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Applying disease management strategies to Medicare

MILBANK QUARTERLY 1999年第4期77卷 461-+页

作者： Tompkins, CP Bhalotra, S Trisolini, M Brandeis Univ Schneider Inst Hlth Policy Heller Grad Sch Waltham MA 02454 USA

Medicare coverage begins for many when they have already developed one or more chronic diseases, and it often pays for the latest and costliest phases. Population-based disease modeling, patient screening, and monitoring would be appropriate interventions for chronic renal disease. Patients who have not get advanced to end-stage renal disease would benefit from management of diabetes and hypertension, avoidance of nephrotoxic substances, and better preparation for dialysis. Administrative support could take the form of clinical guidelines, physician-led multidisciplinary teams, integrated delivery systems, provider and patient education, and new information technologies. Medicare reflects the long-term public perspective, and thus should further this new direction by supporting education, reimbursing for prevention efforts and allied health services, encouraging efficiency, and monitoring cost and quality outcomes.

关键词：社区卫生计划/组织和管理费用控制疾病管理预测肾功能衰竭慢性/经济学肾功能衰竭慢性/治疗长期医疗/组织和管理普查/组织和管理 Medicare/组织和管理需求估价/组织和管理诊疗准则(主题) 一级预防/组织和管理质量保证卫生保健/组织和管理美国人类

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Diabetes education needs of family members caring for American Indian elders

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DIABETES EDUCATOR 1999年第5期25卷 747-754页

作者： Hennessy, CH John, R Anderson, LA Ctr Dis Control & Prevent Hlth Care & Aging Studies Branch Atlanta GA 30341 USA

PURPOSE this qualitative study investigated diabetes care management among family members of American Indian elders with self-care limitations. Focus groups were used to examine the reasons for and content of diabetes care management, the challenges faced, and the support services needed. METHODS Five focus groups were conducted with family caregivers from six tribes. Caregivers' responses related to care management were identified and categorized into themes. RESULTS Participants reported that they provided assistance with a wide range of diabetes care tasks leg, skin and wound care, in-home dialysis) depending on the elder's level of impairment. Caregivers described three major challenges related to diabetes care management: (1) anxiety about in-home care, (2) coping with psychosocial issues, and (3) decision making and communication problems with other family members. They emphasized the importance of developing a care routine for successful diabetes management. CONCLUSIONS Based on these findings, we suggest areas where diabetes educators can assist American Indian family caregivers in meeting the needs of frail elders in the home.

关键词：适应心理学医疗护理提供者/教育医疗护理提供者/心理学信息交流糖尿病 2型/人种学糖尿病 2型/护理家庭/心理学集中研讨小组家庭护理(非专业)/教育印第安人北美洲/心理学需求估价/组织和管理新墨西哥护理方法学研究俄克拉何马老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Evaluation of case management needs of clients from non-English speaking backgrounds by key workers in a public agency.

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The Australian and New Zealand journal of mental health nursing 1999年第4期8卷 176-186页

作者： Shackleton, M.G. Julia Farr Services Adelaide Australia

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.

关键词：医务工作者的态度病例管理/组织和管理信息交流障碍社区精神卫生服务/组织和管理文化多样性人种群/统计学和数值数据需求估价/组织和管理公共卫生工作问卷调查南澳大利亚青少年成年人老年人女(雌)性人类男(雄)性中年人

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Research priorities in mental health nursing

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Issues in Mental Health Nursing 1999年第3期20卷 217-227页

作者： Pullen, Lisa Tuck, Inez Wallace, Debra C. College of Nursing University of Tennessee United States School of Nursing Virginia Commonwealth University United States College of Nursing University of Tennessee Knoxville TN 37996-4180 1200 Volunteer Boulevard United States

This study determined nursing research priorities that focused on mental health nursing in the published literature from 1990 to 1996. Determination of which priorities were related to mental health was completed using 18 sources (experts, organizations, and individual research projects). A content analysis of the 18 sources was completed, and 56 menial health related research priorities were identified. Six categories emerged from the data analysis: support, holism, mental health nursing practice, quality care outcomes, mental health etiology, and mental health delivery systems. As mental health nursing embraces evidenced-based practice, the need for clear research priorities is imperative for knowledge development in the field.

