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PubMed2003

Development of a network system for the care of patients with cleft lip and palate in Thailand.

Cleft lip and palate are major public health concerns in Thailand, particularly in the north-east. The challenge for a developing country is to adapt to its unique environment the form of multidisciplinary care of patients with clefts in industrialised nations. An epidemiological study of the incidence of clefts was made by reviewing previous studies conducted in Thailand as a guide to development of a prospective multicentre study. As a result, a system for the care of patients with clefts has been developed by the Cleft Center in Khon Kaen University. The new aims of cleft care in Thailand are to establish and develop specialised cleft centres and supportive systems for interdisciplinary management, adopt protocols for long-term guidelines, provide education programmes about clefts, develop a database, and conduct relevant research projects. Other key factors in its success are the multicentre project, collaboration, fund raising, and good public relations.

Cleft Lip↗

PubMed1997

The conceptual framework of the PMM Network.

Understanding the determinants of maternal mortality is a complex task, in part because maternal deaths are influenced by many different categories of events or conditions. Biology, economics, culture, demography and the distribution and effectiveness of health services all contribute. Conceptual frameworks have made important contributions to our understanding of the determinants of other, equally complex events, such as fertility and child survival. Also referred to as 'proximate determinants frameworks', such models are useful because they identify the specific mechanisms through which social, economic and cultural factors lead to the event of interest. Our model identifies the precise sequence of events that lead to maternal death (pregnancy, complication and death) and specifies categories of intermediate factors and distant factors that directly affect one or more of these events. When the world literature on maternal mortality was analyzed in light of the causal pathways laid out in the conceptual framework, it became clear that some pathways are more amenable to intervention and change than others. Implications for strategies, programs and monitoring and evaluation are discussed.

Africa, Western↗

PubMed1997

PSNs: a new model for Medicare risk contracting.

The 1995 Republican House Medicare reform proposal introduced the provider services network (PSN) concept as a new healthcare delivery model for accepting and administering Medicare risk contracts. A PSN operates much like an HMO, but is not subject to the reserve requirements established for HMOs. Providers that want to enter the Medicare risk contracting arena and exercise more control over the delivery of healthcare services may consider forming a PSN. To form a PSN, providers must be sufficiently capitalized to compete with HMOs, create a formal legal organization, and develop a financial plan. To ensure that its goals are met, the PSN must develop a sales promotion plan, enroll members, control and monitor financial resources and clinical outcomes, and implement a management information system. Other crucial capabilities that a PSN must develop include establishing mechanisms for utilization review, membership information maintenance, claims adjudication, physician credentialing, quality assurance, and member grievance procedures.

Capital Financing↗

PubMed2004

[Development of health care networks: ethical and political contexts].

The operation of our health care system is in the midst of a major crisis. There is a significantly unacceptable level of health inequities and access to care, high premature mortality rates, lack of a coherent health policy, a weakness in the professional demographic projections, increasing financial deficits, quasi-revolt of professionals, complete disregard for the law (Parliament's vote on the National Insurance's budget)--these are just a few of the symptoms of chaos which have embedded themselves right before our very eyes. This article aims to offer a glimmer of light on this gloomy horizon. It is the first outcome of a new working group which was originally referred to as "les Vignerons d'Uzès", a title which could be seen as lacking substance and has therefore become "The Transdisciplinary Working Group on the Organisation of Health and Care". The group's purpose and objective is to reflect upon the values, practices, regulations, evaluation and what is at stake in the context of our health care system.

Community Networks↗

PubMed1999

Essential strategies for achieving durable population-based maternal and child health services.

