The Army's Community-Based Health Care Initiative: an innovative military case management program.

As more Army National Guard and U.S. Army Reserve soldiers are called to active duty, there has been a rise in injuries sustained or aggravated by deployment. This increase caused an overwhelming explosion in the number of soldiers requiring prolonged medical care. The U.S. Army developed a program to address Army National Guard and U.S. Army Reserve soldiers requiring extended recuperation periods. This article addresses the Army's Community-Based Health Care Initiative. This initiative entails case management through the use of technology involving fax, phone, and e-mail and focuses on reduction in the number of medical holdover soldiers at military treatment facilities. Community-based healthcare organizations allow Army National Guard and Army Reserve soldiers to receive medical care in their hometown while living at home, working for the military, and continuing to receive full benefits as an active duty soldier.

Communication channels to help build an international community of education and practice.

Two-way communication is required if nurses are to build knowledge networks of international communities of nursing education and practice. Are expensive new technologies feasible or preferred for effective communication and productive outcomes? In this report from a longstanding partnership between schools of nursing at Peking University and the University of Michigan, case study methodology is used to evaluate more than a decade of experience with communication modalities: in person, postal mail, express mail, e-mail, fax, telephone, hand delivery by other travelers, and Web sites. Although each education and practice community develops unique ways to build its shared knowledge, a communications plan is suggested, with use of multiple communication techniques, especially those that are low cost and the most dependable. High-cost technologies are not always feasible or preferred. For the project described, they were not necessary to the major outcome, a nursing education and practice network that resulted in the first nurse-managed community-based clinic in China.

Evaluation of a "formal" endocrinology curbside consultation service: advice by means of internet, fax, and telephone.

OBJECTIVE: To describe the development, implementation, and assessment of an Internet- and fax-based endocrinology curbside consultation service. METHODS: An Internet- and fax-based endocrinology consultation service was designed by developing a simple Web site so that requesting physicians could complete a form about the patient. Community and academic-based primary-care physicians were invited to use the service. One month after each consultation, a follow-up questionnaire about the effectiveness and use of the Internet and fax consultation service was sent to each physician who had requested the consultation. RESULTS: During the 5-month period in which the service was offered, 67 physicians requested a total of 85 "formal" endocrinology curbside consultations. Of these 85 requests, 46 were by e-mail, 31 by fax, and 8 by telephone. Follow-up questionnaires were returned by 61 of the 67 physicians who used the service. One hundred percent of the physicians found the service to be useful, and about 33% noted formal consultation had been avoided. In approximately 55% of the consultations, physicians indicated that the response caused them to alter the treatment of their patient. Consultation questions encompassed the full spectrum of endocrinology. The issues were approximately equally distributed among test interpretation, medication, and management. CONCLUSION: We successfully designed and implemented an Internet- and fax-based endocrinology curbside consultation service. This form of consultation was used by physicians and brought about change in the management of their patients.

Improving communication between hospital and community physicians. Feasibility study of a handwritten, faxed hospital discharge summary. Discharge Summary Study Group.

OBJECTIVE: To assess the timing, legibility, and completeness of handwritten, faxed hospital discharge summaries as judged by family physicians and to obtain their opinion on the information categories on a standardized discharge summary form. DESIGN: Fax survey of physicians for consecutive patients discharged from hospital over 8 weeks. SETTING: Three wards in a tertiary care teaching hospital. PARTICIPANTS: One hundred two family physicians and general practitioners practising in Hamilton, Ont. MAIN OUTCOME MEASURES: Proportions of summaries that were received, received within 48 hours of discharge, legible, and complete; types of information missing from incomplete summaries; proportion of physicians satisfied with the information categories. RESULTS: Of 271 consecutive patient discharges, 195 (72%) were eligible for study. Among those ineligible, 22 patients (8%) did not have a family doctor identified on their hospital records. Among records that did have a family physician identified, fax numbers were unavailable or unknown for 54 physicians (20%). One hundred two physicians completed 166 discharge summary assessments for a response rate of 85% (166/195). By 3 weeks after discharge, 138 discharge summaries (83%) had been received by patients' family doctors. Among those received, 86% were received within 48 hours of discharge; 92% were legible; and 88% were complete. Hospital doctors' signatures, patients' diagnoses, and follow-up plans were most frequently missing. Ninety-five percent of physicians were satisfied with the information categories included on the standardized form. CONCLUSIONS: Handwritten, faxed hospital discharge summaries were acceptable to family physicians for most patients. Criteria are needed for determining which patients require both handwritten and dictated discharge summaries.

High touch meets high tech. Distance mental health screening for rural youth using Teleform.

This article presents an overview of distance mental health screening using Teleform. This technology provides nurses with the ability to have questionnaires administered in one location then processed and scored rapidly at a location some distance away by using a facsimile system and Teleform. The authors examine the process of using Teleform, cite its advantages and disadvantages, discuss its application with rural youth, and suggest implications for school personnel and health-care providers. Technology has facilitated many changes in health-care delivery and increasingly will be instrumental in creating changes. Computer technology can help nursing deliver services swiftly to larger populations.