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PubMedDate not supplied

Six challenges in measuring the quality of health care.

Quality monitoring is becoming an accepted method for purchasers, patients, and providers to evaluate the value of health care expenditures. Important advances in the science of quality measurement have occurred over the past decade, but many challenges remain to be addressed so that quality monitoring may realize its potential as a counterforce to the demands of cost containment. This paper describes six such challenges (balancing perspectives, defining accountability, establishing criteria, identifying reporting requirements, minimizing conflict between financial and quality goals, and developing information systems) and proposes some ways in which the public and private sectors might collaborate to respond effectively.

Cost Control↗
PubMed1996

[Internet network and cancer].

Internet is a tool allowing a wide distribution of information. Initially reserved to the field of scientific research, it develops currently in many sectors of the socio-economic life and saved the area of the health. Each day appear new services allowing the access to the information on the diagnostic and treatment of different pathologies. Patients and physicians share their knowledge and their information, through newsgroups and electronic mail. This paper presents the Internet and cancer resources to allow clinicians and researchers a rapid access to the relevant information.

Computer Communication Networks↗
PubMedDate not supplied

From cooperation to competition in national health systems--and back?: impact on professional ethics and quality of care.

Ethical behaviour in health workers is the jewel in the crown of health services. Health system policies need to nurture a professional service ethic. The primary health care policy envisioned a national health system led by the public sector and based on a philosophy of cooperation. A common theme of 'health sector reform' in OECD countries, introduced in the context of neoliberalism, has been the use of 'managed competition' to increase efficiency. Some countries that flirted with health system competition have returned to cooperation. Market relationships tend to be oppositional and to stimulate self-seeking behaviour. Health system relationships should encourage patient and community centred behaviour. The World Bank and bilateral donors have exported health sector reform theories from the north to the south, involving privatization and marketization policies. This is despite the lack of evidence on their desirability or feasibility of implementing them. Private health care has increased in many developing countries, more as a result of economic crisis and liberalization than specific health sector reforms. Much of this private practice is unlicensed and unregulated, and informal privatization has had a damaging effect on health worker ethics. The lead policy should be reconstruction of the public health system, involving decentralization, democratization and improved management. Commonsense contracting of an existing private sector is different from a policy of proactive privatization and marketization. Underlying the two approaches is whether health care should be viewed as a human right best served by socialized provision or a private good requiring governments only to correct market failures and ensure basic care for the poor. It is a matter of politics, not economics.

Cooperative Behavior↗
PubMed1998

Health care quality: from data to accountability.

The many audiences for information about the quality of health care have different and sometimes conflicting interests and priorities. This is reflected in the diversity of current efforts to use health care data to identify, measure, and demonstrate quality. The author surveys three of these approaches in depth: (1) the professional approach, which relies on the actions of private-sector accreditation groups, trade associations and health plans, hospitals, and other providers to assure quality; (2) the market-driven approach, which relies on the use of quality data by health care purchasers and consumers in choosing plans and providers; and (3) the public-sector approach, which relies on the regulatory, oversight, and purchasing actions of government at the federal, state, and local levels to assure quality. The author concludes that efforts to measure and report the quality of health care invariably confront a variety of technical and political issues. Several observers maintain that it is more important for participants in quality issues to reach consensus on the issues than to reach technical perfection in the way the data are handled. Important obstacles in the technical realm include inadequate investment in sufficiently sophisticated and compatible information systems and the fact that where such systems are in place, they generally cannot be linked. But efforts, both technical and legal, are under way to overcome these obstacles. Even so, some of the issues of health care quality will remain moving targets because of constant changes in the health care environment and in technology. The author closes with the hope that the various actors within the health care industry may coordinate their efforts in dealing with these issues.

Accreditation↗
PubMed1995

ATSDR's information databases to support human health risk assessment of hazardous substances. Agency for Toxic Substances and Disease Registry.

