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At least 1,387 records · Page 77Linked to original sources
PubMed2002

Profiling resource use: do different outcomes affect assessments of provider efficiency?

OBJECTIVES: To examine whether 2 outcome measures result in different assessments of efficiency across 22 service networks within the Department of Veterans Affairs (VA). STUDY DESIGN: A retrospective analysis using VA inpatient and outpatient administrative databases. METHODS: A 60% random sample of veterans who used healthcare services during fiscal year 1997 was split into a 40% sample (n = 1,046,803) for development and a 20% sample (n = 524,461) for validation. Weighted concurrent case-mix models using adjusted clinical groups were developed to explain variation in 2 outcomes: "days of care"--the sum of a patient's inpatient and outpatient annual visit days, and "average accounting costs"--the sum of the average service costs multiplied by the units of service for each patient. Two profiling indicators were calculated for each outcome: an unadjusted efficiency index and an adjusted efficiency index. These indices were compared to examine network efficiency. RESULTS: Although about half the networks were identified as "efficient" before and after case-mix adjustment, assessments of individual network efficiency were affected by the adjustment. The 2 outcomes differed on which networks were efficient. For example, 4 networks that appeared as efficient based on days of care appeared as inefficient based on average costs. CONCLUSIONS: Assessments of provider efficiency across the 22 networks depended on the outcome measure used. Knowledge about the extent to which assessments of provider efficiency depend on the outcome measure used is an important step toward improved and more equitable comparisons across providers.

Adult↗
PubMedDate not supplied

Linking ecological science to decision-making: delivering environmental monitoring information as societal feedback.

The paper describes the Ecological Monitoring and Assessment Network's (EMAN) operational and program response to certain challenges of environmental monitoring in Canada, in particular, efforts to improve the ability of the network to deliver relevant information to decision makers. In addition to its familiar roles, environmental monitoring should deliver feedback to society on environmental changes associated with development patterns, trends, processes and interventions. In order for such feedback to be effective, it must be relevant, timely, useful and accessible: all characteristics that are defined by the user, not the provider. Demand driven environmental monitoring is explored through EMAN's experiences with Canada's Biosphere Reserves, the NatureWatch Program and the Canadian Community Monitoring Network.

Canada↗
PubMed2003

Multidisciplinary team working, clinical networks, and chambers; opportunities to work differently in the NHS.

Recently in the United Kingdom some new organisational structures for clinicians have been discussed. So far little has changed, but the intensity of interest suggests this may be an opportunity to link change in working practices with improvements in quality. Multidisciplinary team working is developing within the National Health Service (NHS) and some groups are expanding their roles across traditional institutional boundaries to form complex clinical networks. It would require little to make these functional networks autonomous from current NHS structures. Other models of working without traditional institutional boundaries have been discussed, including the formation of "chambers" for doctors and other professionals. We describe the first tentative steps of one group as an example and suggest that further experimentation with evaluation is required.

Community Networks↗
PubMed2004

Characteristics of family/friend care networks of frail seniors.

This paper tests assumptions often made by policy makers and practitioners that networks of family, friends, and neighbours are able to provide sustained care to frail elderly Canadians. Using national survey data, we examined characteristics of the care networks of 1,104 seniors living with a long-term health problem. Care networks were found to vary considerably in size, relationship composition, gender composition, age composition, and proximity, and these network characteristics were found to help explain variations in the types and amounts of care received. As a result, network characteristics that might place seniors at risk of receiving inadequate care (including small size and higher proportions of non-kin, male, and geographically distant members) were identified. These risk factors appear to be poorly reflected in most existing policy.

Aged↗
PubMed2006

Networking grassroots efforts to improve safety and health in informal economy workplaces in Asia.

Many workers in Asia are in the informal economy. They often work in substandard conditions, exposed to hazards in the workplace. Learning from the recent successes of participatory training programmes to improve safety and health in Asia, the ILO has strengthened its partnership efforts with local people to improve safety and health of informal economy workplaces. The target groups were: (1) home workplaces in Cambodia and Thailand, (2) salt fields and fishing villages in Cambodia where many young workers are working, and (3) small construction sites in Cambodia, Laos, Mongolia, Thailand and Vietnam. The walk-through survey results showed that the workers and owners in the target informal economy workplaces had the strong will to improve safety and health at their own initiatives and needed practical support. In the participatory, action-oriented training workshops carried out, the participated workers and owners were able to identify their priority safety and health actions. Commonly identified were clear and safe transport ways, safer handling of hazardous substances, basic welfare needs such as drinking water and sanitary toilets, and work posture. The follow-up visits confirmed that many of the proposed actions were actually taken by using low-cost available materials. These positive changes were possible by applying the participatory training tools such as illustrated checklists and extensive use of photographs showing local good examples and placing emphasis on facilitator roles of trainers. In conclusion, the target informal economy workplaces in Asia made positive changes in safety and health through the participatory, action-oriented training focusing on local initiative and low-cost improvement measures. Local network support mechanisms to share lessons from good practices played essential roles in encouraging the voluntary implementation of practical improvement actions. It is important to increase our joint efforts to reach more informal economy workplaces in industrially developing countries and provide practical support measures focusing on local self-help initiatives.

