Monitoring equity in health and healthcare: a conceptual framework

This paper aims at articulating a conceptual framework for monitoring equity in health and healthcare. The focus is on four main questions: What is health equity? What is monitoring? What are the essential components of a system for monitoring health equity? and Why monitor health equity? Monitoring equity in health and healthcare requires comparing indicators of health and its social determinants among social groups with different levels of underlying social advantage, i.e. groups who occupy different positions in a social hierarchy. A framework is presented for formulating the key questions, defining the social groups to be compared, and selecting the health indicators and measures of disparity that are fundamental to monitoring health equity. Although monitoring health equity is a scientific endeavour, its fundamental objective is guided by values; technical challenges should be addressed as part of a broader strategy to confront the political obstacles to greater equity.     

Buying a healthcare information system

Replacing an antiquated computer system with state of the art equipment and software is a lengthy, at times frustrating, and never an easy decision. At Wesley Woods Center on Aging, Atlanta, an integrated provider of healthcare for the elderly affiliated with Emory University, the process consumed more than two and a half years. This article takes the reader through the entire process, from the initial decision to replace an existing system, through the final purchase and installation. It looks candidly at the problems that were encountered, including turnover among key personnel, difficulties with involving all of the user groups, changes in the technology and coordination with the University. The lessons Wesley Woods learned in its experience can be of benefit to any healthcare facility contemplating an information system change.     

卫生服务体系发展不充分不平衡与有效治理：一个理论分析框架

新医改十年以来，我国卫生服务体系发展不充分不平衡问题仍较为突出，无法充分有效地适应新时代居民的健康需要。在国家治理现代化的大背景下，卫生服务体系的有效治理得到了广泛的呼吁。但是，目前尚未有成熟的理论分析框架。因此，建构卫生服务体系有效治理的理论分析框架具有重要的研究、政策和实践意义。首先，本研究通过文献综述、概念辨析，基于多学科视角界定了卫生服务体系发展不充分不平衡的层次和维度。其次，结合其与卫生治理的逻辑关系，初步探讨了有效治理的内涵逻辑、作用路径和机制，提出了一个“制度—结构—过程—结果”的理论分析框架。最后，基于卫生治理的三大作用靶点，为相关问题的研究和实践提供了新的思路。     

Text management in a healthcare information system

Virtually there. Natural language or textual data in the patient record plays a critical role in medicine. Read about the innovative system LDS Hospital has implemented to integrate textual data into the computerized patient record.     

Advancing health disparities research within the health care system: a conceptual framework

We provide a framework for health services-related researchers, practitioners, and policy makers to guide future health disparities research in areas ranging from detecting differences in health and health care to understanding the determinants that underlie disparities to ultimately designing interventions that reduce and eliminate these disparities. To do this, we identified potential selection biases and definitions of vulnerable groups when detecting disparities. The key factors to understanding disparities were multilevel determinants of health disparities, including individual beliefs and preferences, effective patient-provider communication; and the organizational culture of the health care system. We encourage interventions that yield generalizable data on their effectiveness and that promote further engagement of communities, providers, and policymakers to ultimately enhance the application and the impact of health disparities research.     

Sexual trauma and pregnancy: a conceptual framework

In this paper, we propose that a history of sexual traumatization is associated with pregnancy complications and poor pregnancy-related outcomes. We further hypothesize that this relationship is mediated by the sequelae of trauma (psychopathology, health problems, and increased negative health behaviors). We review the literature linking sexual trauma with psychopathology, health, and health behavior and then outline the impact of these variables on pregnancy. Based on this review, we draw conclusions about the potential impact of sexual trauma on pregnancy outcomes. We suggest future directions for this area of research and discuss the clinical implications of this association, including the development of prenatal intervention and prevention programs.     

Public health finance: a conceptual framework.

In an attempt to stimulate development of public health finance as a field of practice, policy, and scholarship, this article proposes a working definition of the term "public health finance," embeds it in the context of the maturing literature on the public health system and its infrastructure, and proposes a four-part typology that spans both public-sector and private-sector contributions to the financing of prevention and health promotion. A developmental strategy for the field--in applied research, training and education, and performance standards--is outlined as well.     

