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PubMed2005

Improving the care of Canadian adults with congenital heart disease.

Canadian children with congenital heart disease (CHD) have been well cared for in the past half-century. These childhood success stories have resulted in there now being approximately 100,000 Canadian adults with CHD. Few of these patients have been cured or have normal hearts, and most were left with problems that will need to be addressed later in life. Approximately 55,000 such patients need expert care because their conditions are so rare or complicated that cardiologists and other caregivers have not been trained to look after them. Moreover, these 55,000 Canadians face premature mortality, the need for further surgery or the prospect of major complications. They need expert care to optimize the quality of their lives and to help them to avoid premature death. There is no plan for the care of these patients. When they reached 18 years of age, they were moved into an adult care system that does not understand them, does not care about them and has not provided for their care. Provincial and federal Ministries of Health have not yet taken an interest in these patients. Canadian professionals have taken important steps in support of adults with CHD. They established the Canadian Adult Congenital Heart Network, and they developed a National Care Plan and management guidelines for their care. They have also made important contributions to the scientific literature, advancing the care of these patients. Waiting lists are much too long for adult patients with CHD. There are serious local and regional obstacles to the care of these patients because there are no provincial or regional plans for their care. Cardiologists who treat adult patients with CHD cannot earn enough in a fee-for-service system. There are serious human resource problems in Canadian Adult Congenital Heart Network centres that need to be addressed. There also needs to be greater coordination and integration between the pediatric and adult systems that care for these patients. Adults with CHD desperately need the help of the Heart and Stroke Foundations, leaders in the Canadian health care community and, ultimately, the Ministries of Health to help them protect their health and access expert care when needed in a timely way. The promises offered to them as children must also be honoured in their adult years.

Adult↗

PubMedDate not supplied

Community-based participatory research in practice-based research networks.

PURPOSE: We wanted to describe community-based participatory research in practice-based research networks in the United States. METHODS: We surveyed all identified practice-based research networks (PBRNs) in the United States to find out whether they had a mechanism for obtaining feedback or involvement from the community of patients served by PBRN physicians. We asked open-ended questions on how they involve community members and whether they had plans for future involvement of community members and/or patients. RESULTS: We received 46 completed questionnaires (71% response rate). Twenty-four reported that they have some mechanism to involve community members and/or patients in their research. No PBRN reported full participatory methods; however, several PBRNs reported active involvement by community members to generate research ideas, review research protocols, interpret results, and disseminate findings. CONCLUSION: While perhaps not meeting the classical definition of CBPR, some PBRNs are involving community members and patients in their research. There is a wide spectrum of involvement by community members in PBRN research. Many PBRNs reported plans to involve community members in their research. We believe that community involvement will enhance PBRN research.

Community Participation↗

PubMed2005

[The Essen myocardial infarction network as a model of integrated medical care in the realization of the therapy of acute ST segment elevation myocardial infarction corresponding to guidelines].

Percutaneous coronary intervention (PCI) is superior to thrombolysis treating acute ST segment elevation myocardial infarction (STEMI) and is recommended by guidelines as the preferential treatment, if particular preconditions are fulfilled. The "Herzinfarktverbund Essen" proves that a therapy of STEMI corresponding to guidelines can be offered standardized covering the needs of a city after building the best possible network structure. At the same time, new opportunities of the health care system by a model of integrated medical care are used.

Angioplasty, Balloon, Coronary↗

PubMed1995

Effective planning for managed care.

In response to the changing healthcare market, many providers are forming networks for managed care contracting. These networks may fail, however, if planning focuses on maintaining business practices of the past rather than responding to market forces of the future. Effective planning for managed care requires that network executives establish a vision of the future that is not shackled by experiences of the past, articulate a mission that outlines what the network's role will be in the future, and create strategies that will help the network fulfill its mission. Although financial data are necessary to measure a network's progress toward fulfilling its mission, data on past performance should not be used to shape a vision of the future.

Community Networks↗

PubMed1998

The evolution of primary care networks.

