Practice transformations to optimize the delivery of HIV primary care in community healthcare settings in the United States: A program implementation study.

BackgroundThe United States HIV care workforce is shrinking, which could complicate service delivery to people living with HIV (PLWH). In this study, we examined the impact of practice transformations, defined as efficiencies in structures and delivery of care, on demonstration project sites within the Workforce Capacity Building Initiative, a Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program Special Projects of National Significance (SPNS).Methods and findingsData were collected at 14 demonstration project sites in 7 states and the District of Columbia. Organizational assessments were completed at sites once before and 4 times after implementation. They captured 3 transformation approaches: maximizing the HIV care workforce (efforts to increase the number of existing healthcare workforce members involved in the care of PLWH), share-the-care (team-based care giving more responsibility to midlevel providers and staff), and enhancing client engagement in primary HIV care to reduce emergency and inpatient care (e.g., care coordination). We also obtained Ryan White HIV/AIDS Program Services Reports (RSRs) from sites for calendar years (CYs) 2014-2016, corresponding to before, during, and after transformation. The RSR include data on client retention in HIV care, prescription of antiretroviral therapy (ART), and viral suppression. We used generalized estimating equation (GEE) models to analyze changes among sites implementing each practice transformation approach. The demonstration projects had a mean of 18.5 prescribing providers (SD = 23.5). They reported data on more than 13,500 clients per year (mean = 969/site, SD = 1,351). Demographic characteristics remained similar over time. In 2014, a majority of clients were male (71% versus 28% female and 0.2% transgender), with a mean age of 47 (interquartile range [IQR] 37-54). Racial/ethnic characteristics (48% African American, 31% Hispanic/Latino, 14% white) and HIV risk varied (31% men who have sex with men; 31% heterosexual men and women; 7% injection drug use). A substantial minority was on Medicaid (41%). Across sites, there was significant uptake in practices consistent with maximizing the HIV care workforce (18% increase, p < 0.001), share-the-care (25% increase, p < 0.001), and facilitating patient engagement in HIV primary care (13% increase, p < 0.001). There were also significant improvements over time in retention in HIV care (adjusted odds ratio [aOR] = 1.03; 95% confidence interval [CI] 1.02-1.04; p < 0.001), ART prescription levels (aOR = 1.01; 95% CI 1.00-1.01; p < 0.001), and viral suppression (aOR = 1.03; 95% CI 1.02-1.04; p < 0.001). All outcomes improved at sites that implemented transformations to maximize the HIV care workforce or improve client engagement. At sites that implemented share-the-care practices, only retention in care and viral suppression outcomes improved. Study limitations included use of demonstration project sites funded by the Ryan White HIV/AIDS Program (RWHAP), which tend to have better HIV outcomes than other US clinics; varying practice transformation designs; lack of a true control condition; and a potential Hawthorne effect because site teams were aware of the evaluation.ConclusionsIn this study, we found that practice transformations are a potential strategy for addressing anticipated workforce challenges among those providing care to PLWH. They hold the promise of optimizing the use of personnel and ensuring the delivery of care to all in need while potentially enhancing HIV care continuum outcomes

Affordable Car Ownership Programs: Transporting Families Toward Financial Stability and Success

Outlines the basic components of a program to help rural low-income workers buy cars to keep or improve jobs and achieve financial self-sufficiency. Features success stories from existing programs as well as guidelines for starting a program

Perceived benefits of adopting Standard – Based pricing mechanism for mechanical and electrical services installations

Cost is an important measure of project success and clients will expect a reliable forecast at the early stage of construction projects to inform their business decision. This study was undertaken to investigate the current practices in managing cost of mechanical and electrical (M&E) services in buildings. The perceptions of practitioners on the benefits of adopting Standard – Based Pricing Mechanism for M&E services as used for building fabrics and finishes was ascertained. The methodology adopted for the study was semi – structure interview and questionnaire survey.  Inferential statistics technique was used to analyse the data collected. The results revealed that, M&E services tender documents are often based on lump sum contract. Practitioners are of the opinion that the adoption of Standard – Based Pricing Mechanism (SBPM) could enhance the quality of M&E services price forecast; ensure active post contract cost monitoring and control; encourage collaborative working relationship; enhance efficient whole life cycle cost management; improve risk management and facilitate efficient tendering process. The study suggested the development of local Standard Method of Measurement for M&E services and proposed strategies to facilitate the adoption of SBPM as basis for forecasting contract price of mechanical and electrical services in buildings

Iowa Department for the Blind Performance Report, FY 2006

Agency Performance Repor

The OMII Software – Demonstrations and Comparisons between two different deployments for Client-Server Distributed Systems

This paper describes the key elements of the OMII software and the scenarios which OMII software can be deployed to achieve distributed computing in the UK e-Science Community, where two different deployments for Client-Server distributed systems are demonstrated. Scenarios and experiments for each deployment have been described, with its advantages and disadvantages compared and analyzed. We conclude that our first deployment is more relevant for system administrators or developers, and the second deployment is more suitable for users’ perspective which they can send and check job status for hundred job submissions

