Creating and promoting a sports performance service offering

Many private hospitals and physician groups are exploring the possibility of expanding their facilities to include advanced ancillary services. Services such as a sports performance center provide additional opportunities for quality patient care and at the same time augment the bottom line. By offering additional ancillary services, healthcare organizations such as an orthopaedics practice can become a full-service center enabling clinicians to more fully provide care to their patients. Marketing and promotion play a crucial role in this type of service. These activities must be designed and carried out in a way that encourages productive results and collaboration as the organization strives to position itself as a full-service center and as a sports specialist in its community.     

Coordinating community and public-institutional mental health services: some unintended consequences

Where a target group such as the mentally ill tend to use multiple and varied services over a long period of time, service coordination is often seen as the key to continuity of care. This article argues that coordination also has its perverse effects. To demonstrate, two types of community organizations (COs) working in mental health in the Canadian province of Québec are examined: alternative COs, which have their roots in community action and maintain few formal links with each other or with institutional resources; and transitional structures, COs which are developed with the cooperation of psychiatric professionals, are closely linked to hospitals and are often part of a tightly coordinated system of community services. With respect to access, continuity, programs, internal structure and flexibility, each type of community resource has particular strengths and weaknesses. In the first part of the article, these are described and compared. In the second part of the article, we examine the possible effects of Québec's new mental health policy on COs working in mental health. The policy seeks to create comprehensive systems coordinating all services at the regional level-including alternative organizations, transitional structures and public institutions. The imperatives of the complex planning process risk diluting or even eradicating the differences between the two types of mental health COs described earlier. The process may thus rob certain service users of the particular advantages they found in alternative COs. For those mentally ill who, by choice or by chance, remain marginal to the coordinated system, there may ultimately be no resources available at all.     

Free Library of Health: Consumer Health Information,Health Literacy,and Library Programming in Philadelphia

In 2016, the Free Library of Philadelphia reopened the newly renovated South Philadelphia Library. This full-service neighborhood library is co-located with pediatric primary care services, a city-run health center, and a recreation center in a first-of-its-kind facility called the Community Health and Literacy Center. The South Philadelphia Library aims to improve health literacy in the community through the provision of consumer health information and health programming, and the co-location with health care and recreation services provides unique opportunities to partner and offer health-based library services. A community health librarian certified in consumer health information assists customers with accessing reliable health information, and health programming covers many areas of interest. Partnerships with nearby health organizations also allow the library to connect customers with vetted neighborhood services. By combining health services with traditional library programming, customers are able to increase their health literacy when they visit the library.     

Promoting health, building community

As part of its mission to honor human dignity and to care for the poor and vulnerable, Catholic Healthcare Partners (CHP), Cincinnati, has made a systemwide commitment to address housing needs in the communities it serves. A priority for the system is providing safe, affordable housing options for the low-income elderly. CHP's approach goes beyond "bricks and mortar," however. The system aims not only to provide a home for senior adults but also to enrich their lives. Through various activities and support services, CHP's senior living complexes in Kentucky, Ohio, Pennsylvania, and Tennessee offer residents an opportunity to live in a vibrant community. CHP facilities have developed a variety of initiatives to enhance residents' lives. Among these are: spiritual care services, nurses who serve as a resource to low-income elders, a short-stay shelter for seniors in transition, a service referral program, and therapy to help elders remain independent. In order to offer these comprehensive services to senior adults, CHP relies on partnerships with a variety of organizations and on funding from both the federal government and private investors. Especially as the nation's population ages, CHP continues to make its housing ministry a strategic priority.     

