271 research outputs found
A Celebration of Life for Mrs. Rowena Ford Jackson
No full textFuneral program for Mrs. Rowena Ford Jackson, born March 4, 1904 and died July 30, 2006. The funeral was held Thursday, August 3, 2006 at Jacobs Chapel United Methodist Church, officiated by Reverend Johnny R. Toy, Pastor. Funeral arrangements were made through Lewis Funeral Home and she was buried in Meadowlawn Memorial Park in San Antonio, Texas
The quality of life of female informal caregivers: from Scandinavia to the Mediterranean Sea
No full textWe analyse the impact of the provision of care on the health and quality of life (QoL) of mature female informal caregivers using a representative sample drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE). We match each informal caregiver with a non-carer using Propensity Score matching and test whether matched individuals differ on self-assessed health and a functional indicator of QoL and whether this relationship differs across European regions. We find a North-South gradient both for self-assessed health and QoL and our results show that the provision of caregiving to close relatives in Europe impacts on the caregivers’ quality of life and health in a way that depends on their geographical location, the degree of formal care and specific cultural and social factors of the area. We find that informal caregiving is a complex phenomenon which may bring both psychological rewards and distress to providers of care and this complexity, along with the geographical gradient highlight the importance of ensuring that policies match the needs of individual carers in their own geographical areas and cultural contexts
Determinants of hospital length of stay for people with serious mental illness in England and implications for payment systems: a regression analysis
No full textBackgroundSerious mental illness (SMI), which encompasses a set of chronic conditions such as schizophrenia, bipolar disorder and other psychoses, accounts for 3.4 m (7 %) total bed days in the English NHS. The introduction of prospective payment to reimburse hospitals makes an understanding of the key drivers of length of stay (LOS) imperative. Existing evidence, based on mainly small scale and cross-sectional studies, is mixed. Our study is the first to use large-scale national routine data to track English hospitals’ LOS for patients with a main diagnosis of SMI over time to examine the patient and local area factors influencing LOS and quantify the provider level effects to draw out the implications for payment systems.MethodsWe analysed variation in LOS for all SMI admissions to English hospitals from 2006 to 2010 using Hospital Episodes Statistics (HES). We considered patients with a LOS of up to 180 days and estimated Poisson regression models with hospital fixed effects, separately for admissions with one of three main diagnoses: schizophrenia; psychotic and schizoaffective disorder; and bipolar affective disorder. We analysed the independent contribution of potential determinants of LOS including clinical and socioeconomic characteristics of the patient, access to and quality of primary care, and local area characteristics. We examined the degree of unexplained variation in provider LOS.ResultsMost risk factors did not have a differential effect on LOS for different diagnostic sub-groups, however we did find some heterogeneity in the effects. Shorter LOS in the pooled model was associated with co-morbid substance or alcohol misuse (4 days), and personality disorder (8 days). Longer LOS was associated with older age (up to 19 days), black ethnicity (4 days), and formal detention (16 days). Gender was not a significant predictor. Patients who self-discharged had shorter LOS (20 days). No association was found between higher primary care quality and LOS. We found large differences between providers in unexplained variation in LOS.ConclusionsBy identifying key determinants of LOS our results contribute to a better understanding of the implications of case-mix to ensure prospective payment systems reflect accurately the resource use within sub-groups of patients with SMI
Here be stories: exploring maps in children’s books with medieval cultural treasures and The Stone Feather lighting the way
No full textThrough my creative practice in writing the children’s novel The Stone Feather,inspired by Domesday Book; the creation of my own artworks, including maps of thefictional world I have created; and my research into medieval ‘cultural treasures’ – inparticular manuscripts and mappae mundi – I have discovered a fresh lens throughwhich to explore and illuminate the presence and purpose of maps in children’s books. Ifocus on interlace as a ‘perceptual mode’1 and ideas around the ‘meditativeengagement’2 that interlace design encourages, in relation to the roles that literary mapsplay, as well as its impact on my own process as a writer.My thesis is presented within the context of contemporary publishing and theneed for children to develop a high level of visual literacy in a world dominated byvisual images. My critical commentary includes a review of children’s books thatfeature maps and ‘cultural treasures’ as an integral part of imaginative world buildingand explores the notion of the ‘author as curator’.As an adventure story for 8-12 year olds with an ethical heart, The Stone Featheroffers children the opportunity to reflect on different models of masculinity, compassionand strength – aspects of this original work that are valuable and timely
Giving greater financial independence to hospitals – does it make a difference? The case of English NHS Trusts
No full textIn 2003 a new type of provider organisation, the Foundation Trust (FT), was introduced in England, and the best performing NHS hospitals were able to apply for “Foundation status”. FTs enjoy greater financial flexibility and are subject to less central monitoring and control. The phased introduction of FTs represents an opportunity to examine whether the new financial structures facing FTs have produced any differences in financial performance compared to non-FTs. We use difference in difference methods to examine whether Foundation status had a significant effect on financial management. We find that Foundation status has had a limited impact in terms of acting as an instrument to signal strong financial management of Foundation Trusts. This result may reflect the relatively early stage of the FT process or may be due to the fact that all types of Trusts are experiencing a challenging financial environment, including the introduction of a prospective payment system. However, we explore the nature of the trends emerging over time and discuss the implications of our findings for policy
Giving greater financial independence to hospitals-does it make a difference? The case of English NHS Trusts
No full textIn 2003 a new type of provider organisation, the Foundation Trust (FT), was introduced in England, and the best performing NHS hospitals were able to apply for 'Foundation status'. FTs enjoy greater financial flexibility and are subject to less central monitoring and control. The phased introduction of FTs represents an opportunity to examine whether the new financial structures facing FTs have produced any differences in financial performance compared with non-FTs. We use difference in difference methods to examine whether Foundation status had a significant effect on financial management. We find that Foundation status has had a limited impact in terms of acting as an instrument to signal strong financial management of FTs. This result may reflect the relatively early stage of the FT process or may be due to the fact that all types of Trusts are experiencing a challenging financial environment, including the introduction of a prospective payment system. However, we explore the nature of the trends emerging over time and discuss the implications of our findings for policy. Copyright © 2007 John Wiley & Sons, Ltd.
Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data
No full textBackgroundSerious mental illness (SMI) is a set of chronic enduring conditions including schizophrenia and bipolar disorder. SMIs are associated with poor outcomes, high costs and high levels of disease burden. Primary care plays a central role in the care of people with a SMI in the English NHS. Good-quality primary care has the potential to reduce emergency hospital admissions, but also to increase elective admissions if physical health problems are identified by regular health screening of people with SMIs. Better-quality primary care may reduce length of stay (LOS) by enabling quicker discharge, and it may also reduce NHS expenditure.ObjectivesWe tested whether or not better-quality primary care, as assessed by the SMI quality indicators measured routinely in the Quality and Outcomes Framework (QOF) in English general practice, is associated with lower rates of emergency hospital admissions for people with SMIs, for both mental and physical conditions and with higher rates of elective admissions for physical conditions in people with a SMI. We also tested the impact of SMI QOF indicators on LOS and costs.DataWe linked administrative data from around 8500 general practitioner (GP) practices and from Hospital Episode Statistics for the study period 2006/7 to 2010/11. We identified SMI admissions by a main International Classification of Diseases, 10th revision (ICD-10) diagnosis of F20–F31. We included information on GP practice and patient population characteristics, area deprivation and other potential confounders such as access to care. Analyses were carried out at a GP practice level for admissions, but at a patient level for LOS and cost analyses.MethodsWe ran mixed-effects count data and linear models taking account of the nested structure of the data. All models included year indicators for temporal trends.ResultsContrary to expectation, we found a positive association between QOF achievement and admissions, for emergency admissions for both mental and physical health. An additional 10% in QOF achievement was associated with an increase in the practice emergency SMI admission rate of approximately 1.9%. There was no significant association of QOF achievement with either LOS or cost. All results were robust to sensitivity analyses.ConclusionsPossible explanations for our findings are (1) higher quality of primary care, as measured by QOF may not effectively prevent the need for secondary care; (2) patients may receive their QOF checks post discharge, rather than prior to admission; (3) people with more severe SMIs, at a greater risk of admission, may select into practices that are better organised to provide their care and which have better QOF performance; (4) better-quality primary care may be picking up unmet need for secondary care; and (5) QOF measures may not accurately reflect quality of primary care. Patient-level data on quality of care in general practice is required to determine the reasons for the positive association of QOF quality and admissions. Future research should also aim to identify the non-QOF measures of primary care quality that may reduce unplanned admissions more effectively and could potentially be incentivised.FundingThe National Institute for Health Research Health Services and Delivery Research programme.<br/
Identifying primary care indicators for people with serious mental illness:a systematic review
No full textBackground – Serious mental illness (SMI) – which comprises long term conditions such as schizophrenia, bipolar disorder and other psychoses – has enormous costs for both patients and society. In many countries, people with SMI are treated solely in primary care, and have particular needs for physical care. Aim - The objective of this study was to review systematically the literature to create a list of quality indicators relevant to patients with SMI which could be captured using routine data, and which could be used to monitor or incentivise better quality primary care. Design and setting – A systematic literature review, combined with a search of quality indicator databases and guidelines. Methods – We assessed whether indicators could be measured from routine data and the quality of the evidence. Results – 1,847 papers and quality indicator databases were identified, 27 were included, from which 59 quality indicators were identified, covering six domains. Of the 59 indicators, 52 could be assessed using routine data. The evidence base underpinning these indicators was relatively weak, and was primarily based on expert opinion rather than trial evidence. Conclusions – With appropriate adaptation for different contexts, and in line with relative responsibilities of primary and secondary care, use of the quality indicators has the potential to improve care and to improve the physical and mental health of people with SMI. However, before the indicators can be used to monitor or incentivise primary care quality, more robust links need to be established with improved patient outcomes
Insecure, sick and unhappy? Well-being consequences of temporary employment contracts
No full textThis paper investigates the influences of temporary contracts along several dimensions of well-being (physical and mental health, self-assessed health and happiness) for young Italian workers. Our paper contributes to the literature exploring some new aspects of the relationship between temporary jobs and well-being in a country not frequently analysed in previous literature. We focus on the gender gap in the well-being consequences of non-permanent jobs, the influence of financial support by family in reducing well-being effects caused by temporary contracts and the interaction between gender gap and family support
Autonomy and performance in the public sector:The experience of English NHS hospitals
No full textSince 2004, English NHS hospitals have been given the opportunity to acquire a more autonomous status known as a Foundation Trust (FT), whereby regulations and restrictions over financial, management and organisational matters were reduced in order to create incentives to deliver higher quality services in the most efficient way. Using difference-indifference models, we test whether achieving greater autonomy (FT status) improved hospital performance, as proxied by measures of financial management, quality of care and staff satisfaction. Results provide little evidence that the FT policy per se has made any difference to the performance of hospitals in most of these domains. Our findings have implications for health policy and inform the trend towards granting greater autonomy to public sector organisations
- …
