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At least 1,693 records · Page 94Linked to original sources
PubMed2002

Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.

Adult↗
PubMedDate not supplied

Asset management in theory and practice.

Managing capital-intensive imaging environments continues to be a challenge for nearly all administrators. Asset management, the strategic management of equipment inventory, must include planning, assessment, procurement, utilization review, maintenance, repair and disposal of equipment to reduce costs and improve efficiency. It must involve some shared risk between the facility and the provider, whether an original equipment manufacturer (OEM) or independent service organization (ISO). An absence of risk in the arrangement implies the provider is offering service management or consulting. A case study reports on three hospitals in the OhioHealth system. Their immediate goal, as they began to investigate asset management: cut costs immediately. A cross-functional team from the three hospitals began its investigation of various options, including working with ISOs, OEMs and development of inhouse clinical engineering. After developing a process to evaluate vendors, the team was able to score each against their cost-reduction potential, quality and implementation skills. The team narrowed its selection quickly to two multivendor service providers. An initial contract guaranteed savings of 20 percent of the annual budget, with a projected two to five percent additional savings. OEM relationships were moved to a time-and-materials basis, and ISOs were used in selected areas. In addition, the internal inhouse clinical engineering services group was moved into a "first call" approach in some areas. That expanded role resulted in savings and improved response time. The process, although not without its problems, was viewed favorably overall.

Budgets↗
PubMed1994

Managed care: theoretical or practical.

Managed care organizations that serve the poor face unique challenges. Not only must they empower their enrolled populations with awareness and knowledge about the benefits of being enrolled, but they must also provide significant outreach, offer services that are sensitive to urban and rural concerns, and stress health education and disease prevention. The managed care model offers efficiency and effectiveness that can place providers on the leading edge of not only providing solutions that address the needs of the underserved, but being competitive in servicing these populations.

Health Care Reform↗
PubMed2005

Testing a European set of indicators for the evaluation of the management of primary care practices.

BACKGROUND: Effective practice management is an important prerequisite for offering good clinical care. Internationally valid, reliable and feasible indicators and instruments are needed to describe and compare the management of primary care practices in Europe. OBJECTIVE: This paper describes development and evaluation of the European Practice Assessment instrument and indicators (Engels Y, Campbell S, Dautzenberg M et al. Developing a framework of, and quality indicators for, general practice management in Europe. Fam Pract 2005; 22(2): 215-22). METHODS: The study design was a validation and feasibility study set in 273 general practices in Austria, Belgium, France, Germany, Israel, The Netherlands, Slovenia, Switzerland and the UK. Use was made of a set of 62 valid quality indicators derived previously from an international Delphi procedure. The EPA instrument, based on this set of indicators, was used to collect data in the 273 practices. This instrument consists of self-completed questionnaires for doctors, staff managers and patients. In addition, there is an interview schedule for use by an outreach visitor, to be held with the lead GP or manager, and a visitor checklist. The instrument was analysed using expert review by the project partners, factor and reliability analyses, ANOVA analyses and by determining intraclass correlations. RESULTS: Fifty-seven indicators were found to be valid, feasible, reliable and discriminative in all participating countries. The instrument was able to determine differences in practice management within and between countries. All (but one) practices completed the assessment procedure. The data collection method appeared to be feasible, although some aspects can be improved. CONCLUSION: The EPA instrument provides feedback to practices that facilitates quality improvement and can compare primary care practices on a national and an international level.

Europe↗
PubMedDate not supplied

Information management as a process and product of case management.

Information technology is an invaluable tool in case management practice management. Informed use of information technology can facilitate and enhance the work of case managers. This article reviews the usefulness of information management to nursing case management. The article discusses system requirement, security considerations, and database structure for a practice database. Voice-recognition software, video conferencing, and use of the Web sites are discussed as additional practice enhancement.

Case Management↗
PubMed1998

Assessment of management in general practice: validation of a practice visit method.

BACKGROUND: Practice management (PM) in general practice is as yet ill-defined; a systematic description of its domain, as well as a valid method to assess it, are necessary for research and assessment. AIM: To develop and validate a method to assess PM of general practitioners (GPs) and practices. METHOD: Relevant and potentially discriminating indicators were selected from a systematic framework of 2410 elements of PM to be used in an assessment method (VIP = visit instrument PM). The method was first tested in a pilot study and, after revision, was evaluated in order to select discriminating indicators and to determine validity of dimensions (factor and reliability analysis, linear regression). RESULTS: One hundred and ten GPs were assessed with the practice visit method using 249 indicators; 208 of these discriminated sufficiently at practice level or at GP level. Factor analysis resulted in 34 dimensions and in a taxonomy of PM. Dimensions and indicators showed marked variation between GPs and practices. Training practices scored higher on five dimensions; single-handed and dispensing practices scored lower on delegated tasks, but higher on accessibility and availability. CONCLUSION: A visit method to assess PM has been developed and its validity studied systematically. The taxonomy and dimensions of PM were in line with other classifications. Selection of a balanced number of useful and relevant indicators was nevertheless difficult. The dimensions could discriminate between groups of GPs and practices, establishing the value of the method for assessment. The VIP method could be an important contribution to the introduction of continuous quality improvement in the profession.