英国购买式社区照顾服务模式的发展、改革及启示

英国是当前福利国家中社区照顾历史最悠久的国家,迄今已逾六十年。英国社区照顾服务供给模式的建构深受新自由主义和新管理主义影响,这些意识形态主导了英国历届政府关于购买社区照顾服务的改革与完善。当前,我国正积极推进医养结合、长期照护政策,并确定社区为主的发展模式。本文在借鉴英国购买式社区照顾服务经验并结合中国国情的基础上,提出政府角色重新定位、积极扶持民间服务组织发展及完善购买式照顾服务法律体系等建议,以期减轻政府负担、增强照顾服务效率和提高照顾服务质量。     

Improving service delivery: provider perspectives on building community-based systems of care

This article examines the views of service providers toward different public policy efforts to improve service delivery to elders requiring multiple services from an array of organizations. The authors examine the relationship between provider assessments of the adequacy of their community-based systems of care and community resource levels, coordination strategies, and client characteristics. Findings, based on responses from managers of programs serving older adults (n = 250) to a mailed survey, were that two-thirds (69.4%) evaluated their service delivery systems as adequate or better. A regression model used to explain system adequacy indicated that 22% of the variance was accounted for by community resource level, information and service availability, attention to specific need clients, and percentage of minority clients served by the respondents' programs. Findings suggest that community resource level appears to be an important factor in respondents' evaluation of system adequacy. While respondents indicated that improved coordination could enhance their efforts to deliver services, this strategy was not one they favored in improving their community-based system of care. Instead, they preferred strategies which expanded or improved the services that were available.     

Health and social care costs for young adults with epilepsy in the UK

Maintaining contact with services will help improve clinical and social outcomes as children with epilepsy move into their adult lives. This study has collated evidence on the extent to which young adults with epilepsy are supported by health and social care services posttransition, and the costs of such support. UK prevalence and service use data were taken from policy and research literature, as well as national data sets and reports. Costs were attached to these data to arrive at agency and overall total costs. There are approximately 42 000 young adults (18–25 years) with epilepsy costing the UK health and social care budgets £715.3 million per annum, on average £17 000 per young adult with epilepsy. A further £61 million falls to the social security budget. Most young adults with epilepsy will rarely use these services, but those with additional health needs have high and often long‐term support needs, including supported accommodation and personal care. Current resources used by these young adults are summarised but deficits in service availability can mean long waiting times and sub‐optimal treatment. Young adults also want more support to help them take advantage of education and employment opportunities and more information about managing the impacts of epilepsy on their lives. Improving services will cost money, but has the potential to lead to better outcomes for young adults.     

Transitions in the lives of young people with complex healthcare needs

Background The disabled child population now incorporates a group of children and young people with complex healthcare needs, many of whom are supported by medical devices and technologies. Little is known about their experiences and perspectives, particularly in relation to transitions. Methods Twenty‐eight young people aged between 8 and 19 years old were recruited via Community Children's Nursing Teams. Data were collected by in‐depth qualitative interviews and analysed using Grounded Theory principles and procedures. Results Young people with complex healthcare needs experience multiple and often concurrent transitions in their lives. As well as moving from childhood to adulthood, they experience different organizational and illness transitions. This paper focuses on their experiences of moving from children to adult services and moving from parental care to self‐care. Moving to adult services was characterized as a time of uncertainty because of lack of information and involvement in transition planning. Concerns were expressed about the continuity of support packages into adult services and whether specialist expertise would be available. Young people in adult services described how they had needed to adjust to a different culture and way of working and the loss of relationships with familiar, trusted professionals. In addition to becoming socially independent, young people were in the process of acquiring control over their healthcare and support needs. The acquisition of responsibility for managing therapies and devices was described as an evolving, individually negotiated process. However, responsibility for decision‐making and liasing with services could be acquired suddenly on transfer to adult services and not as part of an integrated self‐care transition process. Conclusions Transition is often too focused on service transition and transfer rather than conceptualizing it holistically as part of the process of moving to adulthood and independence. Young people with complex healthcare needs may have support needs that are unfamiliar for adult services at present. Multi‐agency personalized planning that involves parents and young people is essential to ensure continuity of support and integration with other life transitions.     

Providing Birthing Services in Rural Health Networks: Coping with Change in New York State

Making prenatal and birthing services accessible in rural communities no longer able to support a local full-service hospital and the introduction of managed care cost control has led to consideration of alternative models. One such model, the freestanding birth center located in an isolated rural community, challenges the guidelines of several state and professional organizations directed at assuring adequate emergency response, including cesarean sections. An extensive review of freestanding birth centers and their effect on birth outcomes revealed little outcomes data about birth centers distant from full-service hospitals. Most states have modeled their birth center regulations on recommendations from the National Association of Childbearing Centers, but others, such as New York, have more rigidly defined transport parameters that exclude many rural locations. A consensus panel convened by the New York State Rural Health Council concluded that demonstrations projects featuring a rural birthing center farther than 20 minutes from a full-service hospital and operated within a networked rural health system should be developed. Consumers would need to be fully informed about the implications of their choice of birth services and all qualified providers, including midwives, should be included in a team approach to care giving.     

