Relevant bibliographies by topics / Nursing care delivery system

Academic literature on the topic 'Nursing care delivery system'

Author: Grafiati
Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "Nursing care delivery system"

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Wake, Madeline Musante. "Nursing Care Delivery Systems." JONA: The Journal of Nursing Administration 20, no. 5 (May 1990): 47. http://dx.doi.org/10.1097/00005110-199005000-00011.

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Neidlinger, Susan H., and Marie B. Miller. "Nursing Care Delivery Systems." JONA: The Journal of Nursing Administration 20, no. 10 (October 1990): 43???49. http://dx.doi.org/10.1097/00005110-199010000-00010.

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Matumoto, Silvia, Kátia Cristina dos Santos Vieira, Maria José Bistafa Pereira, Claudia Benedita dos Santos, Cinira Magali Fortuna, and Silvana Martins Mishima. "Production of nursing care in primary health care services." Revista Latino-Americana de Enfermagem 20, no. 4 (August 2012): 710–17. http://dx.doi.org/10.1590/s0104-11692012000400011.

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This descriptive and quantitative study aimed to characterize the production of nursing care in primary health care services in a region of the city of Ribeirão Preto, state of São Paulo, Brazil. The study sample comprised care actions delivered by nurses and registered in the HygiaWeb Information System, from 2006 to 2009. Statistical analysis was performed. Results showed that nursing care delivered by nurses accounted for 9.5 to 14.6% of total professional care provided by professionals. Eventual care actions were the most frequent. The concentration of programmatic care was higher for children, women, pregnant and postpartum women. In conclusion, the predominance of eventual care demonstrated that the health system has been focused on acute conditions. Little of nursing work has been directed at the achievement of comprehensiveness, considering the inexpressive share of longitudinal follow up in total care delivery. The expansion of nursing staff represents potential for care delivery to the population, but further qualification of nursing actions is needed.
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Saputra, C., and Y. Arif. "Nursing Informatics System in Health Care Delivery." KnE Life Sciences 4, no. 10 (March 12, 2019): 38. http://dx.doi.org/10.18502/kls.v4i10.3827.

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Beiranvand, Samira, Maryam Rassouli, Maryam Hazrati, Shahram Molavynejad, Suzanne Hojjat, Hanna Tuvesson, and Kourosh Zarea. "Hospice care delivery system requirements." International Journal of Palliative Nursing 28, no. 12 (December 2, 2022): 562–74. http://dx.doi.org/10.12968/ijpn.2022.28.12.562.

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Background: Hospice care is a perceived need in the Iranian health system. Aim: This qualitative study is explaining the stakeholders’ perception of what is required to develop a hospice care system for patients living with cancer in Iran. Methods: A total of 21 participants (specialists, policymakers, healthcare providers, cancer patients and family caregivers) were selected through purposeful sampling and interviewed in-depth in 2020. Interviews were analysed through directed content analysis. Findings: A total of 1054 codes, 7 categories and 21 subcategories were extracted. The requirements include the need to provide: multiple settings and diverse services; participatory decision making; integration into the health system; specialised human resources; an organised system of accountability; the preparation of the existing health system; and wider capacity-building in existing Iranian society. Conclusion: It is essential that Iranian services create a participatory comprehensive care plan, utilise expert manpower, integrate hospice care into the existing health system and organise a system of accountability. Policymakers should focus on the preparation of the health system and capacity building in society.
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Brennan, Patricia Flatley. "Computer Link-A Computerized Nursing Care Delivery System." Western Journal of Nursing Research 14, no. 2 (April 1992): 239–40. http://dx.doi.org/10.1177/019394599201400211.

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Davis, Anne J. "Nursing and the American health care delivery system." International Journal of Nursing Studies 23, no. 2 (January 1986): 179. http://dx.doi.org/10.1016/0020-7489(86)90008-8.

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Guild, Susan D., Rebecca Wrede Ledwin, Deborah M. Sanford, and Terri Winter. "Development of an Innovative Nursing Care Delivery System." JONA: The Journal of Nursing Administration 24, no. 3 (March 1994): 25???29. http://dx.doi.org/10.1097/00005110-199403000-00008.

