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Bowen, Michael E., Deepa Bhat, Jason Fish, Brett Moran, Temple Howell-Stampley, Lynne Kirk, Stephen D. Persell, and Ethan A. Halm. "Improving Performance on Preventive Health Quality Measures Using Clinical Decision Support to Capture Care Done Elsewhere and Patient Exceptions." American Journal of Medical Quality 33, no. 3 (October 14, 2017): 237–45. http://dx.doi.org/10.1177/1062860617732830.
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Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before–after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures ( P < .05) but not breast or cervical cancer screening. CDS captured clinician-reported services completed elsewhere (2% to 10%) and patient/medical exceptions (<3%). Compared to measures using only within-system data, including services completed elsewhere in the numerator improved performance: pneumococcal vaccine (73% vs 82%); breast (69% vs 75%), colorectal (58% vs 70%), and cervical cancer (53% vs 62%); and osteoporosis (72% vs 75%) screening ( P < .05). Visit-based CDS can capture clinician-reported preventive services, and accounting for services completed elsewhere improves performance on quality measures.
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Starfield, Barbara. "The Future of Primary Care in a Managed Care Era." International Journal of Health Services 27, no. 4 (October 1997): 687–96. http://dx.doi.org/10.2190/fl2w-eljx-l54v-tykh.
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Health care reform in the United States and elsewhere raises many questions about equity and effectiveness of health services. Although the impetus has been cost containment, the reforms have often been justified on the grounds that they will enhance primary care. In this article, health care reform efforts are divided into two types: market-driven, demand-based systems versus systems predicated on meeting population health needs. The two “scenarios” are contrasted with regard to their likely impact on the attainment of primary care characteristics: first-contact care, longitudinality, comprehensive services, and coordination. Since the ultimate outcome of these reforms cannot be predicted, there is compelling need for evaluating them as they proceed.
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Halford, W. Kim. "Behaviour Therapy and Schizophrenia in Context: Challenges and Opportunities Provided within the Changing Mental Health System." Behaviour Change 12, no. 1 (March 1995): 41–50. http://dx.doi.org/10.1017/s081348390000437x.
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Research reported in the last two issues of Behaviour Change, and elsewhere, shows that cognitive behaviour therapy significantly improves a number of the problems suffered by people with schizophrenia. However, behaviour therapy alone does not constitute adequate care of schizophrenia, and inadequate mental health services undermine the effective implementation of behaviour therapy, in Australia, mental health services for people with severe psychiatric disorders such as schizophrenia are grossly inadequate, but are planned to change substantially in the late 1990s. Changes include a significant shift in resources toward community-based care, expansion of the range of treatment and rehabilitation services available, and increased integration of service provision across government and nongovernment sectors. These planned changes present a challenge to those interested in behaviour therapy to go beyond narrowly focused interventions to develop effective systems of rehabilitation.
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Bissell, Richard A., and Jean Conover. "International Emergency Health Care Systems Survey." Prehospital and Disaster Medicine 6, no. 2 (June 1991): 149–58. http://dx.doi.org/10.1017/s1049023x00028272.
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AbstractMedical emergencies occur in every country regardless of its level of socio-economic development. Little comparative data are available which define the characteristics of the system by which some emergencies are managed. Without such comparisons, it is difficult for countries to establish appropriate priorities within their geographic, cultural, and economic constraints. In an effort to gather some of these needed data, a survey was distributed to the participants in an International Conference on Emergency Health Care (EHC) Development convened in Washington, D. C, in August 1989. Each country participating was classified as Industrialized (INDUS), Developing (DC), or Least Developed (LDC) in accordance with World Health Organization definitions. Responses are expressed as proportion of total participants.There were 450 participants from 74 countries. Only 17% of the surveys were returned. The sample included 78 participants from 40 (57%) countries. (INDUS: 30%; DC: 48%; LDC: 22%). All showed considerable dependence on ambulance services, but DC and LDC indicated substantial reliance on friends, neighbors, community health workers, and physician's offices. Prehospital EHC services were available to 93% of INDUS, 63% of DC, and possibly one-third of the LDC. Emergency Health Care is taken to the patients in the same proportions as noted above. The types of manpower dispatched varied widely with a great proportion of the respondents from DC and LDC indicating that care was delivered by non-professionally trained individuals. Interestingly, INDUS had the greatest proportion of volunteers. Response and transport times were shorter for INDUS than for DC. When no prehospital EHC services were available, patients reached the receiving facilities by alternate means such as walking (33%), private automobile (48%), or public transportation (33%). Central emergency access was available for 80%. Considerable variation exists as to the mechanisms by which such services are financed: poorer countries depend more on government support than do INDUS who rely heavily on donations and fee-for-service. Lastly, regardless of level of economic development, cardiovascular disease, trauma, and medical illness comprise the most important reasons for accessing the EHC systems.This preliminary study points to the need for individualizing EHC systems in concert with the priorities of the country for which they are designed. Direct application of operational systems across countries does not seem an appropriate mechanism for the development of EHC. However, the delivery of EHC must be made an important element of overall health care in all the countries of the world.
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Van Teijlingen, Edwin, Cecilia Benoit, Ivy Bourgeault, Raymond DeVries, Jane Sandall, and Sirpa Wrede. "Learning from health care in other countries: the prospect of comparative research." Health Prospect 14, no. 1 (July 23, 2015): 8–12. http://dx.doi.org/10.3126/hprospect.v14i1.13036.
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It is widely accepted that policy-makers (in Nepal and elsewhere) can learn valuable lessons from the way other countries run their health and social services. We highlight some of the specific contributions the discipline of sociology can make to cross-national comparative research in the public health field. Sociologists call attention to often unnoticed social and cultural factors that influence the way national reproductive health care systems are created and operated. In this paper we address questions such as: ‘Why do these health services appear to be operating successfully in one country, but not another?’; ‘What is it in one country that makes a particular public health intervention successful and how is the cultural context different in a neighbouring country?’ The key examples in this paper focus on maternity care and sex education in the Netherlands and the UK, as examples to highlight the power of cross-national research. Our key messages are: a) Cross-national comparative research can help us to understand the design and running of health services in one country, say Nepal, by learning from a comparison with other countries, for example Sri Lanka or India. b) Cultural factors unique to a country affect the way that reproductive health care systems operate. c) Therefore,we need to understand why and how services work in a certain cultural context before we start trying to implement them in another cultural context.
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Fountoulakis, Konstantinos N. "The Contemporary Face of Bipolar Illness: Complex Diagnostic and Therapeutic Challenges." CNS Spectrums 13, no. 9 (September 2008): 763–79. http://dx.doi.org/10.1017/s1092852900013894.
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AbstractManic depression, or bipolar disorder, is a multifaceted illness with an inevitably complex treatment. The current article summarizes the current status of our knowledge and practice concerning its diagnosis and treatment. While the prototypic clinical picture concerns the “classic” bipolar disorder, today mixed episodes with incomplete recovery and significant psychosocial impairment are more frequent. The clinical picture of these mixed episodes is variable, eludes contemporary classification systems, and possibly includes a constellation of mental syndromes currently classified elsewhere. Treatment includes the careful combination of lithium, antiepileptics, atypical antipsychotics, and antidepressants, but not all of the agents in these broad categories are effective for the treatment of bipolar disorder.
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Campion, Thomas R., Evan T. Sholle, Jyotishman Pathak, Stephen B. Johnson, John P. Leonard, and Curtis L. Cole. "An architecture for research computing in health to support clinical and translational investigators with electronic patient data." Journal of the American Medical Informatics Association 29, no. 4 (November 30, 2021): 677–85. http://dx.doi.org/10.1093/jamia/ocab266.
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Abstract Objective Obtaining electronic patient data, especially from electronic health record (EHR) systems, for clinical and translational research is difficult. Multiple research informatics systems exist but navigating the numerous applications can be challenging for scientists. This article describes Architecture for Research Computing in Health (ARCH), our institution’s approach for matching investigators with tools and services for obtaining electronic patient data. Materials and Methods Supporting the spectrum of studies from populations to individuals, ARCH delivers a breadth of scientific functions—including but not limited to cohort discovery, electronic data capture, and multi-institutional data sharing—that manifest in specific systems—such as i2b2, REDCap, and PCORnet. Through a consultative process, ARCH staff align investigators with tools with respect to study design, data sources, and cost. Although most ARCH services are available free of charge, advanced engagements require fee for service. Results Since 2016 at Weill Cornell Medicine, ARCH has supported over 1200 unique investigators through more than 4177 consultations. Notably, ARCH infrastructure enabled critical coronavirus disease 2019 response activities for research and patient care. Discussion ARCH has provided a technical, regulatory, financial, and educational framework to support the biomedical research enterprise with electronic patient data. Collaboration among informaticians, biostatisticians, and clinicians has been critical to rapid generation and analysis of EHR data. Conclusion A suite of tools and services, ARCH helps match investigators with informatics systems to reduce time to science. ARCH has facilitated research at Weill Cornell Medicine and may provide a model for informatics and research leaders to support scientists elsewhere.
