Showing papers on "Integrated care published in 1995"

Rehabilitation of Geriatric Patients

Abstract: Objective To describe the role of geriatric rehabilitation, the methods of practice, and the mechanisms underlying integrated care in rehabilitation medicine. Design We reviewed the rehabilitation-related medical literature and outlined an approach to the evaluation of impairment in older patients and subsequent rehabilitation planning. Results For optimal rehabilitation of geriatric patients, knowledge of general principles of rehabilitation and key areas affecting the elderly population is important. A rehabilitation program will be most successful if a team approach—including a physician, rehabilitation nurse, physical therapist, occupational therapist, psychologist, medical social worker, and recreational therapist—is used. Attention should be paid to special considerations in older patients (such as the presence of comorbid conditions) and potential barriers to care in order to maximize benefit. Conclusion Rehabilitation of elderly patients can assist in preserving functional independence and improving the quality of life. Assessment and management in an individual patient ate best performed by a team approach.

Introduction of integrated care pathways for patients with multiple sclerosis in an inpatient neurorehabilitation setting

Abstract: Rehabilitation of progressive neurological disorders such as multiple sclerosis poses particular problems, and clear setting of goals and clinical audit are essential for effective management. Integrated care pathways (ICPs) offer a unique opportunity to document and audit the rehabilitation process. This preliminary study has shown that ICPs are useful in both assessing process and auditing goals. Their introduction has led to the identification of the key worker role within the neurorehabilitation unit (NRU), and has provided an opportunity to increase the participation of patients and carers in the rehabilitation process. Continuing refinement of the pathway is necessary, and its application to other neurological disorders such as cerebrovascular accident may be appropriate.

A home telecare management system.

Abstract: The increasing tendency to discharge chronic patients from hospital, as well as the growing expectation of improved quality of life for elderly and disabled people at home, was the original motivation for the development of a home telecare management system. The system allows a service centre to perform remote monitoring of biological signals and other data via the public telephone network, as well as to manage different emergency situations arising at home. The system is part of the FU-funded EPIC project (European Prototype for Integrated Care). It was tested in Belfast (Northern Ireland) and is currently being installed in Torre del Mar (Spain). This paper describes the system design and preliminary evaluation. The results indicate that the system operators find it highly acceptable in terms of efficiency, effectiveness, helpfulness, control and learnability. Integration of home telecare data with community-care information systems is essential if data captured at home are to be incorporated into the care process effectively.

Integrated care for asthma: a clinical, social, and economic evaluation

Abstract: The authors conclude that the British Thoracic Society guidelines on asthma management, which recommend closer liaison between primary and secondary care providers, are valid.

A model for collegiality among staff nurses in acute care.

Abstract: For decades, collegiality has persisted as an important issue for nurses, especially for nurse leaders. In an increasingly interdependent healthcare environment, collegial relationships among nurses and other health professionals are vital to achieving the goal of clinically integrated care. Nurse administrators greatly influence decision making among health professionals by monitoring and facilitating their interactions. The model used in this study contributes to an understanding of the factors that affect collegiality among nurses and potentially among other members of the healthcare team.

The octogenarian cardiac surgery patient.

Abstract: As advances are made in medical-surgical technology and overall life expectancy increases, cardiac surgery previously done only in younger populations is now becoming common in older adult age groups. Most of the nursing literature regarding elderly cardiac surgery patients focuses on the 65- to 75-year-old age group; little has been written about the 80- to 90-year-old age group. Very elderly patients present unique and complex challenges to the interdisciplinary teams involved in their care. Nurses must recognize and anticipate the specialized needs of these frail individuals to optimally manage their care. Aortic valve replacement is the most common cardiac valve surgical procedure performed in very elderly persons. A case study and an integrated care plan for the aortic valve surgery patient are described.

