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At least 1,081 records · Page 60Linked to original sources
PubMed1999

Caregiving networks of elderly persons: variation by marital status.

Using data from the 1982 National Long-Term Care Survey, this study examines the relationship between marital status and two dimensions of caregiving networks, size and composition. Results indicate that widowed and never married people have helping networks that are larger than those of married people. Diversity across marital statuses in sources of assistance is revealed in analyses of two measures of caregiving network composition: (a) having more kin than nonkin helpers and (b) presence of specific helpers (adult children, siblings, friends, and formal helpers). Moreover, gender interacts with marital status to influence the composition of caregiving networks.

Aged↗
PubMed1999

Envisioning a network of care for at-risk patients after myocardial infarction.

Myocardial infarction (MI) continues to be a significant health care issue because of its prevalence. As treatment options improve the survival rate, an increasing number of individuals have to learn how to adjust to this major life event and prevent recurrence. Recovery can be difficult. Many patients experience emotional distress, fear of dying, and family turmoil, fail to return to work when physiologically capable of doing so, are unable to return to their previous levels of sexual activity, and are not capable of making the necessary diet and exercise changes. Acute management strategies continue to be aimed at limiting the infarct size, whereas holistic approaches to the patient and family adjustment must target seeking prompt treatment when symptoms present, psychologic adjustment, stress reduction, and patient and family education for self-care and risk reduction. As hospital length of stay for acute MI decreases, health care professionals must provide an interdisciplinary, collaborative approach to ensure that the at-risk MI patient is provided all of the information and support needed to lead a satisfying, productive, healthy life. An excellent way for nurses to not only address this challenge, but to lead the effort, would be to develop a network of care for the at-risk MI patient.

Community Networks↗
PubMed1996

States wrestle with provider network regulation.

Across the country, states are considering whether to permit provider network participation in risk-based arrangements. Interest in this issue is driven primarily by market realities and, to a lesser extent, by two recent developments: the National Association of Insurance Commissioners' 1995 recommendation that provider networks entering certain risk arrangements be subject to state insurance regulation and last year's Federal health legislation allowing "provider sponsored networks" (PSNs) to enter Medicare risk contracts.

Capitation Fee↗
PubMed1996

Strategic plan can start physician network on path to success.

Forming physician networks can improve the ability of healthcare organizations to attract managed care contracts. However, forming physician networks can be risky for organizations new to such affiliations. One way healthcare organizations can reduce the risk and improve the odds of success in network participation is to develop a strategic plan.

Community Networks↗
PubMed2002

Community data--where does the value lie? Assessing confidence limits of community collected water quality data.

Waterwatch is a national community-based monitoring network that aims to involve community groups and individuals in the protection and management of waterways. Waterwatch Victoria has the dual objectives of catchment education and water quality monitoring. The educational outcomes are evident, with the Waterwatch programme facilitating over 9,000 students to monitor more than 2,000 sites in waterways in 2000. This paper aims to assess the scientific value of community-collected data, through examining differences between Waterwatch data and professionally collected data. The study looked at all aspects of volunteer data collection, including data confidence protocols, equipment, and data analysis. All professional data was collated by the Victorian Water Quality Monitoring Network (VWQMN). The parameters examined in this study were turbidity, electrical conductivity (EC), pH and total phosphorus. The level of agreement between community-collected data and professional data varied temporally and spatially. Waterwatch data for EC and pH appeared to be very similar to professionally collected data. Equipment used by Waterwatch volunteers for turbidity and total phosphorus appeared to be limited in accuracy to moderate ranges. Overall the VWQMN professionally collected data showed less variance, suggesting greater variability, potentially due to inaccuracies, in volunteer collected data

Community-Institutional Relations↗
PubMedDate not supplied

Participatory action research: the Indian Family Stories Project.

Community-based research projects are critically needed to reduce health disparities and ensure the delivery of health care that is culturally appropriate and relevant to families and communities. The purpose of this article is to share experiences and lessons learned from utilizing a participatory action approach in a series of five subprojects within the Indian Family Stories Project. Participatory action research (PAR) focuses on identifying community needs and designing action plans in partnership with the community. To effectively implement PAR projects, investigators need to: (a) Build and maintain strong, collaborative working relationships with a broad network of community representatives, (b) Secure funding that addresses community needs and provides mechanisms for giving back to the community, (c) Ensure that the project fits the particular cultural and community context, (d) Evaluate and adapt the project as needed, (e) Keep the community informed, (f) Develop sustainable community resources, and (g) Advocate on behalf of the community.