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Sices, Laura, Jeffrey S. Harman, and Kelly J. Kelleher. "Health-Care Use and Expenditures for Children in Special Education with Special Health-Care Needs: Is Dual Classification a Marker for High Use?" Public Health Reports 122, no. 4 (July 2007): 531–40. http://dx.doi.org/10.1177/003335490712200415.
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Objectives. Children with special health-care needs are an important group for policy and research planning. Special education engages a group of children with increased utilization of services related to education. While increased service utilization in education or health-care settings is often used to classify children as having special needs, considerable heterogeneity exists within each group. The extent to which being identified in two functionally defined systems—special education and health care—relates to health-care utilization is unknown. We sought to determine health-care and mental health utilization and expenditures for children dually classified as receiving special education and having special health-care needs (SHCN) compared with those who only have SHCN, only are in special education, or don't fall into either category. Methods. A nationally representative sample of children aged 5–17 years from the Medical Expenditure Panel Survey was used to compare mean health-care and mental health utilization and expenditures for the four groups. Results. Dually classified children had significantly higher mean utilization of health-care services than the other three groups ( p,0.05). Mean 12-month total health-care expenditures were highest for dually classified children ($3,891/year) ( p,0.05) and higher for children classified only as having SHCN ($1,426/year) than for children with neither classification ($644/year, p,0.05). Conclusions. Children dually classified as receiving special education and having SHCN represent a subgroup of children with SHCN with high levels of health-care utilization and expenditures. This information can assist policy makers in identifying characteristics that place children at risk for very high expenditures, and in allocating health-care resources.
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Worthington, Andrew, Lee Edwards, and Lauren Joiner. "Homelessness and head injury: Health, wellbeing and social integration in referrals to a neurocase management service." Neuropsychologist 1, no. 9 (April 2020): 47–54. http://dx.doi.org/10.53841/bpsneur.2020.1.9.47.
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This paper describes the setting up of a pilot community neurocase management service for homeless adults with a brain injury. Whilst homelessness is a major problem in the UK and elsewhere, to date few brain injury or homelessness services have considered the complex medical, psychological and social factors affecting this population specifically. Investment of resources in service provision should be based upon evidence of the presenting needs and best practice in meeting these. This paper addresses the first of these two requirements, focusing on the initial cohort referred into our service. More detail about the interventions received and outcomes achieved, along with a discussion of the challenges encountered in providing the service will be provided in a follow-up paper. The need for psychologically-informed services to promote social inclusion is supported by our data which revealed concerning levels of community estrangement. Our data also confirm that homelessness often occurs in the context of multiple comorbidities which traverse conventional boundaries across medical, social care and criminal justice systems, meaning that collaborative working is essential. The argument for neuropsychological input in designing and delivering support alongside other services is clear.
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Dutt, Priyanka, Anna Godfrey, Sara Chamberlain, and Radharani Mitra. "Using behavioural design and theories of change to integrate communication solutions into health systems in India: evolution, evidence and learnings from practice." Integrated Healthcare Journal 4, no. 1 (December 2022): e000139. http://dx.doi.org/10.1136/ihj-2022-000139.
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Between 2011 and 2019, an integrated communication programme to address reproductive, maternal, neonatal and child health was implemented in the Indian state of Bihar. Along with mass media, community events and listening groups, four mobile health services were co-designed with the government of Bihar. These wereMobile Academy—a training course for frontline health workers (FLHWs) supporting them as the last mile of the health system;Mobile Kunji—a job aid to support FLHWs’ interactions with families;Kilkari—a maternal messaging service delivering information directly to families’ mobile phones, encouraging families to seek public health services through their FLHWs; andGupShup Potli—mobile audio stimulus used by FLHWs in community events. WhileMobile KunjiandGupShup Potliscaled to other states (two and one, respectively), neither was adopted nationally. The Government of India adoptedKilkariandMobile Academyand scaled to 12 additional states by 2019. In this article, we describe the programme’s overarching person-centred theory of change, reflect on how the mHealth services supported integration with the health system and discuss implications for the role of health communication solutions in supporting families to navigate healthcare systems. Evaluations ofKunji, AcademyandGupShup Potliwere conducted in Bihar between 2013 and 2017. Between 2018-2020, an independent evaluation was conducted involving a randomised controlled trial forKilkariin Madhya Pradesh; qualitative research onKilkariandAcademyand secondary analyses of call record data. While the findings from these evaluations are described elsewhere, this article collates key findings for all the services and offers implications for the role digital and non-digital communication solutions can play in supporting joined-up healthcare and improving health outcomes.
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Kauhl, Boris, Jörg König, and Sandra Wolf. "Spatial Distribution of COVID-19 Hospitalizations and Associated Risk Factors in Health Insurance Data Using Bayesian Spatial Modelling." International Journal of Environmental Research and Public Health 20, no. 5 (February 28, 2023): 4375. http://dx.doi.org/10.3390/ijerph20054375.
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The onset of COVID-19 across the world has elevated interest in geographic information systems (GIS) for pandemic management. In Germany, however, most spatial analyses remain at the relatively coarse level of counties. In this study, we explored the spatial distribution of COVID-19 hospitalizations in health insurance data of the AOK Nordost health insurance. Additionally, we explored sociodemographic and pre-existing medical conditions associated with hospitalizations for COVID-19. Our results clearly show strong spatial dynamics of COVID-19 hospitalizations. The main risk factors for hospitalization were male sex, being unemployed, foreign citizenship, and living in a nursing home. The main pre-existing diseases associated with hospitalization were certain infectious and parasitic diseases, diseases of the blood and blood-forming organs, endocrine, nutritional and metabolic diseases, diseases of the nervous system, diseases of the circulatory system, diseases of the respiratory system, diseases of the genitourinary and symptoms, and signs and findings not classified elsewhere.
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Ang, Zen Yang, Kit Yee Cheah, Md Sharif Shakirah, Weng Hong Fun, Jailani Anis-Syakira, Yuke-Lin Kong, and Sondi Sararaks. "Malaysia’s Health Systems Response to COVID-19." International Journal of Environmental Research and Public Health 18, no. 21 (October 22, 2021): 11109. http://dx.doi.org/10.3390/ijerph182111109.
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This study aimed to highlight the COVID-19 response by the Ministry of Health (MOH) and the Government of Malaysia in order to share Malaysia’s lessons and to improve future pandemic preparedness. The team conducted a rapid review using publicly available information from MOH, PubMed, and World Health Organisation (WHO) Global Research on Coronavirus Disease Database to compile Malaysia’s responses during the COVID-19 pandemic. Measures taken between 31 December 2019 and 3 June 2020 were classified into domains as well as the pillars described in the WHO COVID-19 Strategic Preparedness and Response Plan (WHO SPRP). Malaysia’s response incorporated all pillars in the WHO SPRP and consisted of five domains, (i) whole-of-government, (ii) cordon sanitaire/lockdown, (iii) equity of access to services and supports, (iv) quarantine and isolation systems, and (v) legislation and enforcement. Some crucial measures taken were activation of a centralised multi-ministerial coordination council where MOH acted as an advisor, with collaboration from non-government organisations and private sectors which enabled an effective targeted screening approach, provision of subsidised COVID-19 treatment and screening, isolation or quarantine of all confirmed cases, close contacts and persons under investigation, with all strategies applied irrespective of citizenship. This was provided for by way of the Prevention and Control of Infectious Diseases Act 1988. A combination of these measures enabled the nation to contain the COVID-19 outbreak by the end of June 2020.
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Oronce, Carlos Irwin A., John N. Mafi, Ray Pablo, Andrea Sorensen, Ayan Patel, Lisa Dahm, Samuel A. Skootsky, Rachael Sak, and Catherine Sarkisian. "98179 Identifying Low-Value Care Across A Statewide Health System: Collaboration Between Quality, Population Health, Informatics, and Health Services Research." Journal of Clinical and Translational Science 5, s1 (March 2021): 125. http://dx.doi.org/10.1017/cts.2021.720.
