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PubMed2000

Structural and legal implications of e-health.

Web and attendant e-Commerce phenomena are irretrievably at odds with the traditional structure and hence legal regulation of health delivery. E-Health delivers healthcare information, diagnosis, treatment, care, and prescribing of drugs in a nonlinear, nonhierarchical manner that encourages patients to "enter" the system at an infinite number of points, thus defying current regulatory constructs. Similarly, e-Commerce fundamentals such as disintermediation and disaggregation result in medical information being delivered through unfamiliar channels, creating immensely difficult questions for health lawyers.

Commerce↗
PubMed1982

Development of a chemical information system.

The 10-year history of the development of the NIH-EPA Chemical Information System is described. The System grew from the cooperative efforts of several agencies of the federal government and now is publicly available on a fee-for-service basis on computers in the private sector.

Chemical Phenomena↗
PubMedDate not supplied

Home health care and quality of life of patients with Alzheimer's disease.

BACKGROUND: Little is known about the quality of life (QOL) of people with Alzheimer's disease (AD). The formal home care sector plays an increasingly large role in care for this population, but home care agencies do not routinely collect QOL information or use this information in care planning. METHODS: A series of roundtable discussions with representatives of the home care industry were held to document current practices by home care providers regarding the elicitation, recording, and use of QOL information; to derive indicators of QOL in AD patients; and to develop standardized procedures for using QOL information. Results from this investigation were incorporated into an epidemiological investigation of community-dwelling AD patients, comparing formal sector home attendants to family caregivers regarding efforts to enhance patient QOL. RESULTS: Twenty representatives of the home care industry met over three sessions to discuss these issues. Patient QOL indicators were derived, showing divergence of patient and caregiver perspectives. A survey of 240 AD patients compared family and formal home attendant caregivers and showed that home attendants underutilize opportunities to enhance patient QOL, as referenced by patient participation in activities that require supervision. CONCLUSIONS: Collaboration with home care agencies allowed a better understanding of quality of life for this vulnerable patient population. More research will be required to refine QOL outcomes and develop quality assurance tools for dementia care. Medical Subject Headings (MeSH): Alzheimer's disease, quality of life, home care, paraprofessional care.

Aged↗
PubMedDate not supplied

Health care provider use of private sector internal error-reporting systems.

The purpose of this study was to review the state of the art of private sector internal error-reporting systems and to begin to develop a classification system for comparing systems. Interviews were conducted to research and examine 9 systems currently on the market. Analysis resulted in the following observations: (1) 7 of the systems are stand-alone, while 2 are part of larger hospital information systems; (2) most of the systems have been in existence for less than 5 years; (3) acute care hospitals are the primary clients; (4) systems are capable of interfacing with other information systems and root-cause analysis programs; and (5) systems are browser based and accessible via the Internet and/or the provider's intranet. Additional studies are needed to determine the impact of these systems on health outcomes. However, one fact is clear: tracking incidents will not improve patient safety unless administrators close the feedback loop on quality.

Database Management Systems↗
PubMed2004

Continuity through best practice: design and implementation of a nurse-led community leg-ulcer service.

