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Biomedical subjects

I H Aas

Publications and source records attributed to I H Aas.

18 recordsLinked to original sources
PubMed2001

A qualitative study of the organizational consequences of telemedicine.

The organizational consequences of telemedicine have frequently been mentioned in the telemedicine community, but there are few empirical studies. A study was therefore carried out of what happens in organizations when telemedicine is implemented. Qualitative interviews were undertaken with 30 persons working in teledermatology, telepsychiatry, a telepathology frozen-section service and tele-otolaryngology. Almost all respondents reported numerous organizational changes, some important. Changes in work processes were the most common. Examples of the organizational consequences of telemedicine were organizational restructuring, new organizational units, changed mechanisms for internal coordination, different flows of patients through the health-care system, improved coordination of care, new job descriptions, relocation of the place of work, employment of personnel living far away from the workplace, effects on employees not directly involved in telemedicine, sharing of experiences, minor staffing changes, clinical teamwork independent of co-location, administrative meetings arranged by telemedicine, merger of organizations independent of location, less travel by staff (and patients), a possible beneficial effect on the quality of care, and limited opposition to the adoption of the technology. Telemedicine may be important in the future organization of the disciplines studied and in health-care generally. The infrastructure of electronic networks may play an important role for organizations as the volume of telemedicine activity increases and economies of scale are realized.

Health Facility Administration↗
PubMed2001

Telemedical work and cooperation.

In telemedicine, cooperation occurs via telecommunication. This represents a new situation for medical cooperation. Whether such cooperation works poorly or well will be important with an increasing volume of telemedicine. When personnel are involved in external cooperation, as in telemedicine, the question of cooperation within one's own organization also arises. To investigate these matters, qualitative interviews were performed with 30 persons working in teledermatology, telepsychiatry, a telepathology frozen-section service and tele-otolaryngology. The results showed that cooperating by telecommunication mainly worked well. The cooperation may be influenced by factors such as personality, knowing each other personally, preparation and experience. Telemedical teamwork may be improved by factors like experience and education. Working with telemedicine did not reduce the personnel's cooperation within their own organizations, but rather improved it, although this effect was slight and most commonly involved improved knowledge of others. In general, the findings concerning cooperation and telemedicine were positive.

Humans↗
PubMed2000

[Telemedicine--organizational consequences more than just talk?].

In the telemedicine community, the possibility of organisational consequences of the technology have been mentioned frequently. But little has been published on the subject. We may speak of five categories of application of the new technology: clinical use, medical service functions, extramural applications, skills enhancement; and management and administration. Organisational consequences may be of four types: changes in distribution of tasks between levels of care and between organisations at the same levels, new division of work and change in skills; groups of individuals who are not co-located may co-operate in problem-solving, and the technology may become a tool of co-ordination for organisations. Empirical studies of the impact on organisation are few, but a Norwegian study confirmed that telemedicine already has such impact on the health service.

Attitude of Health Personnel↗
PubMed2000

Working with telemedicine: user characteristics and attitudes.

Combined qualitative and quantitative interviews were conducted with 30 persons involved in four telemedicine specialties. The results showed little technology-related anxiety and all viewed the technology as useful. There was a positive general attitude to telemedical work, with a perception of the possibility of job satisfaction being improved and the technology being found to be easy to use. Negative general attitudes to telemedical work were not found. The implementation of telemedicine may therefore have a positive effect within organizations. Such findings may be important for the future widespread adoption of telemedicine.

Adult↗
PubMed1999

Telemedicine and the organization of the health sector.

The widespread introduction of telemedicine would have organizational consequences for the health sector. However, the problem of health-sector organization is complex. A general framework for analysis of organizational consequences has been developed and consists of eight points. These are: (1) the starting point; (2) mapping of applications of telemedicine where organizational consequences are possible; (3) characterizing the nature of larger organizational consequences; (4) the consequences for the health sector in the chosen area; (5) possible consequences for the number and placement of geographical subunits of the health sector; (6) possible consequences for health sector organizational types; (7) the consequences for the tools of health policy; and (8) design of the change process towards a new organization.

Health Care Sector↗
PubMed1995

Incentives and financing methods.

