Subject(s)
Fraud/prevention & control , Medicaid/legislation & jurisprudence , Medicare/legislation & jurisprudence , Ethics, Institutional , Fraud/legislation & jurisprudence , Guideline Adherence , Health Policy , Hospital Administrators , Humans , Medicaid/economics , Medicare/economics , United StatesABSTRACT
In a one-year study, thirty-two physicians' antibiotic costs decreased significantly and were lower than those in a comparison group. The quality of patient care was not adversely affected, and the hospital's overall rate of nosocomial infection decreased. The success of the program led to its being adopted throughout the hospital. The dynamics of pharmacies' implementing cost-reduction strategies with voluntary medical staffs are discussed throughout the article.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Costs , Medical Staff, Hospital/standards , Pharmacy Service, Hospital/economics , Anti-Bacterial Agents/economics , Cohort Studies , Cost Control/methods , Drug Utilization Review , Formularies, Hospital as Topic , Hospital Bed Capacity, 100 to 299 , Hospital Costs , Hospitals, Community/economics , Hospitals, Proprietary/economicsABSTRACT
Demographic trends and budgetary constraints at many universities suggest that education will not be "business as usual" in the next several years. Academic programs in health care administration can enhance their ability to respond to these challenges by implementing stakeholder analysis as part of their strategic planning process. This article delineates the stakeholder groups which typically influence programs in health care administration and presents a systematic manner of analyzing their relationships to the program in terms of values and beliefs, power, cooperative potential, and likely issues. Actions to strengthen relationships with each stakeholder group are noted. Finally, the utility and limitations of stakeholder analysis are discussed.
Subject(s)
Hospital Administration/education , Investments/organization & administration , Schools, Health Occupations/organization & administration , Decision Making, Organizational , Demography , Education, Graduate/organization & administration , Faculty , Humans , Models, Theoretical , Motivation , Social Values , Students , United StatesABSTRACT
A case study of the proposed development of a regional children's health care system in South Texas is described. Strategic plans for the system are overviewed and the community response to plans are presented. The political, social responsibility and fiscal viability issues raised are reviewed and the research literature base relevant to the health care needs of a key (Hispanic) market is summarized.
Subject(s)
Child Health Services/organization & administration , Community Health Planning/organization & administration , Community-Institutional Relations , Politics , Social Responsibility , Child , Child Health Services/economics , Child Health Services/statistics & numerical data , Community Health Planning/economics , Health Services Needs and Demand , Health Services Research , Hispanic or Latino , Hospitals, Pediatric , Hospitals, Private , Humans , TexasABSTRACT
A large sample of patients (N = 763) with Tourette syndrome (TS) responded to a questionnaire dealing primarily with symptoms, treatment history, and associated disorders. The shrinking duration between symptom onset and diagnostic confirmation confirms that diagnostic awareness of TS is increasing. A significant proportion of the sample identified several common factors that occurred in the year before symptom onset. A significantly lower proportion of subjects whose initial symptoms included facial tics reported a positive response to haloperidol. Obsessive characteristics were associated with age and were more common in females. Patients with attention deficit disorder (ADD) had earlier age at onset of TS symptoms and were diagnosed earlier than patients without ADD. In general the data provide some support for a stress-diathesis model and also support previous suggestions about the genetics of Tourette syndrome and related conditions.
Subject(s)
Tourette Syndrome/genetics , Adolescent , Adult , Aged , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/genetics , Attention Deficit Disorder with Hyperactivity/psychology , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Neurologic Examination , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/genetics , Obsessive-Compulsive Disorder/psychology , Registries , Risk Factors , Stress, Psychological/complications , Tourette Syndrome/diagnosis , Tourette Syndrome/psychologyABSTRACT
Summer camps for juveniles with rheumatic disease are being offered increasingly as components of comprehensive treatment approaches, but the therapeutic value of these sessions is largely undetermined. This study attempted to judge the impact of a summer camping experience on two aspects of participants' psychosocial functioning, self-concept, and locus of control. Both of these constructs have been related to effective disease management. On both measures, the mean scores of 36 campers improved significantly following a week-long camp session, and these positive effects were maintained over a 6-month follow-up period. Campers who had attended previous camping sessions appeared to obtain maximal benefit, and male campers with rheumatic disease were identified as needing special attention. The study's limitations are discussed, and future research directions are outlined.
