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Manager of a Primary Care Clinic
A new primary care facility has been established approximately 25 miles outside of a small city that has a population of 50,000 people. This facility currently has five family physicians, two nurse practitioners, twenty clinical support staff, and two physician assistants. The main objective of this new primary care facility is to provide primary care services to an increasingly diverse community of people within and outside the city. Despites the tremendous growth opportunities in the city, most of the residents still struggle to make end meet. Since the central city comprises two huge acute care facilities and one tertiary care facility, the residents are forced to use the facilities' emergency departments for routine conditions and illnesses in cases where their private physicians are unavailable. Therefore, this new primary care facility will play a crucial role in enhancing the health and well-being of this population…
Alvarez & Marsal Holdings. (2015, May 18). Retail Healthcare: Growing Trend for Healthcare Service Delivery. Retrieved November 3, 2015, from http://www.alvarezandmarsal.com/retail-healthcare-growing-trend-healthcare-service-delivery
Health Resources and Services Administration. (2011, April). Performance Management and Measurement. Retrieved from U.S. Department of Health and Human Services website: http://www.hrsa.gov/quality/toolbox/508pdfs/performancemanagementandmeasurement.pdf
Heidenreich, J. & Peterson, L. (2013, August 14). 4 Tips for Your Primary Care Strategy. Retrieved November 3, 2015, from http://www.beckershospitalreview.com/hospital-physician-relationships/4-tips-for-your-primary-care-strategy.html
Leaders in Healthcare Facilities
THE CAUSE AND ITS REMEDIES
Lack of Leadership in Healthcare Facilities
When clinicians provide care, they necessarily assume leadership responsibilities (lumenthal et al., 2012). Existing evidence demonstrates that effective leadership produces the desired clinical outcomes. Yet only scattered residency programs teach and train residents on leadership. Many clinicians are thus poorly prepared to meet the leadership requirement of their daily tasks (lumenthal et al.).
Canada's national health care system urgently recommended drastic changes, which to this day, have hardly been implemented (Goldberg & Page, 2006). illions have been consistently spent yet patients continue to form long lines in waiting rooms to obtain treatment. Emergency rooms remained full and many still do not have primary physicians to turn to. The cause of the problem is not the lack of money but leadership. This report said that 70% of all the strategic initiatives and approved changes have not…
Blumenthal, D.M. et al. (2012). Addressing the leadership gap in medicine" residents'
need for systematic leadership development training. Vol. 87 Issue 4, Academic
Medicine Journal: Association of American Medical Colleges. Retrieved on February
7, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/22361800
Provide sustained technical assistance (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003)
Evaluation of the process in rural and small communities includes: (1) scope of the project; (2) goals; (3) critical success factors; and (4) technical assistance." (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003) Community grants have been focused on the provision of 'personal digital assistant (PDA) systems in assisting with the decision support role. The initiative is stated to include: (1) development of toolkits; (2) leveraging known tools; (3) developing capacity; and (4) disseminating best practices. (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003)
Ormond, Wallin, and Goldenson report in the work entitled: "Supporting the Rural Health Care Safety Net" (2000) state: "The policy - and market-driven changes in the health care sector taking place across country are not confined to metropolitan areas. Rural communities are experiencing changes impelled by many of the same forces…
Healthcare and Healthcare Insurance Country Report: India (2004) Tata Consultancy Services and Microsoft. WebHealthCentre.com. 2004 August. Online available at http://download.microsoft.com/documents/customerevidence/7144_WebHealth_CS.doc
Expert Panel Meeting: Health Information Technology (2003) Agency for Healthcare Research and Quality (AHRQ) 23-24 July 2003. Online available at http://www.ahrq.gov/data/hitmeet.htm
Silberman, P. And Slifkin, R. (nd) Innovative Primary Case Management Programs Operating in Rural Communities: Case Studies of Three States. Working Paper No. 76 North Carolina Rural Health Research and Policy Analysis Program.
Ormond, Barbara a.; Wallin, Susan Wall; and Goldenson, Susan M. (2000) Supporting the Rural Health Care Net. 15 May 2000 Urban Institute
The results of this analysis highlight the need for hospitals to fine-tune their discharge process to reduce readmissions, and support the expenditure of additional resources for this purpose as a cost-effective intervention; as an example, author cites a hospital in Iowa that implemented a rigorous post-discharge planning process for patients with heart failure and 30-day readmission rates were reduced by 3-9% during the 3-month period following implementation.
The research showed that many elderly patients who suffer from congestive heart failure also suffer from a wide range of comorbid conditions, including diabetes and hypertension. These patients can be reasonably expected to require periodic or even frequent treatment in emergency departments and/or hospitalizations for these conditions, making the need for effective and seamless post-discharge planning especially important. In this regard, the research also showed that there are some valuable evidence-based practice guidelines available, though, that can help clinicians better coordinate post-discharge…
6% of the respondents stated that this was what they did. This number however is not reflected in lower numbers for life style disease and so it must be given greater scrutiny at another time (See table below).
Fruit and vegetable consumption by ethnicity
There are a number of diseases and health conditions that have been linked to life style behaviors and belief systems. The prevalence of these diseases demonstate that while persons may report a certain behavior emperical evidence suggests that another behavior may be taking place. This may occur principally because respondents may over estimate what they do on a daily basis since they are not taking active records of their behaviors.
On several indicators African-Americans have higher rates of the disease and death as a consequency than White populations. The data for diabetes shows that African-Americans are twice as likely to report having diabetes than…
A religious portrait of African-Americans (2009) Retrieved from http://pewforum.org/A-Religious-Portrait-of-African-Americans.aspx
Department of health and senior services New Jersey. (2011).
Dowd, K. (1996). Dietary patterns and physical activity among New Jersey adults. Center for health Statistics 1(3):1-4.
Also, as care is prioritized, those individuals deemed to be in a less urgent need of care are given a lower priority, which results in a wait list. Finally, as physicians are compensated on the same level of salary, fewer people may be attracted to the profession for its financial rewards. In a public system, patients shop around less for providers because most providers charge the same fees. ithin a public system there is less 'siphoning' of middle-income people to higher-cost physicians with short waiting lists.
Visit: http://www.csc-surgery.com/contact.php.hatexactly is this hospital? hat would your policy response be?
According to its website, the Cambie Surgery Centre is a private healthcare clinic. The site notes that the "BC provincial government looks to private health care facilities like the Cambie Surgery Centre to help ease the long public wait lists." The hospital is a paying hospital that uses sophisticated technology to perform its…
Cambie Surgery Centre." Official website. 7 Apr 2008. http://www.csc-surgery.com/contact.php
Economies of scale." Investopedia. 7 Apr 2008. http://www.investopedia.com/terms/e/economiesofscale.asp
Economies of scope." Investopedia. 7 Apr 2008. http://www.investopedia.com/terms/e/economiesofscope.asp
Green, David G., Ben Irvine & Ben Cackett. "Health care in Germany." 2005.
Healthcare System -- Linkages and Alliances
The healthcare system is a complex but integrated system that allows patients, providers, pharmacists, insurance agencies, hospitals, and regulators to all come together so that the needs of each are met. This paper will select one healthcare delivery organization in the U.S. that provides care to patients and discuss the relationship between this organization and the other stakeholders in healthcare -- in particularly how it links and aligns with these stakeholders.
As the Institute of Medicine (2009) points out, "healthcare delivery organizations play a critical role because of their ability to drive practice trends, set standards, and influence smaller practices by sharing information, resources, and guidelines." This is something that Humana Care Delivery Organization is able to help achieve through its extensive network within the overall Humana family. By employing a balanced team, innovative pioneers, and using great locations to reach the population it…
Health Care System
Health care providers must be properly integrated at every system level and must be allowed to lead the processes of designing, implementing and operating ideal health systems. esearch works identify a number of challenges with regard to healthcare personnel integration. Apparent loss of control, status, returns or practice style modifications may lead to healthcare providers becoming discontented. This discontentment can give way to bitterness and, ultimately, practitioners may end up resisting change (Suter et al., 2009).
Capitalizing on current networks, an intense emphasis on patients and informal inter-provider bonds are anticipated to ease healthcare practitioners' functioning within ideal healthcare systems. Economic integration of healthcare providers, utilization of compensation structures for recruiting and retaining the best candidates, measures for improving workplace climate quality and financial incentives are identified as crucial to system success.
Facilities and Supplies
Amodel healthcare system would include a standard formulated list of…
Nelson, A. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Journal of the National Medical Association, 94(8), 666.
Suter, E., Oelke, N. D., Adair, C. E., &Armitage, G. D. (2009).Ten Key Principles for Successful Health Systems Integration. Healthcare Quarterly (Toronto, Ont.), 13(Spec No), 16 -- 23.
alph Peterson, CMH:
There are a number of solutions to the current problem of City indigents frequenting the ED that CMH is now experiencing because of City Hospital's diversion. City cannot afford to treat all of the indigents and neither can we. However, there are a number of steps that we could take to solve this problem. In this memo, I will list and describe these steps. Below is a brief bullet point outline of what I propose.
People who come to the ED regularly go there because they believe it is the only place they can receive primary care. In some cases, it is. This does not mean, however, that CMH must bear the burden of this cost. Even though the problem is that the indigents are unable to pay for their care, there are several options available for relieving this burden and helping these indigents at the same…
CNNMoney. (2013). Who loses out under Obamacare? CNNMoney. Retrieved from http://money.cnn.com/2013/07/25/news/economy/obamacare-medicaid/
DeLia, D., Cantor, J. (2009). Emergency department utilization and capacity. The Synthesis Project Research Synthesis Report, 17: 1-32.
