Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system

<p>Abstract</p> <p>Background</p> <p>Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system.</p> <p>Methods</p> <p>Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models.</p> <p>Results</p> <p>More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration.</p> <p>Conclusions</p> <p>More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.</p

Implementation of CSP-S for description of distributed algorithms

The implementation of CSP-S (a subset of CSP)—a high level language for distributed programming—is presented in this paper. The language CSP-S features a parallel command, communication by message passing and the use of guarded command. The implementation consists of a compiler translating the CSP-S constructs into intermediate language. The execution is carried out by a scheduler which creates an illusion of concurrency. Using the CSP-S language constructs, distributed algorithms are written, executed and tested with the compiler designed

The RTSORAC Real-Time Object-Oriented Database Prototype

INTRODUCTION Applications that interact with their environments, such as automated vehicle control, manufacturing, and air-tra#c control, have large volumes of timeconstrained data on which time-constrained transactions may operate. Such applications can be supported by real-time database management systems #16#. Additionally, these applications often involve complex data types with complex associations among the data items. The vast majorityofwork on real-time databases to date has used the relational data model #16,23#, which has limitations for complex data #24#. This chapter presents a real-time object-oriented data model called RTSORAC #Real-Time Semantic Objects Relationships And Constraints# that incorporates time-constrained data and time-constrained transactions of real-time databases with the support for complex data provided by t

Publishing & production executive : for buyers of printing, prepress, paper & publishing systems for magazines, catalogs, books, agency & corporate communications

During the last decade the decrease in the size of computing machinery, coupled with the increase in their computing power has lend to the development of the concept of mobile computing. Effects of this new vision is currently evident in the flourishing numbers of mobile telephones and portable computing units. In this paper we investigate some issues concerning the security of mobile computing systems, within the framework of the categories of mobility, disconnection, data access modes and scale of operation (Imielinski & Badrinath, 1993). In contrast to previous works which concentrate on security in wireless communications, we focus on the security of interactions which are built upon the underlying wireless communications medium. Some conclusions are presented on the future directions for security research in mobile computing systems

Urovysion&#8482; testing can lead to early identification of intravesical therapy failure in patients with high risk non-muscle invasive bladder cancer

Purpose: In this study, we investigated the ability of UroVysion&#8482; to assess response to intravesical therapy in patients with high risk superficial bladder tumors. Materials and methods: We performed a retrospective review of patients undergoing intravesical therapy for high risk superficial bladder tumors. Urine specimens were collected for UroVysion&#8482; analysis before and immediately after a course of intravesical therapy. Cytology and cystoscopy were performed six weeks after treatment, using either a positive cytology or visible abnormality on cystoscopy as a prompt for biopsy. The operating characteristics of the UroVysion&#8482; test were then determined. Results: 41 patients were identified in whom 47 cycles of induction and 41 cycles of maintenance intravesical therapy were given during the study period. This yielded a total of 88 treatment and evaluation cycles. Median follow-up was 9 months per induction (range 1-21 months) and 13 months per patient (range 1-25 months). A total of 133 urine samples were collected for UroVysion&#8482; of which 40 were positive. Based upon standard clinical evaluation, 41 biopsies were performed which detected 20 recurrences. UroVysion&#8482; testing performed immediately upon completion of therapy for the 41 patients undergoing biopsy yielded a sensitivity, specificity, and accuracy of 85%, 61%, and 71%. Conclusions: The use of UroVysion&#8482; following intravesical therapy for high-risk superficial bladder tumors helps to identify patients at high risk of refractory or recurrent disease who should undergo immediate biopsy under anesthesia