International Journal of Healthcare Delivery Reform Initiatives最新文献

英文中文

Issues in Interoperable Structures of Regional Health Information Networks 区域卫生信息网络互操作结构中的问题

International Journal of Healthcare Delivery Reform Initiatives

Pub Date : 1900-01-01 DOI: 10.4018/JHDRI.2010010104

Stergiani Spyrou, P. Bamidis, N. Maglaveras

引用次数: 1

Perspectives on the Adoption of Electronic Resources for Use in Clinical Trials 电子资源在临床试验中的应用展望

International Journal of Healthcare Delivery Reform Initiatives

Pub Date : 1900-01-01 DOI: 10.4018/JHDRI.2009010102

M. Planas-Silva, Rhoda C. Joseph

Clinical trials are specific medical studies that use human subjects for the advancement of medicine. Evidence-based medicine requires the use of clinical trials to evaluate new treatments, devices, drugs, and modalities for the prevention and treatment of diseases. Clinical trials have not been particularly aggressive in their adoption of information technology (IT). In this analysis, we examine the impact of electronic resources on the execution and management of clinical trials. Further, we present a theoretical model showing the main areas of clinical trials that can be directly impacted by the adoption of electronic resources. The four areas identified are recruitment, data collection, process data management, and information dissemination.

临床试验是为了医学进步而使用人类受试者的特定医学研究。循证医学需要使用临床试验来评估预防和治疗疾病的新疗法、设备、药物和模式。临床试验并没有特别积极地采用信息技术(IT)。在本分析中，我们研究了电子资源对临床试验执行和管理的影响。此外，我们提出了一个理论模型，显示了临床试验的主要领域，可以直接影响电子资源的采用。确定的四个领域是招聘、数据收集、流程数据管理和信息传播。

引用次数: 3

Decentralisation and Health Systems Performance in Developing Countries: Impact of “Decision Space” on Primary Health Care Delivery in Nigeria 发展中国家的权力下放和卫生系统绩效:“决策空间”对尼日利亚初级卫生保健服务的影响

International Journal of Healthcare Delivery Reform Initiatives

Pub Date : 1900-01-01 DOI: 10.4018/JHDRI.2009010103

Adebusoye Anifalaje

This article attempts to elucidate the intricacies of primary health care delivery in Nigeria. Among myriad complexities, the central proposition made herein is that the absence of an effective regulatory and enforcement framework in developing countries results in a prominent informal decision space. The findings show that the prominence of an informal decision space compromises the objectives of an information-based public health system. The article concludes that decentralisation in developing countries must have a coordinated top-down and bottom-up development component for it to be effective in improving the performance of primary health systems. One of the implications of the study is that researching decentralised healthcare delivery requires analytical models which are able to illuminate the complexities of local accountability in developing countries. The study also reveals the need to further research the dynamics of democratic decentralisation in developing countries as this goes beyond administrative structures but involve sociocultural institutions.

本文试图阐明尼日利亚初级卫生保健服务的复杂性。在众多的复杂性中，本文提出的核心主张是，发展中国家缺乏有效的监管和执行框架，导致了一个突出的非正式决策空间。研究结果表明，非正式决策空间的突出损害了基于信息的公共卫生系统的目标。这篇文章的结论是，发展中国家的权力下放必须有一个协调的自上而下和自下而上的发展组成部分，这样才能有效地改善初级卫生系统的绩效。这项研究的一个含义是，研究分散式医疗保健服务需要能够阐明发展中国家地方问责制复杂性的分析模型。这项研究还表明，有必要进一步研究发展中国家民主权力下放的动态，因为这超出了行政结构的范畴，还涉及社会文化机构。

引用次数: 16

Drivers for wireless technology acceptance in Indian healthcare 印度医疗保健接受无线技术的驱动因素

International Journal of Healthcare Delivery Reform Initiatives

Pub Date : 1900-01-01 DOI: 10.4018/JHDRI.2009010104

R. Gururajan

[Abstract]: The outcomes of clinical usefulness as a driver of wireless technology for Indian healthcare are reported here. Using both qualitative and quantitative techniques, 30 physicians were interviewed and 200 health professionals were surveyed. The outcomes established that in addition to technology factors, other factors such as clinical factors, administration factors and communication factors play a crucial role in determining the uptake of wireless technology for healthcare. These factors were further validated using a PLS model.

