Evaluating risk: global fees and episodic care

In 1999, two articles in The Physician Executive -- "Part I: Global Theory and the Nature of Risk (July-August)." and "Part II: Towards a Choice-Based Model of Managed Care (October-November)" -- outlined the flaws of orthodox managed care theory and highlighted the unique advantages of moving to a genuinely market-based model, which included the concept of direct contracting for integrated episodes of care. This follow-up focuses on comparing an episode contracting system to a traditional capitated program and outlines the features that make this approach much more attractive to physicians, payers, and most importantly patients.     

The art and science of winning physician support for Six Sigma change

Active physician participation and acceptance of Six Sigma is critical to successful implementation. Take a look at strategies and techniques that can help secure physician support for Six Sigma.     

How parental drug use and drug treatment compliance relate to family reunification

This study uses Cox regression to assess the relationships among parental drug use, drug treatment compliance, and reunification from substitute care. The study finds that drug treatment compliance is associated with faster reunification, even when accounting for ongoing drug use and three parenting measures. The findings are consistent with a conceptual framework suggesting that certain client actions, such as drug treatment compliance, may serve as markers that substantially affect client outcomes.     

Think they're drunk? Alcohol servers and the identification of intoxication

Despite alcohol server training programs and legal liability aimed at controlling intoxication, server intervention appears to be rare. Given the difficulty in assessing intoxication, it can be assumed that improvement in assessment skills would increase the likelihood of intervention. Unfortunately, little is known regarding practices servers use to identify intoxication. In order to build a more informed base for policy formation and server training, the focus of this inquiry was to examine practices used by servers to assess intoxication. The analysis was based upon questionnaires mailed to a random probability sample of licensed servers from one state (N = 822). Indicators found to be most important were examined in relation to a variety of occupational characteristics. Implications for training curricula, policy formation, and future research are discussed.     

Providers' perceptions of how rural consumers access and use mental health services

This article describes the third phase of a research study undertaken within a Canadian provincial regional health authority to explore and analyze mental health services and other resources used by rural consumers after discharge from inpatient mental health programs. The focus of this article is the qualitative research findings obtained from mental health service providers and members of allied agencies. This article will discuss the literature on rural consumers' access and use of mental health programs and services; describe the context and method used to conduct the focus groups with rural service providers; characterize access and use problems from the service providers' perspectives; and suggest strategies to address these problems.     

Role of workplace safety: a revisit of the relationship between job satisfaction and employment status

This study evaluated the relationship between employment status (i.e., part- and full-time) and job satisfaction, with the focus on the moderating roles of perceived injury risk and injury incidence. The results found that the level of job satisfaction for full-time workers was about the same regardless of the level of injury risk they perceived. In contrast, job satisfaction of part-time workers was significantly higher when they perceived low injury risk rather than high injury risk. The findings also supported the potential adverse impact of injury incidence and injury risk on job satisfaction for both part- and full-time workers. This study highlighted the importance of understanding both workplace safety and job satisfaction when attempting to understand the differences between part-time and full-time workers.     

Experience of cumulative trauma disorders on life roles of worker and family member: a case study of a married couple

The prevalence of diagnosed cumulative trauma disorders (CTD) within the workforce comes at a high price for employers burdened with financial losses from missed work and worker's compensation costs. Research has focused primarily on the impact of CTD on the worker role within the workplace, overlooking the impact on roles across multiple environments [24,35,54]. Furthermore, the influence of CTD on life roles of a spouse has not been examined. This single case study illustrated the experience of CTD within a marital relationship through the use of grounded theory. Results indicated that adaptations to CTD symptoms were least altering to the established routines and roles of the couple. With progression of symptoms, the spouse without symptoms was relied on more heavily for adaptations to manage pain. The results of this study indicate that occupational therapists must examine the client's valued roles and incorporate the family into intervention strategies.     

Pretest-posttest designs and measurement of change

The article examines issues involved in comparing groups and measuring change with pretest and posttest data. Different pretest-posttest designs are presented in a manner that can help rehabilitation professionals to better understand and determine effects resulting from selected interventions. The reliability of gain scores in pretest-posttest measurement is also discussed in the context of rehabilitation research and practice.