Standard Of Health Care Services Research Articles

Integrating precision medicine into medical education: What does it add?

As the branch of medicine continues to evolve, it is our utmost responsibility to stay abreast with the recent developments and incorporate the same while training medical students. Precision medicine is a novel approach to health-care delivery that acknowledges the role of patients’ genes, environments, and lifestyles regarding each person. The rationale for moving in this direction can be attributed to two major factors, namely, the advances reported in the domain of health care and science, and the limitations that have been linked with the conventional approach of one-size-fits-all, which is not appropriate in the health sector. Precision medicine inclusion in the medical curriculum is the need of the hour, as it is bound to influence the clinical decision-making process by medical doctors, which eventually will improve health-related outcomes. In conclusion, the integration of precision medicine into medical education is expected to change the face of health-care delivery from a global perspective. As medical education embraces this evidence-driven approach, we have started our journey to move toward a future where we will not be happy with just standardization of health-care services, rather we will ensure that it becomes customized to the unique needs and characteristics of individual patients. The following core competencies are addressed in this article: Medical knowledge, Patient care, and Practice-based learning and improvement.

The Intersection of Law and Health: Safeguarding Public Welfare

The intersection of law and health is a critical aspect of safeguarding public welfare. This article explores the multifaceted relationship between law and health, emphasizing the key areas where legal principles and regulations contribute to protecting the well-being of individuals and communities. Effective health legislation and regulatory frameworks establish guidelines and standards for healthcare services, ensuring their safety, equity, and quality. Public health laws enable disease control measures, vaccination programs, and health promotion initiatives, reducing preventable illnesses and improving public health outcomes. Medical ethics and legal considerations guide healthcare professionals in upholding principles such as informed consent, patient confidentiality, and end-of-life decisions, safeguarding patient rights and trust. Law also plays a significant role in promoting healthcare access, equity, and human rights. Medical malpractice laws are also discussed in this paper which establish standards of care, deter negligence, and provide compensation for patients harmed by medical errors, promoting accountability and patient safety.

Importance of Core Competencies Assessment Scales for Community Health Nurses in India

The new age nursing profession is primarily based upon the efficient execution of the profession with skills and appropriate knowledge. The core competencies are essential to developing during and after the completion of formal education. The community nursing competencies are a bit more important as they enable the nurses to work independently in the field as a practitioner. The regular evaluation of competencies is direct to achieving the standard of health care services in the community setting. Method: To present this review researcher reviewed almost 70 articles from different online platforms, i.e. PubMed, Scopus, and Google Scholar, were screened and the final 16 were reviewed. Conclusion: Community health nurses working in domiciliary care need immense exposure to develop core competencies in the practice field. A standardized guide for core competencies of community health nurses based upon the indigenous needs/programs of India helps to infuse competencies among community nurses. The evaluation scale will ensure the extent of core competencies development.

An Efficient Fraud Identification Method Combining Manifold Learning and Outliers Detection in Mobile Healthcare Services

With the development of mobile Internet, various mobile applications have become increasingly popular. Many people are being benefited from the mobile healthcare services. Compared with the traditional healthcare services, patients' medical behavior trajectories can be recorded by mobile healthcare services meticulously. They monitor the entire healthcare services process and help to improve the quality and standardization of healthcare services. By tracking and analyzing the patients' medical records, they provide real-time protection for the patients' healthcare activities. Therefore, medical fraud can be avoided and the loss of public health funds can be reduced. Although mobile healthcare services can provide a large amount of timely data, an effective real-time online algorithm is needed due to the timeliness of detecting the medical insurance fraud claims. However, because of the complex granularity of medical data, existing fraud detection approaches tend to be less effective in terms of monitoring the healthcare services process. In this paper, we propose an approach to deal with these problems. By means of the proposed SSIsomap activity clustering method, SimLOF outlier detection method, and the Dempster-Shafer theory-based evidence aggregation method, our approach is able to detect unusual categories and frequencies of behaviors simultaneously. Our approach is applied to a real-world data set containing more than 40 million medical insurance claim activities from over 40000 users. Compared with two state-of-the-art approaches, the extensive experimental results show that our approach is significantly more effective and efficient. Our approach agent which provides decision support for the approval sender during the medical insurance claim approval process is undergoing trial in mobile healthcare services.

