Care Policy Development Research Articles

Developing consumer-directed care for people with a disability: 10 lessons for user participation in health and community care policy and program development

This paper outlines 10 lessons derived from the development of a consumer-directed care program for families with disabled children in Melbourne, Australia. The following program elements proved to be of importance over the course of the development process: (1) research participants should be involved as early as possible; (2) an open, inclusive communication style in conjunction with a good understanding of potential concerns and a careful framing of the policy issue is required to build trust and allow meaningful collaboration; (3) various strands of evidence have to be woven together; (4) ongoing commitment and support from management and key stakeholders; (5) effective knowledge transfer and cultural change processes; (6) capacity building; (7) mediation of power differentials; (8) community building; (9) participant re-engagement strategies; and (10) solid project management skills.

Explaining Differences in Child Care Policy Development in France and the USA: Norms, Frames, Programmatic Ideas

This article provides an answer to the question of why government support for child care policies and programs in the United States remains weak, despite increasing levels of women’s labor market participation and a relatively strong women’s movement, but strong in France, a country that has had lower levels of women’s labor market participation as well as a much weaker women’s movement. While those differences can be explained in part by economic and political interests and institutional and broad cultural differences, a theoretically richer understanding emerges when one examines how the three kinds of ideas underpinning these policy choices — norms, frames, and programmatic ideas — helped shape policies that emerged within specific actor, institutional, and cultural contexts.

Current Funding and Financing Issues in the Australian Hospice and Palliative Care Sector

This article overviews current funding and financing issues in the Australian hospice and palliative care sector. Within Australia, the major responsibilities for managing the health care system are shared between two levels of government. Funding arrangements vary according to the type of care. The delivery of palliative care services is a State/Territory responsibility. Recently, almost all States/Territories have developed overarching frameworks to guide the development of palliative care policies, including funding and service delivery structures. Palliative care services in Australia comprise a mix of specialist providers, generalist providers, and support services in the public, nongovernment, and private sectors. The National Palliative Care Strategy is a joint strategy of the Commonwealth and States that commenced in 2002 and includes a number of major issues. Following a national study in 1996, the Australian National Subacute and Nonacute Patient (AN-SNAP) system was endorsed as the national casemix classification for subacute and nonacute care. Funding for palliative care services varies depending on the type of service and the setting in which it is provided. There is no national model for funding inpatient or community services, which is a State/Territory responsibility. A summary of funding arrangements is provided in this article. Palliative care continues to evolve at a rapid rate in Australia. Increasingly flexible evidence-based models of care delivery are emerging. This article argues that it will be critical for equally flexible funding and financing models to be developed. Furthermore, it is critical that palliative care patients can be identified, classified, and costed. Casemix classifications such as AN-SNAP represent an important starting point but further work is required.

Causes of death and associated conditions (Codac) – a utilitarian approach to the classification of perinatal deaths

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes.We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions.The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal).For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured.The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most common clinical scenarios for future study and comparisons.

The Impact of Professional Development in Family Child Care: A Practice-Based Approach

Research Findings: The purpose of this mixed methods study was to examine the efficacy of a practice-based approach to professional development for family child care providers working in low-income communities. This approach included a literacy coaching component that anchors knowledge in practice. One hundred and twenty-eight family child care providers were randomly assigned to three groups: a language and literacy course plus coaching, the course only, and control. Quantitative results revealed that providers who received the course plus coaching experienced statistically and educationally significant improvements in their literacy practice compared to the other two groups. Qualitative data described specific areas in early literacy that were improved as a result of this professional development intervention. Practice or Policy: Implications of these findings for child care policy and professional development programs for family child care providers are discussed

Nursing policy research: turning evidence-based research into health policy

This book describes key issues related to the dwindling nurse supply, most of the causes of which are well known, and outlines recent research and strategies to enhance the recruitment, education, and retention of the nursing workforce. It emphasizes the role of doctoral prepared nurses in health care policy development and illustrates how research findings can be utilized to generate evidence-based policies that support growth in the workforce. It fosters improvements in all nursing work environments to assure long-term retention.Contributors represent leading academic institutions, foundations, health policy groups including the Agency for Healthcare Research & Quality (US Dept of Health & Human Services), and nursing centers focusing on workforce research and policy.This book covers latest research findings on nurse staffing levels and patient outcomes and nurse recruitment and retention. It examines nursing education issues such as the faculty shortage, recruitment of high school students, and the role of clinical simulation in teaching. It describes how nursing workforce centers are combating the nursing shortage, effective methods to forecast nurse supply and demand, and how to secure funding for workforce projects.

