Compensation and Incentives in Medical Networks with Gate-keeping and Case Management

New approaches in health care, such as e.g. Integrated Delivery Systems, affect the role and tasks of medical suppliers. More and more, medical suppliers are incorporated into the process of guiding patients to medical specialists and hospitals and thus managing the course of disease. In this context, the role of medical gate-keepers and case managers may provide opportunities for undesirable behavior (from the network's point of view). Therefore, compensation-induced incentives for gatekeepers and case managers are in the main focus of the paper. Different health care payment systems and the impact of financial and non-financial incentives on case managers and gate-keepers in medical networks are analyzed. Another focus is laid on medical suppliers that are not involved in managing diseases and guiding patients. Due to their smaller margin of actions and possibilities to take advantage of it, reimbursement should emphasize different aspects than for case managers.networks; compensation; gate-keeping; case management

Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support

Background: increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support.Methods: drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support.Discussion: the translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.<br/

How EHS managers can influence environmental excellence within their organization

The objective of this work is to evaluate the various management styles and systems applicable to the Environmental, Health, and Safety (\u27EHS\u27) profession; furthermore, it will present ways in which managers will discover how to understand and evaluate projects from a \u27business\u27 point of view, allowing them to compete within their organization for capital and human resources. ... This paper will also discuss various evaluations used to ensure proper buy-in from management -- a process that will facilitate the allocation of human and financial resources to environment, health, and safety projects. The evaluation will focus on two primary elements. The first will be a literature review of established EHS management systems, presented in order to illustrate a basic understanding of associated management risks, recognized procedures, and observation techniques. The second element will confirm the efficacy of a new management concept and applicable management techniques. In this phase, it will analyze EHS programs and how they should be structured to facilitate these new techniques

NDPS Business Management Systems Development & Implementation

The purpose of this project is to create systems and methods for the management and expansion of A New Dawn Pedi Spa, a pedicure spa focused on the health and wellness of feet that is owned and operated by Dawn Durocher, C.Pod, CMP. Being a small business there is a great need to establish systems now before expanding with new human resources, facilities or clientele. These systems include administrative, accounting, inventory control and actual physical plant facilities reconfiguration as well as the development of a strategy for the expansion of this business. This system also includes customer communications and clientele management structures. By utilizing project management skills, administrative and accounting experience and IT knowledge, these systems will enable the owner to manage her business, her time and her focus

CDC in Namibia

The Centers for Disease Control and Prevention (CDC) established an office in Namibia in 2002 to focus on implementing HIV programs in regions withhigh HIV burden. CDC partners with the Namibia Ministry of Health and Social Services (MOHSS) to strengthen the capacity of Namibia\u2019s healthcare workforce and systems to prevent, detect, and respond to public health threats. A primary focus for CDC and MOHSS is to control the HIV and tuberculosis (TB) epidemics through tailored strategies that prevent new infections, reduce deaths, and improve quality of life. CDC supports MOHSSthrough a multi-pronged approach that includes strengthening clinical and laboratory systems through the MOHSS Quality Management framework; supporting human resources for health systems to build and maintain an effective health workforce; and optimizing health information systems to ensure that data are available to inform clinical care and policy making.November 2022Namibia_FS_2022.pd

