US lags in health care despite largest investment, survey shows.
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ABSTRACT:
SUBMITTER: Bristol N
PROVIDER: S-EPMC1440636 | biostudies-literature | 2006 Apr
REPOSITORIES: biostudies-literature
Publications
US lags in health care despite largest investment, survey shows.
BMJ (Clinical research ed.) 20060401 7546
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Project description: Not available
| S-EPMC10928537 | biostudies-literature
Project description:ObjectiveTo describe an organization-wide disparity reduction strategy and to assess its success in quality improvement and reduction of gaps in health and health care.Study settingClalit Health Services, Israel's largest non-for-profit insurer and provider serving 3.8 million persons.Study designBefore and after design: quality assessment before and 12-month postinitiation of the strategic plan. A composite weighted score of seven quality indicators, measuring attainment of diabetes, blood pressure, and lipid control, lack of anemia in infants, and performance of mammography, occult blood tests, and influenza vaccinations.Data extraction methodsQuality indicator scores, derived from Clalit's central data warehouse, based on data from electronic medical records.Principal findingsLow-performing clinics, of low-socioeconomic and minority populations, were targeted for intervention. Twelve months after the initiation of the project continuous improvement was observed coupled with a reduction of 40 percent of the gap between disadvantaged clinics, serving ~10 percent of enrollees, and all other medium-large clinics.ConclusionThe comprehensive strategy, following a quality improvement framework, with a top-down top-management incentives and monitoring, and a bottom-up locally tailored interventions, approach, is showing promising results of overall quality improvement coupled with disparity reduction in key health and health care indicators.
| S-EPMC3165188 | biostudies-literature
Project description:This cross-sectional study examines the prevalence and characteristics of real estate investment trust-owned health care properties in the US health care sector.
| S-EPMC9107031 | biostudies-literature
Project description:BackgroundIn Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists' experiences of HMR time investment.ObjectiveThis study aimed to explore accredited pharmacists' experiences of HMR practice regarding time investment in the study's defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient's General Practitioner, including any liaison time).MethodsAn electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment.ResultsThere was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent: <30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2). More HMR career experience resulted in statistically significant (p=0.01) less time performing Stage 1 (initial paper-based assessment and review); with a trend to less time performing Stage 3 (HMR report writing).ConclusionsAccredited pharmacists invest significant time in performing comprehensive HMRs, especially during in-home patient consultations and during HMR report collation and completion. Their significant HMR time investment as medicines experts provides insight for program and workforce considerations and warrants further research to better understand their work processes for optimizing medicines use and improving health.
| S-EPMC8370188 | biostudies-literature
Project description:Through quantitative and qualitative methods, in this article the authors describe the perspectives of indigenous women who received antenatal and childbirth medical care within a care model that incorporates a non-governmental organisation (NGO), Partners in Health. They discuss whether the NGO model better resolves the care-seeking process, including access to health care, compared with a standard model of care in government-subsidised health care units (setting of health services networks). Universal health coverage advocates access for the most disadvantaged and vulnerable populations as a priority. However, the issue of access includes problems related to the effect of certain structural social determinants that limit different aspects of the obstetric care process. The findings of this study show the need to modify the structure of organisational values in order to place users at the centre of medical care and ensure respect for their rights. The participation of agents outside the public system, such as NGOs, can be of great value for moving in this direction. Women's participation is also necessary for learning how they are being cared for and the extent to which they are satisfied with obstetric services. This research experience can be used for other countries with similar conditions.
| S-EPMC7888012 | biostudies-literature
Project description:Massachusetts' health care reform substantially decreased the percentage of uninsured residents. However, less is known about how reform affected access to care, especially according to insurance type.To assess access to care in Massachusetts after implementation of health care reform, based on insurance status and type.We surveyed a convenience sample of 431 patients presenting to the Emergency Department of Massachusetts' second largest safety net hospital between July 25, 2009 and March 20, 2010.Demographic and clinical characteristics, insurance coverage, measures of access to care and cost-related barriers to care.Patients with Commonwealth Care and Medicaid, the two forms of insurance most often newly-acquired under the reform, reported similar or higher utilization of and access to outpatient visits and rates of having a usual source of care, compared with the privately insured. Compared with the privately insured, a significantly higher proportion of patients with Medicaid or Commonwealth Care Type 1 (minimal cost sharing) reported delaying or not getting dental care (42.2 % vs. 27.1 %) or medication (30.0 % vs. 7.0 %) due to cost; those with Medicaid also experienced cost-related barriers to seeing a specialist (14.6 % vs. 3.5 %) or getting recommended tests (15.6 % vs. 5.9 %). Those with Commonwealth Care Types 2 and 3 (greater cost sharing) reported significantly more cost-related barriers to obtaining care than the privately insured (45.0 % vs. 16.0 %), to seeing a primary care doctor (25.0 % vs. 6.0 %) or dental provider (58.3 % vs. 27.1 %), and to obtaining medication (20.8 % vs. 7.0 %). No differences in cost-related barriers to preventive care were found between the privately and publicly insured.Access to care improved less than access to insurance following Massachusetts' health care reform. Many newly insured residents obtained Medicaid or state subsidized private insurance; cost-related barriers to access were worse for these patients than for the privately insured.
