Individual Provider Level Research Articles

Funding Supported Employment

This article describes different methods used by state Vocational Rehabilitation (VR) agencies to fund time-limited supported employment services. Findings are reported from a survey of 385 vendored supported employment provider qencies regarding types of reimbursement method used, the influence of different types of methods on key consumer outcomes, aid recommendations for improviiig funding systems. The findings consistently pointed to significantly more positive response of vendors to funding methods that incorporate negotiated rates at the individual provider level as compared to statewide fixed rates for all vendors. Statewide fixed hourly rates were found to discourage both conversion to community integrated employment opportunities and the reopening of supported employment cases after job loss. The same response pattern held true for respondents' perceptions of reimbursements covering the costs of services. Statewide rates for specified outcomes or for daily, weekly, or monthly service units were found to cover the cost of services at levels significantly lower than the other funding methods.

Medical organization structures that promote quality and efficiency: past research and future considerations.

This article reviews studies of the effects of medical organization structure on quality and cost conducted over the past three decades. Topics of inquiry have proceeded from the organizational to the individual provider level and from the inpatient to the ambulatory level. The article presents the findings of these studies as clues regarding the likely impact of integrated delivery systems. It also considers future areas for study in medical organization.

THE ROLE OF NURSING IN PUBLIC POLICY REFORM

Currently, individuals concerned about the cost and quality of health care, and the necessity of major system reform, are grappling with the concepts of managed competition, managed cooperation, sponsors, and health insurance purchasing cooperatives. Managed competition, broadly defined, is a purchasing strategy designed to obtain maximum value for consumers and employers as they acquire health care. Managed competition occurs at the level of integrated financial and delivery plans, not at the individual provider level. The goal of managed competition is to divide the providers in each community into competing economic units to motivate them to develop efficient delivery systems (Enthoven, 1993). Efficient health care delivery systems have not resulted from the fee-for-service and remote third-party reimbursement practices that currently dominate the health care system. However, more efficient delivery systems have emerged from managed care. Some of the best known models of managed care that have demonstrated cost effectiveness include Kaiser Permanente, Group Health Cooperative of Puget Sound, and Washington Group Health. The rapidly escalating consumption of US economic resources in the name of health care has led to the current pressure for health care reform. Although the public discussion about health care reform centers around the high cost of health care, we are, in truth, in the midst of both a crisis of medical care and an emergence of an era of health care for the nation's people.

Barcelona's asthma epidemics.

<h3>Introduction</h3> The global uptake rates of lung cancer screening (LCS) with low-dose CT remain low. Since numerous factors contribute to the underuse of LCS, a theory-informed approach to identify and address the uptake of LCS barriers and facilitators is required. This study aims to document the methods which were used to identify, appraise, and synthesise the available qualitative, quantitative, and mixed methods evidence, addressing the barriers and facilitators at the individual and healthcare provider level, according to the social–ecological model, before identifying gaps to aid future practices and policies. <h3>Methods and analysis</h3> The following databases will be searched: PubMed, Ovid (Journals @ Ovid Full Text and Ovid MEDLINE), EMBASE, CINAHL, PsycINFO, Cochrane Library, Chinese Biomedical Database, Chinese National Knowledge Infrastructure, and Wanfang database, from their creation up to 31 December 2020. Two reviewers will be involved in independently screening, reviewing, and synthesising the data; and calibration exercises will be conducted at each stage. Disagreements between the two reviewers will be resolved by arbitration by a third reviewer. The Critical Appraisal Checklist for Studies Reporting Prevalence Data from the Joanna Briggs Institute, the Critical Appraisal Skills Programme criteria adapted for qualitative studies, and the 16-item Quality Assessment Tool (QATSDD) will be used in the quality assessment of primary studies. We will perform data synthesis using the Review Manager software, V.5.3. <h3>Ethics and dissemination</h3> This study is a review of published data and therefore needs no ethical approval. The findings of this systematic review will be published in a peer-reviewed journal. <h3>Trial registration number</h3> CRD42020162802.