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Pascual, Glenn D. "Nursing Communication Bundle: Behavior Standards Review Article Series: 1." International Journal of Nursing Sciences and Clinical Practices 2, no. 1 (November 11, 2021): 1–6. http://dx.doi.org/10.47890/ijnscp/glenndpascual/2021/10042116.

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Changing healthcare delivery systems demand greater accountability from hospital organizations and healthcare providers (Briggs et al., 2018). The radical restructuring of the healthcare system that is required to reduce spiraling healthcare costs and make healthcare accessible to all citizens will necessitate ongoing changes in healthcare organizations. The challenge for hospital organizations is to improve quality and service delivery through an ongoing process of innovation, restructuring of systems and processes, and implementation of aligned service behaviors to increase patient satisfaction and enhance clinical outcomes (Figure 1.0). Patient satisfaction scores serve as system indicators for financial reimbursement from government and private insurance agencies and as impetus for hospital organizations to choose the functional system of delivering care to improve quality, achieve desired outcomes, and enhance the patient care experience. Given the macroeconomic nature of the impact of patient satisfaction scores on hospital reimbursement, the challenge for healthcare organizations is to improve quality and service delivery through an ongoing process of innovation, restructuring systems and processes, and implementation of aligned standardized service behaviors to increase patient satisfaction and enhance clinical outcomes. Hospitals under the current healthcare landscape are rewarded for the quality of care provided; thus, better outcomes indicate hospitals’ financial viability (Centers for Medicare and Medicaid Services, 2018).Managing service delivery across a highly divergent and fast-paced healthcare system requires sharp focus on execution and standardized operational excellence. Continuous quality improvement (CQI) has been shown to be a powerful tool to help make health care organizations more effective. CQI is a structured system for creating organization-wide participation and partnership in planning and implementing continuous improvement methods to understand, meet, or exceed patient needs and expectations. Developing a culture of excellence and quality in care can create an enthusiasm for change, passion for results, and drive for innovation equating to better service to healthcare consumers and better patient satisfaction scores.
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Yu, SoYoung, and IlSun Ko. "Healthcare and Nursing Care Delivery System in South Korea." JONA: The Journal of Nursing Administration 40, no. 11 (November 2010): 460–62. http://dx.doi.org/10.1097/nna.0b013e3181f88a5c.

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Dissertations / Theses on the topic "Nursing care delivery system"

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Larsen, Trudean Charlotte. "A study of nurses' empathy in two different nursing care delivery systems." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq24975.pdf.

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Greenberg, Mary E. "The Process of Care Delivery in Telephone Nursing Practice: A Grounded Theory Approach." Diss., Tucson, Ariz. : University of Arizona, 2005. http://etd.library.arizona.edu/etd/GetFileServlet?file=file:///data1/pdf/etd/azu%5Fetd%5F1236%5F1%5Fm.pdf&type=application/pdf.

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Koritor, Christine N. "A study comparing two health care delivery systems, for gerontological patients, and the incidence of hospitalization /." Staten Island, N.Y. : [s.n.], 1994. http://library.wagner.edu/theses/nursing/1994/thesis_nur_1994_korit_study.pdf.

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Mazur, Lukasz Maciej. "The study of errors, expectations and skills for medication delivery systems improvement." Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/mazur/MazurL0508.pdf.

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Medication errors occurring in hospitals are a growing national concern. The enormous gaps in knowledge related to medication errors are often seen as major reasons for increased patient safety risks and increased waste in the hospital setting. However, little research effort in industrial and management engineering has been devoted specifically to medication delivery systems to improve or optimize their operations in terms of patient safety and systems efficiency and productivity. As a result, the current literature does not offer integrated solutions to overcome the workflow and management difficulties with medication delivery. Therefore, a better understanding of workflow and management sources of medication errors is needed to help support decisions about investing in strategies to reduce medication errors. Using qualitative and quantitative research methods the work reported in this dissertation makes several contributions to the existing body of knowledge. First, using healthcare professionals' perceptions of medication delivery system, a set of simple and logical workflow design rules are proposed. If properly implemented, the proposed rules are capable of eliminating the unnecessary variations in the process of medication delivery which cause medication errors and waste. Second, a theoretical model of 'expectations' for effective management of medication error reporting, analysis and improvement is provided. The practical implication of this theoretical model extends to effective management strategies that can increase feelings of competence and help create a culture that values improvement efforts. Third, eight propositions for effective use of a systems engineering method (in this research the "Map-to-Improve" (M2I) method) for medication delivery improvement are offered. Finally, a set of skills needed for future healthcare professionals to effectively use systems engineering methods is provided. The proposed insights into these areas can result in improved pedagogy for professional development of healthcare professionals. The practical implication extends to the development of better methods for healthcare systems analysis. In summary, the author of this research work hopes that the findings and discussions will help healthcare organizations to achieve satisfactory improvement in medication delivery.
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Myers, Robert A. "Engineering Healthcare Delivery: A Systems Engineering Approach to Improving Trauma Center Nursing Efficacy." Wright State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=wright1482419145222356.

