An approach to plan and evaluate the location of radiotherapy services and its application in the New South Wales, Australia.

This paper proposes an integrated modelling approach for location planning of radiotherapy treatment services based on cancer incidence and road network-based accessibility. Previous research efforts have established travel distance/time barriers as a key factor affecting access to cancer treatment services, as well as epidemiological studies have shown that cancer incidence rates vary with population demography. Our study is built on the evidence that the travel distances to treatment centres and demographic profiles of the accessible regions greatly influence the uptake of cancer radiotherapy (RT) services. An integrated service planning approach that combines spatially-explicit cancer incidence projections, and the placement of new RT services based on road network based accessibility measures have never been attempted. This research presents a novel approach for the location planning of RT services, and demonstrates its viability by modelling cancer incidence rates for different age-sex groups in New South Wales, Australia based on observed cancer incidence trends; and estimations of the road network-based access to current NSW treatment centres. Using three indices (General Efficiency, Service Availability and Equity), we show how the best location for a new RT centre may be chosen when there are multiple competing locations.

Modelos de colaboración entre atención primaria y salud mental en la asistencia sanitaria a las personas con depresión: resultados principales y retos metodológicos de una meta-revisión sistemática / Models for primary care and mental health collaboration in the care of people with depression: main results and methodological challenges of a systematic overview

Fundamentos: Las carencias en la colaboración entre Atención Primaria (AP) y Salud Mental (SM) constituyen un problema relevante en la atención a los pacientes con depresión. Resulta necesario analizar y evaluar los modelos de colaboración existentes para valorar su aplicabilidad en el sistema de salud español. El objetivo del presente estudio es conocer las principales características de los distintos modelos de colaboración AP-SM en la atención a los pacientes diagnosticados de depresión y la calidad de la evidencia científica acerca de su efectividad. Métodos: Meta-revisión sistemática de los estudios secundarios publicados entre 2001 y 2010 en MEDLINE, PsycINFO, Embase, LILACS, IBECS, IME y la Biblioteca Cochrane. Las revisiones se evaluaron mediante la herramienta AMSTAR. Se realizó una síntesis aproximativa de la calidad de las evidencias encontradas. Resultados: Se evaluaron 69 estudios. La variabilidad según contextos y las carencias metodológicas condicionan que la calidad de las evidencias sea en general baja o dudosa. Las estrategias más efectivas integran intervenciones de responsabilización en el seguimiento de los pacientes, rediseños en la gestión, e información y comunicación compartidas. Las meta-revisiones de estudios secundarios sobre modelos colaborativos favorecen la accesibilidad a las evidencias publicadas, pero conllevan importantes retos metodológicos. Conclusiones: La calidad de la evidencia sobre la efectividad de los modelos de colaboración AP-SM durante la atención sanitaria a las personas con depresión es predominantemente baja o dudosa y su significado y aplicabilidad son menores cuanto más se simplifica el análisis de sus componentes, procesos y circunstancias de implementación (AU)

Background: Weaknesses in the collaboration between Primary Care (PC) and Mental Health (MH) are a relevant problem in the care of depressed patients. It is necessary to analyse and appraise the existing models of collaboration to assess their applicability to the Spanish Health System. The aim of this study is to know the main characteristics of the different models of collaboration between PC and MH in the care of patients with depression and the quality of their effectiveness evidence. Methods: Systematic overview of secondary studies published from 2001 to 2010 in MEDLINE, PsycINFO, Embase, LILACS, IBECS, IME and The Cochrane Library. Assessment of reviews applying the AMSTAR tool. Approximative synthesis of the quality of evidences. Results: A total of 69 studies were assessed. Quality of evidences is generally low or inconclusive due to the great variability among contexts and the methodological weaknesses. The most effective strategies integrate interventions for assigning responsibility for patient follow-up, redesigning management and communication/information sharing. Overviews of secondary studies on collaborative models facilitate access to published evidence, but entail important methodological challenges. Conclusion: The quality of evidences on effectiveness of PC-MH collaboration models in depression care is mainly low or inconclusive, and the more simplified are the analysis of components, processes and implementation conditions, the less meaningful and applicable they are (AU)

A bigger piece of the pie. For-profit facilities climb to 16% of all community hospitals, as not-for-profits struggle with access to capital, rural challenges.

The percentage of investor-owned hospitals is at an all-time high, helped in part by sales of not-for-profit facilities. Hillcrest HealthCare System's board decided to sell 10 of its hospitals after taking a hard look at its finances. "We weren't concerned about the short term, but the long term," Don Lorack, left, said.

Actividad física. Evaluación de los objetivos del Plan de Salud de Cataluña para el año 2000 / Physical activity. Evaluation of the objectives of the Health Plan for Catalonia for the year 2000

Fundamento y objetivo: La falta de actividad física se considera un factor de riesgo para la salud y por este motivo se incluyó en el Plan de Salud de Cataluña como una de las intervenciones prioritarias. El objetivo de este trabajo fue evaluar el grado de consecución de los objetivos del Plan de Salud de Cataluña para el año 2000 en relación con la actividad física. Población y método: A través de la Encuesta de salud y el examen de salud efectuados en el año 2002 en Cataluña se obtuvieron los indicadores de prevalencia necesarios para evaluar cada uno de los objetivos en la población de entre 18 y 64 años. Resultados: La prevalencia de adultos que caminan más de 30 minutos al día no ha aumentado y se halla en el 60,5%. Se observa un aumento del 19,5% en la prevalencia de adultos que practican ejercicio físico durante el tiempo libre hasta alcanzar el 49%. La prevalencia de personas absolutamente sedentarias ha disminuido hasta el 21,7%. La prevalencia de personas que manifiestan realizar actividades vigorosas muestra un aumento muy discreto. No se han producido cambios en el porcentaje de personas menores de 35 años que han abandonado la práctica de ejercicio físico durante el tiempo libre (77,8%). Conclusiones: Los resultados obtenidos indican unos patrones de actividad física ligeramente más saludables que en años anteriores aunque únicamente se han alcanzado de forma parcial dos de los cinco objetivos (AU)

