Healthcare Alliance Research Articles

Yoga and Healthcare in the United Kingdom

The emergence of yoga therapy in the United Kingdom began about 45 years ago with the emergence of yoga therapy organizations that offered both treatment and training. The integration of yoga into the National Health Service (NHS) is gradually happening Because: (a) yoga research supports its efficacy as a cost-effective, preventive and complementary treatment for a host of non-communicable diseases; and (b) the escalating economic burden of long-term conditions is overwhelming the NHS. The NHS is actively developing 'sustainability and transformation plans' that include yoga. Chief among these is 'social prescribing,' which empowers patients with complex health needs through activities groups. These activities reduce sedentary habits and social isolation, while helping patients to be more self-reliant. The NHS has allocated £450 million in funding to implement a variety of programs for its own staff, in which staff yoga classes were expressly mentioned. The yoga community is mobilizing forces and applying for funding to pilot relevant NHS staff yoga courses that can support the service in achieving its vision. Research shows that integrating yoga therapy for the treatment of low back pain (LBP) into the NHS would result in significant cost savings as compared with usual care. The National Institute for Health and Care Excellence (NICE) Guidelines on LBP and sciatica include yoga as one of the recommended treatments for these conditions. Three groups of yoga teachers, using different yoga practices, have gained traction with the NHS for the application of yoga therapy to LBP. Many regional hospitals in England have yoga classes. The NHS Choices website, which conveys information to the public regarding treatment options, has a page dedicated to the health benefits of yoga. Several institutions offer comprehensive training programs in yoga therapy and yoga therapy is recognized as an official profession. The Yoga in Healthcare Alliance has been established to help integrate yoga therapy into the NHS. This consists of parliamentarians, leaders in the NHS, yoga researchers, health professionals, and representatives from leading yoga organizations.

Yoga and Healthcare in the United Kingdom.

The emergence of yoga therapy in the United Kingdom began about 45 years ago with the emergence of yoga therapy organizations that offered both treatment and training. The integration of yoga into the National Health Service (NHS) is gradually happening Because: (a) yoga research supports its efficacy as a cost-effective, preventive and complementary treatment for a host of non-communicable diseases; and (b) the escalating economic burden of long-term conditions is overwhelming the NHS. The NHS is actively developing 'sustainability and transformation plans' that include yoga. Chief among these is 'social prescribing,' which empowers patients with complex health needs through activities groups. These activities reduce sedentary habits and social isolation, while helping patients to be more self-reliant. The NHS has allocated £450 million in funding to implement a variety of programs for its own staff, in which staff yoga classes were expressly mentioned. The yoga community is mobilizing forces and applying for funding to pilot relevant NHS staff yoga courses that can support the service in achieving its vision. Research shows that integrating yoga therapy for the treatment of low back pain (LBP) into the NHS would result in significant cost savings as compared with usual care. The National Institute for Health and Care Excellence (NICE) Guidelines on LBP and sciatica include yoga as one of the recommended treatments for these conditions. Three groups of yoga teachers, using different yoga practices, have gained traction with the NHS for the application of yoga therapy to LBP. Many regional hospitals in England have yoga classes. The NHS Choices website, which conveys information to the public regarding treatment options, has a page dedicated to the health benefits of yoga. Several institutions offer comprehensive training programs in yoga therapy and yoga therapy is recognized as an official profession. The Yoga in Healthcare Alliance has been established to help integrate yoga therapy into the NHS. This consists of parliamentarians, leaders in the NHS, yoga researchers, health professionals, and representatives from leading yoga organizations.