The design of the new service was intended to facilitate continuity. The results after the first year of the new service revealed that care was both more effective and more efficient for all types of leg ulcers (Harrison, Graham, Friedberg, & Lorimer, 2003). Healing rates had dramatically improved, the frequency of nursing visits decreased, and supply costs declined. With the new service, comprehensive standardized assessments are made at baseline on all new admissions for home leg-ulcer care, and reassessments are regularly scheduled if the condition does not improve. With the evidence-based protocol, all providers and sectors of care are "working from the same script." Specific information is obtained on the client's health history, leg-ulcer history, preferences, and social context. Continuity is further facilitated through implementation of the primary nurse model, whereby one provider is responsible for developing the care plan and for subsequent evaluation and revision. Management continuity is advanced through health-care reorganization, with the development of an expert, dedicated nursing team, a consistent approach to training and skill development, improved coordination, an interdisciplinary approach for referral and consultation, and continuous quality improvement measures for education and practice audit. A number of strategies tailored to the new service have been highly effective. Strategic alliances among the researchers, home-care authority, nursing agency, nurses, and physicians are essential to the success of both design and implementation. Ongoing interdisciplinary and intersectoral communication expedites the referral process and helps to resolve issues as they develop. The majority of physicians have been very supportive of the use of the protocol and the evidence-based service. Surveys of care recipients have been mostly positive. Nurses who have been surveyed concerning the supports to implementation of the evidence-based service have indicated the following supports: ongoing education, nursing knowledge, a supportive clinical leader, support from two specialist physicians (a dermatologist and a vascular surgeon), a dedicated nursing team, positive outcomes (improved healing rates), and regional home care and agency support. The greatest challenge has been establishing and maintaining the dedicated nursing team. Continuity is served when nurses are assigned exclusively to the leg-ulcer team, where they can continue to build expertise and skills. The nursing agency was initially reluctant to embrace the concept of a dedicated team, as it viewed wound care as a general function of all nurses. Many of the nurses trained in leg-ulcer care fulfilled a number of other specialized nursing functions. This had resource implications for the nursing agency, as other nurses needed training in various other specialized skills. There should be a balance between the size of the population being served and the size of the team, in order to maintain efficiency and sufficient exposure to skilful assessment and management of leg-ulcer care. During the first year of the leg-ulcer service a number of nurses were lost from the team for various reasons, including: outside opportunities for career advancement, the physical demands of this type of care, retirement, moving from the area, and lack of job security. In addition, the volume of nursing visits was decreased because of Ontario government cutbacks in the area of home-care services. New staff members on the team were laid off in the context of a unionized environment. The lack of long-term security and the reality of lower wages in the community sector have played havoc with recruitment and retention. A recently formed committee at the nursing agency on continuity of care, with representation from nursing, management, and administration, has identified a number of further barriers to continuity. These include fluctuating caseloads, difficulty attracting nurses to the community sector, and a unionized environment in which senior nurses displace junior nurses on low-caseload days. Strategies aimed at overcoming the barriers to continuity have been identified and are being implemented. Our experience confirms the need for evidence-based planning in order to understand the needs of the population with leg ulcers, current practices, and the organization of care prior to the restructuring of service delivery. The extensive needs assessment indicated the need for broad system changes in addition to adjustments in clinical care in order to meet best-practice guidelines. Despite ongoing barriers, the service model has improved continuity and dramatically increased the effectiveness and efficiency of leg-ulcer care in one community.

Benchmarking↗
PubMed1998

What the private sector does not know about purchasing oncology services.

BACKGROUND: Oncology, as a medical specialty, is usually purchased as part of a comprehensive health care plan offered by a health care network or carrier and is given the same weight in purchasing decisions as all other specialties. Individual practitioners and care facilities generally meet contemporary availability and quality standards. More detailed information generally is not sought and may be difficult to communicate to participants. The cost of network care is the most consistent and easy variable to obtain. Providing health plan participants with contemporary treatment information in any specialty area requires consistent information flow and presumes the ability to communicate this information to participants. METHODS: Providing credible information regarding prevention protocols, success rates for treatment modalities, remission data, and support therapies will help better educate private sector purchasers. More can be done to highlight clinical research and present this information in readily understandable terms. RESULTS: More detailed information could have an impact on the future design of network-based health care plans and could assist participants in selecting among several networks. Quality of life issues would be supported by comprehensive information leading to personal life-style decisions. CONCLUSIONS: Private purchasers need to work with oncologic professionals, care networks, and health carriers to develop more precise information regarding oncologic care specifically and to become better educated regarding each area of specialty care in general. Information, once available, must be available to participants in terms that are easy to understand.

Employer Health Costs↗
PubMed2006

The application of chemical leasing business models in Mexico.

