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Service, quality, efficiency

Larry Polivka, Baozhen Luo
Publicly (mainly Medicaid) funded long-term care (LTC) services have evolved from a nursing home dominated system of service to a much more balanced system including home- and community-based services (HCBS) programs over the last 30 years. The HCBS programs have been largely administered by the state and local level nonprofit aging networks (ANs) consisting of Area Agencies on Aging and thousands of service providers. Over the last decade, however, for-profit HMOs administered primarily by large insurance companies have begun to displace AN organizations...
September 23, 2017: Gerontologist
Julie Tinklenberg, Bina Patel, Kathryn Gelman, Ronald Albucher
OBJECTIVE: To address the increasing demand for assessments of Adult Attention Deficit Hyperactivity Disorder (ADHD), the primary author developed a protocol for Counseling and Psychological Services (CAPS) at Stanford University's Vaden Student Health Center to improve the efficiency of such evaluations. PARTICIPANTS: As part of quality assurance, we reviewed the charts of Stanford students who sought assessment for ADHD before the protocol was implemented (September 2011- June 2013) and after the protocol was established (October 2013 - August 2014)...
October 13, 2017: Journal of American College Health: J of ACH
Ian Painter, Debra Revere, P Joseph Gibson, Janet Baseman
BACKGROUND: Infectious diseases can appear and spread rapidly. Timely information about disease patterns and trends allows public health agencies to quickly investigate and efficiently contain those diseases. But disease case reporting to public health has traditionally been paper-based, resulting in somewhat slow, burdensome processes. Fortunately, the expanding use of electronic health records and health information exchanges has created opportunities for more rapid, complete, and easily managed case reporting and investigation...
2017: Online Journal of Public Health Informatics
Sonali V Thakrar, Diane Bell
Each local health economy has been tasked with producing a sustainability and transformation plan. A health economy is a system that controls and contributes to health-care resource and the effects of health services on its population. This includes commissioners, acute providers, primary care providers, community services, public health and the voluntary sector. Sustainability and transformation plans represent a shift in the way health care is planned for in England. The aim of each sustainability and transformation plan is to deliver care within existing resource limits by improving quality of care, developing new models of care and improving efficiency of care provision...
October 2, 2017: British Journal of Hospital Medicine
Edward M Giesbrecht, William C Miller
BACKGROUND: Providing mobility skills training to manual wheelchair (MWC) users can have a positive impact on community participation, confidence and quality of life. Often such training is restricted or not provided at all because of the expense of, and limited access to, occupational and physical therapists before and after discharge. This is particularly true among middle-aged and older adults, who often have limited access to rehabilitation services and require more time to learn motor skills...
2017: PeerJ
Maria Zubair, Neil H Chadborn, John R F Gladman, Tom Dening, Adam L Gordon, Claire Goodman
INTRODUCTION: Care home residents are relatively high users of healthcare resources and may have complex needs. Comprehensive geriatric assessment (CGA) may benefit care home residents and improve efficiency of care delivery. This is an approach to care in which there is a thorough multidisciplinary assessment (physical and mental health, functioning and physical and social environments) and a care plan based on this assessment, usually delivered by a multidisciplinary team. The CGA process is known to improve outcomes for community-dwelling older people and those in receipt of hospital care, but less is known about its efficacy in care home residents...
October 10, 2017: BMJ Open
Robin M Famiglietti, Emily C Norboge, Valentine Boving, James R Langabeer, Thomas A Buchholz, Osama Mikhail
BACKGROUND: To meet demand for radiation oncology services and ensure patient-centered safe care, management in an academic radiation oncology department initiated quality improvement efforts using discrete-event simulation (DES). Although the long-term goal was testing and deploying solutions, the primary aim at the outset was characterizing and validating a computer simulation model of existing operations to identify targets for improvement. METHODS: The adoption and validation of a DES model of processes and procedures affecting patient flow and satisfaction, employee experience, and efficiency were undertaken in 2012-2013...
