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1.
J Emerg Manag ; 18(2): 141-152, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32181869

RESUMEN

Disasters are diversified in all aspects: they range from storms and tornadoes to earthquakes, tsunamis and cyclones etc. They affect a range of countries. Most disasters are caused by geographical factors. The overall response depends on the wealth of a country. For example, Japan is better prepared than Nepal or Haiti. Disaster responses are multidimensional and are assumed to be effective. From a service quality perspective, groups of responders provide services to victims. Effectiveness and efficiency of victim services are perhaps two outcome measures. Unfortunately, published studies on evaluation of disaster responses are sparse to nonexistent. The intent of this study is to develop a preliminary method for assessing the perceived effectiveness and efficiency (service quality) from the perspectives of both the responders and the victims. A method (preliminary) is proposed in which all anticipated attributes and outcomes are measured. Regression is the proposed modeling tool. It is hoped that the proposed preliminary method will facilitate the preparedness of the response teams and give rise to a permanent method.


Asunto(s)
Planificación en Desastres/organización & administración , Desastres , Modelos Organizacionales , Tormentas Ciclónicas , Terremotos , Humanos , Tsunamis
4.
Gesundheitswesen ; 82(2): 163-171, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-31113006

RESUMEN

BACKGROUND: Every person who is in the need of long-term care (according to German Social Code SGB XI §14) fulfills the requirements of disability according to German Social Code SGB IX, § 2. The right of participation and autonomy must be specially protected and realized for persons with long-term care needs because these persons have a limited capacity to advance their interests. The rights of people in the need of long-term care or assistance are protected not only by the national constitution but also by the UN Disability Rights Convention. Participation is an important principle of these extra-statutory regulations and has an extraordinary significance and individual meaning for quality of life. For concretizing the aim of participation and for realizing participation in daily practice, the following question arises: How must organizations be configured to achieve individual aims of participation for persons with long-term care need, complex health care needs and with potential for rehabilitation across sectoral, disciplinary and professional borders? This analysis focuses on people older than 70 years with geriatric-relevant multimorbidity and with potential for rehabilitation. AIM: The aim of this study was to create a configuration model for the organization of interdisciplinary cooperation in rehabilitation out of a case study and on the basis of the service blueprinting method [1]. In a next step this configuration model can be evaluated concerning its effectiveness for achieving individual participation goals and quality of life of persons with long-term care need and with potential for rehabilitation. METHOD: For creating the configuration model, the service blueprinting method [1] on the basis of Dervin's sense making theory [11] was applied to a case vignette of geriatric rehabilitation against a background of organization theories and nursing science concepts. With the case study the configuration model can be applied exemplarily at the setting of restorative care, therapy and rehabilitation. With the service blueprinting method, the rehabilitation process is aligned onto the geriatric patient's individual health care needs, perceptions of participation and quality of life. RESULTS: As a result of the sequencing and service blueprinting process we offer a dynamic model for the coordination of responsibility of interdisciplinary rehabilitation teams with a user-centered alignment. Its effectiveness (and side-effects) for interdisciplinary cooperation and for patient's individual goals of participation and quality of life must be evaluated in further studies. A mixed-method design should be used to evaluate objective outcome parameters such as dependency on nursing care, hospital admission rates and subjective outcome parameters such as patient's perception of participation, autonomy and quality of life. IMPLICATIONS FOR HEALTHCARE PRACTICE: The configuration model can be used for evaluating already implemented geriatric rehabilitation processes and organizations. The configuration model can be used in health care research or organizational research. After more evidence for desirable effects, it can be implemented into the health care system. Side effects should be monitored.This paper was written in cooperation with the working group "Nursing", department "Practical Social Medicine and Rehabilitation" of the German Society of Social Medicine and Prevention (Deutsche Gesellschaft für Sozialmedizin und Prävention DGSMP e.V.).


Asunto(s)
Enfermería , Medicina Social , Anciano , Alemania , Metas , Humanos , Modelos Organizacionales , Calidad de Vida
5.
J Nurs Adm ; 50(1): 9-11, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31809451

RESUMEN

Despite Health Resources and Services Administration projecting a national excess of approximately 300 000 RNs as compared with demand by 2030, continued regional and local shortages have been confirmed. Pockets of chronic nurse shortages for various reasons, continued margin pressures, increased inpatient care complexity, continued RN turnover, and overall RN resilience are prompting chief nurse executives to investigate staffing model innovations. Next-generation staffing models include those that significantly embrace new teams and technology, as well as the philosophy of primary nursing care. Chief nurse executives must carefully analyze all models from the standpoint of organizational, cultural, and professional norms, as well their role in spearheading such efforts.