Many physician practices and primary care networks owned by hospital-based healthcare systems have not been successful financially. By investing capital, time, energy, and management expertise in these networks, however, systems can dramatically improve their strategic advantage. A three-stage evolutionary process that is necessary to achieve this strategic advantage comprises practice acquisition, network development, and true integration. Although few primary care networks run by hospitals or systems to date have reached stage three, understanding the evolutionary process is a necessary first step toward success.

Capital Financing↗

PubMed2000

[Benchmarks for evaluating health care networks].

The implementation of health care networks is accompanied by a certain number of changes in professional practices. At the heart of the economic, organisational, and political stakes, new questions are posed, especially in terms of evaluation. It is true that no matter what the level of evaluation, it is essential today to rely on the support of existing information systems to develop methodologies and to better describe the produced effects, in economic terms and health outcomes, but also from a more qualitative point of view, in terms of public satisfaction and benefits to clients. Laying down some reference points for evaluating health care networks can only contribute to developing new strategies for showing their effectiveness and efficiency and learning from this experimentation.

Benchmarking↗

PubMed2001

Setting the record straight: physician networking is an effective strategy.

Case studies of 11 leading integrated delivery systems (IDSs) disclose that, despite the widespread perception that integrated health care--and particularly the acquisition of physician networks--is a failed strategy, integration can be a vibrant and effective strategy if approached properly. The successful case-study IDSs have certain attributes in common: many were founded by multispecialty clinics; they involve physicians in a partnership role with administrators; and the primary purpose of their physician networks is to offer patients convenience and broader access to the system, rather than simply to increase referrals to the hospital or to compete for capitation contracts. Moreover, all of the IDSs are actively pursuing measures to improve the financial performance of their physician networks, including closing marginal clinics, improving economies of scale, adding ancillary and specialty services, seeking administrative procedures, and enhancing information technology capabilities.

Community Networks↗

PubMed2002

Demonstrating quality at the physician-office level.

A multidisciplinary task force consisting of administration, quality management, directors of service, and network development staff of a nonprofit organization developed and implemented a comprehensive report card process for its 50 physician-office sites. The goals were to develop and implement a process that would provide a comprehensive summary of the administrative and clinical activity of all network sites, to develop a framework for identifying best practices within the network, and to enhance motivation to improve performance through benchmarking with physician offices within the network. This initiative also sought to transform the voluminous data collected into meaningful information that could be used to improve the process of operations and outcomes.

Benchmarking↗

PubMed2005

Network structure and attitudes toward collaboration in a community partnership for diabetes control on the US-Mexican border.

PURPOSE: This study seeks to provide an examination of a health policy network operating in a single, small community along the US-Mexican border. The purpose of the paper is to discuss why and how this network evolved, and then to present findings on how the network was structured. Analysis will focus especially on agency involvement, or "embeddedness" in the network, and its relationship to attitudes held by network members regarding trust, reputation, and perceived benefit. DESIGN/METHODOLOGY/APPROACH: Data were collected from 15 public and nonprofit agencies trying to work collaboratively to influence local policy and services regarding the prevention of obesity-related chronic disease, especially diabetes. Embeddedness was measured in three different ways and both confirmed and unconfirmed networks were assessed. Network analysis methods were utilized as well as nonparametric correlation statistics. FINDINGS: The network was found to be densely connected through unconfirmed linkages, but much less so when these links were confirmed. Strongest findings were found for shared information. Measures of agency embeddedness in the network were strong predictors of agency reputation, but findings for trust and perceived benefit were generally weak. ORIGINALITY/VALUE: From a practice perspective, the study points to the problems in building and sustaining community-based chronic disease health networks, especially in a small community with substantial health needs. The research also contributes to theory on embeddedness and to methodology for collecting and analyzing data on community health networks.

Adult↗

PubMed2003

German research network on schizophrenia-bridging the gap between research and care.