【摘要】:本文报道了无线技术在印度医疗保健领域的临床应用效果。利用定性和定量技术，对30名医生进行了访谈，对200名保健专业人员进行了调查。结果表明，除了技术因素外，临床因素、管理因素和通信因素等其他因素在决定医疗保健是否采用无线技术方面也起着至关重要的作用。使用PLS模型进一步验证了这些因素。

引用次数: 8

The Adventure of Structuring Knowledge During Emergencies: Applying the Concepts “Knowledge Structuring” and “Knowledge Domination” on a Real-Life Work Situation 突发事件中知识结构化的冒险:“知识结构化”和“知识支配”概念在现实工作情境中的应用

International Journal of Healthcare Delivery Reform Initiatives

Pub Date : 1900-01-01 DOI: 10.4018/JHDRI.2011010102

Carina Beckerman

This paper applies two concepts, ‘knowledge structuring’ and ‘knowledge domination,’ to a real life work situation. The purpose is to explore, analyze and discuss what happens when management interferes into the activities of a knowledge worker in a specific organizational setting by computerizing a key document. Exercising knowledge is delicate and complex. This study makes visible how some parts of performing anesthesia become structured and re-structured when the anesthesia patient record is transformed into a knowledge management system at the same time as someone or something influences how that structuring takes place. is going on today. It is also an example of how modern man tries to manage knowledge to create increased values in society. These efforts have many different implications for people involved. This paper is not meant to be a full description on what happens when a patient record is transformed into a knowledge management system. It directs itself towards management and wants to touch on this very important question of how these computerized systems influence the way a specialist or a knowledge worker exercises his or her knowledge. The section that follow presents the theoretical framework used in this paper, then a description of how research has taken place DOI: 10.4018/jhdri.2011010102 14 International Journal of Healthcare Delivery Reform Initiatives, 3(1), 13-23, January-March 2011 Copyright © 2011, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. is presented, and some information about the research context. THE PRACTICE OF MANAGING KNOWLEDGE IN THE KNOWLEDGE SOCIETY This research takes place in the knowledge society (Lane, 1966; Bell, 1974; Böhme & Stehr, 1986; Drucker, 1993; Castells, 1996; OECD, 1996). OECD has used the expression “the knowledge-based economies” instead of “the knowledge society” and characterized them as “those which are directly based on the production, distribution and use of knowledge and information”. One important difference between the two expressions “the information society” and “the knowledge society” is that the first one is characterized by low-cost information and a general use of information and communication technology while the key factor in the second is mainly investments in people, utilizing new information and communication technology. In the knowledge society there are a continuous structuring and re-structuring, construction and re-construction and learning and re-learning going on due to implementing new information and communication technology. Knowledge is viewed as localized and embedded in a specialist practice. It is an ongoing social process of construction and collective action in organizations and a cognitive capability that empowers its possessors with the capacity for physical or intellectual action. Exercising knowledge is a structured activity. In our heads we always make plans for what to do, ho