Practice and insights of a healthcare alliance development: experiences of a hospital in Xinjiang

The paper covered dominant models and organization of healthcare alliances in Xinjiang, illustrating the hospital group model, synergy development model, focused partnership support model, three-level integration model, and other business models. As described by the authors, healthcare alliances in Xinjiang, thanks to telemedicine, have achieved initial success by means of disciplines support, primary care human resources, new technologies and new service spreading, and promotion of appropriate medical techniques, in such aspects as regional medical cooperation, population benefits and medical resources sharing. Key words: Xinjiang; Healthcare alliance; Telemedicine; Medical resources; Resource sharing

Regional longitudinal healthcare alliances in China: development and policy suggestions

The development status of regional longitudinal healthcare alliances in China was analyzed in the paper. As found by the authors, such existing problems as the healthcare administrative system and fiscal input system, the crisis of confidence on primary medical institutions, poor information platforms, and limited means of medical insurance payment, constitute roadblocks for healthcare alliances to play their roles. Proposals of the paper cover such grounds as follows: the government to make a top-down design and a longitudinal and integrated healthcare system can be built; to build a corporate structure for the alliances, with greater fiscal support; to reform the medical insurance payment practice for integrating interests of medical associations; to clarify the responsibilities of tertiary hospitals, for building a win-win mechanism among stakeholders, and improving the information sharing platform. These measures, if in place, can propel the healthy development of healthcare alliances in China. Key words: Regional longitudinal; Healthcare alliance; Hierarchical medical system; Development status; Policy suggestions

Synergy dilemma of healthcare alliances and trust-based countermeasures

Synergy is key to the formation of a community of interests and responsibilities for a healthcare alliance. This paper analyzed the management synergy dilemma and countermeasures of the alliance, in such terms as its model selection, function orientation and governance; its two-way referral, drug interchange and homogeneity of medical quality; its human resource two-way flow, equipment resource sharing and information platforms unification; as well as its medical insurance policy, financial subsidy and personnel system. On such basis, countermeasures were proposed based on trust. Key words: Healthcare alliance; Synergy; Dilemma; Trust; Countermeasures

Prevalence of intestinal parasitic infection and associated risk factors among village health volunteers in rural communities of southern Thailand

BackgroundIntestinal parasitic infections remain prevalent and constitute a public health problem in certain rural areas of Thailand. Village health volunteers (VHVs), who are members of a Thai healthcare alliance, function as key providers of health prevention measures, disease control, and health education and share national health promotion campaigns with community members. This study is aimed at evaluating the prevalence, intensity, and risk factors for intestinal parasitic infection in VHVs in order to design community awareness and health education campaigns for the target population.MethodsThis cross-sectional study was conducted between January to April 2016 among village health volunteers (VHVs) from four sub-districts of Nopphitam District, Nakhon Si Thammarat Province, southern Thailand. Subjects for the study were selected using a simple random sampling method. Socio-demographic variables and risk factors were collected by a structured questionnaire. Stool specimens were collected and processed using direct wet mount and formol-ether concentration techniques to determine the presence of parasites and modified Kato-Katz thick smear to determine the intensity of infection.ResultsA total of 324 VHVs were enrolled. The overall prevalence of intestinal helminths was 9.3% (95% confidence interval [CI]: 6.3–13.0). The prevalence of hookworm, Strongyloides stercoralis, and Trichuris trichiura were 8.0% (95% CI: 5.3–11.5), 0.9% (95% CI: 0.2–2.7), and 0.3% (95% CI: 0–1.7), respectively. Mean intensity of hookworm infection was 1732 eggs per gram of stool. The prevalence was lower for protozoan infection than for helminth infection. Blastocystis hominis accounted for the highest percentage of intestinal protozoan infections 4.0% (95% CI: 2.2–6.8), followed by Giardia intestinalis 0.6% (95% CI: 0–2.2). No statistically significant difference was observed in the prevalence of intestinal parasitic infection among sub-districts (p > 0.05). Having dogs at home was associated with soil-transmitted helminth (STH) infection in study participants (Crude prevalence ratio [CPR]: 2.3; 95% CI: 1.0–5.2).ConclusionsThis study is the first to describe the prevalence of intestinal parasitic infection VHVs from southern Thailand. Hookworm infection is more prevalent than other types of STH infection. The development of community awareness campaigns and appropriate control measures should be considered to reduce the prevalence of hookworm infection, especially among VHVs who are the key persons providing health education to the community.

Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature

BackgroundMost conventional treatment for musculoskeletal conditions continue to show moderate effects, prompting calls for ways to increase effectiveness, including drawing from strategies used across other health conditions. Therapeutic alliance refers to the relational processes at play in treatment which can act in combination or independently of specific interventions. Current evidence guiding the use of therapeutic alliance in health care arises largely from psychotherapy and medicine literature. The objective of this review was to map out the available literature on therapeutic alliance conceptual frameworks, themes, measures and determinants in musculoskeletal rehabilitation across physiotherapy and occupational therapy disciplines.MethodsA scoping review of the literature published in English since inception to July 2015 was conducted using Medline, EMBASE, PsychINFO, PEDro, SportDISCUS, AMED, OTSeeker, AMED and the grey literature. A key search term strategy was employed using “physiotherapy”, “occupational therapy”, “therapeutic alliance”, and “musculoskeletal” to identify relevant studies. All searches were performed between December 2014 and July 2015 with an updated search on January 2017. Two investigators screened article title, abstract and full text review for articles meeting the inclusion criteria and extracted therapeutic alliance data and details of each study.ResultsOne hundred and thirty articles met the inclusion criteria including quantitative (33%), qualitative (39%), mixed methods (7%) and reviews and discussions (23%) and most data came from the USA (23%). Randomized trials and systematic reviews were 4.6 and 2.3% respectively. Low back pain condition (22%) and primary care (30.7%) were the most reported condition and setting respectively. One theory, 9 frameworks, 26 models, 8 themes and 42 subthemes of therapeutic alliance were identified. Twenty-six measures were identified; the Working Alliance Inventory (WAI) was the most utilized measure (13%). Most of the therapeutic alliance themes extracted were from patient perspectives. The relationship between adherence and therapeutic alliance was examined by 26 articles of which 57% showed some correlation between therapeutic alliance and adherence. Age moderated the relationship between therapeutic alliance and adherence with younger individuals and an autonomy support environment reporting improved adherence. Prioritized goals, autonomy support and motivation were facilitators of therapeutic alliance.ConclusionTherapeutic Alliance has been studied in a limited extent in the rehabilitation literature with conflicting frameworks and findings. Potential benefits described for enhancing therapeutic alliance might include better exercise adherence. Several knowledge gaps have been identified with a potential for generating future research priorities for therapeutic alliance in musculoskeletal rehabilitation.

The new frontier of strategic alliances in health care: New partnerships under accountable care organizations

Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. Little is known about new partnerships formed under the ACO model. We use mixed methods data from the National Survey of ACOs, Medicare ACO performance data and interviews with executive leaders across 31 ACOs to examine the prevalence, characteristics, and capabilities of partnership ACOs and why and how ACO partnerships form. We find that a striking percentage of ACOs – 81% – involve new partnerships between independent health care organizations. These “partnership ACOs” generally report lower capabilities on care management, care coordination, and health information technology. Additionally, under Medicare ACO programs partnership ACO achieved somewhat lower quality performance. Qualitative interviews revealed that providers are motivated to partner for resource complementarity, risk reduction, and legislative requirements, and are using a variety of formal and informal accountability mechanisms. Most partnership ACOs were formed out of existing, positive relationships, but a minority of ACOs formed out of previously competitive or conflictual relationships. Our findings suggests that the success of the ACO model will hinge in large part upon the success of new partnerships, with important implications for understanding ACO readiness and capabilities, the relatively small savings achieved to date by ACO programs, and the path to providers bearing more risk for population health management. In addition, ACO partnerships may provide an important window to monitor a potential wave of health care consolidation or, in contrast, a new model of independent providers successfully coordinating patient care.

The Important Role of Health Care Alliances in Improving Strategies for Cancer Prevention Protocols.

The Important Role of Health Care Alliances in Improving Strategies for Cancer Prevention Protocols.

The Diagnosis and Management of Patients with Renal Colic across a Sample of US Hospitals: High CT Utilization Despite Low Rates of Admission and Inpatient Urologic Intervention.