Increased competition for dwindling financial resources places funding and provision of public health services at risk in all countries of the world. Maternal and Child Health (MCH) clients--often poor, mostly women, their children, and families--are at extraordinary risk of receiving poor or no health care. Not considered a voting constituency, and therefore exercising little leverage over elected officials, specific assurances are necessary to ensure that essential health services are available to MCH target population. Therefore, it is critical that all MCH stakeholders leverage their capacity by networking and by developing common strategies for survival and relevance within the health care system in their jurisdiction. Identifying and working with every segment of the population at risk is a crucial first step. Becoming familiar with the history of the population at risk, and defining their geographic boundaries are essential secondary steps. Developing baseline information on their general health and MCH risk status according to available demographic, socioeconomic and environmental data are important next steps. Then, working with the target population, we propose that MCH advocates adopt the 18 MCH strategies discussed in this article. These strategies will strengthen the ability of programs and initiatives that deal with women, their children and families, to survive the current financial and management struggles of the public health services in developed and developing countries.

Adolescent↗

PubMed1998

The association between the organization of medical practice and primary care physician attitudes and practice orientations.

This study was designed to identify the association between physicians' practice settings and their attitudes and practice orientations. The data for the study were obtained through a cross-sectional survey of 385 primary care physicians in the service area of the Kansas Primary Care Network (PCN), a joint federal-state funded program begun in 1984 to provide medical services for Medicaid consumers. Analysis of variance tests are used to analyze the differences between physicians in the different practice organizations. The results show that older physicians are more likely to join solo practice organizations. Solo practitioners are less supportive of group practice, and are more likely to locate in affluent and low physician population counties than group practitioners. More female physicians practice in institutional settings than their male colleagues. Graduates of schools of osteopathic medicine are more likely than graduates of schools of allopathic medicine to practice in solo and single-specialty organizations. Institutional physicians are more receptive to capitation-based reimbursement arrangements, government involvement in health care delivery and financing, and have larger Medicaid case-loads than the physicians in the other practice organizations examined in the study.

Attitude of Health Personnel↗

PubMed1997

The Cleveland Health Network: a new integrated delivery system.

CHN and its subsidiary CHN MCO have significantly impacted the Cleveland market place in the two years since their inception. CHN will continue to expand geographically with hospital and physician partners who are committed to providing quality care in the most cost-effective manner. Medical management will continue to be the central focus and over-riding success of the CHN MCO, making this organization extremely attractive to the payer market. The integrated CHN and its medical management focus could become a model for other integrated delivery systems. As the market place continues to experience an increase in managed care and more consolidation of healthcare providers (and in some cases, mergers with payers), more integrated delivery systems will emerge. Senior- and mid-level administrators and managers with operational responsibilities need to take into consideration how their patient access systems will need to be modified to meet the demands of managed care through the formation of integrated delivery systems. How patients access the systems is of critical importance in ensuring financial success, ease of access for the patient, and tracking of appropriate medical care.

Community Networks↗

PubMed2003

What are the most important symptom targets when treating advanced cancer? A survey of providers in the National Comprehensive Cancer Network (NCCN).

We derived a set of brief, clinically relevant symptom indices for assessing symptomatic response to chemotherapy for advanced bladder, brain, breast, colorectal, head and neck, hepatobiliary/pancreas, lung, ovarian, and prostate cancers. Questions were extracted from a multidimensional cancer quality of life (QOL) measurement system, the Functional Assessment of Cancer Therapy (FACT). Surveys of disease-related symptoms were presented to expert physicians and nurses at 17 National Comprehensive Cancer Network (NCCN) member institutions. In a two-step procedure, each expert narrowed the list to no more than five of the very most important to attend to when assessing the value of drug treatment for advanced disease. Symptoms endorsed at a frequency greater than chance probability were retained for the nine symptom indices. The resulting NCCN/FACT symptom indices are comprised of 6-15 items, depending on disease. Fatigue, pain, nausea, weight loss, worry about worsening condition, and contentment with current QOL were consistently selected by experts as priority symptoms across tumor sites. These nine tumor-specific symptom indices indicate the most important clinician-rated targets of chemotherapy for many advanced cancers. These results await validation in patient populations and examination of the extent to which changes in symptomatology translate into meaningful improvement to the patient.

Cancer Care Facilities↗

PubMed1998

Estimation of seroprevalence, rape, and homelessness in the United States using a social network approach.

