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PubMed2006

Re-examining the paradox of structure: a child health network perspective.

In their lead paper, Huerta, Casebeer and VanderPlaat argue that there are several key forces driving the development of health services delivery (HSD) networks, and propose a series of paradoxes and propositions to initiate this timely and essential dialogue. Ultimately, they submit that networks are likely to remain within the healthcare system to build system capacity and drive integration. Given this, they challenge us to further the dialogue and investigate these networks. While this peer commentary shares many of the lead author's perspectives, the generic nature of the discussion does not bring us to the relative complexities revealed in some HSD network practices. A Canadian child health network lens is used to re-examine the lead paper's conceptualization of network typologies and the proposed paradox of structure. We combine network practice and academic expertise to highlight the structural, governance and leadership tensions between traditional hierarchical public service organizations and the non-hierarchical nature of inter-organizational networks. Child health network leaders and members must examine and work with the challenges associated with importing traditional organizational cultures into an inter-organizationally networked context, while simultaneously maintaining these dual (or duelling) cultures.

Canada↗
PubMed2001

Critical care. Only connect.

The establishment of a network for critical care services in five hospitals has led to a decrease in transfers of patients for non-clinical reasons. There have been no transfers outside the network's area. The introduction of common admission policies has led to more openness about bed availability. The introduction of the network has standardised data collection. The availability of extra funds and facilities was a big incentive to staff involvement.

Admitting Department, Hospital↗
PubMed2002

Enhancing the quality of care for patients with coronary heart disease: the design and baseline results of the hastening the effective application of research through technology (HEART) trial.

BACKGROUND: Effective therapies exist for reducing mortality in persons with coronary heart disease (CHD), but they remain underused. OBJECTIVE: To report the design and baseline results of a quality improvement project designed to increase the use of hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitors, beta-adrenergic blocking agents, and angiotensin-converting enzyme (ACE) inhibitors in patients with CHD in a network-model managed care setting. METHODS: Patients with CHD were identified by searching a claims database. Use of therapies was assessed by linkage with a pharmacy benefits database. A survey was mailed to primary care physicians to collect information related to attitudes and behavioral intentions regarding aggressive management of CHD. An intervention, consisting of a guideline summary, performance feedback, and medical chart reminders, was evaluated in a randomized, practice-based trial. RESULTS: Among 1189 patients with CHD, the median prevalence of receipt of HMG-CoA reductase inhibitors, beta-adrenergic blocking agents, and ACE inhibitors across practices at baseline (the first 3 months of 1999) was 50.0%, 35.0%, and 18.8%, respectively. Reported barriers included a perception that aggressive management of CHD is thought to be unimportant by support staff yet to require significant staff time. Aggressive management of CHD was perceived to incur non-reimbursable costs, to be unimportant in their patient population, to require a great deal of patient education and self-management, and to be limited because many patients do not adhere to therapy. CONCLUSIONS: Opportunities exist for enhancing the quality of care provided to patients with CHD. Our experience to date supports the logistical feasibility of implementing network-level quality enhancement efforts in managed care networks.

Adrenergic beta-Antagonists↗
PubMed1992

Perinatal substance abuse and AIDS: subject selection, recruitment, and retention.

Studies that involve subjects who are HIV infected as well as chemically dependent present special challenges to the study team. HIV infection is now so common in many parts of the country and infection can potentially influence so many commonly used endpoints for perinatal chemical dependence studies that HIV must be considered in these studies. Some of the factors that need to be taken into account in the design of studies include the staging of HIV illness, the consequences of HIV-induced CNS disease, the effects of HIV treatment, and the biases in subject selection that arise due to inaccurate information about risk factors and imbalance in sources of subjects and controls. In addition, the study team needs to remember the community and staff fear and bias that are often encountered in the care of HIV-infected patients. Fruitful sources of subjects for perinatal studies include prenatal clinics and delivery rooms, chemical dependence programs, and the network of community social agencies. Retention of this challenging group is strongly aided by the establishment of a seamless system of services that includes all aspects of general medical care, HIV specialty care, access to treatment protocols, and psychosocial care.

Female↗
PubMed2006

The Deep South Network for cancer control. Building a community infrastructure to reduce cancer health disparities.