The American public, like persons in many other nations, is concerned about the potential adverse impacts of uncontrolled hazardous wastes. The concerns are often predicated on the fear that adverse health effects will occur because of releases of hazardous substances into community environments. To respond to these concerns, government agencies and private sector organizations must rely on credible, accessible, up-to-date information databases. These databases should be relevant to the needs of the people who respond to uncontrolled releases of hazardous substances. Of particular importance are databases that profile the toxicity of hazardous substances and other information useful to physicians and other health care providers. This paper describes how the federal Agency for Toxic Substances and Diseases Registry (ATSDR) has developed several toxicologic and human health information databases under mandates in the Superfund statute for responding to the public's concerns about hazardous substances.

Databases, Factual↗
PubMed2006

Patterns of fatigue among seafarers during a tour of duty.

BACKGROUND: Work-related fatigue is associated with sickness absence and mental and physical health problems, and may increase the risk of accidents and injuries at work. Relatively little is known about fatigue among seafarers, particularly during a tour of duty. The aim of this study was to describe the pattern of day to day fatigue among seafarers during a tour at sea. METHODS: Participants from the offshore support, short sea and coastal, and deep sea sectors of the UK shipping industry completed daily diaries. Information about sleep and fatigue was collected each day on waking and retiring. RESULTS: Fatigue on waking was a more sensitive measure of cumulative occupational fatigue than fatigue on retiring. Fatigue on waking increased between the start and end of tour. This increase took place in particular during the first week at sea, and was most apparent among those on shorter tours of duty. CONCLUSIONS: Day to day changes in fatigue are measurable, and may vary among particular sub-groups of seafarers. Used among larger groups, such a diary method could help identify times and activities associated with the greatest risk.

Absenteeism↗
PubMed1995

New directions in dietary studies in cancer: the National Cancer Institute.

Through an orderly sequence incorporating epidemiologic and laboratory research, human clinical/metabolic studies, and clinical intervention trials, the NCI develops and maintains cancer prevention and control programs that are directed toward the overall goal to reduce cancer incidence, morbidity, and mortality. Epidemiologic studies have shown correlations between consumption of numerous dietary constituents and cancer risk. Results of in vitro and animal studies have reinforced many of these epidemiologic associations and data from clinical/metabolic studies are being used to evaluate the relevance of these associations in humans. Although much remains to be learned about the influence of specific dietary constituents and dietary patterns on cancer risk, it is clear that diet can have a significant impact in cancer prevention and control. Investigations on the cellular and molecular effects of dietary constituents, as well as their metabolic and physiologic effects should provide better insight on the mechanisms of action of these dietary constituents. There also is a need to develop biomarkers of dietary intake that could be used to monitor compliance in intervention studies, as well as biomarkers as clinical trial endpoints that can be used to predict the emergence and progression of cancer. Working with other agencies and the private sector, the NCI will continue to design and implement information programs that translate the knowledge gained from these diet and cancer prevention studies to help Americans adopt dietary patterns that may reduce cancer risk. Continued emphasis will be placed on intervention programs targeted toward high-risk and underserved segments of the U.S. population in an effort to reduce the high incidence of cancers in these groups.

Animals↗
PubMed1996

Current good manufacturing practices for transfusion medicine.

Transfusion medicine is most tightly controlled in the US by CGMPs that are written as regulations, guidances, and quality management documents. Because the US regulatory scheme requires that each unit of human blood donated for transfusion (and other purposes) be documented from the moment of donor registration until the last component of that donation is finally disposed of, there is precious little that remains solely within the discretion of the treating physician who orders transfusions for her or his patients. An additional complication for transfusion medicine specialists is that the search for the requirements must extend to all possible areas of information, including the possibly unexpected source within the private sector.

Blood Banks↗
PubMed2002

Rural urgent care models: what are they made of?

The study aimed to identify the elements that constitute rural urgent care systems. Participation in the study was sought from health professionals, welfare and emergency services sectors, and community members. Primary data were collected from informants through interviews and focus groups in five rural communities of different sizes. Twelve common elements to rural urgent care systems were identified and divided into two categories: (i) infrastructure; and (ii) personnel. Infrastructure included organisational support, community support, transport, communication and coordination processes, facilities and equipment, and community knowledge and information. Personnel included nurses, doctors, community leaders, health and welfare professionals, emergency service workers and ambulance officers. The study's major outcome was the recognition that rural urgent care systems consist of a balance of interrelated elements. These elements are context driven, with geographical, social and economic environments having a substantial impact on the ability of rural communities to develop and sustain their urgent care systems.

