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PubMedDate not supplied

Academic nurse-managed centers: approaches to evaluation.

A comprehensive evaluation plan was developed to assess the outcomes of a multiuniversity project to support the development of academic nurse-managed centers (ANMCs). The evaluation included measuring ANMC impact on the clients and communities served, on students, and on the sponsoring faculties and universities. This article includes a discussion of the processes used in evaluation plan development, the variables measured, the tools developed to measure selected variables, and a summary of evaluation findings. Recommendations for use of selected evaluation components across ANMCs are presented.

Ambulatory Care↗
PubMed1980

Pharmacy and health planning: a national survey of health planners.

The extent of pharmacy involvement in area health planning, and the perception of health planners on pharmacy and drug-related issues, were assessed. Health Systems Agencies (HSAs) (135, or 66%) and State Health Planning and Development Agencies (SHPDAs) (25, or 45%) responded to a 34-item mail questionnaire on pharmacy planning issues. Pharmacists were involved in developing health plans in 39% of the HSAs and 18% of the SHPDAs. Pharmaceutical services were mentioned in 50% of the local and 58% of the state plans. Thirty-two percent of the HSAs and 42% of the SHPDAs believed there was a poor distribution of pharmacies in health service areas. The respondents also answered questions on the need for pharmaceutical services in given areas and among special populations, drug reimbursement procedures, and the kinds of data health planners need when planning pharmaceutical services. Numerous respondents noted that increased participation by pharmacy groups in health planning would be desirable and welcomed.

Health Planning↗
PubMed1996

The economics of infertility: developing an infertility managed-care plan.

Infertility is a natural disorder for developing a managed-care plan. Infertility has a clearly defined end point. The treatment regimens and protocols used for treating infertile couples have predictable outcomes; it is possible to develop rational treatment plans over a limited period of time. It is not unreasonable for infertile couples to share the cost of treatment and for the physician-providers to share the economic risk by providing a bundle of optimal services at a fixed price. We present the theoretic basis for an infertility managed-care plan and the requirements for developing a plan that can be sold in the marketplace. Finally, we discuss some of the consequences of an infertility managed-care plan on physician relationships, physician manpower, research, and education.

Clinical Protocols↗
PubMed2004

Discharge planning from hospital to home.

BACKGROUND: Discharge planning is a routine feature of health systems in many countries. The aim is to reduce hospital length of stay and unplanned readmission to hospital, and improve the co ordination of services following discharge from hospital thereby bridging the gap between hospital and place of discharge. Sometimes discharge planning is offered as part of an integrated package of care, which may cover both the hospital and community. The focus of this review is discharge planning that occurs while a patient is in hospital; we exclude studies that evaluate discharge planning with follow up care. OBJECTIVES: To determine the effectiveness of planning the discharge of patients moving from hospital. SEARCH STRATEGY: Relevant studies were identified using Medline, Embase, SIGLE database for grey literature, Bioethics database, Health Plan, Psych. Lit, Sociofile, CINAHL, Cochrane Library, Econ Lit, Social Science Citation Index, EPOC register. The review was updated using the EPOC trials register in August 2002. SELECTION CRITERIA STUDY DESIGN: randomised controlled trials (RCTs) that compare discharge planning (the development of an individualised discharge plan) with routine discharge care. PARTICIPANTS: all patients in hospital. INTERVENTION: the development of an individualised discharge plan. DATA COLLECTION AND ANALYSIS: Data analysis and quality assessment was undertaken independently by two reviewers using a data checklist. Studies are grouped according to patient group (elderly medical patients, surgical patients, and those with a mix of conditions), and by outcome. MAIN RESULTS: Three new studies were included in this update. In total we included eleven RCTS: 6 trials recruited patients with a medical condition (2,368 patients), and four recruited patients with a mix of medical and surgical conditions (2,983 patients), one of these four recruited medical and surgical patients as separate groups, and the final trial recruited 97 patients in a psychiatric hospital and from a general hospital. We failed to detect a difference between groups in mortality for elderly patients with a medical condition (OR 1.44 95% CI 0.82 to 2.51), hospital length of stay (weighted mean difference -0.86, 95% CI -1.9 to 0.18), readmission rates (OR 0.91 95% CI 0.67 to 1.23) and being discharged from hospital to home (OR 1.15 95% CI 0.72 to 1.82). This was also the case for trials recruiting patients recovering from surgery and those recruiting patients with a mix of medical and surgical conditions. One trial comparing a structured care pathway for patients recovering from a stroke with multidisciplinary care reported a significant rate of improvement in functional ability and quality of life for the control group (median change in Barthel score between 4 to 12 weeks of 2 points for the treatment group, versus 6 for the control group, p<0.01); (Euroqol scores at 6 months 63 for the treatment group, vs. 72 for the control group, p<0.005). Two trials reported that patients with medical conditions allocated to discharge planning reported increased satisfaction compared with those who received routine discharge. No statistically significant differences were reported for overall health care costs. REVIEWER'S CONCLUSIONS: The impact of discharge planning on readmission rates, hospital length of stay, health outcomes and cost is uncertain. This reflects a lack of power as the degree to which we could pool data was restricted by the different reported measures of outcome. It is possible that even a small reduction in length of stay, or readmission rate, could have an impact on the timeliness of subsequent admissions in a system where there is an shortage of acute hospital beds.

