Measuring healthcare integration: Operationalization of a framework for a systems evaluation of palliative care structures, processes, and outcomes

BACKGROUND: Healthcare integration is a priority in many countries, yet there remains little direction on how to systematically evaluate this construct to inform further development. The examination of community-based palliative care networks provides an ideal opportunity for the advancement of integration measures, in consideration of how fundamental provider cohesion is to effective care at end of life.

AIM: This article presents a variable-oriented analysis from a theory-based case study of a palliative care network to help bridge the knowledge gap in integration measurement.

DESIGN: Data from a mixed-methods case study were mapped to a conceptual framework for evaluating integrated palliative care and a visual array depicting the extent of key factors in the represented palliative care network was formulated.

SETTING/PARTICIPANTS: The study included data from 21 palliative care network administrators, 86 healthcare professionals, and 111 family caregivers, all from an established palliative care network in Ontario, Canada.

RESULTS: The framework used to guide this research proved useful in assessing qualities of integration and functioning in the palliative care network. The resulting visual array of elements illustrates that while this network performed relatively well at the multiple levels considered, room for improvement exists, particularly in terms of interventions that could facilitate the sharing of information.

CONCLUSION: This study, along with the other evaluative examples mentioned, represents important initial attempts at empirically and comprehensively examining network-integrated palliative care and healthcare integration in general.

People and places: Understanding geographical accuracy in administrative data from the census and healthcare systems

Administrative systems such as health care registration are of increasing importance in providing information for statistical, research, and policy purposes. There is thus a pressing need to understand better the detailed relationship between population characteristics as recorded in such systems and conventional censuses. This paper explores these issues using the unique Northern Ireland Longitudinal Study (NILS). It takes the 2001 Census enumeration as a benchmark and analyses the social, demographic and spatial patterns of mismatch with the health register at individual level. Descriptive comparison is followed by multivariate and multilevel analyses which show that approximately 25% of individuals are reported to be in different addresses and that age, rurality, education, and housing type are all important factors. This level of mismatch appears to be maintained over time, as earlier migrants who update their address details are replaced by others who have not yet done so. In some cases, apparent mismatches seem likely to reflect complex multi-address living arrangements rather than data error.

Effects of a green tax reform in Portugal: a general equilibrium analysis

Do ponto de vista da política económica, existe a possibilidade de utilizar a receita dos impostos ambientais para baixar os impostos sobre o trabalho, promovendo assim o emprego. Esta oportunidade surge na literatura como forma dos países industrializados responderem a um duplo desafio: um crescente nível de poluição e um decrescente nível de emprego. Alguns países tomaram já decisões no sentido de alcançar o “duplo dividendo”: melhorias ambientais e diminuição do desemprego. Os resultados teóricos, na sua maioria cépticos em relação à verificação do segundo dividendo, são substancialmente contrariados por uma série de estudos que utilizam modelos de equilíbrio geral. Pretendese com este trabalho fazer uma simulação para a economia portuguesa de uma reforma fiscal ambiental com as características referidas e a verificação da existência do “duplo dividendo”, através de um modelo computacional de equilíbrio geral. Para além disso, é feita uma análise dos impactos do Mercado Europeu de Licenças de Emissão, ao nível sectorial e regional, em Portugal, utilizando dados microeconómicos, com o objectivo de estudar as consequências ao nível das trasacções entre sectores e efeitos distributivos entre regiões.

