Why Not the Best? Results From a National Scorecard on U.S. Health System Performance

Compares the national average healthcare system performance to benchmarks of higher performance. Provides a mechanism for monitoring change over time across goals of health outcomes, quality, access, efficiency, and equity

Health Information Technology in the United States, 2008

Provides updated survey data on health information technology (HIT) and electronic health records adoption, with a focus on providers serving vulnerable populations. Examines assessments of HIT's effect on the cost and quality of care and emerging issues

The management of medical records in government hospitals: An agenda for reform

Health sector reforms aimed at addressing fundamental problems in health care delivery, and also at preparing the ground for a National Health Service, are currently underway. The reform programme is crucially dependent on improving information flows and information management to facilitate resource planning, monitoring and evaluation. Medical record systems and their management are central to this process, and are here made the subject of review. The emphasis throughout is upon practical solutions that are appropriate to the Ghanaian situation. My purpose is to outline a framework for the development and management of a standardised, coherent medical record system. The state of the art in the creation, maintenance, use and final disposition of medical records is critically reviewed and evaluated with a view to recommending remedial measures and formulating research proposals that could contribute to the improvement of the existing system. The study is limited to selected government-run regional and teaching hospitals (6 in all). For purposes of data collection, the study relied on survey research and adopted the 'records life cycle' concept for its analysis. The study revealed that the problems inherent in the present record systems are due to the absence of sufficiently formalised policies, guidelines and procedures, and to the fact that those that exist are not properly enforced. It is argued that the causes of these deficiencies lie in a lack of accountability and lack of appropriate organisational and managerial structures. A second problem has been the paucity of essential resources; financial, material and human. The study is organised into three sections, each divided into a number of chapters. Section I outlines the context of the study and has three chapters: Introduction, Overview of the Ghana Health Service, and The Medical Record in Historical Perspective. Section II presents the case study and documents the findings of the research (Chapters 4, 5, 6, and 7). A detailed analysis of existing routines and procedures (making comparisons with working methods elsewhere, chiefly English and Scottish hospitals) is presented, painting a picture of the current condition of the function, and providing essential insights regarding the changes required. Section III has two chapters. Chapter 8 recapitulates in brief the key problems discussed in the case study and for which practical solutions are required in order to substantially improve the medical record function. This chapter further proposes solutions to the problems that require intervention at the institutional or operational level, and also to problems which require a strategic approach. Chapter 9 concludes the study and outlines the proposals for reforms presented in Chapter 8

Commonwealth Fund - 2008 Annual Report

Contains mission statement, president's message, executive vice president-COO's report, program highlights, grants list, treasurer's report, financial statements, project summaries, and lists of board members and staff

Patients frequently referred from primary care to hospital outpatient clinics for medically 'unexplained' symptoms

