Realist evaluation of the impact of paediatric nurse practitioner clinics, specialist paediatric nurses, and a children’s community nursing team in deflecting attendance at emergency departments and urgent care centres by children with long-term conditions

In 2018, the Greater Manchester Children’s Health and Wellbeing Board developed a 10-point strategy to achieve its objectives, the sixth of which was to reduce unnecessary hospital attendances and admissions for children with long term conditions such as asthma, diabetes and epilepsy. Funding was secured from Manchester Academic Health Science Centre to commission an exploration of the impact of the Paediatric Nurse Practitioner Clinic within the context of the Family Services Model and the impact that the service was having on reducing attendance at urgent care centres or admission to hospital. Alternatives to taking children to the ED/UCC can be a preference. An integrated system, with elements able to book directly into others, with rapid access, information, health promotion, and follow-up were essential to success. Extra consultation time for proactive intervention, with sufficient nurses to provide a seven-days service were valued. Advertisement of the service to the public and to professionals is vital for uptake by professionals and the public

A Critical Literature Synthesis of Low-Income Oral Health Disparities in the United States and Interventions for Improved Access to Care

Over a decade ago the United States Surgeon General released a report about oral health in America which highlighted the disparities that exist between high and low-income populations. The current rates of untreated dental disease in low-income adults and children remain higher in low-income populations. This literature review examines low-income oral health disparities in the United States and the interventions that have been completed to increase access to dental treatment. An unequal distribution of dental providers and high costs for treatments contribute to the access issues that low-income individuals experience. This paper examines interventions at the individual, community, and policy levels. Innovations such as making changes in the dental workforce and expanding the role of mid-level dental providers are discussed. Evidence from the literature suggests that changes in government sponsored insurance policies have had the greatest impact on access to dental treatment. Behavioral interventions have been successful at changing oral health behaviors but further research needs to be done on how to best change the behavior of seeking dental treatment. Increasing the role of primary care providers was identified as an interdisciplinary collaboration to increase access for children. The untreated dental disease of low-income populations is a significant public health problem and further research needs to be done to determine the most effective innovations and interventions to increase access to care

Hospital-based alternatives to acute paediatric admission: a systematic review

Objective: To synthesise published evidence of the impacts of introducing hospital-based alternatives to acute paediatric admission. Design: Systematic review of studies of interventions published in English. Patients: Children with acute medical problems referred to hospitals. Interventions: Services provided in a hospital as an alternative to inpatient admission. Main outcome measures: Admission or discharge, unscheduled returns to hospital, satisfaction of parents and general practitioners, effects on health service activity and costs. Results: 25 studies were included: one randomised controlled trial, 23 observational or cross-sectional studies and one qualitative study. Many studies were of uncertain quality or were open to significant potential bias. About 40% of children attending acute assessment units in paediatric departments, and over 60% of those attending acute assessment units in A & E departments, do not require inpatient admission. There is little evidence of serious clinical consequences in children discharged from these units, although up to 7% may subsequently return to hospital. There is some evidence that users are satisfied with these services and that they are associated with reductions in inpatient activity levels and certain hospital costs. Evidence about the impact of urgent outpatient clinics is very limited. Conclusions: Current evidence supports a view that acute paediatric assessment services are a safe, efficient and acceptable alternative to inpatient admission, but this evidence is of limited quantity and quality. Further research is required to confirm that this type of service reorganisation does not disadvantage children and their families, particularly where inpatient services are withdrawn from a hospital

Providing Language Services in Small Health Care Provider Settings: Examples From the Field

Assesses recent innovations in language service programs and activities at healthcare provider settings with ten or fewer clinicians. Includes an eight-step plan to help providers develop a strategy to meet the needs of their patients

Building Medical Homes in State Medicaid and CHIP Programs

Presents strategies, best practices, and lessons learned from ten states' efforts to advance the medical home model of comprehensive and coordinated care in Medicaid and Children's Health Insurance Programs in order to improve quality and contain costs

An Assessment of Health Care Safety Net Services in Seven Metropolitan Atlanta Counties

The Georgia Health Policy Center (GHPC), the Centers for Disease Control and Prevention (CDC) and the National Network of Public Health Institutes began collaboration in the summer of 2007 on a project designed to establish a framework for public health to help inform the health reform debate. The partnership set out to broaden the health reform conversation to include health promotion, health improvement, and disease prevention. The effort included background research, focus groups, key interviews with internal and external stakeholders from local, state, and national groups, and additional convenings of local, state, and national partners. This report highlights opportunities for public health to bridge the different levels of health reform and create strategies and policies that could be implemented on each level

Systems of Care Coordination for Children: Lessons Learned Across State Models

Outlines features of successful systems that refer children for developmental interventions, help coordinate care, offer support and follow-up, and give providers feedback, including maximum efficiencies and partnerships, as well as policy implications

Funding Cuts to Public Health in Massachusetts: Losses Over Gains

Examines ten public health areas, from children's health to substance abuse, and describes the widening health disparities, reduced data collection, and other effects of budget cuts to programs in prevention, outreach, training, and technical assistance

International Profiles of Health Care Systems, 2012

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views