Maternal health in Jamaica : health needs, services, and utilization

The main health issues for Jamaican women are nutrition, fertility, infection, chronic diseases, and stress and social problems. The two leading causes of adult health for women are cerebro-vascular accidents and coronary heart disease - of which high blood pressure is a major component among black women. The main factors causing stress for Jamaican women include unemployment, economic inadequacy, separation of partners, male promiscuity, limited availability of schooling for children, and violence. The Jamaican health care system needs more family planning services for those who want them; good community-based prenatal education and screening and hospital delivery for high-risk pregnancies, better community education and better transportation so that women and midwifes can visit more often. There is also a great need for health education to overcome broad misperceptions, which may block demand for family planning services.Reproductive Health,Health Monitoring&Evaluation,Adolescent Health,Early Child and Children's Health,Gender and Health

Covering California's Kids: Outcomes from Children's Health Initiatives in California

Examines the outcomes and policy implications of CHIs and the Healthy Kids insurance program in the state

Using a summary measure for multiple quality indicators in primary care: the Summary QUality InDex (SQUID)

BACKGROUND: Assessing the quality of primary care is becoming a priority in national healthcare agendas. Audit and feedback on healthcare quality performance indicators can help improve the quality of care provided. In some instances, fewer numbers of more comprehensive indicators may be preferable. This paper describes the use of the Summary Quality Index (SQUID) in tracking quality of care among patients and primary care practices that use an electronic medical record (EMR). All practices are part of the Practice Partner Research Network, representing over 100 ambulatory care practices throughout the United States. METHODS: The SQUID is comprised of 36 process and outcome measures, all of which are obtained from the EMR. This paper describes algorithms for the SQUID calculations, various statistical properties, and use of the SQUID within the context of a multi-practice quality improvement (QI) project. RESULTS: At any given time point, the patient-level SQUID reflects the proportion of recommended care received, while the practice-level SQUID reflects the average proportion of recommended care received by that practice's patients. Using quarterly reports, practice- and patient-level SQUIDs are provided routinely to practices within the network. The SQUID is responsive, exhibiting highly significant (p < 0.0001) increases during a major QI initiative, and its internal consistency is excellent (Cronbach's alpha = 0.93). Feedback from physicians has been extremely positive, providing a high degree of face validity. CONCLUSION: The SQUID algorithm is feasible and straightforward, and provides a useful QI tool. Its statistical properties and clear interpretation make it appealing to providers, health plans, and researchers

Lifestyle Change for Weight Loss in the Inner-City

In low-income minority communities, there is high prevalence and clustering of obesity, coronary heart disease, dyslipidemia, hypertension and diabetes mellitus. Evidence suggests one way to treat and prevent these conditions is through a very low-fat, high fiber, vegetarian diet. A feasibility study was conducted to determine whether inner-city African American and Latino patients will accept a low-fat vegetarian diet and to assess attitudes about the life-style intervention. Reductions in fat and animal products were acceptable, though complete conversion to vegetarianism was not. Meanwhile, group support was the most highly rated component of the class. Contrary to common perceptions of immigrants needing to maintain traditional habits, the Latino participants enthusiastically adopted new concepts and incorporated new recipes into their diet. Weight loss was achieved during the 8 week course and continued through 18 month follow-up. It appears that individual empowerment through the group intervention, coupled with simple diet messages, supported life-style change in a high-risk group

Determinants of pregnancy outcomes and targeting of maternal health services in Jamaica

Detailed nationally representative population level data were used to investigate the pre-natal care and delivery experiences of pregnant women in Jamaica. The results of this study show that : (a) demographic criteria (particularly first births) and self-reported clinical pregnancy complications are valid predictors of deleterious maternal health outcomes and can be used to stratify mothers into risk groups. (b) There appears to be a significant problem of under and inappropriate utilization of pre-natal care services by all women and in particular by demographically 'high risk' women, i.e. young, first time mothers. Significant proportions of the latter group report either no pre-natal care visits at all or visits which are later than the first trimester. The problems of delayed initiation of pre-natal care are specially exacerbated for poor, teenage mothers who happen to be living in the Kingston Metropolitan Area. (c) In terms of the content and quality of pre-natal care services the message is somewhat mixed. On the positive side the pre-natal care system is doing a moderately satisfactory job with regard to diagnostic tests and educational advice. On the negative side however, the fact that once women enter the health care system they all receive the same moderately adequate care (in terms of diagnostic evaluations and educational advice) with no attempt to focus particular attention on high risk mothers is troublesome. (d) With regard to appropriate delivery venues for pregnant women, pre-natal care visits do not appear to significantly influence the choice of delivery venues. Moreover, rich urban women are much more likely to deliver in a hospital than their rural peers. In conclusion, the study discusses the social and behavioral context of these results, addresses the policy implications and makes some recommendations to improve maternal health services.maternal health services Jamaica

Implementing change in primary care practices using electronic medical records: a conceptual framework

Abstract Background Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR). Methods Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. Results A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting by leaders. Conclusion This conceptual framework provides a mental model which can serve as a guide for practice leaders implementing clinical guidelines in primary care practice using electronic medical records. Using the concepts as implementation and evaluation criteria, program developers and teams can stimulate improvements in their practice settings. Investing in collaborative team development of clinicians and staff may enable the practice environment to be more adaptive to change and improvement.</p

Different Paths to High-Quality Care: Three Archetypes of Top-Performing Practice Sites

PURPOSE Primary care practices use different approaches in their quest for high-quality care. Previous work in the Practice Partner Research Network (PPRNet) found that improved outcomes are associated with strategies to prioritize performance, involve staff, redesign elements of the delivery system, make patients active partners in guideline adherence, and use tools embedded in the electronic medical record. The aim of this study was to examine variations in the adoption of improvements among sites achieving the best outcomes