RESUMEN
BACKGROUND: A home-based record (HBR) is a health document kept by the patient or their caregivers, rather than by the health care facility. HBRs are used in 163 countries, but they have not been implemented universally or consistently. Effective implementation maximizes both health impacts and cost-effectiveness. We sought to examine this research-to-practice gap and delineate the facilitators and barriers to the effective implementation and use of maternal and child health HBRs especially in low- and middle-income countries (LMICs). METHODS: Using a framework analysis approach, we created a framework of implementation categories in advance using subject expert inputs. We collected information through 2 streams. First, we screened 69 gray literature documents, of which 18 were included for analysis. Second, we conducted semi-structured interviews with 12 key informants, each of whom had extensive experience with HBR implementation. We abstracted the relevant data from the documents and interviews into an analytic matrix. The matrix was based on the initial framework and adjusted according to emergent categories from the data. RESULTS: We identified 8 contributors to successful HBR implementation. These include establishing high-level support from the government and ensuring clear communication between all ministries and nongovernmental organizations involved. Choice of appropriate contents within the record was noted as important for alignment with the health system and for end user acceptance, as were the design, its physical durability, and timely redesigns. Logistical considerations, such as covering costs sustainably and arranging printing and distribution, could be potential bottlenecks. Finally, end users' engagement with HBRs depended on how the record was initially introduced to them and how its importance was reinforced over time by those in leadership positions. CONCLUSIONS: This framework analysis is the first study to take a more comprehensive and broad approach to the HBR implementation process in LMICs. The findings provide guidance for policy makers, donors, and health care practitioners regarding best implementation practice and effective HBR use, as well as where further research is required.
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Países en Desarrollo , Control de Formularios y Registros/organización & administración , Registros de Salud Personal , Servicios de Salud Materno-Infantil/organización & administración , Análisis Costo-Beneficio , Control de Formularios y Registros/economía , Literatura Gris , Humanos , Ciencia de la Implementación , Servicios de Salud Materno-Infantil/economía , Registros MédicosRESUMEN
AIMS: Monitoring risk-based approaches in clinical trials are encouraged by regulatory guidance. However, the impact of a targeted source data verification (SDV) on data-management (DM) workload and on final data quality needs to be addressed. METHODS: MONITORING was a prospective study aiming at comparing full SDV (100% of data verified for all patients) and targeted SDV (only key data verified for all patients) followed by the same DM program (detecting missing data and checking consistency) on final data quality, global workload and staffing costs. RESULTS: In all, 137 008 data including 18 124 key data were collected for 126 patients from 6 clinical trials. Compared to the final database obtained using the full SDV monitoring process, the final database obtained using the targeted SDV monitoring process had a residual error rate of 1.47% (95% confidence interval, 1.41-1.53%) on overall data and 0.78% (95% confidence interval, 0.65-0.91%) on key data. There were nearly 4 times more queries per study with targeted SDV than with full SDV (mean ± standard deviation: 132 ± 101 vs 34 ± 26; P = .03). For a handling time of 15 minutes per query, the global workload of the targeted SDV monitoring strategy remained below that of the full SDV monitoring strategy. From 25 minutes per query it was above, increasing progressively to represent a 50% increase for 45 minutes per query. CONCLUSION: Targeted SDV monitoring is accompanied by increased workload for DM, which allows to obtain a small proportion of remaining errors on key data (<1%), but may substantially increase trial costs.
