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As evidence emerges that health outcomes are determined by factors outside of the clinical health care delivery system, the nonprofit sector's relevance to supporting positive health outcomes grows through the delivery of community-based services. This paper examines whether nonprofit community-based organizations have the capacity to absorb new referrals from clinical partners. The expectation of increasing referral activity raises concerns over limited nonprofit community carrying capacity. Using Social Network Analysis, we analyze the network of partners that make up two such community systems and determine the prominence of the referral function, the resources most frequently contributed to the network, dependence on primary revenue sources directly related to the clinical health care delivery system, and the communitybased organizations' perceptions of their financial stability and ability to rapidly respond to increasing referrals. The results suggest steps by which referrals from the clinical health care delivery system to community-based organizations can benefit both parties and health outcomes. [ABSTRACT FROM AUTHOR]

Physician spending has substantially increased over the last few years in Canada to reach $27.4 billion in 2010. Total clinical payment to physicians has grown at an average annual rate of 7.6% from 2004 to 2010. The key policy question is whether or not this additional money has bought more physician services. So, the purpose of this study is to understand if we are paying more for the same amount of medical services in Canada or we are getting more bangs for our buck. At the same time, the paper attempts to find out whether or not there is a productivity difference between family physician services and surgical procedures. Using the Baumol theory and data from the National Physician Database for the period 2004-2010, the paper breaks down growth in physician remuneration into growth in unit cost and number of services, both from the physician and the payer perspectives. After removing general inflation and population growth from the 7.6% growth in total clinical payment, we found that real payment per service and volume of services per capita grew at an average annual rate of 3.2% and 1.4% respectively, suggesting that payment per service was the main cost driver of physician remuneration at the national level. Taking the payer perspective, it was found that, for the fee-for-service (FFS) scheme, volume of services per physician decreased at an average annual rate of -0.6%, which is a crude indicator that labour productivity of physicians on FFS has fallen during the period. However, the situation differs for the surgical procedures. Results also vary by province. Overall, our finding is consistent with the Baumol theory, which hypothesizes higher productivity growth in technology-driven sectors. [ABSTRACT FROM AUTHOR]

The prevalence of chronic illnesses continues to increase as does the cost of such care. Teaching self-management skills is more effective than solely providing information and teaching technical skills at improving health outcomes. Serious games for health provide an opportunity to support learning and health-related behavior change using messages and experiences in an engaging and entertaining format. We developed eSMART-HD with the intention of improving interactions between patients with chronic disorders and their health care providers. This paper describes the factors that we considered when creating eSMART-HD, a serious game for health. [ABSTRACT FROM AUTHOR]

The state of the nation's health and healthcare disparities looms large and is currently at crisis proportions, so much so, that these issues have been advanced as a national priority. These disparities are known to disproportionately afflict minorities and disadvantaged groups who become predisposed to certain risks. However, in light of the ever increasing racial and ethnic diversity of the American population, the visible absence of underrepresented minorities (URMs) in the health professions needed to meet these growing needs continues to fuel these crises. The purpose of this paper is thus fourfold. First, to examine the reason (s) for the persistent shortage of underrepresented minorities in the health professions and the associated barriers they encounter in pursuing opportunities in these professions. Second, to determine the degree to which the shortage of URMs contributes to the current state of health and healthcare disparities among certain groups. Third, to identify nontraditional mechanisms like the military as a medium to help increase the number of URMs in the health professions pipeline. Finally, the authors discuss the role of cultural competence as an essential skill set in rendering quality healthcare to minority patients; the strengths and limitations of their findings; and the implications of these findings for future research. [ABSTRACT FROM AUTHOR]

Objectives: This paper reports on a state agency's training activities undertaken to totally redesign a long-term-care (LTC) delivery system as part of the national Aging and Disability Resource Center (ADRC) initiative. Method: Through the development of an ADRC algorithm and the implementation of a corresponding client pathway, NJ DACS, a division of aging, aligned 14 separate core functions necessary for lifespan services. A Training Academy facilitated the adoption of five new health service delivery products and processes by state and county health and human services personnel. Results: Intensive training activities resulted in the algorithm and client pathway framework being successfully disseminated in all 21 counties within a short timeframe. Barriers to training were reduced and acceptance of new protocols and processes were facilitated leading to rapid adoption. Implications for training of health and human service personnel are presented. Full adoption of the complete ADRC model across the state was directly linked to agency software integration. Conclusions: Promoting standardized service delivery for the aging population through the use of an algorithm and parallel client pathway is feasible as a training model for health care service delivery. [ABSTRACT FROM AUTHOR]

