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Sibbald, Bonnie, Susan Pickard, Hugh McLeod, David Reeves, Nicola Mead, Islay Gemmell, Joanna Coast, Martin Roland, and Brenda Leese. "Moving specialist care into the community: An initial evaluation." Journal of Health Services Research & Policy 13, no. 4 (October 2008): 233–39. http://dx.doi.org/10.1258/jhsrp.2008.008049.
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Objectives: To assess the likely impact on patients and local health economies of shifting specialist care from hospitals to the community in 30 demonstration sites in England. Methods: The evaluation comprised: interviews with service providers at 30 sites, supplemented by interviews with commissioners, GPs and hospital doctors at 12 sites; economic case studies in six sites; and patient surveys at 30 sites plus at nine conventional outpatient services. Outcomes comprised: staff views of service organization and development, impact on primary and secondary care, and benefits for patients; cost per consultation and cost per patient in new services compared to estimates of the price of services if undertaken by hospitals; patients’ views of waiting time, access, quality (technical and interpersonal), coordination and satisfaction. Results: New services required high initial investment in staff, premises and equipment, and the support of hospital consultants. Most new services were added to existing hospital services so expanded capacity. Patient reported waiting times (6.7 versus 10.1 weeks; p = 0.001); technical quality of care (96.2 versus 94.5; p < 0.001), overall satisfaction (88.2 versus 85.4; p = 0.04); and access (72.2 versus 65.8; p = 0.001) were significantly better for new compared to conventional services but there was no significant difference in coordination or interpersonal quality of care. Some service providers expressed concerns about service quality. New services dealt with less complex conditions and undercut the price tariff applied to hospitals thus providing a cost saving to commissioners. There was some concern that expansion of new services might destabilize hospitals. Conclusions: Moving specialist care into the community can improve patient access, particularly when new services are added to existing hospital services. Wider impacts on health care quality, capacity and cost merit closer scrutiny before rollout.
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Kumpalanon, Jutarat, Dusadeee Ayuwat, and Pattara Sanchaisuriya. "Developing Of Health Promotion Of District Hospitals In Thailand." American Journal of Health Sciences (AJHS) 3, no. 1 (December 22, 2011): 43–52. http://dx.doi.org/10.19030/ajhs.v3i1.6752.
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The aim of this research is to investigate the health promotion services provided by district hospitals in the northeast of Thailand in order to improve health promotion guideline for district hospitals. The qualitative research was conducted from January 2009 to March 2010. Informants were the managers, the staff members responsible for developing and providing services of health promotion from 19 small, medium and large-sized district hospitals in the Northeastern region of Thailand. The in-depth interview was employed to gather the information analyzed by using content analysis. It was found that the new health promotion trends in district hospitals in the northeast were as follows. The organizational structures for promoting health were obviously defined while active services inside and outside the hospitals were clearly developed which bring health promotion practices to serviced users. Public policy for health was offered in the form of quality control, information management and active services while environmental management emphasized on creating comfort and learning environments for the hospital staff members and serviced users. Collaborations between professional organizations and multi-level networks had been established by district hospitals resulting in services with more accessibility and strengthening local communities. In addition, personal skill development and public health education yielded change to the health behaviors of hospital staff members, serviced users and people in local communities. For health service reorientation, there was emphasis on development of the quality of local community services in forms of professional standard development and assessment of health behavior outcome. The forms of health promotion provided by district hospitals in the northeast that were found were public policy for health promotion, active services, environmental management for health, community strengthening in form of collaboration networks, personal skill development and public health education for changing behavior, and change of health services. In order to improve health promotion, health promotion policies must be clearly defined and collaboration between stakeholders both inside and outside hospitals must be supported.
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Sampogna, Gaia, Valeria Del Vecchio, Corrado De Rosa, Vincenzo Giallonardo, Mario Luciano, Carmela Palummo, Matteo Di Vincenzo, and Andrea Fiorillo. "Community Mental Health Services in Italy." Consortium Psychiatricum 2, no. 2 (May 25, 2021): 86–92. http://dx.doi.org/10.17816/cp76.
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In 1978, in Italy, approval of Basaglias reform law marked a shift from an asylum-based to a community-based mental health system. The main aim of the reform was to treat patients in the community and no longer in psychiatric hospitals. Following the Italian model, similar reforms of mental health care have been approved worldwide. The community-based model aims to promote integration and human rights for people with mental disorders on the basis of their freedom to choose treatment options.
By 2000, all psychiatric hospitals had been closed and all patients discharged. Mental health care is organized through the Department of Mental Health, which is the umbrella organization responsible for specialist mental health care in the community; this includes psychiatric wards located in general hospitals, residential facilities, mental health centres, and day-hospital and day-care units.
Approval of Law 180 led to a practical and ideological shift in the provision of care to patients with mental disorders. In particular, the reform highlighted the need to treat patients in the same way as any other patient, and mental health care moved from a custodialistic to a therapeutic model.
Progressive consolidation of the community-based system of mental health care in Italy has been observed in the past 40 years. However, some reasons for concern still exist, including low staffing levels, potential use of community residential facilities as long-stay residential services, and a heterogeneity in the availability of resources for mental health throughout the country.
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Nisa Srimayarti, Berly, Devid Leonard, and Dicho Zhuhriano Yasli. "Determinants of Health Service Efficiency in Hospi-tal: A Systematic Review." International Journal of Engineering, Science and Information Technology 1, no. 3 (July 24, 2021): 87–91. http://dx.doi.org/10.52088/ijesty.v1i3.115.
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One of the benchmarks for assessing service performance in hospitals is efficiency in medical services. Measurement of service efficiency will affect the quality of the hospital. Patients will consider the completeness of the service facilities they have and the quality of services to be obtained. This is due to the tendency of people to seek quality health services. Improving service quality standards in hospitals will have an impact on increasing income and getting recognition from the community for the quality of services in hospitals. This study aims to look at the determinant factors that affect hospital efficiency. This study uses a systematic review method based on the PRISMA protocol. Article searches were conducted through four online databases (PubMed, ProQuest, SAGE and SpingerLink). The initial search found 307 articles, filtered using inclusion criteria, so as many as 8 articles were analyzed with a time span of 2017-2021. The efficiency of health services in hospitals is the basis for obtaining a wider patient base and producing quality services. The results of the literature study show that there are 29 factors affecting hospital efficiency. The various factors obtained were categorized into organizational factors, health resource factors, and technical efficiency factors.
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Ruud, Torleif, and Svein Friis. "Community-based Mental Health Services in Norway." Consortium Psychiatricum 2, no. 1 (March 20, 2021): 47–54. http://dx.doi.org/10.17816/cp43.
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Community-based mental healthcare in Norway consists of local community mental health centres (CMHCs) collaborating with general practitioners and primary mental healthcare in the municipalities, and with psychiatrists and psychologists working in private practices. The CMHCs were developed from the 1980s to give a broad range of comprehensive mental health services in local catchment areas. The CMHCs have outpatient clinics, mobile teams, and inpatient wards. They serve the larger group of patients needing specialized mental healthcare, and they also collaborate with the hospital-based mental health services. Both CMHCs and hospitals are operated by 19 health trusts with public funding.
Increasing resources in community-based mental healthcare was a major aim in a national plan for mental health between 1999 and 2008. The number of beds has decreased in CMHCs the last decade, while there has been an increase in mobile teams including crisis resolution teams (CRTs), early intervention teams for psychosis and assertive community treatment teams (ACT teams). Team-based care for mental health problems is also part of primary care, including care for patients with severe mental illnesses. Involuntary inpatient admissions mainly take place at hospitals, but CMHCs may continue such admissions and give community treatment orders for involuntary treatment in the community.