Cultural Characteristics↗
PubMedDate not supplied

Cost considerations as potential barriers to cancer treatment.

PURPOSE: An analytical cross-sectional survey was conducted to determine the prevalence of barriers to cancer treatment in Texas as perceived by diagnosed cancer patients. Results reported here address the role of insurance coverage, indirect costs (transportation, lodging, and work days lost), and direct costs of care as barriers to treatment for white, black, and Hispanic cancer patients. Specific objectives of the analyses undertaken here are to examine 1) racial/ethnic differences in insurance coverage; 2) barriers relating to insurance coverage experienced by cancer patients; and 3) role of treatment-related costs as barriers to cancer treatment. DESCRIPTION OF STUDY: A mail questionnaire was developed to assess the perceived barriers to cancer treatment in Texas for adult cancer patients, 17 years and older, who had been diagnosed with breast, colon, cervical, prostate, or lymphoma during the period of 1989 to 1993. The sampling frame for this study was obtained from a network of cancer treatment facilities throughout the state of Texas within the University of Texas M.D. Anderson Cancer Center Texas Community Oncology Network. A total of 593 cancer patients returned their surveys, yielding a 65.2% response rate. Weighting adjustments were then made to correct for differential sampling and response rates by racial groupings and type of cancer. All of the analyses used adjusted weights. RESULTS: The findings document the financial considerations (insurance, direct and indirect costs) as they relate to barriers to cancer treatment. Specific insurance premium-related barriers with regard to maintaining and affording coverage were more prevalent for blacks. Hispanics were less likely to have insurance coverage; however, more blacks reported being denied insurance coverage when they changed jobs compared with whites and Hispanics. Minorities, particularly Hispanics, were more likely to have experienced cost-related barriers associated with medications, diagnostic tests, and hospitalizations. In addition, Hispanics experienced significant out-of-pocket costs in paying for cancer treatment. CLINICAL IMPLICATIONS: This research shows the need for staff at cancer treatment facilities to be aware that there are nonclinical, financial factors that are important considerations in the treatment of cancer patients. Assessment of cancer patients during the diagnostic and treatment stages, possibly through case management, will provide information on potential barriers to treatment for individual patients. Hospital programs that reimburse out-of-pocket costs, transportation costs to obtain services, and lodging accommodations may be available. Additional services may be offered through cancer advocacy groups, such as the American Cancer Society and the National Coalition for Cancer Survivors, to assist patients with managing costs and overcoming barriers to care.

Adolescent↗
PubMed2004

Origins of community strains of methicillin-resistant Staphylococcus aureus.

To characterize methicillin-resistant Staphylococcus aureus (MRSA) strains circulating in the community, we identified predictors of isolating community MRSA and genotyped a sample of MRSA collected from a community-based, high-risk population. Computerized databases of the Community Health Network of San Francisco and the Clinical Microbiology Laboratory were searched electronically for the years 1992-1999 to identify community-onset infections caused by MRSA. Sequential analyses were performed to identify predictors of MRSA strains. The majority (58%) of infections were caused by strains traceable to the hospital or to long-term care facilities. Injection drug use was associated with infections that were not associated with health care settings. Genotypes for 20 of 35 MRSA isolates recovered from injection drug users did not match any of >600 genotypes of clinical isolates. In a nonoutbreak setting, the hospital was the main source of community MRSA; however, the presence of genetically distinct and diverse MRSA strains indicates MRSA strains now also originate from the community.

Anti-Bacterial Agents↗
PubMed2002

Guiding community-based public health planning in rural New Mexico.

For purposes of clarity in discussion, the work described in this article will be centered in Chaves County. The work of Turning Point in this county is organized through the Community Care Network, an organization representing more than 25 agencies and 100 individuals meeting monthly to provide the action framework for community-initiated programs. Through this collaboration, information is shared regarding the focus of agencies, funding for programming is sought through the most appropriate agency, and much of the competitive energy has been channeled into sharing of resources to write the best funding proposal and implement the best program when funding is obtained.