Goodell, S., DeLia, D., Cantor, J. (2009). Emergency department utilization and capacity. The Synthesis Project Policy Brief, 17: 1-6.
The ACA and the U.S. Health Care System
· The Affordable Care Act (ACA) was meant to promote greater quality care through increased implementation of preventive care; but as Lichtenfeld (2011) and Moynihan (2015) have shown, the health care industry remains committed to a course of treatments and tests because both are generally subsidized by the federal government—and, frankly, preventive care does not ensure that customers will keep coming through the door to make the industry money.
· The problem with the ACA has been that it has done little to reduce the putting of profits before people mentality that plagues the health care industry.
· It idealistically identified the right objectives—increasing access to care, increasing quality of care, lowering the cost of care, and increasing preventive care (Obama, 2016).
· However, in practice it failed to ensure that a mechanism was in place to actually enable the achievement of…
As well as expanding patient's abilities to obtain primary care, virtually, telemedicine can enable patients in isolated locations to see specialists. When rural patients are connected to a hospital network such as the Grinnell egional Medical Center, they are able to access high-quality physicians through some of the more advanced healthcare technology available, although this is not always possible in a local healthcare system with fewer physicians and less access to high-level technology. Technology can still enable patients in a variety of settings to keep track of vital signs such as heart rate, blood pressure, and blood sugar, and to alert their physician immediately if their readings are abnormal.
While some surgeons have even performed procedures through virtual consults, certain aspects of medicine remain challenging to provide rural patients, such as physical rehabilitative services, which may require the patient to travel to receive the full benefit of the services. Patients…
Campbell, James D. (2001, May). Introducing telemedicine technology to rural physicians and settings. Journal of Family Practice. Retrieved January 27, 2011 at http://findarticles.com/p/articles/mi_m0689/is_5_50/ai_75244766/
Spath, Patrice. (2011). Community Continuum of Care planning.
Brown-Spath & Associates. Retrieved January 27, 2011 at http://www.brownspath.com/original_articles/cccplan.htm
Tracy Folsom is a 28-year-old female who was brought to the Emergency Department by her neighbor. The neighbor stated that Miss Folsom was found lying semi-conscious in the shower. The patient was received in the ED by the on call nurse. The nurse's performance with Miss Folsom's management is reviewed in this article.
Emergency evaluation of a patient is supposed be in a systematic manner. A systemic approach prevents the examiner from missing out important clues that may point to a patient's diagnosis. This approach is divided into primary and secondary.
As part of the Primary Assessment, the patient's Airway, Breathing, Circulation and degree of Disability was evaluated, as per protocol. Miss. Folsom's airway was patent, breathing was shallow, and her skin color was pink, indicating good perfusion. She was obeying commands and pupils were equal in size and reactive to light. It is also helpful to state…
Canadian Medical Association. (2007, July). Putting patients first ®: patient-centred collaborative care a discussion paper. Retrieved from http://fhs.mcmaster.ca/surgery/documents/CollaborativeCareBackgrounderRevised.pdf
Dean, R & Mulligan, J, 2009, 'Initial management of patients in an emergency situation', Nursing Standard, vol. 24, no. 5, pp. 35-41, (Academic Search Complete).
Gilbert, G., Souza, P., & Pletz, B. (2009). Patient assessment routine medical care primary and secondary survey. San Mateo County EMS Agency, 1-5. Retrieved from http://smchealth.org/sites/default/files/docs/243322118Patient_Assessment.pdf
Institute of Medicine. (2001) Crossing the quality chasm. Washington, DC: National Academy Press.
The emphasis is on normal, everyday activities provided for residents. According to the authors, however, little research has been conducted to investigate the actual effect of such activities and settings upon residents. The assumption is that such settings have a better effect that traditional institutions, but there is little empirical research to support this.
Hence, Verbeek et al. (2010) conducted a study to compare small-scale living with regular care in nursing homes in the Netherlands. Interestingly, they found no significant difference between the quality of life experienced by residents in traditional institutional settings and those in small-scale living facilities. Furthermore, there was also no significant difference in the job satisfaction levels of nursing staff between both types of institution was found. Another important aspect, namely neuropsychiatric symptoms and agitation were also significantly similar for both institution types. According to the authors, a difference was found in the satisfaction level of…
Gaugler, J.E. (2005, Mar.). Family Involvement in Residential Long-Term Care: A Synthesis and Critical Review. Aging and Mental health, Iss. 9, vol. 2. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2247412/
Lyness, J.M., Yu, Q., Tang, W., Tu, X., and Conwell, Y. (2009, Dec.). Risks for Depression Onset in Primary Care Elderly Patients: Potential Targets for Preventive Interventions. American Journal of Psychiatry. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2982671/
Simonazzi, a. (2009, Jun). Home care and cash transfers. Effects on the elderly care-female employment trade-off. Retrieved from: http://www.aiel.it/bacheca/SASSARI/papers/simonazzi.pdf
Verbeek, H., Zwakhalen, S.M.G., Van Rossum, E., Ambergen, T, Kempen, G.I.J.M., and Hamers, J.P.H. (2010, Nov.). Dementia Care Redesigned: Effects of Small-Scale Living Facilities on Residents, their Family Caregivers, and Staff. American Medical directors Association. Retrieved from: http://www.unimaas.nl/hcns/websiteVW/publications/Publication%20scans/Verbeek.%20Dementia%20care%20redesigned.pdf
Cares for Nurses" by Cecil Deans (2004)
hen people become healthcare practitioners today, perhaps one of the furthest things from their minds is the increasingly violent nature of their potential workplaces. In his article, "ho Cares for Nurses" (2004), though, Cecil Deans makes the point that North American healthcare settings are very violent places to work and many institutions are not providing their practitioners with sufficient protections, and some are simply looking the other way -- all at the expense of the mental and physical well-being of their nursing staff. In their essay, "Challenges Facing Nurses' Associations and Unions: A Global Perspective" (2003), Clark and Clark note that, "Nurses, as the most highly trained caregivers with regular patient contact, are at the heart of any health care system. idespread anecdotal evidence suggests that the problems in health care have had a particularly negative effect on the workplace experience of nurses"…
Antai-Otong, Deborah. (2001). Critical Incident Stress Debriefing: A Health Promotion Model
for Workplace Violence. Perspectives in Psychiatric Care, 37(4):125.
Boyd, Neil. (1995). Violence in the Workplace in British Columbia: A Preliminary
Investigation. Canadian Journal of Criminology, 37(4):491-519.
Beard, C., Weisberg, .B., & Primack, J. (2012). Socially anxious primary care patients' attitudes toward cognitive bias modification (CBM): a qualitative study. Behavioural and cognitive psychotherapy, 40(05), 618-633.
This study shows how traditional methods of approaching patients with information can cause confusion and thus create barriers to accessing patient knowledge in primary care settings. The study focused on working with primary care patients suffering from anxiety and how they reacted to cognitive bias modification (CBM) for that anxiety. Upon initial discussion of the treatment, most participants showed that they understood. However, it was clear by the end of the treatment that the program was not clarified enough to patients prior to treatment and that created a knowledge barrier that caused the treatment not to work as successfully as previously tested. Better methods for communicating the treatment within the primary care setting must be developed to bring down these…
Beard, C., Weisberg, R.B., & Primack, J. (2012). Socially anxious primary care patients' attitudes toward cognitive bias modification (CBM): a qualitative study. Behavioural and cognitive psychotherapy, 40(05), 618-633.
Beckman, H.B., Wendland, M., Mooney, C., Krasner, M.S., Quill, T.E., Suchman, A.L., & Epstein, R.M. (2012). The impact of a program in mindful communication on primary care physicians. Academic Medicine, 87(6), 815-819.
Cheung, P.T., Wiler, J.L., Lowe, R.A., & Ginde, A.A. (2012). National study of barriers to timely primary care and emergency department utilization among Medicaid beneficiaries. Annals of emergency medicine, 60(1), 4-10.
Crabtree, B.F., Nutting, P.A., Miller, W.L., McDaniel, R.R., Stange, K.C., Jaen, C.R., & Stewart, E. (2011). Primary care practice transformation is hard work: insights from a 15-year developmental program of research. Medical care, 49(Suppl), S28.
Evolution of Health Care Information Systems
The objective of this study is to compare and contrast a contemporary healthcare facility or physician's office health care facility or physician's office operation of 20 years ago and to identify at least two major events and technological advantages that influenced current HCIS practices. The physician's office and health care facility of 20 years ago was a paper-based operation. All records were paper records, appointments were written on calendars and prescriptions were handwritten, notations on the patient's health records was done by writing on the physical paper record and all hospital orders were written by hand. During the 1970s hospital growth and expansion occurred and the expenditures for Medicare and Medicaid were on the rise. At this time mainframes were still in use and microcomputers became available and not only were they smaller but they were also less expensive. However, transformation did not come…
Costs and Benefits of Health Information Technology (nd) Evidence Report/Technology Assessment Number 132. Southern California Evidence-based Practice Center, Santa Monica, CA. Retrieved from: http://www.ahrq.gov/research/findings/evidence-based-reports/hitsys-evidence-report.pdf
Friedman, S. (nd) Facts About Health Care Information Systems. eHow Retrieved from: http://www.ehow.com/about_6117257_health-care-information-systems.html
History and Evolution of Health Care Information Systems (nd) Chapter 4. Retrieved from: http://www.slideserve.com/paul/history-and-evolution-of-health-care-information-systems
In the wake on new and very contentious health care reform, many firms have undergone extensive transformations. These transformations have been predicated on both cost control and quality management. In particular quality management has had a profound impact on the underlying business operations of many health care firms. For one, firms are now finding methods in which to enhance the overall patient experience while also mitigating potential loses due to negligent means. The focus on quality management has also made firms more efficient in regards to the overall delivery of service. In particular, my firm has done extensive work with reducing elderly accidents within the facility. This quality management initiative has not only reduced costs associated with accidents, but it also has enhanced the trust and patient experience of all stakeholders within the firm (Kelly, 2011).
