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PubMed2002

Economic evaluation of an acute paediatric hospital at home clinical trial.

AIMS: To compare the privately borne and NHS costs of hospital at home (HAH) and conventional inpatient care for children with selected acute conditions. METHODS: Prospective economic evaluation using cost minimisation analysis within a randomised controlled trial, in paediatric wards of a district general hospital, and private homes in the local catchment area in Wirral, Merseyside. Subjects were children who fulfilled the criteria for admission to HAH, suffering from breathing difficulties (n = 202), diarrhoea and vomiting (n = 125), or fever (n = 72). RESULTS: Direct costs borne by families are reduced by 41% for HAH patients ( pound 23.31 v pound 13.76, p = 0.001). There is no evidence that HAH transfers the burden of care to parents, and there is no difference in absence rates from paid employment. Patients and their careers expressed a strong preference for HAH. Comparison of NHS costs is equivocal, depending on how HAH is implemented alongside the conventional hospital service. CONCLUSION: Paediatric HAH schemes are unlikely to reduce NHS costs and do not increase privately borne costs. They will, however, significantly increase patient and career satisfaction with care provision for sick children with appropriate conditions.

Caregivers↗
PubMed1997

A home-based program for the treatment of acute psychosis.

There is evidence that home treatment is an effective alternative to hospital admission for patients with acute psychiatric illnesses. This report describes processes necessary to establish and disseminate home treatment programs as well as the impact and comparative cost of a home treatment program developed in Metropolitan Toronto. Organizational analysis revealed a number of essential structures and interactions necessary to facilitate smooth functioning for home treatment programs involving several agencies. Attitudes towards home treatment were positive, symptoms were reduced, family burden decreased, satisfaction was high and home treatment was preferred to hospital admission. Economic data indicate that home treatment is less costly than hospitalization.

Acute Disease↗
PubMed1998

Willingness of families caring for victims of dementia to pay for nursing home care: results of a pilot study in Taiwan.

In order to examine the value family caregivers attach to the benefits associated with nursing home services, this contingent survey was designed to investigate the willingness of family caregivers of dementia victims to pay for nursing home care. A total of 136 members of families of dementia patients from the department of neurology and psychiatry of four medical centers in Taiwan were interviewed by phone. These family members provided in-home care for dementia victims and had expressed the need for nursing home placement. These family caregivers were asked to explicitly state the maximum amount of family income per month they are able to give up to receive nursing home services. The willingness to pay (WTP) for nursing home care ranged from US$185 to $2,407 per month, and 37.5 percent of the family caregivers interviewed indicated a willingness to pay at least 50 percent of the monthly family income for nursing home placement. The amount of monthly family income was strongly associated with the WTP for nursing home care in dollars. Age and education of the caregiver, and accessibility of nursing home care were significantly associated with WTP in both cost range and percentage of monthly family income. Interviewees who were older than 65 years (odds ratio is 3.52), and educated equal to or above senior high school (odds ratio is 5.57) were inclined to pay at least 50 percent of monthly family income for nursing home placement. As other variables were adjusted, respondents older than 65 years were willing to pay US$208.4 per month more than those younger than 65 years for nursing home placement; and the educated equal to or above senior high school were inclined to pay US$171.9 per month more than those with less than a senior high school education. The easier it was to find nursing home agencies near the residence, the more willing the family was to pay at least 50 percent of their monthly family income for nursing home services; with an odds ratio of 16.51. The families with the higher accessibility to nursing home agencies were willing to pay US$174.3 per month more than caregivers with lower accessibility. Family caregivers, who were older than 65 years, educated above the senior high school level, with a higher family income, and easier accessibility to nursing home services, were likely to attach higher economic values to nursing home placement.

Aged↗
PubMed2000

Spatial patterns of scent marking in wild moustached tamarins, Saguinus mystax: no evidence for a territorial function.