What improves environmental performance? evidence from Mexican industry

Using new survey evidence, the authors analyze the effects of regulation, plant-level management policies, and plant and firm characteristics on environmental performance in Mexican factories. They focus especially on management policies: the degree of effort to improve environmental performance and the type of management strategy adopted. They index effort with two variables: adoption of ISO 14000-type procedures for pollution management and use of plant personnel for environmental inspection and control. Proxies for strategic orientation are two indices of mainstreaming: assigning environmental responsibilities to general managers instead of specialized environmental managers, and providing environmental training for all plant employees, not just specialists. Detailed survey data let them test the performance impact of such factors as ownership, scale, sector, trade and other business relationships, local regulatory enforcement, local community pressure, management education and experience, and workers'general education. Their findings are: 1) Process is important. Plants that institute ISO 14000-type internal management procedures show superior environmental performance. 2) Mainstreaming works. Environmental training for all plant personnel is more effective than developing a cadre of environmental specialists, and assigning environmental tasks to general managers is more effective than using special environmental managers. 3) Regulatory pressure works. Plants that have experienced regulatory inspections and enforcement are significantly cleaner than those that have not. 4) Public scrutiny promotes stronger environmental policies. Publicly traded Mexican firms are significantly cleaner than privately held firms. 5) Size matters. Large plants in multiplant firms are much more likely to adopt policies that improve environmental performance. 6) OECD (Organization for Economic Cooperation and Development) influences do not matter. It is generally assumed that plants linked to OECD economies show superior environmental performance, but they find no evidence that OECD links--including multinational ownership, trade, management training, or management experience--affect environmental performance. 7) New technology is not significantly cleaner. They find no evidence that plants with newer equipment perform better environmentally (once other factors are accounted for). 8) Education promotes clean production. Plants with more highly educated workers show significantly better environmental management efforts and performance.Environmental Economics&Policies,Agricultural Knowledge&Information Systems,Public Health Promotion,Health Monitoring&Evaluation,Water and Industry,Environmental Governance,Water and Industry,Agricultural Knowledge&Information Systems,Environmental Economics&Policies,Health Monitoring&Evaluation

Minimising medicine use in organic dairy herds through animal health and welfare planning

Livestock is important in many organic farming systems, and it is an explicit goal to ensure high levels of animal health and welfare (AHW) through good management. This will lead to reduced medicine use and better quality of animal products. In two EU network projects NAHWOA & SAFO it was concluded that this is not guaranteed merely by following organic standards. Both networks recommended implementation of individual animal health plans to stimulate organic farmers to improve AHW. These plans should include a systematic evaluation of AHW and be implemented through dialogue with each farmer in order to identify goals and plan improvements. 15 research institutions in 8 European countries are involved in the proposed project with the main objective to minimise medicine use in organic dairy herds through active and well planned AHW promotion and disease prevention. The project consists of 5 work packages, 4 of which comprise research activities building on current research projects, new applications across borders, exchange of knowledge, results and conclusions between participating countries, and adopting them to widely different contexts. International and national workshops facilitate this exchange. Focus areas are animal health planning, AHW assessment using animal based parameters and development of advisory systems and farmer groups. Epidemiological analyses of the effect on AHW from reduced medicine use and herd improvements are planned in all participating countries

The nursing contribution to chronic disease management: a whole systems approach: Report for the National Institute for Health Research Service Delivery and Organisation programme