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ABSTRACT IMPACT: This project demonstrates that addressing low-value care, which has the potential to cause patient harm, relies on novel data tools and collaboration between health system and research stakeholders. OBJECTIVES/GOALS: Reducing low-value care, or patient care that offers no net benefit in specific clinical scenarios, is an important approach to improving value as it can simultaneously lower health care spending and improve quality. We describe an initiative to identify such care in a large statewide employer. METHODS/STUDY POPULATION: Claims data for self-funded University of California (UC) Preferred Provider Organization (PPO) plan members during 2019 were abstracted from the University of California Health (UCH) Clinical Data Warehouse, a unique central database that includes electronic medical record data from >5 million patients across UC medical campuses and all claims from UC self-funded health plans. UCH spans six academic health systems across California. The Milliman MedInsight Health Waste Calculator, a proprietary algorithm-based software tool, was used to identify low-value care and estimate associated spending. The HWC measures 48 low-value services using recommendations from the Choosing Wisely Campaign, the US Preventive Services Task Force, and other clinical specialty guidelines. RESULTS/ANTICIPATED RESULTS: Of 43,882 members of the UC PPO, 11,174 (25.4%) received at least one low-value service. The HWC identified 50,103 eligible services and classified 35% as low-value. Total spending on low-value services ranged between $2,209,516 and $5,089,866, based on a more or less conservative estimate. Across the five sites, the proportion of low-value services ranged from 31% to 39%. Five services comprised 65% of costs from low-value care: annual EKGs, preoperative baseline labs for low-risk surgeries, vitamin D deficiency screening, imaging for eye disease, and headache imaging. The top five services by order frequency were annual EKGs, vitamin D tests, preoperative labs, antibiotics for upper respiratory infections, and imaging for eye disease. DISCUSSION/SIGNIFICANCE OF FINDINGS: Low-value care is prevalent and costly within a large statewide employer. Collaborative multidisciplinary partnerships between employers, health systems, informatics, and researchers can leverage existing data to identify opportunities for improving the value of care for covered populations.
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Russell, Trevor G. "Physical rehabilitation using telemedicine." Journal of Telemedicine and Telecare 13, no. 5 (July 1, 2007): 217–20. http://dx.doi.org/10.1258/135763307781458886.
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Telerehabilitation is the provision at a distance of rehabilitation services such as physiotherapy, speech pathology or occupational therapy. The primary aim is to provide equitable access to rehabilitation services. Broadly speaking, the technologies used for telemedicine-based physical rehabilitation can be classified as: (1) image-based telerehabilitation; (2) sensor-based telerehabilitation; and (3) virtual environments and virtual reality telerehabilitation. To date, much of the research has been technology focused, and has consisted of single case or small sample research designs. The next step is to demonstrate viable telerehabilitation services in real world environments using well controlled research methodologies with large patient cohorts. In addition, the broader issues of cost-benefit and cost-effectiveness require investigation. If this can be done, then the undoubted potential benefits of telerehabilitation, for both the patient and health-care systems, can be realized.
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Peng, Cong, Prashant Goswami, and Guohua Bai. "A literature review of current technologies on health data integration for patient-centered health management." Health Informatics Journal 26, no. 3 (December 30, 2019): 1926–51. http://dx.doi.org/10.1177/1460458219892387.
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Health data integration enables a collaborative utilization of data across different systems. It not only provides a comprehensive view of a patient’s health but can also potentially cope with challenges faced by the current healthcare system. In this literature review, we investigated the existing work on heterogeneous health data integration as well as the methods of utilizing the integrated health data. Our search was narrowed down to 32 articles for analysis. The integration approaches in the reviewed articles were classified into three classifications, and the utilization approaches were classified into five classifications. The topic of health data integration is still under debate and problems are far from being resolved. This review suggests the need for a more efficient way to invoke the various services for aggregating health data, as well as a more effective way to integrate the aggregated health data for supporting collaborative utilization. We have found that the combination of Web Application Programming Interface and Semantic Web technologies has the potential to cope with the challenges based on our analysis of the review result.
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Marutha, Ngoako Solomon, and Mpho Ngoepe. "Medical records management framework to support public healthcare services in Limpopo province of South Africa." Records Management Journal 28, no. 2 (July 16, 2018): 187–203. http://dx.doi.org/10.1108/rmj-10-2017-0030.
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Purpose This study aims to develop a framework for the management of medical records in support of health-care service delivery in the hospitals in the Limpopo province of South Africa. Design/methodology/approach The study was predominantly quantitative and has used the questionnaires, system analysis, document analysis and observation to collect data in 40 hospitals of Limpopo province. The sample of 49 per cent (306) records management officials were drawn out of 622 (100 per cent) total population. The response rate was 71 per cent (217) out of the entire sample. Findings The study discovered that a framework for management of medical records in the public hospitals is not in place because of several reasons and further demonstrates that public health-care institutions need an integrative framework for the proper management of medical records of all forms and in all media. Originality/value The study develops and suggests a framework to embed medical records management into the health-care service delivery workflow for effective records management and ease of access. It is hoped that such a framework will help hospitals in South Africa and elsewhere to improve their medical records management to support health-care service provision.
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White, Pamela, Indra Raj Badu, and Parikshit Shrestha. "Achieving sustainable water supply through better institutions, design innovations and Water Safety Plans – an experience from Nepal." Journal of Water, Sanitation and Hygiene for Development 5, no. 4 (September 23, 2015): 625–31. http://dx.doi.org/10.2166/washdev.2015.002.
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Sustainable functionality of rural water infrastructures is a major challenge in Nepal, as elsewhere. This paper looks at systems for improved community-based water supply and sanitation management in the Rural Village Water Resources Management Project (RVWRMP), in mid and far west Nepal. The paper analysed 496 rural, community-managed drinking water and sanitation schemes (with 30 to 250 beneficiary households per scheme) supported by RVWRMP (2006–2014). Observed results are: 91.5% fully functional, 8.3% partially functional and 0.2% of schemes closed due to natural disasters and social conflicts. This compares very favourably to the systems implemented by the government of similar age. We consider that the experience gained in RVWRMP provides relevant lessons on how to safeguard the functionality of rural water services infrastructure systems. The key elements noted by our staff are: prioritisation of the schemes by the community; application of quality implementation and user committee management; Water Safety Plans and active maintenance; and hands-on technical support and monitoring.
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Gyamfi, Nana Kwame, Richard Dayie, and Eric Kofi Asiedu. "Challenges to Scaling up Mhealth in Ghana. A Framework for Assessing the Health System." Webology 19, no. 1 (January 20, 2022): 458–79. http://dx.doi.org/10.14704/web/v19i1/web19033.
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The promise for improving healthcare services has been confirmed by mobile device technology, but the decision-making process to acquire and use mHealth technologies on a scale is not directed. We apply a methodology to assess the potential and difficulties of efficient deployment of the mHealth at a scale in healthcare systems using the instance of Community Base Health Services (CBS) in Ghana. The advantage and difficulties of mHealth in community-based services in Ghana were examined in comprehensive research via a blend of key informant interviews, document reviews, and local project visits. The lessons gained from Ghana's local experience and elsewhere were based on a framework adjusted from 3 approaches to sustainable information and Communication Technology (ICT) evaluation. Four major characteristics of the system have been identified and evaluated: government stewardship and organizational, technical, and financial system. The prospects for successfully implementing mHealth in Ghana include the high penetration of mobile devices and a favorable e-health policy framework. Again, given a health system with a weal ICT setting and limited implementing ability, it is doubtful if the potential benefits of mHealth would benefit CBS through direct broad-scale adoption. The application of a healthcare system framework facilitates a systematic assessment of possible barriers to CBS growth in Ghana and is helpful for decision-making policy and practice for other small and medium enterprises.
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Chililov, A. M., F. N. Kadyrov, and O. V. Obuhova. "Labour Remuneration in Public Health System in Time of Digital Transformation of Medical Services." Vestnik of the Plekhanov Russian University of Economics, no. 2 (April 13, 2022): 136–48. http://dx.doi.org/10.21686/2413-2829-2022-2-136-148.
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Different aspects of using tele-medical technologies recognized as one of key lines in the development of the advanced public health system are highlighted more and more widely in academic literature. However, prospects of this trend depend not only on progress in the development of medical and information technologies and finance investment in the sphere, but also on economic interest in it on the part of concrete medical workers and it can be directly connected with remuneration systems of workers who render tele-medical services. During the research the authors identified key factors that influence on labour remuneration of workers, who participate in tele-medical technologies. Situations of rendering medical aid were classified in view of the following criteria: time, when telemedical services are to be used (principle and extra); whether the job is included in the job description of a concrete worker; whether remuneration components affect the basic pay of the worker, etc. The authors put forward methodological approaches to working out systems of remuneration aimed at the development of tele-medical technologies by state power bodies and public health institutions.
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Thomson, Kenneth. "Challenges for Research in the Field of Agricultural Economics in the UK." Roczniki Nauk Rolniczych. Seria G, Ekonomika Rolnictwa 98, no. 2 (June 26, 2011): 19–27. http://dx.doi.org/10.22630/rnr.2011.98.2.12.
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Research challenges for agricultural economics in the United Kingdom (UK) can be classified under issues, methods and resources. Under issues, those of environmental land management (e.g. for landscape, biodiversity, outdoor access) have received most attention, along with questions of food security, and of animal health and welfare. In contrast, farm management has been relatively neglected, in line with the traditional (and government-shared) inclination towards economic liberalism. In terms of methods, new concepts, such as multifunctionality, payments for ecosystem services, and environmental valuation techniques, have predominated, with relatively little effort to model the EU Common Agricultural Policy. Resource issues have primarily arisen from the rather radical restructuring (including closure of many UK agricultural faculties) and stringent procedures (e.g. research assessment exercises) within the current and increasingly competitive UK university system. In this context, new staff, as well as ideas and funding, have often been sought, and gained, from elsewhere in the European Union.