Asunto(s)
Modelos Organizacionales , Enfermeras Administradoras , Personal de Enfermería en Hospital/organización & administración , Admisión y Programación de Personal , Humanos , Cultura Organizacional
6.
Int J Med Inform ; 134: 103927, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31864096

RESUMEN

CONTEXT: The Unified Model of Information Systems Continuance (UMISC) is a metamodel for the evaluation of clinical information systems (CISs) that integrates constructs from five models that have previously been published in the literature. UMISC was developed at the Georges Pompidou University Hospital (HEGP) in Paris and was partially validated at the Saint Joseph Hospital Group (HPSJ), another acute care institution using the same CIS as HEGP. OBJECTIVE: The aim of this replication study was twofold: (1) to perform an external validation of UMISC in two different hospitals and country contexts: the Italian Hospital of Buenos Aires (HIBA) in Argentina and the Hospital Sirio Libanes in Sao Paulo, Brazil (HSL); (2) to compare, using the same evaluation model, the determinants of satisfaction, use, and continuance intention observed at HIBA and HSL with those previously observed at HEGP and HPSJ. METHODS: The UMISC evaluation questionnaires were translated from their original languages (English and French) to Brazilian Portuguese and Spanish following the translation/back-translation method. These questionnaires were then applied at each target site. The 21 UMISC-associated hypotheses were tested using structural equation modeling (SEM). RESULTS: A total of 3020 users, 1079 at HIBA and 1941 at the HSL, were included in the analysis. The respondents included 1406 medical staff and 1001 nursing staff. The average profession-adjusted use, overall satisfaction and continuance intention were significantly higher at HIBA than at HSL in the medical and nursing groups. In SEM analysis, UMISC explained 23% and 11% of the CIS use dimension, 72% and 85% of health professionals' satisfaction, and 41% and 60% of continuance intention at HIBA and HSL, respectively. Twenty of the 21 UMISC-related hypotheses were validated in at least one of the four evaluation sites, and 16 were validated in two or more sites. CONCLUSION: The UMISC evaluation metamodel appears to be a robust comparison and explanatory model of satisfaction, use and continuance intention for CISs in late post adoption situations.


Asunto(s)
Actitud del Personal de Salud , Personal de Salud/estadística & datos numéricos , Sistemas de Información en Hospital/estadística & datos numéricos , Hospitales Universitarios/normas , Modelos Organizacionales , Satisfacción Personal , Adulto , Argentina , Brasil , Femenino , Humanos , Agencias Internacionales , Masculino , Encuestas y Cuestionarios
8.
Global Health ; 15(1): 81, 2019 11 28.
Artículo en Inglés | MEDLINE | ID: mdl-31779660

RESUMEN

BACKGROUND: In conflict settings, research capacities have often been de-prioritized as resources are diverted to emergency needs, such as addressing elevated morbidity, mortality and health system challenges directly and/or indirectly associated to war. This has had an adverse long-term impact in such protracted conflicts such as those found in the Middle East and North Africa region (MENA), where research knowledge and skills have often been compromised. In this paper, we propose a conceptual framework for health research capacity strengthening that adapts existing models and frameworks in low- and middle-income countries and uses our knowledge of the MENA context to contextualise them for conflict settings. METHODS: The framework was synthesized using "best fit" framework synthesis methodology. Relevant literature, available in English and Arabic, was collected through PubMed, Google Scholar and Google using the keywords: capacity building; capacity strengthening; health research; framework and conflict. Grey literature was also assessed. RESULTS: The framework is composed of eight principal themes: "structural levels", "the influence of the external environment", "funding, community needs and policy environment", "assessing existing capacity and needs", "infrastructure and communication", "training, leadership and partnership", "adaptability and sustainability", and "monitoring and evaluation"; with each theme being supported by examples from the MENA region. Our proposed framework takes into consideration safety, infrastructure, communication and adaptability as key factors that affect research capacity strengthening in conflict. As it is the case more generally, funding, permissible political environments and sustainability are major determinants of success for capacity strengthening for health research programmes, though these are significantly more challenging in conflict settings. Nonetheless, health research capacity strengthening should remain a priority. CONCLUSION: The model presented is the first framework that focuses on strengthening health research capacity in conflict with a focus on the MENA region. It should be viewed as a non-prescriptive reference tool for health researchers and practitioners, from various disciplines, involved in research capacity strengthening to evaluate, use, adapt and improve. It can be further extended to include representative indicators and can be later evaluated by assessing its efficacy for interventions in conflict settings.