MonALISA : A Distributed Monitoring Service Architecture

The MonALISA (Monitoring Agents in A Large Integrated Services Architecture) system provides a distributed monitoring service. MonALISA is based on a scalable Dynamic Distributed Services Architecture which is designed to meet the needs of physics collaborations for monitoring global Grid systems, and is implemented using JINI/JAVA and WSDL/SOAP technologies. The scalability of the system derives from the use of multithreaded Station Servers to host a variety of loosely coupled self-describing dynamic services, the ability of each service to register itself and then to be discovered and used by any other services, or clients that require such information, and the ability of all services and clients subscribing to a set of events (state changes) in the system to be notified automatically. The framework integrates several existing monitoring tools and procedures to collect parameters describing computational nodes, applications and network performance. It has built-in SNMP support and network-performance monitoring algorithms that enable it to monitor end-to-end network performance as well as the performance and state of site facilities in a Grid. MonALISA is currently running around the clock on the US CMS test Grid as well as an increasing number of other sites. It is also being used to monitor the performance and optimize the interconnections among the reflectors in the VRVS system.Comment: Talk from the 2003 Computing in High Energy and Nuclear Physics (CHEP03), La Jolla, Ca, USA, March 2003, 8 pages, pdf. PSN MOET00

MENU: multicast emulation using netlets and unicast

High-end networking applications such as Internet TV and software distribution have generated a demand for multicast protocols as an integral part of the network. This will allow such applications to support data dissemination to large groups of users in a scalable and reliable manner. Existing IP multicast protocols lack these features and also require state storage in the core of the network which is costly to implement. In this paper, we present a new multicast protocol referred to as MENU. It realises a scalable and a reliable multicast protocol model by pushing the tree building complexity to the edges of the network, thereby eliminating processing and state storage in the core of the network. The MENU protocol builds multicast support in the network using mobile agent based active network services, Netlets, and unicast addresses. The multicast delivery tree in MENU is a two level hierarchical structure where users are partitioned into client communities based on geographical proximity. Each client community in the network is treated as a single virtual destination for traffic from the server. Netlet based services referred to as hot spot delegates (HSDs) are deployed by servers at "hot spots" close to each client community. They function as virtual traffic destinations for the traffic from the server and also act as virtual source nodes for all users in the community. The source node feeds data to these distributed HSDs which in turn forward data to all downstream users through a locally constructed traffic delivery tree. It is shown through simulations that the resulting system provides an efficient means to incrementally build a source customisable secured multicast protocol which is both scalable and reliable. Furthermore, results show that MENU employs minimal processing and reduced state information in networks when compared to existing IP multicast protocols

The fee tendering and service quality issue revisited

Purpose - It is a little over twenty years since mandatory fee scales were abolished by UK professional bodies. During this period fee levels have fluctuated with economic demand, and new procurement strategies such as partnering have been developed, but there is still a widespread view in industry, that fee levels are too low. This view is shared by many professionals, and perhaps more surprisingly by clients, even in the current construction and property boom. The research reported in this paper investigates the link between competitive fee tendering and clients’ perceptions of service quality in the UK Property Industry. The main hypothesis is that there is a causal relationship between service quality and the method of appointment of the professional. Design/methodology/approach - The research involved unstructured interviews with clients and professionals and a postal questionnaire study of one hundred and thirty three UK based clients. The questionnaire study was a repeat of a similar survey conducted eight years previously in very different economic conditions. The public and private sector clients each assessed the service quality received from a professional using a measurement scale developed from the generic service industry instrument SERVQUAL. The scale is used to test the main hypothesis and four sub-hypotheses. There were twice as many private sector clients completing the questionnaires as there were public sector clients and the largest group of professionals assessed were General Practice Chartered Surveyors. Findings - The results of the recent study are similar to the earlier one (in that evidence of the predicted relationship is not provided by the data) but there are some interesting differences in the results of both studies – fee tendering has declined in popularity, direct appointment has increased, but less than 5% of the commissions were let on a partnered basis. Practical implications – Property managers and other professionals

Impact of COVID-19 restrictions on men's mental health services in Australia

Introduction: Mental health services in Australia have faced significant challenges during the COVID-19 pandemic in adopting the new changes to reach service users. The rapid changes in the situation and surge in the number of people seeking help or in crisis have led services to use many strategies which they would not have considered in normal situations. The services working with men were especially experiencing the difficulty in fulfilling the needs of their clients as the evidence shows that Australian men’s help seeking behaviour is lower than women. Materials and Methods: A survey was conducted online to ascertain the level of impact on their services, their client groups and the lessons learned during online service delivery. The survey was conducted by Australian Men’s Health Forum with 20 questions, both with multiple choice and narrative answer options.  Results: In total, 53 male-specific services have responded. 81% made changes to their services; 43% enabled their staff and volunteers to work from home; 84% adopted strategies to conduct their meeting virtually with clients. Conclusion: Most services made significant changes such as phone/video counselling, but felt that this cannot be the norm post-pandemic as it lacks the empathic human touch to service delivery. Innovative strategies were developed to reach men living in remote/rural areas with no cost or travel time. However, there are many concerns about vulnerable groups such as older adults, Aboriginal and Torres Strait Islanders and men living in remote areas, who have limited access to electronic devices and reliable internet access. Implications: These findings have implications for reorienting frontline health services, particularly in times of widespread crisis when service delivery models need to change. There is, therefore, a direct consequence for building healthy public policy in relation to the health of men and boys from marginalised/vulnerable groups that incorporates healthy environments and positive social connections