Clinical Oversight Research Articles

A clinical information system strategic planning model for integrated healthcare delivery networks.

As healthcare organizations are transformed into consolidated healthcare delivery networks, their success is increasingly dependent on the integration and effectiveness of their clinical information systems (CIS). Greater financial investments are being made in CIS products and services to support processes related to clinical care oversight, direct care delivery, and ancillary clinical services. To make good investment decisions, these enterprises must engage in a comprehensive strategic planning process that tightly links their healthcare delivery network clinical strategy, CIS strategic vision, and specific CIS investments. The authors illustrate the linkages among these three strategic planning stages through the application of a clinical information system strategic planning model to a case example.

Seclusion and Restraint: A Review of Recent Literature

An October 1998 Hartford Courant investigative series highlighted alleged cases of brutality and death suffered by involuntarily secluded, restrained, and/or emergently medicated patients. The resulting public and professional furor prompted a spate of new federal regulations and legislative initiatives setting national standards for reporting and clinical oversight. These events provide stimulus for this literature review. Rates, duration, and methods of seclusion and restraint still vary widely. Little evidence is available to guide clinical practice regarding relative benefits and risks of various methods to control acute adult patient aggression; even less evidence exists in child and adolescent populations. Further efficacy and effectiveness studies are needed to address this issue. Various programmatic efforts successfully reduce seclusion and restraint-at times dramatically-and can be used as examples of systematic quality improvement so "best practices" may evolve and spread throughout psychiatric inpatient settings.

Is Clinical Research Oversight Adequate in the United States?

Is Clinical Research Oversight Adequate in the United States?

Form and Function of Mental Health Authorities at RWJ Foundation Program Sites: Preliminary Observations

The Robert Wood Johnson Foundation Program on Chronic Mental Illness provides support for broad change in the organization, financing, and delivery of services in public systems of care for chronic mentally ill persons. To address the lack of an organizational locus of responsibility in these systems, the foundation proposed that each of the nine cities participating in the program create a mental health authority that would centralize administrative, clinical, and fiscal oversight. The authors present site-by-site observations of the developing mental health authorities at the end of the program's two-and-a-half-year planning phase. They conclude that although the Robert Wood Johnson Foundation grant represented a significant incentive for innovation, at this relatively early stage in the demonstration authorities at only a few sites had achieved direct clinical responsibility for chronic mentally ill persons. Although services had expanded, no site had yet developed a comprehensive system of care that included inpatient services as well as a full range of ambulatory, housing, and social welfare services.

Rosemary In Wonderland: A Look At American Hospitals

Rosemary In Wonderland: A Look At American Hospitals

Burnout among CMHC psychiatrists and the struggle to survive.

Comments gathered in a national survey of community mental health center (CMHC) psychiatrists indicate that many suffer from burnout. Of the 96 respondents who provided comments, 46 expressed dissatisfaction with their work in CMHCs, 14 expressed satisfaction, and seven had mixed feelings. Factors contributing to the respondents' dissatisfaction included a lack of administrative support and validation, low pay, responsibility without authority, and pressure to sign documents related to patients unknown to them. Factors contributing to their satisfaction were having a variety of tasks, being valued for having uniquely comprehensive experience, being supported in the clinical oversight role, being in charge of CMHC operations, and working in a CMHC affiliated with an academic center or the medical community. The authors believe that CMHCs must redress the issues contributing to burnout among CMHC psychiatrists if they are to retain psychiatrists and provide quality patient care.

EMANUEL, EJ & GRADY, C. Four paradigms of clinical research and research oversight.

EMANUEL, EJ & GRADY, C. Four paradigms of clinical research and research oversight.