Detecting bad actors in value-based payment models

Health Services and Outcomes Research Methodology - The U.S. federal government is spending billions of dollars to test a multitude of new approaches to pay for healthcare. Unintended consequences...     

The role of actors in teaching communication

This paper describes a series of communication workshops designed to improve the consultation skills of third-year clinical medical students during their period of attachment in general practice, and to enable them to understand the differences in perspective and attitude existing between doctor and patient and their effect on the process and outcome of the clinical interview. The workshops involve a group of professional actors as simulated patients. The advantages of this method are discussed in terms of increased lay participation in the teaching.     

On the question of homosexuality in actors

There is a belief that a high percentage of male actors are homosexual. The specific linking of actors and homosexuality seems to have first appeared in the Elizabethan Puritan condemnations of the theater. Psychoanalytic theory has tended to further promulgate the linkage between effeminacy, homosexuality, and acting. An analysis of the relevant existing empirical literature indicates that few studies have addressed themselves to evaluating this relationship. Those studies supporting the effeminacy-actor relationship were seriously flawed both in design (e.g., use of indirect measures to infer homosexuality) and interpretation of the data. Only one study used direct measures of sexual orientation. Even though that study had methodological problems, its results indicated that the percentage of homosexuality among actors was not verifiably greater than that found in the general population. It is felt that the current belief of greater homosexuality in actors, as compared to the general population, is a product of our Puritan heritage, the actors's unconventionality, and of public flaunting of the homoerotic behavior of that portion of actors that are homosexual.     

Mortality of Polish actors in 1981-1999

The objective of this study was to compare the mortality of Polish actors (males and females) with the general Polish population for the period 1981-1999 and for two sub-periods: 1981-1991 and 1992-1998. Initially the studied cohort included 3992 dramatic actors (2161 males, 1831 females) of age 18-80 years (at the moment of cohort entrance). After detailed data verification statistical analysis was made for 2120 actors and 1767 actresses, contributing 29477.1 and 24886.2 person-years of observation, respectively. A total of 633 deaths (368 males and 265 females) were noted during the analyzed period. Statistical approach based on the follow-up method. Comparison with the reference population (Polish males and females from urban areas) was made by means of the standardized mortality ratios (SMRs) and their 95% confidence intervals. Direct comparison of the selected subgroups' mortality based on the rate ratio analysis. Standardized mortality ratios were 0.739 (95%CI: 0.666-0.819) for the actors and 0.887 (95%CI: 0.784-1.001) for actresses. Mortality of the actors' cohort was found to be significantly lower than in the reference population during total analyzed period, whereas for actresses no significant differences were found. Age-specific SMR dependence was found. Statistically significant lowering of SMR was observed for actors up to 80 years old. Finally, it could be concluded that in contrast to the actresses' cohort the actors' mortality in 1992-1999 significantly decreased in relation to 1981-1991 period. Moreover, the decrease of the actors' mortality exceeded tendencies observed for Polish urban population.     

Balancing influence between actors in healthcare decision making

Background  

Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues.     

脑血管病社会心理因素与预后关系的研究

[目的]脑血管病是严重危害中老年人的常见病、多发病、且发病率高、死亡率高、致残率高，本研究探讨了年龄、性别、职业及文化程序与脑血管病预后的关系。[方法]在天津医科大学总医院神经内科急症及病房共收集200例经颅脑CT扫描确诊的新发脑血管病患者（TAI短暂性缺血发作及蛛网膜下腔出血SAH除外），并于发病后6个月对病人随访，进行Cox比例风险回归模型分析。[结果]年龄、职业是脑血管病预后的影响因素，未发现性别、文化程度与脑血管病预后有关。[结论]提示年龄可作为判断脑血管病预后的一个指标。     

Caregivers of elderly with advanced cancer: vulnerable actors

Cancer presents high prevalence and mortality rates among elderly Brazilians, and family members provide meaningful care, especially during terminal illness. A literature review focused on the impact for families and the physical, psychological, social, and economic burden for family caregivers of seniors with advanced cancer, as well as related interventions. More studies are needed on family caregivers of elderly with advanced cancer in Brazil in order to develop programs to protect these important social actors.     

An assessment of Brazilian psychiatric reform: institutions, actors and policies

The article takes a look at Brazilian Psychiatric Reform over the past decade, after the approval of Federal Law 10.216/2001 and seeks to elicit long overdue discussion about the pressing challenges that Brazilian Psychiatric Reform needs to tackle to promote or review the long-desired utopia of "full citizenship for all in a society without asylums." Is the Reform showing signs of exhaustion? The redirection of the care model for Mental Health in Brazil from the hospital to the community over the past decade is an undeniable achievement. Taking the use of psychoactive substances as the scope of policy and intervention, this incorporates complex demands that the current Crack drama makes it more urgent to question its history, its limits, its power. What will keep the flame alight of a successful movement that, surprisingly, has resisted the force of time and stigma in the ten years since the Law was enacted? These and other questions need to be worked on. It is time to recycle the focus of assessment and analysis in order to identify what threatens its vitality. This is the challenge to which the writer and debaters will be enjoined to contribute.     

