Resource allocation for community-based therapy

Purpose. Adequate and equitable resourcing of services for children with disabilities and their families is a challenge that is faced by agencies as the growth in client numbers outstrips any increase in available funding. While funding models have been developed within the acute health care and education sectors, there have been few attempts to develop funding models for therapy (occupational therapy, physiotherapy, psychology, and speech pathology) provided within community-based, paediatric disability services. This paper outlines a model for allocating staff resources to provide therapy services for children with physical disabilities based on a project conducted by Novita Children's Services (formerly the Crippled Children's Association of South Australia, Inc.).

Method. Services were mapped using a framework based on the International Classification of Function developed by the World Health Organization and adopted by the Australian Institute of Health and Welfare. An action research methodology was employed that included focus groups held with staff to identify potential resource drivers; collection of travel time data, client caseload numbers; and developing profiles of services and client groups. A model for allocating staff time was developed to reflect the differing service demands, travel time, leave allowances and time for activities to develop the social environment for individuals with disabilities.

Results and conclusions. Analysis indicated that the drivers of staff resources were the type of service delivery (early intervention versus school aged services), model specific (e.g., time required to provide community-based services and work within multi-disciplinary teams), and specific client (need for complex technology or equipment; school/preschool transition times; high health care needs due to dysphagia, deteriorating conditions with changing needs, or post surgery/medication rehabilitation) and family well-being issues. While further data collection and refinement of the model is needed, it provides the organization with more objective and equitable resource allocation and enables improved advocacy for client needs.     

Service learning. Resource allocation

Service learning has the potential to increase student learning, assist communities, and provide faculty members with one focus area that brings teaching, service, scholarship, and practice together As nursing programs revise curricula to include community based service learning opportunities, the impact of these projects on material and human resources must be assessed. Planning can increase the probability of adequate resources, faculty productivity, and student learning. When planning service learning activities, addressing the following questions will assist in evaluating projects: Is there a the match between academic mission and community needs? What commitment will be made to the community? Will the project promote faculty productivity? Will it offer students superior learning opportunities? What resources will the project require?     

Resource allocation decisions in critical care nursing

One of the major challenges for critical care nurses is to distribute their professional services in a manner that is consistent with the moral imperatives of nursing. The central values of respect for individual patients, patient-centered beneficence, full beneficence, and justice must be woven together into an ethical framework that assists nurses in allocating their skills. Professional organizations, such as the AACN, are actively trying to order this ethical disorder by proposing guidelines that, on the one hand, acknowledge societal interests in cost-effective utilization of health care resources, and on the other hand, safeguard the interests and well-being of individual patients. In addition to the guidance from professional organizations, health care institutions should address the inequities in health care by developing policies that guide the health care team through an ethical decision-making process. Nurses, as members of the multidisciplinary health care team and as members of an essential and scarce resource, should participate in formulating these directives. Not only is bedside and institutional involvement important, but participation at the local, state, and national levels will empower nurses to influence decisions of resource allocation at the micro and macro levels.     

Step-down therapy for hypertension. Results in a community-based program

The study reported here involved a systematic attempt to withdraw medication from participants in a community-based hypertension treatment program. Sixty-six of 88 patients with well-controlled mild or moderate disease had medication withdrawn after at least six months of treatment; nonpharmacologic intervention was not employed. After one year, 44 (66.6%) remained normotensive and drug free; after two years, 33 (50.0%). Of the 29 patients still available for three-year follow-up, 15 (51.7%) were still normotensive and drug free. Withdrawal of medication was associated with correction of hypokalemia and reversal of impaired glucose tolerance. Thus, nearly one fourth of these patients, who were believed to be reasonably representative of those with mild or moderate hypertension, could discontinue drug therapy and remain normotensive for at least one year. Substantial medical and economic benefits are to be realized from wide replication of this experience.     

Physical therapy use by community-based older people

BACKGROUND AND PURPOSE: Little information is available on factors associated with physical therapy use. Identifying the characteristics of people who use physical therapy and some of the factors associated with its use is a useful first step in determining whether disparities exist in physical therapy use. The purpose of this study was to identify factors associated with physical therapy use by community-based older people. SUBJECTS: The subjects were community-based people 65 years of age or older who participated in the Medicare Current Beneficiary Survey and had at least one physician encounter (N=38,312 person-years across 20,227 individuals). METHODS: Logit and ordinary least squares regression analyses were conducted to identify factors associated with physical therapy use. RESULTS: Several measures of health and function were associated with physical therapy use. Several demographic, insurance, and geographic characteristics also were associated with physical therapy use. Income, education, having supplemental private insurance, participating in a managed care plan, and physical therapist supply were positively associated with physical therapy use. Age was negatively associated with physical therapy use. For people who saw a physical therapist, amount of physical therapy received was positively associated with income, having supplemental private insurance, living in a metropolitan area, physical therapist supply, and being African American. Amount of physical therapy received was negatively associated with being in a managed care plan. DISCUSSION AND CONCLUSIONS: Variation in physical therapy use, explained by factors other than need, suggests potential underuse or overuse of physical therapy by community-based older people.     