October 2017: Quality Management in Health Care
Caixia Song, Guozhen Tan, Chao Yu
Vehicular Ad Hoc Networks (VANETs) employ multichannel to provide a variety of safety and non-safety (transport efficiency and infotainment) applications, based on the IEEE 802.11p and IEEE 1609.4 protocols. Different types of applications require different levels Quality-of-Service (QoS) support. Recently, transport efficiency and infotainment applications (e.g., electronic map download and Internet access) have received more and more attention, and this kind of applications is expected to become a big market driver in a near future...
October 9, 2017: Sensors
Gillian Jean
Accreditation to demonstrate engagement with the National Safety and Quality Health Service Standards (Standards) is compulsory for most hospital and healthcare settings, but to date remains voluntary for private dental practices (PDPs). The regulatory framework governing the dental profession lacks a proactive element to drive improvements in quality and safety of care, and an accreditation scheme can strengthen existing regulation. The current model of accreditation operating in accordance with the Australian Health Service Safety and Quality Accreditation Scheme (Scheme) is based on the Standards, which were written for a hospital model of healthcare service...
October 9, 2017: Australian Health Review: a Publication of the Australian Hospital Association
J Simões, G F Augusto, I Fronteira
In Portugal, the National Health Service (NHS) assures universal access to medical treatment and care that is free at the point of delivery - except for relatively small user charges. Freedom of choice is limited and competition between the public and the private sectors is almost non-existent. In May 2016, the Ministry of Health introduced a new law that facilitates the referral of NHS users from primary healthcare units to outpatient consultations in NHS hospitals outside of the referral area. However, for inpatient care, patients are still bound to receive treatment within their referral area, which is determined by place of residence...
September 20, 2017: Health Policy
Andrea S Gershon, Erin M Macdonald, Jin Luo, Peter C Austin, Samir Gupta, Khalil Sivjee, Ross Upshur, Shawn D Aaron
Background: Pulmonologists provide quality care, however, their number is not adequate to take care of all the chronic obstructive pulmonary disease (COPD) needs of the population and their services come with a cost. Their optimal role should be defined, ideally based on evidence, to ensure that their abilities are applied most efficiently where needed. Objective: To determine if concomitant pulmonologist and primary care physician care after COPD hospital or emergency department discharge was associated with better health outcomes than primary care services alone...
July 7, 2017: Family Practice
Steven D Boggs, Sheila R Barnett, Richard D Urman
PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) has grown from an insignificant percentage of total anesthesia cases into a major percentage of anesthesia workload over the past 30 years. This trend evidences no signs of abating. RECENT FINDINGS: With the rapid development of novel interventional techniques in cardiology, radiology, gastroenterology and pulmonary medicine and other areas, the core responsibilities of the anesthesia provider will no longer be confined to delivering care in traditional operating rooms...
October 3, 2017: Current Opinion in Anaesthesiology
Nicolas A Menzies, Christian Suharlim, Fangli Geng, Zachary J Ward, Logan Brenzel, Stephen C Resch
BACKGROUND: Evidence on immunization costs is a critical input for cost-effectiveness analysis and budgeting, and can describe variation in site-level efficiency. The Expanded Program on Immunization Costing and Financing (EPIC) Project represents the largest investigation of immunization delivery costs, collecting empirical data on routine infant immunization in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. METHODS: We developed a pooled dataset from individual EPIC country studies (316 sites)...
October 6, 2017: BMC Medicine
Emmanuelle Daviaud, Lungiswa Nkonki, Petrida Ijumba, Tanya Doherty, Joy E Lawn, Helen Owen, Debra Jackson, Mark Tomlinson
In light of South Africa's generalized HIV/AIDS epidemic coupled with high infant mortality, we undertook a cluster Randomized Control Trial (2008-10) assessing the effect of Community Health Worker (CHW) antenatal and postnatal home visits on, amongst other indicators, levels of HIV-free survival, and exclusive and appropriate infant feeding at 12 weeks. Cost and time implications were calculated, by assessing the 15 participating CHWs, using financial records, mHealth and interviews. Sustainability and scalability were assessed, enabling identification of health system issues...