BACKGROUND, AIM AND SCOPE: To better address the requirements of the changing multilateral order, the United Nations Industrial Development Organization (UNIDO) Cleaner Production Programme, in 2004, developed the new Sustainable Industrial Resource Management (SIRM) approach. This approach is in accordance with the principles decided at the United Nations Conference on Environment and Development (UNCED) in Rio de Janeiro, Brazil in 1992. Unlike the traditional approaches to environmental management, the SIRM concept captures the idea of achieving sustainable industrial development through the implementation of circular material and energy flows in the entire production chain and reduction of the amount of material and energy used with greater efficiency solutions. The SIRM approach seeks to develop new models to encourage a shift from selling products to supplying services, modifying, in this manner, the supplier/user relationship and resulting in a win-win situation for the economy and the environment. Chemical Leasing represents such a new service-oriented business model and is currently being promoted by UNIDO's Cleaner Production Programme. MAIN FEATURES. One of the potential approaches to address the problems related to ineffective use and over-consumption of chemicals is the development and implementation of Chemical Leasing business models. These provide concrete solutions to the effective management of chemicals and on the ways negative releases to the environment can be reduced. The Chemical Leasing approach is a strategy that addresses the obligations of the changing international chemicals policy by focusing on a more service-oriented strategy. Mexico is one of the countries that were selected for the implementation of UNIDO's demonstration project to promote Chemical Leasing models in the country. The target sector of this project is the chemical industry, which is expected to shift their traditional business concept towards a more service and value-added approach. This is being achieved through the development of company specific business models that implement the above-indicated Chemical Leasing concept with the support from the Mexican National Cleaner Production Centre (NCPC). RESULTS AND CONCLUSIONS: The implementation of Chemical Leasing in Mexico has proven to be an efficient instrument in enhancing sustainable chemical management and significantly reducing emissions in Mexico. Several companies from the chemical industrial sector implement or agreed to implement chemical leasing business models. Based on the positive findings of the project, several Mexican companies started to negotiate contents of possible Chemical Leasing contracts with suitable business partners. The project further aimed at disseminating information on Chemical Leasing. It successfully attracted globally operating companies in the chemicals sector to explore possibilities to implement Chemical Leasing business models in Mexico. At the international level, the results of the UNIDO project were presented on 20th September 2005 during a side event of the Strategic Approach to International Chemicals Management (SAICM) Preparation Conference in Vienna. RECOMMENDATIONS AND OUTLOOK: To facilitate the promotion and application of Chemical Leasing project at international level, UNIDO is currently developing a number of tools to standardize Chemical Leasing projects. These include, among others, Chemical leasing contract models; Chemical Leasing data base to find partners for chemical leasing; and guidelines to implement Chemical Leasing projects and work programmes.

Chemical Industry↗
PubMed2004

Evaluating digital libraries in the health sector. Part 2: measuring impacts and outcomes.

This is the second part of a two-part paper which explores methods that can be used to evaluate digital libraries in the health sector. Part 1 focuses on approaches to evaluation that have been proposed for mainstream digital information services. This paper investigates evaluative models developed for some innovative digital library projects, and some major national and international electronic health information projects. The value of ethnographic methods to provide qualitative data to explore outcomes, adding to quantitative approaches based on inputs and outputs is discussed. The paper concludes that new 'post-positivist' models of evaluation are needed to cover all the dimensions of the digital library in the health sector, and some ways of doing this are outlined.

Information Systems↗
PubMed1990

Progress in the use of computerised recording systems in dairy cow monitoring and extension in Malaysia.

The emphasis on cow records in Malaysian dairy extension programmes reflects the importance of herd fertility in the economics of dairying. Manual record keeping has not been able to make an impact on management due to difficulties experienced in quality control of the data and in analysing the data to produce useful information for farm managers. Computerised recording systems have been in use in Malaysia since 1985, both on government farms and in the small-holder dairy sector. The aim of both systems is firstly to improve farm efficiency by the provision of information to managers and extension workers and secondly to provide information for departmental planning purposes. The systems used in Malaysia are outlined, and the results over the first three years of operation are summarised.

Animals↗
PubMedDate not supplied

Honduran women received no written information on contraceptive pill.