Background and objective: The lack of physical activity is widely considered a risk factor. Therefore, Catalonian Health Plan 2000 included physical activity as a priority intervention. The objective of this paper is to evaluate the degree of achievement of the objectives related to physical activity that were established in the Catalonian Health Plan for the year 2000. Subjects and method: We obtained the appropriate prevalence indicators to evaluate each objective in a population group-age (18-64) by means of the Catalan Health Survey and the Catalan Health Exam made in 2002 in Catalonia. Results: The prevalence of adults that walk more than 30 minutes per day has not increased (60.5%). However, we have noticed a marked rise of adults that make physical exercice during their free time (49%). In the other hand, the prevalence of absolutely sedentary people has diminished a 19,6% arriving to 21,7%. In addition the proportion of people who declare to make vigorous activities shown an slight increase of 16.9%. There is no changes about the percentage of people younger than 35 who has quit making physical exercise during leisure time (77.8%). Conclusions: The results show physical activity patterns more healthy than previous years. However, only 2 of the 5 objectives designed have been completely achieved (AU)

Antecedents of hospital ownership conversions, mergers, and closures.

This study assesses the determinants of conversions in hospital ownership from 1986 through 1996. To place such changes in context, we also analyze causes of hospital mergers and closures, which are often alternatives to hospital ownership conversion. A consistent result from our analysis is that an important antecedent of ownership conversions is a low profit margin. Conversions from private nonprofit or government ownership to for-profit status are preceded by chronically low margins and high debt-to-asset ratios. By contrast, conversions from for-profit ownership occur quickly following declines in margins. Many mergers seem motivated by a desire to increase market power--a consideration not evident for conversions.

The need for a regional weaning centre, a one-year survey of intensive care weaning delay in the Northern Region of England.

Over a period of one year, a weekly telephone survey identified 161 stable patients with weaning delay (defined as patients ventilated for at least 6 h per day for more than 2 weeks) in intensive care units in the Northern Region of England. Their median age was 69 years (range 21-88 years). Sixty patients (37%) were admitted with medical conditions, 89 (55%) were postoperative patients, whereas 12 (8%) were surgical but required non-operative admission. One hundred and thirty (89%) were weaned and discharged from the intensive care unit during the year. Twenty-two (14%) died and two were transferred to the home ventilation service. Seven patients remained ventilated in intensive care at the end of the study period. Twenty patients (12%) required more than 28 days of respiratory support. These patients occupied on average 6.0% of available intensive care unit beds in the region. This study suggests that in the Northern Region of England there are a significant number of stable but ventilator-dependent patients occupying intensive care beds.

Planning and implementing a program of renovations of emergency obstetric care facilities: experiences in Rajasthan, India.

Even though many governments and donors are now putting resources into upgrading facilities, the study of the renovation process is one of the most neglected aspects of quality improvement in emergency obstetric care (EmOC). In a previous publication, we discussed basic concepts and simple techniques to assess, plan and implement renovations. Here we focus on actual in-the-field experiences of the renovation process initiated by the health system in Rajasthan, India and the valuable lessons obtained from it. With the advice of the technical members of the Averting Maternal Death and Disability Program (AMDD) and the United Nations Population Fund (UNFPA), the facilities achieved noticeable changes in the physical infrastructure. As a result, the quality of EmOC services improved. We analyze these experiences critically and draw out lessons which may be instructive for future renovation efforts.

Hospital conversion trends.

This DataWatch presents information on the extent, geographic distribution, and other issues related to hospital conversions during the 1980s and 1990s. On average, 1 percent of hospitals convert each year. Many states experienced hospital conversions, but much of the conversion activity was concentrated in California, Florida, Georgia, and Texas. While conversions of not-for-profit hospitals to for-profit status have received significant attention, conversions of public hospitals and for-profit hospitals raise complex policy issues, as well.

Access implications of rural hospital closures and conversions.

This article examines the effects of rural hospital closures and conversions on various structural dimensions of access. Based on a data set of rural hospitals in Texas during the period 1985-1990, the results indicate that closure or conversion typically had relatively little detrimental effect on hospital services and distance to alternative sources of care, but hospital bed and physician availability may have been adversely affected in certain cases. Rural hospital conversions to alternative types of health care facilities, such as ambulatory care clinics, do appear to have maintained the availability of a restricted set of medical services in some rural areas.

Swing-bed services under the Medicare program, 1984-87.

Under Medicare, swing beds are beds that can be used by small rural hospitals to furnish both acute and post-acute care. The swing-bed program was instituted under the provisions of the Omnibus Reconciliation Act of 1980 (Public Law 96-499). Under Medicare, post-acute care in the hospital would be covered as services equivalent to skilled nursing facility level of care. Data show that the program has had a rapid rate of growth. By 1987, swing beds accounted for 9.7 percent of the admissions to skilled nursing facility services, 6.0 percent of the covered days of care, and 6.2 percent of the reimbursements. Over one-half of the swing-bed services are furnished in the North Central States.