Given the recent advances in cancer treatment, cancer disparity between whites and African-Americans continues as an unacceptable health problem. African-Americans face a considerable disparity with regard to cancer incidence, survival, and mortality when compared with the majority white population. On the basis of prior research findings, the Deep South Network (DSN) chose to address cancer disparities by using the Community Health Advisor (CHA) model, the Empowerment Theory developed by Paulo Freire, and the Community Development Theory to build a community and coalition infrastructure. The CHA model and empowerment theory were used to develop a motivated volunteer, grassroots community infrastructure of Community Health Advisors as Research Partners (CHARPs), while the coalition-building model was used to build partnerships within communities and at a statewide level. With 883 volunteers trained as CHARPs spreading cancer awareness messages, both African-Americans and whites showed an increase in breast and cervical cancer screening utilization in Mississippi and Alabama. In Mississippi, taking into account the increase for the state as a whole, the proportion that might be attributable to the CHARP intervention was 23% of the increase in pap smears and 117% of the increase in mammograms. The DSN has been effective in raising cancer awareness, improving both education and outreach to its target populations, and increasing the use of cancer screening services. The National Cancer Institute has funded the Network for an additional 5 years. The goal of eliminating cancer health disparities will be pursued in the targeted rural and urban counties in Mississippi and Alabama using Community-Based Participatory Research. Cancer 2006. (c) 2006 American Cancer Society.

Black or African American↗
PubMed2001

Ageing and mental health in a developing country: who cares? Qualitative studies from Goa, India.

BACKGROUND: While there is a growing body of epidemiological evidence on the prevalence of mental illnesses in late-life in developing countries, there is limited data on cultural perceptions of mental illnesses and care arrangement for older people. METHOD: This qualitative study used focus group discussions with older people and key informants to investigate the status of older people and concepts of late-life mental health conditions, particularly dementia and depression, in Goa, India. RESULTS: Vignettes of depression and dementia were widely recognized. However, neither condition was thought to constitute a health condition. Dementia was construed as a normal part of ageing and was not perceived as requiring medical care. Thus, primary health physicians rarely saw this condition in their clinical work, but community health workers frequently recognized individuals with dementia. Depression was a common presentation in primary care, but infrequently diagnosed. Both late-life mental disorders were attributed to abuse, neglect, or lack of love on the part of children towards a parent. There was evidence that the system of family care and support for older persons was less reliable than has been claimed. Care was often conditional upon the child's expectation of inheriting the parent's property. Care for those with dependency needs was almost entirely family-based with little or no formal services. Unsurprisingly, fear for the future, and in particular 'dependency anxiety' was commonplace among older Goans. CONCLUSIONS: There is a need to raise awareness about mental disorders in late-life in the community and among health professionals, and to improve access to appropriate health care for the elderly with mental illness. The study suggests directions for the future development of locally appropriate support services, such as involving the comprehensive network of community health workers.

Aged↗
PubMed2004

[Transparency in patient care -- survey of bedsores on communal level to promote quality assurance].

The medical diagnosis of bedsores often applies to open wounds. These wounds are caused by constant pressure to the skin of seniors who cannot change their position in bed or wheelchair without help. In severe cases these wounds extend through all layers of the skin with involvement of muscle and underlying bone. These ulcers can be very painful, so the mobility and quality of life of seniors is thoroughly reduced. Treatment of ulcers costs annually millions of Euro in Germany alone. Primary prevention of bedsores has not yet been established neither in Germany nor in Europe. The first step to improve the situation in a scientific manner has been to set up a comparable database. In order to change that, the German community of Ostalbkreis (part of the German Federal state of Baden-Wurttemberg) developed a process of nursing quality assurance as a project of the local agenda 21, initiated and supported by the health office of the community. Annual networked and anonymous survey from 2001 to 2003, each lasting three months every year, proved that the rate of non stratified prevalence could be reduced. For example the rate of all day spent with bedsores within the community could be reduced from 1.96 % in 2001, to 1.74 % in 2002 and finally to 1.62 % in 2003. During the survey as an additional bonus cooperation of community-organized nursing was optimised and quality assurance in nursing became a pole position of the community. During the QM-process a software was developed to process the survey: it is internet-based, published in the nursing-guide of Ostalbkreis, easy to manage and to establish in any nursing institution or community.

Aged↗
PubMedDate not supplied

The assessment of parent needs following paediatric traumatic brain injury.

The paediatric version of the Family Needs Questionnaire was administered to parents of children with traumatic brain injuries (TBI) a year or more post-injury. Parents of diabetic children (DIAB) and parents of orthopaedically (ORTHO) injured children were included as control groups. Parents rated items on their importance and how well these needs have been met. The ORTHO group rated significantly fewer items as important relative to the TBI and DIAB groups (who endorsed a similar number of items). Of those items rated as important, TBI parents' needs were more likely to remain unmet relative to both the DIAB and the ORTHO groups: out of 28 items rated as important, TBI parents report that 19 needs are still unmet. DIAB and ORTHO parents more consistently reported their needs as met. Needs most often rated as unmet for TBI parents include the needs for health/medical information, professional support, community support networks, and the need to be involved in their child's care. These results present important findings for TBI rehabilitation professionals. Future studies need to investigate whether TBI parents' needs are unmet because of the lack of community resources, or if available resources do not adequately target the needs of the TBI parents.

