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PubMed2005

Function of local networks in palliative care: a Dutch view.

BACKGROUND: Although network formation is considered an effective method of stimulating the integrated delivery of palliative care, scientific evidence on the usefulness of network formation is scarce. In 1998 the Ministry of Health of The Netherlands started a 5-year stimulation program on palliative care by founding and funding six regional Centres for the Development of Palliative Care. These centers were structured around pivotal organizations such as university hospitals and comprehensive cancer centers. As part of the stimulation program a locoregional network model was introduced within each center for the Development of Palliative Care to integrate palliative care services in the Dutch health care system. OBJECTIVE: We performed a study on network formation in the southwestern area of The Netherlands with 2.4 million inhabitants. The study aimed to answer the following questions: (1) how do networks in palliative care develop, which care providers participate and how do they function? (2) which are the achievements of the palliative care networks as perceived by their participants? (3) which are the success factors of the palliative care networks according to their participants and which factors predict the achievements? DESIGN: Between September 2000 and January 2004 eight local palliative care networks in the region of the Center for Development of Palliative Care-Rotterdam (southwestern area of The Netherlands) were closely followed to gain information on their characteristics and developmental course. MEASUREMENTS: At the start of the study semistructured interviews were held with the coordinators of the eight networks. The information from these interviews and from the network documents were used to constitute a questionnaire to assess the opinions and experiences of the network participants. RESULTS: According to the vast majority of responders, the most important reason to install the networks was the lack of integration between the existing local health care services. The networks were initiated to stimulate mutual collaboration, improve accessibility to health care services and increase the quality of these services. The most important achievements obtained by the palliative care networks were: increase in personal contacts between colleagues in a region, improved engagement and collaboration between participating organizations, enhanced insight in the health care provisions, joined initiatives for the development of new care products, and organization of patient-tailored care. Important success factors for the networks were deemed: fruitful mutual contacts, regular funding and the collective development of care products. By logistic regression analyses, the collective development of new care products and the organization of case discussions between caregivers from different health care services turned out to be the most important predictors for success of the palliative care networks. CONCLUSIONS: Projects that stimulate the communication between professionals appear to improve the mutual collaboration between individual participants and between the participating organizations, which consequently enhances the quality of palliative care.

Community Networks↗
PubMed2006

The social ecological model and physical activity in African American women.

Little is known about the social and contextual correlates (e.g., social norms, environment, social networks, and organizational support) influencing the adoption and maintenance of regular physical activity among minority and underserved populations. The purpose of this review was to apply the social ecological model to better understand physical activity among African American women. A review of the literature pertaining to correlates of physical activity among African American women was conducted and applied to a social ecological perspective. Understanding and addressing social and contextual correlates of physical activity behavior among African American women are necessary to establish comprehensive programs, particularly within community settings. The social ecological model provides a strong theoretical basis to guide physical activity intervention in this population.

Black or African American↗
PubMed1997

Achieving incremental volume increases.

Despite provider assumptions that managed care contracts will yield incremental increases in patient volume, there are no guarantees that volume increases will be realized. Providers can improve the likelihood that incremental volume increases will be achieved, however, by including certain provisions in managed care contracts related to volume-based discounts, limitations on network size and composition, access to physicians, provider directory listings, patient financial incentives, service scope/carve-outs, and participation in all service products offered by the managed care organization. Negotiating such provisions may be difficult, but providers and managed care organizations that reach agreement on these provisions gain mutual understanding and frequently can form more successful relationships.

Community Networks↗
PubMed1998

Positioning the library at the epicenter of the networked biomedical enterprise.

The changing economic environment in which our biomedical enterprises operate presents unparalleled opportunities to the profession of medical librarianship. Evidence-based medicine, patient empowerment, asynchronous learning networks, and research colaboratories each involve a new type of shared information, or access to information in new ways or by different people. These tasks are ones with which librarianship is directly involved. Librarians are therefore placed perfectly to provide new products and services. To position the library at the epicenter of the networked biomedical enterprise we must meet three challenges: We must align the library's business strategy with that of the larger enterprise. We must provide services in ways that will scale-up to enable new business strategies. We must measure the effectiveness of services in ways that document their role in supporting the enterprise.

Community Networks↗
PubMed1987

Community development and preventive work.

The theoretical frame of reference in connection with prevention, some theoretical approaches, and the practical consequences of giving priority to prevention are discussed. The following points are stressed: that one must expand the theoretical frame of reference of prevention to include theory on local community, social networks and concepts of mutuality and self-supporting processes that preventive work is most efficient when it is developed in the form of fruitful interaction between primary intervention and selective intervention that giving priority to preventive work rather than implementing continuous expansion of institutions and fields of administration involves changes in the ones that already exist.