A telematic platform towards regional connected healthcare

As tecnologias de informação e comunicação na área da saúde não são só um instrumento para a boa gestão de informação, mas antes um fator estratégico para uma prestação de cuidados mais eficiente e segura. As tecnologias de informação são um pilar para que os sistemas de saúde evoluam em direção a um modelo centrado no cidadão, no qual um conjunto abrangente de informação do doente deve estar automaticamente disponível para as equipas que lhe prestam cuidados, independentemente de onde foi gerada (local geográfico ou sistema). Este tipo de utilização segura e agregada da informação clínica é posta em causa pela fragmentação generalizada das implementações de sistemas de informação em saúde. Várias aproximações têm sido propostas para colmatar as limitações decorrentes das chamadas “ilhas de informação” na saúde, desde a centralização total (um sistema único), à utilização de redes descentralizadas de troca de mensagens clínicas. Neste trabalho, propomos a utilização de uma camada de unificação baseada em serviços, através da federação de fontes de informação heterogéneas. Este agregador de informação clínica fornece a base necessária para desenvolver aplicações com uma lógica regional, que demostrámos com a implementação de um sistema de registo de saúde eletrónico virtual. Ao contrário dos métodos baseados em mensagens clínicas ponto-a-ponto, populares na integração de sistemas em saúde, desenvolvemos um middleware segundo os padrões de arquitetura J2EE, no qual a informação federada é expressa como um modelo de objetos, acessível através de interfaces de programação. A arquitetura proposta foi instanciada na Rede Telemática de Saúde, uma plataforma instalada na região de Aveiro que liga oito instituições parceiras (dois hospitais e seis centros de saúde), cobrindo ~350.000 cidadãos, utilizada por ~350 profissionais registados e que permite acesso a mais de 19.000.000 de episódios. Para além da plataforma colaborativa regional para a saúde (RTSys), introduzimos uma segunda linha de investigação, procurando fazer a ponte entre as redes para a prestação de cuidados e as redes para a computação científica. Neste segundo cenário, propomos a utilização dos modelos de computação Grid para viabilizar a utilização e integração massiva de informação biomédica. A arquitetura proposta (não implementada) permite o acesso a infraestruturas de e-Ciência existentes para criar repositórios de informação clínica para aplicações em saúde.

Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK

Aim There is growing interest in the contribution of public-private partnerships (PPPs) bridging the shortage of financial resources and management expertise in developing public healthcare infrastructure. However, few studies have evidenced PPPs’ ability in increasing efficiency in public procurement of primary healthcare infrastructure. The aim of this study was to assess to what extent PPPs would increase efficiency in public procurement of primary healthcare facilities. Subject and Methods A qualitative analysis, adopting a realistic research evaluation method, used data collected from a purposive sample of public (n=23) and private sector staff (n=2) directly involved in the UK National Health Service Local Improvement Finance Trust (LIFT). Results We find a positive association of LIFT helping to bridge public sector capital shortages for developing primary care surgeries. LIFT is negatively associated with inefficient procurement because it borrows finance from private banks, leaving public agencies paying high interest rates. The study shows that some contextual factors and mechanisms in LIFT play a major part in obstructing public staff from increasing procurement efficiency. Conclusion PPP’s ability to increase efficiency may be determined by contextual factors and mechanisms that restrict discretion over critical decisions by frontline public sector staff. Developing their capacity in monitoring PPP activities may make partnerships more efficient.

Challenges and Opportunities in Healthcare Volunteer Management: Insights from Volunteer Administrators

Volunteer administrators from 105 hospitals in five states in the northeast and southern United States provided open-ended survey responses about what they perceived to be the most pressing challenges and opportunities facing healthcare volunteer management. Taken together, these 105 hospitals used a total of 39,008 volunteers and 5.3 million volunteer hours during a 12-month period between 2010 and 2011. A qualitative content analysis of administrator responses suggests that primary challenges include volunteer recruitment and retention, administrative issues, and operational difficulties brought about by the current economic crisis. Key opportunities include more explicitly linking the volunteer function to hospital outcomes and community impact, expanding volunteer recruitment pools and roles and jobs, and developing organizational support for volunteers and making the volunteer management function more efficient and effective.

The First Government of Northern Ireland, Education Reform, and the Failure of Anti-populist Unionism, 1921–1925

This article examines education reform under the first government of Northern Ireland (1921–5). This embryonic period offered the Ulster Unionist leadership a chance to construct a more inclusive society, one that might diminish sectarian animosities, and thereby secure the fledgling state through cooperation rather than coercion. Such aspirations were severely tested by the ruling party’s need to secure the state against insurgency, and, more lastingly, to assuage the concerns of its historic constituency. The former led to a draconian security policy, the latter to a dependency on populist strategies and rhetoric. It is argued here, however, that this dependency was not absolute until July 1925. Before that, the Belfast government withstood growing pressure from populist agitators to reverse controversial aspects of its education reforms, only relenting when Protestant disaffection threatened the unity of the governing party and the existence of the state.

