MANAGING PATIENT RECORDS AND DOCUMENTING SERVICE DELIVERY: THE RESULTS OF A 'BEST PRACTICE' REMOTE AREA NURSING PROGRAM

ABSTRACT: This paper describes a 'best practice' demonstration program for monitoring nursing services in remote locations. A four-phase project involving paper and computer-based patient information systems was implemented at nursing climes on islands off the coast of Queensland. Patient demographics, diagnoses and details of health service provision were recorded. Results showed a marked improvement in the detail of patient records over the program period. Monitoring of services also provided useful planning and policy information for company management, while a systematic approach to maintaining patient records addressed several medico-legal issues.     

Computer-based ambulatory information systems: recent developments

This article updates the author's earlier review of some of the major computer-based ambulatory information systems and the literature evaluating their costs, benefits, effect on quality of care, and physician acceptance. The evidence suggests that computer-based information systems can increase access to clinical information, improve physician performance, enhance quality of care, and facilitate outcomes research review. In addition to presenting health information networks and clinical decision support systems such as reminder systems, drug ordering systems, and medical care management systems, the article describes applications of telemedicine and Web-based systems. It also discusses barriers to the widespread use of computer-based ambulatory information systems.     

Kinderschutz und Frühe Hilfen aus Sicht der Kinder- und Jugendmedizin

Demands for prevention in the areas of child protection, child development and early education are increasingly being discussed in the health care system, social services and the educational and school system. Concepts in health care include health promotion, risk assessment and primary and secondary prevention. Child protection promotes strategies such as early social support services and at-risk screening and educational systems advocate early intervention and concepts to enhance child development. The complexity of children's developmental needs and their living environments require a comprehensive approach of all three systems and integration of services and interventions. Each child's needs must be individually analysed and services tailored appropriately. A case vignette demonstrates and analyses typical problems of interacting systems. A systemic view of systems of care allows planning of efficient and sustainable social and health care policies.     

School-Based Health Centers in the Context of Education Reform

ABSTRACT: The rapid proliferation of school-based health centers is taking place at the same time that school systems are seeking to improve their educational practices. Many different school reform models are being promulgated with modest success. Absence of connections between school reorganization and the provision of human services may lead to failure. The emerging community school model integrates quality education with effective health, mental health, and social services in "one stop" school centers that become student, parent, and community hubs     

The health information manager of the years 1993 to 2000

With the introduction of the computer-based patient record, the role of "medical record director" will be changed to that of "health information manager." This piece argues that health information managers, as a result of their education and experience, are the most qualified to serve as administrators of the data banks that the new technologies will require.     

Point of care and patient privacy: who is in control?

Public and patient access to medical records has been severely limited through policies limiting physical and timely access and intellectual understanding of content. New expectations of patient/public access and control have arisen accompanying the new paradigms of health care delivery and health information (computer-based patient records). Examples from these new paradigms are personalized and presented in information system contexts from bedside to community settings. Patient and family involvement in care delivery, education, assessment, and control of privacy are explored. A personalized confidentiality/security/privacy module of the computer-based patient record is suggested.     

The association between women’s health information use and health care visits

OBJECTIVE: To determine the effect of the type of information sources used on health services use. METHODS: Population-based random-digit dialing survey of 498 women, between December 1999 and January 2000, on use of health information sources and health visits. RESULTS: After adjustment for sociodemographic and medical factors, use of print health media and computer-based resources was associated with 1.9 and 1.6 more visits, respectively compared to non-use (Regression coefficients 1.9; [95% confidence interval {CI} 0.1, 3.7] and 1.6; [95% CI 0.3, 3.0]). CONCLUSIONS: Print health media and computer-based sources are associated with a higher number of health care visits.     

