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[A descriptive national survey of 166 Alzheimer health networks].

OBJECTIVE: Assess and describe the organization, operation, and aims of Alzheimer health networks in France. METHODS: Questionnaire sent by post or handed to physicians in France identified as involved in management of Alzheimer patients by Novartis Pharma sales representatives. RESULTS: 166 networks managing Alzheimer's disease (2/3 primarily gerontological and 1/3 specializing specifically in Alzheimer's). In 61.9% of the cases, the physician supervising the network was a hospital staff physician, often a geriatrician (48%). The other member physicians were essentially general practitioners. Several paramedics and social workers also participated. Most networks were organized as not-for-profit organizations. Financial support most often came from the relevant ministries and the health insurance funds. The number of active cases handled by the networks could not be globally assessed. The operating tools for the networks included membership charters, management guidelines and protocols, and shared medical files, but fewer than 30% of the networks used any one of these. The networks had as their primary objectives training and information, patient follow-up and gerontological coordination. These aims were consistent with the goals they felt that had come closest to attaining, i.e., improving the quality and organization of care, sharing information with and training other health professionals, and providing information to the public. Barely one third of the networks had developed an assessment procedure. Among the obstacles to network operations were the participants' lack of availability, the absence of collaboration between professionals, and financial problems. CONCLUSION: Despite the disparity in the quality and exhaustiveness of the data collected, our survey confirmed the diversity and dynamism, but also the lack of formal structure and the difficulties confronted by the Alzheimer networks in France.

Allied Health Personnel↗

Comparison of early performance indicators for screening projects within the European Breast Cancer Network: 1989-2000.

In 1989 the European Breast Cancer Network (EBCN) was established by the first pilot projects for breast cancer screening, co-funded by the Europe Against Cancer programme. We report early performance indicators for these EBCN projects while taking into account their organizational setting. Out of 17 projects in the network, 10 projects from six European countries contributed aggregated data on number of invitations, screening examinations, and breast cancers detected over the period 1989-2000. Results were summarized separately for projects in centralized versus decentralized health care environments. The European Guidelines for quality assurance in mammography screening provided reference values for the performance indicators. The most prominent finding in this study was the higher participation rate in centralized versus decentralized projects (average participation in 1998: 74 versus 33%; P<0.001), whereas the invitation system and screening policy in these projects were similar. Detection rates and characteristics of cancers detected at initial and subsequent screening examinations showed no significant differences between centralized and decentralized projects. Even though early performance indicators for centralized versus decentralized projects were similar, the impact of breast screening on mortality from this disease at the population level will differ since the decentralized projects reach only part of the target population.

Adult↗

Attracting physicians to underserved communities: the role of health networks.

As health networks battle for additional market share and encourage additional Medicaid HMO subscribers to use their physicians and hospitals, more health executives are analyzing proposals of how to attract qualified doctors to practice in poor rural or inner-city communities. Supplying more physicians to those areas by increasing the number of medical schools, expanding the National Health Service Corps (NHSC) program, and allowing more international medical graduates (IMGs) to pursue residency training in the United States have been relatively unsuccessful strategies to improve America's geographic maldistribution of medical manpower. This article focuses on several approaches that health networks might use to increase market penetration and at the same time deliver enhanced health services to the underserved. Health networks may provide eminent leadership in the overall design and governance of soundly conceived Medicaid HMOs; strengthen existing or develop additional community health/primary care centers; interface more effectively with local schools to foster Medicaid HMOs for children of low-income families; and reimburse at "premium rates" primary care physicians who practice in underserved communities. The reluctance of physicians to practice in these areas and of middle-income and upper-income taxpayers, and therefore elected officials, to support increased spending or redirection of funds continue to be major barriers for health alliances to demonstrate willingness to invest additional resources in poor inner-city and rural environments.

Ambulatory Care↗

[Supporting system for regional medical liaison and role of a central hospital].

The current status and future development of the supporting system for regional medical liaison and a role of the central hospital in the network were outlined. One of such supportive systems for regional medical network would be tele-medicine or tele-mentoring that include radiological and pathological diagnoses in distance, tele-surgery, and tele-education. Most of these systems are facilitated in the universities and affiliated hospitals and generally need high-cost communication equipment. Another approach is the information sharing system through the modern telecommunication network. Electronic patient record (EPR) systems are the key to achieving this and currently active in several areas. Since the recent progress in information technology (IT) is astonishing, community-based EPR systems are practical with the capability of clinical information exchange between different institutions and even with patients. The role of a central hospital in these systems must be capacious. Management and continuous operation of the system would be the most important affairs. For extending these supporting systems to the ones working in a broader area, the establishment of a "one ID for one patient" system is crucial. Strict security management of the data base and legal institution for distant medical practice still remain as the future tasks.