Home care for life-supported persons: the French system of quality control,technology assessment,and cost containment.

Home care for persons who require the prolonged use of life-supportive medical technology is a reality in several nations. France has had more than a quarter of a century of experience with providing home care for patients with chronic respiratory insufficiency and with a system to evaluate the patients'' outcomes. The French approach features decentralized regional organizations which offer grassroots involvement by the beneficiaries who participate directly in the system. Since June 1981, a national organization has provided patients, professionals, and others concerned with direct access to national funding authorities and governmental officials and has created a data base for evaluation of the experience. This system permits direct input by current users of the services and creates informed opinion among members of the general public, governmental officials, and others involved (health care professionals and service providers). This is essential for the development of responsive public policy and for the determination of the relevancy of programs. In the United States, increasing demands are being made upon expensive hospital services by patients with diseases such as AIDS and other catastrophic, long-term care conditions. Cost-saving, community-oriented home care models serving complex medical-societal needs abroad are worthy of study to discern possible applications to health and social problems in our nation.     

The role of managed care in integrated delivery networks

Health care reform, especially if as anticipated via a capitated payment system, will lead providers to integrate the services they provide to the community with those of other organizations. Vertical integration strategies, such as the formation of physician-hospital organizations, and horizontal integration through alliances and holding companies, are the primary vehicles that hospitals and other providers will use to establish integrated networks. By including insurers and primary care physicians in the network and developing information systems to support the delivery of high quality, cost-effective services, the networks can offer a full continuum of care and minimize service duplication.     

A blueprint for community benefit. A CHA-AAHA (Catholic Health Association-American Association of Homes for the Aging) document helps long-term care providers plan for and implement needed services

A collaborative effort of the Catholic Health Association (CHA) and the American Association of Homes for the Aging, The Social Accountability Program: Continuing the Community Benefit Tradition of Not-for-Profit Homes and Services for the Aging helps long-term care organizations plan and report community benefit activities. The program takes long-term care providers through five sequential tasks: reaffirming commitment to the elderly and others in the community; developing a community service plan; developing and providing community services; reporting community services; and evaluating the community service role. To help organizations reaffirm commitment, the Social Accountability Program presents a process facilities can use to review their historical roots and purposes and evaluate whether current policies and procedures are consistent with the organizational philosophy. Once this step is completed, providers can develop a community service plan by identifying target populations and the services they need. For facilities developing and implementing such services, the program suggests ways of measuring and monitoring them for budgetary purposes. Once they have implemented services, not-for-profit healthcare organizations must account for their impact on the community. The Social Accountability Program lists elements to be included in community service reports. It also provides guidelines for evaluating these services' effectiveness and the organization's overall community benefit role.     

Delivering care to the streets

St. Francis Hospital's management team has collaborated with other community organizations to respond to the very real needs of the homeless and indigent in Wilmington, DE. St. Francis Hospital has developed two innovative programs: St. Clare Medical Outreach and Tiny Steps. Recognizing that the poor and indigent find transportation, clinic schedules, and intimidating paperwork to be major barriers to healthcare, St. Francis Hospital and its partner in this collaborative ministry, Ministry of Caring, sought a creative approach that would bring healthcare to Wilmington's needy in a nonthreatening way, while also offering continuity of care. St. Clare Medical Outreach van staff began administering much-needed healthcare services on April 27, 1992. For years, St. Francis Hospital has supported a pediatric clinic at West End Neighborhood House, an organization offering a variety of family-related services to the indigent. In September 1992 the hospital collaborated with other community organizations to offer a more comprehensive, holistic healthcare service to those in need. This joint-venture of St. Francis Hospital and 11 other community organizations is designed to lower the infant mortality rate by identifying high-risk pregnancies early on and managing complications during pregnancy and after birth.     