Asunto(s)
Conflictos Armados , Investigación Biomédica/organización & administración , Creación de Capacidad/organización & administración , Modelos Organizacionales , África del Norte , Humanos , Medio Oriente
9.
BMC Health Serv Res ; 19(1): 774, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666057

RESUMEN

BACKGROUND: The Child Health Services in Sweden is a well-attended health promoting setting, and thereby has an important role in promoting healthy living habits in families with young children. Due to lack of national recommendations for health dialogues, a Child Centred Health Dialogue (CCHD) model was developed and tested in two Swedish municipalities. The aim of this study was to explore parents' experiences of health dialogues based on the CCHD model focusing on food and eating habits during the scheduled child health visit at four years of age. METHODS: A qualitative design with purposeful sampling was used. Twelve individual interviews with parents were conducted and analysed with qualitative content analysis. RESULTS: The analysis resulted in three categories: The health dialogue provides guidance and understanding; Illustrations promote the health dialogue; and Space for children and parents in the health dialogue. In addition, analysis of the latent content resulted in a single theme reflecting the parents' voice on the importance of having a health dialogue on food and eating habits. The health dialogue, promoted by illustrations, provided guidance and understanding, and gave space for children's and parents' involvement. CONCLUSIONS: The results indicate that health dialogues using the CCHD- model create supportive conditions for family members' active participation in the visits, which may strengthen empowerment and health literacy. The study provides knowledge and guidance for further development, evaluation and implementation of the model.


Asunto(s)
Actitud Frente a la Salud , Servicios de Salud del Niño/organización & administración , Comunicación , Padres/psicología , Relaciones Médico-Paciente , Adulto , Preescolar , Conducta Alimentaria , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Modelos Organizacionales , Investigación Cualitativa , Suecia
10.
Perm J ; 232019.
Artículo en Inglés | MEDLINE | ID: mdl-31634112

RESUMEN

The time it takes for clinical innovation and evidence-based practices to reach patients remains a major challenge for the health care sector. In 2015, the Veterans Health Administration (VHA) launched the Diffusion of Excellence Initiative aimed at aligning organizational resources with early-stage to midstage promising practices and innovations to replicate, scale, and eventually spread those with greatest potential for impact and positive outcomes. Using a 5-step systematic approach refined over time, frontline VHA staff have submitted more than 1676 practices since the initiative's inception, 47 of which have been selected as high-impact, Gold Status practices. These Gold Status practices have been replicated more than 412 times in Veterans Affairs hospitals across the country, improving care for more than 100,000 veterans and approximately $22.6 million in cost avoidance for the VHA. More importantly, practices such as Project HAPPEN (Hospital-Acquired Pneumonia Prevention by Engaging Nurses to complete oral care) and rapid availability of intranasal naloxone have saved veterans' lives. Several practices are now being implemented across the country, and the Diffusion of Excellence Initiative is playing a pivotal role as the VHA works to modernize its health care system. This initiative serves as a promising model for other health care systems seeking to accelerate the spread and adoption of clinical innovation and evidence-based practices.


Asunto(s)
Innovación Organizacional , Guías de Práctica Clínica como Asunto , Calidad de la Atención de Salud/organización & administración , United States Department of Veterans Affairs/organización & administración , Hospitales de Veteranos/organización & administración , Hospitales de Veteranos/normas , Humanos , Modelos Organizacionales , Estados Unidos
11.
Nephrol Nurs J ; 46(5): 533-541, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31566348

RESUMEN

Successful health care transition from pediatric to adult care emphasizes the need for a collaborative effort to employ systematic processes. The development of a structured health care transition program for adolescents with chronic kidney disease (CKD) was the goal of this quality improvement program. The non-experimental design included development of an individualized health care transition treatment plan and TRxANSITION Scale™ application of the transition plan with patient evaluation; success designated full transition to adult care. Of the 19 patients enrolled, 74% had CKD, and 26% were renal transplant recipients. TRxANSITION Scale variables with the highest Pearson Correlation coefficients for total scores and strong positive relationships were self-management, insurance, and school. Four participants successfully transitioned. Purposeful, interprofessional health care transition preparation provides youth with CKD ongoing access to subspecialists, promotes self-care, and allows continued support of long-term health care planning. This evidence-based project adds to the body of knowledge for a topic that has proven to be challenging and often difficult for patients, families, and providers.


