Improving Care at the End of Life

Reviews RWJF's investments in improving end-of-life care, impact on the field, and lessons learned, including the need to coordinate objectives, integrate strategies, tie strategies to policy changes and incentives, and link communications and evaluation

Achieving Efficiency: Lessons From Four Top-Performing Hospitals

Synthesizes lessons from case studies of how four hospitals achieved greater efficiency, including pursuing quality and access, customizing technology, emphasizing communications, standardizing processes, and integrating care, systems, and providers

Information systems and healthcare XXIV: Factors affecting the EAI adoption in the healthcare sector

Recent developments in the field of integration technologies like Enterprise Application Integration (EAI) have emerged to support organizations towards improving the quality of services and reducing integration costs. Despite the importance of EAI, there is limited empirical research reported on its adoption in the healthcare sector. Khoumbati et al. [2006] developed a model for the evaluation of EAI in healthcare organizations. In doing so, the causal interrelationship of EAI adoption factors was identified by using fuzzy cognitive mapping. This paper is a progression of previous work in the area and seeks to contribute by validating the model through a different case environment. Thus, this paper contributes by deriving and proposing the MAESTRO model for EAI adoption. MAESTRO identifies a set of factors that influence EAI adoption and it is evaluated through a real-life case study. It provides an understanding of the EAI adoption process through its grounding on empirical data. In doing so, the MAESTRO model supports the management of healthcare organizations during the decision-making process for EAI adoption

Groping for Autonomy: The Federal Government and American Hospitals

This article chronicles the slow but steady emergence of countervailing power in the hospital industry since mid-century. The transformation of American health care policymaking reflects the federal government\u27s growing fiscal obligations as the single largest purchaser of health care. As John Kenneth Galbraith [1956,113] notes, Power on one side of a market creates both the need for, and the prospect of reward to, the exercise of countervailing power from the other side. The federal government\u27s effort to exercise countervailing power over health care providers shows no sign of abating in the future, for Medicare and Medicaid costs threaten the stability of the balanced budget agreement negotiated by the Clinton administration and the Republican leadership of the 105th Congress

Children’s Futures: Lessons From a Second-Generation Community Change Initiative

· This article describes Children’s Futures, a 10-year initiative in Trenton, N.J., that seeks to improve the health and well-being of children from 0 to 3 years old and ensure that they are ready for school. · During the first five years, the initiative was successful in implementing a number of evidence-based practices to improve children’s health, such as providing home visits to pregnant women, measuring and improving the quality of day care centers, and improving the use of information systems to track childhood immunizations. · Efforts to provide services for fathers and improve home-based child care were not successful; these are areas in which there are not any evidence-based practices. · Leveraging public and private money beyond the Robert Wood Johnson Foundation’s substantial $20 million commitment proved challenging because the foundation’s commitment was so large. The authors recommend obtaining agreements for matching funds prior to finalizing commitments. · A lack of attention to initiative-wide communications hindered integration across programs. · A need for a citywide data system was identified; this is being implemented in the second five-year funding cycle

EVALUATING TELEMEDICINE TECHNOLOGIES IN RURAL SETTINGS

Changes in health care policies, demographics, and technology have presented new opportunities for the delivery of medical care services and information to rural communities. Telemedicinethe use of electronic information and communications technologies to provide and support health care when distance separates the participantshas significantly impacted the delivery of rural health care services. This paper presents an overview of the telemedicine technologies, government involvement in support of telemedicine, and issues that need to be addressed in designing an economic framework to evaluate the net benefits of telemedicine to rural communities and consumers. Federal and state governments have invested millions of support dollars in the form of equipment, infrastructure, and incentives for consumers and providers to expand the use of telecommunications in medical care. Since disbursement of these funds is already underway, it only makes sense to develop a method to determine both where and whether an additional dollar of funding for telemedicine development would be of the greatest benefit to society. If telemedicine can prove itself as a useful method for improving the likelihood of survival of rural hospitals, then, in the interest of rural development, it may be a technology worth investing in; i.e., the social benefits, measured as the sum of the private and public benefits, may outweigh the costs. According to its supporters, telemedicine systems have the potential to simultaneously address several problems characteristic of health care in rural areas, including access to care, cost containment, and quality assurance. Access can be improved by linking providers in remote areas with specialists in metropolitan centers or peers in rural areas. Telemedicine not only enables a wider range of services to be offered in the local community but may have the added effect of improving physician retention in isolated areas, one of the primary challenges in maintaining access for frontier medical centers. Telemedicine can promote cost containment through the substitution of lower-cost rural providers and facilities. Ideally, improved quality will be achieved by the ready availability of consultations and referrals. These are the potential benefits of telemedicine implementation, but they have not yet been verified by research in a field setting. An evaluation framework for telemedicine needs to be capable of modeling changes in the behavior of health care consumers (i.e., altered visitation patterns), recognizing differences in quality of service, and finally, quantifying the value of these changes. This is no small task, and obtaining the required data will likely require the cooperation of many parties, including health care providers, patients, hospital and program administrators, and policymakers. These are the same groups that could benefit greatly from a better understanding of how telemedicine technologies affect health care delivery, but a meaningful framework for analysis needs to capture the many aspects of telemedicine implementation.rural health care, telemedicine, averted costs, economic benefits, telecommunications technology, R0, Community/Rural/Urban Development, Health Economics and Policy, Research and Development/Tech Change/Emerging Technologies, I1,