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Edgar, Linda. "The relationship between the characteristics of nursing care delivery systems and work-motivation, satisfaction, and intent to leave." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp02/NQ36974.pdf.

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Miller, Donna Marie. "Establishing Inter Rater Reliability of the National Early Warning Score." Walsh University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=walsh1429472548.

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Bosire, Joshua. "Designing an integrated surgical care delivery system." Diss., Online access via UMI:, 2007.

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Johnston, Diann M. "The relationship between RN job satisfaction in a modified primary nursing delivery system and a team nursing delivery system /." Staten Island, N.Y. : [s.n.], 1989. http://library.wagner.edu/theses/nursing/1989/thesis_nur_1989_johns_relat.pdf.

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Phiri, Jane. "Socioeconomic inequalities in Zambia's public health care delivery system." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/9458.

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Includes bibliographical references.
In this thesis, equality is considered as the absence of differences in utilization among individuals of different socioeconomic status while equity is taken to mean that individuals in equal need of health care should use the same amount of care, irrespective of their socioeconomic status. Using the above definitions, this thesis, examines equity/inequality in the utilization of public health care in Zambia. Concentration curves, concentration indices and horizontal equity indices were used for this purpose. This thesis focuses specifically on public health care that is subsidized by the Government. It is anticipated that the findings of this thesis will broaden the knowledge base on health care utilization inequities in Africa.
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Books on the topic "Nursing care delivery system"

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author, Manthey Marie, Manthey Marie, and Creative HealthCare Management (Minneapolis, Minn.), eds. Primary nursing: Person-centered care delivery system design. Minneapolis, MN: Creative Health Care Management, 2015.

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Hawkins, Joellen Watson. Nursing and the American health care delivery system. 3rd ed. New York City: Tiresias Press, 1989.

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Pierfedeici, Higgins Loretta, ed. Nursing and the American health care delivery system. 4th ed. New York City: Tiresias Press, 1993.

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Terry, T. J. The systems nurse: Designing health care systems for quality care delivery to all people. DeLand, FL: Health Care Systems, 1994.

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Shaw, Sally. Globalisation and health system reform: Implications and strategies for nursing. Geneva, Switzerland: ICN, 2004.

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Premier's Commission on Future Health Care for Albertans. Caring and commitment: Concerns of nurses in the hospital and nursing home system : interim report, June 1988. Edmonton, Alta: Premier's Commission on Future Health Care for Albertans, 1988.

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Health policy: Crisis and reform in the U.S. health care delivery system. 4th ed. Sudbury, Mass: Jones and Bartlett Publishers, 2004.

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K, Raffel Norma, ed. The U.S. health system: Origins and functions. 4th ed. Albany, N.Y: Delmar Publishers, 1994.

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Raffel, Marshall W. The U.S. health system: Origins and functions. 3rd ed. New York: Wiley, 1989.

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Gumbiner, Robert. Curing our sick health care system: A solution to America's health care crisis. 2nd ed. Bloomington, IN: AuthorHouse, 2008.

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Book chapters on the topic "Nursing care delivery system"

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Bramwell, Donna, Kath Checkland, Jolanta Shields, and Pauline Allen. "2015–Date: Focus on Integration." In Community Nursing Services in England, 83–91. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-17084-3_8.

