摘要:

High and increasing consumer demand for complementary and alternative medicine (CAM) services necessitates a concerted focus to determine the effectiveness of such practices and to ensure that future possible integration of CAM with conventional medicine is founded on sound evidence-based principles of quality health care delivery. The example of chiropractic provides useful insights to guide further research and integration of evidence-based CAM into mainstream health care in the United States. A critical point of departure for this area of inquiry is identifying and addressing barriers to conducting scientifically sound and meaningful cross-disciplinary, practice-based research.

ISSN:0148-9917    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We examined the relationship between physician adherence with a smoking cessation guideline and organizational structures, policies, leadership support, and physician knowledge and attitudes. A random sample of 844 physicians practicing in 127 VHA hospitals was surveyed. Survey results were aggregated to the hospital level and linked with data on organizational characteristics from the 1998 annual survey of hospitals by the American Hospital Association. Significant predictors of adherence included organizational policies related to nicotine replacement prescriptions, the timing and effectiveness of guideline implementation, physicians' knowledge of VHA clinical guidelines generally, and physicians' beliefs about the receptiveness of patients to smoking cessation.

ISSN:0148-9917    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This article evaluates the usefulness of the Consumer Assessment of Health Plan Study (CAHPS®) surveys and reports in a demonstration and evaluation with three health care purchasers in Iowa. The CAHPS survey detected significant differences between health plans in several domains of health care. Both paper- and Web-based consumer reports were developed and distributed to consumers and stakeholders. There was some agreement on the value of these reports, but areas for improvement were noted.

ISSN:0148-9917    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The need for concerted action to improve quality was stressed in the recent Institute of Medicine report,Crossing the Quality Chasm: A New Health Care System for the 21st Century. This article describes an innovative community-based delivery system initiative designed to improve quality and health outcomes for occupational health conditions. Known as the Occupational Health Services (OHS) project, this Washington State initiative focuses on three targeted conditions: low back sprain, carpal tunnel syndrome, and fractures. To fulfill its purpose, which is to provide clinical resources and training opportunities and foster quality improvement activities on a community-wide basis, the OHS incorporates several key delivery system components, including systems to track patient and employer satisfaction and health outcomes; formal physician agreements that will provide incentives for using best-practices; and community-based Centers of Occupational Health and Education (COHEs) that will function as a resource for providers, patients, and employers. Our experience in developing the OHS quality improvement initiative should have relevance for health care clinicians, administrators, policy makers, and researchers engaged in similar pursuits outside the field of occupational health.

ISSN:0148-9917    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Little is known about the access barriers homeless women face at the sites where they are most likely to receive primary health care. To investigate this issue, we administered a mail survey to administrators and clinicians at clinic sites that were actual or potential providers of primary health care to homeless women in Los Angeles County in 1997. The response rate was 65%. Ninety percent of the homeless women seen by responding sites were seen at only 34% of those sites (designated as “major providers”). Deficiencies were identified in several structural and process characteristics that enhance access to and quality of care for homeless women, including clinician training in care for homeless persons; formal screening for homeless status and associated risk factors; and on-site provision of comprehensive health services, including mental health, substance abuse, reproductive health, and ancillary services. Some, but not all, deficiencies were less severe at major providers. Our results suggest that, although providers of care to homeless women share challenges faced by many safety net providers, there are several policy interventions that could improve access to and quality of care for homeless women.

ISSN:0148-9917    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Crossing the Quality Chasm,the Institute of Medicine's recently issued report on the quality of health care in America, is a call to arms for the urgent redesign of the U.S. health care system. The big question confronting health care organizations is how to mount new strategies that will enhance organizational effectiveness and reduce system failures as well as individual errors. Redesign implies organizational restructuring and engineering as well as serious steps in organizational development, with the emphasis on leadership enhancement strategies focused on performance excellence. This article addresses the state of the leadership literature and concludes that massive new investments will have to be made to tackle the issues of leadership training and accountability.

ISSN:0148-9917    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Physicians for Human Rights has released a ground-breaking survey of more than 1,000 Afghan women and men on their attitudes and experiences regarding health and human rights for Afghan women. Health care for women in Afghanistan still poses daunting challenges.

ISSN:0148-9917    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This article builds on my article in the January 2002 issue ofJACMon the use of run charts to analyze data variation and document process improvement. It describes a more powerful tool than the run chart for analyzing variation and measuring process improvement, namely, the control chart developed by Walter Shewhart. This article first explains the basic elements of a control chart, the tests for detecting a special cause variation, and how to choose the best control chart for the type of data being collected. It concludes with one case study using a control chart to document a successful intervention and some suggestions regarding computer software.

ISSN:0148-9917    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2002

数据来源: OVID