What health plans should know about clinical practice guidelines--round-table discussion. (1/211)

Quality is the watchword for health plans that wish to survive to see the new century, and accreditation by the National Committee for Quality Assurance is becoming quality's indispensable stamp. Practice guidelines are an imperative for that accreditation. Here's what seven managed care leaders had to say about guidelines in a recent round-table discussion.  (+info)

Organizational selection and assessment of women entering a surrogacy agreement in the UK. (2/211)

In the UK, surrogacy procedures are unregulated and not monitored. Information concerning the selection and assessment of intended (the mother commissioning) and surrogate mothers (the mother carrying and delivering the baby) is therefore not generally available (BMA, 1996). It is important to determine what type of assessment is used, and how selection takes place within the organizations dealing with surrogate motherhood arrangements. The present survey enquired about the incidence, selection and assessment procedures of all registered surrogate and commissioning couples, and aimed to find out what advice and support is given. Eight organizations took part in the survey, six were clinics and two agencies dealing with surrogate arrangements. Two voluntary organizations/helplines were also surveyed, but their data are not relevant to the results presented here. An interview and questionnaire approach was used. Psychosocial assessment was minimally addressed by all organizations, and no fixed procedures for assessment and selection were employed. Despite this, few incidences of controversial cases were reported. Confidence in this practice could be increased in the future if both parties embarking on a surrogacy arrangement knew they were properly selected and assessed. A regulatory body could monitor consistent use of professional evidence-based criteria prior to arrangements.  (+info)

Benchmarking organ procurement organizations: a national study. (3/211)

OBJECTIVE: An exploratory examination of the technical efficiency of organ procurement organizations (OPOs) relative to optimal patterns of production in the population of OPOs in the United States. DATA SOURCES: A composite data set with the OPO as the unit of analysis, constructed from a 1995 national survey of OPOs (n = 64), plus secondary data from the Association of Organ Procurement Organizations and the United Network for Organ Sharing. STUDY DESIGN: The study uses data envelopment analysis (DEA) to evaluate the technical efficiency of all OPOs. PRINCIPAL FINDINGS: Overall, six of the 22 larger OPOs (27 percent) are classified as inefficient, while 23 of the 42 smaller OPOs (55 percent) are classified as inefficient. Efficient OPOs recover significantly more kidneys and extrarenal organs; have higher operating expenses; and have more referrals, donors, extrarenal transplants, and kidney transplants. The quantities of hospital development personnel and other personnel, and formalization of hospital development activities in both small and large OPOs, do not significantly differ. CONCLUSIONS: Indications that larger OPOs are able to operate more efficiently relative to their peers suggest that smaller OPOs are more likely to benefit from technical assistance. More detailed information on the activities of OPO staff would help pinpoint activities that can increase OPO efficiency and referrals, and potentially improve outcomes for large numbers of patients awaiting transplants.  (+info)

Political analysis of health reform in the Dominican Republic. (4/211)

This article examines the major political challenges associated with the adoption of health reform proposals, through the experience of one country, the Dominican Republic. The article briefly presents the problems of the health sector in the Dominican Republic, and the health reform efforts that were initiated in 1995. The PolicyMaker method of applied political analysis is described, and the results of its application in the Dominican Republic are presented, including analysis of the policy content of the health reform, and assessment of five key groups of players (public sector, private sector, unions, political parties, and other non-governmental organizations). The PolicyMaker exercise was conducted in collaboration with the national Office of Technical Coordination (OCT) for health reform, and produced a set of 11 political strategies to promote the health reform effort in the Dominican Republic. These strategies were partially implemented by the OCT, but were insufficient to overcome political obstacles to the reform by late 1997. The conclusion presents six factors that affect the pace and political feasibility of health reform proposals, with examples from the case of the Dominican Republic.  (+info)

Dr Louis T. Wright and the NAACP: pioneers in hospital racial integration. (5/211)