Strengthening care of injured children globally

Part of the solution to the growing problem of child injury is to strengthen the care that injured children receive. This paper will point out the potential health gains to be made by doing this and will then review recent advances in the care of injured children in individual institutions and countries. It will discuss how these individual efforts have been aided by increased international attention to trauma care. Although there are no major, well-funded global programmes to improve trauma care, recent guidance documents developed by WHO and a broad network of collaborators have stimulated increased global attention to improving planning and resources for trauma care. This has in turn led to increased attention to strengthening trauma care capabilities in countries, including needs assessments and implementation of WHO recommendations in national policy. Most of these global efforts, however, have not yet specifically addressed children. Given the special needs of the injured child and the high burden of injury-related death and disability among children, clearly greater emphasis on childhood trauma care is needed. Trauma care needs assessments being conducted in a growing number of countries need to focus more on capabilities for care of injured children. Trauma care policy development needs to better encompass childhood trauma care. More broadly, the growing network of individuals and groups collaborating to strengthen trauma care globally needs to engage a broader range of stakeholders who will focus on and champion the improvement of care for injured children.

O campo de atenção à saúde de sujeitos com problemáticas decorrentes do uso de álcool: apontamentos para a formulação de práticas de cuidado

The problems caused by the harmful use of alcohol bring significant impacts to the public health field and require the development of attention and health care policies. In this scenario, the implementation of an integral care network is emphasized, consisting of actions and services of all assistance levels which respond to the complex needs of individuals. In this network, we focus on the role of Psychosocial Care Centers to patients with disorders in consequence of the harmful use and/or alcohol or other drugs dependence - CAPSad. Located on the territory where the attended individuals live, such services may be privileged places to the articulation of actions and contexts and to the construction of singular therapeutic projects, committed to the principle of integral care and to the complex world of users needs.

Breast cancer-related preferences among women with and without BRCA mutations

Preference ratings are used to quantify quality of life in analyses used for health care policy making. Subjects indicated how many years of their life expectancy they would trade to avoid BRCA mutations, breast/ovarian cancer, and five preventive measures including prophylactic surgery, annual mammograms, and annual magnetic resonance imaging (MRI). Among 243 respondents, both the 83 women with mutations and the 160 controls rated mammography highest (most favorably), MRI next highest, having a child with a mutation lowest, and ovarian cancer next lowest. Controls rated prophylactic surgery higher than cancer (P < 0.01), but women with mutations did not. In logistic regression, controls were twice as willing as women with mutations to trade time except for screening modalities; younger, lower-income, and non-white women were more willing to trade time than older, higher-income, and white women. Our findings support the use of average-risk individuals' time trade-off preference ratings for health care policy development.

APIC State-of-the-art Report: The role of the infection preventionist in emergency management

BackgroundThis report summarizes the scope and role of infection preventionists in emergency management for all types of disasters. Preventing the transmission of infectious agents during a disaster is an essential component of emergency management. Previous disasters have illustrated the need for better infection prevention and the involvement of an infection prevention professional in planning for and responding to such events.MethodsAn evidence-based approach was used, consisting of a literature review and review by members of the Association for Professionals in Infection Control and Epidemiology, Inc, Emergency Preparedness Committee.ResultsNine domains were identified that describe the role of the infection preventionist in emergency management: knowledge of disasters and emergency management, assessing readiness and emergency management plans, infection prevention coverage, participation in disaster response and recovery, health care policy development, surveillance, patient management, physical plant issues, and infection preventionist as educator. Details for each domain are provided.ConclusionInfection preventionists need to become more involved in emergency management at the personal, facility, and community level. This report outlines the infection preventionist's responsibilities related to emergency management.

