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Background: Supervision in health sector means a system, process, or mechanism by which some aspects or characteristics of a health care organization is evaluated and analyzed by an external body. This study compared the mechanisms of supervision in ambulatory care in selected countries to provide lessons learnt from global experiences. Methods: In this comparative study USA, UK, Germany, Canada, Turkey, and Iran were selected based on inclusion criteria, including development level and type of the health system. Required data were gathered by searching the internet, browsing the websites of related organizations, and searching research databases. Then, the results were summarized and reported using comparative tables. Results: Some regulations and frameworks exist for assuring and improving the quality and safety of the services in all health systems. The supervising bodies of this subject include central and local governments along with nongovernmental organizations. The supervision in studied countries is mostly compulsory and unannounced. Moreover, accreditation of ambulatory care exists voluntarily and compulsorily. Results of the supervision include temporary or permanent suspension of license for care provision, impact on payment to the providers, and change in popularity of the provider by public communication of the result. Conclusion: Improving the supervision on ambulatory care requires an effective structure for separation of provider and supervisor and the involvement of the professional associations. It is suggested to elevate the ambulatory care supervision through better resource allocation, follow up of the supervision results, enforcement of regulations, and application of novel approaches.

SUMMARYA statewide mail survey of hospital ambulatory dental programs in Massachusetts was conducted for FY 80.Of the state's 123 short‐stay hospitals, 105 reported ambulatory dental visits but only 21 had dental clinics. The 141,410 ambulatory dental visits at these hospitals with dental clinics represented 79% of all dental patient visits in hospitals and approximately l.2% of visits in all settings statewide. Most of these hospitals were in the Greater Boston area and all but three hospital dental clinics provided general dental care. Unfortunately, responses were usually based on estimates rather than actual data.

Despite a large body of literature testing interventions to improve heart failure care, care is often suboptimal. This scoping study assesses organizational interventions to improve heart failure outcomes in ambulatory settings. Fifty-two studies and systematic reviews assessing multicomponent, self-management support, and eHealth interventions were included. Studies dating from the 1990s demonstrated that multicomponent interventions could reduce hospitalizations, readmissions, mortality, and costs and improve quality of life. Self-management support appeared more effective when included in multicomponent interventions. The independent contribution of eHealth interventions remains unclear. No studies addressed management of comorbidities, geriatric syndromes, frailty, or end of life care. Few studies addressed risk stratification or vulnerable populations. Limited reporting about intervention components, implementation methods, and fidelity presents challenges in adapting this literature to scale interventions. The use of standardized reporting guidelines and study designs that produce more contextual evidence would better enable application of this work in health system redesign.

Recent years have witnessed challenges to our health care delivery system, in part as a result of changes to our economy. This paper describes the changing climate and discusses the increasing need of health care organizations for computer-based information to more efficiently manage their operations within a competitive and cost-conscious economy. Specific references are made to technology trends in clinics funded by the Federal Government for the health care of migrant workers.

Thailand implemented a Universal Coverage Scheme (UCS) of national health insurance in April 2001 to finance equitable access to health care. This paper compares inequalities in health service use before and after the UCS, and analyses the trend and determinants of inequality. The national Health and Welfare Surveys of 2001 and 2005 are used for this study. The concentration index for use of ambulatory care among the population reporting a recent illness is used as a measure of health inequality, decomposed into contributing demographic, socio-economic, geographic and health insurance determinants. As a result of the UCS, the uninsured group fell from 24% in 2001 to 3% in 2005 and health service patterns changed. Use of public primary health care facilities such as health centres became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off. Decomposition analysis shows that the increasingly common use of health centres among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the UCS. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes. Although the UCS scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine

Convergent experimental data, autobiographical studies, and investigations on daily life have all demonstrated that gathering information retrospectively is a highly dubious methodology. Retrospection is subject to multiple systematic distortions (i.e., affective valence effect, mood congruent memory effect, duration neglect; peak end rule) as it is based on (often biased) storage and recollection of memories of the original experience or the behavior that are of interest. The method of choice to circumvent these biases is the use of electronic diaries to collect self-reported symptoms, behaviors, or physiological processes in real time. Different terms have been used for this kind of methodology: ambulatory assessment, ecological momentary assessment, experience sampling method, and real-time data capture. Even though the terms differ, they have in common the use of computer-assisted methodology to assess self-reported symptoms, behaviors, or physiological processes, while the participant undergoes normal daily activities. In this review we discuss the main features and advantages of ambulatory assessment regarding clinical psychology and psychiatry: (a) the use of realtime assessment to circumvent biased recollection, (b) assessment in real life to enhance generalizability, (c) repeated assessment to investigate within person processes, (d) multimodal assessment, including psychological, physiological and behavioral data, (e) the opportunity to assess and investigate context-specific relationships, and (f) the possibility of giving feedback in real time. Using prototypic examples from the literature of clinical psychology and psychiatry, we demonstrate that ambulatory assessment can answer specific research questions better than laboratory or questionnaire studies.

Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). I studied the impact of ASC market presence on actual prices paid to HOPDs during 2007-2010 for four common surgical procedures that were performed in both provider types. For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25% to 5.15% lower for each additional ASC per 100,000 persons in a market. HOPDs may have less negotiating leverage with commercial insurers on price in markets with high ASC market penetration, resulting in relatively lower prices.

