Health policy
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We aggregate long-term care (LTC) facility-level data collected by Statistics Canada to National and regional levels to make observations relating to environmental characteristics--including the age distribution by region, and market share by type of ownership--and organizational characteristics--including ownership, facility size, resident age distribution, and the types of care provided in facilities by ownership. We observe significant differences in ownership by region, in facility size by ownership, and in levels of resident care provided by ownership. Further, we examine some of the classic proxies for quality of care for the LTC sector in this paper, including a variety of staffing intensity levels, observing significant differences in staffing intensities by region. We hope that our observations prompt researchers and policy makers to question the desirability and implications of this variation in the Canadian LTC industry.
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Controlled randomized trials have demonstrated the efficacy, safety, effectiveness, and cost-effectiveness of neuroreflexotherapy (NRT) for the management of non-specific back pain. In this audit study, we describe the implementation of NRT into the routine practice of primary care within the Spanish public health service of the Balearic Islands and the results obtained after one year (2004). A referral protocol was made available to all general practitioners (GPs) who could refer eligible patients to specialized units in performing NRT interventions. ⋯ Adverse effects related to the procedure were only a skin reaction in 3.3% of patients. We conclude that it is feasible to implement NRT in the public health service complying with methods and application conditions used in previous randomized controlled trials (RCTs). In such conditions, implementation of this technology obtained positive audit results at one year.
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To describe the level of emergency department (ED) volumes according to the hospital characteristics and to identify the relationship between hospital capacity characteristics and ED volumes in Korea. ⋯ With the service area population, the ED volumes significantly related with nurse staffing and inpatients per bed. These could be used as one of criteria to designate a LEMC.
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All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. ⋯ PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance service innovations; investment in human resource development - was critical to the reform success.
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To assess the relationship between admission stroke severity and outcomes of acute hospitalization in patients with first-ever ischemic stroke in Taiwan. ⋯ In patients with first-ever ischemic stroke in Taiwan, admission NIHSS is predictive of outcome of acute hospitalization.