In the period 1989-1994, Honduran women participating in the Project Health Sector 2 have been exposed to a contraceptive mini-pill, Ovrette. The Institute of Honduran Social Security (IHSS) approved the program (in which Ovrette distribution is included) in May 1990. The program is partly funded by the Population Council, which is funded by USAID Registry with the Department of Health was not required under the Health Code since Ovrette had entered the country as a donation. In June 1993, a Commission of the Honduran Medical Association reported that the women were not given any written information on the drug. Ovrette is an oral contraceptive manufactured by Wyeth. Its active ingredient is a progestagen, Norgestrel. Contraindications for Ovrette include: non-lactating women who exhibit side-effects such as dizziness, water retention, migraine, etc.; non-lactating women with contraindications for estrogen; lactating women who reject other contraceptive drugs. The US Pharmacopeia and the US Food and Drug Administration do not authorize the drug for use by lactating women. As with other progestagens, Norgestrel passes through to the mother's milk. In 1993, the US Pharmacopeia reported that these hormones can cause harmful effects to the child, and recommended switching medications or discontinuation of lactation. In 1983, the WHO expressed concern about the possibility of injury caused by the progestagens. The possibilities included alterations to personality, behavior, anatomy of sexual organs, reproductive capacity, immunological function and development of neoplasia. Possible damages in puberty or during the reproductive age are not known since there is no study of exposed children that are older than 12 years of age.

Americas↗
PubMedDate not supplied

Staying committed.

After an intensive and collaborative two-year effort, the Michigan Health and Safety Coalition (MH&SC) has publicly released hospital-specific information for seven serious medical conditions and for care provided in intensive care units. Hospitals' willingness to share this information and to commit to participation in ongoing collaborative improvement activities serves as a catalyst to achieving a mutual goal--statewide, systemic improvement in the safety and quality of health care.

Health Care Coalitions↗
PubMed1998

Comprehensive health data systems spanning the public-private divide: the Massachusetts experience.

As systems of health care delivery have evolved from claims-based fee-for-service to capitated or managed care, with its emphasis on cost-effectiveness, quality, and performance measurement, some states have begun to experiment with new ways to collect, organize, and share health information. In many cases, the drivers of these changes have been purchasers of health care, including large and small private employers and public agencies such as Medicaid. One of the results of these changes is the increased interest in the sharing of health information, between health plans and employers, and, in some instances, between private plans and public agencies such as public health. Massachusetts, which has one of the highest rates of managed care penetration in the United States, has brought together the various parties involved in the collection and utilization of health information, to craft agreements on standards and protocols that will allow the sharing of health data. While much of the activity involves business transactions between private sector health plans, the Department of Medical Assistance (Medicaid) has joined with its private sector purchasing partners in demanding cost-effective, high-quality care; it is these demands that have helped stimulate the need to reorganize previously proprietary health information systems. The activities of two public-private coalitions, the Massachusetts Healthcare Purchaser Group and the Massachusetts Health Data Consortium, have been critical in initiating and supporting the complex processes that have led to significant changes in state-based systems of health information.

Health Maintenance Organizations↗
PubMed2005

[Advantages of cooperation with self-help organisations for out-patient physicians].

AIM OF THE STUDY: Self-help groups and organisations are important contributors to the provision of rheumatological care. No systematic studies exist thus far on the cooperation between professional care providers and the German Rheumatism League, the most significant patient organisation for rheumatoid patients. METHODS: To gain information about the extent of the co-operation between rheumatologists and the German Rheumatism League and to estimate the benefits of the co-operation, a survey was conducted among German rheumatologists in the out-patient sector (n = 787). RESULTS: The response rate was 40.7%. As many as 98.7% of the rheumatologists were informed about self-help initiatives, with 78.1% receiving this information from their own patients. Regular or frequent co-operation with self-help initiatives was reported by 46%. Among the physicians with experience in co-operation, 84.1% wished more contact with self-help initiatives, compared with only 61.9% of non-experienced physicians. The benefit of the activities of the Rheumatism League was highly appreciated: the long-term training of functional capacity was evaluated as helpful by 73.4%; the training for coping with pain by 62.2%; the occupational therapy groups by 60.6%; the patient-education groups by 61.6%; and the self-help groups by 56.3%. The benefit of co-operation was appreciated more by rheumatologists experienced in co-operation than by rheumatologist without specific experience: on a rating scale from 1 (little benefit) to 6 (high benefit) the former group scored an average of 3.7, the latter an average of 2.7. DISCUSSION AND CONCLUSIONS: In spite of the relatively low response rate (40.7%), the results cover a relevant part of rheumatologists in the out-patient sector. The more experience physicians have with co-operation, the higher they estimate the benefits of co-operation with the Rheumatism League. This underlines the necessity of technical information about self-help initiatives and the promotion of contacts and co-operation in the rheumatological out-patient sector.