关键词：循证医学卫生工作重点/组织和管理知识需求估价/组织和管理护理研究/组织和管理组织目标精神病护理学/教育精神病护理学/组织和管理问卷调查研究设计人类

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Proposed changes to designations of medically underserved populations and health professional shortage areas: Effects on rural areas

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JOURNAL OF RURAL HEALTH 1999年第1期15卷 44-54页

作者： Goldsmith, LJ Ricketts, TC Univ N Carolina Sheps Ctr Hlth Serv Res Chapel Hill NC 27599 USA

This paper reports an analysis of the proposed rule to combine medically underserved population (MUP) and health professional shortage area (HPSA) designations, as published by the Bureau of Primary Health Care (BPHC) in the Federal Register on Sept. 1, 1998 (Department of Health and Human Services, 1998). The effects of the proposed rule over all and on rural communities were examined, particularly with respect to current whole county HPSA designations and eligibility for federal assistance programs. National, county-level estimates of primary care provider counts and other measures included in the proposed rule were used. Different primary care provider sources were compared;results were highly dependent on the data source nod the inclusions of counts of nurse practitioners and physician assistants. The projections of losses from the proposed rule were higher than those of the BPHC, probably due to the use of different sources for provider counts. Overall, the authors projected that more than 50 percent of current whole-county HPSAs would lose designation using the proposed nib. The proportion of rural counties that lost designation was not significantly greater than the proportion Of urban counties, but because there are many more rural counties, more de-designations were projected to occur in rural areas. The researches also predicted that 58 percent of rural whole-county HPSAs with National Health Service Corps providers would lose their designation, but most rural whole-county HPSAs with Community and Migrant Health Centers or Rural Health Clinics retained their MUP designation using the proposed rule. The proposed rule likely has a larger effect on current designations than originally projected by the BPHC.

关键词：数据说明统计卫生人力/分类卫生服务研究健康状况指标缺医地区需求估价/组织和管理北卡罗来纳开业护士/供应和分配组织改革医师助理/供应和分配初级卫生保健/人力方案评价乡村卫生服务/人力人类

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Delphi technique: one cycle of an action research project to improve the pre-registration midwifery curriculum

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NURSE EDUCATION TODAY 1999年第6期19卷 495-501页

作者： Fraser, DM Univ Nottingham Acad Div Midwifery Sch Human Dev Fac Med & Hlth SciQueens Med Ctr Nottingham NG7 2UH England

Facilitating a unified interpretation of new or re-designed curricula can be problematic in multi-sited universities. This paper discusses the use of the Delphi technique when implementing an innovative pre-registration midwifery curriculum. It formed one of the action research cycles of the author's doctoral study and was used in an attempt to seek the views of all midwife teachers and achieve a critical mass consensus. The most important issues that emerged from the Delphi process were grouped into four categories. These four categories (the teacher's base site, communications, staff development and administration issues) formed the agenda for a staff away day. The outcome of the process was the generation of a list of priorities and actions for curriculum implementation and the identification of ways in which staff development needs might be met more effectively. An unexpected, but equally important, outcome was the way it helped with team building and agreement on positive actions for its further development. (C) 1999 Harcourt Publishers Ltd.

关键词：医务工作者的态度课程/标准德尔菲技术教育护理研究生/标准全体教工护理院校卫生服务研究/方法助产学/教育需求估价/组织和管理助产士/教育助产士/心理学护理教育研究/方法问卷调查人类

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Understanding and controlling response bias in needs assessment studies

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EVALUATION REVIEW 1999年第4期23卷 399-417页

作者： Calsyn, RJ Winter, JP Univ Missouri St Louis MO 63121 USA

This study demonstrated that estimates of agency awareness in the typical needs assessment study are probably inflated by a response bias labeled "agency awareness overclaiming." Over- claimers (respondents who reported being aware of fictitious agencies) reported being aware of more real agencies than other respondents. Estimates of agency awareness may also be biased, because certain segments of the population were more likely to exhibit agency awareness overclaiming. Age was positively correlated with overclaiming, and African Americans were more likely to exhibit agency awareness overclaiming than Caucasians. General overclaiming was correlated with agency awareness overclaiming, but social desirability and acquiescence were not.

关键词：非洲裔美国人/心理学年龄因素觉知偏倚(流行病学) 教育考核欧洲大陆世系人群/心理学健康知识态度实践密苏里需求估价/组织和管理问卷调查可重复性结果性别因素社会性愿望成年人老年人女(雌)性人类男(雄)性中年人

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The biosciences in the pre-registration nursing curriculum: staff and students' perceptions of difficulties and relevance

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NURSE EDUCATION TODAY 1999年第3期19卷 215-226页

作者： Jordan, S Davies, S Green, B Univ Coll Swansea Sch Hlth Sci Swansea SA2 8PP W Glam Wales Univ Coll Swansea Sch Hlth Sci Swansea W Glam Wales

This paper considers the problematic position of the biological sciences in pre-registration nurse education -'The Bioscience Question'. There is no consensus and little research on the appropriate content and depth of bioscience knowledge required by nurses. Attempts to apportion curriculum time for the biosciences are confounded by the difficulty experienced by nursing students with this area. Within one university department, a survey was undertaken to investigate the perceptions of pre-registration students, and their teachers, of the teaching and learning of biological science, in comparison with other areas of the curriculum. Our findings concur with others that the biosciences are a source of disproportionate difficulty and anxiety to nursing students. Among the students, but not the lecturers, there was some, by no means universal, support for the suggestion that these problems could be reduced by a reallocation of curriculum time in favour of the biosciences. Although it was agreed that bioscience theory should be related more closely to nursing practice, there was no evidence that this lessened the students' difficulties with the subject. In contrast to lecturers, students felt the biosciences to be one of the areas of the pre-registration curriculum most relevant to clinical practice.