ObjectivesSymptomatic ureterolithiasis (renal colic) is a common Emergency Department (ED) complaint. Variation in practice surrounding the diagnosis and management of suspected renal colic could have substantial implications for both quality and cost of care as well as patient radiation burden. Previous literature has suggested that CT scanning has increased with no improvements in outcome, owing at least partially to the spontaneous passage of kidney stones in the majority of patients. Concerns about the rising medical radiation burden in the US necessitate scrutiny of current practices and viable alternatives. Our objective was to use data from a diverse sample of US EDs to examine rates of and variation in the use of CT scanning, admission, and inpatient procedures for patients with renal colic and analyze the influence of patient and hospital factors on the diagnostic testing and treatment patterns for patients with suspected renal colic.MethodsWe conducted a retrospective cohort study of adult patients who received a diagnosis of renal colic via a visit to an ED at 444 US hospitals participating in the Premier Healthcare Alliance database from 2009–2011. We modeled use of CT, admission, and inpatient urologic intervention as functions of both patient characteristics and hospital characteristics.ResultsOver the 2-year period, 307,612 patient visits met inclusion criteria. Among these patients, 254,211 (82.6%) had an abdominal CT scan, with 91.5% being non-contrast (“renal protocol”) CT scans. Nineteen percent of visits (58,266) resulted in admission or transfer, and 9.8% of visits (30,239) resulted in a urologic procedure as part of the index visit. On multivariable analysis male patients, Hispanic patients, uninsured patients, and privately insured patients were more likely to have a CT scan performed. Older patients and those covered by Medicare were more likely to be admitted, and once admitted, white patients and privately insured patients were more likely to have a urologic intervention. Only hospital region was associated with variation in CT rates, and this variation was minimal. Region and size of the hospital were associated with admission rates, and hospitals with more practicing urologists had higher intervention rates.ConclusionsIn this dataset, the majority of patients did not require admission or immediate intervention. Despite this, the large majority received CT scans, in a cohort representing 15–20% of all US ED visits. The CT rate was minimally variable at the hospital level, but the admission rates varied 2-fold, suggesting that hospital-level factors affect patient management. The high rate of CT usage coupled with the low rate of immediate intervention suggests that further research is warranted to identify patients who are at low risk for an immediate intervention, and could potentially be managed with ultrasound alone, expectant management, or delayed CT.

Research on Talent Incentive Mechanism in the Closed Type Healthcare Alliance

The construction and development of the closed type health care is an important measure to deepen the reform of the three medical entities, to rationally allocate medical and health resources, to enable the grassroots people to enjoy the high quality and convenient medical services, and for the efficient implementation of closed type medical alliance, the perfect incentive mechanism plays a particularly important role. Through combing the current situation of talent incentive mechanism in closed type health care alliance of China, this paper discusses the challenges in practice and puts forward some feasible suggestions in order to promote the further development of close type medical alliance.

