摘要:

This report describes the evolution of an evaluation unit organized to assess the impact of a changing hospital care program upon the community it serves. Evaluation activities have been developed to suit the specific characteristics of the program to be evaluated and also to provide continuous, in contrast to single-shot, appraisals of programmatic change. Methodological problems encountered in defining and developing the overall program of evaluation are reviewed. The rationale for the organization of a clinical assessment team— one of the component evaluation activities—is also described.

ISSN:0025-7079    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

The newly-created National Center for Health Services Research and Development, as the focal point for research and development in the personal health services of the nation, has as one of its major objectives improvement in the precision with which health services can be evaluated. This effort, to the extent that it is successful, will permit better monitoring of ongoing programs and more valid experimentation with novel approaches to health care delivery. Initial efforts in evaluation will be concentrated on health care programs for the disadvantaged and on multiphasic screening. This initial approach is justified by the Center's concern with helping to solve pressing sociomedical problems and by the conviction that techniques developed in these efforts should have general applicability in improving the assessment of the impact of health services on populations.

ISSN:0025-7079    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

Policy planning decisions can be characterized by conditions of high or low coordination. Holistic, deterministic and scientific traits are assumed under conditions of high coordination; incremental and pluralistic traits with low coordination. The latter may interfere with the achievement of program goals inherent in legislation, e.g., Title XIX. Identification of the nature and etiology of such interference is prerequisite to preventive or remedial efforts by an administrative agency. California Title XIX policy planning decisions were analyzed and classified. Findings were examined against the theoretical framework and against constraints imposed by federal policy decisions. Medi-Cal policy planning decisions were found to be incremental, remedial, serial and pluralistic. They were found to be the result of a disjointed political process, with three major interest groups vying with the responsible administrative agency. This resulted in a failure to include mandated service components and in preferential treatment for certain provider groups and program components.

ISSN:0025-7079    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

Efforts to involve community residents maximally, in a meaningful way, in policy making, while the university holds the purse strings and the Office of Economic Opportunity has the final say, have led to many organizational problems. In this report one of these problems, intergroup conflict, is described. Illustrations of conditions thought to be necessary for such conflict are presented. Consideration is given to how intergroup conflict has been influenced by: (1) the felt need for joint decision-making among the OEO, the medical school and a lay community health council, (2) differences in perception of goals; (3) differences in perception of reality. The ways in which these three situations have arisen and the effects they have had on realization of the objectives of the program are considered. Attention is also directed to the coalitions which have been formed among the government, the university and the community, and the stability of these coalitions.

ISSN:0025-7079    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

This paper examines whether a formally structured relationship with a general hospital is necessary for the neighborhood health center to achieve its goals and continue to function as a viable organization. The experiences of the Gouverneur Health Services Program and the Beth Israel Hospital of New York City and their effects upon each other are used to illustrate the relevant issues and considerations.

ISSN:0025-7079    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

Data about the use of physicians' services, collected by means of surveys of the populations of Chester, England, Chittenden County, Vermont, and Smederevo, Yugoslavia, were analyzed by multivariate techniques. The results indicate that levels of perceived morbidity account for the greatest amounts of variance of utilization within each area, and that the occupational level of household heads and persons' tendencies to use services are also related to utilization. In addition to these factors, the variable measuring the availability of medical care contributed to explaining differences in the use of physicians' services in Smederevo.

ISSN:0025-7079    

出版商:OVID    

年代:1969

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1969

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

For ideal classification of chronic disease in large populations, identification of the presence or absence of every chronic disease in every person would be desirable, as would knowledge of specific causes and pathogenesis, means to define cause, measure severity, and identify important milestones. The authors have approached the problems by analyzing advantages and disadvantages of certain aids to classification of chronic disease, namely, categorical disease classification, disability classification, and multiphasic screening. They describe a modified approach to classification, developed in conjunction with studies of the chronically ill and aged, which consists of establishing for each person a profile that includes principal diagnosis, disease status defined by chronic disease screening, and disability status based on comparable and systematic evaluation. A set of classes which combines the advantages of each of the separate approaches to chronic disease description is synthesized. An illustration of the use of this approach in describing the chronic disease status of one group is presented. The approach can be adapted to other populations and other purposes, and the authors suggest that it should be of particular use in large-scale population studies.

ISSN:0025-7079    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

The fundamental problem of rural health is the extremely low density of health professionals per unit of surface area, resulting in large distances between patient and services. To deliver services in rural areas either stationary facilities or mobile units can be used. The underdeveloped world has had considerable experience with different varieties of mobile units. From this experience, certain principles can be derived which are useful in choosing between stationary and mobile facilities for specific situations. The first consideration is the geographic-demographic layout. Second is the type of health service desired, with mobile units most applicable to periodic health services employing simple facilities, but not desirable for comprehensive care. The third factor in deciding between stationary and mobile systems is the determination of which provides more benefits per cost. Whereas mobile units are an attractive method for rural health service delivery, stationary facilities are often preferable.

ISSN:0025-7079    

出版商:OVID    

年代:1969

数据来源: OVID