Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial.

BACKGROUND: Increasing access to health and social services through service-integration approaches may provide a direct and sustainable way to improve health and social outcomes in low-income families. METHODS: We did a community-based randomized trial evaluating the effects of two service-integration practices (healthy family lifestyle and recreational activities for children) among low-income families in Alberta, Canada. These two practices in combination formed four groups: Self-Directed (no intervention), Family Healthy Lifestyle, Family Recreation, and Comprehensive (Family Healthy Lifestyle plus Family Recreation programs). The primary outcome was the total number of service linkages. RESULTS: We randomized 1168 families, 50 % of which were retained through the last follow-up visit. The number of service linkages for all three intervention groups was not significantly different from the number of linkages in the Self-Directed group (Comprehensive 1.15 (95 % CI 0.98-1.35), Family Healthy Lifestyle 1.17 (0.99-1.38), and Family Recreation 1.12 (0.95-1.32) rate ratios). However, when we explored the number of linkages by the categories of linkages, we found significantly more healthcare service linkages in the Comprehensive group compared to the Self-Directed group (1.27 (1.06-1.51)) and significantly more linkages with child-development services in the Family Healthy Lifestyle group compared to the Self-Directed group (3.27 (1.59-6.74)). The monthly hours of direct intervention was much lower than the assigned number of hours (ranging from 5 to 32 % of the assigned hours). CONCLUSIONS: Our findings are relevant to two challenges faced by policymakers and funders. First, if funds are to be expended on service-integration approaches, then, given the lack of intervention fidelity found in this study, policymakers need to insist, and therefore fund a) a well-described practice, b) auditing of that practice, c) retention of family participants, and d) examination of family use and outcomes. Second, if child-development services are widely required and are difficult for low-income families to access, then current policy needs to be examined. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00705328 . Registered on 24 June 2008.

Introducción a la gestión por procesos en el servicio de kinesiologia del hospital de urgencia Córdoba-Argentina / Introduction to process management in service kinesiologia hospital emergency Córdoba-Argentina

El objetivo de este trabajo es evaluar la gestión organizacional del servicio de Kinesiología del Hospital de Urgencia, con base en el modelo EFQM, centrado en tres criterios facilitadores. Esto nos va a permitir realizar un diagnostico de la gestión en cuanto al liderazgo, politico, estrategia y gestión del personal. Metodología: en primer lugar se realiza la recolección la de información por medio de entrevistas individuales y reuniones colectivas para contextualizar el momento actual en cuanto a gestión organizacional en la que se encuentra el servicio al momento de hacer el estudio, posteriormente se realiza la autoevaluación del servicio utilizado en modelo EFQM como método de referencia, se identifican los principales puntos fuertes y áreas de mejora, finalmente se plantea una propuesta de intervención. Resultados: se logran evaluar los criterios de liderazgo, politica y estrategia y gestión del personal, encontrando oportunidades de mejora y puntos fuertes en los tres criterios, sin embargo en el de política y estrategia los ajustes que deben hacerse son mayores. Se identifican las mejoras, se organiza la información correspondiente a la gestión administrativa del servicio de kinesiología del hospital.(AU)

SUMMARY: The objective of this work was to evaluate the organizational management of the service of inesiology of mergency hospital based on the EFQM model, focusing on three criteria facilitators. This will allow us to make a diagnosis of management. Methodology: first is performed the collection of information through individual interviews and group meetings to contextualize the actual moment in terms of organizational management in which the service is located at the time of the study; subsequently carried out the self-assessment of the service using the EFQM model as a reference method, identifies the main strengths and areas for improvement, ultimately based on the above presents a proposal for intervention. Results: is able to evaluate the criteria of leadership, policy and strategy and management of staff, finding opportunities for improvement and strategy and management of staff, finding opportunities for improvement and stregths in all three criteria, however in the policyu and strategy adjustments to be made are greater. Improvements are identified; information is organized for the administration of the kinematics of the hospitalservice.(AU)

Introducción a la gestión por procesos en el servicio de kinesiologia del hospital de urgencia Córdoba-Argentina / Introduction to process management in service kinesiologia hospital emergency Córdoba-Argentina

El objetivo de este trabajo es evaluar la gestión organizacional del servicio de Kinesiología del Hospital de Urgencia, con base en el modelo EFQM, centrado en tres criterios facilitadores. Esto nos va a permitir realizar un diagnostico de la gestión en cuanto al liderazgo, politico, estrategia y gestión del personal. Metodología: en primer lugar se realiza la recolección la de información por medio de entrevistas individuales y reuniones colectivas para contextualizar el momento actual en cuanto a gestión organizacional en la que se encuentra el servicio al momento de hacer el estudio, posteriormente se realiza la autoevaluación del servicio utilizado en modelo EFQM como método de referencia, se identifican los principales puntos fuertes y áreas de mejora, finalmente se plantea una propuesta de intervención. Resultados: se logran evaluar los criterios de liderazgo, politica y estrategia y gestión del personal, encontrando oportunidades de mejora y puntos fuertes en los tres criterios, sin embargo en el de política y estrategia los ajustes que deben hacerse son mayores. Se identifican las mejoras, se organiza la información correspondiente a la gestión administrativa del servicio de kinesiología del hospital.

