Self-administered interventions: a health education strategy for improving population health

A case is presented for using self-administered interventions (SAIs) as a viable public health education/promotion option. SAIs are promulgated as a means to more fully participate in projected health care changes. One readily available opportunity is to incorporate SAIs into managed care organizations concerned about balancing costs and care, and responsible for the health care of the populations they serve. SAIs are both clinical and 'population-based' strategies that are viable alternatives to 'usual' care because SAIs offer a means to enhance reach, efficiency and efficacy when used independently or as part of a sequential, systematic series of interventions. SAIs also have other advantages such as being easily shared, disseminated, reusable and capable of including a valuable, inexpensive human resource, trained peer helpers or volunteers. The SAIs of minimal intervention and self-instruction have been widely used with a variety of lifestyle behaviors associated with cardiovascular disease. Research from the weight management literature is used as a heuristic illustration of the application of SAIs, and to describe the nature and potential of SAIs as public health strategies to meet health care challenges of the future related to service delivery.     

Well-being revisited: improving the health of a population

Changes in society and the healthcare system are challenging healthcare executives to do more than provide medical services. Leaders now take broader responsibility for the health and well-being of the people and communities they serve. Health--the "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (World Health Organization 1944)--is determined by four forces: environment, heredity, lifestyle, and medical care services. Health-care managers who want to improve the health of their served populations must improve these forces. Strategic and operational lessons can be learned from the pioneering work done by several hospitals, health plans, and healthcare systems to improve their local environment, heredity, lifestyles, and medical care services. Managers who wish to improve health in their communities should strongly embrace and commit to "health" rather than mere "medical services" in their mission, vision, and values. They should collaborate with many other organizations and people--such as schools, churches, police, and businesses--to build partnerships that extend beyond the healthcare sector into the total community. Healthcare organizations should provide some resources and funds to improve the health of their served populations, and they should view this commitment as an investment (especially if there are capitated lives) rather than as an expense. They should also obtain public and private grant funds and leverage the resources of their collaborative partners to improve their local environment, heredity, lifestyles, and medical care services. Finally, leaders can advocate and support public policy that would improve the four forces that shape health.     

Effective strategy for improving health care outcomes: Multidisciplinary care in cerebral infarction patients

Multidisciplinary teams provide effective patient treatment strategies. South Korea expanded its health program recently to include multidisciplinary treatment. This study characterized the relationship between multidisciplinary care and mortality within 30 days after hospitalization in cerebral infarction patients. We used the National Health Insurance claim data (n = 63,895) from 120 hospitals during 2010–2013 to analyze readmission within 30 days after hospitalization for cerebral infarction. We performed χ² tests, analysis of variance and multilevel modeling to investigate the associations between multidisciplinary care and death within 30 days after hospitalization for stroke. Deaths within 30 days of hospitalization due to cerebral infarction was 3.0% (n = 1898/63,895). Multidisciplinary care was associated with lower risk of death within 30 days in inpatients with cerebral infarction (odds ratio: 0.84, 95% confidence interval: 0.72–0.99). Patients treated by a greater number of specialists had lower risk of death within 30 days of hospitalization. Additional analyses showed that such associations varied by the combination of specialists (i.e., neurologist and neurosurgeon). In conclusion, death rates within 30 days of hospitalization for cerebral infarction were lower in hospitals with multidisciplinary care. Our findings certainly suggest that a high number of both neurosurgeon and neurologist is not always an effective alternative in managing stroke inpatients, and emphasize the importance of an optimal combination in the same number of hospital staffing.     

医疗服务需求管理是解决“看病难、看病贵”的关键路径

对如何解决＂看病难、看病贵＂的问题,目前政策切入点主要是增加投入,加强基层卫生服务能力建设,扩大医疗服务机构规模和医疗保险覆盖范围,而对医疗服务需求管理尚缺乏足够的重视。     

How effective is outdoor-based training in improving management behaviors: a health care application

This study explores the impact of an outdoor-based training program on management behaviors at a major regional medical center. Sixteen managers attended a combination high and low "ropes" training course given in three phases over a one-year period. This program was designed to increase trust and improve communications within the hospital. A number of group measures from previous research are examined, including trust, group awareness, group effectiveness, self-esteem, and bonding of the group. Empirical evaluations of these items were done prior to training and three months after training. Scales that tapped both interpersonal relations and communications were developed from interviews with previous participants, and were evaluated prior to training and six months after training. Behavioral observations were also used to evaluate the effectiveness of the program. Results indicate that the outdoor-based training program was effective in improving certain key behaviors within the group. While stressing the need for future research, this study strongly supports the further use of outdoor-based training programs in health care settings.     

Providing evidence of good allied health care for the veteran population: development of a unique management system

A unique management system was developed to enhance the quality of allied health care for the elderly. The management system is a multipronged framework of processes and outcomes, which address key stakeholder needs, and is based on best scientific evidence. Use of the management system provides efficiencies for funding bodies in data collection and monitoring service quality. It also confirms the professional integrity of the allied health service provider and underscores the importance of client-therapist partnership in determining appropriate health outcomes. Further testing is required to assess the relationship between use of the allied health management system and better quality service provision, cost containment, and consistently good client health outcomes.     

Estimating the demand for health care with panel data: a semiparametric Bayesian approach

This paper is concerned with the problem of estimating the demand for health care with panel data. A random effects model is specified within a semiparametric Bayesian approach using a Dirichlet process prior. This results in a very flexible distribution for both the random effects and the count variable. In particular, the model can be seen as a mixture distribution with a random number of components, and is therefore a natural extension of prevailing latent class models. A full Bayesian analysis using Markov chain Monte Carlo simulation methods is proposed. The methodology is illustrated with an application using data from Germany.     