Identify the milestone you chose in the history of quality improvement in…
1) Draper, Elaine, Joseph LaDou, and Dan J. Tennenhouse. 2011. "Occupational Health Nursing and the Quest for Professional Authority," New Solutions 21, 47 -- 81
2) Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (Eds). (2000). To err is human: Building a safer health system. Washington, D.C.: National Academy Press.
3) Kelly, D.L. (2011). Applying quality management in healthcare: A systems approach (3rd ed.). Chicago, IL: Health Administration Press
4) Lucia, Patricia R.; Otto, Tammy E.; Palmier, Patrick A. (2009). "Chapter 1
ole of Family Physician
It is important for us to understand the role of a family physician before we begin our discussion on the importance of family physicians in any health care system of the community. Many reforms have been made in the health care systems of various communities all over the world. Almost all of these reforms lay their focus on the prevention as well as the treatment of any disease along with the promotion of health and management of conditions that have become a chronic problem for the patients. All of these areas are the center of the family physicians and therefore family medicine has a huge role to play in here.
In this paper, we shall look at the current health care system in Libya and see how the government and other organizations like WHO are playing their role to improve the health care system in the…
(2005). Libya country profile. Library of Congress Federal Research Division (April 2005).
(2004). Pfizer Clear Health Communication Initiative. What it Health Literacy? [Online].
(2004). The American Heritage Dictionary of the English Language, Fourth Edition; 2000. [Online].
Kates N. (1997). Psychiatry and family medicine: sharing care. Can J. Psychiatry. Vol. 42:913-14.
com). A certain amount of errors is to be expected, but there should not be so many that it demonstrates a certain level of skewedness about the model in its entirety. Thus, if the NHI model is the one which is selected, then it needs to be tested against a range of different scenarios. The following demonstrate some truly relevant what-ifs: what if the doctors only move half the projected volume; what if medicare slashes rates; what if competitors open a comparable program (dgapartners.com).
There are a range of factors which can change or adjust once a healthcare facility opens their doors for business. And as much as this facility is attempting to engage in a solid humanitarian effort, at the end of the day, it's still a business and people need to get paid. Thus, before engaging in further developmental activities, one needs to determine in what ways the…
Brakatu Ofori-Adjei, a. (2007). Microfinance: An Alternative Means of Healthcare Financing for the Poor. Ghana Medical Journal, 193-194.
Burnstein, L., Harris, R., & Love, L. (2012, August 30). Top Four Legal Issues to Consider When Opening an Urgent Care Center. Retrieved from Mondaq.com: http://www.mondaq.com/unitedstates/x/194082/Healthcare/Estate+planning+is+important+step
Burnstein, M., Harris, R.L., & Love, L. (2012, August 20). Top Four Legal Issues to Consider When Opening an Urgent Care Center. Retrieved from Mondaq.com:
INTENET'S IMPACT ON HEALTH CAE INFOMATION
The Internet's Impact on Health Care Information
The Internet's Impact on Health Care Information
This paper explores some of the best and well-known cites and sites around the world for information and health care. Early in the 21st century, the World Health Organization made its first attempt to rank the quality of health care in approximately 200 countries. (NYT, 2007) The WHO ranked the countries' health care based on factors such as fairness, quality, access, insurance coverage, patient satisfaction, and use of information technology among other factors. (NYT, 2007) According to this research, some of countries in the world that provide the best health care overall are France, Italy, Malta, Japan, and Monaco, among others. (NYT, 2007) As much as the United States of America boasts at being the best in the world at nearly everything, United States health care was not in…
Global Health Council. (2012). Health Linkages. Web, Available from: http://www.globalhealth.org/Health_Linkages.html . 2012 August 26.
Mayo Foundation for Medical Research and Education. (2012). Mayo Clinic. Web, Available from: http://www.mayoclinic.com/ . 2012 August 26.
National Institutes of Health. (2012). Health Information. Web, Available from: http://health.nih.gov/ . 2012 August 26.
No listed author. (2007). Editorial -- World's best health care? The New York Times, Web, Available from: http://www.nytimes.com/2007/08/12/opinion/12sun1.html?pagewanted=all . 2012 August 26.
Strategic Management of a Healthcare Facility in St. Louis
In the late 1800's and early 1900's St. Louis was a major center for automotive and other heavy manufacturing but the industrial restructuring of the Midwest during the latter half of the century has resulted in consistent economic decline of the St. Louis region. Today however as the rest of the country faces a slowing economy this region is showing new signs of growth. [Kotkin, 2002] Due to changing socio-demographics, the demand for health care and advanced medical technologies is growing consistently with a concomitant rise in health expenditure. [Zhou 2001] Health expenditure in the U.S. has risen from 7.4% of the GNP in 1970 to 15% of the GNP in 1995.[Zhou, 2001] The Health care sector deals with not only the clinical medical services, but also include methods which finance them, for e.g. insurance, benefit schemes, Medicare and Medicaid. eforms…
1. Kotkin, J, 2002 St. Louis: On the Way to Somewhere? Rebuz Inc.
2. Author not available, 1997, Economic Report of the President. Government Printing Office, Washington, D.C. [accessed on 4/4/03]: http://www.umsl.edu/services/govdocs/erp/1997/chap3.htm
3.Author not available, 1996, Focus... Non-Elderly Missourians without Health Insurance, March 1996, Vol. 30, No. 1 [accessed on 4/4/03]: http://www.dhss.state.mo.us/MonthlyVitalStatistics/March96Vol30No1.html
4. Author not available, January 1999, Focus... Managed Care (MC+) in Medicaid Population, January 1999 Vol. 32, No. 11[accessed on 4/4/03] at http://www.dhss.state.mo.us/MonthlyVitalStatistics/Jan99Vol32No11.html
Access to Health Care in USA
This research paper focuses on the degree of accessibility to the health care services in the U.S.A. Accessibility refers to the ability of an individual to meet health care needs and to acquire the needed medical services on time. It then discusses the findings of the research. The suggestions for the elimination of the prevailing problems in the health care system are also given in the preceding paper.
Health Care: Access to Health Care in United States of America
To achieve a long-lasting life and to save oneself from major diseases it is important that people have an easy access to the medical and health care services. Access to the health care services means that individual gets timely health services to attain the best heath results. In other words it refers to the ability of an individual to meet health needs and to acquire…
Albert, R. (2009). The U.S. Health Care Rip-Off. Retrieved May 16, 2013, from http://rendezvous.blogs.nytimes.com/2013/03/03/the-u-s-health-care-rip-off/
Alex, E. (2012). Health Care Access Worsened For Americans Since 2000: Report. Retrieved May 16, 2013, from http://www.huffingtonpost.com/2012/05/07/health-care-access-urban-institute_n_1497658.html
Maria, E. (2012). Benefits of the United States Health Care System. Retrieved May 17, 2013, from http://www.ehow.com/list_7411670_benefits-states-health-care-system_.html
Maryann, B (2011). Health Care Systems: Three International Comparisons. Retrieved May 17, 2013, from http://www.stanford.edu/class/e297c/poverty_prejudice/soc_sec/health.htm
Healthcare: Clinical Integration
What is clinical integration
History of clinical integration
Goals of clinical integration
Importance of clinical integration
New payment models
Barriers to clinical integration
Lack of practitioner alignment
Lack of interoperability
How to achieve success in clinical integration
The future of health care systems
Physician acquisitions vs. clinical integration
HIEs -- solution to clinical integration?
Policy makers are beginning to appreciate the fact that only systemic change can effectively change, for the better, the manner of health care delivery in the U.S.; and that anything less would only alter the system's edges - with little or no substantial effect on cost-control, innovation-promotion, effectiveness of reward incentive schemes, coordination and coverage (AHA, 2010). Clinical integration has been found to be crucial to the change needed for the achievement of the aforementioned goals (AHA, 2010). Despite…
AHA. Clinical Integration -- the Key to Real Reform. Trend Watch. Retrieved from [HIDDEN]
Athena Health. (2014). History of the Clinical Integration Model. Athena Health. Retrieved from https://www.athenahealth.com/knowledge-hub/clinical-integration/clinical-integration-model.php
eHealth Initiative. (2012). The Rise of the Private Health Information Exchange and Changing Role of Public Exchanges. eHealth Initiative. Retrieved from [HIDDEN]
Fridsma, D. (2013). Interoperability Vs Health Information Exchange: Setting the Record Straight. Health IT Buzz. Retrieved from http://www.healthit.gov/buzz-blog/meaningful-use/interoperability-health-information-exchange-setting-record-straight/
Terrace Hospital Marketing Plan
Marketing trategy -- Terrace Community Hospital
ummary- Terrace Hospital is a smaller, community hospital, located in a suburb of a major city. There are a number of large urban hospitals within 45-60 minutes of Terrace, but the focus for Terrace is as an expanded clinic that provides basic services for urgent care, seniors, obstetrics, general practice, counseling and education programs, radiology, complete blood work, and an osteo-care unit for citizens of the outlying communities that are 45-60 minutes from Terrace, and thus quite a distance from the urban hospitals. The hospital is reviewing its marketing plan in order to focus more on profitable and complete care, knowing that more complicated specializations are more available in the urban center.