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Barger, Brian, Catherine Rice, Christina Anne Simmons, and Rebecca Wolf. "A Systematic Review of Part C Early Identification Studies." Topics in Early Childhood Special Education 38, no. 1 (December 20, 2016): 4–16. http://dx.doi.org/10.1177/0271121416678664.
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Authors conducted a systematic literature review on early identification steps leading at-risk young children to connect with Part C services. Authors classified data collection settings as primary (settings for general population) or specialized (settings for children at risk of developmental delay) and according to the phases of early identification in the study: (a) original population of children aged 0 to 6 years who had received Part C services, (b) screening and/or referral and/or developmental assessment from 0 through age 2 years, and (c) were deemed eligible and/or received Part C services. Authors identified 43 articles including at least two phases of the early identification process. The literature about connecting children to Part C early intervention (EI) is sparse and fragmented; few studies document the full process from community monitoring to service receipt. Results indicate opportunities for development of systems to better track and improve the identification of young children in need of EI.
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Buchan, I., and J. Ainsworth. "Combining Health Data Uses to Ignite Health System Learning." Methods of Information in Medicine 54, no. 06 (2015): 479–87. http://dx.doi.org/10.3414/me15-01-0064.
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SummaryObjectives: In this paper we aim to characterise the critical mass of linked data, methods and expertise required for health systems to adapt to the needs of the populations they serve – more recently known as learning health systems. The objectives are to: 1) identify opportunities to combine separate uses of common data sources in order to reduce duplication of data processing and improve information quality; 2) identify challenges in scaling-up the reuse of health data sufficiently to support health system learning.Methods: The challenges and opportunities were identified through a series of e-health stakeholder consultations and workshops in Northern England from 2011 to 2014. From 2013 the concepts presented here have been refined through feedback to collaborators, including patient/citizen representatives, in a regional health informatics research network (www.herc.ac.uk).Results: Health systems typically have separate information pipelines for: 1) commissioning services; 2) auditing service performance; 3) managing finances; 4) monitoring public health; and 5) research. These pipelines share common data sources but usually duplicate data extraction, aggregation, cleaning/preparation and analytics. Suboptimal analyses may be performed due to a lack of expertise, which may exist elsewhere in the health system but is fully committed to a different pipeline. Contextual knowledge that is essential for proper data analysis and interpretation may be needed in one pipeline but accessible only in another. The lack of capable health and care intelligence systems for populations can be attributed to a legacy of three flawed assumptions: 1) universality: the generalizability of evidence across populations; 2) time-invariance: the stability of evidence over time; and 3) reducibility: the reduction of evidence into specialised subsystems that may be recombined.Conclusions: We conceptualize a population health and care intelligence system capable of supporting health system learning and we put forward a set of maturity tests of progress toward such a system. A factor common to each test is data-action latency; a mature system spawns timely actions proportionate to the information that can be derived from the data, and in doing so creates meaningful measurement about system learning. We illustrate, using future scenarios, some major opportunities to improve health systems by exchanging conventional intelligence pipelines for networked critical masses of data, methods and expertise that minimise data-action latency and ignite system-learning.
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Kwon, Hyuktae, Sunhee An, Ho-Young Lee, Won Chul Cha, Sungwan Kim, Minwoo Cho, and Hyoun-Joong Kong. "Review of Smart Hospital Services in Real Healthcare Environments." Healthcare Informatics Research 28, no. 1 (January 31, 2022): 3–15. http://dx.doi.org/10.4258/hir.2022.28.1.3.
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Objectives: Smart hospitals involve the application of recent information and communications technology (ICT) innovations to medical services; however, the concept of a smart hospital has not been rigorously defined. In this study, we aimed to derive the definition and service types of smart hospitals and investigate cases of each type. Methods: A literature review was conducted regarding the background and technical characteristics of smart hospitals. On this basis, we conducted a focus group interview with experts in hospital information systems, and ultimately derived eight smart hospital service types.Results: Smart hospital services can be classified into the following types: services based on location recognition and tracking technology that measures and monitors the location information of an object based on short-range communication technology; high-speed communication network-based services based on new wireless communication technology; Internet of Things-based services that connect objects embedded with sensors and communication functions to the internet; mobile health services such as mobile phones, tablets, and wearables; artificial intelligence-based services for the diagnosis and prediction of diseases; robot services provided on behalf of humans in various medical fields; extended reality services that apply hyper-realistic immersive technology to medical practice; and telehealth using ICT. Conclusions: Smart hospitals can influence health and medical policies and create new medical value by defining and quantitatively measuring detailed indicators based on data collected from existing hospitals. Simultaneously, appropriate government incentives, consolidated interdisciplinary research, and active participation by industry are required to foster and facilitate smart hospitals.
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Grant, Melita, Tim Foster, Dao Van Dinh, Juliet Willetts, and Georgia Davis. "Life-cycle costs approach for private piped water service delivery: a study in rural Viet Nam." Journal of Water, Sanitation and Hygiene for Development 10, no. 4 (October 5, 2020): 659–69. http://dx.doi.org/10.2166/washdev.2020.037.
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Abstract Sustaining rural water services in Viet Nam requires an improved understanding of the costs and relative opportunities, especially given the government's support for private sector involvement in expanding water schemes. In particular, the life-cycle costs associated with the delivery of safe and sustainable water services in rural Viet Nam, as indeed elsewhere, are not well known, potentially compromising their long-term sustainability. To address this gap, this study assessed the cost structures of 14 water schemes in Viet Nam managed by private enterprises. Results showed that both capital and operational expenditures varied widely across the schemes assessed, reflective of the diversity of the age and characteristics of the schemes studied. Twelve of the 14 schemes generated a cash profit in the most recent calendar year; however, when taking into account depreciation, as well as historical subsidies and connection fee payments, only four of the schemes were profitable based on a 20-year design life assumption. The study complements previous research demonstrating barriers to achieving universal access when relying on user-pays systems. The results provide a useful reference point to inform business planning for enterprises, as well as policy and support mechanisms important for securing sustainable rural water supply services.
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Helu-Brown, Paula, and Concepcion Barrio. "Latinx Mental Health in the Mexican Consulate: Addressing Barriers Through Social Good." Research on Social Work Practice 30, no. 2 (April 3, 2019): 151–62. http://dx.doi.org/10.1177/1049731519839465.
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Objectives: This article examines an innovative mental health program in the largest Mexican consulate in the United States guided by a social good organizing framework and an intersectionality lens. The mental health program, Modulo de Salud Mental, was designed to address barriers to help seeking. Methods: The Modulo used the central characteristics of the social good model, such as innovative collaborations between systems that otherwise do not typically collaborate and burgeoning technologies to overcome barriers for service utilization among this population. We conducted a qualitative study to examine how the Modulo addressed structural and cultural barriers to care. Results: The salient themes from interviews were classified into four categories: current political situation, reasons for seeking services, prior barriers to care addressed by program, and perceived benefits of the program. Conclusions: Findings suggest that the Modulo's services and convenient location in an unconventional setting can serve as a model for promoting social good by facilitating help seeking and alleviating illness burden for this immigrant community.
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Hugman, Richard. "Social Work and Case Management in the UK: Models of Professionalism and Elderly People." Ageing and Society 14, no. 2 (June 1994): 237–53. http://dx.doi.org/10.1017/s0144686x00000337.
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ABSTRACTDiscrimination against old age and work with elderly people are evident in the practices and organisation of caring professions, of which social work may be taken as an example because of its central role in community care provision. This article examines the implications for the status of professional social work with elderly people of recent proposals to develop the role of care manager in place of the case management model developed in Kent and elsewhere. It is argued that such a move derives from managerial concerns, which ignore the likely consequences for retrenching ageism and other forms of discrimination in services for older people. It is concluded that more careful consideration will be required concerning the context in which new professional models are being developed, if these discriminations are not to be reproduced and reinforced, as well as the benefits from case management systems being lost.
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Lee, Seok-Hwan, Yongho Chon, and Yun-Young Kim. "Comparative Analysis of Long-Term Care in OECD Countries: Focusing on Long-Term Care Financing Type." Healthcare 11, no. 2 (January 10, 2023): 206. http://dx.doi.org/10.3390/healthcare11020206.
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This study aims to examine the characteristics of long-term care (LTC) financing in Organization for Economic Cooperation Development (OECD) countries. To this end, the 26 OECD countries that have introduced LTC systems were classified into three types of models: tax-based, health insurance, and LTC insurance (LTCI) systems. Thereafter, these systems were analyzed using Gilbert and Terrell’s policy analysis framework. The results indicated differences in the characteristics of each type of financing in terms of allocation, benefit provision, service delivery, and finance. It is likely that while the LTC insurance model was mainly based on universalism and showed the highest level of coverage, the tax-based and health insurance models adopted selectivism with lower level of benefits per capita. In terms of service delivery, local authorities tended to have the responsibility to decide LTC service users and provide services in many countries, regardless of the type of model. In terms of finance, LTC insurance-based countries had the highest LTC expenditure as a percentage of GDP, followed by countries with tax-based and health insurance systems.