Ambulatory Care Facilities↗
PubMed1996

The adaptability of the health promoting schools concept: a case study from Australia.

The adoption of the concept of the health promoting school internationally indicates that it is a timely and flexible concept that can be utilized by different countries to accommodate their particular contexts. Political, economic and socio-cultural factors are powerful forces that shape the construction of health promoting schools globally. How some of these factors operate will be exemplified through a description of the health promoting school movement in Australia with commonalities and variations with activities in member countries of the European Network of Health Promoting Schools highlighted. The unique role globally of the Australian Health Promoting Schools Association, as a non-government organization specifically established to promote the concept of the health promoting school, is described. Its contribution is as a neutral body representing diverse interests that can advocate in different settings and at all levels of influence. Additionally it provides a mechanism for networking, awareness raising and information exchange. The structure of the health and education sectors in Australia has shaped the conceptualization of a health promoting school, one that accommodates the country's specific context. Barriers, facilitating factors and challenges that exist for future work in the area are described.

Australia↗
PubMed2002

Spatial distribution and density of prefrontal cortical cells projecting to three sectors of the premotor cortex.

The spatial distribution of prefrontal cortical cells projecting to three different sectors in the premotor cortex was examined. The cells projecting to the three sectors were distributed in separate regions in the dorsolateral prefrontal cortex with a small overlap. Cells projecting to the ventral sector were distributed in the lower bank of the principal sulcus (PS). Those projecting to the restro-dorsal sector were located near the superior limb of the arcuate sulcus, and in the dorsal convexity and upper bank of the PS. Cells projecting to the caudo-dorsal sector were observed in the upper bank of the PS and in the area 8a. These findings suggest that each of the three sectors of the premotor cortex receive different sets of information from the prefrontal cortex.

Amidines↗
PubMed1995

Nursing in nosocomial infection control in Spain.

This is a descriptive study of nursing practices in nosocomial infection control (NIC) in Spain. During the period 1990-1991, a questionnaire, adapted from that used in the Study on the Efficacy of Nosocomial Infection Control (SENIC), was mailed to all Spanish general hospitals, public and private, having more than 400 beds, and to all those in the public health sector having more than 100 beds. Nursing-related information was selected for analysis from each of three sections: staff, surveillance systems and programmes. The response rate was 70%. While nursing resources allocated to NIC in Spain registered an overall ratio of nosocomial infection control nurses (ICNs) of mean 0.45, SD 0.71 ICN per 250 hospital beds, ICN/beds ratios were below 0.34 and 0.30 in medium-sized and large hospitals respectively. Nurses who were active in NIC were either lacking or worked only a few hours per week in a considerable proportion of hospitals, with this trend being more pronounced in smaller facilities. The intervening period since 1965, and the last decade in particular, has been marked by the progressive adoption of a range of NIC policies. Most procedures proving NIC-efficient had been implemented in approximately 70-80% of responding hospitals. Teaching was most qualified and intensive in medium-sized hospitals. Nursing in NIC has only recently been developed in Spain, is increasingly accepted, exhibits diffusion levels comparable to those reported internationally, lacks monitoring and quality assessment systems and, in general, could be substantially improved.

Cross Infection↗
PubMed1999

Waiting for Godot: wishes and worries in managed care.

