No abstract

We examined the level of hospice knowledge of caregivers of minority elderly hospice patients and determined how it influences the hospice enrollment decision and the decision on the use of hospice services after enrollment. Based on qualitative analysis of medical records and interviews with caregivers of minority elderly hospice patients who received personal care from paid caregivers (eg, other than family caregivers), we found that hospice knowledge increased access to hospice among minority patients who otherwise would not opt for hospice or enroll too late for comprehensive hospice care services. Furthermore,the highest level of knowledge-acquired through caregivers' health care occupations-appears to influence hospice care after hospice enrollment. Caregivers with that level of knowledge made requests for changes in site of care and/or additional services that may enhance the quality of hospice care that their loved ones receive.

Although many perspectives on the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) on health services research have been wide spread, little empirical evidence has been reported about HIPAA-related barriers during the implementation of research projects. Using three cases of health services research projects, this study examined practical barriers created by HIPAA regulation. During the stage of implementation of the three projects, we experienced some HIPAA-related concerns, previously raised in the field of health services research. We found that technically complicated consent forms and privacy protection forms as well as socially-sensitive clinical conditions make patients less willing to participate in research projects; concerns about safety of patient medical information makes health organizations more hesitant to let researchers have access to the patient's information, especially through electronic transfer; more restrictive IRB processes and challenging patient recruiting processes make health services researchers reluctant to go through the process; and as a result, they may compromise with the scientific soundness of the project. Overall, HIPAA complicates the research process and requires more resources and longer time to conduct research.

Background-The length of hospice stay, as an indicator of timing of hospice referral, is an important outcome to examine in end-of-life care because it is relevant to the quality and cost efficiency of end-of-life care that patients receive. Although the majority receives nonmedical care from informal caregivers, many elderly hospice users rely on paid caregivers or staff of residential facilities.

A national survey was conducted of current ICH exposure and curriculum in pediatric residency programs. Our objectives were to quantify ICH teaching presently occurring, to identify how programs support trainees in undertaking ICH electives during their training, to determine attitudes towards ICH amongst paediatric program directors and chief residents across the country, and to identify barriers to ICH curriculum expansion within the post-graduate programs. A population census of all 44 chief residents and program directors from the 16 Canadian pediatric programs was undertaken. A self-administered survey was developed de novo for this study. Twenty-two qualitative and quantitative questions were developed under the following domains: demographics, program content, electives, attitudes and perceptions, barriers and future directions. Surveys were completed electronically. Descriptive statistics were used, and common themes were extracted from qualitative responses. The response rate was 65% (29 surveys), with 81% of the training programs represented. Seventy-three percent of the program directors, and 44% of the chief residents from across the country responded. Eighty-nine percent reported that their program did not have a formal curriculum in ICH. All respondents reported some ICH related educational sessions, however certain areas felt to be key were lacking. 80% agreed that electives should be encouraged as part of residency training, but 72% indicated lack of adequate funding for these electives. Overall, 86% agreed that ICH issues are important for paediatric trainees and 84% indicated that more emphasis should be placed on ICH in the paediatric resident curriculum. Eighty-six percent of respondents agreed that their program would be interested in new initiatives regarding ICH. The results of this survey demonstrate that although there are opportunities for ICH exposure in most paediatric training programs, formalized curriculum is lacking. The majority of programs indicated a willingness to support the integration of an ICH curriculum into their core educational components. The Association of Faculties of Medicine of Canada (AFMC). Towards a Medical Education Relevant to All : The Case for Global Health in Medical Education. A Report of the Global Health Resource Group. April 2006. Bateman C, et al. Bringing global issues to medical teaching. Lancet, 2001; 358:1539-42. Edwards R, et al. Understanding global health issues: are international health electives the answer? Medical Education, 2004; 38:688-690.