Partnerships between universities and nonprofit transition coaching organizations to increase student success.

AIMS: This study aims to understand the motivations and benefits for universities and nonprofit college access and success organizations to develop formal partnerships. METHODS: Participants in this study were staff from a major urban research university (n = 22) and four nonprofit organizations (n = 17) that promote college access and success among underrepresented, low-income, and first-generation college students. Participants engaged in an audio-recorded interview that was transcribed and analyzed using thematic analysis. RESULTS: Data suggested that staff from the universities and nonprofit organizations were both holistic in their understanding of college student success. In addition, they were both motivated to form partnerships in an effort to reduce barriers to success, although they, at times, identified different barriers that they wanted the partnership to address. Both university and nonprofit staff saw increased effectiveness of their practice as a result of partnering and university staff gained a better understanding of the greater nonprofit college access and success community. CONCLUSION: Given the intense support that nonprofit organizations are able to provide with their level of funding, partnerships with universities can increase the success of underrepresented, low-income, and first-generation college students.

Investing in acute health services: is it time to change the paradigm?

OBJECTIVE: Capital is an essential enabler of contemporary public hospital services funding hospital buildings, medical equipment, information technology and communications. Capital investment is best understood within the context of the services it is designed and funded to facilitate. The aim of the present study was to explore the information on capital investment in Australian public hospitals and the relationship between investment and acute care service delivery in the context of efficient pricing for hospital services. METHODS: This paper examines the investment in Australian public hospitals relative to the growth in recurrent hospital costs since 2000-01 drawing from the available data, the grey literature and the reports of six major reviews of hospital services in Australia since 2004. RESULTS: Although the average annual capital investment over the decade from 2000-01 represents 7.1% of recurrent expenditure on hospitals, the most recent estimate of the cost of capital consumed delivering services is 9% per annum. Five of six major inquiries into health care delivery required increased capital funding to bring clinical service delivery to an acceptable standard. The sixth inquiry lamented the quality of information on capital for public hospitals. In 2012-13, capital investment was equivalent to 6.2% of recurrent expenditure, 31% lower than the cost of capital consumed in that year. CONCLUSIONS: Capital is a vital enabler of hospital service delivery and innovation, but there is a poor alignment between the available information on the capital investment in public hospitals and contemporary clinical requirements. The policy to have capital included in activity-based payments for hospital services necessitates an accurate value for capital at the diagnosis-related group (DRG) level relevant to contemporary clinical care, rather than the replacement value of the asset stock. WHAT IS KNOWN ABOUT THE TOPIC?: Deeble's comprehensive hospital-based review of capital investment and costs, published in 2002, found that investment averages of between 7.1% and 7.9% of recurrent costs primarily replaced existing assets. In 2009, the Productivity Commission and the National Health and Hospitals Reform Commission (NHHRC) recommended capital, for the replacement of buildings and medical equipment, be included in activity-based funding. However, there have been persistent concerns about the reliability and quality of the information on the value of hospital capital assets. WHAT DOES THIS PAPER ADD?: This is the first paper for over a decade to look at hospital capital costs and investment in terms of the services they support. Although health services seek to reap dividends from technology in health care, this study demonstrates that investment relative to services costs has been below sustainable levels for most of the past 10 years. The study questions the helpfulness of the highly aggregated information on capital for public hospital managers striving to improve on the efficient price for services. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Using specific and accurate information on capital allocations at the DRG level assists health services managers advance their production functions for the efficient delivery of services.

Translating evidence to practice: two stories from the field.

Translating research evidence into daily practice is a challenging process at the organizational level. Conceptual models about this process point to the importance of resources for change and environmental influences as two key factors that need to be addressed in translation efforts. Two organizational case studies focused on improving care for adults with depression are described that illustrate lessons about translating evidence to practice that may be helpful to others.

[New forms of remuneration and care delivery: their impact on rehabilitation]. / Neue Vergütungs- und Versorgungsformen und ihre Auswirkungen auf die Rehabilitation.

Current health policy reform efforts in Germany include introduction of a DRG (Diagnosis Related Group) based funding system in the hospital sector as well as integrated delivery of health care and disease management programs, developments that will directly affect the medical rehabilitation sector. Decreasing lengths of hospital stay induced by the DRG system will inter alia entail a shifting of cases and costs to subsequent sectors. Moreover, hospitals might not least seek compensation for shorter hospital stays by extending their scope to include rehabilitation and long-term care services. Introduction of the DRG system in acute-hospital care has resulted in major changes in respect of early rehabilitation. Existing specialized early rehabilitation facilities providing high-quality care face serious funding problems on account of the newly introduced early rehabilitation DRGs. For hospitals previously not involved in early rehabilitation on the other hand, incentives arise to set up new early rehabilitation structures although the need for these additional capacities obviously is questionable. Introduction of the DRG-based funding system has reinforced the discussion about applying a flat-rate system also in the rehabilitation sector. This form of remuneration however is inappropriate to medical rehabilitation concepts. On the other hand, a remuneration system incorporating cross-institutional per-diem fees and "treatment time" budgets might enable using essential advantages of flat-rate payment without having to expect repercussions for the quality of care. In the context of integrated care and disease management programs the issue at stake for rehabilitation primarily is to be able to contribute its specific competencies appropriately. Also, integrated health care is bound to result in stronger competition among the various health care sectors. If rehabilitation is set to face this competition, further research efforts will urgently have to be made along with ongoing development of clinical practice guidelines.