Search results

The RAF method for regulation, assessment, follow‐up and continuous improvement of quality of care was developed in Israel in the late 1980s by the Quality of Care Unit at the JDC‐Brookdale Institute. The goal of the RAF method is to continuously increase the level of quality in organizations providing any kind of a service. This article presents the developmental processes for the method’s adaptation to a specific regulatory service – its structuring, implementation and assimilation – based on our experience in developing and implementing the RAF method in Israel. It describes how the RAF method encourages the development of reliable data bases, adaptation of the organizational structure, and introduction of a positive ideology that together promote changes leading to continuous improvement in quality of care.

Attention has been increasingly devoted to the development of methods for assessing the quality of care in long‐term care (LTC) facilities, especially for government surveillance. A study is described which used the tracer method to provide data on the quality of care in Israeli LTC institutions. Advantages of the tracer method include its incorporation of structural, process and outcome measures and its focus on a number of representative tracer conditions. The study tested the ability of the tracer method to provide data on the quality of care, and facilitated adoption of this methodology by the government for their annual inspections.

The research articles in this volume were initially presented at a conference, entitled “Cutting Edge Theories and Recent Developments in Conflict Resolution,” which celebrated the 20th anniversary of the Program on the Analysis and Resolution of Conflicts (PARC) at Syracuse University's Maxwell School of Citizenship and Public Affairs. Presenters were encouraged to submit their papers for consideration, and following a rigorous peer review and revision process, nine articles were accepted. The volume explores some of the major themes of conflict analysis, including how powerful dominant discourses can both soothe and exacerbate conflict, the roles of civic organizations in promoting peace and incubating democratic principles, the ways in which different forms of dialogue are used to heal historically dysfunctional intergroup relations, and the importance of a deeply institutional, structural understanding of ethnocentrism and racism. The authors conducted their research in several different countries – the US, Canada, Bosnia, and Northern Ireland – and used a wide range of analytical techniques including in-depth interviews, surveys, and document analysis. What holds them together is the rigorous tie they make between theory and empirical data. Some authors have built conflict theory inductively, based on their own research and/or secondary sources, while others have tested existing models with empirical data. These articles collectively make a solid contribution to theoretical development in the conflict analysis field.

Explains the conceptual framework behind and the foundation and implementation of the regulation, assessment, follow‐up (RAF) method, and continuous improvement of quality of care in the Israeli Government surveillance of long‐term care institutions. The RAF method has made crucial changes in the goals, tasks and tools of surveillance and in therapeutic approaches to the elderly. The “maintenance approach” has been replaced by a “rehabilitative approach” bringing about a real improvement in the quality of care in institutions. Presents selected findings from an evaluation of the RAF method’s use in the surveillance system operated by the Israeli Service for the Aged of the Ministry of Labor and Social Affairs.

This article describes actual UI prevalence and quality of care at Israeli LTC institutions for the elderly. The analysis is based on current regulatory data on 14,406 residents at 196 residential homes, and 8,278 patients at 159 hospitals for the chronically ill. It includes a calculation of summary indices of quality, the percentage of institutions with deficient items and of those showing change, and a description of functional status profiles. Multiple regression explains the deficiency rate variance through independent institutional variables. There is a higher prevalence of severe functional impairment and full incontinence at hospitals for the chronically ill than at residential homes. There were higher rates of deficiencies and lower rates of corrections for structural items than for process items at both. A major improvement occurred for process items (50‐100 per cent). Regarding outcomes, 34 percent of the residents with UI during the first assessment were continent two years later.

The RAF method for regulation, assessment, follow‐up and continuous improvement of quality of care was developed in Israel in the late 1980s by the Quality of Care Unit at the JDC‐Brookdale Institute. During the past decade the RAF method has been adapted to and implemented successfully in a number of government regulatory systems operated by services in the Ministry of Health and the Ministry of Labor. This article presents the conceptual framework of the RAF method. It describes the three theoretical approaches that have been integrated – the tracer approach, the model for quality assurance and the introduction of organizational change – to create a broad conceptual framework. It then presents the key operational principles at work in the field that drive the RAF mechanism in its efforts to achieve a constant improvement in quality of care.

In Israel, institution staff classify residents’ functional status as part of the routine governmental surveillance of institutions for semi‐independent and frail elderly. However, owing to a lack of clarity and specificity in the regulation which defines functional status categories, nurse surveyors, who conduct the routine surveillance of institutions, have begun to make their own estimates of functional status. Data were collected and compared on the functional status classification of 78 per cent of the elderly residents by institution staff and nurse surveyors. Data analysis showed that the poorer the functional status, the less congruity between the classifications. This has practical consequences for estimating the number and type of staff needed. It was found that the waste of resources and discrepancies caused by reclassification of the elderly by the nurse surveyors may be avoided by using more specific and precise definitions as suggested in this article.

Describes a methodological study to evaluate the quality of care for an elderly population in the treatment of hypertension from a fairly simple analysis of medical records in primary care, with or without the use of additional information from patients, and shows how this type of data can be used to point out shortcomings in primary care. The data derive from a community survey of elderly people in one area of Jerusalem and relied on personal interviews, blood pressure measurements and an analysis of medical records over a period of four years. The measures used are: the percentage of persons without blood pressure (BP) measurement in a given year; the maximum “gap” between consecutive BP measurements in a given year; the rate of BP measurement per clinic visit; the percentage of hypertensives treated; and the percentage of hypertensives under control. The prevalence rates for hypertension in this elderly population vary between 40 per cent and 59 per cent according to the definition used. Using a simple and straightforward analysis of sick‐fund records several shortcomings in the surveillance and control of hypertension were detected. Calculation of the percentage of untreated hypertensives required a separate information source ‐ the screening. A BP survey is an important complement to an analysis of records. An ongoing evaluation of the quality of care of hypertensives in an elderly population should be based on screening, interviews with patients and analysis of the physician′s records. These provide an overall picture of the care in each medical practice enabling the physician to improve the quality of care provided to his or her patients.