Community Mental Health Services↗
PubMed2003

Treatment of anaemia in cancer patients: implications for supportive care in the National Health Service Cancer Plan.

The National Health Service (NHS) Cancer Plan published in 2000 has a short-term focus on the most pressing problems of improving survival rates and replacing equipment. It also mentioned as a target 'improved quality of life for those affected by cancer'. Continuity of care for longer-term care programmes was seen predominantly in terms of palliative care. Recent National Institute for Clinical Excellence (NICE) reports may have reinforced this approach by focussing on the clinical and cost effectiveness of chemotherapy for late-stage cancer. The impact on local decision-makers has been that drug funds have been prioritised for use on survival-enhancing interventions, with few resources left for short and longer-term supportive care targeted primarily on improving quality of life. Within supportive care, resources are particularly limited for funding treatments such as erythropoietin for the management of cancer-related anaemia, a common and very debilitating side-effect of intensive therapy. The need for a re-focusing on supportive care is associated with cancer becoming, in many instances, a longer-term illness. The prevalence of cancer is rising markedly due to increased survival rates. However, this creates a new challenge of reducing disability and improving quality of life. In surveys, patients have rated fatigue associated with anaemia as one of the most debilitating effects of their cancer and its treatment with chemotherapy. This paper reviews the evidence demonstrating the quality of life benefits of erythropoietin, and then considers the policy constraints that have limited the adoption of this treatment within the NHS. Through co-ordinated planning there are opportunities for cancer networks and primary care trusts (PCTs) working with cancer centres to develop more support in ways which are feasible and fundable. The case is argued that PCTs and cancer networks, in implementing the Cancer Plan locally, need to integrate short- and longer-term supportive care into their cancer service development plans, and recognise the importance of anaemia management as an integral part of this. Lessons can be learnt from UK renal services where anaemia management with erythropoietin is standard practice.

Anemia↗
PubMed1996

Vertical integration and organizational networks in health care.

This paper documents the growing linkages between primary care-centered medical groups and specialists and between physicians and hospitals under managed care. We evaluate the two alternative forms of organizational coordination: "vertical integration," based on unified ownership, and "virtual integration," based on contractual networks. Excess capacity and the need for investment capital are major short-term determinants of these vertical versus virtual integration decisions in health care. In the longer term, the principal determinants are economies of scale, risk-bearing ability, transaction costs, and the capacity for innovation in methods of managing care.

California↗
PubMed2002

Integrated local networks as a model for organizing mental health services.

Organizing services in an integrated network as a model for transforming healthcare systems is often presented as a potential remedy for service fragmentation that should enhance system efficiency. In the mental health sector, integration is also part of a diversified response to the multiple needs of the clients, particularly people with serious mental health disorders. The authors describe how the notion of integrated service networks came to serve as a model for transforming the mental health system in Quebec, and they propose a frame of reference for this notion. They also address the challenges and issues raised by this mode of service organization in the mental health sector and more generally in a context of transforming healthcare systems.

Community Mental Health Services↗
PubMed2000

Enhancing the financial performance of a health system laboratory network using an information system.

We describe the improvements created by successful implementation of a laboratory information system for a multi-institutional integrated delivery system, including an analysis of the financial results. Conditions at the outset of the project, methods of management and project design, selected aspects of services redesign and consolidation, integration of services among the sites and their effects on laboratory staff and productivity are illustrated. A method for and example of measuring the financial outcomes in the sense of quantifiable improvements in operating expenses and new revenue for a whole health system clinical laboratory computer system are discussed. In this health system, the measurable financial improvements facilitated by an information system were the ability to control operating expenses and to grow the hospital laboratory network through the development of an outreach program. With organizational commitment to process innovation and improvement, using team processes and customer-driven decision-making criteria, the financial performance of our consolidated laboratory network was enhanced substantially. A fully implemented laboratory information system is considered the major enabler of positive change when combined with a genuine commitment from all levels of staff and leadership. Over time, this system's financial return is several times that of the information system investment.

Clinical Laboratory Information Systems↗
PubMed2003

[Treatment of pulmonary diseases from the 20th to the 21st century].

