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At least 145 records · Page 8Linked to original sources
PubMed1993

Interorganizational exchanges as performance markers in a community cancer network.

OBJECTIVE: This study examines how "strategic partnerships" between community-based consortia of oncologists and hospitals (CCOPs) and clinical cooperative groups emerge, develop, and influence patient accruals (i.e., the number of patients enrolled in clinical trials) over time. DATA SOURCES AND STUDY SETTING: Study analyses are based on 65 pairwise relationships that 38 CCOPs established with eight clinical cooperative groups in September 1983 and maintained through February 1989. Data are drawn from grantee applications and progress reports. STUDY DESIGN: The study examines how different types of CCOP-cooperative group exchange relate to one another and to CCOP patient accruals over six time points. Key independent variables include resource dependence, information exchange (i.e., meeting attendance and committee membership), and protocol exchange (i.e., the number of different protocols used). DATA COLLECTION METHODS: Data extracted from secondary sources were entered in a data base. PRINCIPAL FINDINGS: The number of CCOP physicians and support staff who attend cooperative group meetings during the first two years of a clinical research partnership has a significant influence on meeting attendance and protocol use in later years. Two-thirds or more of the variance in patient accruals at each time point can be explained by the number of different protocols used and the number of CCOP representatives serving on cooperative group committees (or attending cooperative group meetings). CONCLUSIONS: The findings highlight the importance of historical relationships and anticipated resource dependence in shaping initial exchange patterns. They also suggest that strategic partnerships need to emphasize structures and processes that encourage early involvement in collaborative activities and that reward participants for maintaining high levels of interaction.

Cancer Care Facilities↗
PubMed1993

A proposal to provide care to the uninsured through a network of community health centers.

While a national health insurance plan is needed, this alone will not provide access for approximately 30 million persons who face geographic, cultural, language, or health care system barriers, or who live in areas with provider shortages. These barriers often coexist with lack of insurance coverage, but they also affect millions who have public, or even private, coverage. Moreover, large segments of this population suffer from health problems not adequately addressed by the traditional medical model: teenage pregnancy, AIDS, injury, substance abuse, and the like. To provide appropriate care for these underserved persons, we propose to expand the existing network of community health centers over the next 10 years to a total of approximately 3,000. Such an expansion would provide a cost-effective approach to improving provider distribution, increasing consumer input, combining personal health services with health promotion, and removing both financial and nonfinancial barriers to care. This model can be implemented either independent of or in conjunction with other health care system reform efforts.

Community Health Centers↗
PubMed2005

Implementing the CanMEDSTM physician roles in rural specialist education: the Multi-Speciality Community Training Network.

CONTEXT: Changing medical education to realign it with societal needs has become a renewed priority in many countries. Advanced training in rural settings to prepare physicians to better serve rural areas has received particular attention around the world. Such initiatives are usually targeted at primary care practitioners. Few initiatives have been designed to enhance specialist training in a rural setting, let alone adapt specialist competency frameworks such as the CanMEDSTM roles of the Royal College of Physicians and Surgeons of Canada to non-urban medical education. ISSUE: We describe an innovation in medical training for rural competence for specialist physicians using the CanMEDS framework near London, Ontario, Canada. Since 1997, the University of Western Ontario has established its Multi-Specialty Community Training Network (MSCTN) to provide rural and regional training opportunities for specialty residents in anaesthesia, general surgery, internal medicine, paediatrics, obstetrics and psychiatry. It became the first program in Canada to fully adapt the new CanMEDS roles into learning objectives and evaluations. LESSONS LEARNED: Competency-based frameworks like CanMEDS are important because they provide a comprehensive tool to organize outcome-based curricula. The CanMEDS roles framework has been very useful in developing educational goals for rural/regional specialty resident rotations as well as forming a constructive basis for resident, preceptor, and program evaluations. Our experiences with this program may provide lessons for others planning training for specialists in rural settings, and those adopting the CanMEDS competency framework.

Canada↗
PubMedDate not supplied

A midwestern perspective: the development of community care networks.

One of the most significant public misconceptions today is that we have a health care system in the United States. For those of us in the industry, we know we have a hospital system, a public health system, a physician system, a financing system, an insurance system and many other systems. But all of these separate systems have not created a health care system--a system of care that is seamless, coordinated and accountable for cost and outcomes.

Community Networks↗
PubMedDate not supplied

Oxytocin and the induction of labor: use in a network of community hospitals.

This study uses a matched cohort design to compare the process and outcome of patients whose labor was induced using oxytocin with those entering labor spontaneously in a network of small community hospitals. The patients with induced labor more frequently had an arrest of dilatation and had infants who showed more abnormalities of fetal heart rate. There were no differences in infant APGAR scores. The previously reported increases in epidural anesthesia, episiotomy, and assisted deliveries in patients with induced labor were not found, suggesting a significantly different style of care provided by family physicians in small community hospitals.

Alabama↗
PubMed2003

Members' perceptions of community care network partnerships' effectiveness.

Investment in voluntary partnerships raises important questions: Should we invest in collaboration in moving toward the goals of health system redesign? What makes collaborative groups effective? Given the voluntary nature of these partnerships, membership perceptions of their experiences and the partnership's effectiveness should be important predictors of success. This article provides a preliminary analyses of perceived effectiveness of participants' perceptions of their own partnership, particularly focusing on leadership, conflict management, decision-making dynamics, and the breadth and depth of partnership membership. Members' perceptions that the partnership membership was "sufficiently broad to accomplish objectives" had a negative and highly significant relationship to perceived effectiveness. Members' perceptions about leadership being ethical was positively related to perceived effectiveness while perceptions that the leadership was not effective a keeping the group focused was negatively related to perceived effectiveness.

