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At least 127 records · Page 7Linked to original sources
PubMed2004

Re-organizing services for the management of upper gastrointestinal cancers: patterns of care and problems with change.

The 'Calman-Hine' report (1995) recommended that cancer surgery should be limited to specialist high-volume units. National guidance from the National Health Service (NHS) Executive in 2001 stated that specialist oesophagogastric cancer centres should 'aim to draw patients from catchment areas with a population of 1-2 million.' For pancreatic cancers, the catchment areas should be between 2 and 4 million, reflecting the relatively lower incidence of disease. For the West Midlands region, these recommendations would suggest that four or five centres might be required to provide specialist surgical management for oesophagogastric cancer, and one or two centres for pancreatic disease. We used Hospital Episode Statistics to analyse trends in management patterns for these tumours within the West Midlands during the period 1992-2000. Over 20 different units were involved in the management of oesophagogastric and pancreatic disease, and we were unable to discern any clear and consistent move towards the centralisation of the upper gastrointestinal work in high-volume units since the publication of the Calman-Hine report in 1995. Although the drive for centralisation might be anticipated to increase following the publication of the NHS Executive's guidance, there is a substantial way to go before the provision of surgical services for upper gastrointestinal cancers is limited to a small number of high-volume specialist units.

Cancer Care Facilities↗
PubMedDate not supplied

Is your organization eligible for accreditation of equipment management and clinical respiratory services?

Organizations that are eligible for Joint Commission survey and accreditation of equipment management and clinical respiratory services (CRSs) often are surprised that they are actually providing these services. The traditional home medical equipment (HME) provider is a company that selects an appropriate piece of medical equipment for a patient, delivers the medical equipment to the patient in his or her home, assembles the equipment, instructs the patient about its use, and performs maintenance on the equipment as specified by the manufacturer and organization policy and procedure. These organizations are easily identified. However, a number of other health care providers also are involved in the provision of equipment to patients in their homes and, consequently, are eligible for equipment maintenance accreditation.

Equipment and Supplies↗
PubMed1984

Perspectives on dismissal as a management prerogative in social service organizations.

The process and practice of employee dismissal is an important and nagging task in personnel management in the human services. The employee has come to view one's status, following a probationary period, as permanent. Antidiscrimination laws, unionization, grievance rights, the cost of replacing and retraining, etc., increasingly make firing an option less open to administrators. The author offers several practical considerations for using the dismissal prerogative, linking supervision and dismissal through a typology of supervision proposed for employees throughout their tenure with the organization.

Employment↗
PubMed2002

Women referred for on-site domestic violence services in a managed care organization.

BACKGROUND: Limited data about victims of domestic violence in health care settings hinder development of appropriate services. A comprehensive program was established in a managed care organization to increase identification and referral of domestically abused female patients. METHODS: Female victims of domestic abuse were referred to a trained social worker for further assessment. Information about the women was obtained from clinical consultation forms; initial interviews conducted by social workers; a survey administered to a convenience sample of women seen by the program; and medical chart review. RESULTS: Of 265 women who agreed to a domestic violence referral, 177 (67%) were contacted for further evaluation. The study sample was ethnically diverse and included female victims seen for routine care, women who had been assaulted, women who had depression, and women with various somatic symptoms. Responses from 51 of the 177 women showed the most cited reasons for accepting referral were unhappiness with current situation, wanting to leave or change the situation, concern about children who witnessed abuse, and the suggestion by a health care practitioner that the patient's symptoms could be related to the abuse. Most reported having symptoms of depression in the previous year. CONCLUSIONS: Comprehensive programs in the health care setting can increase identification of victims of domestic abuse. This descriptive report provides a greater understanding of victims of domestic abuse, their presentation in the medical setting, their motivation for accepting referral, and issues which affect their recovery. Links between health care and community resources are necessary for effective intervention.

Adult↗
PubMed2000

Child development services in Medicaid managed care organizations: what does it take?