Knowledge-Based Support to the Treatment of Exceptions in Computer Interpretable Clinical Guidelines

Clinical guidelines are one of the major tools that have been introduced to increase the rationalization of healthcare processes, granting both the quality and the standardization of healthcare services, and the minimization of costs. Computer interpretable clinical guidelines (CIGs) are widely adopted in order to assist practitioners in decision making, providing them evidence-based recommendations based on the best available medical knowledge. However, a main problem in CIG adoption is the fact that, in the medical context, some degree of uncertainty is often present. Thus, during guidelines executions on specific patients, unpredictable facts and conditions (henceforth called exceptions) may occur. A proper and immediate treatment of such exceptions is mandatory, but most of the current software systems coping with CIGs do not support it. In this paper, the authors describe how the GLARE system has been extended to deal with this purpose. They identify different types of exceptions, considering their “pre-locability” and “pre-plannability”. On the basis of such parameters, the authors propose different treatment modalities, consisting of both data structures to model the different types of exceptions, and the algorithms to treat them. The resulting methodology is an innovative one, integrating different Artificial Intelligence techniques (ranging from planning to ontology-based reasoning). Finally, they also discuss how they implemented their system-independent methodology on top of GLARE, and describe its application in the ROPHS project, considering the management of the severe trauma guideline.

Time to analgesia and pain score documentation best practice standards for the Emergency Department - A literature review.

Emergency Department pain management is an often overlooked aspect of acute care and is of paramount importance. Patients are often forced to wait extended periods of time without pain assessment or being offered analgesia for their painful condition. This has been associated with poor psychological and physiological consequences both for the health system and the patient. This is suggestive of a lack of clarity around best practice standards for time to analgesia and pain score documentation in the ED. A literature review was undertaken to investigate best practice in relation to acute pain management. Key outcomes were pain score documentation and time to analgesia. After a search of the electronic databases, a total of 992 abstracts were screened and 38 potentially relevant full articles were reviewed. There were 23 articles excluded for a variety of reasons including poor methodology, indirect specialty and inappropriate focus or age of study. A total of 15 studies were appropriate for inclusion in the review. Of the 15 studies, only eight included pain score as an outcome and 13 used time to analgesia as a measure. Four studies specifically investigated nurse initiated analgesia programs in relation to improving acute pain management. A higher incidence of pain assessment, reassessment and pain score documentation was generally correlated with decreased time to analgesia. Whilst there is an abundance of evidence available on the current practice and challenges of quality acute pain management in the ED, there is a lack of well-controlled studies on best practice standards for health care services to benchmark their practice and improve. Mandating pain score reporting, pain assessment and reassessment within specific timeframes and analgesia administration within 30 min of arrival is highly recommended. The implementation of nurse led analgesia protocols should be encouraged to increase incidence of documented pain assessment and reduce time to analgesia.

Performing well in financial management and quality of care: evidence from hospital process measures for treatment of cardiovascular disease.

BackgroundFiscal constraints faced by U.S. hospitals as a result of the recent economic downturn are leading to business practices that reduce costs and improve financial and operational efficiency in hospitals. There naturally arises the question of how this finance-driven management culture could affect the quality of care. This paper attempts to determine whether the process measures of treatment quality are correlated with hospital financial performance.MethodsPanel study of hospital care quality and financial condition between 2005 and 2010 for cardiovascular disease treatment at acute care hospitals in the United States. Process measures for condition-specific treatment of heart attack and heart failure and hospital-level financial condition ratios were collected from the CMS databases of Hospital Compare and Cost Reports.ResultsThere is a statistically significant relationship between hospital financial performance and quality of care. Hospital profitability, financial leverage, asset liquidity, operating efficiency, and costs appear to be important factors of health care quality. In general, public hospitals provide lower quality care than their nonprofit counterparts, and urban hospitals report better quality score than those located in rural areas. Specifically, the first-difference regression results indicate that the quality of treatment for cardiovascular patients rises in the year following an increase in hospital profitability, financial leverage, and labor costs.ConclusionsThe results suggest that, when a hospital made more profit, had the capacity to finance investment using debt, paid higher wages presumably to attract more skilled nurses, its quality of care would generally improve. While the pursuit of profit induces hospitals to enhance both quantity and quality of services they offer, the lack of financial strength may result in a lower standard of health care services, implying the importance of monitoring the quality of care among those hospitals with poor financial health.