Controlled Clinical Trials as Topic↗
PubMed2004

The workforce in health and social care services to older people: developing an education and training strategy.

Planning workforce development across the health and social care services for older people presents a formidable challenge. In England, Workforce Development Confederations are responsible for commissioning the education and training of the current and future health and social care workforce. This article reports on an analysis of local issues in planning the workforce for older people's services undertaken in one Confederation. It reports on the perceived priorities for developing the workforce in older peoples services in a policy environment where multiple initiatives were competing for attention. It highlights the key challenges in planning a strategy that embraces numerous service and education providers and offers practical solutions. Although this analysis was in one Confederation, the issues raised have relevance for other Confederations and their education and service partner organisations.

Aged↗
PubMed1992

Developing a nurse recruitment plan.

Your hospital's nurse staffing needs will be more effectively served if recruiters develop and implement a formal nurse recruitment plan for each fiscal year. Such an annual planning process proactively manages nurse recruitment by rational anticipation. It systematically determines current nursing needs, predicts future needs, establishes recruitment objectives, identifies matching strategies for realizing these objectives, executes the plan, and evaluates its success.

Budgets↗
PubMed2003

Use of a program logic model to guide the development of a strategic plan for Wellington County Hospitals Network.

This article describes how the Wellington County Hospitals Network successfully used a program logic model as a decision-making framework to guide the development of the Network's first strategic plan. The advantages and disadvantages of this approach to the development of a strategic plan and identification of short-term priorities for action by the Network are discussed.

Decision Making, Organizational↗
PubMed1990

Demographic, employment and development trends: the need for integrated planning.

"The authors contend that problems associated with rapid demographic growth in developing countries have to be tackled through comprehensive population and human resource planning. Linkages between population and development are especially close in the area of labour markets. Following a discussion of the impacts of demographic factors on labour supply, labour demand and migration, the article proposes a practical framework in which population and human resource development plans may be operationalised. The concluding section briefly discusses the emerging area of population policy formulation and implementation."

Demography↗
PubMed1996

Recent developments in radiation therapy planning and treatment optimization.

Radiation therapy of cancer is today going through a very dynamic development with the introduction of a large number of new treatment principles, new types of treatment units and new radiobiologically based optimization algorithms for treatment planning. All of these make use of the recent developments in three dimensional tumor diagnostics, molecular biology of cancer, the fractionation sensitivity of different tissues and most recently predictive assays of radiation sensitivity. The most efficient but also least developed area of treatment optimization is to use a few (approximately 3) non uniform radiation beams directed towards the tumor. Today patient individual collimation with beam blocks or multileaf collimators protect organs at risk laterally outside the tumor volume. Non uniform dose delivery also allows protection of normal tissues anterior, posterior and even inside the target volume by shaping the isodoses tightly around the tumor tissues and thereby also allowing longitudinal protection of normal tissues. Some of the most advanced new algorithms are even treating therapy optimization as an inverse problem where the optimal incident beam shapes are determined directly from the location of gross disease, presumed microscopic tumor spread and organs at risk. The optimization is then performed such that the probability, P+, to eradicate all clonogenic tumor cells without severely damaging healthy normal tissues is as high as possible. Already with a few non uniform beams the treatment outcome is within a few percent of what can be achieved with infinitely many co-planar beams in a dynamic mood. With such optimized non uniform treatments it should be possible to improve the treatment outcome by as much as 20% and more, particularly in patients with a local complex spread of the disease or several organs at risk.

Algorithms↗
PubMed2002

Nurses and English primary care groups: their experiences and perceived influence on policy development.

AIMS OF THE STUDY: To investigate the experiences and perceived influence of nurses serving on English primary care group boards. BACKGROUND: The development of the nursing workforce and nursing services in primary care have been piecemeal and nurses have not always contributed to policy development. The recent establishment of primary care groups (PCGs) in the United Kingdom (UK) potentially offers nurses the opportunity to take a concerted and strategic role in developing professional roles and planning service developments. RESEARCH METHODS: As part of a longitudinal study of a 15% random sample of English primary care groups, nurse board members were surveyed in the winter of 1999. One hundred and forty-four nurses were invited to return self-completion questionnaires. RESULTS: Completed questionnaires were returned by 106 of those invited to participate (73%). Respondents reported that combining their usual work with their role in the PCG was frequently difficult. Only 26% perceived that they had been well prepared for their new role. Compared with other board members [for example, general practitioners (GPs)], nurses perceived that their own influence was limited, with only a quarter rating the influence of nurses on decision-making as great. Most of the sample were feeding back information to other primary care and community nurses working in the locality and 52% rated communication with this wider constituency as good or better. Nurse board members were enthusiastic about their role and optimistic about the positive future impact of PCGs on health. CONCLUSIONS: PCGs are still at a relatively early stage in their development. It is still too early to assess their impact on nurses working in primary care and community settings. Board membership offers nurses a voice in local health policy development.

Attitude of Health Personnel↗