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Maternal substance abuse and infant health: Policy options across the life course

MILBANK QUARTERLY 1999年第4期77卷 531-+页

作者： Frohna, JG Lantz, PM Pollack, H Univ Michigan Sch Med Dept Internal Med Taubman Ctr 3110G Ann Arbor MI 48109 USA Univ Michigan Sch Med Dept Pediat Ann Arbor MI 48109 USA

Maternal substance abuse is a significant contributor to infant morbidity and mortality. The setting of prenatal care has long been the focus of interventions and policies to prevent these adverse outcomes. However, substance abuse programs and policies that are designed for women who are not yet pregnant can have a significant impact upon this problem. Thus it is essential to view the female life course from a broader perspective in order to consider the full range of policy options for reducing the infant mortality and morbidity caused by maternal substance abuse. This framework also allows comparisons across and between substances and offers new directions for policy development.

关键词：青少年保健服务/组织和管理年龄因素儿童保健服务/组织和管理综合保健/组织和管理病人医护连续性/组织和管理卫生政策婴儿福利产妇卫生保健服务/组织和管理妊娠并发症/流行病学妊娠并发症/预防和控制产前保健/组织和管理物质相关性障碍/流行病学物质相关性障碍/预防和控制美国/流行病学妇女卫生青少年女(雌)性人类婴儿新生妊娠

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Primary health care in Turkey: a passing fashion?

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HEALTH POLICY AND PLANNING 1997年第3期12卷 224-233页

作者： Tatar, M Tatar, F UNIV HACETTEPE SCH HLTH ADMTR-06100 ANKARATURKEY

The Alma-Ata Declaration has long been regarded as a watershed in the health policy arena. The global goal of the World Health Organization, 'Health for All by the Year 2000' through primary health care, has attracted many countries both in the developed and the developing world and commitments to this end have been made at every level. However, albeit this consensus on the paper, a common and explicit definition of the concept has not been reached yet. This paper aims at discussing various definitions of primary health care that emerged after the Declaration and also presenting a case study from Turkey, a country that advocates primary health care in her recent health policy reform attempts. After setting the conceptual framework for discussion the Turkish case is presented by using research carried out among Turkish policy-makers at different levels of the State apparatus. It has been concluded that application of primary health care principles as defined in the broad definition of the concept requires major changes or rather shake-ups in Turkey. These areas are outlined briefly at the end of the paper.

关键词：综合保健/组织和管理发展中国家筹资政府筹资个人卫生保健改革卫生保健部门卫生政策健康状况指标初级卫生保健/经济学初级卫生保健/组织和管理初级卫生保健/标准土耳其人类

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Measuring and Evaluating the Performance of Vertically Integrated Rural Health Networks

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The Journal of Rural Health 1995年第1期11卷 9-21页

作者： Moscovice, Ira Wellever, Anthony Institute for Health Services Research University of Minnesota Minneapolis Minnesota 55455‐0381 Box 729 420 Delaware St. S.E United States

Abstract: The grouting interest in health care networks is extraordinary given the lack of a common understanding of what networks are and what they can accomplish. The purpose of this article is to develop a conceptual approach to the study of vertically integrated rural health networks. This article provides a network typology, a framework for assessing network performance, and examples of measurable performance indicators. It concludes with a description of the salient research questions that need to be addressed concerning the relationships between the environment, structure, and performance of vertically integrated rural health networks. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：综合保健/组织和管理综合保健/标准费用效益分析效率组织卫生服务研究管理审计/方法模型组织管理组织隶属关系结果与过程评价(卫生保健) 农村卫生/标准系统综合美国

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A typology of service patterns in end-stage aids care:relationships to the transprofessional model

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Home Health Care Services Quarterly 1998年第1期17卷 73-92页

作者： Huba, G.J. Brief, Diana E. Cherin, David A. Panter, A.T. Melchior, Lisa A. The Measurement Group United States Visiting Nurse Association of Burbank Health Research Center United States

Objective. To determine the relationship among 11 types of home health care services for patients with HIV/AIDS and to develop a terminal-care, service-usage profile of persons receiving such services. Services include the number of psychiatric nurse visits, MedicalSocial Work (MSW) visits, evaluation visits, physical therapy visits, occupational therapy visits, homemaker visits, home health aide visits, public health nurse visits, registered nurse (RN) visits, Licensed Vocational Nurse (LVN) visits, and Intravenous (IV) nurse visits. Data Sources and Study Setting. Data were collected on 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). The service utilization data were collected from the VNA-LA’s computerized datasystem. Study Design. The relationship among the service types was evaluated with principal component analysis. A service-usage profile was developed for patients using cluster analysis. To control for the variability in the amount of time that patients were on service, the numberof days that patients were in the VNA-LA program and were actuallyreceiving services was included as a factor that yielded a variable reflecting the number of each type of service that a patient received perday. Principal Findings. Five components were found to best describe the relationships among the service-type variables. These were identified as being: the Number of Evaluation Visits, the Number of Intensive Nursing Visits, the Number of Physical Therapy Visits, theNumber of Psychosocial Visits, and the Number of Attendant *** were found to cluster into 1 of 5 groups based on the type ofservice utilization profile that they received. The variables that appeared to have the most influence on this profile were the number ofhome health aide visits per day that the patient received, the numberof RN visits that were made, the number of IV nurse visits that wereprovided, and the number of LVN v