Social and political actors in the formulation of health reform in Spain

An analysis of the participation of social and political actors in the process of formulating health policy allows one to understand the specific characteristics of the organization and operation of a health system. This study analyzes the drafting process for the General Health Act (LGS) in Spain with the purpose of establishing the relationship between social, political, and economic actors in both the formulation of the Act itself and the organization of the Spanish Health System. A case study was carried out from 1982 through 1986. Documentary parliamentary data, the medical press, national magazines and journals, and press reports by political, social, and public health actors were analyzed. The first version of the General Health Act presented by the Spanish Socialist Workers' Party (PSOE) proposed a health system with funding and public administration aimed at achieving universal health coverage, integrated care, community participation, and health education. This proposal was submitted to a complex negotiating process with business groups, unions, and health professionals. The General Health Act as finally approved excludes the principles of equity and incorporates private interests in health: "free choice of doctor and hospital", public funding and private administration of the health system, and the establishment of Social Security as the core of the entire health system.     

Value importance and value congruence as determinants of trust in health policy actors

The paper examines levels and determinants of trust in a health care system and in key actors in the health policy community. Talcott Parsons theorizes that the sharing of common values is a necessary condition for interpersonal trust to exist; this paper tests that notion at the level of systemic (institutional) trust. The paper reports findings of a 1999 survey of 493 randomly selected residents of Calgary, Alberta, Canada. It uses multiple regression analysis to identify the determinants of three different types of trust-generalized systemic trust, fiduciary trust, and generalized trust in particular actors' input to health system changes. Among the numerous independent variables, special attention is devoted to the degree of congruence or incongruence between the importance which respondents attach to one of the values enunciated in the Canada Health Act-namely, 'accessibility' (equal access to quality health care)-and the importance which respondents believe is attached to that value by the Regional Health Authority and by the Premier of the province. Both value importance and value congruence on equal accessibility are found to be important factors explaining variation in all three types of trust. In explaining levels of trust in the Premier on the issue of health care system reform, congruence on equal accessibility proved to be even more important than such factors as political partisanship, political cynicism, and personal experience as a patient in the health care system. Findings also suggest that there is an emotional component to systemic trust.     

Collective actors and corporate targets in tobacco control: a cross-national comparison.

Cross-national comparative analysis of tobacco control strategies can alert health advocates to how opportunities for public health action, types of action, and probabilities for success are shaped by political systems and cultures. This article is based on case studies of tobacco control in the United States, Canada, Britain, and France. Two questions are addressed: (a) To whom were the dangers of smoking attributed? and (b) What was the role of collective action--grassroots level organization--in combating these dangers? Activists in Canada, Britain, and France moved earlier than the United States did to target the tobacco industry and the state. Locally based advocacy centered on passive smoking has been far more important in the United States. The author concludes that U.S.-style advocacy has played a major role in this country's smoking decline but is insufficient in and of itself to change the corporate practices of a wealthy and politically powerful industry.     

广州市家庭食品安全操作及影响因素分析

目的 了解广东省广州市家庭食品安全操作情况及其影响因素.方法 在广州市5个城区各随机抽取1所学校,每校随机抽取4～5个班学生,由所抽取学生的家庭食品制备者匿名填写食品操作调查表.结果 共发问卷1 050份,收回有效问卷1 006份;食品安全操作满分15分,调查对象得分中位数为9分;不同性别(Z=4.594,P=0.000)、年龄(χ²=16.790,P=0.001)、学历(χ²=16.967,P=0.002)、医学背景(Z=2.426,P=0.015)、家庭收入(χ²=21.389,P=0.000)者得分差异有统计学意义;洗手频率和方法,擦布及用具清洁、虫鼠控制,砧板菜刀生熟分开,食物烧熟煮透,储存食品方面能安全操作的分别占46.1%(464/1 006),22.4%(225/1 006)2,5.2%(254/1 006),58.3%(255/1 006),53.0%(533/1 006);Logistic回归结果表明,进入模型的有操作者性别、对食品安全操作的认知、态度、获取知识的意愿及家庭人均收入.结论 应加强对居民进行食品安全操作宣教,特别应注重低学历、低收入、男性人群.     

Finding a voice. Like individuals, organizations are moral speakers and actors

Though "good people' are important for the life of any organization, it is a myth to think that enough good people will make for a good organization. To break free of this myth, a health care organization, which is made up of numerous persons and groups, ought to be regarded as a single, unitary actor in society. When seen as a single actor, the organization's systems for carrying out its mission can be better assessed and improved if necessary. If the organization's systems are not functioning as they should, then even good people will be hindered in their efforts. It can be said, therefore, that organizational ethics takes seriously the idea that every Catholic health care organization is a moral actor needing to reflect carefully on what it does in relation to its employees, leaders, and the outside community. In an environment where the organization's actions are reflected upon, and its character is carefully and continually shaped according to its mission, individual persons in that organization will be better equipped for making and carrying out good decisions that are aligned with that same regard for the mission.     

