In many areas of Ireland, children dying at home still have inadequate access to specialist palliative care. This causes unnecessary emotional and physical distress to the child, family, caregivers and healthcare professionals. Irish health policies aimed at improving the situation need to be fully resourced, structured, implemented, supported and evaluated. Timely referral of the child, advanc...

In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term ca...

OBJECTIVE To investigate the impact of advance care planning on end of life care in elderly patients. DESIGN Prospective randomised controlled trial. SETTING Single centre study in a university hospital in Melbourne, Australia. PARTICIPANTS 309 legally competent medical inpatients aged 80 or more and followed for six months or until death. INTERVENTIONS Participants were randomised to r...

OBJECTIVE To assess the initial impact of offering consumer-defined health plan (CDHP) options on employees. DATA SOURCES/STUDY SETTING A mail survey of 4,680 employees in the corporate offices of Humana Inc. in June 2001. STUDY DESIGN The study was a cross-sectional mail survey of employees aged 18 and older who were eligible for health care benefits. The survey was conducted following ope...

Persons with continuous complex care needs frequently require care in multiple settings. During transitions between settings, this population is particularly vulnerable to experiencing poor care quality and problems of care fragmentation. Despite how common these transitions have become, the challenges of improving care transitions have received little attention from policy makers, clinicians, ...

Network design is an often overlooked aspect of health insurance contracts. Recent policy factors have resulted in narrower provider networks. We provide plausibly causal evidence on the effect of narrow network plans offered by a large national health insurance carrier in a major metropolitan market. Our econometric design exploits the fact that some firms offer a narrow network plan to their ...

BACKGROUND The Affordable Care Act of 2010 proposed maximum penalty equal to 1% of regular Medicare reimbursements which prompted change in how hospitals regard 30-day readmissions. While several hospital to home transitional care models demonstrated a reduction in readmissions and cost savings, programs adapted to population needs and existing resources was essential. METHODS Focusing on pro...