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PubMed2006

Asian American Network for Cancer Awareness, Research, and Training's legacy. The first 5 years.

The Asian American Network for Cancer Awareness, Research, and Training (AANCART) is the first special populations network for Asian Americans on a national basis and includes collaborating organizations from Boston, New York, Houston, Seattle, San Francisco, Los Angeles, Hawaii, and Sacramento (where it is headquartered at the University of California, Davis). NCI funding of AANCART in 2000 brought together investigators and leaders from 9 cities across 6 states to establish an infrastructure for addressing cancer awareness, research, and training. Since 2000, AANCART has conducted needs assessments, held community awareness activities and trainings, trained trainees, sponsored National Asian American Cancer Control Academies, and produced presentations, publications, and grants. All specific aims have been attained, including the establishment of an infrastructure to promote Asian American cancer awareness, research, and training in 4 targeted regions; the establishment of partnerships to promote accrual to clinical trials, training, and pilot studies; and the formulation and successful implementation of grant-funded research to reduce the cancer burden among Asian Americans. AANCART's first 5 years have increased cancer awareness, trained special populations scientists, and advanced the field of Asian American cancer control research. Cancer 2006. (c) 2006 American Cancer Society.

Asian↗

PubMed2005

[Bacterial resistance to antibiotics. Data from the National Observatory of Bacterial Resistance Epidemiology (ONERBA)].

This quantitative data (MIC, diameter of inhibition), presented as distribution curves, had for aim to identify and describe, among major bacterial species relevant for clinical use, sub-populations according to their sensitivity level. This information lead the Antibiogram Committee of the French Microbiological Society to establish and redefine breaking points necessary to classify bacteria in three clinical groups: sensitive, intermediately resistant, and resistant. This classification takes into account, for each species, MIC distribution, pharmacokinetic and pharmacodynamic data, and results of microclinical studies. Global data for the bacterial resistance of major species is obtained from laboratories included in the network. Results are stratified according to simple information, easily obtained in the laboratory: out patient or hospitalized patient, hospitalizing unit, duration, etc. This global data is used, most of the time, to assess the prevalence of species resistance. ONERBA (in collaboration with the national public health system) is part of the European Network for the Surveillance of Bacterial Resistance. This network was created in 1999 and includes 28 countries. ONERBA manages two networks: Ile-de-France (8 general hospitals) and AZAY-resistance (15 university hospitals). They work on E. coli, S. aureus, and Enterococcus (S. pneumoniae is observed by the National Reference Center and regional centers of pneumococcus surveillance).

Anti-Bacterial Agents↗

PubMed2005

[The role of primary care physicians in the detection and control of epidemics: the Geneva experience].

Private practice physicians play a central role in the detection and control of outbreaks. In Geneva, a local alert and response network completes the federal surveillance system, based on the mandatory reporting of infectious diseases. The common objective of these two mechanisms is to help health authorities in detecting, assessing, and controlling infectious diseases treats. Private practice physicians are one of the most effective and timely sources of information. As network members, they receive brief reports and information and are involved in the implementation of control and prevention measures. Their key-role was confirmed during a measles epidemic which occurred in Geneva in the spring of 2003.

Community Networks↗

PubMed1998

Specification of social support behaviours and network dimensions along the HIV continuum for gay men.

This study aimed to investigate social supports that HIV-infected persons find helpful and unhelpful, and the size and composition of networks along the disease continuum. Ninety six HIV-infected and 33 seronegative gay men were interviewed. The HIV continuum was represented by seronegative, HIV asymptomatic and symptomatic groups. Emotional and physical support were the most frequently identified helpful supports. Symptomatic persons identified physical support as helpful more often than asymptomatic persons. Availability, acceptance and nurturing were the most frequently identified helpful emotional support behaviours, while domestic support was the most frequently identified physical support behaviour. The most frequently mentioned unhelpful support was overprotectiveness. Overall, HIV-infected people had adequate social networks. Composition of the networks of HIV-infected persons differed from that of seronegative participants in that the former had markedly more professional and family persons and fewer friends in their network. HIV education and counseling interventions should provide emotional support, facilitate physical support for symptomatic persons, offer support that matches specific needs, include significant others, incorporate peer-help and be gay-sensitive.

