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At least 1,081 records · Page 60Linked to original sources
PubMedDate not supplied

Internal and external auditing in health systems: an integrative approach.

Traditionally, auditors are apprehensive when it comes to auditing clinical decisions. A novel model might lead to better integration of auditors into the core activities of health system medical care, while creating common interests among all participants in the process.

Delivery of Health Care↗
PubMedDate not supplied

Integration of a statewide public hospital laboratory system.

Louisiana operates one of the largest public hospital and clinic systems in the nation, consisting of nine geographically dispersed hospitals, providing a full range of medical care to approximately 1 million low-income and indigent citizens. For many years, these hospitals were under the auspices of the State Department of Hospitals. In 1997, just at the end of a multi-million-dollar procurement project to install laboratory information systems at several of the sites, governance of the nine hospitals was transferred formally to Louisiana State University (LSU) under a new branch, the LSU Health Care Services Division. As a result of Y2K issues at several sites not originally included in the procurement, the LIS installation had to be expanded while facing a very critical implementation deadline. This article describes the procedural and organizational strategies used to successfully accomplish a major project of reorganization and systemic integration of nine geographically distant and disparate public hospital laboratories while simultaneously installing a new networked LIS at all sites within a relatively short span of 3 years.

Clinical Laboratory Information Systems↗
PubMed1988

A model for capacity planning of a comprehensive integrated information system for hospitals and clinics.

Appropriate system sizing is essential to ensuring a reasonable computer response time for end users. A model is discussed that describes the type and number of interactions between user terminals and printers and the central processor for a comprehensive, integrated medical information system. The system modeled includes support to inpatient and outpatient order entry and results reporting for clinical services; registration; admission, disposition, and transfer; patient appointing; pharmacy, clinical laboratory, and radiology; medical record management; and electronic messages. Originally developed for use in benchmark testing of comprehensive systems designed for military hospitals and clinics, the model has been generalized to be applicable to other systems and settings. Results are presented for a routine busy day in a 200-bed teaching hospital providing extensive outpatient services, and a large free-standing clinic. The model results can be applied to several facets of system planning, including sizing of the central processor and communications network, determining the optimal number of storage devices and user devices, and fine tuning the user interface.

Ambulatory Care Information Systems↗
PubMed2001

Portable cell-based biosensor system using integrated CMOS cell-cartridges.

The use of cell-based biosensors outside of the laboratory has been limited due to many issues including preparation of the sample, maintenance of the biological environment, and integration of the electronics for data collection and analysis. This paper describes a system that addresses several of these issues with the development of an integrated silicon-polydimethylsiloxane cell-cartridge. The cell-cartridge contains a CMOS silicon chip that incorporates a digital interface, temperature control system, microelectrode electrophysiology sensors, and analog signal buffering. Additionally, the cell-cartridge supports two separate cell populations in two 10 microl sealed chambers that have independent fluidic channels for sample injection. A portable, microcontroller-based electronics system capable of monitoring the action potential (AP) activity within the cell-cartridges was also developed. The AP activities of cardiomyocyte syncytia in the two chambers differentially responded to the flow of a control medium versus the flow of a biochemical agent. The cell-cartridges and portable electronics system were used to successfully record AP activity from cardiomyocytes outside of the laboratory under realistic application conditions.

Action Potentials↗
PubMed1996

Joint operating agreements: a new integration model.

Many healthcare system integrations are inherently contradictory: The participants want the benefits of integration but do not want to give up self-governance, relinquish title to their assets, or assume unwanted liabilities. A new integration model--the joint operating agreement--appears to resolve some of these concerns.

Delivery of Health Care, Integrated↗
PubMedDate not supplied

Initial experience of a nephrologist-operated vascular access center.

A nephrology practice in Alabama did not feel in control of vascular access management. Scheduling delays, as well as variable techniques and outcomes, leading to high morbidity and mortality, caused frustration with the existing care system for vascular access. Our objective was to develop an integrative system of vascular access care, involving nephrologists along with the other caregivers, and to demonstrate an improvement in outcomes. Nephrology Vascular Labs (NVL), a recent RMS-Lifeline acquisition, opened a vascular access center (VAC) as an extension of the nephrology practice. Both pre-ESRD and ESRD patients are evaluated and treated in the VAC. Treatment is rendered in a timely fashion, to the benefit of the patients. Nephrologists serve as the interventionists. More than 90% of vascular access problems detected at dialysis are treated at the VAC. More than 2000 procedures have been performed over 2 years. Procedures carried out include thrombolysis with angioplasty, fluoroscopy alone or with angioplasty, placement of cuffed and noncuffed catheters, removal of cuffed catheters, and minor surgeries. Success rates have been high. Minor and major complications have been relatively low. Referrals to both surgeons and radiologists are shown to emphasize the role of the VAC as part of an integrative system of vascular access care. Results of a patient satisfaction survey were excellent. The VAC has fulfilled the vision of creating a seamless integration of care for vascular access. Hospitalization rate has been reduced and it is suspected that the global cost of access care is markedly lower than prior to the VAC. Multiple nephrologists can rotate as the VAC's interventionist and jointly obtain good outcomes and have little variability among them. Several reasons for using a nephrologists as the interventionist are discussed.