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Mugo, Mercy G., and Peterson J. Muriithi. "Cost Effectiveness Analysis of Family Planning Provision in Kenya." Journal of African Development 20, no. 1 (April 1, 2018): 13–22. http://dx.doi.org/10.5325/jafrideve.20.1.0013.
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Abstract In Kenya, total fertility rate and contraceptive prevalence rate have shown marginal changes since the 1990s, raising questions about efficiency and effectiveness of provision of reproductive health services, which has received little attention in the country and elsewhere in Africa. We use data from Thika sub-county in central Kenya to conduct a cost-effectiveness analysis of family planning service provision alternatives. The results show that costs per couple year of protection vary widely across facilities within government and non-government providers, but are slightly higher amongst the former. The cost-effectiveness ratios were sensitive to exclusion of certain commodity costs. We conclude that family planning provision systems found in Thika are efficient but call for strengthening of lower level facilities, which are more cost effective and largely serve the poor.
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Oliveira, Camila Almeida de, Bernardete Weber, Jair Lício Ferreira dos Santos, Miriane Lucindo Zucoloto, Lisa Laredo de Camargo, Ana Carolina Guidorizzi Zanetti, Magdalena Rzewuska, and João Mazzoncini de Azevedo-Marques. "Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool." PLOS ONE 17, no. 2 (February 18, 2022): e0263702. http://dx.doi.org/10.1371/journal.pone.0263702.
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Background Health complexity includes biological, psychological, social, and health systems. Having complex health needs is associated with poorer clinical outcomes and higher healthcare costs. Care management for people with health complexity is increasingly recommended in primary health care (PHC). The INTERMED complexity assessment grid showed adequate psychometric properties in specialized settings. This study aimed to evaluate INTERMED’s validity and feasibility to assess health complexity in an adult PHC population. Method The biopsychosocial health care needs of 230 consecutive adult patients from three Brazilian PHC services were assessed using the INTERMED interview. Participants with a total score >20 were classified as “complex”. Quality of life was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF); symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); social support using the Medical Outcomes Study—Social Support Survey (MOS-SSS); comorbidity levels using the Charlson Comorbidity Index (CCI). We developed two questionnaires to evaluate health services use, and patient perceived feasibility of INTERMED. Results 42 participants (18.3%) were classified as “complex”. A moderate correlation was found between the total INTERMED score and the total scores of WHOQOL-BREF (rho = - 0.59) and HADS (rho = 0.56), and between the social domains of INTERMED and MOS-SSS (rho = -0.44). After adjustment, the use of PHC (β = 2.12, t = 2.10, p < 0.05), any other health care services (β = 3.05, t = 3.97, p < 0.01), and any medication (β = 3.64, t = 4.16, p < 0.01) were associated with higher INTERMED scores. The INTERMED internal consistency was good (ω = 0.83), and the median application time was 7 min. Patients reported satisfaction with the questions, answers, and application time. Conclusion INTERMED displayed good psychometric values in a PHC population and proved promising for practical use in PHC.
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Burnett, Anthea, Ling Lee, Fabrizio D'Esposito, Geoffrey Wabulembo, Anaseini Cama, Georgia Guldan, Marleen Nelisse, et al. "Rapid assessment of avoidable blindness and diabetic retinopathy in people aged 50 years and older in the National Capital District of Papua New Guinea." British Journal of Ophthalmology 103, no. 6 (July 4, 2018): 743–47. http://dx.doi.org/10.1136/bjophthalmol-2017-311803.
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Background/aimsTo conduct an assessment of avoidable blindness, diabetes mellitus and diabetic retinopathy (DR) in adults aged 50 years and older in the National Capital District (NCD) region of Papua New Guinea (PNG).MethodsA cross-sectional population-based survey was performed for which 25 clusters of 50 people aged ≥50 years were randomly selected from the NCD region. The standardised rapid assessment of avoidable blindness (RAAB) with diabetic retinopathy (+DR) methodology was used. Blindness was defined as presenting visual acuity <3/60 in the better eye. Participants were classified as having diabetes if they were known to have diabetes or if their random blood glucose level was ≥200 mg/dL. Dilated fundus examination and Scottish DR grading were performed.ResultsIn total, 1192 out of 1250 eligible participants (95.4%) were examined. Of these, 7.8% had known or newly diagnosed diabetes. Seventy-one per cent of participants with known diabetes had a blood glucose level ≥200 mg/dL, and 82.9% had never had an ophthalmological examination for DR. Prevalence of DR and/or maculopathy was 46.4%. The age-adjusted and sex-adjusted prevalence of diabetes was estimated at 8.1% (95% CI 5.7% to 10.4%) in the population aged 50 years or older in the NCD region of PNG.ConclusionsPrevalence of diabetes in adults aged 50 years and older was lower than reported elsewhere in the region, and lower than other RAAB+DR surveys. Despite this, the prevalence of DR is high compared with other RAAB+DR surveys and demonstrates the need for increased awareness and accessibility to eye services for people with diabetes.
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Ahmad, Norain, and Rosnah Sutan. "Aligning theory with practice: Child health programmes in Malaysia, a Narrative Review." Malaysian Family Physician 18 (April 23, 2023): 28. http://dx.doi.org/10.51866/rv.210.
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Introduction: The Malaysian healthcare system, particularly for maternal and child health, has been well recognised to provide high-quality services and be at par with systems in other developed countries. Current health programmes and technological advancements effectively detect vulnerable groups of children, such as small-for-gestational-age (SGA) infants, antenatally. However, the postnatal care for SGA infants is not clearly evaluated, as this group of children is mostly classified as healthy in many medical contexts, especially in primary care settings. Available health programmes and healthcare service delivery must be continuously evaluated by implementing beneficial and relevant evidence-based theories. Methods: Articles, reports and guidelines used in providing mother and child health services in Malaysia published since 2000 were reviewed. Results: There was no specific monitoring strategy used for SGA infants without critical health issues in early childhood, as they were commonly treated as healthy infants. Several challenges in aligning theory with the current practice of healthcare service delivery and recommendations for dealing with such challenges were identified. Conclusion: The alignment of theory with the current practice of service delivery should be tailored to the needs and demands parallel to the dynamic change in populations in the urbanisation era.
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Dyer, R., M. Tafuna'i, I. Meredith, and D. Sarfati. "Cancer Care in Small Pacific Island States." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 214s. http://dx.doi.org/10.1200/jgo.18.86400.
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Background: Like other LMICs, many Pacific Island countries and territories (PICTs) have fragile and overburdened health systems with which to combat an increasing burden of cancer. Additionally, a combination of small geographically dispersed populations, limited resources, isolation and frequent natural disasters make cancer control in Pacific Islands also significantly different to elsewhere in the world. No prior work has provided a stocktake of current capacity for diagnosis and treatment of cancer across the region to date. Aim: To describe the specialized health services available for cancer control in the Pacific region, and show the complexity associated with accessing cancer care for Pacific Islanders. Methods: A cross-sectional review of medical services and human resources available for cancer control was undertaken for 21 Pacific Community (SPC) member countries and territories in April-May 2018 , specifically diagnosis (pathology and radiology) and treatment (chemotherapy, radiotherapy and surgical modalities and overseas referrals for services not available on-island) by contacting individual countries and territories. Common travel routes were mapped individually for 4 PICTs; Papua New Guinea, Solomon Islands, Kiribati and Tokelau; as examples of the unique challenges faced by rural dwelling Pacific Islanders when accessing the highest level of care available in-country. Results: Capacity for cancer diagnosis and care is extremely limited in the Pacific region. The exceptions are the 2 French territories (French Polynesia and New Caledonia) and Guam where a near full complement of services for diagnosis and treatment are operational. Some pathology services are generally available in the larger PICTs, while specimens are sent to affiliated off island laboratories for the rest. Plain x-ray and ultrasound are available at 1 or more locations in all PICTs. General and gynecologic surgery is the most widespread treatment modality available. Some to full chemotherapy administered in 7 and radiotherapy in 3 (formerly 4) PICTs. Overseas referrals for medical services not available in-country are a common feature to all PICTs health systems. A need to travel long distances to access health care is a challenged faced by Pacific Islanders on outer islands and rural villages. Examples will be presented. Conclusion: Cancer control services are few and far between in the Pacific region, and PICTs will always likely rely on overseas referrals for care not available. Access barriers exist for those on outer islands and in villages, and an unknown number seek treatment late or not at all for these reasons. Governments need to invest into strengthening primary and secondary care services, making them an option that is more easily accessible to remote populations. Collaboration between transport and health sectors to look at ways to improve frequency, regulation and safety of modes of transportation to outer islands to improve current systems.
