The open health services and policy journal最新文献

{"title":"Improving Access to Preventive Services for Marginalized Families During Early Childhood: An Integrative Review of Inter-organizational Integration Interventions","authors":"Dawn A Smith, W. Peterson, M. Jaglarz, K. Doell","doi":"10.2174/1874924000902010016","DOIUrl":"https://doi.org/10.2174/1874924000902010016","url":null,"abstract":"Marginalized populations exhibit low rates of preventive service use, often avoiding use of non-urgent services. Poor access to preventive and health promoting care serves to maintain inequities in health experienced by many marginalized populations. Of particular concern are marginalized families with young children below the age of school entry, when physical, emotional and psychological foundations for life-long health are being established. Many community based organizations recognize the need to improve families' access and use of preventive services. However, they are faced with a gap in understanding what inter-organizational interventions could be implemented to improve integration of services particularly focused on addressing experiences of marginalized families. Therefore, we used the integrative review method to identify and describe inter-organizational (I-O) interventions in the literature that aim to improve access to preventive services by marginalized families. As per integrative review methods, the literature was searched for research studies using qualitative, quantitative or mixed method designs, and investigating I-O interventions aiming to improve access to preventive services through increased service integration. Three levels of screening and relevance review identified fourteen articles. A conceptual model informed by socio-ecological theory was used to classify interventions as relational or structural. Results show that reports of rigorously conducted studies of I-O interventions are relatively sparse, and emphasize structural factors such as shared leadership, shared review or development of policies/protocols, changes to referral mechanisms and geographical/caseload matching. Inter- organizational interventions that influence relational factors were rare but have included: joint training/education, facilitated communication, addition of an integration role, and strategic partnerships. We suggest that combining both structural- and relational-focused strategies in inter-organizational integration intervention design may have greater impact on improving access to preventive services for marginalized families, with increased use of early childhood preventive services contributing to reducing health disparities.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"22 1","pages":"16-25"},"PeriodicalIF":0.0,"publicationDate":"2009-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Rationing and Professional Autonomy: The Case of Cardiac Care in Ontario","authors":"L. Kapiriri, G. Randall, Douglas K. Martin","doi":"10.2174/1874924000902010034","DOIUrl":"https://doi.org/10.2174/1874924000902010034","url":null,"abstract":"The purpose of this paper is to explore how rationing decisions are made by government and hospital policy makers and practitioners, at the micro, meso and macro levels of analysis, through examining the rationing of cardiac care in a Canadian hospital, and discussing how the interaction between policy makers and practitioners at each of these levels affects the process and outcomes. Data were collected through in-depth interviews with 20 key informants. We found that decision-making for rationing cardiac care is a complex process. As government and hospital policy makers seek to control costs through greater oversight of clinical decisions, practitioners resist this perceived challenge to their autonomy. Attempts by policy makers at the macro and meso levels to standardize the rationing process have had limited success as practitioners have largely retained their ability to make independent rationing judgments at the micro level. This study underscores the difficulties associated with efforts to constrain the autonomy of practitioners in making \"bedside rationing\" decisions and the need to move towards a more collaborative model of clinical governance.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"2 1","pages":"34-41"},"PeriodicalIF":0.0,"publicationDate":"2009-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Utility Analysis of the Oral Fluoropyrimidine S-1 Versus Conventional Intravenous Chemotherapy in Advanced or Recurrent Gastric Cancer","authors":"H. Sakamaki, S. Ikeda, S. Yajima, N. Ikegami, Katsumi Tanaka, Hisanori Shimizu, J. Murayama","doi":"10.2174/1874924000902010026","DOIUrl":"https://doi.org/10.2174/1874924000902010026","url":null,"abstract":"Objective: The aim of this study was to compare the cost-utility of S-1, an oral anticancer agent developed in Japan, and conventional intravenous chemotherapy in patients with advanced or recurrent gastric cancer on the basis of the cost and quality of