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At least 1,153 records · Page 64Linked to original sources
PubMed1997

Validity of the minimum data set for assessing nutritional status in nursing home residents.

The Minimum Data Set (MDS), a Health Care Financing Administration (HCFA)-mandated resident assessment system used in community nursing homes, is potentially useful for assessing nutritional status. We compared anthropometric measures of nutritional status available in the MDS [weight and body mass index (BMI)] with other anthropometric and bioelectrical measures of nutritional status, not available on the MDS. We also studied associations of MDS-measured clinical characteristics of nursing home residents with anthropometric and bioelectrical measures of lower and higher nutritional status, defined as measures in the 25th percentile and below, and 75th percentile and above, respectively. Data were from a sample of residents of an academic long-term care facility (n = 186, 75% female, mean age 89.9 +/- 5.6 y). Results were as follows: 1) MDS measures of weight and BMI were significantly correlated with all the anthropometric and bioelectrical measures of nutritional status in women, and most measures in men; 2) some MDS variables, including poor oral intake and advanced cognitive decline, were significantly associated with two or more anthropometric and bioelectrical measures of low nutritional status; and 3) complaints of hunger were significantly associated with two or more anthropometric and bioelectrical measures of high nutritional status. Results suggest that 1) weight and BMI, available in the MDS, are correlated with other measures of nutritional status not available, and 2) MDS clinical variables are associated with measures of low and high nutritional status, and may be useful in identifying patients at nutritional risk.

Aged↗
PubMedDate not supplied

The Management Academy for Public Health: program design and critical success factors.

The Management Academy for Public Health is a team-based training program jointly offered by the School of Public Health and the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill. This 9-month program teaches public health managers how to better manage people, information, and finances. Participants learn how to work in teams with community partners, and how to think and behave as social entrepreneurs. To practice and blend their new skills, teams develop a business plan that addresses a local public health issue. This article describes the program and explains the findings of the process evaluation, which has examined how best to structure and deploy a team-based method to create more effective, more entrepreneurial public health managers. Findings indicate that recruitment and retention are strong, program elements are relevant to learners' needs, and learners are satisfied with and value the program. Several specific benefits of the program model are identified, as well as several elements that support business plan success and skills' application on the job. On the basis of these findings, four success factors critical for developing similar programs are identified.

Entrepreneurship↗
PubMed2000

Mental health services for American Indians and Alaska Natives: need, use, and barriers to effective care.

This special review summarizes and illustrates the state of our knowledge regarding the mental health needs of American Indians and Alaska Natives. These needs are considerable and pervasive. The discussion begins by reflecting on the limits of psychiatric nomenclature and conceptual frameworks for revealing Native constructions of mental health and mental illness. The experience and manifestation of psychopathology can be both different and the same across cultures, hinging upon the extent to which such basic assumptions as the relationship of mind to body--and spirit in the case of Native people--or the primacy of the individual or social collective are shared. Having set the stage, this paper moves to recent empirical evidence regarding the mental health needs of American Indians and Alaska Natives: we review that evidence and consider it within the broader context of available services. The report closes with a brief overview of the most pressing issues and forces for change afoot in Indian country in the US. Most have to do with the structure and financing of care as tribes and other Native community-based organizations seek to balance self-determination and resource management to arrive at effective, fiscally responsible, culturally informed prevention, treatment, and aftercare options for their members. These changes may herald similar trends among First Nations people to the immediate north.

Adult↗
PubMed1999

What determines the need for nursing home admission in a universally insured population?

OBJECTIVES: People in lower socio-economic groups are more likely to experience disability and cognitive impairments at earlier ages than those in higher status groups. As a result, the need for nursing home care would be expected to be greater among older people of lower socio-economic status. This study examines the effects of income and education on the probability of nursing home entry in a universally insured elderly population. METHODS: Using a prospective observational study design, a range of predictors of nursing home admission was examined over a three-year period in a representative sample of 7220 residents, aged 60 years or older, in a Canadian province. Individual census records and computerized administrative records of health care utilization were linked to form a database for analysis. RESULTS: An increased risk of institutionalization was associated with older age, male gender, unmarried status and self-reported disability. In addition, lower household income and lower attained education were independently associated with a higher risk of nursing home admission. CONCLUSIONS: These results emphasize the independent role of socio-economic status in accentuating or accelerating the need for institutional care towards the end of life. It is important that these effects are recognized in policies that determine the finance of both nursing home care and formal community-based supportive care.

