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PubMed1996

The Maine Lumbar Spine Study, Part I. Background and concepts.

STUDY DESIGN: This paper describes the background and factors that led to the development and implementation of the Maine Lumbar Spine Study, a prospective cohort study of patients undergoing surgical and nonsurgical treatment of herniated lumbar disc with sciatica and symptomatic spinal stenosis. OBJECTIVES: To define the factors leading to the study and the methods of designing and implementing a community-based effectiveness study to evaluate the outcomes of herniated lumbar intervertebral disc and spinal stenosis. SUMMARY OF BACKGROUND DATA: Variations in the utilization of surgery for these conditions and physicians' uncertainty regarding the best way to manage them resulted in support of a community-based study of the effectiveness of treatment alternatives. METHODS: A prospective cohort design was used. Methods of patient enrollment, data collection, management, and analysis are described. An innovative method of ascertaining the representativeness of the enrolled versus nonenrolled patient population is presented. RESULTS: The importance of developing community-based networks of physicians is discussed. CONCLUSIONS: These networks play an important role in analyzing practice pattern variations and in stimulating and participating in effectiveness research. Because effectiveness studies must be conducted at the community level, mechanisms must be developed with which to support and implement these efforts.

Cohort Studies↗
PubMed1999

Pharmacovigilance of over-the-counter products based in community pharmacy: a feasible option?

PURPOSE: With the increasing range of potent medicines available for sale 'over-the-counter' (OTC) in community pharmacies, this feasibility study set out to develop and validate a method for the pharmacovigilance of OTC medicine, using ibuprofen as a model. METHOD: A trained network of community pharmacies (n=61) in Grampian, Scotland, tested different methods for recruiting people buying ibuprofen for their own use (pilot 1) and then used the 'best' method to test two methods of follow-up (pilot 2). RESULTS: Recruitment rates-method 1 (pharmacy staff inserted the patient information sheet and recruitment questionnaire in the shop bag of eligible subjects): 18% (41/227) of questionnaires issued; method 2 (staff explained the study and asked eligible subjects to complete the questionnaire outwith the pharmacy): 31% (61/194); method 3 (staff explained the study and asked eligible subjects to complete the questionnaire in the pharmacy): 52% (100/192). A further 200 subjects were recruited in pilot 2. The majority of recruits (n=402) were female (75%), mean age 43 years (range 18-84 years), 73% drank alcohol, 72% were non-smokers, and 56% were in the two most affluent socio-economic categories. There was a strong association between the drug dose data collected prospectively and that collected retrospectively. The average response to postal follow-up was 80% (315/392) at 1 week and 79% (308/390) at 2 months. CONCLUSION: The study has confirmed the support of pharmacy personnel in undertaking research and indicated the feasibility of a major pharmacovigilance project of OTC medicines.

Journal Article↗
PubMed1991

Barriers to individualized community support services: the impact of some current funding and conceptual models.

Methods now used to fund and monitor community support services for long term mentally ill persons work at cross purposes to the goals they are to promote. Commonly, community supports are offered through a limited number of programs selected by systems managers. Often these programs have a primary goal of providing treatment or helping consumers achieve some higher purpose with only a secondary focus on the consumer obtaining wanted goods and services needed to develop and sustain an individualized community support network. Consumer directed vouchers offer a preferred alternative to these approaches.

Activities of Daily Living↗
PubMed2003

Scaling laws for the movement of people between locations in a large city.

Large scale simulations of the movements of people in a "virtual" city and their analyses are used to generate insights into understanding the dynamic processes that depend on the interactions between people. Models, based on these interactions, can be used in optimizing traffic flow, slowing the spread of infectious diseases, or predicting the change in cell phone usage in a disaster. We analyzed cumulative and aggregated data generated from the simulated movements of 1.6 x 10(6) individuals in a computer (pseudo-agent-based) model during a typical day in Portland, Oregon. This city is mapped into a graph with 181,206 nodes representing physical locations such as buildings. Connecting edges model individual's flow between nodes. Edge weights are constructed from the daily traffic of individuals moving between locations. The number of edges leaving a node (out-degree), the edge weights (out-traffic), and the edge weights per location (total out-traffic) are fitted well by power-law distributions. The power-law distributions also fit subgraphs based on work, school, and social/recreational activities. The resulting weighted graph is a "small world" and has scaling laws consistent with an underlying hierarchical structure. We also explore the time evolution of the largest connected component and the distribution of the component sizes. We observe a strong linear correlation between the out-degree and total out-traffic distributions and significant levels of clustering. We discuss how these network features can be used to characterize social networks and their relationship to dynamic processes.