life (QOL) data we previously reported. Methods: Patients with advanced or recurrent gastric cancer who could ingest food were identified retrospectively from the ordering system database of Showa University Hospital between January 1998 and July 2001. Costs incurred during chemotherapy were calculated on the basis of hospital billing data. The utilities of chemotherapy were assessed by oncology pharmacists and nurses on the basis of the patients' medical records. Cost-utility analysis was conducted from a societal perspective. Results: Of the 23 patients who met the inclusion criteria, 13 received S-1 (S-1 group) and 10 received conventional intravenous chemotherapy (IV chemotherapy group). The average (± SE) monthly cost during chemotherapy was significantly lower in the S-1 group (327,640 ± 47,647 yen) than in the IV chemotherapy group (852,874 ± 62,412 yen). Average (± SE) utilities in the S-1 group (0.84 ± 0.02 - 0.94 ± 0.01) were significantly higher than those in IV chemotherapy group (0.52 ± 0.04 - 0.79 ± 0.02). Conclusion: S-1 is a dominant strategy with lower costs and better health outcomes than conventional intravenous chemotherapy in patients with advanced or recurrent gastric cancer.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"2 1","pages":"26-33"},"PeriodicalIF":0.0,"publicationDate":"2009-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Employer Subsidies for Health Insurance Premiums: Massachusetts' Unique Experiment","authors":"J. Mitchell, Joseph C. Burton, Deborah S. Osber","doi":"10.2174/1874924000902010010","DOIUrl":"https://doi.org/10.2174/1874924000902010010","url":null,"abstract":"Efforts to enroll low-income workers in premium assistance programs are constrained by the health insurance offer rates of the firms who employ them. One solution is to target premium subsidies to small firms as well as to their low-income workers, and Massachusetts is the sole state to have tried this. Firms participating in the state's Insurance Partnership were more likely to be self-employed compared with non-participating small firms. Self-employed firms re- ceive a double bonus: assistance payments as both employer and employee. Employer participation in the program has been limited by the low income eligibility threshold and small employer subsidies.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"2 1","pages":"10-15"},"PeriodicalIF":0.0,"publicationDate":"2009-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward an Understanding of High Performance Pharmaceutical Policy Systems: A \"Triple-A\" Framework and Example Analysis","authors":"S. Morgan, J. Kennedy, Katherine Boothe, M. McMahon, D. Watson, E. Roughead","doi":"10.2174/1874924000902010001","DOIUrl":"https://doi.org/10.2174/1874924000902010001","url":null,"abstract":"Drawing on international examples of published policy objectives for national pharmaceutical policies, we pro- pose a framework for gauging system performance on the health-related goals of policy in the pharmaceutical sector. We review basic policy structures and performance indicators for the seven participating countries of the Commonwealth Fund\"s 2007 International Health Policy Survey. We explore performance on three inter-related objectives that support overarching health goals: promoting the accessibility, appropriateness, and affordability of medicines. Indicators of per- formance along these dimensions are compared across countries and stratified by age, income and morbidity. Though no country appears uniformly strong in all areas, several appear to have done well to manage sometimes-difficult tensions in the pharmaceutical sector.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"2 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2009-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contextual Analysis of Breast Cancer Stage at Diagnosis Among Women in the United States, 2004.","authors":"Steven S Coughlin,&nbsp;Lisa C Richardson,&nbsp;Jean Orelien,&nbsp;Trevor Thompson,&nbsp;Thomas B Richards,&nbsp;Susan A Sabatino,&nbsp;Wei Wu,&nbsp;Darryl Cooney","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>BACKGROUND: To explore contextual effects and to test for interactions, this study examined how breast cancer stage at diagnosis among U.S. women related to individual- and county-level (contextual) variables associated with access to health care and socioeconomic status. METHODS: Individual-level incidence data were obtained from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology and End-Results (SEER) program. The county of residence of women with diagnosed breast cancer (n = 217,299) was used to link NPCR and SEER data with county-level measures of health care access from the 2004 Area Resource File (ARF). In addition to individual-level covariates such as age, race, and Hispanic ethnicity, we examined county-level covariates (residence in a Health Professional Shortage Area, urban/rural residence; race/ethnicity; and number of health centers/clinics, mammography