The aim of this paper is to evaluate and report the impact of the Health Services Utilization Improvement Model (HUIM) on utilization and satisfaction with care, as well as knowledge regarding prevention, detection, and treatment of asthma, diabetes, tuberculosis, and child injury among low income health services consumers. HUIM outcomes data shows that the coupling of parental education and ecological factors (service linkage and provider orientation) impacts the health services utilization experience of low income consumers evidenced by improved self-efficacy ( knowledge and voice), and satisfaction with care from a child's regular provider. Participation in HUIM activities also improved the low income consumer's knowledge of disease identification, self-care and prevention. [ABSTRACT FROM AUTHOR]

Caring and humanism in hospitals exist on both the organizational and the individual levels. This paper identifies key organizations and foundations that have succeeded in promoting or fostering caring environments in hospitals. These include the Picker Institute, the Baptist Healing Trust, Sage Consulting, and the Caritas Consortium. Exemplary, caring clinicians in hospitals are also described. These clinicians developed positive relationships with patients and in interviews communicated a number of approaches to express caring to patients. Health and human services managers can take a number of steps to promote caring among their clinicians. However, they must implement a culture and a reward system that encourages humanism. [ABSTRACT FROM AUTHOR]

This paper discusses the nature of humanism in healthcare management and leadership. Humanism in healthcare management should entail serving 1) patients and their families, 2) organizational members, and 3) the community. The article describes how humanism is largely absent from healthcare organizations as a critical and important value. In the twentieth century, a number of models of healthcare leadership were developed that were humanistic in focus. These models primarily stressed the value of attention by leaders on the needs and values of people working in the organization. However, humanistic, healthcare leadership involves not only motivating and empowering employees, but a primary, essential focus is for leaders to create environments that support and uplift patients and their families. Humanistic care in healthcare organizations can be facilitated by leaders establishing positive, supportive, and empowering environments for clinicians and other employees. Secondly, managers can establish programs to develop and train employees to provide humanistic care. [ABSTRACT FROM AUTHOR]

Despite numerous advances in technology, medicine, and health care, infant mortality continues to reach very high levels in southern states. The purpose of this paper is to examine demographic, economic, and health care factors that are likely to affect infant mortality. In so doing, we first compare infant mortality and other critical factors in southern states to other regions of the country. Second, we use cross tabulation tables to determine if there is a correlation between infant mortality and several independent variables. Third, we use regression analysis to determine how each of these variables affects the change in infant mortality for the 1990-2003 periods. The results of the cross tabulation tables indicate relationships between infant mortality and each of the independent variables. When these variables were placed in a regression model, high school graduation rates, race, geographic region, unemployment rates, uninsured rates, teenage pregnancy rates, single parent families, and the number of doctors and hospitals were significant. [ABSTRACT FROM AUTHOR]

Relationship management can be applied in a variety of fields, but there is perhaps no other field that could benefit more from the application of relationship management than public health. The achievements of public health in the United States over the last century are many, but its challenges are daunting. This paper begins with a review of the mission of public health and the status of public health in this nation, including an examination of the most significant public health challenges. I then describe the complex nature of the public health system and summarize the latest positive development in public health planning. Finally, I outline how relationship management can be implemented in order to help improve public health outcomes. [ABSTRACT FROM AUTHOR]

This paper seeks to determine the relative effect of socioeconomic variables and medical conditions in explaining changes in infant birth weight, specifically, low birth weight (LBW). Using ordinary least squares regression, we first analyze the effects of these variables on the birth weight of 621 infants. Four of the independent variables - gestational age in number of days, sex, parity, and health insurance - are statistically significant (P<.05) and explain 64 percent of the variation in infant birth weight. But in a subset of 18 infants born with LBW to mothers ≤18 years of age or 35≥ years of age, only gestational age in number of days is statistically significant. [ABSTRACT FROM AUTHOR]

Personal care services are often provided to clients in community settings through highly discretionary processes. Such processes provide little guidance for caseworkers concerning how public resources should be allocated. The results of such processes almost guarantee that individuals with very similar needs will receive very different levels of care resources. Such disparities in treatment open the door to inequity and ineffectiveness. One way to address this problem is through case-mix classification systems that allocate hours of care according to client needs. This paper outlines the preliminary steps taken by one state in its movement toward such a system. [ABSTRACT FROM AUTHOR]