The increasing specialization of mental health services are considered to have improved services. However, this may also have resulted in more fragmented services and less continuity of care from service providers whom the patients know and trust. This can be a particular problem for patients with severe mental illnesses. As the outcomes of routine mental health services are usually not measured, the effects of community-based mental care for the patients and their families, are mostly unknown.
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Malcolm, Laurence, and Pauline Barnett. "Decentralisation, Integration and Accountability: Perceptions of New Zealand's Top Health Service Managers." Health Services Management Research 8, no. 2 (May 1995): 121–34. http://dx.doi.org/10.1177/095148489500800204.
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This paper reports on the findings of a representative survey of senior managers within New Zealand's health system. Respondents report most favourably upon the implementation of a new organisational structure, service management, which appears to have largely replaced the traditional division of health services into hospitals and community services. Service management, which is the decentralisation of decision making to integrated patient groupings, i.e. medicine, surgery, mental health, women's health, primary health care etc., appears to have been remarkably successful, in the view of the respondents, in achieving greater efficiencies, better quality care, better decision making about priorities and greater accountability of doctors. A majority of respondents consider that services have replaced hospitals as organisational entities. Significant progress is reported in the integration of hospital and community services, primary and secondary care, preventive and treatment services and of public, private and voluntary services through service management. The findings point to a new paradigm which may be of fundamental significance in the future organisation of health services.
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Mardiyanti, Siti, Dewi Rahayu, Ahmad Karbito, and Atikah Adyas. "Management of Free Health Services in Hospital." Indonesian Journal of Global Health Research 3, no. 3 (August 14, 2021): 341–52. http://dx.doi.org/10.37287/ijghr.v3i3.525.
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The Government of Indonesia is obliged to provide guarantees for the fulfillment of the right to a healthy life for every citizen by enforcing the Social Security Administration (BPJS) for Health. The success of hospitals in carrying out their functions is marked by an increase in the quality of hospital services. To implement the implementation of SJSN in the BPJS program, the phenomenon of existing problems where the management of free health services in hospitals has not been carried out optimally, seeing some complaints in the community, therefore it is necessary to study the management of health services in terms of input, process and output. and 5M management at Tjokrodipo Hospital, Bandar Lampung City. This study aims to determine and describe the Management of Free Health Services at Tjokrodipo Hospital, Bandar Lampung City in 2021. This research is a qualitative study with a descriptive approach. The time of the study was carried out from May to June 2021 in Tjokrodipo Hospital Bandar Lampung Research subjects were selected using purposive sampling technique, researchers used data triangulation techniques and data processing carried out in this study was source triangulation. not available for BPJS patients, so patients are advised to look for other dispensaries, medical equipment such as patient beds are still lacking because during the pandemic, the availability of health human resources (HR), such as dentists and specialists are not in accordance with class C hospital standards, patients feel that the free health services provided are not good, the average patient complains of a lack of equipment such as uncomfortable beds and rooms because there are many patients.
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Ginn, Gregory O., and Charles B. Moseley. "Community Health Orientation, Community-based Quality Improvement, and Health Promotion Services in Hospitals." Journal of Healthcare Management 49, no. 5 (September 2004): 293–306. http://dx.doi.org/10.1097/00115514-200409000-00005.
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Wilson, Asa B., Bernard J. Kerr, Nathaniel Bastian, and Lawrence V. Fulton. "From surviving to community benefit: A proposed rural health services research agenda." Journal of Hospital Administration 3, no. 5 (April 29, 2014): 104. http://dx.doi.org/10.5430/jha.v3n5p104.
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Background: The research history of rural hospitals from 1980 forward is reviewed. This summary, in turn, becomes a foundation for proposing an updated applied research agenda; one focused on ensuring health services for rural America. Research history: From 1980 to 1997 rural hospitals closed at a disproportionally higher rate than non-rural facilities. This trend prompted an academic search (Phase I) for the factors associated with the closure-conversion threat to hospitals. The public policy response was the Balanced Budget Act of 1997 and the creation of the Critical Access Hospital (CAH). Once the closure-conversion threat diminished as a result, the research focus (Phase II) shifted from survival to financial performance monitoring, economic efficiency, quality of care, and patient safety of CAHs. Phase II research demonstrates that CAHs can sustain themselves and are not necessarily victims of adverse rural circumstances. Today, CAHs, Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) exist as an established rural health safety net. Also, the 1332 CAHs are considered the hub of health services for rural communities. Significance: The rural environment remains a changing, challenging arena in which to ensure care for it residents. As such, the expanded Internal Revenue Service (IRS) definition of Community Benefit, specifically the periodic Community Health Needs Assessment (CHNA), provides a template for assessing the rural health safety net’s capacity to meet local health needs and improve the health status of its communities. This rubric also balances fiscal stewardship with positive health service outcomes. It is argued that the CHNA expansion of Community Benefit is an ideal research template and performance standard for all rural hospitals. It enables one to offer researched answers to the enduring question, “What is the best way to ensure health services for rural America?”
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McCullough, J. Mac. "Government Health and Social Services Spending Show Evidence of Single-Sector Rather Than Multi-Sector Pursuit of Population Health." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 56 (January 2019): 004695801985697. http://dx.doi.org/10.1177/0046958019856977.
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Population health improvements can be achieved through work made possible by government spending on health care, public health, and social services. The extent to which spending allocations across these sectors is synergistic with or trade-off against one another is unknown. Achieving a balanced portfolio with multi-sector contributions is key to improving health outcomes. This study tested competing hypotheses regarding achievement of balanced multi-sector resources for health. County-level U.S. Census Bureau data on all local governmental spending measured each county’s average per capita local government spending for public hospitals, public health, social services, and education. American Hospital Association (AHA) Annual Survey data on hospital community health service provision were used to calculate an index of hospital community service provision aggregated to county level by year. County Health Rankings data measured each county’s health outcomes and health factors. Longitudinal mixed-effects regression models (n = 1877 counties) predicted changes in spending for each government spending category based on two sets of predictors ( government spending vs community health services and needs) from current and prior year. Models account for average spending in each category and county-, state-, and time-trends. Models showed that spending increases in each of the four spending categories examined (public hospitals, public health, social services, and education) were not associated with changes in spending across other categories in current or prior years. For all categories, an increase from baseline spending levels in Year 1 was always significantly associated with an increase from baseline spending level in that same category in Year 2 (ie, spending stayed above baseline in Year 2). Multi-sector initiatives to health outcomes require funding across sectors, yet there was little evidence to suggest that communities that invest in public hospitals, public health, or other social services see commensurate increases in other areas. Underlying funding decisions may reflect strategic decisions within a community to scale up single sectors, constrained resources for multi-sector scale up, or a host of additional factors not measured here.
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Thornicroft, G., and M. Tansella. "The balanced care model for global mental health." Psychological Medicine 43, no. 4 (July 11, 2012): 849–63. http://dx.doi.org/10.1017/s0033291712001420.
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BackgroundFor too long there have been heated debates between those who believe that mental health care should be largely or solely provided from hospitals and those who adhere to the view that community care should fully replace hospitals. The aim of this study was to propose a conceptual model relevant for mental health service development in low-, medium- and high-resource settings worldwide.MethodWe conducted a review of the relevant peer-reviewed evidence and a series of surveys including more than 170 individual experts with direct experience of mental health system change worldwide. We integrated data from these multiple sources to develop the balanced care model (BCM), framed in three sequential steps relevant to different resource settings.ResultsLow-resource settings need to focus on improving the recognition and treatment of people with mental illnesses in primary care. Medium-resource settings in addition can develop ‘general adult mental health services’, namely (i) out-patient clinics, (ii) community mental health teams (CMHTs), (iii) acute in-patient services, (iv) community residential care and (v) work/occupation. High-resource settings, in addition to primary care and general adult mental health services, can also provide specialized services in these same five categories.ConclusionsThe BCM refers both to a balance between hospital and community care and to a balance between all of the service components (e.g. clinical teams) that are present in any system, whether this is in low-, medium- or high-resource settings. The BCM therefore indicates that a comprehensive mental health system includes both community- and hospital-based components of care.