Principal-agent theory: a framework for improving health care reform in Tennessee

Using a framework based on principal-agent theory, this study examines problems faced by managed care organizations (MCOs) and major health care providers under the state of Tennessee's current capitation-based managed care programs called TennCare. Based on agency theory, the study proposes a framework to show how an effective collaborative relationship can be forged between the state of Tennessee and participating MCOs which takes into account the major concerns of third-party health care providers. The proposed framework further enhances realization of the state's key health care reform goals which are to control the rising costs of health care delivery and to expand health care coverage to uninsured and underinsured Tennesseans.     

Rubella elimination and improving health care for women

In the Americas, the Pan American Health Organization supports strategies for the appropriate control and elimination of vaccine-preventable diseases, especially if the strategies are designed to reduce health inequities, strengthen the political commitment for immunization services, and promote the culture of prevention. In September 2003, the 44th Directing Council of the Pan American Health Organization adopted a goal to eliminate rubella and congenital rubella syndrome by 2010. One of the main objectives of this initiative is improving women's health, consistent with achieving the Millennium Development Goals. An important component of rubella elimination is conducting vaccination campaigns for men and women of childbearing age to reduce rapidly the number of people susceptible to rubella infection. From 1998 to 2002, the English-speaking Caribbean, Chile, Costa Rica, Brazil, and Honduras conducted mass rubella vaccination campaigns aimed at adults. Vaccination coverage reached > 95% in each country with an exception of the Caribbean, where the coverage was 80%.     

改善医患关系的几点思考

该文通过接待775人次投诉案例,找出医疗服务中的医患矛盾,结合当前医疗服务新形势,提出改善医患关系的几点思考方法,为建立良好的医患关系作出了初步的理论探讨.     

Productivity management: a model for participative management in health care organizations

The current cost of inflation in the health care industry, contributed to in part by the Medicare and Medicaid legislation, has created concerns for productivity that can no longer be ignored by health care administrators. Despite these concerns and in the face of increasingly scarce resources, many hospitals have not yet established productivity tracking systems or methods for measuring and analyzing potential areas for productivity improvement.     

人口老龄化和老年医疗保健

从人口老龄化和老龄化社会的概念谈起，论述了中国人口老龄化的趋势的特点：①来势猛，发展快，而且是在经济不发达的情况下到来的；②在时间上具有阶段性和累进的性质；③地区之间发展不平衡；④老年人口众多。探讨了人口老龄化在医疗卫生领域产生的影响和适应老龄化社会的医疗保健对策。强调要从可持续发展的战略高度来研究和解决老年医疗保健问题；要把老年医疗保健的基点放在社区。     

Journal club: a tool for health care management and development

While the journal club concept has its roots in medical practice, the premise of the concept can easily and effectively be assimilated into health care management practice. Health care executives and managers can greatly facilitate the journal club process by establishing a solid methodology for article presentations that focuses on critical and timely issues related to health care management. With upper management support and member commitment, the journal club can be a powerful vehicle for ongoing management and personal career development.     

Linking the delivery of health care to service population needs: the role of the epidemiologist on the health care management team

Historically, in the United States, the practice of most epidemiologists has been oriented toward the public health needs of persons living in communities, and has focused on the determination of rates of disease, risk factors for disease, and evaluating prevention and screening efforts. Continuous profound changes in demographic patterns throughout the world, increases in the rates of many chronic and communicable diseases and disabling conditions, and payer constraints all test the ability of health systems managers to provide quality health care. Over time, managers of health systems will recognize that the most cost-effective strategies will be derived from a population-based perspective. With this viewpoint, the epidemiologist can be a pivotal link in assisting the management team to align the delivery of health care services more effectively with the needs of populations targeted for services, either those residing in communities or those currently receiving services by a system, organization, or an individual provider. This article will describe the increasing role of the epidemiologist in health care organizations and illustrate the functions of the epidemiologist on the health care management team based upon the author's own experience at Rush-Presbyterian-St. Luke's Medical Center, an academic health care center in Chicago, Illinois.     

Predictive modeling in practice: improving the participant identification process for care management programs using condition-specific cut points

The objective of this study was to optimize predictive modeling in the participant selection process for care management (CM) programs by determining the ideal cut point selection method. Comparisons included: (a) an evidence-based "optimal" cut point versus an "arbitrary" threshold, and (b) condition-specific cut points versus a uniform screening method. Participants comprised adult Medicaid health plan members enrolled during the entire study period (January 2007-December 2008) who had at least 1 of the chronic conditions targeted by the CM programs (n?=?6459). Adjusted Clinical Groups Predictive Modeling (ACG-PM) system risk scores in 2007 were used to predict those with the top 5% highest health care expenditures in 2008. Comparisons of model performance (ie, c statistic, sensitivity, specificity, positive predictive value) and identified population size were used to assess differences among 3 cut point selection approaches: (a) single arbitrary cut point, (b) single optimal cut point, and (c) condition-specific optimal cut points. The "optimal" cut points (ie, single and condition-specific) both outperformed the "arbitrary" selection process, yielding higher probabilities of correct prediction and sensitivities. The condition-specific optimal cut point approach also exhibited better performance than applying a single optimal cut point uniformly across the entire population regardless of condition (ie, a higher c statistic, specificity, and positive predictive value, although sensitivity was lower), while identifying a more manageable number of members for CM program outreach. CM programs can optimize targeting algorithms by utilizing evidence-based cut points that incorporate condition-specific variations in risk. By efficiently targeting and intervening with future high-cost members, health care costs can be reduced.