Introducing clinical supervision for community-based nurses

City and Hackney Teaching Primary Care Trust has introduced mandatory clinical supervision for all front-line nursing staff (district nurses, health visitors, school nurses, staff nurses, health care assistants). A group model is used, with sessions occurring monthly and lasting 90 minutes. Groups include a mixture of qualified and unqualified staff. The project was introduced in two phases. First, external facilitators were used to run sessions for 18 months. An evaluation toward the end of this period found very strong staff support for the innovation. Internal facilitators were then trained to implement the second phase. A second evaluation found continuing support for clinical supervision, and a preference for multidisciplinary groups. Clinical supervision is now firmly embedded in the organization. It is primarily 'restorative', offering staff relief from the stresses of working in a very deprived and ethnically diverse area where the recruitment and retention of staff is an enduring challenge.     

A performance improvement program for community-based gastroenterology

A robust performance improvement program based in a community gastrointestinal (GI) practice is described. The need for continual improvement and attention to both quality and the bottom line is now essential for independent GI practices. This article provides both a roadmap for developing a program and benchmarks derived from a large integrated single specialty GI practice.     

Haemophilus influenzae in respiratory tract infections in community-based clinical practice: therapy with gatifloxacin

In this community-based safety surveillance study, the advanced-generation fluoroquinolone gatifloxacin was administered empirically to 15625 adults with community-acquired respiratory tract infections (RTIs), including 1562 clinically evaluable patients with community-acquired pneumonia (CAP) and 2391 with acute exacerbations of chronic bronchitis (AECB). Haemophilus influenzae was the most common pathogen isolated in AECB (40.1%) and the second most common in CAP (36.8%). In vitro susceptibility to gatifloxacin and other fluoroquinolones, amoxicillin/clavulanate, ceftriaxone, cefuroxime axetil, tetracycline, and azithromycin ranged from 95.8% to 100%. In comparison, a significant percentage of the isolates were not susceptible to clarithromycin ( approximately 41%), ampicillin (22% to 28%), and trimethoprim/sulfamethoxazole (14% to 18%). The susceptibility pattern was generally independent of exposure to another antimicrobial in the previous 30 days. CAP and AECB patients infected with H. influenzae had signs and symptoms similar to those infected with Streptococcus pneumoniae. Among clinically evaluable patients with H. influenzae, gatifloxacin cured 159 of 166 (95.8%) with AECB and 112 of 118 (94.9%) with CAP. The cure rate was independent of the beta-lactamase status or serotype of the H. influenzae strain. H. influenzae is not a more benign pathogen in community-acquired RTIs but causes signs and symptoms that are indistinguishable from those caused by other pathogens, notably S. pneumoniae.     

Resource allocation and resident outcomes in nursing homes: Comparisons between the best and worst

The purpose of this study was to identify patterns of resource allocation that relate to resident outcomes in nursing homes. Data on structure, staffing levels, salaries, cost, case mix, and resident outcomes were obtained from state-level, administrative databases on 494 nursing homes. We identified two sets of comparison groups and showed that the group of homes with the greatest percentage of improvement in resident outcomes had higher levels of registered nurse (RN) staffing and higher costs. However, comparison groups based on best–worst average outcomes did not differ in resource allocation patterns. Additional analysis demonstrated that when controlling for RN staffing, resident outcomes in high- and low-cost homes did not differ. The results suggest that, although RN staffing is more expensive, it is key to improving resident outcomes. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 297–313, 1998     

Creating a community-based memory clinic for older people

This article describes the development of a multidisciplinary, nurse-led memory clinic. The clinic has grown out of research activity to become an important component of a community service for older people with dementia and other mental health problems. A detailed analysis of the interaction between the clinic and the community mental health team, as practised in this model of care, is presented for consideration.     

Viable methods for evaluation of community-based rehabilitation programmes

PURPOSE: The purpose of this article is to discuss some viable and practically feasible methods for evaluation of community-based rehabilitation (CBR) programmes in developing country settings. METHOD: Based on review of literature the role of qualitative approaches for evaluation of CBR programmes are analysed. RESULTS: Aspects of the qualitative paradigm are discussed. The specific qualitative methods of case studies, focus groups, nominal groups, participatory techniques, content analysis, and key informant interviews are deliberated. CONCLUSIONS: Viable alternatives to the qualitative paradigm offer promise in evaluation of CBR programmes. Issues in qualitative designing, sampling, data collection, analysis, and interpretation are discussed. The classical, quantitative paradigm needs to be complemented with viable qualitative methods for evaluation of CBR programmes.     

HIFU消融治疗中监控定位的B超伪像

目的 探讨HIFU消融治疗中B超伪像到探头、探头到目标组织以及治疗头到目标组织三者之间的距离关系. 方法 在不同位置固定治疗头到目标组织的距离,分别测量伪像到探头以及目标组织到探头之间的距离. 结果伪像到探头的距离和目标组织到探头的距离之间呈线性变化关系. 结论 本实验中伪像的形成主要由B超探头引起,与治疗头的位置基本无关.