The German Research Network on Schizophrenia (GRNS) is a nationwide network of presently 16 psychiatric university departments, 14 state and district hospitals, as well as six local networks of psychiatric practices and general practitioners, which are collaborating in about 25 interrelated, multicentre projects on schizophrenia research. The GRNS aims to intensify collaboration and knowledge exchange between leading research institutions and qualified routine care facilities, both within (horizontal network) and between (vertical network) the two levels of research and care, in order to create the scientific preconditions for optimization of care in patients with schizophrenia. With respect to illness development, the network is organized into two main "Project Networks" (PN). Whereas PN I targets the implementation of early detection and early intervention strategies, PN II aims at optimization of acute and long-term treatment, especially in first-episode patients. PN II also includes projects aiming at improvement of rehabilitation, particularly in patients with residual symptoms. Furthermore, there is a "Special Network" on molecular and pharmaco-genetics. Several more general projects address fighting stigma and discrimination, health care economy, continuing medical education, quality assurance, and methodology. The network is mainly funded by the German Ministry for Research spanning a period of 5 years.

Community Networks↗

PubMed2006

Influenza surveillance: Why?

Surveillance is also one of the few bright spots in influenza preparedness in Europe. A sentinel network of 13,500 physicians provides an early warning in the event of an influenza outbreak. The network is part of the European Influenza Surveillance Scheme (EISS). Germany has one of the most advanced surveillance networks in Europe, and has made the reporting of laboratory-confirmed cases of influenza mandatory. Monitoring avian influenza is a good way to anticipate human influenza outbreaks. Coordinated surveillance of influenza in humans and animals is needed, and the human and veterinary surveillance systems should be linked to exchange information, diagnostic tools and antigens. Although not perfect, the current surveillance network managed by EISS functions effectively, and can play a key role in the early identification and ongoing monitoring of a pandemic influenza virus as well as the annual epidemics.

Animals↗

PubMed1997

Lessons for program design from the PMM projects.

The Prevention of Maternal Mortality (PMM) Network designed and tested projects for reducing maternal deaths. The focus was on improving the availability, quality and utilization of emergency obstetric care (EmOC) for women with serious complications. Teams' projects included interventions in health facilities (to improve skills and services and reduce delays in treatment) and in communities (to address lack of transport, funds and information concerning obstetric complications). The teams' results, reported in this volume, offer several lessons for program planners. Despite difficult conditions in the project countries, the teams demonstrated that it is almost always possible to make improvements in the delivery of EmOC. Their work shows that EmOC can be improved not only by concentrating on hospitals and physicians, but also by focusing on peripheral facilities and other qualified staff. The teams' findings regarding utilization of EmOC suggest that more people utilize services when they know them to be functioning well. Community efforts, including education and mobilization, have a role to play in improving utilization once services are in place. Improving EmOC need not be costly, because in many areas the necessary facilities exist and staff are already in place.

Africa, Western↗

PubMed2005

Clarification of social support.

PURPOSE: To clarify the concept of social support. DESIGN: Template Verification and Expansion Model. METHODS: Meta-synthesis strategies. FINDINGS: Social support is composed of emotional and instrumental support. It is an advocative interpersonal process characterized by reciprocal exchange of information, it is context specific, and it results in improved mental health. Antecedents of emotional and instrumental support include a perceived need plus a social network and climate that are conducive to the exchange of social support. CONCLUSIONS: In keeping with the nonprofessional nature of social support, nurses are advised to encourage patients to use and enhance personal support networks. For the same reason, nurses should reconsider investigating social support as a nursing intervention. Expanded efforts are needed to differentiate social support from concepts such as caring.

Community Networks↗

PubMed1997

JCAHO mental health care network accreditation as a performance improvement project.

In June 1995 the Southeastern Area of the Massachusetts Department of Mental Health became the third health care network, and first mental health care network, to be accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) under its new network standards. This paper provides a brief overview of how the Southeastern Area network prepared for and went through the JCAHO survey. The author shows how the effort undergoing the accreditation procedure helped improve the performance of the network. To help other organizations considering JCAHO network accreditation, specific aspects of the survey process are presented, including preparing documents, understanding key concepts emphasized by JCAHO, and preparing staff for participation in the survey interviews.

Accreditation↗

PubMedDate not supplied

Information architects: data by design.

HMOs and other network-based health plans are harnessing the power of information--building integrated data infrastructures to meet the needs of members, caregivers, and employers.

Community Networks↗

PubMed1996

A network approach to outpatient service delivery systems: resources flow and system influence.