The authors have developed and tested scale-up methods, based on a simple social network theory, to estimate the size of hard-to-count subpopulations. The authors asked a nationally representative sample of respondents how many people they knew in a list of 32 subpopulations, including 29 subpopulations of known size and 3 of unknown size. Using these responses, the authors produced an effectively unbiased maximum likelihood estimate of the number of people each respondent knows. These estimates were then used to back-estimate the size of the three populations of unknown size. Maximum likelihood values and 95% confidence intervals are found for seroprevalence, 800,000 +/- 43,000; for homeless, 526,000 +/- 35,000; and for women raped in the last 12 months, 194,000 +/- 21,000. The estimate for seroprevalence agrees strikingly with medical estimates, the homeless estimate is well within the published estimates, and the authors' estimate lies in the middle of the published range for rape victims.

Adolescent↗

PubMed2003

The imperative for quality: a call for action to medical schools and teaching hospitals.

Patient safety and quality improvement are critical clinical and research endeavors supported by the federal government, accrediting bodies, regulatory agencies, and patient-advocacy groups. The Boston-based Institute for Healthcare Improvement has led in educating physicians, nurses, and other health professionals to improve the effectiveness and efficiency of their delivery systems. Recently, academic medical institutions have come together to improve patient outcomes by participating in the institute's IMPACT network. Each participating institution works in one or more of five improvement domains: patient safety, intensive care, patient flow, office practice, and workforce development. In addition, the chief executive officer of each participating organization focuses on leadership. The infrastructure for raising the bar of performance is improving at medical schools and teaching hospitals in this country. Important trends include interdisciplinary centers of excellence, improved faculty practice plan governance and management, leadership recruitment and development, and a commitment to quality as a high educational priority at a number of medical schools. Quality improvement efforts are intellectual activities that are consistent with the values of academic medicine and discovery. Academic medical centers are well positioned to lead the way in the improvement of quality of care. As institutions entrusted with the education of future health professionals and charged with developing new knowledge, the authors call for a complete commitment to the highest level of quality in patient care.

Community Networks↗

PubMed2000

The role of total laboratory automation in a consolidated laboratory network.

BACKGROUND: In an effort to reduce overall laboratory costs and improve overall laboratory efficiencies at all of its network hospitals, the North Shore-Long Island Health System recently established a Consolidated Laboratory Network with a Core Laboratory at its center. METHODS: We established and implemented a centralized Core Laboratory designed around the Roche/Hitachi CLAS Total Laboratory Automation system to perform the general and esoteric laboratory testing throughout the system in a timely and cost-effective fashion. All remaining STAT testing will be performed within the Rapid Response Laboratories (RRLs) at each of the system's hospitals. RESULTS: Results for this laboratory consolidation and implementation effort demonstrated a decrease in labor costs and improved turnaround time (TAT) at the core laboratory. Anticipated system savings are approximately $2.7 million. TATs averaged 1.3 h within the Core Laboratory and less than 30 min in the RRLs. CONCLUSIONS: When properly implemented, automation systems can reduce overall laboratory expenses, enhance patient services, and address the overall concerns facing the laboratory today: job satisfaction, decreased length of stay, and safety. The financial savings realized are primarily a result of labor reductions.

Automation↗

PubMed2005

An evaluation of independent consumer assistance centers on problem resolution and user satisfaction: the consumer perspective.

Individuals who wish to receive independent assistance to resolve access to care health problems have limited options. The Health Consumer Alliance (HCA) is an independent, coordinated effort of nine legal services organizations that provide free assistance to low-income health consumers in 10 California counties. The need for the HCA stems from the vast number of health consumers with unanswered questions and unresolved problems relating to access to care issues, among both insured and uninsured populations. However, little is known about the effectiveness of independent consumer assistance centers. This paper examines the effectiveness of a network of independent consumer assistance programs in resolving consumer problems and consumers' level of satisfaction with services received. As the project evaluators, we conducted telephone surveys with 1,291 users of the HCA to assess if this independent program resolved consumer problems, and to measure the level of satisfaction among HCA users. Specifically, we asked questions about the HCA's influence on problem resolution, consumer satisfaction, health insurance status and use of preventive care services. From 1997 to 2001, more than 46,000 consumers contacted the seven health consumer centers (HCCs). According to our sample of respondents, results show that the HCCs are an important resource for low-income Californians trying to access health care. After contacting the HCCs, 62 percent of the participants report that their problems were resolved. In addition, 87 percent of the participants said the HCCs were helpful and 95 percent said they would be likely to contact the HCC again if necessary.