Cambodia↗
PubMed2005

The Arkansas Southern Rural Access Program: strategies for improving health care in rural areas of the state.

Rural residents often have poorer health than their urban counterparts. Many factors, including the availability of rural health care providers, contribute to their poorer health status. The Arkansas Southern Rural Access Program offers innovative strategies for improving health care in rural areas of the state including assisting with recruitment and retention, developing rural health networks, nurturing rural health leaders, and facilitating the availability of development capital to enhance the rural health care infrastructure. This paper describes the program, its components and successes, as well as how these resources can be accessed by health care providers around the state.

Arkansas↗
PubMed2006

Recruitment bias in a population-based study of children with cerebral palsy.

OBJECTIVE: The purpose of this analysis was to assess recruitment bias in a population-based study of locomotor ability in children with cerebral palsy. METHOD: A population-based case register was used as a sampling frame and was considered a highly ascertained record of children with the condition. A twin track approach to recruitment for the Locomotor Study was adopted through: (1) a specialist orthopedic service and (2) a community pediatric network on behalf of the case register. The subjects included children with cerebral palsy aged 4 to 16 years in 2003, able to walk > or = 10 m, and a resident in Northern Ireland, as well as their parents. RESULTS: The Orthopaedic Service identified clinically distinct children with cerebral palsy in terms of type, severity, age, and geographic residence. More families responded to an invitation, and more were ultimately recruited into the study via the Orthopaedic Service compared with a case register using community pediatric contacts. Overall, 37.8% of the eligible cerebral palsy population participated in the Locomotor Study, but there was no evidence of any systematic biases in demographic or key clinical characteristics when compared with nonparticipants. One follow-up reminder led to an increase in recruitment of 10%. CONCLUSIONS: Care must be taken in the recruitment of children with cerebral palsy through clinic-based populations, although these routes may prove more successful in follow-up. Provided they are comprehensive, case registers have a valuable contribution to make to clinical research by providing a sampling frame including information on baseline characteristics of an affected population.

Benchmarking↗
PubMed2006

Value of recruitment strategies used in a primary care practice-based trial.

PURPOSE: "Physicians-recruiting-physicians" is the preferred recruitment approach for practice-based research. However, yields are variable; and the approach can be costly and lead to biased, unrepresentative samples. We sought to explore the potential efficiency of alternative methods. METHODS: We conducted a retrospective analysis of the yield and cost of 10 recruitment strategies used to recruit primary care practices to a randomized trial to improve cardiovascular disease risk factor management. We measured response and recruitment yields and the resources used to estimate the value of each strategy. Providers at recruited practices were surveyed about motivation for participation. RESULTS: Response to 6 opt-in marketing strategies was 0.40% (53/13290), ranging from 0% to 2.86% by strategy; 33.96% (18/53) of responders were recruited to the study. Of those recruited from opt-out strategies, 8.68% joined the study, ranging from 5.35% to 41.67% per strategy. A strategy that combined both opt-in and opt-out approaches resulted in a 51.14% (90/176) response and a 10.80% (19/90) recruitment rate. Cost of recruitment was $613 per recruited practice. Recruitment approaches based on in-person meetings (41.67%), previous relationships (33.33%), and borrowing an Area Health Education Center's established networks (10.80%), yielded the most recruited practices per effort and were most cost efficient. Individual providers who chose to participate were motivated by interest in improving their clinical practice (80.5%); contributing to CVD primary prevention (54.4%); and invigorating their practice with new ideas (42.1%). CONCLUSIONS: This analysis provides suggestions for future recruitment efforts and research. Translational studies with limited funds could consider multi-modal recruitment approaches including in-person presentations to practice groups and exploitation of previous relationships, which require the providers to opt-out, and interactive opt-in approaches which rely on borrowed networks. These approaches can be supplemented with non-relationship-based opt-out strategies such as cold calls strategically targeted to underrepresented provider groups.

Advertising↗
PubMed1997

Physician equity alliances: attractive alternatives to PHOs.

Physician equity alliances are becoming attractive alternatives to PHOs as integrative models for partnering with physicians, securing managed care contracts and increasing revenue. Unlike many PHOs, these alliances provide mechanisms for asset integration and long-term relationships along with utilization management, sophisticated information systems, access to capital and opportunities for physicians to integrate clinically. There are six major types of physician equity alliances: majority physician-owned, clinic without walls, health system joint venture, publicly held physician practice management company, specialty network, and venture capital. The type of alliance that a physician group practice ultimately develops depends on vision, values, method of capitalization, initial organizer of the alliance, level of involvement of physicians in business issues, corporate structure desired, and characteristics of the managed care market in which the alliance will operate.

Capital Financing↗
PubMed1997

As more and more doctors join physician groups, antitrust experts wonder whether hospitals and health plans will be ... outgunned.

To increase market leverage, more doctors are forming networks. That's setting off alarms among economists and antitrust experts who say such organizations are mushrooming without proven benefits for consumers. Some argue that more areas of the country could be saddled with monopolies that stifle competition. Hospitals and health plans fear physicians' new power could leave them outgunned.