Collaborating Outside the Box: When Employers and Providers Take On Environmental Barriers to Guideline Implementation

Abstract: Article-at-a-Glance Background In 1992 15 employers in Minneapolis/St Paul, operating as the Business Health Care Action Group (BHCAG), combined their self-insured plans. To successfully bid for the BHCAG contract, three competing group practices and a health plan cooperated, operating functionally like a fully integrated care system to measure outcomes, develop practice guidelines, and meet other BHCAG requirements. To accomplish this, a new organization, the Institute for Clinical Systems Integration (ICSI), was conceived. Providers and employers collaborate To reduce costs ICSI has implemented 16 of 80 planned guidelines. Teams including members from clinics and BHCAG develop best-practice algorithms. Each guideline is then reviewed and piloted before being implemented in all ICSI clinics. Managing external environment The guideline on cystitis in healthy women eliminated two costly practices–obtaining a urine culture and visiting the doctor. Yet many physicians and the clinics were afraid of losing significant revenue because they were reimbursed by BHCAG on a fee-for-service basis. In turn, BHCAG's hands were tied. If they changed to a capitated payment system, they would face onerous state insurance requirements. The solution lay in collaborating at a higher level. ICSI and BHCAG leaders persuaded the state legislature to pass a new law that allowed BHCAG to capitate providers without state regulation. As a result, the cystitis guideline is now widely implemented in ICSI clinics. Lessons learned The cystitis guideline experience highlights the need to manage the external environment so that it reinforces, rather than inhibits, quality improvement in medical practices. Guidelines will not be implemented unless the macro-environment into which they are introduced is supportive.

Managed care and integrated health care.

Abstract: Managed care and integrated care may be viewed as stages in the evolution of the U.S. health care system. The authors discuss the essential characteristics of an integrated delivery system, including patient satisfaction, maintenance of clinical skills, cost-effective practice, and professional reputation.

Social and political actors in the formulation of health reform in Spain

Abstract: An analysis of the participation of social and political actors in the process of formulating health policy allows one to understand the specific characteristics of the organization and operation of a health system. This study analyzes the drafting process for the General Health Act (LGS) in Spain with the purpose of establishing the relationship between social, political, and economic actors in both the formulation of the Act itself and the organization of the Spanish Health System. A case study was carried out from 1982 through 1986. Documentary parliamentary data, the medical press, national magazines and journals, and press reports by political, social, and public health actors were analyzed. The first version of the General Health Act presented by the Spanish Socialist Workers' Party (PSOE) proposed a health system with funding and public administration aimed at achieving universal health coverage, integrated care, community participation, and health education. This proposal was submitted to a complex negotiating process with business groups, unions, and health professionals. The General Health Act as finally approved excludes the principles of equity and incorporates private interests in health: "free choice of doctor and hospital", public funding and private administration of the health system, and the establishment of Social Security as the core of the entire health system.

Child care programmes as an entry point for maternal and child health components of primary health care.

Abstract: This document begins with an overview of the situation young children live in worldwide and the changing family environment. Specifically changes in the traditional functions of the family the family structure and the nature of womens work as well as changes for the girl child are addressed. Section 2 describes the special needs of children aged less than 6 and their parents. It also defines maternal and child health (MCH) components that can be introduced into child health services to meet those needs. The next section illustrates the range of settings within which child care is currently being provided. These day care programs include parent/caregiver education child minding/family day care workplace (in support of womens development) community-based day care formal preschools and integrated care centers. Section 4 discusses what is needed to strengthen and expand existing programs to provide better health care. Section 5 addresses the curriculum materials and support services (i.e. training monitoring and evaluation) that the health sector must develop to introduce MCH components into existing programs. Section 6 examines cost issues: costs associated with child care programs constructing a budget and outcomes/benefits. The conclusion briefly describes what needs to happen next to foster the development of integrated services for young children and their families through early childhood care and development programs.

A cooperative model of the German Ministry of Health funded rheumatic disease centers

Abstract: The German Ministry of Health has granted since 1992 the institution of 21 multipurpose arthritis centers in 21 regions of Germany to improve the integrated care for patients with chronic rheumatic diseases. To coordinate and combine their efforts the supported rheumatic centers have joint together into a model cooperation. The basic founding for all centers aim to advance the interdisciplinary care network inside the centers, to elaborate appropriate measures of audit, to test new modalities for better care and to advance post-graduate and continuing medical education. In addition, continuing funding supports individual projects (n = 5) and since 1994 in 5 of the centers the German Ministry of Research and Technology granted the institution of integrated rheumatological research projects. The development and effects of the multipurpose arthritis center programme is evaluated by the Scientific Institute of the German Medical Association. The successful structural development of the centers and the first results of the joint efforts of the model cooperation (recommendation for surveillance of treatment with long acting antirheumatic drugs, basic documentation, data set for documentation of rheumatological out-patients) shows the promising outcome of the programme.

Telematics and protocols of care in critical care environments.