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Nyakutombwa, Content P., Wilfred N. Nunu, Nicholas Mudonhi, and Nomathemba Sibanda. "Factors Influencing Patient Satisfaction with Healthcare Services Offered in Selected Public Hospitals in Bulawayo, Zimbabwe." Open Public Health Journal 14, no. 1 (April 20, 2021): 181–88. http://dx.doi.org/10.2174/1874944502114010181.
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Introduction: Patient satisfaction with health care services is vital in establishing gaps to be improved, notably in public health facilities utilised by the majority in Low and Middle-Income Countries. This study assessed factors that influenced patient satisfaction with United Bulawayo Hospitals and Mpilo Hospital services in Bulawayo in Zimbabwe. Methods: A cross-sectional survey was conducted on 99 randomly selected respondents in two tertiary hospitals in Bulawayo. Chi-squared tests were employed to determine associations between different demographic characteristics and patient satisfaction with various services they received. Multiple Stepwise Linear regression was conducted to assess the strength of the association between different variables. Results: Most of the participants who took part in the study were males in both selected hospitals. It was generally observed that patients were satisfied with these facilities' services, symbolised by over 50% satisfaction. However, patients at Mpilo were overall more satisfied than those at United Bulawayo Hospitals. Variables “received speciality services,” “average waiting times,” and “drugs being issued on time” were significant contributors to different levels of satisfaction observed between Mpilo and United Bulawayo Hospitals. Conclusion: Generally, patients are satisfied with the services and interactions with the health service providers at United Bulawayo Hospitals and Mpilo Hospitals. However, patients at Mpilo were more satisfied than those at United Bulawayo Hospitals. There is generally a need to improve pharmaceutical services, outpatient services, and interaction with health service provider services to attain the highest levels of patient satisfaction.
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Wasylenki, Donald, Paula Goering, and Eric Macnaughton. "Planning Mental Health Services: I. Background and Key Issues*." Canadian Journal of Psychiatry 37, no. 3 (April 1992): 199–206. http://dx.doi.org/10.1177/070674379203700311.
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Planning mental health services is a complex task requiring an understanding of background developments and key issues related to mental health services. In Canada, the deinstitutionalization of patients attempted to shift the locus of care from provincial psychiatric hospitals to general hospital psychiatric units. This resulted in the isolation of provincial psychiatric hospitals, general hospital psychiatric units and community mental health programs, with little overall accountability for the services provided — three solitudes. To move toward the creation of responsible, integrated systems a number of issues must be addressed: target population(s); the roles of provincial psychiatric and general hospitals; community support services; continuity of care; co-morbidity; consumerism; and methods of integration. In the development of a comprehensive mental health plan, each issue should be recognized and decisions made which are in keeping with current knowledge. A companion report will survey Canadian initiatives in mental health planning and discuss approaches to many of the issues identified.
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Ellis Paine, Angela, Daiga Kamerāde, John Mohan, and Deborah Davidson. "Communities as ‘renewable energy’ for healthcare services? a multimethods study into the form, scale and role of voluntary support for community hospitals in England." BMJ Open 9, no. 10 (October 2019): e030243. http://dx.doi.org/10.1136/bmjopen-2019-030243.
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ObjectiveTo examine the forms, scale and role of community and voluntary support for community hospitals in England.DesignA multimethods study. Quantitative analysis of Charity Commission data on levels of volunteering and voluntary income for charities supporting community hospitals. Nine qualitative case studies of community hospitals and their surrounding communities, including interviews and focus groups.SettingCommunity hospitals in England and their surrounding communities.ParticipantsCharity Commission data for 245 community hospital Leagues of Friends. Interviews with staff (89), patients (60), carers (28), volunteers (35), community representatives (20), managers and commissioners (9). Focus groups with multidisciplinary teams (8 groups across nine sites, involving 43 respondents), volunteers (6 groups, 33 respondents) and community stakeholders (8 groups, 54 respondents).ResultsCommunities support community hospitals through: human resources (average=24 volunteers a year per hospital); financial resources (median voluntary income = £15 632); practical resources through services and activities provided by voluntary and community groups; and intellectual resources (eg, consultation and coproduction). Communities provide valuable supplementary resources to the National Health Service, enhancing community hospital services, patient experience, staff morale and volunteer well-being. Such resources, however, vary in level and form from hospital to hospital and over time: voluntary income is on the decline, as is membership of League of Friends, and it can be hard to recruit regular, active volunteers.ConclusionsCommunities can be a significant resource for healthcare services, in ways which can enhance patient experience and service quality. Harnessing that resource, however, is not straight forward and there is a perception that it might be becoming more difficult questioning the extent to which it can be considered sustainable or ‘renewable’.
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Taylor, Judy, Joanne Dollard, Colin Weetra, and and David Wilkinson. "Contemporary management issues for Aboriginal Community Controlled Health Services." Australian Health Review 24, no. 3 (2001): 125. http://dx.doi.org/10.1071/ah010125.
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Aboriginal Community Controlled Health Services face particular management issues as they adjust to the dominantWestern paradigm of managerialism and the market model of health service provision. Their cultural orientation leadsto distinctive organisational features which both advantage and disadvantages them in this environment. The holisticmodel of health used and community control enable the delivery of integrated, culturally appropriate health care.However, effective community control is difficult to achieve. Services may benefit from partnerships with collaboratorssuch as hospitals, regional health services and university departments of rural health if the partnerships are based onmutual respect and ensure that community control is retained.
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Rahadian, Bayu, Nurrachma Hakim, Andre Kurniawan, Andin Rahmania Putri, and Claritasha Adienda. "Implementation of Halal Product Guarantee in Dental Health Services in Islamic Hospital." International Journal of Human and Health Sciences (IJHHS) 3, no. 2 (January 22, 2019): 54. http://dx.doi.org/10.31344/ijhhs.v3i2.77.
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Islamic hospitals have the responsibility for implementing sharia service standards in all aspects, including in dental health services. As consumers, Muslim patients demand a certainty of halal status on materials used in dental treatment. Many reports said that the materials are not all halal-guaranteed. Islamic hospitals are expected to meet the needs of the Muslim community for sharia-compliant dental health services. For Muslim patients, the halal status of medical products is clearly a concern. Therefore it is necessary to protect Muslim patients when they want to use dental health services in Islamic hospitals. This is in line with a number of regulations, such as the law on hospital, the law on consumer protection, and the law on halal product guarantee. The halal product guarantee is important and feasible to be implemented to dental health services in Islamic hospitals because of the demands of Islamic hospitals to apply sharia standards and the needs of Muslim patients.International Journal of Human and Health Sciences Vol. 03 No. 02 April’19. Page: 54-57
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Pitchforth, Emma, Ellen Nolte, Jennie Corbett, Céline Miani, Eleanor Winpenny, Edwin van Teijlingen, Natasha Elmore, et al. "Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies." Health Services and Delivery Research 5, no. 19 (June 2017): 1–220. http://dx.doi.org/10.3310/hsdr05190.
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BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Munce, Sarah E. P., Kristen B. Pitzul, Sara J. T. Guilcher, Tarik Bereket, Mae Kwan, James Conklin, Joan Versnel, et al. "Health and Community-Based Services for Individuals with Neurological Conditions." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, no. 6 (August 14, 2017): 670–75. http://dx.doi.org/10.1017/cjn.2017.207.
