Joint Commission International accreditation: relationship to four models of evaluation.
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OBJECTIVE: To describe the components of the new Joint Commission International (JCI) accreditation program for hospitals, and compare this program with the four quality evaluation models described under the ExPeRT project (visitatie, ISO, EFQM, organizational accreditation). RESULTS: All the models have in common with the JCI program the use of explicit criteria or standards, and the use of external reviewers. The JCI program is clearly an organizational accreditation approach with evaluation of all the 'systems' of a health care organization. The JCI model evaluates the ability of an organization to assess and monitor its professional staff through internal mechanisms, in contrast with the external peer assessment used by the visitatie model. The JCI program provides a comprehensive framework for quality management in an organization, expanding the boundaries of the quality leadership and management found in the EFQM model, and beyond the quality control of the ISO model. The JCI organizational accreditation program was designed to permit international comparisons, difficult under the other models due to country specific variation. CONCLUSION: We believe that the organizational accreditation model, such as the international accreditation program, provides a framework for the convergence and integration of the strengths of all the models into a common health care quality evaluation model. (+info)
Bordering on environmental disaster.
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Millions of people live on the U.S.-Mexico border, drawn by employment opportunities from industry and agriculture, and booming growth is expected to continue in the coming decades. But the influx of people has long outstripped the capacity of border towns and cities to provide for their citizens, and a large percentage of the population lives in sprawling, underserviced shantytowns. Although investment in environmental infrastructure on both sides has led to improvements, shortages among necessities such as drinking water, wastewater treatment, and solid waste disposal are at crisis levels. In addition, a host of diseases including gastrointestinal infections, asthma, tuberculosis, multiple myeloma, systemic lupus erythematosus, hepatitis A, neural tube defects, and lead poisoning have been linked to environmental conditions on the border. Ongoing binational studies are attempting to define the breadth of the public and environmental health crisis and find ways to help make the border a healthier place. (+info)
Trusting in a better future: the global environment facility.
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Individual countries acting alone cannot solve environmental problems that span national borders. The Global Environment Facility (GEF) was created in 1991 to serve as a mechanism for international cooperation in the funding of grants to address concerns in four areas of the global environment: biological diversity, climate change, international waters, and ozone layer depletion. To date, more than 500 projects have been funded with over $2 billion of GEF funds and another $5 billion leveraged from public and private sources, including $2 billion in matching funds from developing countries. (+info)
Is the international prognostic score for advanced stage Hodgkin's disease applicable to early stage patients? German Hodgkin Lymphoma Study Group.
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BACKGROUND: The seven-factor International Prognostic Score (IPS) has been developed and verified for patients with advanced stage Hodgkin's disease (HD). This report aims to assess the predictive power of the IPS for early stage HD patients. PATIENTS AND METHODS: Data on patient characteristics, therapy and follow-up were available for 1424 adult patients in clinical stages I-IIIA treated for primary HD in two German Hodgkin's Lymphoma Study Group (GHSG) trials (1988-1994). Patients with risk factors or in stage IIIA received chemo radiotherapy (CMT; trial HD5); others received extended field radiotherapy (RT) alone (HD4). The IPS could be calculated for 712 HD5 and 249 HD4 patients (70%). The prognostic value of the IPS and its component factors was assessed using Cox proportional hazards regression. A search was made for additional factors which could add predictive power to the IPS. RESULTS: The IPS identified 40% of the unfavourable early stage patients with an 8% lower disease-free survival at six years (hazard ratio 1.66, P = 0.0018). The factor 'low albumin' was the only score component giving a significant individual contribution. Allowing for the IPS, extranodal involvement, particularly in stages IIB-IIIA, was associated with worse prognosis, but no further significantly prognostic factors were revealed. The IPS identified a similar hazard ratio in HD4, although here the effect was not significant. CONCLUSIONS: The IPS for advanced HD has modest predictive ability in unfavourable early stage patients. Modification of the IPS for use with early stages may improve its prognostic power. (+info)
Challenges for health systems in member countries of the Organisation for Economic Co-operation and Development.
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For reasons of equity most OECD countries have chosen to base their funding of health care mainly on public sources. There is an almost universal problem of affordability in the health systems of these countries, arising from the tension between the willingness of populations to pay taxes and the eagerness of patients to use health services where these are free or heavily subsidized at the point of use. These tensions are likely to be exacerbated by a surge of new medical technologies adding to demands for health care. Some observers have predicted the breakdown of publicly funded systems of health care under new spending pressures. However, governments can deploy a range of policies for handling new demands. They can also take comfort from the fact that many of them have already coped with successive waves of technological change in health care without abandoning their core commitment to the public funding of health systems. Furthermore, if standards of living continue to rise, public and private insurers should find it easier to obtain the revenues needed to pay for the improved health care expected by consumers. (+info)
International comparison of health care systems using resource profiles.
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The most frequently used bases for comparing international health care resources are health care expenditures, measured either as a fraction of gross domestic product (GDP) or per capita. There are several possible reasons for this, including the widespread availability of historic expenditure figures; the attractiveness of collapsing resource data into a common unit of measurement; and the present focus among OECD member countries and other governments on containing health care costs. Despite important criticisms of this method, relatively few alternatives have been used in practice. A simple framework for comparing data underlying health care systems is presented in this article. It distinguishes measures of real resources, for example human resources, medicines and medical equipment, from measures of financial resources such as expenditures. Measures of real resources are further subdivided according to whether their factor prices are determined primarily in national or global markets. The approach is illustrated using a simple analysis of health care resource profiles for Denmark, France, Germany, Sweden, the United Kingdom, and the USA. Comparisons based on measures of both real resources and expenditures can be more useful than conventional comparisons of expenditures alone and can lead to important insights for the future management of health care systems. (+info)
What can we learn from international comparisons of health systems and health system reform?
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Most commonly, lessons derived from comparisons of international health sector reform can only be generalized in a limited way to similar countries. However, there is little guidance as to what constitutes "similarity" in this respect. We propose that a framework for assessing similarity could be derived from the performance of individual policies in different contexts, and from the cause and effect processes related to the policies. We demonstrate this process by considering research evidence in the "public-private mix", and propose variables for an initial framework that we believe determine private involvement in the public health sector. The most influential model of public leadership places the private role in a contracting framework. Research in countries that have adopted this model suggests an additional list of variables to add to the framework. The variables can be grouped under the headings "demand factors", "supply factors", and "strength of the public sector". These illustrate the nature of a framework that could emerge, and which would help countries aiming to learn from international experience. (+info)
Behavioral toxicology of carbon disulfide and toluene.
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Organic solvents are pervasive in the communal and industrial environments. Although many are potent central nervous system agents, clearly delineated behavioral effects have played only a minor role in the formation of exposure standards. A comprehensive behavioral pharmacology and toxicology of these compounds is one aim of US/USSR collaboration. The current report describes some actions of carbon disulfide and toulene. Earlier data about the actions of carbon disulfide on pigeon operant performance indicated disruption of schedule-controlled key-pecking. Primate data are now described from a situation designed to determine aversive thresholds to electrical stimulation. Effective concentrations of carbon disulfide produced both a rise in the amount of electric shock tolerated and a diminution of the response force exerted by the monkeys. In experiments with toluene, pigeons were shown to elevate key-pecking rate in an operant situation at certain concentrations. Toluene also was studied for its capacity to maintain self-administration in the same way as drugs of abuse. Monkeys worked to gain access to toulene vapor just as they work for opiates or amphetamines. The current experiments demonstrate how comprehensive the range of behavioral toxicology needs to be to deal with environmental health issues. (+info)