A Rational Care Model for Health Care of a Nation

1980 ◽  
pp. 137-144
Author(s):  
S. R. Garfield
Keyword(s):  
Health Care ◽  
Care Model

A randomized clinical trial of home telemonitoring in patients with advanced heart and lung diseases.

2021 ◽  
pp. 1357633X2110597
Author(s):  
Carlos Hernandez-Quiles ◽  
Máximo Bernabeu-Wittel ◽  
Bosco Barón-Franco ◽  
Alfonso Aguirre Palacios ◽  
M Rocio Garcia-Serrano ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Functional Status ◽  
Integrated Care ◽  
Lung Diseases ◽  
Care Model ◽  
Emergency Admissions ◽  
Perceived Satisfaction ◽  
Lung Failure ◽  
Functional Features

Brief Summary The addition of home monitoring to an integrated care model in patients with advanced chronic heart/lung diseases decreases mortality, hospital and emergency admissions, improves functional status, HRQoL, and is cost-effective. Background Telemonitoring is a promising implement for medicine, but its efficacy is unknown in patients with advanced heart and lung failure (AHLF). Objective To determine the efficacy of a telemonitoring system added to coordinated clinical care in patients with AHLF. Design Randomized phase 3 multicenter clinical trial with parallel groups in adult patients. Participants Five spanish centers including patients with AHLF at discharge or in out-patient clinics. Intervention Patients were randomly assigned to receive a remote bio-parameters telemonitoring system (TELECARE) or best usual care (UCARE). TELECARE patients were provided with devices that collected symptoms and bio-parameters, and transferred them synchronously to a call-center, with a real-time health-care response. Main Measures Primary end point was the need of admissions/emergency room visits at 45, 90, 180 days. Secondary end points included health care requirements, mortality, functional assessment, health related quality of life (HRQoL), perceived satisfaction, and cost-efficacy. Results 510 patients were included (54.5% women, median age 76.5 years; 63.1% suffered heart failure, 13.9% lung failure, and 22.9% both conditions). Clinical and functional features were comparable in both arms. TELECARE globally needed less admissions with respect UCARE after 45 days of inclusion (35.4% vs. 46.9%, p < 0.05). This tendency was maintained in the subgroups of patients with multimorbidity (34.2% vs. 46.9%, p < 0.05), intermediate risk of mortality (36.5% vs. 51.1%, p < 0.05), and those included after hospital discharge (34.9% vs. 50.5%, p < 0.01). HRQoL significantly improved (TELECARE/UCARE EuroQol baseline of 56.2 ± 18.2/55.1 ± 19.7, p = 0.054, and 64 ± 19.9/56.3 ± 21.6; p < 0.01 at the end), and perceived satisfaction was also higher (6.77 ± 0.52 vs. 6.62 ± 0.81, p < 0.001; highest possible score = 7). A trend to mortality decrease was also observed (12.9% vs. 19.3%, p = 0.13). TELECARE was cost-efficacious (TELECARE/UCARE QALY 3.94 Euros/0.81Euros). Conclusions The addition of a telemonitoring system to an integrated care model in patients with AHLF decreases hospital and emergency admissions, improves functional status as well as HRQoL, and is cost-efficacious.

scholarly journals Care production for tuberculosis cases:analysis according to the elements of the Chronic Care Model

2016 ◽  
Vol 50 (2) ◽  
pp. 239-246 ◽  
Author(s):  
Daiane Medeiros da Silva ◽  
Hérika Brito Gomes de Farias ◽  
Tereza Cristina Scatena Villa ◽  
Lenilde Duarte de Sá ◽  
Maria Eugênia Firmino Brunello ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Chronic Care Model ◽  
Health Care Services ◽  
Chronic Care ◽  
Capital City ◽  
Care Model ◽  
Care Services ◽  
Primary Health ◽  
Primary Health Care Services

Abstract OBJECTIVE: To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. METHOD: Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum. RESULTS: The organization of care for tuberculosis and supported self-care presented reasonable capacity.In the coordination with the community, the presence of the community agent presented optimum capacity.Partnership with organizations of the community and involvement of experts presented limited capacity.The qualification of professionals, the system for scheduling and monitoring tuberculosis in the community, and the clinical information system presented basic capacity. CONCLUSION: The capacity of the primary health care services to produce tuberculosis-related care according to the elements of the Chronic Care Model is still limited.Overcoming the fragmentation of care and prioritizing a systemic operation between actions and services of the health care network remains as a major challenge.

scholarly journals Perceptions of Spanish nurses on economic crisis and the impacts on health care system

2020 ◽  
Vol 73 (3) ◽  
Author(s):  
Helena Maria Scherlowski Leal David ◽  
José Ramón Martínez-Riera ◽  
Sonia Acioli ◽  
Maria Fernanda de Lima da Costa
Keyword(s):  
Health Care ◽  
Population Health ◽  
Economic Crisis ◽  
Dialectical Materialism ◽  
Vulnerable Groups ◽  
Care Model ◽  
Work Health ◽  
Negative Impacts ◽  
The Impact ◽  
Depth Interviews

ABSTRACT Objective: to analyze the perceptions of Spanish nurses regarding the country’s economic crisis situation, and its impacts on nursing work, health system and population’s health. Methods: qualitative approach, with data collection using an internet-based questionnaire and individual in-depth interviews. Data were analyzed according to Thematic-Categorical Content Analysis, supported by Historical and Dialectical Materialism perspective. Results: the categories produced discuss themes as: cutbacks in health care and the consequences of workforce non-replacement and work overload; salary impact; care model changes; negative impacts on population health. The impact on population health and work was discussed, especially regarding vulnerable groups, as well as in assistance model reconfiguration, reinforcing the biomedical and assistance perspective.

Examining the effectiveness of a coordinated perinatal mental health care model using an intersectional-feminist perspective

2018 ◽  
Vol 41 (5) ◽  
pp. 627-640 ◽  
Author(s):  
Natalie R. Stevens ◽  
Nicole M. Heath ◽  
Teresa A. Lillis ◽  
Kenleigh McMinn ◽  
Vanessa Tirone ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Feminist Perspective ◽  
Perinatal Mental Health ◽  
Care Model ◽  
Health Care Model

scholarly journals Managers Shaping the Service Triangle: Navigating Resident and Worker Interests Through Work Design in Nursing Homes

2020 ◽  
pp. 073088842093077
Author(s):  
Lander Vermeerbergen ◽  
Aoife M. McDermott ◽  
Jos Benders
Keyword(s):  
Health Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
Care Delivery ◽  
Work Design ◽  
Service Users ◽  
Care Model ◽  
Golden Mean ◽  
Stakeholder Interests ◽  
Centered Care

Managers play a key role in shaping the service triangle and navigating stakeholder interests within this. In health care, labor shortages are prompting consideration of the consequences of care delivery for service users and staff. Here, the authors consider how senior nursing home managers tasked with balancing resident and worker interests manage tensions using work design. The findings identify a five-cluster typology, reflecting variations in how managers from 20 Flemish nursing homes operationalize the same resident-centered care model. Managers purposively shape a different service triangle in each operationalization, variously prioritizing benefits for residents, seeking the golden mean, or attempting to suppress tensions.

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