In the 21st century, the treatment of pulmonary diseases will undergo fundamental change. The treatment of patients in general and of pulmonary diseases in particular will transcend the vertical and fragmented approach based on analytical and reductionistic disease concepts to emphasize holistic care given by an interdisciplinary team. Extended life expectancies, understandably ones that represent significant progress in 20th century medicine, will lead to considerably higher costs in the healthcare system and to a redistribution of therapeutic resources. Healthcare centers will form that are better equipped to handle the true needs of the patients and provide better continuity of care. Likewise, this nascent century will bring forth one irreversible sociological change, namely the better informed and better educated patient who, by demanding access to medical information in order to profit from modern technological advances, will become an active partner of the healthcare professionals. The Swiss Lung League, which is celebrating its 100th anniversary this year, has been able to tackle the real pulmonological challenges of the 20th century by taking on a pioneering role in the fight against tuberculosis, smoking and setting benchmarks by providing patients with sophisticated respiratory technology like mechanical home ventilation. Unlike other medical disciplines, it recognized early on the importance of working within a healthcare network. Its strength derives from a synergy of the cantonal leagues' medical and social commitment and the Pulmonological Society's scientific support. Indeed, this trend can be observed all over Europe and the USA. This partnership is self-perpetuating and has adapted its own mentalities and structures to scientific progress and the changing needs of pulmonary patients.

Community Networks↗
PubMed2002

Clinical networks. Sum of the parts.

A simulation exercise intended to ease the development of clinical networks found that primary care trusts were eager to co-operate with one other. Acute trusts emerged as the most confident 'players'; they were perceived as a 'provider cabal' by PCTs. Participants felt the legacy of the internal market might have impeded joint-working across trusts. The regulator role of strategic health authorities was crucial.

Community Networks↗
PubMedDate not supplied

The MYSound Project: building an estuary-wide monitoring network for Long Island Sound, USA.

A network of five water quality monitoring stations has been established in Long Island Sound, measuring temperature, salinity, and dissolved oxygen since 1999. The stations are located in areas of extreme water quality degradation (western Long Island Sound) as well as in pristine areas (eastern Long Island Sound). The data from these stations are collected every 15 minutes and posted to the project web site in real time as provisional data. After subsequent quality assurance procedures, the data are archived to the project File Transfer Protocol (FSP) site for downloading by the user community. The network of stations is in part supported logistically by a number of partners, including state and local agencies, schools, and non-governmental organizations. Data from the monitoring programs of some of these partners are also published to the project website providing a more comprehensive and complete picture of the status of the Sound than can be provided independently. This repository of information is used by marine educators, resource managers, scientists, and the general public, each with a different end purpose. We use the data from two of the stations to show that these high frequency time series measurements can be used to complement and enhance other monitoring programs within the Sound, documenting in greater detail the occurrence and duration of hypoxic events.

Automation↗
PubMed2005

[Surveillance of infectious diseases: principles and organisation in France in 2005].

Surveillance is a continuous and systematic process of collection, analysis, and diffusion of health data to all those who contributed to the collection and all those who need this data in order to take action. Surveillance activities first target health problems for which effective prevention or control measures are available. Surveillance objectives include the following-up of trends and changes in disease characteristics, evaluation of public health actions, and early detection of infectious diseases threats and epidemic and their investigation. The data produced by surveillance systems allow prioritizing public health actions and defining the objectives of infectious diseases control or prevention. The surveillance of infectious diseases relies on a large number of partners grouped in a public health network in which clinicians and microbiologists have a prominent role. In France, the surveillance of infectious diseases is based on mandatory notification of some diseases, national reference centers, networks of voluntary health professionals or services, and repeated surveys. The national surveillance is coordinated by a public health institute, "l'Institut de Veille Sanitaire", the missions of which are public health surveillance of the population, alerting health authorities in case of health threats, and identifying the determinants of changes in the population's health status.

Communicable Diseases↗
PubMed2003

[Network for the treatment of acute myocardial infarction in the province of Mantova: results after 2 years of work].

