Twelve questions to ask about your outcomes monitoring system--Part I

Outcomes monitoring is an integral part of any decision maker's information resources--the cornerstone of a provider's commitment to quality improvement or of a purchaser's strategy for seeking value. In their eagerness to obtain useful information about provider performance, purchasers and consumers naively may accept flawed evaluations and thereby create perverse incentives for providers that undermine the very qualities they wish to foster. Inaccurate or misleading information about provider performance will lead managers to reward the wrong behavior and so induce more of it. Inaccurate information also can discourage better providers whose performances are not recognized and can lead all providers to distrust and denounce clinical monitoring in general. When these things happen, the great value of outcomes monitoring systems as a tool for quality improvement is lost.     

Strategically integrating hospital/home care services for improved profitability

Because hospitals and home health agencies have been predominantly separate organizations, coordination of their efforts has not been optimized. However, with the recent proliferation of hospital-based home health agencies, opportunities to integrate these health care service delivery systems have increased. Bethesda Memorial Hospital, Boynton Beach, Fla., is a 362-bed not-for-profit community hospital with a Medicare-certified home health agency organized as a department of the hospital. Until recently, the home health agency was generally perceived as a separate entity whose services were distinct from hospital services. Progress toward integration of hospital and home care services was given impetus through collaboration of the home health agency administrator and a newly appointed director of medical affairs who was given the responsibility as medical director of the home health agency. A prime responsibility of the director of medical affairs was to reduce length of stay and hospital costs through appropriate resource management.     

The influence of the farm size on the parity of a farming family in Poland

This paper aims at statistical identification of the relationship between the parity of farming families and the area of the farm and the role this variable plays among variables describing the model of families' parity. To reach this objective results of a questionnaire survey were used, one performed among the group of individual farmers' families keeping agricultural accounting in 1985. The analysis covered 1291 rural farming couples who married in the years 1920-1984. According to the results obtained, the thesis posed by W. Stys with regard to positive relationships between parity in a family and the farm's area only relates to marriages entered into between 1920-1964. In single five-year marriage cohorts, a change of shape of this relationship was observed. It took the shape of a parabolic function or polynomial of the third order. The research results showed that in marriage cohorts with finished fertility, variable area of the farm turned out to be almost insignificant in explaining changes in the number of live born children compared to other demographic factors, especially cultural and demographic ones.     

The power of boards in service providing agencies: three models

Tensions in the relationship between boards and staff are a common feature of voluntary and nonprofit agencies which deliver services. Many of the difficulties reflect lack of clarity about the power of boards. The author describes three models of governance: traditional, membership, and entrepreneurial. Each model has different implications for the power of a board in relation to staff. Practitioners in nonprofit service delivering agencies in the UK have found the models to be a useful tool for explaining the practical difficulties they experience.     

Capitation and informatics

When physicians, hospitals, and allied health professionals bill for services they render, their information processing requirements are relatively simple, at least compared to those of capitated organizations. When payers (insurers or employers) accept financial risk for the health care services of beneficiaries, they have usually invested in claims processing, membership tracking, and, under managed care, utilization review and provider profiling systems. But payers, for the most part, have not invested in electronic collection of clinical information about beneficiaries, nor have they tended to keep all claims they have processed in electronic form for study after accounts are settled and payments disbursed. In this article, we will explore why informatics is so important to capitated organizations and why payers that have traditionally taken financial risk for insuring the health care costs of populations are also learning about the importance of informatics.     

LET''''S MAKE ENGLISH MORE EXCITING

"Teacher, what are we going to do next class?" This is an exciting question which I often hear from my students. As an English conversation teacher, I can make the learning of English either a dull and boring duty, or an exciting adventure. It is very important that I make my students hate missing my class, and keep them guessing just what will happen the next time! Let us consider some important ways that any teacher can help his other students want to do their     

Freedom of movement vs. exclusion: a reinterpretation of the "insider"-"outsider" divide in the European Union

"This article argues that the question of free movement vs. exclusion within the European Union (EU) can be addressed satisfactorily only if we move away from the narrow state-centrism inherent in the current debate. What is required is to 'open' the state concept and examine the implications of state-society relations for EU policy making. Once this is done, it can be seen that the exclusionist stance of the immigration policy and the essentially intergovernmental nature of the policy making are due to an implicit contract between states and constituents implied by the concepts of nationality and citizenship. According to this perspective, the focus on the state or the political elite alone is too one-sided and misses the more complex factors bearing upon EU policy making in this area."     

Immigration to the Federal Republic of Germany as a demographic and social problem

"Addressing the question of immigration to Western Europe and especially to Germany from east and southeast Europe and from developing countries of the South, this article considers whether such immigration can compensate for reductions in population in developed countries. It is argued that the demographic deficits of an aging population can only be corrected to a limited extent through immigration. Any solution, in order to be effective, must include a simultaneous increase in the birthrates of Germany and other European Community countries. With particular regard to future social development in Germany and the EC, it would be advisable for governments to effect measures that will provide both for controlled admissions of immigrants from outside the EC and an increase in local reproductive capabilities."