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AbstractThis chapter centres on the publishing of the NHS Long Term Plan in 2019 and subsequent revised Health and Social Care Act (2022), both of which focus on integrated, out-of-hospital approaches to health service delivery. The creation of a layered system across geographical levels is advocated, with nested levels of ‘place’ and ‘neighbourhood’ intended to be the building blocks of Integrated Care Systems (ICS), which replaced CCGs in July 2022. We introduce the concept of newly created, ‘neighbourhood level’, Primary Care Networks (PCNs) of general practices and how district nurses fit into them, especially with regard to their organisation around geographical versus GP registered lists. Whilst not explicitly mentioned in the H&SC Act, it is clear that the Act situates community-based services as essential in the context of the desire to reduce the amount of hospital care, which has implications for district nursing services in particular. This mode of care delivery will require multi-disciplinary team working across all levels of the new system whereby community nurses will be required to liaise and co-ordinate with primary and social care to deliver services. Continuance of case management approaches for patients with complex needs and lack of funding in the social care system, means that we discuss in this chapter, the further strain on already pressured community nursing teams.
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Bramwell, Donna, Kath Checkland, Jolanta Shields, and Pauline Allen. "1990s: The Introduction of the Internal Market." In Community Nursing Services in England, 43–59. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-17084-3_5.

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AbstractThe National Health Service and Community Care Act 1990, set in motion by the publication of the 1989 White Papers—Working for Patients and Caring for People, saw an intense time of policy change which would profoundly impact community and district nursing services. These papers ushered in the introduction of the internal market with purchaser/provider split between commissioners and providers of services, aiming for better services, better patient choice and to reduce costs. This chapter focuses on how the NHS was re-structured to facilitate this quasi-market organisation with Health Authorities (HAs), once pivotal, replaced by Primary Care Groups (PCGs) at the end of the decade. We document here the impact of these changes on the district nursing service as well as bringing to the fore that it was a service in crisis and in need of attention. Heavy caseloads coupled with a diminishing workforce led to a review of the grading system and an increasing use of ‘skill-mix’. We also highlight that aligned with internal marketisation ideals, funding of community services was based on a crude count of average number of contacts rather than based on the complexities of the role. As ever, there was a need for district nurses to ‘deliver more for less’ (Audit Commission, 1999, p. 94) at the end of the era.
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Woodrow, Philip. "Central nervous system injury." In Intensive Care Nursing, 363–76. Fourth edition. | Abingdon, Oxon ; New York, NY : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781315231174-36.

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Squires, Allison. "The Global Context of Health Care Delivery." In Nurses and Nursing, 149–62. Abingdon, Oxon ; New York, NY : Routledge, 2017.: Routledge, 2017. http://dx.doi.org/10.4324/9781315641744-12.

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Frith, Jennifer, and Nelson J. Chao. "Oncology Nursing Care." In The Comprehensive Cancer Center, 57–62. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-82052-7_7.

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AbstractThis chapter explores the recommendations in developing oncology nursing care for a comprehensive medical center. Nursing orientation, continuing education, and competencies are required for the oncology nurse to remain successful in care delivery. Nurse–patient ratios should be benchmarked with other competitive centers, acuity taken into consideration, and various workflows depending on the clinical settings. Nurses play an instrumental role in delivering oncology care, from preventative screening, throughout the continuum, and into end-of-life care.
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Buchanan, Eileen. "Older people in society: sociopolitical implications and the impact on health care delivery." In Nursing in Primary Care, 279–306. London: Macmillan Education UK, 2001. http://dx.doi.org/10.1007/978-0-230-21366-1_13.

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Bradley, Cynthia Sherraden, Joanne Donnelly, and Nellie Munn Swanson. "Simulations-Based Care Delivery." In Nursing and Informatics for the 21st Century – Embracing a Digital World, 3rd Edition, Book 3, 169–88. New York: Productivity Press, 2022. http://dx.doi.org/10.4324/9781003281016-10.

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Blythin, Peter. "Triage — A Nursing Care System." In Management and Practice in Emergency Nursing, 97–120. Boston, MA: Springer US, 1988. http://dx.doi.org/10.1007/978-1-4899-3146-7_6.

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Shu-Chin, Lu. "An Experimental Hospital-based Oncology Home-Care Nursing System." In Cancer Nursing, 145–46. London: Macmillan Education UK, 1989. http://dx.doi.org/10.1007/978-1-349-10714-8_50.