An ontological knowledge and multiple abstraction level decision support system in healthcare

The rationalization of the healthcare processes and organizations is a task of fundamental importance to grant both the quality and the standardization of healthcare services, and the minimization of costs. Clinical Practice Guidelines (CPGs) are one of the major tools that have been introduced to achieve such a challenging task. CPGs are widely used to provide decision support to physicians, supplying them with evidence-based predictive and prescriptive information about patients’ status and treatments, but usually on individual pathologies. This sets up the urgent need for developing decision support methodologies to assist physicians and healthcare managers in the detection of interactions between guidelines, to help them to devise appropriate patterns of treatment for comorbid patients (i.e., patients affected by multiple diseases). We identify different levels of abstractions in the analysis of interactions, based on both the hierarchical organization of clinical guidelines (in which composite actions are refined into their components) and the hierarchy of drug categories. We then propose a general methodology (data/knowledge structures and reasoning algorithms operating on them) supporting user-driven and flexible interaction detection over the multiple levels of abstraction. Finally, we discuss the impact of the adoption of computerized clinical guidelines in general, and of our methodology in particular, for patients (quality of the received healthcare services), physicians (decision support and quality of provided services), and healthcare managers and organizations (quality and optimization of provided services).

Financial Analysis of the Access to Pharmacotherapy for Rare Diseases in Bulgaria

The absence of adequate national strategies for rare diseases (RD), high medicines prices and insufficient experts’ knowledge creates to the barriers in therapy, as well as the added factors of inappropriate diagnostics and difficulties in peoples’ access to health care. A heavier burden is placed on patients’ physical, mental, psychological and intellectual wellbeing as well as on the financial capabilities of the third party payers. This study aims to analyze the financial flow for RD therapy as part of the health insurance budget and regional differences in their financing. The point of view is that of the third party payer for a 4-year period. The study is a macro costing top down financial analysis of the expenditures for medicines for rare diseases spent by the 3rd party payer, in Bulgaria that is the national health insurance fund (NHIF). Applied were financial and statistical analyses towards the budget data for expenditures for pharmaceuticals at national and regional level. Results show a constant rise in healthcare medicines expenditures, including those for rare diseases therapy from 20 to 27 million € for a three-year period but it is not above 10% from the budget for medicines due to regulatory restrictions. A variety of deviations exist among regional counties, accounting for more than 50% differences in payment per diagnosis. This could be explained with insufficient knowledge and lack of therapeutic standards. There is a need for collaboration on a European level and the creation of a global fund to be able to satisfy therapeutic needs. A closer look at national differences and regional therapy is necessary, as well as standardization of health care services for better health care expenditures management.

