It takes a village

Faced with the question of what to do with an aging, under-used hospital in northeast Detroit, St. John Health, Warren, MI, turned to the community for help in developing a plan for transforming the campus in a way that would better meet local needs. Through meetings and interviews with local residents, St. John Health learned that community members needed job training, career development, employment, health care, housing, and a safe environment. To meet these needs, St. John Health developed a plan to convert the facility, ST. John NorthEast Community Hospital, into a senior housing community called "Conner Creek: A partnership for healthy lives." Inpatient care has been phased out. Now St. John Health is working with local partners to build affordable, safe, and attractive apartments for seniors. Plans call for Conner creek to offer a wide variety of supportive services to complement the housing and to meet needs identified by the community. a nursing school, chronic care services, job training, and recreational activity areas are among the offerings under consideration. Townhouses may be added in the future. St. John Health's leaders say that Conner Creek May prove to a model for urban health care sites in need of revitalization.     

互补还是替代：家庭照料与社区居家养老服务

文章使用国家卫生健康委2014年开展的中国计划生育家庭发展追踪调查数据,采用Probit模型和工具变量方法,实证检验家庭老年照料与社区上门生活护理服务和社区上门医疗服务之间的关系。研究发现：（1）家庭照料会显著减少老年人使用社区上门生活护理服务的概率,二者呈替代关系,但是在高龄和中、重度失能老人中,两者呈互补关系;（2）对于上门医疗服务则存在互补关系,家庭照料会显著增加老年人使用社区上门医疗服务的概率,但是在低收入老年人中,二者存在替代关系。文章建议社区居家养老服务体系建设要注重与家庭照料之间的协调发展,特别要关注高龄、中、重度失能和低收入老年人群体的照料需求,实现家庭照料与社区居家养老服务的优势互补。     

The posthospital needs and care of patients: implications for discharge planning

Sixty-nine patients hospitalized for a serious illness and discharged to their own or relative's homes were followed up to learn about patient's posthospital needs; sources of help they received and how well they met these needs; and the extent to which hospital social work targets these needs in the discharge planning process. The patients, who were mostly elderly, had substantial needs for care. The family was the major care provider. Although service provision was limited, the social worker had a pivotal role in linking the patient to community services. This exploratory study points to gaps in the hospital screening and discharge planning process.     

Fewer hospitalizations result when primary care is highly integrated into a continuing care retirement community

Meeting the medical and social needs of elderly people is likely to be costly, disruptive, and at odds with personal preferences if efforts to do so are not well coordinated. We compared two different models of primary care in four different continuing care retirement communities. In the first model, used in one community, the physicians and two part-time nurse practitioners delivered clinical care only at that site, covered all settings within it, and provided all after-hours coverage. In the second model, used in three communities, on-site primary care physician hours were limited; the same physicians also had independent practices outside the retirement community; and after-hours calls were covered by all members of the practices, including physicians who did not practice on site. We found that residents in the first model had two to three times fewer hospitalizations and emergency department visits. Only 5 percent of those who died did so in a hospital, compared to 15 percent at the other sites and 27 percent nationally. These findings provide insight into what is possible when medical care is highly integrated into a residential retirement setting.     

The Arjeplog project: comprehensive health promotion in a community.

The municipality of Arjeplog, Sweden, is an example of extensive and successful community participation in the aims of health promotion. At the health care centre, personnel from diverse departments meet on a regular basis to discuss patient needs and exchange knowledge on medical and social matters. Care groups exist in order to enable specialists to discuss and meet community needs: a psychiatric group, a rehabilitation group, a home care group, a child and family care group, etc. The municipality's resources include an old person's home which runs a day centre, A nursery, adult evening colleges, sports clubs, and services such as Alcoholics Anonymous, all serve as centres for the health promotion movement. Preventing ill health among the elderly and encouraging short-term visits to the centre has resulted in the need for hospital beds remaining steady despite an increase in the number of elderly people in the municipality. Preventive work in the form of health education has taken place in schools and through study circles specially formed by health education leaders. Public lectures have been successful and met with requests for further talks. Visits to the outpatient clinic have dropped by about a quarter. Arjeplog has one of the lowest number of people on the sick list in Sweden and the duration of diseases is lower than average. People are generally aware of what a healthy lifestyle involves and often take measures to prevent ill health. A Health Council has been formed and is to initiate future health work through work groups set up to meet health problems identified collectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