本文将“知识结构”和“知识支配”两个概念应用于现实生活中的工作情境。目的是探索、分析和讨论当管理人员通过计算机化关键文件干预特定组织环境中知识工作者的活动时会发生什么。运用知识是微妙而复杂的。这项研究表明，当麻醉患者记录被转换为知识管理系统时，麻醉执行的某些部分是如何结构化和重新结构化的，同时有人或物影响了结构的发生。今天正在进行。这也是现代人如何管理知识以创造更多社会价值的一个例子。这些努力对相关人员有许多不同的影响。本文并不打算全面描述将患者记录转换为知识管理系统时会发生什么。它的方向是管理，并希望触及一个非常重要的问题，即这些计算机化系统如何影响专家或知识工作者运用其知识的方式。接下来的部分介绍了本文使用的理论框架，然后描述了研究是如何进行的DOI: 10.4018/jhdri。2014国际医疗服务改革倡议杂志，3(1)，13-23,2011年1月- 3月版权所有©2011,IGI Global。未经IGI Global书面许可，禁止以印刷或电子形式复制或分发。的介绍，以及有关研究背景的一些信息。知识社会中的知识管理实践本研究发生在知识社会(Lane, 1966;贝尔,1974;Böhme & Stehr, 1986;德鲁克,1993;中文版1996;经合组织,1996年)。经合组织使用“知识经济”来代替“知识社会”，并将其定义为“直接以知识和信息的生产、分配和使用为基础的经济”。“信息社会”和“知识社会”的一个重要区别是，“信息社会”的特点是信息成本低，普遍使用信息通信技术，而“知识社会”的关键因素主要是对人的投资，利用新的信息通信技术。在知识社会中，由于新的信息通信技术的实施，不断地进行着构建与重构、构建与重构、学习与再学习。知识被视为本地化和嵌入在专业实践中。它是一个持续的社会建设过程和组织中的集体行动，是一种认知能力，赋予其拥有者身体或智力行动的能力。运用知识是一项有组织的活动。在我们的头脑中，我们总是计划要做什么，怎么做，下一步做什么。在大脑额叶中甚至有一个特定的地方对计划至关重要。当一个组织环境是结构化的，在这个环境中运用的知识也变得结构化。我认为知识的结构取决于谁主导了知识的运用。专业知识和专业知识是基于科学知识和技能的正规教育的问题(雅培，1988)。专业人士在同一领域的教育水平和其他人一样，但有更好的和不太好的专业人士。不同之处在于他们从经验中学习的能力，获得“隐性”知识的能力。所有的知识都有一个隐性的维度。隐性知识是通过体验和执行任务来学习的，在此过程中，个体发展了对活动成功执行的感觉和直觉判断的能力。隐性知识包括搜索规则，或启发式，识别问题和组成解决方案的要素(Polanyi, 1966)。它们也可以与心理图式或解释图式进行比较。解释方案等模式在社会和组织环境中构成相互作用。它们影响着编码理论，而这是由符号顺序或话语模式决定的。图式影响新信息的编码(解释和吸收)、对旧信息的记忆和对缺失信息的推断。它是一种组织与特定任务相关的世界信息的方式，可以被描述为过滤机制。心理图式是很难改变的。人们经常忽略模式的例外情况;它们甚至将异常解释为对模式的证明。如果模式在每次遇到稍微不一致的信息时发生变化，那么模式的许多信息处理优势就会丧失。但是拥有一个不正确的模式也是代价高昂的，因为它会使人们无法解决问题。错误的心理图式会导致不准确的、有偏见的编码、记忆和推理。但是图式仍然被认为比重新理解每个实例更有效(Fiske & Taylor, 1991)。有个人图式，自我图式，角色图式和事件图式。解释图式受到一群人对一种现象的共同理解的影响。某一专业领域的医生在如何解释特定情况和解决特定问题方面是社会化的。当他这样做的时候，他扮演了一个医生的角色。他扮演了医生的角色图式。本文档的完整版还有另外9页，可通过产品网页上的“添加到购物车”按钮购买:www.igi-global.com/article/adventure-structuring-knowledgeduring-emergencies/54728?camid=4v1。本标题可在InfoSci-Journals、InfoSci-Journal journals、医学、保健和生命科学期刊中找到。向您的图书管理员推荐此产品:www.igi-global.com/e-resources/libraryrecommendation/?id=2

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引用次数: 8

Managing E-Procurement in Public Healthcare: A Knowledge Management Perspective 公共医疗保健电子采购管理:知识管理视角

International Journal of Healthcare Delivery Reform Initiatives

Pub Date : 1900-01-01 DOI: 10.4018/JHDRI.2009010101

T. Federici, A. Resca

In large parts of Europe, the development of healthcare is subject to contrasting forces: explosion in spending, while governments are faced with budget constraints, and pressures to be innovative, technologically advanced in order to improve the services’ quality. Even though e-procurement initatives can be seen as a solution to the first issue in this dilemma, such initiatives have not been widely deployed and have not delivered the expected benefits so far. In this perspective, as case study of an e-procurement implementation of an Italian local healthcare agency has been examined because of the comprehensive design of the e-procurement system, the differentiation of tools adopted and the multiple solutions already implemented or in progress. The aim of this work is to reconstruct, by following a knowledge management approach, the steps that led to the introduction of e-procurement as a new operating practice, by redesigning supply purchasing, supply chain and logistic processes.

