ABSTRACT
BACKGROUND: Few empirical studies have been conducted on the continuity of rehabilitation services, despite the fact that it may affect clinical outcomes, patient satisfaction, the perception of quality, and safety. OBJECTIVES: The aim of this study was to explore experiences and perceptions of inpatients receiving physical rehabilitation in an acute care hospital and how these experiences may have led to perceived gaps in the continuity of rehabilitation care. METHOD: Using qualitative research methods, fifteen semi-structured interviews were conducted with patients who received physical rehabilitation during hospital stay in an acute care hospital in Murcia, Spain. Interviews were transcribed verbatim, analyzed, and grouped into predetermined and emergent codes. RESULTS: Patients described three main themes in continuity of care: informational, management, and relational continuity. Several factors were described as influencing the perceived gaps in these three types of continuity. Informational continuity was influenced by the transfer of information among care providers. Relational continuity was influenced by patient-therapist relations and consistency on the part of the provider. Management continuity was influenced by consistency of care between providers and the involvement of patients in their own care. CONCLUSION: The participants in this study identified several gaps in three types of continuity of care (informational, management, and relational). Inpatients often perceive their experiences of rehabilitation as being disconnected or incoherent over time.
Subject(s)
Continuity of Patient Care , Managed Care Programs/standards , Rehabilitation/methods , Humans , Inpatients , Patient SatisfactionABSTRACT
Gubernatorial administrations in New Mexico have initiated four overhauls of the publicly funded behavioral health care system over the past two decades. The most recent effort, Centennial Care, was implemented under a Section 1115 Medicaid waiver in January 2014. The authors describe Centennial Care, which closely resembles the now defunct restructuring of the public system that introduced Medicaid managed behavioral health care to the state in 1997. They also note disruptions in services to clients and hardships for providers, described locally as a "behavioral health crisis," that resulted from actions taken in 2013 by the current gubernatorial administration to force the takeover of 15 nonprofit service delivery agencies by five Arizona companies. These actions led to an onsite investigation by the Centers for Medicare and Medicaid Services.
Subject(s)
Health Policy , Managed Care Programs/organization & administration , Medicaid/organization & administration , Mental Health Services/organization & administration , Humans , Managed Care Programs/standards , Medicaid/standards , Medicare/organization & administration , Medicare/standards , Mental Health Services/standards , New Mexico , United StatesABSTRACT
In 1994 the government of Puerto Rico adopted a capitated managed health care system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special health care needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special health care needs in capitated managed health care programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special health care needs under a capitated managed health care system.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Chronic Disease , Disabled Children , Patient Satisfaction , Managed Care Programs/standards , Caregivers , Data Collection , Puerto Rico , Time FactorsABSTRACT
OBJECTIVE: To evaluate the consistency of pediatric asthma care with the National Asthma Education and Prevention Program Guidelines. DESIGN: Cross-sectional survey at 2 managed care organizations in the United States (winter 1997-1998). The participants were parents of children (n = 318) age 5 to 17 years with asthma. There were no interventions. The outcome measures were indicators of care in 4 domains: (1) periodic physiologic assessment, (2) proper use of medications, (3) patient education, and (4) control of factors contributing to asthma severity. RESULTS: Of 533 eligible patients with asthma, 318 (60%) parents responded; 59% of children were male, 76% were white, and 60% were aged 5 to 10 years. Deficiencies in care were identified in all care domains including, for patients with moderate and severe persistent symptoms, only 55% used long-term control medication daily, 49% had written instructions for handling asthma attacks, 44% had instructions for adjustment of medication before exposures, 56% had undergone allergy testing, and 54% had undergone pulmonary function testing. CONCLUSIONS: There are significant opportunities to improve the quality of care for children with asthma enrolled in managed care. A comprehensive approach to improving care may be necessary to address multiple aspects of care where opportunities exist.
