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John Muir-Mt. Diablo Health Network in northern California has found the perfect employee--RoboCOPS, an automated program from IntelliClaim, the Norwalk, CT-based claims performance company.
This article looks at the development of a group dedicated to meeting the clinical supervision and networking needs of multiple sclerosis nurse specialists. It describes the evolution of the group, the structure and content of group meetings and how they have both improved practice and reduced the isolation of MS specialists who work independently. The nurses involved have found that working collaboratively and developing an interactive network has not only significantly affected their clinical practice but also helped to address work-related stress.
Regional practice-based network research has grown significantly in the past 15 years. Previous studies have reported on characteristics of physicians who participate in network research, but little is known about the specific a priori research interests of practicing physicians. Knowledge of such interests could be useful in planning network research studies. We conducted a mail survey to assess the research interests of primary care physicians in two contiguous research networks at the University of California at San Francisco (UCSF) and at Stanford University. Among 120 respondents from the UCSF Collaborative Research Network and 85 from the Stanford Ambulatory Research Network, the most common topics of interest were disease prevention, communication and compliance, and managed care. Among specific conditions, heart disease, hypertension, and respiratory infection were of interest to the majority of respondents. Topics not of interest to network members were obstetrics, diagnostic procedures, alcoholism, drug abuse, tuberculosis, male genito-urinary problems, occupational hazards, domestic violence, and AIDS and HIV. Identification of network physician research interests can help focus research and recruitment efforts on topics of interest and provide estimates of participation levels for planning studies and preparing funding applications for research networks.
This paper presents the recent findings from a study on the postdiagnosis support needs of women with breast cancer living in rural and remote Queensland. The findings presented in this discussion focus on support needs from the perspective of the women experiencing breast cancer as well as health service providers. The tyranny of distance imposes unique hardships, such as separation from family and friends, during a time of great vulnerability for treatment, the need to travel long distances for support and follow-up services, and extra financial burdens, which can combine to cause strains on the marital relationship and family cohesion. Positive indications are, however, that the rural communities operate on strong, informal networks of support. This network of family, friends and community can, and does, play an active role in the provision of emotional and practical support.
Changing business practices, customers needs, and market dynamics have driven many organizations to implement interorganizational systems (IOSs). IOSs have been successfully implemented in the banking, cotton, airline, and consumer-goods industries, and recently attention has turned to the health care industry. This article describes an exploratory study of health care IOS implementations based on the voluntary community health information network (CHIN) model.
Community Health Information Networks (CHINs) require the ability to provide computer network connections to many remote sites. During the implementation of the Washington Heights and Inwood Community Health Management Information System (WHICHIS) at the Columbia-Presbyterian Medical Center (CPMC), a number of remote connectivity issues have been encountered. Both technical and non-technical issues were significant during the installation. We developed a work-flow model for this process which may be helpful to any health care institution attempting to provide seamless remote connectivity. This model is presented and implementation lessons are discussed.
BACKGROUND: Earlier studies on the direct effect of social support and social network upon mental health have mostly been done in cross-sectional studies and the results have been conflicting. METHODS: The direct effect of social network and social support upon mental distress was tested in population-based health surveys conducted in 1987, 1990 and 1993. The population consisted of all persons aged 40-62 years and a random sample of persons aged between 20 and 39 years living in five small municipalities in Finnmark, the northernmost county in Norway. The attendance rates were 77%, 74% and 70% for the three health surveys, respectively. All those who had attended the health surveys more than once and answered the key questions about mental distress, social support and social network were selected for analyses (966 persons who attended both the two first health surveys and 1425 persons attending both the two last surveys). A theoretical full cross-lagged panel model was used to search for the predictive effects of time 1 variables (mental distress, social network and social support) upon corresponding subsequent variables. RESULTS: Mental distress, social support and social network at time 1 strongly predicted the corresponding variable at the next time point. Emotional support at time 1 exerted a weak positive effect upon mental distress on the next time point, explaining approximately 1% of the variance. Neither the social network nor instrumental support at time 1 predicted degree of mental distress at the subsequent time point. CONCLUSION: We conclude that social network and social support have very little direct predictive effect upon mental distress 3 years later in this population.
Cooperation is needed for evolution to construct new levels of organization. Genomes, cells, multicellular organisms, social insects, and human society are all based on cooperation. Cooperation means that selfish replicators forgo some of their reproductive potential to help one another. But natural selection implies competition and therefore opposes cooperation unless a specific mechanism is at work. Here I discuss five mechanisms for the evolution of cooperation: kin selection, direct reciprocity, indirect reciprocity, network reciprocity, and group selection. For each mechanism, a simple rule is derived that specifies whether natural selection can lead to cooperation.
Pressure is mounting on state insurance commissioners to treat provider-run health networks like insurers. Like a distant tropical depression, this potential threat to collaborative networks hasn't shown up on the radar screens of most hospitals. But it will. Put on your galoshes.