BACKGROUND One third of frequent attenders to UK outpatient clinics have symptoms that are inadequately explained by disease according to specialist opinion (medically 'unexplained'). Some of these patients are frequently referred for similar symptoms to multiple specialties. The characteristics and treatment needs ofthese frequently referred patients are poorly understood.AIM The aim was to identify and describe patients frequently referred from primary care to hospital clinics for medically 'unexplained' symptoms (FRMUS) and compare them with patients frequently referred with medically explained symptoms (FRMES) and patients infrequently referred for symptoms (IRS).HYPOTHESES Compared to FRMES and IRS patients, a greater proportion of FRMUS patients would have anxiety or depression and this would be inadequately treated. Subsidiary hypotheses relating to: consulting multiple doctors, health care costs, perceived general health, satisfaction with care, and health beliefs, as well as the general practitioners' (GPs) expressed difficulty managing the patient, were also tested.METHODS The methodology employed for this study involved three phases as follows: (1) Identification of cases and controls from five Edinburgh general practices using a combination ofNational Health Service (NHS) referral data and primary care case notes. (2) A case-control study to describe and compare FRMUS patients with the two control patient groups. This comprised a questionnaire survey of GPs and patients, and a lifetime case note review for a 15% random selection of FRMUS and FRMES participants. (3) An economic analysis of the health care contacts.RESULTS FRMUS patients made up 1.1% (293/26252; CI 0.01-0.013) of the primary care population aged 18-65 years, and nearly two thirds (218/293, 74.4%) were female. The FRMUS patients had statistically more anxiety (67/193, 34.7%) when compared to 37 ofthe 162 FRMES (22.8%, OR 1.8, CI 1.12-2.88) and 23 of the 152 IRS (15.1%, OR 2.98, CI 1.75-5.09) comparison patient groups. Although there was no statistical difference for diagnoses of depression between the FR groups, the FRMUS patients had a significantly greater mean score for depressive symptoms than the FRMES control patients (mean difference 2.03, CI 0.66-3.41). Of the 67 FRMUS patients with an anxiety disorder 41(61.2%) were receiving adequate treatment, and this was considerably more than the six of 37 FRMES (16.2%, OR 8.147, CI 2.99- 22.21) and the six of 23 IRS (26.1%, OR 4.47, CI 1.56-12.8) comparison patients who had an anxiety disorder. Treatment for those patients with depression was also significantly greater for FRMUS patients (43/64, 67.2%) compared with the FRMES (10/41, 24.4%, OR 6.35, CI 2.62-15.36) and IRS (5/21, 23.8%, OR 6.56, CI 2.11- 20.32) groups. FRMUS patients were also more likely to: be female, reside in a deprived area of Lothian, referred by multiple doctors, have problems considered to be more difficult to help by a GP, have high health care costs, and report poor general physical and mental health.DISCUSSION A third of FRMUS patients had anxiety and depression, the majority of whom were receiving 'adequate treatment'. Factors other than undetected anxiety and depression may better explain why these patients are repeatedly referred to outpatient clinics for 'unexplained' symptoms

‘Myth or reality?’ Preoperative pain planning and management: A critical ethnographic examination and exploration of day surgery preoperative practices

The assessment and management of surgical pain are paramount to good quality perioperative care. Regrettably, patients still declare inadequate satisfaction levels within this important area of practice. Holistic preoperative pain planning and education is a useful strategy to address this issue which has never been fully studied in day case surgery. This thesis has used a critical ethnographic research approach to explore and examine preoperative cultural practices and provide insight into what influences and shapes pain planning, management strategies and interactions with day surgical patients. This methodology observed healthcare interactions in the day case unit through a critical lens, underpinned by critical social theory and a transformative paradigm. Using Carpspecken’s (1996) analytical enquiry framework, the preoperative practice of one department was investigated over nine months. Both qualitative and quantitative data collection methods were used, including observations, interviews and timings of interactions. One hundred and twenty-four patients and thirty-three healthcare professionals took part in the study, one hundred and thirty hours of practice were observed, and twenty in-depth interviews with healthcare professionals took place. Data were analysed using reconstructive and statistical analysis, and four main themes were identified as having an impact on preoperative interactions. These four themes were: • The prioritisation of patient safety over pain management. • A production line culture which negatively impacted on holistic practice. • The existence of paternalism and power that affected staff and patient autonomy. • Unconscious gender and surgery bias, which had a direct impact on the levels and depth of preoperative pain conversations and management strategies. These were explored further in relation to Bourdieu's (1977) sociological theory of habitus and capital, in an attempt to raise awareness of practice culture and increase transparency, in order to challenge the status quo

Craft knowledge in medicine : an interpretation of teaching and learning in apprenticeship

