Framework for reform

Ordinary people are starting to add their voices to the debate on the U.S. healthcare system. But the chorus is not yet loud enough to transcend a budget crisis, a savings and loan bailout, competing interests of other industries and a siege of self-interest within the healthcare industry.     

Using the Clinical Prevention and Population Health Curriculum Framework to encourage curricular change

The Healthy People Curriculum Task Force was established in 2002 to encourage implementation of Healthy People 2010 Objective 1.7: "To increase the proportion of schools of medicine, schools of nursing and health professional training schools whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention." In 2004, the Task Force published a Clinical Prevention and Population Health Curriculum Framework ("Framework") to help each profession assess and develop more robust approaches to this content in their training. During the 6 years since the publication of the Framework, the Task Force members introduced and disseminated it to constituents, facilitated its implementation at member schools, integrated it into initiatives that would influence training across schools, and adapted and applied the Framework to meet the data needs of the Healthy People 2010 Objective 1.7. The Framework has been incorporated into initiatives that help promote curricular change, such as accreditation standards and national board examination content, and efforts to disseminate the experiences of peers, expert recommendations, and activities to monitor and update curricular content. The publication of the revised Framework and the release of Healthy People 2020 (and the associated Education for Health Framework) provide an opportunity to review the efforts of the health professions groups to advance the kind of curricular change recommended in Healthy People 2010 and Healthy People 2020 and to appreciate the many strategies required to influence health professions curricula.     

Documentation for change

Based on the experiences of the Voluntary Health Association of India, this article provides an outline for establishing a health documentation center. Noting the importance of readily available information, the Association decided to form a documentation center that would serve its staff in preparing materials for training programs, in drawing attention to health hazards, and in providing information to member organizations. The center is also open to other community groups, international organizations, and other health organizations. And in order to help the voluntary sector develop its own documentation center, the Association conducted a 5-day workshop to teach the necessary skills. When establishing a documentation center, the services offered must be determined in advance. These will probably include the following services: reference, selective dissemination of information, reprography, clipping, bibliography and referral, and clearing-house facilities. Those organizing the documentation center must also identify the core areas of information (possible education and health), which will enable them to easily specify the secondary areas. They must also devise an acquisition policy. The selection of information, the article stresses, is the most important activity of any documentation center, since the usefulness of the collection largely depends on the methods of collection. The article also points out the need of establishing indexing and cross-referencing systems, of using audiovisual aids, and of networking with other documentation centers. The article provides suggestions for disseminating information, and also points out to certain obstacles, including: budget, personnel, and space limitations; and the diversity of languages found in India.     

Managing for change

Since 1988, the Health Services Management Development Trust has given some 34,000 pounds in awards to people embarking on management projects in the health services. The Trust is funded by a partnership of the Institute of Health Services Management and a group of major suppliers to the health services: Boots, Four Square Division of Mars GB, Gardner Merchant, Hewlett Packard and IBM. They also offer mentoring and assist in publicising the project results.     

An Ethics Framework for Public Health

More than 100 years ago, public health began as an organized discipline, its purpose being to improve the health of populations rather than of individuals. Given its population-based focus, however, public health perennially faces dilemmas concerning the appropriate extent of its reach and whether its activities infringe on individual liberties in ethically troublesome ways. In this article a framework for ethics analysis of public health programs is proposed. To advance traditional public health goals while maximizing individual liberties and furthering social justice, public health interventions should reduce morbidity or mortality; data must substantiate that a program (or the series of programs of which a program is a part) will reduce morbidity or mortality; burdens of the program must be identified and minimized; the program must be implemented fairly and must, at times, minimize preexisting social injustices; and fair procedures must be used to determine which burdens are acceptable to a community.     

A Framework for Measuring Low-Value Care

Background

It has been estimated that more than 30% of health care spending in the United States is wasteful, and that low-value care, which drives up costs unnecessarily while increasing patient risk, is a significant component of wasteful spending.

Joint working. Framework for success

PCTs and councils can improve commissioning through shared agreements setting out local priorities. The enhanced role of local authority directors of adult social services will play a key role. One successful example of joint working is in Southwark, which has joint appointments for senior health and social services commissioning roles.     

病种成本测算理论与方法的研究

通过对成本核算理论和方法现状的研究,总结目前我国病种成本核算中存在的问题与不足,结合医院实际情况,构建病种成本测算方法,为按病种付费提供支持。