Community Networks↗
PubMed1997

Rural health network development: public policy issues and state initiatives.

Rural health networks are a potential way for rural health care systems to improve access to care, reduce costs, and enhance quality of care. Networks provide a means for rural providers to contract with managed care organizations, develop their own managed care entities, share resources, and structure practice opportunities to support recruitment and retention of rural physicians and other health care professionals. The results of early network development initiatives indicate a need for state officials and others interested in encouraging network development to agree on common rural health network definitions, to identify clearly the goals of network development programs, and to document and analyze program outcomes. Future network development efforts need to be much more comprehensive if they are to have a significant impact on rural health care. This article analyzes public policy issues related to integrated rural health network development, discusses current efforts to encourage network development in rural areas, and suggests actions that states may take if they desire to support rural health network development. These actions include adopting a formal rural health network definition, providing networks with alternatives to certain regulatory requirements, and providing incentives such as matching grants, loans, or technical assistance. Without public sector support for networks, managed care options may continue to be unavailable in many less densely populated rural areas of the country, and locally controlled rural health networks are unlikely to develop as an alternative to the dominant pattern of managed care expansion by large urban entities. Implementation of Medicare reform legislation could provide significant incentives for the development of rural health networks, depending on the reimbursement provisions, financial solvency standards, and antitrust exemptions for provider-sponsored networks in the final legislation and federal regulations.

Antitrust Laws↗
PubMed2006

HIV risk behaviour patterns, predictors, and sexually transmitted disease prevalence in the social networks of young men who have sex with men in St Petersburg, Russia.

HIV seroconversions and sexually transmitted diseases (STDs) are often clustered in social networks within community populations. The present study was carried out among men who have sex with men in Russia, where a major HIV epidemic is unfolding, and where social networks have played a historically important role. In all, 38 social networks were recruited into the study, and members of all networks (n = 187) completed risk behaviour assessments and were tested for STDs. About 17% of participants had STDs, and 10% of men had syphilis. Over 64% of men had recent unprotected anal intercourse (UAI), including 51% who did so with main partners, 30% who did so with casual partners, and 32% who had UAI with multiple male partners. The strongest predictor of all risk behaviour indicators and STDs was the social network, to which an individual belonged, supplemented by peer norm perceptions and intentions to practise safer sex. There was a high level of correspondence in behaviour between the social leader of a network and its other members. Social networks should be directly targeted in HIV prevention efforts.

Adult↗
PubMed2006

Using networks to enhance health services delivery: perspectives, paradoxes and propositions.

There is a growing need to better understand and address the consequences of an increasing reliance on networks used to enhance health services delivery. Networks seem to have emerged as the definitive solution for tackling complex healthcare problems together that we have not been able to adequately address separately. Emphasizing the collective and the collaborative, networks are assumed to address healthcare issues in ways that are superior to previous service-delivery models. While this assumption would appear to be sound theoretically, we have little empirical information available to actually understand what networks are, what they do and whether they achieve their stated goals--truly making a difference in the delivery of care and the maintenance of health. With a diversity of networks within Canada focused on health services delivery, this paper offers a multi-dimensional framework for conceptualizing how these complex inter-organizational relationships generate both challenges and opportunities. We identify six paradoxes that the networks create when used to enhance the delivery of health services and posit several propositions concerning the evaluative work that needs to be done to enhance our understanding of and confidence in this inter-organizational form. Unless these paradoxes are adequately recognized and addressed, the value and costs associated with developing and using networks in healthcare contexts will remain unclear at best. Given the broad interest in and use of networks proliferating in health-related arenas, it is time to amass the evidence and than align the perspectives. Are networks here to stay in healthcare because they make a difference or because we got tired of talking about the need for greater collaboration and so gave it a new name and frame? At the very least, it will be important to build on what we have already learned through research into collaboration in healthcare and related fields, and even more critical to be mindful of the pitfalls and possibilities of using networks as the solution of choice as we move forward.

Canada↗
PubMedDate not supplied

Building a collaborative network.

The treatment of children who require long-term hospitalization cannot remain encapsulated within the hospital. Collaborative efforts must be established within a network of community physicians, health specialists, and facilities. Each child is treated within the context of his family and community, even while hospitalized. Such treatment plans can be conceived and carried out only when there is a commitment to develop and maintain a viable collaborative treatment network.

Attitude↗
PubMed2005

[Applying social network analysis to the health system].