Subject(s)
Asthma/therapy , Guideline Adherence/standards , Managed Care Programs/standards , Pediatrics/standards , Practice Guidelines as Topic , Quality of Health Care , Adolescent , Asthma/diagnosis , Asthma/etiology , Attitude to Health , Child , Child, Preschool , Cross-Sectional Studies , Female , Guideline Adherence/statistics & numerical data , Health Services Research , Humans , Male , Managed Care Programs/statistics & numerical data , Midwestern United States , Needs Assessment/organization & administration , New England , Outcome Assessment, Health Care , Parents/education , Parents/psychology , Patient Education as Topic/standards , Pediatrics/methods , Pediatrics/statistics & numerical data , Quality Indicators, Health Care , Severity of Illness Index , Surveys and Questionnaires , Total Quality Management/organization & administrationABSTRACT
In 1994 the government of Puerto Rico adopted a capitated managed health care system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special health care needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special health care needs in capitated managed health care programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special health care needs under a capitated managed health care system.
Subject(s)
Chronic Disease , Disabled Children , Managed Care Programs/standards , Patient Satisfaction , Adolescent , Adult , Caregivers , Child , Child, Preschool , Data Collection , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Puerto Rico , Time FactorsSubject(s)
Managed Care Programs/standards , Physician-Patient Relations , Chile , Ethics, Medical , HumansABSTRACT
El crecimiento cada vez mayor de los costos que demanda la atención de la salud, coloca a la sociedad y a los gobiernos en situaciones conflictivas y espinosas y creemos que es útil pretender soluciones de tipo coyuntural. Con frecuencia nos olvidamos que dentro la Seguridad Social, la atención de la salud representa un compromiso social, cuyo verdadero alcance no se puede captar, si el análisis no se sitúa en una prespectiva de largo alcance y que incluya inexorablemente la cobertura recional y completa del nivel primario de salud
Subject(s)
Male , Female , Humans , Health Strategies , Health Plan Implementation , Managed Care Programs , Managed Care Programs/statistics & numerical data , Managed Care Programs/standards , Managed Care Programs/organization & administration , Analysis of Situation , Vision, OcularABSTRACT
Con información derivada de los trabajos de investigación sobre cáncer cervical de un grupo multidisciplinario del Centro de Investigaciónes en Salud Poblacional, se propone una reorganización del Programa de Detección Oportuna de Cáncer en México para mejorar su eficiencia y efectividad. Para lograr que la detección oportuna de cáncer cervical en México sea efectiva se necesita que exista una infraestructura de prevención disponible, que sea accesible y proporcione atención de calidad, en función de utilizar los métodos más deseables y factibles en el programa de detección. La iniciativa propuesta tiene como componentes principales: Políticas globales del programa de DOC. 1) Una modificación de la norma técnica para aumentar la periodicidad del papanicolaou de uno a tres años, en mujeres con dos pruebas de Papanicolaou previas negativas. 2) Una regionalización del programa, con áreas de influencia no mayores de 250,000 mujeres en riesgo. 3) Inclusión del Papanicolaou en el paquete universal de servicios de salud en México. 4) Cobertura universal y gratuita. Vigilancia epidemiológica: 5) Un sistema de vigilancia epidemiológica del programa, que es concebido como el conjunto de acciones sistematizadas y continuas tendientes a prevenir y/o resolver oportunamente problemas o situaciones que impidan el mayor beneficio o que incrementen los riesgos a los pacientes a través de cinco elementos fundamentales: evaluación, monitoreo, diseño, desarrollo y cambio organizacional. Se hace explícito que no sólo es necesario evaluar, sino también cambiar a la organización para prevenir o corregir oportunamente los problemas, así como la necesidad de un flujo de información de cada uno de los componentes del programa. En servicios de salud: 6) Reorganización del programa de DOC. 7) Mecanismos de control de calidad en la obtención del espécimen que incluye mecanismos de acreditación y registro de los centros de obtención de Papanicolaou. 8) Regulación institucional y gubernamental de la práctica de la citotecnología, para garantizar precisión diagnóstica, que incluye creación de escuelas de citotecnología en unidades de patología de hospitales generales, homogeneización de nomenclatura diagnóstica, así como mecanismos de acreditación y registro de centros de lectura de citotecnología, mediante certificación periódica de citotecnólogos y control de calidad interna y externa...
Subject(s)
Humans , Female , Health Policy , Organizational Policy , Managed Care Programs/standards , Managed Care Programs/organization & administration , Health Promotion/organization & administration , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control , Vaginal SmearsABSTRACT
In the second part of a three-part series on patient-centered asthma care, the authors describe the eight critical elements of multidisciplinary care management for patients with moderate to severe asthma.