Adaptation, Psychological↗

PubMedDate not supplied

Forming physician organizations. Part 2: The underlying reason a PO succeeds: an offense, not defense.

How has Community Health Partners been able to move the ball down the field toward the goal of a preferred network in its community? What are the specific offensive strategies CHP has implemented to bring about its vision? Part 1 of this series explored five reasons for CHP's progress: (1) A working, knowledgeable board of respected physicians, (2) A board that moves ahead on simultaneous tracks, (3) a willingness to affiliate with any hospital or payer that really knows how to partner with physicians, (4) developing quick wins and communicating the progress, and (5) educating physicians about the new ground rules for capitation. Here are six more reasons for CHP's success in forming a PO.

Capitation Fee↗

PubMed1998

Integrated health care: passing fad or lasting legacy?

The breakup of several integrated delivery systems (IDSs), and a continuing focus on the failures of many of these organizations to live up to expectations, suggests that integration may be a passing trend. Nonetheless, some systems, particularly those driven by multispecialty clinics, are achieving considerable marketplace success. Integrated systems that base their strategies on delivering value-added services to patients and healthcare purchasers still appear viable. Strategies typically used by IDSs include developing primary care networks, gainsharing with or owning health plans, reducing clinical variation, demonstrating high quality, cutting costs, and developing a seamless system of care. Primary care strategies are especially controversial given the fact that most hospital-affiliated primary care practices are losing money. However, research indicates that primary network development is one of the strategies that adds the most value for consumers and, thus, may be assumed to be of particular benefit to IDSs. Strategies aimed at reducing clinical variation can be expected to reap huge long-term benefits.

Community Networks↗

PubMed2003

A network-informed approach to investigating a tuberculosis outbreak: implications for enhancing contact investigations.

BACKGROUND: To elucidate networks of Mycobacterium tuberculosis transmission, it may be appropriate to characterize the types of relationships among tuberculosis (TB) cases and their contacts (with and without latent TB infection) in addition to relying on traditional efforts to distinguish 'close' from 'casual' contacts. SETTING: A TB outbreak in a US low incidence state. OBJECTIVE: To evaluate whether social network analysis can provide insights into transmission settings that might otherwise go unrecognized by routine practices. DESIGN: All adult outbreak-associated cases (n = 19) and a convenience sample of their contacts with and without latent TB infection (LTBI) (n = 26) were re-interviewed in 2001 using a structured questionnaire. Network analysis software was used to create diagrams illustrating important persons within the outbreak network, as well as types of activities TB cases engaged in with their contacts. RESULTS: Drug use and drug sharing were more commonly reported among cases and their infected contacts than among contacts without LTBI. TB cases central to the outbreak network used crack cocaine, uncovering the need to focus control efforts on specific sites and persons involved in illicit drug use. CONCLUSION: Outbreaks occur even in areas with low TB incidence, frequently among groups whose drug use or other illegal activities complicate control efforts. TB programs should consider the use of network analysis as a supplement to routine contact investigations to identify unrecognized patterns of M. tuberculosis transmission.

Adolescent↗

PubMed1996

Caveats for physicians in the financing of practice networks.

There are advantages for physicians to affiliate in networks with other practitioners in order to contract with third party payers and to achieve economies of scale. However, doctors must assure themselves of the viability of the organization they may be joining in terms of long-term financial stability and managerial expertise.

Capital Financing↗

PubMed2000

A quality network model for the daily care of multiple sclerosis.