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Exactitud de los Datos , Recolección de Datos/normas , Manejo de Datos/normas , Bases de Datos Factuales/normas , Registros Electrónicos de Salud/normas , Control de Formularios y Registros/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Carga de Trabajo/normas , Análisis Costo-Beneficio , Control de Formularios y Registros/economía , Control de Formularios y Registros/normas , Humanos , Estudios ProspectivosAsunto(s)
Registros Electrónicos de Salud/legislación & jurisprudencia , Control de Formularios y Registros/legislación & jurisprudencia , Costos de la Atención en Salud/legislación & jurisprudencia , Reembolso de Seguro de Salud/legislación & jurisprudencia , Formulación de Políticas , Centers for Medicare and Medicaid Services, U.S./economía , Centers for Medicare and Medicaid Services, U.S./legislación & jurisprudencia , Registros Electrónicos de Salud/economía , Control de Formularios y Registros/economía , Humanos , Reembolso de Seguro de Salud/economía , Estados UnidosAsunto(s)
Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/legislación & jurisprudencia , Medicare Part B/economía , Medicare Part B/legislación & jurisprudencia , Mecanismo de Reembolso , Control de Formularios y Registros/economía , Control de Formularios y Registros/legislación & jurisprudencia , Personal de Salud/economía , Personal de Salud/legislación & jurisprudencia , Humanos , Formulario de Reclamación de Seguro/economía , Formulario de Reclamación de Seguro/legislación & jurisprudencia , Sistema de Pago Prospectivo/economía , Sistema de Pago Prospectivo/legislación & jurisprudencia , Mecanismo de Reembolso/economía , Mecanismo de Reembolso/legislación & jurisprudencia , Estados UnidosRESUMEN
AIM: The misuse and abuse of Enduring Powers of Attorney (EPAs) by attorneys, particularly in relation to financial decision-making, is a growing concern. This paper explores the opportunities to enhance accountability of attorneys at the time of the execution of the document in Queensland. METHOD: A four-stage multi-method design comprised a critical reference group; semi-structured interviews with 32 principals or potential principals, attorneys and witnesses; two focus groups with service providers and a state-wide survey of 76 principals, attorneys and witnesses. RESULTS: Across all methods and user groups, understanding the role and obligations of the attorney in an EPA was consistently identified as problematic. CONCLUSIONS: Promoting accountability and understanding can be addressed by greater attention to the role of the attorney in the forms/ guidelines and in the structure and witnessing of the forms, increased direction about record keeping and access to appropriate advice and support.
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Directivas Anticipadas/ética , Directivas Anticipadas/psicología , Toma de Decisiones/ética , Conocimientos, Actitudes y Práctica en Salud , Abogados/psicología , Apoderado/psicología , Responsabilidad Social , Directivas Anticipadas/economía , Financiación Personal/economía , Financiación Personal/ética , Grupos Focales , Control de Formularios y Registros/economía , Control de Formularios y Registros/ética , Guías como Asunto , Costos de la Atención en Salud/ética , Humanos , Internet , Entrevistas como Asunto , Abogados/normas , Mala Conducta Profesional/ética , Mala Conducta Profesional/psicología , Rol Profesional/psicología , Queensland , Encuestas y Cuestionarios , Consentimiento por Terceros , ConfianzaRESUMEN
The permanent adjustments ââsince 2003 to the G-DRG system have made the system even less understandable, so that many users have the feeling of feeding data into a black box which gives them a result without them being able to actively use the system itself. While chief physicians, senior physicians, and nursing managers are responsible to management for the results of the billing, they are in most cases not involved in the steps of DRG coding and billing. From this situation, a common question arises: "How well does my department code?" This uncertainty is exploited by many commercial vendors, who offer a wide variety of approaches for DRG optimization. The goal of this work is to provide advice as to how coding quality can be determined.
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Grupos Diagnósticos Relacionados/economía , Grupos Diagnósticos Relacionados/normas , Costos de la Atención en Salud , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/normas , Garantía de la Calidad de Atención de Salud/métodos , Control de Formularios y Registros/economía , Control de Formularios y Registros/normas , Adhesión a Directriz/economía , Adhesión a Directriz/normas , Humanos , Registros Médicos/economía , Registros Médicos/normas , Guías de Práctica Clínica como Asunto , Garantía de la Calidad de Atención de Salud/organización & administración , Garantía de la Calidad de Atención de Salud/normasAsunto(s)
Control de Formularios y Registros/economía , Formulario de Reclamación de Seguro/economía , Reembolso de Seguro de Salud/economía , Medicare Part B/economía , Bases de Datos Factuales , Control de Formularios y Registros/legislación & jurisprudencia , Personal de Salud/economía , Personal de Salud/legislación & jurisprudencia , Humanos , Formulario de Reclamación de Seguro/legislación & jurisprudencia , Reembolso de Seguro de Salud/legislación & jurisprudencia , Medicare Part B/legislación & jurisprudencia , Mecanismo de Reembolso/economía , Mecanismo de Reembolso/legislación & jurisprudencia , Estados UnidosRESUMEN
OBJECTIVES: To develop a database for documenting pharmacist intervention through a web-based application. The secondary endpoint was to determine if the new, web-based application provides any benefits with regards to documentation compliance by clinical pharmacists and ease of calculating cost savings compared with our previous method of documenting pharmacist interventions. SETTING: A tertiary care hospital in Saudi Arabia. METHOD: The documentation of interventions using a web-based documentation application was retrospectively compared with previous methods of documentation of clinical pharmacists' interventions (multi-user PC software). MAIN OUTCOME MEASURE: The number and types of interventions recorded by pharmacists, data mining of archived data, efficiency, cost savings, and the accuracy of the data generated. RESULTS: The number of documented clinical interventions increased from 4,926, using the multi-user PC software, to 6,840 for the web-based application. On average, we observed 653 interventions per clinical pharmacist using the web-based application, which showed an increase compared to an average of 493 interventions using the old multi-user PC software. However, using a paired Student's t-test there was no statistical significance difference between the two means (P = 0.201). Using a χ² test, which captured management level and the type of system used, we found a strong effect of management level (P < 2.2 × 10⻹6) on the number of documented interventions. We also found a moderately significant relationship between educational level and the number of interventions documented (P = 0.045). The mean ± SD time required to document an intervention using the web-based application was 66.55 ± 8.98 s. Using the web-based application, 29.06% of documented interventions resulted in cost-savings, while using the multi-user PC software only 4.75% of interventions did so. The majority of cost savings across both platforms resulted from the discontinuation of unnecessary drugs and a change in dosage regimen. Data collection using the web-based application was consistently more complete when compared to the multi-user PC software. CONCLUSIONS: The web-based application is an efficient system for documenting pharmacist interventions. Its flexibility and accessibility, as well as its detailed report functionality is a useful tool that will hopefully encourage other primary and secondary care facilities to adopt similar applications.