Delivery of Health Care↗
PubMed1990

Current evaluation of sonography of the meniscus. Results of a comparative study of sonographic and arthroscopic findings.

Sonography of the knee has gained in significance in the diagnosis of the meniscus; experimental and clinical studies have demonstrated that the normal and pathological anatomy of the meniscus can be visualized on a sonogram. The aim of this comparative investigation is to evaluate sonographic lesion diagnosis in comparison with arthroscopic findings, using a standardized examination method. Two hundred and six knee joints were first scanned sonographically using a 7.5 MHz sector transducer. The examining doctor had neither anamnestic nor clinical information in advance. On the following day, the joints were examined arthroscopically, without the findings of the day before being available to the examiner. When the findings were compared, the sensitivity of sonographic diagnosis of lesions was found to be 82.2% and its specificity 87.6%. The patients were of varying ages and had varying anamneses. The results show that sonography of the meniscus is a valuable diagnostic help when the knee-joint symptoms are not clear, given that the correct technical equipment and sufficient experience with this form of examination are at hand. The advantage of sonography is that, in contrast to arthroscopy, it is noninvasive and easily available.

Adolescent↗
PubMed2002

Evidence for an auditory subsector within the zona incerta of rats.

This study explores the patterns of connections between the zona incerta (ZI) of the thalamus and the major auditory centres of the rat brain. Two series of experiments were performed using neuroanatomical tract tracing methods (biotinylated dextran or cholera toxin subunit b). First, tracers were injected into the ZI and resultant patterns of labelling in the auditory centres were examined. Labelling was seen in distinct subdivisions of the temporal cortex (Te3), medial geniculate complex (medial division; MGm), inferior colliculus (external cortex; ICe) and cochlear nucleus (dorsal and ventral divisions). For the most part, these subdivisions are involved in more associative or integrative aspects of audition. In a second series of experiments, three of these centres (Te3, ICe, cochlear nucleus) were injected with tracers and the labelling patterns formed in the ZI were explored. These results show that each of these connections makes a very distinct territory or subsector within the most lateral region of the ZI. This subsector of connectivity with the auditory centres does not respect the well defined cytoarchitectonic sectors of ZI, being made up of small slabs in both the dorsal and ventral sectors. Overall, the results suggest that ZI may integrate auditory information together with the other exteroceptive and interoceptive information that it receives and then influences subsequently global states of arousal and/or attention.

Animals↗
PubMed2000

Public spending on health care: how are different criteria related? A second opinion.

A natural response to difficult questions is to increase the number of objectives one pursues in the hope that each of them separately will be easy to satisfy. This note critically evaluates this strategy as employed in a recent paper in this journal [Musgrove, Health Policy 1999;47:207-223], especially its evaluation of the role of cost-effectiveness in priority setting in the health sector. It is suggested that cost-effectiveness measures provide information of limited use, and that the tools of applied welfare economics are sufficient to guide the policy choices addressed in the paper. Students of health economics and health policy makers would do well to be exposed to these tools.

Cost-Benefit Analysis↗
PubMed2001

Adoption of smart cards in the medical sector: the Canadian experience.

This research evaluates the factors influencing the adoption of smart cards in the medical sector (a smart card has a micro-processor containing information about the patient: identification, emergency data (allergies, blood type, etc.), vaccination, drugs used, and the general medical record). This research was conducted after a pilot study designed to evaluate the use of such smart cards. Two hundred and ninety-nine professionals, along with 7248 clients, used the smart card for a year. The targeted population included mostly elderly people, infants, and pregnant women (the most intensive users of health care services). Following this pilot study, two surveys were conducted, together with numerous interviews, to assess the factors influencing adoption of the technology. A general picture emerged. indicating that although the new card is well-perceived by individuals, tangible benefits must be available to motivate professionals and clients to adopt the technology. Results show that the fundamental dimension that needs to be assessed before massive diffusion is the relative advantage to the professional. The system must provide a direct benefit to its user. The relative advantage of the system for the professional is directly linked to the obligation for the client to use the card. The system is beneficial for the professional only if the information on the card is complete. Technical adequacy is a necessary but not sufficient condition for adoption.

Attitude↗