在欧洲大部分地区，医疗保健的发展受到两股截然不同的力量的制约:支出激增，而政府面临预算限制;创新和技术先进的压力，以提高服务质量。尽管电子采购倡议可以被视为解决这一困境中第一个问题的办法，但到目前为止，这些倡议尚未得到广泛部署，也没有产生预期的效益。从这一角度来看，由于电子采购系统的全面设计，对意大利地方卫生保健机构的电子采购实施情况进行了案例研究，所采用的工具的差异以及已经实施或正在实施的多种解决方案。这项工作的目的是通过遵循知识管理方法，通过重新设计供应采购、供应链和物流流程，重建导致引入电子采购作为一种新的操作实践的步骤。

引用次数: 7

Physicians' Non-Use of Technology: Why, Oh Why Aren't Physicians Heavily Using Technology? What Technology Acceptance Theories Do Not Explain 医生不使用技术:为什么，哦，为什么医生不大量使用技术?技术接受理论无法解释的问题

International Journal of Healthcare Delivery Reform Initiatives

Pub Date : 1900-01-01 DOI: 10.4018/JHDRI.2010010101

Jon Blue

引用次数: 6

Healthcare Information Exchange in Advancing Shared Care Regionally 促进区域共享护理的医疗保健信息交换

International Journal of Healthcare Delivery Reform Initiatives

Pub Date : 1900-01-01 DOI: 10.4018/JHDRI.2010010103

K. Harno

引用次数: 6

Preferred Types of Menopause Service Delivery: A Qualitative Study of Menopausal Women’s Perceptions 绝经期服务提供的首选类型:绝经期妇女认知的定性研究

International Journal of Healthcare Delivery Reform Initiatives

Pub Date : 1900-01-01 DOI: 10.4018/JHDRI.2011010101

A. Hyde, J. Nee, M. Butler, J. Drennan, E. Howlett

引用次数: 7

Analysis Using Identical Patient Types Across Providers and the Implications for the Health Care Supply Chain 跨供应商使用相同患者类型的分析及其对医疗保健供应链的影响

International Journal of Healthcare Delivery Reform Initiatives

Pub Date : 1900-01-01 DOI: 10.4018/JHDRI.2011010103

B. Cameron, F. Payton

Along the health care supply chain, cost and quality measures are vital in the decision-making process for treatment and care delivery. This study applies statistical significance to a hypothesis about cost effectiveness of patients’ total charges by health insurance providers for different heart conditions. A retrospective, observational analysis of data is collected from an urban hospital in the Southeastern United States. Using the Agency for Healthcare Research and Quality (AHRQ) database, diagnoses are selected for further analysis based on their prevalence in the general population. The numbers of procedures as well as the patient’s length of stay in the hospital are significantly higher among the Medicare population. However, results indicate that although Medicaid and Medicare have significantly higher ordinary average total charges than the private counterparts, the difference is negligible when comparing means adjusted to remove covariate influence. One implication is that if private insurers were to insure the same types of high risk patients as Medicare and Medicaid the average total charges of a visit would be comparable between providers. These results also suggest that to enhance cost saving measures in government funded insurance programs, the clinical pathways need to be adapted to reduce length of stay and number of procedures per visit. this should not be an issue for the government to tackle (Goodridge, 2007). In 1945, however, President Truman publicly addressed the need for a national health care plan to United States Congress (Igel, 2008). Given escalating health costs during the last few decades, much of the focus has been on what entity should shoulder the cost for national health insurance and how citizens should be transitioned to such a plan. Currently, in the U.S. Congress, the goal is to DOI: 10.4018/jhdri.2011010103 International Journal of Healthcare Delivery Reform Initiatives, 3(1), 24-38, January-March 2011 25 Copyright © 2011, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. create a government-funded insurance plan to compete with private insurers, and one school of thought is to expand upon the already existing Medicare and Medicaid programs. The Centers for Medicare and Medicaid estimate that health care spending accounted for a record 16.2% of the United State’s gross domestic product in 2008; this translates to $2.3 trillion (U.S. Department of Health and Human Services Centers for Medicare and Medicaid, 2011). The cost of cardiovascular disease in that year was $448.5 billion, 19.5% of the total health care spending (American Heart Association, 2008). Coronary artery disease (CAD) was the most expensive diagnosis followed by acute myocardial infarction (AMI) and congestive heart failure (CHF). Non-specified (NOS) chest pain also appears on the list of conditions associated with health disease. In 2004, these medical conditions account