Aged↗
PubMed1998

Improving prenatal care services for low-income African American women and infants.

Increasing the level of prenatal care among African American women may be one method of improving the health and well-being of African American women and children. This article identifies factors influencing access to and use of prenatal care and strategies for increasing the use of prenatal care among low-income African American women. Barriers to prenatal care, the strengths and limitations of prenatal care in reducing infant mortality and improving infant outcomes, and the importance of providing more comprehensive prenatal care that addresses both the medical and psychosocial needs of the low-income African American mother and her infant are discussed. Changes in prenatal care services that include the medical and lay communities, public health organizations, public policy organizations, and medical financing institutions are identified.

Adult↗
PubMedDate not supplied

A new Medicaid program.

This paper suggests a new federal-state partnership--a new Medicaid program--for coverage of the uninsured and long-term care. It discusses national eligibility standards, based on financial need (rather than categorical eligibility); buy-ins and reinsurance for high-risk populations; a national strategy of "Medicaid plus tax credits" to cover the uninsured; Medicaid long-term care with expanded eligibility, better financial protection, and home and community-based care benefits; quality initiatives; administration; and possible financing sources (such as estate taxes and an increased Social Security Disability Insurance wage base). Without a new mission and national standards, Medicaid will continue to grow in a patchwork fashion with huge gaps and inequities.

Cooperative Behavior↗
PubMed1976

The community hospital as a focus for health planning.

A community hospital focus for health planning has been developed by a Department of Community Medicine in a "non-teaching" voluntary hospital. Results of three years of planning experience have included: descriptions of service area populations and utilizer populations; implementation of neighborhood based health centers with transportation and outreach programs; integration of emergency services with other ambulatory care resources; and proposals for geriatric day-care, ambulatory surgery, and patient education. Working relationships have been developed between the hospital Department and local planning bodies, among them the Comprehensive Health Planning agency, the County Health Services Department, consumer groups, voluntary agencies and a University Health Services Center.

Aged↗
PubMed1992

Hospitals on the frontier.

The concept of a limited service rural hospital recently gained nationwide attention when Montana introduced the medical assistance facility (MAF) model, which allows a hospital to have a license under less stringent rules (rather than close completely). The MAF is a down-scaled, limited-service rural hospital that makes extensive use of midlevel practitioners and has flexible staffing requirements. MAFs restrict admission to patients with low-intensity, acute illnesses who typically require short-term hospitalization. Montana currently has four MAFs certified as Medicare and Medicaid providers under the terms of a waiver agreement with the Health Care Financing Administration (HCFA). MAFs are located in four "frontier" communities--counties or regions with fewer than six residents per square mile. A 96-hour cap on inpatient stay effectively guarantees that the MAF's scope of services will be circumscribed. However, the array of services that meet the definition of low intensity and short term is potentially broad. The flexibility--and thus the real strength--of the MAF model is in the licensure rules, which relax some of the requirements that the small rural hospital has difficulty meeting (such as those regarding staffing). The demonstration project is now entering its final two years. So far, it has gained widespread interest and support. The central question is whether HCFA will extend the waiver after 1993. Another possibility is the reclassification of MAFs to rural primary care hospitals, which do not require waiver coverage to receive Medicare and Medicaid reimbursement.

Health Services Accessibility↗
PubMedDate not supplied

Medicaid and managed care: opportunities for innovative service delivery to vulnerable populations.

The crisis in state "safety-net" funding for high-need, high-risk, high-cost vulnerable populations has led to the development of creative strategies and financing mechanisms by the states for delivering essential community-based services. This is also an opportunity for private-sector providers who can recognize the special needs of these populations, form links with other key constituencies and apply managed care concepts to long-term health and human service delivery.

Community Mental Health Services↗
PubMed1995

Do transition grants help rural hospitals?