BACKGROUND: Social network analysis is a method for describing and contextualising the structural relationships amongst social entities. The aim of this study was to assess the relationships between hospitals through the use of an example of a hospital that takes care of myocardial infarction in the region of Provence Alpes Côte d'Azur (PACA). METHOD: This retrospective study included all patients hospitalised for acute coronary syndrome in the PACA region between January and June 2000. The description analysis consisted of making a graph describing the transfer of patients between hospitals to calculate indicators for the centrality of the hospital and its prestige. The graph was also used to determine and measure the sub-group cohesion (cliques) and the density of the hospital network. RESULTS: A total of 2049 patients suffering from myocardial infarction were admitted to 78 hospitals during the study period. There were 867 transfers from one hospital to another. 51 cliques were highlighted; 29 hospitals do not belong to a clique. Among the 49 hospitals who do belong to sub-groups, 50% are linked to two cliques. Eight hospitals belong to more than 8 sub-groups, and the maximum number of sub-groups to which a hospital is linked is 12. The density of the hospital network is 0.12. CONCLUSIONS: Social network analysis is a field of research open and adaptable to the public health scene. This method could be applied to the evaluation of health and hospital administration and management networks.

Community Networks↗
PubMedDate not supplied

Developing an income distribution methodology for cardiovascular physician groups and networks.

Developing an income-distribution model that rewards physicians equitably and fairly for cost-effective patient care services provided, practice building efforts, and complying with practice guidelines and standards is an important step which all practices must take to align the payment-mechanism incentives with the physician income-distribution methodology. Recalibrating the compensation arrangement to the market requires open dialogue, the identification of shared values and convictions, and the development of compensation components that align compensation and payment incentives. Through the aligning of incentives, networks and group practices will be better positioned for changes in the market. As changes occur, compensation arrangements may have to be adjusted to ensure that payment-arrangement incentives are being rewarded and to ensure the network's or group's long-term profitability and viability.

Algorithms↗
PubMed1998

Is there a PSO in your future?

A decision to form a provider-sponsored organization and go after the lucrative Medicare market depends on several variables. Chief among them are risk-management and marketing capabilities, strength of the provider network, the potential market and the competition, and availability of appropriate information systems and controls.

Aged↗
PubMedDate not supplied

[Public health networks: practical aspects and contribution to clinical research. Round table no. 2. XV].

A public health network involves several and different health professionals who work in synergy to achieve a common objective: to improve the management of a given disease. Per se, this objective could not be achieved by each of these professionals if working separately. In practice, existing public health networks ensue from very different legal frameworks and come up against various impediments. They have been developed mainly for the management of chronic and serious diseases (e.g. asthma, diabetes, virus C hepatitis, Parkinson's disease, drug abuse). Public health networks can be a very valuable source of data for clinical and epidemiological research, mainly because patients are followed up over a very long period and information coming from various health professionals (general practitioners, specialists, nurses, etc.) is centralized and recorded in a common database. It can also be useful for pharmacovigilance purposes (assessment of Type A and delayed reactions). In any case, the relative interest of such networks should be regularly assessed by an ad hoc methodology, e.g. an experimental or pseudo-experimental design vs. a reference. Despite the fact that there are relatively few operational networks, they can be of great interest for clinical research.

Community Networks↗
PubMed2000

[Transplantation collaborative networks].

The collaborative networks in Italy are described, with their objectives and the geographical areas covered. Their main features are: function of the reference centres, waiting lists, criteria for organ assignment, common programmes for some patients, services offered to the network members, organ procurement activity. The analysis of the activities performed included organ exchanges within and outside the network, common activities for tasks that could not be satisfactorily attained by a single centre or region, the collaborative studies. Finally, the role of the networks and of a national coordination, in order to better develop transplants nationwide, is discussed.

Community Networks↗
PubMed1997

[Current status of antenatal diagnosis & perinatal medical network].

Antenatal diagnosis has undergone an explosion of growth in the last decade. This has revolutionized the practice of fetal medicine. Ideally, the antenatal diagnosis of congenital anomalies should improve antenatal counseling, it may also affect the timing, site, and method of delivery and potentially allow for intrauterine surgical correction. Paradoxically worse outcomes, however, have been observed in cases of some anomalies such as diaphragmatic hernia and omphalocele. Most of them combined premature birth and/or low birth weight with associated lethal anomalies: the combination almost inevitably led to mortality. In order to reduce the mortality, new approaches will be required for such anomalies in the future. Perinatal medical network will also be important to promote a closer association between perinatal medicine and perinatal surgery.

Community Networks↗