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Valentine, Fay, and Peter Mcnee. "Context of Care and Service Delivery." In Nursing Care of Children and Young People with Chronic Illness, 29–54. Oxford, UK: Blackwell Publishing Ltd, 2008. http://dx.doi.org/10.1002/9780470692103.ch2.

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Conference papers on the topic "Nursing care delivery system"

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"Remaining Connected with our Graduates: A Pilot Study." In InSITE 2019: Informing Science + IT Education Conferences: Jerusalem. Informing Science Institute, 2019. http://dx.doi.org/10.28945/4162.

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[This Proceedings paper was revised and published in the 2019 issue of the Interdisciplinary Journal of E-Skills and Lifelong Learning, Volume 15.] Aim/Purpose This study aims to determine where nursing students from a metropolitan university subsequently work following graduation, identify the factors that influence decisions to pursue careers in particular locations, ascertain educational plans in the immediate future; and explore the factors that might attract students to pursue postgraduate study. Background The global nursing shortage and high attrition of nursing students remain a challenge for the nursing profession. A recurrent pattern of maldistribution of nurses in clinical specialities and work locations has also occurred. It is imperative that institutions of learning examine their directions and priorities with the goal of meeting the mounting health needs of the wider community. Methodology Qualitative and quantitative data were obtained through an online 21-item questionnaire. The questionnaire gathered data such as year of graduation, employment status, the location of main and secondary jobs, the principal area of nursing activity, and plans for postgraduate study. It sought graduates’ reasons for seeking employment in particular workplaces and the factors encouraging them to pursue postgraduate study. Contribution This study is meaningful and relevant as it provided a window to see the gaps in higher education and nursing practice, and opportunities in research and collaboration. It conveys many insights that were informative, valuable and illuminating in the context of nurse shortage and nurse education. The partnership with hospitals and health services in providing education and support at the workplace is emphasized. Findings Twenty-three students completed the online questionnaire. All respondents were employed, 22 were working in Australia on a permanent basis (96%), 19 in urban areas (83%) with three in regional/rural areas (13%), and one was working internationally (4%). This pilot study revealed that there were varied reasons for workplace decisions, but the most common answer was the opportunity provided to students to undertake their graduate year and subsequent employment offered. Moreover, the prevailing culture of the organization and high-quality clinical experiences afforded to students were significant contributory factors. Data analysis revealed their plans for postgraduate studies in the next five years (61%), with critical care nursing as the most popular specialty option. The majority of the respondents (78%) signified their interest in taking further courses, being familiar with the educational system and expressing high satisfaction with the university’s program delivery. Recommendations for Practitioners The results of the pilot should be tested in a full study with validated instruments in the future. With a larger dataset, the conclusions about graduate destinations and postgraduate educational pursuits of graduates would be generalizable, valid and reliable. Recommendation for Researchers Further research to explore how graduates might be encouraged to work in rural and regional areas, determine courses that meet the demand of the market, and how to better engage with clinical partners are recommended. Impact on Society It is expected that the study will be extended in the future to benefit other academics, service managers, recruiters, and stakeholders to alert them of strategies that may be used to entice graduates to seek employment in various areas and plan for addressing the educational needs of postgraduate nursing students. The end goal is to help enhance the nursing workforce by focusing on leadership and retention. Future Research Future directions for research will include canvassing a bigger sample of alumni students and continuously monitoring graduate destinations and educational aspirations. How graduates might be encouraged to work in rural and regional areas will be further explored. Further research will also be undertaken involving graduates from other universities and other countries in order to compare the work practice of graduates over the same time frame.
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Hong, Sun-yeun, and Mi-ye Kim. "Effect of Application of Hybrid Simulation for Delivery Nursing Care." In Healthcare and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.116.15.

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Harvey, Clare, Rachel Forrest, Alannah Meyers, Clare Buckley, Jennifer Roberts, Shona Thompson, and Judy Searle. "Aberrant Work Environments – Rationed Care As System Failure Or Missed Care As Skills Failure?" In Annual Worldwide Nursing Conference. Global Science & Technology Forum (GSTF), 2014. http://dx.doi.org/10.5176/2315-4330_wnc14.78.