OBJECTIVE: We sought to understand why certain Medicaid managed care organizations (MMCOs) implemented child development services or programs and how they had done so. We also sought to identify barriers and facilitators to successful initiation and implementation of child development programs. METHODS: We conducted 9 key informant interviews and 4 site visits, and performed qualitative analyses to identify major themes across responses. RESULTS: We identified a small number of MMCOs with child development services. High-level support was crucial for program initiation; physician buy-in, staff support, and strong working relationships with outside health professionals or agencies were principal factors in successful program implementation. CONCLUSIONS: MMCOs that were committed to implementing child development services were successful in doing so, without external funding or regulatory mandate. The results provide valuable strategies for MMCOs interested in developing programs and for researchers and advocates interested in promoting child development services for low-income children.

Child Development↗
PubMed2005

Impact of direct-to-consumer advertising for hereditary breast cancer testing on genetic services at a managed care organization: a naturally-occurring experiment.

PURPOSE: To describe the impact of Myriad Genetics, Inc.'s direct-to-consumer advertising (DTC-ad) campaign on cancer genetic services within two Managed Care Organizations, Kaiser Permanente Colorado (KPCO), Denver, Colorado, where the ad campaign occurred, and Henry Ford Health System (HFHS), Detroit, Michigan, where there were no advertisements. METHODS: The main outcome measures were the changes in number and pretest mutation probability of referrals approved for cancer genetic services at KPCO and HFHS during the campaign versus the year prior, and mutation probability of those undergoing testing. RESULTS: At KPCO, referrals increased 244% during the DTC-ad compared to the same time period a year earlier (P value<0.001). The proportion of referrals at high pretest probability of a mutation (10% or greater) dropped from 69% the previous year to 48% during the campaign (P value<0.001). There was no significant change in pretest mutation probability among women who underwent testing between the two time periods. HFHS reported no significant change between the two time periods for numbers or mutation probability of referrals, or for mutation probability of women tested. CONCLUSION: The DTC-ad caused significant increase in demand for cancer genetic services. In the face of potential future DTC-ad for inherited cancer risk, providers and payers need to consider the delivery of genetic services and genetic education for persons of all risk levels.

Adult↗
PubMed1994

Managing diversity in health services organizations.

The changing ethnic, racial, and gender workforce characteristics require innovations in management philosophy and practice. Valuing employees' differences is believed to be a competitive advantage in many modern corporations. This article offers recommendations to health care managers for rethinking and improving the management of their heterogeneous workforces. A conceptual framework and evaluative criteria are developed in an attempt to better understand the factors that influence effective diversity management. The experiences of health services institutions in the Southwest (already a multicultural region) are studied to illustrate various approaches to diversity management. Leader philosophy and support, organizational policies and programs, workforce composition, structural integration, and organizational type constitute the main elements in this study. As the nation debates restructuring the health industry, it should also take the opportunity to integrate a management philosophy that values diversity and its practice.

Ethnicity↗
PubMed1994

Integrating mental health into a general health care system.

To implement the proposed Clinton mental health benefit for the year 2001 requires a capacity to manage a flexible, comprehensive benefit. If fragmentation of services and discontinuity of care are to be reduced, mechanisms must be developed to coordinate services among domains--between acute and chronic care, and among public and private providers. Evidence exists that basic mental health services generally can be managed in health maintenance organizations (HMOs) with considerable cost savings and without detrimental effects on health, but it is less clear whether this is true of services for persons with severe and persistent mental illness. Effective services for persons with severe disorders require a capacity to organize and manage services across broad medical and social areas, but anticipated costs encourage providers to narrow the scope of care they offer and to select low-risk patients. Much will depend on developing methodologies that allow providers to be reimbursed accurately in relation to risk and that protect small providers from the potential cost of acquiring too many high-risk patients.

Community Mental Health Services↗
PubMed2005

The status of health services research on adjudicated drug-abusing juveniles: selected findings and remaining questions.

This article focuses on the factors that affect the availability, accessibility, and opportunity of effective treatment for the adjudicated adolescent drug user The social and developmental context of "drug abuse" and its treatment in adolescents, and particularly in adjudicated adolescents, is reviewed and compared with that in adults. Selected health services research findings on this population are discussed in terms of the effectiveness of delivering treatment services; the organization, management, and financing of services; and adoption of best practices (technology transfer).

Adolescent↗