Nontraditional Health Care Research Articles

Outcomes research: the history, debate, and implications for the field of occupational therapy.

The field of occupational therapy, as with all facets of health care, has been profoundly affected by the changing climate of health care delivery. The combination of cost-effectiveness and quality of care has become the benchmark for and consequent drive behind the rise of managed health care delivery systems. The spawning of outcomes research is in direct response to the need for comparative databases to provide results of effectiveness in health care treatment protocols, evaluations of health-related quality of life, and cost containment measures. Outcomes management is the application of outcomes research data by all levels of health care providers. The challenges facing occupational therapists include proving our value in an economic trend of downsizing, competing within the medical profession, developing and affiliating with new payer sources, and reengineering our careers to meet the needs of the new, nontraditional health care marketplace.

Voting and priorities in health care decision making, portrayed through a group decision support system, using analytic hierarchy process

Within the health care industry many decision making approaches and tools are used. This paper explores a new tool, the Analytic Hierarchy Process (AHP), which permits both subjective and objective information to be considered in a decision. AHP has tremendous potential to solve both traditional and non-traditional health care problems. Its strength as a decision-making tool is its ability to combine both subjective and objective data. Application of AHP is discussed within the context of a Group Decision Support System (GDSS) model developed by Hatcher. The model is reviewed in limited detail, and readers are referred to the original article that defined and discussed the uniqueness and level of sophistication of GDSS applications in the health care industry. Health and medical delivery problems are discussed to highlight AHP requirements and the complexity of AHP applications. Health care applications are unique in that they lend themselves ideally to the use of computer data, image, voice, text, and multimedia concepts.

Regional and Intrametropolitan Differences in the Location of Freestanding Ambulatory Surgery Centers∗

The freestanding ambulatory surgery center (FASC), also known as an outpatient or day surgery center, is one of several modern health care providers which are currently challenging the dominance of traditional medical professionals. This paper examines the location and distribution of FASCs in the United States for the period 1987–1992. FASCs tend to be concentrated in the states of the South and West, and have exhibited increasing concentration in these regions during the five-year study period. In addition, FASCs are found mostly in metropolitan areas and appear to be moving toward more suburban locations, although central city sites still dominate. Future research should concentrate on more micro-scale locations of the FASC and other nontraditional health care providers.

Foods perceived by adults as causing adverse reactions

This study was undertaken to identify differences in offending foods reported by 45 patients with classic symptoms of food allergy and/or subjective food-related complaints not traditionally associated with food allergy. On the basis of a comprehensive clinical history, skin testing, and double-blind food challenges, patients were diagnosed as having confirmed (n = 22) or unconfirmed (n = 23) adverse reactions to foods. The majority of patients in both groups were women — 17 of those with confirmed reactions and 21 of those with unconfirmed reactions. Individuals with confirmed reactions were significantly younger, 34.8±10.9 years, than those with unconfirmed reactions, 41.5±9.6 years. The symptoms and reaction patterns of adults with confirmed reactions were generally consistent with immunoglobulin E-mediated food hypersensitivity. Individuals with unconfirmed reactions were more likely to report frequently occurring, delayed-onset symptoms of a nonspecific nature, and they had an average of five times as many foods causing adult-onset symptoms than those with confirmed reactions. Adults with confirmed reactions more often reported common food allergens such as tree nuts, legumes, and crustaceans; those with unconfirmed reactions were more apt to name foods not commonly implicated in adult food allergies confirmed by conventional diagnostic methods. The types of offending foods reported suggested that individuals with unconfirmed reactions were influenced by the popular news media and clinical ecology-oriented literature. Their use of nutrition supplements was consistent with the attitude of health activism. Such individuals may seek nontraditional health care or adopt questionable dietary practices. Individuals with adverse food reactions of a nonspecific nature pose challenging problems to dietitians.

Use of nontraditional health care by patients attending an HIV-related psychiatric clinic

Use of nontraditional health care by patients attending an HIV-related psychiatric clinic

Financing health services in school-based clinics: Do nontraditional programs tap traditional funding sources?

This telephone survey of directors of 50 school-based clinics (SBCs) examined the influence of organizational factors on use of traditional funding sources, such as Medicaid and private insurance. These factors included: initial funding source (Robert Wood Johnson Foundation's School-Based Adolescent Health Care Program vs. comparison), administrative structure, age of clinic, and state Medicaid policy. Results indicated that over half (51%) of the clinics used Medicaid as a funding source to some extent, while fewer (32%) used private insurance. Use of Medicaid and private insurance, however, varied with the initial funding source, administrative structure, and age of the clinic. Initial funding source and age of the clinic were the strongest predictors of Medicaid usage. Barriers to traditional funding sources, as well as methods used to overcome constraints, are discussed. The importance of the link between a nontraditional health care delivery system, the school-based clinic, and the traditional funding sources of Medicaid and private insurance is examined in light of the organizational factors which facilitate this link.

Internships in Nontraditional Health Care Settings: A Pilot Program

This paper reports on efforts to establish master's-level internships in nontraditional health care settings. With the encouragement of the Medical Sociology Section of the American Sociological Association, seven students were placed in the following settings: workplace wellness programs, a center for independent living for the physically handicapped an educational program for unwed adolescent fathers, a health policy organization, a communitybased AIDS intervention program, and the Life Sciences Directorate at the Johnson Space Center. The project addressed the following issues: the advent of new problems in health care, such as those resulting from AIDS; the increase in health care work accomplished in nonmedical settings; the increased importance of credentialism in sociology; and the increasingly blurred line between research and practice in the sociology of health. Suggestions are made for the application of findings to the management of undergraduate internships.

The Effects of Religious Beliefs on the Health Care Practices of the Amish

The religious and cultural beliefs of the Amish result in many health care beliefs and practices which are significantly different from the dominant American culture. For example, the Amish are excluded from social security and health insurance coverage; they have different perceptions of health and illness; they do not practice birth control; they often lack the preventive practices of immunizations and prenatal care; and they may use a variety of traditional and nontraditional health care providers. Only by understanding the religiocultural belief system of this minority religious sect can nurse practitioners effectively meet the health care needs of their Amish patients.

Redefinition of school nursing practice: integrating the developmentally disabled.

Results of three needs assessment studies which had the purpose of providing direction for school nursing practices which would address some of the unmet health needs of today's children and adolescents are reported. Results provide specific examples of how school nurses have not been meeting school health needs through an analysis of one specific need -- integrating the developmentally disabled into the regular school setting. Data were collected from parents, teachers and other supportive personnel in schools by interview and survey methods. Environmental assessments were conducted and the policies and procedures governing health-related activities required by special need students were reviewed. The data indicated that for developmentally disabled students, nurses were not performing the commonly accepted functions of nursing and were not transposing their knowledge of the components of health care ordinarily provided in health care settings to care provided in nontraditional health care settings. Examples of nursing functions and the activities needed to fulfill those functions are provided.