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Aninanya, Gifty Apiung, Easmon Otupiri, and Natasha Howard. "Effects of combined decision-support and performance-based incentives on reported client satisfaction with maternal health services in primary facilities: A quasi-experimental study in the Upper East Region of Ghana." PLOS ONE 16, no. 4 (April 20, 2021): e0249778. http://dx.doi.org/10.1371/journal.pone.0249778.
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Background Computerized decision-support systems (CDSS) and performance-based incentives (PBIs) have potential to contribute to client satisfaction with health services. However, rigorous evidence is lacking on the effectiveness of these strategies in lower-income countries such as Ghana. This study aimed to determine the effect of a combined CDSS-PBI intervention on client satisfaction with maternal health services in primary facilities in the Upper East Region of Ghana. Methods We employed a quasi-experimental controlled baseline and endline design to assess the effect of the combined interventions on client satisfaction with maternal health services, measured by quantitative pre/post-test client satisfaction survey. Our analysis used difference-in-difference logistic regression, controlling for potential covariates, to compare variables across intervention and comparison facilities at baseline and endline. Results The combined CDSS-PBI intervention was associated with increased or unchanged client satisfaction with all maternal health services compared at endline. Antenatal client difference-in-difference of mean satisfaction scores were significant at endline for intervention (n = 378) and comparison (n = 362) healthcare facilities for overall satisfaction (DiD 0.058, p = 0.014), perception of providers’ technical performance (DiD = 0.142; p = 0.006), client-provider interaction (DiD = 0.152; p = 0.001), and provider availability (DiD = 0.173; p = 0.001). Delivery client difference-in-difference of satisfaction scores were significant at endline for intervention (n = 318) and comparison (n = 240) healthcare facilities for overall satisfaction with delivery services (DiD = 0.072; p = 0.02) and client-provider interaction (DiD = 0.146; p = 0.02). However, mean overall satisfaction actually reduced slightly in intervention facilities, while DiD for technical performance and provider availability were not significant. Conclusion This combined CDSS-PBI intervention was associated with greater antenatal and delivery client satisfaction with some aspects of maternity services within two years of implementation. It could be expanded elsewhere if funds allow, though further research is still required to assess cost-effectiveness and long-term effects on client satisfaction and maternal health outcomes.
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Liu, Wenchang, and Yongchao Gao. "Analysis of Stakeholder Concerns in Pandemic." Advances in Education, Humanities and Social Science Research 6, no. 1 (June 8, 2023): 83. http://dx.doi.org/10.56028/aehssr.6.1.83.2023.
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Public health emergencies are not the norm in cities and have significant specificity, but they impact nearly all systems in a city. This paper analyzes the stakeholders concerns during a pandemic based on their activities and the citizens’ needs during Covid-19 pandemic in a city that has the population of around 8 million people. These data are classified by real city service hotline calls. The analysis of concerns and needs of stakeholders can support city governance and help citizens live as normal a life as possible with city services in a pandemic.
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Iliffe, Steve, and Penny Lenihan. "Integrating Primary Care and Public Health: Learning from the Community-Oriented Primary Care Model." International Journal of Health Services 33, no. 1 (January 2003): 85–98. http://dx.doi.org/10.2190/40hl-u1b9-f7k7-kk64.
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Community-oriented primary care (COPC), a 50-year-old widely applied innovative approach to primary care development, seems to be the same combination of public health and general practice perspectives currently sought in the formation of primary care trusts in Britain's NHS. The article reviews the experience of implementing COPC methods, the outcomes, and the applicability to and implications for primary care policy, taking the current British reforms as an example. The COPC model has been developed mainly in underserved populations to integrate public health objectives and primary care through interdisciplinary approaches, with active involvement of the target population. COPC methods are time consuming, can create problems with professional boundaries, and are vulnerable to socioeconomic changes. They can also deliver complex packages of care for target populations, particularly in poor areas underserved by traditional medical services. British primary care reforms may be seen as an unplanned, uncontrolled, nationwide experiment in applying COPC methods. They differ from COPC as applied elsewhere because change has been introduced from above rather than below, into a well-developed primary care system rather than underserved communities. International experience suggests the need for attention to factors promoting and impeding success and to reliable outcome measures. If this experiment succeeds, COPC methodology may facilitate similar changes in other health care systems.
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Song, Eun Hyang, Yeon Sil Moon, Jung Hyun Park, Byung Euk Joo, Ho Seong Han, Chan-Nyoung Lee, Hyun Jeong Han, and Jae Moon Kim. "Current Status of Public Long-term Care Insurance Services and Future Perspective: A Questionnaire Survey and National Health Insurance Service Data of South Korea." Journal of the Korean Neurological Association 42, no. 1 (February 1, 2024): 1–12. http://dx.doi.org/10.17340/jkna.2023.0100.
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The continuing growth of population aged 65 years and above, the socioeconomic burden of long-term care insurance has consistently increased. This study aimed to review the current system and efficiently develop long-term care insurance services according to changes in socioeconomic situations. First, a 21 items questionnaire survey was conducted from August 16 to August 31, 2022, for all members of the Korean Neurological Association. The survey was divided into seven areas, and individualized results were analyzed. Second, cumulative data on long-term care insurance services were collected and analyzed from July 1, 2008 to December 31, 2021, for the National Health Insurance system, and the results were summarized. In the survey, approximately 21% of the neurologists answered a web-based questionnaire survey on current doctors’ referral slips for long-term insurance services. Most (94%) had doctor referral slips for long-term insurance services. However, the authors estimated that doctors’ referral slips did not sufficiently affect the grading of longterm insurance services. The long-term care insurance services data according to several categories were classified and then, we statistically analyzed the socioeconomic burden of long-term insurance. Those cumulative data showed a gradual increase in the recipient number, diversity of geriatric diseases, and socioeconomic burden. We suggested that it is necessary for the government and academic society to continue to cooperate to develop the long-term care insurance systems for elderly.
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Therrien, Marie-Christine, Julie-Maude Normandin, and Jean-Louis Denis. "Bridging complexity theory and resilience to develop surge capacity in health systems." Journal of Health Organization and Management 31, no. 1 (March 20, 2017): 96–109. http://dx.doi.org/10.1108/jhom-04-2016-0067.
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Purpose Health systems are periodically confronted by crises – think of Severe Acute Respiratory Syndrome, H1N1, and Ebola – during which they are called upon to manage exceptional situations without interrupting essential services to the population. The ability to accomplish this dual mandate is at the heart of resilience strategies, which in healthcare systems involve developing surge capacity to manage a sudden influx of patients. The paper aims to discuss these issues. Design/methodology/approach This paper relates insights from resilience research to the four “S” of surge capacity (staff, stuff, structures and systems) and proposes a framework based on complexity theory to better understand and assess resilience factors that enable the development of surge capacity in complex health systems. Findings Detailed and dynamic complexities manifest in different challenges during a crisis. Resilience factors are classified according to these types of complexity and along their temporal dimensions: proactive factors that improve preparedness to confront both usual and exceptional requirements, and passive factors that enable response to unexpected demands as they arise during a crisis. The framework is completed by further categorizing resilience factors according to their stabilizing or destabilizing impact, drawing on feedback processes described in complexity theory. Favorable order resilience factors create consistency and act as stabilizing forces in systems, while favorable disorder factors such as diversity and complementarity act as destabilizing forces. Originality/value The framework suggests a balanced and innovative process to integrate these factors in a pragmatic approach built around the fours “S” of surge capacity to increase health system resilience.
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Li, Lele, Mengyi Tian, and Debin Gu. "Policy Evaluation of the Reform of Ambulatory Patient Groups Based on Access, Quality, and Cost of the Iron Triangle Value Chain in China." Health & Social Care in the Community 2024 (February 5, 2024): 1–13. http://dx.doi.org/10.1155/2024/5581353.
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Objective. As part of the efforts to build a practical, effective, and diversified medical insurance payment method, it is crucial for China to deepen the reform of ambulatory patient groups (APGs). This study was aimed to explore the mechanism and effect of this policy from three dimensions, including medical expenses, medical insurance funds, and medical services. Methods. In 2020, China’s pilot reform of APG was initiated in Jinhua City, Zhejiang Province. Descriptive statistics, correlation analysis, and OLS regression analysis were utilized to evaluate the effect of the APG reform in Jinhua. Results. The implementation of the reform can contribute significantly to establishing a comprehensive medical service governance mechanism of classified settlement and coordinated promotion. It also plays a critical role in safeguarding people’s lives and health by promoting the high-level development of medical insurance systems and public hospitals, optimizing the quality of medical services, and improving the efficiency of medical insurance funds. Conclusion. Through the lens of policy evaluation, our findings can provide useful experience for the implementation of the outpatient medical insurance payment method in developing countries.
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Colville, Tracey, James M. E. Boyle, and Marc C. Obonsawin. "‘Why is this child in special education?’: A cultural-historical activity theory-based research intervention with senior UK education leaders on assessment for, and allocation of, specialist educational resources." Educational and Child Psychology 40, no. 2 (June 2023): 23–53. http://dx.doi.org/10.53841/bpsecp.2023.40.2.23.