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AbstractBackground:The current study involves a national survey of healthcare providers who offer services for individuals with a variety of neurological conditions. It aims to describe the provision of health and community-based services as well as the admission criteria, waitlist practices, and referral sources of these services.Methods:An online survey was directed at administrators/managers from publicly funded hospital programs, long-term care homes, and community-based healthcare provider agencies that were believed to be providing information and/or services to patients with a variety of neurological conditions.Results:Approximately 60% (n=254) of respondents reported providing services in either urban/suburban areas or rural/remote areas only, whereas the remaining 40% (n=172) provided services regardless of patient location. A small proportion of respondents reported providing services for individuals with dystonia (28%), Tourette syndrome (17%), and Rett syndrome (13%). There was also a paucity of diverse healthcare professionals across all institutions, but particularly mental healthcare professionals in hospitals. Lastly, the majority of respondents reported numerous exclusion criteria with regard to service provision, including prevalent comorbid conditions.Conclusions:If the few services provided for these neurological patient populations exclude common comorbidities, it is likely that there will be no other place for these individuals to seek care.
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Gautam, K., C. Campbell, and B. Arrington. "Financial Performance of Safety-Net Hospitals in a Changing Health Care Environment." Health Services Management Research 9, no. 3 (August 1996): 156–71. http://dx.doi.org/10.1177/095148489600900302.
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Safety-net hospitals serving the poor and indigent in inner-cities have received inadequate research attention regarding the determinants of their financial performance in the changing health care environment. We analyze how the 1990–1992 financial performance of 275 such hospitals is related to exogenous and endogenous factors such as payer mix, service mix, staffing and ownership. Models of hospital financial performance are developed using operating margin, cost per discharge and revenue per discharge as measures of performance. Stepwise regression is used to test the model with data from the American Hospital Association (AHA) and Health Care Investment Analysts (HCIA). Results suggest that: 1) The profitability of inner-city hospitals appears positively related with technical complexity of care; 2) High interest and low operating surplus may constrain the addition of technically sophisticated services to enhance profitability; 3) There is some evidence that new governmental programs, e.g. Medicaid managed care and Medicaid Diagnosis Related Groups (DRGs), may not have improved operating margins, though Medicaid DRGs appear to have contained costs. Follow-up research is needed on this issue; 4) Given external fiscal realities, internal management strategies for inner-city hospitals require research, e.g. developing appropriate managed care systems and timely expansion of sub-acute services and; 5) Services such as AIDS treatment and community health education represent opportunities to respond to community needs, especially since unit cost of such services will decline with high volume.
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Wang, Qingtong, Yuzhu Gong, and Kezhen Niu. "The Yantai Model of Community Care for Rural Psychiatric Patients." British Journal of Psychiatry 165, S24 (August 1994): 107–13. http://dx.doi.org/10.1192/s0007125000293069.
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The main characteristics of the Yantai model are (a) a three-tier (county, township, village) management structure; (b) the vertical integration of community mental health workers, including a professional advisory group of psychiatrists from the central psychiatric hospital, groups of community psychiatrists at small county psychiatric hospitals, non-psychiatric physicians who run psychiatric out-patient clinics at township general hospitals, and village paramedics (‘village doctors’) who supervise patients in the community; (c) ongoing training of all community mental health workers; (d) registration and yearly follow-up of all patients with mental illnesses in the community; (e) provision of home-care services to a proportion of acutely ill patients; and (f) most of the cost of the service is borne by the state. The network of services provided by this model makes it convenient for patients to obtain treatment and, if necessary, go into hospital; it reduces the economic burden on the family and the community; it combines treatment, prevention, rehabilitation, and supervision under one administrative network; and it decreases the overall level of psychopathology and psychosocial dysfunction in the community.
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Swerissen, Hal. "Implications of Hospital Deinstitutionalisation for Primary Health and Community Support Services." Australian Journal of Primary Health 8, no. 1 (2002): 9. http://dx.doi.org/10.1071/py02002.
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Interest in expanding and reforming the role of primary health and community support services is increasing. In part this reflects the steadily building evidence that stronger primary health care services lead to better health outcomes. But probably more importantly substitution, prevention and diversion through primary health and community support are seen as a way of reducing the pressure and costs of expensive secondary and tertiary services in hospitals and residential institutions. There is considerable interest in limiting growth in demand and expenditure for hospital and residential care services.
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Wilkinson, David. "Issues and challenges facing rural hospitals." Australian Health Review 25, no. 5 (2002): 94. http://dx.doi.org/10.1071/ah020094.
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Australia's rural hospitals face most of the same issues and challenges faced by metropolitan hospitals. However they also face additional challenges around geographic isolation,their iconic status and role as major employers in local communities,and their close relationship with community based health services. Future opportunities include more formal integration with community service through multipurpose service arrangements, regional networking with urban centers,expanded us of IT linkages, and with the expanding rural academic networks. Rural hospitals' roles as key aged care providers in the country is a particular challenge.
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Gaddini, A., M. Ascoli, and L. Biscaglia. "Mental health care in Rome." European Psychiatry 20, S2 (October 2005): s294—s297. http://dx.doi.org/10.1016/s0924-9338(05)80177-4.
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AbstractAimTo describe principles and characteristics of mental health care in Rome.MethodBased on existing data, service provision, number of professionals working in services, funding arrangements, pathways tocare, user/carer involvement and specific issues are reported.ResultsAfter the Italian psychiatric reform of 1978, an extensive network of community-based services has been set up in Romeproviding prevention, care and rehabilitation in mental health. A number of small public acute/emergency inpatient units inside general hospitals was created (median length of stay in 2002 = 8 days) to accomplish the shift from a hospital-based to a community-based psychiatric system of care. Some private structures provide inpatient assistance for less acute conditions (median length of stay in 2002 = 28 days), whilst the large Roman psychiatric hospital was closed in 1999.DiscussionWhilst various issues of mental health care in Rome overlap with those in other European capitals, there also are some specific problems and features. During the last two decades, the mental health system in Rome has been successfully converted to a community-based one. Present issues concern a qualitative approach, with an increasing need to foresee adequate evaluation, especially considering mental health patients' satisfaction with services and economic outcomes.
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Barbato, Angelo. "Psychiatry in Transition: Outcomes of Mental Health Policy Shift in Italy." Australian & New Zealand Journal of Psychiatry 32, no. 5 (October 1998): 673–79. http://dx.doi.org/10.3109/00048679809113122.
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Objective: To assess the outcomes of changes in mental health policy introduced in Italy in 1978. Methods: Data on psychiatric services, before and after the policy change, are presented. Effects of change are evaluated through indicators related to four issues: transfer of care, criminalisation of the mentally ill, suicides, and homelessness. Results: Admissions of new patients to mental hospitals have been stopped and the size of the mental hospital population is now very low (26 per 100 000 population). Psychiatric care has been shifted to community services including general hospital psychiatric units. There has been an overall reduction of psychiatric hospitalisation. However, the provision of residential facilities is inadequate and community services are unevenly distributed across the country. Few negative effects of changing patterns of care have been reported, although the low quality of data limits the validity of such a conclusion. Outcome of care in areas where the full range of community services is available has been rated as satisfactory. Conclusions: Although care of the mentally ill has been shifted to community services, we lack hard data on the social and clinical outcome of communty care at the nation-wide level. Long-term monitoring and evaluation of community services is a high priority in Italy.
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Xiao, Zheng Rong, Bang Guo Lv, Xin Wang, and You Jun Zhao. "A Healthcare Service System Based on Internet of Things." Advanced Materials Research 774-776 (September 2013): 1903–7. http://dx.doi.org/10.4028/www.scientific.net/amr.774-776.1903.
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With the development of networking technology and cloud computing technology, low-cost, high level of general practitioners of public health services and basic health service support, as well as the effective supervision of the centralized management and control of public health and primary health care can be achieved. A health cloud service system based on Internet of Things is provided, which is divided into six modules. The system can be used to subordinate all hospitals and medical institutions to provide hospital management and health of residents file management application services using a mobile terminal to collect community and clinical health data entry, upload the community, the region's public medical health data.