Stress and preterm delivery: a conceptual framework

Numerous epidemiological studies of various kinds of stress and preterm delivery have produced either negative or weakly positive results. Those inconclusive findings could be either because of the absence of an association or because of recognised methodological problems that may have masked an association. The biological plausibility of the stress hypothesis provides one rationale for continuing stress research, using better study designs. To further this agenda, we propose an epidemiological model, based on the classic 'host, environment, agent' triangle of epidemiological causality. The host is the individual woman, more or less susceptible to stressor-induced pathology. The environment includes the social and cultural conditions that are ongoing stressors as well as social and cultural modifiers of stress e.g. those factors that may influence how a particular stressor is experienced or what the physical response to it may be. The agent is the immediate emotional or physical stressor requiring her response. We draw from recent literature, published principally since 1990, to illustrate this model.
This epidemiological model posits that whether the individual is overwhelmed by stressors depends not only on the strength of the agents but also upon host susceptibility to stress, as well as the background level of acute, environmental and contextual stressors, and the moderating influence of host, environmental and contextual resources for handling stress. Future research needs to be based on stress hypotheses that include all sides of the triangle, data collection instruments that adequately capture relevant stressors and stress responses, and analytical techniques capable of handling complex, multilevel relationships.     

Health care requirements planning: a conceptual framework

A clearly defined closed-loop operations management system comparable to the Manufacturing Resource Planning System (MRP-II) does not exist in the health care industry. Therefore, a study was conducted to evaluate the basic modules of MRP-II in terms of their applicability for developing a workable health care requirements planning system.     

The sustainability of Canada's healthcare system: a framework for advancing the debate

The debate of whether Canada's healthcare system is sustainable is mired in ideology. This paper offers a framework that takes us beyond the ideological standoff with a process to deal ethically with the issue of the sustainability of publicly funded healthcare.     

Development of a web-based multifacility healthcare surveillance information system

This article describes recent work to develop a Web-based statistical surveillance information system to monitor in real time the status of the U.S. Air Force's worldwide healthcare network. The intent is to incorporate statistical and related methods in order to identify unusual events and patterns of concern in large, highly distributed organizations. The work recently received an award from Vice President Gore for reinventing government.     

Contracting-out health care services: a conceptual framework.

Contracting-out has become increasingly prominent in the health-care sector. It has been used in activities ranging from 'internal market' arrangements in which providers compete for funding from government payers to purchases of medical and non-medical inputs by service providers. While contracting-out arrangements for non-medical services have been widely adopted with apparent success, the contracting-out of medical services has met with criticism. Specifically, prominent 'market failures' have been identified which allegedly make contracting-out inefficient and even potentially disruptive to health care delivery. This paper presents and discusses a systematic framework for policymakers to identify and assess potential problems in contracting-out health care services, as well as some generic approaches to mitigating these potential problems. A key to the framework is the notion that conditions contributing to potential market failure problems can often be mitigated by policymakers, and that the strategic choices of policymakers in the 'first stage' of the contracting process should include an analysis of how the contracting-out environment can be changed to mitigate potential market failure problems.     

Factors affecting breastfeeding practices: applying a conceptual framework

Knowledge about factors affecting breastfeeding can be developed by further research on underlying factors and by drawing out the implications and lessons from intervention research. The use of a conceptual framework to guide this research and the interpretation of results can help us to understand the relative importance of different factors, and how they interact, in turn, helping us to design effective interventions.     

Illness as adjustment: a methodology and conceptual framework

Abstract This paper describes a method for studying individual adjustment to illness. The methodology draws upon the conceptual framework offered by Herzlich (1973) and defines four modalities of adjustment - accommodation, active-denial, secondary gain and resignation. The relevance of these modalities for understanding how people come to terms with illness is indicated with reference to a variety of studies of chronic illness describing such adjustments. The technique, which invites free responses to a series of questions, engages respondents on a number of issues which have been designated salient in the literature on illness behaviour and is intended to be used (a) to distinguish between individuals in their adaptation to their condition, and (b) to relate personal experience of illness to changing social situations and relationships. The methodology is offered as a way of describing, within a single conceptual scheme, the ways in which individuals resolve the dual demands of bodily change and of cultural constraint during chronic illness.     

The health impacts of globalisation: a conceptual framework

This paper describes a conceptual framework for the health implications of globalisation. The framework is developed by first identifying the main determinants of population health and the main features of the globalisation process. The resulting conceptual model explicitly visualises that globalisation affects the institutional, economic, social-cultural and ecological determinants of population health, and that the globalisation process mainly operates at the contextual level, while influencing health through its more distal and proximal determinants. The developed framework provides valuable insights in how to organise the complexity involved in studying the health effects resulting from globalisation. It could, therefore, give a meaningful contribution to further empirical research by serving as a 'think-model' and provides a basis for the development of future scenarios on health.