Alabama↗
PubMedDate not supplied

Managed care and patient safety: risks and opportunities.

OBJECTIVE: Patient safety practices have primarily focused on providers, such as hospitals and ambulatory or long-term care. Based on the premise that most medical errors and patient safety problems arise from system issues, and that managed care constitutes the largest, most integrated system in health care, the authors examine the role of managed care in making patient care safer. STUDY DESIGN: Review of the literature and analysis of the role of managed care in patient safety. RESULTS: Authors find that although much has been written regarding managed care and quality, there is little research on managed care's relationship to patient safety. Research shows that managed care is not significantly different from indemnity insurance in terms of quality of care. However, managed care contracting, reimbursement, and management practices result in health care utilization changes that could pose potential risks for patient safety. Although managed care may pose possible risks to patient safety, practices can be monitored and adjusted to maintain quality and safety. At the same time, managed care provides opportunities for promoting patient safety at an integrated system level. Managed care organizations are in a unique position to influence patient safety by using safety strategies in selective contracting, financial incentives for performance, quality improvement programs, consumer education, and management and integration of care delivery. Our literature review reveals that health plans are starting to implement some of these strategies, but the practice is not widespread. CONCLUSIONS: Authors conclude with a framework and recommendations for patient safety.

Humans↗
PubMedDate not supplied

A "next generation" ethics committee. St. Joseph Health system has integrated performance-improvement features into its ethics work.

Understanding the limitations that accompany the traditional model of ethics committees, St. Joseph Health System (SJHS), Orange, CA, has been working to integrate ethics expertise and quality-improvement methodology into its "Next Generation Model" (NG Model) for such committees. However, moving from a traditional structure to the NG Model (introduced to SJHS facilities in 1999) brought some challenges, not the least of which was a deep-rooted culture of resistance to change. Following a 2004 audit of how the NG model was working, some common challenges were identified. To deal with those challenges, SJHS developed some tools and techniques that have helped ease the ongoing transition. These tools have helped the system's ethics committees address such issues as collaboration for the sake of organizational integration, setting goals, and measuring performance of various ethics roles.

California↗
PubMed1988

Host-vector system for integration of recombinant DNA into chromosomes of transformable and nontransformable streptococci.

We describe a genetic system in which transformation of Streptococcus pneumoniae and Streptococcus sanguis was used to insert recombinant DNA into the conjugative chromosomal element omega (cat tetM) 6001 (omega 6001). The element containing the recombinant DNA was then transferred by conjugation to the chromosome of transformable and nontransformable streptococci. When Escherichia coli plasmid pDP36 was used as donor in transformation, it was capable of inserting 5.9 kilobases of heterologous DNA into the chromosome of competent streptococcal strains carrying omega 6001; the transformants were scored for erythromycin resistance. Genetic analysis showed that in a fraction of the erythromycin-resistant transformants the integration via flanking homology of the heterologous DNA caused inactivation of the tetM gene of omega 6001. By analyzing the stability of the resistance markers, we found that stable integration of heterologous DNA was achieved only in the erythromycin-resistant, tetracycline-sensitive transformants. It was possible to detect conjugal transfer of the heterologous sequences from stable transformants to strains of S. pneumoniae, S. sanguis, Streptococcus pyogenes, and Streptococcus faecalis. The omega 6001-pDP36 host-vector system opens new possibilities for gene transfer in streptococci. By this method cloned streptococcal DNA (possibly mutagenized in vitro) can be returned to the original host, greatly facilitating complementation tests and fine physiological studies.

Chromosomes, Bacterial↗
PubMed1994

Lacrimal collecting system lymphomas: integration of magnetic resonance imaging and therapeutic irradiation.

Lymphomas arising within the lacrimal collecting system are rare tumours and unusual causes of lacrimal obstructive symptoms. The presentation, diagnosis, and treatment of this disease in five patients are described, as well as a review of the existing literature. Emphasized in this series is the efficacy of magnetic resonance imaging of these presentations and the importance of irradiation in their treatment.

Adult↗
PubMed2003

Transcription of endogenous and exogenous R2 elements in the rRNA gene locus of Drosophila melanogaster.

R2 retrotransposons insert into the rRNA-encoding units (rDNA units) that form the nucleoli of insects. We have utilized an R2 integration system in Drosophila melanogaster to study transcription of foreign sequences integrated into the R2 target site of the 28S rRNA genes. The exogenous sequences were cotranscribed at dramatically different levels which closely paralleled the level of transcription of the endogenous R1 and R2 elements. Transcription levels were inversely correlated with the number of uninserted rDNA units, variation in this number having been brought about by the R2 integration system itself. Females with as few as 20 uninserted rDNA units per X chromosome had expression levels of endogenous and exogenous insertion sequences that were 2 orders of magnitude higher than lines that contained over 80 uninserted rDNA units per chromosome. R2 insertions only 167 bp in length exhibited this range of transcriptional regulation. Analysis of transcript levels in males suggested R2 insertions on the Y chromosome are not down-regulated to the same extent as insertions on the X chromosome. These results suggest that transcription of the rDNA units can be tightly regulated, but this regulation gradually breaks down as the cell approaches the minimum number of uninserted genes needed for survival.

Animals↗