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Beck, Lt Col Lisa M. "PRACTITIONER APPLICATION: Community Health Orientation, Community-based Quality Improvement, and Health Promotion Services in Hospitals." Journal of Healthcare Management 49, no. 5 (September 2004): 306. http://dx.doi.org/10.1097/00115514-200409000-00006.
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Tan, Amy CW, Lynne M. Emmerton, H. Laetitia Hattingh, and Adam La Caze. "Funding issues and options for pharmacists providing sessional services to rural hospitals in Australia." Australian Health Review 39, no. 3 (2015): 351. http://dx.doi.org/10.1071/ah14081.
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Objective Many of Australia’s rural hospitals operate without an on-site pharmacist. In some, community pharmacists have sessional contracts to provide medication management services to inpatients. This paper discusses the funding arrangements of identified sessional employment models to raise awareness of options for other rural hospitals. Methods Semistructured one-on-one interviews were conducted with rural pharmacists with experience in a sessional employment role (n = 8) or who were seeking sessional arrangements (n = 4). Participants were identified via publicity and referrals. Interviews were conducted via telephone or Skype for ~40–55 min each, recorded and analysed descriptively. Results A shortage of state funding and reliance on federal funding was reported. Pharmacists accredited to provide medication reviews claimed remuneration via these federal schemes; however, restrictive criteria limited their scope of services. Funds pooling to subsidise remuneration for the pharmacists was evident and arrangements with local community pharmacies provided business frameworks to support sessional services. Conclusion Participants were unaware of each other’s models of practice, highlighting the need to share information and these findings. Several similarities existed, namely, pooling funds and use of federal medication review remuneration. Findings highlighted the need for a stable remuneration pathway and business model to enable wider implementation of sessional pharmacist models. What is known about the topic? Many rural hospitals lack an optimal workforce to provide comprehensive health services, including pharmaceutical services. One solution to address medication management shortfalls is employment of a local community pharmacist or consultant pharmacist on a sessional basis in the hospital. There is no known research into remuneration options for pharmacists providing sessional hospital services. What does this paper add? Viability of services and financial sustainability are paramount in rural healthcare. This paper describes and compares the mechanisms initiated independently by hospitals or pharmacists to meet the medication needs of rural hospital patients. Awareness of the funding arrangements provides options for health service providers to extend services to other rural communities. What are the implications for practitioners? Rural practitioners who identify unmet service needs may be inspired to explore funding arrangements successfully implemented by our participants. Innovative use of existing funding schemes has potential to create employment options for rural practitioners and increase provision of services in rural areas.
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Beynon, JH, and D. Padiachy. "The past and future of geriatric day hospitals." Reviews in Clinical Gerontology 19, no. 1 (February 2009): 45–51. http://dx.doi.org/10.1017/s0959259809990049.
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SummaryThe status of the geriatric day hospital within the National Health Service (NHS) in the UK has changed significantly over the past fifty years. We conducted a literature review starting from the inception of the geriatric day hospital, when it was viewed as the ‘shop front for geriatric services’ and was subsequently replicated in many western health systems, to the present uncertainty surrounding the model in terms of outcomes and cost effectiveness. The article also highlights the input of the Royal College of Physicians and the British Geriatric Society to the management and development of day hospitals. The geriatric day hospital has become one of the many service models under the umbrella of intermediate care services, offering comprehensive geriatric assessment and care to older people in the community. However, with the current practices of commissioning of services and ‘payment by results’, the future of this precious health resource remains uncertain.
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Nancarrow, Susan A., Alison Roots, Sandra Grace, and Vahid Saberi. "Models of care involving district hospitals: a rapid review to inform the Australian rural and remote context." Australian Health Review 39, no. 5 (2015): 494. http://dx.doi.org/10.1071/ah14137.
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Objectives District hospitals are important symbolic structures in rural and remote communities; however, little has been published on the role, function or models of care of district hospitals in rural and remote Australia. The aim of the present study was to identify models of care that incorporate district hospitals and have relevance to the Australian rural and remote context. Methods A systematic, rapid review was conducted of published peer-reviewed and grey literature using CINAHL, Medline, PsychInfo, APAIS-Health, ATSI health, Health Collection, Health & Society, Meditext, RURAL, PubMed and Google Scholar. Search terms included ‘rural’, ‘small general and district hospitals’, ‘rural health services organisation & administration’, ‘medically underserved area’, ‘specific conditions, interventions, monitoring and evaluation’, ‘regional, rural and remote communities’, ‘NSW’, ‘Australia’ and ‘other OECD countries’ between 2002 and 2013. Models of teaching and education, multipurpose services centres, recruitment and/or retention were excluded. Results The search yielded 1626 articles and reports. Following removal of duplicates, initial screening and full text screening, 24 data sources remained: 21 peer-reviewed publications and three from the grey literature. Identified models of care related specifically to maternal and child health, end-of-life care, cancer care services, Aboriginal health, mental health, surgery and emergency care. Conclusion District hospitals play an important role in the delivery of care, particularly at key times in a person’s life (birth, death, episodes of illness). They enable people to remain in or near their own community with support from a range of services. They also play an important role in the essential fabric of the community and the vertical integration of the health services. What is known about the topic? Little has been published on the function of small-to-medium district hospitals in rural and remote Australia, and almost nothing is known about models of care that are relevant to these settings. What does this paper add? District hospitals form an important part of vertically integrated models of care in Australia. Effective models of care aim to keep health services close to home. There is scope for networked models of care that keep health care within the community supported by hub-and-spoke models of service delivery. What are the implications for practitioners? This review found limited evidence on the skill mix required in district hospitals; however, the skill mix underpins the extent of service and speciality that can be provided locally, particularly with regard to the provision of surgery and emergency services. International evidence suggests that providing surgical services locally can help increase the sustainability of smaller hospitals because they typically provide high return, short episodes of care; however, this depends on the funding model being used. Similarly, the skill mix of staff required to sustain a functioning emergency department brings a skill base that supports a higher level of expertise across the hospital.
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Davidson, Deborah, Angela Ellis Paine, Jon Glasby, Iestyn Williams, Helen Tucker, Tessa Crilly, John Crilly, et al. "Analysis of the profile, characteristics, patient experience and community value of community hospitals: a multimethod study." Health Services and Delivery Research 7, no. 1 (January 2019): 1–152. http://dx.doi.org/10.3310/hsdr07010.