Congress introduced the Rural Health Care Transition (RHCT) Grant Program in 1989 to assist financially troubled, small rural hospitals. This article discusses grant effects on the second cohort of hospitals to complete their 3-year grants. Although three-quarters of the grantees implemented all or most of their goals, 11 percent could not implement a viable project. Grantees added or upgraded 523 services with the help of their grants, especially outpatient and social services, most of them financially self-supporting. Except among the largest hospitals, there was no evidence that the grants improved grantee finances. Management appeared unaffected by the grants.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1982

Will funding cutbacks force hospitals to abandon care for the needy?

Cutbacks in funding for health care services are forcing hospitals to reexamine their traditional mission of caring for those in need. Hospitals will have to cooperate with local community service agencies, funding agencies, and churches and congregations to meet the needs of their communities.

Economics, Hospital↗
PubMed1994

[The decentralization and municipalization of health services in Säo Paulo, Brazil].

The health system in Brazil has undergone profound changes since the 1980s. In the state of São Paulo, the processes of decentralization to the municipio and regional levels, as well as integration of health services, began in 1983. This study describes the strategies adopted by the Ministry of Health of the state of São Paulo to implement these processes and create 65 regional health offices, and discusses the role of these offices in the new unified health system. It is concluded that decentralization has resulted in increased local government participation in financing the health system, that production of medical and community health services has grown, and that health indicators have improved.

Brazil↗
PubMed1997

A tale of two New Jersey cities.

Judging from the social and health measures considered in this article, Newark and Jersey City face similar challenges as other large cities. For Newark, the challenges are more extreme. The high rates of poverty and violence, coupled with a low rate of high school graduation and a large number of single parent households bode ill for the city. The hospitals in Newark and Jersey City have undergone major changes in meeting the needs of their communities. They have adjusted their size, shortened their lengths of stay, and provided more intensive care services and outpatient services. Of special concern for New Jersey's hospitals is the reliance on Medicaid financing. If dramatic changes are made to the Medicaid program, Newark hospitals should be on high alert. Legislatures need to tread carefully in designing policies that address the needs of New Jersey's large cities. The state is undergoing major changes in its health care system. The demise of the all-payer rate setting system, the establishment of the Health Care Subsidy Fund to finance uncompensated care and subsidize insurance for low and middle-income families, modifications to the community rating system for private insurance, and changes to the welfare system that affect eligibility for Medicaid all require legislators to consider the context in which these programs operate.

Adolescent↗
PubMed1997

Sustaining malaria prevention in Benin: local production of bednets.

Through a Benin-Canada participatory research initiative which included both Benin and Canadian non-governmental organizations, a local capacity to produce and market bednets for the prevention of malaria was developed. The development process began following a community-based assessment of local needs and skills. All materials for the manufacture and distribution of the bednets were obtained locally with the exception of the netting which was imported from Canada. The sustainability of the enterprise is enhanced by the community's recognition of the importance of malaria and the culturally acceptable practice of bednet use.

Benin↗
PubMed1986

Community-oriented primary care: an examination of the US experience.

Community-oriented primary care (COPC) represents a specific variation on the general primary care model. Seven case studies from vastly different health care settings were examined and this report describes the diversity of expression of the principles of COPC observed. The results suggest that COPC is not limited to publicly funded programs, but can find expression in the private sector as well. The organization of financing and the lack of feasible quantitative tools hinder the full development of the model.

Community Health Services↗
PubMed1992

Building systems of care for youth with serious mental illness.

In 1990 the Robert Wood Johnson Foundation's Mental Health Services Program for Youth awarded grants to eight state-community partnerships to develop systems of care for mentally ill children and adolescents. The authors describe approaches to system building in the program's first two years of implementation. The evolving systems consist of government agencies in child welfare, mental health, public health, education, and juvenile justice, as well as private-sector health and mental health care providers. Basic system features include interagency steering committees and long-term intensive case management. Fundamental principles guiding system development are individualization of care to meet the needs of the specific child, organization of care to empower families to manage care over the long term, flexible financing of care, and normalization of care in family and community settings.

Adolescent↗