The Impact of Technology on Health Care Cost and Policy Development

The Impact of Technology on Health Care Cost and Policy Development

Translating research into maternal health care policy: a qualitative case study of the use of evidence in policies for the treatment of eclampsia and pre-eclampsia in South Africa

BackgroundFew empirical studies of research utilisation have been conducted in low and middle income countries. This paper explores how research information, in particular findings from randomised controlled trials and systematic reviews, informed policy making and clinical guideline development for the use of magnesium sulphate in the treatment of eclampsia and pre-eclampsia in South Africa.MethodsA qualitative case-study approach was used to examine the policy process. This included a literature review, a policy document review, a timeline of key events and the collection and analysis of 15 interviews with policy makers and academic clinicians involved in these policy processes and sampled using a purposive approach. The data was analysed thematically and explored theoretically through the literature on agenda setting and the policy making process.ResultsPrior to 1994 there was no national maternal care policy in South Africa. Consequently each tertiary level institution developed its own care guidelines and these recommended a range of approaches to the management of pre-eclampsia and eclampsia. The subsequent emergence of new national policies for maternal care, including for the treatment of pre-eclampsia and eclampsia, was informed by evidence from randomised controlled trials and systematic reviews. This outcome was influenced by a number of factors. The change to a democratic government in the mid 1990s, and the health reforms that followed, created opportunities for maternal health care policy development. The new government was open to academic involvement in policy making and recruited academics from local networks into key policy making positions in the National Department of Health. The local academic obstetric network, which placed high value on evidence-based practice, brought these values into the policy process and was also linked strongly to international evidence based medicine networks. Within this context of openness to policy development, local researchers acted as policy entrepreneurs, bringing attention to priority health issues, and to the use of research evidence in addressing these. This resulted in the new national maternity care guidelines being informed by evidence from randomised controlled trials and recommending explicitly the use of magnesium sulphate for the management of eclampsia.ConclusionNetworks of researchers were important not only in using research information to shape policy but also in placing issues on the policy agenda. A policy context which created a window of opportunity for new research-informed policy development was also crucial.

Center‐Based Early Childhood Education and Care in China: Policies, Trends, and Implications

The development of early childhood education and care (ECEC) policies and programs in China has been closely intertwined with social, economic, and demographic changes. This article systematically reviews center‐based ECEC policies and programs in China and presents the major trends and implications for future research and policy. The focus of China’s ECEC policy has shifted from health and custodial care to nurturing and child‐centered education since the economic reforms and the one‐child policy were launched in the late 1970s. Empirical data show that the costs of ECEC services have been continuously increasing. Both the number of children enrolled and the overall enrolment rates have declined during the late 1990s but they have increased slightly since 2001. The ECEC programs vary substantially in every regard by urban or rural residence, type of organization, and region. The quality of center‐based ECEC programs in China is still quite low, indicated by their high child–teacher ratios and low levels of education among principals and teachers relative to developed countries. Children living in rural areas or less developed regions and those from low‐income families suffer from fewer resources and lower quality ECEC as compared to their peers. These problems must be addressed by future policy interventions.

Increasing Individual Responsibility in Dutch Health Care: Is Solidarity Losing Ground?

This article presents various developments in Dutch health care policy toward a greater role for individual financial responsibility, such as cost-control measures, priority setting, rationing, and market reform. Instead of the collective responsibility that is characteristic of previous times, one can observe in government policies an increased emphasis on the need for individuals to take care of one's own health and health care needs. Moreover, surveys point to decreasing levels of public support for "unlimited" solidarity and "irresponsible" health behavior. This article attempts to answer the question of how these policies and public attitudes are limiting the ethical principles of solidarity and equal access to care that have long guided Dutch health care policy making. The authors argue that from a moral point of view, the increased emphasis on individual responsibility is acceptable as long as it does not affect solidarity with those weak and vulnerable groups who are not able to take individual responsibility, such as the demented and mentally handicapped.

The Impact of Technology on Health Care Cost and Policy Development

As health care spending in the United States continues to increase at a pace significantly faster than that of other sectors of the economy, there seems to be greater interest and willingness to consider the root causes of the rise and to explore options for reform. Some of the reasons for cost escalation are associated with a growing and aging population that all too often makes inappropriate personal choices, but others are clearly attributable to growth in the cost of drugs, hospital and nursing home care, provider reimbursement, and durable medical equipment. Some health care economists have suggested that the rapid introduction of new technologies has also played a major role. Vendors understandably desire early market penetration of any new device or technology, but often this may be accomplished before significant evidence of benefit is available. Our current system of device approval unlinked to coverage and payment has produced further disruption in the system. The nature of the problem and consideration of various factors in the introduction, implementation, and evaluation of new technologies will be considered.