OBJECTIVE: The study tests a path model for the effects on organizational influence of an organization's centrality in four resource exchange networks in order to gain insight into the network relations that may affect coordination and effectiveness of outpatient health and mental health service systems. DATA SOURCES: Primary data are used from face-to-face interviews with the directors of every organization in the predefined service systems in three urbanized counties in Oregon. Each system consisted of 19 to 20 organizations. Data were collected during 1986 and 1987. STUDY DESIGN: The path model contains five variables: the major dependent variable is attributed organizational influence; the independent variables are three sets of primary resource exchanges: funds allocation, client referrals, and client inflow. An intervening variable of general network contacts, as an informational resource, is modeled as an outcome of the three primary resource exchanges, as well as one of the predictors of influence. DATA COLLECTION: Organizations were identified as system members through a modified snowball sampling procedure. Measures of organizational influence and centrality in each of the exchange networks were derived from interviews with all directors about their interactions with each organization in the system. Multiple regression analysis was used to test the path model. PRINCIPAL FINDINGS: The most important resource in predicting centrality in a general contact network is centrality in a client referral network, while contacts and funds allocation centrality are significant predictors of organizational influence. CONCLUSIONS: The organization with the greatest influence within the system (because of its ability to allocate funds) may not be the organization that takes the largest role in terms of coordinating routine contacts (because of its ability to refer clients). This disjuncture may signal a weakness in the coordination network and system effectiveness, since the more influential organization may not be the most knowledgeable one in terms of the needs of the system.

Ambulatory Care↗

PubMed1998

Medical reduction of stone risk in a network of treatment centers compared to a research clinic.

PURPOSE: We determined whether a network of 7 comprehensive kidney stone treatment centers supported by specialized stone management software and laboratory resources could achieve reductions in urine supersaturation comparable to those in a single research clinic devoted to metabolic stone prevention. MATERIALS AND METHODS: Supersaturation values for calcium oxalate, calcium phosphate and uric acid in 24-hour urine samples were calculated from a set of kidney stone risk factor measurements made at a central laboratory site for the network and research laboratory for the clinic. Individual results and group outcomes were presented to each center in time sequential table graphics. The decrease in supersaturation with treatment was compared in the network and clinic using analysis of variance. RESULTS: Supersaturation was effectively reduced in the network and clinic, and the reduction was proportional to the initial supersaturation value and increase in urine volume. The clinic achieved a greater supersaturation reduction, higher fraction of patient followup and greater increase in urine volume but the treatment effects in the network were, nevertheless, substantial and significant. CONCLUSIONS: Given proper software and laboratory support, a network of treatment centers can rival but not quite match results in a dedicated metabolic stone research and prevention clinic. Therefore, large scale stone prevention in a network system appears feasible and effective.

Adult↗

PubMed2005

An inter-centre quality assurance network for IMRT verification: results of the ESTRO QUASIMODO project.

BACKGROUND AND PURPOSE: IMRT necessitates extension of existing inter-centre quality assurance programs due to its increased complexity. We assessed the feasibility of an inter-centre verification method for different IMRT techniques. MATERIALS AND METHODS: Eight European radiotherapy institutions of the QUASIMODO network, have designed an IMRT plan for a horseshoe-shaped PTV surrounding a cylindrical OAR in a simplified pelvic phantom. All centres applied common plan objectives but used their own equipment for planning and delivery. They verified the delivery of this plan according to a common protocol with radiographic film and ionisation chamber measurements. The irradiated films, the results of the ionisation chamber measurements and the computed dose distributions were sent to one analysis centre that compared the measured and computed dose distributions with the gamma method and composite dose-area histograms. RESULTS: 4% (relative to the prescribed dose) and 3mm (distance-to-agreement) were decided feasible gamma criteria. The composite dose-area histograms showed a maximum local deviation of 3.5% in the mean dose of the PTV and 5% in the OAR. Systematic differences could be identified, and in some cases explained. CONCLUSIONS: This multi-centre dosimetric verification study demonstrated both the feasibility of a multi-centre quality assurance network to evaluate any IMRT planning and delivery system combination, as well as the validity of the methodology involved.

Community Networks↗