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BackgroundCommunity hospitals have been part of England’s health-care landscape since the mid-nineteenth century. Evidence on them has not kept pace with their development.AimTo provide a comprehensive analysis of the profile, characteristics, patient experience and community value of community hospitals.DesignA multimethod study with three phases. Phase 1 involved national mapping and the construction of a new database of community hospitals through data set reconciliation and verification. Phase 2 involved nine case studies, including interviews and focus groups with patients (n = 60), carers (n = 28), staff (n = 132), volunteers (n = 68), community stakeholders (n = 74) and managers and commissioners (n = 9). Phase 3 involved analysis of Charity Commission data on voluntary support.SettingCommunity hospitals in England.ResultsThe study identified 296 community hospitals with beds in England. Typically, the hospitals were small (< 30 beds), in rural communities, led by doctors/general practitioners (GPs) and nurses, without 24/7 on-site medical cover and provided step-down and step-up inpatient care, with an average length of stay of < 30 days and a variable range of intermediate care services. Key to patients’ and carers’ experiences of community hospitals was their closeness to ‘home’ through their physical location, environment and atmosphere and the relationships that they support; their provision of personalised, holistic care; and their role in supporting patients through difficult psychological transitions. Communities engage with and support their hospitals through giving time (average 24 volunteers), raising money (median voluntary income £15,632), providing services (voluntary and community groups) and giving voice (e.g. taking part in communication and consultation). This can contribute to hospital utilisation and sustainability, patient experience, staff morale and volunteer well-being. Engagement varies between and within communities and over time. Community hospitals are important community assets, representing direct and indirect value: instrumental (e.g. health care), economic (e.g. employment), human (e.g. skills development), social (e.g. networks), cultural (e.g. identity and belonging) and symbolic (e.g. vitality and security). Value varies depending on place and time.LimitationsThere were limitations to the secondary data available for mapping community hospitals and tracking charitable funds and to the sample of case study respondents, which concentrated on people with a connection to the hospitals.ConclusionsCommunity hospitals are diverse but are united by a set of common characteristics. Patients and carers experience community hospitals as qualitatively different from other settings. Their accounts highlight the importance of considering the functional, interpersonal, social and psychological dimensions of experience. Community hospitals are highly valued by their local communities, as demonstrated through their active involvement as volunteers and donors. Community hospitals enable the provision of local intermediate care services, delivered through an embedded, relational model of care, which generates deep feelings of reassurance. However, current developments may undermine this, including the withdrawal of GPs, shifts towards step-down care for non-local patients and changing configurations of services, providers and ownership.Future workComparative studies of patient experience in different settings; longitudinal studies of community support and value; studies into the implications of changes in community hospital function, GP involvement, provider-mix and ownership; and international comparative studies could all be undertaken.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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De Salvia, Domenico, and Angelo Barbato. "Recent Trends in Mental Health Services in Italy: An Analysis of National and Local Data." Canadian Journal of Psychiatry 38, no. 3 (April 1993): 195–202. http://dx.doi.org/10.1177/070674379303800308.
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This paper reviews trends in Italian mental health services after the implementation of the 1978 Mental Health Act. Data available at the national level on public and private inpatient services, community mental health centres, residential and day care facilities are presented and discussed. Findings from two case-register areas, where comprehensive community services according to the Mental Health Act have been implemented, are discussed. Public mental hospitals are no longer used for psychiatric treatment, except for a small number of long stay patients. General hospital psychiatric units are the only setting in the public sector where psychiatric patients can be admitted. In private mental hospitals, the number of residents has decreased, while admissions have remained stable. However, community services are unevenly distributed and residential facilities are generally lacking. Little is known about quality of care provided, although data from some pilot studies are encouraging. Stable admission rates to forensic mental hospitals suggest that the criminalization of mentally ill has not increased. The effect of changing patterns of mental health care on suicide rates are discussed.
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Ellis, Andrew. "Forensic psychiatry and mental health in Australia: an overview." CNS Spectrums 25, no. 2 (October 7, 2019): 119–21. http://dx.doi.org/10.1017/s1092852919001299.
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This article reviews the development of forensic psychiatry and mental health services in Australia for the international reader. It covers the legacy of a series of colonial systems that have contributed to a modern health service that interacts with justice systems. The development of relevant legislation, hospitals, prison services, community, and courts services is reviewed. The training and academic development of professionals is covered. Gaps in service delivery and future directions are considered.
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Luke, Jenny, Richard Franklin, Peter Aitkin, and Joanne Dyson. "Safer Hospitals in North Queensland - Assessment of Resilience." Prehospital and Disaster Medicine 34, s1 (May 2019): s80. http://dx.doi.org/10.1017/s1049023x19001699.
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Introduction:Hospitals are fundamental infrastructure, and when well-designed can provide a trusted place of refuge and a central point for health and wellbeing services in the aftermath of disasters. The ability of hospitals to continue functioning is dependent on location, the resilience of buildings, critical systems, equipment, supplies, and resources as well as people. Working towards ensuring that the local hospital is resilient is essential in any disaster management system and the level of hospital resilience can be used as an indicator in measuring community resilience. The most popular measure of hospital resilience is the World Health Organisation’s Hospital Safety Index (HSI) used in over 100 countries to assess and guide improvements to achieve structurally and functionally disaster resilient hospitals. Its purpose is to promote safe hospitals where services “remain accessible and functioning at maximum capacity, and with the same infrastructure, before, during and immediately after the impact of emergencies and disasters.” It identifies likely high impact hazards, vulnerabilities, and mitigation/improvement actions.Aim:The HSI can be a valuable tool as part of the 2015-2030 Sendai Framework for Disaster Risk Reduction. However, to date, it has been used infrequently in developed countries. This project pilots the application of the HSI across seven facilities in a North Queensland health service (an area prone to cyclones and flooding), centered on a tertiary referral center, each providing 24-hour emergency health services.Results:Key indicators of resilience and the result of the audit will be discussed within geographical and cultural contexts, including the benefits of the HSI in augmenting existing hospital assessment and accreditation processes to identify vulnerabilities and mitigation strategies.Discussion:The research outcomes are to be used by the health service to improve infrastructure and provide anticipated community benefits, especially through the continuation of health services post disasters.
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Whiteford, Harvey, Bill Buckingham, and Ronald Manderscheid. "Australia's National Mental Health Strategy." British Journal of Psychiatry 180, no. 3 (March 2002): 210–15. http://dx.doi.org/10.1192/bjp.180.3.210.
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BackgroundAustralia commenced a 5-year reform of mental health services in 1993.AimsTo report on the changes to mental health services achieved by 1998.MethodAnalysis of data from the Australian National Mental Health Report 2000 and an independent evaluation of the National Mental Health Strategy.ResultsMental health expenditure increased 30% in real terms, with an 87% growth in community expenditures, a 38% increase in general hospitals and a 29% decrease in psychiatric hospitals. The growth in private psychiatry, averaging 6% annually prior to 1992, was reversed. Consumer and carer involvement in services increased.ConclusionsMajor structural reform was achieved but there was limited evidence that these changes had been accompanied by improved service quality. The National Mental Health Strategy was renewed for another 5 years.
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Cockburn, J. J. "Clinical decisions about patients." Psychiatric Bulletin 13, no. 3 (March 1989): 130–34. http://dx.doi.org/10.1192/pb.13.3.130.
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The structure of mental illness services is changing rapidly. Large hospitals are closing or preparing to close and the service will be provided in other ways, partly by smaller units, partly by increased care in the community outside hospital and partly by amalgamations of two or more large hospitals. Smaller units allow closer working relationships with GPs, social workers and other professionals.
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Briscoe, Jane, Rosemarie McCabe, Stefan Priebe, and Thomas Kallert. "A national survey of psychiatric day hospitals." Psychiatric Bulletin 28, no. 5 (May 2004): 160–63. http://dx.doi.org/10.1192/pb.28.5.160.
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Aims and MethodWe conducted a postal questionnaire survey of all psychiatric day hospitals in England to identify the range of aims, organisational structure and content of service provision.ResultsOf 102 identified day hospitals, 77% responded to the questionnaire. The findings confirmed that there is great heterogeneity in English day hospital service provision. The function or aim with the highest mean rating was ‘providing an alternative to in-patient care’, with 66% of day hospitals giving this a rating of great or greatest importance. However, the majority of respondents prioritised multiple roles, with many day hospitals aiming to provide acute and chronic care concurrently.Clinical ImplicationsThe label ‘day hospital’ covers a considerable range of community psychiatric services. The heterogeneity of service provision in existing day hospitals could lead to difficulties in generalising research findings on day hospital efficacy.
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Shukla, Ramesh K. "Factors and Perspectives Affecting Nursing Resource Consumption in Community Hospitals." Health Services Management Research 5, no. 3 (November 1992): 174–85. http://dx.doi.org/10.1177/095148489200500302.