On an incentive theory background the different financing methods for health care are discussed. Three main categories of financing methods are presented: (1) global budget solutions (capitation and global budget based on historical costs), (2) per-case reimbursement (per-diem rates, fee-for-service, prospective reimbursement on the basis of product groups, episode of care-based reimbursement, result graded reimbursement with use of e.g. the Oregon model concept), (3) hybrid methods of financing. Financing methods can be used to obtain different goals. Organizations and individual physicians seem to respond generally in the same way to similar incentives. Also unwanted effects seem common. Shifts in financing methods over time may look natural to attack problems. Empirical research has demonstrated financing methods as important tools in the management of a health service. Knowledge of possible health effects for the patients as a consequence of financing methods seems limited.

Budgets↗
PubMed1994

[Management of health services--financing method tool].

Financing methods for health care have great actuality in the Nordic countries. Incentive theory background is briefly presented. The main categories and subcategories of financing methods are listed. For the global budget solutions capitation and global budget based on historical costs, the advantages and problems are discussed. The two main categories per-case reimbursement, retrospective and prospective, are presented. The retrospective category includes per-diem rates and fee-for-service payment. Prospective reimbursement can be done on the basis of product definitions or episodes of care. The possibility of result grading the per-case reimbursement is mentioned. Problem solving by hybrid methods of financing is presented. Requirements to reimbursement methods can be: 1) They should be clinically neutral or assist in reaching formulated goals. 2) They should not result in unwanted use of any level of care. 3) They should not present barriers to justified referral between any level of care.

Budgets↗
PubMed1991

Malpractice.

The problem of malpractice suits and patient complaints is frequently mentioned in discussions concerning the quality of health care. The present paper reviews the following aspects of this problem: the magnitude of the problem, the categories of cases, insurance and legal aspects, effects on medical practice, institutionalized possibilities for solving conflicts, an answer to the question of why patients complain and sue, and risk management.

Consumer Behavior↗
PubMed1988

Quality of hospital data and DRGs.

Research on and application of DRG is frequently performed with the aid of computerized data. This study has been made to assess the importance of errors in hospital data bases for DRG research, and the financial consequences if DRG is used as a reimbursement system. For the same hospital stays information on the DRG grouping variables has been collected from medical records and a data base. Frequencies of errors in the data base for the DRG grouping variables (principal diagnosis, secondary diagnosis, complications, procedures, age and discharge status of death) and length of stay are given. DRG grouping is performed on the basis of both medical record and data base information. The analysis shows the DRG system to be robust towards errors in the data bases. The procedure used in many countries for testing the US DRG definitions with national data found in data bases is also considered to be robust towards errors. Data quality in the studied data base is sufficient for DRG research purposes. The factors giving the robustness are of a general nature and may also apply to other data bases. Quality of computerized data is a less critical factor for DRG than for other applications of such data. If the present data base had been used in financial connection the errors would have had almost no deteriorating effect on hospital incomes.

Abstracting and Indexing↗
PubMed1983

Variability of a dental morphological trait.

A study of morphologic variability was made for maxillary incisor lingual fossa depth. The problem of variability is discussed, and new methods for the statistical treatment of variability are presented. Possibly, the best procedure to express biologic variability is to present SDs, CVs, Xs, ranges, RCs, and the logarithmic graphic method of the relationship between CV and X. No sex differences in variability could be demonstrated. Maxillary centrals and laterals in the Eskimo were found to have relatively equal variability. This is seen in connection with the great functional demand on Eskimo incisors, giving less reduction of the laterals, a possible simultaneous commencement of calcification for I1sup and I2sup, and possible genetic drift. Comparison of variability for six populations shows no racial differences in variability. Variability is not found to increase with inbreeding. Population comparisons do not confirm little reduction in the Eskimo to be associated with high variability. Genetic drift might be the explanation of the homogeneity of maxillary incisor lingual fossa depth in East Greenland Eskimos.

Female↗
PubMed1982

The depth of the lingual fossa in permanent maxillary incisors of East Greenland Eskimos. I. Statistical distribution and fluctuating dental asymmetry.