Background Transforming the delivery of care for people with Long Term Conditions (LTCs) requires understanding about how health care policies in England and historical patterns of service delivery have led to different models of chronic disease management (CDM). It is also essential in this transformation to analyse and critique the models that have emerged to provide a more detailed evidence base for future decision making and better patient care. Nurses have made, and continue to make, a particular contribution to the management of chronic diseases. In the context of this study, there is a particular focus on the origins of each CDM model examined, the processes by which nursing care is developed, sustained and mainstreamed, and the outcomes of each case study as experienced by service users and carers. Aims To explore, identify and characterise the origins, processes and outcomes of effective CDM models and the nursing contribution to such models using a whole systems approach Methods The study was divided into three phases: Phase 1: Systematic mapping of published and web-based literature. Phase 2: A consensus conference of nurses working within CDM. Sampling criteria were derived from the conference and selected nurses attended a follow up workshop where case study sites were identified. Phase 3: Multiple case study evaluation Sample: 7 case studies representing 4 CDM models. These were: i) public health nursing model; ii) primary care nursing model; iii) condition specific nurse specialist model; iv) community matron model. Methods: Evaluative case study design with the unit of analysis the CDM model (Yin, 2003): • semi-structured interviews with practitioners, patients, their carers, managers and commissioners • documentary analysis • psycho-social and clinical outcome data from specific conditions • children and young people: focus groups, age-specific survey tools. Benchmarking outcomes: Adults benchmarked against the Health Outcomes Data Repository (HODaR) dataset (Currie et al, 2005). Young people were benchmarked against the Health Behaviour of School aged Children Survey (Currie et al, 2008). Cost analysis: Due to limitations in the available data, a simple costing exercise was undertaken to ascertain the per patient cost of the nurse contribution to CDM in each of the models, and to explore patterns of health and social care utilisation. Analysis: A whole system methodology was used to establish the principles of CDM. i) The causal system is a “network of causal relationships” and focuses on long term trends and processes. ii) The data system recognises that for many important areas there is very little data. Where a particular explanatory factor is important but precise data are lacking, a range of methods should be employed to illuminate each factor as much as possible. iii) The organisational whole system emphasises how various parts of the health and social care system function together as a single system rather than as parallel systems. iv) The patient experience recognises that the whole system comes together and is embodied in the experience of each patient. Key findings While all the models strove to be patient centred in their implementation, all were linked at a causal level to disease centric principles of care which dominated the patient experience. Public Health Model • The users (both parents and children) experienced a well organised and coordinated service that is crossing health and education sectors. • The lead school nurse has provided a vision for asthma management in school-aged children. This has led to the implementation of the school asthma strategy, and the ensuing impacts including growing awareness, prevention of hospital admissions, confidence in schools about asthma management and healthier children. Primary Care Model • GP practices are providing planned and routine management of chronic disease, tending to focus on single diseases treated in isolation. Care is geared to the needs of the uncomplicated stable patient. • More complex cases tend to be escalated to secondary care where they may remain even after the patient has stabilised. • Patients with multiple diagnoses continue to experience difficulty in accessing services or practice that is designed to provide a coherent response to the idiosyncratic range of diseases with which they present. This is as true for secondary care as for primary care. • While the QOF system has clearly been instrumental in developing and sustaining a primary care nursing model of CDM, it has also limited the scope of the model to single diseases recordable on a register, rather than focus on patient centred care needs. Nurse Specialist Model • The model works under a disease focused system underpinned by evidence based medicine exemplified by NICE guidelines and NSF’s. • The model follows a template drawn from medicine and sustainability is significantly dependent on the championship and protectionism offered by senior medical clinicians. • A focus on self-management in LTCs gives particular impetus to nurse-led enablement of self-management. • The shift of LTC services from secondary care to primary care has often not been accompanied by a shift in expertise. Community Matron Model • The community matron model was distinctive in that it had been implemented as a top down initiative. • The model has been championed by the community matrons themselves, and the pressure to deliver observable results such as hospital admission reductions has been significant. • This model was the only one that consistently resulted in open access (albeit not 24 hours) and first point of contact for patients for the management of their ongoing condition. Survey Findings Compared to patients from our case studies those within HODaR visited the GP, practice nurse or NHS walk-in centres more, but had less home visits from nurses or social services within the six weeks prior to survey. HODaR patients also took significantly more time off work and away from normal activities, and needed more care from friends/ relatives than patients from our study within the last six weeks. The differences between the HODaR and case study patients in service use cannot easily be explained but it could be speculated when referring to the qualitative data that the case study patients are benefiting from nurse-led care. Cost analysis – The nurse costs per patient are at least ten times higher for community matrons conducting CDM than for nurses working in other CDM models. The pattern of service utilisation is consistent with the focus of the community matron role to provide intensive input to vulnerable patients. Conclusions Nurses are spearheading the kind of approaches at the heart of current health policies (Department of Health, 2008a). However, tensions in health policy and inherent contradictions in the context of health care delivery are hampering the implementation of CDM models and limiting the contribution nurses are able to make to CDM. These include: ? data systems that were incompatible and recorded patients as a disease entity ? QOF reinforced a disease centric approach ? practice based commissioning was resulting in increasing difficulties in cross health sector working in some sites ? the value of the public health model may not be captured in evaluation tools which focus on the individual patient experience. Recommendations Commissioners and providers 1. Disseminate new roles and innovations and articulate how the role or service fits and enhances existing provision. 2. Promote the role of the nurses in LTC management to patients and the wider community. 3. Actively engage with service users in shaping LTC services to meet patients’ needs. 4. Improve the support and supervision for nurses working within new roles. 5. Develop training and skills of nurses working in the community to enable them to take a more central role in LTC management. 6. Develop organisations that are enabling of innovation and actively seek funding for initiatives that provide an environment where nurses can reach their potential in improving LTC services. 7. Work towards data systems that are compatible between sectors and groups of professionals. Explore ways of enabling patients to access data and information systems for test results and latest information. 8. Promote horizontal as well as vertical integration of LTC services. Practitioners 1. Increase awareness of patient identified needs through active engagement with the service user. 2. Work to develop appropriate measures of nursing outcomes in LTC management including not only bureaucratic and physiological outcomes, but patient-identified outcomes. Implications of research findings 1. Investment should be made into changing patient perceptions about the traditional division of labour, the nurses’ role and skills, and the expertise available in primary care for CDM. 2. Development and evaluation of patient accessible websites where patients can access a range of information, their latest test results and ways of interpreting these. 3. Long-term funding of prospective evaluations to enable identification of CDM outcomes. 4. Mapping of patient experience and patient satisfaction so that the conceptual differences between these two related ideas can be demonstrated. 5. Development of appropriate measures of patient experience that can be used as part of the quality outcome measures. 6. Cost evaluation/effectiveness studies carried out over time that includes national quality outcome indicators and valid measures of patient experience. 7. The importance of whole system working needs to be identified in the planning of services. 8. Research into the role of the health visitor in chronic disease management within a public health model