BACKGROUND: Since June 2001, in the province of Mantova, we have been carrying out a program for the management of acute myocardial infarction based on early assessment of the patients' risk profile, on telematic connection among care centers and on optimization of in- and out-of-hospital critical pathways for the access to care. METHODS: Our network provides connection among the following centers: advanced life support ambulances, 7 hospitals, 3 coronary care units, 1 cath lab on call 24 hours a day for primary angioplasty, 1 thoracic surgery division. This program, through its strong telematic platform, allows early assessment of myocardial infarction, and provides primary angioplasty to all high-risk patients, being fibrinolytic treatment reserved only to the low-risk patients admitted in peripheral hospitals. RESULTS: Two hundred and twenty patients with acute myocardial infarction were treated with angioplasty; 179 (81%) patients underwent primary angioplasty, 26 (12%) patients facilitated angioplasty and 15 patients (7%) rescue angioplasty; 121 patients (55%) were first admitted in the Mantova hospital, 65 patients (30%) were referred to Mantova from peripheral hospitals and 34 patients (15%) were directly transported to the cath lab by advanced life support ambulances. Procedural success was obtained in 98% of cases, with 05% intraprocedural mortality. In-hospital mortality was 55%, while mortality of cardiogenic shock patients was 36%. Recurrence of acute myocardial infarction occurred in 1% and major bleeding in 2.2% of patients. One patient with cardiogenic shock died during transport. Mean door-to-balloon time was 73 min with 39% reduction in the second period of recruitment after telematic connection. CONCLUSIONS: This program, developed in the setting of a provincial network for the management of acute myocardial infarction, provided primary angioplasty to all high-risk patients, with a high procedural success rate. Within a few months, time to treatment was minimized by the employment of telematic facilities.

Adult↗
PubMed1997

The emerging infections network: a new venture for the Infectious Diseases Society of America. Executive Committee of the Infectious Diseases Society of America Emerging Infections Network.

The Infectious Diseases Society of America (IDSA), in cooperation with the Centers for Disease Control and Prevention, has launched an Emerging Infections Network (EIN). This network of infectious diseases consultants was conceived as a sentinel system to monitor new or resurgent infectious diseases in a way that would complement other public health surveillance efforts. A pilot study with 169 participants recruited from 32 of the IDSA's state and regional societies confirmed the feasibility and potential value of this network. More than 300 infectious diseases consultants are currently participating in the IDSA EIN. Future plans include aggressive probing for clinical experiences that indicate or suggest the presence of emerging infections, initiation of prospective studies for selected infectious diseases, and other activities designed both to benefit consultants in infectious diseases and to make use of their services.

Communicable Disease Control↗
PubMed2000

[Ambulatory management of chronic cardiac failure. Possible value of health networking].

Cardiac failure is one of the commonest medical conditions. It usually affects the elderly and is responsible for repeated hospital admission with its high cost for the social security. Several attempts at ambulatory management in certain countries have been successful. Their application may be possible in France. The setting up of health systems like the ones which exist for diabetes, could be a solution to the problem.

Ambulatory Care↗
PubMed2006

Organizing the public health-clinical health interface: theoretical bases.

This article addresses the issue of the interface between public health and clinical health within the context of the search for networking approaches geared to a more integrated delivery of health services. The articulation of an operative interface is complicated by the fact that the definition of networking modalities involves complex intra- and interdisciplinary and intra- and interorganizational systems across which a new transversal dynamics of intervention practices and exchanges between service structures must be established. A better understanding of the situation is reached by shedding light on the rationale underlying the organizational methods that form the bases of the interface between these two sectors of activity. The Quebec experience demonstrates that neither the structural-functionalist approach, which emphasizes remodelling establishment structures and functions as determinants of integration, nor the structural-constructivist approach, which prioritizes distinct fields of practice in public health and clinical health, adequately serves the purpose of networking and integration. Consequently, a theoretical reframing is imperative. In this regard, structuration theory, which fosters the simultaneous study of methods of inter-structure coordination and inter-actor cooperation, paves the way for a better understanding of the situation and, in turn, to the emergence of new integration possibilities.

Clinical Medicine↗
PubMed2006

[Three years of vertical networking in the German Network of Competence on Viral Hepatitis: what can we learn from the usage of different information tools?].

Treatment of patients with viral hepatitis is time-consuming and sometimes complicated. Several sources of information have been established as internet sites, however systematic analyses of the need and use of these information platforms are lacking. The Competence Network on Viral Hepatitis (Hep-Net) was established in 2002 and offers a telephone hotline, an e-mail service and a home page with frequently asked questions (FAQs). On the internet pages "FAQs" 38 125 hits have been registered on single "question-answer-units" within three years. In a half of the cases the question are associated with modes of transmission. In contrast, patient's questions in e-mail and the telephone hotline are mainly dealing with the treatment of hepatitis C. More than 46 % of the physician's questions referred to unclearness in indications for treatment. Questions on specific medical problems of individual patients and, in e-mail, also on legal issues played a major part. Many of these questions have not been addressed in the actual guidelines in Germany. In summary, the Hep-Net vertical networking tools represent a fast, quality-assured endorsement to the daily management of patients with viral hepatitis. The combination of internet, e-mail service and telephone hotline gives consideration to individual necessities of patients and physicians. However, the detailed analysis of usage also shows limitations of current guidelines which should be considered during updating.

Community Networks↗