ISSN:0148-9917    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Summary:Computer simulation modeling has evolved during the past twenty years into an effective tool for analyzing and planning ambulatory care facilities. This article explains the use of this tool in three case-study, ambulatory care settings—a GI lab, holding beds for a cardiac catheterization laboratory, and in emergency services. These examples also illustrate the use of three software packages currently available: MedModel®, Simul8®, and WITNESS®.

ISSN:0148-9917    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Summary:Quality of service and corporate productivity may be improved when employees are formed into semi-autonomous teams that are empowered to be innovative in service and are rewarded for attaining performance goals. This article describes the planned staffing and implementation strategies for three models of primary health care teams (HCTs) in a managed care organization (MCO). Implementation of each model focussed on (1) changes to primary care staffing mix (structural integration of roles) and (2) development of teamwork (functional integration of roles). Evidence from other industries suggests that the planned changes to structural and functional integration of existing primary care delivery models could improve system productivity, patient satisfaction, clinical quality, and employee morale. Retrospective evaluations of whether the planned improvements were achieved, and whether these achievements can be attributed to changes in staffing mix or teamwork, are now being conducted. Opportunities and limitations in conducting these retrospective evaluations are discussed, particularly with reference to use of existing data sources. The article concludes with recommendations for evaluation of natural experiments in primary care redesign.

ISSN:0148-9917    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Summary:Three different implementations of team-based innovations at Kaiser Permanente describe increased use and changed roles of associate providers and improved communication and coordination among HCT staff. These descriptions emphasized integration of the practitioners (mid-level and physician providers) to allow physicians to see new patients, see more acute patients, practice “desk-top” medicine, or mentor mid-level practitioners. Further consideration of primary care as a microsystem (a team of health care professionals serving a defined panel of patients with information technology and the help of support staff, equipment, and a supportive environment) may be useful in fostering the continual improvement of primary care. Complexity theory and the development of “simple rules” for primary care may also assist in change efforts. Stories of innovation are valuable in sharing the success and challenges of primary care improvement.

ISSN:0148-9917    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Summary:Many believe that physician payment mechanisms that include incentives to restrain utilization create conflicts of interest for physicians and result in the withholding of needed services. Pooled data from two rounds of the Community Tracking Study physician survey, a nationally representative telephone survey of physicians, are the basis of this analysis. We examine the association between explicit financial incentives linked to physician profiling and perceived conflict of interest, and the reported ability to obtain specific, medically necessary secondary services (referrals, hospitalizations and diagnostic imaging). Logistic regression models were employed to control for potentially confounding influences. After controlling for other factors, physicians subject to profiling linked with financial incentives were much less likely than physicians not affected by profiling to strongly agree that they can make clinical decisions in the best interests of their patients without the possibility of reducing their income. They were also less likely to report that they could always obtain selected medically necessary secondary services for their patients. Physicians subject to explicit financial incentives based on profiling are more likely than other physicians to perceive a conflict of interest. Physicians with financial incentives tied to profiling also experience greater difficulty obtaining medically necessary secondary services for their patients.

ISSN:0148-9917    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Summary:In 1997 Congress established the State Child Health Insurance Program (SCHIP) to address the problem of the nation's low-income uninsured children. To help children become eligible for SCHIP and to tap into the potential revenue stream for previously uninsured children, community health centers have taken differing approaches. This study examines the lessons learned from enrolling children at 14 health centers in six states. The lessons can be valuable for primary care centers and other safety-net providers.

ISSN:0148-9917    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Summary:While safety risks are widespread in ambulatory settings, there has been insufficient attention directed at developing the evidence base that is needed to improve ambulatory safety. In this article, the current state of knowledge about ambulatory safety is reviewed. A research agenda in ambulatory safety is proposed, as well as a series of potential interventions that could be used to improve safety in the ambulatory setting.

ISSN:0148-9917    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Summary:Large samples of the general population are exposed to the possibility of being enrolled in clinical trials on preventive strategies. Because little information is available on the general population, data were collected on what Italians know and how they feel about clinical research and factors that might help implement measures to improve participation in the main phases of clinical research were assessed. A random sample of 950 citizens representative of the Italian population was interviewed by ad hoc trained interviewers, using a standardized questionnaire with seven multiple-choice questions and two scenarios. Participants' knowledge and opinions about clinical research were in general limited, attitudes toward participation in clinical studies were unsatisfactory, and the results varied significantly according to sociodemographic and geographic variables. These results give a description of the people's level of knowledge and attitude about clinical research in Italy and also clarify the importance of factors that may be related to the study's principal variables. These findings might be useful in helping design and implement effective interventions to improve people's participation in the main phases of clinical research.

ISSN:0148-9917    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Summary:General attitudes toward clinical research can have substantial effects on the research process. Recent studies, including the study by Apolone and Mosconi in this issue, suggest that certain attitudes toward research and evaluations of the risks and benefits of therapies may differ according to various cultural, rhetorical, and health contexts. Researchers must work to further understand societal attitudes toward research and to improve the attractiveness of clinical research for the general population.

ISSN:0148-9917    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Summary:The United States is the only nation in the world that continues to execute its youth. The use of the death penalty against those who committed crimes as children is an act contrary to American standards of decency and fairness, as well as international law. The adolescent brain has not fully developed before the age of 18 years of age. Thus children do not have the same emotional and mental capacity as adults. Although juveniles should be held accountable for their crimes, the United States must not impose this most extreme punishment. The medical profession must take a stand to stop the execution of juvenile offenders in the United States.

ISSN:0148-9917    

出版商:OVID    

年代:2003

数据来源: OVID