Family Practice↗
PubMed1994

Managing a culturally diverse staff. Legal considerations.

Effective human resource management practices with an increasingly diverse work force must include consideration of relevant employment law. But leading organizations will venture beyond simply avoiding discriminatory practices. Managing staff differences that emerge from cultural diversity begins with awareness, moves toward sensitivity, evolves into understanding, and concludes with respect.

Civil Rights↗
PubMed1992

Audit of deaths in general practice: pilot study of the critical incident technique.

OBJECTIVE: To develop and pilot a method for conducting an audit of deaths in general practice by the critical incident technique. DESIGN: Prospective use of the technique within a primary health care team, with the aid of a facilitator, to analyse the events surrounding patients' deaths. SETTING: One inner city academic general practice. PARTICIPANTS: Practice team, comprising general practitioners, trainee, practice manager, practice nurse, and attached health visitor and district nurses. MAIN MEASURES: Identification and classification of critical incidents associated with the case studies of eight recently decreased patients in the practice and subsequent impact on the practice. RESULTS: Among the eight case studies, 57 critical incidents were identified (mean 7.1 per case, range 2 to 15). A failure of communication was the most common factor identified in incidents giving rise to concern, but positive factors in patient care were also identified. Changes in practice included developing protocols for follow up of bereaved relatives and carers and a checklist to ensure completion of administrative follow up tasks resulting from the patient's death; cases of recent deaths and terminally ill patients were reviewed monthly. The practice team found the method acceptable and felt that the discussions had provided useful opportunities for reflecting on their role in patient care. CONCLUSIONS: The critical incident technique fulfils the needs of an audit of deaths in general practice; however, further evaluation based on more cases from different practices is now required.

Cause of Death↗
PubMed2005

Veterinary students as elite performers: preliminary insights.

The KPMG ''Mega Study'' (Brown JP, Silverman JD. The current and future market for veterinarians and veterinary medical services in the United States. J Am Vet Med Assoc 215:161-183, 1999) and other studies (Cron WL, Slocum JV, Goodnight DB, Volk JO. Impact of management practices and business behaviors on small animal veterinarians' incomes. J Am Vet Med Assoc 217:332-338, 1999; Lewis RE. Non-technical Competencies Underlying Career Success as a Veterinarian: A New Model for Selecting and Training Veterinary Students. Minneapolis: Personnel Decisions, 2002) concur that improvement in veterinary practitioner performance is necessary. Improvement in practitioners' non-technical competencies is considered most vital. Little research exists that identifies underlying psychological factors harbored by veterinary students that inhibit ability to achieve sustained maximum professional performance. Left unaddressed, these same characteristics may lead to coping behaviors that disrupt or, in the worst cases, lead to voluntary or involuntary termination of professional careers. Several performance-related characteristics and interpersonal dynamics are investigated in this study that provide preliminary evidence for the long-term shortcomings addressed in previous veterinary practice management literature. Pedagogical recommendations for addressing these student psychological characteristics are submitted for consideration.

Adult↗
PubMed1991

Connecting healthcare providers. An effective computer network can create durable relationships.

Physician networks are computerized systems that link primary care physicians and specialists to one another and to hospitals and other providers. The networks have four key components: communication, practice management, practice marketing, and diagnostic testing capabilities. Advantages of physician networks for hospitals include increased physician loyalty and increased market share through additional admissions and outpatient registrations. From physicians' perspective, networks can help them expand their patient bases and increase revenue, provide additional services for existing patients, automate their offices, and improve their administrative efficiency. Networks also affect the way physicians practice medicine. Changes in practice patterns improve patient care, speed test results, and improve physicians' relationships with each other and their patients. They also save time for physicians and their staff. In deciding whether to develop a network, executives must examine the architectural framework and components they need, their commitment to physician relations, how reliant they are on primary care referrals, the competitive environment, the resources they are willing to commit, legal issues, and the physicians' role in planning.

Catholicism↗
PubMed1995

Innovation in general practice: is the gap between training and non-training practices getting wider?

