Competitive health policies and community health

Concept Analysis and Proposed Definition of Community Health Center

Background: Community health centers (CHCs) have been used for delivery of health services since the 1920s and originally were intended to provide care to underserved populations. CHCs have become an integral part of healthcare systems in many countries; however, the term CHC is used synonymously with other concepts and there is no clear definition for CHC. The purpose of our concept analysis was to determine how CHCs are described in the literature and to develop a concept definition for CHC. Methods: Informed by the 8-step process described by Walker and Avant, we searched for literature spanning disciplines within health, business, and policy. We used a systematic review process to identify a range of peer-reviewed articles that help illustrate the attributes, antecedents, and consequences of CHCs. A total of 102 articles from 7 databases were included in our concept analysis. Results: We distinguished 6 attributes of a CHC: primary care; accessibility; preventative care; defined population; health promotion; and comprehensive and integrated care. About 4 antecedents fundamental to a CHC included: secure funding; vision and support; adequate human resources; and governance structure. Consequences of CHCs are improved health outcomes, efficiency, and cost-effective provision of healthcare services. Conclusions: Our concept analysis revealed core characteristics of CHCs that assisted us in synthesizing a concept definition for CHC. These characteristics and our proposed definition will help provide clarity on the concept of CHC to benefit evaluation, research, and policy development of CHCs.

Frameworks for evaluation of community health centers' services and outcomes: a scoping review protocol

REVIEW OBJECTIVES/QUESTION

The objective of this scoping review is to identify and map the frameworks used to evaluate services and outcomes of community health centers within the broader context of primary health care.The primary question for this scoping review is: what are the frameworks used to evaluate services and outcomes of community health centers?Secondary questions for this review are.

Expanding a Canadian community health centre

PURPOSE

The current study's purpose is to examine, through a case study, a community health centre board's governance during an expansion period with particular attention to the organizational and internal board relations that contribute to or inhibit expansion.

DESIGN/METHODOLOGY/APPROACH

All board members on the slate during the expansion were invited to participate in one semi-structured interview. Administrative data (board documentation and correspondence) were also used to inform the study. Discourse analysis was used to analyze the data.

FINDINGS

While board members agreed with the expansion they acknowledge that the expansion process should be examined. Board members identified missing board skill sets, comfort with governance and low organizational understanding as personal barriers to an enhanced process. External barriers included: absent decision support tools; documentation and information availability and historical decision making processes.

RESEARCH LIMITATIONS/IMPLICATIONS

Half the board members agreed to participate in the interviews. Of those declining, 30 percent cited difficulties during the expansion period as their rationale for withdrawing.

ORIGINALITY/VALUE

Findings add to: the limited publications regarding primary healthcare service expansion; and understanding expansion and volunteer board members' roles and their governance process during this time.

Whole of Client Health Care in a Gridlocked System: An Insider Dialogue Between the Theory and Practice of Community Case Management

This article blends theory with empirical qualitative research to investigate the present practices of Community Case Management and develop a new and informed model driven by a whole of client approach rather than agency ownership. The Case Management Society of Australia presents an idealistic model that has never been fully implemented. Our exploration of the gap between this theory and the actual real-world practice demonstrates that a whole of client focus has been marginalized and frustrates full implementation. Recent Australian government policy changes to the Home and Community Care program have encouraged competitive, market-oriented delivery in an attempt to reempower the client, but it has come at the expense of collaboration. Introducing competition has added another dimension to impediments to client-centered care that include funding pressures, turf wars, territorialism, and organizationally induced gridlocked systems, all of which shift the focus from the client to the organization. In the face of this, it is paramount that case managers remain client focused and be willing to collaborate/communicate with all parties involved in the cares of the client. Failure to do so may lead to the eventual failure of the Home and Community Care program.