ED03.01 Tobacco Control in the Middle East

Despite many countries signing and ratifying the Framework Convention on Tobacco Control (FCTC), the prevalence of tobacco continues to be on the rise in the Middle East. For example, in countries like Jordan and Tunisia, tobacco prevalence among males is close to 50% and in Jordan specifically it is estimated to increase to 88% over the next 5 years according to the World Health Organization (WHO). In 2008 it was estimated that five million people died due to tobacco related illnesses. This number is expected to increase to eight million in the year 2030 with individuals from low- and middle-income countries making up approximately 80% of these deaths. Tobacco is a risk factor for all major non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, pulmonary diseases and diabetes mellitus. The developing countries and the Middle East in particular is bracing for at least a 25% increase in such diseases over the next few years. The world economic forum estimates that the cost for such chronic disabling diseases will exceed USD 15 trillion with cancer costs specifically reaching close to USD 3 trillion. The WHO outlined six strategies that, when implemented simultaneously, will result in significant reduction in tobacco prevalence and its related morbidity and mortality. Those strategies known as MPOWER (Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco) when implemented in a country like Jordan, for example, close to 180,000 deaths can be prevented over 5 years. Despite the documented benefits of these six strategies, compliance with implementing them across the Middle East remains low. Only few countries have pictorial warnings, exposure to second hand smoke (SHS) is high, tobacco prices remain low and smoking cessation services are scarce. As the population in the Middle East age and with the ongoing rise in tobacco prevalence and obesity, cancer is expected to be on top of the list of diseases causing death and disability in the region. For that reason, King Hussein Cancer Center (KHCC), one of the leading cancer centers in the region, took on the challenge of fighting tobacco across the region in collaboration with regional and international partners. KHCC became the regional host for Global Bridges (an international TDT healthcare alliance co-founded by the Mayo Clinic, the American Cancer Society, and the University of Arizona). The main mission of this collaboration is to address the implementation of article 14 of the FCTC agreement and design and implement effective programs to promote the cessation of tobacco use and provide adequate treatment for tobacco dependence (TDT). This will also serve to address one of the six strategies recommended by the WHO; Offer help to quit tobacco use. Tobacco dependence in the region is severe. The high number of cigarettes smoked per capita and the significant exposure to SHS make people less capable of quitting on their own. Availing TDT across the region would respond to the high demand for such service (more than 65% of smokers are interested in quitting) and help curb the expected epidemic of NCDs. Long term, quitting tobacco generally reduces the risk of disease and premature death by 90% for those who quit before the age of 30 and by 50% for those who quit before the age of 50. In addition, TDT will optimize the management of certain NCDs such as cancer resulting in better treatment outcomes and long-term survivals. Over the past 5 years, KHCC developed partnership with countries across the Middle East and worked on training healthcare providers (HCPs) on how to treat tobacco dependence (figure 1). More than 2000 HCPS were trained to date (figure 2). Furthermore, 4 hubs designated for TDT training were established in Oman, Egypt, Tunisia and Morocco. In addition, an evidence-based TDT training curriculum specifically designed for the Middle East was developed and in the process of being made available in 3 languages; Arabic, English and French. In conclusion, tobacco dependence represents a major threat to the health and wellbeing of the people in the Middle East. Significant rise in NCDs including cancer is expected over the next few years. Many collaborative initiatives are underway to address this sever epidemic.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Middle East, Training, tobacco, treatment

A Framework for Assessing Enablers and Risks in Health and Care System Integration

A Framework for Assessing Enablers and Risks in Health and Care System Integration

A New Healthcare Alliance: Consumer Engagement in the New Healthcare Economy

A New Healthcare Alliance: Consumer Engagement in the New Healthcare Economy

Navigating Primary Care

Navigating Primary Care

Strategic Map for Hospital Management: Perspectives and Priorities

IntroductionIt seems certain that there will be more changes in the healthcare industry in the next 15 years then there has been in the past 15 years. Why? What is the source of change? First of all, healthcare institutions continue to face a turbulent, confusing, and often threatening environment. It means that one of the most well described source of the change is external (Luigi et al., 2014). Legislative and policy initiatives, changes in demographics, increasing prevalence of chronic diseases, changes in lifestyles, consumers' lack of trust in traditional health systems, demand for more sophisticated, convenient, transparent, affordable and personalized service as well as increasing costs on healthcare (as % to GDP) have great impact on healthcare institutions Rudawska & Pctlak, 2013). This trends are well described in literature, and continuously researched by organizations and institution like: PWC (2014, 2015), CDC (Bernstein et al., 2003), Premier Healthcare Alliance, individual scientists (Rudawska & Urbanczyk, 2014) and practitioners.But there are also other sources of change. Nowadays, healthcare institutions change in the way every organization does (Rudawska, 2013). One issue of this change is especially important for healthcare institutions because of their specificity. It is sustainable development. The concept of sustainable development represents a shift in understanding of humanity's place on the planet (Hopwood et al., 2005). Why it is so important for management of a healthcare institution? Mostly, because these organizations are predestinated to implement sustainable development in some parts world-wide. In some parts they are doing it already. The UN have identified 17 goals and 169 targets of sustainable development (UN, 2015). One of the main goals is to ensure healthy lives and promote well-being for all at all ages. Some of the targets are obvious: reduce the global maternal mortality ratio to less than 70 per 100,000 live births or preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births. But some of them need additional effort. In particular, the epidemics of AIDS, tuberculosis, malaria and tropical diseases; combating hepatitis, water-borne diseases and other communicable diseases by the end of 2030 or reduce by one third premature mortality from non-communicable diseases through prevention and treatment and also, promoting mental health and well-being. Summarizing, healthcare institutions in future should become more open for the society, and more cooperative in fulfilling these goals.For hospital management it becomes increasingly difficult to adapt to the pace of policy changes and reforms while balancing economical considerations, social responsibility to provide high-quality health care to the community served and, finally, ecological concerns (Glouberman, Mintzberg, 2001). In this context, hospital management focuses on understanding the interconnections on the macro level - between society and the ecosystem - and changing its strategy to optimize the outcomes for these systems.Sustainable development concept requires managing hospitals on three different fields using three different value systems. Economic aims requires economic calculation of revenues, costs, incomes and expanses. Social aims in hospital management requires considering social reflections i.e. impacts of various diseases on society (epidemiology). Ecologic aims requires also different calculation. Ecologic calculation is focused on hospital impact on the environment. It is connected with waste management, drugs usage, as well as bioethics issues (Fig. 1).Between economic, social and ecologic aspects here there is an obvious conflict. The main source of this conflict is the lack of resources, especially financial ones (Urbaniec, 2015). …