I investigated whether scent marking has a territorial function in wild moustached tamarins. I examined the spatial distribution of scent marking within the home ranges of four groups of this neotropical primate and tested predictions from Gorman & Mills' (1984, Journal of Zoology,202, 535-547) model for border and 'hinterland' marking. Although home ranges were economically defensible, no evidence was found for increased marking along the territorial boundary or in areas of home range overlap, but there was also no evidence for hinterland marking. Observed distributions of scent marking in exclusively used and overlapping areas of the home range did not deviate from distributions that would be expected if scent marking occurred at random (expectation based both on size of area and on frequency of quadrat occupation), and there was a strong correlation between frequency of quadrat occupation and frequency of scent marking per quadrat. These results indicate that scent marking has no territorial function in moustached tamarins. This is in line with mainly qualitative findings from the majority of other studies on wild marmosets and tamarins. These and other findings on scent marking in moustached tamarins suggest that this behaviour functions mainly in intersexual communication. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1997

Oral fluid intake following tonsillectomy.

Children undergoing tonsillectomy surgery traditionally have been required to drink a specified amount of fluid before being discharged home. With increasing economic pressures, same-day discharge tonsillectomy has become common, and several studies have shown it to be safe for the appropriately selected child. To examine the role of required oral fluid intake following tonsillectomy, a non-randomized cohort study was performed with 200 consecutive tonsillectomy patients scheduled for same-day discharge. The first 100 patients (group 1) were required to drink 20 cc/kg prior to discharge, and the next 100 patients (group 2) were not required to drink. The mean oral fluid intake prior to discharge decreased significantly between the two groups from 524 cc in group 1 to 130 cc in group 2 (P = 0.0001). The mean length of stay also decreased significantly from 13.8 h for group 1 to 10.0 h for group 2 (P = 0.0001). Sixty percent of children in each group vomited at least once following surgery. Fewer children in group 2 had protracted vomiting (8 versus 15) although this was not statistically significant (P = 0.12). No children were readmitted to the hospital for dehydration following discharge. Overall, 71% of children in group 1 scheduled to go home the same day were discharged on time, compared to 94% of children in group 2. In conclusion, it is safe and economically efficient to discharge tonsillectomy patients home prior to the resumption of normal oral fluid intake.

Adenoidectomy↗
PubMedDate not supplied

Economic analysis of a pragmatic randomised trial of home visits by a nurse to elderly people with hypertension in Mexico.

OBJECTIVE: To analyse the costs and the effectiveness of an intervention of home visits made by nurses to elderly people versus usual care given by the family medicine units. MATERIAL AND METHODS: A sample of 4,777 subjects aged 60 years and over covered by the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social, IMSS) were screened. Those with a systolic and/or diastolic blood pressure level higher or equal than 160/90 mm Hg were randomly allocated to the intervention or control groups. The intervention consisted of visits at home by nurses who gave health and lifestyle advice to the participants. The economic evaluation was considered from a health services and patient perspective. Direct and indirect costs were calculated as incremental. Effectiveness was measured in terms of cost per millimetre of mercury reduced. RESULTS: Three hundred and forty five participants were allocated to the intervention group and compared with 338 controls. At the end of the intervention period the difference in the mean change in systolic blood pressure was 3.31 mm Hg (95% CI 6.32, 0.29; p = 0.03) comparing with the control group. In diastolic blood pressure the difference was 3.67 (95% CI 5.22, 2.12; p < 0.001). The total cost of the intervention was 101 901.66 pesos. The intervention cost per patient was 34.61 pesos (US$3.78), (CI 95% 34.44, 35.46). The cost-effectiveness ratios was 10.46 pesos (US$1.14) for systolic (CI 95% 129.31, 5.51) and 9.43 (US$1.03) for diastolic (CI 95% 19.90, 2.49). CONCLUSIONS: The reduction in blood pressure obtained may well justify the small incremental cost of the intervention.

Aged↗
PubMedDate not supplied

Economic aspects of dementia special care units in Veterans Affairs nursing homes.