Health literacy within the reality of immigrants' culture and language

The Second Canadian Conference on Literacy and Health addressed issues of health literacy, culture, and linguistic diversity. This article aims to introduce the presenters' ideas, reports of the learners' discussion, and attendees' recommendations. There is also a literature review of the links between health literacy and use of health services among newcomers in Canada. Newcomers to Canada tend to be unfamiliar with the Canadian health care system in terms of navigating needed services and/or seeking health-related information. Health professionals report difficulties in communicating effectively with these populations about risk-taking behaviours. Educational resources and approaches only partially reach people from cultural minorities. E-health information does little for those with language and literacy limitations. Barriers to accessing information, specifically written material, are widely reported. Consequently, many ethnocultural groups do not participate in health promotion initiatives. Among newcomers to Canada, the problems of adapting to a new health culture are linked to both a lack of information about the new health care available and subsequently their experience with that health care system. There is also a structural barrier. It includes lack of access to preventive health care services and the lack of a formal and informal support network. This results in less effective use of these preventive services. Linguistic, religious, and cultural factors contribute to the newcomers' social isolation. Multidisciplinary work to enhance health literacy and awareness about health and healthy lifestyles will permit ethnocultural populations to develop their potential and more fully enjoy their lives in Canada. Simultaneously, health educators should have the opportunity to realize their limitations and challenges in dealing with the complexity of providing health education to this population. There remain gaps in our knowledge about the access and use of health services by subpopulations from different cultural groups in terms of their gender, learning practices, ways of navigating services, and help-seeking behaviours.     

Primary health care for refugees and asylum seekers: a review of the literature and a framework for services

OBJECTIVES: This paper aims to provide a framework for primary health care services to meet the recognized health needs of refugees and asylum seekers that can be used in planning and evaluating services for this group. REVIEW: Primary care services for refugees and asylum seekers are reviewed and presented in terms of a tripartite framework of gateway, core and ancillary services. Gateway services facilitate entry into primary care by identifying unregistered patients and carrying out health assessments. They are typically undertaken by nurse-led outreach services and specialist health visitors. Core services provide full registration and may be provided by dedicated practices or by mainstream practices, with or without additional support. Ancillary services are those that supplement and support core services' ability to meet the additional health needs of this group. They include language and information services, close links with community-based organizations, specialist mental health services and services for survivors of torture and organized violence, as well as targeted health promotion and training of health workers. CONCLUSIONS: The framework can be used for education and training, planning and commissioning, and to provide criteria for comparison and evaluation. The paper suggests that a lack of published evaluations and reports about interventions for refugees and asylum seekers constrains further policy development that could build on the strengths of such interventions. It also stresses the importance of ancillary services to successful mainstream provision.     

Keeping health promotion in the pink. Documentation can show how programs contribute to hospital goals

Health promotion encompasses a wide range of services, including health information, health education, wellness, and employee health programs--important efforts, but hardly life-or-death matters. So with increased pressure to put programs to an institutional "worth" test, few health promotion programs make the grade, not because they fail, but because their managers do not know how to document and demonstrate their contributions to hospital goals. The tools that can be used to track program impact range from simple hand-written record keeping on file cards to more complicated and computer-supported systems of data gathering and analysis. It is a mistake to assume that only computer-based systems can yield meaningful information. In the documentation process it may be necessary to start small, but it is necessary to start. Sound management decisions depend on practical evidence that a program is helping a hospital's operations. When one hospital implemented an employee assistance program, program managers set out to document how the program saved the hospital money, improved the work environment, and improved quality of care. At another hospital, the manager of the inpatient cardiac rehabilitation program enlisted the assistance of the medical records department to document to the hospital that patients not in the program had longer lengths of stay than program participants.     

Are Primary Care Practices Ready to Become Patient‐Centered Medical Homes?

Purpose: To measure the readiness of rural primary care practices to qualify as patient‐centered medical homes (PCMHs), one step toward participating in changes underway in health care finance and delivery. Methods: We used the 2008 Health Tracking Physician Survey to compare PCMH readiness scores among metropolitan and nonmetropolitan primary care practices. The National Committee on Quality Assurance (NCQA) assessment system served as a framework to assess the PCMH capabilities of primary care practices based on their services, processes, and policies. Findings: We found little difference between urban and rural practices. Approximately 41% of all primary care practices offer minimal or no PCMH services. We also found that large practices score higher on standards primarily related to information technology and care management. Conclusions: Achieving the benefits of the PCMH model in small rural practices may require additional national promotion, technical assistance, and financial incentives.     