关键词：适应心理学医务工作者的态度生物学/教育课程/标准教育护理学士/标准全体教工护理院校需求估价/组织和管理护理教育研究问卷调查学生护理/心理学时间因素人类

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The Medicare Critical Access Hospital program: The first year

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JOURNAL OF RURAL HEALTH 1999年第1期15卷 61-66页

作者： Reif, SS Ricketts, TC Univ N Carolina Sheps Ctr Hlth Serv Res Chapel Hill NC 27599 USA

The Medicare Critical Access Hospital (CAH) program, part of the Balanced Budget Act of 1997, is a nationwide limited service hospital program. Structured interviews were conducted in August and September 1998 with key people in state offices of rural health, state hospital associations, departments gf health or departments of facility licensing in all 50 states to assess their progress in the development of the CAH program. The majority of states expressed interest in the CAH program. Twenty-one states were moving formally toward involvement in the program. States that had developed or were in the process of developing a state plan estimated that between 183 to 227 hospitals would convert to CAHs in the next one to two years. States that were the most successful with plan de development appeared to be states that participated in the Essential Access Community Hospital/Rural Primary Care Hospital program, states where there was dialogue about the possibility of a limited service hospital program and states with widespread support in the state. A pressing need for most states is for reliable fiscal consulting or analysis that could be applied to individual hospitals that are considering conversion to CAHs. The CAH program shows promise for successful implementation based on its early results.

关键词：预算/立法和法学卫生服务易得程度/组织和管理卫生服务研究医院公立/经济学医院公立/组织和管理医院乡村/组织和管理医院慈善/经济学医院慈善/组织和管理缺医地区 Medicare/组织和管理需求估价/组织和管理试点项目初级卫生保健/组织和管理规划制订方案评价预期支付系统/组织和管理问卷调查偿还途径/组织和管理美国人类

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Are there need-based geographical differences between international medical graduates and US medical graduates in rural US counties?

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JOURNAL OF RURAL HEALTH 1999年第1期15卷 26-43页

作者： Mick, SS Lee, SYD Univ Michigan Sch Publ Hlth Dept Hlth Management & Policy Ann Arbor MI 48109 USA

The objectives of this study are to compare the rural location of international medical graduates (IMGs) and U.S. medical graduates (USMGs) by specialty (primary care vs. specialty care) according to geographical measures of need. This study utilized a cross-sectional survey using the 1997 American A;Medical Association Physician Masterfile for all active post-resident allopathic physicians aln the Area Resource File (ARF) (Bureau of Health Professions, 1996) for all active post-resident osteopathic physicians irt 1995 in the rural U.S. physician work force (N=69,065). Allopathic physician ZIP code location was matched to county data using the ARF. The key measure was the difference in proportions between USMGs and LMGs in each state's rural counties characterized by need: high infant mortality, low socioeconomic status, high proportion of nonwhite population, high proportion of population 65 years and older, and low physician-to-population ratio. Primary care and specialty care rural physicians were studied separately. A disproportion of IMGs were located in needy rural counties of more states than were USMGs. Further, IMG disproportions were generally larger than USMG disproportions when they existed. Disproportions of IMGs tended to be located more often in the central and south census regions. Disproportions of specialty care IMGs were more frequent and of greater magnitude than those of primary care IMGs. Variations in the relative and absolute numbers of IMGs and USMGs among the states was wide. Services delivered by active post-resident primary care and specialty care IMGs appeared to be disproportionate to their overall number compared with USMGs in numerous needy rural counties. The extent of the IMG "safety net" presence differed, however, by the criteria used. Still, proposed limits on IMG entry into U.S. residency training may create long-term problems of access to rural physician services absent policies to induce USMGs or midlevel practioners to locate

关键词：人口普查横断面研究外国医学研究生/供应和分配卫生服务易得程度/组织和管理卫生服务研究健康状况指标缺医地区需求估价/组织和管理骨病医学/人力医师/供应和分配初级卫生保健/人力居住特征乡村卫生服务/人力社会经济因素专业医学/人力美国人类

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