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Biomedical subjects

S A Finkler

Publications and source records attributed to S A Finkler.

At least 19 recordsLinked to original sources
PubMed1994

Nursing care delivery models and nurse satisfaction.

The relative impact of various nursing care delivery models and management interventions on nurse satisfaction was assessed in 37 New Jersey hospitals. Nurses ranked pay as the most important factor, followed by autonomy and professional status. Changes in scores between pilot and comparison units were significantly different for satisfaction with interactions and task requirements. Change in satisfaction with interaction was significant for all initiatives in aggregate, as well as for each of the five types of initiatives separately. The change in satisfaction with task requirements was significant for all initiatives taken as a group and for those units that implemented reorganization, computer, and education initiatives. Even among nurses who eventually liked the new environment there was a period of initial dissatisfaction.

Humans↗
PubMed1993

Changing the delivery of nursing care. Implementation issues and qualitative findings.

Faced with a shortage of professional nurses, 37 hospitals in New Jersey implemented a variety of approaches to changing the delivery of nursing care. Implementation issues, including the positive and negative effects of the changes, are discussed. Most project coordinators reported that implementation was more difficult than they had anticipated.

Computer Terminals↗
PubMed1993

A comparison of work-sampling and time-and-motion techniques for studies in health services research.

OBJECTIVE: This study compares results and illustrates trade-offs between work-sampling and time-and-motion methodologies. DATA SOURCES: Data are from time-and-motion measurements of a sample of medical residents in two large urban hospitals. STUDY DESIGN: The study contrasts the precision of work-sampling and time-and-motion techniques using data actually collected using the time-and-motion approach. That data set was used to generate a simulated set of work-sampling data points. DATA COLLECTION/EXTRACTION METHODS: Trained observers followed residents during their 24-hour day and recorded the start and end time of each activity performed by the resident. The activities were coded and then grouped into ten major categories. Work-sampling data were derived from the raw time-and-motion data for hourly, half-hourly, and quarter-hourly observations. PRINCIPAL FINDINGS: The actual time spent on different tasks as assessed by the time-and-motion analysis differed from the percent of time projected by work-sampling. The work-sampling results differed by 20 percent or more of the estimated value for eight of the ten activities. As expected, the standard deviation decreases as work-sampling observations become more frequent. CONCLUSIONS: Findings indicate that the work-sampling approach, as commonly employed, may not provide an acceptably precise approximation of the result that would be obtained by time-and-motion observations.

Bias↗
PubMed1992

The potential for using non-physicians to compensate for the reduced availability of residents.

Both the number of residents and the amount of time existing residents have in which to carry out their activities may soon be decreasing. To consider the potential for alternative ways of staffing teaching hospitals, it is necessary to know how residents spend their time. The authors sought to learn this by conducting a time-motion study of eight internal medicine residents at two urban hospitals in New York City in 1988. The residents' activities were observed and coded by premedical students, and the authors independently classified the possible activities into (1) those that had to be done by a physician, (2) those that were educational only, and (3) those that could be done by a non-physician. A total of 1,726 activities of 67 kinds were coded, averaging 7.75 minutes each. The authors analyze and project their data using two models--the traditional model of care in which the physician is the primary medical manager of the patient, and an alternative model in which a midlevel practitioner, such as a nurse practitioner, would perform the day-to-day monitoring of patients. For example, the data indicate that in the traditional model, almost half of a resident's time is spent in activities that must be done by a physician, meaning that another kind of physician would be needed to do those activities if the resident were unavailable; but in the midlevel practitioner model, only around 20% of the activities would require a physician. The authors give detailed breakdowns of their data, estimate the kinds and numbers of non-physician health care professionals necessary to substitute for residents in appropriate activities, and review possible difficulties in implementing such substitutions.

Evaluation Studies as Topic↗
PubMed1991

Variance analysis. Part II, The use of computers.

This is the second in a two-part series on variance analysis. In the first article (JONA, July/August 1991), the author discussed flexible budgeting, including the calculation of price, quantity, volume, and acuity variances. In this second article, the author focuses on the use of computers by nurse managers to aid in the process of calculating, understanding, and justifying variances.

Accounting↗
PubMed1988

Measuring the economic impact of perioperative total parenteral nutrition: principles and design.

Although the use of total parenteral nutrition (TPN) has been increasing in recent years, few studies have been performed on both its costs and its effectiveness or benefits. This paper provides a general review of the methods of cost-effectiveness and cost-benefit analysis, summarizes briefly the existing cost-analysis studies of TPN, and outlines the authors' proposed study design for their economic assessment of TPN.

Clinical Trials as Topic↗
PubMed1988

The cost effects of protocol systems. The marginal cost-average cost dichotomy.

Protocol systems are a mechanism that some have contended will maintain high quality of patient care and will result in improved delivery of care, more efficient management of care, and in lower costs. Cost savings reported from protocol care generally are based on average costs. This article reports on an analysis of the cost effects of a pediatric protocol system. The impact of the system on both average and marginal costs was considered. The study results indicated that care adhering to the protocols, when compared to nonadherent care, resulted in a substantial savings measured against average costs. However, only a very small decrease in the marginal cost of care occurred. Ancillary department costs were found to be fixed in most cases and not subject to variation without substantial changes in the volume of services ordered. None of the volume changes attributable to the protocols were sufficiently large to result in the reallocation of labor resources or the reconfiguration of departmental equipment. Although protocol systems still may be of great value in generating more appropriate care, their ability to reduce costs is apparently less than was supposed.