Major Health Concerns -- Quality pediatric care, childhood obesity and Type-II diabetes, alcohol and cigarettes, substance abuse, TDs, geriatric care, obesity and cardio-renal issues.
Target Patients- The community…
Buckley, P. (2009). The Complete Guide to Hospital Marketing. Marblehead, MA: HCPro, Inc.
City University of New York. (2011). Marketing Planning, Strategic Planning and the Marketing Process. Retrieved from: http://academic.brooklyn.cuny.edu/economic/friedman/mmmarketingplanning.htm
Eckrich, D.; Schlessinger, W. (2011). An Application of the marketing concept in health-care services planning. Journal of Marketing Research. Retrieved online from: http://www.www.aabri.com/manuscripts/10571.pdf
HR Council. (2012). HR Planning. Retrieved from: http://hrcouncil.ca/hr-toolkit/planning-strategic.cfm
Quality Improvement in Healthcare
Nearly all healthcare organizations today are aware of the Quality Improvement (QI) movement and seek to actively instill their businesses with such elements. In fact, the past few decades have shown the QI movement to be the main approach for healthcare organizations to measure performance and engage in lasting changes (Colton, 2000). The foundations of QI reside with its origins which come from multiple arenas: "in systems engineering, as a way of defining production processes; in quantitative analysis, as a methodological approach for collecting and analyzing data; and in organizational behavior, as a way of understanding how QI fits with an organization's structure and management philosophy" (Colton, 2000). QI fundamentally stands as a mode for a healthcare organization to better itself through enhancing the way in which it delivers service and by improving patient outcomes (Colton, 2000). "The U.S. Agency for Healthcare esearch and Quality defines…
Colton, D. (2000). Quality improvement in health care. Conceptual and historical foundations. Eval Health Prof., 7-42.
Familydoctor.org. (n.d.). Medical Errors: Tips to Help Prevent Them. Retrieved from Familydoctor.org: http://familydoctor.org/familydoctor/en/healthcare-management/self-care/medical-errors-tips-to-help-prevent-them.html
Varkey, P., Reller, K., & Resar, R. (2007). Basics of Quality Improvement in Health Care. Mayo Clin Proc., 735-739.
All spending includes state and federal expenditures. Growth figures reflect increases in benefit payments and disproportionate share hospital payments; growth figures do not include administrative costs, accounting adjustments, or costs for the U.S. Territories.
Federal Fiscal Year: Unless otherwise noted, years preceded by "FY" on statehealthfacts.org refer to the Federal Fiscal Year, which runs from October 1 through September 30. for example, FY 2009 refers to the period from October 1, 2008 through September 30, 2009.
Urban Institute estimates based on data from CMS (Form 64) (as of 12/21/11).
From this entire chart, the entire increase in expenditure of…
Clark, Cheryl et al. "State Medicaid Eligibility and Care Delayed Because of Cost." New England Journal of Medicine, 368 (2013): 1263-1265. Print.
Ellwood, Marilyn Rymer et al. An Exploratory Analysis of the Medicaid Expenditures of Substance Exposed Children Under 2 Years of Age in California. U.S. Department of Health and Human Services, 1993. Print.
Goodnough, Abby. "October 25th." The New York Times. 25th October. 2012. Web. 29th March 2013. [ http://www.nytimes.com/2012/10/26/us/spending-on-medicaid-has-slowed-survey-finds.html?_r=0 ].
Grannemann, Thomas W. And Mark V Pauly. Controlling Medicaid Costs: Federalism, Competition, and Choice. Washington DC: American Enterprise Institute, 1983. Print.
United States healthcare programs to citizens compare with the healthcare provided to residents in other countries? That question will be the focus of this paper, along with the background to the decision of major health insurance companies to support the candidacy of Republican Mitt Romney.
here does the U.S. stand in the world when it comes to healthcare?
According to a statement by the Speaker of the House of Representatives, John Boehner, the U.S. has "…the best health care delivery system in the world" (Politiface.com). Boehner, who was a guest on the CBS Sunday program "Face the Nation," was commenting on the candidacy of Mitt Romney. On the July 1, 2012 program, Boehner said he supports Romney for president because Romney "…understands that Obamacare will bankrupt our country and will ruin…" that healthcare system that the speaker believes is best in the world (politifact.com).
Meanwhile on Fox News Sunday (also…
Balanced Politics. (2009). Should the Government Provide Free Universal Health Care for All
Americans? Retrieved November 17, 2012, from http://balancedpolitics.org .
Business Insider. (2012). Health Insurance Companies Are Worried About A Romney
Victory. Retrieved November 17, 2012, from http://www.businessinsider.com .
This is the strategy used in Canada, where drug costs have been substantially reduced.
The challenges presented by this law have spilled over into the current health-care reform debate. Many people and many legislators who might have been more open to engage in productive dialogue during the current debate were no doubt made more leery of the process and of the possibility that there could be significant reform that would bring benefits to more people while bringing down the federal deficit.
The fears of opponents of the bill were correct in their fears that the bill would been even more expensive than originally budgeted. The initial estimate for the net cost was $400 billion for the period from 2004-2013. However, only a month after the bill's passage, that estimate was raised to $534 billion. It has since been raised to over $550. The cost over-runs in this bill will no…
Day treatment programs can provide services at less cost because the patient goes home at night after being treated during the day, which often is used for rehabilitating chronically ill patients (Sharfstein, Stoline, & Koran, 1995, p. 249). The mere fact of having more choice benefits some patients by giving them more say in their care.
Patient-focused care involves a method for containing in-patient costs for hospitals and for improving quality by "restructuring services so that more of them take place on nursing units rather than in specialized units in other hospital locations, and by cross-training staff on the nursing units so that they can do several 'jobs' for the same small group of patients rather then one 'job' for a large number of patients" (Kovner, 1995, p. 186). Kovner notes a number of barriers to this type of care. One reason has been that hospitals have not had to…
Doctors Say Managed Care Strains Patient Relationships (1997, June 9). Westchester County Business Journal 36(23), p. 24.
Kovner, a.R. (1995). Hospitals. In Jonas's Health Care Delivery in the United States, a.R. Kovner (ed.), pp. 162-193. New York: springer Publishing.
Moore, G.T. (1991,
April 24). Let's provide primary care to all uninsured Americans ? now! JAMA, pp. 2108-2109.
Leadership & Management, Health Care
Leadership & Management in Health Care
President Clinton's Secretary of Health and Human Services, Donna Shalala, used to tell a story about her mother, who was 86 at the time but still a full-time attorney representing several clients who lived in nursing homes. She would tell Shalala, "Donna, I don't care whether they are good nursing homes or bad nursing homes, you have to watch them like a hawk" (Cited in White House, 1998, quoted by Hovey 2000, 43). Clinton's presidency was very aware of health care issues, even if it was unable to solve them. Shalala's remarks were delivered at a press conference regarding nursing home regulation; arguably, under the current administration, issues of health care for the aged have gotten more problematical rather than less.
Despite relatively little action regarding health care for the aged by the federal government, there is little…
Fox-Grage, W., & Shaw, T. (2000, April). The crisis ahead in long-term care. State Legislatures, 26, 30. Retrieved June 30, 2004, from Questia database, http://www.questia.com .
Froeschle, M.L., & Donahue, P.M. (1998). Academic health care: Leadership in time of change. Journal of Leadership Studies, 5(4), 60. Retrieved June 30, 2004, from Questia database,
Social, Cultural, And Political Influence in Healthcare Delivery
Social, cultural, and political inequalities are detrimental to the health and healthcare system of the U.S. This is because the U.S. is one of the most multicultural, overpopulated, diverse and undergoing rapid economic growth. The federal government has embarked on efforts geared at addressing unsustainable costs of health care in the U.S. With the leadership of the current president, Barrack Obama, initiatives of containing health care costs will evaluate and explore strategies to contain the growing costs of health care based on a system-wide while enhancing the value and quality of health care (Ubokudom, 2012). The apparent system of health care is rife with opportunities of minimizing waste, delivering coordinated, effective care, and improving well-being and health of all Americans. The government in collaboration with care providers must prioritize cost effective containment strategies with the greatest possibility for political success and non-partisan…
Albrecht, G.L., Fitzpatrick, R., & Scrimshaw, S. (2013). Handbook of social studies in health and medicine. London: Sage Publications.
Armstrong, E.G. (2011). The health care dilemma: A comparison of health care systems in three European countries and the U.S. Singapore: World Scientific.
Bale, J.R., Stoll, B.J., & Lucas, A.O. (2013). Improving birth outcomes: Meeting the challenge in the developing world. Washington, DC: National academies press.