关键词：获得性免疫缺陷综合征/治疗聚类分析社区保健护理/组织和管理综合保健/组织和管理人口统计学卫生服务研究家庭医疗保健服务/组织和管理家庭医疗保健服务/利用洛杉矶模型组织管理社会支持临终医护/组织和管理临终医护/利用女(雌)性人类男(雄)性

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The state hospital and the community: an essential continuum for persons with severe and persistent mental illness.

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New directions for mental health services 1999年第84期1999卷 85-97页

作者： Monroe-DeVita, M.B. Mohatt, D.F. Clinical Psychology Training Program University of Nebraska-Lincoln United States

Assertive Community Treatment and related approaches will have a defining impact on state hospitals, now and in the future.

关键词：慢性病社区精神卫生服务/组织和管理综合保健/组织和管理病人医护连续性/组织和管理医院外治疗/组织和管理卫生服务研究医院精神病/组织和管理医院州立/组织和管理精神障碍/治疗结果评价(卫生保健) 疾病严重程度指数美国人类

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Health care clusters in hospitals: The market audit and frameworks for planning

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Journal of Hospital Marketing 1993年第2期7卷 61-76页

作者： Gruca, Thomas S. Kaltenbach, Katherine M. Nath, Deepika University of Iowa Iowa City IA 52242 United States Alexian Brothers Medical Center Elk Grove Village IL United States York University Toronto Canada

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 continuum of care to a defined geographic region through integration of referral and payment systems. To aid in successful planning for healthcare clusters, a market audit and frameworks for examining the current healthcare market are presented. © 1993 Taylor & Francis Group, LLC.

关键词：卫生服务范围综合保健/组织和管理综合保健/标准病人医护连续性/组织和管理病人医护连续性/标准评价研究医院计划卫生服务使用研究模型组织管理多机构系统/组织和管理美国

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An Expert Panel Approach to Assessing the Rural Implications of Health Care Reform: The Case of the Health Security Act

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The Journal of Rural Health 1994年第1期10卷 6-15页

作者： Coburn, Andrew F. Cordes, Sam M. Crittenden, Robert A. Hart, J. Patrick Mueller, Keith J. Myers, Wayne W. Ricketts, Thomas R.

The policy arena is hungry for objective information regarding the potential effects of comprehensive national and state health care reform. Such information reduces the dependence of policy-makers on information generated solely by advocacy groups and serves as a checkpoint for such information. Unfortunately, the academic community is often unable to mobilize its resources quickly enough to help meet this information need. This article describes one model for overcoming this difficulty. When the time frame is especially short, academic expertise can be brought together in the form of an expert panel. However, for such an approach to be effective, it must be carefully configured and orchestrated. Critical ingredients include much preparatory groundwork, a well-defined framework and methodology for conducting the policy analysis, and a professional facilitator. The Rural Policy Research Institute used such an approach to analyze President Clinton's Health Security Act shortly after the initial blueprint was released (but before the legislative language was released). The consensus of the expert panel was that the Health Security Act would, on balance, represent an improvement over today's rural reality. However, a number of troubling aspects were noted. First, the Act's emphasis on primary care and nonphysician providers is a double-edged sword. While these are precisely the types of providers needed in rural areas, the short-run effect may be to create increased competition for such providers from urban areas.(ABSTRACT TRUNCATED AT 250 WORDS)

关键词：综合保健/组织和管理综合保健/发展趋势集中研讨小组卫生保健费用/立法和法学卫生保健费用/发展趋势卫生保健改革/经济学卫生保健改革/立法和法学卫生保健改革/发展趋势卫生人力/发展趋势卫生服务研究/方法医院乡村/经济学医院乡村/立法和法学医院乡村/发展趋势多机构系统/组织和管理多机构系统/发展趋势医师家庭/供应和分配农村卫生/发展趋势美国

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A national program of innovative aids care projects and their evaluation

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Home Health Care Services Quarterly 1998年第1期17卷 3-30页