The urgent need to optimise treatment strategies for patients with Multiple Sclerosis (MS) was recognised by the participants at the 1998 European Charcot Foundation (ECF) symposium in Nice. The 'Nice Declaration' led to the formation of a Task Force Essentials Group charged with developing measures of the quality of MS care in Europe. Algorithms for nine critical domains (disability, spasticity, ataxia, pain, cognition, mood, fatigue, bladder function and sexual activity) and 'educated guesses' have been developed to measure interventions and outcomes which reflect the quality of clinical decision-making processes. A generic model called a 'quality network', consisting of a group of clinics connected to a central server, has been successfully applied to the care of diabetes across Europe. This model will now be developed and applied to MS management, to provide clinicians with longitudinal epidemiological data and, to evolve treatment algorithms and further quality measures. The ECF will next validate the system in a 1-year pilot study using a net of 10 clinics. Finally, an extended European network working in a learning environment will continuously assess, update and improve the quality of care of MS patients. Multiple Sclerosis (2000) 6 231 - 236

Algorithms↗

PubMed1997

Automated patient surveys link risk assessment, satisfaction to action--in real time.

A New Hampshire physician network's unique yet simple and inexpensive patient risk assessment surveys are administered, completed, and acted upon in real time--resulting in measurably improved quality and outcomes. Here's how the surveying program works, how physician buy-in is achieved, and samples of a survey and feedback form.

Community Networks↗

PubMed1996

Social networks, social support, personal empowerment, and the adaptation of psychiatric consumers/survivors: path analytic models.

In this paper, we examine the relationships between social network characteristics, personal empowerment, social support, and adaptation of psychiatric consumer/survivors. Using path model analyses, we found that: (1) personal empowerment had statistically significant direct effects on positive affect, meaningful activity, and negative affect; (2) positive social support mediated the relationship between the proportion of women in consumer/survivors' networks and positive affect and meaningful activity; and (3) negative social interaction mediated the relationship between consumer/survivors' gender and negative affect. The results point out the importance of gender effects in social support processes, the differential association between type of social interaction (positive vs negative) and adaptation indices (positive vs negative), and the importance of personal empowerment for consumer/survivors' adaptation. We discuss the findings in terms of their implications for further research and community-based housing programmes for psychiatric consumer/survivors.

Adaptation, Psychological↗

PubMed1997

Maintaining the new practice networks.

Unless acquired physicians are managed carefully, many will flee the acquiring networks in anger and frustration. Because older networks relied on a self-selected population of physicians, the newer networks will have to develop alternative strategies to motivate those physicians who did not self-select for employment. This article makes recommendations about how to build a corporate practice culture under these new conditions.

Attitude of Health Personnel↗

PubMed2005

Integrated service delivery networks for seniors: early perceptions of family physicians.

OBJECTIVE: To document the early perceptions of family physicians regarding integrated service delivery (ISD) networks a few weeks before and 6 months after establishing these networks and to identify obstacles to using case managers. DESIGN: Cross-sectional survey with two questionnaires mailed 6 months apart. SETTING: Three regional municipalities (one urban and two rural) in the Eastern Townships of Quebec. PARTICIPANTS: All family physicians in the three areas (n = 267). A total of 124 physicians (of 206 eligible; 60% response rate) answered the first questionnaire, and 104 of these the second (86% response rate). MAIN OUTCOME MEASURES: The first questionnaire asked what family physicians thought about ISD networks and the emerging case management function, and whether they were interested in participating in ISD networks. The second measured physicians' participation in ISD networks, asked whether their perceptions of case management had changed, and identified obstacles to using case managers. RESULTS: Nearly all (98%) respondents to the preimplementation questionnaire believed that family physicians will increasingly have to belong to ISD networks. Very few (8.2%), however, felt involved or consulted in decisions about developing and implementing these networks. More than one quarter (27%) did not know that an ISD network for older people would be established in their area, and 84.3% did not feel sufficiently informed to be involved. Most family physicians (85.7%) said they were interested in using case managers. Six months after implementation, 70.2% of physicians knew that case managers were available; 35.6% had used a case manager. During implementation, physicians' opinions about case management were slightly less positive than they had been. The three main obstacles to using case managers were forgetting to use them (69.1%), the habit of using social workers instead (63.6%), and not knowing how to contact them (59.4%). CONCLUSION: Physicians are interested in participating in ISD networks and working with case managers. They must be better informed, however, about the availability of case managers, how they can reach case managers, case managers' precise role, and the advantages to themselves and their patients of using these services.

