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PubMedDate not supplied

Urban U.S. hospitals and the mission to provide HIV-related services: changes and correlates.

In 1988, the vast majority of urban U.S. hospitals (84 percent) exhibited some formal response to the demand for HIV-related services. Despite the fact that HIV-related care is now normative in many respects and the demand for inpatient care has decreased, nearly half of hospitals surveyed in 1997 (42 percent) report no formalized service provision, suggesting a heightened distinction between hospitals in terms of their varying commitments to providing HIV-related services. Certain organizational variables (such as ownership, size, system affiliation, and stigmatized services and post-acute care services indices) were connected to HIV-related services provision. When the sample was controlled for other variables, the study found that changes in teaching status, changes in bed size, and changes in post-acute services from 1988 to 1997 did influence the provision of HIV-related services. Despite significant changes over the study period in the treatment of persons living with HIV/AIDS, and structural changes in the delivery of U.S. healthcare, the organizational-level predictors of HIV-related service provision have remained remarkably stable among U.S. hospitals in urban settings. These data also suggest that organizational missions consistent with serving indigent and socially marginalized populations continue to influence the ways that the pluralistic U.S. hospital system organizes HIV-related care.

American Hospital Association↗
PubMed2001

Implementing nursing clinical indicators.

Clinical indicators state desirable patient outcomes using evidence-based targets. Locally based indicators give professional staff ownership of the process of audit, and the programme can be adapted to the local circumstances.

Evidence-Based Medicine↗
PubMed2002

The National Nursing Home Survey: 1999 summary.

OBJECTIVE: This report presents estimates of nursing homes and their current residents and discharges in the United States. The data are summarized by characteristics of facilities such as information about Medicare and Medicaid certification, bed size, type of ownership, services provided, and per diem rates. Data are also summarized by characteristics of current residents and discharges such as demographic and resident characteristics, health and functional status, services provided, primary diagnosis, and all-listed diagnoses. METHODS: Estimates in this report are from the 1999 National Nursing Home Survey (NNHS), the sixth in a series of surveys. This nationwide sample survey was conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention, from July through December 1999. RESULTS: About 1.6 million current residents and 2.5 million discharges received nursing home care during 1999. About two-thirds (67 percent) of nursing homes are proprietary (for profit) and are located in the Midwest and South. There were 1.5 million full-time equivalent (FTE) employees providing health-related services to residents. Ninety percent of current residents were age 65 years or over, 72 percent were female, and 57 percent were widowed. Nearly half (46 percent) of current residents were admitted from a hospital. The average length of time since admission for current residents was 892 days. Most nursing home discharges were female (62 percent) and 88 percent were age 65 years and over. The main reasons for most discharges were admission to a hospital (29 percent) and death (24 percent). The average length of stay for a discharge was 272 days.

Aged↗
PubMed2001

Evaluating health information sites on the Internet in Korea: a cross-sectional survey.

Through the internet the public in South Korea has access to a growing supply of information on health and disease. In South Korea an estimated 13.93 million people used the internet in 2000. The number has increased rapidly compared to 1.63 million in 1997. Health information is often said to be one of the most retrieved types of information on the internet. However, a concern has emerged for the quality of health information documents contained on the World Wide Web. Lack of evaluation and oversight, and ease of publication, have led to inaccurate and misleading health-related publications on the Internet. For those seeking easy ways to identify high-quality and reliable information, rating systems to evaluate the quality of health information on the internet should be provided and developed. Given this background, the purpose of this research was to evaluate health information web sites on the internet. In this study we aimed to survey websites providing health information. 440 websites were selected using four search engines, YahooKorea (http://www.yahoo.co.kr), LycosKorea (http://www.lycos.co.kr), Empas (http://www.empas.co.kr), and Naver (http://www.naver.com), to conduct searches in December 2000. General quality criteria were used for the evaluation. These included ownership, currency, authorship, source, feedback mechanism, links, and functionality. More than 50% of web sites did not provide the date of publication or update of information, author and author credentials, references to source, etc. Websites of universities and universities' hospitals were more likely to provide name and type of provider (p < .01), author's name (p < .001), and references to source (p < .01) than other service providers. There is a need for better evidence-based health information as well as a need to develop simple criteria that ordinary people can understand and use. In addition, gateway services that operate a selective process and provide links to other organizations that provide high-quality health information should be offered and developed.