Adolescent↗
PubMed2004

Where to go? Strategic modelling of access to emergency shelters in Mozambique.

This paper, through spatial-analysis techniques, examines the accessibility of emergency shelters for vulnerable populations, and outlines the benefits of an extended and permanently established shelter network in central Mozambique. The raster-based modelling approach considers data on land cover, locations of accommodation centres in 2000, settlements and infrastructure. The shelter analysis is a two-step process determining access for vulnerable communities first, followed by a suitability analysis for additional emergency shelter sites. The results indicate the need for both retrofitting existing infrastructure (schools, health posts) to function as shelters during an emergency, and constructing new facilities - at best multi-purpose facilities that can serve as social infrastructure and shelter. Besides assessing the current situation in terms of availability and accessibility of emergency shelters, this paper provides an example of evaluating the effectiveness of humanitarian assistance without conventional mechanisms like food tonnage and number of beneficiaries.

Community Networks↗
PubMed2001

[Care networks of visiting nurse agencies before the long-term care insurance act].

PURPOSE: To describe how organizational background impacts on care networks of visiting nurse agencies. METHODS: A questionnaire was sent to all visiting nurse agencies (3,178) in Japan, and 1,548 responded. Questions were asked about the agency's background, management system, and cooperation with other community care agencies. FINDINGS: Seventy-nine percent of visiting nurse agencies were affiliated to medical organizations consisting of hospitals, clinics, or medical nursing facilities, The exceptions cooperated with various types of community service agencies, including home care agencies, assisted device agencies, housing improvement agencies, or volunteer services. The visiting nurse agencies had more frequent contact with housing improvement agencies when home care aid agencies were included within the same organizations. The results suggest that visiting nurse agencies can be divided into two types with reference to the long-term care insurance system. One has strong cooperative relationships with hospitals, and the other with community care agencies.

Community Health Nursing↗
PubMed1996

Revised DOJ and FTC policy statements offer more options for physician joint ventures.

Physician networks and multi-provider networks that do not demonstrate financial integration through substantial risk sharing present antitrust risk and face possible scrutiny by the Department of Justice and Federal Trade Commission. However, the DOJ and the FTC have recently revised statements 8 and 9 of their Statements of Enforcement in Health Care. The revised statements allow increased flexibility in the formation of provider networks and describe in detail the extent of integration--financial or otherwise --required for a joint venture to be lawful.

Antitrust Laws↗
PubMed2003

Clinical management where medicine meets management. Network solutions.

Sexual health appears to be an ideal candidate for a managed clinical network, although there are doubts about whether networks deliver better patient care. With no dedicated staff, clinicians have to put in much of their own time to establish and run a network. For SWAGNET in south-west London, Inclusion is a problem. HIV teams are large and multidisciplinary--everyone needs to be represented.

Community Networks↗
PubMed1996

Self-regulation: the true key to success of physician-directed networks.

The purpose of regulation is to promote uniformly high quality health care at a reasonable cost. The purpose of self-regulation is to make regulation more acceptable to the network physicians and create an atmosphere of continual improvement in bedside care. Interviews with medical directors of group practices, independent physician associations, managed care plans, national specialty networks, and physician-hospital organizations were used to learn what methods of self-regulation are popular and effective.

Academic Medical Centers↗
PubMed2006

Coalitions and networks: facilitating global physical activity promotion.

This article aims to synthesise the experience of coalitions and networks working for physical activity promotion. By introducing the concept of partnerships, especially within the Brazilian context, the authors outline the factors that comprise a successful partnership, describing key elements, such as, financing, membership and methods of empowerment. Agita São Paulo, the Physical Activity Network of the Americas-RAFA-PANA and Agita Mundo are used as examples. The article shows that local, national and global programmes, partnerships and networks at all levels are essential to guarantee the success of physical activity promotion as a public health strategy.

Brazil↗
PubMed1998

Will pharmacy costs overwhelm medical networks?

A crisis looms as medical networks, already reeling from ongoing drug cost increases, face the Viagra crisis and anticipate the release of whole groups of expensive new therapeutics on the market.

Community Networks↗
PubMed2001

Practice unwinds and disengagements.

Many employed physicians are being forced to consider entering the private practice arena as physicians networks and groups are contemplating total or partial divestitures. Still other physicians are evaluating the possibility of leaving their current practice or hospital based network and opening their own practice. This article is designed to better prepare a physician for this situation ad proactively plan for their future.

Community Networks↗