家庭功能对老年人家庭访视护理需求影响

目的探讨社区老年人家庭功能、家庭访视护理需求状况及两者之间的关系,为社区医护人员实施家庭访视护理提供依据。方法采取便利抽样入户调查方法,选取宁夏自治区银川市妇幼保健院永丰社区医疗卫生服务站管辖的2个居委会660户家庭,应用家庭关怀度指数问卷和自制的社区老年人家庭访视护理服务需求问卷进行调查。结果家庭功能总分为（5.50±2.503）分,家庭功能良好占34.8%,家庭功能障碍占65.2%;家庭功能障碍组老年人的家庭访视护理总需求及生活护理、健康促进和护理服务需求得分分别为（139.76±30.083）、（27.75±6.491）、（33.42±5.577）、（78.59±19.006）分,均高于家庭功能良好组的（133.95±34.451）、（26.38±7.502）、（32.43±6.536）、（75.14±21.347）分（P均<0.05）;且社区老年人家庭功能与家庭访视护理需求呈负相关（r=-0.135,P<0.01）,其中家庭功能障碍与家庭访视护理需求的生活护理、健康促进、护理服务各维度均呈负相关（r=-0.142~-0.166,P均<0.01）。结论社区老年人的家庭功能有待进一步改善,家庭功能与家庭访视护理需求密切相关。     

From assessment to action. A hospital-community coalition provides needed services to children

In December 1991 St. Mary Hospital, Port Arthur, TX, began a three-phase procedure to provide underserved persons in the community better access to care. The process began with a community needs assessment, after which St. Mary developed a hospital-community coalition to plan and implement programs to address identified needs. The needs assessment revealed two underserved populations: racial and ethnic minorities, and youth in two separate categories (below five years old, and from five to the teen years). The top needs were for greater access to healthcare and an increase in primary care services. Having determined that St. Mary Hospital was better equipped to address the lack of primary care, the needs assessment team forged a coalition with community leaders and providers. Collaborative efforts led to the opening of three primary care clinics for children in 1993. The hospital also participated in a task force that identified and alerted the parents of more than 3,800 Port Arthur children in need of Early and Periodic Screening and Developmental Testing. St. Mary is currently working on a plan to contact the family of every Port Arthur child at the age of three months to ensure immunizations are current and a relationship has been established with a healthcare provider.     

Long-term benefits. A retirement community grows by reaching out to area residents

At St. Leonard Center, a retirement community in Dayton, OH, community benefit programs are such a critical part of daily operations that the organization could not continue to flourish without them. Founded in 1983, the center now serves more than 600 persons. St. Leonard offers independent living arrangements, as well as assisted living and skilled nursing care. From its beginning the center has depended on collaborative arrangements with local churches, agencies, and other organizations. As the center has grown, it has continued to work with others to enhance services to its clients and to local residents. Recent arrangements with St. Elizabeth Medical Center in Dayton have enabled the center to offer home healthcare, as well as outpatient and inpatient rehabilitation. Integrated pharmacy, medical supply, and laboratory services are also available, and a systemwide management information system is currently under development. St. Leonard Center also reaches out to local elderly residents through adult day care and respite programs, as well as through its Senior Network, a resource center (cosponsored by St. Elizabeth) with about 25,000 enrollees. The center also offers three special educational programs for children.     

Primary care: hospitals begin to target community needs

When financial doom threatened St. John (KS) District Hospital, executives there adopted an unusual strategy. In a bid for survival, St. John is abandoning its acute care service and converting to a primary care-only facility. St. John executives viewed their decision as one way to keep health care services available in a one-hospital town. Other hospital executives are also realizing that expanding primary care services is a smart move. According to experts, in the long run such a move will also help to enhance market share for these hospitals. The need to expand primary health care services has also not escaped the notice of the federal government. Physician payment reform puts more money in the pockets of primary care physicians. "The Health Care Financing Administration is beginning to realize their bang for the buck is in primary care and prevention," says one physician.     

Primary care. Home truths

Charging social services for delays in patients being discharged from hospital is unlikely to result in improved care for older people. A new kind of community support worker dedicated to care of the elderly is needed. These workers could provide sustained support and prevent avoidable admissions to residential care. Care packages should take more account of what service users want. Government focus needs to shift from the management of beds to community resources.     