screening centers, primary care physicians, and obstetrician-gynecologists per 100,000 female population or per 1000 square miles) as predictors of stage of breast cancer at diagnosis. RESULTS: Both individual-level and contextual variables are associated with later stage of breast cancer at diagnosis. Black women and women of \"other race\" had higher odds of receiving a diagnosis of regional or distant stage breast cancer (P <0.0001 and P = 0.02). With adjustment for age, Hispanics were more likely to receive a diagnosis of later stage breast cancer than non-Hispanics (P <0.0.001). Women living in areas with a higher proportion of black women had greater odds of receiving a diagnosis of regional or late stage breast cancer compared with women living in areas with the lowest proportion of black women. The same was noted for women living in areas with intermediate proportions of Hispanic women (age-adjusted odds ratio [OR], 0.94; 95% confidence interval [CI], 0.92-0.97]. Other important contextual variables associated with stage at diagnosis included the percentage of persons living below the poverty level and the number of office-based physicians per 100,000 women. Women living in counties with a higher proportion of persons living below the poverty level or fewer office-based physicians were more likely to receive a diagnosis of later stage breast cancer than those living in other counties (P < 0.001). In multivariable analysis, residence in areas with a higher proportion of non-Hispanic black women modified the associations of age and Hispanic ethnicity with later stage breast cancer (P = 0.0159 and P = 0.0002, respectively). CONCLUSIONS: This study found that county-level contextual variables related to the availability and accessibility of health care providers and health services can affect the timeliness of breast cancer diagnosis. This information could help public health officials develop interventions to reduce the burden of breast cancer among U.S. women.</p>","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"2 ","pages":"45-46"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039173/pdf/nihms153055.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29680701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predisposing, Enabling, and Reinforcing Factors Associated with Mammography Referrals in U.S. Primary Care Practices.","authors":"Susan A Sabatino,&nbsp;Trevor Thompson,&nbsp;Steven S Coughlin,&nbsp;Susan M Schappert","doi":"10.2174/1874924000902020057","DOIUrl":"https://doi.org/10.2174/1874924000902020057","url":null,"abstract":"<p><p>OBJECTIVE: We examined how predisposing, enabling and reinforcing factors influence mammography referrals by primary care physicians (PCPs). METHODS: Using the 2001-2003 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys, we identified visits to office (n=8,756) and outpatient (n=17,067) PCPs by women≥40 without breast symptoms or breast cancer. We examined mammography referrals by predisposing (age, race, ethnicity, education, chronic problem), enabling (income, payer, visits within 12 months, time with physician), and reinforcing factors (physician age, gender, specialty/clinic, PCP status, region, MSA, solo/group practice). Gender, specialty, physician age, time with physician and solo/group were only in NAMCS. Clinic type was only in NHAMCS. We fitted logistic regression models adjusted for all factors and year. RESULTS: Office-based referrals were more likely during visits: for preventive or chronic care; with private payer vs self/uninsured; by women with no visit within 12 months vs≥3; lasting≥15 minutes; to female PCPs; to PCPs aged ≥45; to gynecologists. Outpatient referrals were more likely during visits: by Hispanics; for preventive or chronic care; by women with no visit within 12 months; to one's own PCP; to gynecologic clinics; in the Northeast or Midwest. CONCLUSIONS: Reinforcing factors, in addition to predisposing and enabling factors, are associated with mammography referral. Interventions to increase referrals should consider provider factors and aspects of the healthcare environment, and recognize differences between settings. Efforts to facilitate referrals during chronic care visits or outpatient visits to non-PCP providers may provide opportunities to increase screening. Efforts are needed to ensure that uninsured women are receiving appropriate referrals.</p>","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"2 ","pages":"57-70"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848507/pdf/nihms153057.