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The consumption of professional and non-professional nursing resources on medical/surgical nursing units varies sharply among community hospitals. In an effort to explain the variation, this study examines several factors: socio-economic characteristics of the population; supply of registered nurses; hospital characteristics such as size, complexity and diversity of services; patient characteristics such as case mix index and nursing care acuity index; and production system characteristics such as efficiency of technical support systems and the structure of nursing care delivery. Nursing skill mix varies more than the staffing levels among hospitals. The research suggests that factors associated with a clinical-rational model such as nursing acuity index and the efficiency of clinical/support systems explains little, whereas factors associated with economic-rational model of hospital revenues – like case mix, number of hospital services, poverty (through Medicaid program) and age distribution (through Medicare program) – do significantly affect nursing resource consumption. The results point to the presence of resource allocation to nursing based on hospital revenues rather than patient care needs.
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Swenson, John Robert, and Jacques Bradwejn. "Mental Health Reform and Evolution of General Psychiatry in Ontario." Canadian Journal of Psychiatry 47, no. 7 (September 2002): 644–51. http://dx.doi.org/10.1177/070674370204700706.
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Objectives: To discuss developments in Ontario mental health reform, describe general psychiatric services in contrast to tertiary services, describe guidelines for the training of general psychiatrists, and suggest what changes may be required to develop an integrated mental health system (IMHS). Method: We review the Ontario government's recent blueprint for mental health reform and the Canadian federal government's document on best practices in psychiatry, in the context of defining general psychiatric services and their relation to tertiary services. From this, we consider the education of general psychiatrists and make suggestions for their training. Results: General psychiatric services correspond to first-line and intensive psychiatric services delivered by community mental health agencies, community psychiatrists, and general hospitals for patients with moderate or serious mental illness. Many suggest that psychiatrists are not being trained to meet the needs of a reformed mental health system. An education program for general psychiatrists should include training in a wide range of community and general hospital settings, work within a multidisciplinary mental health team, and experience working in a shared care model with family physicians. Conclusions: Along with training general psychiatrists better, we must also develop recruitment and payment incentives, which would allow general psychiatrists who are based in the community and general hospitals to work within an IMHS.
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Fry, John, and W. John Stephen. "Primary Health Care in the United Kingdom." International Journal of Health Services 16, no. 4 (October 1986): 485–95. http://dx.doi.org/10.2190/m0l4-qp4q-50k2-8rgv.
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General practice is one of the three bases of care in the British National Health Service (NHS); the other two are hospital and community services. Each is administered separately. There are 30,000 general practitioners (for a population of 57 million), who are independent and can organize their work as they see fit. Few are single-handed (13 percent) and the majority work in groups of three to five physicians. They are paid by capitation fees, and fees for specific services, and also receive reimbursements for staff, premises rental, and local taxes (rates). They work in close association with practice teams that include nurses, midwives, and social workers. There are no universal hospital privileges but many general practitioners hold appointments in local hospitals. Important trends in the NHS include mandatory vocational training of general practitioners for three years; the growing importance of attempts by the Royal College of General Practitioners to shift care from the hospital to the community; increased patient participation; clashes between the government and the medical profession over restricted funding of the NHS; definition and improvement of “quality,” and a need for improved data collection; and long waits for hospital services.
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Fridgant, Yelena, Gawaine P. Powell Davies, Brian I. O'Toole, Luc Betbeder-Matibet, and Mark F. Harris. "Integration of General Practitioners with Hospitals and Community Health Services: A Qualitative Examination." Australian Journal of Primary Health 4, no. 4 (1998): 68. http://dx.doi.org/10.1071/py98062.
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A series of focus groups was conducted with general practitioners (GPs), community health workers, hospital staff and consumers to examine the issue of integration of general practice within the wider Australian health system. Groups were held in various urban and rural locations to provide coverage of urban and rural conditions. The groups had representation from managerial as well as service provider staff and included GPs, hospital discharge planners, and emergency department staff, and from community health staff, nurses, physiotherapists, mental health workers, occupational therapists, and educators. Agreement was widespread that enhanced integration would confer benefits to patients, GPs, other health professionals, and to the health system generally. However, the health system was seen to be limited in its ability to integrate services. General practice, as small business working within the public health system, had different procedures and methods of remuneration than other health system components. Barriers to integration included structural, procedural and organisational factors, and included communication difficulties, variability in the roles and expectations of various service providers, and resource allocation and methods of funding. It is necessary to examine the barriers to integration more closely within the context of each type of service, to investigate effective ways of overcoming these barriers, and to describe and quantify the benefits that might arise from increased integration.
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Singh, Simone Rauscher. "Not-for-profit hospitals’ provision of community benefit during the 2008 recession: An analysis of hospitals in Maryland." Journal of Hospital Administration 3, no. 3 (December 17, 2013): 7. http://dx.doi.org/10.5430/jha.v3n3p7.
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During the 2008 recession, many U.S. hospitals had to lay off staff and cut services to reduce costs, yet little is known about how these cuts affected hospitals’ provision of community benefits. While the need for charitable programs and services grew during this economically difficult time, financial pressures may have forced hospitals to cut back on their community benefit spending. Using data for not-for-profit hospitals in the state of Maryland for the years 2006 to 2010, this study explored whether, and if so how, hospitals changed their provision of community benefit during the 2008 recession. The findings showed that, on average, Maryland hospitals increased their charitable activities during the recent recession. Between 2006 and 2010, total spending on community benefits grew from an average of 5.6% to 7.7% of operating expenses with the most substantial growth in hospitals’ provision of charity care and mission-driven health services. Panel regression analysis showed that this increase in charitable activity was associated with increases in community need. Hospitals’ financial performance, on the other hand, was unrelated to their community benefit spending. These findings indicate that even in times of constrained budgets, Maryland hospitals provided substantial amounts of community benefit in response to the needs of the communities they serve. Hospital-based community benefit programs thus have the potential to play an important role in on-going community-wide efforts aimed at reducing the burden of illness and improving population health.
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Pullen, Ian, and Simon Shepherd. "Community ward rounds (T. Burns (1990) Health Trends, 22, 62–63)." Psychiatric Bulletin 15, no. 6 (June 1991): 363–64. http://dx.doi.org/10.1192/pb.15.6.363.
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It is interesting to observe just how much (or little) psychiatric services adapt to changing circumstances. The progressive move to community care, with the resettlement of seriously ill patients outside hospital and the avoidance of admission for many acutely ill patients, has shifted the focus of the psychiatric team away from its traditional institutional base – or rather the focus should have shifted. Yet it is probable that many psychiatrists, while paying lip service to the needs of patients in the community, have not altered their weekly routine. Hospitals, and the security they represent, retain their magnetic attraction for many staff. But with the growing number of out-patients and chronically disabled patients being supported by team members outside hospital, how should the multidisciplinary team respond?
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Galvan, Pedro, Miguel Velazquez, Ronald Rivas, Juan Portillo, Julio Mazzoleni, and Enrique Hilario. "PP132 Telemedicine Enhances Community Hospital Response Capacity." International Journal of Technology Assessment in Health Care 35, S1 (2019): 62. http://dx.doi.org/10.1017/s0266462319002496.
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IntroductionTelediagnostic apps based on information and communication technology tools can be used to enhance community hospital response capacity. Evidence on how this innovative technology can improve health services is limited, but will likely expand in the new decade. The ability of different telediagnostic methods to enhance the response capacity of community hospitals in rural areas of Paraguay was investigated.MethodsThis descriptive study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare, in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute and the University of the Basque Country, to evaluate the utility of telediagnostic apps for different disciplines in public health. The results from implementing telediagnosis apps in 60 public community hospitals across the country were analyzed and evaluated.ResultsA total of 410,840 diagnoses were performed remotely between January 2014 and August 2018 across 60 rural community hospitals. The diagnoses involved computed tomography (147,627 or 36%), electrocardiography (256,422 or 62%), electroencephalography (6,772 or 2%), and ultrasound (19 or 0.01%). There were no significant differences between the remote and face-to-face diagnoses; remote diagnoses were correct in 93 percent of cases. Utilizing telediagnostic apps reduced costs, which is an important benefit for the 60 communities.ConclusionsThe results showed that telemedicine can significantly enhance the community hospital response capacity of diagnostic services and health programs, making optimal use of professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out the systematic implementation of this technology, contextualization with the regional epidemiological profile must be performed.