When the Private Sphere Goes Public: Exploring the Issues Facing Family Caregiver Organizations in the Development of Long-Term Care Policies

SUMMARY Though family caregiving forms the backbone of the long-term care system in the United States, long-term care policies have traditionally focused on paid services that frail older people and people with disabilities utilize for their day-to-day functioning. Part of the exclusion of family caregiving from the long-term care discourse stems from the traditional separation of the private sphere, where family caregiving occurs, from the public sphere of policy making. However, the passage of the Family and Medical Leave Act (FMLA), the National Family Caregiver Support Program (NFCSP) and Medicaid waiver legislation may reflect recent changes in the government's position on their role in addressing issues related to the “private spheres.” In this article, we explore the nature of family caregiving in the United States, the divide between the public and private spheres and provide an overview of family caregiving-related policies and programs in the U.S. In our review, we examine the provisions in the FMLA, NFCSP, and Medicaid waiver legislation that support family caregiving efforts. We also examine the roles of family caregiver organizations in making family caregiving an important element of long-term care policy and influencing policy-making.

The Use of Complementary and Alternative Medicine among Chinese Canadians: Results from a National Survey

This study examines the relationship between Chinese Canadian ethnicity and the use of complementary and alternative medicine (CAM) and explores some of the factors that contribute to CAM use among this visible minority group. Using data from cycle 2.1 of the Canadian Community Health Survey (2003), we use multivariate logistic regression to investigate the extent to which CAM use varies among Chinese Canadians and non-Chinese Canadians. Two three-way interactions, which demonstrate how the combination of certain identity markers increases their predictive value within the model, are also examined. The use of CAM varies according to ethnicity, with Chinese Canadians being more likely to use than non-Chinese Canadians. The findings also indicate that cultural factors play a key role in establishing the necessary conditions for increasing the likelihood of CAM use for Chinese Canadians. Findings are discussed in terms of their implications for health care policy and program development.

Ethnic differences in self-rated and functional health: does immigrant status matter?

The current study examines self-rated health status and functional health differences between first-generation immigrant and Canadian-born (CB) persons who share the same ethnocultural origin, and the extent to which such differences reflect social structural and health-related behavioural contexts. Multivariate analyses of data from the 2000/2001 Canadian Community Health Survey indicate that first-generation immigrants of Black and French ethnicity tend to have better health than their CB counterparts, while the opposite is true for those of South Asian and Chinese origins, providing evidence that for these groups, immigrant status matters. West Asians and Arabs and other Asian groups are advantaged in health regardless of country of birth. Health differences between ethnic foreign-born and CB persons generally converge after controlling for sociodemographic, socioeconomic status (SES), and lifestyle factors. Analysis of the data does however reveal extensive ethnocultural disparities in self-rated and functional health within both the immigrant and CB populations. Implications for health care policy and programme development are discussed.

Determining caseloads in the community care of frail older people with chronic illnesses

The purpose of this paper is to discuss and critique the literature related to the measurement of caseloads by sociomedical case managers in the context of community care for frail older people. As a result of reduced mortality rates, there is an ageing, chronically ill population in need of long-term continuity of care. Case management is a model of care designed to maintain the quality of life of frail older people living in the community whilst constraining the associated costs of care. A review of the literature was undertaken to examine methods of determining caseloads for frail older people in the community setting to identify where investigations are absent or not robust. An absence of empirically tested approaches to determining caseloads and the wide variability in caseloads in caring for frail older people was evident. Predictors of variations in case management resources have been described at both the programme and client level, although controversy about the validity of these predictors, such as age and functional status, has been reported. The ageing population is a vulnerable group, and is entitled to live out their lives in the comfort and familiarity of their own homes where possible. Coordinated and supportive healthcare organizations and health system policies are critical to support empirically tested caseload indexes. These findings have implications for quality of care, planning and workforce policy development for our increasingly aged society. Recommendations for further research conclude this paper.

Sustainable Practice Improvements: Impact of the Comprehensive Advanced Palliative Care Education (CAPCE) Program

This paper describes an education program designed to improve palliative care practice through the development of workplace hospice palliative care resources (PCRs), and its impact on knowledge transfer and longer-term changes to clinical practice. Evaluation methods included pre- and post-program questionnaires, and a survey of learners' (n=301) perceptions of program learning strategies. Interviews (n=21) were conducted with a purposeful sample of PCRs and representatives from their work sites. Ratings of the sessions indicated that they were relevant to learners' clinical practice. At follow up, the majority of learners (83%) continued to serve as PCRs. Many positive effects were identified, including enhanced pain and symptom management, staff education, and development of care policies and guidelines. Management support, particularly the prioritization of palliative care and staff development, were factors facilitating sustained implementation. These findings highlight the importance of multimodal learning strategies and supportive work environments in the development of PCRs to enhance palliative care practice.