Community Networks↗
PubMed2006

Cardiovascular risk factor control in communities--update from the ASH Carolinas-Georgia Chapter, the Hypertension Initiative, and the Community Physicians' Network.

The prevalence of hypertension dictates that blood pressure must be managed effectively in primary care. The American Society of Hypertension (ASH) regional chapters and clinical hypertension specialists represent a positive response by ASH to the growing problems of hypertension and metabolic syndrome-related risks and disease. To have a significant public health effect, the impact of clinical hypertension specialists must be leveraged. Key activities in the community include educating other providers locally, delivering care for complex referral patients, and fostering growth of a practice network with a central database in collaboration with academic partners. The database supports practice audit and feedback reports to enhance quality improvement, identify continuing medical education topics, and facilitate clinical trials to test new therapeutic and best-practice approaches to risk factor management. The ASH regional chapters serve as a forum for community and academic hypertension specialists to collaborate with like-minded individuals and organizations. The collaboration among the ASH Carolinas-Georgia chapter, the Hypertension Initiative, and the Community Physicians' Network provides a model for other ASH chapters and health delivery groups to partner in delivering continuing medical education programs focused on cardiovascular risk factor management, recruiting practices into the network, and developing and maintaining a centralized patient database. Evidence suggests that this collaboration is facilitating application of evidence-based medicine and risk factor control.

Aged↗
PubMed1995

Predicting agency participation in interorganizational networks providing community care.

In response to health care reform, health care providers have begun to develop interorganizational networks. At present, however, relatively little is known about factors facilitating participation in networks. To this end, organizational characteristics and views were obtained from key informants from both "Lead" and "Affiliate" Agencies participating in the networks for the Living-at-Home Program (LAHP) Demonstration (N = 131) using an Organizational Change Survey. Logistic regression analysis was used to examine factors related to network member agencies' participation. Significant relationships were found between decreased participation and lack of agreement between network agencies regarding expectations (P = 0.02), membership in a network with a Medical Lead Agency (P < 0.01), and Lead Agency inexperience (P < 0.01). Agencies with lower ratings of the impact that LAHP had on their community were more likely to decrease their participation (P = 0.01). The number of unoccupied nursing home beds in the community was positively and significantly related to decreased participation (P < 0.001). These results suggest that leadership skills of the Lead Agency, and in particular, experience, may be among the chief requirements for the creation and development of successful networks, and confirm that inexperienced Lead Agencies may face an uphill battle in terms of recruiting and maintaining network members.

California↗
PubMed1995

Teleform scannable data entry: an efficient method to update a community-based medical record? Community care coordination network Database Group.

Community-based multi-disciplinary care of chronically ill individuals frequently requires the efforts of several agencies and organizations. The Community Care Coordination Network (CCCN) is an effort to establish a community-based clinical database and electronic communication system to facilitate the exchange of pertinent patient data among primary care, community-based and hospital-based providers. In developing a primary care based electronic record, a method is needed to update records from the field or remote sites and agencies and yet maintain data quality. Scannable data entry with fixed fields, optical character recognition and verification was compared to traditional keyboard data entry to determine the relative efficiency of each method in updating the CCCN database.

Chronic Disease↗
PubMedDate not supplied

The implementation of telemedicine within a community cancer network.

Telemedicine is being used by physicians at the member hospitals of the Jefferson Cancer Network (JCN) for consultations regarding the diagnosis and management of cancer patients. The technology employed for this telemedicine system was chosen to meet three related specifications: low capital and operating cost, internal maintainability by community hospital data processing staffs, and compatibility with the existing technologic infrastructure. The solution selected is the ubiquitous desktop personal computer and associated software, and Integrated Services Digital Network (ISDN) communications links. The overall performance of this technology has been very satisfactory; ISDN communications has sufficient bandwidth for the transfer of patient data, including text reports, radiographs, and pathology slide images. The presence of the radiologist's interpretation along with the radiographic images allows the presentation of the images on these systems to be acceptable for review purposes. The video frame rates of these systems (12 to 15 frames per second) is adequate, particularly given the "talking heads" nature of the video presentations. Furthermore, the quality of the video image (resolution, size, frame rate) is secondary to the quality of the presentation of the medical information displayed and the capability for mutual annotation of the patient data during the consultation.

Clinical Trials as Topic↗
PubMed1980

Community-family network therapy in a rural setting.

A model of family intervention with extended family members and significant community agency people is presented in an attempt to deal with the total social network surrounding a seriously dysfunctional family. They describe how this approach adapts itself well to a rural setting and seems to encompass most if not all of the significant helping systems in the family social sphere. The roles of the various team members are carefully outlined and the process of the therapeutic meeting is described. The authors believe that this approach has a facilitative effect to increase the functionality of already existing natural social systems on which the families are already quite dependent, but which prior to the network sessions were largely nonfunctional. The effect of all of this is to reduce drastically the amount of wasted time, energy, and effort that occurs when all the significant persons and agencies in the psychosocial sphere of a family are not working together in a coordinated manner.

Adolescent↗
PubMed2003

[Home medical care network in the community supporting hospital--nursing consultant acting for community coordination].

Tama Nambu-Chiiki Hospital is a secondary medical institution providing the acute short-term care centered on cancer treatment and emergency medical service, which few other medical institutions in the region provide. The hospital, which has no system to directly support home medical care by house visit or visiting nurses, needs to coordinate home medical care with other community medical institutions. 2 nurses serve as the Nursing Consultants who provide consultation services over the issues related to home medical care and other issues face to face or by phone and coordinate home medical care with other community medical institutions. Medical coordination based on trust and understanding of home medical care by hospital staffs are essential for the smooth transfer to home medical care. Activities of the hospital are studied to cope with the changes in healthcare trend.

Community Health Nursing↗