Defining and implementing arsenic policies in Bangladesh: possible roles for public and private sector actors

A UN report warned up to 50% of Bangladesh's population (57 million) are at risk of arsenic poisoning from naturally occurring arsenic in well water. This article explores how this problem occurred, assesses what factors impede progress eliminating this problem and recommends governmental measures for prevention of arsenic poisoning.     

Identification and priority setting for health technology assessment in The Netherlands: actors and activities.

This article describes the actual situation at the beginning of 1999 with regard to identification and priority setting for health technology assessment (HTA) on a national level in the Netherlands. For this purpose the literature on HTA published in 1980-1998, mainly national, was thoroughly reviewed. Many policy documents and other reports from the 'grey literature' of identification and priority setting for HTA in the Netherlands were also used. The results show that attempts to identify and set priorities for HTA is a new activity in the Netherlands. The three most important actors in the field are the Health Council, the Council for Health Research and the Health Insurance Council. Methodologies differ depending on the content and scope of each programme. In addition, the methods used are not always transparent and the activities are not co-ordinated. The lack of co-ordination is due to the fact that there is no single organisation that is authorized to identify and set priorities for HTA. Suggestions for improving co-ordination are proposed with the aim of developing a truly national effort in this field, which will enable a more balanced and efficient set of HTA activities.     

Cooperation or conflict over child health surveillance? Views of key actors.

OBJECTIVE--To describe the views of general practitioners, health visitors, and clinical medical officers on child health surveillance, recent changes, perceptions of each other's roles, and attitudes to audit. DESIGN--Postal questionnaire survey. SETTING--Three health districts in North West Thames health region. SUBJECTS--All 602 general practitioners, 272 health visitors, and 42 clinical medical officers in these districts. MAIN MEASURES--Attitudes to and perceptions of child health surveillance and audit. Questionnaires were completed by 440 general practitioners (response rate 73%), 164 health visitors (60%), and 39 clinical medical officers (93%). RESULTS--Attitudes to child health surveillance were less positive among general practitioners than health visitors or clinical medical officers. Few respondents agreed that child health surveillance was a cost effective use of general practitioners' time (general practitioners 28%, 113/407; health visitors 28%, 40/145; clinical medical officers 39%, 15/39) and most thought that health visitors should carry out more of the doctors' examinations (68%, 262/387; 65%, 89/136; 66%, 25/38). General practitioners thought that clinical medical officers were less supportive than other relevant groups of their doing more child health surveillance. Most (72%, 105/146) health visitors thought that the 1990 contract had reduced parental choice of where to attend for child health surveillance. General practitioners were less enthusiastic than health visitors about most forms of clinical audit. CONCLUSIONS--Despite reservations about the impact of recent changes all groups were willing to explore innovative ways of delivering child health surveillance. IMPLICATIONS--There is scope for health visitors to increase their responsibilities and for more varied relationships between general practitioners and community child health doctors.     

Mental health in France,policies and actors: developing administrative knowledge in a segmented world

The new mental health care policy, which has been set up in France, involves a change of paradigm, which has been going on since the 2000s: the emphasis is shifting from psychiatry to mental health care. This shift mainly concerns the knowledge about mental health is produced and circulates among an increasingly large number of bodies. Mainly grounded on actor interview analysis, official reports and blueprints, this study shows that the results of this process are numerous. They include the development of ambulatory care and strong moves towards decentralization. More data and knowledge are therefore to be shared in this more complex system. However, the French State, in the form of the central administration, is taking advantage of this move and is still contributing significantly to the definition and implementation of the new policy. On the other hand, the new governance dynamic is not leading to standardization of medical practices, as the mental health field remains highly heterogeneous. Copyright © 2012 John Wiley & Sons, Ltd.     

上海市宝山区外来儿童免疫预防现状及影响因素

目的：进一步提高上海宝山区外来儿童免疫预防管理工作。方法：采用分层抽样方法对本区外来流动儿童免疫接种现状及其影响因素进行流行病学调查。结果：不论是“四苗“基础免疫、加强免疫还是乙肝疫苗全程免疫，该区外来儿童疫苗接种率、及时率都远远低于本地儿童。外来儿童“四苗“全程接种率的高低与外来儿童性别、家庭收入、父母亲的职业、年龄及文化程度等内容无关，但与居住时间有关，父母亲在当地居住时间0.5a以上的儿童“四苗“全程接种率明显高于居住0.5a以下者、居住该区时间在1a以上的儿童“四苗“全程接种率明显高于居住1a以下者。结论：区外来儿童免疫接种状况不佳，尤其对于流动频繁的外来儿童，还有无效管理手段。提醒该区借鉴其他省市的经验，结合当地实际情况，探索当地外来儿童免疫预防工作管理方法，促进预防接种工作的开展。