Louis Tompkins Wright, the son of a man born into slavery, was an outstanding African American surgeon who devoted his life to the racial integration of health care in the United States. Despite the fact that both his father and stepfather were physicians, despite his innate intellectual gifts and disciplined character, Wright experienced discrimination throughout his life and career. This experience led him to fight for the rights of African Americans, both health care professionals and patients. In addition to making numerous contributions in the fields of surgery and infectious disease, Wright held leadership positions in the National Association for the Advancement of Colored People for more than 20 years, leaving a legacy of equity for African Americans in medical education and in health care.  (+info)

Public health aspects of the Rainbow Family of Living Light annual gathering--Allegheny National Forest, Pennsylvania, 1999. (6/211)

The Rainbow Family of Living Light (RFLL) is a loosely organized group that developed out of the late 1960s counterculture movement. RFLL has had a 2-week "Gathering for World Peace and the Healing of the Earth" in a different national forest each summer since 1972. For the June 21-July 10, 1999, gathering, RFLL selected the Allegheny National Forest in Pennsylvania. The site was not accessible by vehicle and was an hour's walk to the nearest road. No sanitary facilities were available, and water from streams was consumed without treatment. Approximately 20,000 persons attended from the United States and several foreign countries. The state health department requested federal assistance to establish and maintain public health surveillance and to advise on outbreak prevention and control. This report describes the public health aspects of the gathering and presents recommendations for the management of health risks at large outdoor events.  (+info)

Patient safety: a call to action: a consensus statement from the National Quality Forum. (7/211)

OBJECTIVE: The Institute of Medicine (IOM) and the Presidential Advisory Commission on Consumer Protection and Quality in the Healthcare Industry have both recently highlighted healthcare errors as a serious public health problem. An in-depth review of the issue was conducted by the National Quality Forum (NQF) in preparation for work the federal government has asked the NQF to do. PARTICIPANTS: The membership of the NQF includes a wide array of public and private health agencies, healthcare provider organizations, consumer groups, healthcare purchasers, and research and quality improvement organizations. EVIDENCE: Published literature, including more than 350 journal articles and over 30 books and monographs, were reviewed, and input was solicited from individuals and organizations known to be knowledgeable on the topic, including the Harvard University Executive Session on Medical Error, the VA National Patient Safety Center, the Joint Commission on Accreditation of Healthcare Organizations, the National Patient Safety Foundation, and the IOM. The principal observations and findings were collated; 10 high-priority strategic areas needing action were identified; and specific recommendations for each area were crafted. CONSENSUS PROCESS: A draft statement was prepared and submitted to the NQF membership and Directors, as well as to external reviewers. The statement was revised following subsequent rounds of review and comment, after which it was approved by the NQF Board of Directors. CONCLUSIONS: There is an urgent need to reduce healthcare errors; however, numerous barriers impede progress in this regard, including widespread misunderstanding about why healthcare errors occur, the prevailing culture of "name and blame" surrounding these events, lack of user-friendly error-reporting mechanisms, and fear of litigation if errors are acknowledged and reported. To eliminate these barriers, and to begin to reduce healthcare errors, the NQF recommends that concerted action be taken in the 10 strategic areas identified here.  (+info)

Paying for reproductive health services in Bangladesh: intersections between cost, quality and culture. (8/211)

In 1997 a consortium of non-governmental organizations (NGOs) in Bangladesh began to implement health sector reform measures intended to expand access to and improve the quality of family planning and other basic health services. The new service delivery model entails higher costs for clients and requires that they take greater initiative. Clients have to travel further to get certain services, and they have to pay more for them than they did under the previous door-to-door family planning model. This paper is based on findings from a qualitative study looking at client and community reactions to the programme changes. It examines a number of barriers to access and constraints to cost recovery, including gender, class and ideas about entitlements, the role of government and obligations among people. The NGOs want to maximize cost recovery while making the basic services they offer accessible to most people. The findings suggest that this requires more than the establishment of an appropriate pricing structure. Attitudes related to charging and paying for services must also change, along with the institutional policies and practices that support them.  (+info)