Community Health Planning↗
PubMed1997

The strategic agenda for community health care organizations.

This article proposes a vision, strategies, and structure for the organizations that will replace community hospitals. The vision must embrace health rather than health care, and cost reduction as an explicit, measured goal. Strategies must include immediate cost savings, but also longer-term revision of organizations, wage structures, prevention, and medical attitudes. Structures must assure local stakeholders their voice in health issues.

Community Health Services↗
PubMed2004

Design of a patient-centered, multi-institutional healthcare information network using peer-to-peer communication in a highly distributed architecture.

OBJECTIVE: to design a community healthcare information network for all 450,000 citizen in the State of Geneva, Switzerland, connecting public and private healthcare professionals. Requirements include the decentralized storage of information at the source of its production, the creation of a virtual patient record at the time of the consultation, the control by the patient of the access rights to the information, and the interoperability with other similar networks at the national and european level. METHODS: a participative approach and real-world pilot projects are used to design, test and validate key components of the network, including its technical architecture and the strategy for the management of access rights by the patients. RESULTS: a distributed architecture using peer-to-peer communication of information mediators can implement the various requirements while limiting to an absolute minimum the amount of centralized information. Access control can be managed by the patient with the help of a medical information mediator, the physician of trust.

Community Networks↗
PubMed1999

Resource allocation in integrated delivery systems and healthcare networks: a proposed framework to guide ethical thinking.

Drawing on a management perspective and the literature, this article suggests an ethical framework to be used at the meso or community level of resource allocation in a Canadian setting. The suggested framework enlarges on the program-level framework developed by Meslin et al primarily by building in stakeholder inclusiveness and public accountability, both of which are essential to resource allocation at the population-based level.

Canada↗
PubMedDate not supplied

Faculty practice as partnership with a community coalition.

Faculty practice as partnership with a community coalition can be a dynamic strategy for retooling the future of nursing. The Escalante ElderCARE Coalition was formed in 1991, with the Community Health Division of the Arizona State College of Nursing taking a leadership role. Since that time, more than 50 aging network and community agencies have become involved. More than $300,000 in grant funding has been awarded for Healthy WAY services with low-income seniors as health care and program partners. The conceptual model includes health-promotion services, participation of community elders in program planning and evaluation, and education of health professionals. Participation theory is the basis for the conceptual model. A large number of undergraduate and graduate nursing students have been involved in the nontraditional delivery of services provided by the coalition. The Short Form 36 (SF-36) and the Lifestyle Directions Questionnaire are the health status outcome measures, and elder satisfaction, coalition effectiveness, and cost-savings measures are the process indicators. Elders reported healthier scores in six of the eight SF-36 dimensions, including general health, than the older US general population, but they also report that their amount of physical exercise and fiber intake is less than adequate. Overall, the elders express great satisfaction with the Healthy WAY programs but do not perceive as much ownership as do the coalition's agency professionals. Coalitions are emerging as a force for change and a public health strategy, and faculty members are encouraged to take seriously the opportunities afforded by them for proactive, advanced practice roles.

Arizona↗
PubMedDate not supplied

MAPP in Chicago: a model for public health systems development and community building.

The Chicago Department of Public Health's (CDPH's) community planning efforts came from a city-wide strategic plan that called for the establishment of a city-wide network of community partnerships that focus on community needs and resource assessment and program development. Using Mobilizing for Action through Planning and Partnerships as a framework for planning at the community level, the CDPH supports five community coalitions through the Chicago Center for Community Partnerships. The overall goal of the Center is to increase community capacity, build new partnerships, provide coalitions with access to decision makers, and inform the role of local public health agencies in supporting this type of work. Bringing together a wide spectrum of stakeholders, coalition members work to conduct assessments and develop and implement strategies. While coalitions demonstrate outcomes related to specific strategies, they also exhibit infrastructure-level results, with increased levels of community organizing, leveraging of existing resources, and new systems for information dissemination. Simultaneously, the CDPH has gained new partners in public health, increased collaboration, and more information about communities. These outcomes are contingent on certain elements of success: (1) committed leadership; (2) commitment to a new way of doing business; (3) prepared public health workforces; and (4) community readiness.

Chicago↗