Authorship↗
PubMed1990

Residential mobility in France and in Paris since 1945: the history of a cohort.

Using data from two retrospective surveys carried out in France in 1981 and 1986, the authors "reconstitute the residential history of a cohort and...measure the differences [in migration histories] between Paris and the whole of France.... We shall attempt to reconstruct the residential histories of these individuals, by analysing firstly the stage when they left their parents to set up their first independent home, and secondly mobility throughout their life course, paying particular attention to the extension of home ownership in this cohort."

Cohort Studies↗
PubMed1986

Migration as a demographic response: the age differentials.

"This study uses the theory of demographic response as the background against which regional human migration is examined as a response to selected environmental conditions for the 1,056 counties in the North Central Region [of the United States]. Specifically, this study addresses two migration-related questions concerning county populations in the North Central Region: (1) What are the socioeconomic, demographic, and ecological factors to which county populations respond in adjusting their migration behavior? (2) Do socially important age cohorts respond to these factors differently or in a similar manner?" Factors affecting migration are employment status, income levels, educational status, ethnic group, residence location, marital status, home ownership, and age. Data are from the U.S. Census Bureau for the period 1965-1970.

Age Factors↗
PubMedDate not supplied

[Intra-urban population and housing in Sao Paulo].

"This paper outlines an analysis of intra-urban demography in Sao Paulo [Brazil], by means of differentials among rates of population growth, densities and age distributions of the several spatial segments of the city. In trying to analyze together housing and demographic variables, it associates the youth of the peripheral population to the housing model prevalent till the eighties--irregular allotment, self-help and home ownership. The data show changes in this peripheral pattern for the last decade: the population growth rate of the central zone (mainly the interior ring) has been greater than that of the periphery. This would be explained by the increase of inner city slums and by verticalization. This tendency was already visible from census data of 1970 and 1980, which show an increase in the number of slums and in the proportion of tenants." (SUMMARY IN ENG)

Americas↗
PubMed1991

International migration and welfare in the source country.

"In a recent paper, Rivera-Batiz (1982) points out that the economic effects of migration should be studied in the presence of non-traded goods in the source country.... We will show that Rivera-Batiz's explanations do not consider all the aspects of ownership and transfer of inputs by migrants. Consequently, we will show that if...additional issues are taken into account, the non-migrants can turn out to be actually better off as a result of emigration."

Commerce↗
PubMed1987

Patterns of household immigration into South Texas.

This article examines Mexican migration into South Texas in recent decades and focuses on changes in the characteristics of the migrants' households. An ethnographic approach is used in examining 56 permanent, immigrant households. "This article introduces a hypothesis for explaining the increase and permanency of household immigration." It is found that "immigration often leads to downward social mobility with respect to legal status of household members, type of employment, and property ownership. Of particular note is the transformation of the household from a single to a multiple worker unit, in response to agricultural labor demands and growing employment opportunities in the non-agricultural sector."

Agriculture↗
PubMedDate not supplied

Organizational design consistency: the PennCARE and Henry Ford Health System experiences.

There has been much discussion of the appropriateness of various organizational strategies for today's healthcare industry. This article presents case studies of two healthcare organizations that have pursued very different configurations. PennCARE uses a virtually integrated, loose contract-based arrangement, while Henry Ford Health System employs a vertically integrated, tight ownership model. Despite these different approaches, their overall designs are strikingly similar. In essence both systems demonstrate a property called organizational design consistency; they simply approach it from different ends of the spectrum. This article presents the notion of organizational design consistency and defines it as the steady pursuit of a single preferred configuration strategy across key elements of organizational design. To illustrate the framework the case studies target four key elements of organizational design (governance structure, organizational culture, strategic planning processes, and decision-making procedures) and explain how consistency across these components adds value to both of these differently configured healthcare systems. There is room enough for diverse configurations of organizations in the current healthcare environment. Consistency does not mandate conformity; value can be derived from both tight and loose models. Furthermore, when fashioning organizational design consistency strategies, healthcare systems should carefully choose tightly or loosely modeled configurations to appropriately suit their aims, their markets, and the capabilities and resources available to them.