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28903838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-Based Risk Reduction in Zambia","authors":"D. Jones, S. Weiss, Drenna Waldrop-Valverde, Ndashi Chitalu, Miriam Mumbi, S. Vamos","doi":"10.2174/1874924000801010045","DOIUrl":"https://doi.org/10.2174/1874924000801010045","url":null,"abstract":"Following the trial of a sexual risk reduction intervention conducted at the University Teaching Hospital (UTH) in Lusaka, Zambia, this pilot study sought to evaluate the feasibility of conducting the intervention at the Community Health Center (CHC) level. UTH staff implemented assessments and the intervention while CHC staff provided logistic and administrative support. HIV seropositive women (CHC n = 200; UTH n = 612) attended group sessions in which male partners were randomized to a three-session or one-session group intervention arm. At baseline, consistent use of male and female condoms differed between sites (HIV+ UTH, 73%, CHC, 88%, HIV- UTH, 42%, CHC 65%); both sites in- creased combined condom use at 6 months post baseline and maintained increases over baseline at 12 months. Partici- pants did not differ between sites at baseline on condom attitudes, HIV knowledge or self efficacy. At 12 months post baseline, both sites had improved in attitudes, knowledge and efficacy and participant retention was lower at the UTH site (77% versus 82%). Inconsistent sexual barrier users increased to consistent use at both sites after 6 months (HIV positive UTH, 96%, CHC, 99%, HIV negative UTH, 84%, CHC 100%). At 12 months, HIV negative CHC participants maintained higher levels of condom use in comparison with UTH participants (F = 7.17, p = .001). Results illustrate the feasibility and efficacy of conducting group sexual risk reduction interventions in the Zambian community, and the potential for the use of group interventions in conjunction with existing CHC Voluntary Counseling and Testing (VCT) programs.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"1 1","pages":"45-51"},"PeriodicalIF":0.0,"publicationDate":"2008-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population Prevalence of First-Degree Family History of Breast and Ovarian Cancer in the United States: Implications for Genetic Testing§","authors":"I. Hall, Andrea Middlebrooks, S. Coughlin","doi":"10.2174/1874924000801010034","DOIUrl":"https://doi.org/10.2174/1874924000801010034","url":null,"abstract":"Background: The U.S. Preventive Services Task Force (USPSTF) recommends that women whose family his- tory is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation. Methods: Using data from the 2005 National Health Interview Survey, we examined the percentage of respondents in the U.S. population who report specific first-degree family history patterns and the percentage who reported they had received testing services. Results: Overall, less than 1% of the general population (about 1.4 million persons) reported a family history of breast and ovarian cancers that would be appropriate for referral for genetic counseling and possible genetic testing for cancer sus- ceptibility. Males comprised 40% of those with a positive specified family history. The number of persons who reported having had a genetic test for breast or ovarian cancer susceptibility was very small. Conclusion: Very few of those eligible for testing actually report having been tested for breast or ovarian cancer suscepti- bility. Healthcare providers need opportunities to improve knowledge of genetics concepts and clear guidelines on the use of genetic cancer susceptibility tests.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"1 1","pages":"34-37"},"PeriodicalIF":0.0,"publicationDate":"2008-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Reimbursement and Quality of Care for Patients Hospitalized with Heart Failure","authors":"E. Havranek, P. Wolfe, F. Masoudi, J. Foody, S. Rathore, H. Krumholz","doi":"10.2174/1874924000801010027","DOIUrl":"https://doi.org/10.2174/1874924000801010027","url":null,"abstract":"Data supporting the existence of a relationship between reimbursement and quality are limited. We assessed the association between quality of care for 34,318 patients hospitalized with heart failure across the US and heart failure Di- agnosis-Related Group (DRG) payment for the 3,905 hospitals at which patients were admitted. Payment varied from $2606 to $11,845. We found a discontinuous relationship between documentation of ejection fraction and payment; below $4200, there was a steep increase in rates of the quality indicator with increasing DRG payment (OR 1.15 for each $100 increase, 95% CI 1.12-1.18). For ACE inhibitor prescription, the increase in rates below the threshold was of borderline significance (OR 1.04 for each $100 increase, 95% CI 1.00-1.07). Hospitals with reimbursement below the threshold were more likely non-urban (p<0.001), public (p<0.0001), and without advanced cardiac facilities (p<0.0001), and had fewer full-time registered nurses per adjusted patient-day (p<0.0001). We conclude that hospitals with low rates of Medicare DRG-based reimbursement have lesser performance on a heart failure quality measure, perhaps because of difficulty in- vesting in advanced cardiac facilities or maintaining patient care staffing.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"22 1","pages":"27-33"},"PeriodicalIF":0.0,"publicationDate":"2008-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}