OBJECTIVE: There is no accepted definition of geriatric post-acute or rehabilitation care. The exact role within the healthcare network and the function of units providing such care remain to be clarified. We describe the activity of geriatric post-acute or rehabilitation care units in four French hospitals to identify common features and provide elements of practical interest concerning their role in the healthcare network. METHODS: Data from 4 healthcare institutions in France recorded in the 1999 Medical Information System were analyzed. RESULTS: Geriatric post-acute or rehabilitation units generally provided care for patients over 80 years of age in short-stay wards. These patients were dependent and recovering from an acute illness. In addition to rehabilitation and medical care, given according to the patients' needs, the units also provided social counseling and acute care as in other short-stay wards. A wide variety of pathological conditions was observed. At discharge most patients returned to their home or were transferred to a nursing home. CONCLUSION: Geriatric post-acute or rehabilitation units meet the requirements proposed in French legislation and in addition provide social counseling and acute care services, which is evidence of the deficiencies in the healthcare network in the field of elderly patient care.
The Medicare+Choice (M+C) program was intended to expand choice of managed care plans for Medicare beneficiaries. In the past few years, the opposite has occurred as many participating HMOs reduced Medicare service areas or withdrew from the program. This paper presents findings from a study of the provider networks of 85 HMOs that were participating in M+C in 1999. The study shows that provider networks serving Medicare enrollees are usually similar to those developed for HMOs' commercial line of business, but when they are different, Medicare provider networks are smaller. Most HMOs also had at least some problems maintaining their Medicare provider networks. These findings have implications for the future of the Medicare+Choice program and Medicare enrollees' access to health care.
BACKGROUND: The growth of managed care presents a challenge to academic medical centers, because the demand for the services of specialists is likely to continue decreasing. We estimated the number of enrollees the University of Michigan Medical Center would need in its health maintenance organization (HMO) system in order to provide revenue equivalent to the total revenue it received for professional specialty care in 1992. METHODS: Rates of utilization and payment were based on the medical center's experience with managed care in 1992 in its independent practice association HMO, in which 25,000 members had capitated coverage and received primary and all specialty care from university physicians, and 15,000 members received primary care and most specialty care from physicians outside the university. We assumed that persons not enrolled in Medicare were all enrolled in managed-care plans. Primary care activity was excluded from the calculations of expense, revenue, and numbers of faculty members. RESULTS: If all specialty services were provided by the university to HMO members, all the 21 specialties examined except obstetrics and gynecology and emergency services would require an enrollment of more than 250,000 to support the 1992 level of professional revenue and maintain the number of faculty members. If university services were provided only for referrals from a loosely affiliated network of community physicians in the HMO system, all the 19 specialties examined except plastic surgery would require an HMO enrollment of more than 1 million. In a combined model in which all specialty services were provided to 100,000 HMO members and network referrals were provided to 500,000 members, substantial changes in faculty composition would be needed in all the departments studied. CONCLUSIONS: Because of the large number of HMO members required, unless other changes occur, it is unrealistic to expect that the University of Michigan Medical Center could create an HMO or network large enough to support the specialty practice of the current number of faculty members at the 1992 level of financing.
This article links the forces of managed care and investor-owned firms as major factors driving the industry toward consolidation into vertically integrated, merged firms, often financed with investor capital. This relentless pressure to build regional systems of health services has transformed the industry from a charitable, community orientation to one of business, market shares, and profits.
The existing insurance coverage for mental health benefits provides incentives for hospital as compared with community care and reinforces a medical approach to psychological disability. Moreover, the structure of benefits favors the affluent as compared with the disadvantaged and provides little assistance for the community integration of the chronic mental patient. In considering mental health benefits under National Health Insurance we must be careful to avoid reinforcing these patterns. It is suggested that NHI include a mental health resource development fund intended for building a stronger network of community mental health care and that the pattern of insurance benefits under NHI be consistent with developing psychiatric services on a capitation basis.
A national network of health education information officers was established at the end of 2001. The aim and objective of this group is "to contribute to the development of a solid, coherent documentation service delivery for the health education field in France." The professionals decided to commence by undertaking an assessment of the documentation activities in both the regional and departmental health education committees in order to establish sub-working groups which would collaborate to better achieve this goal. The survey's results have shown that there are existing skills and competencies available within the different committees in spite of current gaps between the various regions and department in terms of their levels of qualifications, resources and information activities and practices. It is for this reason that the national network of health education information officers designed and implemented the smaller working groups in order to gradually enable them to solidify and strengthen the network to ensure that they have the capacity to meet the stated objectives. This approach could constitute the basis for a national health education documentation network as described and called for by the law delineating the missions of the French Institute for Prevention and Health Education (Inpes).
Electronic transfer of data within health systems and between offsite facilities, including payers, is becoming a cost-effective strategy for members of the Brookfield-based Wisconsin Health Information Network. The intranet technology is particularly well-suited for managed care because it generates even greater efficiencies and allows electronic communication between newly integrated health system partners.
We describe here our own experience in creating a regional multidisciplinary network made up of health professionals involved in the treatment of pain. The rationale, aims, difficulty already experienced and still expected, and the results are discussed.
There's a flood of change coming, and health care executives are quickly building and loading big boats to sail to the future. But what do you take--and what do you leave behind? What will be needed in the new world--and what won't? In the third of an exclusive four-part series planned by McManis Associates and co-sponsored by Hospitals & Health Networks, some top CEOs talk about their travel plans.