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Waste management is a critical issue for public health care services. Although operations management provides several tools for completing some stages of this process, the definition of a storage policy and the optimal packing of ...
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Waste management is a critical issue for public health care services. Although operations management provides several tools for completing some stages of this process, the definition of a storage policy and the optimal packing of boxes with sharps waste in a storage area of a health care center are particular problems of high complexity. In this paper, a two-stage approach is proposed: The first stage considers the subproblem associated with the selection of the best policy. The second stage addresses the issue of waste packaging optimization. The multicriteria aspect of the first stage is addressed using the analytic hierarchy process, whereas the optimization of waste packaging is conducted using two heuristic methods: a sorting heuristic and the simulated annealing method. The best alternative method that is identified for the storage area considers the establishment of a specific room that is intended for the temporary storage of sharps waste. Furthermore, both heuristic methods provide suitable waste packaging options. The results suggest that the most appropriate method for each health care center must be selected by considering the order and sizes of the packing boxes, the required computational time and the required packaging efficiency.
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Abstract This article addresses the urgent need for a transition in health care to deal with the increasing prevalence of chronic diseases and associated rapid rise of health care costs. Chronic diseases evolve and are predominant...
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Abstract This article addresses the urgent need for a transition in health care to deal with the increasing prevalence of chronic diseases and associated rapid rise of health care costs. Chronic diseases evolve and are predominantly related to lifestyle and environment. A shift is needed from a reductionist repair mode of thinking, toward a more integrated biopsychosocial way of thinking about health. The aim of this article is to discuss the opportunities that complexity science offer for transforming health care toward optimal treatment and prevention of chronic lifestyle diseases. Health and health care is discussed from a complexity science perspective. The benefits of concepts developed in the field of complexity science for stimulating transitions in health care are explored. Complexity science supports the elucidation of the essence of health processes. It provides a unique perspective on health with a focus on the relationships within networks of dynamically interacting factors and the emergence of health out of the organization of those relationships. Novel types of complexity science–based intervention strategies are being developed. The first application in practice is the integrated obesity treatment program currently piloted in the Netherlands, focusing on health awareness and healing relationships. Complexity science offers various theories and methods to capture the path toward unhealthy and healthy states, facilitating the development of a dynamic integrated biopsychosocial perspective on health. This perspective offers unique insights into health processes for patients and citizens. In addition, dynamic models driven by personal data provide simulations of health processes and the ability to detect transitions between health states. Such models are essential for aligning and reconnecting the many institutions and disciplines involved in the health care sector and evolve toward an integrated health care ecosystem.
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Background : In order to offer better services in health care centers, awareness of perception and expectations of services recipients in these centers, and determination of existing gap between these two components, have a substa...
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Background : In order to offer better services in health care centers, awareness of perception and expectations of services recipients in these centers, and determination of existing gap between these two components, have a substantial role. This study was performed to assess the quality of health care services provided in health care centers of Khorramabad city using SERVQUAL model in 2010. Materials and Methods: In this descriptive cross-sectional study, 650 clients of health care centers of Khorramabad city were selected by stratified and random sampling method. The standard SERVQUAL questionnaire was used for data collection. Data were analyzed by SPSS 16 using descriptive statistics and Wilcoxon, Mann-Whitney, Kruskal-Wallis tests and Spearman correlation coefficient. Results: In all 5 dimensions of offering services (including tangibility, reliability, responsiveness, assurance, and empathy), negative quality gaps were observed. The highest quality gap average was in empathy dimension and the lowest quality gap average was in reliability dimension. Between age of clients and quality gap score, reverse association was observed (P=0.026). There was no statistically significant relationship between the quality gap with sex and education level of clients. Conclusion: Expectations of the clients in all aspects of offering services are beyond than their perceptions, and needed to improve the quality of offering services in these centers in all the dimensions especially empathy dimension. It is recommended that the quality of the offering services be assessed periodically in these centers and intervene to improve the delivering of health services.
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Health centers (HCs) funded by the Health Resources and Services Administration provide access to primary and preventive care to almost 26 million vulnerable or medically underserved people. Over half a million women receive prena...
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Health centers (HCs) funded by the Health Resources and Services Administration provide access to primary and preventive care to almost 26 million vulnerable or medically underserved people. Over half a million women receive prenatal care from those HCs annually, however little is known about their care. We used the 2014 Health Center Patient Survey and the 2013 Pregnancy Risk Assessment Monitoring System to report on rates of 10 prenatal counseling measures among low-income HC patients, compared with their counterparts from the general U.S. population. A majority of HC patients reported receiving counseling, ranging from 70% to 88% depending on the measure. Health center patients are receiving similar or better care than their national counterparts for several measures of prenatal care counseling, including seatbelt use, physical abuse, smoking, and HIV testing. Rates of counseling are comparable across groups for screening tests, signs of preterm labor, and depression. However, there may be room for improvement in counseling HC patients regarding breastfeeding, alcohol, and safe medications.