Adult↗

PubMed1999

Integrated care: the impact of governmental behaviour on collaborative networks.

Integration of care is necessary to secure the most appropriate match of the individual demands and the organisational and professional supply. Although this is a basic assumption of all the people involved in health and social care, the magnitude and persistence of obstacles to integration is a common problem in most European countries. In this article, we will explore the role of the Dutch government in the complex interplay of forces around the development of integrated care, within networks of collaborating health and social care agencies. By analysing the behaviour of the Dutch government, we will argue that, in principle, the authorities can play a facilitating role here. For several reasons, however, the government appears not to be able to adequately stimulate the establishment of integrated care arrangements. Examples of such ineffective governmental behaviour are measures with contradictory effects and the adoption of a traditional public finance perspective of comprehensive planning. Our conclusion is that, where local networks play a dominant role in integrated care delivery, the most effective governmental steering should be tailored steering, including a mix of specific steering measures suitable to specific local circumstances, combined with more general steering measures, like financial stimuli, based on legislation.

Community Networks↗

PubMed2000

Computer-based ambulatory information systems: recent developments.

This article updates the author's earlier review of some of the major computer-based ambulatory information systems and the literature evaluating their costs, benefits, effect on quality of care, and physician acceptance. The evidence suggests that computer-based information systems can increase access to clinical information, improve physician performance, enhance quality of care, and facilitate outcomes research review. In addition to presenting health information networks and clinical decision support systems such as reminder systems, drug ordering systems, and medical care management systems, the article describes applications of telemedicine and Web-based systems. It also discusses barriers to the widespread use of computer-based ambulatory information systems.

Ambulatory Care Information Systems↗

PubMed1997

Managing the human side of change in VA's transformation.

Transformational change interventions often fail or short fall of their intended impact on organizations and systems. One main reason is that these interventions frequently do not strategically address the complex human dynamics of change. This happens despite awareness of and commitment to intervening at this level by top management and change leaders. The wisdom that "systems don't change; people change" is widely acknowledged but inadequately applied. These are exactly the conditions the U.S. Department of Veterans Affairs (VA) faces in deploying its new Veterans Integrated Services Networks (VISNs). Applying validated behavioral science strategies that address the human side of change will help VA implement VISNs effectively. Six strategies derived from many years of study and practice in the public and private sectors are discussed, along with suggestions for VISN managers about how to implement them.

Community Networks↗

PubMed2003

Properties of a random attachment growing network.

In this study we introduce and analyze the statistical structural properties of a model of growing networks which may be relevant to social networks. At each step a new node is added which selects k possible partners from the existing network and joins them with probability delta by undirected edges. The "activity" of the node ends here; it will get new partners only if it is selected by a newcomer. The model produces an infinite-order phase transition when a giant component appears at a specific value of delta, which depends on k. The average component size is discontinuous at the transition. In contrast, the network behaves significantly different for k=1. There is no giant component formed for any delta and thus in this sense there is no phase transition. However, the average component size diverges for delta> or =1/2.

Cluster Analysis↗

PubMed1999

[Splendor and misery in the local organization of mental health: a look at the field].

Collaboration among public and community resources (or concentration as it is referred to in French) is a practice much favoured by governments for ideological and economic reasons. But if administrative collaboration is relatively easy to set up, what about collaboration among front-line field workers? What are the ingredients likely to engender true collaboration among practitioners, and what obstacles do they meet with on a practical day-to-day level? Experience acquired in the West Island area of greater Montreal has led us to the conclusion that many issues need to be examined and understood: the difficulty of reconciling client empowerment with treatment; the difficulty of harmonizing the values and convictions prevailing in institutional and community-based networks; the tendency for practitioners to keep clienteles for themselves within a treatment environment. Despite these difficulties, it is evident that there will be a trend towards increasing collaboration where clienteles are growing and where problems are becoming more complex.

Community Mental Health Services↗