The aims of this paper are to analyze the role of medical and health professions in creating and establishing the disability category. We also explore how the diagnosis, measurement, and treatment of disability have contributed to stigmatization and promoted social, political and economic inequality. Theories from a variety of disciplines are used to examine the ways that medicine and the health-related professions have contributed to the oppression of people with disabilities, including the maintenance of a 'medical/knowledge power differential,' reinforcement of the 'sick role,' and objectification of people with disabilities. We also explore opportunities for empowerment versus 'sick role' status. The medical and health professions are uniquely positioned to promote the empowerment of people with disabilities as active partners in their own health care. Replacing the biomedical model of disability with a socio-political model that prioritizes disease/health care management, wellness and prevention of further disability as opposed to treatments aimed at curing disability could facilitate the empowerment process. [ABSTRACT FROM AUTHOR]

Helpful and appropriate responses by health and human services providers to cases of suspected elder sexual abuse are often challenged by lack of awareness of how best to proceed. The purpose of this paper is to provide an introduction to the concept, scope and dynamics of elder sexual abuse and to offer suggestions for appropriate responses that are applicable across a wide range of health and social services. Definitions, demographic aspects and proposed causes of elder sexual abuse are discussed. Risk profiles for both community-dwelling older adults and those living in facilities are presented as a guide for professionals, followed by a discussion of physical and psychological signs of sexual abuse, and approaches for determining a client's capacity to consent to sexual activity Finally, recommendations for appropriate responses once it is determined that abuse is likely to have occurred, including meeting obligations as a mandated reporter and providing effective communication and support to victims, are provided. [ABSTRACT FROM AUTHOR]

The US health care system has changed dramatically over the past forty years or so. This paper analyzes its potential transformation into a consumer-driven health care system (with the newly enacted HSAs and the increased popularity of employer defined contributions). The emphasis in the first part is the evolution of the role of providers (mostly physicians) into bearers of financial risk and gatekeepers. The second part discusses the new consumer-driven health care proposals and its potential impact on the future of health care as it pertains to putting consumers under financial risk and gives them a perceived sense of control over health care decisions. [ABSTRACT FROM AUTHOR]

It has been an important financial issue in the U.S. Medicare expenditures that health care expenses of Medicaid-Medicare dual eligibles (MMDE) are much higher than those of Medicare only beneficiaries (MOB). This paper compares health care use and health status of MMDEs and MOBs who are either Afro-American or white recipients. Using total health care use information from the Medical Expenditure Panel Survey (MEPS) 2000, we find that the proportion of dual eligibles with chronic health conditions is higher by 4% than that of the Medicare only beneficiaries and that dual eligibles make more frequent uses of various health care services. The number of office-based physician visits and outpatient physician visits are higher for Afro-American dual eligibles than white dual eligibles. This finding seems to be contributed to by relatively high medical needs among dual eligibles. Higher utilization of agency-related home health services among Afro-American dual eligibles than among white dual eligibles is considered as a consequence of different ethnicity-specific responses to insurance coverage. [ABSTRACT FROM AUTHOR]

The practice of public relations has experienced tremendous growth and evolution over the past 25 years, especially in the area of medical public relations. The constant changes in health care delivery have often led to increased need for communication with important publics. At the same time, practitioners in all fields of public relations have explored methods of accurately measuring the effectiveness of public relations programs. One such method of evaluation is the communication audit. This paper includes a brief overview of the communication audit concept followed by a case study based on an audit conducted for a small, multicultural non-profit health-care agency. Steps taken to conduct the audit and the methodology used are discussed. An analysis of the data is used to address two research questions regarding the efficacy of the Center's mission and vision. Suggestions for future audits are provided. [ABSTRACT FROM AUTHOR]

In this paper, we report the development of a theoretical model for health care administration programs at the graduate level. Our model development was prompted by recently-expressed concerns that the training available to managers and executives in health care fields is encountering a number of problems: it is typically lengthy and expensive, and involves too many prerequisites. In terms of content, the training available may be too narrowly focused on performing functions, such as accounting, rather than managing the functions. We begin development by conducting a content analysis of several highly-regarded programs with commonly identified features. We next describe how those features can be incorporated into a fast-track, 33 hour program without prerequisites which is consistent with accreditation guidelines. Implications for executive education and research are discussed. [ABSTRACT FROM AUTHOR]

Evaluating health care quality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health care quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings. [ABSTRACT FROM AUTHOR]

New information technologies place data on integrated information systems, and provide access via pervasive computing technologies. Pervasive computing puts computing power in the hands of all employees, available wherever it is needed. Integrated systems offer seamless data and process integration over diverse information systems. In this paper we look at the impact of these technologies on healthcare organizations in the future. [ABSTRACT FROM AUTHOR]