作者： Huba, G.J. Melchior, Lisa A. De Veauuse, Natasha F. Hillary, Kris Singer, Barney Marconi, Katherine The Measurement Group United States Visiting Nurse Association United States HealthResources and Services Administration United States

As the number of people seeking HIV care in the U.S. has grown, the demand has increased not only for medical care, butalso for a wide range of supportive services. This in turn has increased the need for demonstrated and tested HIV care service models that can address a comprehensive set of needs. The Special Projects of National Significance (SPNS) Program’s HIV InnovativeModels of Care Initiative funded by the Health Resources and Services Administration (HRSA) began on October 1,1994. This initiative is an effort by 27 HRSA-funded projects to jointly establishgoals and objectives, develop common evaluation methods, and produce comparable and measurable outcomes for innovative models ofHIV care. The five projects of the SPNS Program Capitated Care Work Group share, as a central theme, the study of the health care provided to individuals with HIV disease under models where thehealth care is capitated, or paid on a “flat fee” basis per patient permonth. These projects differ in the ways that they provide healthcare, ranging from community- and university-based clinics to ahome-based hospice to a statewide health care system. Each of theprojects shares the goals of determining costs for providing healthcare services to AIDS patients under a capitated care system and ofensuring that high quality care is provided under such a system. © 1998, Taylor & Francis Group, LLC. All rights reserved.

关键词：获得性免疫缺陷综合征/心理学获得性免疫缺陷综合征/治疗按人收费综合保健/经济学综合保健/组织和管理合作行为筹资组织卫生服务需求模型组织管理组织改革试点项目方案评价/方法社会支持美国人类

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A 10‐Point Strategic Checklist for Rural Health Care Systems

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The Journal of Rural Health 1995年第1期11卷 53-59页

作者： Zismer, Daniel K. Partners Consulting Group Ltd Mount Horeb Wisconsin 53572 1406 Business Highway 18–151 East United States

Abstract: A checklist format is used to provide a framework for rural hospital executives and community members for gauging the health and stability of rural hospitals and rural hospital systems. Benchmarks are provided for financial and operational performance and emphasis is placed on medical staff size and physician recruitment. Physician/hospital organizations and regional partnerships are used as examples of strategies available to rural providers. The importance of market knowledge and regional strategic alliances also is stressed. In an era of dwindling resources and tight reimbursement, rural providers are encouraged to consider cooperative clinical programming and technology consolidation. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：综合保健/组织和管理财务审计医院费用医院乡村/组织和管理管理审计/方法医务人员医院/供应和分配模型组织管理多机构系统/组织和管理规划技术地区卫生计划美国

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The Relationship of Farm Residency Status to Demographic and Service Characteristics of Agricultural Injury Victims in Central Wisconsin

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The Journal of Rural Health 1995年第2期11卷 98-105页

作者： Stueland, Dean Cleveland, David A. Rothfusz, Ron R. Zoch, Tom Jr., Peter Stamas Department of Emergency Medicine Marshfield Clinic Marshfield Wisconsin 54449‐5777 1000 N. Oak Ave. United States

Abstract: This study performed a surveillance of a defined population in central Wisconsin during a two‐year period that included six months of follow‐up. The study included those who worked and lived on farms and those who only worked on farms. The injury rate for farm residents was 3.15 injuries per 100 persons per year. However, 195 of the 510 injuries (38.2%) involved persons who were not farm residents. For nonfarm residents, 88.7 percent of the victims were male, whereas for farm residents 79 percent of the victims were male. More than one half of the farm residents who were injured were the owners and an additional 21 percent were juvenile children. Of those aged 18 to 29 years, 51.3 percent were nonfarm resident victims and 15.2 percent were farm resident victims. Of nonfarm residents, 41.1 percent were married;of farm residents, 65.3 percent were married. More than one half of all injured nonfarm residents were seen within two hours of injury while one quarter of the injured farm residents were seen more than 24 hours after the injury. Only 4 percent of the injured farm residents were self‐insured, but 15 percent of the nonfarm residents were self‐insured. However, the time of injury, actual injuries, diagnoses rendered, and services received were similar for injured farm residents and injured nonfarm residents. Effective attempts to intervene on agricultural injuries will need to consider different risk factors for injuries for nonfarm residents as compared to farm residents. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：事故职业/预防和控制事故职业/统计学和数值数据农业/统计学和数值数据卫生服务范围/统计学和数值数据卡方分布社区卫生服务/组织和管理综合保健/组织和管理数据收集人口统计学保险健康/统计学和数值数据居住特征/统计学和数值数据农村卫生病人转送/方法病人转送/统计学和数值数据威斯康星/流行病学创伤和损伤/流行病学成年人老年人儿童人类中年人

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