Adolescent↗

PubMed2002

[The present situation and subject].

Terumo Corporation has been supporting the regional medical network, developing new products for home health care and providing service through the Home-Joint system in the fields of HPN, HEN, and HOT. In the chain of servicing, we are carrying out call center operations that can receive inquiries regarding machine operation and machine trouble from the patients, for 24 hours a day, all year round. Most inquiries are settled then and there, but some cases need further treatment. The principal cases are, Lowness mastery degree of patients or tenders, wants of knowledge of the person in charge of answering inquiries, and coming under the medical treatment. It is indispensable to connect closely with Hospitals, the visiting nurse, and agencies. Today's Subject: Pursuit of simplicity and safety of equipment based on On-Call experience. Thorough, careful confirmation for several days from the start. Standardization of On-call information and sharing with the agency and hospital. Advancement of knowledge for answering inquiries. Making a system to cope with medical facilities.

Community Networks↗

PubMed2005

Religious congregations as social services providers for older adults.

A large proportion of older adults are affiliated with congregations. The literature suggests that, in general, religious participation among the older adults enhances their quality of life and provides a network of social care. In this article, we explored the relevant literature on organized religion and social support for older adults. Based on a census study of congregations in Philadelphia (N = 1,393), we documented the following: (1) the number of congregations serving older adults, (2) the types of services provided, and (3) the number of beneficiaries. The study also identified the organizational factors that predict the provision of congregation-based services for older adults. The findings suggest that serving older adults is not a top priority for most congregations. Most senior programs are small and often informal. Approximately half (48%) of the congregations do not provide a formal social service. However, those congregations that are more likely to serve older adults have larger budgets, more members over 65-years-old, and a moderate political orientation. We recommend that congregations, social service providers, and older adults explore ways to maximize this underutilized resource of congregational services to meet the needs of the increasing number of older adults.

Aged↗

PubMed1995

Struggles of neonatology staff and the network system in the Hanshin-Awaji earthquake disaster.

More than 5500 people were killed in the Hanshin-Awaji earthquake disaster. Most of the neonatal intensive care units (NICU) could not offer proper services as a result of the earthquake and the Hyogo Emergency System for Neonates could not function. No one imagined that such a great disaster would occur in their home town, Kobe; however, the devastation of the quake has raised the opportunity to examine the operation of neonatal medicine in an emergency. We sent out questionnaires to perinatologists in the damaged area 2-3 months after the quake. Some hospitals in the demolished area suffered such serious damage that they could not continue work as NICU, and some in the surrounding area had problems in a number of areas, including staff, room capacity and transport methods. Under these difficult circumstances the greatest problem encountered by staff was maintaining fundamental care in NICU, that is to say keeping temperature, formula (nutrition) and prevention of infection techniques operating. In this report we discuss the effects on neonatal medicine of the earthquake in Kobe. Medical staff struggled patiently and made great efforts to recover and maintain the functioning of NICU. We believe this information will be useful for neonatology staff in other areas which may experience an earthquake in the future.

Community Networks↗

PubMed1997

Physician participation in a Medicaid managed care program, the Kansas Primary Care Network.