Buseh, A.G. (2008). Empowering resilience: Improving health care delivery in war-impacted African countries: a case study of Liberia. Lanham, Md: University Press of America.
International Cooperative Healthcare Model
PLEASE WRITE THE SPEAKERS NOTES. I WILL EVELOP THE 15 SLIES FROM THOSE NOTES. THE NOTES MUST SUPPORT THE 15 SLIES. PLEASE USE MY PREVIOUS PAPERS AS RESOURCES IN AITION TO THE BOOKS I HAVE ATTACHE. If you are unsure, please contact me.
Resources: Cooperative elivery Model and Annotated Bibliography assignments; course readings
Address potential challenges to your model in the presentation and the feasibility of using your model as a pilot program that could be expanded to other countries, thereby creating a global service network.
Format any citations and references in your presentation consistent with APA guidelines.
International cooperative healthcare model
Healthcare cooperatives involve many different types of organizations: Nonprofit agencies, Non-governmental organizations (NGO), commercial companies, and government, depending on the political jurisdiction. The cooperative can take many different forms, including purchased or shared services, worker-owned or patient-owned organizations, community owned organizations, or jointly…
Davis, K. (2009, June 22). Cooperative Health Care: The Way Forward?, The Commonwealth Fund. [Blog]. Retrieved http://www.commonwealthfund.org /Content/Blog/Health-Cooperatives-The-Way-Forward.aspx
International Health Co-operative Organization (IHCO), International Co-operative Alliance (ICA). (2011). [Web]. Retrieved http://www.ica.coop/ihco/newsanddoc.html
The Zambia Prevention, Care, and Treatment Partnership: A Model Program. (2008). U.S. President's Emergency Plan for AIDS Relief, U.S. Agency for International Development (USAID) Retrieved http://www.fhi.org/NR/rdonlyres / etkgr3honbl4chb7p5mxtcbioozlrk2pmfxctmfcu2ozsmunapqkvxdblxk4wtme6ij7xpj3thdfik/ZPCTModelProgramReportHV1.pdf
Stated to be barriers in the current environment and responsible for the reporting that is inadequate in relation to medical errors are:
Lack of a common understanding about errors among health care professionals
Physicians generally think of errors as individual that resulted from patient morbidity or mortality.
Physicians report errors in medical records that have in turn been ignored by researchers.
Interestingly errors in medication occur in almost 1 of every 5 doses provided to patients in hospitals. It was stated by Kaushal, et al., (2001) that "the rate of medication errors per 100 admission was 55 in pediatric inpatients. Using their figure, we estimated that the sensitivity of using a keyword search on explicit error reports to detect medication errors in inpatients is about 0.7%. They also reported the 37.4% of medication errors were caused by wrong dose or frequency, which is not far away from our result of…
Discussion Paper on Adverse Event and Error Reporting In Healthcare: Institute for Safe Medication Practices Jan 24, 2000
Patient Safety/Medical Errors Online at the Premiere Inc. page located at: http://www.premierinc.com/all/safety/resources/patient_safety/downloads/patient_safety_policy_position_2001.doc
Medstat / Shortell, S. Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What It Will Take to Accelerate Progress.
Health Policy Monitor (2001) A Publication of the Council of State Governments Vol. 6, No. 1 Winter/Spring 2001 PO18-0101
EMR System Implementation
The healthcare industry is increasingly impacted by advanced in Information Technology (IT). As our abilities to coordinate, interconnect and streamline the transmission of data through IT solutions improve so too do our abilities to provide efficient, safe and effective healthcare decisions for presenting patients. This is the notion that underscores the present discussion regarding Inter-Regional Health Systems, an organization identified specifically for the purposes of this discussion and approaching a proposed IT transformation. Inter-Regional is a multi-site healthcare complex with a wide variety of emergency room, clinic, specialist and outpatient facilities on each site. On the whole, the company has roughly 10,000 employees across its various sites. The private health firm is seeking to improve efficiency as a way of improving its economic performance and considers that it will likely benefit from the implementation of an Electronic Medical Records system. The discussion here evaluates this proposition.
AHIMA. (2008). Enterprise Content and Record Management for Healthcare. Journal of AHIMA, 79(10), 91-98.
Draper, J. (2012). Electronic Medical Records Can Mean Life or Death. San Francisco Chronicle.
McNamara, C. (2008). Organizational Change and Development. Management Help.
Medinformatix. (2010). Homepage. Medinformatix, Inc.
Health care, and that too, a quality health care is one of the most basic needs of any human being. In current times, where the fast paced lives are getting faster each day, work stresses are increasing, streets are being storm with junk foods and fast foods, and pollution and congestion is increasing, human lives are getting more and more prone to physical and mental diseases. As a result, the importance of health care systems and health care facilities increases. While, surgeons and doctors are generally seen as the captain of the ship as far as health sector is concerned, very important personnel of the health sector are the nurses. Once quite ignored, the importance of the nursing profession was highlighted by Florence Nightingale, one of the nursing pioneers. Florence Nightingale broke the conventional perceptions associated with the profession of nursing and took it to a new level, explored various…
Lee, H. & Winters, C. (2006). Rural nursing: concepts, theories and practice. New York:
Joel, A. & Kelly, L. (2002). The nursing experience: trends, challenges and transitions. New York: Mc Graw Hill.
Lumby, J. & Picone, D. (2000). Clinical Challenges: focus on nursing. St. Leonards, N.S.W: Allen and Unwin.
To analyze and compare the U.S. healthcare, internationally, it is important to know what really constitutes a good health care system. The U.S. Institute of Medicine describes this quality as, "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." This system, in its broad sense, should comprise of two main branches of preventative and curative medicine, both of which should cover different aspects of health, such as travel medicine, school health, occupational health, mental health, reproductive health and so on. Furthermore, a well established health care system does not act independently but in co-ordinance with other industries, such as the agricultural industry. Therefore, since a well developed nation has better access to proper sanitation, housing and adequate nutrition, it is more likely to have a better developed health care system. Other factors,…
Atrash, H.K., Alexander, S., & Breg, C. (1993, Feburary 05). Maternal mortality in developed countries: not just a concern of the past Obstetrics and Gynecology, 15(3), Retrieved from http://www.inamay.com/?page_id=86
Docteur, E. & Berenson, R.A. (2009, August). How does the quality of u.s. health care compare internationally?. Timely Analysis Of Health Policy Issues, Retrieved from http://www.urban.org/uploadedpdf/411947_ushealthcare_quality.pdf
Health care for all: a frameworkfor moving to a primary care-based health care system in the United States. (2011). American Academy Of Family Physicians, Retrieved from Kurt, H. (2008). A success story in american health care: eliminating infections and saving lives in michigan. Healthreform.gov
Mark A., S., McGlynn, E.A., & Brook, R.H. (1998). How good is the quality of health care in the United States? The Millibank Quarterly, 76(4), retrieved from http://www.milbank.org/760401.html
Controlling Violent Health Care Patients and Employees
This is a paper discussion on the identification and control of violence amongst health care patients and employees. It has 11 sources.
An Introduction to Violence
Violence has become a common feature of our society found in every area of the nation from quiet neighborhoods in the suburbs to the urbanized cities of the U.S. To make the matter worse, the media including radio, TV, private cable networks, have become a part of the culture that promotes the concepts of violence, if there is no violence exhibited in either every day programs then these programs, including those of children are presumed to be a failure. Hence, it would not be wrong to assume that our entire culture has been virtually gripped in a sphere of violence to which there is no end.
This culture of violence continues despite the fact that the sociologists…
Erickson L. Williams-Evans SA. Attitudes of emergency nurses regarding patient assaults. J Emerg Nurs. 2000; 26(3):210-215.
Felton JS. Violence prevention at the health care site. Occup Med. 1997; 12(4):701-715.
Hegal MT, Ferguson RJ. Differential reinforcement of other behavior (DRO) to reduce aggressive behavior following traumatic brain injury. Behav Modif. 2000; 24(1):94-101.
Levin PF, Hewitt JB, Misner ST. Insights of nurses about assault in hospital-based emergency departments. Image J. Nurs Sch. 1998; 30(3):249-254.
Leadership and Management in Healthcare
Models of management and leadership in health care contexts
As when it comes to modern company structures, management and leadership play a main function in health care as well, specifically focusing on reform motions, kinds of services offered, quality of services and capital use. As we specified earlier, there is no universal dish for effective management and leadership, contextual aspects like political system and socio-economic elements play a substantial part in the results.
In basic terms, a health care system has to complete 2 standard things (adjusted from Dorros, 2006):
Enhance the wellness condition of the population (according to specific requirements and targets);
Provide services in the most reliable method possible in order to achieve the first objective.
Furthermore despite the condition of the economy and nation, when attempting to reform health care systems, governments have to ask themselves 3 standard concerns: Who spends for…
Collins, J.C. (2001). Good to Great. New York, NY: HarperCollins: 17 -- 40.
Collins, J.C. And Porras, J.I. (1997). Built to Last. New York, NY: HarperCollins; 173 -- 174.
Contino, D.S. (2001). Budget training: it's overdue. Nurs Manage; 32:16 -- 17.
