Local health department perspectives on linkages among birthing hospitals.
(25/75)
OBJECTIVES: To describe perinatal linkages among hospitals, changes in their numbers and their impact on relationships among high-risk providers in local communities. STUDY DESIGN: Data were obtained about the organization of perinatal services in 1996-1999 from a cross-sectional study evaluating fetal and infant mortality review (FIMR) programs nationwide. Geographic areas were sampled based on region, population density, and the presence of a FIMR. A local health department representative was interviewed in 76% (N=193) of eligible communities; 188 provided data about hospitals. RESULTS: Linkages among all hospitals were reported in 143 communities and with a subspecialty hospital in 122. All but 12 communities had a maternity hospital, and changes in the number of hospitals occurred in 49 communities. Decreases in the number of Level II hospitals were related to changes in relationships among providers of high-risk care for mothers and newborns; they were associated with changing relationships only for mothers in Level I hospitals. These relations were noted only where established provider relationships existed. CONCLUSIONS: Decreases in the number of maternity hospitals affect provider relationships in communities, but only where there are established linkages among hospitals. (+info)
Partnerships between health care organizations and medical schools in a rapidly changing environment: a view from the delivery system.
(26/75)
BACKGROUND AND OBJECTIVES: The Undergraduate Medical Education for the 21st Century (UME-21) project encouraged the formation or enhancement of partnerships between medical schools and health care organizations distinct from the traditional teaching hospitals. The purpose was to prepare medical students in nine content areas that were components of the UME-21 project. Despite their importance today to medical schools, such partnerships with health care organizations are a challenge to develop and maintain in the midst of a rapidly changing health care environment. This article categorizes the partnerships formed and discusses the benefits and the barriers encountered in such collaborations. METHODS: Information about the partnerships was abstracted from written reports from each of the UME-21 partner schools. Additional information was obtained from personal communications with external project representatives and from a post-project survey presented to all UME-21 partner schools. RESULTS: The eight partner schools established or enhanced 32 educational partnerships with external organizations. External partner organizations contributed to curriculum planning and implementation, course development and presentation, and provision of clinical sites and preceptors. Twenty-seven of 32 initial affiliations continued in some form beyond the contract period. CONCLUSIONS: Partnerships formed as part of the UME-21 project improved medical students' exposure to the health care system and their knowledge and skills for effective practice in the 21st century health system. Barriers encountered included financial pressures, changes in leadership, different organizational missions and priorities, and preexisting prejudices against new relationships. Factors associated with successful partnerships include the presence of a health care organization and an academic "champion" dedicated to the project, strong individual relationships, and a medical school commitment to involve external partners. (+info)
Characteristics of dental school feeder institutions.
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A major challenge faced by all dental schools is the need to attract highly qualified student applicants. The purpose of this study was to use 2002-03 AADSAS data to identify and characterize feeder colleges and universities that are the major source of applicants to U.S. dental schools. Feeder schools were defined as any institutions with five or more applicants, and minority-feeder schools as those with two or more minority applicants. Feeder schools were ranked by their total numbers of applicants (Category 1) and by their ratio of applicants to total undergraduate enrollment (Category 2). Feeder institutions were compared using total enrollment, degree status, geographic distribution, religious affiliation, numbers of minority applicants, and college admissions selectivity criteria. The top fifty Category 1 schools had an average enrollment of over 19,000 students and an average of sixty-seven applicants. The top fifty Category 2 schools had an average enrollment of approximately 8,500 students and an average of forty-nine applicants. Less than 1 percent of applicants from the top feeder institutions attended the nation's most competitive schools. California and Utah accounted for 28 percent of the total applicants from feeder institutions, followed by Florida (6.2 percent) and New York (5.7 percent). Seventeen of the top twenty-five Category 2 schools (68 percent) were affiliated with or had student bodies associated with a particular religion, with the Seventh-Day Adventist and Mormon institutions accounting for 544 applicants. The majority of all applicants from feeder institutions attended schools in the Southwest. The majority of black and Hispanic feeder institutions were in Florida, Tennessee, Louisiana, and Puerto Rico. Results suggest that factors such as school size, geographic location, religious affiliation, and admissions selectivity criteria of colleges and universities may have a direct impact on the dental applicant pool. (+info)
Consumers as tutors - legitimate teachers?