This study was designed to identify the factors that enhance and impede physician participation in a Medicaid managed care program, the Kansas Primary Care Network (PCN). The data for the study were collected in the summer of 1993 through a mail survey of primary care physicians in the PCN service area. Logistic regression and cross tabular analytic techniques were employed for data analysis. The results indicate that physicians who are not receptive to capitation-based reimbursement practices, those who practice in the higher per capita income counties, those who do not compare the PCN reimbursement rates favorably with private insurance rates, and physicians who think that untimely payment and the requirement to document patient referrals for specialty treatment pose problems for them are less likely to participate in the PCN program. Further, the study shows that institutional physicians have larger Medicaid caseloads than solo practitioners, who have larger Medicaid caseloads than single-specialty and multi-specialty group practitioners. Since most of the variables that attain statistical significance in explaining physician participation in the PCN program have to do with money, the study reaffirms the two market theory of the United States' health care delivery system.

Attitude of Health Personnel↗

PubMed1998

Influenza A and B epidemic criteria based on time-series analysis of health services surveillance data.

Many countries now have epidemiological surveillance systems using health services-based indicators that allow detection of influenza epidemics. However, there is no accepted criterion for defining an influenza epidemic. An epidemic criterion has been developed, based on a time-series analysis of health services-based indicators collected on a weekly basis by a surveillance network implemented in the Paris region since 1984: the Groupe Regional d'Observation de la Grippe (GROG). For each new season, an epidemic threshold is independently defined for each health services-based indicator as the upper limit of the one-sided confidence interval of the expected value calculated from the weekly differences between the observed number of events and those predicted by a SARIMA model fitted on the non-epidemic data of previous seasons. Epidemic criteria for influenza A and B are then defined from the combination of both viral indicators and epidemic thresholds of individual health services-based indicators. Among health indicators, sick-leave data collected from GP's or the Health Insurance system, emergency home medical visits, and influenza-like-illness reported by GP's are the most sensitive indicators for the early recognition of epidemics. The exceeding of the above mentioned thresholds combined with virological data allows the specific detection of influenza A or B epidemics. This time-series method of analysing surveillance data provides early and reliable recognition of these epidemics.

Community Networks↗

PubMed1998

Overall survival of the medical oncologist: a new outcome measurement in cancer medicine.

BACKGROUND: Changing patterns of patient referral, decreasing payments for service provision, confusing network participation and reimbursement, as well as challenges to autonomous clinical decision-making jeopardize the traditional role of the oncologist in delivering cancer care. The cancer patient also may be at risk with unproven cancer delivery systems that displace the oncologist as decision-maker and care provider. The authors have constructed a model that preserves the oncologist's clinical and financial autonomy while meeting marketplace demands for improved access, decreasing costs and preserved quality of care. METHODS: During a 4-year period, a group of private practice medical oncologists initiated a formal business plan to evaluate marketplace needs, then designed and implemented a novel cancer care delivery model. The model required reconfiguring the practice into an integrated Joint Commission on Accreditation of Healthcare Organizations-certified cancer service corporation, providing medical, radiation, and gynecologic oncology. Palliative care, pain management, psychologic, and nutritional services were instituted as well as the vertical integration of home health and hospice care. Clinical pathways and treatment protocols were designed to enhance patient care and facilitate cost-of-care projections in designated populations using a cancer incidence forecasting model. Outcomes analysis are performed as part of ongoing continuous quality improvement, which continues to change this health care delivery system. RESULTS: In the 3 years since implementation of the model, the practice has increased from 16 to 24 physicians, and the number of offices has increased from 12 to 17. Patient encounters, both new and established, have doubled. Cost of services, specifically hospitalization, have been reduced by 50%. Clinical research referrals have increased 300%. Physician compensation has improved >20%. CONCLUSIONS: The model created a low cost, high value provider not burdened by allocated overhead. Decentralized care enhanced community access, which improved patient compliance, enhanced patient satisfaction, decreased hospitalization, and thereby decreased cost. The horizontal structure permited the flexibility for varied purchaser products and politically sensitive physician and hospital provider panels. Consensus-based protocol and pathway determination achieved maximum physician participation, which preserved clinical and financial autonomy, decreased variance, and facilitated clinical research.

Age Distribution↗