzed. Trends in this field are also given.

Bioreactors↗

PubMed1992

Computer-based image analysis of prostate cancer: comments with emphasis on use of commercially available systems.

This review is concerned with computer-based image analysis (CBIA) in prostate cancer. The emphasis is placed on evaluating extent and grade of prostate cancer. The quest for reproducibility in these evaluations has provided an important area of possible application for CBIA studies. Commercially available CBIA systems allow an opportunity for increased efforts in studying the merits of CBIA in prostate cancer. Many CBIA systems with various capabilities are currently on the market. They can be described as either "general" or "dedicated" CBIA systems and are exemplified by two systems: the Werner Frei Imlab/Imtool (Werner Frei Associates, Venice, CA) and the CAS 200 (Cell Analysis Systems, Inc, Lombard, IL), respectively. "General" systems are composed of individual components with data being stored and analyzed using a personal computer (Werner Frei Imlab/Imtool). "Dedicated" systems are integrated systems, usually with little variability of either software or hardware specifications (CAS 200). It is helpful to be cognizant of the contrasting abilities provided by these two systems when evaluating which CBIA system would be most appropriate for a particular application in the study of prostate cancer.

Humans↗

PubMed2002

The fall and rise of in vivo pharmacology.

Pharmacology is, by definition, the study of the mechanism of action of drugs, and requires a knowledge and understanding of responses to drugs induced both in vitro and in vivo. Such analysis of drug action is needed to transform molecular or cellular discoveries into clinical practice and, equally, to identify the molecular questions that arise from clinical observations. These studies are essential because responses observed in vitro can be magnified, diminished or totally different in the more complex integrated system. However, there is currently a severe shortage of pharmacologists with the skills needed to carry out in vivo studies in medical research, and a diminishing number of academic staff qualified to teach these skills to students. This article explores the reasons for this situation and outlines why in vivo work is vital for the analysis of drug action and for the discovery and development of new therapeutic agents.

Animals↗

PubMed2005

Design of a description language for generating wrapper to collect biological data.

The biological data are scattered in various areas with various formats and they are changing continuously. Therefore, data integration becomes an important issue to provide researcher a dynamic access of data. In the data integration process, the method of extracting heterogeneous data dynamically from the data source is an essential part. Data extraction method using wrapper can provide flexibility and extensibility to an integration system.

Computational Biology↗

PubMed2005

Assessing the quality of preparation for posthospital care from the patient's perspective: the care transitions measure.

BACKGROUND: Evidence that both quality and patient safety are jeopardized for patients undergoing transitions across care settings continues to expand. Performance measurement is one potential strategy towards improving the quality of transitional care. A valid and reliable self-report measure of the quality of care transitions is needed that is both consistent with the concept of patient-centeredness and useful for the purpose of performance measurement and quality improvement. OBJECTIVE: We sought to develop and test a self-report measure of the quality of care transitions that captures the patient's perspective and has demonstrated utility for quality improvement. SUBJECTS: Patients aged 18 years and older discharged from one of the 3 hospitals of a vertically integrated health system were included. RESEARCH DESIGN: Cross-sectional assessment of factor structure, dimensionality, and construct validity. RESULTS: The Care Transitions Measure (CTM), a 15-item uni-dimensional measure of the quality of preparation for care transitions, was found to have high internal consistency, reliability, and reflect 4 focus group-derived content domains. The measure was shown to discriminate between patients discharged from the hospital who did and did not have a subsequent emergency department visit or rehospitalization for their index condition. CTM scores were significantly different between health care facilities known to vary in level of system integration. CONCLUSIONS: The CTM not only provides meaningful, patient-centered insight into the quality of care transitions, but because of the association between CTM scores and undesirable utilization outcomes, it also provides information that may be useful to clinicians, hospital administrators, quality improvement entities, and third party payers.

Adult↗

PubMed2005

Implementation of a water compensator for total body irradiation.

This paper presents the design, implementation, and testing of an integrated system for improving dose homogeneity in total body irradiation (TBI). TBI is a radiation therapy technique that consists in delivering a uniform X-ray dose to the entire body of the patient. Because of variations in patient's tissues thickness and density, achieving a uniform dose over the entire body is one of the major challenges in TBI. The system proposed in this paper, whose main goal is to compensate for tissues heterogeneities, is made up of a translating bed, a linear accelerator, a vision system for body thickness assessment, a dynamically controlled water filter, and a main control unit. The water filter, placed between the X-ray source and the patient, is made up of an array of 70 small water containers (cells). The water level in each cell is controlled in real time, so as to modify the dose distribution both in the transverse direction and in the longitudinal direction. A prototype of the water filter system was implemented and tested, achieving good results in terms of dose uniformity.

Beds↗

PubMed1994

Understanding capitation and at-risk contracting.

New payment methods are driving the formation of integrated systems, but how do these payment plans really work? HSL researched capitation and other forms of at-risk contracting with primary care practices, specialty groups, and hospitals in both second and third generation managed care. Our story clarifies the complexities underlying capitation so leaders can identify the implications for their systems.

Capitation Fee↗

PubMed1995

The physician executive "arrives"--a new generation prepares for the future.

The recent rise in the number of physician executives in the health care industry vividly demonstrates that a genuinely new generation of physician executives is seeking to combine the sensitivity of their clinical skills with the business acumen that today's health care organizations need to prosper and grow. But physicians who are preparing themselves to be selected one day as chief executive officers by hospitals, integrated systems, and managed care organizations should understand that the CEO role is radically different from that of the CEO of a physician practice. The corporate CEO role requires the management of managers and responsiveness to the organization's board. Those who imagine that the corporate CEO role bears any resemblance to the autonomous, independent existence of the practitioner are certain to have a rough time.