Contract Services↗
PubMedDate not supplied

The effect of governing board composition on rural hospitals' involvement in provider-sponsored managed care organizations.

Rural hospitals are actively pursuing various strategic alternatives to confront the dramatic changes taking place in the delivery, organization, and financing of healthcare. One of these strategic alternatives is involvement in provider-sponsored managed care organizations. Studies have argued that this form of managed care would enhance public trust and might improve the performance of hospitals. The changing healthcare environment has also increased the importance of the competence and composition of hospital boards. This article examines the effect of the governing board's composition on rural hospitals' involvement in provider-sponsored managed care organizations. The study sample consisted of 140 rural hospitals in Iowa and Nebraska whose CEOs responded to a survey conducted by the Center for Health Services Research at the University of Iowa between June and December 1997. The principal finding was that the likelihood of a hospital owning any form of managed care organization increases with the number of community leaders and health professionals on the board. The number of business leaders had no effect on the likelihood of involvement in such an arrangement. Other factors that affected the likelihood of owning a managed care organization were the health status of the population and ownership type. Key recommendations to managers are to (1) revisit the hospital board's composition before actively pursuing a strategic action, (2) examine the compatibility of the type of strategic activity pursued with the background of board members and the interests of the populations they represent, and (3) use the governing board as a resource in determining which new strategic activities to undertake.

Attitude of Health Personnel↗
PubMed2001

Protecting genetic materials and genetic information: a case study of Guthrie Cards in Victoria.

The authors are privileged to have been provided with correspondence about a dispute over the ongoing storage of genetic material (as Guthrie Cards) in Victoria. The correspondence details confusion over the roles of government and the private sector service provider in accounting for the storage, use and destruction of these stored genetic materials collected as part of a government public health program. The purpose in publishing this account is to highlight the present inadequacies in current practices and the ongoing potential for a crisis in the management of collected genetic materials through a lack of appropriate regulation, transparency and accountability. The article suggests measures to remedy some of the existing inadequacies in contractual arrangements and recommends that the government retain ownership and control of both the genetic materials and the derived information to ensure some accountability in the present legal environment.

Contract Services↗
PubMed2003

Beyond empowerment: building a company of citizens.

We live in a knowledge economy. The core assets of the modern business enterprise aren't its buildings, machinery, and real estate, but the intelligence, understanding, skills, and experience of its employees. Harnessing the capabilities and commitment of knowledge workers is arguably the central managerial challenge of our time. Unfortunately, it is a challenge that has not yet been met. Corporate ownership structures, governance systems, and incentive programs--despite the enlightened rhetoric of business leaders--remain firmly planted in the industrial age. In this article, the authors draw on history to lay out a model for a democratic business organization suited to the knowledge economy. Some 2,500 years ago, the city-state of ancient Athens rose to unprecedented political and economic power by giving its citizens a direct voice and an active role in civic governance. The city's uniquely participative system of democracy helped unleash the creativity of the Athenian people and channel it to produce the greatest good for society. The system succeeded in bringing individual initiative and common cause into harmony. And that is precisely the synthesis today's companies need to achieve if they're to realize the full power of their people and thrive in the knowledge economy. The Athenian model of organizational democracy is just that--a model. It does not provide a simple set of prescriptions for modern managers. What it offers is a window into how sizable groups of people can, in an atmosphere of dignity and trust, successfully govern themselves without resorting to a stifling bureaucracy.

Creativity↗
PubMed2002

Post-acute service use following acute myocardial infarction in the elderly.

