Managed care organizations are paving the way to the future of health care delivery in the United States and countries around the world. As managed care systems evolve, a major concern is quality. Managed Care Quality: A Practical Guide is a collection of applications and experiences gathered from practicing health professionals in the field of managed care. This first "how to" guide was written to help managed care organizations meet the common objective of ensuring the best quality of services and care. Managed Care Quality: A Practical Guide presents successive steps in implementing quality in health care organizations. It introduces the methods, skills, and practices involved in quality health care programs and offers solutions to problems typically encountered in managed care.

Of all the recent changes in health care, none have more dramatically affected both patients and care providers than managed care. Not only has it altered the way we pay for health care but also it has compelled a change in the way we approach health care, focusing increasingly on preventive care to reduce costs. In Managed Care, Dr. Margaret M. Conger and her colleagues examine the impact of managed care on nursing as a profession and nurses as individual caregivers. Organized into three sections, Managed Care looks at the nature of managed care, nursing strategies in acute care hospitals, and nursing strategies in community settings. Section I examines the evolution of managed care, definitions, and issues informing this method of service delivery, and nursing involvement in quality of care and case management. In Section II, the authors look at acute care settings, discussing the use of nurse extenders, advanced practice nursing, case management, automated clinical pathways, and outcome research. Section III addresses the community settings and explores case management, advanced practice roles in community health clinics, and collaboration in primary care settings. Managed Care will serve as an excellent course text on nursing and managed care, as well as being a useful introduction and shelf reference for professional nurses at all levels.

Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

Public Health

Using a straightforward systems approach, Public Health: What It Is and How It Works explores the inner workings of the complex, modern U.S. public health system—what it is, what it does, how it works, and why it is important. The book covers the origins and development of the modern pubic health system; the relationship of public health to the overall health system; how the system is organized at the federal, state, and local levels; its core functions and how well these are currently being addressed; evidence-based practice and an approach to program planning and evaluation for public health interventions; public health activities such as epidemiological investigation, biomedical research, environmental assessment, policy development, and more. Updated and New Information in the Fifth Edition: • NACCHO Profile data from 2008 and 2010 surveys • Accreditation of public health agencies • Public health workforce development activities including the credentialing of public health workers • Health reform provisions enacted in 2010 • Updated and revised section on public health financing

Provides physicians, administrators, and other health professionals with information on managed care, from its history, forms and practices to detailed information on managed care contracting, physician compensation, monitoring, reporting, management, risk, productivity, and accountability. Annotati

In the dynamic and ever-changing healthcare landscape of South Asia, effective leadership and management in nursing are crucial. The unique demands of this region require a specialized approach that bridges the gap between international nursing practices and regional requirements. This adaptation seeks to empower nurses to provide care of the highest quality and to lead with unwavering confidence. By harmonizing the roles and responsibilities of nurses in South Asia, this resource aims to inspire devoted nurses to overcome challenges encountered in healthcare settings. With the rich tapestry of cultures and traditions that characterize this region, this adaptation serves as a sincere endeavour to address the specific needs of the patients and healthcare systems. This title has been tailored to meet the requirements of nursing students enrolled in PG Nursing and Advanced Practice Nursing Course (ANP), aiming to enhance their leadership qualities as they assume managerial roles. It also serves as a useful reference for final-year UG Nursing students in developing a comprehensive understanding of Management and Leadership. - Serves as a compass to guide the nurses towards the development of essential leadership skills that align with the ever-changing demands of healthcare institutions and organizations. - Illuminates the unique roles played by national regulatory bodies and national-level nursing associations. - Covers all the important aspects of Nursing management with the latest updates. - Flowsheets and diagrams make it simpler and easier to comprehend. - The Challenge opens each chapter with a real-world scenario in which practising nurse leaders/managers offer personal stories, encouraging you to think about how you would handle the situation. - The Solution closes each chapter with an effective method to handle the real-life situation presented in The Challenge, demonstrating the ins and outs of problem-solving in practice. - Tips for Leading, Managing, and Following offer practical guidelines for applying the information in each chapter. - Next-Generation NCLEX® case studies familiarize you with these new testing items for the NGN exam. - AACN Essentials Core Competencies for Nursing Education outlines the necessary curriculum content and expected competencies of nursing graduates.

We all want to believe that when people get cancer, they will receive medical care of the highest quality. Even as new scientific breakthroughs are announced, though, many cancer patients may be getting the wrong care, too little care, or too much care, in the form of unnecessary procedures. How close is American medicine to the ideal of quality cancer care for every person with cancer? Ensuring Quality Cancer Care provides a comprehensive picture of how cancer care is delivered in our nation, from early detection to end-of-life issues. The National Cancer Policy Board defines quality care and recommends how to monitor, measure, and extend quality care to all people with cancer. Approaches to accountability in health care are reviewed. What keeps people from getting care? The book explains how lack of medical coverage, social and economic status, patient beliefs, physician decision-making, and other factors can stand between the patient and the best possible care. The board explores how cancer care is shaped by the current focus on evidence-based medicine, the widespread adoption of managed care, where services are provided, and who provides care. Specific shortfalls in the care of breast and prostate cancer are identified. A status report on health services research is included. Ensuring Quality Cancer Care offers wide-ranging data and information in clear context. As the baby boomers approach the years when most cancer occurs, this timely volume will be of special interest to health policy makers, public and private healthcare purchasers, medical professionals, patient advocates, researchers, and people with cancer.