Career Mobility↗

PubMed1998

Dialogue. Carve-out or HMO: which will serve public sector beneficiaries better?

We are pleased to have three distinguished and thoughtful participants take part in this issue's Dialogue section. As the healthcare industry changes dramatically, new ideas and different approaches are being aired and debated. The three panelists in this discussion attempt to meet head on some of the problems that presently beset managed care and give us their expertise about the pros and cons of privatization, integrated systems, carve-outs, and carve-ins. They provide examples of steps that are being taken right now and suggest alternative means to achieving a more responsive and equitable system. Dr. Patterson provides an overview of the history of this question. Dr. Stelovich argues for systems that integrate mental health and medical services in a managed care setting and suggests that they provide the mental health patient with better healthcare delivery. Deborah Happ makes the case for the carve-out approach in which behavioral health and physical health services are separated and put under the direction of managed behavioral healthcare organizations (MBHOs). She cites Tennessee's TennCare Partners Program as an example of a successful endeavor and carve-out alternative.

Delivery of Health Care, Integrated↗

PubMed1998

The role of electronic merges in an integrated delivery system.

The electronic-only merge method poses a serious challenge to HIM management for ensuring that all clinical documentation for patient care is provided in a timely manner. The organization must be aware of all of the issues affecting the departments so that informed decisions can be made before, during, and after the project. This approach can be successful with comprehensive planning, meticulous procedures for record retrieval and chart folder updating, and extensive staff training. The proactive, traditional merge approach remains the community standard. However, the reactive, electronic-only merge approach has found a niche and can be a viable, cost-effective option when faced with time and budgetary constraints. However, a combination of these approaches may provide the best solution, depending upon an organization's resources, time requirements, and strategic goals.

Computer Systems↗

PubMed2004

[A cytological study as a part of integrated examinations of patients with the mammary gland pathologies in the ambulatory and clinical settings].

An integrated system of examination of female patients was used to detect the mammary-gland pathologies at the Central Clinic of Russia's Federal Security Service in the ambulatory and clinical settings. Fine-needle aspiration biopsy monitored by ultrasound as well as target aspiration biopsy based on the "Mammodiagnost-400" X-ray unit with the "Cytoguide" stereoscopic attachment (pistol-needle system) were applied to obtain the cell samples in nonpalpable neoplasms of the mammary gland; fine-needle aspiration biopsy without ultrasound monitoring was used in palpable neoplasms. Diagnosis was morphologically verified in all cases. Pathologies of the mammary gland prevailed, within the examinees, at an age of 44 to 53. The number of malignant neoplasms made 7.6% of the total number of examinees. The results of intraoperative cytological examinations correlated, in all cases, with histological conclusions. The final diagnosis was made on the basis of clinical and X-ray examinations and of cytological conclusions. The diagnosis was histologically verified in 40% of cases. According to the data analysis, histological examinations are necessary and should be in the list of diagnosis-verification measures within the system of integrated examinations of female patients with pathologies of the mammary gland.

Adolescent↗

PubMed1995

Emergency medical services for children and pediatric subspecialty practice: a call to action.

For many pediatric subspecialists, their role in the emergency medical services for children system is unclear. However, subspecialists have an affirmative responsibility to contribute to development of a system that integrates consumers and providers from each subsystem. Avoiding fragmentation with an integrated system will yield the best outcome for patients while minimizing resource utilization. Additional roles for the subspecialist include responsibilities for advocacy, for guiding policy decisions and implementation, and for education, quality assurance, and research.

Child↗

PubMed1995

[Neuroimmune interactions in the gastrointestinal tract].

The enteric nervous system and immune system are integrated systems that play an important role in the regulation of gastrointestinal functions. Recent studies suggest a bidirectional interaction between both systems. The relationship is based on the synthesis and release of neuropeptides from immune cells and the receptor-mediated alteration of nervous and immune functions by neurotransmitters and inflammatory mediators. The activity of the enteric nervous and immune system can be modulated by the central nervous system. These psycho-neuro-immuno-interactions are involved in gut inflammation, in functional bowel diseases and in the physiological control of gastrointestinal functions.

Animals↗

PubMed1994

Primary and secondary care integration.

Integration of primary and secondary health care is a goal of the 1993 New Zealand health reforms. Focus groups were selected to raise options and stimulate improved integration between primary and secondary care in the Auckland metropolitan and rural areas. Cooperation, communication, coordination, were considered relevant. Several detailed recommendations were produced. They fell into six groups; (1) liaison committees or meetings, (2) communication, (3) referral admission discharge, (4) joint ventures, (5) horizontal integration and (6) general. A key recommendation was that regional health authorities should fund liaison committees or functions to promote inter provider integration. The findings of the focus groups are placed in context of the wider requirements for integration. These are integrated funding, integrated information systems, integrated purchasing and utilisation management.

Communication↗

PubMedDate not supplied

Decision support and data warehousing tools boost competitive advantage.

The ability to communicate across the care continuum is fast becoming an integral component of the successful health enterprise. As integrated delivery systems are formed and patient care delivery is restructured, health care professionals must be able to distribute, access, and evaluate information across departments and care settings. The Aberdeen Group, a computer and communications research and consulting organization, believes that "the single biggest challenge for next-generation health care providers is to improve on how they consolidate and manage information across the continuum of care. This involves building a strategic warehouse of clinical and financial information that can be shared and leveraged by health care professionals, regardless of the location or type of care setting" (Aberdeen Group, Inc., 1997). The value and importance of data and systems integration are growing. Organizations that create a strategy and implement DSS tools to provide decision-makers with the critical information they need to face the competition and maintain quality and costs will have the advantage.

Decision Making, Computer-Assisted↗