Maxillary incisor lingual fossa depth was measured in East Greenland Eskimos. It was shown that the statistical distribution for the trait may vary from population to population, from tooth type to tooth type and between the sexes. Examination of statistical distribution should be a part of studies giving detailed statistical analysis of trait. The statistical distribution is probably compatible with a hypothesis of polygenic inheritance. The correlations across the midline were higher for I1 than for I2, and I1 to I2 correlations were lower than across midline correlations for both I1 and I2. It was shown that the degree of fluctuating asymmetry may vary from one dental trait to another. For lingual fossa depth no population variation in fluctuating asymmetry could be demonstrated, in spite of obvious differences in environmental conditions for the populations compared. No sex differences in fluctuating asymmetry were found.

Female↗
PubMed1982

The depth of the lingual fossa in permanent maxillary incisors of East Greenland Eskimos. II. Side asymmetry, sex differences, comparison of centrals and laterals and anthropologic aspects.

Maxillary incisor lingual fossa depth was measured on casts of East Greenland Eskimo dentitions. No directional side asymmetry was found. The present study is the only which shows mean lingual fossa depth to be significantly deeper in the female than in the male. Larger incisor strength in the females is functional as the females are known to use their incisors as tools. The present investigation shows that on the question of sex differences conclusions should be drawn for the examined population only, and that generalization to other populations should be avoided. Mean lingual fossa depths were significantly different for centrals and laterals, but the laterals demonstrate special lack of reduction in this population. Lack of reduction of incisors together with frequent agenesis of third molars demonstrate that the posterior dentition may reduce independently of the anterior dentition. Mean lingual fossa depth, and relative fossa depth, in East Greenland Eskimos clearly show Mongoloid values.

Anthropology, Physical↗
PubMed1982

The lingual angle of incisors.

A morphologic trait, not previously registered, on the incisor lingual surface: "The lingual angle of incisors", was studied in Norwegians. The lingual angle is the angle between the floor of the lingual fossa and the dental tubercle. Measurements of the lingual angle could be performed with sufficient accuracy. Deviations from normal distribution in skewness and kurtosis values did not affect statistical testing. The general similarity of the frequency polygons for all incisors in the way they were peaked and stepped is possibly due to participation of the same factors on the genetic level in the determination of the trait. The mean lingual angles were (in degrees): I1sup = 142, I2sup equal 156, I1inf = 153 and I2inf = 154. No significant bilateral asymmetry or sex differences were found. Correlations were high for both central to central and lateral to lateral incisors in both jaws, highest for centrals in the maxilla and laterals in the mandibula. Central to lateral correlations were relatively low, especially in the upper jaw. Interjaw correlations were low, but I1sup showed a tendency to be better correlated than I2sup to lower incisors. I2sup and I1inf were the most variable incisors in each jaw. The dental tubercle probably plays an important role in determining the lingual angle. Measurements of the lingual angle give information on the profile of the lingual surface in inciso-cervical direction. Statistical analysis of a phenotypic trait may give information on factors which determine the trait.

Adolescent↗
PubMed1979

The depth of the lingual fossa in permanent maxillary incisors of Norwegian Lapps.

The depth of the lingual fossa in permanent maxillary incisors of three groups of Norwegian Lapps was measured. No statistically significant sex differences or group differences were found. The assembled weighted estimates for lingual fossa depth of three groups of Norwegian Lapps were for I1 sup: 0.44 mm and I2 sup: 0.30 mm. Mean lingual fossa depths in Norwegian Lapps clearly fall within the Caucasoid range.

Anthropology, Physical↗
PubMedDate not supplied

Organizational change: decentralization in hospitals.

Decentralization may be defined as the spread of power from higher to lower levels in a hierarchy. For hospitals, decentralization is an organizational change of special importance. Decentralization in hospitals may be accomplished through decentralization to departments; more general changes in organizational structure (reduction in the number of hierarchical levels and divisionalization); and, delegation of tasks. A framework for an analysis of decentralization status in hospitals is proposed in four main points; its starting point; the need for change in decentralization status; decentralization solutions; and, the need for review before a decentralization proposal is put into practice. Positive effects of decentralization may be obtained; but, to date, empirical investigations on the impact of decentralization in hospitals are few.

Centralized Hospital Services↗