Managed care has done a better job at reducing expenditure growth than it has in improving quality. Although reduced expenditure growth is not appreciated by many, it has real benefits. For the majority of Americans who are privately insured, it results in greater disposable income for goods and services other than health care (although the illusion of employer-paid health insurance obscures this reality for many). For Medicaid programs, slower growth of expenditures facilitates efforts at expanding coverage. For low-income workers, slower expenditure growth results in larger numbers of people retaining insurance coverage than would have been the case if premiums rose more quickly. While there are some victories to which managed care organizations can point, we cannot credibly argue that overall levels of quality and health outcomes are improving as the health care system is massively disrupted by changes in health care finance and delivery. The disruptions create real hardships for some physicians and other health care workers, and worries for many consumers. These worries fuel the managed care backlash. The danger is that politicians will respond to these worries with policies that inhibit the development of high-quality delivery systems. The opportunity is for relatively modest public policy changes--external review organizations, better public-sector purchasing capabilities, public investment in producing and publicizing information on health plan and medical group performance, and establishment of a public ombudsperson--to respond to consumer worries and lead to improvements in health care quality and outcomes. Finally, I would be remiss without a reminder that the single most effective action politicians could take to improve health care quality and outcomes would be to change the rules of health care financing to assure that all Americans are covered by managed care. Even with all of its inadequacies, managed care is much superior to the patchwork care available to the 43 million Americans who are uninsured. The managed care backlash is concerned with protecting patients who are insured (and their providers). Far more valuable would be to protect those without insurance. Sadly, no politician has yet figured out how to do this. Still waiting.

Attitude to Health↗
PubMed1993

The effects of federalism on policies for care of the aged in Canada and the United States.

Debates about who should care for the elderly often center on the relative responsibilities of the state and family. In federal societies such as Canada and the United States, however, multiple governments are involved. This article compares and contrasts federalism in these two nations and its effects on the division of fiscal, administrative, and programmatic responsibilities for care of the aged between the national and regional (i.e., state, provincial) governments. Two major policy arenas, health care and social services, are examined, with particular attention focused on the roles played by the nongovernmental sector. Because most care of the aged is provided informally--a situation firmly rooted in the value systems and public policies of both nations--national and regional policies that assist family caregivers directly are examined. Policymakers at the regional level have been more active and often more innovative in constructing policies that are supportive of family caregiving, but in general, few programs of direct assistance exist in either nation and these largely depend on their geographic location. The article concludes with a discussion of the continued effects of federalism for future policies affecting care of the aged and suggests some approaches that can be undertaken to empower families in their caregiving roles.

Aged↗
PubMed2006

Emerging lessons from the drug effectiveness review project.

The Drug Effectiveness Review Project (DERP) is an alliance of fifteen states and two private organizations, which have pooled resources to synthesize and judge clinical evidence for drug-class reviews. The experience shines a bright light on challenges involved in implementing an evidence-based medicine process to inform drug formulary decisions: When should evidence reviewers accept surrogate markers and assume therapeutic class effects? How open and participatory should review procedures be? Should reviewers consider cost-effectiveness information? What is the appropriate role of the public sector in judging evidence? The DERP illustrates that attempts to undertake evidence-based reviews, apart from the methods themselves, which continue to evolve, involve questions of organization, process, and leadership.

Cost-Benefit Analysis↗
PubMed2002

The value of wildlife.

The value of wildlife has been widely ignored or under-rated in the past by the international community. At most, wildlife was considered from the limited aesthetic and touristic aspects. This situation has changed somewhat. In the majority of the veterinary profession, which is largely livestock-oriented, wildlife is increasingly considered in terms of wild animal production and occupies just as relevant a position as domestic animal production. Some economists are now trying to quantify the informal nature of a large portion of the wildlife sector. The importance of wildlife to local communities is now globally recognised in community-based or participatory natural resources management programmes. The authors highlight not only the economic importance of wildlife (which amounts to billions of United States dollars world-wide), through consumptive and non-consumptive uses, but also the present and potential nutritional value, the ecological role as well as the socio-cultural significance of wildlife for human societies of both the developed and the developing worlds. Also addressed in this chapter is a discussion on one of the main threats to wildlife conservation which consists of the reduction or even retrieval of the different values wildlife can offer.

Animal Husbandry↗
PubMed1991

An analysis of the American Medical Association's recommendations for change in the medical care sector of the United States.

In several recent publications, the American Medical Association has provided explanations of the current crisis in the medical sector of the United States. This article presents empirical information that questions the basic assumptions behind the AMA's explanations of the U.S. realities and the AMA's recommendations on how to solve the current crisis. The author also critically reviews some of the major proposals--such as employer mandated coverage--that are being put forward by several forces in the United States, including the AMA, for resolving the twin problems of high costs and limited health benefits coverage for the U.S. population. The political context in which the AMA's calls for reforms are being made is also discussed.

American Medical Association↗