Ultrasound and infections on the Tibetan Plateau

IntroductionThe authors report on an ultrasound (US) outreach program for the nomadic people living in Yushu, a remote area of Qinghai, Tibet, People's Republic of China (PRC) about 4800 m above sea level. The program was carried out in cooperation with ROKPA INTERNATIONAL, a non-profit organization (NGO) that aims at helping the poorest peoples living in remote regions of the world. Materials and methodsA hand-held US scanner (Sonosite 180 Plus, Sonosite Inc., Bothell, WA, USA) equipped with a 3.5–5 MHz convex probe was used at a local clinic for 21 days in 2007 and for 32 days in 2009. ResultsA total of 1128 US examinations were performed (578 in 2007 and 550 in 2009). The main diagnoses were: Echinococcal cysts (66 cases; 6.23%) – Biliary tract and intrahepatic gallstones (10% of patients examined) – Ascariasis – Acute and chronic hepatitis, liver cirrhosis, abdominal masses – Abdominal tuberculosis – Miscellaneous (trophoblastic tumor, megacalicosis, splenomegaly in acute leukemia).After the first experience in 2007, collaboration with the local hospital was established for the treatment of patients affected by active echinococcal cysts using albendazole and puncture, aspiration and injection of scolicidal agent and re-aspiration (PAIR) and subsequent follow-up. Discussion and conclusionsUS scanning was well accepted by the local population and allowed diagnosis, classification and choice of treatment of the echinococcal cysts according to recent criteria based on a stage-specific approach. Percutaneous treatment was also introduced, but more training of local healthcare providers is needed to secure continuation of this practice.Further experience may help improve the standard of health care services offered to the nomadic populations in this remote area.

Osteoporotic hip fracture costs in the elderly Turkish population.

This study was designed to determine the length of hospital stay and treatment costs of patients with osteoporotic hip fractures in Turkey. A total of 1,118 osteoporotic hip fractures taken from patient records in 35 hospitals connected to a Disease Related Group (DRG) network were included in the study. Inclusion criteria were patients over the age of fifty with a diagnosis of a single, low-energy fracture located at the neck, head, or intertrochanteric region of the femur treated with total/hemi-arthroplasty, screw or nail methods. We examined the demographics, location of fracture, treatment type, length of hospital stay (LOS), direct cost and cost extrapolation based on the numbers of hospitals, beds and patient by hospital. Of the 1,118 patients (mean age: 75.3 ± 9.9 years), 62.8% were female. The main fracture type was of the femur neck without precise localization. The average LOS was 11.0 ± 7.9 days. The total weighed cost of all 1,118 hip fractures was $2,249,885 per year, indicating an average direct medical cost of $3,119 per patient in the 35 DRG hospitals. Based on this sample, the estimated total number of patients is 15,602 by number of hospitals; 8,521 by number of hospital beds and 9,365 by number of hospitalization, costing $31,530 million; $14,793 million and $18,948 million, respectively. Diverse results in cost estimations of osteoporotic hip fractures reflect the incoherence of data as well as a lack of standardization of health care services. Therefore, ICD and DRG coding needs to be improved and a national database must be created at least for the invoices of importation of prostheses to fully be able to calculate the burden of osteoporosis across Turkey.

Regione Lombardia capo fila nel File F

File F is a “new kind” of entry in health financial compensation in different Italian Regions. Italy has a National Health Service, structured with different regional and local authorities; within centrally-defined standards for healthcare services, each Region can decide how to spend its own money, but also has the responsibility for its own citizens’ well-being, health costs and expenses. File F specifically concerns the drugs that are administered directly in the out-patients setting and allows Regions to get a re-payment for services they supply to citizens from outside the local level. File F is also used within the same Region for reimbursements to the different local health authorities. Lombardy is one of the better-structured Regions in Italy as far as File F is concerned: this is used to monitor, finance and regulate health costs, providing an efficient and effective administrative tool in the healthcare field.

