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PubMed2005

The effects of medicaid reimbursement on the access to care of medicaid enrollees: a community perspective.

Previous research has not found a strong association between Medicaid reimbursement levels and enrollees' access to medical care, even though higher fees increase the acceptance of Medicaid patients by physicians. This study shows that high Medicaid acceptance rates by physicians in a community are more important than fee levels per se in affecting enrollees' access to medical care. Although high fee levels increase the probability that individual physicians will accept Medicaid patients, high fee levels do not necessarily lead to high levels of physician Medicaid acceptance in an area. Numerous other physician practice, health system, and community characteristics also affect Medicaid acceptance. The effects of Medicaid fees on Medicaid acceptance are substantially lower in areas with high Medicaid managed care penetration and for physicians who practice in institutional settings. The results suggest that a broad range of factors need to be considered to increase access to physicians for Medicaid enrollees.

Data Collection↗
PubMed2001

Time to think small.

Explore the source record for details and available documents.

Education, Medical, Continuing↗
PubMed2006

Quality of care associated with number of cases seen and self-reports of clinical competence for Japanese physicians-in-training in internal medicine.

BACKGROUND: The extent of clinical exposure needed to ensure quality care has not been well determined during internal medicine training. We aimed to determine the association between clinical exposure (number of cases seen), self- reports of clinical competence, and type of institution (predictor variables) and quality of care (outcome variable) as measured by clinical vignettes. METHODS: Cross-sectional study using univariate and multivariate linear analyses in 11 teaching hospitals in Japan. Participants were physicians-in-training in internal medicine departments. Main outcome measure was standardized t-scores (quality of care) derived from responses to five clinical vignettes. RESULTS: Of the 375 eligible participants, 263 (70.1%) completed the vignettes. Most were in their first (57.8%) and second year (28.5%) of training; on average, the participants were 1.8 years (range = 1-8) after graduation. Two thirds of the participants (68.8%) worked in university-affiliated teaching hospitals. The median number of cases seen was 210 (range = 10-11400). Greater exposure to cases (p = 0.0005), higher self-reports of clinical competence (p = 0.0095), and type of institution (p < 0.0001) were significantly associated with higher quality of care, using a multivariate linear model and adjusting for the remaining factors. Quality of care rapidly increased for the first 100 to 200 cases seen and tapered thereafter. CONCLUSION: The amount of clinical exposure and levels of self-reports of clinical competence, not years after graduation, were positively associated with quality of care, adjusting for the remaining factors. The learning curve tapered after about 200 cases.

Clinical Competence↗
PubMed2006

How are health professionals earning their living in Malawi?

BACKGROUND: The migration of health professionals from southern Africa to developed nations is negatively affecting the delivery of health care services in the source countries. Oftentimes however, it is the reasons for the out-migration that have been described in the literature. The work and domestic situations of those health professionals continuing to serve in their posts have not been adequately studied. METHODS: The present study utilized a qualitative data collection and analysis method. This was achieved through focus group discussions and in-depth interviews with health professionals and administrators to determine the challenges they face and the coping systems they resort to and the perceptions towards those coping methods. RESULTS: Health professionals identified the following as some of the challenges there faced: inequitable and poor remuneration, overwhelming responsibilities with limited resources, lack of a stimulating work environment, inadequate supervision, poor access to continued professionals training, limited career progression, lack of transparent recruitment and discriminatory remuneration. When asked what kept them still working in Malawi when the pressures to emigrate were there, the following were some of the ways the health professionals mentioned as useful for earning extra income to support their families: working in rural areas where life was perceived to be cheaper, working closer to home village so as to run farms, stealing drugs from health facilities, having more than one job, running small to medium scale businesses. Health professionals would also minimize expenditure by missing meals and walking to work. CONCLUSION: Many health professionals in Malawi experience overly challenging environments. In order to survive some are involved in ethically and legally questionable activities such as receiving "gifts" from patients and pilfering drugs. The efforts by the Malawi government and the international community to retain health workers in Malawi are recognized. There is however need to evaluate of these human resources-retaining measures are having the desired effects.

Attitude of Health Personnel↗
PubMed2005

Patient advocacy and professional associations: individual and collective responsibilities.

