RF is a unique situation. It is specific in diagnosis and yet, at the same time, broad in concept. It can be acutely life threatening or chronic in presentation and need for intervention. Patients are cared for in ICU...
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RF is a unique situation. It is specific in diagnosis and yet, at the same time, broad in concept. It can be acutely life threatening or chronic in presentation and need for intervention. Patients are cared for in ICUs, medical-surgical floors, and nursing homes as well as at home. When RF is a complicating condition of an already hospitalized patient, the road to recovery may be long and complicated. It is important that the health care team provides education and counseling so that the patient and family can cope with the changing events and the potentially long road to recovery. Outcome data from all the sites of care are currently lacking for a comparative analysis of the most effective site. All the sites of care discussed in this article are cost-effective alternatives to the ICU, but there is a lack of standards and evidence of measurable outcomes such as the quality and cost relationship. Outcome data are needed to document the cost of care and the relationship of that cost to specific outcomes such as final discharge disposition, survival, complications, and quality of life. Health care provides have a much clearer image of the care that can be provided in the multiple sites available. Unfortunately, patients and families do not have that same level of understanding. For many patients and families, regardless of what the facility is called, it is not the acute hospital, and that is where they wish to remain until discharge home. Clarification and standardization are needed regarding the terminology used to describe the various sites of care. It is important that integrated health care institutions provide education and counseling to patients and families regarding the continuum of care and the many alternatives along that path.
Service delivery under two systems of care-a traditional Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) reimbursement system and an innovative continuum of care-was examined along six dimensio...
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Service delivery under two systems of care-a traditional Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) reimbursement system and an innovative continuum of care-was examined along six dimensions: access, type, mix, volume, timing, and continuity of services received by children and adolescents. It was found that the Demonstration sewed over three times as many children as the Comparison. In addition to sewing more children, the Demonstration also provided more and different types of services to each child treated. Finally, the Demonstration appears to have delivered services in a more timely fashion and made a considerable effort to match children's and families' needs with services.
The issue of integrating MCH/FP and STD/HIV services has gained an increasingly high priority on public health agendas in recent years. In the prevailing climate of health sector reform, policy-makers are likely to be...
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The issue of integrating MCH/FP and STD/HIV services has gained an increasingly high priority on public health agendas in recent years. In the prevailing climate of health sector reform, policy-makers are likely to be increasingly pressed to address the broader concept of 'reproductive health' in the terms consolidated at the Cairo International Conference on Population and Development, and the UN Conference on Women in Beijing. Integrated MCH/FP and STD/HIV services could be regarded as a significant step towards providing integrated reproductive health services, but clarity of issues and concerns is essential. A number of rationales have emerged which argue for the integration of these services, and many concerns have been voiced. There is little consensus, however, on the definition of 'integrated services' and there are few documented case studies which might clarify the issues. This paper reviews the context in which rationales for 'integrated services' emerged, the issues of concern and the case studies available. It concludes by suggesting future directions for research, noting in particular the need for country-specific and multi-dimensional frameworks and the appropriateness of a policy analysis approach.
The Implementation Study of the Fort Bragg Evaluation documented how the Demonstration was executed and whether it met the expectations of the continuum of care philosophy upon which it was based. Based on the theory-...
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The Implementation Study of the Fort Bragg Evaluation documented how the Demonstration was executed and whether it met the expectations of the continuum of care philosophy upon which it was based. Based on the theory-driven and component approaches to program evaluation, a case study methodology was employed. First, the theories and assumptions about the Demonstration were explicated to derive a program model. Next, the program-as-implemented was compared to the program-as-planned. Barriers responsible for diluting full-scale implementation were documented. This study provides a comprehensive description of how the Demonstration was put into place and the evidence necessary to conclude that the Demonstration was executed with high fidelity, despite barriers, to provide an excellent test of the program theory.
This article introduces the Fort Bragg managed care experiment. This study was a 5-year, $80 million effort to evaluate the cost-effectiveness of a full continuum of mental health services for children and adolescents...
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This article introduces the Fort Bragg managed care experiment. This study was a 5-year, $80 million effort to evaluate the cost-effectiveness of a full continuum of mental health services for children and adolescents. The article describes the development of the Demonstration, the program theory underlying intervention, and how this theory was tested.
This article reports on a process evaluation of the Texas Children's Mental Health Plan, a statewide initiative to provide interagency coordinated mental health services to severely emotionally disturbed children ...
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This article reports on a process evaluation of the Texas Children's Mental Health Plan, a statewide initiative to provide interagency coordinated mental health services to severely emotionally disturbed children and their families. Researchers followed the activities of the state management ream and three local sites during the first year and a half of the project's implementation. This article delineates the major positive effects of the plan as well as the facilitating factors and barriers to the development of such an effort.
The traditional separation of mental health and medical programs is problematic because mental health issues are inseparable from the larger medical system. By contrast, a collaborative primary care model of mental he...
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The traditional separation of mental health and medical programs is problematic because mental health issues are inseparable from the larger medical system. By contrast, a collaborative primary care model of mental health care, augmented and supported by secondary specialty mental health services, has the potential to optimize quality and cost goals while reinforcing health care reform principles. The flexibility of mental health treatment in this delivery structure provides opportunities to customize services according to patient and purchaser expectations.
This article presents the findings and recommendations of a statewide interagency task force on parents with mental illness who have young children. Based on testimony from consumers, providers, and advocates, the tas...
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This article presents the findings and recommendations of a statewide interagency task force on parents with mental illness who have young children. Based on testimony from consumers, providers, and advocates, the task force concluded that this is a substantial and neglected public policy issue requiring an intergovernmental, services integration approach. Recommendations were made in the areas of services, policies and procedures, and service coordination.
Many hospitals are turning to cluster relationships to gain the benefits of diversification without the troubles of increased capital costs and management conflicts. The goal of healthcare clusters is to provide a con...
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