216 Jewish Hospital of St. Louis

https://digitalcommons.wustl.edu/bjc_216/1164/thumbnail.jp

National evaluation of Partnerships for Older People Projects

Executive Summary The Partnership for Older People Projects (POPP) were funded by the Department of Health to develop services for older people, aimed at promoting their health, well-being and independence and preventing or delaying their need for higher intensity or institutional care. The evaluation found that a wide range of projects resulted in improved quality of life for participants and considerable savings, as well as better local working relationships. • Twenty-nine local authorities were involved as pilot sites, working with health and voluntary sector partners to develop services, with funding of £60m • Those projects developed ranged from low level services, such as lunch-clubs, to more formal preventive initiatives, such as hospital discharge and rapid response services • Over a quarter of a million people (264,637) used one or more of these services • The reduction in hospital emergency bed days resulted in considerable savings, to the extent that for every extra £1 spent on the POPP services, there has been approximately a £1.20 additional benefit in savings on emergency bed days. This is the headline estimate drawn from a statistically valid range of £0.80 to £1.60 saving on emergency bed days for every extra £1 spent on the projects. • Overnight hospital stays were seemingly reduced by 47% and use of Accident & Emergency departments by 29%. Reductions were also seen in physiotherapy/occupational therapy and clinic or outpatient appointments with a total cost reduction of £2,166 per person • A practical example of what works is pro-active case coordination services, where visits to A&E departments fell by 60%, hospital overnight stays were reduced by 48%, phone calls to GPs fell by 28%, visits to practice nurses reduced by 25% and GP appointments reduced by 10% • Efficiency gains in health service use appear to have been achieved without any adverse impact on the use of social care resources • The overwhelming majority of the POPP projects have been sustained, with only 3% being closed – either because they did not deliver the intended outcomes or because local strategic priorities had changed • PCTs have contributed to the sustainability of the POPP projects within all 29 pilot sites. Moreover, within almost half of the sites, one or more of the projects are being entirely sustained through PCT funding – a total of 20% of POPP projects. There are a further 14% of projects for which PCTs are providing at least half of the necessary ongoing funding • POPP services appear to have improved users’ quality of life, varying with the nature of individual projects; those providing services to individuals with complex needs were particularly successful, but low-level preventive projects also had an impact • All local projects involved older people in their design and management, although to varying degrees, including as members of steering or programme boards, in staff recruitment panels, as volunteers or in the evaluation • Improved relationships with health agencies and the voluntary sector in the locality were generally reported as a result of partnership working, although there were some difficulties securing the involvement of GP

Ready or Not? Protecting the Public's Health From Diseases, Disasters, and Bioterrorism, 2009

Based on ten indicators, assesses progress in the readiness of states, federal government, and hospitals to respond to public health emergencies, with a focus on the H1N1 flu. Outlines improvements and concerns in funding, accountability, and other areas

Models and methods for determining the optimal number of beds in hospitals and regions: A systematic scoping review

Background: Determining the optimal number of hospital beds is a complex and challenging endeavor and requires models and techniques which are sensitive to the multi-level, uncertain, and dynamic variables involved. This study identifies and characterizes extant models and methods that can be used to determine the required number of beds at hospital and regional levels, comparing their advantages and challenges. Methods: A systematic search was conducted using Web of Science, Scopus, Embase and PubMed databases, with the search terms hospital bed capacity, hospital bed need, hospital, bed size, model, and method. Results: Twenty-three studies met the criteria to be included in the review. Of these studies, a total of 11 models and 5 methods were identified, mainly designed to determine hospital bed capacity at the regional level. Common determinants of the required number of hospital beds in these models included demographic changes, average length of stay, admission rates, and bed occupancy rates. Conclusions: There are no specific norms for the required number of beds at hospital and regional levels, but some of the identified models and methods may be used to estimate this number in different contexts. Moreover, it is important to consider alternative approaches to planning hospital capacity like care pathways to fix the limitations of "bed numbers". © 2020 The Author(s)