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Documentación , Control de Formularios y Registros , Internet , Farmacéuticos , Servicio de Farmacia en Hospital/métodos , Rol Profesional , Distribución de Chi-Cuadrado , Ahorro de Costo , Bases de Datos como Asunto , Documentación/economía , Control de Formularios y Registros/economía , Adhesión a Directriz , Costos de Hospital , Humanos , Internet/economía , Farmacéuticos/economía , Servicio de Farmacia en Hospital/economía , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Arabia Saudita , Análisis y Desempeño de TareasRESUMEN
Inspired by recent scholarship that calls for a more critical engagement with archives and knowledge production, this article plots the biography of an archive in Cape Town. Unravelling the layers of paperwork, it locates the origins of the archive in a repressive state project of excluding Indian immigrants and controlling those within the borders of the Cape Colony. The paper trail reveals documents of identity and the state's attempts to verify identity. In seeking to answer the question as to how the historian should approach such an archive of control and surveillance, it concludes that a social history and gendered approach to migration is possible and the real treasures are those documents that enter the archive beyond the limits of state intentions.
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Documentación , Emigrantes e Inmigrantes , Control de Formularios y Registros , Dinámica Poblacional , Vigilancia de la Población , Políticas de Control Social , Archivos/historia , Documentación/economía , Documentación/historia , Emigrantes e Inmigrantes/educación , Emigrantes e Inmigrantes/historia , Emigrantes e Inmigrantes/legislación & jurisprudencia , Emigrantes e Inmigrantes/psicología , Control de Formularios y Registros/economía , Control de Formularios y Registros/historia , Control de Formularios y Registros/legislación & jurisprudencia , Historia del Siglo XX , Historia del Siglo XXI , India/etnología , Fotograbar/economía , Fotograbar/educación , Fotograbar/historia , Fotograbar/legislación & jurisprudencia , Dinámica Poblacional/historia , Políticas de Control Social/economía , Políticas de Control Social/historia , Políticas de Control Social/legislación & jurisprudencia , Sudáfrica/etnología , Migrantes/educación , Migrantes/historia , Migrantes/legislación & jurisprudencia , Migrantes/psicologíaAsunto(s)
Medicare/economía , Neurología/economía , Oftalmología/economía , Derivación y Consulta/economía , Mecanismo de Reembolso/economía , Control de Formularios y Registros/economía , Control de Formularios y Registros/tendencias , Política de Salud/economía , Política de Salud/tendencias , Humanos , Medicare/legislación & jurisprudencia , Medicare/tendencias , Medicina/tendencias , Neurología/tendencias , Oftalmología/tendencias , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/tendencias , Derivación y Consulta/tendencias , Mecanismo de Reembolso/legislación & jurisprudencia , Mecanismo de Reembolso/tendencias , Sociedades Médicas/tendencias , Estados UnidosRESUMEN
Genetic testing is becoming a common component of medical practice and is used to determine definitive diagnoses for several adult pulmonary diseases. It is important for pulmonologists to know when to use genetic tests for diagnosis and medical management. This article describes diagnosis of rare hereditary pulmonary disease in adults and the role of genetic testing. A summary on coding and reimbursement is included.