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Hawkes, N. "England's mental and community health services face deeper cuts than hospitals." BMJ 348, jan17 2 (January 17, 2014): g289. http://dx.doi.org/10.1136/bmj.g289.
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Keumala, Cut Muftia, and Zanzibar Zanzibar. "Pelayanan Pihak Rumah Sakit Swasta Terhadap Pasien Miskin di Kota Lhokseumawe." HUMANIS: Jurnal Ilmu Administrasi Negara 6, no. 1 (April 4, 2020): 37–51. http://dx.doi.org/10.52137/humanis.v6i1.12.
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The hospital as a health service facility has a very strategic role in an effort to accelerate the improvement of the health status of the Indonesian citizens - both public and private hospitals. This is because hospitals have the capacity of affording quality health services that are affordable to the poor community. Based on the research results, it shows that the health services provided by the Bunda Lhokseumawe Hospital have been carried out optimally according to the applicable procedures. Patient satisfaction with the health services. There are those who give satisfying responses to a friendly doctor's attitude and there are also the patient's responses that are not satisfactory. The lack of ability of IT operators to computer applications is a very fatal obstacle in online administration services. To overcome this predicament, intensive socialization and training are required for the IT operators so that they will be able to overcome various obstacles in the event of technical errors during data entry. Another obstacle to health services carried out by the Bunda Lhokseumawe Hospital for patients is the lack of specialist doctors. To overwhelm this matter, the management must recruit more specialist doctors to the hospital.
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Summers, Michele L., and Serdar Atav. "Community Characteristics and Readmissions: Hospitals in Jeopardy." Online Journal of Rural Nursing and Health Care 21, no. 1 (May 4, 2021): 131–58. http://dx.doi.org/10.14574/ojrnhc.v21i1.638.
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Objective: The purpose was to identify community characteristics that contribute to reductions in readmission rates and reimbursement penalties for hospital systems in upstate New York.
Methods: Hospitals in upstate NY were selected (N = 94). Using an ex post facto design and the ecological model, community characteristics of hospital systems were analyzed and coded. Independent t-tests, ANOVA, and Pearson Correlation tests were conducted.
Results: Characteristicscorrelated with reduced hospital readmission rates and reimbursement penalties included hospitals (1) with critical access status; (2) located in counties with a better county health rank; and (3) located in a primary care shortage area that utilized house calls.
Discussion: Implications include supporting policies that increase access to services, improve formulas for reimbursement, and encourage innovation in care delivery models. Future research efforts should focus on house calls in primary care shortage areas.
Keywords: readmission rates, ecological model, house calls, community health
DOI: https://doi.org/10.14574/ojrnhc.v21i1.638
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Suharmiati, Suharmiati, Lestari Handayani, and Zainul Khaqiqi Nantabah. "Pemanfaatan Pelayanan Kesehatan Tradisional Integrasi di Rumah Sakit Pemerintah. Studi di 5 Provinsi Indonesia." Buletin Penelitian Sistem Kesehatan 23, no. 2 (July 2, 2020): 126–34. http://dx.doi.org/10.22435/hsr.v23i2.2361.
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Nowadays, Traditional Health Services increasingly in demand by the Indonesian Community. According to the National Basic Health Research data of 2018, 31.4% of the population utilized THS. Moreover, the practice of traditional medicine has widely provided in several places. Traditional health services at public hospitals are known as integrated traditional health services (ITHS). This study aims at analyzing the utilization of integrated traditional health services at public hospitals by the community in fi ve provinces. This study, a descriptive with a cross-sectional design, involved ten public hospitals. It selected according to the availability of traditional health services, which is before or since 2014. The number of patients (called respondents) interviewed was determined purposively as many as fi ve patients per hospital; therefore, there were fi fty people. The results of this study indicated that Integrated Traditional Health Services has utilized by most patients aged 20 to 50 years. Information sources regarding the availability of Traditional Health Services mainly from physicians or health professionals. Most respondents lived not far from hospitals so that access to the hospitals can be reachable. Most respondents are satisfi ed with the services accepted. Manager of Traditional Health Services is a physician. Even though most respondents said that not only the cost of treatment for Traditional Health Services is expensive, but also is not covered in benefi t packages of the National Health Insurance Scheme (JKN). Therefore, they remain seeking Traditional Health Services practicing out of pocket payment method. It is recommended that the financing of Traditional Health Services should be covered by Social Security Administration Body (BPJSK) through
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Ramadhani, Neula Armyttha Rizki. "LITERATURE REVIEW: THE ROLE AND EFFECTS OF HOSPITAL HEALTH PROMOTION ON HEALTH POLITICS." Indonesian Journal of Public Health 16, no. 2 (August 30, 2021): 327. http://dx.doi.org/10.20473/ijph.v16i2.2021.327-335.
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ABSTRACTAn applicable health system must be integrated with existing health facilities in the community, such as health facilities at hospitals. One of the efforts made by the hospital is hospital health promotion aimed to enable patients and their families to prevent health problems, improve health more independently, and be active in the healing process, of course while being supported by policy regulations. This study aimed to describe the implementation of hospital health promotion as a health political product that certainly affects the degree of public health. This study was a literature review. Data were collected by library research. Based on the results, making a political decision (especially in the health sector) would affect the health of the community, in addition to politics being influenced by the state of public health. The role of hospitals as health promoters could be realized through hospital health promotion with a new preventive paradigm. Moreover, health promotion could also help improve fair and equal health services while still prioritizing quality and promoting preventive and promotive efforts. More numbers of health personnel both in the curative and preventive treatment should be considered for health policymaking to improve health services, especially in hospital settings. Keywords: health promotion in hospital, health politics
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Suminah, Suminah, and Nasser Kelly. "Implementation minimal service standards in outpatients hospital district Bogor." SOEPRA 5, no. 1 (August 2, 2019): 77. http://dx.doi.org/10.24167/shk.v5i1.1633.
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Minimum Service Standards were made to serve as guidance for regions in organizing hospitals. The standards were then used as working indicators by the hospital management. In the field of health, the Minimum Service Standards were regulated by Health Minister’s Decree Nr. 43 of 2016. It was used as a tool to ensure even basic services access and quality to the community that was established and accountable to the Central Government. The Minimum Health Service Standards were very important for hospital’s outpatients in relation with the services provided and were closely related to the outpatient’s protection. This research applied socio-legal approach having analytical-descriptive specification. The data were gathered by having interviews to some resources, namely Head of Health Office of Bogor District, Director of Mary Hospital of Cileungsi Hijau, Unit Head of Sentosa Hospital of Parung.The results of the research showed that the Health Minister’s Decree Nr. 43 of 2016 on Minimum Service Standards in Health Field had not well implemented. The absence of minimun service standards setting issued by the Local Government, namely Bogor District, had made the health services run the minimum service standards in accordance with the existing regulations that referred to Health Office’s Strategic Planning (Renstra) and Health Minister’s Regulation on Hospital Classification and Permit. Bogor District should refer to the Health Minister’s Decree Nr. 43 of 2016 on Minimum Service Standards in Health Field so that the implementation of minimum services standards to outpatients could be well performed.
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Evashwick, Connie, James H. Swan, and Peggy Smith. "Geriatric Services Offered by Hospitals: Predicting Services by Internal and External Community Characteristics." Home Health Care Services Quarterly 19, no. 3 (May 21, 2001): 19–33. http://dx.doi.org/10.1300/j027v19n03_02.
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