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Within the field of medical sociology, there is an extensive body of literature on notable family transitions and stages in the reproductive cycle, such as getting married…
Within the field of medical sociology, there is an extensive body of literature on notable family transitions and stages in the reproductive cycle, such as getting married or becoming a parent, as they relate to mental health and well-being. However, the transition to becoming a completed family, that is, the process of determining or recognizing that one’s family is complete, is notably absent. In response to this empirical gap, this chapter presents findings from 114 semi-structured interviews with participants who reported having at least one child and who considered their family to be complete. First, the concept of “family completion” is introduced and conceptualized based on the qualitative considerations of participants and the contextual medical sociology literature. Then, thematic considerations around the process of family completion, related emotional preparations, and factors associated with mental health and well-being are explored. Findings suggest that family completion can be an important transitional period for parents and can be associated with emotional hardship for some individuals. Participants described experiencing conflict with their partner if they disagreed on the completion decision, frustration and sadness related to infertility, and/or feelings of loss or depression when completion was regarded as the end of a personal or familial life phase. This chapter concludes that creating a cultural context in which family completion is a recognized family transition period may spur intentional consideration among parents and promote the design of intervention services for parents experiencing changes in mental health or well-being.
Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of…
Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.
We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.
The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.
While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.
Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.
Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.
This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.
THE College of Librarianship is best considered on its own terms, as an institution unique in the history and present pattern of British library education, but its significance and probable future development can best be assessed if two external factors are kept in mind.
Mood and anxiety disorders affect 20–30 percent of school-age children, contributing to academic failure, substance abuse, and adult psychopathology, with immense social…
Mood and anxiety disorders affect 20–30 percent of school-age children, contributing to academic failure, substance abuse, and adult psychopathology, with immense social and economic impact. These disorders are treatable, but only a fraction of students in need have access to evidence-based treatment practices (EBPs). Access could be substantially increased if school professionals were trained to identify students at risk and deliver EBPs in the context of school-based support services. However, current training for school professionals is largely ineffective because it lacks follow-up supported practice, an essential element for producing lasting behavioral change. The paper aims to discuss these issues.
In this pilot feasibility study, the authors explored whether a coaching-based implementation strategy could be used to integrate common elements of evidence-based cognitive behavioral therapy (CBT) into schools. The strategy incorporated didactic training in CBT for school professionals followed by coaching from an expert during co-facilitation of CBT groups offered to students.
In total, 17 school professionals in nine high schools with significant cultural and socioe-conomic diversity participated, serving 105 students. School professionals were assessed for changes in confidence in CBT delivery, frequency of generalized use of CBT skills and attitudes about the utility of CBT for the school setting. Students were assessed for symptom improvement. The school professionals showed increased confidence in, utilization of, and attitudes toward CBT. Student participants showed significant reductions in depression and anxiety symptoms pre- to post-group.
These findings support the feasibility and potential impact of a coaching-based implementation strategy for school settings, as well as student symptom improvement associated with receipt of school-delivered CBT.
Purpose – This chapter argues that the concept of agility is an effective robust framework for designing sustainable health care systems.Design/methodology/approach – This…
Purpose – This chapter argues that the concept of agility is an effective robust framework for designing sustainable health care systems.
Design/methodology/approach – This case study of Alegent Health was based on 7 years of data collection. It includes observations of meetings, large-group interventions, and other activities; site visits to different hospitals in the system to observe changes in practice; interviews with Alegent Health executives, primary care physicians, hospital presidents, specialist physicians and physician groups, and health systems staff and nurses; and a variety of archival data including meeting minutes, video tapes, conference proceedings, and web site material.
Findings – The Alegent Health system has evolved over time according to the principles of agility. It built a series of new capabilities that contribute to improved clinical outcomes, sustained financial results, and more socially and ecologically responsible results. Designing health care systems based on agility is a more effective and sustainable approach than relying on legislative or other criteria.
Originality/value – The discussion of sustainability in health care has focused primarily on specific projects or how to respond to specific technological, regulatory, or clinical changes. Alegent Health's experience provides important lessons, opportunities, and challenges that can help advance our understanding of effective health care and use organizational agility to create more sustainable health care systems. This chapter provides health care system administrators an alternative design option.