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Ramazanu, Sheena, and Jane Griffiths. "Caregivers' Experience Following Hip Fracture in Elderly Patients: Strengthening the Delivery of Integrated Nursing Care." In Annual Worldwide Nursing Conference (WNC 2017). Global Science & Technology Forum (GSTF), 2017. http://dx.doi.org/10.5176/2315-4330_wnc17.28.

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Lee, Hyunsook Zin. "Political Analysis of Chronic Disease Management System at Outpatient Clinic in Korea." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.21.

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Sun, Winnie, and Diane Doran. "Using Remote Activity Monitoring and Guideline System for Home Care Clients to Support Geriatric Nursing Care in the Community." In Annual Worldwide Nursing Conference. Global Science & Technology Forum (GSTF), 2014. http://dx.doi.org/10.5176/2315-4330_wnc14.20.

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Takahara, Madoka, Kakiha Nakamura, Fanwei Huang, Ivan Tanev, and Katsunori Shimohara. "Caregiver Support System for Nursing Care for Older Adults." In 2018 5th Asia-Pacific World Congress on Computer Science and Engineering (APWC on CSE). IEEE, 2018. http://dx.doi.org/10.1109/apwconcse.2018.00028.

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Hirata, Yasuhisa, Yusuke Sugiyama, and Kazuhiro Kosuge. "Control architecture of delivery robot for supporting nursing staff." In 2015 IEEE/SICE International Symposium on System Integration (SII). IEEE, 2015. http://dx.doi.org/10.1109/sii.2015.7404944.

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Kim, Hye Jin, Eun Kwang Yoo, Mi Joon Lee, and Myoung Hee Kim. "Operating System and Services of Sanhujori Centers as the Traditional Postpartum Care Facilities in Korea." In Healthcare and Nursing 2013. Science & Engineering Research Support soCiety, 2013. http://dx.doi.org/10.14257/astl.2013.40.18.

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Sakashita, Reiko, Atsuko Uchinuno, Kazuko Kamiizumi, Keiko Tei, and Noriko Awaya. "Web-Based Nursing Care Quality Improvement System with Fuzzy Recommendation System." In 2009 39th International Symposium on Multiple-Valued Logic. ISMVL 2009. IEEE, 2009. http://dx.doi.org/10.1109/ismvl.2009.22.

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Reports on the topic "Nursing care delivery system"

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Warren, Carolyn S. The Ambulatory Care Workload Management System for Nursing Reference Manual. Fort Belvoir, VA: Defense Technical Information Center, May 1991. http://dx.doi.org/10.21236/ada237257.

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Hoadley, Jack Hoadley, and Laura Summer Summer. The Role of Medicaid Managed Care In Delivery System Innovation. New York, NY United States: Commonwealth Fund, April 2014. http://dx.doi.org/10.15868/socialsector.25072.

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Bachrach, Deborah Bachrach, Mindy Lipson Lipson, and Lammot du Pont Pont. Arkansas: A Leading Laboratory for Health Care Payment and Delivery System Reform. New York, NY United States: Commonwealth Fund, August 2014. http://dx.doi.org/10.15868/socialsector.25009.

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Abrams, Melinda Abrams, Stuart Guterman Guterman, Rachel Nuzum Nuzum, Jamie Ryan Ryan, Mark Zezza Zezza, and Jordan Kiszla Kiszla. The Affordable Care Act's Payment and Delivery System Reforms: A Progress Report at Five Years. New York, NY United States: Commonwealth Fund, May 2015. http://dx.doi.org/10.15868/socialsector.25091.

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Billings, Deborah, Eliana Del Pozo, and Hugo Arevalo. Testing a model for the delivery of emergency obstetric care and family planning services in the Bolivian public health system. Population Council, 2003. http://dx.doi.org/10.31899/rh4.1124.

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Wiener, Joshua M., Mary E. Knowles, and Erin E. White. Financing Long-Term Services and Supports: Continuity and Change. RTI Press, September 2017. http://dx.doi.org/10.3768/rtipress.2017.op.0042.1709.