Transforming Healthcare in Australia: The PeCC Initiative

Many of the current crises in contemporary healthcare management centre on issues concerning information management and costs. Electronic commerce (or e-commerce) activity, grounded in the development of the Internet, is challenging traditional management models and providing new paradigms and possible solutions for improved health care management. Australia’s health industry, like other economic sectors here and globally, is grasping the need to use IT and telecommunications with e-commerce strategies for improved cost-effective services to its key stakeholders. This paper addresses the changes occurring in Australia’s health care industry influenced by trends in information systems. While the Federal government’s recent report, From Telehealth to E-Health: The Unstoppable Rise of EHealth [3], outlines a diverse range of projects and practices, here the authors focus on Australia’s first Internet trading community, The Project Electronic Commerce and Communication for Healthcare, otherwise known as PeCC. This study is supported by an ARC Collaborative Grant. The Industry partner is IBM

Redox Status and Proteostasis in Ageing and Disease.

Morbidity and mortality from preventable, noncommunicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology, and design thinking. The purpose of this paper is to summarize the results of a consensus meeting on NCD prevention sponsored by the International Olympic Committee (IOC) in April 2013. Within the context of advocacy for multifaceted systems change, the IOC's focus is to create solutions that gain traction within health care systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following: 1. Focus on behavioral change as the core component of all clinical programs for the prevention and management of chronic disease. 2. Establish actual centers to design, implement, study, and improve preventive programs for chronic disease. 3. Use human-centered design (HCD) in the creation of prevention programs with an inclination to action, rapid prototyping and multiple iterations. 4. Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programs for the prevention and treatment of chronic disease focused on physical activity, diet, and lifestyle. 5. Mobilize resources and leverage networks to scale and distribute programs of prevention. True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programs within health care. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad hoc Working Group charged with the responsibility of moving this agenda forward