The words of the body: psychophysiological patterns in dissociative narratives

Trauma has severe consequences on both psychological and somatic levels, even affecting the genetic expression and the cell\u2019s DNA repair ability. A key mechanism in the understanding of clinical disorders deriving from trauma is identified in dissociation, as a primitive defense against the fragmentation of the self originated by overwhelming experiences. The dysregulation of the interpersonal patterns due to the traumatic experience and its detrimental effects on the body are supported by influent neuroscientific models such as Damasio\u2019s somatic markers and Porges\u2019 polyvagal theory. On the basis of these premises, and supported by our previous empirical observations on 40 simulated clinical sessions, we will discuss the longitudinal process of a brief psychodynamic psychotherapy (16 sessions, weekly frequency) with a patient who suffered a relational trauma. The research design consists of the collection of self-report and projective tests, pre-post therapy and after each clinical session, in order to assess personality, empathy, clinical alliance and clinical progress, along with the verbatim analysis of the transcripts trough the Psychotherapy Process Q-Set and the Collaborative Interactions Scale. Furthermore, we collected simultaneous psychophysiological measures of the therapeutic dyad: skin conductance and hearth rate. Lastly, we employed a computerized analysis of non-verbal behaviors to assess synchrony in posture and gestures. These automated measures are able to highlight moments of affective concordance and discordance, allowing for a deep understanding of the mutual regulations between the patient and the therapist. Preliminary results showed that psychophysiological changes in dyadic synchrony, observed in body movements, skin conductance and hearth rate, occurred within sessions during the discussion of traumatic experiences, with levels of attunement that changed in both therapist and the patient depending on the quality of the emotional representation of the experience. These results go in the direction of understanding the relational process in trauma therapy, using an integrative language in which both clinical and neurophysiological knowledge may take advantage of each other

Financing health services in Africa : an assessment of alternative approaches

This paper outlines a strategy for financing health services in sub-Saharan Africa. The individual components of the strategy are as follows: general tax revenues, international finance, a system of user charges, community finance, health insurance, and contributions from nongovernmental organizations, including the private sector. The author states that financial positions of public health care systems in sub-Saharan Africa would be greatly enhanced if governments in the region were to adopt policies that would use each of the above sources of finance. Since a strong financial base is a prerequisite for an effective health care system, such policies would considerably improve the health status of the population. It is important that for each country different policies be pursued at various levels of society, and in different sectors of the economy.Health Systems Development&Reform,Health Monitoring&Evaluation,Housing&Human Habitats,Health Economics&Finance,Pharmaceuticals&Pharmacoeconomics

Cities and population health.

A majority of the world's population will live in urban areas by 2007 and cities are exerting growing influence on the health of both urban and non-urban residents. Although there long has been substantial interest in the associations between city living and health, relatively little work has tried to understand how and why cities affect population health. This reflects both the number and complexity of determinants and of the absence of a unified framework that integrates the multiple factors that influence the health of urban populations. This paper presents a conceptual framework for studying how urban living affects population health. The framework rests on the assumption that urban populations are defined by size, density, diversity, and complexity, and that health in urban populations is a function of living conditions that are in turn shaped by municipal determinants and global and national trends. The framework builds on previous urban health research and incorporates multiple determinants at different levels. It is intended to serve as a model to guide public health research and intervention

Key Components for an Ethics Consultation Curriculum

Due to a lack of formal credentials for clinical ethics consultants, the professionalization of clinical ethics as a normative discipline in contemporary American health care is diminished amongst other health care professionals. While medical specialties, organizational leadership positions, and other miscellaneous health care occupations possess governing bodies that posit credentials that justify these roles, clinical ethics consultants lack a standard of competence. While this gap has been temporarily reconciled by individual employer criteria, a national standard that attempts to educate and demonstrate a clinical ethicist’s abilities does not exist. Still, various attempts have been made to establish a certification program for clinical ethicists. These programs contain central concepts in ethics consultation and are effective in demonstrating the impact of a clinical ethicist’s knowledge. However, the educational facets entailed in proposed certification programs that clinical ethicist ought to be familiar with do not include information surrounding the nature of clinical ethics and the role a clinical ethicist must embody in order to perform his job effectively. The central supposition of this dissertation is that additional work needs to be completed around clinical ethics education and certification. While no formal certification or educational standard exists for clinical ethicists, this dissertation proposes key components for an ethics consultation curriculum. The key components in this dissertation emphasize the nature and value of virtue in clinical ethics and the role virtue plays in orchestrating an effective certification program for ethicists. This dissertation aims to do the following: (i) Clarify and demonstrate the problems associated with a lack of formal certification standard for ethicists; (ii) Define and examine the nature of clinical ethics and the role philosophy plays in this line of work; (iii) Explain and demonstrate the effectiveness of teaching virtues as key components for a formalized ethics consultation curriculum; and (iv) Illustrate how key components for an ethics consultation curriculum manifest in an educational venue for clinical ethicists. This dissertation seeks to contribute a novel approach to educating and certifying clinical ethicists in the United States. By combining knowledge points associated with moral philosophy and medicine with general skill objectives for ethics consultants, this dissertation aids in developing analytic moral reasoning skills for clinical ethicists which in turn fosters the overall education and professional development of clinical ethics consultants