SUMMARY: The objective of this work was to evaluate the organizational management of the service of inesiology of mergency hospital based on the EFQM model, focusing on three criteria facilitators. This will allow us to make a diagnosis of management. Methodology: first is performed the collection of information through individual interviews and group meetings to contextualize the actual moment in terms of organizational management in which the service is located at the time of the study; subsequently carried out the self-assessment of the service using the EFQM model as a reference method, identifies the main strengths and areas for improvement, ultimately based on the above presents a proposal for intervention. Results: is able to evaluate the criteria of leadership, policy and strategy and management of staff, finding opportunities for improvement and strategy and management of staff, finding opportunities for improvement and stregths in all three criteria, however in the policyu and strategy adjustments to be made are greater. Improvements are identified; information is organized for the administration of the kinematics of the hospitalservice.

Implementation issues in tuberculosis/HIV program collaboration and integration: 3 case studies.

The many interactions between tuberculosis (TB) and human immunodeficiency virus (HIV) infection influence the design and implementation of programs to address the needs of patients living with or at risk for both diseases. Collaboration between national TB and HIV programs and some degree of integration of services at a local level have been advocated by the World Health Organization and other international bodies and are recognized as essential in areas where the 2 diseases are prevalent. However, in most settings, strategies to accomplish this are only beginning to reach the field where their impact will be made and the expectation of improving the outcome of both diseases realized. In this article, 3 such strategies, offering varying degrees of collaboration and integration, are described, 1 at a national level in Malawi and 2 at local sites in South Africa. These geographically and programmatically distinct experiences in TB/HIV service integration are instructive, illustrate common themes, and show that the strategy can be successful, but they also show that programmatic, medical, staffing, resource, and scale-up challenges remain. In addition, they indicate that, although broad program principles of TB/HIV service integration are essential, program designs and components may vary by country and even within countries, as a result of differing TB and HIV disease prevalences, resources, levels of expertise, and differences in program settings (urban vs. rural and/or primary vs. district vs. specialty site). Large national programs can successfully provide rapid, uniform and widespread change and implementation but also must negotiate the subtleties of intricacies of TB/HIV interactions, which confound a uniform "one size fits all" public health approach. Conversely, smaller demonstration projects, even with successful outcomes, must grapple with issues related to generalization of findings, wider implementation, and scale up, to benefit larger populations of those in need.

Buenas prácticas en gestión sanitaria: el caso Kaiser Permanente / Good practices in health care management: Kaiser Permanente case

Objetivo. Describir y analizar los rasgos generales que caracterizan el modelo de organización y gestión de la institución sanitaria estadounidense Kaiser Permanente. Material y métodos. Estudio realizado a través de una metodología de estudio de caso, elaborado con información recabada de manera directa en una visita de estudio a Kaiser Permanente y complementada con fuentes documentales procedentes de una revisión bibliográfica. Resultados. Kaiser Permanente engloba las funciones de aseguramiento y de provisión de servicios sanitarios para una población superior a 8 millones de personas. Algunos de los resultados que obtiene pueden ser calificados de "excelentes", principalmente en aspectos de integración de la atención, reducción de hospitalizaciones y de estancias innecesarias, y prevención y control de enfermedades crónicas. Estos resultados son atribuibles en gran medida a un modelo de gestión y de organización de servicios caracterizado por su enfoque poblacional, liderazgo clínico y utilización de modelos innovadores de atención. Conclusiones. Kaiser Permanente muestra un elenco de buenas prácticas de gestión, ya sean a nivel macro, como su enfoque de salud poblacional, meso, como su abordaje de atención integrada, y micro, en el que destacan múltiples herramientas innovadoras vinculadas a la gestión de enfermedades. Estas prácticas suponen oportunidades de aprendizaje relevantes para el Sistema Nacional de Salud español. Desde una óptica de teoría organizativa pueden identificarse en el modelo Kaiser Permanente los principales rasgos que caracterizan una "organización que aprende"

Objective. To describe and analyze the main features of the United States Kaiser Permanente organization and management model. Methods. Study performed with a case study method, elaborated with information obtained directly during a study visit to Kaiser Permanente and completed with documents from a review of the literature. Results. Kaiser Permanente is both a health care insurer and provider and covers a population that exceeds eight million affiliates. Kaiser excels in several performance areas, such as integration of care, hospital care minimization, prevention and control of chronic diseases. These results are mainly attributable to a management model characterized by its population focus, clinical leadership, and broad use of innovative care models. Conclusions. Kaiser Permanente has a wide range of good management practices, for instance, macro-level, such as its population health focus, meso-level, such as its integrated care system and micro-level, in which there are many innovative approaches to disease management. These practices offer good learning opportunities for the Spanish National Health system. From an organizational theory perspective, the Kaiser Permanente models shares many of the features of a "Learning Organization"