Patients'' perceptions and experiences of ''continuity of care'' in diabetes

BACKGROUND: 'Continuity of care' is an important aspect of quality. However, definitions are broad and existing models of continuity are not well grounded in empirical data. OBJECTIVE: To identify patients' experiences and values with respect to continuity in diabetes care. METHODS: In-depth semi-structured interviews with 25 type 2 diabetic patients from 14 general practices in two inner London boroughs. Interviews were transcribed and responses analysed thematically and grouped into dimensions of continuity of care. RESULTS: Patients' accounts identified aspects of care they valued that were consistent with four dimensions of experienced continuity of care. These were receiving regular reviews with clinical testing and provision of advice over time (longitudinal continuity); having a relationship with a usual care provider who knew and understood them, was concerned and interested, and took time to listen and explain (relational continuity); flexibility of service provision in response to changing needs or situations (flexible continuity); and consistency and co-ordination between different members of staff, and between hospital and general practice or community settings (team and cross-boundary continuity). Problems of a lack of experienced continuity mainly occurred at transitions between sites of care, between providers, or with major changes in patients' needs. CONCLUSIONS: The study develops a patient-based framework for assessing continuity of care in chronic disease management and identifies key transition points with problems of lack of continuity. It is important that service 'redesign' and developments in vertically integrated services for chronic disease management take account of impacts on patients' experience of continuity of care.     

Organizing mental health services: an evidence-based approach

BACKGROUND AND AIMS: Health policy makers and program developers seek evidence-based guidance on how to organize and finance mental health services. The Swedish Council on Technology Assessment in Health Care (SBU) commissioned a conceptual framework for thinking about health care services as a medical technology. The following framework was developed, citing empirical research from mental health services research as the case example. FRAMEWORK: Historically, mental health services have focused on the organization and locus of care. Health care settings have been conceptualized as medical technologies, treatments in themselves. For example, the field speaks of an era of "asylum treatment" and "community care". Hospitals and community mental health centers are viewed as treatments with indications and "dosages", such as length of stay criteria. Assessment of mental health services often has focused on organizations and on administrative science. There are two principal perspectives for assessing the contribution of the organization of services on health. One perspective is derived from clinical services research, in which the focus is on the impact of organized treatments (and their most common settings) on health status of individuals. The other perspective is based in service systems research, in which the focus is on the impact of organizational strategies on intermediate service patterns, such as continuity of care or integration, as well as health status. METHODS: Examples of empirical investigations from clinical services research and service systems research are presented to demonstrate potential sources of evidence to support specific decisions for organizing mental health services. RESULTS: Evidence on organizing mental health services may be found in both types of services research. In clinical services research studies, service settings are viewed as treatments (e.g. "partial hospitalization"), some treatments are always embedded in a service matrix (e.g. assertive community treatment), and, where some treatments are organizationally combined (e.g. "integrated treatment" for co-occurring mental disorder and substance abuse), sometimes into a continuum of care. In service system research, integration of services and of the service system are the main focus of investigation. Studies focus on horizontal and vertical integration, primary care or specialty care and local mental health authorities - each of which may be conceptualized as a health care technology with a body of evidence assessing its effectiveness. IMPLICATIONS: A conceptual framework for assessing the organization of services as a health care technology focuses attention on evidence to guide program design and policy development. Mental health services research holds promise for such decision-making guidance.     

Lost in Transition: Missed Opportunities for the 4 Ms to Support Post-Acute Care Transitions

Thousands of health systems have adopted the 4 Ms framework, a set of evidence-based practices specific to older adults, as part of the Age-Friendly Health Systems (AFHS) initiative. However, implementation efforts have largely been setting-specific and approaches to achieve continuity of the 4 Ms during care transitions are nascent. Transitions from hospitals to skilled nursing facilities (SNFs) are one type of care transition that would greatly benefit from continuity of 4 Ms practices. Drawing from the authors' insights and 5 exploratory interviews at 3 health systems that implemented the 4 Ms in the inpatient setting, we describe a set of current-state challenges when trying to extend specific inpatient 4 Ms practices (eg, deprescribing of high-risk medications) as well as the nuanced understanding of the individual's clinical trajectory developed during an inpatient stay. We also offer concrete opportunities, such as developing 4 Ms–centric discharge summary templates, to address the challenges. With the large investment in AFHS transformation and associated efforts to implement the 4 Ms framework in all care settings used by older adults, it is critical to raise awareness of the specific obstacles to promoting continuity of successful 4 Ms practices during care transitions and work to overcome them. Our insights from hospital-to-SNF transitions offer a starting point.     