This exploratory study examined the extent to which factors beyond characteristics of the patient, such as discharging hospital attributes and State factors, contributed to variations in post-acute services use (PASU) in a cohort of elderly Medicare patients following acute myocardial infarction (AMI). Thirty-seven percent of this cohort received PAS within 30 days of discharge and home health care was the most common type of service used. Patient severity of illness at hospital discharge, for-profit ownership of the discharging hospital, and discharging hospital provision of home health services were shown to be important predictors of PASU. After adjusting for many patient and hospital characteristics, however, variation in PASU remained across States.

Activities of Daily Living↗
PubMed1976

Reorganizing the nursing home industry: a proposal.

This paper proposes a reorganization of the nursing home industry with capital facilities owned by government, but with management conducted through a system of competitive contracts with the private sector. The paper explicity demonstrates in real estate finance terms how the present system of private ownership of capital facilities inherently impedes providing a high quality of care. The authors believe that in the proposed industry reorganization, market forces, instead of working against quality care, would be supportive of quality care in a framework that would involve generally less regulation than exists today.

Accounting↗
PubMed2003

Quality and comparison of antenatal care in public and private providers in the United Republic of Tanzania.

OBJECTIVE: To compare the quality of public and private first-tier antenatal care services in Dar es Salaam, United Republic of Tanzania, using defined criteria. METHODS: Structural attributes of quality were assessed through a checklist, and process attributes, including interpersonal and technical aspects, through observation and exit interviews. A total of 16 health care providers, and 166 women in the public and 188 in the private sector, were selected by systematic random sampling for inclusion in the study. Quality was measured against national standards, and an overall score calculated for the different aspects to permit comparison. FINDINGS: The results showed that both public and private providers were reasonably good with regard to the structural and interpersonal aspects of quality of care. However, both were poor when it came to technical aspects of quality. For example, guidelines for dispensing prophylactic drugs against anaemia or malaria were not respected, and diagnostic examinations for the assessment of gestation, anaemia, malaria or urine infection were frequently not performed. In all aspects, private providers were significantly better than public ones. CONCLUSION: Approaches to improving quality of care should emerge progressively as a result of regular quality assessments. Changes should be introduced using an incremental approach addressing few improvements at a time, while ensuring participation in, and ownership of, every aspect of the strategy by health personnel, health planners and managers and also the community.

Adolescent↗
PubMed2003

PCT merger. Building bridges.

Primary care trusts can be torn between the need for critical mass and the danger of losing local vision and ownership; mergers are politically unpopular and fraught with difficulty. A review of Trafford South PCT stakeholders enabled a range of organisational models to be tested. The result was the creation of a 'joint and integrated management structure' for the two Trafford PCTs.

Community Health Planning↗
PubMedDate not supplied

Strategic planning for radiology: opening an outpatient diagnostic imaging center.

Launching a new diagnostic imaging center involves very specific requirements and roadmaps, including five major areas of change that have a direct impact on planning: Imaging and communication technology Finances and reimbursement Ownership structure of imaging entities Critical workforce shortages Imaging is moving outside radiology First, planning must focus on the strategic level of any organization, whether it is a multi-national corporation or a six-person radiology group. Think of all organizations as a triangle with three horizontal levels: strategic, managerial and operational. The strategic level of decision-making is at the top of the triangle, and here is where planning must take place. For strategic planning to work, there must be focused time and energy spent on this activity, usually away from the reading room and imaging center. There are five planning strategies, which must have the explicit goal of developing and growing the imaging center. The five strategies are: Clinical and quality issues, Governance and administration, Technology, Relationships, Marketing and business development. The best way to plan and implement these strategies is to create work groups of radiologists, technologists, and administrative and support staff. Once the group agrees on the strategy and tactic, it takes responsibility for implementation. Embarking on the launch of a new outpatient diagnostic imaging center is no small undertaking, and anyone who has struggled with such an endeavor can readily attest to the associated challenges and benefits. Success depends on many things, and one of the most important factors relates to the amount of time and the quality of effort spent on strategic planning at the outset. Neglecting or skimping on this phase may lead to unforeseen obstacles that could potentially derail the project.

Ambulatory Care Facilities↗