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AimsThis paper focuses upon systemic change in a local authority decision-making process (DMP) for allocating specialist resources for children with complex educational needs in a local authority in Scotland. The aim of the paper is to provide reflections and insights into the learning of senior managers and leaders of children’s services to lead organisational change processes.MethodThe original research study design was a two-stage, CHAT-based Developmental-Work-Research (DWR) formative intervention with nine senior managers over an 18-month period. Stage one, reported in this paper, comprised four, three-hour sessions enabling expansion of participants’ learning through a collective zone of proximal development (ZPD). Stage two was evaluation of the intervention as a change process framework and evaluation of implementation of the new model considered as a cycle of expansive learning (discussed elsewhere).FindingsExpansive learning and transformative agency in DWR sessions occurred via four key turning points. An initial focus on problems with, and then improvement of, the DMP shifted to a re-configuration of children’s services leading to the generation of a new model for meeting the children’s needs in mainstream school settings. Findings indicate that a CHAT-based intervention can support the development of new ways of learning, leadership and working to enable public services to make more effective use of resources.LimitationsSeveral groups such as social workers, allied health professionals, parents and young people were not represented directly in this study. Further research using DWR with these groups would contribute to a broader understanding of how systems within children’s services impact on service users.ConclusionCHAT has theoretical and practical relevance for professionals who engage in collaborative real-world research. Findings from the study contribute to the body of knowledge for leadership learning and intervention around change processes in educational systems.
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Kern, Christoph, Dun Jack Fu, Karsten Kortuem, Josef Huemer, David Barker, Alison Davis, Konstantinos Balaskas, Pearse A. Keane, Tom McKinnon, and Dawn A. Sim. "Implementation of a cloud-based referral platform in ophthalmology: making telemedicine services a reality in eye care." British Journal of Ophthalmology 104, no. 3 (July 18, 2019): 312–17. http://dx.doi.org/10.1136/bjophthalmol-2019-314161.
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BackgroundHospital Eye Services (HES) in the UK face an increasing number of optometric referrals driven by progress in retinal imaging. The National Health Service (NHS) published a 10-year strategy (NHS Long-Term Plan) to transform services to meet this challenge. In this study, we implemented a cloud-based referral platform to improve communication between optometrists and ophthalmologists.MethodsRetrospective cohort study conducted at Moorfields Eye Hospital, Croydon (NHS Foundation Trust, London, UK). Patients classified into the HES referral pathway by contributing optometrists have been included into this study. Main outcome measures was the reduction of unnecessary referrals.ResultsAfter reviewing the patient’s data in a web-based interface 54 (52%) out of 103 attending patients initially classified into the referral pathway did not need a specialist referral. Fourteen (14%) patients needing urgent treatment were identified. Usability was measured in duration for data input and reviewing which was an average of 9.2 min (median: 5.4; IQR: 3.4–8.7) for optometrists and 3.0 min (median: 3.0; IQR: 1.7–3.9) min for ophthalmologists. A variety of diagnosis was covered by this tool with dry age-related macular degeneration (n=34) being most common.ConclusionAfter implementation more than half of the HES referrals have been avoided. This platform offers a digital-first solution that enables rapid-access eye care for patients in community optometrists, facilitates communication between healthcare providers and may serve as a foundation for implementation of artificial intelligence.
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Fraser, Benjamin T., and Russell G. Congalton. "Monitoring Fine-Scale Forest Health Using Unmanned Aerial Systems (UAS) Multispectral Models." Remote Sensing 13, no. 23 (November 30, 2021): 4873. http://dx.doi.org/10.3390/rs13234873.
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Forest disturbances—driven by pests, pathogens, and discrete events—have led to billions of dollars in lost ecosystem services and management costs. To understand the patterns and severity of these stressors across complex landscapes, there must be an increase in reliable data at scales compatible with management actions. Unmanned aerial systems (UAS or UAV) offer a capable platform for collecting local scale (e.g., individual tree) forestry data. In this study, we evaluate the capability of UAS multispectral imagery and freely available National Agricultural Imagery Program (NAIP) imagery for differentiating coniferous healthy, coniferous stressed, deciduous healthy, deciduous stressed, and degraded individual trees throughout a complex, mixed-species forests. These methods are first compared to assessments of crown vigor in the field, to evaluate the potential in supplementing this resource intensive practice. This investigation uses the random forest and support vector machine (SVM) machine learning algorithms to classify the imagery into the five forest health classes. Using the random forest classifier, the UAS imagery correctly classified five forest Health classes with an overall accuracy of 65.43%. Using similar methods, the high-resolution airborne NAIP imagery achieved an overall accuracy of 50.50% for the five health classes, a reduction of 14.93%. When these classes were generalized to healthy, stressed, and degraded trees, the accuracy improved to 71.19%, using UAS imagery, and 70.62%, using airborne imagery. Further analysis into the precise calibration of UAS multispectral imagery, a refinement of image segmentation methods, and the fusion of these data with more widely distributed remotely sensed imagery would further enhance the potential of these methods to more effectively and efficiently collect forest health information from the UAS instead of using field methods.
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Dharmawan, Yudhy, Ahmad Fuady, Ida J. Korfage, and Jan Hendrik Richardus. "Delayed detection of leprosy cases: A systematic review of healthcare-related factors." PLOS Neglected Tropical Diseases 16, no. 9 (September 6, 2022): e0010756. http://dx.doi.org/10.1371/journal.pntd.0010756.
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Background In new leprosy cases, grade 2 disability (G2D) is still a public health burden worldwide. It is often associated with the delayed leprosy diagnoses that healthcare systems should play a crucial role in preventing. The aim of this systematic review was to identify healthcare factors related to delays in case detection in leprosy. Methods PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was used as a guideline in this research. The study protocol was registered in the PROSPERO (International Prospective Register of Systematic Reviews) with reference code CRD42020189274. Data was collected from five electronic databases: Embase.com, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. Results After applying the selection criteria for original empirical studies, and after removing duplicates, we included 20 papers from 4313 records. They had been conducted in ten countries and published between January 1, 2000, and January 31, 2021. We identified three categories of healthcare factors related to delayed case. 1) Structural factors, such as i) financial and logistic issues, and geographical circumstances (which we classified as barriers); ii) Health service organization and management including the level of decentralization (classified as facilitators). 2) Health service factors, such as problems or shortages involving referral centers, healthcare personnel, and case-detection methods. 3) Intermediate factors, such as misdiagnosis, higher numbers of consultations before diagnosis, and inappropriate healthcare services visited by people with leprosy. Conclusions Delays in leprosy case detection are due mainly to misdiagnosis. It is crucial to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services.
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HARDILL, IRENE, JACQUI SPRADBERY, JUDY ARNOLD-BOAKES, and MARIA LUISA MARRUGAT. "Severe health and social care issues among British migrants who retire to Spain." Ageing and Society 25, no. 5 (August 23, 2005): 769–83. http://dx.doi.org/10.1017/s0144686x05004034.
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In recent years, there has been a growth in academic interest in international retirement migration in Europe, particularly north-south retirement migration to destinations like Spain. In this paper we focus on those members of the British community who have lived in Spain for a considerable time and for whom familial, social and institutional ties with Britain are weak or disrupted. Age Concern España was established by members of the British community to provide information and services on healthcare, benefits and local services in Spain. Four indicative case studies of those requesting assistance and classified as being of ‘serious need’ are presented. They illustrate the ways in which happy and fulfilling lives in Spain were abruptly changed as the person's resources (bodily, economic, social and skills) for independent living diminished, and in which institutions and friendship networks played a key role in supporting life. The paper is the product of collaboration between researchers and practitioners in Spain and the UK, and brings together previous research with new qualitative case studies. Whilst policy-makers, practitioners and gerontologists have an increasing awareness of the needs of older migrants and the challenges they pose for public policy, particularly for health and social care systems in Spain, there have been little sustained analysis and cross-country debate.
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Barry, Sarah, Malgorzata Stach, Steve Thomas, and Sara Burke. "Understanding service reorganisation in the Irish health & social care system from 1998 to 2020: lessons for reform and transformation." HRB Open Research 4 (September 24, 2021): 106. http://dx.doi.org/10.12688/hrbopenres.13342.1.
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Background: Given policy drives for integrated care and other reforms requiring service reorganisation this study analyses service reorganisation in the Irish health and social care system from 1998 to 2020 with the aim of identifying lessons for reform implementation and system learning generally. Methods: A mixed-method, co-designed study of three distinct datasets through in a policy document analysis, a thematic analysis of interviews with elite respondents, and a formal review of the international literature, sets the Irish reorganisation story in the context of services and system reorganisation elsewhere. This approach is apt given the complexity involved. Results: We find repeated policy declarations for forms of integrated care from the early 1990s in Ireland. These have not resulted in effective change across the system due to political, organisational and implementation failures. We identify poor clarity and commitment to policy and process, weak change management and resourcing, and reluctance from within the system to change established ways of working, cultures and allegiances. Given its narrative approach and identification of key lessons, this study is of use to policy makers, researchers and practitioners, clinical and managerial. It forms part of a bigger project of evidence building for the implementation of Sláintecare, Ireland’s 10-year health system reform programme. Conclusions: The paper captures important lessons for regionalisation of services delivery and other reorganisations in service-based systems more generally. We find evidence of a negative policy/implementation/practice cycle repeatedly missing opportunities for reform. Learning to break this cycle is essential for implementing Sláintecare and other complex reorganisational health reforms generally.