In its ten-year existence the Dr. Martin Luther King Jr. Health Center has been pledged to quality health care and has developed detailed procedures to assure its staff and consumers that such care can and does exist.

Abstract Background There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM) The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. Methods Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale). 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi 2 test was used to investigate distribution of two or more categorical variables. Results Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP) as well as general practitioners (GP) agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP) or specialists (S) (Student's t-test mean GP 2.57, S 2.84, p < 0.01; mean GrP 2.55, SP 2.80, p < 0.05). 33.1% of the participants demonstrated a strong rejection to the application of guidelines in patient care. Acceptance of guidelines from a governmental institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%). 73.8% of doctors interpret EBM as a combination of scientific research and individual medical knowledge; 80% regard EBM as the best basis for patient care. Conclusion Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs.

A sub-sample, from a large prospective study examining the effects on utilization from the introduction of medical self-care materials, was followed to determine the timeliness of that utilization. Judgments on early, on time, or late visits, by patients, providers, and algorithms showed agreement for experimentals (n = 203) but not controls (n = 56). Comparisons on the rates of judged early, on time, and late visits differed between groups (by the physician and algorithm comparison), and further differed when comparing late only visits (by the algorithm comparison). The experimentals demonstrated a trend to delay care seeking though no adverse effect on health was identified when comparing subsequent illness days and hospitalizations. Medical self-care can reduce utilization and improve patients' ability to judge visit timeliness. Apparent trends to increase late visits may be an artifact of conservative judgments rendered by medical opinion.

Cover -- Contents -- Preface -- Abbreviations -- Dictation/Documentation Guidelines -- Adult Medical Template -- Adult Trauma Template -- Pediatric Medical Template -- Pediatric Trauma Template -- Review of Systems -- Billing Considerations -- Skin Rashes/Lesions -- HX -- PE -- MDM/DDx -- Primary Lesions -- Management -- Dictation/Documentation -- Medication-Related Rashes -- Burns -- HX -- PE -- MDM/DDx -- Management -- Criteria for Admission to a Burn Center -- Dictation/Documentation -- Headache -- HX -- PE -- MDM/DDx -- Management -- Dictation/Documentation -- Cranial Nerves -- Dizzy/Weak -- HX -- PE -- Management -- Dictation/Documentation -- Altered Mental Status -- HX -- PE -- MDM/DDx -- Management -- Dictation/Documentation -- Terms -- AEIOU Tips for AMS -- Head Injury -- HX -- Peds -- PE -- MDM/DDx -- Management -- Dictation/Documentation -- Eye Pain -- HX -- PE -- MDM/DDx -- Visual Field Defects -- Management -- Dictation/Documentation -- Earache -- HX -- PE -- MDM/DDx -- Management -- Dictation/Documentation -- Nasal Pain/Injury -- HX -- PE -- MDM/DDx -- Management -- Dictation/Documentation -- Facial Pain -- HX -- PE -- MDM/DDx -- Management -- Facial Injury -- HX -- PE -- MDM/DDx -- Management -- Dictation/Documentation -- Throat Pain -- HX -- PE -- Centor Criteria -- MDM/DDx -- Management -- Dictation/Documentation -- Dental/intraoral Pain/Trauma -- Definitions -- Fracture Classification -- Dental Infections -- HX -- PE -- MDM/DDx -- Management -- Cervical Injury -- HX -- Peds -- PE -- MDM/DDx -- Management -- Dictation/Documentation -- Cough/Sob -- HX -- PE -- MDM/DDx -- Management -- Dictation/Documentation -- Chest Pain -- HX -- PE -- MDM/DDx -- Management -- Dictation/Documentation -- Pulmonary Embolus -- HX -- PE -- MDM/DDx -- Management -- Dictation/Documentation -- Abdominal Pain -- HX -- PE -- MDM/DDx -- Management.

Thailand implemented a Universal Coverage Scheme (UCS) of national health insurance in April 2001 to finance equitable access to health care. This paper compares inequalities in health service use before and after the UCS, and analyses the trend and determinants of inequality. The national Health and Welfare Surveys of 2001 and 2005 are used for this study. The concentration index for use of ambulatory care among the population reporting a recent illness is used as a measure of health inequality, decomposed into contributing demographic, socio-economic, geographic and health insurance determinants. As a result of the UCS, the uninsured group fell from 24% in 2001 to 3% in 2005 and health service patterns changed. Use of public primary health care facilities such as health centres became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off. Decomposition analysis shows that the increasingly common use of health centres among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the UCS. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes. Although the UCS scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine

Freestanding Surgery Centers (ASC), have emerged in the alternate health care delivery system as a cost effective alternative to inpatient surgery. Over the last seven years, surgery centers have grown substantially. It is felt that these facilities have reached a maturation point in the market. The question of the future viability of this type of delivery system is being debated. Hospitals have become extremely competitive with these centers. Government regulations and insurance reimbursement patterns all add to the competitive edge. This research will review ASC's role currently in the health industry and analyze their potential viability as a health care delivery system. There are conflicting views on ambulatory surgery centers being able to grew and/or maintain their current market niche. Much of the controversy arises over the methods of reimbursement for ASC's and hospital based outpatient departments. The government's regulations do assist ASC's but not necessarily hospitals. Freestanding centers are less expensive because they do not carry the same administrative overhead as a hospital. But as health care costs continue to rise and hospitals become competitive, freestanding ASC's may have difficulty keeping their doors open.