(28/75)
BACKGROUND: The aim of this study was to research the feasibility of training mental health consumers as tutors for 4th year medical students in psychiatry. METHODS: A partnership between a consumer network and an academic unit in Psychological Medicine was formed to jointly develop a training package for consumer tutors and a curriculum in interviewing skills for medical students. Student attitudes to mental health consumers were measured pre and post the program. All tutorial evaluation data was analysed using univariate statistics. Both tutors and students evaluated the teaching program using a 4 point rating scale. The mean scores for teaching and content for both students and tutors were compared using an independent samples t-test. RESULTS: Consumer tutors were successfully trained and accredited as tutors and able to sustain delivery of tutorials over a 4 year period. The study found that whilst the medical students started with positive attitudes towards consumers prior to the program, there was a general trend towards improved attitude across all measures. Other outcomes for tutors and students (both positive and negative) are described. CONCLUSIONS: Consumer tutors along with professional tutors have a place in the education of medical students, are an untapped resource and deliver largely positive outcomes for students and themselves. Further possible developments are described. (+info)
Is there evidence that recent consolidation in the health insurance industry has adversely affected premiums?
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James Robinson suggests that recent consolidation in the insurance market has been a cause of higher health insurance prices (premiums). Although the recent consolidation among health insurers and rising premiums are indisputable, it is unlikely that consolidation has had any adverse effect on premiums nationwide, and Robinson provides no data that suggest otherwise. Specifically, he does not present data showing an increase in concentration in any relevant market during the past few years, let alone any resulting increase in premiums. Health insurance consolidation in certain local markets could adversely affect premiums, but it seems clear that it is not a major national antitrust issue. (+info)
Planning and implementing the first stage of an oral health program for the Pika Wiya Health Service Incorporated Aboriginal community in Port Augusta, South Australia.
(30/75)
The oral health of the Indigenous community in South Australia's mid-north has been a concern for some years. There has been a history of under-utilisation of available dental services by the local community. This is in part due to the services not meeting their cultural and holistic health care needs. The Indigenous community resolved to establish a culturally sensitive dental service within the Aboriginal Health Service already operating in Port Augusta in South Australia's mid-north. To achieve this, a partnership between Pika Wiya Health Service Incorporated, the South Australian Dental Service, the University of Adelaide Dental School and the South Australian Centre for Rural and Remote Health was formed. The aim of the project partners was to establish a culturally sensitive, quality dental service that caters to the needs of the Indigenous community serviced by Pika Wiya Health Service Inc. This article describes the process of planning and implementing the first stage of this project. (+info)
Profit-seeking, corporate control, and the trustworthiness of health care organizations: assessments of health plan performance by their affiliated physicians.
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OBJECTIVE: To compare the relative trustworthiness of nonprofit and for-profit health plans, using physician assessments to measure dimensions of plan performance that are difficult for consumers to evaluate. DATA SOURCE: A nationally representative sample of 1,621 physicians who responded to a special topics module of the 1998 Socioeconomic Monitoring System Survey (SMS), fielded by the American Medical Association. Physicians assessed various aspects of their primary managed care plan, defined as the plan in which they had the largest number of patients. STUDY DESIGN: Plan ownership was measured as the interaction of tax-exempt status (nonprofit versus for-profit) and corporate control (single state versus multistate health plans). Two sets of regression models are estimated. The dependent variables in the regressions are five measures of performance related to plan trustworthiness: two related to deceptive practices and three to dimensions of quality that are largely hidden from enrollees. The first set (baseline) models relate plan ownership to trustworthy practices, controlling for other characteristics of the plan, the marketplace for health insurance, and the physician respondents. The second (interactive) set of models examines how the magnitude of ownership-related differences in trustworthiness varies with the market share of nonprofit plans in each community. DATA COLLECTION: The 1998 SMS was fielded between April and September of 1998 by Westat Inc. The average time required for a completed interview was approximately 30 minutes. The overall response rate was 52.2 percent. PRINCIPAL FINDINGS: Compared with more local nonprofit plans, for-profit plans affiliated with multistate corporations are consistently reported by their affiliated physicians to engage in practices associated with reduced trustworthiness. Nonprofit plans affiliated with multistate corporations have more physician-reported practices associated with trustworthiness than do for-profit corporate plans on four of five outcomes, but appear less trustworthy than locally controlled nonprofits on two of the five measures. The magnitude of these ownership-related differences declines as the market share of nonprofit plans rises: for two of the five measures, ownership-related differences in practices related to trustworthiness are entirely eliminated when the nonprofits enroll more than 30 percent of the local market. CONCLUSIONS: The combination of for-profit ownership and multistate corporate control appears to consistently and substantially reduce physician-reported measures related to the trustworthiness of health plans. Because this is the fastest growing form of managed care, these results raise concerns about further erosion of trust in American health care. Preserving a substantial market niche for nonprofit plans appears to reduce this erosion and should be considered by policymakers as a strategy for restoring trust in the health care system. (+info)
Drew/Meharry/Morehouse Consortium Cancer Center: an approach to targeted research in minority institutions.
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This article describes the process by which three private minority medical schools planned and developed a consortium cancer research center focusing on the prevention of cancer in the African-American population. Several lessons were learned that may have relevance as minority schools search for ways to improve the health status of blacks. (+info)