Browsing by Subject "Case Management"

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    Case management of patients with Type 2 diabetes mellitus: a cross-sectional survey in Chongqing, China.
    (BMC Health Serv Res, 2017-02-11) He, Miao; Gao, Jiaqi; Liu, Weiwei; Tang, Xiaojun; Tang, Shenglan; Long, Qian
    BACKGROUND: Type 2 diabetes mellitus has been identified as one of the priority diseases and included in the essential public health service package in China. This study investigated the frequency of follow-up visits and contents of care for case management of patients with Type 2 diabetes in Chongqing located in the western China, in terms of the regional practice guideline; and analyzed factors associated with the use of care. METHODS: A cross-sectional survey was conducted with patients diagnosed with Type 2 diabetes in two areas in Chongqing. Total 502 participants (out of 664 people eligible) completed the interview. The outcome measures included at least four follow-up visits in a year, annual HbA1c test, blood lipid test and diabetic screening for nephropathy and eyes. Logistic regression analysis was applied to examine the association between participants' demographic and socio-economic characteristics and outcome measures. RESULTS: Over the one-year study period, 65% of participants had four or more follow-up visits. In light of the recommended tests, the proportions of having HbA1c test, blood lipid test and screening for nephropathy and eyes annually were 8, 54, 45 and 44%, respectively. After adjusting for study sites, age, sex, education, type of residence, level of income, the patients who were covered by Urban Employee Basic Medical Insurance, were enrolled in the targeted disease reimbursement program, and lived with diabetes more than five years were more likely to have regular follow-up visits and the recommended tests. CONCLUSIONS: Case management for patients with Type 2 diabetes mellitus was not effectively implemented in terms of frequency of follow-up visits and recommended tests over one-year period, as indicated in the regional practice guideline.
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    Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america.
    (Clin Infect Dis, 2010-02-01) Perfect, John R; Dismukes, William E; Dromer, Francoise; Goldman, David L; Graybill, John R; Hamill, Richard J; Harrison, Thomas S; Larsen, Robert A; Lortholary, Olivier; Nguyen, Minh-Hong; Pappas, Peter G; Powderly, William G; Singh, Nina; Sobel, Jack D; Sorrell, Tania C
    Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)-infected individuals, (2) organ transplant recipients, and (3) non-HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary cryptococcosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and cryptococcomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.
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    Differences between chest pain observation service patients and admitted "rule-out myocardial infarction" patients.
    (Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 1997-07) Dallara, J; Severance, HW; Davis, B; Schulz, G

    Objective

    To compare and contrast the patient characteristics of ED patients at low risk for acute cardiac ischemia who were assigned to a chest pain observation service vs those admitted to a monitored inpatient bed for "rule-out acute myocardial infarction" (R/O MI).

    Methods

    This was a retrospective, cross-sectional comparison of adult patients considered at relatively low risk for cardiac ischemia and who were evaluated in 1 of 2 settings: a short-term observation service and an inpatient monitored bed. All patients had an ED final diagnosis of "chest pain," "R/O MI," or "unstable angina" during the 7-month study period. Demographic features and presenting clinical features were examined as a function of site of patient evaluation.

    Results

    Of 531 study patients, 265 (50%) were assigned to the observation service. Younger age (OR = 1.75, 95% CI 1.26, 2.44, for each decrement of 20 years), the complaint of "chest pain" (OR = 2.35, 95% CI 1.34, 4.12), and the absence of prior known coronary artery disease (OR = 1.64, 95% CI 1.13, 2.38) were the principal independent factors associated with assignment to a chest pain observation service bed.

    Conclusions

    Patients evaluated in a chest pain observation service appear to have different clinical characteristics than other individuals admitted to a monitored inpatient bed for "R/O MI." Investigators should address differences in clinical characteristics when making outcome comparisons between these 2 patient groups.
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    Is implementation fidelity associated with improved access to care in a school-based Child and Family Team model?
    (Eval Program Plann, 2015-04) Gifford, Elizabeth J; Wells, Rebecca S; Bai, Yu; Malone, Patrick S
    Effective child and family centered service planning is crucial to addressing vulnerable children's needs. However, there is limited evidence about what facets of these processes improve service use and outcomes. The current study used a Poisson random effects hazard model to test correlations between fidelity to NC's Child and Family Support Team model and time to service receipt, using case management data for 3396 children served by that program during the 2008-2009 school year. Students were more likely to receive recommended services more quickly when caregivers and the students attended planning meetings, when their plans included services for caregivers, and when child and family team leaders followed up after meetings to verify service receipt. Contrary to the Child and Family Support Team theory of change, match between student needs and the lead agency of the meeting was not associated with the odds of quicker service receipt, nor was attendance by natural supports. Findings from this study demonstrate the potential effectiveness of using case management systems to measure service planning process fidelity, as well as how results thereof can both inform process improvement and potential refinements to models' theories of change.
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    Strengthening Alignments between National Health Financing System and Primary Health Care: Lessons from Taiwan
    (2020) Liu, Yangyujin

    Background: To tackle the demographic and epidemiologic challenges, countries around the world need to build a health system centered on primary health care (PHC) in which a supportive financing system is a premise. In this study, the Taiwanese PHC system is taken as a key example. It represents a system that the study can analyze to identify best practice and, additionally, draw out lessons that other systems can consider, replicate and apply for their own primary healthcare delivery needs. Methods: This study used a qualitative research approach to explore stakeholders’ perspectives on the role that the National Health Insurance (NHI) of Taiwan plays in the delivery of PHC. The qualitative data was two-fold: (1) 21 in-depth interviews with local and national health insurance administrators, hospital and health centers’ administrative managers, and service providers at private and hospital levels; and (2) participatory on-site observations of PHC delivery in health facilities and communities. Results: Nvivo 12 was used to conduct data analysis. The data revealed five main themes: (1) Payment method system reform; (2) integrated care services to improve PHC delivery; (3) E-health and technology’s role in regulation and care delivery; (4) leadership support; and (5) education for both service users and providers. Conclusions: The study’s findings include a need to refine the payment methods while keeping geographic disparities and effective incentives in mind; strengthen leadership support at different levels; improve the feasibility and performance of e-health tools; improve the transparency and accountability of the regulation policies; and continuously work on health education.