Health and Well-Being of Children in Foster Care Placement

1. Sandra H. Jee, MD, MPH 1. Department of Pediatrics University of Rochester Rochester, NY 1. Mark D. Simms, MD, MPH 1. Department of Pediatrics Medical College of Wisconsin Milwaukee, Wisc Improving the Odds for the Healthy Development of Young Children in Foster Care . Dicker S, Gordon E, Knitzer J. National Center for Children in Poverty: Columbia University Mailman School of Public Health. Promoting the Emotional Well-Being of Children and Families (Policy Paper No. 2). January 2002;1–28 Children and Family Services Reviews, Part V: Most States Fail to Meet the Mental Health Needs for Foster Children . Huber J, Grimm B. Youth Law News . 2004;Oct-Dec:1–36 CWLA Standards for Health Care Services for Children in Out-of-Home Care . Washington, DC: Child Welfare League of America; 1988. Educational Experiences of Children in Out-of-Home Care . Smithgall C, Gladden RM, Howard E, Goerge R, Courtney M. Chicago, Ill: Chapin Hall Center for Children at the University of Chicago; 2004:1–77 Fostering Health: Health Care for Children and Adolescents in Foster Care . 2nd ed. Task Force on Health Care for Children in Foster Care, American Academy of Pediatrics, District II, New York State. Elk Grove Village, Ill: American Academy of Pediatrics: 2005 Healthy Foster Care America . www.aap.org/advocacy/HFCA/ On any given day, more than 500,000 children are living in state-supported foster home care. In the course of a year, more than 800,000 children experience placement in a foster home. Many of these children return home quickly, but for some, placement may extend for years and may involve care in multiple foster homes. Most of the children have experienced serious family dysfunction prior to placement, including exposure to domestic violence and to their parents’ mental health disorders, addiction, or criminal activity. Serious neglect and abuse are the most frequently stated reasons for removing children from their parents’ care. Children entering foster homes have extremely high rates of physical and mental health problems, developmental delays, and educational underachievement. As a group, children in foster care …

Youth health in Canada.

Youth Health in Canada is at a favorable level and adolescents have access to a reasonable standard of health care services. The framework is evolving in response to changing concepts and to the participation of youth themselves. The role of the academic and research leadership in Canada is described. The youth population is healthy and contributes in a positive way to the national fabric and the needs of the majority are adequately met. However, there are sub-populations of youth, who continue to warrant a special focus and are deserving of the attention of youth health professionals. Youth health in Canada is emerging as an adaptation of the American Adolescent Medicine model of the early 1960s. It is a challenging multidisciplinary field in which should play a significant role in shaping its future. Its mandate will be to exercise leadership in addressing the changing needs of the general adolescent population and bringing renewed focus to the special needs of identifiable sub-populations.

Telemedicine of the future: teleneuropathology

The chief relevance of telemedicine lies in its capability to link medical practitioners and remote hospitals to larger or specialized facilities in a very fast electronic manner. This may become even more important due to current increase in subspecialization and demand for more precise diagnosis and consultation in difficult cases. A network attaching small clinics or laboratories to larger and more specialized units, and to highly specialized referral centers may improve the professional standard of health care services and education. For a wider use, a technological standardization will be required, since the existence of several types of computer and numerous image manipulation programs, have resulted in a proliferation of file formats. However, every potential user or client of telemedicine should keep in mind, that standardization also includes legal and ethical issues such as patient confidentiality and malpractice avoidance. The adoption of workable guidelines and protocols is required. Telepathology in general and teleneuropathology in particular is the practice of pathology at a distance, viewing digitized images of histological slides on a video monitor rather than directly through a light microscope. For the transmission of the digitized images from a telemicroscope to the remote diagnostic video monitor, different technologies such as ordinary telephone lines, broadband telecommunications channels, and the Internet can be used. The transmitted images may serve for primary neuropathological diagnosis, teleconsultation, quality assurance, proficiency testing, and distance learning. Static-imaging and dynamic-imaging are the two major competing technologies of telemicroscopy. Static-imaging systems appear to have levels of diagnostic accuracy which are not satisfactory for diagnostic neuropathology. On the contrary, high levels of diagnostic accuracy can be achieved using dynamic-imaging systems with the transmission of live video images in real time and by using a robotized telemicroscope with the possibility to examine the entire histological specimen under control of the remote teleneuropathologist.

WHO initiative

In recent years, the countries of central and eastern Europe, the Baltic States, and the newly-independent countries (established in place of the former Soviet Union), have experienced a much heavier burden of cancer as compared to other subregions of Europe. This appears to be the result of a decline in the standard of health care services, environmental neglect and the high prevalence of health-damaging behaviour, smoking in particular. Their anti-cancer potential falls short of their needs. The existing and still widening gap between what are considered best and worst patterns, practices and prospects in cancer control in Europe has posed a challenge to both the World Health Organization (WHO) and the international cancer community. On WHOs initiative, a group of major European cancer organizations is determined to use their considerable potential, both moral and scientific, in supporting national efforts in all possible ways in those countries that need progress. Recently, WHO has initiated an all-European alliance with the intention of narrowing the gap between what are regarded as best and worst patterns, practices and prospects in cancer control in Europe.