Evolution of computer-based information systems and networks to support integrated health care delivery systems

As health care delivery systems become more integrated with an emphasis on community wellness and prevention, well-developed information infrastructures will be needed to support their activities. The article introduces several previously published independent models for the evolution of integrated delivery systems, computer-based patient records (CPRs), and health information networks as well as a summary model that illustrates the relationship among these entities and their somewhat parallel development.     

Back to the future for many hospital-physician relationships: where do we go from here?

Many hospitals, health systems, and large physician group practices have experienced the rise and fall of "managed care," over the past decade or so. The impact has been large and has included the rapid growth and acquisition of physician practices, followed by huge financial losses, and subsequent re-organization, divestiture, and bankruptcies. Regardless, physicians, hospitals, and health systems still face the burden of a rising demand for patient care services. Hospital-physician relationships are still crucial to the health care system. Suggestions with regard to how to analyze your local market and move forward from here to rebuild hospital-physician relationships and care systems are presented and discussed.     

Prevention and health promotion in primary care: baseline results on physicians from the INSURE Project on Lifecycle Preventive Health Services

The INSURE Project on Lifecycle Preventive Health Services is a 3-year feasibility study to develop and test a clinical model of preventive health services, including patient education, in primary medical care as an insurance benefit. Seventy-four primary care physicians in group practices were surveyed regarding their baseline attitudes toward, and practice of, preventive services. Physicians report that they tend to be conscientious in educating their patients about their health risks, although they spend little time in patient education. Physicians are not sanguine about their success in getting their patients to follow their recommendations and tend to harbor doubts about their own efficacy in these areas. Specialty differences exist in these parameters. Physicians evidence contradictory attitudes about prevention. They believe doctors should spend more time providing preventive services but also believe that the lack of insurance reimbursement is an obstacle to providing these services. The concept of structural or sociological ambivalence is advanced to explain this pattern.     

The INSURE project on lifecycle preventive health services.

The INSURE Project on Lifecycle Preventive Health Services is a 3-year study to determine the feasibility of implementing preventive services in primary medical care as a health insurance benefit and to assess the short-term impact of this implementation on providers and consumers. Initiated by the life and health insurance companies, the project has received additional support from private philanthropic foundations. Preventive services, which will be provided under a lifecycle approach according to the age and sex of the patient and include education of patients on health-related behavior, will range from prenatal care through geriatrics. A quasi-experimental design will be used in which three study (experimental) group practice sites are matched with three control group practice sites. At the study sites, the primary care physicians will participate in orientation sessions on recommended preventive services and patient education procedure; they will also examine and counsel the study patients. The study and control physicians and patients will be surveyed before and after the program of intervention is conducted at the study sites to assess their knowledge, attitudes, and behavior toward health behavior practices.     

The GP's response to pandemic influenza: a qualitative study

BACKGROUND: Current pandemic influenza plans to place GPs at the front line of a pandemic influenza response. However, little is known about GPs' perceptions of their role and preparedness in the event of a pandemic occurring. OBJECTIVE: Our aim was to assess general practice preparedness to respond to pandemic influenza and to identify issues that need to be addressed to enhance preparedness for the next pandemic. METHODS: We conducted a series of semi-structured interviews to explore GPs' views regarding their role in responding to pandemic influenza, practice preparedness and planning issues, and the expectations and requirements of GPs for provision of professional services during a pandemic. The subjects were 60 Australian GPs, purposively selected to maximize diversity within the sample. RESULTS: GPs in this study expressed a willingness to provide professional services in a pandemic. The motivation for this was largely altruistic and was in the context of high personal risk of becoming infected. Participants did not have stockpiles of antivirals or personal protective equipment within their practices and felt that government had a duty of care to stockpile on behalf of the general practice workforce. Participants were enthusiastic about receiving further information and training in pandemic preparedness. The most appropriate setting for this was within practices. CONCLUSIONS: GPs were willing to provide clinical services in a pandemic. However, appropriate education, training and supply of equipment were necessary to support them in this role. This information will inform further planning for the public health response to pandemic influenza.