Abstract: The paper discusses the potential roles for protocols of care within critical care environments from the perspective of providing real-time support for their application. The discussion is based around a conceptual model of care in critical care environments. This model has been developed in the wider context of developing information technology systems to support clinical care in critical care environments. The conceptual model of care is a three layer model which demonstrates both the hierarchical and temporal aspects of the care delivered to patients. It is proposed that if the value of protocols of care is to be realised in critical care environments then they must be seamlessly integrated into the routine data management associated with the care of patients. In order to demonstrate this and to evaluate the utility of this concept in the clinical environment, the systems from the AIM TANIT (Telematics in Anaesthesia and Intensive Therapy) project have been used as prototype platforms. The application of the concepts developed are described in two critical care environments: the anaesthesia department and the intensive care unit. Problems in using protocols of care in intensive care units suggest that integrating these with a problem solving methodology to create an integrated care plan may be a more appropriate approach to patient management.

The limits of co‐ordination as a strategy

Abstract: Looks at the author′s work as a co‐ordinator of early years services in an authority which has not integrated care and education provision. Her job is to liaise between the education and social work departments of the local authority, and to persuade and negotiate for changes in practice. In the absence of a true corporate strategy she has focused her efforts on working in the private and voluntary sector – often neglected in the power broking of local authority services – and on the creation of single‐issue projects to further the development of co‐ordinated services.

The application of antitrust laws to the healthcare industry.

Abstract: The move toward managed care initiatives and multiprovider networks has intensified in recent years in response to escalating healthcare costs and increasing market dominance by the insurance industry. As a consequence, the antitrust laws have played a significant role in defining the limits of physician cooperation. An understanding of the application of antitrust laws to evolving healthcare delivery systems and a knowledge of the specific areas where providers must exercise caution are essential to physicians' strategic planning. This article looks at the major areas of innovation emerging in the healthcare delivery market and details some of the most important guidelines for safeguarding physician collaborations. The authors compare the ability of physicians and insurers to organize integrated care systems and question the continued protection of the insurance industry under the McCarran-Ferguson Act.

Description of the development of a new model of primary care in the community of Valencia

Abstract: Objective The aim of this study was to determine to what extent the new model of primary care (NMPC) had been introduced and developed in the Community of Valencia by means of an assessment of the structure, procedures and results attained by the primary care teams (PCT). Design An observation study of a crossover type. Setting Primary health care. Patients and other participants 70 health centres in the Valencia Community were studied. The criteria for inclusion in the study were that the centre should have been open for at least two years on March 1st 1991 and/or had the accreditation (or had requested it) to teach family and community medicine. Measurements and main results 51 indicators were applied. These evaluated the seven fundamental attributes which make up the theoretical model: accessibility, integrated care, programmed performance, ongoing care, team work, community involvement and research and teaching. Of these seven primary care attributes, the highest valued were geographical accessibility and ongoing care; and those which needed to be strengthened, non-geographical accessibility and integrated care. Conclusions The analysis of the results obtained makes us reflect on the model of primary care which can be developed in our environment, with peoples' real needs and the resources available being borne in mind.

Los Actores Políticos y Sociales en la Formulación de la Reforma Sanitaria, en España 1 Social and Political Actors in the Formulation of Health Reform in Spain

Abstract: . Cad. Saude Publ., Rio de Janeiro, 11 (1): 34-44, Jan/Mar, 1995.An analysis of the participation of social and political actors in the process of formulatinghealth policy allows one to understand the specific characteristics of the organization andoperation of a health system.This study analyzes the drafting process for the General Health Act (LGS) in Spain with thepurpose of establishing the relationship between social, political, and economic actors in boththe formulation of the Act itself and the organization of the Spanish Health System. A case studywas carried out from 1982 through 1986. Documentary parliamentary data, the medical press,national magazines and journals, and press reports by political, social, and public health actorswere analyzed.The first version of the General Health Act presented by the Spanish Socialist Workers’ Party(PSOE) proposed a health system with funding and public administration aimed at achievinguniversal health coverage, integrated care, community participation, and health education. Thisproposal was submitted to a complex negotiating process with business groups, unions, andhealth professionals. The General Health Act as finally approved excludes the principles ofequity and incorporates private interests in health: “free choice of doctor and hospital”, publicfunding and private administration of the health system, and the establishment of Social Securityas the core of the entire health system.