The Use of Public Mental Health Services by Older Californians and Complementary Service System Effects

Older adults with mental disorders are less likely to use specialty care than any other population group. In this study, we created a multisource secondary data file and examined the use of public mental health services by older adults across California’s county-based community mental health systems. We specifically considered complementary service system effects relative to compositional effects representing individual service users and more general contextual effects. Service use was defined in terms of treated prevalence rates, repeat service use, and intensity of service use. Differences across 49 county-based systems were evaluated by regressing the 3 service use measures onto compositional characteristics including client age, diagnosis, and insurance status; variables reflecting complementary service systems including mental health, health, long-term care, and aging services; and other contextual effects such as the size of the county population and average education level. The analyses were adjusted statistically for regional, yearly, and seasonal differences, and for longitudinal clustering within the 49 counties over 12 quarters of observation. Results suggested that older adults’ service use varied significantly from one county to the next, and differences were associated with both compositional and contextual effects. As the aging population continues to grow and place an increasing demand on public mental health service systems, this research may help policy makers and program administrators understand some of the critical elements that affect service use patterns among older adults.     

Barriers and facilitators to partnership working between Early Intervention Services and the voluntary and community sector

Partnership working between health and the voluntary and community sector has become an increasing political priority. This paper describes and explores the extent and patterns of partnership working between health and the voluntary and community sector in the context of Early Intervention Services for young people with a first episode of psychosis. Data were collected from 12 Early Intervention Services and through semistructured interviews with 47 voluntary and community sector leads and 42 commissioners across the West Midlands of England. Most partnerships were described as ad hoc and informal in nature although four formal partnerships between Early Intervention Services and voluntary and community sector organizations had been established. Shared agendas, the ability to refer clients onto an organization that could provide a service they could not and shared training facilitated partnership working in this context. Barriers to closer working included differences in culture such as managing risk, the time required to make and maintain relationships and recognition of the advantages of remaining a small and autonomous organization. The four more formal partnerships were also built on the organizations' experience of working together informally, in one case through a specific pilot project. The voluntary and community organizations involved were also branches of larger national organizations for whom finding sustainable funding was less of an issue. In theoretical terms, eight Early Intervention Service: voluntary and community sector partnerships were at a stage of 'pre-partnership collaboration', three at 'partnership creation and consolidation' and one at 'partnership programme delivery'. The empirical data viewed through the lens of the partnership life-cycle model could help early intervention services, and voluntary and community sector professionals better understand where they are, why they are there and the conditions needed to realise the full potential of partnership working.     

Advancing community health through community health partnerships

Improving a community's health is a key goal of health services organizations. Effectively pursuing that goal requires health services organizations to create partnerships with other organizations to help identify community health needs and to create and carry out programs that bring together community members and needed health services. Drawing on community systems concepts and a recent study of community health partnership efforts in three cities, this article provides a framework for such partnerships. Types of partnerships described include: Community action partnerships, in which the partnership forms to address a specific problem or pursue a specific opportunity. Community organization partnerships, in which a set of organizations in a similar service sector agree to collaborate for mutually agreed upon goals; and Community development partnerships, in which a partnership attempts to increase participation by people and organizations in collaborative activities that advance the community on multiple fronts or that contribute to community assets and services in multiple areas. The article also describes how the pressures to create large integrated delivery systems can affect creation of partnerships to improve community health. Increasingly, healthcare leaders are being held accountable for the health of communities they serve. When creating partnerships for community health and carrying out health-improvement activities, leaders should be aware of and respond to four key dimensions of accountability: political accountability, commercial accountability, clinical/patient accountability, and community accountability.