Asunto(s)
Modelos Organizacionales , Insuficiencia Renal Crónica/terapia , Transición a la Atención de Adultos/organización & administración , Adolescente , Humanos
12.
G Ital Nefrol ; 36(5)2019 09 24.
Artículo en Italiano | MEDLINE | ID: mdl-31580549

RESUMEN

In 2017 the Italian Society of Nephrology operating in the Triveneto area investigated through a questionnaire, distributed to the various nephrological centers in the regions of Friuli Venezia Giulia, Trentino Alto Adige and Veneto, the differences concerning organizational models, choice of dialysis, creation and management of vascular access. The results emerging from the analysis of the collected data are presented.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Diálisis Renal/estadística & datos numéricos , Insuficiencia Renal Crónica/epidemiología , Dispositivos de Acceso Vascular/estadística & datos numéricos , Instituciones de Atención Ambulatoria/provisión & distribución , Análisis de Datos , Encuestas de Atención de la Salud , Humanos , Italia/epidemiología , Cuerpo Médico/estadística & datos numéricos , Modelos Organizacionales , Nefrología , Diálisis Peritoneal/estadística & datos numéricos , Densidad de Población , Prevalencia , Derivación y Consulta , Insuficiencia Renal Crónica/terapia , Sociedades Médicas
15.
Rev Saude Publica ; 53: 85, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31576945

RESUMEN

Group prenatal care is an alternative model of care during pregnancy, replacing standard individual prenatal care. The model has shown maternal benefits and has been implemented in different contexts. We conducted a narrative review of the literature in relation to its effectiveness, using databases such as PubMed, EBSCO, Science Direct, Wiley Online and Springer for the period 2002 to 2018. In addition, we discussed the challenges and solutions of its implementation based on our experience in Mexico. Group prenatal care may improve prenatal knowledge and use of family planning services in the postpartum period. The model has been implemented in more than 22 countries and there are challenges to its implementation related to both supply and demand. Supply-side challenges include staff, material resources and organizational issues; demand-side challenges include recruitment and retention of participants, adaptation of material, and perceived privacy. We highlight specific solutions that can be applied in diverse health systems.


Asunto(s)
Estructura de Grupo , Atención Prenatal/métodos , Femenino , Humanos , México , Modelos Organizacionales , Embarazo , Atención Prenatal/normas , Reproducibilidad de los Resultados
16.
Am J Health Syst Pharm ; 76(1): 34-43, 2019 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31603982

RESUMEN

PURPOSE: The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. SUMMARY: With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4-8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. CONCLUSION: BJC's ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.


Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Desarrollo de Programa , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Illinois , Missouri , Modelos Organizacionales , Grupo de Atención al Paciente/organización & administración , Educación del Paciente como Asunto/organización & administración , Educación del Paciente como Asunto/estadística & datos numéricos , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/estadística & datos numéricos , Brechas de la Práctica Profesional/organización & administración , Brechas de la Práctica Profesional/estadística & datos numéricos
17.
Glob Health Action ; 12(1): 1664103, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31526179

RESUMEN

Background: Uganda is an ecological hot-spot with infectious disease transmission belts which exacerbates its vulnerability to epidemics. Its proximity to the Congo Basin, climate change pressure on eco-systems, increased international travel and globalization, and influx of refugees due to porous borders, has compounded the problem. Public Health Events are a major challenge in the region with significant impact on Global Health Security. Objective: The country developed a multi-hazard plan with the purpose of harmonizing processes and guiding stakeholders on strengthening emergency preparedness and response. Method: Comprehensive risk profiling, identification of preparedness gaps and capacities were developed using a preparedness logic model, which is a step by step process. A multidisciplinary team was constituted; the Strategic Tool for Analysis of Risks was used for risk profiling and identification of hazards; a desk review of relevant documents informed the process and finally, approval was sought from the National Task Force for public health emergencies. Results: Target users and key public health preparedness and response functions of the multi-hazard plan were identified. The key capabilities identified were: coordination; epidemiology and surveillance; laboratory; risk communication and social mobilization. In each of these capabilities, key players were identified. Risk profiling classified road traffic accident, cholera, malaria and typhoid as very high risk. Meningitis, VHF, drought, industrial accidents, terrorism, floods and landslides were high risk. Hepatitis E, avian influenza and measles were low risk and the only plague fell into the category of very low risk. Risk profiling using STAR yielded good results. All risk categories required additional preparedness activities, and very high and high-risk categories required improved operational response capacity and risk mitigation measures. Conclusion: Uganda successfully developed a national multi-hazard emergency preparedness and response plan using the preparedness logic model. The plan is now ready for implementation by the Uganda MoH and partners.