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This article provides an overview of financing for long-term services and supports (LTSS) in the United States, paying special attention to how it has changed and not changed over the last 30 years. Although LTSS expenditures have increased greatly (like the rest of health care), the broad outline of the financing system has remained remarkably constant. Medicaid—a means-tested program—continues to dominate LTSS financing, while private long-term care insurance plays a minor role. High out-of-pocket costs and spend-down to Medicaid because of those high costs continue to be hallmarks of the system. Although many major LTSS financing reform proposals were introduced over this period, none was enacted—except the Community Living Assistance Services and Supports Act, which was repealed before implementation because of concerns about adverse selection. The one major change during this time period has been the very large increase in Medicare spending for post-acute services, such as short-term skilled nursing facility and home health care. With the aging of the population, demand for LTSS is likely to increase, placing strain on the existing system.
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Hatef, Elham, Renee F. Wilson, Susan M. Hannum, Allen Zhang, Hadi Kharrazi, Jonathan P. Weiner, Stacey A. Davis, and Karen A. Robinson. Use of Telehealth During the COVID-19 Era. Agency for Healthcare Research and Quality (AHRQ), January 2023. http://dx.doi.org/10.23970/ahrqepcsrcovidtelehealth.

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Objectives. To assess how to provide telehealth care by identifying characteristics of telehealth delivery, patient populations, settings, benefits and harms, and implementation strategies during the COVID-19 era. Data sources. PubMed®, CINAHL®, PsycINFO®, and the Cochrane Central Register of Controlled Trials were searched from March 2020 to May 2022. Additional studies were identified from reference lists and experts. Review methods. We included studies that reported characteristics of telehealth use; benefits and harms of telehealth; factors impacting the success of telehealth, including satisfaction/dissatisfaction and barriers/facilitators; and implementation outcomes. We conducted a mixed-methods review, synthesizing quantitative and qualitative studies. Two reviewers independently screened search results for eligibility, serially extracted data, and independently assessed risk of bias of included studies. Results. We included 764 studies; 310 studies were included in our syntheses. Patients using telehealth were more likely to be people who are young to middle-aged, female, White, of higher socioeconomic status, and living in urban settings. Visits for mental and behavioral health conditions were more frequent than visits for other conditions, and mental or behavioral care was also more likely to be delivered via telehealth than care for other conditions. Across a variety of conditions, telehealth produced similar clinical outcomes as compared with in-person care. Telehealth care is appropriate for some patients, but more information is necessary to determine the suitability of telehealth for specific patient populations; patients and providers felt that telehealth may be less suitable and less desirable for patients with complex clinical conditions; and some patients perceive telehealth as a barrier to improved health outcomes owing to the absence of a physical exam and challenges in developing rapport and communicating with their care team. There was a lack of evidence addressing implementation cost, penetration, and sustainability of telehealth, and about telehealth implementation at the health system level. Conclusions. Whereas telehealth use spiked after the beginning of the pandemic, the characteristics of patients using telehealth follow a pattern similar to that for other healthcare and digital health services. We found that the use of telehealth may be comparable to in-person care across different clinical and process outcomes. Telehealth implementation has addressed the needs of both patients and providers to some extent, even as clinical conditions, patient and provider characteristics, and type of assessment varied. Telehealth has provided a viable alternative mode of care delivery during the pandemic and holds promise for the future.
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Toloo, Sam, Ruvini Hettiarachchi, David Lim, and Katie Wilson. Reducing Emergency Department demand through expanded primary healthcare practice: Full report of the research and findings. Queensland University of Technology, January 2022. http://dx.doi.org/10.5204/rep.eprints.227473.

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Demand for public hospital emergency departments’ services and care is increasing, placing considerable restraint on their performance and threatens patient safety. Many factors influence such demand including individual characteristics (e.g. perceptions, knowledge, values and norms), healthcare availability, affordability and accessibility, population aging, and internal health system factors (e.g patient flow, discharge process). To alleviate demand, many initiatives have been trialled or suggested, including early identification of at-risk patients, better management of chronic disease to reduce avoidable ED presentation, expanded capacity of front-line clinician to manage sub-acute and non-urgent care, improved hospital flow to reduce access block, and diversion to alternate site for care. However, none have had any major or sustained impact on the growth in ED demand. A major focus of the public discourse on ED demand has been the use and integration of primary healthcare and ED, based on the assumption that between 10%–25% of ED presentations are potentially avoidable if patients’ access to appropriate primary healthcare (PHC) services were enhanced. However, this requires not only improved access but also appropriateness in terms of the patients’ preference and PHC providers’ capacity to address the needs. What is not known at the moment is the extent of the potential for diversion of non-urgent ED patients to PHC and the cost-benefits of such policy and funding changes required, particularly in the Australian context. There is a need to better understand ED patients’ needs and capacity constraint so as to effect delivery of accessible, affordable, efficient and responsive services. Jennie Money Doug Morel
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Tipton, Kelley, Brian F. Leas, Nikhil K. Mull, Shazia M. Siddique, S. Ryan Greysen, Meghan B. Lane-Fall, and Amy Y. Tsou. Interventions To Decrease Hospital Length of Stay. Agency for Healthcare Research and Quality (AHRQ), September 2021. http://dx.doi.org/10.23970/ahrqepctb40.