Subject(s)
Arthritis, Juvenile/rehabilitation , Camping , Adolescent , Arthritis, Juvenile/psychology , Child , Female , Humans , Internal-External Control , Male , Psychology, Social , Seasons , Self Concept , Sex CharacteristicsABSTRACT
Tourette Syndrome (TS) is an uncommon developmental disability characterized by repetitive and involuntary verbal and motor tics. A survey of all known affiliates of the Tourette Syndrome Association of Ohio was conducted to document the special problems and needs of the TS student. A total of 431 questionnaires was returned, and the types and frequency of interpersonal and academic school problems were found to be pervasive. Problems did not differ by grade level, but students medicating their TS symptoms experienced more problems. In most cases, current students described similar problems to adults, suggesting that recent attempts to provide optimal educational opportunities to all handicapped children have not been successful where TS is involved. The presence of a behavioral or learning disability diagnosis indicated that substantial percentages of respondents were in need of specialized educational services, but not all those in need were receiving them. Parents were generally satisfied with their child's education, but less satisfied when specialized education was involved. Suggestions are offered for more effectively dealing with the TS child in the classroom.
Subject(s)
Schools , Tourette Syndrome/rehabilitation , Adolescent , Adult , Child , Child, Preschool , Education, Special , Female , Humans , Male , Tourette Syndrome/drug therapy , Tourette Syndrome/psychologyABSTRACT
This study examines the system dimensions of need, barriers to receiving services, and utilization within a single mental health service area. The gap between estimates of service need and service utilization is conceptualized as due to a set of specific barriers covering the access attributes of availability, accessibility, acceptability and affordability. Data from community telephone surveys (N = 2183) of mental health need are analyzed to determine the relationship between the system dimensions of need, barriers and utilization. Respondents were able to distinguish among different types of service barriers. Those in the service gap were potentially more influenced by barriers than the rest of the sample, as were, paradoxically, those who had utilized services within the past year. The implications of these findings for service provision and system design are discussed.
Subject(s)
Community Mental Health Services/statistics & numerical data , Mental Disorders/therapy , Anxiety Disorders/therapy , Cognition Disorders/therapy , Depressive Disorder/therapy , Health Services Accessibility , Health Services Needs and Demand , Humans , Ohio , Risk , Social AdjustmentABSTRACT
Tourette Syndrome (TS) is an uncommon developmental disability characterized by repetitive and involuntary verbal and motor tics. A survey of all known affiliates of the Tourette Syndrome Association of Ohio was conducted. A total of 431 questionnaires was returned, and behavioral problems were found to be pervasive in Tourette people. Some 53.1 per cent of the sample had sought some form of counseling for these problems, but this counseling was generally not perceived as being very helpful. Medication was not reported to ameliorate behavioral problems. When compared to a normal population sample, self-ratings of mental health status were low among Tourette persons. Problems experienced by TS persons were aggregated into a Behavioral Problem Scale, which successfully discriminated between levels of need in TS persons.
Subject(s)
Mental Health , Tourette Syndrome/psychology , Adolescent , Adolescent Behavior , Adult , Child , Child Behavior , Counseling , Female , Humans , Male , Sex Factors , Surveys and QuestionnairesABSTRACT
Community surveys for needs assessment purposes have gained considerable popularity in recent years, yet the prevalence estimates of psychiatric impairment or mental health need vary widely across studies. It is hypothesized that part of this variability may reflect methodological concerns, in particular the directory listing status of respondents when telephone survey methods are employed. Using data from two independent community surveys, the mental health needs of listed versus unlisted subscribers were compared on a series of mental health scales. The implications of the differences observed are discussed both for further telephone needs assessment projects, as well as for service providers.
