Organizational systems to support publicly funded tobacco treatment services

BACKGROUND: Professional societies and government organizations have promoted guidelines and best practices that encourage clinicians to routinely integrate cessation counseling into patient encounters. While research in health maintenance organizations has demonstrated that the development and maintenance of office systems do enable clinicians' smoking-cessation services, little is known about the adoption of system strategies in diverse organizations serving disadvantaged populations. METHODS: Data were collected via face-to-face interviews from November 2001 to October 2002 using a standardized systems assessment checklist at service delivery sites of 83 funded community health service agencies, which included hospitals, community health centers, and other organizations (e.g., substance abuse, mental health, and multiservice). The content of the structured assessment reflected system elements with proven effectiveness that have been included in guidelines and best practices recommendations. Detailed information was collected on the implementation strategies. RESULTS: This study found considerable attention to systems that support cessation services in diverse healthcare organizations, but much remains to be done. There is a wide diversity of implementation strategies employed, with varied degrees of sophistication. CONCLUSIONS: A major challenge is to develop systems capable of providing population-based feedback to, and between, providers, which will enable further quality improvement efforts.     

A multipurpose comorbidity scoring system performed better than the Charlson index

BACKGROUND AND OBJECTIVES: To develop a comorbidity scoring system that out-performs the Charlson index. METHODS: Population-based cohorts of medical (n=326,456), procedural (n=349,686), and psychiatric (n=16,895) inpatients in Western Australia were followed for 1-year mortality, 30-day readmissions, and length of stay (LOS) using data linkage. Conditions were identified at index admission and over the preceding 12 months. A Multipurpose Australian Comorbidity Scoring System (MACSS) was developed, based on the most frequent 102 comorbid conditions associated with a rate ratio (RR) > or = 1.1 of death or readmission or a LOS difference > or =0.5 days. The performance of MACSS and the Charlson index in predicting mortality, readmission, and LOS, and in controlling confounding by comorbidity, was compared in five test scenarios involving asthma, myocardial infarction, mastectomy, transurethral prostatectomy, and major depressive illness. RESULTS: MACSS performed better than the Charlson index on all three outcomes in all five clinical groups. It reduced the failure of the Charlson index to discriminate on mortality and readmission outcomes by 5-40%, improved R(2) in LOS models by up to fourfold and often doubled the correction of originally confounded effect measures. CONCLUSION: The use of the MACSS and similar alternatives to the Charlson index are a new methodologic standard for adjustment of comorbidity risk.     

Do health and medical workforce shortages explain the lower rate of rural consumers' complaints to Victoria's Health Services Commissioner?

OBJECTIVE: To identify which explanations account for lower rural rates of complaint about health services--(i) fear of consequences where there is little choice of alternative provider; (ii) a higher complaint threshold for rural consumers; (iii) lack of access to complaint mechanisms; or (iv) reduced access to services about which to complain. DESIGN: Ecological study incorporating consumer complaint, population and workforce distribution data sources. SETTING: All health care providers practising in Victoria. PARTICIPANTS: De-identified records of all closed consumer complaints made to the Health Services Commissioner, Victoria, between March 1988 and April 2001 by Victorian residents (13 856 records). MAIN OUTCOME MEASURES: Differences in the percentage of under-representation in complaint rates in total and for each of four categories of health services providers for different size communities. RESULTS: No consistent relationship was observed between community size and either degree of under-representation of complaints against any category of provider, or the proportion of serious or substantial complaints. Rural under-representation was highest (41%) for dentists, the provider category with the lowest proportion working in rural areas (17%), and lowest (18%) for hospitals, with the highest representation in rural areas (28% of beds). More rural complaints were about access issues (10.7% rural and 8.4% metropolitan). CONCLUSIONS: Reduced opportunity to use health services due to rural health and medical workforce shortages was the best-supported explanation for the lower rural complaint rate. Workforce shortages impact on the quality of rural health services and on residents' opportunities to improve their health status.     

Community hospital reports focus on people

Summit Health of Chambersburg, PA; Rush-Copley Medical Center of Aurora, IL; and Little Company of Mary in Evergreen Park, IL, tailor their individual reports to the needs and interests of their communities. The results are varied in format, style, and tone.     

Web site review. Carolinas HealthCare recognized Internet marketing potential early

Since the early days of the Internet, administrators Carolinas HealthCare System in Charlotte, NC, have appreciated its potential as a marketing tool. This places a lot of expectations on the Web site, www.carolinashealthcare.org, which is managed by the marketing-public relations department. Find out how the well-established site fulfills its mission and more.     

Parma and Prince William hospitals deliver magazines with purpose

Two quarterly publications are featured here for your consideration. One is Informed, the newly re-designed magazine by Parma Community General Hospital, Parma, Ohio. Also, we present Healthy Perspective magazine, published quarterly Prince William Health System, Manassas, Va.     

Doctors develop vascular center. Marketing new Jupiter, Fla., facility a collaborative effort

Two interventional radiologists came to Jupiter Medical Center, Jupiter, Fla., as it was making a number of strategic expansion efforts. Together, the doctors developed a center devoted exclusively to their specialty, committing some of their time to the marketing and outreach education about interventional radiology. Using a multi-faceted marketing approach, the campaign has raised knowledge and awareness of The Vascular Institute to the point of reversing the outflow of patients.     

Salmonella agona outbreak from contaminated aniseed, Germany

A nationwide outbreak of Salmonella Agona caused by aniseed-containing herbal tea occurred from October 2002 through July 2003 among infants in Germany. Consumers should adhere strictly to brewing instructions, although in exceptional cases this precaution may not be protective, particularly when preparing tea for vulnerable age groups.