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Fisher, Andrew, Patrick McLane, and Eddy Lang. "The Alberta Health Services Emergency Strategic Clinical Network™ Quality Improvement and Innovation Forum presented on February 22, 2022." Canadian Journal of Emergency Nursing 45, no. 2 (July 12, 2022): 1. http://dx.doi.org/10.29173/cjen191.
Full textAbstract:
Evidence-based research and quality improvement work are pivotal to health systems meeting their goals. Translating findings and disseminating innovative practices to new settings occurs in part through knowledge translation events, such as conferences and workshops.
The Emergency Strategic Clinical Network™ (ESCN) Quality Improvement and Innovation Forum fills a gap between local and national events. It is devoted to sharing methods and results of emergency department projects in Alberta among those working in emergency care. Despite the challenges presented by the COVID-19 pandemic, 2022 was the fourth consecutive year the ESCN has held this event.
The event provides an opportunity for those working on quality improvement in emergency medicine to network with one another, share innovative projects, share know how and translate promising works to new settings. In addition, the event provides an opportunity to identify projects for potential development through local, provincial, or national funding opportunities. This year’s forum was, again, held virtually due to the ongoing pandemic. 18 teams provided oral presentations including the ESCN patient advisors who shared details of how to engage patients in quality improvement work.. Not all abstracts are published in this collection, as some abstracts will have been previously published elsewhere.
Strong attendance shows the value practitioners see in the forum. In 2022, approximately 121 educators, managers, nurses, physicians and researchers from across Alberta and British Columbia, attended the forum. Post-event evaluation survey feedback suggests that the online format was greatly appreciated and many of the initiatives presented would be pursued further by participants.
The findings presented in the abstracts are solely the work of the submitting authors. The ESCN does not guarantee the accuracy of any reported information. The views expressed in the abstracts are solely the views of the authors and do not represent the ESCN or Alberta Health Services.
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Jauhiainen, Annikki, Päivi Sihvo, Heli Jääskeläinen, Juuso Ojasalo, and Susanne Hämäläinen. "Skenaariotyöskentelyllä tietoa tulevaisuuden sosiaali- ja terveyspalveluista ja osaamistarpeista." Finnish Journal of eHealth and eWelfare 9, no. 2-3 (May 21, 2017): 137. http://dx.doi.org/10.23996/fjhw.61002.
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The aim of the two development projects was to provide information about the future of digital social- and health care and the necessary future competencies. Data acquisition was carried out by scenario work in the future workshops. The workshops were attended total of 73 people. The participants worked in the social and health care, both in the public and private sectors, in ICT companies, in educational organizations, and in the third sector. Among the participants were also ordinary citizens. The workshops were remotely connected and data was collected into electronic bulletin boards.
The workshops produced total of 25 scenarios, which found eight different themes: information management, quantified self, remote services, robotics - automation of manual labour, multiprofessionality, digital architecture, customer-oriented services and the customer's responsibility, and human encounter.
Future competency consisted of ten areas of expertise, which classified into three broader categories: basic know-how of social and health care professionals, special know-how of social and health care professionals and the collective know-how of social and health care and technology professionals. The special know-how also includes information systems and software development skills.
Scenario work provided preliminary information about the future social and health services and qualifications. This information will be used in further development projects of digital services as well as more widely in education planning. The future workshops provided information about the scenario method and its compatibility with development activities.
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Claude Mutiganda, Jean. "Circuits of power and accountability during institutionalisation of competitive tendering in public sector organisations." Qualitative Research in Accounting & Management 11, no. 2 (June 10, 2014): 129–45. http://dx.doi.org/10.1108/qram-04-2014-0034.
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Purpose – This study aims to analyse the role of circuits of power in institutionalising competitive tendering in public sector organisations and effects on accountability among public decision makers. Design/methodology/approach – The study used intensive field research data based on interviews, meeting observations and document analysis in a city, referred to as Sunset City, in Finland from 2008 to 2013. Findings – The relationship between institutionalisation of competitive tendering and accountability for total costs of public services depends on how public officials use management accounting and control systems to limit procurement risks and how political decision makers hold public officials to account. This study uses the concept of organisational outflanking within the circuits of power to analyse and explain the finding of ceremonial accountability. Research limitations/implications – Empirical findings cannot be generalised to other situations, but the theoretical framework used in this study can be applied elsewhere. Practical implications – It is advisable to avoid institutionalising macro-institutional market-based mechanisms, such as open competitive tendering in public health care organisations and municipalities in the EU, the consequences of which in terms of total costs, quality of services and accountability among organisational actors at local levels cannot be foreseen, minimised or controlled. Originality/value – This study uses the framework of circuits of power to extend the Burns and Scapens institutional framework to accountability for using public funds in outsourcing services during the ongoing financial crisis.
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Hudson, Christopher G., and Eva Dragomirecka. "Decision Making in Psychiatric Reform: A Case Study of the Czech Experience." Central European Journal of Public Policy 13, no. 2 (November 12, 2019): 15–27. http://dx.doi.org/10.2478/cejpp-2019-0007.
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Abstract This study examines the initial impact of a broadly participatory planning process in the Czech Republic during 2016–2017, aimed at both reducing inpatient care and expanding community mental health systems, on policy and programmatic decision making. A central focus of the study involves the trade-offs between and efforts to integrate shared decision making with evidence-based planning methods within the context of a national psychiatric reform strategy, particularly one involving a former Soviet bloc state. Given the uniqueness of the Czech experience, an exploratory case study methodology is used, one involving ten interviews with key informants and examination of a wide variety of documents. Results include the development of broad new decision and oversight structures, and the initial implementation of community mental health services. The nation faces some of the same trade-offs found elsewhere, such as in the United States, between an inclusive participatory process, and one that systematically incorporates empirical rational and evidence and best practices within bounded parameters. Implications for new psychiatric deinstitutionalization initiatives are identified, including development of a national mental health authority, a professional workforce, new funding strategies, multi-level service coordination, mechanisms to assure transparency, among others.
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Rona, Almos, and Pramono Pramono. "LEKSIKON ETNOMEDISIN DALAM PENGOBATAN TRADISIONAL MINANGKABAU." JURNAL ARBITRER 2, no. 1 (April 29, 2015): 44. http://dx.doi.org/10.25077/ar.2.1.44-53.2015.
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System of traditional medicine to this day is still alive, although the practices of modern medicine is growing rapidly with the emergence of centers of government and private health services. The phenomenon Back to Nature (back to nature) are increasingly intensified by the developed countries have a positive impact on the flourishing of the traditional medical systems. The method used to analyze the data are unified method. Unified method used is equivalent translational methods and methods of unified referential. In this study lexicon Minangkabau traditional medicine can be classified into three groups: the types of diseases, types of herbs and treatment process. Keywords: traditional medicine, Minangkabau, lexicon
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Pogorzelczyk, Katarzyna, Joanna Synoweć, Andrzej Basiński, Daniel Ślęzak, Marlena Robakowska, Przemysław Żuratyński, and Wioletta Mędrzycka-Dąbrowska. "Cost analysis of treating pain patients on the example of the Clinical accident ward Of university Clinical Centre in Gdańsk." BÓL 20, no. 2 / Zjazd PTBB (September 17, 2019): 1–6. http://dx.doi.org/10.5604/01.3001.0013.4614.
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The cost analysis of pain treatment is not a topic often taken up by the health economists community. The subjective dimension and pain assessment by the patient is one of the main determinants of the lack of interest in this topic. Work carried out on this topic currently includes analysis accompanying the process of pharmacotherapy treatment, care provided by medical personnel as well as costs resulting from administrative services. The aim of the work is to present the cost analysis of care for a „pain” patient and to indicate the most optimal financial package of these activities. The study was performed on the basis of financial data of the Clinical Emergency Department of the University Clinical Center in Gdańsk for the last year. We analyzed the cases of patients complaining of pain who received pharmacotherapy. Results The total cost for 2017 amounted to 1.128.668 PLN. The largest amount of money was allocated to the group of patients qualified to the group R: „Symptoms, disease features and abnormal results of clinical trials not classified elsewhere” – 327.313.72 PLN. The symptom of pain is one of the most frequently indicated symptoms among patients who receive medical help at the Clinical Emergency Department of the University Clinical Center in Gdańsk, which should be associated with a greater degree of involvement in analgesic therapy in patients who require it.