北京市失能老人社区照顾现状及需求分析

目的:通过研究北京市失能老人的社区照料现状与需求,为完善老人社区照顾体系提供建议。方法:利用北京市社区老人社会支持状况调查数据,运用描述性统计分析、单因素卡方检验及多元Logistic回归分析方法,对失能老人的社会照顾情况进行分析。结果:失能老人健康状况不容乐观,其对社区提供公益性医疗卫生服务和为老设施建设均有很高需求,对社区提供钟点工入户、日间照料、志愿者服务也有需求,但社区供给服务与设施建设不足。结论:我国失能老人基数大、增长快,但社区照顾供给不足,难以满足老人的需求,亟需完善社区医疗卫生服务建设与社区居家照顾体系。     

宁波市养老护理服务体系建设现状及对策分析

目的：分析宁波市养老护理服务体系建设现状,并提出对策以提升养老护理服务质量。方法采用文献研究、个人深入访谈及问卷调查相结合的方法进行。结果当前提供养老护理服务的机构有老年康复护理中心、社区卫生服务机构老年护理站、综合医院及社区医院康复科、家庭病床、养老院及社区居家养老服务中心,其中以养老院为主;养老护理提供者主要为养老护理员。结论当前宁波市养老护理服务由卫生系统及民政系统提供,服务数量不足且两部门间协作不够;养老护理服务提供者整体素质偏低,无法满足老年人需求。     

A comparative analysis of the community contributions and profits of Virginia's hospitals

BACKGROUND: In return for receiving favorable treatment from the government, U.S. general hospitals are expected to provide contributions to their community consisting of charity care, bad debt, and taxes paid. Recently, the Government Accountability Office proposed that an analysis that compares what for-profit and nonprofit hospitals contribute be conducted. PURPOSE: For 72 Virginia hospitals, it is determined whether (a) for-profit hospitals' community contributions exceed their profits and (b) nonprofit hospitals' community contributions exceed the for-profits' contributions in addition to the nonprofits' forgone taxes. METHODOLOGY/APPROACH: Based on audited fiscal year 2004 financial statements, six null hypotheses were tested for significant differences between the two independent variables, namely, hospital charter and size, and the three dependent variables, including (a) operating income, (b) the ratio of community contributions to net patient revenues, and (c) the ratio of community contributions to operating income. FINDINGS: No significant differences were found to exist between (a) hospital charter and operating income, (b) hospital charter and the percentage of community contributions to net patient revenues, and (c) hospital charter and the percentage of community contributions to operating income. The community contributions of nonprofits exceeded their taxes forgone by a wide margin, but they fell short of exceeding the for-profits' community contributions plus the taxes forgone by a very slight margin. PRACTICE IMPLICATIONS: Hospital management, in conjunction with health care policy planners, needs to develop mutually acceptable standards regarding the required level of hospitals' community contributions. It is proposed that the most equitable standard is "quartile comparisons" for a given hospital's financial performance and its level of community contributions. Furthermore, to reduce charity care, it is imperative that high-cost hospital treatment of primary health care for indigent patients be shifted to lower cost delivery systems.     

Psychiatric home care of elderly persons with depression: unmet caregiver needs

The purpose of this study was to explore what nursing interventions are currently being provided to family caregivers of elderly persons with depression as a part of standard home health care; and identify unmet needs of these family caregivers. Unmet caregiver needs were examined from both the family caregiver and staff nurse perspective, using caregiver structured interviews and staff focus groups. Ten caregivers participated in structured interviews and nine staff nurses participated in three focus groups. Caregivers reported unmet needs concerning support and respite, dealing with their own feelings, learning more about care-related tasks and role changes, and stress management. Similarly, nurses speculated that nursing interventions should focus on increased counseling, family and community support, assisting caregivers with their learning needs and care-related responsibilities. These findings contribute toward a better understanding of interventions currently provided to caregivers of depressed elderly persons, as a part of standard psychiatric home care; identify unmet caregiver needs; and suggest areas for future psychiatric research in home care settings.     

Interdisciplinary teaching of community paediatrics

An experiment of combining decentralized and interdisciplinary teaching is described. Seminars were arranged at a district hospital for medical, nursing and social work students to discuss families with a chronically ill child. The purpose of these seminars was to teach co-operation between different health care workers, and to stress the importance of becoming acquainted with the family situation, and learn what a child's illness means to the whole family.
An evaluation of the first three seminars shows that this type of teaching was very well received by the students, professionals and families concerned. The students considered house calls an important part of their education and felt that more interdisciplinary teaching should be included in their curriculum. In addition to the teaching aspect, the families involved also considered the seminars a positive experience as they received more information about their child's disease, and deficiencies in treatment could be corrected.     