Community Networks↗

Pastoral care's role in a reformed system. Pastoral care professionals need to promote the spiritual dimension of healing throughout the continuum of care.

The emerging structure of healthcare delivery is challenging many elements of traditional pastoral care. With these changes, how can pastoral care professionals be on the cutting edge of tomorrow's pastoral care ministry? Pastoral care givers must understand that the individual with holistic needs will be at the center of the reformed healthcare system. All providers will share the responsibility and financial risk of providing high-quality care to each client. Pastoral care departments will need to develop systems to objectively measure the quality of their spiritual and religious care services, as well as patient or client satisfaction. Pastoral care professionals must take the lead in developing a vision of spiritual care that reflects the new paradigm of integrated delivery. They must also share the vision of integrated spiritual care with opinion leaders who can be advocates for an expanded vision of pastoral and spiritual care within the network. Ideally, faith communities should be centers for care, healing, and wellness, with hospitals as extensions of those communities. Within such a network, pastoral care givers can organize programs, workshops, and retreats around spirituality and wellness as part of the faith community's mission. In addition, pastoral care professionals can help clients learn about themselves and their life-styles and make healthier choices. Pastoral care givers need to recognize that within brokenness there is also wholeness, wisdom, and new opportunities. When we are free of our own agenda, we can empower others. Together, with God's grace, pastoral care givers can shape a new future and make it happen.

Chaplaincy Service, Hospital↗

A rural and regional community multi-specialty residency training network developed by the University of Western Ontario.

BACKGROUND: Traditionally, specialty vocational/residency training is totally done in tertiary care university-hospital settings, making it very difficult for specialty residents to learn about the joys and challenges of rural and regional patient care. DESCRIPTION: The University of Western Ontario's Multi-Specialty Community Training Network (MSCTN) was developed to provide specialty residents with the opportunity to do part of their postgraduate vocational training in rural and regional practice settings. The network involves 10 medical school departments/divisions and 7 rural/regional communities. From 1997 to 2004, 174 residents have completed 287 months of rural/regional training. EVALUATION: Residents rated their overall learning experience at 6.41 on a 7-point scale. Nineteen of the 39 graduating residents have chosen to practice in rural and regional underserviced communities. CONCLUSION: Rural/regional specialty postgraduate vocational training rotations can provide excellent learning experiences. Preliminary results indicate that this exposure encourages many specialty residents to establish rural and regional practices.

Data Collection↗

The relationship between social support and adolescent mothers' interactions with their infants: a meta-analysis.

OBJECTIVE: The purpose of this meta-analysis was to statistically summarize the results of independent quantitative studies regarding the relationship between social support and adolescent mothers' interactions with their infants. DATA SOURCES: The following sources were selected from 1980 to 1999: citations from bibliographies of previously located articles, dissertations abstracts, the Social Sciences Citation Indexes, and researchers at a regional conference; online sources used were CINHAL, MEDLINE, ERIC, Psych Lit, and Social Work Abstracts. STUDY SELECTION: Of a potential sample of 31 studies, 14 were excluded because they did not meet the sampling criteria, and 4 were deleted as outliers. The final sample consisted of 13 studies. DATA EXTRACTION: Each study was coded for methodologic and substantive variables, including quality indicators. DATA SYNTHESIS: Most of the studies were cross sectional in design and used a variety of measures. Together, the studies included a sample of 823 mothers. CONCLUSIONS: A medium effect size and a significant relationship between social support of adolescent mothers and their interactions with their infants were established. No difference was found in the relationship when support was provided by the family or through a network.

Adolescent↗

Structuring networks for maximum performance under managed care.

Healthcare providers interested in forming delivery networks to secure managed care contracts must decide how to structure their networks. Two basic structural models are available: the noncorporate model and the corporate model. The noncorporate model delivery network typically has a single governing body and management infrastructure to oversee only managed care contracting and related business. The corporate model delivery system has a unified governance management infrastructure that handles all of the network's business. While either structure can work, corporate model networks usually are better able to enforce provider behavior that is in the best interest of a network as a whole.

Community Networks↗

Volunteer Hospice Network. A grass-roots model for community coalitions.

In 1995, the Hospice Association of America established the Volunteer Hospice Network to promote the growth, diversity, and development of volunteer organizations that serve those who are dealing with life-threatening illness and those who are grieving. Partnerships between these volunteer hospices and Medicare-certified hospices may possibly be a part of the answer to the future of the hospice movement.

Community Networks↗

Creating frameworks for providing services closer to home in the context of a network.

Networks can be used to develop shared frameworks that extend limited specialized healthcare services beyond tertiary level settings to provide services closer to home. This article provides an overview of networks, describes the context and purpose of the Southern Alberta Child & Youth Health Network, reports on early experiences with implementation of an Outreach Services Framework, and discusses implications from a network perspective.

Adolescent↗