Professions have traditionally treated advocacy as a collective duty, best assigned to professional associations to perform. In North American nursing, advocacy for issues affecting identifiable patients is assigned instead to their nurses. We argue that nursing associations' withdrawal from advocacy for patient care issues is detrimental to nurses and patients alike. Most nurses work in large institutions whose internal policies they cannot influence. When these create obstacles to good care, the inability of nurses to affect change can result in avoidable distress for them and for their patients. We illustrate this point with a case study: the circumstances of the death of Michael Joseph LeBlanc, an inmate at Kingston Penitentiary Regional Hospital (Ontario). We conclude that patient and their nurses will suffer unnecessarily unless or until nursing associations cease to burden individual nurses with the responsibility for patient advocacy.

Ethics, Nursing↗
PubMed2003

Database design to ensure anonymous study of medical errors: a report from the ASIPS Collaborative.

Medical error reporting systems are important information sources for designing strategies to improve the safety of health care. Applied Strategies for Improving Patient Safety (ASIPS) is a multi-institutional, practice-based research project that collects and analyzes data on primary care medical errors and develops interventions to reduce error. The voluntary ASIPS Patient Safety Reporting System captures anonymous and confidential reports of medical errors. Confidential reports, which are quickly de-identified, provide better detail than do anonymous reports; however, concerns exist about the confidentiality of those reports should the database be subject to legal discovery or other security breaches. Standard database elements, for example, serial ID numbers, date/time stamps, and backups, could enable an outsider to link an ASIPS report to a specific medical error. The authors present the design and implementation of a database and administrative system that reduce this risk, facilitate research, and maintain near anonymity of the events, practices, and clinicians.

Computer Security↗
PubMed2002

Siblings or foes: what now in spiritual care research?

This article uses a sibling metaphor to outline the relationship between science and spirituality. This metaphor forms the backdrop for exploring several directions in spiritual care research. It argues that science and functional spirituality were born as siblings and need to dance now without either estrangement or incest, intent on measuring the material effects of excellent pastoral care.

Chaplaincy Service, Hospital↗
PubMed2002

Ministry for the good of the whole.

Clinical pastoral education and professional chaplaincy have long struggled with their relationships to various scientific worlds. With others, I affirm that the Emmanuel Movement, which produced unprecedented collaboration between clergy and physicians, died because its leaders failed to grow, to continue collaboration, and to train other physicians. I describe various indicators that suggest an increasing rapport between pastoral care and the sciences.

Chaplaincy Service, Hospital↗
PubMed2003

The violence of heteronormativity in communication studies: notes on injury, healing, and queer world-making.

Heteronormativity is everywhere. It is always already present in our individual and collective psyches, social institutions, cultural practices, and knowledge systems. In this essay, I provide some sketches for a critical analysis of heteronormativity in the communication discipline. More specifically, I examine the symbolic, discursive, psychological, and material violence of heteronormativity, and begin exploring ways to heal, grow, transform, and contemplate new possibilities in our social world. To accomplish this, this essay is divided into live sections. First, I discuss the study of sexuality in Communication. Next, through the notion of injury, I focus on the violence of heteronormativity. Third, using the concept of healing, I discuss ways of unpacking heteronormativity through a critique of hegemonic heterosexuality. Further, I offer potential ways for queer world-making through the lens of queer theory. I conclude by exploring the need for more sexuality research in the discipline by engaging the productive tensions between constructive and deconstructive impulses.

Communication↗
PubMed2005

Family presence at cardiopulmonary resuscitation: considerations in a rehabilitation hospital.

The presence of family members in the resuscitation room is an issue that is extremely controversial, with strong opinions for and against the practice in both medical and lay communities. Routinely, family members have remained in a nearby waiting room while resuscitative efforts were performed on a loved one. Meanwhile, medical and nursing personnel, driven by their desire to meet the needs of the patient, may not have considered the needs of the family. Recently, a movement has begun that has challenged and provoked a change in practice in institutions across the United States and beyond. Research shows that a vast majority of family members wish to be present or, at minimum, be given the opportunity to be present. Health care providers have mixed opinions, with more nurses in favor than physicians. Patients expressed appreciation for the presence of and support by a family member during the emergency. Family presence is a difficult issue; presently there is no universally satisfactory conclusion. The purpose of this article is to explore the movement of family presence at resuscitation and its adoption in rehabilitation hospitals.

Attitude of Health Personnel↗