Asunto(s)
Planificación en Desastres/organización & administración , Urgencias Médicas , Salud Pública , Humanos , Modelos Organizacionales , Medición de Riesgo/métodos , Uganda
18.
Infez Med ; 27(3): 251-257, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31545768

RESUMEN

The emergence of antibiotic resistance as a consequence of inappropriate use results in higher mortality rates and has become a major public health challenge worldwide. Antimicrobial stewardship programs (ASPs) aim to ensure proper use of antimicrobials and reduce health care costs. We assessed the impact of using a behavioral approach during a persuasive ASP on antibiotic appropriateness, consumption and costs. We conducted a prospective interventional cohort before-and-after study in the intensive care unit (ICU) of a 554-bed, university teaching hospital in Terni, Italy, 14 of which are located in the ICU. We describe a 10-month persuasive ASP intervention model used in a referral ICU with daily rounds. The aim of the study was to improve medication appropriateness through educational action and reduce the consumption of carbapenems and echinocandins by conducting post-prescription reviews, prescribing reviews and holding daily discussions with the ICU team. We analyzed the prescribing appropriateness of the ICU team in accordance with the decisions made by the Antimicrobial Stewardship (AMS) team to improve the quality of antibiotic prescribing during the first five months and the last five months of the surveillance period. The results were expressed as the defined daily dose (DDD) per 100 occupied bed-days and costs. The data were compared with those previously obtained during the pre-educational period (the year before ASP implementation). Comparisons were made between the decisions taken to improve antimicrobial treatments administered during the first half of the surveillance period (March-July) and those administered during the second half (August-December). In all, 116 decisions were made from March to July while only 65 were made from August to December (p-value 0.00001). A significant reduction was observed in the consumption of carbapenems and echinocandins (11.15% and 25.62%, respectively). Total antibiotic cost savings amounted to 57,541.16 euros. The persuasive ASP strategy positively influenced the prescribing behavior of physicians, thus improving the appropriateness of antibiotic therapy and reducing antimicrobial consumption.


Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos , Carbapenémicos/uso terapéutico , Farmacorresistencia Bacteriana , Equinocandinas/uso terapéutico , Prescripción Inadecuada/prevención & control , Unidades de Cuidados Intensivos , Carbapenémicos/economía , Estudios Controlados Antes y Después , Equinocandinas/economía , Hospitales de Enseñanza , Humanos , Italia , Modelos Organizacionales , Estudios Prospectivos , Factores de Tiempo
19.
Artículo en Inglés | MEDLINE | ID: mdl-31547496

RESUMEN

Background: The aim is to explore how an organisational work environment support model, the Stamina model, influences employees' work situations and the development of sustainable work systems. Methods: It was a qualitative study with semi-structured, focus-group interviews, including 45 employees from six work groups. Eighteen focus group interviews were conducted over a period of two years. Data were analysed with constant comparative method. Results: The core category, shifting focus from an individual to an organisational perspective of work, illustrated how communication and increased understanding of one's work tasks changed over time and contributed to deeper focus on the actual operation. These insights were implemented at different time points among the work groups during the two-year process. Conclusions: Our results indicate that working with the model engages employees in the work environment management, puts emphasis on reflections and discussions about the meaning and purpose of the operations and enables a shared platform for communication. These are important features that need to continue over time in order to create a sustainable work system. The Stamina model, thus seems to have the potential to promote productive and healthy work places.


Asunto(s)
Modelos Organizacionales , Lugar de Trabajo , Adulto , Comunicación , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Adulto Joven
20.
Emerg Med J ; 36(10): 625-630, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31494576

RESUMEN

Primary care services in or alongside emergency departments look and function differently and are described using inconsistent terminology. Research to determine effectiveness of these models is hampered by outdated classification systems, limiting the opportunity for data synthesis to draw conclusions and inform decision-making and policy. We used findings from a literature review, a national survey of Type 1 emergency departments in England and Wales, staff interviews, other routine data sources and discussions from two stakeholder events to inform the taxonomy. We categorised the forms inside or outside the emergency department: inside primary care services may be integrated with emergency department patient flow or may run parallel to that activity; outside services may be offered on site or off site. We then describe a conceptual spectrum of integration: identifying constructs that influence how the services function-from being closer to an emergency medicine service or to usual primary care. This taxonomy provides a basis for future evaluation of service models that will comprise the evidence base to inform policy-making in this domain. Commissioners and service providers can consider these constructs in characterising and designing services depending on local circumstances and context.


Asunto(s)
Servicios Médicos de Urgencia/clasificación , Servicio de Urgencia en Hospital/clasificación , Atención Primaria de Salud/clasificación , Servicios Médicos de Urgencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Inglaterra , Modelos Organizacionales , Atención Primaria de Salud/organización & administración , Gales
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