Does a public single payer system deliver integrated care? A national survey study among professional stakeholders in Denmark

Background: Integrated health care delivery is a goal of health care systems; to date there has been limited information on the integration of medical care in practice. Purpose: To examine and compare perceptions of clinical integration and to identify associated strategic, cultural, technical and structural factors. Design and setting: A national survey addressed to: all county administrative managers (n=15); all hospital managers (n=44); and randomized selected samples of hospital department physician managers (n=200) and general practitioners (n=700) in Denmark. Results: Several initiatives have been implemented in Denmark to integrate care. Nevertheless, most physicians agree that only half of all patients experience well coordinated pathways. Clinical integration is a strategic priority at the managerial levels, but this is not visible at the functional levels. Financial incentives are not used to encourage coordination. The information communication technology to facilitate clinical integration is perceived to be inadequate. Conclusion: The scope for improvement is high due to the structural composition of the system. Increased managerial stewardship, alignment of the financial incentives, and expanded use of information communication technology to link sub-organisations will be a way to move the system forward to meet its explicit goal of providing an integrated delivery of services

Measurement of integrated healthcare delivery: a systematic review of methods and future research directions

Background: Integrated healthcare delivery is a policy goal of healthcare systems. There is no consensus on how to measure the concept, which makes it difficult to monitor progress. <br><br> Purpose: To identify the different types of methods used to measure integrated healthcare delivery with emphasis on structural, cultural and process aspects. <br><br> Methods: Medline/Pubmed, EMBASE, Web of Science, Cochrane Library, WHOLIS, and conventional internet search engines were systematically searched for methods to measure integrated healthcare delivery (published – April 2008). <br><br> Results: Twenty-four published scientific papers and documents met the inclusion criteria. In the 24 references we identified 24 different measurement methods; however, 5 methods shared theoretical framework. The methods can be categorized according to type of data source: a) questionnaire survey data, b) automated register data, or c) mixed data sources. The variety of concepts measured reflects the significant conceptual diversity within the field, and most methods lack information regarding validity and reliability. <br><br> Conclusion: Several methods have been developed to measure integrated healthcare delivery; 24 methods are available and some are highly developed. The objective governs the method best used. Criteria for sound measures are suggested and further developments should be based on an explicit conceptual framework and focus on simplifying and validating existing methods

Coordination between primary and secondary healthcare in Denmark and Sweden

Introduction: Insights into effective policy strategies for improved coordination of care is needed. In this study we describe and compare the policy strategies chosen in Denmark and Sweden, and discuss them in relation to interorganisational network theory. Policy practice: The policy initiatives to improve collaboration between primary and secondary healthcare in Denmark and Sweden include legislation and agreements aiming at clarifying areas of responsibility and defining requirements, creation of links across organisational boarders. In Denmark many initiatives have been centrally induced, while development of local solutions is more prominent in Sweden. Many Danish initiatives target the administrative level, while in Sweden initiatives are also directed at the operational level. In both countries economic incentives for collaboration are weak or lacking, and use of sanctions as a regulatory mean is limited. Discussion and conclusion: Despite a variety of policy initiatives, lacking or poorly developed structures to support implementation function as barriers for coordination. The two cases illustrate that even in two relatively coherent health systems, with regional management of both the hospital and general practice sector, there are issues to resolve in regard to administrative and operational coordination. The interorganisational network literature can provide useful tools and concepts for interpreting such issues

Are joint health plans effective for coordination of health services? An analysis based on theory and Danish pre-reform results

Background: Since 1994 formal health plans have been used for coordination of health care services between the regional and local level in Denmark. From 2007 a substantial reform has changed the administrative boundaries of the system and a new tool for coordination has been introduced. <br><br> Purpose: To assess the use of the pre-reform health plans as a tool for strengthening coordination, quality and preventive efforts between the regional and local level of health care. <br><br> Methods: A survey addressed to: all counties (n=15), all municipalities (n=271) and a randomised selected sample of general practitioners (n=700). <br><br> Results: The stakeholders at the administrative level agree that health plans have not been effective as a tool for coordination. The development of health plans are dominated by the regional level. At the functional level 27 percent of the general practitioners are not familiar with health plans. Among those familiar with health plans 61 percent report that health plans influence their work to only a lesser degree or not at all. <br><br> Conclusion: Joint health planning is needed to achieve coordination of care. Efforts must be made to overcome barriers hampering efficient whole system planning. Active policies emphasising the necessity of health planning, despite involved cost, are warranted to insure delivery of care that benefits the health of the population

Milk production performance of Ankole crossbreds and Holstein Friesian cattle in different production environments of Rwanda