The Impact of the Affordable Care Act on Health Care Alliances’ Quality Improvement Efforts in Targeted Communities: Perceptions of Health Care Alliance Leaders

The Impact of the Affordable Care Act on Health Care Alliances’ Quality Improvement Efforts in Targeted Communities: Perceptions of Health Care Alliance Leaders

Patient Factors Predictive of Hospital Readmissions Within 30 Days.

Under the Affordable Care Act, the Congress has mandated that the Centers for Medicare and Medicaid Services reduce payments to hospitals subject to their Inpatient Prospective Payment System that exhibits excess readmissions. Using hospital-coded discharge abstracts, we constructed a readmission measure that accounts for cross-hospital variation that enables hospitals to monitor their entire inpatient populations and evaluate their readmission rates relative to national benchmarks. Multivariate logistic regressions are applied to determine which patient factors increase the odds of a readmission within 30 days and by how much. This study uses deidentified discharge abstract data from a database of approximately 15 million inpatient discharges representing 611 acute care hospitals from Premier healthcare alliance over a 2-year period (2008q4-2010q3). The hospitals are geographically diverse and represent large urban academic centers and small rural community hospitals. This study demonstrates that meaningful risk-adjusted readmission rates can be tracked in a dynamic database. The clinical conditions responsible for the index admission were the strongest predictive factor of readmissions, but factors such as age and accompanying comorbid conditions were also important. Socioeconomic factors, such as race, income, and payer status, also showed strong statistical significance in predicting readmissions. Payment models that are based on stratified comparisons might result in a more equitable payment system while at the same time providing transparency regarding disparities based on these factors. No model, yet available, discriminates potentially modifiable readmissions from those not subject to intervention highlighting the fact that the optimum readmission rate for any given condition is yet to be identified.

Patient-Centered Medical Home Adoption: Results From Aligning Forces For Quality.

To improve health care quality within communities, increasing numbers of multistakeholder alliances-groups of payers, purchasers, providers, and consumers-have been created. We used data from two rounds (conducted in July2007-March2009 and January2012-November2013) of a large nationally representative survey of small and medium-size physician practices. We examined whether the adoption of patient-centered medical home processes spread more rapidly in fourteen Robert Wood Johnson Foundation Aligning Forces for Quality communities, where multistakeholder health care alliances promoted their use, than in other communities. We found no difference in the overall growth of adoption of the processes between the two types of communities. However, improvement on a care coordination subindex was 7.17percentage points higher in Aligning Forces for Quality communities than in others. Despite the enthusiasm for quality improvement led by multistakeholder alliances, such alliances may not be a panacea for spreading patient-centered medical home processes across a community.

The Dissemination of Innovations by Multi-sectoral Health Care Alliances

The dissemination of innovative technologies and evidence based practices has become a central concern of health care practitioners and policy makers over the past 10 to 15 years. Multi-sectoral he...