The diagnosis and management of patients requires professional know-how or medical craft knowledge. To explain how this knowledge is acquired, this research asked 'How do medical experts pass on their craft?' Other questions arose through successive data collections and progressive focusing on what medical experts did well in their work and teaching. The programme comprised: pilot interviews with three expert physicians; a case study in a hospital medical unit; and paired consultant/SHO interviews. Participant observation, interviews, and expert-novice comparisons explored clinical work, teaching, and learning in apprenticeship.Data analysis of participants' responses and ward round discussions allowed identified categories to cluster within three inter-related constructs instrumental to the acquisition of medical knowledge: gaining experience in the experiential process of clinical practice (1); and the products of experience which manifest as experts' clinical expertise (2) and teaching/learning expertise (3). These constructs can be located within a model of apprenticeship based on Spady's (1973) analysis of authority in effective teaching containing two frames of reference: the social, 'traditional-legal'; and the individual, 'expert-charismatic'. The medical apprenticeship is associated with similar perspectives: the 'traditional-experiential' represents the professional process of learning through patient care with its infrastructure of clinical methods in presentation, discourse, and commentary; and the 'expert-charismatic' represents clinical and teaching expertise coupled with vocational enthusiasm.Experienced experts synthesised two repertoires of knowledge and skills derived from the craft knowledge of medicine and pedagogy, respectively. Both crafts are required for effective clinical education. While apprenticeship accommodates a range of teaching/learning experiences, in postgraduate education experts pass on knowledge through the deliberate engagement of junior doctors in diagnosis and management. The skills involved in this process were largely unrecognised by most senior and junior doctors and were not perceived as 'clinical teaching' although learning was structured through service-based work

Redesign and operation of the National Home and Hospice Care Survey, 2007

Introduction -- Background -- Redesign process -- National survey methods -- Survey instruments and data collection -- Data quality assurance -- Data processing -- Disclosure risk review -- Response rates and module timings -- Estimation procedures -- Reliability of survey estimates -- Confidentiality -- Data dissemination -- References -- Appendix I. Recommendations from the Hospice Care Survey Technical Advisory Group Working Meeting -- Appendix II. Content Wish List for the Redesigned National Nursing Home Survey -- Appendix III. Recommendations from the Home Health Care Survey Technical Advisory Group Working Meeting -- Appendix IV. Advance Mail Screener Script -- Appendix V. Agency Advance Package Materials -- Appendix VI. Corporate Advance Package Materials -- Appendix VII. Setan Appointment Script -- Appendix VIII. Appointment Confirmation Package Materials, Including Self-administered Staffing Questionnaire (SAQ) -- Appendix IX. Appointment Confirmation Script -- Appendix X. Reminder Call Script -- Appendix XI. CAPI: Agency Qualifications and Characteristics (AQ) Questionnaire -- Appendix XII. CAPI: Patient Health (PH) Questionnaire -- Appendix XIII. CAPI: Charges and Payments (PA) Questionnaire -- Appendix XIV. Agency Gaining Cooperation Debriefing Agenda and Discussion Guide -- Appendix XV. Agency Visit Debriefing Agenda and Discussion Guide"By Lisa L. Dwyer, M.P.H., and Lauren D. Harris-Kojetin, Ph.D., National Center for Health Statistics, Division of Health Care Statistics; Laura Branden, Westat, Inc.; and Iris M. Shimizu, Ph.D., National Center for Health Statistics, Office of Research and Methodology." - p. 1"July 2010."Also available via the World Wide Web as an Acrobat .pdf file (4.1 MB, 201 p.).Includes bibliographical references (p. 16-17).Dwyer LL, Harris-Kojetin LD, Branden L, Shimizu IM. Redesign and Operation of the National Home and Hospice Care Survey, 2007. National Center for Health Statistics. Vital Health Stat 1(53). 2010

Creating the Future of Health

Creating the Future of Health is the fascinating story of the first fifty years of the Cumming School of Medicine at the University of Calgary. Founded on the recommendation of the Royal Commission on Health Services in 1964 the Cumming School has, from the very beginning, focused on innovation and excellence in health education. With a pioneering focus on novel, responsive and systems-based approaches, it was one of the first faculties to pilot multi-year training programs in family medicine and remains one of only two three-year medical schools in North America. Drawing on interviews with key players and extensive research into documents and primary material, Creating the Future of Health traces the history of the school through the leadership of its Deans. This is a story of perseverance through fiscal turbulence, sweeping changes to health care and health care education, and changing ideas of what health services are and what they should do. It is a story of triumph, of innovation, and of the tenacious spirit that thrives to this day at the Cumming School of Medicine