作者：
Pye, HOrris, PCook Cty Hosp
Div Occupat Med Chicago IL 60612 USA Univ Illinois
Sch Publ Hlth Great Lakes Ctr Occupat & Environm Safety & Hlth Chicago IL USA
The workers' compensation system was designed as a no-fault system in the early years of the last century. The system is organized on a state level. There are three differing models in current use: the single publ...
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The workers' compensation system was designed as a no-fault system in the early years of the last century. The system is organized on a state level. There are three differing models in current use: the single public fund, the single private fund, and an open market. States range as well in the amount of choice available to the injured workers in their selection of health care providers. In each state though, the physician plays an integral role in ensuring that the injured worker obtains adequate medical care in a prompt and efficient manner. The physician's function is either as treating physician, or as one who provides an independent medical evaluation for either the employee's lawyer, the employer, the insurer or their counsel or the state. Many obvious improvements in the system have not been made because political agreement on the state level is often lacking.
Background Studies of intensive case management (ICM) for patients with psychotic illnesses have produced conflicting results in terms of outcome. Negative results have sometimes been attributed to a failure to delive...
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Background Studies of intensive case management (ICM) for patients with psychotic illnesses have produced conflicting results in terms of outcome. Negative results have sometimes been attributed to a failure to deliver differing patterns of care. Aims To test whether the actual care delivered in a randomised clinical trial of ICM v. standard case management (the UK700 trial) differed significantly. Method Data on 545 patients' care were collected over 2 years. All patient contacts and all other patient-centred interventions (e.g. telephone calls, carer contacts) of over 15 minutes were prospectively recorded. Rates and distributions of these interventions were compared. Results Contact frequency was more than doubled in the ICM group. There were proportionately more failed contacts and carer contacts but-there was no difference in the average length of individual contacts or the proportion of contacts in the patients' homes. Conclusions The failure to demonstrate outcome differences in the UK700 study is not due to a failure to vary the treatment process. UK standard care con-rains many of the characteristics of assertive outreach services and differences in outcome may require that greater attention be paid to delivering evidence-based interventions;Declaration of interest None.
[...]those in the intensive management service also received a brief course of training in the Boulder Community Support System (CSS) model of care; this shows similarities with assertive community treatment (ACT) pra...
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[...]those in the intensive management service also received a brief course of training in the Boulder Community Support System (CSS) model of care; this shows similarities with assertive community treatment (ACT) practised elsewhere in the USA (Stein & Santos, 1998, p. 33).
The main question the findings pose is why the greater frequency of contact in ICM was not translated into any clinical improvement with regard to either the primary outcome (duration of in-patient psychiatric treatment during the study) or a range of secondary outcomes, including the specific one that improvement with ICM might be more effective in those of African-Caribbean ethnicity (UK700 Group, 1999a ).
Assertive community treatment comprises six essential features: case-loads of no fewer than 8 and no more than 12 per keyworker, an integrated team structure with at least three professional disciplines, no more than 20% of staff part-time, 24-hour availability, team autonomy and (an important consideration) part-time psychiatrist input only (Stein & Santos, 1998, pp. 64-65).
The presence of 24-hour cover is also not as important in the UK as in the USA.
Because there is often no real health cover available for these patients in the USA it is easy to see why it was necessary to set up a telephone contact system.
The authors report on a study testing the hypothesis that persons with serious mental illness (SMI) would report more utilization of community support services if they had a case manager. Individuals with SMI were ask...
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The authors report on a study testing the hypothesis that persons with serious mental illness (SMI) would report more utilization of community support services if they had a case manager. Individuals with SMI were asked to complete a survey reporting their use of 10 community support services and case management Having a case manager was not associated with increased utilization of any support service or case management by persons with serious mental illness in this rural state.
Twenty key workers in a government agency evaluated the effectiveness of their interventions with culturally diverse clients. The sample comprised 73 clients, from 18 language groups. Forty per cent reported not havin...
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Twenty key workers in a government agency evaluated the effectiveness of their interventions with culturally diverse clients. The sample comprised 73 clients, from 18 language groups. Forty per cent reported not having enough to do during the day and seventy-three per cent were visited regularly by their key workers. Ninety-two per cent were social security recipients. Though eighty-five per cent of key worker respondents perceived that the major needs of their clients were being met, twenty-one per cent felt they had insufficient contact with clients. The cultural appropriateness of interventions and client's accessibility to services were not confirmed in anecdotal comments.
Healthcare organizations throughout the United States are attempting to find solutions to spiraling healthcare costs. Hospital administrators are questioning the cost-effectiveness of their care delivery models, while...
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Healthcare organizations throughout the United States are attempting to find solutions to spiraling healthcare costs. Hospital administrators are questioning the cost-effectiveness of their care delivery models, while healthcare professionals are developing innovative measures to increase the cost-effective use of resources. This article explores hospital-based case management measures that are being used not only to control costs but also to de-escalate the continuously accelerating cost increases.
The objective of the study teas to identify factors that affected the implementation ion of an inpatient case measurement program In rural hospitals, The hospitals studied were from the Western New York Rural Health C...
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The objective of the study teas to identify factors that affected the implementation ion of an inpatient case measurement program In rural hospitals, The hospitals studied were from the Western New York Rural Health Care Cooperative. Five of the hospitals implemented the program in 1992. A qualitative evaluation was conducted by analyzing tape-recorded interviews with nurses and chief executive officers to identify obstacles to and facilitators of program implementation. Many obstacles to implementation could be traced to workload and time constraints, physician autonomy concern, and limited nursing staff and physician participation. Implementation was facilitated foremost by the effort and supportive attitudes of nursing leaders and hospital chief executive officers. This study concluded that it should be possible to successfully implement conceptually sound managed cave and case management programs in rural hospitals, but it will require a relatively long period of support, especially from hospital administration and nursing leaders.
At the request of our readers, we present this special feature on case management. This feature appears on an occasional basis in the Journal. Based on the suggestion of a reader, we are using a Panel approach to prov...
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At the request of our readers, we present this special feature on case management. This feature appears on an occasional basis in the Journal. Based on the suggestion of a reader, we are using a Panel approach to provide a forum for sharing ideas, viewpoints, and perspectives. We have put together a group of individuals with expertise from a variety of case management arenas who have agreed to share their opinions and perspectives in response to specific questions or scenarios. Opinions and perspectives are those of the panel members, and do not necessarily represent the views of the AAOHN, the Editor, or the Publisher. We encourage readers to submit their questions or scenarios for the Panel. This month's Panel members include Christine M. Kalina, Annette B. Haag, Robin Tourigian, and Mary Lou Wassel.
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