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Background. Timely discharge of hospitalized patients can prevent patient harm, improve patient satisfaction and quality of life, and reduce costs. Numerous strategies have been tested to improve the efficiency and safety of patient recovery and discharge, but hospitals continue to face challenges. Purpose. This Technical Brief aimed to identify and synthesize current knowledge and emerging concepts regarding systematic strategies that hospitals and health systems can implement to reduce length of stay (LOS), with emphasis on medically complex or vulnerable patients at high risk for prolonged LOS due to clinical, social, or economic barriers to timely discharge. Methods. We conducted a structured search for published and unpublished studies and conducted interviews with Key Informants representing vulnerable patients, hospitals, health systems, and clinicians. The interviews provided guidance on our research protocol, search strategy, and analysis. Due to the large and diverse evidence base, we limited our evaluation to systematic reviews of interventions to decrease hospital LOS for patients at potentially higher risk for delayed discharge; primary research studies were not included, and searches were restricted to reviews published since 2010. We cataloged the characteristics of relevant interventions and assessed evidence of their effectiveness. Findings. Our searches yielded 4,364 potential studies. After screening, we included 19 systematic reviews reported in 20 articles. The reviews described eight strategies for reducing LOS: discharge planning; geriatric assessment or consultation; medication management; clinical pathways; inter- or multidisciplinary care; case management; hospitalist services; and telehealth. All reviews included adult patients, and two reviews also included children. Interventions were frequently designed for older (often frail) patients or patients with chronic illness. One review included pregnant women at high risk for premature delivery. No reviews focused on factors linking patient vulnerability with social determinants of health. The reviews reported few details about hospital setting, context, or resources associated with the interventions studied. Evidence for effectiveness of interventions was generally not robust and often inconsistent—for example, we identified six reviews of discharge planning; three found no effect on LOS, two found LOS decreased, and one reported an increase. Many reviews also reported patient readmission rates and mortality but with similarly inconsistent results. Conclusions. A broad range of strategies have been employed to reduce LOS, but rigorous systematic reviews have not consistently demonstrated effectiveness within medically complex, high-risk, and vulnerable populations. Health system leaders, researchers, and policymakers must collaborate to address these needs.
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IntegratE Project results: Family planning knowledge and quality of care received from community pharmacists and patent and proprietary medicine vendors. Population Council, 2021. http://dx.doi.org/10.31899/sbsr2021.1018.

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In Nigeria, Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are the first point of care for many common illnesses. Although CPs and PPMVs are not formally recognized as family planning (FP) service providers, 22% of modern contraceptive users report receiving their last method from a PPMV and 12% from a private pharmacy. PPMVs are popular for FP because of their widespread availability, consistent drug stocks, extended hours, personable interactions, and lack of separate fees for consultations. As the Federal Ministry of Health explores expanding its task sharing policy to include CPs and PPMVs, evidence is needed on an effective regulatory system to support CPs and PPMVs in providing high-quality FP services. The IntegratE Project (2017-21) seeks to increase access to contraceptive methods by involving the private sector in FP service delivery in Lagos and Kaduna states. The Project seeks to establish a regulatory system with the Pharmacists Council of Nigeria to ensure that CPs and PPMVs provide quality FP services and comply with regulations. To achieve this, the Project is implementing a pilot accreditation system for PPMVs. CPs function outside the pilot accreditation system but would receive the same training. This brief compares knowledge of FP and quality of care received among PPMVs and CPs as reported by FP clients served.
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