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Biomedical subjects

P H Arford

Publications and source records attributed to P H Arford.

11 recordsLinked to original sources
PubMed1998

Cost-effectiveness analysis in the nursing literature, 1992-1996.

PURPOSE: To review the recommendations by the U.S. Panel on Cost-Effectiveness in Health and Medicine (panel) for use in future nursing research. The review (a) provides a critique of the nursing cost-effectiveness and cost utility literature from the perspective of the recommendations set forth by the panel and other recognized authorities in cost-effectiveness analysis (CEA), (b) constructs an interdisciplinary framework to show the steps in the conduct of CEA, (c) makes the techniques and major findings of nursing CEA studies available and understandable, and (d) offers guidelines for the incorporation of CEA into the evaluation of future nursing intervention and research. DATA SOURCES: Seven nursing studies published between 1992 and 1996 that compared two or more interventions for costs and outcomes. ORGANIZING FRAMEWORK: For each study, the (a) perspective, (b) net costs, (c) net effect, (d) analysis of costs and effects, and (e) decision outcomes were analyzed. FINDINGS: If the panel's recommendations reflect the problems in the health care CEA literature in general, then on balance, the nursing CEA 1992-1996 studies are no more or less flawed than CEA studies in the health or medical care fields. CONCLUSIONS: Methodologic guidelines and interdisciplinary strategies are needed to advance the progress of nursing cost-effectiveness research.

Cost-Benefit Analysis↗
PubMed1995

Coordination as a critical element of managed care.

Although the concept of coordination is not new to nursing, little is known about how it contributes to cost-effective patient care outcomes. The authors examined the mechanisms used by staff nurses to coordinate patient care services in practice environments characterized by low, moderate, and high levels of uncertainty. Regardless of practice environment conditions, nurses used the same mechanisms to coordinate patient care. These findings suggest a potential for inadequate communication among providers, poor coordination of services, and lost efficiency. Strategies to improve coordination of patient care services are discussed.

Continuity of Patient Care↗
PubMed1995

Value = quality + cost.

Development of a quality index allows a quantifiable synthesis of selected patient-care outcomes and service costs. The quality index provides potential buyers of healthcare a way to judge the costs associated with a particular level of quality and thus, compare the value of alternative services.

Academic Medical Centers↗
PubMed1992

Cost comparison of oral, nasogastric, and intramuscular cimetidine drug delivery systems.

Under diagnosis-related group prospective payment, the role of the hospital pharmacy department is to develop and promote cost effective and rational drug therapy. This study, conducted in a simulated fashion, evaluated the cost effectiveness of various cimetidine drug delivery systems: oral, nasogastric, and intramuscular. The evaluation was also extended to compare time efficacy between different dosage forms for each route of administration with the exception of the intramuscular route. Each of four nurses and four pharmacy technicians conducted 10 trials for each system to detect a statistical significance difference in pharmacy preparation and nursing administration time with at least 80% statistical power. The results showed no statistically significant difference (P > 0.1) between the total oral administration time of a unit-dose tablet or liquid. A significant difference was detected among the pharmacy-prepared liquids, and unit-dose liquid administered nasogastrically (P < 0.01). The most cost-effective system is the orally administered unit-dose tablet and the most expensive system is the unit-dose liquid administered nasogastrically.

Administration, Intranasal↗
PubMedDate not supplied

Case management: the relationship between structure & environment.

In response to increasingly uncertain practice environments, case management structural dimensions of role differentiation, task coordination, and decentralization remained constant, while nurse participation in decision making increased significantly.

Decision Making, Organizational↗
PubMedDate not supplied

A cost-effectiveness analysis of acute care case management outcomes.

Case management was more cost effective in a moderately uncertain practice environment than in either a low or a high uncertainty environment. The environmental state, case manager role differentiation, and information coordination contributed most strongly to these outcomes.

Cost-Benefit Analysis↗
PubMedDate not supplied

Environmental uncertainty: implications for practice model redesign.

Analysis of one academic medical center revealed three distinct nursing practice environments distinguished by increasing levels of complexity, change, unpredictability, and uncertainty. Designing practice models to accommodate these conditions will facilitate more efficient and effective patient outcomes.

Academic Medical Centers↗
PubMedDate not supplied

Quality and cost outcomes of transitional care.

Longitudinal analysis of the outcomes of a transitional care program documented success in discharging patients home with remarkable compliance to discharge plans and sustained improvement in mental status and functional independence. Inpatient costs were significantly reduced.

Activities of Daily Living↗
PubMedDate not supplied

A cost-effectiveness analysis of neonatal nurse practitioners.

This retrospective study compares the cost and quality outcomes of two matched groups of infants; one of which received neonatal care provided by neonatal nurse practitioners (NNPs), the other delivered by the medical house staff in one hospital's NICU. Parameters evaluated for both groups included LOS, days on ventilator, days on oxygen, mortality, morbidity, and costs. The infants in the study were matched by place of birth, gestational age, birth weight, sex, race, and Apgar scores. This study showed that in the 35 cases cared for by NNPs, in collaboration with neonatoologists, neonates received care equal in quality to the 35 matched cases cared for by medical house staff at lower cost with greater continuity and consistency. Cost effectiveness of the NNP group was documented as $18,240 less per infant than those managed by medical house staff. Differences were seen as chiefly attributable to the NNP's unique blend of knowledge, communication skills, and continuous presence plus early identification of service coordination needs.

Cost Savings↗