The aim of the study was to assess the productive performance of dairy cattle in three different agro-ecological zones of Rwanda: Congo-Nile/Western (WAZ), Central plateau/Central (CAZ), and Eastern plateau/East Agro-ecological Zones (EAZ). A single-visit multi-subject survey was conducted to obtain information on the dairy cattle performance from 51 farms. The breed groups were classified as Ankole x Holstein Friesian (AF), other Ankole crossbreds (AX), and pure Holstein Friesian (F). The F had higher (p < 0.001) milk yield than AF in all zones except EAZ and AF had higher (p < 0.0001) milk yield than AX in all zones. Across all zones, F produced 9 L more than AX and 6 L more than AF per day. Cows from EAZ had the highest average milk yield; however, it was not significantly different from CAZ. The difference that was observed between AF in EAZ and AF in the other two zones indicates that agro-ecological zones should not only be the target in livestock development activities rather additional factors such as feed availability at farm level, social economic, and market infrastructure should be considered in Rwanda

Needs of Head and Neck Cancer Patients and Stakeholders During Rehabilitation

The foreseen growth of Head and Neck cancer (HNC) incidents will require future rehabilitation services to meet the needs of a wider population. This study reports the empirical findings of a case study conducted at a cancer rehabilitation center in Copenhagen, aiming to elicit the needs of HNC patients, informal caregivers and healthcare professionals (HCPs). Our results point out that patients and stakeholders' needs are interrelated, as they faced common challenges pertinent to provision and distribution of information. This study, though preliminary, underlines the importance of inclusion of all actors in the design of future interventions

Reducering av svinnet i färskvaruhandeln genom förbättrade efterfrågeprognoser

Bakgrund Att ha rätt mängd varor, vid rätt tid och på rätt plats är ett centralt problem i färskvarubranschen. För att ta itu med denna problematik har författarna undersökt i vilken utsträckning avancerade prognosmodeller kan hjälpa branschen med detta problem. I arbetet undersöks effekterna av både enkla och avancerade modeller och jämförs med manuella prognoser som görs av säljarna på Pågen AB. Syfte Att visa olika prognosmodellers effekter på Pågen ABs dagliga verksamhet i form av returmängd och servicegrad samt att jämföra modellerna med Pågens befintliga situation. Metod För att genomföra projektet behöver författarna gå igenom tre steg: 1. Samla in data och analysera den 2. Göra prognoser 3. Simulera verksamheten utifrån att den bedrevs med prognosmodellerna Slutsats Vid jämförelse av de olika prognosmodellerna framgår det tydligt att de mer avancerade modellerna ger bättre resultat. Skillnaden i antal returnerade bröd och missade försäljningar är så pass stor att författarna vid en implementation skulle rekommendera de mer avancerade modellerna. Jämfört med Pågens nuvarande situation innebär de avancerade iv prognosmodellerna en klar förbättring. De enklare modellernas resultat liknar Pågens nuvarande resultat vilket skulle kunna förklaras med att Pågens säljare gör sina prognoser på ett liknande sätt. Det framgår också att ju mer information som finns tillgänglig om systemet desto bättre går det att förutsäga var varor kommer behöva levereras. Ett förslag till ytterligare förbättring vore att skaffa ännu mer kampanjinformation och att samla in ännu mer data kring hur bröden exponeras i butikerna. Det finns dock en sannolikhet att detta är en orimlighet på grund av den stora mängden arbete det skulle kräva att samla in sådan data

Milk production and lactation length in Ankole cattle and Ankole crossbreds in Rwanda

This study assessed daily milk yield (DMY), 100-day (MY100), and 305-day (MY305) milk yield, and lactation length (LL) in purebred Ankole cattle and Ankole crossbreds, and the influence of environmental factors on these traits. Milk yield data were obtained for 865 cows and 1234 lactations and analyzed using a mixed linear model. The overall least squares mean of DMY, MY100, and MY305 across breed groups was 2.7 L (N = 1234, SD = 1.7), 262 L (N = 959, SD = 176), and 759 L (N = 448, SD = 439), respectively, while the average lactation length was 256 days (N = 960, SD = 122). All factors included (breed group, season and year of calving, and parity) were significant for yield traits, except season of calving for MY305. First-parity cows had the lowest milk production, and fourth-parity cows the highest. For all traits, pure Ankole cows had the lowest milk yield. Among the crossbreds, there was no significant difference between Ankole x Friesian, Ankole-Jersey mother x Sahiwal sire, and Ankole-Sahiwal mother x Jersey sire, or between Ankole x Sahiwal and Ankole-Sahiwal mother x Sahiwal sire. It was concluded that Ankole crosses with Friesian or Jersey can be beneficial, even under a management system of limited nutrition as in Rwanda