Antitrust Laws↗
PubMed1995

[Sentinel networks. The national public health network. State information].

In the area of health, the information system used by the authorities is based on a series of networks that need to be coordinated. 1. State information: State information as regards health epidemiology was for a long time fragmented. The reasons for this relative ignorance are varied, and are based both on professional and technical factors (preference of physicians for personal exchange rather than for statistical analysis, difficulties in data collection and mathematical processing), and on socio-political factors (the euphoria of years of economic growth). For a long time only the causes of death were appropriately documented (cf. Mme Facy's report). In the last decade, a variety of initiatives has been directed towards all fields, and morbidity is becoming better defined thanks to the ORS (Regional Health Observatories) (cf. M. Garro's speech) and health registers (cf. M. Schaffer). Warning systems are becoming a principal preoccupation for most people in positions of authority, and explain the proliferation of surveillance networks. 2. Sentinel networks: A 'sentinel network' is an interactive surveillance system involving the collection of health data on a routine basis by a group of doctors (general physicians, biologists, etc.). Initially conceived for the surveillance of communicable diseases, they are also used for all diseases requiring early warning and rapid intervention (effects of sudden pollution, surveillance of drugs and poisons, etc.). These sentinel networks have expanded in our countries to complement the compulsory notification systems for infectious diseases, whose 'passive' nature often leads to under-notification (and therefore a non-representative selection) and delayed notification of cases, and whose range of influence does not cover all communicable diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Networks↗
PubMed1997

Creating a physician network can pay off--with the right tools.

Putting together a physician practice group and then creating the management and administrative structure for that practice to financially succeed is one of the greatest challenges health systems face today. The marriage can work, experts tell Managed Care Strategies, but only with innovation and careful attention to details such as physician compensation design, governance issues, and methods for resolving conflict resolution.

Community Networks↗
PubMed1999

[Current networks in perinatal care. From practice to theory...].

Perinatal care networks have been organized in a conventional way in six different French areas. This paper describes the four successive steps of this organization: description of the perinatal dysfunctions through survey(s), elaboration of medical recommendations, set up of a new organization, evaluation of the efficiency of the new organization.

Community Networks↗
PubMed2006

Partnerships in specialty care: exploring rural haemophilia provider resource needs.

OBJECTIVE: The purpose of this study was to determine whether rural providers have adequate preparation for safe and effective haemophilia care. DESIGN: This qualitative study proceeded in two phases: focus group (phase I) and telephone (phase II) interviews. SETTING: Five Canadian rural hospitals served by one urban haemophilia treatment centre and providing service to at least one haemophilia family. PARTICIPANTS: Phase I: focus groups of rural health professionals (site 1: n = 5; site 2: n = 6), including nursing, medicine and lab technology. Phase II: telephone interviews with nine participants from nursing, medicine, lab technology, social work and physiotherapy across three sites. MAIN OUTCOME MEASURES: Qualitative content analysis yielded categorical themes for specialty care resource requirements in a rural context. RESULTS: Resource needs reflected five main categories: communication network, subjective knowledge, team roles, objective knowledge and partnerships (C-STOP). CONCLUSIONS: The five C-STOP categories require resources and alignment of urban specialist, rural provider and family expertise. Specialty clinic efforts promoting self-care are incomplete without matched resources for rural providers.

Canada↗
PubMed1998

UCLA rewrites the script for academic networks.

Known worldwide for its high-tech tertiary and quaternary specialties, UCLA Medical Center developed a two-pronged strategy for maintaining referral volume in the face of intensifying managed care cost/referral control. Its 1. Recruited primary care clinician educators, and built a network of affiliated PC physicians and small PC offices in its historical service area. Now it draws 36% of outpatient visits, 40% of fee-for-service Medicare discharges, and 20% of total discharges from its network, providing "role models for academic-affiliated primary care medicine." 2. Began to bolster its draw further afield, developing long-distance consultation relationships/shared protocols with specialists in the rest of the L.A. Basin (home to another 45% of UCLA's business), and as far away as Las Vegas.

Academic Medical Centers↗
PubMed1999

Placing the incentive on quality through contact capitation.

Contact capitation is emerging as a reimbursement method of choice among capitated physician networks. It allows for a more equitable allocation of dollars and permits physicians to benefit financially from the savings they individually create through more effective, efficient care practices. However, in order to operate at peak efficiency, the contact capitation system should be designed with thorough and ongoing input from the participating physicians.

Capitation Fee↗
PubMed2006

Maintaining relationships is critical in network's success.

As the authors of the lead paper recognize, networks have become an increasingly popular form of organizing, both in the delivery of public services and within political arenas. A network is an arrangement of individuals and/or organizations that are linked through connections that range from informal relationships to formally agreed protocols. Networks have proved useful in addressing complex and intractable problems that require a holistic approach to identifying and implementing long-term solutions. They succeed in situations where hierarchies and "silo-based" systems have failed, and are particularly valuable in facilitating the transfer of resources and knowledge across sectoral and organizational boundaries.

Canada↗