Contino, D.S. (2004). Leadership Competencies: Knowledge, Skills, and Aptitudes Nurses Need to Lead Organizations Effectively. Critical Care Nurse; 24: 52-64.
educed costs for medical education would be the second to last alternative that would be likely to be effective. First, reducing the costs of medical eduction, through tax incentives and tuition caps, may make the medical field more attractive to some students; however, even with these in place, the costs would still be so significant that many potential future doctors would be still turned off from the profession. In contrast, free medical education would likely be very effective in recruiting students to pursue the medical profession. This would likely be especially attractive to good students who weren't good enough to receive significant scholarship money to help offset their education. However, this would be the most expensive alternative to implement for the United States. This cost could be offset by the service these doctors give, in exchange, for government-run medical facilities, but the infrastructure alone to this type of innovative plan…
Fox, R. & Abrahamson, K. (Oct-Dec 2009). "A critical examination of the U.S. nursing shortage: Contributing factors, public policy implications." Nursing Forum, 44(4). p. 235-244.
Ganley, B. & Sheets, I. (Jul 2009). "Educational innovations: A strategy to address the nursing faculty shortage." Journal of Nursing Education, 48(7). p. 401-405.
Medical student debt. (2011). Retrieved January 9, 2011, from http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacy-policy/medical-student-debt.shtml .
The Patient Protection and Affordable Care Act. (No date). Retrieved January 9, 2011, from http://dpc.senate.gov/healthreformbill/healthbill04.pdf .
In the current era of managed care in medicine, physicians and other healthcare providers and institutions have been under tremendous pressure to reduce costs. In that regard, avoiding unnecessary hospitalization is one of the most important goals of lowering the costs of healthcare delivery (Stanhope & Lancaster, 2004). Toward that end, diverse strategies have evolved to provide as many healthcare services as possible on an ambulatory basis.
Hospitals and insurance companies now encourage patients to participate in preventative medicine and routine testing intended to lower the costs associated with hospitalization over the long-term. The strategy is simply to reduce the incidence of serious illnesses, particularly those that typically develop over many years and which are capable of prevention through behavior modification and early detection through diagnostic testing (Stanhope & Lancaster, 2004).
Because state and federal governments must absorb much of the costs of uncompensated medical services, the many administrative agencies…
References Stanhope, M., Lancaster, J. (2004) Community and Public Health Nursing (6th ed.) St. Louis: Mosby.
ecause unions retain the exclusive right to negotiate on behalf of its members, the individual worker may have little recourse to easily address incompetent leadership.
The Disadvantages of Unionized Labor for Healthcare Employers:
The primary disadvantages of unionized labor for healthcare employers correspond to the relative loss of control over issues and workplace elements commonly transferred to workers (through their unions), which accounts for the traditional resistance with which many employers responded to unionization attempts. On the one hand, unionized workforces are able to secure better pay and benefits from employers than would have been available to workers without union representation; likewise, employers must cede control over many aspects of operational and personnel decisions traditionally within administrative control.
On the other hand, particularly in light of the beneficial effect that unionized nursing has had on the quality of patient care and reduction in patient mortality, it is difficult to conceive…
Daft, R. (2005) Management (7th ed.) Mason: Thomson South Western.
Nevins, J., Commager, H. (1992) a Pocket History of the United States.
New York: Pocket Books
Seago, J., Ash, M. (2002)
nurses deliver evidence-Based care?
Define main ideas within the title supported from the literature
Nurse instructors confront many hurdles in the present healthcare environment. Educational methods, philosophies, and the content of curricula is required to reviewed to cater to the requirements of the professional nurses who would practice in the coming millennium. (Kessenich; Guyatt; DiCenso, 25) Evidence-based practice or EBP has currently emerged to be a remarkable attribute in nursing literature along with a key impetus in restructuring nursing practice. (Elizabeth; Pyle, 64) Evidence-Based Nursing or EBN is the strategy by which the nurses formulate clinical conclusions applying the best available research evidence, their clinical skill and patient prioritization. (Evidence-Based Nursing: University of Minnesota) It could be narrated as the meticulous, unequivocal and judicious application of the current best evidences in formulating decisions about the care of individual patients. When clinicians formulate health care conclusions for a population or group…
Asking Clinical Questions: Introduction. Retrieved from http://www.poems.msu.edu/InfoMastery/Questions/Questions.htm Accessed on 18 June, 2005
Beyers, Marjorie. About Evidence-Based Nursing Practice. Nursing Management. October, 1999. Vol: 11; No: 1; pp: 103-105
Code of professional Conduct. Retrieved from http://www.nmc-uk.org/nmc/main/publications/reqForPre-regNursing.pdf Accessed on 17 June, 2005
Cronenwett, L. Research, Practice and Policy: Issues in Evidence-Based Care. Journal of Issues in Nursing. February 19, 2002. Vol: 7; No.2; pp: 57-61
Neuman Health Care Systems Model:
Preventative Care for Mr. H
The Neuman Health Care Systems Model was created by Betty M. Neuman in an effort to help nursing students focus on wellness for the client system (McHolm & Geib, 1998). In order to create wellness for a client system, the nursing students use an Assessment and Analysis Tool, which will help in identifying Mr. H's problems (McHolm & Geib, 1998).
First, a nurse must find out Mr. H's profile and define his stressors. This must be done by the nurse and by the concerns expressed by the client (NeumanSystemsModel.org, 2011). It is clear that stressors in this 72-year-old widower's life are affecting his overall health. ecent changes in his life, such as the loss of his wife of 45 years, are a factor in his health changes. It is good that Mr. H is still trying to maintain his normal…
A.D.A.M. (2011). Hypotension. Retrieved January 21, 2011 from https://health.google.com/health/ref/Hypotension .
McHolm, F.A. & Geib, K.M. (1998, January-March). Nursing diagnosis: Application of the Neuman systems model of teaching health assessment and nursing process. Retrieved January 21, 2011 from http://findarticles.com/p/articles/mi_qa3836/is_199801/ai_n8792656/?tag=content;col1
NCBI. (2010, July 1). Pubmed health - Atorvastatin. Retrieved January 20, 2010 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH
NCBI. (2008, September 1). Pubmed health -- Furosemide. Retrieved January 20, 2010 from
Where, it will reduce the total amount by $138 billion in ten-year. This is despite, the fact that $950 billion is going to be spent implementing such changes. What this shows, is that when implementing the strengths of the French system with that of the American system, you can have high quality health care services and maintain costs.
Health Care ill to Cut Deficit. (2010, March 18). Retrieved April 12, 2010 from Reuters website:
Tired of Waiting for Your Doctor. (2006, November 20). Retrieved April 12, 2010 from MSNC website:
Dutton, P. (2007, August 11). France's Model Health Care System. Retrieved April 12, 2010 from oston.com
Foley, T. (2009, March 8). 5 Questions about French Health Care. Retrieved April 12, 2009 from Change.org website: http://healthcare.change.org/blog/view/5_questions_about_french_health_care
Foy, A. (2009, September 10). Give Me Liberty or Give Me Health Care. Retrieved April 12, 2010 from American…
Health Care Bill to Cut Deficit. (2010, March 18). Retrieved April 12, 2010 from Reuters website:
Tired of Waiting for Your Doctor. (2006, November 20). Retrieved April 12, 2010 from MSNBC website:
Aaron, H.J. 1994. Thinking About Medical Costs. Health Affairs, 13, 5 (winter): 8-13 in Hong, G-S and Kim, S.Y. (2000). Out-of-Pocket Health Care Expenditure Patterns and Financial Burden across the Life Cycle Stages. Journal of Consumer Affairs. 34. 2.
Acs, G. And John S. 1995. Trends in Out-of-Pocket Spending on Health Care, 1980-1992. Monthly Labor eview, 35-45 in Hong, G-S and Kim, S.Y. (2000). Out-of-Pocket Health Care Expenditure Patterns and Financial Burden across the Life Cycle Stages. Journal of Consumer Affairs. 34. 2.
Cote, J. And Latham, C. (2003). Exchanges between Healthcare Providers and Insurers: A Case Study. Journal of Managerial Issues. 15, 2.
Health, United States. (2003). Chartbook on trends in the health of Americans. HHS, Centers for Disease Control and Prevention (CDC). National Center for Health Statistics in Lesnik, J. (2006). Community Health Centers: Health Care as it Could Be. Journal of Law and Health. 19, 1..…
Aaron, H.J. 1994. Thinking About Medical Costs. Health Affairs, 13, 5 (winter): 8-13 in Hong, G-S and Kim, S.Y. (2000). Out-of-Pocket Health Care Expenditure Patterns and Financial Burden across the Life Cycle Stages. Journal of Consumer Affairs. 34. 2.
Acs, G. And John S. 1995. Trends in Out-of-Pocket Spending on Health Care, 1980-1992. Monthly Labor Review, 35-45 in Hong, G-S and Kim, S.Y. (2000). Out-of-Pocket Health Care Expenditure Patterns and Financial Burden across the Life Cycle Stages. Journal of Consumer Affairs. 34. 2.
Cote, J. And Latham, C. (2003). Exchanges between Healthcare Providers and Insurers: A Case Study. Journal of Managerial Issues. 15, 2.
Health, United States. (2003). Chartbook on trends in the health of Americans. HHS, Centers for Disease Control and Prevention (CDC). National Center for Health Statistics in Lesnik, J. (2006). Community Health Centers: Health Care as it Could Be. Journal of Law and Health. 19, 1..
Community Dementia Care and the Chronic Care Model
nd-Stage Dementia valuation Proposal
Health Promotion Plan for Community nd-Stage Dementia Care: The Chronic Care Model
Health Promotion Plan for Community nd-Stage Dementia Care: The Chronic Care Model.