| S-EPMC3475814 | biostudies-other
Project description:BACKGROUND:Virtual communities of practice (VCoPs) have been shown to be an effective means for knowledge and research uptake, but little is known about why health care workers choose to use them. The elaboration likelihood model (ELM) is a theoretical model of persuasion that distinguishes between different routes of information processing that influence attitude formation and change. To date, no research has investigated the antecedents to these processing routes for VCoPs within a health care setting. In understanding these determinants, VCoPs can be appropriately designed to increase their chances of use and value among health care professionals. OBJECTIVE:Our aim is to explore how motivation and ability affect attitudes toward using VCoPs for those working in health care. METHODS:Data were collected from 86 health care workers using an online survey at two Canadian health care conferences. Participants were shown a mock VCoP and asked about their perceptions of the online platform and related technologies. The survey instrument was developed based on previously validated scales to measure participants' ability and motivation toward using a VCoP. Attitudes were assessed both at the beginning and end of the study; intention to use the platform was assessed at the end. RESULTS:Ability (expertise with CoPs and VCoPs) was found to directly affect intention to use the system (P<.001 and P=.009, respectively) as was motivation (P<.001). Argument quality had the greatest effect on formed attitudes toward VCoPs, regardless of the user's level of experience (lower expertise: P=.04; higher expertise: P=.003). Those with higher levels of CoPs expertise were also influenced by peripheral cues of source credibility (P=.005 for attitude formation and intention to use the system) and connectedness (P=.04 for attitude formation; P=.008 for intention to use the system), whereas those with lower levels of CoP expertise were not (P>.05). A significant correlation between formed attitude and intention to use the VCoPs system was found for those with higher levels of expertise (P<.001). CONCLUSIONS:This research found that both user ability and motivation play an important and positive role in the attitude toward and adoption of health care VCoPs. Unlike previous ELM research, evidence-based arguments were found to be an effective messaging tactic for improving attitudes toward VCoPs for health care professionals with both high and low levels of expertise. Understanding these factors that influence the attitudes of VCoPs can provide insight into how to best design and position such systems to encourage their effective use among health care professionals.
| S-EPMC6920901 | biostudies-literature
Project description: Not available
| S-EPMC1800312 | biostudies-literature
Project description:Evolutionary theory predicts a downward flow of investment from older to younger generations, representing individual efforts to maximize inclusive fitness. Maternal grandparents and maternal grandmothers (MGMs) in particular consistently show the highest levels of investment (e.g. time, care and resources) in their grandchildren. Grandparental investment overall may depend on social and environmental conditions that affect the development of children and modify the benefits and costs of investment. Currently, the responses of grandparents to adverse early life experiences (AELEs) in their grandchildren are assessed from a perspective of increased investment to meet increased need. Here, we formulate an alternative prediction that AELEs may be associated with reduced grandparental investment, as they can reduce the reproductive value of the grandchildren. Moreover, we predicted that paternal grandparents react more strongly to AELEs compared to maternal grandparents because maternal kin should expend extra effort to invest in their descendants. Using population-based survey data for English and Welsh adolescents, we found evidence that the investment of maternal grandparents (MGMs in particular) in their grandchildren was unrelated to the grandchildren's AELEs, while paternal grandparents invested less in grandchildren who had experienced more AELEs. These findings seemed robust to measurement errors in AELEs and confounding due to omitted shared causes.
| S-EPMC8848246 | biostudies-literature
Project description:As part of federal and local efforts to increase access to high quality, clinical preventive services (CPS) in underserved populations, the Los Angeles County Department of Public Health (DPH) partnered with six local health system and community organization partners to promote the use of team care for CPS delivery. Although these partners were at different stages of organizational capacity, post-program review suggests that each organization advanced team care in their clinical or community environments, potentially affecting >250,000 client visits per year. Despite existing infrastructure and DPH's funding support of CPS integration, partner efforts faced several challenges. They included lack of sustainable funding for prevention services; limited access to community resources that support disease prevention; and difficulties in changing health-care provider behavior. Although team care can serve as a catalyst or vehicle for delivering CPS, downstream sustainability of this model of practice requires further state and national policy changes that prioritize prevention. Public health is well positioned to facilitate these policy discussions and to assist health system and community organizations in strengthening CPS integration.
| S-EPMC5809468 | biostudies-literature