Given the intermittent use of special care units (SCUs), we consider economic aspects associated with dementia SCUs by reviewing the literature and surveying 2 nursing homes in the VA healthcare network. In addition to reporting the features in different types of facilities in the Veterans Affairs (VA), we present an economic characterization useful for hospital and nursing home administrators whose decision-making processes incorporate clinical, management, and financial factors. We conclude that, theoretically, benefits likely outweigh the costs of instituting dementia SCUs in VA nursing homes with a large number of cognitively impaired residents.

Alzheimer Disease↗
PubMed1997

An empirical study of economies of scope in home healthcare.

OBJECTIVE: To apply the economic theory of economies of scope to the home healthcare industry. DATA SOURCES: Data on 488 observations obtained from the Cost Report (HCFA Form 1728-86) of all Connecticut state-licensed, Medicare-certified home health agencies. STUDY DESIGN: The Cost Report was the primary source of data for this study. Information on total cost, scope, and other related factors was collected. Logarithmic and nonlinear regression analyses were used to identify factors related to scope and also to test for economies of scope. DATA COLLECTION METHOD: Data collected were both cross-sectional and time series (from 1988-1992). Data accuracy was verified using description of frequencies, measures of central tendency and variation, and a calculation package so that a computer calculation on the data could be compared with the agency's calculation. PRINCIPAL FINDINGS: It was determined that initially as scope increases, costs go down, thus proving economies of scope. For larger values of scope, it was determined that costs go up, proving diseconomies of scope. CONCLUSIONS: Many of the home health agencies included in this study provide more services than is cost effective given the economic theory of economies of scope.

Connecticut↗
PubMed1990

Opening the gateway to home health care.

Traditionally, home health agencies have been passive in seeking out referrals for patient care. Competition and a tighter economy, however, are altering the way they view themselves. Although physicians continue to be the gatekeepers to home health care, agencies must begin to promote themselves to physicians by using effective marketing techniques. Techniques that use a personal approach have been beneficial to the central Massachusetts agencies studied. It is necessary to expand beyond this method, however, and develop the philosophy of collaborative practice with physicians in the delivery of home care.

Economic Competition↗
PubMed2005

Home chaos: sociodemographic, parenting, interactional, and child correlates.

We conducted 2 studies to (a) establish the usefulness of the construct of home chaos, (b) investigate its correlates, and (c) determine the validity of the Confusion, Hubbub, and Order Scale (CHAOS) used to measure the construct in each study. Study 1 relied on a sample of European American preschoolers and their mothers and Study 2 on a sample of African American school-age children and their caregivers. Home chaos was associated with less effective parental discipline; elevated behavior problems, limited attentional focusing, and reduced ability to understand and respond to social cues in children; and reduced accuracy and efficiency in a cooperative parent-child interactional task, after controlling for potential confounds. It is concluded that (a) home chaos is not a proxy for adverse social or psychological circumstances but a useful construct in its own right; (b) home chaos is associated with multiple detrimental correlates in parents and children; and (c) the CHAOS scale provides an adequate and economical measure of home confusion and disorganization that should prove useful in clinical research with diverse populations.

Adult↗
PubMed1991

The financial impact of a nursing home practice on an academic medical center.

This study reports the economic contributions of nursing home practice to an academic department of family practice as well as the fiscal impact of referrals from nursing home practice on an academic medical center. Payment to primary physician faculty for nursing home service did not fully compensate for faculty effort. Nevertheless, these services did result in significant revenues to consulting physicians and the University Hospital. In aggregate, an average nursing home visit was associated with $33 in charges for the visit by the primary physician, $15 for additional primary care services in the clinic and hospital, $72 for services by consulting physicians, and $307 in charges by the University Hospital. The average nursing home patient provided $3,744 in charges and $2,403 in income to the academic medical center per year, with $1,813 going to the hospital and $331 to consulting physicians. Even though primary care is not well reimbursed, a relatively small number of patients have the capacity to create substantial income for consulting physicians and the hospital. The study does not address whether these nursing home referrals to the hospital utilized disproportionately high hospital resources.

Academic Medical Centers↗