Articles: community-health-services.
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Sedentary time spent with screen media is associated with obesity among children and adults. Obesity has potentially serious health consequences, such as heart disease and diabetes. This Community Guide systematic review examined the effectiveness and economic efficiency of behavioral interventions aimed at reducing recreational (i.e., neither school- nor work-related) sedentary screen time, as measured by screen time, physical activity, diet, and weight-related outcomes. ⋯ Among children, these interventions demonstrated reduced screen time, increased physical activity, and improved diet- and weight-related outcomes. More research is needed among adolescents and adults.
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The Milbank quarterly · Mar 2016
Differing Strategies to Meet Information-Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems' Enterprise Health Information Exchanges.
Community health information exchanges have the characteristics of a public good, and they support population health initiatives at the state and national levels. However, current policy equally incentivizes health systems to create their own information exchanges covering more narrowly defined populations. Noninteroperable electronic health records and vendors' expensive custom interfaces are hindering health information exchanges. Moreover, vendors are imposing the costs of interoperability on health systems and community health information exchanges. Health systems are creating networks of targeted physicians and facilities by funding connections to their own enterprise health information exchanges. These private networks may change referral patterns and foster more integration with outpatient providers. ⋯ Both community and enterprise HIEs support aggregating clinical data and following patients across settings. Although they can be complementary, community and enterprise HIEs nonetheless compete for providers' attention and organizational resources. Health policymakers might try to encourage the type of widespread information exchange pursued by community HIEs, but the business case for enterprise HIEs clearly is stronger. The sustainability of a community HIE, potentially a public good, may necessitate ongoing public funding and supportive regulation.
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Mobile integrated health care and community paramedicine are models of health care delivery that use emergency medical services (EMS) personnel to fill gaps in local health care infrastructure. Community paramedics may perform in an expanded role and require additional training in the management of chronic disease, communication skills, and cultural sensitivity, whereas other models use all levels of EMS personnel without additional training. ⋯ Observations from existing program data suggest that these systems may prevent congestive heart failure readmissions, reduce EMS frequent-user transports, and reduce emergency department visits. Additional studies are needed to support the clinical and economic benefit of mobile integrated health care and community paramedicine.