Ancillary Services, Hospital↗
PubMed1988

Utilization of inpatient services under shortened lengths of stay: a neonatal care example.

In the last several years many hospitals have experienced a significant reduction in average length of stay (LOS). We know relatively little about whether such reductions are likely to be accompanied by proportional reductions in the utilization of all inpatient services or whether services are merely condensed into a shorter time frame. Average patient severity may well rise as a result of shortened LOS, causing daily resource consumption to rise. In this paper, however, we hypothesize that patients with shorter LOS consume significantly fewer resources. Our empirical results support the hypothesis for some, but not all, of the services were examined.

Adult↗
PubMed1986

A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants.

To determine the safety, efficacy, and cost savings of early hospital discharge of very-low-birth-weight infants (less than or equal to 1500 g), we randomly assigned infants to one of two groups. Infants in the control group (n = 40) were discharged according to routine nursery criteria, which included a weight of about 2200 g. Those in the early-discharge group (n = 39) were discharged before they reached this weight if they met a standard set of conditions. For families of infants in the early-discharge group, instruction, counseling, home visits, and daily on-call availability of a hospital-based nurse specialist for 18 months were provided. Infants in the early-discharge group were discharged a mean of 11 days earlier, weighed 200 g less, and were two weeks younger at discharge than control infants. The mean hospital charge for the early-discharge group was 27 percent less than that for the control group ($47,520 vs. $64,940; P less than 0.01), and the mean physician's charge was 22 percent less ($5,933 vs. $7,649; P less than 0.01). The mean cost of the home follow-up care in the early-discharge group was $576, yielding a net saving of $18,560 for each infant. The two groups did not differ in the numbers of rehospitalizations and acute care visits, or in measures of physical and mental growth. We conclude that early discharge of very-low-birth-weight infants, with follow-up care in the home by a nurse specialist, is safe and cost effective.

Body Weight↗
PubMed1985

Determinants of market share for a hospital's services.

This study identifies and analyzes factors under a hospital's control that can affect its market share. The study, utilizing the Multiplicative Competitive Interaction model, specifically focuses on determining the market share for each hospital within a geographic area, as opposed to the total demand for hospital services within an area. The results indicate that the effect of the number of physician affiliations on hospital patient share is statistically significant. The article investigates the variables that affect the level of physician affiliation. Besides physician affiliation, hospital location, a PROFILE factor based on a composite of a number of variables, and the proportion of affiliated physicians who are not affiliated elsewhere have a significant impact on each hospital's market share. The variables examined resulted in an R2 = 0.901 for individual hospital patient market share.

Catchment Area, Health↗
PubMed1985

Microcomputers in nursing administration. A software overview.

The current environment of prospective payment systems and cost control requires nursing administrators to have fast access to useful, reliable information. Microcomputers can be used by individuals who are not computer experts to generate that information. This article discusses the various types of computer software used on microcomputers and gives examples of nursing administration applications for microcomputer software.

Administrative Personnel↗
PubMed1983

The hospital as a sales-maximizing entity.

This paper extends the Baumol sales-maximization theory to the not-for-profit hospital industry. Hospital demand is modeled as a function of both price and the number of physicians affiliated with a hospital. The latter variable results in interdependency of demand among the products offered by a hospital. The broader the product scope, the greater the number of affiliated physicians, and, therefore, the greater the demand for each of the hospital's products. Hospital competition is focused on the physician rather than the consumer (patient), as hospitals vie to maintain their market share.

Economics, Hospital↗
PubMed1982

Improved cost allocation in case-mix accounting.

Traditionally, many hospital costs have been allocated to patients using indirect measures that do not always reflect the value of the resources used to provide care. When, for example, costs are allocated by multiplying the patient's charges by the hospital's ratio of costs to charges, the allocated cost does not reflect actual cost because the hospital does not uniformly charge for services in proportion to their cost. The choice of method for cost allocation will be as important for the newly developed case-mix cost-accounting systems as it has been for traditional cost-accounting systems. To illustrate how the use of an indirect cost-allocation method might affect the output of a case-mix cost-accounting system, operating room, radiology and clinical laboratory costs were assigned to 106 hospitalized inguinal hernia patients in two diagnosis-related groups (DRGs) using both the hospital's existing cost-allocation method and a method that measures costs directly. Total costs and the costs in each department were significantly lower in each DRG using the direct method. It was concluded that patients in these two DRGs were being assigned more than the actual cost of their care with the existing cost-allocation method and, therefore, that the existing method prevented the case-mix accounting system from providing accurate management information.

Accounting↗
PubMed1982

The distinction between cost and charges.

The literature on economic efficiency in providing hospital services has been growing recently. Often such literature examines the costs of providing services at varying volumes of treatments per location per year. However, instead of measuring cost directly, these studies use patient bills (charges) aa a proxy for cost. Charges may bear little resemblance to economic cost, and use of charges as a proxy for economic cost may lead researchers to draw unwarranted conclusions about economic efficiency. Because of the differences between economic cost, accounting cost, and charges to the patient, actual resource consumption should be used as a measure of cost.

Cost Allocation↗