BACKGROUND: Training practices are more developed than non-training practices in terms of a wide range of educational and clinical activities, facilities and staff. If training practices are also adopting new innovations at a faster rate than non-training practices the gap between them will increase. AIM: The aim of this study was to determine whether, between 1982 and 1990, training practices did develop at a faster rate than non-training practices. METHOD: In 1982 a questionnaire was sent to 153 practices in Gloucestershire, Avon and Somerset which all had one or more partners who were members of the Royal College of General Practitioners. A second questionnaire was sent to the same practices in 1990. Information was sought about practice features including organization, size, facilities, staff and clinical and educational activities. A total of 124 practices (62 training and non-training) completed questionnaires on both occasions. RESULTS: There were substantial changes in the cohort between the surveys in 1982 and 1990, with many practices gaining, for example, a practice manager, practice nurse and purpose built premises, and introducing audits, screening activities and specific clinics. For each feature of practice a logistic regression was undertaken with training used as an explanatory variable. Training practices were more likely to develop than non-training practices for a number of features including personnel, aspects of practice organization, educational activities, clinical activities and equipment. CONCLUSION: Training practices are not only more developed than non-training practices but are also more innovative. The gap between training and non-training practices did grow wider between 1982 and 1990. This may be because the members of training practices are inherently more innovative, face fewer obstacles to innovation or that the scheme for approval of practices for training has encouraged specific innovations. Any future accreditation scheme for general practices must be organized to encourage accelerated development in less developed practices rather than only stimulate innovation in already advanced practices.

Education, Medical, Continuing↗
PubMed2000

Psychiatric residency training, managed care, and contemporary clinical practice.

Managed care has transformed the health care environment that residents encounter on completion of their training. Unfortunately, residency education has not kept pace with changes in the field, leaving graduates inadequately prepared. The authors identify necessary changes in the residency training tasks of instilling values, imparting required knowledge, building core skills, selecting appropriate training sites, and offering a diversity of instructors and supervisors. They also discuss the obstacles that have impeded the evolution of academic clinical services and clinical training. They suggest strategies of change that may lead to more relevant educational programs that provide residents with a balanced perspective on the strengths and weaknesses of both traditional and contemporary approaches to delivering care.

Humans↗
PubMed1990

Legal aspects of orthodontic practice: risk management concepts. Performing a risk management audit of your practice.

In this and succeeding issues of the AMERICAN JOURNAL OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS, factual risk management scenarios will be presented. These scenarios are based on composites of actual court cases that have been tried to verdict or decision. Valuable risk management lessons may be learned from careful analysis of the course of the events described. Please be advised that the standard of care determined in any case is specific for that jurisdiction and that set of facts as established by expert testimony for the prevailing party. Readers' comments may be addressed to Dr. Donald E. Machen, 5801 Beacon St., Pittsburgh, PA 15217.

Costs and Cost Analysis↗
PubMed2000

Community care management. Advanced practice nurses as care managers.

A group of advanced practice nurses partnered with a major insurer in the design and implementation of a care coordination model for high-risk older adults. This article will discuss the process of such an undertaking, highlighting the successes and barriers encountered. The key elements of this program included early identification and regular reassessment of each member's acuity level; fostering close partnerships between individual or teams of APRNs and groups of physicians; and uninterrupted clinical management of high-risk members across the health care continuum. This model was designed to achieve the following outcomes: to support the physician management of high-risk, chronic individuals; to increase or maintain the health of members; and to reduce health care costs. Outcome studies have demonstrated a substantial net savings by decreasing acute care admissions by 54%, reducing hospital days by 42%, and trimming primary care physicians' and specialists' visit costs by 37%. There was a 33% reduction in the overall costs of health care for members enrolled in this program. Physicians and members both rated their satisfaction with the APRN-based model of care as very high.

Aged↗
PubMed2003

Quality assurance practices in care management: a perspective from the United Kingdom.

Alongside the development of care management in many countries has emerged a need to monitor the quality of both care management practices, as well as the quality of services provided as a consequence of care planning by care managers. Designing and implementing quality assurance practices in care management present special challenges. This article examines current practices from the perspective of the United Kingdom (UK). First, current performance initiatives at the central government level are described, including an indication of their limitations in judging quality in care management; second, existing work on assuring quality in care management is reviewed along with its relevance for the UK; and third, a local study, identifying measures within an analytical framework and using them to monitor care management against set dimensions, is described. Parallel developments are now occurring at both national and local levels in the UK, with local work both influencing and being informed by national developments. Future issues to address include the problems in collecting relevant data and in extending methods of analysis to monitor care management more comprehensively.

Health Care Reform↗