In 2013 an estimated 5.0 million Americans over the age of 65 suffered from Alzheimer's disease (Alzheimer's Association, 2013). Although the U.S. Centers for Disease Control and Prevention (CDC) considers dementia/Alzheimer's to be the fifth leading cause of death among adults 65-years of age or older, careful examination of Medicare claims data revealed that dementia is probably right behind cardiovascular disease as the second leading cause of death for this age group (Tinetti et al., 2012). Most of these patients would prefer to die at home, not only because of comfort concerns, but due to the higher quality of care that tends to be provided by informal and paid caregivers in this setting (reviewed…
Eloniemi-Sulkava and colleagues (2009) evaluated patients at baseline using the Barthel Index and Neuropsychiatric Inventory (NPI) (see Appendix). The Barthel Index (Stone, Ali, Auberleek, Thompsell, & Young, 1994; University of Iowa Healthcare, n.d.) and NPI (Cummings et al., 1994) were administered again at 6 and 12 months into the study and will be used in the current study to track ADL and BPSDs using the same intervals. PQOL will represent a composite score obtained using the Color Analog Scale for pain (Santos & Castanho, 2013) and the Quality at the End of Life Scale (QUAL-E) (National Palliative Care Research Center, 2005) (see Appendix). In cases of severe cognitive impairment, completion of the QUAL-E may depend on family caregivers. FCQOL will be evaluated using the Zarit Burden Scale (Regional Geriatric Program Central, 2014) (see Appendix). The success of the intervention, as perceived by family caregivers and providers, will be assessed using the questionnaires developed by Morita and colleagues (2013). The goal of these questionnaires will be to evaluate how effective the community palliative intervention was in improving the knowledge and skills of palliative care, increasing access to specialized services, coordinating care services, and increasing deaths at home. This evaluation will be performed following the death of the patient or the end of the study period, whichever comes first. The validity and reliability of the questionnaires developed by Morita et al. (2013) have not been evaluated, but should prove informative and provide context for the other findings.
A review of interventions designed to improve the quality of community palliative care has revealed mixed findings, but the trend is in the desired direction of reducing the number of patients dying in hospital wards, ICUs, and hospice facilities. CCM has garnered the interest of researchers interested in improving palliative care outcomes for patients, family caregivers, and providers alike, and have begun to study the efficacy and quality of interventions, including CCM. This proposal provides justification for implementing CCM for end-stage dementia patients residing at home and details an evaluation strategy that can be implemented to determine the efficacy, effectiveness, and quality of the care provided. In contrast to many other studies, however, this proposal places equal value on the experiences of patients, family caregivers, and providers alike, in addition to the more common outcome measures of BPSDs and institutional admissions. The methods of data gathering will involve the review of patient records and several instruments designed
Healthcare system in USA
The health care system in the United States of America is a well established and structured system that aims at offering services to American citizens for the treatment and prevention of diseases, further more the system also seeks to promote mental and physical well being of its citizens. On a broader perspective the health care system in the U.S.A. can be defined as system concerned with where and how medical services are offered to America's citizens, secondly the system is concerned with medical expense and who pays for this and thirdly who offers these medical care services, for example, nurses, specialist physicians or primary care physicians.
Importance of knowing how to prepare healthcare system in the U.S.A.
The preparation of the healthcare system in the U.S.A. is a critical issue in the country because it is this system that's responsible for improving the overall health…
Then, when you combine this with the fact that Medicaid serves 53 million people with an annual budget of $329 billion, means that rising costs is severely affecting this program. ("Medicaid Reform," 2005) the inflexibility of this program has contributed to problem as a one size fits all approach is taken. Then, when you combine the different state programs offered through Medicaid, means that an uneven standard of inflexibility is used. An illustration of this can be seen by looking no further than the overall focus of Medicaid, where an emphasis is placed on addressing major health issues. This is problematic because like with Medicare, an approach must be taken of dealing with the patient once they are facing major health issues. Then Medicare has to engage in multiple functions to include: comprehensive acute / primary care, long-term care services (for those who qualify), a source of funding for uncompensated…
Medicaid Reform. (2005, June 15). Retrieved March 3, 2010 from National Governors Association website:
President Cuts Medicare, Medicaid to Help Reform Costs. (2009, June 15). Retrieved March 3, 2010 from California Health Line website: http://www.californiahealthline.org/articles/2009/6/15/president-outlines-cuts-to-medicare-medicaid-to-help-cover-reform-costs.aspx
Anderson, L. (2009, July 9). Research Project Finds Medicare Part D Increases Spending on Prescription Drugs.
Barak concludes by suggesting that the issue and concept of diversity take on a "special urgency" in human service healthcare organizations among the organization as a whole and staff, and that the organization review its quality of service and commitment to the community in order to truly impact the lives of diverse populations.
Managing Diversity: Best Practices
H Management often works off of the ideals of 'best practices.' This concept is discussed in the next article, "Managing the Diversity evolution: Best Practices for the 21st Century Business." Aronson takes a more general approach to diversity but one that can be applied directly to the healthcare industry nonetheless. Aronson points out many of the trends previously identified with regard to diversity problems in the nation's business climate as a whole. In particular the author points out that diversity issues may stem from a number of causes including cultural differences and systematic…
Aronson, D. (2002). "Managing diversity revolution: Best practices for the 21st century."
Civil Rights Journal, 6(1):46
Barak, M.E.M. (2000). "The inclusive workplace: An ecosystems approach to diversity
Management." Social Work, 45(4):339
Contracts with doctors often contain a clause which doesn't allow the doctors to discuss
Health care 7 with their patients financial incentives to deny treatment or about treatments not covered by the plan (Glazer, 1996). This has caused many consumers, especially those with chronic illnesses, to form organizations with the American Medical Association and physician specialty groups to promote legislation forbidding "gag rules" (Glazer, 1996). One group, Citizen Action, has 3 million members and "has been lobbying in state legislatures for laws that would require plans to disclose how they pay their doctors; give patients the right to choose specialists outside the plan; and provide appeals for patients who get turned down for expensive treatments" (Glazer, 1996).
The doctor-patient relationship is also affected if a patient must switch to a new doctor under managed care. Having a longterm relationship with a primary doctor is important because he or she is…
Bennett Clark, Jane (1996, July). What you should ask your HMO.
Kiplinger's Personal Finance Magazine. pp. 92-93.
Glazer, Sarah (1996, April 12). Managed Care. CQ Researcher, 6,
Koop, C. Everett (1996, Fall). Manage with care. Time. pp. 69.
Within this section of Chapter One, a historical perspective of NHS will be provided. This discussion will identify problem areas that have emerged in relation to NHS with an attempt made to address the manner in which such problems have historically influenced reform efforts.
With the passage and associated provisions of the NHS Act of 1946, NHS was implemented in the UK in 1948. The NHS Act of 1946 served as the means by which a pattern of health service finance and provision was established in the UK following World War II (Baggot, 1998). According to Baggot, on the basis of the Act, the principle of collective responsibility by the state for the establishment of a comprehensive health service system was introduced, allowing for the planned use of services by the entire population at no cost. It was also intended that equality of access to services would be…
Baggott, R. (1998). Health and Health Care in Britain. London, Macmillan,
Barlow, M. (1998). The Fight of My Life. Toronto: Harper Collins
BMA Central Consultants and Specialists Committee (1990). Guidance on Clinical
Directorates London: BMA.
Scope of Training
Large health care organizations will undoubtedly have a large scope of training. The investments and systems approach is beneficial for companies who can realize economies of scale. Through economies of scale the unit cost for each selective individual trained decreases. This ultimately allows the cost of investments and systems to be spread throughout the entire organization. The systems approach is particularly beneficial as it creates and distills consistent behavior throughout the entire organization. Each individual that is trained is usually receiving and absorbing the same information as their peers. This insures the continuity of the business and its underlying operations. The scope will depend primarily on the needs of the business. In some instances, training may involve the entire health care organization while in other instances; it may only require a select department. In either case, investments in systems allows for the most efficient use of…
1) Draper, Elaine, Joseph LaDou, and Dan J. Tennenhouse. 2011. "Occupational Health Nursing and the Quest for Professional Authority," New Solutions 21, 47 -- 81
2) Fang, D., Wilsey-Wisniewski, S.J., & Bednash, G.D. (2006). 2005-2006 enrollment and graduations in baccalaureate and graduate programs in nursing. Washington, DC: American Association of Colleges of Nursing
3) Levsey, K.R., Campbell, D., & Green, A. (2007). Yesterday, Today, and Tomorrow; Challenges in Securing Federal Support for Graduate Nurses. Journal of Nursing Education, 46(4), 176-183
4) Lucia, Patricia R.; Otto, Tammy E.; Palmier, Patrick A. (2009). "Chapter 1
A good example of this can be seen with popular Chinese talk show host Yang Lang donating $72 million, to start his own foundation to: help support and develop the health care system. This is important, because it shows how both international and domestic-based non-profits are addressing these underlying problems facing the health care sector. (Dobryzski, 2010)
Clearly, the biggest challenges facing the health care systems in the United States and China are vastly different. Yet, they are also wrestling with similar problems, as they face the issue of increasing numbers in the elderly population. In the case of the United States, this is challenging because there are a variety of disadvantages that must be addressed to include: they have access to some of the most cutting edge procedures, there is large number of choices about health care providers and the elderly can be able to receive effective treatment for…
Advanced Practice Nurses. (2010). Bukisa. Retrieved from: http://www.bukisa.com/articles/352958_advanced-practice-nurses-a-global-role
Health Systems. (n.d.). WHO. Retrieved from: gis.emro.who.int/HealthSystemObservatory/.../Conceptual%20frameworks. Ppt Health Care in China. (2006). IBM. Retrieved from: http://www-05.ibm.com/de/healthcare/downloads/healthcare_china.pdf
More About RN's. (2011). ANA. Retrieved from: http://www.nursingworld.org/especiallyforyou/studentnurses/rnsapns.aspx
Opportunities in the Health Care Sector. (2006). Grail Research. Retrieved from: http://www.grailresearch.com/pdf/ContenPodsPdf/Opportunities_in_the_China_Healthcare_Sector.pdf
Success in several high-profile areas, such as stroke prevention, acute coronary intervention, or nosocomial infection have the benefits of focusing the organization on a task which can bring tangible results, measured in clinically-relevant ways.