在整个卫生保健供应链中，成本和质量措施在治疗和护理提供的决策过程中至关重要。本研究对医疗保险提供者对不同心脏疾病患者总收费的成本效益假设应用统计显著性。回顾性的，观察性的数据分析收集自美国东南部的一家城市医院。使用医疗保健研究和质量机构(AHRQ)数据库，根据其在一般人群中的患病率选择诊断以进行进一步分析。在医疗保险人群中，手术次数和病人住院时间明显更高。然而，结果表明，尽管医疗补助和医疗保险的普通平均总收费明显高于私人同行，但在比较调整后去除协变量影响的均值时，差异可以忽略不计。一个暗示是，如果私人保险公司要为与医疗保险和医疗补助相同类型的高风险患者提供保险，那么供应商之间的平均总费用将是相当的。这些结果还表明，为了加强政府资助的保险计划的成本节约措施，需要调整临床路径，以减少每次就诊的住院时间和次数。这不应该是政府要解决的问题(Goodridge, 2007)。然而，1945年，杜鲁门总统公开向美国国会提出了制定国家医疗保健计划的必要性(Igel, 2008年)。鉴于过去几十年医疗费用不断上升，重点主要集中在由哪个实体承担国家医疗保险费用以及公民应如何过渡到这种计划上。目前，在美国国会，目标是DOI: 10.4018/jhdri.2011010103国际医疗服务改革倡议杂志，3(1)，24-38,2011年1月-3月25版权所有©2011,IGI Global。未经IGI Global书面许可，禁止以印刷或电子形式复制或分发。创建一个政府资助的保险计划，与私营保险公司竞争，一种想法是扩大现有的医疗保险和医疗补助计划。医疗保险和医疗补助中心估计，2008年医疗保健支出占美国国内生产总值(gdp)的16.2%，创历史新高;这相当于2.3万亿美元(美国卫生和人类服务中心医疗保险和医疗补助，2011年)。那一年心血管疾病的费用为4485亿美元，占医疗保健总支出的19.5%(美国心脏协会，2008年)。冠状动脉疾病(CAD)是最昂贵的诊断，其次是急性心肌梗死(AMI)和充血性心力衰竭(CHF)。非特定胸痛(NOS)也出现在与健康疾病相关的条件列表中。2004年，这些医疗条件占全国医疗保健支出的14%，其中包括影响心脏状况的最昂贵的循环系统疾病，如冠心病和高血压(Russo et al.， 2007)。我们认为，这些保险计划和它们之间的差异是任何医疗服务过程的关键。对这些保健提供过程至关重要的是费用、提供者和慢性病(如心脏病和相关疾病)之间的关系。在这种程度上，护理的发展和提供跨越了一个供应链，而这一供应链离不开卫生保健财务和成本评估。护理的发展和提供是影响治疗决策的因素。正如Charles, Gafni和Whelan(1999)所描述的，在医疗保健中有各种各样的治疗决策模型，特别是在危及生命的疾病的背景下。这一分析的证据表明，从长远来看，通过可能(部分地)复制私人保险公司的结构和政策，联邦医疗保险和医疗补助计划可以提供注重成本效益和高质量的医疗保险。我们将提供证据表明，如果像医疗保险和医疗补助这样的项目，与私人保险公司一样，为同一类型的患者提供保险，那么，因心脏病状况或诊断而去诊所就诊的费用就不会显著增加。与私营保险公司分担高风险心血管患者的费用将降低分配给医疗保险和医疗补助计划的国家预算比例。

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