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PubMed1994

Providing treatment to persons with mental illness.

The RWJF Program on Chronic Mental illness created centralized mental health authorities in nine cities as a demonstration project. Evaluation teams, selected after the project began, and a national program office, established to provide technical assistance and to communicate progress and results, worked in tandem with the program staff. The project was evaluated as "logic model" to determine the feasibility of centralized authorities and to estimate their effect on various outcomes. One finding was that service reorganization does not cancel out the need to supply funds or mental health care. The problems of delay in the publication of results and of public officials' reluctance to act without "definitive" research data are described, as are the remedies for these difficulties.

Chronic Disease↗
PubMed1977

Effective use of patient resources: a training guide for family physicians.

Effective use of resources available to patients in their homes, in their neighborhoods, and in their communities can give the family physician much assistance in the provision of total health care to his patients and their families. Patients' resources can be divided into two broad categories--"Personal" and "Institutional". Examples of the former are family, church, neighbors, unions, etc. Institutional resources can be public or private, and they cover a broad spectrum of services. Patients' needs for dignity and independence are best served by Personal resources. Institutional resources should be used only for those services that cannot be met any other way. Success in using any resource requires an orderly five-step process which is presented and discussed in this paper.

Community Health Services↗
PubMed1977

Private practice in the public sector: a unique relationship among local government, physicians, and health care consumers in Cincinnati.

Because of health care inequities that still persist under federal and state sponsorship plans, many local government agencies are starting to consider ways of directly providing medical services to the poor. Over 100 years' experience with direct provision programs in the City of Cincinnati, however, have been ultimately counterproductive. A unique three-way contract developed by the Board of Health, a private multispecialty physicians' group and a consumer advocate organization has recently allowed Cincinnati to implement a delivery system that integrates mechanisms for prepaid public health care into a fee-for-service private group practice, all within the context of a community-based neighborhood health care facility. While it is still too early to make a full evaluation of this public health care group practice model, there are already indications that is services will be superior to those offered in Cincinnati's traditional public clinics.

Attitude of Health Personnel↗
PubMed1997

Gold in goldenseal.

Healing herbs and alternative therapies already represent a market as big as $40 billion a year--with consumers paying most of the tab. That's why hospitals and entrepreneurs aren't waiting for insurers to expand coverage before venturing into alternative medicine.

Attitude of Health Personnel↗
PubMed1994

Sustaining the Bamako Initiative in the Gambia--some management implications.

There is increasing pressure in developing countries to improve the social, political and economic status of their people. For former colonies such as the Gambia, pre-independence promises of equity in health, education, water supply and sanitation were vaguely presented in political manifestos. Some of these promises were not translated into concrete plans because of the economic difficulties that the countries experienced. The Alma Ata Declaration on Primary Health Care in 1978 was seen as a strategy to improve the deteriorating health status in developing countries. The economic crisis however, which these countries were facing forced them into implementing Structural Adjustment Programmes (SAP). This resulted in a search for alternative methods of financing health care including that of the Bamako Initiative in 1987 to strengthen the implementation of PHC. The Gambia adopted The Bamako Initiative in 1993 to help in strengthening its already well-developed PHC infrastructure. The Bamako Initiative, like any other form of financing health services, is however not without shortcomings. This paper assesses the structural bottlenecks likely to affect the sustainability of the programme in the Gambia. It examines the political and operational management issues such as political stability, donor commitment and support, effective community management, health sector support and the availability of financial resources.

Community Health Planning↗
PubMed1993

The rural hospital as a provider of health promotion programs.

Although patient education has always been recognized as an essential function of a hospital, it was not until the health concerns of the nation focused on prevention that hospitals began to develop activities aimed at primarily healthy individuals. Hospital health promotion evolved from patient education about specific diseases to programs focused on modifying of lifestyle practices to prevent future debilitating conditions. Studies conducted in the early 1980s show hospital-based health promotion programs increasing in number and including such target populations as senior citizens, children, business people, and hospital employees. However, the extent of involvement of the rural hospital in offering health promotion programs has not been clearly established. The current study was conducted to determine the status of health promotion programs in rural North Carolina hospitals. Elements considered were types of programs, target audiences, methods of financing, staff use, and availability of specialized facilities for health promotion programs. The results indicate rural hospitals do offer health promotion programs, but their primary focus is on hospital employees. Most programs are offered at low or no cost, making those offered for the community readily accessible. If input from the community is used and programming is aimed at specific health needs of rural populations, the rural hospital could make a significant contribution to an overall primary prevention strategy, lowering community health care costs.

Community-Institutional Relations↗
PubMed2001

Service learning: integrating student learning and community service.

Health professions education is directly effected by changes in health care service delivery and financing systems. In the United States, as the health care industry increasingly shifts to a market economy, service delivery venues are moving away from acute care facilities and into community-based settings. Additionally, there is increased emphasis on primary prevention programs, often provided in public health settings. For health professions programs that traditionally provide clinical training in hospitals and long-term care facilities, there are unique challenges associated with identifying new venues in order to insure that students are exposed to a wide variety of patients with a range of chronic to acute disease conditions. One set of tools that has demonstrated usefulness during these kinds of transitions is service learning. This teaching methodology emphasizes increased partnership with clinical training sites, extensive orientation to patient populations and community resources, structured reflection and instilling the ethic of service in future health care providers. Although this article describes utilization of service learning in the context of current conditions in the United States, we hope that the principles presented here can be readily adapted in any setting.

Journal Article↗
PubMed1982

A reasoned approach to hospital planning in an uncertain world.

The historical approach to planning community hospitals fails to recognize the substantial impact of finance on program decisions. A fundamentally different approach, an approach that involves the chief financial officer in the planning effort, is proposed here. By integrating financial planning within the overall planning effort, a hospital can develop a truly strategic plan based on the best information from everyone on the hospital management team.

Financial Management↗
PubMed2000

Transformational leadership: moving total quality management to world-class organizations.

Transformational values and competencies will become critically important by the year 2001 if we are to achieve a health system that fosters community well-being and basic care for all, financed through a combined public-private partnership that is cost effective and uses treatments that unite body, mind and spirit. This article will focus on the use of transformational leadership as a strategy to move health-care organizations beyond traditional values and approaches by building upon the core values of total quality management (TQM). Learning organizations will emerge and finally world-class organizations will evolve, combining the characteristics of total quality and learning organizations, and more. A world-class organization can be described as being the best in its class or better than its competitors in the community, state, nation or world.

Delivery of Health Care↗
PubMed1997

The cost of outpatient training of residents in a community health center.

BACKGROUND: The system of paying for graduate medical education is undergoing reform. As financing changes, understanding the costs of training family practice residents in the outpatient setting will be critical. METHODS: A financial model was used to analyze retrospective data from an existing residency and community health center linkage in Utah. Data from 1994 were used to estimate fixed and variable costs and income associated with the training program. The net cost of training residents was determined, as well as the cost of replacing their services with staff physicians. RESULTS: This outpatient program generated an average of $1,933 per resident in annual revenues above expenses. If staff physicians replaced residents in providing the same services, the health center would have generated an additional $5,033 per resident in income. If precepting faculty were paid rather than volunteer, the program would cost $7,912 per resident per year. Under baseline assumptions, an educational supplement of $9.52 per patient would be required for the residents to break even relative to staff physicians. CONCLUSIONS: Graduate medical education reform will need to include provisions for reimbursing host facilities for the increased cost of outpatient care provided by residents.

Ambulatory Care↗