Impact of the Closure of a Large Urban Medical Center: A Qualitative Assessment (Part I)

This community health needs assessment-the first part of a mixed-methods project-sought to qualitatively examine the impact of the closure of St. Vincent's Catholic Medical Center, a large not-for-profit hospital in NYC, on individuals who used its services. Key informant interviews with organizational leaders and focus groups with residents were conducted to understand hospital utilization, unmet health care needs, health care utilization and experiences post closure, perceptions of the most significant effect of the closing, and recommendations for improving health care in the community. Most respondents spoke positively of the hospital's accessibility, comprehensive, high-quality services, and its close relationship with the community. Conversely, experiences post-closure were largely negative, including decreased access, interrupted care, and loss of emergency and specialty care. Lack of information concerning medical records reflected a larger problem of poor planning and community outreach. Another issue was widespread anxiety in a community now lacking a hospital. Further, while the hospital's closure might cause inconveniences, these effects were described as more daunting to vulnerable groups. Our findings provide a consistent picture of a hospital highly regarded by residents, patients, and leaders of several health and social services organizations. Regardless of whether it should have been permitted to close (as raised by many respondents), the lack of advance planning and outreach to community members and patients remains a major criticism. Coordinated efforts to provide the community with information about health and social services in the area will respond to a clear need while reducing some of the complexity encountered with utilizing local health care services.     

参与式艾滋病致孤儿童关怀项目结果分析

目的了解以社区、家庭为基础的艾滋病致孤儿童关怀项目开展3年后的效果。方法征集项目覆盖的艾滋病致孤儿童志愿者30人,培训后,由儿童自行设计访谈提纲并到社区对受艾滋病影响的家庭进行定性访谈,对结果进行分析。结果接受调查的20个家庭的儿童代表中,只有5%(1/20)认为项目的设计不好,原因是“更困难的家庭没有得到帮助”;有10%(2/20)的儿童认为项目的运作过程不好,原因是“艾滋病儿童没有得到特别的照顾”;对项目的效果受访儿童没有认为不好的;对项目产生的影响有20%(4/20)的儿童认为不好,原因是担忧项目的持续性、项目没有解决艾滋病流行的根本问题以及“每月按时给钱可能会造成依赖”等。结论大部分的受访儿童认为项目使儿童、家庭得到了基本需求的支持。儿童参与式的评价在我国是成功的尝试。     

Standardized screening of elderly patients' needs for social work assessment in primary care: use of the SF-36

Fewer hospitalizations and decreased lengths of stay in the hospital have resulted in an increased need for extensive support services and continuing care planning for elderly people in primary care. Early identification of elderly patients needing community and hospital nonmedical services is necessary so that timely appropriate services can be delivered. This study addresses the issue of whether a standardized health-related quality of life questionnaire, the SF-36, can be used independently as a screen predicting primary care elderly patients' needs for social work assessment. In addition, the question of what scales on the SF-36 a social worker would use to screen patients in need of assessment is explored.     

Family practice residencies in community health centers--an approach to cost and access concerns.

An inadequate number of trained primary care clinicians limits access to care at Community Health Centers. If family practice residents working in these centers can provide care to patients at a cost that is comparable to the center''s hiring its own physicians, then expansion of Family Practice Residency Programs into community centers can address both cost and access concerns. A cost-benefit analysis of the Family Practice Residency Program at the Fresno, CA, community center was performed; the community center is affiliated with the University of California at San Francisco. Costs included (a) residents'' salaries, (b) supervision of the family practice residents, (c) family practice program costs for educational activities apart from supervision at the community center, and (d) administrative costs attributable to family practice residents in the community center. Benefits were based on the number of patients that residents saw in the community center. Using this approach, a cost of $7,700 per resident per year was calculated. This cost is modest compared with the cost of training residents in inpatient settings. The added costs attributable to training residents in community health centers can be shared with agencies that are concerned with medical education, providing physicians to underserved communities, and increasing the supply of primary care physicians. Redirecting graduate medical education funding from hospitals to selected ambulatory care training centers of excellence would facilitate placing residents in community centers. This change would have the dual advantage of addressing the current imbalance between training in ambulatory care and hospital sites and increasing the capacity of community health centers to meet the health care needs of underserved populations.     

A conditional approach for modelling patient readmissions to hospital using a mixture of Coxian phase‐type distributions incorporating Bayes' theorem

The number of elderly patients requiring hospitalisation in Europe is rising. With a greater proportion of elderly people in the population comes a greater demand for health services and, in particular, hospital care. Thus, with a growing number of elderly patients requiring hospitalisation competing with non‐elderly patients for a fixed (and in some cases, decreasing) number of hospital beds, this results in much longer waiting times for patients, often with a less satisfactory hospital experience. However, if a better understanding of the recurring nature of elderly patient movements between the community and hospital can be developed, then it may be possible for alternative provisions of care in the community to be put in place and thus prevent readmission to hospital. The research in this paper aims to model the multiple patient transitions between hospital and community by utilising a mixture of conditional Coxian phase‐type distributions that incorporates Bayes' theorem. For the purpose of demonstration, the results of a simulation study are presented and the model is applied to hospital readmission data from the Lombardy region of Italy. Copyright © 2016 John Wiley & Sons, Ltd.