Geographic Distribution of Physician Manpower: the GMENAC Legacy*

ABSTRACT: The Graduate Medical Education National Advisory Committee (GMENAC) projected the need for and supply of physicians and other providers, recommended time and access standards for health care services, and developed guidelines for the geographic distribution of physicians. Since this study, analysts have given scant attention to national problems of physician geographic distribution. The issue deserves additional scrutiny in light of the current continuing problems of underservice in rural areas. The emergence of geographic information systems offers a unique opportunity to acquire data on provider distribution and provide a framework for developing and testing redistribution policy.

Geographic Distribution of Physician Manpower: the GMENAC Legacy

The Graduate Medical Education National Advisory Committee (GMENAC) projected the need for and supply of physicians and other providers, recommended time and access standards for health care services, and developed guidelines for the geographic distribution of physicians. Since this study, analysts have given scant attention to national problems of physician geographic distribution. The issue deserves additional scrutiny in light of the current continuing problems of underservice in rural areas. The emergence of geographic information systems offers a unique opportunity to acquire data on provider distribution and provide a framework for developing and testing redistribution policy.

A Management Approach to Monitoring Quality Health Assurance Standards

AN ALL-PERVASIVE phenomenon within the health bureaucracy centers around the setting, cataloging, and monitoring of quality assurance standards for health care services. For lack of a better definition, standards can be defined as agreed upon set values-the degree of compliance with these values is intended to influence and to assist in indirectly assessing progress towards (or away from) reaching stated objectives; that is, it is agreed that if the standards are met in a proportion of cases, the probability is greater that the objectives will be reached. In the present context, the objective is usually couched in terms of providing health care of quality, often through improving the efficiency or effectiveness of delivery of health services. Attempting to define the best, valid, minimal, and optimal standards appears to consume the majority of the health bureaucrats' efforts. In an attempt to insure that the or most valid standards are set, considerable discussion is often generated concerning the latest and scientific or health evaluation studies. Although such an undertaking might well be justified, I must occasionally adjust my microscope from high dry to scanning in order to comprehend the relevance of such efforts as regards their applicability to the larger health system. What follows is a discussion of the obvious but often forgotten -a summary of many tough management questions which must be resolved before application of even the most valid standard can have any real impact or utilitarian value within a health system. As the setting, cataloging, and monitoring of standards are being attempted, attention paid to such management considerations might well prevent the best laid plans from going agley.

RELUCTANCE TO SERVE IN RURAL AREAS: DOCTORS' PERSPECTIVE

Background: Pakistan's health care system has been adversely affected by the non-availability of doctors in its rural and remote areas. It is the high time to realize that the improvement in the standard of health care services can be achieved with willingness and dedication of doctors to work in these areas which is only possible by providing them with suitable working environment. Methods: This was a descriptive cross-sectional study conducted on 200 doctors working in public and private hospitals/clinics of Islamabad, Pakistan. Data was collected through a questionnaire and processed in SPSS software version 16. Results: 200 doctors comprising of 113 males and 87 females were recruited for the study. The mean age was 30 years (0.65 SD). Majority (86.5 %) of the doctors were of the view; that indeed it was the non-availability of doctors at rural health care centres for poor health services in such areas. 83.9 % agreed that basic facilities were lacking in rural areas. Regarding transportation, 74.5 % had the opinion that these facilities were inadequate in rural areas. Nevertheless, 84.5 % agreed that by improving the basic facilities of life, working conditions could be improved. However, 72.5 % supported the idea of extra hard area grant to improve doctors' motivation towards serving rural areas. Conclusion: Doctors were reluctant to serve in rural areas because of the difficulties affecting their social, professional and family life. By developing the infra-structure of health centres and by providing some special incentives to the serving doctors, this issue can be resolved to a considerable extent.