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PURPOSE: Increasing health care expense and rising numbers of uninsured Americans have led many to propose a national health insurance. This study describes the process, rationale, and requirements in creating a regional pediatric...
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PURPOSE: Increasing health care expense and rising numbers of uninsured Americans have led many to propose a national health insurance. This study describes the process, rationale, and requirements in creating a regional pediatric surgical service in the setting of a single-payer system. METHODS: Our health care system consists of 10 medical centers providing comprehensive care to more than 3 million members. All services are provided by salaried physicians/practitioners to prepaid members. Before July 2004, pediatric surgical care was performed at multiple medical centers with many services contracted out. Starting July 2004, a multidisciplinary, comprehensive pediatric perioperative plan was established. Implementation has occurred in steps; current status and preliminary results are reviewed. RESULTS: Strict guidelines for pediatric anesthesia and requirements for support services, personnel, and equipment were defined. Pediatric surgery is now performed at 3 community medical centers and 1 tertiary, tea
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PURPOSE: Increasing health care expense and rising numbers of uninsured Americans have led many to propose a national health insurance. This study describes the process, rationale, and requirements in creating a regional pediatric...
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PURPOSE: Increasing health care expense and rising numbers of uninsured Americans have led many to propose a national health insurance. This study describes the process, rationale, and requirements in creating a regional pediatric surgical service in the setting of a single-payer system. METHODS: Our health care system consists of 10 medical centers providing comprehensive care to more than 3 million members. All services are provided by salaried physicians/practitioners to prepaid members. Before July 2004, pediatric surgical care was performed at multiple medical centers with many services contracted out. Starting July 2004, a multidisciplinary, comprehensive pediatric perioperative plan was established. Implementation has occurred in steps; current status and preliminary results are reviewed. RESULTS: Strict guidelines for pediatric anesthesia and requirements for support services, personnel, and equipment were defined. Pediatric surgery is now performed at 3 community medical centers and 1 tertiary, tea
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The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce repo...
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The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.
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Abstract Objective To examine and compare health care provider perceptions for integrating family caregivers into patient encounters and other processes of care by medical specialty. Data Sources/Setting Data were from 19 intervie...
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Abstract Objective To examine and compare health care provider perceptions for integrating family caregivers into patient encounters and other processes of care by medical specialty. Data Sources/Setting Data were from 19 interviews conducted in 2018, 10 with primary care or palliative care providers and nine with proceduralists or interventionists in practices located in Minnesota, Florida, and Arizona. Study Design This was a qualitative study using data collected from one‐on‐one, semi‐structured interviews with physicians. Data Collection By using purposeful “maximum variation” sampling to capture differences between primary and palliative care providers and proceduralists/interventionists, data were collected, reviewed, coded, and then analyzed using inductive content analysis with a constant comparison approach. Primary Findings Primary care providers described a lack of organizational and institutional resources to support caregivers. Accordingly, they were compelled to curb caregiver engagement in order to meet patients' clinical care needs within the time and workflow demands in encounters. Proceduralists and interventionists described the need to assess caregivers for suitability to provide care during intense periods of treatment. They reported having access to more formal organizational resources for supporting caregivers. Overall, providers described a paradox, where caregivers are seen as contributing value to patient encounters until they need training, education, or support to provide care, at which point they become burdensome and require more time and resources than are typically available. Conclusions Results highlight how organizational constraints inhibit caregiver engagement in patient encounters and influence provider attitudes about engaging caregivers and assessing their unmet needs. Findings also provide insights into challenges across practice types for implementing state and federal laws that promote caregiver engagement.
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Rationale, aims, and objectives Medication-related problems are frequent and can lead to serious adverse events resulting in increased morbidity, mortality, and costs. Medication use in frail older patients is even more complex. T...
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Rationale, aims, and objectives Medication-related problems are frequent and can lead to serious adverse events resulting in increased morbidity, mortality, and costs. Medication use in frail older patients is even more complex. The aim of this study was to investigate the effect of a pharmacist-led medicines management model among older patients at admission, during inpatient stay and at discharge on medication-related readmissions. Method A randomized controlled trial conducted at the acute admission unit in a Danish hospital with acutely admitted medical patients, randomized to either a control group or one of two intervention groups. The intervention consisted of pharmacist-led medication review and patient interview upon admission (intervention ED) or pharmacist-led medication review and patient interview upon admission, medication review during inpatient stay, and medication report and patient counselling at discharge (intervention STAY). Results In total, 600 patients were included. The pharmacist identified 920 medication-related problems with 57% of the recommendations accepted by the physician. After 30 days, 25 patients had a medication-related readmission, with no statistical significant difference between the groups on either primary or secondary outcomes. Conclusions This study showed that a clinical pharmacist can be used to identify and solve medication-related problems, but this study did not find any effect on the selected outcomes. The frequency of medication-related readmissions was low, leaving little room for improvement. Future research should consider other study designs or outcome measures.
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