A scoping review of studies evaluating the education of health professional students about public health.

BACKGROUND: The purpose of this article is to identify and describe key components of research into the teaching methods of public health to postgraduate students. STUDY DESIGN: This is a systematic review of the published literature. METHODS: A detailed search of the literature based on keywords, Boolean operators, and free-text terms, identified from PubMed, Scopus and ERIC, published in the English language, between January 2000 and December 2017, was made. Teams of independent pairs agreed studies eligible for the review and performed data extraction. RESULTS: Of the 2,442 potential studies on education of public health professionals, 86 met all the inclusion criteria. Specific study designs, data collection, and techniques for data analysis varied widely across the individual studies, and there was a lack of consistency on the whole. The number of students in each study ranged from ten to 1,300. Forty-seven studies used quantitative methods to assess the effectiveness of teaching. Curriculum evaluation was the most common focus (n = 33), followed by course evaluation (n = 22). Few studies considered inequalities in terms of the types of students registered on the different courses/programs, with just three evaluating strategies to increase students from minority ethnic groups. Most studies evaluated short-term or medium-term outcomes rather than long-term impacts of education on students' careers or the relationship of education in meeting future public health workforce demands. CONCLUSIONS: This comprehensive systematic review identified a dearth of the literature on evaluations of approaches for teaching public health to health professions students. Those studies that had been published varied to such an extent in terms of their aims, methods, analysis, and results such that it was impossible to make any consistent comparisons of the observations reported in the studies. We conclude that evidence-based approaches for teaching public health to health professions students are either not sought by faculty and programs or, if conducted, not shared. As such, there are likely to be missed opportunities for ensuring that future graduates of health professions programs are as well prepared as possible to contribute to the health of the public.

Geriatric services offered by hospitals: predicting services by internal and external community characteristics.

This article explores the role of hospitals in providing geriatric services and identifies associated community and hospital characteristics. The sample is 4571 community hospitals responding to the 1995 American Hospital Association (AHA) Annual Survey. Most hospitals offer some geriatric services; the mean is 3.3. The dependent variable is an index of 13 geriatric services created from the AHA data. Independent variables are taken from the AHA survey, Area Resource File, and census data. Regression analysis explains fifteen percent of the variance. Hospital characteristics predicting provision of geriatric services are non-profit tax status, hospital bed size and system membership. Community characteristics predicting provision of geriatric services included higher population density, high percentage of county aged, and county nursing facility beds. Hospital characteristics yielded slightly higher predictive ability than did community characteristics. The findings suggest policies to increase hospital leadership in providing access to senior services require a multi-dimensional approach.

Enhancing managed care's role in long-term care: building on the aging network.

As Medicare managed care organizations grow, they will likely enroll more functionally impaired older people, as well as individuals with special linguistic and cultural needs. Traditional aging network service providers have special expertise to serve these populations. To date, however, the aging network has only been integrated into the operations of managed care on a very limited basis, primarily by demonstration projects. This article highlights program examples of collaboration between the aging network providers and managed care organizations for case management, screening, assisted living, and adult day care. The steps managed care organizations should take to build on the expertise of the aging network are described.

The role of home care in integrated delivery systems.

The health care field is moving rapidly toward integrated delivery systems (IDS). The role of home care in such system is unclear. This study seeks to describe the current status of home care in IDS and to examine health care administrators' perceptions about the importance of IDS components. A random sample of 1600 administrators was surveyed, 400 each from home care agencies, hospitals, nursing homes, and medical groups. Results reveal that hospitals lead integration, nursing homes are least involved, and home care agencies and medical groups fall in between. Administrator's opinions vary considerably about the importance of select services and integrating mechanisms.

Strategic management of a continuum of care.

Why would an organization want to undertake the changes required to be a continuum of care? Because providers of residential and long-term nursing care that continue to function in isolation may survive, but they will not thrive in the 21st century.

Creating a continuum. The goal is to provide an integrated system of care.

The idea of a continuum of care is hardly new. In its purest form, it is simply the essence of good patient care. Today, the complex U.S. healthcare organization has emerged as a highly sophisticated but fragmented collection of service providers. We now must put energy and resources into rebuilding the comprehensiveness and continuity that represent high-quality care. The rationale for a continuum of care is that it is appropriate for patients' needs, demanded by today's consumers, an organized way of maximizing use of healthcare resources, and cost-effective for providers, patients, and payers. A continuum of care comprises services and integrating mechanisms. The services can be broken into seven basic categories: extended care, acute hospital care, ambulatory care, home care, outreach, wellness, and housing. The four basic integrating mechanisms are interentity planning and management, care coordination, case-based financing, and integrated information systems. Shaping a continuum mandates translating broad principles into pragmatic application suitable for the organization and community. The organization should define goals and objectives, identify a target population, assess services, evaluate integrating mechanisms, communicate, and prepare a business plan.

Creating the continuum of care.

Continuum of care is a concept involving an integrated system of care that guides and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care. This article presents a definition of continuum of care, including objectives, basic components, and operating principles. The purpose is to provide a concept that will encourage leadership by offering a vision for the future and providing a framework to guide day-to-day decision-making. Two case scenarios illustrate the effectiveness of the continuum of care concept in providing a framework for delivery of optimum health care to patient populations.

Members program targets the senior market.

Senior membership programs offer hospitals an opportunity to achieve strategic positioning among older adults, the highest users of health-care services. Initially, older consumers are linked with the hospital through a variety of services. Over the long term, the hospital expects to gain financially as members use inpatient and other services.

Factors explaining the use of health care services by the elderly.

The Anderson model of health services utilization, which relates use of service to predisposing, enabling, and need factors, has not often been applied to an elderly population. In this study, the factors of the Andersen model were used prospectively to predict utilization for a population sample of 1,317 elderly persons. Taken alone, the NEED construct was the most important single predictor of use of physician services, hospitalizations, ambulatory care, and home care. PREDISPOSING factors were better predictors of the use of dental services. Some of the variables studied were not related to utilization in the direction that would have been predicted from previous studies on general populations. Multivariate analyses demonstrated that the three constructs should be applied simultaneously when predicting use of services. These findings can be applied to the specific task of planning services for older people.

Hospitals and the provision of care to the aged: a cluster analysis.

As the American population ages, the hospital industry will undergo substantial restructuring to meet the increased demand for geriatric and long-term care services. Understanding this important trend, however, has been inhibited by limited research and the vast range of services that currently exists. This investigation develops empirically a classification schema of hospitals that reflects the mix of geriatric services they provide. The study also identifies the organizational and environmental characteristics of hospitals providing these geriatric service categories. Factor analysis, clustering, and analysis of variance were performed on a sample of 416 hospitals. Seven distinct groupings of hospitals that differed systematically on geriatric service mix and other contextual factors were identified.