Reform, Standards and Teacher Identity: Challenges of Sustaining Commitment

Teacher commitment has been found to be a critical predictor of teachers’ work performance, absenteeism, retention, burnout and turnover, as well as having an important influence on students’ motivation, achievement, attitudes towards learning and being at school (Firestone (1996). Educational Administration Quarterly, 32(2), 209–235; Graham (1996). Journal of Physical Education, Recreation and Dance, 67(1), 45–47; Louis (1998). School Effectiveness and School Improvement, 9(1), 1–27; Tsui & Cheng (1999). Educational Research and Evaluation, 5(3), 249–268). It is also a necessary ingredient to the successful implementation, adaptation or resistance reform agendas. Surprisingly, however, the relationship between teachers’ motivation, efficacy, job satisfaction and commitment, and between commitment and the quality of their work has not been the subject of extensive research. Some literature presents commitment as a feature of being and behaving as a professional (Helsby, Knight, McCulloch, Saunders, & Warburton (1997). A report to participants on the professional cultures of Teachers Research Project, Lancaster University, January). Others suggest that it fluctuates according to personal, institutional and policy contexts (Louis (1998). School Effectiveness and School Improvement, 9(1), 1–27) and identify different dimensions of commitment which interact and fluctuate (Tyree (1996). Journal of Educational Research, 89(5), 295–304). Others claim that teachers’ commitment tends to decrease progressively over the course of the teaching career (Fraser, Draper, & Taylor (1998). Evaluation and Research in Education, 12 (2), 61–71; Huberman (1993). The lives of teachers. London: Cassell). In this research, experienced teachers in England and Australia were interviewed about their understandings of commitment. The data suggest that commitment may be better understood as a nested phenomena at the centre of which is a set of core, relatively permanent values based upon personal beliefs, images of self, role and identity which are subject to challenge by change which is socio-politically constructed.

Prospects and Problems for Religious Education in England, 1967-1970: Curriculum Reform in Political Context

This article provides an historical case study of an abortive attempt to revise policy and legislation relating to Religious Education (RE) in English schools in the late 1960s and early 1970s. Drawing upon published sources, including parliamentary debates, as well as previously unutilised national archival sources from the Department of Education and Science, it comments upon events which have hitherto been omitted from the historiography of RE, but which help to contextualise significant changes in RE theory and practice at that time. Moreover, it demonstrates that the current parlous state of RE in schools is in part the result of latent and longstanding issues and problems, rather than a consequence of present-day government policy alone. Therefore, in reviewing and developing RE policies and practices, all stakeholders are urged to look more closely at both changes and continuities in the subject’s past and the contexts in which they occurred.

Prediction and Privacy in Healthcare Analytics

Thesis (Master's)--University of Washington, 2016-03

A review of dynamic Bayesian network techniques with applications in healthcare risk modelling

Coping with an ageing population is a major concern for healthcare organisations around the world. The average cost of hospital care is higher than social care for older and terminally ill patients. Moreover, the average cost of social care increases with the age of the patient. Therefore, it is important to make efficient and fair capacity planning which also incorporates patient centred outcomes. Predictive models can provide predictions which their accuracy can be understood and quantified. Predictive modelling can help patients and carers to get the appropriate support services, and allow clinical decision-makers to improve care quality and reduce the cost of inappropriate hospital and Accident and Emergency admissions. The aim of this study is to provide a review of modelling techniques and frameworks for predictive risk modelling of patients in hospital, based on routinely collected data such as the Hospital Episode Statistics database. A number of sub-problems can be considered such as Length-of-Stay and End-of-Life predictive modelling. The methodologies in the literature are mainly focused on addressing the problems using regression methods and Markov models, and the majority lack generalisability. In some cases, the robustness, accuracy and re-usability of predictive risk models have been shown to be improved using Machine Learning methods. Dynamic Bayesian Network techniques can represent complex correlations models and include small probabilities into the solution. The main focus of this study is to provide a review of major time-varying Dynamic Bayesian Network techniques with applications in healthcare predictive risk modelling.

The Big Society and the conjunction of crises: Justifying welfare reform and undermining social housing

This article considers the idea of the ‘Big Society’ as part of a long-standing debate about the regulation of housing. Situating the concept within governance theory, the article considers how the idea of the Big Society was used by the UK coalition government to justify a radical restructuring of welfare provision. The fundamental rationale for this transformation was that the UK was forced to respond to a conjunction of crises in morality, the state, ideology and economics. Representing a fundamental departure from earlier attempts at welfare reform, the government has undertaken a reform programme which has had a severe effect on the social housing sector. The article argues that the result has been a combination of libertarianism and authoritarianism, alongside an intentionally more destructive combination of stigmatization and fatalism. The consequence is to undermine the principle of social housing which will not only prove detrimental for residents but raises significant dilemmas for those working in the housing sector.