Specific Program for our Institution
This memo recommends that we choose five treatment areas, and implement specific quality improvement programs for each one. The focus on each should include procedures which are important to the overall quality of this institution's morbidity and mortality results. Given the hospital's focus on acute care, the following procedures might be candidates for quality improvement programs:
Ischemic stroke treatment
ACS treatment (acute coronary syndrome).
Trauma in the ER related to gunshot wounds.
Maternal ward delivery performance
Nosocomial infection reduction.
In each case, the procedures should proceed as outlined above: (1) an identification of the problem, (2) identification of best practices as demonstrated in peer-reviewed clinical trials, (3) adoption of the best…
CancerCenter. (2007). Cancer Treatment Centers of America. Retrieved November 23, 2007, from CCA: www.cancercenter.com
Civitarese, L.A. (1999). Congestive Heart Failure Clinical Outcomes Study in a Private Community Medical Group. Journal of American Board of Family Practice, 467-472.
Dana Farber. (2005). Dana-Farber attains nation's highest honor for nursing excellence; first cancer center in New England to earn Magnet recognition. Boston: Dana Farber Cancer Institute.
Katzan, I.L. (2003). Quality Improvement and Tissue-Type Plasminogen Activator for Acute Ischemic Stroke. JAHA, 799-800.
Healthcare Finance: hat is the break-Even analysis approach and its application in health care organizations?
Unfortunately, hospital and health care budgeting of resources has become increasingly important in this cost-conscious era of health care. The last decades of cost-controlled medicine have required fiscally conscious approaches to the healthcare for many organizations, often at the expense of patient services. A financial analyst must strive to minimize this, yet still keep the organization afloat. A segment that does not make money or at least break even for the health care provider may have to be eliminated.
Health care facilities may take longer to break even on their initial investment than other forms of businesses. Also, the break-even period for primary care is different compared to tertiary care. Still, developing any break-even action plan begins with a clear understanding of any significant shortfalls against benchmark, with a special focus on provider productivity in…
Halley, Marc D. & Lloyd. (Nov 2000) "How to Break Even on an Acquired Primary Care Network." Healthcare Financial Management. Retrived 17 Apr 2005 at http://www.findarticles.com/p/articles/mi_m3257/is_11_54/ai_66936335/pg_2
Health Care Access Ethical Dilemma
Access to health care services is not equitable in the United States. The 15% of Americans without health insurance coverage find it extremely difficult to access health care services (Trotochaud, 2006). This is an injustice that should be addressed. Patients going to rural health care facilities face myriad challenges that are occasioned by stigmatization. Stigmatization of illnesses that patients grapple with occasions ethical conflicts. In the process, patients' right to privacy and confidentiality are often violated. There are practical guidelines that can be used to minimize ethical conflicts. It is imperative that confidentiality and trust be made paramount under circumstances where healthcare professionals deal with patients with stigmatizing illnesses.
A typical example of confidentiality, overlapping relationships and lack of willingness to seek care can be attested to in a situation where a woman working at a local store finds out that her partner is HIV-positive…
Trotochaud, K. (2006). Ethical Issues and Access to Healthcare. Journal of Infusion Nursing,
Tummala, A. & Roberts, L.W., (2009). Ethics Conflicts in Rural Communities: Stigma and Illness. Hanover, NH: University Press of New England.
Organizational esponsibility and Current Health Care Issues
Ethics is the assessment and research of the human habits in regard to moral concepts, particularly those in a certain team, occupation, or specific organization (The Free Dictionary, 2012). People deal with lots of ethical/moral problems everyday and how they react might result in significant and legal ethical/moral ramifications. In the healthcare market, having approaches for making ethical/moral choices is a necessary part of the task. This paper will provide a circumstance that happens in a medical workplace and if the choice of the medical assistant will have an effect on the decision-making procedure, which can bring about legal and honest complexities.
The situation provides a skillfully experienced medical assistant and Licensed Practical Nurse (LPN) working in a clinic or medical workplace as a workplace assistant. Alone in the workplace and in charge of the phone calls throughout lunch, the assistant gets…
Bagheri, A. (2012). Elements of human dignity in healthcare settings: the importance of the patient's perspective. Journal of Medical Ethics; 38:12-729.
Bureau of Labor Statistics. (2009). Medical Assistants. Retrieved on October 31, 2010 from, http://www.bls.gov/oco/ocos164.htm
Buzzle. (2010). Medical Assistant Job Description. Retrieved on November 1, 2010 from, http://www.buzzle.com/articles/medical-assistant-job-description.html
Fremgen, B.F. (2009). Medical Law and ethics (3rd. ed.) Upper Saddle River, NJ: Pearson Prentice Hall.
Marketing in Healthcare
Catholic Healthcare West
Catholic Healthcare West (CHW) is a not-for-profit healthcare organization serving parts of Arizona, Nevada and the majority of California. With 42 hospitals it is the largest Catholic hospital system in this part of the United States. The organization focuses its services upon the poor, who cannot afford private hospital services. Regardless, the aim is also to provide high-quality healthcare to those in need. The target market is thus the poor in the western areas of the United States.
Taking into account the size of Catholic Healthcare West, it should not be a problem to implement new services without a loss of either mission or customers. New services should however be implemented with the proper care to ensure that the focus remains as originally intended.
The service management strategy of CHW has always been collaborative. y collaborating with other groups who share the vision and…
Allen, G. "New Product Development." 1999
Catholic Healthcare West. 2003. http://www.chwhealth.com/
Rice, T., B. Biles, E.R. Brown, F. Diderichsen & H. Kuehn. "Reconsidering the role of competition in health care markets." Journal of Health Politics, Policy and Law. Durham, Oct 2000
On the other hand, the industry will most likely insist on the service quality segment rather than on the price transparency. A constant improvement of the services provided within the healthcare facility will not only produce the appropriate competition on the market, but it will also provide the incentives for the other healthcare organizations, thus rising overall quality levels in the market. This will rather change the way hospitals price their services rather than price transparency.
Nevertheless, price transparency will change ridiculous situations in which the client is charged $35,000 to change a battery in a pacemaker. It will drive such prices lower, encouraging price competition.
1. A Call for Transparency in Healthcare Cost and Quality. On the Internet at http://blogs.msdn.com/healthblog/archive/2006/05/16/599064.aspx.Last retrieved on June 30, 2007
2. Feld, Stanley. What Is Real Price Transparency? Medicine: Healthcare System. May 2007. On the Internet at http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/05/what_is_real_pr.html.Last retrieved on June 30, 2007…
1. A Call for Transparency in Healthcare Cost and Quality. On the Internet at http://blogs.msdn.com/healthblog/archive/2006/05/16/599064.aspx.Last retrieved on June 30, 2007
2. Feld, Stanley. What Is Real Price Transparency? Medicine: Healthcare System. May 2007. On the Internet at http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/05/what_is_real_pr.html.Last retrieved on June 30, 2007
Call for Transparency in Healthcare Cost and Quality. On the Internet at
S. than in any other developed nation, yet the quality of care, even for those who are insured, is mediocre at best (Hawkins, 2007).
Doctors and hospitals often treat patients free of charge, if they do not have health insurance. However, that raises costs for other patients and makes healthcare and insurance even more costly. Most Americans recognize that the country's healthcare system is not sustainable and that without significant reform, it is headed for a complete meltdown.
In the U.S., identity theft is a major concern. Now, that, too, has gone into the medical arena. Medical identity theft is being described as the newest frontier in the ever-evolving crime of identity theft and presents a major opportunity for a wide range of criminals as the healthcare industry evolves into an electronic culture. Yet this environment is not properly protected by present law enforcement agencies and criminal offenses (Latour, 2007,…
Andrews, J. (2006). Where the jobs are: eldercare is already creating more jobs than there are people willing to do them. And the market is just heating up. Here's a look at where some of the greatest demand will be. Assisted Living 4(6) S6-9.
Hawkins, D.(12 February, 2007). Bush's Remedy Isn't a Cure; the President's health-care won't help those who need insurance most or the underinsured who can't afford primary care. Business Week Online
Institute of Medicine (2007). Preventing medication errors. National Academies Press, Washington, D.C.:
Lafferty, L. (2007). Medical identity theft: the future threat of health care fraud is now: lack of Federal Law Enforcement efforts means compliance professionals will have to lead the way. Journal of Health Care Compliance 9 (1) 11-21.