October 1, 2017: Health Policy and Planning
Judd E Hollander, Theresa M Davis, Charles Doarn, Jason C Goldwater, Stephen Klasko, Curtis Lowery, Dimitrios Papanagnou, Peter Rasmussen, Frank D Sites, Danica Stone, Brendan G Carr
In January 2015, the US Secretary of Health and Human Services announced targets for the transformation of Medicare reimbursement from a fee-for-service model to payments based on alternative payment models. People now use technology for virtually everything - from paying bills to purchasing almost anything; it is therefore natural to think that they will use technology to take ownership of their own health care. The remote provision of health care, where providers and patients are not in the same location, will allow patients to receive the right care, at the right time, at the right place, and in the manner they consider right for them...
October 4, 2017: Population Health Management
Tomas Zapata, Norbert Forster, Pedro Campuzano, Rejoice Kambapani, Heena Brahmbhatt, Grace Hidinua, Mohamed Turay, Simon Kimathi Ikandi, Leonard Kabongo, Farai Zariro
INTRODUCTION: During the past two decades, HIV and Sexual and Reproductive Health services in Namibia have been provided in silos, with high fragmentation. As a consequence of this, quality and efficiency of services in Primary Health Care has been compromised. METHODS: We conducted an operational research (observational pre-post study) in a public health facility in Namibia. A health facility assessment was conducted before and after the integration of health services...
July 12, 2017: International Journal of Integrated Care
Byungseok Kang, Khuong Quoc Anh, Hyunseung Choo
Mobile IP allows for location-independent routing of IP datagrams on the Internet. Mobile IP specifies how a mobile node (MN) registers with its home agent and how the home agent routes datagrams to the MN through the tunnel. Current Mobile IP protocols have difficulties meeting the stringent handover delay requirements of future wireless networks. Fast handover for Proxy Mobile IPv6 (FPMIPv6) is used to resolve handover latency and packet loss problems that occur in the Proxy Mobile IPv6 (PMIPv6) protocol...
2017: PloS One
Alan R Teo, Christopher W Forsberg, Heather E Marsh, Somnath Saha, Steven K Dobscha
Promoting patient engagement in treatment and reducing frequency of missed appointments result in higher value through both improved outcomes and improved efficiency. For this reason, continuous quality improvement (CQI) efforts to increase engagement are important in service operations. This column illustrates the results of a CQI study to determine the impact of method of delivery of phone appointment reminders on attendance rates for a cohort of 250 primary care patients with depression. Results indicated that the type of reminder had a significant impact on attendance...
October 2, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
George A Alemnji, Martine Chase, Songee Branch, Giselle Guevara, John N Nkengasong, Rachel Albalak
Scientific evidence showing the benefits of early initiation of antiretroviral therapy (ART) prompted World Health organization (WHO) to recommend that all persons diagnosed HIV-positive should commence ART irrespective of CD4 count and disease progression. Based on this recommendation, countries should adopt and implement the HIV "Treat All" policy to achieve the UNAIDS 90-90-90 targets and ultimately reach epidemic control. Attaining this goal along the HIV treatment cascade depends on the laboratory to monitor progress and measure impact...
October 1, 2017: AIDS Research and Human Retroviruses
Ajay Aggarwal, Daniel Lewis, Arunan Sujenthiran, Susan C Charman, Richard Sullivan, Heather Payne, Malcolm Mason, Jan van der Meulen
PURPOSE: To investigate whether patients requiring radiation treatment are prepared to travel to alternative more distant centers in response to hospital choice policies, and the factors that influence this mobility. METHODS AND MATERIALS: We present the results of a national cohort study using administrative hospital data for all 44,363 men who were diagnosed with prostate cancer and underwent radical radiation therapy in the English National Health Service between 2010 and 2014...
August 24, 2017: International Journal of Radiation Oncology, Biology, Physics
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